Did SA get it right when tackling the coronavirus pandemic?
As the country prepares for a possible second surge and marks 200 days since the first positive test for Covid-19, medical, economic and scientific experts weigh in on failures and triumphs
SECURITY FORCE ABUSES
Professor Salim Abdool Karim
The ministerial advisory committee chair said he was “deeply disappointed” at the behaviour of security forces tasked with protecting South Africans and enforcing the lockdown.
But he felt buoyed by the government’s response to the challenge.
“We had political authority that quickly understood the challenge, the importance and the magnitude of the threat, and were deeply committed to fixing it.
“They were not afraid to take difficult decisions … with minimum information we had at the time.”
Karim said the health-care service was able to cope, with the exception of the Eastern Cape, which struggled for a short while.
He said teams are now hard at work preparing for a second surge.
“Now the whole thing is about to identify, when we start seeing the first signs of a second surge, how to respond, what capacity is needed, what new strategies we are putting into place. We have no idea when it is likely to happen.”
After early challenges, “now we are doing really well, our mortality rate is quite low because doctors know how to treat these patients”, he said. — Suthentira Govender
A STRONG RESPONSE
Dr Shakira Choonara
The independent public health practitioner said the government showed it values the health of the nation by its “strong response from the get-go”.
“Instituting lockdown in the early stages was necessary to understand the virus, curb transmission and set behavioural norms.
“We also saw the nation stand together in terms of many community initiatives, civil society coming together through the CP19 coalition. The private sector also contributed to cushioning the blow.”
But Choonara said it came as no surprise that even in a pandemic “we were still exposed to corruption”.
“Relief funds did not reach our health system. From the onset there were PPE [personal protective equipment] shortages, with many frontline workers resorting to buying their own PPE.
“A paper-based [Unemployment Insurance Fund] system meant allocated funds would be out of reach for beneficiaries.”
Choonara said Covid-19 has brought to the fore the urgent need to build a strong health system. — Suthentira Govender
COLLABORATION WAS KEY
Dr Angelique Coetzee
There were a lot of positives to take away from how SA had dealt with the pandemic, said Coetzee, who is head of the South African Medical Association.
“A positive was around the removal of certain competition regulations allowing different health-care groups to speak to each other and share critical life-saving information.
“Collaboration across the health-care industry proved crucial for saving lives.”
SA learnt from other countries, she said.
“The time Covid-19 took to arrive in SA gave a crucial window. We were able to see from other countries what treatments worked and what didn’t.”
A big negative was how the advice from the ministerial advisory committee, while accepted by the health minister, was often ignored by other departments — as could be seen through the type of regulations issued.
Coetzee said the national health department engaged with private health care but, other than in the Western Cape, very few provincial health departments followed suit. — Graeme Hosken
Professor Glenda Gray
The CEO of the South African Medical Research Council said facets of the health response to the pandemic — like mass testing — had been impeded by global factors beyond local control.
The controversial booze ban had borne fruit, she said, and the transparency and candour of the health department brought South Africans onside.
Certain lockdown regulations had “no merit impacting on transmission and were thus hard to explain”. — Jeff Wicks
A MAJOR LACK OF SUCCESS
“At the moment we are bringing down infections far more successfully than other countries but … with the world’s 25th largest population, we are ranked eighth in terms of infections and 13th when it comes to deaths,” said the economist.
“This suggests a major lack of success with the virus having spread far more readily than in other countries.”
The lockdown had been “ridiculously excessive” and “far too destructive for overall economic activity”. — Graeme Hosken
JOBLESSNESS HIT HARD
Dr Paula Armstrong
“The question is whether it was necessary to prolong various restrictions for as long as we did. In addition, the evidence of corruption that is emerging is heart-breaking,” said Armstrong, an economist.
She said joblessness will be one of SA’s biggest challenges.
“Unemployment surged during the early stages of lockdown … early observations estimate that 3-million people became unemployed between February and April of 2020.” — Suthentira Govender
Professor Martin Veller
“The biggest challenge was preparedness,” said Veller, the dean of the faculty of health sciences at Wits University. “Globally not many countries were prepared.”
He said: “The initial decision, which was incredibly brave, to shut down SA — which ended up saving the lives of thousands of people — shows how absolutely essential leadership is in dealing with a pandemic.”
The pandemic “has shown that we need to invest heavily in our pharmaceutical production capacity”. — Graeme Hosken
BETTER AT TREATMENT
Professor Marc Mendelson
The University of Cape Town infectious diseases expert said the way patients with severe disease were treated in hospitals has changed.
“We have learnt a lot about optimising oxygen delivery in hospitals for those needing support,” he said.
A breakthrough had been the UK recovery trial which “taught us that patients requiring oxygen support in hospital have reduced mortality if given a daily dose of steroid”.
Compared to the onset of the pandemic, if you are admitted to hospital now “you may well be offered to participate in such a trial of new treatments”.
The biggest lesson, said Mendelson, is the “critical importance” of well-conducted trials that produce verifiable results.
Small studies had been used to tout treatments that were “of no benefit from a public health perspective”.
Also, “we have relearnt the central role of infection prevention in our communities and hospitals”, and learnt that we have to step up our work on pandemic preparedness. — Tanya Farber
CRUCIAL ADVICE IGNORED
Alex van den Heever
The Wits University health economist slammed the government’s approach to the pandemic. “The processes in dealing with the pandemic were dismal,” he said.
“Crucial advice from the ministerial advisory committee was ignored. The country lost billions of rands in taxes through prohibition of tobacco and alcohol products.
“We were told the bans were to save bed space, save lives and stop the spread of Covid-19, which was total rubbish.
“There were a myriad other more practical ways of approaching the alcohol issue to save beds. Prohibitions just fuel black markets.”
He said in the first 21 days of lockdown SA lost R13bn a day.
Decisions made by the National Coronavirus Command Council were disastrous.
“The textile industry, which could have been used to produce life-saving PPEs and generate taxes and income, was shut down. Clearly, from the level of corruption around PPEs, this happened because of agendas.”
He also slammed the decision to stop NGOs from distributing food to desperate people. — Graeme Hosken
Professor Mosa Moshabela
Head of the University of KwaZulu-Natal’s school of nursing and public health, Moshabela believes SA was slow off the mark.
“When we realised the pandemic was coming there was this misplaced hope it may not come to us. The minister of health kept reassuring us we were ready, but we now know we were not ready.
“It was only after we had our first case that people were scrambling. We should have started teaching people about hygiene in February. We knew these things but we did not talk about them.
“There were so many blindspots. We started late, we could have saved a lot of people by introducing prevention early on.
“Nothing else has shown us better that prevention is better than cure than Covid-19 did.”
He praised President Cyril Ramaphosa for his leadership.
“Every time he spoke, he spoke about washing hands, social distancing and mask wearing; what amazing public health promotion is that, including the whole accident with his own mask. That in itself promoted the use of masks.” — Suthentira Govender