On 30 January 2020, when the World Health Organisation (WHO) declared COVID-19 a Public Health Emergency of International Concern, outside of China there were 83 people from 18 countries diagnosed with COVID-19. At this point, immigration controls were being amplified, and the world could not have imagined that the virus could not be contained. Five weeks later, however, the WHO declared COVID-19 to be a pandemic, reporting a 13-fold increase in the number of COVID-19 cases outside China, and that 114 countries had been affected. On the same day, 11 March 2020, 13 cases had been reported in South Africa. Four days later, as the total number of cases in the country increased to 51, President Cyril Ramaphosa declared a national state of disaster, introducing travel restrictions, closing schools, and prohibiting mass gatherings of people. Subsequently, on 23 March 2020, in an attempt to limit further spread of the virus in the country, the President declared a three-week national lockdown, from 26 March 2020 to 16 April 2020.
Best available evidence, experiences in other countries, and the highly contagious and novel nature of SARS-CoV-2, advocated that a nation-wide lockdown was unequivocally necessary to attempt to interrupt transmission of the virus in South Africa. Interrupting transmission was critical, especially given our country’s background burden of disease. Patients with a chronic illness or any form of immune-compromise, are at higher risk of dying from COVID-19. This was of critical importance for us, given the high burden of diseases like HIV, TB, Hypertension and Diabetes in the country. The predicted health sector capacity to manage an exponential increase in the number of severe cases of COVID-19, if spread was not contained, was also a grave concern. As the number of severe cases increase, the increasing demand for hospital beds, especially ICU beds, is very likely to exceed the availability in our health system and many very ill patients may not be able receive the health care that they need. The well-deliberated and decisive resolution for a national lockdown was subsequently announced.
The call to action was clear- abide by the lockdown rules and stay at home, maintain social distancing, maintain hand hygiene by handwashing with soap and water or hand sanitiser, maintain cough hygiene, avoid touching one’s face, and seek medical care if unwell. Despite these seemingly uncomplicated guidelines, best intentions were threatened by the complexity of existing inequities in the country. When considering just the lack of basic housing and amenities, adherence to behaviours to limit the risk of viral transmission pose a challenge for the 13.1% of the population reported to live in close proximity and in informal dwellings. Furthermore, appropriate handwashing for 20 seconds is not as straightforward for the 15% of people living in homes without access to piped water in their dwellings or on-site. The bold decision to quarantine a nation was certainly not without consideration of the serious societal consequences and the President simultaneously announced targeted interventions aimed at supporting vulnerable groups during the lockdown period, though as could be expected during an outbreak, most were not affected rapidly enough. This was a glaring reminder that if these inequities are not addressed in a more sustainable manner, then there is no doubt that the country will remain compromised, especially during outbreaks, and the basic right to all for equitable health will never be achieved.
As we navigate through familiar challenges, albeit during unfamiliar circumstances, the unparalleled urgency to protect ourselves, our families, and our fellow South Africans has inspired a level of extraordinary patriotism and social solidarity. As we journey on through the next few weeks, living through the trajectory of the COVID-19 curve in the country, every person, organisation, and sector has been called upon to serve the country by combatting risks for viral spread and mitigation. When we emerge from these exceptional circumstances, we will need to remember this moment and the critical nature of our advocacy and work to address the health inequities we are exposed to every day. This pandemic has emphasized our interconnectivity and highlighted that the health of one depends on the health of all, and that health risks for one are health risks for all.