A recent study published in the South African Journal of Science by Bradshaw et al1 provides interesting reflections on the number of reported COVID-19 deaths in the four waves of coronavirus infections compared against the total number of excess “natural” deaths during the same periods. While in one province, Western Cape, the ratio between reported COVID-19 deaths and the excess natural deaths was 69% in some other provinces, Mpumalanga and Limpopo respectively, the ratios were as low as 10 and 13%. From this it appears that quality of the provincial data systems varies markedly. The data also indicates that the quality of official COVID-19 reporting may be worsening over time. The study indicated that the timing, duration and spread of the respective waves differed across the provinces.
A particularly significant finding is that the various levels of disaster lockdown, imposed nationally, were “largely ill-timed relative to the timing of excess deaths”. The initial period of “hard lockdown” from March to May 2020 did have a marked impact on the number of natural deaths, interestingly particularly amongst children. The authors do not speculate on the possible cause of this increased impact on the number of natural death amongst children. The study reveals that the restrictions placed on schools, businesses, travel, alcohol and tobacco sales which had a devastating effect on the economy and lead to over two million job losses were ineffective at limiting the cumulative number of natural deaths estimated in excess of 280 000 in the first four waves. While the restrictions placed on the sale of alcohol reduced the number of non-natural deaths, this together with the initial restriction of the sale of tobacco products had little impact on the number of natural deaths.
Van Wyk and Reddy2 in the same publication, provide a well thought through analysis of the restrictions imposed by government with the implementation of the a national state of disaster and the so-called “risk adjusted alert levels” in March 2020. The authors note that the restrictions were based on a strictly biomedical approach recommended by a Ministerial Advisory Committee (MAC) and that this approach was initially generally lauded as an example of good governance and decisive action. They question however whether a more appropriate approach would not have been to consider how the co-occurrence of epidemics and various social factors, such as poverty, food insecurity, gender-based violence and housing insecurity interact to complicate public health outcomes having a greater impact on socially disadvantaged groups. While accepting that government had to act, the authors indicate there were alternatives such as a “community lockdown” rather than a national lockdown, allowing people to move more freely in these areas accepting that social distancing is impossible in many informal settlements.
A leading article in the same journal with, as the authors Jansen and Madhi indicate, an “ironic title” “How to do social distancing in a shack: COVID-19 in the South African context”3highlights the irrationality of “imposing social and policy interventions based on middle class sensibilities” in a South African context, at times by force, as was the case during the initial period of hard lockdown, where many if not a majority of citizens do not have adequate housing with adequate physical space or sanitation to apply the mitigation measures of social distancing. Coming from that middle class myself, it has been painfully obvious that exercising social distancing was and is for the majority in this country a distant utopian dream but nevertheless was and still is propagated by those in positions of authority whom one would assume are well aware of this reality. The irrationality of many of the restrictions imposed during the pandemic has led to both cynicism about and a failure to adhere to restrictions of this nature.
As a scientist myself, I found particularly insightful Van Wyk and Reddy’s analysis of the impact of “Scientism” which is defined as “an exaggerated kind of deference towards science” and was become particularly prevalent as the pandemic progressed with scientific experts becoming media personalities and such expertise being used to justify irrational actions in what the authors term as the “COVID theatre” to which we were all exposed. Amongst examples quoted are the tobacco ban, the 12-4am curfew and the ban on open-toed sandals.
Sobering findings considering the severe impact on the lives of many South Africans, most especially amongst those with lower income levels. With the benefit of hindsight it is easy to be critical of what initially would have seemed to be logical responses to a global pandemic caused by a pathogen which at that time had unknown consequences. Nevertheless, it seems that government remains wedded to a biomedical approach that seeks to impose centrally legislated and imposed controls on the population. Over two years since the first coronavirus cases were identified in this country, some restrictive regulations still remain in place that seek, albeit in many aspects unsuccessfully, to control the behaviour of South Africans.
A telling fact is that despite numerous lockdowns and restrictions in South Africa justified to protect people from COVID-19 infections that several studies report that at least 70% of the population has nevertheless been infected, many on more than one occasion. While the initial period of hard lockdown could possibly be justified, it seems that the persisting with lockdowns of varying severity achieved very little in preventing infections, but further damaged an already damaged South African economy. Even worse was the fraud and corruption that followed in the wake of the requirement to urgently procure personal protective equipment and materials to sanitise hands and surfaces, again much of it proving subsequently unnecessary.
The failure to achieve the targets to immunise a majority of South Africans and a growing resistance to acceptance of coronavirus vaccines by many South Africans is not surprising given the fact that it was initially stated by experts that immunisation would prevent infection while later it was confirmed that while immunisation reduces the risk of severe infection and hospitalisation, it appears not to have significantly limited the spread of infection. As COVID-19 progressed from the second wave to the third and fourth waves, the severity of infections has decreased, particularly during the fourth wave resulting from the Omicron variant that resulted in unnecessary disruption in travel to and from South Africa. This is to an extent accounted for by the characteristics of the various mutations and immunity acquired from the natural infections as indicated by the generally high levels of infections in the South African population probably related to the socio-economic factors alluded to above.
There are anecdotal accounts of people who, if they had been able to access to health services but were prevented from doing so during the various waves of coronavirus infections, would have received treatment for conditions that have either worsened or become untreatable as a result. It has been reported that the management of people with tuberculosis, AIDS and cancer, all prevalent in South Africa, was significantly negatively affected by largely focusing health services on COVID-19 alone, to the detriment of other conditions during the height of the coronavirus pandemic.
These and other lessons are emerging from the documented research on the COVID-19 pandemic now being published. It can only be hoped that those formulating and implementing policy are receptive to the important work and accept the constructive criticism of researchers such as that published in the South African Journal of Science.
- Bradshaw D, Dorrington R, Laubscher R, Greenwald P, Moultrie T S COVID-19 and all-cause mortality in South Africa- the hidden deaths in the first four waves. S Afr J Sci 2022;118(5/6)
- Van Wyk DT, Reddy V Pandemic governance: Developing a politics of informality. S Afri J Sci 2022(5/6)
- Jansen J, Madhi SA How to do cordial distancing in a shack: COVID-19 in a South African context. S Afr J Sci 2022;118(5/6)
