Beds are seen inside the Johannesburg Expo Centre that is expected to accommodate Covid-19 cases in addition to hospitals and health centers. Picture: Michele Spatari / AFP
Beds are seen inside the Johannesburg Expo Centre that is expected to accommodate Covid-19 cases in addition to hospitals and health centers. Picture: Michele Spatari / AFP

In just eight days, Covid-19 cases in Gauteng doubled. SA’s most populous province reported 12,193 cases by Monday June 15, 16.6% of the national total.

In absolute terms, those numbers are relatively low for a province with over 15-million people. But that growth in numbers is a sign of what’s to come for SA’s economic heartland. On June 8, Gauteng had just 6,258 cases. Two weeks ago, when SA switched from level 4 to level 3 lockdown, the province had only 4,231 cases, 12.3% of the total.

Using the lockdown as a tool to delay the curve worked well in Gauteng. It came into effect early enough to delay the sort of community transmission we’ve seen in the Western Cape. But whether the province used that time to adequately prepare is up for debate.

Premier David Makhura admits that Gauteng risks “undoing the gains” made during the lockdown.

Makhura is under no illusion how serious the situation is. “The pandemic is gaining momentum in the Gauteng province. We have to face this reality head-on,” he said last Friday, just days after Gauteng’s cases overtook the Eastern Cape’s.

July, he said, would be a “critical month” for the province. By then, he said, Gauteng should have additional beds ahead of August and September, which is anticipated as the Covid-19 peak.

But even this rapid growth is still well short of the projections in the most recently published models. A model prepared for SA’s Covid-19 Modelling Consortium last month suggests that, in the pessimistic scenario, Gauteng will have 500,000 infections. And it expected those numbers to peak in July, which now looks to be too early.

Even by international standards, the rise in the growth rate of infections is alarming. SA’s infection rate rose over 6% on Monday – the highest daily growth rate in the world at the moment.

So, is Gauteng ready for the onslaught?

Makhura said Gauteng has already received “lots of” support from the national department of the health and the president. However, it has asked for more assistance to enable it to “be proactive” ahead of its peak. Provinces where cases are increasing (the Western and Eastern Cape) have already received extra resources and the assistance of “high-calibre teams of specialists”.

“We have 15.2-million people in this province that we look after. That is our burden and as we go into the next phase of the pandemic we are going to have a lot more people that we have got to worry about,” he said.

Hospital admissions are also rising. By Monday, 565 people were admitted to Gauteng hospitals (public and private) for Covid-19-related illnesses — more than double the 256 of about 10 days ago. And the rate of fatalities is up too: 87 people have died in Gauteng since the epidemic began. And 54 of those deaths have happened in the last two weeks.​

Makhura said last week the province has 8,301 beds available. But that same figure was used by provincial figureheads as far back as May 1. Has the province added no extra beds since?

With ample time to prepare — and enough warning signs from the Western Cape of what to expect – Gauteng should have a lot more to show.

Calls for reform

The debate about health sector reform is raging in the US. The JAMA Network, a medical journal of the American Medical Association, has published a fascinating account of the need for the US to change its attitude about health care being a privilege rather than a basic right.

Authored by Don Berwick, the former administrator of the US agency that runs Medicare, it says that most hospitals and physician offices are “repair shops, trying to correct the damage of … social determinants of health”. The factors include income, conditions of birth and early childhood, education, work, housing, a sense of community and even levels of exposure to gun violence, loneliness and environmental toxins.

These are all factors that either nurture or impair health.

But, says Berwick, the status quo is simply too strong. “The vested interests in the health-care system are too deep, proud, and understandably self-righteous; the economic and lobbying forces of the investment community and multinational corporations are too dominant; and the political cards are too stacked against profound change.”

In Project Syndicate economists Dani Rodrick and Stefanie Stantcheva critique recent proposals for reforming capitalism, saying they do not fundamentally alter the narrative about how market economies should work.

These proposals include enhancing training programmes to prepare the workforce for new technologies, better social protection and social insurance, progressive taxation to address income inequality, stronger antimonopoly policies, and a far more aggressive policy to tackle climate change.

Rodrick and Stantcheva say these and other reforms would substantially change the way our economies operate. “But they do not fundamentally alter the narrative about how market economies should work; nor do they represent a radical departure for economic policy. Most critically, they elide the central challenge we must address: reorganising production.”

Personal toll

Of course, the mental health impact of workers forced to work from home is also a factor that deserves careful consideration. The Financial Times delves into this, discussing “worker’s block” and the hidden risks of life after lockdown.

Journalist Andrew Hill examines how staff working at home are handling it. For one thing, they’re a lot more cynical about some of the early gestures made by executives, which are starting to look pretty flimsy at this point: their many well-publicised decisions to renounce part of their salary sounds hollow when compared with the potential value of stock option grants they received when shares were at a Covid-19 low. “As furlough turns to redundancy, friction will increase,” he writes.

Psychologists point out that past crises presaged periods of employee disengagement, dubbed “work inhibition” or “worker’s block”. “One small advantage over past crises is that this time everyone is affected in some way, so everyone ought to be able to discuss their trauma more openly.”

The main burden of motivating despondent staff will fall on managers. At the start of the crisis, they were able to call on a heroic collective effort from their teams.

But can they sustain that shared sense of mission through the long, flat grind of the coming months?

* Munshi is News & Fox editor of the FM​

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