The Difficult Dilemma of COVID-19 in our 2020 World!

I write this article as a 72-year old man with hypertension well-controlled on antihypertensive medication and as such an individual who falls into the group of individuals at higher risk for a more complicated course of COVID-19 should I acquire that infection. I am also a doctor and spent my professional life as both a practicing specialist clinician and a manager of health services. The reason for my stating this at the outset will become apparent to the reader.

In South Africa the surge of COVID-19 cases and COVID-19 associated deaths overall first peaked around July of this year, 2020, and subsequently declined. Prior to the surge the country went into a series of levels of severity of “lockdowns” that initially shut down almost every activity of the population. The aim was to enable a “so-called flattening of the curve” of infections and during this time allow the health services to prepare for the surge that was predicted to come. The Government allocated vast amounts of money that it did not have, incurring massive national debt, to fund the strengthening of the health services and to ameliorate the economic impact of severely curtailing economic activity in the country.

I have in a previous article on this website expressed my views on the nature and logic of the response to the pandemic by the South African Government and my anger at the manner in which so much of the precious allocated funds were wasted through fraud, corruption and naked greed. But having been granted the privilege to be a member of a team assessing the manner in which COVID has been managed in some South African hospitals, it was heartening to see that that the surge to date did not overwhelm the health services and how health workers, often unsupported by those in higher office, despite many challenges pulled together to address the challenges of managing patients with a disease caused by an unknown pathogen.

The first COVID-19 cases were identified in KwaZulu-Natal apparently originating from tourists returning from Europe. This was followed by an outbreak in Bloemfontein in the Free State after a church gathering held in that town. This prompted a draconian national “lockdown” in which people were restricted to their homes for all but essential activities. Thereafter the initial significant peak of infections and deaths occurred in the Western Cape in June, a month earlier than elsewhere in the country. Thereafter, a similar rise was experienced by the most populous province of South Africa, Gauteng, which as the months progressed overhauled the Western Cape in terms of the number of infections. KwaZulu Natal and Eastern Cape followed registering significant numbers of COVID-19 infections.

After a decline of cases countrywide, the Eastern Cape has recently experienced a sharp rise in case numbers apparently stretching the resources of State hospitals in that province to a breaking point. A similar increase in COVID cases is being experienced in the Western Cape as it appears community spread has occurred along the Garden Route toward Cape Town. This has lead to the consideration of the imposition of further “lockdown” measures to limit the spread of the virus in what are now termed “hotspots”.

In Europe and especially the US, COVID cases have again increased at an alarming rate in what is termed a “second wave” necessitating the reintroduction of measures to limit the contact between people and even quite harsh what have been labelled “circuit-breaker” lockdowns in an attempt to reduce the spread of the virus. In many countries, including South Africa, there has been increasing evidence that while initially people were willing to cooperate with limitation of their personal freedoms that there is a growing reluctance to do so indefinitely. Reports of widespread fraud, corruption and self-enrichment by an elite in a South African context, has further eroded public trust in government, making people resistant to further calls to remain observant of precautions to prevent the spread of COVID-19. The behaviour of people across the country in what has been termed, “COVID fatigue” in large gatherings ignoring social distancing and the need to wear masks, faced by what to most is at best an existential threat, is stark evidence of this.

The economic destruction resulting from harsh lockdown measures has impacted on the livelihoods of many but in particular the poor. Closed businesses, boarded shopfronts, vacant buildings and people in long queues seeking financial assistance from the State are visible signs of the severe financial distress that has resulted from attempts to limit the spread of the virus by shutting down economic activity. For those who are now unemployed, been declared insolvent and lost the means to sustain themselves, it seems that the consequences of the measures to limit the spread of COVID-19 have become worse than the consequences of the virus itself.

Another consequence of the continued global focus on the COVID-19 pandemic to the exclusion in many instances of other essential health care, has been, for example, the failure to routinely immunise children against other infectious diseases and the fact that patients with other life threatening diseases, such as cancer and heart disease for instance, have found it challenging to access the healthcare services that they require. Routine elective surgery has been curtailed with the consequence that what may have been routine could become an emergency and life-threatening.

So to return to my opening comment. As a health professional it appears there is an absolute imperative to take every step possible to limit the spread of the COVID-19 virus. Faced by the inability to ensure that people either by persuasion or coercion adhere to social distancing and in particular wear masks, the surge of infections such as in the Eastern Cape and areas of the Western Cape, leads to recommendations that the activities of people are again severely limited in a “lockdown” justified as before by the need to ensure that there are enough hospital beds to manage those people requiring hospitalisation.

But is that the correct approach? Should the health services in the almost a year that the pandemic has been upon us not have developed sufficient capacity to absorb the increase in infections as they were purported to have done during the initial “hard lockdown” as the curve was “flattened”? Can the economic activity that provides the wherewithal that people require to exist, be curtailed again and again while the world awaits the release of an effective vaccine? At what point is the cost benefit analysis of doing so, trumped by the need, despite the consequences that some people will succumb, to allow economic activity to continue unhindered? When does society adopt a utilitarian approach to actions of this nature and determine that for the good of the majority, policies are adopted that may significantly disadvantage a minority? Everyone has the option to adopt sensible measures to reduce their personal risk of acquiring a COVID-19 infection and if they fail to do so where does the responsibility lie? Considering the consequences of the lockdown to the economic health of a country already struggling to create adequate employment opportunities for the majority of its population, can another restriction in economic activity be afforded?

This is the difficult dilemma that policy makers across the globe and here in South Africa face. As a 72-year old South African with a co-morbidity at greater risk if I were to acquire a COVID-19 infection I have the opportunity to protect myself and that is my personal responsibility as it is for every citizen of this country. However, I would sincerely hope that whatever decisions are taken by those in positions of authority in South Africa to address the current upsurge in COVID infections that the welfare in the widest possible sense of all the people of this country are taken into account.