– by Shannon Arnold, Kapil Narain, Pholla Samkezi Mbalane.
With almost 2,5 million cases and 200 000 deaths globally, the Coronavirus Disease 2019 (COVID-19) pandemic escalates.[1]
In this unprecedented war, health care systems and frontline workers are overburdened and under-resourced, prompting governments to undertake rapid and decisive public health interventions in an endeavour to contain the pandemic.
In South Africa, within 3 weeks of the index case (5 March) a national lockdown was declared by the President (23 March), and swiftly implemented (27 March).[2] It was strange, finding myself on my parents’ couch listening to President Ramaphosa declare a National State of Disaster. As I watched, I was completely absorbed by every word and syllable uttered from our President’s mouth. Initially, I felt that this was an impressive move – it demonstrated impeccable leadership, the kind of leadership for which our country has desperately yearned. While other heads of state in the global North were scratching their heads and proverbially ‘uming-and-ahing’ about their next move, President Ramaphosa acted decisively. Our President led. Many South Africans shared this sentiment, with all my social media platforms blowing up with that unique South African pride and faith in resilience. And with that, we entered into ‘lockdown’.
The stimulus behind the lockdown is the basic epidemiological principle of limiting physical interaction to disrupt transmission with the aim of establishing a plateau in the number of cases (“flatten the curve”) and utilising time to test, trace and isolate positive cases. The nature of the virus is that it is easily transmitted, and as we have witnessed in Europe, this presents an overwhelming burden on the healthcare system.
The basic reproductive number (R-naught) of a disease refers to the number of people that an individual confirmed with the disease is expected to infect. For COVID-19, this value is placed between 1.4-2.5 according to WHO.
To illustrate this, imagine you have 10 people who are confirmed with COVID-19. Each of these 10 transmit it to 2 other people resulting in 20 people who now have the virus. Each of these 20, in turn, transmit the disease to 2 other people each resulting in 40. Within a short space of time, due to the exponential nature of this transmission, a country can reach a high number of cases.
It is as plain as it is simple, if we as South Africans continued our day-to-day lives as normal, handshaking, hugging, kissing, attending places of worship in mass, cases would rise dramatically and our healthcare system would not have the capacity to effectively treat the number of people that would inevitably contract the virus. In terms of disease progression, approximately 80% of people would have mild symptoms and 20% require hospitalisation. On the other hand, 5% of patients would require intensive intervention, such as ventilation warranting ICU admission. Although this seems to be a small proportion of patients, if infections soar, then 5% constitutes a significant number! In a resource-limited setting such as South Africa, there are only so many ICUs. Even in more developed nations, the pandemic has crippled health systems.
Whilst key to curbing the pandemic, the lockdown has not been practical for all, subsequently leading to non-adherence amongst certain communities. The government must be cognisant of the social determinants of health to ensure that interventions are context-specific, and do not exacerbate current social challenges endemic to the fabric of many, if not most, South African communities. The difficulty with the lockdown is two-fold. The first being that this particular approach to flattening the curve is based on the action taken by countries from a different socio-economic context than ours. The second being the nature of our administration’s tendency to have political path dependence with the authoritarian nature of the Apartheid state.
To address the first, the success of the lockdown implemented in China is directly related to the social support the state was able to provide for their citizens. South Africa is one of the most unequal countries in the world.[4] The social conditions in some areas, such as Khayelitsha and Alexandra, make distancing very difficult, if not impossible, to achieve. In these over-populated areas, self-quarantine is challenging due to overcrowding, lack of proper housing and poor access to clean water. Consequently, this holds potential for a much greater outbreak.[3]
This leads us to the second element of this problematique. The question of whether the lockdown is appropriate hinges on the ability of the state to support its citizens, fostering a Janus-faced social crisis: “allow citizens to continue working so that they do not starve”, or “impose draconian regulations to prioritise health and prevent collapse of our healthcare system”. And so, it is one thing to ask the middle class to self-isolate and social distance, but it is another thing entirely to expect the same adherence on part of most other South Africans.
As a relatively new democracy, South Africa has not entered into a State of Emergency or Disaster in its democratic history before. The nature of democratic governance is that it relies on two interrelated concepts: legitimacy and authority. Authority is the right to rule, and legitimacy is the defining feature of a government with authority. In order for a government to have authority, it must have legitimacy, and vice versa. As such, there is a definitive relationship between government and its citizenry, one that teeters around this double-edged sword of authority and legitimacy, one that is called the social contract. We, as citizens, bequeath our government to rule, based on the principles of normal political procedure, it is legitimate in its authority; however, when the government exceeds the scope of its authority, and it becomes illegitimate, we, the citizens, then have the right to call on new leadership (think Jacob Zuma in 2017). However, when a state enters into a State of Emergency or Disaster, this then allows it to act beyond the bounds of normal political procedure in order to implement emergency measures to securitise a threat – the contract is thrown out of the window, and now the government makes the rules.
South African Police Services (SAPS) and South African National Defense Force (SANDF) are currently deployed to communities to ensure maximum compliance to lockdown regulations. Protecting citizens from, what the President termed, an ‘invisible enemy’ remains priority.[4] Although a necessary public health measure, the alleged gross brutality and violation of human rights by these security forces cannot be ignored. Recently, a video went around Twitter showing the SANDF ‘punishing’ citizens through physical exercise. This has manifested in the three alleged deaths of citizens who violated lockdown protocol.
The Independent Police Investigative Directorate (IPID) has already filed 38 complaints against the conduct of police and the SANDF including six allegations of assault, three deaths and three discharging of firearms.[5] We witness the government approaching a public health issue through intense force. Immediate militarization of the lockdown has placed SANDF in an unfamiliar environment and this poses a threat to the lives of the very citizens they have sworn to protect.
The approach of the SANDF and the SAPS isn’t surprising, especially when one takes a look at the treatment of citizens in protest, whether that be in the case of #Feesmustfall, #RUReferencelist, or service delivery protests. At this moment in time, coercion is the foundation of the authority of the state, not the social contract.
There has been research done on how the SANDF and SAPF have shown a path-dependence with the methods of the security forces of apartheid South Africa, in which, a state of emergency was the norm. The question becomes whether this path-dependence will continue once the lock-down is lifted and whether South Africa will be in a better position of ‘know-how’ the next time it is required.
Ultimately, in principle the necessity of the lockdown is irrefutable. But 3 weeks in, the lockdown has revealed there to be serious issues with compliance and enforcement. When dealing with such draconian policy, the government must deeply consider the wide and far-reaching ramifications for every member of society – to ensure no-one gets left behind.
References
- Johns Hopkins University. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. 2020. https://coronavirus.jhu.edu/map.html (Accessed 5 April 2020).
- The Presidency RoSA. Statement by President Cyril Ramaphosa on escalation of measures to combat the Covid-19 epidemic, Union Buildings, Tshwane, 23 March. 2020. http://www.thepresidency.gov.za/speeches/statement-president-cyril-ramaphosa-escalation-measures-combat-covid-19-epidemic%2C-union (Accessed 4 April 2020).
- Mabena, S., 2020. Virus Fears Have Overcrowded Townships On A Knife Edge. [online] The Citizen.https://citizen.co.za/news/covid-19/2262787/virus-fears-have-overcrowded-townships-on-a-knife-edge (Accessed 6 April 2020).
- DefenceWeb, 2020. “Ramaphosa tells military and police they are fighting an invisible enemy”.https://www.google.co.za/amp/s/www.defenceweb.co.za/featured/ramaphosa-tells-military-and-police-they-are-fighting-an-invisible-enemy/amp/ (Accessed 6 April 2020)
- Hosken, G., 2020. “Experts call for mediators to ease tensions created by soldiers and officers during lockdown”, Times Live, 04 April. https://www.timeslive.co.za/amp/news/south-africa/2020-04-04-experts-call-for-mediators-to-ease-tensions-created-by-soldiers-and-officers-during-lockdown/ (Accessed 4 April 2020)
