After any time spent in coronavirus lockdown, you will probably be asking the same question as I am – when will this end?
But, while we are all eager to get out and about again, the danger is clear – if lockdown is lifted too early or in the wrong way, infections will surge again. We’ll see a new peak in cases and deaths, and the healthcare system will get swamped. Linked to this, a secondary danger is that a second wave would unnerve people, causing long-lasting economic damage as people would be afraid to go out or take economic risks.
What we want, then, is to lift the lockdown at the right moment and in the right way, so that we don’t experience a second wave and people have the confidence to pick up with normal life again. The question is, when will we be able to do so?
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Unfortunately, it’s a tough question to answer. There is so much that we don’t know about the coronavirus – how fast it is spreading, how many people have been infected, how deadly it is, even how many people have really died from Covid-19. Plus, every country, every city, and every town is different. Countries with many elderly people will have more trouble with the coronavirus than young countries, countries’ BCG vaccine strategies may also change outcomes. Places that shut down early may have a very different trajectory than those that shut down later in the curve. Population density is a factor.
In short, it is almost impossible to imagine a blanket date for the end of lockdown that would apply everywhere. However, we can at least think about how we’re going to decide whether to lift the lockdown.
A recent report from the American Enterprise Institute, a public policy think tank, offers a helpful way to think about what we need to know before we decide to reopen our economies. The report says that, before we can even consider reopening an economy, we need some combination of the following:
- Good information about where the coronavirus is spreading, the rate of its spread, and how much immunity there is in the population – in short, widespread testing
- Robust public health infrastructure that allows us to identify cases, contain them by imposing a quarantine, and trace their close contacts and quarantine them too
- A balance of cases that ensures hospitals have the capacity to treat everyone without undue strain
- Improved treatment options or a reliable prevention option (a vaccine)
Right now, South Africa is in the very early days of its coronavirus response. It has locked down the country to contain the spread of the disease and is using the time gained by our early warning, the relatively late start of our outbreak, and the lockdown to gear up its testing and hospital capacity.
This is all to the good. However, for those hoping to be back at work in a few weeks, it’s important to consider how ready the country really is to reopen.
Right now, South Africa is doing a good job ramping up testing. The country will need a very robust and widespread testing operation to identify outbreaks in vulnerable communities such as our crowded townships. More problematic is the public health infrastructure to contain cases, do the necessary contact tracing, and treat the people who need medical interventions.
South Africa’s health system is a bit of a mess. The two-tier, public/private system means great care for some, no care for others. The private sector is under-utilised – lots of care for nonsense, great facilities that aren’t available for the really ill – while the public sector is under-resourced and saddled with inefficient administrators and various other issues. The government will need to mobilise all of SA’s health resources to deal with this challenge but doing so will raise the hackles of the wealthy who want to keep their private system private. This will be a major challenge for SA’s coronavirus response.
As far as treatment and prevention measures go, SA is largely reliant on the big medical research centres in Europe, the US, and Asia, which are working feverishly to identify potential vaccines and drugs and get them tested. While various existing interventions – including some existing antivirals and the BCG vaccine – have shown some promise in anecdotal studies, there is no hard evidence yet that they really work. Therefore, we cannot expect to have reliable treatments or a vaccine any time soon. Our response will have to rely on testing and effective public health management.
The bottom line, then, is that lifting the lockdown in a week or two may be foolhardy. Without enough testing and health capacity, all we will have done is slightly delayed the pandemic. SA has many immune-compromised citizens who are at particular risk of death from coronavirus, as well as high incidence of obesity, diabetes, and heart disease. SA is also older than most other African nations. This makes us vulnerable to a true humanitarian, social, and economic disaster.
Whatever happens, let us hope that the president and health minister continue to act wisely and to be informed by good science, good common sense, and the lessons learned from the rest of the world.
