Zweli Mkhize: Just one week of alcohol ban will see 3,400 fewer hospital traumas
SA health minister on the rationale behind the booze ban
President Cyril Ramaphosa on Sunday announced that a nationwide ban on the sale and distribution of alcohol would take effect immediately.
The decision has been met with mixed reaction from various sectors. Some have argued that this further imposes on their individual liberties while others have lauded the move as an important measure to alleviate pressure on our health-care system and curb the rate of gender-based violence in our communities.
For one to understand the decision, it is vital to assess the evidence of the social impact alcohol has in the South African context.
According to the World Health Organisation’s (WHO) Global Status Report on Alcohol and Health published in 2018, about a third of South Africans 15 years and older are current drinkers (have consumed alcohol in the past 12 months), and almost 60% of those engage in binge drinking.
Research has also shown that 83.6% of households reporting violence recounted alcohol intoxication by the perpetrator. Studies linking alcohol consumption and intimate partner violence have found that 45% of men were drinking while perpetrating these acts.
Despite the aggravating influence alcohol poses within these scenarios, they were not the main causal factors in government’s decision to reinstate the liquor ban.
During this time of Covid-19, when every bed, every health-care worker, and every ounce of oxygen is needed, it would be unforgivable to identify a clear burden on the health-care system – such as alcohol – and do nothing about it.
During the hard lockdown earlier this year, when the sale of liquor was initially banned, there was a 60% to 70% reduction in hospital visits and admissions related to trauma.
On the weekend of March 21, for example, there was a 25%-50% drop in transport emergencies dealt with by ER24’s contact centre, a drop in assaults and stabbings recorded by Rescue786 Ambulance Services, and a decline in surgical and medical emergency cases at Johannesburg’s Chris Hani Baragwanath Hospital.
Such patients place a strain on medical facilities for extended periods, facilities that are now essential for the treatment of Covid-19 cases.
For example, 2% of stab-related cases and 25% of blunt force trauma cases (both commonly associated with alcohol abuse) require admission into ICU for a number of days. By preventing thousands of such cases entering hospitals, critical staff, medicine, funds, equipment and beds can be saved for Covid-19 patients.
To further highlight the importance of the ban, one also needs to consider what happens once the ban is lifted and alcohol sales continue, even with restrictions.
When SA moved to lockdown level 3 on June 1, allowing the sale of alcohol except for on-site consumption, there was a noticeable surge in trauma-related hospital admissions. Facilities reported up to a 60% increase in trauma emergency centre admissions and up to a 200% increase in ICU trauma admissions.
Gauteng had an 80% increase in trauma cases; Eastern Cape reported 94 murders and 77 rape cases in the first week of lockdown level 3; and according to data collected from five hospitals in the Western Cape, 90 people were admitted in each of the hospitals per day since alcohol restrictions were lifted.
The majority of trauma patients who will block much-needed beds during the Covid-19 surge are aged between 20 and 39, yet this age group hardly needs hospitalisation for natural sickness. Even Covid-19 tends to present as a mild disease treatable from home in this age group.
At a crucial point in SA’s fight against Covid-19, when our social behaviour needs to urgently change, it has been shown that alcohol abuse can reduce one’s adherence to non-pharmacological methods of reducing the transmission of Covid-19, such as social distancing, hand sanitation and the use of masks in public.
The question then remains as to what we expect the liquor ban to achieve, tangibly.
Models predict the reintroduction of the ban could result in a 20% reduction of all trauma cases and a 40% reduction of all alcohol-related trauma by the third week of restrictions.
This translates to 3,400 alcohol-related trauma cases across secondary and tertiary public hospitals in the first week alone, and approximately 6,800 similar cases by the end of the third week.
This is likely to have a substantial impact on reducing the burden on staff in trauma units, the demand for inpatient beds, ICU facilities and ventilation capacity.
Alcohol cannot remain a social lubricant at a time when distance from one another can save lives. It cannot be a contributor to gender-based violence and intimate partner violence when we are supposed to be safest from Covid-19 in our homes, and it cannot lead to violence when the only fight we should be having is against the coronavirus.