The coronavirus is with us – for better or worse, richer or poorer, till death do us part. The response has been predictable across the board: batten down the hatches as the spiked corona balls rail down on the ship’s deck and as the beleaguered vessel limps into port and the voice from Monty Python’s Life of Brian is heard above the creaking wheels of the wagon – “bring out yer dead”.
The captains of the ships, be they Boris from the infirmary, Cyril from the Command Council, Angela from the Bismarck battleship or Xi Jinping from the paddle steamers of the Yangtze, are all singing from the same hymn sheet with the Psalm Singers of the ship’s choir: keep your distance, stay inside, half rations all, and prayer in the absence of communion.
Only the longships of the Vikings of Sweden appear to have broken ranks. Their larder grows as the Viking boats drag across long portages, withstand fierce ocean storms, continue to trade, make war, carry animals, and cross open oceans while attempting to provide protection for the crew.
The jury is out as to whether Boris, Cyril & Co or the lone Swedes will emerge least scathed from this modern-day Battle of Jutland. Many see the parameters of victory as being defined by short-term containment or long-term preservation of the economic engine, but the battle is not binary and the wisest course of action is to secure lives, attack the virus and preserve and defend the economy by understanding the risk of spread and plotting it against the opening up of the economy.
The most sensible course of action appears to involve a phased approach to opening the lockdown. In parallel, we need to test to find out how many people are positive, but, crucially, how many of these people do not show any symptoms.
According to a breakdown of confirmed coronavirus cases by age, published by the Health Ministry of Israel and by The Times of Israel, almost a third of children under the age of nine infected with the coronavirus are asymptomatic carriers of the disease, or so-called “silent spreaders.” This is a significant indicator and it should exercise minds everywhere.
Our fortuitous closing of schools between 15 and 18 March and the partial lockdown and closure of airports and ports seems to have been responsible for the flattening of the curve as of 28 March. The data suggests that since then the lockdown has had no real effect, allowing for an incubation period of approximately 10 days. Our daily rate has not decreased further: shouldn’t we be seeing an impact of the lockdown approximately 10 days later?
On the basis of an aspirational assumption that SA will not exceed a 3.5% ICU-rate required for treatment of acute Covid-19 cases and assuming a low ICU-rate, 60,000 active cases can be tolerated. On the other hand and on the basis of a working assumption that SA will have a 10% ICU-rate, we cannot exceed 20,000 active cases in order to cope in our health sector’s capacity.
In order to get a handle on the epidemic, the government should provide, on a daily basis, information about the number of tests conducted by type of test, type of patient and stage of patient, broken down by province. We must understand the antibodies, the symptoms or lack thereof, whether patients are new or have never been tested and if tested, whether they were negative or positive.
We need to understand positive cases, negative cases, those still in progress and which results were faulty. We need a handle on how many new positive cases we have, the total positive cases, new deaths, total deaths, new recoveries and total recoveries.
Importantly, the number of patients, the hospital beds used by Covid-19 patients and the results of continuous random testing for Covid-19 and symptoms stratified by age, gender, urban/rural, race, LSM, education level, employment status and income level must be tabulated and made available.
In the absence of this we have no plan that will guide us to the recovery of afflicted people and the economy; and if we do, it is locked up in a black box in the Command Council and drip-fed to the nation on a need-to-know basis. This is not good enough. We are a democracy and plans and actions require interrogation and oversight by the opposition and experts.
Accountability and transparency run like a golden thread through our Constitution. The government in all three spheres must be held accountable by the opposition, otherwise it’s simply a case of “trust me, I’m a doctor”. Oversight and interrogation of plans and actions must cover health measures, economic restitution and recovery initiatives as well as infringements on the rights of citizens.
To return to the naval metaphor, in the words of Mark Twain, “Twenty years from now, you will be more disappointed by the things you didn’t do than those you did. So throw off the bowlines. Sail away from safe harbour. Catch the wind in your sails. Explore. Dream. Discover.”
At the same time, it would be wise to note the words of GW Curtis: “It is not the ship so much as the skilful sailing that assures the prosperous voyage.”
There is a strategy to be formulated and all strategy hinges on choices being made. To make sound choices, to avoid the icebergs and navigate the tides we need information, analysis and timely action. That’s how we beat this pandemic – all hands on deck. DM