What we don’t know about SA’s Covid-19 response
When it comes to the health department, you almost get the sense that information is only shared when there’s no other choice
You can utter a lot of words and say nothing at all. Ask anyone who has had to endure any of the protracted press conferences on Covid-19, convened by some politician to create the illusion of transparency.
But that veneer of openness doesn’t necessarily mean the citizens of SA – a country which now faces more than 3-million job losses – actually have the information they need.
This is critical, since last week, organised business group Business for SA estimated that SA’s GDP could contract by between 10.3% and 16.7% this year.
Given those sorts of numbers, you’d think the government would want to explain its model for the continued lockdown. Yet in March and April, the FM asked the health department repeatedly to reveal the models it is using, and all we got was silence.
This week, presidency spokesperson Khusela Diko admitted that the government was purposely keeping modelling data under wraps. “We don’t want to put these models out in the public as if they are the gospel truth. There is an element where we want to avoid panic in communities,” she told the Sunday Times.
As a result, others have stepped into that information vacuum.
Last week, two actuaries, Nick Hudson and Peter Castleden, published a model that predicted that 29 more life years would be lost due to the lockdown than would be lost due to Covid-19 directly.
Their model drew plenty of criticism, with even the Actuarial Society of SA surprisingly quick to distance itself from this helpful contribution to the debate. Yet, Hudson and Castleden provided the first publicly available model of the impact of the lockdown, with all their calculations published for experts to debate.
Initially, the SA Centre for Epidemiological Modelling & Analysis provided a model for the department of health and President Cyril Ramaphosa, which predicted there would up to 350,000 Covid-19 deaths in SA.
This model was never publicly released, but when it was leaked to the media and critiqued, health minister Zweli Mkhize stressed it wasn’t the model the government relied on to decide on a lockdown. Instead, he said, the government relied on other models, provided by a consortium.
So, what are those other models? And who is in that consortium? Only the government and a tight-knit scientific circle seem to know.
These details remain hidden in a black hole, even though our economy’s fate remains tied to those models – of which we really know nothing substantial.
Need for public support
In the perfect illustration of this opacity, a few weeks ago, Mkhize spoke to the country on TV using Zoom and referenced a slide that explained the Covid-19 models.
It was something of a farce, since, apparently due to a technical hitch, no-one watching that broadcast could see the slide.
Still, the next day his media team shared the slide: it showed that the government expected 12-million Covid-19 cases without the lockdown, and now, thanks to the lockdown, it expects 8-million infections, which will peak in the middle of winter.
Considering that 75% of those 8-million infections will be asymptomatic, it translates into 2-million people who will get sick. Of that, using a 1% fatality rate, we get to 20,000 deaths.
Put another way, Mkhize’s slide suggested the lockdown prevented 4-million cases, stopped 1-million people getting sick and, using that 1% fatality rate, ensured 10,000 deaths didn’t happen.
These are intriguing numbers, but again, they may not be accurate given how little information was shared. Until Mkhize shares the full models, it’s hard to offer any useful critique.
It also makes it harder for the public to continue to support the lockdown when companies like Comair and Edcon are being put into business rescue, and the basis for keeping the economy on ice remains shrouded in secrecy.
But then, we also don’t even know exactly who is advising Ramaphosa and Mkhize on the lockdown, and what data they have.
Perhaps Ramaphosa should take a leaf out of the book of Prime Minister Boris Johnson: when the British public began complaining about government secrecy, Johnson released the names of all the UK’s Covid-19 advisers.
Least possible disclosure
When it comes to the health department, you almost get the sense that information is only shared when there’s no other choice, and it’s kept to the bare minimum.
A few weeks ago, the National Institute for Communicable Diseases told the FM that it couldn’t reveal details of SA’s epidemiological models, since these were subject to a “nondisclosure agreement” with the department of health. This seems to imply that the only person authorised to share details is Mkhize.
But if the only person who can speak about the spread of the disease in the country is a politician, we’re asking for trouble.
What we need is far more consistent information. As it is, when the daily reports of new infections are released, the data is sporadic.
Sometimes there is information on the ages and pre-existing conditions of those who died, other times not; sometimes we get the number of state tests that are conducted, other times not; sometimes there are details of outbreaks, like at St Augustine’s Hospital in KwaZulu-Natal, and other times, it’s a vague one-page statement.
It would also be good to know each day how many cases are being treated in hospital, and how many people are in intensive care, as this would give some insight into the severity of the epidemic in SA.
The St Augustine’s confusion
There’s no more apt illustration of bungled messaging than the story of Netcare’s St Augustine’s Hospital in Morningside, Durban, which became a hotspot for Covid-19.
Initially, Netcare said the outbreak began with two patients, who were being treated for other illnesses at the hospital in early March. It got worse after another 23 patients arrived at the hospital with Covid-19.
The problem was that the information about what was happening was either sketchy or contradictory.
Asked to clarify what was happening, Netcare CEO Richard Friedland said the virus spread in the hospital from infected patients to other patients. But he said he couldn’t release the details of how many patients got sick from being treated at the hospital – only Mkhize could.
Only Mkhize never did. We still don’t know how many cases were transmitted within the hospital’s doors.
What Mkhize did say, in the end, was that there were 66 confirmed cases at the hospital. But even those numbers don’t add up: there have been 47 confirmed cases of health-care workers at St Augustine’s, and 25 patients who arrived with the illness. Add that up, and you’re already at 72.
This raises the question: is the government being open and honest with us about what’s happening with the virus? Or even the economy?
When you look at it, there’s an awful lot we don’t know. And yet, as our economy bleeds, we’re paying an awful price.