As SA hunkers down into a 21-day national lockdown, the country will do well to heed what other countries have done to fight the seemingly unstoppable march of Covid-19.
Early testing, isolation and strict social distancing appear to be among the key ingredients for success.
There are countries who have managed to slow the spread of the disease.
South Korea appears to have one of the most successful strategies, with a casualty rate of 0.97%. It learnt much of its current Covid-19 responses from the 2015 battle with the Middle East Respiratory Syndrome coronavirus (MERS-Cov), which struck the country. It quickly set up accessible testing centres within the public and private sector, very quickly testing almost 20,000 people a day – more people per capita than anywhere else – quarantining those ill and getting all citizens to practise safe hygiene.
The South Korean government also very effectively traced those who had been in contact with infected people through cellphone records, payment receipts and the transport movements of those infected. The government sent alerts to phones to tell individuals they were near a coronavirus-positive individual. Everyone infected, even with mild symptoms, was quarantined in hospital, rather than at home.
Singapore also learnt from a prior epidemic, the 2002-3 Severe acute respiratory syndrome (SARS) outbreak. Singapore’s coronavirus spread has been lower than country peers. After the SARS outbreak the country dramatically improved its public health system, building isolation hospitals for future epidemics.
China also appeared to learn from the MERS-Cov and SARS outbreaks. And although China started late in tackling the coronavirus when it emerged in December 2019 and January 2020, by mid-January the country had introduced a lockdown in Wuhan, the epicentre of the epidemic, and in other cities in Hubei province, quarantining more than 50 million people. Leaving and entering the areas was stopped, and people were banned from leaving their homes, except to get food or medical help.
China began mandatory checks of temperatures at every point, from entering or leaving public transport, to workplaces and shops. Social distancing was strictly enforced. Those with high temperatures or symptoms of the coronavirus were immediately put into quarantine. It used cellphone platforms such as WeChat and AliPay to monitor the movements of those infected.
Those with high temperatures or showing symptoms of the coronavirus were immediately put into quarantine.
Every individual’s health status was designated by colour codes of red, yellow and green, on their cellphones – these were checked at roadblocks, public transport centres and workplaces. Only those with designated colours proving they were healthy were allowed to travel.
The country built two special hospitals, with 50,000 beds, where it housed everyone who was positive, even if they have only mild symptoms. It quickly brought healthcare capacity from across China to outbreak areas. It aggressively traced everyone who had been in contact with coronavirus-positive individuals.
The coronavirus is now beginning to spread after a slow start in impoverished African countries. These countries had more recently battled epidemics such as cholera (between 1970 and 2011), HIV-Aids (from mid-1990s) and Ebola (2014-16). However, local public health capacity, skills and governance were not improved thereafter, and traditional, cultural and behavioural changes, such as improving hygiene, stopping the custom of multiple partners, and clean governance, were not implemented afterwards.
International organisations such as the World Health Organisation, World Bank and International Monetary Fund have not been as focused on helping African and developing countries with funds, skills, or medicines, in contrast to its response to SARS, MERS, HIV/Aids and Ebola epidemics in more developed countries.
The danger is that once the coronavirus fully takes hold in Africa, it may rapidly spread in countries with high levels of immune-compromised citizens, whether because of HIV, TB, or malnutrition, and where sanitisation is generally poor and public health systems are weak.
The challenge is developing countries with high levels of poverty, homelessness and high-density settlements, and levels of informal businesses, such as India, SA and other African countries, but with poor or uneven public health services.
Furthermore, in SA and many African countries people are more social, gathering in groups and with families – which increases the spread of the virus. There will have to be strong external enforcement of social distance, or the virus will spread quickly, as seen in Italy.
Rwanda has been the most proactive, introducing the first total shutdown of the country to combat the coronavirus after 17 cases of the disease.
Nevertheless, the typical response on the continent to the coronavirus, in places like Tanzania, Kenya and Nigeria, includes discouraging intimate greetings such as handshakes and hugs, banning large gatherings, closing schools and sealing off borders.
In Kenya, transaction fees for money transfers below $10 have been lifted to decrease the hand-exchange of cash.
Rwanda has been the most proactive, introducing the first total shutdown of the country to combat the coronavirus after 17 cases of the disease. Before, the country made it obligatory to have sanitary measures at public transport hubs such as taxi and bus stations. Rwandan President Paul Kagame fired his health minister after she said the country had 3,500 coronavirus testing kits but it turned out it had only 95.
Long periods of lockdown are a death knell for businesses, especially self-employed, small and informal ones. Industrial countries such as the US are promising giant economic stimuli, with direct payments to vulnerable businesses, the self-employed and the unemployed, which SA and other developing countries cannot afford.
During the coronavirus countries producing critical medicine, equipment and food have stopped these vital items from being exported, keeping them for local use. The European Union has imposed a ban on the export of medical protective equipment to outside countries. The US was accused by German biopharmaceutical firm CureVac of trying to procure a coronavirus vaccine the company is developing. German ministers reacted with anger to the US offer. India has curbed exports of basic medicines, such as painkillers, for use by its own citizens.
A basic income grant to the powerless in SA to carry them through the lockdown should be considered. Those in poor areas will have to get accessible water, sanitation and public education. Civil society groups can be used to educate impoverished communities. A lockdown may cause “cabin fever” in many households, increasing violence against women and children, alcohol abuse and mental disturbances.
Community centres, schools and government buildings will have to quickly be converted into isolation centres in townships, informal settlements and rural areas.
Private-sector telecommunications should send SMS and social media messages about where testing areas are, about symptoms and how to seek help, to poor citizens. Government and telecommunications can provide free minimum data for people to access information.
During the Ebola outbreak in Senegal, mobile hotlines were introduced where people could seek information, help and support. The government, civil society and business can run support hotlines to communities in similar vein during this coronavirus crisis.
Community centres, schools and government buildings will have to quickly be converted into isolation centres in townships, informal settlements and rural areas, to make up for building new hospitals as was the case in China. Not making testing widely and accessibly available will defeat the objectives of the lockdown.
*This article was originally published on the Times Select website. To view the article on their site click here.
