One of the most remarkable things about Monday night’s announcement by President Cyril Ramaphosa of a 21-day lockdown of South African society is that it came before anyone in South Africa had died of Covid-19. The country might now have more than 500 confirmed cases, but in a sense, the lockdown is a pre-emptive, or at least an early, strike against the virus.

Ramaphosa and Health Minister Dr Zweli Mkhize’s response to Covid-19 is the almost exact opposite of former President Thabo Mbeki and former Health Minister Manto Tshabalala-Msimang’s response to HIV.

With HIV, the South African government dragged its feet long after the science was crystal clear and even after the Constitutional Court ordered it in 2002 to make treatment available to pregnant women living with HIV. (The impact of AIDS denialism  is clear to see in these seven graphs on HIV in South Africa.)

Last night Ramaphosa announced a far-reaching lockdown on the basis of experiences in other countries, knowledge of the virus, its spread in South Africa so far, and mathematical models of how the epidemic might evolve in future. The decision to institute a lockdown is evidence of a government taking both scientific evidence and the need to save lives seriously and then taking carefully considered action. As we know all too well in South Africa, this kind of good sense in government cannot be taken for granted.

Put another way, we can be grateful that this crisis hit at a time when Ramaphosa and Mkhize are steering the ship.

Even so, that people are feeling anxious or uncertain at this time is to be expected. With the lockdown we have set a course into the unknown. It is hard to know what unintended social or political consequences the lockdown might have. In the places where our social fabric is already thinnest, it might start tearing in new ways. These are risks that Ramaphosa and other members of the National Coronavirus Command Council would have been well aware of.

This is in part what makes the announcement both brave and commendable. By not waiting until it might be too late, by taking incredibly hard decisions based on the available evidence, Ramaphosa and the National Coronavirus Command Council have shown clear and decisive leadership. Indefinite waiting and denial of the threat would have been so much easier.

One might wonder if the government needed a few more days to ramp up testing and tracing capacity and to prepare more thoroughly for a lockdown, but such a delay would have had to be weighed against new infections that would have occurred in those extra days. It is a difficult balance to find and whether or not the timing is right is hard to judge from the outside and with limited information.

Either way, that a lockdown would have had to come at some point seems clear from experience from China and other countries and from epidemiological models. A lockdown both slows the spread of the virus and gives us more time to prepare for the impact. And, as compellingly argued by Tomas Pueyo, hitting hard early with a lockdown and other measures, may win countries more flexibility down the line and in that way reduce the overall economic impact.

But none of this is absolutely certain. Ultimately, given the many, many unknowns, only time will tell whether instituting a lockdown now, or at all, was in fact the right thing to do. The best we can say for now is that it was a sensible decision based on what was known at the time.

Much more can and must of course be said and done in the coming days about the urgent need to scale up Covid-19 testing, about whether a 21-day lockdown will be long enough, about the need to ensure people have access to water and food, about measures taken to help people who suddenly can’t work or businesses that have to close. These and related issues require urgent attention and unprecedented coordination and efficiency in government, the private sector, and civil society. 

It also cannot be taken for granted that the National Coronavirus Command Council will continue to be guided by the scientific evidence and that they will make the right decisions going forward. We also can’t simply assume that the Covid-19 response in South Africa will be free of the kind of petty territorialism and political in-fighting that is often the sand in the gears of our public service.

Even so, it is worth pausing for a minute and to reflect that, unlike with the HIV epidemic 20 years ago, at least this time there are mostly calm and knowledgeable people in government making the decisions. This time the scientific experts are in the room and generally being listened to. This time there is no question of the state promoting unproven treatments such as garlic and beetroot. We have come a very, very long way. 

That at least is something to hold onto in this time of uncertainty. DM

Marcus Low is the editor of Spotlight. This article is produced by Spotlight – health journalism in the public interest.