In this time of crisis it is comforting to have a president who refers to science and scientific evidence as a guide to his decision making.
We are further comforted when an actual scientist, or at least someone trained as one, presents the government’s response and planning for the coronavirus pandemic.
We are grateful that fate has put Cyril Ramaphosa in charge and not those who serve under him in his Cabinet, themselves mostly leftovers from the Nine Lost Years under the profoundly corrupt Zuma regime. “Imagine if this had happened under his watch?” we ask ourselves. As, on cue, our gratefulness turns to something more like pride when we watch the antics of the president of the United States.
And yet we should be careful about all this because, in relation to the coronavirus, science does not have any clear answers of what to do – besides, this changes all the time (What Covid-19 can teach us about being wrong), there is a divergence of opinion between scientists in within specialist fields and, of course across, different fields. The data scientists use is also often unreliable and subject to differing categorisation across different jurisdictions and research institutions.
One thing science can tell us (as can the study of history) is that this pandemic ends in only one of two ways. Either populations achieve immunity, or we achieve some sort of resistance to the disease. Immunity is achieved when enough of us are infected and then recover, thereby becoming immune and unable to infect anyone else or that a vaccine is developed which produces the same result. If everything goes well, a vaccine may be two years away.
Failing immunity – because we may discover that those previously infected can become reinfected for whatever reason or that vaccines (like the flu vaccines) provide just partial or temporary immunity – populations must therefore become resistant to the pathogen. Surviving or not becoming critically ill could be helped by what clinicians learn on the frontline and future drugs that could effectively treat the worst symptoms and improve the chances of those infected.
In certain rich and advanced countries, another outcome is being considered. This amounts to treating the pandemic as if it were epidemic and to crush any trace of the virus as has been done before in the MERS, SARS and, in West Africa and the DRC with Ebola outbreaks: Ending Pandemics. With strict physical distancing and a comprehensive (and hugely intrusive) test trace and isolation regime, it is theoretically possible to get rid of the virus within a geographical area. Had these measures been put in place in Wuhan, the epicentre of the first outbreak, these measures could have worked as well. But they didn’t implement them quickly enough and now it is everywhere. Given the interconnectedness of the world, any solution needs to be global in nature.
None of the available options are good ones so it comes down to choosing the least-bad ones. Science, in a popular conception of it, allows us to think we can beat this disease without the difficult trade-offs. Well, it cannot. Perhaps the foundations of modern scientific thought, derived as it is from the enlightenment or age of reason, can prevent us from making disastrous decisions. On a personal level, however, understanding this requires that we transition through what psychologists (and not scientists) call the five stages of grief – to finally reaching acceptance.
With this in mind, all of us have to be wary about politicians using science to explain their decisions, whether lockdown protocols or other measures that may follow. It is not about science deciding, it is about politics, because the questions at stake are about values: How much risk is acceptable? How do we weigh competing alternatives? What kind of society do we want to live in and have our children inherit? There is no scientific answer to any of these questions.
While scientists themselves may welcome the prominence given to their work and what they recommend (who of us before two months ago could give the name of a single epidemiologist?), they should be very clear that the same politicians who used their advice for making whatever decision will not hesitate for a moment to throw the same scientists and perhaps science itself under the bus when things are looking especially dire – as they most certainly will be.
The scientific community should guard against science becoming a proxy battle covering the political motivations. Science cannot solve those issues. Politics is primarily about power and control, so it is not surprising that politicians are particularly attracted to the work done by epidemiologists. This scientific discipline is essentially a search for the cause of disease, identification of people at risk and determining how to control or stop the spread of pathogens. A by-product of controlling the disease is the control of the potential carriers of the disease. That is to say, the rest of us.
Already in countries like the UK there is increasing disquiet (Scientists criticise UK government’s ‘following the science’ claim) about the disproportionate influence of epidemiological models to justify lockdowns and not enough on the economic, social and psychological costs of being under lockdown.
To a very large extent, the nature of the Covid-19 disease gives it the high prominence it has. Current estimates of its mortality rate, globally, is around 1% of those infected but varies significantly depending on age and the presence of certain defined pre-existing co-morbidities. The tidal waves of the very sick, some critically sick in hospitals and other treatment facilities, is highly visible and politically unpalatable. This is quite different from the large number of existing chronic illnesses from which many South Africans die every year, a large part of them made worse by pervasive poverty and poor service delivery. These are deaths that are largely unknown and unseen. Already, the coronavirus epidemic is displacing critical vaccination programmes for measles given to children:
SA’s Covid-19 models were ‘flawed’, says former NICD expert. In the absence of these vaccinations, the awful diseases they stop will be back.
Facing the prospect of a cratering economy – itself a consequence of years of poor governance, corruption and theft and not just the pandemic – it is not at all surprising that different levels of lockdowns, associated curfews and special permissions to run businesses must seem very attractive options.
Beyond the imposition of lockdown measures, any viable test, trace and isolation regime that might work will require enormous amounts of surveillance and monitoring of our daily lives. It is far from clear that the country can test at anywhere like the level required, much less isolate sections of the population that may be infected (but are otherwise healthy). But the technology to build a huge digital surveillance state that would otherwise be unconstitutional certainly does exist: Analysis: Inside amaBhungane’s landmark ruling on surveillance….
The whole thing puts us in a bind. The government might ask whether you have better ideas, whether you care more about our grandparents more than your privacy. For now, the government’s approach has support. Success in dealing with the pandemic is measured by how few people have died at this point. Some go further, and make the completely facile claim that this success has something to do with the gender of the leadership of countries with this success: Are female leaders more successful at managing the coronavirus crisis?, without an understanding of the different approaches between them or that success in a two-year or longer period cannot be called three months in.
Perhaps most disturbing is the collective punishment aspect – you get to win more rights, or a different lockdown level (thanks for that, Democratic Alliance) if the infection rates fall below some completely arbitrary level. The idea, punted by the Trade and Industry minister, that the economy and its various supply chains that make it up can be neatly divided into essential or non-essential businesses is obviously absurd.
By now it should be clear that lower levels of lockdown are no longer attainable after the disease spreads into the informal settlements: De-densification is just a fancy word for eviction. The facts of the matter are this: no matter how hard you lock down in the suburbs, if the disease gets into informal settlements, there is nothing anyone in the suburbs can do about it. In fact, lockdowns in informal settlements will make the spread of the disease there even worse, not better. That this is not taken into account by anyone in authority, including the DA in opposition, is cause for considerable concern.
Remember, this pandemic will be with us for at least another two years.
The suspension of basic rights to combat the pandemic is not a uniquely South African problem. In Germany, Chancellor Angela Merkel recognised the democratic impositions required to curb the spread because it restricts “exactly what our existential rights and needs are”. For this reason, transparent and comprehensible communication is necessary, and criticism and opposition must be demanded: Angela Merkel’s Government Statement | Full English Transcript.
Our government, on the other hand, feels it has no such obligation about the suspension of our rights. Instead, it does the opposite – again fully backed by the official opposition. Epidemiologists might say what measures can slow the spread of the disease. Our politicians – all of them – see this opportunity as a welcome measure to control you.
What the epidemiological interventions don’t show is that their measures require the voluntary cooperation of everyone. This means giving access to screening/testing personnel into all areas, including our homes, and allowing the high levels of surveillance required by the testing, tracing and isolation component of the programme. One would think that our government would have learnt something about the stigma surrounding HIV/Aids and use these lessons for the present pandemic. Obviously not.
What do we get instead? The very opposite of confidence building.
Instead, we see efforts by politicians to do the kinds of things that they otherwise would be prevented from doing. One example is the arbitrary lockdown regulations on the sale of alcohol or cigarettes. Alcohol abuse in this country is a problem, no doubt, and one reason ICU facilities are overloaded. But while banning alcohol might work for a month or so, beyond that the trade in it just moves underground with the associated gangsters controlling the trade expanding their territory deep into the suburbs. As with the trade in other drugs, sellers and buyers here both have good reasons not to be subject to any kind of surveillance, much less the surveillance required by a comprehensive coronavirus test, trace and isolate programme. Criminologists or economists or historians would know this. Epidemiologists? Probably not.
We now see that the health minister wants the cover of the crisis we face to introduce his NHI scheme. This is not to criticise NHI itself, which is a different debate; it is the using the cover of a crisis to slip it in.
This effort to slide in other agendas is not, by any stretch, limited to the KwaZulu-Natal arm of the governing party. Everyone is piling in. So, in tourism, support from the government is dependent on a failed BEE scheme. The finance minister, who should know better, thinks his role in supporting small business, especially the restaurants, also gives him an opportunity to chase out the participation of foreigners or to change the nature of the spaza shop trade: WRAP | Mboweni argues for hiring more South Africans in post-lockdown economy.
If there are not sufficient causes for great concern, how is it that the deployment of 73,000 soldiers could occur in an irregular fashion? SA’s Constitutional Democracy?: The path of Ramaphosa’s letter for major SANDF deployment raises serious concerns around separation of powers or that SANDF Chief of Joint Operations Lieutenant-General Rudzani Maphwanya could feel free enough to state, “While we are being provoked, law enforcement will not allow anyone to insult the president. We will react immediately. It is important that this is known.”
What about several reports of gross misconduct by variously the police, the military and metro law enforcement and their inclination to humiliate those they decide have breached the lockdown regulations? Or the vindictive arrests of informal traders just trying to get by?
The government seems completely unaware that the imposition of lockdowns, to be successful, will need the support of all its citizens. As these lockdowns continue for the foreseeable future, support for them will evaporate, and with that the mushrooming of a vast underground economy in which the majority of the country participates. No amount of force, particularly from the already highly compromised police service, much less the military, can change this.
If our constitutional rights remain suspended for anything like the duration of the pandemic, a period during which the economy will be in severe depression causing immense additional suffering, then President Ramaphosa will be remembered as the man who both birthed the Constitution and extinguished it. DM