While many have hunkered down literally ‘zooming’ across the net attending webinars, conference calls and Pilates classes from the comfort of their homes relatively safe from contracting the SARS-CoV-2 virus, fellow South Africans are facing an even bigger threat from the economic fallout created by the lockdown; the very tool deployed to prevent the spread of the virus.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the scientific name given to the novel coronavirus, whereas it gives rises to a constellation of symptoms called coronavirus disease (COVID-19). Infection by SARS-CoV-2 can lead to COVID-19
Many question the merits of the lockdown especially given that it may be extended yet again in light of the emerging incidence data. Unfortunately, the number of new cases has stubbornly remained over 100 per day – our world-renowned epidemiologists have set a target of 91 cases per day or fewer to consider easing the lockdown.
Moreover, we are being told by experts that ultimately at least 50% of the population globally will at some point be infected. I initially also questioned the merits of a lockdown if eradicating the virus was never a possibility.
The South African economy was already teetering on the brink of collapse before the virus reached our shores. Our fiscus was cornered with little room to manoeuvre and talks of approaching the International Monetary Fund and World Bank had already snuck into dinner conversations. Of course, since then Moody’s finally downgraded our Sovereign Debt Credit Rating, a blow that was perhaps inevitable but perhaps easier absorbed against a backdrop of worldwide economic turmoil. Even before the pandemic, unemployment rates had been approaching levels not seen in decades and economic stagnation had become the trend while corrupt politicians and businesspeople unlawfully siphoned billions from the economy.
Yet in a bold, calculated and deliberate move, our executive chose to implement a nationwide lockdown of the economy to limit the interaction between people with the goal of ‘flattening the rate of infection curve’.
So why try to flatten the curve? First, it allows the spread of the disease to be contained while we take stock and formulate a strategy: a public health one and an economic revival one. In our case this includes, identifying hot spots, ramping up testing and active case finding (actively going to look for infected people) while developing an economic strategy that is socially just and equitable. Admittedly, the latter still needs much work.
Second, it allows us to deploy resources and get an already-buckling health care sector more prepared to deal with the cases when they arrive. And they will arrive! This includes acquiring protective supplies and equipment (including PPE for health care workers), rescheduling elective procedures, hiring staff, and setting up additional and make-shift facilities to increase bed capacity and allow isolation of infected patients from other hospital patients.
Third, and perhaps most importantly, it slows the spread of the virus so that the number of new infections per day and ultimately the overall burden on the health care sector is alleviated, thereby reducing the overall mortality rate – fewer people turned away with seemingly more resources to care for fewer infected patients on any given day. In effect, it reduces the chances that you will be turned away from a public or private hospital should you succumb to the virus.
Fourth, it buys some time to research and understand the virus and to search for vaccines and more effective treatment methodologies. Fifth, the lockdown has significantly halted the spread of the virus in our densely populated townships and informal settlements where social distancing is just not plausible. And finally, it has prevented an absolute and uncontrolled annihilation of our population and has prevented widespread panic and pandemonium that may have erupted if we as a country did absolutely nothing about curtailing the spread. One only needs to consider the USA in this regard. A lockdown, whether imposed nationwide in an organised, controlled manner or in a chaotic, reactive, knee-jerk manner, would have been inevitable. At some point, one by one, companies, farms, factories, schools and restaurants would have had to close or implement extreme measures as employees started to test positive with each being its own social experiment except that mortality and morbidity would be the variables tested.
It would be naïve to ignore the economic cost and social fallout from the lockdown. The lockdown is decimating our impoverished communities the most. People are starting to cry out that starvation may kill them before the coronavirus does. Yet, on the one hand we are measuring economic cost (which may be bit easier to measure objectively) versus loss of life and its ramifications (which even if adequately measurable, we will not have a control against which a comparison can be made). Is it even morally comprehensible to argue economic cost versus loss of human life? But in a country like ours, economic downturn can translate into actual loss of life. I truly empathise with our leaders who have had to choose between the lesser of these two evils.
Some argue that our population is younger and thus more resilient. On paper our population is certainly younger, but we are not as healthy as you would expect a younger population to be. We have among the highest alcohol consumption rates in the world, we carry a notable HIV and TB burden, malnutrition is rife, and we have lower than expected literacy and education levels, all of which inform the ‘healthiness’ of a population.
Judging by the increasing number of people on the roads and at supermarkets over the last few days, people are already becoming desensitised toward the virus and its potential spread. Perhaps we acted too swiftly and when we ease the lockdown, which too is inevitable, many may assume that it’s business as usual. Perhaps we imposed a lockdown too early. Perhaps the lockdown should have been minimised to buy just enough time so that the economic cost could have somewhat justified the planning and strategising on the way forward.
Then again, hindsight has an uncanny ability to make everything seem so much clearer. Re-opening the economy and spreading the virus are both inevitable. There could and may still be absolute chaos (including massive economic disruption just by people not pitching up to work en masse) as this virus works through the system. How best can we minimise the impact on human life and then on economic fallout is now perhaps the only way forward.
So again, we need to be brazen and implement as many measures as possible to limit further fallout but that unfreezes the economy bit by bit.
Even after the lockdown we need to remember that social interaction is the only means by which the virus spreads – it can either be inhaled or introduced to the body via touching the mucosal surfaces of the face with contaminated hands. Sure, the debate on whether we should have or should not have had a lockdown may continue for years to come, but there is no denying that many fellow South Africans are facing starvation, joblessness and homelessness.
Let us stand together as a proud profession and spare a thought (or a penny) for those less fortunate than us. Let us spare a thought for the overwhelming burden that will be placed on our health care system, essential services and government. Let us spare a thought for the many who may perish depending on how we conduct ourselves individually and collectively as we navigate these uncharted and trying times.
AUTHOR | Dr Mitan Nana CA(SA), MCom (Wits), MBBCh (Wits) is a medical doctor and chartered accountant based in Cape Town