Guest Column

John Steenhuisen | The sprint and the marathon - winning the battle against Covid-19

2020-04-17 13:49
DA interim leader John Steenhuisen addresses the Parliamentary Press Gallery Association.

DA interim leader John Steenhuisen addresses the Parliamentary Press Gallery Association. (Jan Gerber, News24)

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This battle requires a sprint and then a marathon. How we fare in the sprint determines how we fare in the marathon.

The sprint is to get our strategy, systems and infrastructure in place for the marathon. Most importantly, it is to ramp up the scale and speed of our testing capability so that we know exactly when and where the virus is flaring up in communities, so we can control it, rather than have it control us.

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It has required a hard lockdown. No point in letting covid19 spread out of control until we're ready to fight.

The marathon is to control the spread of Covid-19 so that as many infected people as possible survive.

It will require a smart lockdown. Covid-19 may be with us right up until a vaccination is widely administered in 18-24 months’ time. Treatment will hopefully come sooner. South Africa's borders are porous, so there is no option for an "elimination" strategy such as New Zealand is pursuing. We are not an island.

The sprint must be as fast as possible because a hard lockdown is very expensive and we need to save some of our resources for the marathon. A hard lockdown costs SA an estimated R13 billion per day. An effective testing programme (testing to the scale and speed required to produce the same amount of control over the virus as the hard lockdown) will cost SA an estimated R5 billion per year. Even if that estimate is out by a factor of three so that testing costs SA R15 billion per year, it still equates to the cost of a single day of hard lockdown.

The marathon must be as smart as possible so that our resources don't run out before we get to the finish line.

Smart lockdown

A "smart lockdown" means we keep control over the virus while still being able to allow as many people as possible to get back to work, so that we don't run out of money before we get to the finish line.

We keep control over the virus by knowing exactly where it is springing up and how many new people are getting infected each day, and by knowing how many new daily infections our hospitals can cope with.

If we know this, then we know what level of lockdown we can operate at, and at what location. Localised lockdowns are obviously preferable, as they keep as few people out of work while still suppressing outbreaks.

"Smart lockdown" makes use of clear levels of lockdown and we move between them, depending on what the data is telling us about covid19. Perhaps:

Level 4 – Hard lockdown
Level 3 – Soft lockdown
Level 2 – Soft open
Level 1 – Open

Rather like how we move between stages of load-shedding or water restrictions according to how much electricity/water is available.

No point locking down too hard if the virus is spreading slowly and our hospitals are coping fine. More of us should then be back at work to earn the money (taxes) we need to get to the finish line.

No point locking down too soft and letting the virus spread out of control. If we lose control of the virus, it means we lose control of knowing what level of lockdown we should be operating on. In which case, we need to revert to hard lockdown to get the virus back under control again.

That's why hard lockdown is an important level of smart lockdown.

Of course, staying at home isn't the only way of controlling the spread of the virus. There are other ways of doing this. We can call these other ways "smart interventions" because they allow us to control the virus AND get more of us back to work. They are more of a targeted and less of a blanket approach than a hard lockdown. They are a key component of the smart lockdown strategy.

Smart Interventions

If we agree to all wear masks whenever we leave home, the virus will find it harder to spread.

If we agree that all public facilities - shops, taxis, buses, trains, banks, municipal offices – have spray-on hand sanitiser on entrance and exit, the virus will find it harder to spread.

If we agree on physical distancing protocols for when we aren't at home, the virus will find it harder to spread.

If we assist high-risk people - those over 65 and/or immune-compromised - to continue self-isolating, the virus will find it harder to spread. That way more of the rest of us can get back to work to support them.

Remember, the younger we are and the stronger our immune systems are, the quicker our bodies kill the virus before it can spread any further. The older we are and the weaker our immune systems are, the more chance the virus can build up in our body and the more infectious we become.

If we boost our immune systems our bodies can fight the virus quicker and harder. So if we keep our stress levels low and get enough food and sleep, the virus will find it hard to spread. Right now, people are starting to stress more about their jobs and income than about this virus itself. That’s why getting back to work is in a sense a Smart Intervention in itself.

If we keep tight control over our border and test and isolate all those coming in, the virus will find it harder to spread.

If we test a large number of people every day for the virus, so that we identify and isolate the “explosions” of infection in our communities – through local lockdown - before they get properly under way, the virus will find it harder to spread. Professor Karim, chief advisor to SA Health Minister Zweli Mkhize, uses the analogy of small fires starting up in a forest. If we can locate them early on, we can target our fire-fighting resources at them and put them out before the fire rages out of control.

Of the “smart interventions”, testing has the greatest leverage. It’s the thing we absolutely have to get right. If we can get it right, it will justify this current hard lockdown.

Test, trace, track

Our ability to test effectively is pivotal to the success of a smart lockdown.

Other countries – South Korea, Taiwan, Germany, Kerala in India - that have best managed to control the spread of the virus attribute their success to an effective testing programme. Germany is testing at a level of 60 000 tests per day and still driving that number higher. The UK is aiming for 100 000 tests per day.

Once someone tests positive three things have to happen.
1.    They must be immediately isolated for at least 14 days so they don't spread it further.
2.    Their contacts must be immediately traced to know who else they may already have infected, so we can test them too.
3.    We need to anonymously track their movements so we know where we need to focus our testing, in case they are not self-isolating.

This is a targeted testing approach. We only have so much testing capacity, so we test those people most likely to be positive.

But we also need to do randomised testing in communities, to make sure that there are no new "explosions" (hotspots) that we don't yet know about. People can spread the virus without knowing about it, because they become infectious four to seven days before symptoms appear.

The most important communities to do randomised testing in are those that find it very hard to lockdown. It is simply not possible for households to stay at home when they share facilities such as water points and toilets with other households. And when large families are crammed into small houses which themselves are crammed closely together.

A successful testing programme has a double benefit:

1.    It saves lives. Fewer people get the virus and our hospitals aren't over-run.
2.    It saves lives. Enables data-driven decisions about what level of lockdown we can be on. So as many as possible of us can work while still having the virus under control. So we get as much tax revenue as possible to fund our health response – doctors, nurses, PPE (personal protective equipment), field hospitals, testing programme – right up until we get over the marathon's finish line, which may still be 18-24 months away.

Treat

The greater the capacity of our hospitals, the more infected people will be able to get the treatment they need and the fewer will die from the virus.

South Africa must direct additional resources to strengthening our healthcare system over the coming months, to ensure optimal treatment for as many patients as possible – both those with Covid-19 and those with other serious illnesses.

But there’s a second reason that building health capacity is such a powerful intervention. The greater our health capacity, the higher the average number of new daily infections can be before we need to move to a higher lockdown level.

Virtuous circle

It should be clear now that the greater our testing and hospital capacity, the more of us can work, the more money (taxes) we have to fight the virus – including by growing our hospital capacity still further – and the less chance we run out of money before we get to the finish line.

It’s a virtuous circle, which is why it is a false choice to choose between saving lives and saving livelihoods.

The more lives we save, the more livelihoods we'll be able to save.
The more livelihoods we save, the more lives we'll be able to save.

A smart lockdown approach enables maximum coordination between our health and economic response. It is a highly data-driven approach.

Data

This is why it is so important that we have transparent, reliable, up-to-date information about the capacity of our hospitals – including any temporary field hospitals we set up. The government should ideally be publishing a daily dashboard for the public, showing test results and hospital capacity by area.

Sprint

So we are in a race against time to build testing capacity. At this point, no amount of money we throw at our testing programme would be too much.

We must be ready for mass virus testing before the end of April 2020. SA cannot extend the current hard lockdown on the same terms any further.

If the pressure is not released, there will be an explosion of non-compliance anyway. And we are fast running out of money. Our economy is underwater and running out of oxygen.

The bridge

We need to provide a "bridge" to assist poor people, struggling businesses and hospitals to survive this crisis and bounce back afterwards.

The sprint is to get them onto the bridge. The marathon is to get them over it.

The sprint - getting onto the bridge

Government needs to take a "helicopter drop" approach to giving relief to poor people and struggling businesses to help them survive this lockdown. This means rapid, generalised, direct cash transfers, to “bridge” poor people and struggling businesses to the other side.

The DA suggests R50 billion of cash transfers to poor people over the next three months by increasing every type of social grant by R1000 per month. If this is done in conjunction with a phased opening up of the economy wherever possible, this expense will ultimately be budget neutral, due to the multiplier effect. In other words, if government directs cash as quickly as possible to as many poor people as possible, they will get that R50 billion back as tax revenue once it has worked its way through the economy.

The DA suggests R50 billion in direct business support in the form of low-interest loans to any business, repayment of which need only commence after 12 months.

We suggest that the TERS (temporary employment relief scheme which assists businesses with their wage bills) should be administered by SARS rather than the UIF. SARS is best-placed and has the capacity to make more rapid, generalised cash transfers to business than does the UIF.

Government also needs to ramp up the health budget, to get hospitals onto the bridge. The DA suggests allocating an additional R50 billion to healthcare-related costs.

This sprint part of "bridging" requires a fiscal response – we need to reprioritise our budget to get this right.

The marathon part of "bridging" requires a policy response. We need to reform our economy to get this right.

The marathon - getting over the bridge

We make electricity more affordable and more reliable for people and businesses. We do that by opening our energy market. All independent producers should be able to produce and sell electricity.

We make data more affordable for people and businesses by auctioning spectrum.

We make investing in SA more attractive by walking away from investment-killing policies like EWC, BEE, NHI, asset prescription, and SARB nationalisation.

Smart lockdown

All these interventions are part of what the DA has called a "Smart Lockdown" strategy. This strategy is completely within South Africa's capacity to implement. It gives us the best chance of winning the battle against Covid-19.


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Read more on:    john steenhui­sen  |  coronavirus
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