Tackling Covid-19 outbreak
SOUTH AFRICA: UNCERTAINTY OVER WHICH OUTCOME IS BEING PURSUED BY GOVERNMENT
There is wide range of possible policy objectives at the moment.
South Africa has aggressively intervened to contain Covid-19. But it is far from clear which strategic outcome is being pursued. Is it following the lead of countries such as New Zealand or South Korea and trying to stop virus transmission altogether until a suitable vaccine becomes available?
Or is it attempting to manage the infection rates so that extreme peaks in morbidity are prevented?
As the government’s strategy is not currently explicit, the intervention framework implemented so far appears consistent with a wide range of possible policy objectives.
The rapid emergence of the pandemic defaulted policy to intervene first and ask questions later. But the dust is now settling, and the strategic endgame can, and should, be made transparent.
Any strategy requires a rational combination of what is known with what is not.
What is not known includes the possible outcomes of interventions, as well as contingencies that can materially influence the trajectory of the disease.
Given the substantial uncertainties of disease elimination, South Africa should adopt at least a multiyear strategic perspective – that is the time until a vaccine or treatment is probable and has been implemented.
The strategy should, however, allow for the possibility that each month introduces more certainty about the success of public health interventions and the options for treatment and vaccines.
The various options mapped out below take into account what is known and what is not known.
First, the virus is highly infectious.
In the absence of interventions it has an average reproduction rate every four days of roughly 2.5.
Infections are also associated with levels of morbidity and mortality that make an active public health response necessary.
Second, no vaccine is available yet and no drug has been shown to prevent transmission of the virus.
Third, no virus-specific treatments exist to mitigate the current levels of morbidity.
Fourth, the complexity of the economic and social problems arising from general lockdowns means it is very difficult to rely on extended lockdowns without creating a new range of severe socioeconomic problems.
First, the extent to which reliance can be placed on social distancing and lockdown strategies in South Africa’s high-density, poor and informal settlements is in question.
Second, South Africa appears unable to get testing to the levels necessary to successfully manage a health prevention strategy based on testing and contact tracing.
This is true of a number of well-resourced countries, too.
It is also unclear whether South Africa is able to ramp up testing and associated isolation of those infected or their contacts, to the level needed to stay ahead of the epidemic during the course of 2020.
Third, it is unclear when a vaccine will become available. Even under ideal circumstances, it is likely that it will only be available for wider use in 2021. And even with the development of suitable vaccines, it may still take years to eliminate the virus.
Fourth, therapeutic options based on existing treatments, which could be available soon, are still speculative and unlikely to prove wholly successful.
Fifth, therapeutic options based on new technologies are unlikely to be available in South Africa until the latter part of 2021.
Van den Heever: Adjunct professor in the School of Governance,
University of the Witwatersrand; Valodia: Dean of the Faculty of Commerce, Law and Management, University of the Witwatersrand; Allais: Professor of philosophy, University of the Witwatersrand; Veller: Dean of the Faculty of Health Sciences, University of the Witwatersrand; Venter: Faculty of Health Sciences, University of the Witwatersrand
– GroundUp.
The virus is highly infectious