President Cyril Ramaphosa declared a National State of Disaster which in terms of the National Disaster Management Act enables the government to institute a range of measures that can include limiting some constitutionally enshrined rights.

Among these measures are closing schools from Wednesday this week until the Easter weekend and instituting travel bans to and from high-risk countries, cancelling large-scale events like the upcoming Human Rights Day celebrations on 21 March and prohibiting meetings and any gathering of more than 100 people.

 Measures widely praised

Professor Shaheen Mehtar, an infectious disease specialist affiliated with Stellenbosch University, told Spotlight that Ramaphosa’s announcement were “the best measures one can take”.

Mehta said that it’s clear these measures were not taken lightly. 

“Consider that the first 51 or so cases had contact with European travel, however, we were satisfied that local transmission had not occurred. Now that local transmission has occurred, it is time to close physical links with high-risk countries, albeit for a short time. So, it is most timely.”

Another public health expert, Professor Harsha Somaroo of Wits University, called Ramaphosa’s intervention “well-considered and appropriate for the moment”.

According to Somaroo the prospect for local transmission is concerning. 

“I think we likely still have a window of opportunity but need to work aggressively to prevent transmission,” she said.

Test, test, test

The World Health Organisation this week urged countries to scale-up testing. The message was clear – “test, test, test”.

In South Africa the National Institute for Communicable Diseases (NICD) and private laboratories by 16 March reported 2,405 tests having been conducted in the country.

The NICD, in a notice on its website, said that in an effort to expand and streamline testing of Covid-19, the institute has decided that doctors no longer need approval from NICD to test for the virus but should still communicate with their local laboratory experts, in the private or public sector, to help streamline the taking of specimens and laboratory testing.

Health Minister Zweli Mkhize this week confirmed testing has increased and private and public laboratories are working together with NICD to ensure reliable data. Mkhize also announced that some PEPFAR funding aimed at HIV programmes, will be redirected to Covid-19 testing.

When Spotlight asked Mehta if South Africa is testing too few, she said she does not agree. 

“What is the point of testing at great cost when this is extended beyond contacts and high risk? We have limited resources so we should use them efficiently, otherwise we will land up like Europe and the USA who are very short of testing kits,” she said. 

“Testing must have a purpose and an outcome to be cost-effective.”

Politics aside

In the wake of Ramaphosa’s announcement, some politicians agreed to “put politics aside” and welcomed the intervention. DA leader John Steenhuisen in a statement said his party welcomes Ramaphosa’s “drastic contingency measures to inhibit the spread of the virus and ensure the safety of each and every South African”.

“Now, more than ever, we must put politics aside if we are going to succeed in the fight against Covid-19,” he said.

The IFP, in a statement, praised Ramaphosa’s “decisive action to safeguard South Africans”. 

“The extraordinary measures are an indication of the seriousness in which all South Africans should take in curbing the spread of the coronavirus.”

The EFF, however, slammed the government for its slow response and hinted that the travel bans in place are not effective enough. The party, in a statement, also said: 

“We have not heard a coherent plan as to how public healthcare facilities will engage those who come forth with symptoms and whether health professionals have been briefed on how to engage with the multitudes of people within higher education.”

According to Russel Rensburg, director of the Rural Health Advocacy Project, more transparency is needed about contingency plans should there be greater community transmissions. 

“But for now, the government needs to engage with all stakeholders on contingency plans should we move from containment to community transmission,” he said.

More praise

Healthcare professionals also welcomed Ramaphosa’s intervention. The South African Medical Association (Sama), in a statement, gave its support to the measures announced by Ramaphosa to contain the spread of Covid-19 and says it supports “appropriate and evidence-based measures to deal with the spread of the virus”.

Sama chairperson Dr Angelique Coetzee, in the statement, said: “Mitigation strategies are proving key in addressing the spread of the virus in many countries throughout the world, and appropriate steps such as those announced by the president will, we believe, have a similar impact locally in mitigating the spread of infection.”

The nursing union Denosa also threw their weight behind Ramaphosa’s plan. The union urged the government to provide healthcare workers with sufficient personal protective equipment. In a statement, it also called on nurses to report facilities that do not have protective clothing as this poses a threat to both health workers and patients.

“This is an area that health workers cannot compromise on, especially as health workers in China have been lost to Covid-19,” the Denosa statement read.

Civil society responses

Dr Louis Reynolds, a member of the People’s Health Movement in South Africa (PHM-SA), said the measures are “sensible”. 

“They are far-reaching but not excessive. Reynolds also hit back at those claiming Ramaphosa’s intervention is too late. 

“The timing does not seem too late,” he said. “In such situations, it is important to find the balance between freedoms and responsibilities, and in theory the steps should be appropriate for where this balance lies at a particular time. Given the circumstances, this seems to be an appropriate balance for now.”

The head of health at SECTION27, Sasha Stevenson, told Spotlight they welcome the strong leadership of both Ramaphosa and Mkhize in the response to Covid-19. Noting the measures taken under the Disaster Management Act, Stevenson said such measures will entail the limitation of some rights including the freedom of movement. 

“While the Constitution allows for the limitation of rights, we must be careful always to ensure such limitation does not extend beyond what is strictly necessary. Ensuring this will be a matter of careful monitoring and vigilance both by government and civil society,” she said.

Justice Minister Ronald Lamola during the press briefing said stringent measures are put in place under the act and “whatever the law permits us to do, we are going to do”. 

Lamola said if the law does not provide for what is needed to be done to curb the pandemic, new laws will be created or the State of Emergency will have to be declared. He, however, stressed that South Africa is not there yet.

Some concerns

During the same press briefing to unpack the president’s announcement, Minister of Basic Education Angie Motshekga said schools will be closed until the Easter weekend, which means the school year will probably have to be extended. The closure of schools raised concerns about some children losing out on their only meal of the day because they depend on the school feeding programme. Rensburg told Spotlight the closure of schools seems “sensible” but more information is needed on how the impact on the poor will be mitigated, especially for those who rely on school feeding schemes.

During the press briefing, Minister of Social Development Lindiwe Zulu announced some measures her department will institute to ease the load on poorer citizens.

“Our efforts will be directed at ensuring that we protect the most vulnerable who will continue to require our services at this difficult time,” she said. Zulu later, in a statement, said there is no doubt that the spread of Covid-19 will exacerbate the vulnerability of poor households and that it is likely to increase the demand for social services in the form of social grants, Social Relief of Distress, food relief and psychosocial services for affected individuals and families. 

Some of the immediate intervention measures the department will take include using R96-million from the Disaster Management Fund to provide immediate assistance to affected individuals and families. Zulu said psycho-social support services will also be provided. 

The money

Finance Minister Tito Mboweni said the government’s efforts will be financed through the Disaster Manager Fund. Although he did not want to commit to amounts, he said the funds will be available immediately. Mboweni also did not rule out the possibility that funds already allocated to some programmes will have to be shifted to make sure testing facilities are adequately resourced.

Rensburg said the national disaster declaration “is a big unknown”. 

“How will it be coordinated, how will disaster funds be allocated particularly in terms of equity and effectiveness?” he asked. 

“And what level of transparency can we expect to ensure that funding is not abused?” 

Social solidarity

Many stakeholders – from government to civil society and the health worker community agree that for these measures to have the intended impact, everyone, including the public must come to the party. Many, especially in government made the call for active citizenship.

Mehta told Spotlight she has great faith in the system as long as the public plays its part as well.

Coetzee, speaking for members of Sama said the organisation understands that “imposing community lockdowns, limiting public gatherings to 100 people, and closing schools are drastic steps which have the potential to damage the country’s already fragile economy”. 

“These measures should not be taken lightly. However, we have seen that several other countries which developed heavy caseloads have implemented drastic mitigation strategies,” she said in a statement. “These have depended on strong community responses, led by clear government directives.”

 Reynolds told Spotlight the success of these interventions depends on the extent “we come together as a nation, and this in turn depends on to what extent the president and his government inspire trust and social solidarity”.

Reynolds said it is now crucial that politicians and political parties “drop tit-for-tat politics and act and speak in non-sectarian language”. “Furthermore,” he said, “we need active citizenship — everyone has a role to play and this starts with community mobilisation.”

Ramaphosa, during his announcement on Sunday, called it South Africa’s definitive Thuma Mina-moment. 

“While we are battling a contagious virus, perhaps the greatest dangers to our country at this time are fear and ignorance,” Ramaphosa said.

“Although we may be limiting physical contact, this epidemic has the potential to bring us closer together. We are responding as a united nation to a common threat.”

Mkhize, in his address, made it clear South Africa, like the rest of the world, is in for the fight of its life. He used a war analogy and said this is a time for “hard combat” where every South African should turn themselves into a  soldier. Each one of us can cause our own mini-outbreak, he warned.

Public-private collaboration

Social solidarity does not just mean active citizenship on the part of members of the public but also a closer collaboration between the public and private health sector. According to Reynolds, should Covid-19 escalate it may overwhelm the health system. Reynolds echoed some concerns already in the public domain. 

“It is very likely that there will not be enough hospital and ICU beds for everyone who needs them. If that happens, some people will not find an ICU bed. Will some people have easier access than others? How will we decide who gets the bed?”

Mkhize this week said the public health sector has a general bed capacity of 87,309 beds of which 813 are ICU beds. In the private health sector, bed capacity totals 2,146 beds of which 161 are ICU beds. (The department is now verifying these numbers after it was presented with new figures.) The minister said at this stage just a small percentage of beds have been used as many people don’t need beds yet.

But Professor Alex van den Heever, chair in the field of Social Security Systems Administration  and Management Studies at Wits, in a recent article set the number much higher. He estimates there are about 7,195 critical care beds in total (2,238 in the public sector and 4,957 in private sector) but he writes “it is important to understand [they are]… not necessarily available”.

“Assuming 80% occupancy in the public sector and 50% occupancy in the private sector we only have 448 public sector and 2,479 private sector CC beds available. This means a total of 2,926 nationwide. His figures are based on the national health department’s own figures of 2013. 

Reynolds said this pandemic shows us “the weakness of our fragmented and inequitable health system”. 

“We have extensive resources for healthcare, but we have failed to bring them together around the common goal of health for all.” He said neither Ramaphosa or Mkhize gave a clear idea of what the private sector contribution towards dealing with the Covid-19 outbreak will be. 

“Civil society must monitor this and ensure that the epidemic is not exploited to make profits.”

According to Rensburg, there is a fair amount of capacity within the public and particularly the private sector. 

“The problem is whether the capacity will be availed  towards public interest rather than profiteering.”

The minister this week said discussions are underway with the private sector on sharing services should the need arise. MC

 *Note: SECTION27 is mentioned in this article. While Spotlight is published by SECTION27 and the Treatment Action Campaign, Spotlight is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

This article was produced by Spotlight – health journalism in the public interest.