RAZINA MUNSHI: Were South Africans asked to make an enormous sacrifice for few gains?
Citizens embraced the strict early measures and welcomed the government's explanation for the need for it. But the cost has been very high – to the economy and to individuals – and the hard lockdown was ended before the country approached a peak in the infection rate
In the months ahead, scrutiny of government’s Covid-19 strategy will continue, then shift gear, and afterwards circle back again.
Was implementing five levels of Covid-19 lockdown the right way to deal with the effect on the economy? Did opening places of worship during level 3 cause infection rates to spike? Did government work hard enough to secure protective equipment for hospital staff, or improve staffing and equipment levels at public hospitals? What are the costs of its response to the changing economic conditions of its people?
And then there is the question of the value of the lockdown itself: was it a wasted opportunity? Were South Africans asked to make an enormous sacrifice for few gains?
The early implementation of the lockdown has been welcomed, especially when measured against countries such as the UK, which went into lockdown only as the country’s infection rate was already rocketing. There is no doubt that it helped delay (rather than flatten) the curve and helped stem early community transmission. The government insists it also gave the health sector time to prepare. This – rather than crushing the virus – was its stated intention with the lockdown.
Wits University professor of vaccinology Shabir Madhi tells the FM that the government’s biggest problem was trying to fix a public health sector that was in no way prepared for the onslaught that an epidemic would unleash. “A crisis is not the time to fix the healthcare system,” he says
He agrees that the lockdown could have been a lot more effective. But he says it did give the public health-care sector time to prepare. SA’s reality is that after the lockdown was enforced, hospitals emptied out as the public stayed at home. The prohibition of the purchase of alcohol and the limits imposed on elective and other surgeries contributed to reduced admissions rates in private and public facilities.
Yet a report carried by News24 on Sunday reveals that state hospitals added only 207 critical care beds to its total of 2,300 in the past two months. And just 350 ventilators were added to existing capacities. Of these, 50 were donated.
But Madhi is less concerned about the number of high-care beds. Using the number of such beds (or the number of ventilators) as a measure of the readiness of the public sector is not helpful, he says. In the US, for example, 90% of people who were placed on a ventilator still succumbed to the virus. “ICU beds are a wasted investment in a resource-constrained country,” Madhi says.
Securing sufficient oxygen is far more important than the actual number of ventilators, he says. Other ways the government has been able to ready itself relate to a secure supply of protective equipment for medical workers, the adequacy of available staff and the increasing number of general hospital beds.
But there have been missed opportunities.
The effort should have extended outside hospitals to include workers in other sectors. Infection prevention and control as well as adequate protective equipment in mines, small essential businesses and public transport have not received nearly as much focus. This is where transmission rates are spiking, and from there it will reach poorer communities quicker.
Another missed opportunity relates to the lack of a sustained public awareness campaign beyond just emphasising hand washing and the wearing of masks.
The government has failed to remain in control of the messaging. In fact, it hasn’t even tried to do that. Yet, better communication would have helped counter misinformation, reinforce key messages to influence people’s behaviour and ultimately save lives.
Of course, a more productive lockdown also depended on the government having the right testing strategy in place at the beginning. In the first week of the lockdown, SA was testing only 1,000 people a day. In the last week of level 4 about 10,000 people a day were tested.
With broad testing, and contact tracing (and quarantine) of at least 80% of contacts, the lockdown would have been more effective. A lockdown also makes it easier to trace and quarantine contacts.
Mass testing, however, is still an ongoing problem. Even when testing is taking place, getting results from overburdened labs has been fraught with challenges.
Here’s the thing: South Africans embraced the early lockdown and welcomed the government’s explanation for the need for it. But low early infection rates, coupled with the economic impact of the shutdown, a paralysed early response to social needs such as food provision, a decline in quality communication by the government and government decisions that destroyed goodwill bred noncompliance. And this contributed to a spike in the rate of infections.
It means there was no option other than to end the hard lockdown months before the country approached a peak in the infection rate. By June 1, when SA moved to level 3, most businesses were allowed to open. The lockdown (and certainly citizens’ tolerance for it) has ended when the risk of transmission is at its worst.
SA’s lockdown took effect on Friday, March 27, when SA had 927 cases of Covid-19. When SA dropped to level 3 on June 1, infection numbers had climbed to over 32,600. And within just seven days since then the infection rate has jumped to 48,300.
After reporting low infection rates for weeks, Gauteng suddenly experienced rising figures. Cape Town, SA’s hardest-hit city, is four weeks ahead of that. The Eastern Cape, experts estimate, is about three weeks ahead of Gauteng.
But Madhi says that without the lockdown the Western Cape’s infection rate would have been twice what it is now. And Gauteng would have been where the Western Cape is today. The lockdown delayed the onset of the peak.
There was precedent for the early lockdown. New Zealand this week dropped Covid-19 restrictions, but only after declaring that the country had no more known active cases of the virus. President Jacinda Ardern’s “go hard, go early” lockdown strategy had paid off. Though it’s difficult to compare SA to a well-resourced, fairly isolated island nation, it is worth heeding the lessons.
But as two of the epidemiologists who worked on New Zealand’s elimination strategy explain, maintaining zero new cases will be challenging. The article sets out what the country needs to do. Even in New Zealand, it says, national public health infrastructure was failing after decades of neglect, fragmentation and erosion.
Bringing it back home, University of Johannesburg academic Seán Mfundza Muller writes that SA’s use of Covid-19 modelling to inform decisions about the lockdown has been deeply flawed.
Modelling is sophisticated guesswork, he says. And outside sciences like physics, they are almost always wrong to some degree. In the case of Covid-19, models predict the possible scale of death and illness relative to health-system capacity, as well as the way this is expected to play out over time. And the models have been used to assess the success and effects of the government’s intervention strategies. Muller says in both cases, there are failures in the modelling itself and especially in the way it has been used.
And as the process of engaging with current tactics to fight the virus continues, researchers are now exploring less blunt instruments than a lockdown to stem the rise of infections. The New York Times says researchers believe more targeted approaches might have protected public health with less economic pain.
The article says the researchers are pushing for the EU to reopen tourism, which is so critical for southern European countries like Greece, Italy and Spain. With no tourists in their summer, they could face a catastrophic recession. In the US, cellphone data and surveys are being used to identify which businesses are more crowded than others, how much of their business is conducted indoors and how much interaction it involves, either person to person or via touching shared surfaces. This, researchers seem to believe, is a better way to manage the growth rate of infections.
* Munshi is News & Fox editor of the FM
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