In the term “social distancing” I include the full spectrum of measures introduced to counter the spread of the coronavirus. With the lifting of almost all the restrictions on the movement of individuals in South Africa “social distancing” to prevent the spread of the coronavirus becomes the last line of defence.
Recently pictures on social media have shown groups of apparently well educated and informed people in South Africa happily congregating in groups without masks completely ignoring the need to remain at a safe distance from one another. Counter intuitively some are those who continue to work from home due to their age or because they have co-morbidities.
For riders of a Harley Davidson motorcycle like myself, the Sturgis Rally held annually in the American State of South Dakota is a must do “bucket list” event. In normal times the rally is attended by many thousands of Harley Davidson riders from across America and the globe. This year, despite the COVID-19 pandemic with America one of the countries most affected by the virus, around 400 000 rally goers from across the USA thronged the streets, bars and events of the rally with hardly a mask in sight. It is inconceivable that all 400 000 rally goers were unaware of the risks posed by the COVID-19 pandemic. If there was ever a “super spreader” event then this was to be it! It seems that those participating in this mass gathering consciously ignored the need to socially distance themselves from others. The consequences of this for a spike of infections, in a country where the impact of the pandemic has been severe, are still to be determined although preliminary reports, hotly contested by the Republican Governor of South Dakota, indicate that the rally could have resulted in an additional 250 000 coronavirus cases.
The psychology of why people are resistant to the wearing of masks is interesting with reasons being wide and varied. In America and in some other countries the wearing of masks has become a highly politicised issue as compulsion to do so is seen as an invasion of personal freedom. Recently in the United Kingdom with an increase in COVID-19 cases and fear of a “second wave”, whether or not the wearing of masks should be legally enforced has become a point of contention. In South Africa, at alert level 1 in terms of the State of Disaster regulations, the wearing of a mask when in public remains obligatory. While many South Africans adhere to this legal obligation, the pictures to which I referred at the outset reveal that under various circumstances many have not.
But it is not just the wearing of masks that is an issue. Social distancing implies that we should remain physically distant from all but those who are closest to us. Most people are naturally gregarious by nature, meaning that prolonged isolation and removal from our supportive social networks is stressful. Remaining isolated from family, friends and colleagues at home is for many untenable in the longer term. At the outset of the pandemic and its spread to South Africa, the coronavirus and its consequences were front of mind for most South Africans. The number of people infected and those succumbing to the virus reported on a daily basis were a sufficient motivation to exercise restraint by remaining in our homes where it was possible and to withdraw, at least physically, from our social networks. With the numbers of infections and deaths now on a downward trajectory together with the large number of recoveries, currently almost 90% in South Africa and the relatively low mortality rate of around 2.4%, the urge to reconnect directly with friends and colleagues has begun to override that restraint.
Scientists have provided rational reasons for the continued need to remain socially distant from others, referring to the risk of a “second wave” of coronavirus infections. However, as the perceived risk of infection has decreased a greater threat for many has become losing the means to earn a living. Anger and frustration has built amongst many against restrictions imposed upon them with dire financial consequences for what is for most at best an existential threat. Further to this has been the, at times, perceived illogical nature of the restrictions imposed and the heavy handed manner of implementation that has reduced the willingness to cooperate. Fraud and corruption related to government contracts and financial aid during the pandemic in the face of companies closing or retrenching staff has eroded the credibility of government in the eyes of the general public. It seems that displays of defiance, as evidenced by people congregating without adherence to social distancing are a reaction to what is perceived now as an unjustified restriction of personal freedom.
The effective reproduction rate (Rt) estimates how many further infections on average are likely to occur from a single infection. Any value greater than 1.0 indicates that the number of infections will continue to increase, while when the Rt is less than 1.0 the number of infections will decrease. In South Africa the Rt has declined from a high point of around 2.5 to currently a figure of around 0.8, which is reflected in the decreasing numbers of active infections across the country. However, if the measures that mitigate against the transmission of the coronavirus are removed it is entirely possible that the Rt could again rise above 1.0 and the number of active infections will rise.
It is possible that the number of people who have had an asymptomatic COVID-19 infection providing a degree of immunity is larger than was initially thought resulting in a degree of so-called “herd immunity” which has limited the spread of the virus. Nevertheless, until an effective vaccine is introduced, effective testing and tracing aside, “social distancing” together with basic hygiene remains the last line of defence to ensure that the Rt remains under 1.0 and that the number of infections continues to fall. The cost of very restrictive lock down measures has been high with a national debt generated that the country will be paying off for years to come. This renders again imposing very restrictive measures an unaffordable option that few would support.
Consequently it is vital that people are persuaded rather than coerced to adhere to the simple actions that they can take to prevent the spread of the virus. Effective messaging is required that transcends the current cynicism, anger and frustration of many South Africans. Some of the rhetoric that has accompanied the introduction of the various alert levels in the country has not been helpful. What is needed is a honest and open compact with civil society that motivates every citizen for their own good and the good of others to adhere to the requirement of social distancing. It is now the last line of defence.
