Salim Abdool Karim, a formidable and respected scientist, was blunt at the start of the initial Covid-19 lockdown. South Africa would not escape the worst of the coronavirus epidemic; an exponential spread was unavoidable.
That was six months ago. A second wave was inevitable and there was no clear strategy to tackle it then. There still isn’t one now.
Minister of Health Zweli Mkhize announced on Wednesday night, 9 December, that the country has officially entered the second wave of the pandemic. The four provinces leading this new wave are the Eastern Cape, Western Cape, KwaZulu-Natal and Gauteng.
Mkhize said that teenagers between the ages of 15 and 19 have been leading the rapid rise in infections in the past few days. There were 6 000 new cases recorded in a single day after a massive end-of-year matric rage festival in Ballito was, bizarrely, allowed to go ahead. Similar events in Gauteng, the Western Cape and the Eastern Cape have since been cancelled.
The festive season brings with it widespread interprovincial and international travel, and the state’s response over the next three weeks will be critical in determining how the second wave plays out.
The initial level-five lockdown imposed six months ago was an authoritarian strategy that was not justified by medical best practice. Huge numbers of jobs, businesses and livelihoods were lost; many people were subject to serious state violence, including murder; the lockdown was used as cover to enable the state to attack grassroots activists; and there was a grim increase in violence against women as people were confined to their homes.
The second wave has hit the Eastern Cape particularly hard. The province has been sinking into crisis for years. Appalling mismanagement of the state, pervasive corruption and a general sense of entitlement and impunity on the part of self-serving politicians has led to worsening impoverishment and crumbling social infrastructure, including the healthcare system.
People are dying in the packed waiting rooms of hospitals and entire units of health workers are being infected with Covid-19 while politicians steal food parcels and get rich off unscrupulous personal protective equipment tenders. Critical frontline workers are bearing the deadly consequences of the shortage of protective gear and lifesaving equipment.
“We were not expecting a second wave and are not prepared for it,” Eastern Cape healthcare workers told disaster relief organisation Gift of the Givers in recent interviews.
“We need more bed space, our hospitals are full. We are using B&Bs, but there’s no oxygen there. It’s a risk. We need oxygen, high-flow nasal oxygen machines, flowmeters, oxygen gauges, splitters and oxygen masks. We need blankets to cover our patients, it’s a question of their dignity, linen for our beds and infrastructure upgrade. The response from authority is standard: ‘There are no funds. It has to be considered in the next financial year.’”
Gift of the Givers reported that hospital chief executives and senior management sobbed uncontrollably when they received life-saving equipment from the organisation.
The state’s response to the escalating crisis in the Eastern Cape has been to extend the curfew and restrict alcohol sales. This is wholly inadequate.
Global experience shows, clearly, what works and what does not. Countries presided over by right-wing populists such as America’s Donald Trump, India’s Narendra Modi, Britain’s Boris Johnson and Brazil’s Jair Bolsonaro have experienced high rates of infection and been unable to bring the pandemic under control. Trump has been particularly reckless, with his nods to conspiracy theorists, crude attempts to racialise the virus and maskless election rallies that provided the perfect petri dish for superspreader events. The United States hit a new global daily record with a staggering 3 124 Covid-19 deaths on 9 December.
But in Vietnam, South Korea, Germany, New Zealand, the Indian state of Kerala and China – the source of the outbreak – governments effectively slowed the rate of infection and number of deaths by quickly implementing track, trace and test protocols while ensuring that all citizens had a strong support system.
South Korea avoided a second wave early on by using retrospective tracing to investigate outbreaks and identify key transmission spots such as bars, nightclubs and places of worship.
Taiwan has had no reported deaths since May. Authorities followed up on cases telephonically, by text message or with home visits. They offered support, including meals and grocery delivery.
China and New Zealand initiated strict travel bans and rigorous quarantines, and deployed rapid testing and tracing systems.
Germany was initially well prepared. The country tracked, traced and tested on a large scale after the summer holidays, but in recent weeks saw a resurgence of 24 000 infections in a single day and 590 deaths on Wednesday. Chancellor Angela Merkel has pleaded for a full lockdown after Christmas to reduce infection rates.
Huge social cost
The South African government certainly did better than the likes of Trump. Here, there was no equivocation on the science in terms of the seriousness of the virus. But by failing to implement an effective track-and-trace system, in the end the state substituted crude authoritarianism for medically effective and nuanced social policy. And that authoritarianism came with a huge social cost.
Now that a second wave is manifesting in many of the countries that initially mishandled the pandemic, states are moving quickly to try to contain the virus.
Italy has banned midnight mass, the most important church service of the year in the deeply Catholic country. And movement between towns has been restricted as it posted its highest daily death toll of the pandemic. On Thursday 10 December, 993 people died.
In the United Kingdom, Johnson has implemented a three-tier system that places citizens at one of three levels, depending on their circumstances, each with its own set of medium to hard regulations. The UK has also administered the first clinically approved BioNTech-Pfizer vaccine, which is issued with a warning for people with a “significant history of allergic reactions” to steer clear of it.
South Africa is hoping to receive its first batch from the Covax global vaccine distribution scheme in mid-2021, but it has missed the first payment window. More positively, South Africa has joined India in calling for the World Trade Organization to suspend all intellectual property rights linked to Covid-19 to ensure it is not only rich countries that are able to afford access to vaccines.
But not all countries are experiencing a second wave. South Korea, China, Taiwan and Vietnam have been rigorous about tracking, tracing, testing, isolating and supporting their citizens, who have been long accustomed to wearing masks. Vietnam, a country with a population of 95 million, has a recorded infection rate of fewer than 2 000 cases. The country employed effective contact tracing, isolated infected people in hospitals and quarantined infected neighbours to curb a rise in infections. In Wuhan, where the virus was first recorded, life is back to normal.
The contrast with South Africa is bleak. On Thursday night, the country recorded more than 8 000 new infections and there’s no apparent sign from the government of an urgent, sustainable, medically credible and life-saving response.
We can be pleased that President Cyril Ramaphosa is a vastly more rational actor than Trump, Modi, Johnson and Bolsonaro. But the South Africa state has been instrumentalised for years by a predatory political class who misuse the state to enrich themselves at the direct expense of the rest of society.
The Covid-19 crisis was very effectively exploited to enrich those in and linked to the political class. It was also effectively exploited to indulge the authoritarian fantasies held by some of our most powerful politicians. However, after years of the state being organised to enable the private accumulation of the political elite rather than the development of the public good, we simply don’t have a government capable of meeting the challenge of the Covid-19 crisis.
Urgent and decisive action is required against the corrupt elements in the state, and equally urgent and decisive action is required to retool the state to serve the public good. But this cannot be achieved in the weeks ahead. What is required now is a strategy that brings our best medical and social scientists together with popular organisations and the best elements in the state to do what we can, as effectively as we can, and as quickly as we can.