The dark at the end of the lockdown tunnel

Jeremy Gordin on why Dr Salim Abdool Karim's recent presentation was less than reassuring

On Monday evening Durban-based epidemiologist and infectious diseases specialist Dr Salim “Slim” Abdool Karim, who has emerged as the government’s main adviser on Covid-19, made a presentation on a number of TV networks on what is happening and what we can expect to happen with the virus in South Africa.

A few other epidemiological experts, including Dr Brian Williams and Dr Glenda Gray, joined Karim and Health Minister Dr Zweli Mkhize via Zoom (or perhaps Skype, I’m not certain). Unfortunately, those not in Durban were largely inaudible. “They [presumably eNCA or perhaps the KZN health department, host of the public presentation] make incompetence into an art form,” a friend WhatsApped.

Previously, in a private “paper” circulated to colleagues, friends and acquaintances, Geneva-based epidemiologist Williams indicated that he was opposed to a full-on lockdown. On Monday evening, however, he congratulated Karim and then mostly held his tongue.

I mention this not to embarrass Williams (or Karim for that matter) but to note that Williams’ private “paper” was emailed 21 days ago, on March 24. Maybe Williams has changed his mind; perhaps what Karim mainly covered – SA’s apparently successful flattening of the expected infection curve by means of a lockdown – was reasonably accurate, so why muddy the waters on a public platform, one where the message was clearly aimed at boosting our national morale?

What I’m trying to highlight is that, when it comes to the Covid-19 virus, 21 days is a very long time indeed. The effects, trends and treatment of the virus are moving very rapidly even by modern computer-speed standards. What even the “expert” was certain about four days ago seems to have shifted by yesterday. Secondly, in South Africa, where Covid-19 has not truly hit, where it is still largely unknown and therefore scary, we tend to grasp at and embrace warmly any information that seems cogent and authoritative.

Back to Karim’s presentation. As already noted, its aim was to tell us how well South Africa has done by turning the usual vertical trajectory of new Covid-19 infections into a more horizontal line and thereby buying us more time for the acquisition of equipment, hospitals and especially doing more testing.

But – and this is important, Karim is far from being irresponsible – having pumped up the tyre, Karim did not shy away from immediately letting all the air out, by pointing out that “we” are not going escape the contagion; all we’ve done is buy time.

Nonetheless, members of the media and others promptly gushed on Twitter. Adam Habib, Wits vice-chancellor: “The eNCA public engagement with experts ... is a master stroke. Astute political and public leadership on the part of the President & the government.” Nickolaus “there’s the pesky old flag” Bauer: “Good to see South Africa has medical experts to mansplain [sic] to the whining political class and WhatsApp group experts.” Ferial Haffajee: “Sharp move by ... Mkhize to let the chief scientist explain the viral curve’s hopeful [sic] movement. ... It shows a close concert between science and politics [sic] ...”. Andrew Harding of the BBC: “Deeply impressive briefing from SA’s top virus expert ...... Karim ...shows nation’s current success in abruptly flattening curve ... is ‘unique’ in the world. Due – it appears – to early actions and lockdown.”

Well, why not? Given the past decade and more of our history, we need all the self-congratulation we can muster, especially if some can find a way to applaud the President and government into the bargain.

But I can’t help wondering about people, especially experts, who seem to suggest that they have Covid-19 under control – that they know precisely how it’s going to behave and what it’s going to do. When Pope Francis warned in 2017 that the Devil is far smarter than mere mortals, he was ridiculed; but if you said the same about Corona-19, I wouldn’t be able to summon up any derision. Not now anyway.

For example, what if Karim is ascribing to his own brilliance – or the government’s or ours – what is largely due to favourable weather, other important interventions (such as halting international flights), and only partly to the lockdown itself? He was asked about the effect of the weather and replied rather disparagingly that Covid-19 lives happily at 37.5 degrees C (the human body temperature), the implication being that warmth/seasonality does not affect Covid-19.

Not really a satisfactory response, is it? Influenza also lives happily at 37.5 degrees C. There does exist a “flu season”. It is coming to an end in central Europe and the United States, with the onset of spring, and, coincidentally or not, indications are that the number of new daily Covid-19 cases are now declining steadily in these regions. This is also, one supposes, a key reason why infections in southern hemisphere countries have, up until now, been lagging far behind the northern hemisphere ones. Look at other countries now in autumn and there’s little that is all that “unique” about our flattening of the curve. In fact, both Australia and New Zealand have bent their curve downwards more successfully than we have, and currently report far fewer daily cases than we do.

Significantly, our figures are not so flat if you look at the right metric. Strip out the imported cases from March – which have ended due to the grounding of most international air travel – and it is evident the trajectory of local infections remains upward. It’s ancient history by now but up until Sunday 22 March there had been only 26 recorded cases of local transmissions, out of 274 confirmed cases. On April 14 there were 143 new cases, almost entirely local, with a large cluster of infections at an East London prison a major contributor. Today there were 91.

This brings us to the “second part” of Karim’s presentation. A major step or steps outlined here (stages 4 and 5) is “hotspot identification and intervention”. According to Karim, we have more than 28 000 community health care workers who will be going house-to-house in “vulnerable” communities for screening and testing purposes – to establish precisely where infections have caught fire (“hotspots”).

If, as Karim put it, the separate little fires can be pinpointed and quenched, before they become like those major conflagrations that from time to time envelop Table Mountain, we’ll be in control. He called this “ongoing CHW (community health workers) house-to-house screening and testing especially in vulnerable communities”.

But will this happen, and can it happen effectively? And, most importantly, will it happen in time? If your testing has lagged, or if you haven’t done much of it yet among the poor, you have a lot of catching up to do, given how quickly and quietly the virus can travel. This would be less of a problem were we not about to go into winter – a time when a large part of the country, such as (eastern) SA, is cold and dry, and when Covid-19 looks set to run riot along with the other respiratory infections we get. 

Finally, regarding the lockdown, which is estimated to be costing us R13 billion per day. Karim lauds it because it has helped flatten the infection trajectory and “bought us time”. Fair enough. He noted, almost in passing, that of course the lockdown can’t go on forever. (I’d suggest there are people in the cabinet who think it could and should – but this is another matter.) 

Karim suggested a staggered unlocking of the lockdown – a “systematic easing” – lest there be a sudden abrupt increase of the infection spread. If the average daily cases from the 10th to 16th April were over 90 then the lockdown should continue, he said. Under 44 and it could be eased. In between he had a more complex formula dependent on cases picked up through surveillance.

From the 10th to the 15th, cases have averaged 95 per day, so no prospect of any “easing” soon. And if the infection rate takes off, with the onset of cooler weather, when exactly will the lockdown be lifted? 

Mkhize was asked about the economic consequences of the lockdown, but he dodged the question, a little uncomfortably, it looked to me. For whatever some might remind us about Mkhize – that he’s a politician, served as ANC Treasurer-General from 2012-2017 and was (maybe still is) a good friend of Jacob Zuma – he does seem to possess the most important character trait that the Talmud contends a wise person should have: “S/he concedes to the truth”. But perhaps Mkhize thinks, or has been clearly advised, that economic consequences are not within his bailiwick.

A friend of mine, a veteran journalist under lockdown overseas, messaged me a while back: “It’s the economic argument that pixxes me off – better to save the economy than lives. It’s probably right, but still pixxes me off”.

I’ve been pondering about that comment for about 10 days. Admittedly, my thoughts have been fed by anecdotal information, not anything as reasoned as the essays on Politicsweb on why and how the lockdown should be halted, including those by Shabir Madhi et al and DA leader John Steenhuisen.

What I have noted is that those arguing for an extension of our lockdown are, with rare exceptions, people who are paid handsome salaries by government (vu den?) and by established companies, including media houses; and what I’ve also learned is that the lockdown is destroying lives and families, not to mention the country’s already-crippled economy, whatever brave words Finance Minister Tito Mboweni and Reserve Bank Governor Lester Kganyago muster. And it’s happening now.

On Tuesday, according to Media24, in Manenberg in the Cape, a man claimed he was held at gunpoint while his store was robbed as other shops in the suburb were looted by large groups of people. The Sowetan reported that, also on Tuesday, police fired rubber bullets to disperse Alexandra residents who had gathered near the Marlboro Gardens Secondary School, thinking they were going to receive food parcels.

Bongani Maluleke, 44, a husband and father of four said: “I don't know why they are shooting at us. We are peacefully waiting for food. We were told by our councillor to come receive food. We were here yesterday and were told to come back today. I’m a contract worker and last worked in November; it has been very difficult to survive during this lockdown.”

Coming soon to a supermarket near your home?