Category Archives: COVID-19

Judgement Date with Dennis Davis

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Earlier this week Judge Dennis Davis and I spoke about COVID-19, school closures, the National School Nutrition Programme, child hunger, NIDS-CRAM, job losses, gender discrimination and the Basic Income Grant. The full interview is available here.

New research on COVID-19 infections among teachers in Gauteng

There are three new pieces of writing worth highlighting on COVID-19 and schools:

(1) Today the DBE launched a report “Patterns in the COVID-19 cases among learners and staff in Gauteng schools Analysis of school-level data to 8 July” (PDF) written by Prof Martin Gustafsson in collaboration with Albert Chanee (DDG in GDE). Executive Summary below. It shows teachers have a 0.8% risk which is the same as the 0.8% risk for the general public in Gauteng.

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(2) Martin’s Daily Maverick op-ed “Figuring out what the WHO is really saying about schools and the pandemic.” ‘A careful reading of the World Health Organisation’s policy documents shows that it does not stipulate when schools should reopen’.

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(3) The new strongly worded position statement by the SA Paediatric Association’s on public school closures.

“The paediatric community, as represented by the Paediatrician Management Group (PMG) and the South African Paediatric Association (SAPA), is disappointed with the recent cabinet decision to close all public schools again. Following on the original SAPA position statement, supported by PMG, we believe this recent decision is not based on best available scientific evidence and it is not in the best interest of children in South Africa.”

“Six reasons why schools must be open if we are to fight Covid-19” (My DM Op-ed)

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Nationwide lockdowns and school closures have incredibly high costs for families and children. Limiting Covid-19 infections must be a top priority, but it cannot come ‘at any cost’.

These are six main reasons why schools must remain open while implementing rigorous safety protocols and physical distancing:

  1. Schools provide essential meals to hungry children

When schools were open and operational, they provided a nutritious meal to 9 million children every day. Child hunger has more than doubled since the start of lockdown with 1-in-7 people reporting that a child went hungry in their household in the past week. The courts have ordered the Minister of Basic Education, Angie Motshekga to reinstate school feeding for all 9 million children immediately. Realistically, schools cannot provide meals to 9 million children if they are closed. While children do not get severely ill from Covid-19, they are at risk of suffering from stunting and malnutrition.

2. You cannot reopen the economy without reopening schools

There are 4.5 million essential workers in South Africa and 650,000 healthcare workers who are on the frontline of dealing with the pandemic. If schools are closed, what happens to their children while they are at work? We compromise the healthcare system if schools are closed. Furthermore, we have already lost 3 million jobs during 2020, plunging more than 1 million people into food poverty. Parents cannot go back to work if schools are closed.

3. There is no evidence that schools lead to above-average Covid-19 infections among teachers or pupils

It is true that some teachers have been infected with Covid-19, but it is also true that many teachers were infected even before schools reopened. Teachers are more likely to get infected in their community than at school. An analysis of 709 Gauteng schools shows that Covid-19 infection rates are no higher among teachers than similar people in the Gauteng population. Put differently, just because teachers get infected does not mean they got it at school. Further evidence comes from hospital admission data from the Western Cape during its Covid-19 surge and provides reassuring evidence. Opening schools had little impact on children getting infected with Covid-19 or getting admitted to hospitals.

4. Medical experts and advisors are saying that children returning to school is what is in the best interests of the child

The South African Paediatric Association, the Ministerial Advisory Committee and the South African Human Rights Commission have all stated clearly that they believe that children returning to school is in the best interests of children. The costs of being locked up at home (potentially alone), are far greater than the small risks they face at school. Children do not get severely ill from Covid-19. Those under the age of 20 make up less than 1% of total Covid-19 deaths in SA.

5. The World Health Organisation’s recommendation must be contextualised to South Africa

When the WHO is making recommendations, it is doing so for 195 countries. But there is no one size fits all approach. What makes sense for Germany might not make sense for Malawi. What makes sense in South Korea does not make sense in South Africa. They do not have 1 million stunted children, widespread HIV and TB, school feeding schemes etc. South Africa’s own epidemiologists are advising that schools must stay open if we are to fight the pandemic.

6. School closures will increase inequality

Only 20% of households have a computer and 10% have an internet connection. Closing schools will increase inequality between rich and poor for the next 10 years. Elderly teachers with serious comorbidities should be replaced in schools. Schools that do not have adequate masks and sanitisers should remain closed until they do, but closing all schools will hurt the poor much more than temporarily closing the 10-20% of schools that are not yet ready to open.

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Teacher unions are undermining our pandemic response. All other government officials as well as those in the private sector have gone back to work and implemented physical distancing, wearing masks etc. But somehow teachers are different? The evidence is showing that teachers are not at higher risk than others and yet they are being paid whether they work or not. By refusing to work, they are risking the lives of children and undermining other parts of society that rely on schools at this critical time. By forcing parents to choose between going to work and taking care of their children at home, they are weakening our ability to fight the pandemic.

The question is not: “When is it safe to reopen schools?” The question is: “Does the cost of closing schools outweigh the benefits?” We should not implement a nationwide lockdown again and we should not implement nationwide school closures either. The costs to children and their families are simply too great, and importantly, fighting the pandemic needs all hands on deck and schools need to be open for that to happen. Limiting Covid-19 infections must be a top priority, but it cannot come “at any cost”.

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This article first appeared in the Daily Maverick on the 22nd of July.

“Women are bearing more costs & receiving fewer benefits” – my DM op ed (with Daniela Casale & Dori Posel)

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Covid-19: Women are bearing more costs and receiving fewer benefits

By Nic Spaull, Daniela Casale and Dorrit Posel

Even though women have suffered two thirds of the job losses since February, men have received two thirds of Covid-19 grants (65%).


On 15 July we released the results of the largest non-medical Covid-19 research project in South Africa: the National Income Dynamics Study (NIDS) Coronavirus Rapid Mobile Survey (CRAM). It shows that three million jobs were lost during the first stage of the lockdown, and of those, two million (66%) were accounted for by women, and in particular poor women. This is a very concerning finding since there are large knock-on effects of this income loss for women and for the children who live in their households, especially when the woman is the sole breadwinner.

Perhaps unsurprisingly, given that initial job losses were so large and concentrated among women, we see unprecedented levels of household vulnerability, with half of all respondents (47%) saying that their household ran out of money to buy food in April and one in five (22%) reporting that someone in their household went hungry in the last seven days. Child hunger has at least doubled since 2018 with one in seven (15%) reporting that a child went hungry in the last week because there was no money for food.

What makes these results all the more devastating is that women are not receiving the new R350 Covid-19 grant at the same rate as men.

In a presentation to NEDLAC on 30 June, SASSA reports that of the 3.25 million Covid-19 grants paid out up until the end of June, only 1.15 million were paid out to women. Put differently, two thirds of Covid-19 grants (65%) were paid to men even though women suffered two thirds of the job losses. 

One potential reason is that people who receive other grants are ineligible for the new Covid-19 grant. For example, many women receive the Child Support Grant which has now been topped up by R500 per caregiver (note not per child). Yet, this grant is primarily for the benefit of the child rather than the caregiver. The implication is that women who have lost their jobs are being disadvantaged because they have children.

This policy response assumes that those who receive the CSG were not personally dependent on their employment or earnings to make ends meet. It is a mistake to think that those who receive grants are somehow “immune” from job losses since they already have a grant.

Gabrielle Wills’ analysis of the General Household Survey of 2018 shows that 63% of grant-receiving households report receiving some income from employment or business, and only 42% said that grants were their “main source of income”. In other words, even grant recipients depend heavily on earnings from employment. And this is not surprising, since the CSG is not sufficient to lift a child above the poverty line, let alone children and their caregiver.

Because the top-up paid for the CSG is constant, regardless of the number of children the caregiver is responsible for, the extra support is often spread very thin, and in a sense is regressive – the more children you have the less there is to go around.

Let’s take the example of a mother living with two children who has lost her job and has no other income support. Her household of three would have to live on R1,380 a month (i.e. the R440 CSG per child plus the R500 top-up). This amounts to R460 per person, which is below StatsSA’s “food poverty line” of R578 a month.

And, of course, this minimum subsistence amount does not take into account the cost of rent, fuel, electricity, clothing and other essentials. Add to this rising food prices during the lockdown, and the loss of the one meal a day through the school-feeding scheme that 9 million children relied on to meet their minimum caloric needs, and it is easy to see how quickly families can fall into destitution.

The Covid-19 grant was designed to protect those who have suffered job loss and the income they were relying on. These grants should be provided regardless of whether a CSG is being received on behalf of a child.

Why so many women are not receiving the Covid-19 grant is not clear at the moment, and Sassa should investigate this urgently. The exclusionary criterion which prevents concurrent grant-holding is likely to be a key factor. It may also dissuade women from applying in the first place. What is clear is that half as many women as men are receiving these grants and yet twice as many have lost their jobs.

This is deeply troubling and requires immediate attention.

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Nic Spaull is a Senior Researcher at RESEP in the Economics Department at Stellenbosch University; Daniela Casale is an associate professor in the School of Economics & Finance at Wits University; Dorrit Posel is Helen Suzman chair and a distinguished professor in the School of Economics & Finance at Wits University. They are also part of the Nids-Cram consortium of researchers, visit http://www.cramsurvey.org

**This article first appeared in the Daily Maverick on the 17th of July**

‘Maternal hunger & mental health’ – with Mark Tomlinson

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(The article below first appeared in the Financial Mail on the 15th of July under the heading ‘Feeding a family‘ – a slightly longer version of that article is included below.)

As the NIDS-CRAM data began to come in during the month of May, it was immediately clear that hunger was widespread. As has been reported in other articles in this edition, 47% of NIDS-CRAM respondents reported that their household had run out of money to buy food, with 22% reporting that someone in the household had gone hungry in the last 7 days. In households with children, 15% of respondents reported that a child had gone hungry in the last 7 days. These are all especially worrying, and considerably higher than anything we have seen in other household surveys. However, given that NIDS-CRAM survey is sampled to look at the entire population, we could not reliably disaggregate these results and explore the impacts on especially vulnerable groups. Two groups of people are at particular risk of long-term negative outcomes if they experience hunger: (1) pregnant women, and (2) new mothers and their young babies.

In order to sample a large enough group of these women, we conducted a separate survey, the Maternal and Child Health (MATCH) survey. This is completely independent of NIDS-CRAM. With the permission and support of the national Department of Health, we were granted access to the MomConnect platform. This is an innovative mobile-phone service and more than half of the women attending public sector antenatal care services in South Africa are registered on the platform. It is the largest database of pregnant women and new mothers in the country. Together with Professor Ronelle Burger, we drew a sample of 15,000 new and prospective mothers from the MomConnect platform with the sampling done such that it is broadly representative of the 930,000 new and prospective mothers on the platform. This was a short SMS survey with two waves of about 15 questions (in English), with mothers receiving R10 airtime per wave to thank them for their participation. The survey covers access to antenatal care, vaccinations, ART, as well as maternal hunger and maternal mental health. We will focus on these last two in this article. It must be noted that because this is an SMS survey, the number and types of questions that can be asked are limited. Mothers’ English literacy levels are also likely to affect the results.

We asked mothers “In the last 7 nights did you ever go to bed hungry?” and if they answered yes, then how many nights they went to bed hungry. Of the 2,214 pregnant and new mothers that answered both questions, 350 (16%) reported that they had gone to bed hungry at least once in the last week (246 for 1-2 days and 102 for 3+ days). More worryingly, 11% reported going to bed hungry for 1-2 nights and 5% reported going to bed hungry for 3+ nights in the last seven.

The evidence is now indisputable that in the first 1000 days (conception to age 2) a child’s brain is hypersensitive to either benefit or harm. In utero, the foetal brain grows rapidly, and after birth the infant brain grows 1% heavier every day for the first three months of life and reaches 80% the size of the adult brain by the age of 3. Because of this profound and rapid development, the foetus and the infant are highly susceptible to potential harms, including frequent hunger. The consequences of maternal and child undernutrition are enormous and include shorter adult height, less schooling, mental illness, diabetes, obesity and reduced economic productivity, and—for women—lower offspring birthweight.

From existing research, we also know that maternal hunger is a risk factor for depression during pregnancy, and that maternal antenatal depression during pregnancy is a strong predictor of a depressive episode in the postnatal period and beyond which is itself associated with a range of later negative outcomes. In addition to the hunger questions we also asked women “In the last 7 days have you felt hopeless, down or depressed?” with frequency options of a few days or most days. Figure 1 below reports those results relative to reported frequency of going to bed hungry. The trends are quite clear, and incidentally are identical for pre- and post-birth mothers. New and prospective mothers who report going to be hungry for 3+ nights in the week were eight times more likely to say that they felt hopeless, down or depressed “most days”.

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In our view, new and pregnant mothers must be prioritized when targeting government relief. Many do not yet receive the Child Support Grant and are thus without that important lifeline. Maternal hunger and poor mental health can have profound long-term consequences for both mother and child.

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*Dr Nic Spaull is the Principal Investigator of the NIDS-CRAM project and the co-investigator of the MATCH study. Prof Mark Tomlinson is a Professor of Maternal and Child Health at Stellenbosch University.

**Note the MATCH data should be publicly available in the next 2 weeks.

 

“A National Reckoning” – My FM essay on NIDS-CRAM W1

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(The article below first appeared in the Financial Mail on 15 July. The unedited version is available below and their slightly edited version is available here).

A National Reckoning

The impacts of COVID-19 on employment, hunger and inequality

– Nic Spaull

The coronavirus pandemic is the largest social and economic shock in our lifetimes. It has fundamentally interrupted everything we do and exacerbated existing problems like poverty, inequality and unemployment. The collateral damage of this one virus has been profound and will be with us for the next 10 years, if not longer. While the South African government acted swiftly and decisively to limit the spread of the coronavirus, implementing a nationwide lockdown within 7 days – arguably necessary and defensible – these mitigation measures have come at a high cost. Never before have we seen so much damage caused in such a short space of time, at least not in the last 50 years. This includes damage from the lockdown, the recession and the pandemic itself. As will become evident in this essay, the true scale of job loss and hunger throughout South Africa is difficult to fathom.  We estimate that between February and April 2020, 3 million South Africans lost their jobs, and a further 1,5 million lost their income (through being furloughed). Furthermore, losses were concentrated among women who accounted for 2 million of those 3 million job losses. Half of all respondents (47%) reported losing their main source of income. These are sobering results. In this essay I will summarize the findings of the 11 research papers that were released on the 15th of July focusing on two related areas: employment and hunger.

Over the last three months, and together with 30 leading social science researchers, we have surveyed over 7000 South Africans from the length and breadth of our country. Using 50 call center agents and interviewing in 10 languages, we administered a 20-minute telephonic questionnaire asking respondents about their employment, household hunger, migration, and receipt of grants. This study, the National Income Dynamics Study (NIDS) – Coronavirus Rapid Mobile Survey (CRAM) is the largest non-medical COVID-19 research project currently underway in South Africa. Our sample was drawn from, and is representative of, a previous survey – the National Income Dynamics Study (NIDS). NIDS was a nationally representative sample of South Africans in 2008 who were selected to be part of the study and have subsequently been visited every 2-3 years, with follow-up surveys in 2010, 2012, 2014 and 2017. Hundreds of academic papers have been written using this study. Earlier this year we were given permission by the Presidency to use the NIDS sampling frame for a new ‘NIDS-CRAM’ study. Due to the operational constraints around surveying people during a pandemic, and the limitations of telephone surveys compared to in-person surveys, this latest iteration has a much shorter questionnaire and a smaller sample size than previous rounds of NIDS. (See also the essay by Andrew Kerr and his co-authors on representivity). While these caveats should not be brushed over, and they are readily and freely acknowledged by the researchers, it is also our view that the trends evident in the NIDS-CRAM data are indicative of the underlying labour market and welfare dynamics in South Africa today. It is also the only broadly nationally representative survey currently available.  As the authors in this special issue, we all agree with economist Stefan Dercon when he says that “waiting for better data is not an option: decisions have to be made now as this risks turning into a disaster, not just for health, but also for people’s livelihoods.” And it is to livelihoods that I would now like to turn and summarise some of the findings emerging from the data.

Unprecedented job losses

During our survey in May and June, the NIDS-CRAM survey asked respondents whether their household had lost its ‘main source of income’ since the start of the lockdown on the 27th of March. A staggering two in five respondents (40%) reported that they had. This has profound consequences for welfare and hunger in South Africa. An underappreciated fact in South Africa is that grant-receiving-households also rely heavily on income earned from the labour market, not only income from grants. Gabrielle Wills and her co-authors show that 39% of grant-receiving-households reported that income from wages was the main source of income, compared to 70% for non-grant-households. If many people lost their job, were furloughed, or were locked-out of their income (for example informal traders), this helps explain the sharp increase in reported hunger that we see in the survey. So, how many people lost their income?

The survey asked respondents a number of retrospective questions about employment and income in both April and February allowing us to compare job losses and income losses over this period. In their paper Vimal Ranchhod and Reza Daniels find that 1-in-3 income earners in February (33%) did not earn an income in April. The weighted NIDS-CRAM data further shows that there was an 18% decline in employment between February and April 2020. In terms of real numbers, the estimate is that there were 17 million people employed in February but only 14 million in April 2020, i.e. that 3 million people lost their jobs. A further 1,5 million (9%) were furloughed. That is, they received no income but reported they had a job to return to. If these numbers are true, the scale of this job loss is unprecedented in South African history.

The next important question is who are we talking about? Who lost their jobs? Who lost their income? It turns out that job losses were most severe for those who were already disadvantaged in the labour market. The rates of net job loss are much higher for manual labourers (-24%) compared to professionals (-5%), for those with verbal contracts (-22%) compared to those with written contracts (-8%), for women (-26%) compared to men (-11%), and for those with a tertiary education (-10%) compared to those with matric or less (-23%). The graph below draws on data from the paper by Ronak Jain and her co-authors and starkly illustrates the disproportionate nature of net job losses and income losses (furlough).

Figure 1: The net percentage of respondents experiencing job loss (i.e gains minus losses) or furlough (an employment relationship but no income) in the working age population: February to April 2020

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It is important to note that the data reported by Ronak Jain and her co-authors is “net job loss”, i.e. it takes account of the people (albeit a smaller percentage) who gained jobs over this period. In another paper, Vimal Ranchhod and Reza Daniels look specifically at job loss (not net job loss) among those who were employed in February, and report this by income and race (Figure 2). What is clear is that Black people were three times more likely to lose their job (28%) compared to White people (11%), and that those earning less than R3,000 a month were eight times more likely to lose their job (38%) compared to those earning more than R24,000 a month (5%).

Figure 2: Percentage of respondents experiencing job loss or furlough (an employment relationship but no income) in the working age population February to April 2020

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Clearly the collateral damage of the lockdown has landed disproportionately on the poor who are also more likely to be in the informal sector, have lower earnings, are less educated, and are more likely to be Black African. This finding is corroborated by all the NIDS-CRAM papers looking at employment.

Women face a double disadvantage

One final trend that is perhaps most clear across all domains is that this pandemic and the job losses it has left in its wake have fallen most heavily on women.  Of the approximately 3 million net job losses between February and April, women accounted for 2 million, or two thirds of the total. Daniela Casale and Dori Posel show that among those groups of people that were already disadvantaged in the labour market, and already faced a disproportionate share of job losses from the pandemic (the less educated, the poor, Black Africans and informal workers), women in these groups faced even further job losses, putting them at a ‘double disadvantage.

Hunger

Given what we know now about the extent of job losses and income losses it was inevitable that household hunger would rise. This is clearly what the data shows. Half of all respondents (47%) reported that their household ran out of money to buy food in the month of April. This ‘monthly figure’ is double the ‘annual figure’ reported in the General Household Survey (GHS). 21% of households in the GHS reported they ran out of money to buy food at some point in the last year.

Looking specifically at reported hunger and depth of hunger in NIDS-CRAM, 1-in-5 (21%) respondents indicated that someone in their household had gone hungry in the past week. 1-in-8 (13%) reported frequent hunger (3+ days / week) and 1-in-14 (7%) reported perpetual hunger (every day or almost every day in the week). The same questions were repeated asking specifically about child hunger. In households with children, 1-in-7 respondents (15%) indicated that a child had gone hungry in the last week because there wasn’t enough food. 1-in-13 (8%) reported frequent child hunger (at least every other day), and 1-in-25 (4%) reported perpetual child hunger (child hunger every day or almost every day).

Figure 3: Reported hunger in the last seven days (asked separately for “anyone in the household” and children (<18 years).

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Source: Van der Berg et al., 2020 using NIDS-CRAM Wave 1 data weighted.

In a set of reports that makes for disturbing reading, there is also clear evidence of altruism, sacrifice and resilience within poorer households. The best example of this is the practice of “shielding” where households report adult hunger but not child hunger. In households that experienced hunger in the past week, nearly half (42%) managed to ‘shield’ children from that hunger, despite adults going hungry in the household. Where adult hunger was less than 4 days per week, the practice of shielding is higher (47%), but where adult hunger is perpetual (almost every day or every day) fewer households seem able to shield their children from hunger since only 33% reported that children did not go hungry in those households. It would seem that in times of acute crisis, like this pandemic, many households have managed to protect or ‘shield’ their children. But this protective capacity of households has its limits; where adult hunger becomes too pervasive, households seem unable to protect their children from hunger.

While the employment losses reflect on the period February to April (and before the roll-out of the government’s COVID-19 Social Relief of Distress Grant), the hunger questions reflect on the “last 7 days.” Given that this survey was done in May and June, and that government grants were topped up from the beginning of May, these hunger figures are after households have received grant top ups (note also that these top ups were largest in May).

Capacity to prevent and capacity to provide

The severely delayed roll-out of the COVID-19 grant and UIF payments to those who have lost their jobs or incomes, reflects the difficulty of rapidly implementing social relief. This is in stark contrast to the rapid pace at which the lockdown was implemented. On the one hand government implemented a hard lockdown swiftly and severely, deploying the army across the country within 7 days of the announcement. On the other hand, government has taken more than two months to provide any form of relief to those most affected by that same lockdown. Two months after at least 4,5 million South Africans lost their income (3 million from job loss, 1,5 million from furlough) only 117,000 people (3% of that number) had received the Special COVID-19 Social Relief of Distress Grant. That 117,000 number is the official number of payouts up to the 31st of May 2020. Clearly governments ability to prevent (travel, socialising, commerce) is far greater than its ability to provide. This lopsided capacity of government is critical in understanding why hunger has risen to unprecedented proportions.

Knowing what we know now about the collateral damage of a nationwide lockdown, including who it affects and how it affects them, as well as knowing what we know now about government’s administrative and financial capacities to provide, we should exercise extreme caution before again implementing a nationwide lockdown. While hindsight is 20:20, we can all acknowledge that the great uncertainty around the pandemic justified the lockdown (at least initially), but going forward other mitigation measures like implementing social distancing will have to be found and pursued with greater vigor. Preventing COVID-19 deaths should clearly be one of the top priorities of government, but it cannot come “at any cost.”

What is to be done?

There is a saying in banking that “it’s only when the tide goes out that you realize who has been swimming naked.” This refers to liquidity positions when there is a run on the bank or a financial crisis, but it is equally applicable here. It is only in times of crisis that we are able to see the true nature of things. In our case, the true nature of South African society. We have always known that there are large inequalities between the rich and the poor in our country, and that these inequalities are heavily determined by the colour of your skin, the place of your birth and the wealth of your parents. All of that is now uncomfortably laid bare in front of us. The pandemic has forced on us the unwelcome realization that we are only as safe as the least among us. “Your health is as safe as that of the worst-insured, worst-cared-for person in your society. It will be decided by the height of the floor, not the ceiling” (Anand Giridharadas).

We know that one of the true measures of a country is whether it can provide basic dignity for all who live in it. In our context this means enough food to eat, warm running water in a safe and dignified shelter, and access to essential healthcare and basic education. Of course, this is not the ceiling of our aspirations, which might include things like meaningful employment, higher education, art and cultural production etc. Rather we are speaking about the floor of our obligations to each other as citizens of the same country.

This is not usually something we think about when talking about budgeting, tax rates or property laws, yet it is very much at the heart of what it means to be civilized. How will we feel about our collective selves if we continue to turn our backs on the least among us simply because it is “legal” to do so? What is legal is not always ethical, and quite often not what is moral.

Which brings us back to inequality. Three months ago, Aroop Chaterjee and his co-authors published an important study analyzing South African tax data and showed that the richest 10% of South Africans own 86% of all wealth and the richest 1% own half of it (55%). Furthermore, the richest 3,500 individuals alone own more wealth than the poorest 32-million people in the country (the poorest 90%). Of course, all of this is strongly racialized. White South Africans make up the majority (60%) of the richest 10%.  One doesn’t have to be a statistician to do the maths here; white South Africans own at least half of the country’s wealth despite being only 9% of the population.

Figure 4: Shares of total South African wealth using tax data (Source: Charterjee et al., 2020: p20)

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The pandemic is a rare opportunity to reflect on the country we have inherited and the country we are building. To recognize in earnest that the pre-pandemic South Africa only worked for a few and that people like me and you will have to agree (or at the very least accept) that we will need to share more of our wealth and privileges going forward. Both through new private acts of generosity and new public forms of redistribution.

That is what the situation requires. As Van der Berg and his co-authors explain in their NIDS-CRAM paper, “Social grant top-ups must continue beyond October. The severity of the economic shock and the depth of poverty make this imperative, despite fiscal constraints. Although top-ups are inadequate to compensate for other income and job losses in many households, the most common social grants, the Old Age Pension and the Child Support Grant (CSG), inject much needed financial resources into many poor households.” Furthermore, they argue that the CSG top-ups must be paid per child not per caregiver, and must increase if they are to prevent further child hunger. Gabrielle Wills and her co-authors come to a similar conclusion: “To stave off mass, chronic hunger we simply cannot let up on the support being provided to households … Failure to do so will deepen an emerging humanitarian crisis, hamper economic recovery and threaten socio-political stability.”

All of this will cost a lot money that the state does not currently have. Either we must find new social compacts and mechanisms to share wealth, income and opportunity, or we will continue towards our dystopian future, with islands of excess sitting precariously on a sea of poverty.

It is obvious that the willingness of the rich to part with some of their wealth – especially when compelled to do so via government – is far greater when there is a trust that the money will be used wisely, by competent and ethical bureaucrats and to achieve goals we can all believe in. That means that government will need to clean house and show their own moral integrity before they call on rich South Africans to do likewise. Appoint clearly competent and ethical technocrats to lead key initiatives and deliver results. Put in place consequences for non-performance and inept bureaucrats, and jail corrupt politicians. Realistic targets with reasonable time frames must be met with success or resignations. Build 400,000 new houses and apartments within the next two years. Eradicate pit-latrines within two years. What is the reason why these things cannot be done? Perhaps most importantly, a competent development State is also necessary for long-term economic growth since redistribution can only take us so far. Ultimately the economy will also have to start growing and employing large numbers of people.

While there has been some tinkering around the edges of the political and economic possibilities available to us, nothing we have done has made inroads into the gross income inequality that characterizes our country. And now with a pandemic on our doorstep, a decimated labour-market, and a hunger crisis not far behind it, where are we to turn?

One thing that is clear is that business as usual will not cut it. Like those resilient parents who manage to shield their children from hunger, it will require altruism and sacrifice. That is because, like those parents, there really are limits to the poor’s benevolence. I recall being told about a popular slogan during the democratic transition that went something like this: “If they don’t eat, we don’t sleep.”

There is no longer any room for the fat of corruption, or the waste of ineptitude. But similarly, there is also no room for those who cannot see the basic dignity inherent in all people. A dignity that is currently being eroded. I have little doubt that this pandemic will be the straw that broke the camel’s back in South Africa. Whether that is for good or for ill, remains to be seen.  I also have no doubt that South Africa has the skills and the moral conscience to forge a new and better path, but it will require decisiveness and clarity of vision, and above all, leadership.

President Ramaphosa, I know you already know this; don’t waste a good crisis. Leadership requires courage and moral integrity. Be bold.

//

Nic Spaull is the Principal Investigator of the NIDS-CRAM study. The views expressed here and those of the author not necessarily those of the other NIDS-CRAM researchers. All papers are available at cramsurvey.org. and the NIDS-CRAM data is freely available for download on the DataFirst website

 

 

 

 

Invitation: Launch of NIDS-CRAM W1 results (15 July 12:00 via Zoom)

During this launch event we will present the main findings from the National Income Dynamics Study (NIDS) Coronavirus Rapid Mobile Survey (CRAM). This includes the increase in unemployment during the lockdown, the rise in hunger and child hunger and the impact on women. All are welcome to attend but must register first. 

  • Date & Time: 15 July, 12:00-2pm
  • Register: HERE to receive the Zoom link. 

PROGRAM

  1. Welcome and introduction to the study Nic Spaull (SU)
  2. Overview of findings :Employment Vimal Ranchhod (UCT)
    • Discussant/response: Murray Leibbrandt (UCT)
  3. Overview of findings :Hunger & Welfare  Servaas van der Berg (SU)
    • Discussant/response: Ruth Hall (UWC)
  4. Overview of findings: Gender & Migration Daniela Casale (Wits)
    • Discussant/response: Umunyana Rugege (S27)
  5. Overview of findings: Health Ronelle Burger (SU)
    • Discussant/response:  TBC
  6. Overview of Survey Implementation Reza Daniels (UCT)
  7. Overview of Sampling & Representivity Andrew Kerr (UCT)
  8. Comments from other authors
  9. Q&A – 30-min
  10. Closing & thanks -Nic Spaull (SU)

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COVID & Kids: What is in the best interests of children?

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Van der Berg & Spaull (2020). Counting the Cost: COVID-19 school closures in South Africa and its impact on children. Research on Socioeconomic Policy. Stellenbosch University. (Released: 16 June 2020).

Included below is a short blog post based on a new 32-page report we released today (16 June 2020). It is publicly available on the RESEP website.


 

There are decades where nothing happens, and there are weeks where decades happen.” — Vladimir Lenin

 


Looking back to the end of last year, it’s difficult to think that anyone in the world knew how everything was about to change. Here in South Africa, what began as a three-week lockdown period on the 28th of March morphed into an eight-week lockdown that is now in its eleventh week and still on-going, albeit with much fewer restrictions. The eight- week lockdown included bans of all public gatherings, closing all schools, and prohibiting all forms of physical commercial activity, except for the sale of food and medicine. The sale of alcohol and tobacco was banned. A national curfew was imposed prohibiting movement between 8pm and 5am. For the first time since apartheid the army was deployed with 70 000 reserve soldiers distributed across the country, largely in informal settlements, with the intention of maintaining law and order and supporting the police. Even parliament was temporarily closed. Only the courts remained open out of fear that there would be no recourse to challenge government actions or to oppose the constitutionality of the measures being implemented.

By and large these containment measures were initially welcomed, or at the very least accepted, by the public, opposition parties and most scientific advisors. This is now to starting to change.

In the beginning there was so much uncertainty and fear surrounding COVID-19. How deadly was it? How was it transmitted? Who got it? How fast was it spreading? Were kids at risk? There are still key unknowns around immunity, when and if a vaccine will be discovered, and perhaps most importantly, how the impact of the virus will be different in lower- and middle-income countries like South Africa compared to high-income countries. Initially European countries and America made up over 80% of COVID-19 cases, that is now rapidly changing.

In my own field – education and schooling – everything came to a grinding halt. At the time of writing remain schools, ECD centres and creches remain closed for 90% of children, despite the economy re-opening from 1 June 2020. For the ten weeks of lockdown up to the 8th of June, children were not allowed to go to school or see their friends and family outside of their house. During the first five weeks of ‘hard’ lockdown children were not allowed to leave their homes for any reason except to seek medical attention. Based on the government’s current plans, by the end of Term 2 (7th of August 2020), South African children will have lost between 25% and 57% of the ‘normal’ school days scheduled up to that point.


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In the beginning, like everyone else, we were supportive of these drastic (but defensible) measures. The logic behind the three-week lockdown was sound; slow the spread the virus, buy time for the Health Department to prepare and ‘flatten the curve.’ Had anyone known this would be a 3-month lockdown I’m not sure there would have been the same support.

It is within this context that my colleague and mentor, Prof Servaas van der Berg, and I decided to write a report setting out some of the evidence on COVID-19 and children in South Africa. We wanted to document some of the non-COVID-19 concerns that affect children specifically, many of which have been drastically exacerbated by the extended lockdowns and prolonged school closures. The aim was not to focus too much on whether children are at risk of getting severely ill or dying from COVID-19 (they aren’t), or whether they are as likely to transmit as adults (they aren’t). Instead we looked at five areas which I’ll touch on briefly here in a Q&A format (see the full report for the detailed discussion).

(1) Does the South African distribution of COVID-19 deaths follow the international trends with respect to age?

In short, yes, but the Western Cape data does show higher mortality from 40+ and 50+ while the high-income trend was 50+ and 60+.

Screen Shot 2020-06-16 at 07.03.51Let’s compare the Case Fatality Rate (CFR) in China and the Western Cape (Table 2). The Western Cape was selected as the best proxy for South African risk by age since it has the highest number of infections (66% of the national total), the highest number of deaths (77% of the national total), as well as the highest rate of testing per 100 000 persons – at least as at the time of writing (NICD, 2020a: p.6). If we are concerned about issues that are especially prevalent in SA (TB, HIV, inequality, malnutrition) then the Western Cape is the best proxy we have at the moment.

While the overall CFR in the WC (2.5%) seems to be comparable to China (2.3%), mortality risk does start increasing from 40+ years.

(2) How does COVID-19 mortality risk in South Africa compare to “normal” mortality risk? 

This is a key question since the justification of the extreme measures implemented in South Africa (lockdown, school closures, deploying the army etc.) are warranted to the extent that the the threat is so severe and unusual that the collateral damage from these measures is “necessary”, “unavoidable” or “worth it.”

Although this is not an easy question to answer and any response will rely on certain assumptions, it’s worth emphasising that the justification for the lockdown also relies on many of these same assumptions. Using StatsSA mid-year population estimates and mortality data for the same year, we report the risk of dying by age group for a “normal” year (i.e. non-COVID-19 year), in this case 2016. Of the 55.9-million people alive in 2016, 435 000 died, with higher death rates among the elderly, as one would expect. In order to compare this annual figure to COVID-19 deaths, one needs a figure of total COVID-19 deaths in 2020. This relies on projections and assumptions. The Department of Health has consulted numerous modelling experts to predict the total number of infections and deaths from COVID-19 since this is important information needed for planning and preparation. Reviewing the projections put forward by the Actuarial Society of South Africa (ASA, 2020: p.4), the South African COVID-19 Modelling Consortium (SACMC) and Deloitte indicate that there may be as many as 40 000 deaths (optimistic) or 48 000 deaths (pessimistic) from COVID-19 by the end of 2020. These are also the current projections cited by the Minister of Health. Taking a conservative approach and using the higher projection of COVID-19 deaths in South Africa in 2020 (48 000), we use the distribution of deaths by age in the Western Cape (Column E) to apportion the 48 000 total deaths across the different age categories. For example, if the 48 000 deaths follow the Western Cape distribution of COVID-19 deaths then there will be 13 142 deaths among the 60-69 year age group in South Africa in 2020.

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This table allows one to ask “What is the probability that someone in a particular age category is going to die from COVID-19 in 2020 in South Africa?”. It shows that for those under 70 the risk of death from COVID-19 is exceedingly small. For example the average 45 year old has a 1-in-1028 chance of dying of COVID-19 in 2020. the average 45 year old had a 1-in100 chance of dying of non-COVID causes in 2016.

While it is true that these projections depend on the assumption of 48 000 COVID-19 deaths in South Africa in 2020, there are very few specialists who believe that the figure will be higher than this. Furthermore, even if COVID-19 deaths were twice as large as predicted here (96 000) (which would halve the chance numbers in Column H), the risk of death from regular causes for all age groups would still drastically outweigh the risk of death from COVID-19 multiple times over. It is for this reason that the risk categorization in Column I, which reports the relative risk of COVID-19 mortality and regular mortality, indicates that for the population at large under 70 years of age, the risk of death from COVID-19 is low or very low when compared to regular mortality risk. Put differently, people should be far more worried about dying of regular causes than from COVID-19. This doesn’t mean that COVID-19 hasn’t increased mortality risk for everyone 18 years and older – it has – but not nearly as much as one would think when looking at the precautionary measures being taken by government. If you asked the average 50 year old in South Africa “If you died this year do you think the cause would be COVID-19 or something else?” If these assumptions are correct then the average 50 year old has a 5 times higher chance of dying of something else than of dying of COVID-19. This does not, however, indicate that sensible precautions such as social distancing or wearing a mask should be ignored.

The above discussion has important implications for school closures, since these measures are justified partly on the basis that they will prevent the healthcare system becoming overwhelmed, but also because of the excess mortality risk to teachers. For example, schools were scheduled to be opened for some grades on the 1st of June 2020, but this was delayed based on teacher union opposition that schools were not adequately prepared to protect learners and teachers. Yet if the assumptions underlying the above data are correct, the additional mortality risk to teachers and caregivers up to age 70 is low relative to the normal mortality risk that they face. For children the risk is exceedingly small. Following analysis of COVID-19 mortality data in the United Kingdom by Professor David Spiegelhalter at Cambridge University, he concluded that “In school kids aged five to 15 it’s not only a tiny risk, it’s a tiny proportion of the normal risk.” He went on to say that the risk was so low that children were more likely to get struck by lightning (a chance of one in 1.7-million) than die of COVID-19 (one in 3.5-million) (Spiegelhalter, 2020).

The evidence emerging from South Africa on children’s COVID-19 risk of severe illness is completely congruent with international research showing that children do not get severely ill from COVID-19. There are so few recorded deaths of children from COVID-19 that it is difficult to draw any conclusions (see Spaull, 2020 for an overview of the epidemiological research on this). The South African Paediatric Association (SAPA) in their statement on COVID-19 (SAPA, 2020) explain that “Children biologically contain SARS-CoV-2 better than adults, are less likely to get sick if infected, have milder disease, are unlikely to die from COVID-19, and are probably less infectious than adults.”

(3) What is the age and comorbidity distribution of teachers in South Africa?

In the paper we do report the age distributions of teachers in South Africa and show that only 10% of teachers (38,000 individuals) are aged 58-65 years.

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There is currently no nationally-representative data on the comorbidities of teachers specifically. However, nationally 4 581 200 South Africans aged 20-79 are estimated to have diabetes, according to the International Diabetes Federation (2019). Applying the ratio of teachers to the national population in this age group, there could be perhaps around 47 500 teachers who have diabetes, or one in every eight teachers. Cardiovascular disease is a major source of mortality in South Africa, often associated with hypertension. These diseases increase an individual’s COVID-19 mortality risk. However, it should be noted that the mortality total provided in Table 3 is a national figure and already includes deaths associated with these and other comorbidities.

(4) What percentage of South African schools have running water?

The School Monitoring Survey 2017 data show that nationally 74% of primary schools and 80% of secondary schools report access to running water in 2017 (DBE, 2018: p.80). However, there is considerable provincial variation in access to this most basic resource. Lack of access to running water is especially acute in KwaZulu-Natal, where only 53% of primary schools and 59% of secondary schools report access. In contrast, approximately 95% of primary schools and high schools in Gauteng and the Western Cape have running water (DBE, 2018: p.81). Without access to running water, how are children and teachers expected to wash their hands? Thus special measures had to be instituted. COVID-19 is an opportunity for South Africans to reflect and acknowledge that in 25 years of democracy we have not managed to provide all schools with basic infrastructure like running water, electricity, and safe toilet facilities. The fact that a quarter of primary schools do not have access to running water in a middle-income country like South Africa is an indictment and an ongoing source of shame. While this is clearly a pre-requisite for basic hygiene during a pandemic, it is also a pre-requisite for basic dignity in everyday life.

Due to teacher union opposition about returning to schools where there is no running water and therefore limited ability to practice personal hygiene, the Department of Basic Education went into overdrive to provide schools with water tanks so that teachers would return. On the 7th of June the Minister announced that 95% of schools now had running water (Motshekga, 2020). This was accomplished through a contract with Rand Water to provide water tanks to 3500 schools:

“The support provided by the Department of Water and Sanitation, Rand Water, the Department of Health, National Treasury; and the recent involvement of the South African National Defence, the Development Bank of Southern Africa (DBSA), the Department of Transport, and Mvula Trust is second to none. Their involvement has accelerated our interventions in the provinces, especially the reach to the most rural and remote schools” (Motshekga, 2020).

This is a commendable achievement, and may yet be one of the few positive outcomes of the pandemic. It is truly remarkable that in the space of six weeks the Department of Basic Education has managed to do what it was unable to do in the last 20 years.

(5) Is social-distancing feasible in South African classrooms?

The School Monitoring Survey 2017 data on “largest class taught” in Grade 3, 6, 9 and 12 show that nationally 63% of primary school children are in classes of 40 or more learners per class, with 16% in classes of 60 or more per class. In secondary schools 70% of learners are in classes of 40 or more learners per class and 26% are in classes of 60 or more learners per class.

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Given that COVID-19 mortality risk is low compared to regular mortality risk (Table 3), and virtually non-existent for children, we believe the Department of Basic Education should acknowledge that it is not feasible for most South African schools to practice social distancing within the classroom. Where they can, they should. Where they can’t they should take the precautions that they can but continue with schooling. While it should require mask-wearing for older children and social distancing on the playground, social distancing within the classroom is simply not realistic. Attempts to do so are futile in our context and are likely to further disrupt teaching and learning, to the detriment of children. Furthermore, as the South African Paediatric Association has explained:

“Teachers are not at high risk of being infected by children. Teachers are at a higher risk of contracting the virus from other adults (e.g. colleagues), at home or in the community (outside school). Teachers with comorbidities are at increased risk for severe Covid-19″ (SAPA, 2020).

We cover a number of other topics in the report including malnutrition, learning losses, economic impacts etc. The last one I want to touch on here is something I am especially worried about:

(6) With the economy re-opening and schools still (largely) closed, how many young children are left “home alone”?

Short answer: 3.3 million kids (18% of all children) are in households were the only adult caregiver in the house has a job. Of these 1-million are aged 0-6 years. What happens to these kids when their parents have to return to work while creches, ECD-centers and schools are still shut for 90% of children?

Reviewing the South African media discourse on the ‘post-lockdown’ regulations, one of the areas that has been most neglected are the unintended consequences of re-opening the economy while schools and crèches remain closed for most children.

Using data from the Quarterly Labour Force Survey (QLFS) of StatsSA for the fourth quarter of 2019, it is possible to determine how many schoolchildren, pre-schoolers and toddlers would be at home with or without an adult caretaker, if everyone who had jobs at the end of 2019 were again to return to work. The table shows that 3.3 million children (18% of all children in this age group) were in households were there was no additional adult care-giver apart from employed adults. In the remaining 82% of households there would still be an adult available to act as caretaker, especially in extended families. As one would expect, proportionately the number of children without a caretaker would be largest in metropolitan areas, where this ratio is 25%. The biggest proportion of children would be affected In the Western Cape (30%) and Gauteng (24%).

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One can further estimate these ratios allowing for older siblings (15 or above) who might be able to act as caretakers. While that reduces the numbers (Figure 7), the basic problem remains. Even if one includes household members 15-years and older as possible caretakers, there would still be 2.3 million children aged 0-15 years that could be home alone if their employed caregivers returned to work and their school grade or their ECD centre or crèche remained closed.

Given the job-losses expected to result from the lockdown and the COVID-19 induced recession, more caregivers will become unemployed and therefore would be at home and available to care for children (albeit now with less income). While this does decrease the percentage of children that are home alone, as the figure shows, even if there were 30% job losses there would still be 1.8 million children aged 18 or below that would be left home alone because their only caregivers would be at work, or 1.2 million if 15 year olds can act as caretakers.

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Perhaps the most severe instance of this would be the care of very young children, i.e. those under the age of 6 years. Our analysis shows that if all employed workers return to work, there would be almost one million (974 000) children below the age of six who would be left alone in households without an adult caretaker. While it is true that parents and caregivers would try and make some arrangements for members of other households to take care of their children, many caregivers may not have the networks needed, and may feel compelled to go to work to earn income to support their child(ren). This is all because community-based early childhood development centres and preschools are still not allowed to operate despite the economy re-opening.

Government Gazette No. 43381 (1 June 2020) reports that Early Childhood Development (ECD) will be allowed to re-open on the 6th of July 2020, despite the fact that the vast majority of the economy ‘re-opened’ on the 1st of June 2020 when the country moved to Level 3 Lockdown (DBE, 2020a: p.4). It is unclear what the Department of Basic Education and the Department of Social Development think is meant to happen to these 974 000 children under the age of six who have no alternative non-working caregiver.

In addition to the above, given that most ECD facilities in South Africa are primarily privately-operated small businesses, it is unclear how many of these ECD centres and creches will have been able to survive the income loss of the extended lockdown.

(7) What are your conclusions and policy recommendations?

After reviewing the evidence presented in this paper, it is our view that keeping children out of school is not in the best interests of the child. Consequently, all children should return to schools, crèches and ECD centres without any further delay. The profound costs borne by small children and families as a result of the ongoing nationwide lockdown and school closures will be felt for at least the next 10 years.

When the new coronavirus rapidly spread across the globe, the impact of the virus on children was still unclear, and closing schools from an abundance of caution seemed the responsible thing to do. But much has been learnt since about both COVID-19 and about the effects of lockdown and school closures, both in South Africa and internationally. Given the large social and economic costs of hard lockdowns and wholesale school closures we would strongly caution against future nation-wide lockdowns or school closures, even in the presence of a surge in COVID-19 infections. Policy-makers and government leaders have an obligation to weigh up the costs and collateral damage of their policies, particularly for those who are most vulnerable, such as small children, the elderly and those in poverty.

Millions of South African children’s education and mental health have been compromised in this initial period of uncertainty. Given what is now known about the mortality rates of COVID-19, we believe that the ongoing disruptions to children’s care, education and health are no longer justified.

— END —

To read the full report download it HERE.

Policy brief: Who should go back to school first in South Africa?

Spaull 2020 Schooling Policy Brief (10 May 2020) 1


Spaull, N. 2020. COVID-19 Policy Brief: Who should go back to school first? Research on Socioeconomic Policy (RESEP). Stellenbosch University.

For the full hyperlinked and formatted version of this policy brief please see HERE.


1. Overview

Risks, transmission rates and costs: The question of when and how children should return to school depends on three main points: (1) Risks to children of illness and death, (2) Transmission of the virus from children to adults and the need to ‘flatten the curve’, and (3) The social and economic costs of keeping children at home. The policy brief below presents evidence on these three issues and argues that when children go back to school the youngest should go back first.

Overview of research on children and COVID-19: The brief presents what appears to be a clear and emerging consensus in the international research literature across all countries[1]: Children aged 0-10 years old are considerably less likely than adults to get infected, either from each other or from adults. They are less likely to transmit the virus, even when they are infected. And it is extremely rare for them to get severely ill or die from COVID-19.

Why the youngest should go back first: In addition to the fact that children 10 years and younger are considerably less likely to get infected, they also present the highest child-care burden to their households. This prevents many parents and caregivers from going back to work and earning an income to support their families. Any response to mitigate the economic disaster from the lockdown and COVID-19 must take account of parent’s additional child-care responsibilities while schools are closed. Secondly, young children are also the least able to follow self-directed learning at home. This is partly because they have not yet learnt to read by themselves, but also because young children simply require higher levels of human interaction and “activity” for them to learn. For most children in South Africa all curricular learning has stopped while schools are closed leading to further inequalities in learning outcomes. Lastly children’s wellbeing increases when they can go to school. Children receive free school meals to supplement their diet, they can interact with their same-age peers, and it gives their caregivers a break from otherwise constant child-care. This improves parents’ mental health and allows them to work, plan and relax, making them better caregivers when children come back from school.

Young children being “locked-up” at home when there are few health benefits to themselves or society is bad for the well-being children, bad for parents and bad for the economy.

Using research to inform policy responses: Judgements about the national threat posed by COVID-19 and mitigation strategies should be informed primarily by advice from virologists and epidemiologists (the author is neither). However, the Department of Basic Education in South Africa, in consultation with these experts, has already decided that schools will now go back (from 1 June 2020), starting with Grade 7 and Grade 12. The current policy-brief argues for a different phasing-in approach to the current one, namely, at the same time that Grade 12 goes back, ECD sites should be opened and Grade R, 1, 2 and 3 should be allowed to return incrementally (rather than Grade 7) using a phased-in approach with special precautions for teachers. This should be combined with close monitoring of infection rates among a random sample of teachers and families of Grade R-3 children. There is a clear rationale for this that is informed by the best available research. Such an approach minimizes the risk to learners and teachers and also allows many parents to go back to work. In short, children should go back to school and the youngest should go back first.


2. International research on COVID-19 and children

The evidence emerging from countries around the world is clear and consistent: children are less likely to catch COVID-19 and almost never die from it. The graph below shows the fatality rates from COVID-19 by age group for China, Italy, Spain and South Korea. The data reflects all deaths up to 24 March 2020 (Our World in Data, 2020). The clear age bias is evident, with less than 0,3% of fatalities for those less than 40 years of age and “0%” for the 0-9 year-old category.

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Included below is a short summary of authoritative research studies reviewing the COVID-19 outbreak in different countries with a special focus on children. To date the best available evidence on whether children can catch and transmit COVID-19 comes from Iceland since they have tested the largest percentage of their population.

Iceland: In their 14 April 2020 article in the New England Journal of Medicine Gudjartsson et al (2020) report that “In the population screening, no child under 10 years of age had a positive result, as compared with 0.8% of those 10 years of age or older.” Even amongst a pre-selected high-risk group that had likely exposure to the virus, children under the age of ten were half as likely to test positive compared to those older than 10.” Furthermore, in an interview with the CEO of the genetic sequencing company working with the Icelandic Directorate of Health to trace all COVID-19 infections they explain that: “Children under 10 are less likely to get infected than adults and if they get infected, they are less likely to get seriously ill. What is interesting is that even if children do get infected, they are less likely to transmit the disease to others than adults. We have not found a single instance of a child infecting parents.”

South Korea: The Korean experience is notable because they were one of the first countries to undertake widespread community testing. In a study looking at the first 7,755 confirmed cases of COVID-19 in Korea, only 1% of cases were among the 0-9 age group (Choe et al 2020). There were no fatalities for any patient under 30 years of age.

Switzerland: In May 2020, the Swiss health ministry’s infectious diseases chief Daniel Koch reported that after wide consultation with clinicians and researchers, “Young children are not infected and do not transmit the virus,” he said. “They just don’t have the receptors to catch the disease.” And went on to say that children under the age of 10 in Switzerland can now hug their grandparents (BBC). This is now the official policy in Switzerland and has subsequently been supported by infectious-diseases paediatricians and the Swiss Pediatric Society (RTS, 1 May 2020).

America: On 1 May 2020 the CDC in America reported that of 37,308 deaths from COVID-19 in America, only 9 (0.02%) were among children aged 0-14 years.

Germany: One German study showed that the children who tested positive for COVID-19 harbour just as much of the virus as adults (Drosten et al. 2020). This has led to speculation that children are as infectious as adults. However, a number of other recently published studies refute this. Studies that look at this question specifically (i.e. tracing studies to identify index cases) show that this is not the case. Children are very rarely the source of infection in a household or a population. These tracing studies are consistent with each other and come from America, Australia, China, the Netherlands, Singapore, and South Korea, and all support the hypothesis that children are not the primary spreaders of the virus.

Italy: In the town of Vo in Italy they screened 86% of their population and found that “No infections were detected in either survey in 234 tested children ranging from 0 to 10 years, despite some of them living in the same household as infected people” (Lavezzo et al. 2020, p.5).

Japan: In a study that reviewed the 313 domestically acquired cases in Japan from January to March 2020, Mizumoto et al (2020) found that: “Children are less likely to be diagnosed as cases, and moreover, the risk of disease given exposure among children appears to be low.”

Netherlands: In April 2020, the Dutch National Institute for Public Health and the Environment reported that “children play a small role in the spread of the novel coronavirus. The virus is mainly spread between adults and from adult family members to children. Cases of children infecting each other or children infecting adults are less common.”

There are also a range of synthesis studies which review evidence across a number of countries and studies. These help to draw out the similarities and differences across these studies. A review of 67 studies on COVID-19 and children concluded that “The role of children in transmission is unclear, but it seems likely they do not play a significant role” (DFTB, 2020: p.8). In a review of 31 household transmission clusters from China, Singapore, the USA, South Korea and Iran, only 3 households (10%) had a child as the index case (Zhu et al, 2020). To put this in perspective, in the H5N1 outbreak, children were the index case in 54% of cases (Zhu et al, 2020). The researchers conclude that “Whilst SARS-CoV-2 can cause mild disease in children, the data available to date suggests that children have not played a substantive role in the intra-household transmission of SARS-CoV-2.”

In their April 2020 paper paediatric infectious disease experts Munro & Faust (2020) summarise three recent studies: “A case study of a cluster in the French Alps included a child with COVID-19 who failed to transmit it to any other person, despite exposure to more than a hundred children in different schools and a ski resort (Danis et al., 2020).  In New South Wales Australia none of 735 students and 128 staff contracted COVID-19 from nine child and nine adult initial school cases despite close contact (NSW, 2020). In the Netherlands, separate data from primary care and household studies suggests SARS-CoV-2 is mainly spread between adults and from adult family members to children (RIVM, 2020).”

Research emerging across all countries seems to be highly consistent. In brief, children are less likely to get infected (either from each other or from adults) and they are less likely to transmit even where they are infected. The literature on COVID-19 is being rapidly updated as new papers come out. This helpful website summarizes new pediatric COVID-19 literature as it comes out. It is managed by pediatric infectious disease experts Alison Boast, Alasdair Munro and Henry Goldstein. See also this resource from Nature.


3. Are children less susceptible than adults?

Munro (2020) reports that there have been five studies looking specifically at whether children catch the disease at the same rate as adults after they are exposed to a confirmed positive case (an index case). The first study came from Shenzen in China looked at 1286 contacts exposed to 391 positive cases. They found that children caught the disease at the same rate as adults (7.4% for children < 10 years vs population average of 6.6%) (Bi et al, 2020). This finding caused a lot of concern, but four more studies have now been published and all show that children are significantly less likely to get infected compared to adults.

The next study came from Japan and looked at 2496 contacts exposed to 313 positive cases and found children were much less likely to get the disease after exposure. Among children aged 0-19 years who were exposed, 7.2% of boys were infected, and 3.8% of girls were infected compared to 22% of males and females aged 50-59 (Mizumoto et al., 2020).

The third study is from Guangzhou in China which looked at close contacts of 212 positive cases. They found that children were much less likely to get infected (5.3%) compared to adults (12.6%) after exposure (Jing et al., 2020).

The fourth study came from Wuhan in China and looked at 392 contacts exposed to 105 positive cases. They found that only 4% of children (<18) became infected compared to 17% among adults (Li et al., 2020).

The last study comes from Hunan in China which traced 7375 contacts exposed to 136 positive cases. They find that adults aged 15-64 are about four times as likely to get infected compared to those 14 and under (Zhang et al., 2020).

To quote Munro (2020) who summarizes these five studies “In conclusion, we have five studies assessing the secondary attack rate of COVID-19 across age groups, in which four report a considerably lower attack rate in children and one which reports the same in children as the general population. It appears fairly convincing that children are less likely to acquire the infection than adults, by a significant amount.” 


4. Infection rates by age in South Africa

While South Africa has a considerably smaller number of infections and fatalities compared to any of the countries reviewed above, the age-profile of infections and deaths is consistent with the international experience. As of 2 May 2020, 123 people had died of COVID-19 in South Africa but none of these deaths were among those under 20 years of age (NICD, 2020). Of the 3,144 positive cases of COVID-19 in South Africa as at 19 April 2020, only 0,3% were aged 0-10 and 4% were aged 11-20.  The two figures below present the full set of data.

Screen Shot 2020-05-10 at 08.32.48


5. Do school closures help?

In a widely cited study published in the Lancet Journal of Child and Adolescent Health, Viner et al (2020) conducted a rapid systematic review on the effectiveness of school closures in limiting the spread of COVID-19, They conclude as follows: “Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic…Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2–4% of deaths, much less than other social distancing interventions.” In another article, published in Science and also modeling the impacts of different interventions to limit the spread of COVID-19, Zhang et al (2020) use contact surveys of 136 confirmed index cases infected in Wuhan and Shanghai. They conclude that “social distancing alone, as implemented in China during the outbreak, is sufficient to control COVID-19.” Yet they also argue that school closures can help to flatten the curve: “While proactive school closures cannot interrupt transmission on their own, they can reduce peak incidence by 40-60% and delay the epidemic.” It should be noted that while Zhang et al. do consider age-specific susceptibility to infection (p.2), they do not consider age-specific transmissibility or infectiousness (i.e. whether transmission rates are different for different ages). See “Modelling SARS-CoV-2 transmission” in the supplementary materials (p.31) to Zhang (2020) where. A common transmission parameter applies to all ages. If it is true that children are less likely to transmit the virus when infected, which seems likely given the above findings from the literature (also RIVM, 2020) then the assumptions underlying the school closure analysis are incorrect and over-estimate the gains from school closures.


6. Are children continuing to learn at home during lockdown in South Africa?

It is difficult to answer this question definitively but given what we know about learning losses during holiday periods, the lack of access to technology and educational materials at home for the poorest 70% of South African children, and the lack of preparation for distance-learning before the lockdown started, the short answer to this question is no. If one is realistic, for the poorest 80% of learners in South Africa there is virtually no curricular learning that is taking place during lockdown.

Apart from the fact that parents and care-givers are not trained or equipped to teach their own children, the existing lockdown ‘plans’ for learning will not significantly mitigate the losses in learning for children that do not have proper technology-enabled learning at home. At most 5-10% of learners can continue learning at home given their access to computers and the internet. Data from the Trends in International Mathematics and Science Study (TIMSS 2015 Grade 9) shows that for no-fee schools (the poorest 75%), less than half of children in a class have a computer with the internet. Only in the wealthiest 5% of schools do at least 90% of learners have access to a computer and the internet at school (Gustafsson, 2020).

The DBE’s partnership with the south African Broadcasting Corporation (SABC) to provide “COVID-19 Learner Support” via television and radio (DBE, 2020), while admirable, is not a replacement for school. It targets only “Grade 10-12 and ECD” and is only available for 1.5 hours per day across three television channels. Given that these programs would need to be subject and grade specific for them to continue with curricular work, this still amounts to less than 5% of the ‘instruction’ time learners would be receiving if they were in school, assuming they watch all programs dedicated to their grade. It is also not clear what children in Grades R-9 are meant to do.

Access to computers and the internet in South African homes is very low. The General Household Survey of 2018 shows that only 22% of households have a computer in them (StatsSA, 2019: p.63), and only 10% have an internet connection in their home (p.57). While it is true that 90%+ of South African households report access to a mobile phone (p.56), only 60% report access to the internet via their mobile phone. It should further be emphasised that these rates are for adults in the household. One cannot assume that during lockdown children in a household would have exclusive or unlimited access to the cell phone to access educational content. There is also the issue of multiple children in the same household needing to share a mobile-phone, and the high cost of data, although there are now some zero-rated educational sites (Duncan-Williams, 2020).

Given the practical impossibility of continuing with meaningful learning from home – at least for the poorest 80% of learners, the emphasis for the Department of Basic Education should be making schools safe for learners and teachers to return.


7. Conclusion

South Africa’s choice to re-open schools is in-keeping with a number of other countries that have far greater COVID-19 outbreaks and some with shorter lockdown periods. These countries include China, Denmark, Israel, Finland, France, Germany, Japan and the Netherlands. In all cases governments are introducing precautionary measures such as temperature checks, reduced class-sizes, holding classes outside and spacing desks further apart.

Deciding to re-open schools and bring children back in a phased-in approach will involve a number of administrative complexities. These include how to manage the infection risks for adults that facilitate schooling including teachers, principals, administrative staff, transport workers and school feeding employees. Temporarily replacing high-risk individuals such as those older than 60, those with diabetes and other pre-existing conditions etc., will not be simple or easy. Yet this should be held in tension with the severe limitations imposed by school closures; to children’s ability to learn, to care-giver’s ability to earn an income, and to the economy’s ability to function. The economy cannot properly ‘re-open’ while schools are closed. This is especially true for schooling for those 10 years of age and younger who require the most care when at home.

The aim of this policy brief has been to summarize some of the emerging international evidence. The latest evidence suggests that by allowing the youngest children to go back first, policymakers are putting teachers and parents at lower risk than if high-school learners went back to school first. As two pediatric infectious disease experts explain “Severe COVID-19 is as rare as many other serious infection syndromes in children that do not cause schools to be closed” (Munro & Faust: 2020, p.2).

As the Department of Basic Education considers when and how to bring children and teachers back to school, it would be wise to heed the epidemiological evidence emerging from around the world. Younger children are far less likely to catch or transmit the COVID-19 virus and therefore bringing them back to school first is the safest approach – for them, for their teachers, and for the health of our economy and society as a whole.


8. References

Although all references in this brief have been hyperlinked, the full reference list is also provided below.

BBC News. 29 April 2020. Coronavirus: Switzerland says young children can hug grandparents [Online]. Available: https://www.bbc.com/news/world-europe-52470838

Bi, Q., et al. 2020. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzen, China: a retrospective cohort study. Lancet Infect Dis 2020 April 27.

Boast, A., Munroe, A., Goldstein, H. 2020. An evidence summary of Paediatric COVID-19 literature [Online]. Available: https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/

Children and Covid-19. 6 May 2020. National Institute for Public Health
and the Environment,
[Online]. Available: https://www.rivm.nl/en/novel-coronavirus-covid-19/children-and-covid-19

Danis, K., Epaulard, O. Bénet, T., Gaymard, A., Campoy, S., Bothelo-Nevers, E., Bouscambert-Duchamp, M., Spaccaferri, G., Ader, F., Mailles, A., Boudalaa, Z., Tolsma, Julien Berra, V., Vaux, S., Forestier, E., Landelle, C., Fougere, E., Thabuis, A., Berthelot, P., Veil, R., Levy-Bruhl, D., Chidiac, C., Lina, B., Coignard, B., Saura, C. 2020. Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020, Clinical Infectious Diseases, dio: https://doi.org/10.1093/cid/ciaa424

DBE. 2020. Basic Education and SABC launch Coronavirus COVID-19 TV and radio curriculum support programmes for learners. (Online). Available: https://www.gov.za/speeches/basic-education-and-sabc%C2%A0launch%C2%A0coronavirus-covid-19-tv-and-radio-curriculum-support [Accessed 7 May 2020]

DFTB. 21 April 2020. DFTB Covid-19 Evidence review [Online]. Available: https://dontforgetthebubbles.com/wp-content/uploads/2020/04/COVID-data-3.pdf

DoH. 2020. Statistics of COVID19 by age and gender. Department of Health. Online. Available: https://twitter.com/healthza/status/1252331290684162048 [Accessed 7 May 2020]

Duncan-Williams, K. 2020. South Africa’s digital divide detrimental to the youth. Mail & Guardian 19 April 2020 (Online): https://mg.co.za/article/2020-04-19-south-africas-digital-divide-detrimental-to-the-youth/ [Accessed 7 May 2020]

Faulconbridge, G. 2020, May 2. UK Could Allow Primary Schools to Reopen as Soon as June 1: Telegraph. New York Times [Online]. Available: https://www.nytimes.com/reuters/2020/05/02/world/europe/02reuters-health-coronavirus-britain-lockdown.html

Gudbjartsson, D.F., Helgason, A., Jonsson, H., Magnusson, O.T., Melsted, P., Norddahl, G.L., Saemundsdottir, J., Sigurdsson, A., Sulem, P., Agustsdottir, A.B. and Eiriksdottir, B., 2020. Spread of SARS-CoV-2 in the Icelandic population. New England Journal of Medicine. DOI: 10.1056/NEJMoa2006100.

Gustafsson, M. 2020 Basic Education the Coronavirus. Department of Basic Education. Pretoria.

Highfield, R. 27 April 2020. Coronavirus: Hunting down Covid-19, Science Museum Group [Online]. Available: https://www.sciencemuseumgroup.org.uk/hunting-down-covid-19/

Jing, Q et al. 2020. Household Secondary Attack Rate of COVID-19 and Associated Determinants. medRxiv preprint doi: https://doi.org/10.1101/2020.04.11.20056010

Li et al., 2020. The characteristics of household transmission of COVID-19. Clinical Infectious Diseases, ciaa450. (Online). Available: https://doi.org/10.1093/cid/ciaa450

Lavezzo, E., Franchin, E., Ciavarella, C., Cuomo-Dannenburg, G., Barzon, L. and Del Vecchio, C., 2020. Suppression of COVID-19 outbreak in the municipality of Vo’. Italy. medRxiv preprint. doi: https://doi. org/10.1101/2020.04, 17.

Mandavilli, A. 2020, May 5. New Studies Add to Evidence that Children May Transmit the Coronavirus. New York Times [Online]. Available: https://www.nytimes.com/2020/05/05/health/coronavirus-children-transmission-school.html

Mizumoto, K., Omori, R. and Nishiura, H., 2020. Age specificity of cases and attack rate of novel coronavirus disease (COVID-19). medRxiv. doi: https://doi.org/10.1101/2020.03.09.20033142

Munro, A. 2020. The missing link? Children and transmission of SARS-CoV-2, Don’t Forget the Bubbles, 2020. Available at: http://doi.org/10.31440/DFTB.25585

Munro, A. P. S., Faust, S. N. 2020, May 5. Children are not COVID-19 super spreaders: time to go back to school. Archives of Disease in Childhood Published Online. doi: 10.1136/archdischild-2020-319474

National Centre for Immunisation Research and Survailance. 26 April 2020. Covid-19 in schools – the experience in NSW [Online]. Available: http://ncirs.org.au/sites/default/files/2020-04/NCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf

NICD. 2020 COVID-19 Update 2 May 2020. National Institute for Communicable Diseases (NICD). Online. Available: https://www.nicd.ac.za/covid-19-update-46/  [7 May 2020]

Our World in Data. 2020. Case fatality rate for COVID-19 by age. Online. Available:

https://ourworldindata.org/coronavirus#case-fatality-rate-of-covid-19-by-age  [7 May 2020]

Provisional Death Counts for Coronavirus Disease (Covid-19). 1 May 2020. Centres for Disease Control and Prevention [Online]. Available: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

RTS News. 1 May 2020. Daniel Koch: “Je suis sûr de notre analyse concernant les enfants” [Online]. Available: https://www.rts.ch/info/suisse/11291943-daniel-koch-je-suis-sur-de-notre-analyse-concernant-les-enfants-.html

StatsSA. 2019. General Household Survey 2018. Statistics South Africa. (Online). Available: http://www.statssa.gov.za/publications/P0318/P03182018.pdf. [Accessed: 1 May 2020].

Viner, R.M., Russell, S.J., Croker, H., Packer, J., Ward, J., Stansfield, C., Mytton, O., Bonell, C. and Booy, R., 2020. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. The Lancet Child & Adolescent Health, 4(5). DOI: https://doi.org/10.1016/S2352-4642(20)30095-X

Vogel, G., Couzin-Frankel, J. 2020, May 4. Should schools reopen? Kids’ role in pandemic still a mystery. Science [Online]. Available: https://www.sciencemag.org/news/2020/05/should-schools-reopen-kids-role-pandemic-still-mystery#

Williams, D. 2020, May 3. Hope and Havoc as Some Israeli Schools Reopen Under Coronavirus Curbs. New York Times [Online]. Available: https://www.nytimes.com/reuters/2020/05/03/world/middleeast/03reuters-health-coronavirus-israel-schools.html

Zhanget, J. et al., 2020. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science. Science10.1126/science. Available: https://science.sciencemag.org/content/sci/early/2020/04/28/science.abb8001.full.pdf

Zhu, Y., Bloxham, C.J., Hulme, K.D., Sinclair, J.E., Tong, Z.W.M., Steele, L.E., Noye, E.C., Lu, J., Chew, K.Y., Pickering, J. and Gilks, C., 2020. Children are unlikely to have been the primary source of household SARS-CoV-2 infections. medRxiv. doi: https://doi.org/10.1101/2020.03.26.20044826

[1] The majority of the current research comes from high-income countries (with the exception of China and Iran), mostly because high income countries experienced the outbreak first and the research response has been largest in these countries. They have also conducted the most screening and testing and therefore have the most reliable indicators of transmission.

COVID-19 tunnel vision

tunnel

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/