The 11 factors that will shape SA’s lockdown

A lockdown is necessary to slow the spread of disease and allow SA’s health authorities to prepare for a rapid demand for hospital beds. But it won’t be a panacea — and it comes with some serious drawbacks.

1. Lockdowns slow the disease — not stop it

Many studies suggest that a lockdown will not reduce the total number of cases, but instead delay the spread of Covid-19. In those models, the spread of Covid-19 begins to flourish again after social distancing measures are removed.

Researchers from Italy, Spain and the US have argued that in the end, 80% of the population gets sick anyway -it’s just that the mitigation efforts slow the spread. However, a lockdown allows authorities to buy time to increase testing systems and hospital beds. Massive testing and isolation of every case is how Taiwan and Korea brought the disease under control.

The landmark Imperial College study into Covid-19 released two weeks ago in the UK, warns that until a vaccine or effective treatment becomes available, increased testing and lockdown strategies need to continue. The reality is, vaccines aren’t likely to be ready within the next 18 months.

But it does mean that during the lockdown, the SA government and health experts can prepare hospitals, increase testing capacity and find places to quarantine the sick who live in crowded shacks.

2. Does a lock down work in a township?

It is not clear on what data South Africa modelled its lock down on, and whether this took into account what it will mean in townships where disease can spread easily between individuals in crowded shacks and houses. Even the minister of social development, Lindiwe Sisulu, has called social distancing “a middle class solution”.

Before implementing the lockdown, president Cyril Ramaphosa spoke to Chinese authorities, presumably for ideas on an optimal lockdown plan. The problem is, SA’s informal settlements look very different to suburbs in Wuhan in China.

The government needs to be more adaptable in modelling its solutions to a South African setting, and its plans for what what will happen once people who have been infected at home during the lock down eventually head back to work.

3. Is the lockdown really in time?

Ramaphosa was told by his advisors, when deciding whether to institute a lock down, that SA was early enough to slow it down the epidemic with severe restrictions on movement. But is this true?

Government, understandably, does not want this disease spreading into crowded informal settlements where water and space is limited. But because of the backlog in testing, it’s not clear how widespread the epidemic actually is and, consequently, whether it was in time to make a difference.

In particular, we don’t know if it could it have spread further as people desperate to escape crowded, hot townships travelled back to rural areas. Or indeed, what impact people crowding into shops to buy booze and food before Friday had on the spread.

4. It’s unclear how the poor will eat

The Human Science Research Council says that one in four children is malnourished, which weakens your immune system. During the lock down, many including hawkers, car guards, part-time domestic workers, taxi drivers and their children will go without food as they go without income. The 9 million children who may have had a meal at school are at risk of having no food since schools are shut.

5. The army and police have unmitigated power and are revelling in it

Verified videos are already being circulated showing army and police army brutality aimed at the poor. During the first weekend of lock down, cops sprayed shoppers in Delft, Cape Town with water; there were running battles in Hillbrow between cops and residents ; and shoppers queuing for food in Khayelitsha were shot with rubber bullets.

On Friday morning, as police tried to deal with looters in Yeoville looters raiding a liquor store, they threatened a News24 journalist who was present. On Saturday night, armed police harassed Khayelitsha residents for being in their yards. When a journalist asked minister of police Bheki Cele on the weekend about the excessive use of force, his response was ominous: “wait until you see more force”.

Eli Kunene, a lawyer at class action attorney Richard Spoor’s firm, said eight cops intimidated him in his house, after Kunene witnessed the the police harassing homeless people near his home. Such measures may become more common.

6. The looting time-bomb

In past times of stress, South Africans resorted to looting stores and targeting foreign-owned stores. Already, we’ve seen disturbing incidents including the attempt to loot a closed liquor store in Yeoville. If people who might be hungry, or those seeking alcohol, resort to looting and the army responds with brute force, it won’t end well. Even in developed countries, we’ve seen echoes of this: in the poorer parts of southern Italy, there have been a number of incidents of civil distress.

7. Home is dangerous too

China reported an increase in domestic violence during its lock down in Wuhan, and there have been similar reports from the UK and elsewhere. To make it worse, SA has a ban on outdoor exercise, which means most people have no means to escape homes or violent spouses for even 20 minute periods.

8. Red tape and dodgy websites

The government has promised assistance to small businesses battling for cash, and workers retrenched during the lockdown. But like many of government’s promises, it may be more words than action. Last week, the government’s bizportal website collapsed, as more than 15,000 businesses applied for exemptions to keep operating.

Tanya van Lill, president of the Southern African Venture Capital and Private Equity Association, warned that the promised bridging finance to help small businesses start-up again after the lock down will have to be paid out promptly. “How do we do this timeously? How do we take away the red tape. Speed is of the essence.”

Bitter experience suggests there may be delays in these payments. The Compensation Fund, for one, pays about R5.4bn per year to doctors and therapists who treat injured workers. But it is massively behind in these payments after it shut down its old website in August, and only opened the new bug-ridden one (ironically called Compeasy) in October. While it paid out R450m per month, on average, last year, it has only paid out a cumulative R100m since September. This example doesn’t bode well for small businesses.

9. No beer, no cry

Alcohol sales are banned, partly to reduce the need for hospitals beds as a result of drunken stabbings, road accidents and drunken crime, which is known to increase hospital demand on pay day weekends. But experts have warned that forcing alcoholics to go cold turkey can result in their need for hospital care.

Still, Charles Parry, a drug and alcohol researcher at the Medical Research Council has argued that fewer people could die from forced withdrawal than his estimates of deaths caused by alcohol-fuelled violence, accidents and disease.

10. Getting poorer = getting sicker

Poverty is a predictor of a shorter lifespan and the lock down will further weaken the economy and increase job losses.

Doctor Michael Marmot, former head of the World Medical Association writes in his book The Health Gap that wealth and life expectancy are almost perfectly correlated.

For example, if a commuter on the tube in London takes the Jubilee Line from wealthy central Westminster outwards to more middle class and poorer areas, the life expectancy of residents drops by a year at each tube station.

Better analysis of the balancing act between making people poorer and sicker over the long term, and delaying the epidemic must be done.

The Imperial College study admitted that it didn’t consider “the wider social and economic costs of suppression, which will be high and may be disproportionately so in lower income settings”. Better data is needed here.

11. The irrationality of certain governments regulations

The government, for some reason, determined that retailers may not sell stationery. This led one doctor to note, sarcastically: “I guess I will write clinical notes in blood”.

There are many potential unintended consequence of all their decisions. For example, the ban on alcohol may lead to more dangerous home-brews being created. There are no doubt many other such outcomes we’ll see in the next few days. How the government responds to this will, to some extent, determine how successful the lockdown has been. — Financial Mail

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