COVID-19 tunnel vision

Six weeks ago I walked into a grocery store in Cape Town and started crying. I didn’t really know why I was crying, but there I was picking up onions and garlic and doing my best to (unsuccessfully) hide my overt emotion. Maybe it was all the masks, or that everyone was anxious, but I think it was that we all knew something was coming but we didn’t know how bad it would be. In any event, it’s my first memory of noticing that the virus was affecting me, even if I wasn’t infected.

Normally I numb the guilt of being rich in an unequal country by throwing myself at  meaningful work that I think helps make things right. It’s kind of like karma and emotional bargaining all wrapped up into one coping strategy. Whatever it is, it usually does the job. Yet here was a virus that would go on to devastate the lives of the poor and there was nothing that I could do about it. Like the drought before it, and the financial crisis before that, the real costs of this virus will land on the people who are already on the wrong end of the scale in South Africa. Maybe it takes a virus to remind me of how genuinely fucked up the South African social contract is. That some of us get to live in comfort and pleasure and follow our dreams, while others face the daily injustices of living in a place where you are denied the most basic things to live a dignified life. To have running water in your home, a job to provide for your family and enough food to eat so that you don’t go hungry. And all of this because we can’t find politically feasible ways of sharing the wealth we have.

It’s horrible to realise not only that the world is unfair, but that it is unfair in your favour. And now we have the latest instalment of it: a virus that has stopped us in our tracks. We cannot travel, we cannot work, we cannot touch each other. Sometimes it seems that all we can do is wait and trust that the government knows what it’s doing, and that we have the people and the resources to fix the problem and limit the suffering.

Listening to the President’s speeches announcing how our country will tackle the coming challenges I was initially filled with pride and hope. Hope that the competent part of the ANC had prevailed, and that this was Ramaphosa’s finest hour. He showed leadership and vision as he unveiled his plans with clarity and resolve. All of us were taken into his confidence and we prepared a place for him in our national mythology.  He would be the leader who listened to the science in a way that Mbeki never did, and  the one who could spend R500-billion with moral integrity, something Zuma always lacked. His speeches harked back to Mandela’s era where bold policy reforms were coupled with competent and mostly ethical leaders. There was hope that things were improving steadily, even if they weren’t improving as fast as we would like.

The optimist in me wants to hold on to this belief and trust that the “good guys” can pull through and steer our ship away from the rocks and keep the crew clothed and fed. But the realist in me is starting to doubt. How did it happen that the discussion on ‘flattening the curve’ changed to avoiding COVID-deaths at all costs? As a fellow economist recently said to me “I worry that public health experts are luring us into this unsustainably conservative “But-is-it-worth-the-risk?” way of thinking. We do allow risk into our lives all the time and with COVID-19 we have always been navigating trade-offs from the start. The real question is whether the benefits are worth these massive costs?“

I now also wonder whether the benefits to the wholesale closing of  the economy, closing schools and shutting down all forms of public life are worth the costs, especially if they are prolonged beyond their initial duration. Well respected economists have estimated that an additional 4-million people have moved into “extreme poverty” in South Africa as a result of the lockdown, i.e. they have moved below the food poverty line. While some of this will be alleviated by the increased grants, in the month of April during the lockdown there were no increased grants. Extreme poverty is essentially surviving on less than R10 per person per day (R337/month) which means that you no longer have “the minimum expenditure needed for sufficient calories if people spend their money only on food.” So, in order to “flatten the curve”, for as long as we keep the economy locked down, an additional 4-million people will no longer have enough food to eat, even if they spend all their money on food.

Already 1.6-million children under the age of five are stunted in South Africa, a number that has almost certainly risen as a result of the extended lockdown. These millions of children are now at further risk of other non-COVID diseases because their immune systems are compromised. To quote a  2017 overview of stunting in South Africa: “Undernourished children are at risk of infectious diseases, especially diarrhoea and pneumonia. They also take longer to recover.” Given the long-term effects of child-stunting, how should we be balancing these extra-ordinary measures for preventing the deaths of some of the elderly and infirm with their impact on children and poor households?

The lockdown is also likely to be highly costly to the elderly as well, many of whom will not seek medical attention for other illnesses that can also kill them. In 2018 alone a total of 63,000 people in South Africa died of tuberculosis, a completely treatable disease, yet one that requires uninterrupted medication and adherence. Last month the UN announced that it was concerned that COVID-19 was putting routine childhood immunisations in danger given that schools are closed and countries are locked-down.

I think in hindsight the 21-day lockdown will have been necessary, but extending the lockdown indefinitely is not sustainable. It is not clear that the epidemiologists advising the president are taking into account all the non-COVID impacts of these mitigation strategies. Surely there are ways of offering reasonable protections to the elderly and infirm while not drastically exacerbating other equally-serious problems in South Africa.

It feels that we have now moved into a space of COVID-19 tunnel vision, with a single-minded focus on infections and deaths specifically from COVID-19.  What about all the other causes of death and long-term suffering introduced by these ongoing lockdowns? Perhaps what we are winning on the swings we are more than losing on the roundabout?

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PS: In order to try and measure the impact of COVID-19 on income, employment, hunger and welfare in South Africa, I – together with over 30 researchers – am heading up the Coronavirus Rapid Mobile Survey (CRAM). It is a nationally-representative telephone survey of 10,000 South Africans surveyed monthly for six months. the aim is to provide rapid, reliable research to policy-makers so that they can make evidence-based decisions. More info here: http://cramsurvey.org/