Marius Strydom: At current rate, South Africa’s Covid-19 deaths heading for 100 000 – concrete steps are needed

Our government should take the lessons, the energy and the focus that this pandemic has given them and apply it to a post-Covid world. Let us exit this pandemic, a more focused and united country, driving a more efficient and growing economy for all, writes Marius Strydom. 

The chorus to fast-track a relaxation of the South African lockdown has grown over the past weeks: from economists pointing to the long-term damage being done to GDP, to researchers pointing at the years of lives that may be lost due to lockdown.

Also, informal traders and small businesses who are losing their livelihoods, business leaders who are seeing revenue pressure and face having to lay off staff, to a cramped up citizenry wanting to meet their friends, buy cigarettes and alcohol, walk their dogs, and surf a few waves. 

While the economic damage is indisputable and there is clear evidence that we have slowed the spread of the disease, with daily case growth averaging 6% over the past month compared with 30% per day prior to lockdown and death growth of 7% per day over the past month, there are important reasons why we should take a breath and not be overly hasty in our calls. 

A daily death rate of 7% still means that our deaths are doubling every 10 days, which would take us to 12 500 deaths in two months and 100 000 deaths in three months.

This is above or below the total deaths predicted, depending on which actuarial model you use.

Factors that could pull actual deaths down are that, as time passes, more people build up an immunity to the disease and that the more people that have been infected in your circle, the fewer you will be able to infect if you get sick.

Factors that could push up deaths are that a relaxation of lockdown increases the number of people you are able to infect and that the healthcare system may not be able to cope with the number of cases, leading to more deaths. 

There is clear evidence that, in addition to this disease being much more risky for older people who disproportionately account for deaths, it is also very risky for people with co-morbidities like diabetes, lung disease or heart disease, with most of the younger people who die, being sufferers of other diseases.

In South Africa, we have a large population of HIV+ individuals who are not on ARVs, with estimates ranging between 2m and 2.5m.

Although we have limited information available, there is the fear that people who are immuno-compromised, who have a low T-Cell count caused by HIV, could be particularly vulnerable to Covid-19. 

We are short of data and information on the Covid-19 pandemic and anyone who makes confident pronouncements on an immediate end to lockdown, are doing so based on as limited information as the rest of us.

Improved information is our most powerful ally in moving from our current state of lockdown to an eventual return to normal. 

There are a number of steps that we as a country should take to improve our visibility about this crisis and allow us to proceed to normality without risking unnecessary lives, overburdening our medical system and doing even worse damage to our economy and social fabric. 

We should be doing more testing than we currently are to make sure that we identify hotspots like the Western Cape.

It is only by investing in more testing capacity on top of our screening programme that we will obtain the information needed to isolate the affected and tracing who they have been in contact with.

The current delays in testing results in the Western Cape and the hesitation by government to ramp up tests to the theoretical 36 000 daily tests that we are able to do, compared to the less than 20 000 we are actually doing, could point to bottlenecks in the test pipeline.

We likely have a limited supply of reagents, the fuel needed for the GeneXpert machines that do the tests. It should be a national priority to deal with such shortages, if they exist. 

In addition to testing people who exhibit symptoms, it is imperative that South Africa tests a randomised sample of our population to get a proper reading of how many people are impacted, how many people are asymptomatic, where these people live, what their ages are and what their socio-economic situation is.

Based on the Iceland experience, a randomised sample of 10 000 carefully selected individuals by location, age, gender, socio-economic background and HIV status, including if they are on ARVs, should provide a statistically significant picture of the prevalence and characteristics of Covid-19 in our entire population.

This will provide our modellers with better data to predict the future and our decision-makers with better inputs to relax our lockdown and move us to normalcy. This needs to be another priority during these uncertain times. 

Furthermore, we need concrete steps in South Africa to better understand how vulnerable our HIV+ community is and to actively reduce that vulnerability.

It would make sense for our 28 000 healthcare workers who are moving around the country to include an HIV element in their screening, to identify people who are HIV+ and help them gain access to ARVs.

In addition, there should be a drive to encourage people to know their status and to receive treatment.

Even as lockdown restrictions are lifted, it is important that we protect the most vulnerable like the aged and people with low T-Cell counts, by making sure they adhere to social distancing, stay away from work-places and crowded areas. 

Even once we have the additional information to allow the majority of South Africans to return to a modicum of normalcy, we will still be faced with protecting the at-risk, who may be financially vulnerable.

Although the financial support that we currently spread thinly amongst all who are economically impacted could be more focused on the vulnerable in a post-lockdown environment, we need to find much better ways of allocating that support.

It is unthinkable that the aged stand in queues to collect social grants and the hungry congregate in large numbers to receive food parcels.

Food could be distributed using existing mechanisms, including supermarkets and spaza shops, except for the minority who cannot gain access to these offset points.

Payment for such food could occur through a voucher system, run by government or a central fund, assisted by banks and mobile companies. There should a significant drive to deliver food vouchers and grants electronically, possibly using mobile phone technology. 

Empowered with the necessary information and with the steps in place to protect and look after the most at-risk people of our society, we could proceed to lift lockdown at a more rapid pace than many of us are fear we will experience.

In the meantime, we need to find ways of moderating the undue regulatory pressures being placed on businesses who are allowed to operate, even under level 4 of lockdown.

As long as the most vulnerable are kept away from places of work, it may be overkill to expect all workers to go into self-isolation if someone at their work tests positive and in the process resulting in significant production impacts. 

As we get back to normal, it is important that we take some of the positive lessons learnt from lockdown and apply it to the post-Covid South Africa.

The numerous lives that have been saved from unnatural deaths during our lockdown period should be the start of a safer South Africa.

Through visible policing and traffic policing, stricter control on after-hours alcohol sales, select curfews, etc. we could build on this trend and make South Africa the safer country that we all desire. 

The Covid-19 pandemic offers us the opportunity for a reset of our economy, removing or reducing the structural constraints to GDP growth, including electricity supply, dealing with inefficient SOEs, improved labour relations, regulatory pressures, dependence on resource exports, lack of domestic manufacturing, etc.

We could use the weak rand to embrace new technologies, including renewable energy, expand local manufacture and beneficiation, create jobs, boost exports and drive a more equitable outcome for all.

Except for the medical supplies and treatments that we will need to deal with the pandemic, the only real import item that we absolutely cannot do without is oil, and this is trading at historically low levels. 

The Covid-19 pandemic also offers the potential for a more efficient and focused government, not hamstrung by endless talk-shops, infighting, corruption and the need for satisfying disparate factions.

The South African government is arguably working harder in dealing with the pandemic and its after-effects than it has ever done before, and it has arguably never been as united in its focus.

If this energy and focus can be channelled into a post-Covid world, South Africa may face an optimistic future, despite the economic pain it is currently experiencing. 

As we sit in our homes today, whether in luxury with our share portfolios under pressure or in difficult circumstances, not knowing where next month’s rent will come from or next week’s food, we need to recognise that we all face uncertainty, but that there is hope.

We need to recognise that our government, like governments across the world are trying to balance lives and the economy based on limited information.

They are walking a very fine line between complacency leading to numerous deaths and over-reaction damaging the economy and people’s lives. 

However, we look to our government to make the right decisions now and to implement them effectively so that the scale can shift to a measured and risk-adjusted return to normalcy.

We need more transparency and information sharing, we have to gather the data we need to move forward, we need to address testing bottlenecks and do a proper randomised sample test, we need to protect the most vulnerable, whether it is the aged or people living with HIV, we need safer ways of distributing support to the most vulnerable, we need to find a risk-adjusted way of promoting the economy during partial lockdown and we need government to find a path out of lockdown sooner, rather than later. 

Our government should take the lessons, the energy and the focus that this pandemic has given them and apply it to a post-Covid world. Let us exit this pandemic, a more focused and united country, driving a more efficient and growing economy for all.

Let the pain we are all experiencing at the moment, be channelled into a brighter, inclusive future. 

by  Marius Strydom, is CEO of Austin Lawrence Gidon, a provider of research to South African corporates.  


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