The ANC government and many other commentators have stoked enormous fears about Covid-19, while a recent model – developed by the Covid-19 consortium advising the government – has projected that some 40 000 to 48 000 people could die from the virus.
This projected death toll is, of course, deeply disturbing. However, it is also far lower than an earlier model which projected between 87 900 and 351 000 Covid-19 deaths – and was instrumental in prompting the government’s initial lockdown decision in March.
The estimated Covid-19 death toll is now significantly lower than likely deaths from other causes. The country commonly experiences some 29 000 TB deaths a year, at least 21 000 AIDS deaths, and roughly 350 000 further fatalities a year from diabetes, heart disease, and other natural causes.
Sadly, however, the normal toll of non-Covid deaths has probably been pushed up significantly by nine weeks of hard lockdown. Lost jobs and income have doubtless added to acute malnutrition, for one. This was already evident in the first month of the lockdown, when an opinion poll conducted by the HSRC found that 55% of the people living in informal settlements lacked money to buy food, as did 66% of township residents.
Health experts fear a significant increase in malnutrition resulting from the lockdown. Though this is not yet reflected in patient numbers, this is largely because admissions and hospital attendance have dropped sharply since the restrictions began.
The lockdown has also severely disrupted health and vaccination services. TB testing has dropped by some 48% since the start of the lockdown, while in Gauteng alone the collection of medicines for TB and HIV/AIDS has declined by 1.4% and 19.6% respectively. Childhood vaccination programmes have also been interrupted, increasing the risk of substantial outbreaks of childhood diseases in the future.
These developments, all products of the lockdown, have greatly increased the risk that additional deaths from TB, HIV/AIDs, diabetes, cancer, malnutrition, and the like will significantly exceed the Covid-19 death toll.
Says Professor Haroon Saloojee, Professor and the head of the Division of Community Paediatrics at Wits University: ‘There is a real possibility that malnourished children and others with other conditions are dying at home during the lockdown. We will only know the truth when we examine mortality statistics much later.’
Disruption to health systems
Alarm is growing in other countries too as governments start looking at both sides of the balance sheet and weighing likely Covid-19 deaths against probable additional deaths from other causes. As The Economist reports, a team at Johns Hopkins University has calculated that ‘across 118 poor and middle-income countries, disruption to health systems and hunger could kill 1.2m more children and 57 000 mothers over six months’. In addition, a report by the London School of Hygiene and Tropical Medicine has estimated that, if lockdown restrictions prevent vaccinations, ‘140 people in Africa will die for every Covid-19 death prevented’.
This is one of the key reasons South Africa’s lockdown must now be lifted – and why the entire country needs, at minimum, to move from Level 4 to Level 3 on 1 June, as announced by President Cyril Ramaphosa last Sunday.
Having implemented the lockdown on 27 March without first taking effective steps to mitigate its devastating impact on the poor (as health experts had advised), the government must now end the lockdown to reduce hunger, restore livelihoods, and reinvigorate essential health services.
At the same time, the lockdown – even at its hardest level in the first five weeks – has always been impossible to implement in crowded townships and informal settlements. Hence, despite the humanitarian and non-Covid health disaster it has caused, it has not been effective in halting the spread of the disease.
Since early in April, the reproduction rate of the virus has remained at an estimated 1.2. This is significantly above the vital level of 1. An R number below 1 is important because, if every infected individual infects fewer than one other person, the virus will stop spreading. By contrast, if R remains above 1 and every infected individual infects more than one other person, then the virus will continue to spread and will do so with increasing speed.
Given the key failure of the lockdown to reduce the R number below 1, infections are sure to grow strongly after the country shifts to Level 3. Trade unions and others on the Left will then be quick to blame business for putting ‘profits before people’ by pushing for the lockdown to be lifted too soon.
The National Union of Mineworkers (NUM) has already warned that ‘workers [must not be] sacrificed for profits by…heartless and evil mining companies’. The South African Federation of Trade Unions (Saftu) has also strongly criticised the decision to shift to Level 3, saying: ‘The government’s message to workers seems to be, “sorry we can’t stop the virus from spreading, we are aware that the virus will infect and kill even more than the past, but the employers need profits now, so go and die in your thousands”.’
The real failure
But the real failure lies, of course, with the government and not the private sector. It was the government that decided on a lockdown strategy that could not succeed in crowded informal settlements – and was thus (in the graphic words of Professor Alex van den Heever, health economics expert at Wits University) ‘equivalent to no intervention’ at all for the millions of people living there.
It was the government that failed to develop the most important mechanism of all – an effective testing and tracing strategy which could quickly pinpoint infected individuals and put them and their contacts into self-isolation or quarantine. No effective tracing is possible when tests take seven or more days to process – and testing backlogs stand at 18 000 in the Western Cape and 20 000 in KwaZulu-Natal.
It is the government too that has helped to stoke great fear among the public. Yet much could be done to reduce this anxiety if only the ruling party would be more frank about the dangers from the virus.
Instead of falsely comparing Covid-19 to the Spanish Flu of 2018/19 – which killed an estimated 50 million people around the globe – the government should be stressing (as the Covid-19 consortium’s model has confirmed) that 75% of Covid-19 cases will be ‘asymptomatic’. People in this category will have no symptoms at all and most will never realise that they have been infected.
What of those who do develop symptoms? According to the Covid-19 consortium, 96% of these individuals will have mild symptoms only. They might develop a fever and other common Covid-19 symptoms, but they will not become particularly sick.
It is only the remaining 4% of those who develop symptoms who will become badly ill and will need hospitalisation. Of these individuals, says the consortium, 2.6% will become severely ill, while the remaining 1.4% will become critically ill.
The 40 000 to 48 000 deaths the consortium projects will come from the relatively small proportion of people likely to fall badly ill. Most of these individuals will be particularly vulnerable because they are elderly and have serious existing illnesses or ‘co-morbidities’.
Almost all the rest of the people who become infected will have mild symptoms or none at all. For the great majority of South Africans, thus, having the misfortune to become infected with Covid-19 will be far from the death sentence that many have been led to fear.