Lockdown: The 193 day option

With the economy now having been on hold for more than three weeks, public support for President Cyril Ramaphosa’s punitive lockdown is waning. In part the disquiet has been fuelled by what appear to be irrational regulations, prohibiting cooked food and cigarettes from being sold.

But it comes amid a growing sense that, as retrenchments rise, a lengthy lockdown may do more harm than good.

New research by Wits University health economics professor Alex Van den Heever concludes that if SA chooses a lockdown as its main way to control Covid-19, it would have to last 193 days. But he says that length of time under lockdown is “inconceivable”, given the economic devastation it would cause.

As Covid-19 is unlikely to be eliminated as a risk during 2020, he argues that the “public health strategies need to be designed to be compatible with continued economic activity”. Says Van den Heever: “the current health strategy places the economic welfare of more than 70% of the population in jeopardy … the sustainability of the programmes of support also ultimately depend on the sustainability of government finances, which in turn depend on the existence of a working economy”. In other words, any continuation of the lockdown into May would erode the ability of the government to help its citizens manage the economic hit they’ve already taken.

Van den Heever’s research is timely. However, disturbingly, no-one in the government has yet revealed their modelling around the economic damage from the lockdown or said whether deaths from Covid-19 would outnumber the potential fatalities from hunger.

Last week, Business4SA, a task force formed from organised business to deal with Covid-19, said it had no model that looked at whether a prolonged lockdown was more damaging than none at all. But investment banker Martin Kingston, part of Business4SA, estimated that more than 1-million people would lose their jobs.

At a press conference on Saturday night health minister Zweli Mkhize promised that the economic risks were being weighed up in determining the length of the lockdown.

“All sorts of issues have to be taken into account. There isn’t one factor: [we must ask] how do we contain the spread of the virus; how do we make sure our economy continues to function; how do you make sure hunger and starvation [are kept at bay]. ... We need to contain the virus and still make sure people are able to survive,” he said.

At this point, there is scant evidence that the lockdown is actually working in high-density areas in SA such as the townships. Economist Russell Lamberti argues that the lockdown is choosing “certain economic harm” over “uncertain health outcomes”. Van den Heever, who is a health economist, calls the chance of reducing an infectious disease in congested areas “a leaky bucket”. “While [a lockdown] may prove effective in the more affluent suburbs, it may fail in the townships and informal settlements. The current lockdown may have therefore only reduced, but not prevented, the spread of the disease into the general population,” he writes.

At a national level, Mkhize hasn’t provided infection figures for the townships – one of the many areas in which the public release of data is sorely lacking. But the Western Cape government does release these numbers, and the infection numbers aren’t promising.

By April 10, Khayelitsha had six cases, while Mitchells Plain had 10. Just over a week later, there were 44 confirmed cases in Khayelitsha and 40 in Mitchells Plain. In other words, during a week of lockdown cases had increased seven-fold and four-fold respectively.

This is important, as, Van den Heever argues, if a lockdown doesn’t stop infections in SA’s high-density areas, it is largely ineffective. With regard to the population at large, “a general lockdown may prove equivalent to no intervention,” he says.

Has SA bought enough time?

The central purpose of Ramaphosa’s lockdown was to buy time to prepare SA for the epidemic. But the slower the preparation, the longer the lockdown may need to be.

Much turns on the question of what preparations have been made by the health department and how much testing is being done. Kami Chetty, head of the National Health Laboratory Service, says that part of the delay in widespread testing is due to SA having to wait for test kits to arrive from overseas. Some came during the past week, but more are expected soon. On Saturday Chetty said that right now the demand for testing is being met without delay.

Another element of the planning is isolating people who have tested positive for the virus and tracing those who may have been exposed to it. However, there is scant data on contact tracing. The latest publicly released data, already quite dated, was that the authorities had traced nearly 11,000 contacts from 2,000 cases. That equates to about five contacts per person, which seems low for an average person living with a family and in contact with work colleagues.

Getting kids back in classrooms

At this point, insiders say the lockdown is likely to be lifted incrementally – something the government will want, as large taxpaying companies, which contribute the most to the fiscus, are at the moment earning no revenue. But the government has yet to detail a framework on how lifting the lockdown would work and whether large companies will be prioritised over smaller firms.

Van den Heever favours a scenario in which people go back to work, but use specific risk-reduction techniques, along with social distancing, to limit the spread of the virus.

Quite how lifting the lockdown would affect schools is another open question.

Keeping schools closed is more controversial than one might think. A recent study published by medical journal Lancet suggests children are weak transmitters of the coronavirus and school closures have little effect in reducing virus spread.

In Taiwan, a model country in controlling disease, schools opened in late February. In Sweden and in Denmark, schools are open, and those in Germany, Austria and Norway are expected to open soon.

Researchers for Unesco, the UN organisation for education, science and culture, estimate that the longer schools stay closed in low-income countries, the higher the rate of dropouts there will be. The researchers, Blandine Ledoux and Koffi Segniagbeto, write: “the risk to the most marginalised populations is huge … many students may not return to the classroom even once the crisis is resolved, increasing the numbers of out-of-school children and youth”.

In SA, the stakes are high, since as many as 8-million children get given meals at school – which they haven’t had during the lockdown. In this context, keeping these children at home until May or June may do more harm than good.

At this point, it’s clear that if it would take 193 days of a lockdown to control Covid-19, the government needs to find a different way to slow down the spread of the virus. And it must begin lifting the restrictions so the economy can breathe again.

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