The government has finally released a mathematical model showing the number of Covid-19 deaths it expects in the next six months. The model predicts 40 000 such fatalities by November, on a best-case scenario, and some 48 000 by that time in a worst-case one.
This mathematical model has been produced by a consortium of experts from the South African Centre for Epidemiological Modelling and Analysis at Stellenbosch University (Sacema), the Modelling and Simulation Hub, Africa (Masha) at the University of Cape Town, and the Health Economics and Epidemiology Research Office at Wits.
In all models of this kind, the accuracy of the projections made depends, among other things, on the quality of the data fed into them, the validity of the assumptions underpinning them, and the coherence of the model itself.
Probably the best known Covid-19 model is the Imperial College one produced in March 2020 by Professor Neil Ferguson in the United Kingdom. This model has been shown to be fatally flawed in its design and operation. It was also wildly inaccurate in initially projecting that Covid-19 deaths in the UK could rise to some 500 000, when the current total is fewer than 40 000.
South Africa’s model may also prove flawed. The model assumes an infection fatality rate of between 0.3% and 0.4%, but this could be far too high. It is based on death rates in Europe and elsewhere, and may not adequately recognise the youthfulness and potential resilience of South Africa’s population.
A far more fundamental flaw is also in issue. Governments around the world have resolved to lock down their economies on the basis of projected Covid-19 deaths – but have given far too little thought to the additional non-Covid deaths likely to result from their lockdown decisions.
Spiralling health risks
This problem is particularly acute in low- and middle-income countries, said Dr Stefan Peterson, chief of health at the United Nations Children’s Fund (Unicef), in an interview last week. ‘The risk of children dying from malaria, pneumonia or diarrhoea in developing countries is spiralling’ and ‘far outweighs any threat presented by the coronavirus’.
Dr Peterson also cautioned against the use of blanket lockdowns in such countries. These lockdowns are not effective in controlling Covid-19, particularly in the teeming informal settlements where millions live. They can also have fatal consequences for children, in particular.
In some countries, people are avoiding hospitals and clinics for fear of picking up the virus, while health services are being diverted to focus on the pandemic. Vaccination campaigns have been particularly disrupted, with some 117 million children worldwide now likely to miss out this year on routine immunisations against measles and other potentially fatal diseases.
This shift in the focus of health services, cautions Dr Peterson, could be ‘more dangerous than the virus itself’. Lockdowns are also sure to exact a heavy economic toll and trigger increases in poverty and malnutrition.
These warnings are already proving salient for South Africa. According to Dr Glenda Gray, a member of the Ministerial Advisory Committee (MAC) and chairperson of the South African Medical Research Council (SAMRC), Chris Hani Baragwanath Hospital in Soweto is now ‘seeing children with malnutrition’ for the first time in decades.
Dr Ian Sanne, associate professor at the clinical HIV Research Unit at Wits University and another member of the MAC, adds that ‘non Covid-related diseases’ are not being given the attention they deserve.
Chronic medication
The proportion of HIV patients missing appointments has increased by between 40% and 60% since the lockdown began. A similar pattern is likely for those with diabetes or other illnesses requiring chronic medication.
Childhood vaccination programmes have witnessed a substantive decline, which could trigger substantial outbreaks of childhood diseases in the future. Semi-urgent surgeries – for the early treatment of cancer, for instance – have been interrupted as well. So too have maternity screenings important in guarding against maternal and early-childhood related illnesses.
Hospital admissions in the private sector (and perhaps the public sector too) have dropped by 75%. Usually crowded clinics are largely empty as well, as people are fearful of the virus or worried that attendance is barred by the lockdown.
More precise projections have been put forward by a consortium of actuaries and other experts calling itself Panda (Pandemic ~ Data Analysis). The Panda group has developed a model which estimates the ‘years of lives lost’ to both the virus and the lockdown.
This model notes that the lockdown will increase poverty and hunger, with predictable effects in terms of death and sickness for children and many others. Hence, the ‘years of lives lost’ from the lockdown are likely to range from 14 million to 24 million. This is 29 times greater than the years of lives likely to be lost to the virus.
The Panda consortium has urged President Cyril Ramaphosa to end the lockdown to avert this outcome. Business For South Africa (B4SA) has also urged a speedy lifting of the lockdown, as have the Democratic Alliance (DA) and other organisations.
Dr Gray has been particularly critical of the government’s plan to terminate the lockdown by slow degrees and one risk-alert level at a time. ‘The de-escalation, month on month, to various levels is nonsensical and unscientific’, said Dr Gray earlier this week.
Government remains intransigent
Even health minister Dr Zweli Mkhize now acknowledges that ‘the lockdown has served its purpose’ and cannot prevent a further surge in infections. Yet the government remains intransigent, refusing to sanction a speedy end to the lockdown.
With the executive determined not to budge and Parliament failing to hold it to account, both the DA and others are turning to the courts for relief. Legal action is being brought to challenge the unnecessary night curfew; the irrational prohibition on the sale of cigarettes; the absurd three-hour window for outside exercise; the unwarranted refusal to allow hairdressers to resume work; the unlawfulness of the permits and other licensing requirements being imposed on business; the validity of BEE criteria in limiting access to relief funds; the illegality of the executive’s implicitly assuming emergency powers without Parliament’s endorsement; and the unconstitutionality of the Disaster Management Act (DMA) under which all lockdown rules have been adopted.
All these legal challenges have substantial merit – but the one challenging the constitutionality of the entire DMA is, of course, the most far-reaching. This challenge is also being brought by the DA, which commands significant support as the Official Opposition.
The DA is therefore being demonised by various commentators for its (supposed) aims of protecting the privileged and ‘prioritising the economy over human lives’, as the national secretary of the Young Communist League, Tinyiko Ntini, has put it.
According to Mr Ntini, it is ‘the SACP and Cosatu, joined by the ANC, [which are] correctly prioritising the lives of South African people over profits’. But this assessment could not be more wrong.
It is not ‘lives versus profits’ that the lockdown puts in issue but rather ‘lives versus lives’. In addition, the lives likely to be lost to the increased poverty and disease triggered by the lockdown far exceed the likely death toll from the virus.
But those intent on expanding state ownership and control en route to a socialist economy have always put power before people. The lockdown they are determined to retain, regardless of the lives it will cost, is simply another means to this coercive end.
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