Covid-19 cannot be stopped from spreading around the world. At least not unless a vaccine is found (which could take 12 months to develop), or the human body develops some kind of resistance to the virus. 

Either way, it could be at least another year before we can say that the virus has been stopped from spreading, that its worst effects have been rolled back, and that all cases have been eradicated. 

What we can say, with some confidence, is that many more people will get infected, and many will die. What we can do, while we deal with the current crisis, is start preparing for the next one.

We cannot rule out the possibility that there may well be another pandemic within the next 10-15 years. Recall that we had three pandemics in the 20th century: the 1918 pandemic (H1N1 virus), the 1957-1958 pandemic (H2N2 virus) and the 1968 pandemic (H3N2 virus). Already we have had two in the last 10 years: the 2009 H1N1 pandemic (H1N1pdm09 virus), and the Covid-19 pandemic, which started at the end of 2019.

The case for state intervention

We cannot be sure that this particular coronavirus, or anything similar will not emerge and spread again within a generation. What we can do now, is regulate, and for the state, in collaboration with the private sector, to invest, heavily, in infrastructure, by which is meant intellectual, human and physical capacities – especially in research and development, plugging into global knowledge and information networks, and upgrading technology. 

Forget the free market fundamentalists. Forget the libertarians. Evidence from South Korea shows that active state intervention, in collaboration with the private sector has stalled the spread of the virus. Compare this with the USA where they would rather a section of the population died off to “save the economy” – and get back to business.

The market, such as it is, seeks early (quick) returns. People with money want to make more money – quickly. Investing in health, education, infrastructure or community safety do not bring immediate (financial) returns. These are essentially public goods.

Where then, do we start? My immediate instinct is to start at the frontline. Invest in getting more people into nursing. Let’s get to the data. As things stand (based on data approved by the British Medical Bulletin last year), nurses make up half the global workforce. In 2014 there was a nine million shortage of nurses (globally), with predictions of up to a two million decrease by 2030. Africa will be the worst hit, for a range of reasons.

Let me start with a couple of anecdotes. 

I read the research results more than a decade ago, but can’t find the actual data. There were more nurses in Zambia before the World Bank arrived, than there were after structural adjustment. As mentioned, that’s just anecdotal. It may come as a surprise to some people, but one survey that was done also about a decade ago showed that nurses don’t always leave their jobs because they want more money. In very many cases they leave because they don’t have basic necessities like cotton swabs, bandages or protective gear. In other words, they just want to do their jobs with pride, professionalism and excellence.

In a study by the Pan African Medical Journal, it was confirmed in 2017 that medical equipment is an essential health intervention tool used by nurses for prevention, diagnosis and treatment of disease and for rehabilitation of patients. But this is a major challenge in low- and middle-income countries. The World Health Organisation estimated at the time that 50-80% of medical equipment in most developing countries is not working, which creates a barrier to the ability of the health system to deliver health services to patients. 

In short, critical shortages of medical equipment at hospitals across Africa were in the unavailability of equipment, and low quality and poor maintenance of the little that was available. This severely (and negatively) impacted nursing care, the nursing profession in general and the hospitals across the continent.

Train and keep more nurses employed and resourced

The shortage of nurses exacerbates this problem. At the moment, in the face of Covid-19, we face a nursing shortage in South Africa that will lead to the deaths of very many people. The state has been preparing for a new generation of nurses to emerge since 2011, when seven priorities were identified: nursing education and training; resources in nursing; professional ethos and ethics; governance, leadership, legislation and policy; positive practice environments; compensation, benefits and conditions of employment; and nursing human resources for health. So, we should have been better prepared. A decade ago, a group of researchers found that South Africa was in a crisis with the serious shortage of nurses, which had to be addressed if we were to prevent a meltdown in services. We are, now, in such a crisis.

What we need is direct state intervention in education. And, above all, we need to assure that we pass nursing students on the basis of their high grades, and not because we feel sorry for them.

People joke about “30 percenters,” but, as the old adage goes, many a true word is spoken in jest. Anyway, after they graduate, nurses will be working with human lives. And so, we need the state, in collaboration with the private sector (both of which must be held accountable, with transparency and close ethical scrutiny), to set standards, to produce data on specific in-country requirements, with evidence-informed policy, and resource allocation at national, subnational and organisation levels.

Second, we need to stop the attrition of health workers. Very many nurses are leaving Africa for better working conditions in Europe, North America and Asia, where ageing populations require care. Nurses (and doctors for that matter) also emigrate because of “contextual factors” like the World Bank’s Structural Adjustment Programme, public service reform programmes that reduce service delivery to bunk, or what passes for health reform, and because of high levels of HIV/AIDS, TB and malaria infections. Some also leave because they oppose affirmative action.

In sum, we need very many nurses that are better trained, and when they enter the profession they need to be paid well – forget what “the market” or the World Bank says – they need to be sure that they have equipment, and that the medical fraternity can benefit from the sharing of technology, knowledge, information and better education. This issue of education cannot be skirted over. We have seen how students in the wealthiest country in the world ignored warnings about Covid-19 and continued to enjoy their spring break from university, and caused infections among themselves, and when they got back home.

Africa is relatively unaffected, for now

While the novel coronavirus is a very clear and present danger to millions of South Africans, healthcare across the continent is shocking. Malawi, one colleague reminded me, has about 25 ICU beds for a population of 17 million people. Across South East Asia there are an estimated 2.8 critical care beds per 100,000 people on average. Bangladesh has an estimated 1,100 such beds for a population of over 157 million – about 0.7 critical care beds for every 100,000 people. 

The lack of knowledge and information is devastating. One 2015 research paper estimated that more than 50% of low-income countries lacked available data on ICU infrastructure. Without such information, it is difficult to imagine how these countries could possibly plan to meet the inevitable demand for critical care arising from Covid-19.

While there is some praise to be had over the G20 meeting addressing the Covid-19 pandemic as a global crisis, it is shameful that the World Bank saw, in the crisis, an opportunity for private capital. At last week’s G20 meeting, World Bank President David Malpass  said:

“Countries will need to implement structural reforms to help shorten the time to recovery and create confidence that the recovery can be strong.  For those countries that have excessive regulations, subsidies, licensing regimes, trade protection or litigiousness as obstacles, we will work with them to foster markets, choice and faster growth prospects during the recovery.”

In short, according to Malpass, the crisis is big, but we have to turn to “markets”, “choice” and “faster growth”. I understand the growth part, we need to generate the financial resources to invest in solving the problem, but we cannot leave it up to the market alone, and believe that everyone, from the woman in Houghton or Bishop’s Court, has the same “choice” as the woman in Khayelitsha, Diepsloot or Cofimvaba. 

The state, in collaboration with the private sector, should start preparing for the next crisis – with the knowledge we acquire, and the lessons we learn from the current Covid-19 virus. DM