Is SA’s booze ban actually working?
The drop in trauma cases and violence has been significant, leaving hospital beds open for Covid-19 cases, researchers say
The government’s lockdown may be effective, but it’s also been one of the more draconian in the world. Besides an irrational ban on exercising outdoors, buying cooked food and cigarettes, one of the most unpopular regulations has been a ban on alcohol sales.
The Gauteng Liquor Forum – which represents shebeens, bars and bottle store owners – has threatened to take the government to the Constitutional Court. But as much as it might irk those whose alcohol supplies are running low, the government has a strong argument for why the booze ban should remain.
On Wednesday this week, Prof Charles Parry, an alcohol and drug abuse researcher at the SA Medical Research Council (SAMRC), shared his model which showed that the reduction in drinking had probably led to 9,000 fewer trauma cases being admitted to wards every week, against an average of 35,000 cases. In other words: a likely 25% fall in cases.
Parry built his model with help from Prof Richard Matzopoulos, an injury surveillance epidemiologist at the SAMRC’s burden of disease research unit, and Prof Andrew Nicol, head of trauma services at the University of Cape Town.
It confirmed what many doctors say has been their experience: on payday weekends before the lockdown, state trauma wards thronged with casualties related to alcohol – stabbings, gunshots and alcohol poisoning.
This week, South Korean doctor Sae-ouk Oh, who trained in SA and works in a local hospital, posted on Facebook about why doctors don’t necessarily agree with those demanding an end to the alcohol ban.
“Most of you … know that the public healthcare system sucks. What you don’t know is just how bad it actually is.”
In reality, he says: “Intensive care and high care units are full all the time. There are never enough beds to save everyone. Try as we might, doctors have to decide every single day which patient gets the chance of survival and which doesn’t. Patients who need emergency surgery often cannot be operated on timeously because there aren’t any ICU or high care beds available.”
The horrific instances of triage in Italy, where doctors had to make tough calls on who lives or dies, are just an average day in SA, he says. “One contributing factor to all of this is alcohol consumption.” The consequence: violence and car accidents.
But, he says, “the ban of alcohol sales these past few weeks has dramatically reduced the patient load in emergency units across the country”.
Nuance in the numbers
It accords with the conclusions reached by Parry, Matzopoulos and Nicol. But how did they reach the total of 9,000 fewer trauma admissions?
Rather than collate all the data from SA’s 400 trauma units, they extrapolated the numbers from the reduction in cases at Groote Schuur and Chris Hani Baragwanath hospitals, then weighted that reduction depending on each hospital’s demand and patient load. Then they factored in previous research on injuries caused by alcohol consumption.
Every day, Parry estimates, there are 174 alcohol-related deaths in the country –including those linked to disease.
The researchers realised, however, that the ban on alcohol wasn’t the sole reason for the drop in trauma cases. They said there were “nuances” in the reduced hospital numbers.
These included “less travelling, fewer drownings, the fact people have less money to spend, there are fewer drunk pedestrians and [fewer] cars to knock them over, less drinking at shebeens, but more drinking at home with the risk of domestic violence and harm to children and possibly self-harm”.
Their model hasn’t been published in a journal yet, which means it hasn’t been peer-reviewed or critiqued by experts.
Parry says: “It is a rough model but we have tried to be realistic and if in doubt, slightly conservative. Where we had data we used it, if not we worked on reaching a consensus.”
However, so significant has been the drop in trauma cases and violence that Parry has proposed much stricter limits around alcohol sales, zero drinking if driving, and an older legal drinking age (it is a proposal he has made even before the pandemic). He also advocates a ban on alcohol advertising and sports sponsorships – something former health minister Aaron Motsoaledi promised he would enact into law.
Grim social consequences
When the Gauteng Liquor Forum case will go to court, if ever, remains unclear.
Eric Mabuza, the forum’s lawyer, says the government is expected to file its response to the forum’s demand to allow alcohol sales today. After that, the forum will decide whether to go to court.
But if the forum took this route, Mabuza could argue that a complete ban on alcohol isn’t necessary: strict alcohol sales, off-site consumption and closed shebeens would still lead to fewer hospital cases. And he could argue that the empty beds in hospital aren’t yet needed for Covid-19 patients, as the virus has yet to hit the country hard.
Yet, the social consequences of the ban have been harsh: shebeen owners are going without income, which means no food for them or their families; alcoholics who go cold turkey face a real fatality risk; liquor outlets have been looted by people seeking alcohol.
Mabuza argues that the booze ban exposes SA’s stark inequality: the wealthy can sip on whisky they have at home while the poor couldn’t afford to stock up have no such luxury.
Meanwhile, the risk of alcohol being traded illicitly, or people making potentially toxic home-brews, has risen.
Gus Silber, the wordsmith and author, joked this week that the lockdown had created “underpreneurs” – “a new breed of SA entrepreneur, operating under the radar to offer customers alcohol, cigarettes, and quite possibly, roast chicken, during lock down. A thriving new economic subcategory.”
Yet, it’s clear that once the liquor ban is lifted, the number of trauma cases will rise – though, since there are fewer drivers on the roads, it’s unlikely it will rise back to what it was before.
Nonetheless, says Parry: “We estimate that just under 5,000 alcohol-related admissions to trauma units will reappear in a given week if alcohol sales are permitted.”
Some doctors, like Sae-ouk, believe the ban should stay for now. “When the surge in Covid-19 cases comes – and don’t kid yourself thinking that it won’t, because it most certainly will sooner or later – this will help better manage the outbreak. We’ll most likely still be overwhelmed, but we might have a better shot at making it through,” he says.