ANTHONY BUTLER: What HIV has taught SA about managing pandemics
We still have an intervention window and each national department needs to prepare a plan
The World Health Organisation (WHO) has declared the Covid-19 outbreak a global pandemic. Harvard epidemiologist Marc Lipsitch argues that “within the coming year some 40%-70% of people around the world will be infected with the virus that causes Covid-19”.
The WHO has called for greater urgency on the part of governments. By its estimate, 13% of symptomatic patients will require hospitalisation and 6% will need intensive care.
In Japan, Iran, Italy and South Korea cases exploded from tens to hundreds to thousands in the course of weeks. Affected governments are moving from containment strategies to mitigation ones, trying to flatten the peak of the epidemic to allow time to prepare health systems for the huge caseload.
South Korea, Hong Kong, Singapore and others are quite effectively using “social distancing” measures, initially isolating sick individuals and their contacts but then moving swiftly to “reduce social connectivity” by cancelling gatherings and events. Citizens have been told to work from home, wash hands regularly and thoroughly, avoid travel and crowded places, and self-isolate when they feel sick.
SA may be vulnerable. We are young, but we have poor respiratory health as a result of our high prevalence of HIV and tuberculosis (TB) infection. There are weaknesses in the public health system with regard to training, overcrowding and shortages of protective masks, clothing and critical care ventilators.
Poverty may increase vulnerability as a result of immune system weakness, a lack of access to reliable information, and overcrowded settlements and public transport systems. Most workers cannot work from home, and they lack paid sick leave to fund self-isolation. Further challenges result from the circulation of people between rural and urban areas, and hostel accommodation in institutions such as prisons.
SA can learn from the experiences of countries at a more advanced stage of the pandemic, and we are fortunate to have the capabilities of the National Institute for Communicable Diseases (NICD) to draw on.
Three lessons of our own HIV epidemic may be especially valuable. First, credible communication is vital and the government must remain honest to retain public trust.
Second, we need a “whole of government” approach. Like HIV/Aids, Covid-19 is not just a health challenge that can be managed by the health department. Every government institution, especially large employers such as the departments of education and police, must take steps to prevent the spread of Covid-19 among their workforces. Feasible self-isolation strategies cannot be planned from the centre.
Each national department needs to prepare a plan for supporting its particular “clients”. Are schools implementing appropriate hygiene and disinfection strategies? How exactly will Covid-19 be managed in our prisons? How will our development and trade departments support businesses facing disrupted supply chains?
Moreover, intervention windows are available to every minister, if they can be identified. Has the department of transport formulated guidance for minimising the spread of the coronavirus in taxis, trains and buses? Has traditional affairs developed a strategy for mobilising traditional leaders and healers? How will the transmission risk posed by social grant distribution be managed? Will the water & sanitation department resurrect former minister Ronnie Kasrils’s water, sanitation and health (Wash) programme from the early 2000s to facilitate handwashing in poorer communities?
A third lesson from HIV is that the government sometimes needs to grasp the nettle. It is difficult to see why sporting events, religious meetings, university lectures and any other large and unnecessary gathering in a public venue or private company should go ahead given that these pose a clear risk of accelerating the epidemic. As Lipsitch observes, the goal is to minimise the number of contacts between people early on, in the hope of averting the need for more drastic and costly interventions later.
• Butler teaches public policy at the University of Cape Town.