The physical distancing measures announced by President Cyril Ramaphosa on 15 March followed by an extended lockdown may have bought us time to prepare for Covid-19. Good leadership has helped the response, but the current lockdown is not sustainable.
In city centres and middle-class suburbs there is largely adherence, but in many marginalised areas the lockdown is fraying or not being followed. Income has been abruptly stopped, making paying rent or buying food difficult.
Job losses and the prohibition of informal trade are causing increased hardship, making life unbearable.
If there is a further lockdown extension, physical distancing measures will lose legitimacy, allowing the virus to run free with catastrophic consequences for life and the economy.
So, what should we do? The truth is that no-one knows the answer with certainty. But we should all debate this. Our suggestions attempt to balance slowing the spread of the virus with opening the economy and making life more bearable:
Scale up daily tests rapidly. Currently we do about 5,000, which is promising, but not enough. Only by monitoring the epidemic properly can we know which measures work. A spike in infections in a specific area, can attract direct resources: food support, rent and bond relief, suspension/reduction of debit orders, housing, medical support, human rights monitoring and social orientated military support.
The cost of even the most ambitious testing programme, with door-to-door screening, is a pittance compared to that of an extended lockdown.
Allow people to be outside with strict physical distancing. Open parks, streets and public spaces. Let children play ball games and allow people to walk their pets. Encourage walking and running.
Explain to the public why physical distancing is vital. Experience with HIV suggests that most people armed with facts, can work out the details, and act with care towards others. However, they need to understand and trust what they are being told.
Engage with communities, ask for their ideas, equip them to become informed and to communicate reliable information and knowledge and get feedback and questions. Establish inspirational community-based organisations such as the Community Action Networks, and include official government collaborations at this level.
The lockdown necessarily was designed on the fly from the top, but after several weeks of experience, tapping into the creativity of people who bear the brunt of the lockdown would encourage desperately needed social buy-in.
Urge police to take a backseat except for blatant non-adherence, and then without violence. The army should be used to support food distribution and medical programmes, not law enforcement. When lockdown was announced, it was not to punish, but to protect, people. This reason needs to be reinforced and explained within communities by those whom they trust.
Make free or highly subsidised data available to people, now that connectivity is key. Poorer people without access to unlimited fibre or free internet hotspots, need to communicate with anxious families, access information, report food shortages or medical emergencies, or just deal with the boredom and anxiety. More accessible data will allow people to access online learning and free psychological support at this time of uncertainty. Expanding access to what increasingly is a basic right, would be responsible and kind.
Ensure that taxi and bus drivers have protective gear, and insist that all people entering or leaving a vehicle have their hands sanitised, similar to what’s happening at many stores. Limiting numbers of bus trips, as Johannesburg has done, may be unwise, leading to remaining vehicles being more crowded. Large corporates should be encouraged to look into transporting workers who cannot afford their own vehicles.
Businesses, both formal and informal, should be allowed to open again, albeit under strict physical distancing measures, including queue management and access to hand sanitiser. Work from home needs to be strongly encouraged, especially in people over a certain age or with chronic illnesses such as diabetes. Masks must be worn in workplaces. No more than a certain number of people should be allowed to work in a specified space. Every meeting should be prefaced with the question: “Can this be virtual?” People with cough or cold symptoms should be sent home to recover, and encouraged to get tested. Government functions where possible should be moved online, with, for example, virtual renewal of driver and car licences, identity documents, voting, and deeds registration.
Relax the list of essential items. People need to be able to buy exercise equipment, toys, crafts and other things to keep themselves and especially their children occupied. People also require clothing – especially as seasons change and as children grow.
Allow people on chronic medication prescriptions to receive three to six months supply at a time.
Encourage restaurants to grow the delivery side of their businesses.
Bars, shebeens, clubs, cinemas, gyms, hairdressers and other potentially high-risk facilities are more challenging to open, but that’s all the more reason for consultation with them to find practical suggestions that may allow them to do business, perhaps in a limited way.
The time for government to increase the provision of housing is now. High-rise low cost housing projects, with garden and play amenities, near urban centres run by large, reputable companies are needed to house the millions of South Africans living in informal settlements.
De-densifying informal settlements by moving people en-masse to other remote areas, is reminiscent of apartheid forced removals and bound to fail.
Hotels that are standing vacant with the collapse of the tourism industry, could be contracted by government in the interim to house people.
Despite the long-term public health reasons for discouraging excessive alcohol use pre Covid-19, further prohibition is likely to encourage dangerous illegal markets, with associated criminality. Compromise is possible, for example by limiting how much each person is allowed to buy at the till, and geographically limiting who sells alcohol to prevent hopping from store to store.
End the ban on cigarette sales. Although smoking causes cardiovascular and respiratory diseases and may lead to poorer outcomes with Covid-19, it is unclear whether a ban is effective. Unnecessarily enacting and enforcing rules without clear cause and reason is likely to lead to non-compliance and growth in the already flourishing illegal tobacco market.
Schools are an especially hard problem, as keeping them closed while insisting that parents, especially single parents, return to work, may be impossible. Children appear to be at very low risk of the severe consequences from Covid-19, but they can spread the infection, putting older family members and teachers at high risk. However, parents often rely on schools for childcare and for the associated school feeding schemes. Calls for home-schooling have placed tremendous strain on parents unprepared and untrained for this. Much more discussion is needed to find a way forward. School camps for primary school children where they are boarded for a few weeks at a time, with monitoring of infection rates, should be researched for acceptability and feasibility. Allowing public schools access to private school distance-learning platforms, associated with free wi-fi, should be considered. Universities should be exploring similar options. In the meanwhile read this open letter to Minister Angie Motshekga.
Economic recommendations are beyond our expertise and yet a vital part of the discussion. Increasing cash through the existing child grants and pension programmes appear to us to be a good idea, especially as government food provision programmes miss large numbers of people. There is clear evidence that the social grant system in South Africa mitigates some of the effects of poverty. We recommend reading this open letter to the president by over 70 economists.
Rounding up homeless people should cease. Homeless people, left to stay where they usually do, are probably at no greater risk of a Covid-19 outbreak than if all placed into camps. Homeless people are a minimal infection risk to the rest of the population, and the approach to them needs to be humane.
We need information on immunity urgently, and we need to validate tests that tell us whether people can be issued an ‘’immunity passport’’, so as to allow them to take positions in society that others, at risk of infection or infecting others, can’t. It is still unclear whether this immunity exists, or that it holds for everyone, or that we will have a test for it, but if we can, it may allow some people to return to normal life more quickly. We will need to address people’s possible fear of testing and its implications for their return to work and their concerns for their and their families’ health.
No doubt the above is controversial in parts, but these are not decisions only for political leaders and health experts to make without consultation. A public debate is vital.
Venter has been involved in HIV and broader public health and clinical programme design and implementation. Mngadi works in HIV Vaccine Research in Tembisa. Mashabane has been involved in HIV clinical trials implementation, aiding transformation through the inclusion of unemployed graduates and digital innovations. Lalla-Edward is a public health monitoring and evaluation specialist focussed on research capacity strengthening in HIV, non-communicable diseases and digital health. Geffen is GroundUp editor. Cooper works in Public Health at the University of the Western Cape, and is involved in the socio-economic determinants of health and community health outreach.
