As the chatter about renewed lockdowns gets louder, one surely has to consider the lessons learnt from earlier lockdowns. The main lesson is that not even a military-enforced regime of testing, isolation and non-pharmaceutical interventions works.
With hospitals overflowing, there is great pressure on the National Coronavirus Command Council to ‘do something’ to curb the second wave of Covid-19 infections. It is likely that by the time you read this, it will have revived some number of the restrictions and prohibitions with which we became painfully familiar during lockdown levels two to five.
Perhaps alcohol will have been banned again, perhaps taverns and bars will have been closed again, perhaps a stricter curfew will be enforced, and perhaps the army will have been called out again to terrify citizens into compliance by occasionally beating someone to death.
The notion that lockdown was necessary to ‘get our healthcare system ready’ was obviously pie in the sky. It wasn’t ready during the first wave, and it still isn’t ready now.
That’s not to take away from the dedication of our overworked healthcare staff, labouring with limited resources under extremely difficult circumstances. It’s purely down to a lack of planning and preparation on the part of government.
What we do know by now, however, is that lockdowns do not work. It doesn’t matter that ‘everyone is doing them’. If you jump off a cliff because everyone else is doing it, you’re nothing but a lemming.
Lockdown accelerated spread
In November, the government’s top epidemiology adviser, Professor Shabir Mahdi, confirmed that in South Africa’s case, lockdown actually accelerated the spread of Covid-19.
It corralled vast numbers of people into crowded townships and informal settlements, where people live cheek by jowl, often sharing water and ablution facilities with many neighbours.
The virus swept through these crowded residential areas with nothing to stop it. When lockdown was relaxed, it spread from these townships back into suburbia where the initial lockdown was observed, but where much of the second wave then occurred.
Basic infection control measures, including masks, handwashing, social distancing, and avoiding crowds, especially indoors, remain sensible precautions that slow down the infection rate.
Further lockdown measures will not work, however. If you close businesses and tell people to stay home, you get into the same situation as during the first wave: concentrating people into overcrowded residential areas. If you don’t, then no matter what you do, you still have crowded public transport as a major transmission vector.
If you close certain public spaces, you’re just crowding people into the remaining public spaces. If you restrict opening hours, you’re squeezing more people into less time, which increases crowding instead of decreasing it. If you restrict numbers at gatherings at places you do control, then people are more likely to gather in places you don’t control, like private residences.
The virus is now endemic. It is widespread. Crude, heavy-handed lockdown measures will not make much difference in how fast it continues to spread.
The Lancet published a paper in its August issue in which the authors conducted ‘a country-level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on Covid-19 mortality and related health outcomes’.
The authors concluded that government actions such as border closures, full lockdowns, and a high rate of Covid-19 testing were not associated with statistically significant reductions in the number of critical cases or overall mortality.
The most important factors that affected national caseload and gross mortality – that is, number of deaths per million of population – were levels of preparedness, the scale of testing, and population characteristics.
A higher prevalence of obesity, for example, significantly increased mortality and caseloads, as did a higher median population age. Higher smoking prevalence was associated with a reduction in the number of critical cases. (Puff on that, Dr Zol.)
Lower GDP and higher income inequality were associated with a reduction in critical cases, for reasons the paper did not explain.
Higher unemployment was associated with a higher number of critical cases, so increasing unemployment by imposing lockdowns is exactly what we don’t want.
South Africa was widely praised for how early and harshly it locked down, but the study found that the longer the implementation of lockdown was delayed, the lower the number of detected cases per million were.
In a paper posted online, Danish economist Christian Bjørnskov studied the association between lockdown severity and mortality rates. He observed that lockdowns have caused severe economic recessions and an erosion of fundamental rights and separation of powers. This might be a small price to pay for saving many lives, but it saved none.
Bjørnskov concluded: ‘Comparing weekly mortality in 24 European countries, the findings in this paper suggest that more severe lockdown policies have not been associated with lower mortality. In other words, the lockdowns have not worked as intended.’
A study of 92 countries, states and provinces, also in preprint, did not find any statistically significant difference in effectiveness between countries with and without lockdown. There was also no significant difference in mortality during lockdown, however a significant difference after lockdown, with higher mortality for lockdown countries.
‘The results indicate that lockdown measures are not necessarily superior to relaxed measures, which in turn are not necessarily a recipe for failure,’ the authors wrote.
The evidence shows that lockdowns do not work for their stated purpose, which is to reduce Covid-19 mortality or the incidence of serious cases.
Is SA different?
A preprint study by Shafiun N. Shimul, an associate professor in the Institute of Health Economics at the University of Dhaka and a consultant to the World Bank, finds that lockdown measures are less effective in developing countries than in developed countries.
Another paper, also in preprint, studied lockdowns in Bangladesh, Brazil, Chile, Pakistan, and South Africa, and found no compelling evidence in favour of the effectiveness of country-wide lockdown.
In a paper on the economic development and inequality tradeoffs in South Africa’s response to Covid-19, published in the journal World Development, the authors claim to find a correlation between reduced mobility as a consequence of lockdown and a reduction in infection growth rates two weeks later.
However, it isn’t at all clear that this is not entirely coincidental, especially given that country-comparison papers do not find such an association. It also finds that lockdown exacerbates inequality.
A paper specifically about South Africa claims to present a model for developing ‘optimised lockdown strategies’. It was published by the Institute of Electrical and Electronics Engineers, and written by engineers.
It claims that ‘the early strict lockdown measures in South Africa have been successful from an epidemiological point of view,’ but fails to cite any sources to corroborate this opinion.
Considering the expertise of the authors, and being based on the same sorts of models that so comprehensively mis-predicted how the epidemic would unfold, it seems wise to take its unsupported claims and other findings with a pinch of salt.
In fact, the paper’s very first warning about its limitations is that ‘any model-based controller inherits the limitations of the model that it is based upon’.
Given Mahdi’s statement that lockdowns accelerating the spread of Covid-19 in South Africa, it doesn’t look like this country is any different.
So what if lockdown measures were just better enforced? We hear all the time that the real problem is the delinquents among us who refuse to heed government’s instructions.
Will it help to call upon the military to whip us into shape? A new study in the New England Journal of Medicine suggests it won’t.
It tested US Marine Corps recruits after they volunteered for a supervised two-week quarantine period at a closed college campus that involved mask wearing, social distancing, and daily temperature and symptom monitoring. A control group was also tested after two weeks.
One can assume – based on the documentary Full Metal Jacket – that the supervised quarantine was strictly enforced, and discipline was high, lest their guts got stomped out.
The headline result was not lifted out into the abstract, nor was it covered by the media, which focused on the fact that more than 90% of the Covid-19 positive cases in the study were asymptomatic.
The real news was buried in Table 1, where we learn that of the 1 848 study participants, 2.8% tested positive for Covid-19 after 14 days. By contrast, the 1 554 non-participants who were in the control group, only 1.7% tested positive after 14 days.
So even a military quarantine, enforced by the ghost of Gunnery Sergeant Hartman, did not reduce the spread of Covid-19. On the contrary, it accelerated its spread.
Treat the sick
The Covid-19 pandemic has brought the authoritarianism out in our political leaders.
Instead of viewing himself as a servant of the people, the president, Cyril Ramaphosa, rather offensively paints himself as a father who routinely needs to have stern talks to his children, without getting any backchat.
The minister of police, Bheki Cele, parades around like a petty tyrant. Surrounded by a coterie of so-called generals (so-called only because Cele re-introduced Apartheid-style military ranks into the South African Police Service), he harasses women in bikinis engaged in perfectly legal sunbathing, instead of policing actual crime.
Nkosazana Dlamini-Zuma heads the National Coronavirus Command Council, which is as Stalinist a body as there ever was, demanding that citizens be obedient to the totalitarian state.
Meanwhile, their own duty was not to stop the pandemic in its tracks, but to gear up our healthcare system to cope with the onslaught that it would inevitably face. They have failed to make adequate provision to deal with staff shortages. They have failed to procure adequate supplies of oxygen, personal protective equipment and all the myriad other things hospitals need to diagnose and treat Covid-19. After all, they paid half the money set aside for this purpose to scoundrels and thieves.
If Ramaphosa wants to be our daddy – creepy as that thought is – perhaps he should pull his weight in this family, instead of abusing his children with lockdowns that destroy livelihoods but are now scientifically proven not to save lives.
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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