A Zimbabwean woman outside a building in the Kwa Mai Mai area in Johannesburg. Picture: MARCO LONGARI / AFP
A Zimbabwean woman outside a building in the Kwa Mai Mai area in Johannesburg. Picture: MARCO LONGARI / AFP

A continued lockdown will not decrease the number of Covid-19 cases that will hit SA.

In fact, the only thing that South Africans can do right now is control the rate at which the virus spreads, thereby allowing hospitals to treat cases on a staggered basis, says Wits University professor of vaccinology Shabir Madhi.

This can be done by “citizens buying into the idea” of reducing the spread by consistent social distancing, mask wearing and hand washing.

Madhi, a top-rated scientist, was speaking to Daily Maverick Citizen editor Mark Heywood during a webinar on Sunday night.

He delivered a sobering message: “A lockdown is not a magic bullet. Instead, citizens need to take collective responsibility for slowing the rate of transmission of the virus.”

This is especially so since, Madhi warned, Covid-19 will be with us for at least two years, continuing to spread in three or four waves. In fact, he said, a surge in cases is imminent, and ultimately 60% of the population will be infected.

Global studies show that at least 70% of people infected will be asymptomatic, while 25 out of every 1,000 people will need hospital care, and three or four people per 1,000 will die. “We are not going to eliminate this virus. We need to guard against collateral damage in our response to Covid-19,” said Madhi.

Why the lockdown?

Discussing the limits of the lockdown’s effectiveness, Madhi said that for the first time in years, children with severe acute malnutrition — starvation, in other words – have been admitted to Chris Hani Baragwanath Academic Hospital.

He warned that the government response to the illness must not cause “collateral damage”.

Asked why there was a need for the lockdown, Madhi explained that lockdowns can be used at the beginning of an epidemic, so that a test, trace and isolate strategy can be rolled out to reduce the spread of a disease.

Taiwan and New Zealand showed the strategy can work, provided that a minimum of 80% of every infected person’s contacts are reached. South Korea managed to trace 95% of every known patient’s close contacts, and ensured those people were then placed in isolation.

But SA was unable to do this, as it had too little testing capacity at the beginning of its lockdown. “A lockdown has got a place in epidemic [but] it needs to have an objective. Conditions have to be conducive when you embark on a lockdown to achieve the objective,” he said.

In the developed world, Madhi said, patients had contact with an average of 17 people per day, who had to be traced. But testing and tracing becomes an “implausible” strategy once there are as many as 500 new cases a day.

SA seems to have passed this point. On Monday, health minister Zweli Mkhize announced new 637 cases. Madhi reckons that by June, SA will likely be reporting 6,000 new cases per day.

Madhi said the lockdown has been used to increase hospital beds and buy time to access more protective gear for health workers. But he warned that you can’t “build a health system in three to five weeks”, suggesting that even preparation has a limit. It’s pointless to get more hospital equipment such as ventilators without an increase in skilled doctors who know how to use them.

On Sunday, he said the current testing strategy is fundamentally flawed, arguing that because results are taking so long, the tests are “meaningless”. By the time someone gets a result, they may not be infectious anymore, so there’s no point getting them to self-isolate.

Instead, patients with symptoms of respiratory disease are being kept in hospitals for up to 10 days before the results arrive. It means hospitals remain overloaded.

Madhi and global infectious diseases expert Prof Marc Mendelson have argued on The Conversation website that testing must be restricted to hospitals, with results delivered within 24 hours. This would allow for better management of Covid-19 and for patients who test negative to be discharged, they say.

Coercion backfiring

The government has threatened to force people into isolation. But it’s a strategy that is backfiring.

On Saturday, Mkhize said that all infected people who can’t self-isolate in the Western Cape – even those without symptoms — will be forcibly hospitalised. “We are going to put them in field hospitals … People will be kept in hospital, not because they need treatment, but until they are past the point where they are infectious,” said Mkhize.

Madhi said coercion is undermining SA’s response to the virus. At the moment, he said, roughly 30% of people being screened for Covid-19 symptoms in Soweto are refusing to be tested for fear of what would happen to them if the result was positive.

Yet, as a respiratory disease, Madhi said it can’t effectively be stopped.

The only virus in human history that has been eliminated is the smallpox virus — and that happened thanks to vaccination, he said. Yet, SA’s attempt to halt Covid-19 has led to “increased mortality and morbidity” from other diseases that could be treated.

“For example, we have had a 50% reduction in the number of TB tests conducted during lockdown,” he said. This is partly because sick people are avoiding going to see doctors. “If you delay a TB diagnosis, you get a poorer outcome,” he said.

It’s a potentially fatal behavioural shift, since tuberculosis remains SA’s biggest killer.

On Monday, the HIV Modelling Consortium, convened by the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/Aids (UNAIDS), warned that disruptions to HIV services due to Covid-19 could cause 500,000 extra deaths in Sub-Saharan Africa between now and 2021, as people are unable to get medical care.

As HIV activist Mitch Warren, executive director of NGO Avac, warned: “This would set the trajectory of the epidemic back more than a decade … We cannot play global health whack-a-mole and ignore other devastating diseases while we turn our attention to Covid.”

In such a model, even if a country succeeds against Covid-19, it fails against everything else.