Covid in SA: first 90 days
A critical assessment of how the government handled the first phase of the pandemic
EIGHT months ago, when President Cyril Ramaphosa announced a strict lockdown for an initial 21 days in response to the Covid-19 threat, the decision was widely praised.
A few critics, including myself, disagreed. I warned against “a strident ‘conventional wisdom’ which holds that governments and societies should respond through drastic measures”.
I argued that the government had moved too rapidly to drastic measures, and that the negative consequences might outweigh the benefits. I said this would constrain South Africa’s options later in the pandemic.
Evidence of the widespread harms of the lockdown and government decisions to weaken regulations when case numbers were increasing corroborates these arguments. Many commentators now agree the government’s approach was not optimal. But they still argue that we can only say this with the benefit of hindsight. I disagree. The reasons the government’s actions and approach were likely to be flawed were evident at the outset.
In a recent paper, I examine in detail the crucial first 90 days of the government’s response from March 1 to May 31. The overall lesson I suggest we draw is that while anti-scientific approaches are harmful, naive reliance on scientific evidence and overly confident scientists is too.
Most analyses of government responses to Covid-19 internationally have focused on the dangers of unscientific or anti-scientific attitudes. The result has been to neglect the fact that excessive confidence in claims by scientists is dangerous as well.
Based on publicly available evidence, which is detailed in my paper, I conclude that the response by the South African government put excessive faith in scientific claims that were unreliable, and also made a performance of that to give its response more credibility than warranted.
Even after eight months it remains unclear what the government’s strategy actually was when it imposed the strict lockdown.
Many commentators seemed to think that it was to suppress the spread of the virus. This despite the fact that the health minister’s earlier comments had suggested a “herd immunity” strategy in which 60% to 70% of the population get infected. Yet, instead of interrogating what the core strategy was, various social actors – including the media – alternated between uncritical praise of the government and sharp, sometimes unfair, criticism of aspects of the lockdown regulations or their consequences.
The fact that the government seems to be seriously considering unrestricted national travel during the December holiday period, even as infections increase, is simply further confirmation of the swing in the opposite direction to its initial strategy.
Government’s own numbers already show how its strategy failed on various dimensions.
First, critical care capacity was not increased very much during the strict (level 5) lockdown. Since the original definition of “flattening the curve” referred to reducing critical care cases below hospital capacity, this means that government failed to flatten the curve through its efforts. The fact that critical cases ended up being far lower than predicted does not change this conclusion.
Second, the strict lockdown did not have a large effect on the rate that the virus was being spread and never reduced the rate low enough to make stopping transmission possible.
Third, the initial modelling predictions (as reported in the press but never released officially) and subsequent more sophisticated ones have been very inaccurate, overestimating the number of critical cases.
Fourth, dramatic worsening of social indicators (like hunger and access to health-care services), unemployment and public finances demonstrate the large social and economic cost paid.
In other words, the strict lockdown over five weeks had devastating societal consequences but did not achieve the objectives set out, and was arguably unjustified anyway because it was based on simplistic generalising from other contexts.
The South African government placed all its faith in modelling by a small number of advisers. That modelling appears to have been based on crude use of evidence from different parts of the world.
It probably exaggerated even the consequences in the countries it was taken from. Failing to make that modelling public violated two key principles of scientific activity: transparency and independent peer review.
It is therefore not surprising that the predictions turned out to be wrong.
Fortunately, South Africa has experienced better epidemiological outcomes than many countries outside the African continent. The reasons for that are still not clear, but there is little evidence that it is the result of government’s stringent response.
To make the best possible decisions for society, policymakers should avoid pseudoscience and excessive deference to science. Scientists and policymakers need to be more humble in their claims of what they know. Policymaking must reflect uncertainty and ignorance, not “incredible certitude” and arrogance.