On the evening of Sunday, 15 March 2020, President Cyril Ramaphosa addressed South Africans about the coronavirus (Covid-19). He must be commended for issuing decisive directives to citizens and highlighting the need for social distancing, but there are gaps which urgently need to be addressed by a follow-up awareness campaign.
The campaign is needed to communicate “why” social distancing is imperative to combat this highly contagious pandemic. South Africa is unique compared to many parts of the world, including parts of Africa, and adopting a rubber-stamp approach in dealing with this situation will create blind spots that must be avoided.
A pandemic is the worst-case scenario for public health. Ramaphosa stressed that Covid-19 is indeed exceptional and that South Africa has never been confronted with such a severe situation.
In South Africa, the number of infections continues to increase rapidly. Data from other countries indicates that 10% to 20% of infected people could end up being seriously affected by the virus: this could consequently require hospitalisation, which could potentially overburden an already limited (both in staff and resources), healthcare system. In the US, identified cases doubled over an average of two days due to the slow start to testing and the lax pace of isolating those with the virus. Covid-19 is unique because it spreads rapidly and has the potential for substantial community transmission in what can be described as an “excess of normal expectancy”.
While Ramaphosa declared the pandemic a national disaster, announced travel bans, closed ports of entry and highlighted the dangers of local transmission, it is the social distancing campaign aspect that is key. This is the one way to stop and to slow the spread of infectious diseases through less physical contact with others.
Covid-19 is primarily spread via respiratory droplets and close contact with another person, but this does not explain all cases. It is also more commonly spread through close contact with a person who coughs or sneezes or by touching objects obtained from an infected person and subsequently touching one’s face. However, asymptomatic carrier transmission has also been reported for Covid-19. This means that one can be both a carrier, and spread the virus, without showing any clinical symptoms. Therefore, minimising contact between people is the best measure to take to stop the spread of the virus to the vulnerable. It is an uncomfortable strategy, but it is necessary to mitigate the pandemic’s spread.
The closing of schools, and now universities is a key measure, and Ramaphosa also announced a ban on mass gatherings with more than 100 people. While he categorically stated that, “where small gatherings are unavoidable…”, people still think that gatherings with 99 people should be fine and hence there is confusion. More worryingly is that some people believe that because their sports teams, gym facilities and churches have fewer than 100 people, they are safe.
This indicates that more work needs to be done to raise awareness about the virus, especially to mitigate the risk of exposing rural areas and informal settlements. Social distancing may not be a possible solution for those subject to informal settlement housing who remain impoverished and overcrowded without proper sanitation and running water. Rigorously and aggressively interrupting transmission chains is key at this stage to avoid a peak in the pandemic.
Not only is South Africa classified as the country with the highest number of people in the world living with the HIV epidemic, with 7.97-million as of 2019, 19.07% of those infected are aged between 15-49 years. In 2018, UNAids declared that only 62% of infected people are on HIV treatment in South Africa – those who are not taking treatment and those who are positive, but are unaware they are at a higher risk of infection.
The country also faces a high burden of tuberculosis. These numbers indicate that South Africans of reproductive and working-age are vulnerable – challenging the global norm that it is the elderly who are most vulnerable to Covid-19. To further strain this population with exposure to Covid-19 by failing to implement mass social distancing would be an injustice to the future of South Africa. Moreover, it indicates that the number of vulnerable people in the country include both the youth and the elderly – a special characteristic of the South African context – and this can potentially overburden the health system’s capacity.
Though evidence from China also suggests that early containment is necessary to avoid the increased spread of the epidemic, adopting a blueprint imported from another country will not work in South Africa. This will only expose the limitations of social distancing if one considers the inequities in the healthcare system. Therefore, beyond universal temperature monitoring and the promotion of frequent handwashing, there is a further need for provincial and community level reach for early detection and response. It will require well-coordinated inter-departmental efforts from the government in cooperation with the private sector.
Key departments are Human Settlements; Water and Sanitation; Health; Transport; Economic development; Cooperative Governance and Traditional Affairs; Tourism; Education and the Presidency. The Department of International Relations and Cooperation will also have to play a key role in reaching out to international allies such as the European Union for resources to combat the pandemic, and Germany’s leadership was demonstrated in this regard when it announced a R2.5-million donation to the South African government on 14 March 2020.
To increase social cohesion regarding the social distancing narrative, the private sector can play its role by allowing employees to work from home (especially since schools will be closed), decreasing data prices, and providing healthcare as well as sustenance packages for the vulnerable. It may also be necessary to negotiate the regulation of key household items in their quantity and price soon.
It is important to support the most vulnerable populations and communities because they will be disproportionately affected by the virus if it is not contained. Ramaphosa indicated that quarantine sites are being identified in each metro and district, and that hospital capacity and tracing processes will be bolstered. In addition, designated community-level quarantine sites may be necessary and the government must react decisively about its intention to quarantine people according to exposure levels. This will also require a level of unity, vigilance and selflessness at an individual level in practising containment and social distancing.
Self-imposed reporting and testing, given the possibility of exposure, will be necessary to protect the vulnerable. This is especially necessary in cases where people could be asymptomatic.
The nationwide campaign announced by the president should be a priority for the newly established National Command Council and the inter-ministerial committee led by Minister of Health, Zweli Mkhize. This is critical – we need to ensure that South Africans understand the nuances of how the virus spreads and why social distancing is imperative to avert higher crisis levels.
And essentially, the campaign should unwaveringly reflect the South African context. The government is justified in not driving narratives of panic, however, it should be made clear that promoting nuances specific to South Africa is not inciting panic. DM