I am glad that the South African Social Security agency, Sassa, has made extra provisions to pay existing grant beneficiaries under the lockdown. But what about the many who, because of bad luck or bad timing, will be left in the lurch?

Since last week, Sassa has closed its doors to new temporary disability applications, as well as to applications for renewal of prior disability grants that have lapsed. We do not know when the offices will reopen for people seeking to apply for grants.

I am an HIV/TB doctor on the Cape Flats. Every day I see an increasing number of anxious patients asking if they will be able to renew temporary disability grants that have come to an end. Some of these patients had dates for disability exams that have now come and gone. Others were sent letters stating that their disability grants had expired and they had planned to reapply.

Many serious medical conditions do not qualify for permanent disability grants because they have the potential to improve with good treatment. However, my patient with a CD4 cell count of 20 and chronic headaches from prior cryptococcal meningitis legitimately cannot work and will starve without assistance. The same goes for a current tuberculosis patient who was re-hospitalised with a necrotising lung abscess and is too short of breath to go back to work. These patients were on the brink before the lockdown and certainly cannot wait for assistance.

The president has promised a Solidarity Fund to assist vulnerable South Africans, but none of my patients has any idea how to access that assistance. Moreover, these same patients are still coming to the hospital and require attention at a moment when doctors’ and nurses’ time is at a premium and when we want to keep vulnerable patients away from those who are sick.

Sassa could easily help people with temporary medical disabilities now.

First, it could automatically extend all temporary medical disability grants for another six months to avoid assistance lapsing during the height of the pandemic. There is an added advantage here. We do not want to flood hospitals with people seeking the renewal of their grants just as the Covid-19 surge hits.

Second, it should automatically reinstate a six-month temporary disability grant for any South African whose disability grant recently lapsed. This will assist people who qualified to re-apply but are now unable to do so due to the lockdown.

Finally, Sassa should allow doctors to complete disability evaluations on severe patients whose conditions are new and where the assistance is essential to survival. Grant paperwork could be emailed to select emergency Sassa representatives for processing without patients having to go to the offices in person.

Primary healthcare centres across South Africa are busy cancelling non-essential outpatient services to clear outwards in anticipation of a surge of Covid-19 patients in the coming four to eight weeks. One of the ways to keep those who are extremely vulnerable away from already stressed hospitals is to ensure that their basic needs are met.

Sassa needs to do its part to help the South African medical system focus its energy on acutely ill patients, while simultaneously not sending our pre-existing vulnerable patients into starvation. DM

Andrea Mendelsohn is an American family physician. She received her medical and public health degree from Tufts University School of Medicine in Boston. She has worked in primary healthcare and public health in underserved communities in the US, Ethiopia, India, Ghana and South Africa. She has been working as a senior medical officer in an HIV/TB primary healthcare clinic in Cape Town since 2017.