Winter is coming: 4 reasons to be wary of SA’s Covid-19 response
Why it is too early to claim victory just yet and why the toughest days lie ahead
It will be one of our most trying moments. Mistakes will be made. There will be loss, of various kinds.
Yesterday, we discussed five reasons why we can be positive about the initial steps taken by the government to combat the threat of Covid-19. On balance, the SA response has done a fair deal more good than bad, but today we discuss a few reasons why it is too early to claim victory just yet and why the toughest days lie ahead.
1. Ability to meet resource demands
Much like in wartime, the success of each state is heavily dependent on its ability to manufacture, procure, allocate and roll out supplies to the frontline. In this battle, the most important supplies are what we now all know as personal protective equipment (PPE), such as masks and gloves, as well as testing kits and critical care equipment such as ventilators.
The most harrowing tales of the virus peak in Europe concern the damage inflicted on the frontline soldiers in this war: health-care workers. As they fall to the virus, so do our hopes of fighting it. We need to protect our health-care practitioners, both for us and for them, and make sure they have the equipment they need to do their jobs.
In the initial phase, the SA government was unsettlingly quiet on the issue of PPE availability. You don’t need us to tell you that the fiscus has come under severe strain in recent times, with austerity measures in recent budgets aimed at cutting social spending, including some health budgets. And the effect of the economic downturn and ratings downgrades on the value of the rand, as well as limited supply from the main importer (China), makes it even tougher for SA to source this kind of kit from abroad.
We also know that the human resources in the SA health system are spread unequally. Wealthy citizens can receive can world-class medical treatment in this country, but working-class people usually do not have private health insurance and the same level of access, and so tens of thousands are sometimes dependent on just a few doctors and other health personnel.
SA’s dangers with PPE supply are not unique, and stories from some of the most capacitated health-care systems are replete with photos of makeshift solutions to prevent health personnel from becoming casualties. SA does have stock for the next few weeks, assuming it can be properly rolled out and allocated, and is consistently looking for means to get more. But supply is not endless, and we have already seen the dangers of this at St Augustine’s Hospital in Durban where more than two-thirds of the 66 cases reported are hospital staff. We cannot expect health practitioners to sacrifice themselves, and the danger of them fleeing the frontlines has already been shown from the National Education, Health and Allied Workers’ Union’s application to the Labour Court (which it has since withdrawn after health minister Zweli Mkhize agreed to meet with the union).
2. Weaknesses in the cabinet and public service
Yesterday, we spoke of the composure and accomplishment of the “Front 2” in SA’s Covid-19 response – President Cyril Ramaphosa and Mkhize. But unfortunately, the president’s batting lineup has a rather long tail. When Ramaphosa took office in February 2018, he faced political battles as well as the battle for reform. We all know that the ANC is still deeply divided, and that the nature of Ramaphosa’s victory at the ANC’s elective conference at Nasrec in 2017 meant that compromises would have to be made to factions in the ANC that are not so well disposed towards Ramaphosa and his reform agenda.
But where to make those compromises? Think back to the time when Ramaphosa took the reins and what the most important issues were at that time: the economy, state-owned enterprises, trade and industry, and international relations. This is where Ramaphosa stacked his strongest forces, making compromises in the areas that were less of a priority at the time. Now the game has – at least temporarily – changed; ministers who were on the periphery are now at the centre.
Thus, Covid-19 has really brought into stark contrast the strength of each individual in the Ramaphosa cabinet, and we’ve all seen the confusion and uncertainty that some of the less able and adept have caused when they’ve drifted off the president’s hymn sheet.
An even tougher nut to crack, though, than the mischievous forces in the cabinet, has been the public service that was abundantly stacked by Jacob Zuma loyalists during the previous “reign of error”. SA has very many exceptional doctors and nurses, but at the same time has several weaknesses in its broader welfare safety net that may well be exposed as this crisis unravels. That being said, there have been encouraging early signs from the National Institute for Communicable Diseases (NICD) and the National Health Laboratory Service (NHLS), for example, and several African states do have a strong understanding of these types of outbreaks from prior experience.
3. Society on the brink
SA is one of the most unequal societies in the world, and Covid-19 threatens to exaggerate those inequalities in a way not seen before. A lockdown experience in a cosy, warm home with a spacious back garden is a world away from the reality confronted by the majority of the population. Add that to likely inequalities in the medical services people receive, as well as supplies and other services, and you can see that lots of people are (understandably) going to get very frustrated, potentially very quickly.
Accordingly, as political risk analysts, we are bound to conclude that the risk of public disorder and civil unrest is substantially higher than usual.
4. Winter is coming (literally) …
Let’s be clear on this. The question of whether Covid-19 has seasonal characteristics is a medical question, and we stay well clear of suggesting that it is so. No firm medical conclusion has been reached on this question. But what we can say is that because no medical conclusion has been reached, we must factor in the possibility that the virus may be more transmissible when it gets colder – and the flu season begins.
Accordingly, various models in SA have provided for the possibility that the virus may, for whatever reason (whether social or genetic), have seasonal characteristics, similar to previous coronaviruses in the form of severe acute respiratory syndrome and Middle East respiratory syndrome – even though there is no clear conclusion on why that was. Again, we stress the need for a medical conclusion on that point and until then the safest bet is to stay buckled up and prepare for the fact that it may get worse before it gets better.
The bottom line:
Over the past two days we have detailed some of the reasons to be cheerful as well as concerned about the future trajectory of Covid-19 in SA. At a time of crisis, it is easy to be a critic and it is easy to be a praise-singer. But it is difficult to govern. There is a strong chance that it will get a bit ugly (as we have seen with isolated instances of police and army mischief and brutality), and that some lasting damage will be inflicted. But most of it will be recoverable.
On balance, we feel that there are more, and stronger reasons, to form a positive opinion about the government’s initial measures than a negative one, though we await a new broadcast to the nation from the president with keen expectation.
Just as important, the government needs to explain its economic recovery strategy – and so we also wait to hear from finance minister Tito Mboweni with bated breath.
* The Paternoster Group is an independent consultancy that provides corporate and other clients with political risk and political economy analysis as well as strategic advisory services.
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