EXCLUSIVE: The 11 factors that will shape SA’s lockdown
A lockdown is necessary to slow the spread of disease and allow SA’s health authorities to prepare for a rapid demand for hospital beds. But it won’t be a panacea — and it comes with some serious drawbacks.
1. Lockdowns slow the spread — they don’t stop it
Many studies suggest that a lockdown will not reduce the total number of cases, but instead will delay the spread of Covid-19. In those models, the spread of Covid-19 begins to flourish again after social distancing measures are removed.
Researchers from Italy, Spain and the US have argued that in the end 80% of the population gets sick anyway — it’s just that mitigation efforts slow the spread. And a lockdown allows authorities to buy time to increase testing systems and hospital beds. Massive testing and isolation of every case is how Taiwan and South Korea brought the spread of the disease under control.
The landmark Imperial College London study of Covid-19, released two weeks ago in the UK, warns that until a vaccine or effective treatment becomes available, increased testing and lockdown strategies need to continue. The reality is that vaccines aren’t likely to be ready within the next 18 months.
But during the lockdown, the SA government and health experts can prepare hospitals, increase testing capacity and find places to quarantine the sick who live in crowded shacks.
2. Will a lockdown work in a township?
It is not clear what data SA modelled its lockdown on, and whether this took into account what it will mean in townships, where disease can spread easily between people in crowded shacks and houses. Even the minister of social development, Lindiwe Zulu, has called social distancing “a middle-class solution”.
Before implementing the lockdown, President Cyril Ramaphosa spoke to Chinese authorities, presumably for ideas on an optimal lockdown plan. The problem is that SA’s informal settlements are very different from suburbs in Wuhan, China.
The government needs to be more adaptable in modelling its solutions to an SA setting, and its plans for what will happen once people who have been infected at home during the lockdown eventually head back to work.
3. Is the lockdown really in time?
Ramaphosa was told by his advisers, when deciding whether to institute a lockdown, that SA was early enough to slow the spread of the disease with severe restrictions on movement. But is this true?
The government, understandably, does not want Covid-19 spreading into crowded informal settlements where water and space is limited. But because of the backlog in testing, it’s not clear how widespread the disease actually is and, consequently, whether the lockdown was announced in time to make a difference.
In particular, we don’t know if it could have spread further as people desperate to escape crowded, hot townships travelled back to rural areas. Or indeed, what impact people crowding into shops to buy booze and food before the lockdown went into effect at midnight on Thursday March 26 had on the spread.
4. It’s unclear how the poor will get food
The Human Sciences Research Council says that one in four children is malnourished, which weakens the immune system. During the lockdown, many people, including hawkers, car guards, part-time domestic workers, taxi drivers and their children, will go without food as they go without income. The 9-million children who may have had a meal at school are at risk of having no food since schools are shut.
5. The army and police have unmitigated power — and are revelling in it
Verified videos are already being circulated showing army and police brutality aimed at the poor. During the first weekend of the lockdown, cops sprayed shoppers in Delft, Cape Town, with water, there were running battles in Hillbrow between cops and residents, and shoppers queuing for food in Khayelitsha were shot with rubber bullets.
On Friday morning, as police tried to deal with looters in Yeoville raiding a liquor store, they threatened a News24 journalist who was present. On Saturday night, armed police harassed Khayelitsha residents for being in their yards. When a journalist asked police minister Bheki Cele on the weekend about the excessive use of force, his response was ominous: “Wait until you see more force.”
Eli Kunene, a lawyer at Richard Spoor Inc, said eight cops intimidated him in his house, after Kunene witnessed the police harassing homeless people near his home. Such measures may become more common.
6. The looting time bomb
In past times of stress, South Africans resorted to looting stores and targeting foreign-owned stores. Already, we’ve seen disturbing incidents including the attempt to loot a closed liquor store in Yeoville. If people who might be hungry, or those seeking alcohol, resort to looting and the army responds with brute force, it won’t end well. Even in developed countries, we’ve seen echoes of this: in the poorer parts of southern Italy, there have been several incidents of civil unrest.
7. Home is dangerous too
China reported an increase in domestic violence during its lockdown in Wuhan, and there have been similar reports from the UK and elsewhere. To make it worse, SA has a ban on outdoor exercise, which means most people have no means to escape homes or violent spouses for even 20-minute periods.
8. Red tape and dodgy websites
The government has promised assistance to small businesses battling for cash, and workers retrenched during the lockdown. But like many of the government’s promises, it may be more words than action. Last week, the government’s bizportal.gov.za website collapsed, as more than 15,000 businesses applied for exemptions to keep operating.
Tanya van Lill, president of the Southern African Venture Capital & Private Equity Association, warned that the promised bridging finance to help small businesses start up again after the lockdown will have to be paid out promptly. “How do we do this timeously? How do we take away the red tape? Speed is of the essence.”
Bitter experience suggests there may be delays in these payments. The Compensation Fund, for one, pays about R5.4bn per year to doctors and therapists who treat injured workers. But it is massively behind in these payments after it shut down its old website in August, and only opened the new, bug-ridden one (ironically called Compeasy) in October. While it paid out R450m per month, on average, last year, it has only paid out a cumulative R100m since September. This doesn’t bode well for small businesses.
9. No beer, no cry
Alcohol sales are banned, partly to reduce the need for hospital beds as a result of drunken stabbings, road accidents and drunken crime, which are known to increase hospital demand on payday weekends. But experts have warned that forcing alcoholics to go cold turkey can result in their need for hospital care.
Still, Charles Parry, a drug and alcohol researcher at the SA Medical Research Council has argued that fewer people could die from forced withdrawal than his estimates of deaths caused by alcohol-fuelled violence, accidents and disease.
10. Getting poorer = getting sicker
Poverty is a predictor of a shorter lifespan and the lockdown will further weaken the economy and increase job losses.
Dr Michael Marmot, former head of the World Medical Association, writes in his book The Health Gap that wealth and life expectancy are almost perfectly correlated.
For example, along the Jubilee line on the London Underground from wealthy central Westminster outwards to more middle-class and poorer areas, the life expectancy of residents drops by a year at each Tube station.
Better analysis of the balancing act between making people poorer and sicker over the long term and delaying the epidemic must be done.
The Imperial College study admitted that it didn’t consider “the wider social and economic costs of suppression, which will be high and may be disproportionately so in lower-income settings”. Better data is needed here.
11. The irrationality of certain government regulations
The government, for some reason, determined that retailers may not sell stationery. This led one doctor to note, sarcastically: “I guess I will write clinical notes in blood.”
There are many potential unintended consequences of all the government’s decisions. For example, the ban on alcohol may lead to more dangerous home brews being created. There are many other such outcomes we’ll see in the next few days. How the government responds to this will, to some extent, determine how successful the lockdown will be.