Although the South African government implemented very strict lockdown measures, the number of new COVID-19 cases during this period have increased exponentially. Irrespective of the criticism or praise the government has received for its actions, Shrikant Peters points out that the country’s health crisis precedes the COVID-19 pandemic, and poverty will exacerbate the country’s ability to effectively contain the rise in infections.
As of 21 May 2020, the dashboard for the National Institute of Communicable Diseases reads:
- Total case numbers: 19 137
- Total deaths: 369
- Total recoveries: 8 950
- Cases in last 24 hours: 1 134
- Case numbers per province
- Western Cape: 12 153
- Gauteng: 2 453
- KwaZulu-Natal: 1 693
- Eastern Cape: 2 324
- Free State: 184
- Mpumalanga: 95
- Limpopo: 121
- North West: 77
- Northern Cape: 37
In the past two weeks, we have added more than 10 000 new cases to our total COVID-19 caseload. The total number of cases in the last 24-hour period stood at 1 160, the majority of these being found in the Western Cape.
Although previous predictions expected the incidence of infections to peak around August and September, in the Western Cape this has been adjusted with new incoming data, to June or July. Currently, hospitals in the province are escalating their medical and Intensive care bed space in preparation.
Government’s approach to containment, via lockdown, is increasingly being questioned. Both health and economics experts are questioning its efficacy in preventing further infections, given that the effect on South African livelihoods is and will be disastrous. The relationship between health and economics is a complex, bi-directional one, which cannot be linearised for policy and sense-making. This relationship will bedevil government’s response as the epidemic grows in the country but has already been affecting the nation’s health for centuries.
The socio-economic determinants of health
It is a well-established fact that ill-health and poverty travel together. Compounding this, is the inverse-care law: the observation that those who require medical care are often those who cannot afford it.
South Africa, with its high levels of poverty, unemployment and inequality, has for these reasons historically under-performed in terms of return on investment for per capita expenditure on healthcare, which is relatively high, at approximately 8%. Of course, this expenditure is lopsided, with half of this expenditure being on less than a fifth of the population, which accesses healthcare in private facilities.
However visible and emotive this is for politicians and the public alike, differential access to healthcare is not the largest determinant of health status. This belongs to the more subversive and all-encompassing socio-economic determinants of health. These include where and how we live and work, our level of access to education, hygiene and sanitation, and the quality of our police, justice system and the responsiveness of our political system to these circumstances. The phenomenon of inequality, which although seemingly afflicts those who suffer in poverty, also inflicts negative externalities on societies that foster it.
Trajectory and response
An infectious disease such as COVID-19 is transmitted by air droplet spread and physical contact between persons. By doing so, it can infect, on average, 2-4 persons surrounding the index case. Adding poverty and inequality to the mix is akin to adding tinder to a woodland fire.
A typical application received by provincial health authorities assisting with isolation procedures, will detail the plight of a recently infected person. Upon hearing that they are infected, the patients are perplexed by health warnings to “self-isolate”, wearing a mask at all times, sleeping in a different bedroom from others, using a separate bathroom, toilet and sink, and cooking one’s own food.
These measures are impossible for a person sharing a single shack room and a communal outside tap and toilet with four other adults and three children. When considering these realities in South African communities, it is easy to understand why the disease is spreading like wildfire.
Of serious concern is the fact that the numbers of people currently testing positive would have been infected during the lockdown period. Healthcare facilities are being inundated with further COVID-19 cases already, and we have just started on what will be an exponential rise in cases, seemingly despite any further lockdown measures that will be attempted by government.
Having held off the onslaught for the small amount of time that we could, the country’s focus will now shift to triage and salvage. This will be done by increasing the number of beds available to those who become ill, and upskilling and protecting those healthcare and other essential workers who are likely to come into contact with symptomatic and asymptomatic persons.
However, once this ends, if indeed it ever does, we would do well in future to focus on the ultimate cure – a moral society that treats all with dignity and respect, and which cherishes equity between people.Republish