Hunger, SA’s worst threat
AS South Africa deliberates on the next steps to take after the lockdown to stop the spread of Covid-19, University of Johannesburg’s expert on causation in public health Professor Benjamin Smart said the worst threat for South Africa was hunger and poverty-related diseases.
He warned the government to look beyond just minimising the number of Covid-19 deaths, but to also focus on the psychological and physical harm caused by its interventions.
Sunday Independent (SI): Historically, would you say South Africa has effectively managed disease transmission in densely populated informal settlements?
Benjamin Smart (BS): I think it’s best to ask the NICD (National Institute for Communicable Diseases) on this one. Africa’s main offenders are malaria, TB and HIV. They are spread in different ways so the campaigns differ, but there have been large-scale screening and treatment campaigns in targeted areas.
SI: Is a lockdown the best solution for South Africa to contain the spread of Covid-19?
BS: Lockdowns can cause poverty, hunger, stress, and violence on a scale far greater that the virus itself. Being prepared means knowing what to expect if we let the virus carry on without intervention, and what to expect given a variety of different interventions tailored to the South African context.
The government is wisely doing extensive testing in the townships now. It may turn out that many more people are already infected than we expect, that the majority of cases are asymptomatic (most infected individuals don’t feel sick), and that the number of serious cases and fatality rate is lower than expected. This is not unlikely, given that the average age in South Africa is significantly less than in Europe and Asia (where age is the main risk-factor for Covid-19), and no evidence suggests the prevalence of HIV here will prove problematic, so long as people continue their ARV medication.
In this instance, the government might be best allowing the informal economy to operate as normal, so people can feed their families.
SI: What should happen to the more vulnerable, especially the elderly?
BS: The virus is unquestionably dangerous for the elderly and some with pre-existing conditions. It might be prudent to remove these individuals from the township environment and perhaps house them in some of the many empty hotels around the country.
SI: Are our public health facilities adequate to serve the population for the Covid-19 outbreak?
BS: I don’t know if our public health facilities will be adequate. That depends on how many people get very sick and how soon that comes about. Certainly, if 5 million people suddenly require ventilators we do not have the capacity.
That is the logic of “flattening-thecurve” – to make sure that not everyone gets sick at once.
SI: What would be your advice to avert the worst-case scenario?
BS: The guidance from the WHO (World Health Organization) such as washing hands and social distancing should be respected as far as possible. But the government must acknowledge that in high-population density townships, social distancing is practically impossible.
In truth, the worst-case scenario for most South Africans is not death from Covid-19 at all, but hunger, povertyrelated diseases brought on by an inability to work, and/or domestic violence (the rate of which has shot up, as people are locked in their homes without their cigarettes and/or alcohol).
PROFESSOR BENJAMIN SMART