Health commentary

COVID … is there another way to navigate through difficult times?

I have been reflecting on the latest response by Government to the COVID-19 pandemic. The “second wave”, it has been announced, is upon us in South Africa with even the addition a new COVID strain. Daily there are reports of an increasing count of positive COVID tests, intensive care admissions and sadly COVID-related deaths.

So what has been the response to the increase in COVID cases? In a previous article I reflected on the need to develop a community-based response rather than a heavy-handed law and order response. As a seasoned health professional, I fully understand the need to carefully husband the health care resources at the country’s disposal to deal with the load place upon the healthcare system by the COVID-19 pandemic. However, given the fact that the country has had 9 months to prepare the health system to handle the expected and now real surge in cases, is the argument that as with the “first wave”, similar harsh steps must be taken to protect the health care system still valid? This was the justification of the lockdown measures that decimated the country’s economy in an attempt to “flatten the curve” to enable the health system to be prepared. Unfortunately this was not as successful as it should have been in the public health sector due to a multiplicity of factors.

The collateral damage of the well-intentioned lockdown was immense with many businesses going under, impacting negatively on the sources of government revenue that fund the activities of government. With that price having been paid once, there was a justifiable expectation, that the same should not happen again as the country faces the consequences of the “second wave” of infections.

So what has been announced in response to the second wave? Alcohol sales are again restricted to four days in the week and “on-site consumption of alcohol” forbidden after 10pm in an attempt to reduce the burden of alcohol related trauma on the health services. This seems to be a logical step although whether it will have the desired outcome is uncertain. No mention of the restriction of tobacco sales this time after a recent Western Cape High Court judgement finding that the initial ban on the sale of tobacco products was both “unconstitutional and unnecessary”. The curfew has been extended by an hour and gatherings limited to 100 people indoors and 250 people outdoors or 50% of the capacity of the venue. Again while well intentioned it is uncertain without adherence to social distancing to what degree this will limit the potential spread of the virus.

However, the coup de grace for the hospitality sector is the closure of certain beaches for the festive season, just as many South Africans of all persuasions would expect to be able to spend time at the beach. Understandable in terms of events that result in gross overcrowding of beaches on days such as Christmas and New Year, but to my mind inexplicable for the balance of the festive season. Beaches in general promote outdoor activity with in most cases a sea breeze and sunshine in themselves safety factors and as long as over crowding is controlled the justification for the total ban on access to the beaches in areas such as the Garden Route is unclear. For commerce struggling to survive in coastal towns in these areas, to paraphrase and reword Charles Dickens in “A Tale of Two Cities”, “what should have been the best of times has now become the worst of times!”

Law enforcement has again been placed in the invidious position of enforcing compliance with these decisions. A picture in a Cape Town newspaper of the Minister of Police “inspecting a beach in Cape Town to assess compliance with COVID-19 regulations” with a group consisting of almost exclusively men on 16th December, with a TV cameraman in tow, standing around a woman in a bathing costume lying alone on a Cape Town beach, is unfortunate both in the context of South Africa’s chauvinistic society and the subliminal message that it sends. On the front page of the same daily newspaper, there is picture of an armed SAPS member with an automatic weapon apparently patrolling a beach. One may ask why an automatic weapon is required to police a beach and what would be the consequences if that weapon were indeed discharged on a beach.

I remain convinced, as has been argued by myself and others previously, that the law and order approach, as epitomised by the recent actions of the Minister of Police, is entirely the wrong approach in dealing the COVID-19 pandemic in South Africa. It was wrong in the initial lockdown and resulted in multiple arrests for trivial transgressions and it remains as wrong now as it was then. Let the SAPS rather focus on the “real” crime that threatens the lives and livelihoods of so many South Africans and not on actions by citizens that have been made criminal by COVID-related policies and result in the alienation of law enforcement officers from communities.

The health services must utilise the additional resources provided to them at great cost to the country to manage the increased COVID infections requiring hospitalisation. South Africans must work cooperatively with government in a partnership to take the necessary steps to protect each other for the common good with support from community-based organisations and civil society across the country. Effort and goodwill of communities cannot be wasted by imposition of restrictions and sanctions that do more harm than good. Most people will react positively to logical and reasonable restrictions but many will become resistant to all restrictions when these threaten their economic survival and in particular when they are combined with those that are deemed by most as unreasonable and illogical.

For the sake of this beautiful country let us find another way to navigate our way cooperatively through these difficult times together!

A health professional with over 40 years of experience both as a clinician and a senior health manager in South Africa