When Covid goes, booze curbs must stay, experts tell government

There is no medical reason for continued bans on alcohol and cigarette sales under SA’s eased lockdown conditions – but that doesn’t mean the country shouldn’t take a long, hard look at what to do about these products when Covid-19 goes away.

This is the word from the Ministerial Advice Committee (MAC) on Covid-19 – a group of experts offering advice to the government, particularly health minister Dr Zweli Mkhize.

In one of their submissions to Mkhize, dated August 17 – the day SA moved to level 2 of the lockdown – the experts said the rationale that smoking and drinking cases could overwhelm the country’s already overburdened healthcare system no longer made sense as the number of infections was on the decline. The MAC agreed the prohibitions on tobacco products should be lifted under level 2 of the lockdown, but that some regulations needed to remain on alcohol sales.

However, the experts said the government must look at increasing taxes and implementing additional restrictions on the products once Covid-19 was no longer a factor.

“There may be many non-Covid-19-related reasons for additional controls on both tobacco and alcohol, such as increased taxes and controls on quantities. These should be implemented separately at a later stage not linked to Covid-19,” the committee said in the August 17 letter.

The health ministry on Thursday released 45 of the MAC advisories to the public, with Mkhize saying “less than 5%” of the advisories were not implemented in their entirety.

“This followed consultations with various stakeholders and, in some instances, guidelines published by institutions such as the [World Health Organisation]. Over the years, the department of health has had the benefit of gaining expert insight through various ministerial advisory committees dealing with a plethora of health issues,” said Mkhize in a statement.

In the August 17 document, the MAC said the prohibition on alcohol and tobacco products no longer offered significant value to the country’s health services. This, the committee said, was because the number of Covid-19 cases was on the decline and the health system could now cope with any incidents linked to the two products.

“The imperative to implement interventions aimed at protecting health services so that they are better able to cope with the surge is no longer essential. Therefore, most of the health reasons for maintaining restrictions on tobacco and alcohol fall away,” the committee said.

It also added any fears that tobacco “may cause more severe forms of Covid-19” were no longer a concern.

“The healthcare system will be in a better position to deal with this once there is a consistent decline in cases and health services are no longer under the pressure of the surge in cases,” the MAC said.

However, it said some of the restrictions on alcohol should be retained, an approach the government followed by restricting liquor sales from Monday to Thursday.

“With regard to alcohol, a stepwise easing of restrictions may be more appropriate based on the experiences of easing alcohol restrictions at the end of level 4. The main goal for maintaining some temporary restrictions on alcohol is to reduce the sharp rise in initial binge drinking and dangerous drunkenness as seen with the easing of the previous alcohol restrictions,” the letter reads.

However, in an earlier letter, dated July 22, when cases across SA were at their peak, the MAC strongly recommended a ban on alcohol sales.

It said that, drawing from its modelling, the ban could prevent thousands of hospital beds being filled up on non-Covid-19 cases.

“It is estimated that a ban could achieve a reduction of about 3,400 alcohol-related trauma presentations across public secondary and tertiary hospitals by the end of the first week following a ban on liquor sales [that is, an estimated 10% reduction in level 3 weekly trauma presentations, or 20% of the alcohol-related trauma presentations], levelling out to a maximum reduction of about 6,800 alcohol-related trauma presentations by the end of the third week [or 20% of all trauma admissions/40% of alcohol-related trauma presentations].

“This is likely to have a substantial impact on reducing the burden on staff in trauma units, the demand for inpatient beds, ICU facilities and ventilation capacity,” the MAC said.

It added this was vital because of the country’s “fragile” health system, which had “little reserve”.

“It makes sense to protect our resources as much as possible and as early as possible. In addition, we expect the major impact of the ban/restriction to be gradual over several weeks. Therefore, we favour an early implementation of a ban/restriction,” the MAC wrote.

But it also advised looking forward so that SA could best deal with alcohol trauma.

“For the future, we strongly recommend that all trauma related to alcohol should be made reportable/notifiable so we can build a sustained bank of information to inform the impact on the health system and economy of the country,” the MAC said.