As coronavirus infections increase, at ferocious speed, in South Africa, I spent the last two weeks driving through this huge country trying to understand where and why things are going well and badly.
Here, at seven points, there are some initial conclusions and, perhaps, some more lessons for the rest of the continent.
1) The fog of war
Watch out for statistics, even here in South Africa, which has one of the best data compilations on the continent.
And be even more careful with anecdote-based assumptions.
Some observers have been quick to celebrate the numbers that seem to show an impressively low death rate for Covid-19 patients in the country: 1.4% compared to 15% in the UK. Could it be due to a relatively young population? Or perhaps Africans enjoy some special immunity, genetic or otherwise?
The short answer is No. Or, rather, it is still too early to know.
If you compare, for example, the death rates of confirmed virus patients in the main hospitals in South Africa, they are almost exactly the same as in Italy or the United Kingdom.
But when it expands the statistical set beyond hospital admissions, each country and each province is using fundamentally different criteria and methods.
“It doesn’t make sense,” the University of the Witwatersrand vaccine expert Professor Shabir Madhi told me.
He notes that so little testing is being done in the rest of the continent that it is impossible to draw any useful conclusions or comparisons. Their hunch is that, as with the 2009 swine flu pandemic, we will only know the true impact of the virus in Africa in several years.
2) Fear of hospitals.
Staying on the topic of statistics, South African researchers have released alarming data on 17,000 excess deaths that appear to show a significant underreporting of Covid-19 deaths here.
As the researchers point out, a growing fear of going somewhere near hospitals or clinics, not unfounded in some places, can be a significant factor.
This means that many people with the virus die at home, while others succumb to different diseases instead of seeking treatment.
TB testing, for example, has decreased by about 50% in recent weeks, and there has been a 25% reduction in vaccines in South Africa.
The solution? There is no quick fix for this, but local health departments need to do a better job of working with their communities, to build trust with both patients and staff who have often reacted to new infections and possible exposure, for example, completely closing clinics for weeks.
3) Beware of white elephants
In Port Elizabeth, the private sector has built a new giant coronavirus “field hospital”. But, as of last week, only about 30 of its 1,200 beds were being used due to a shortage of essential personnel and oxygen.
“Brainless,” said Professor Madhi, disparagingly when speaking of the hospital.
The Gauteng provincial government has built something, but again, almost none of the beds are staffed or supplied with oxygen, leaving the facility nearly empty and prompting volunteers and private donors to step in to try to rescue the situation.
“Oxygen is the new currency,” a doctor told me, complaining that more than half of the facilities were still “a white elephant” and that plans to add another 700 beds would be a total waste of time and money if the local government did not. secure additional oxygen supplies and hire required medical personnel.
4) Here to stay
“The storm is upon us,” President Cyril Ramaphosa said last week, and his choice of climate metaphor was successful. After all, wars, the virus analogy favored by many world leaders, tend to end, while the weather will always be with us, and perhaps so will this coronavirus.
In the absence of a vaccine, herd immunity, or a significant behavior change, several experts have told me that they believe South Africa may have to treat Covid-19 in the same way that it handled TB (which still kills about 200 people all the days here) and HIV and learning to live with the virus long term.
5) Ground Up
Much has been written about the energetic, generous and sometimes effective role that South Africa’s private sector plays in helping to combat the virus. But, as usual, it is local communities and small organizations that make the biggest difference in such crises, and too often overlooked.
Doctors in Cape Town told me that it was the clinics that enjoyed the closest long-term relationships with local communities and understood how to communicate with them.
Cape Town’s Facebook page is a good portal through which to explore the types of grassroots work that thrive during the blockade, for example Community Action Networks, and which can still help reconfigure one of the most unequal of the world, and isolated societies, once the immediate storm has passed.
6) Expose the rot
It was a revealing moment. Amid this health crisis, powerful figures from South Africa’s ruling ANC were found to be pushing to reinstate two high-ranking figures who had been implicated in one of the country’s most egregious corruption scandals of the country: looting and the collapse of the rural bank VBS.
It was a sobering reminder of institutional rot within the ANC, where competition and honesty are sometimes valued less than party loyalty, and where a culture of “cadre deployment” has left some key state institutions, such as hospitals and services health, for example. by unskilled match hacks.
“If you don’t have strong management systems, you can’t change the situation overnight, during a pandemic,” a senior doctor in Johannesburg complained, arguing that the Gauteng Provincial Health Department was almost as incompetent as the Eastern Cape.
You may also be interested in:
Following this crisis, and I recall that something similar was revealed in every village after the Asian tsunami, the quality of local leadership seems to be a defining factor in distinguishing between successes and failures.
7) Masks, masks, masks
As the UK agonizes over the details of when and where and how to wear masks in public, it is encouraging to note how quickly and relatively obediently South Africans have turned to the business of covering their faces.
Yes, there are huge and growing frustrations here, not least in the hospitality and alcohol industries, as they grapple with the implications of contradictory and sometimes erratic government shutdown rules.
For example, why can passengers get on a minibus but people don’t eat in restaurants?
But many doctors here seem convinced that masks will prove to be the most important step in fighting the virus, particularly in populated villages, where social distancing is almost impossible.
