Hunger, SA’s worst threat

The Sunday Independent - - METRO - KENNETH MOKGATHLE

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

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