Funerals, food and fare are important issues we need to keep in mind as we hopefully reach the end of the peak of the Covid-19 pandemic, writes Jenny Pheiffer-Coetzee.
As South Africa approaches what we truly hope could be the end of the peak of our Covid-19 pandemic, and information overload and Covid fatigue sets in for some, there are three critical points around transmission which need to be better understood and addressed if we are to avoid a prolonged tail to our pandemic, or worse yet a second spike in infection rates.
As a country, we have formally recorded over 500 000 cases, at the time of writing this we have the fifth highest infection rate in the world, with a case fatality rate (proportion of people who have died) of 1.7% (over 9 000 deaths).
Given challenges to testing, backlogs in specimens being processed, and the likelihood that many ill people have not tested, scientists and specialists alike have suggested that South Africa has possibly already exceeded the one million mark in terms of number of infections.
Further, the death rate is also assumed to be substantially higher, due in part to many factors - including people dying at home, undiagnosed Covid-19 deaths not being counted, challenges in reporting statistics within our health system (that have been problematic for years), and the complexity of classifying a Covid-19 related death.
While our more recent non-pharmaceutical interventions (NPIs) have included masking up, hand washing and physical distancing, there are some important social activities of our everyday life and community practices that can increase risk exponentially, which we need to discuss.
We all need to say goodbye - The Funeral
Having lost my father 24 months ago, I can attest to the incredible importance of collective mourning.
The grief, tears and tissues that abounded us as we celebrated his life and tore ourselves from his physical presence. It was a terribly sad and yet beautiful moment. A reflection of the cycle of life – our collective ululation guiding him to the next world and uniting us in finding a way forward without his physical presence. I was comforted by people I had not seen in 20 years, by my father’s old friends, his colleagues, neighbours, my own work colleagues, my friends, my sisters friends – the list goes on.
I did not know a funeral could be such a celebration of life, could be so wonderful and so painful all at once.
The beauty in celebrating another should not be cast aside nor scoffed at – it is a vitally important cultural moment, one of human connection, of letting go, and of finding our way towards acceptance. One which Covid-19 challenges us to rethink, reconsider, and redefine how we enact this coming together, this united moment of grief. But why?
Covid-19 is spread through small drops of saliva or mucus (droplets). These can be inhaled through our nose or mouth - each new breath in while speaking, singing or just normal breathing can become an opportunity for infection under the right circumstances.
The most recent information suggests that viral particles can remain suspended in the air for as long as 20 minutes. Luckily there is a minimum volume of virus that needs to be inhaled for you to become infected. So inhaling only a few droplets is very unlikely to cause you to develop Covid-19. This is why wearing a face mask is so important in keeping your level of exposure as low as possible.
Covid-19 can also enter through our eyes - as we wipe them with our hands not recently washed but unknowingly infected with viral particles, or as we dry them with a tissue kindly shared by a friend.
Funerals are typically accompanied by intensive grief.
Our grief often takes the form of tears needing drying, runny noses needing blowing, emotions needing release through sobbing or speaking or ululating. As social beings, we crowd together to comfort one another, unable to watch another mourn in isolation. This makes funerals a merciless opportunity for the spread of an infectious virus such as SARS-CoV-2.
Funerals are rife with droplets that dance through the air as we sing our farewells, as we wail out our desperate heart longing for our lost love. They spread on hugs, quick cheek kisses, tissues, sleeves, on song and speech.
Our need to wipe wet eyes, to blow snotty noses all provide an opportunity for increased risk through touching our faces and potentially needing to remove our face masks, through deep breathing and close physical contact.
All that is required is one individual (knowingly or unknowingly) infected. They kindly share a tissue, offer a shoulder to cry on, sing loudly, or sob inconsolably, and the stage is set for this novel virus to spread among fellow mourners
The recommended solution to this is unkind to our mourning traditions.
It requires us to consider carefully whether we need to attend the funeral, to consider whether the person was an immediate relative (mother, father, child, sibling), and to go against our customs and possibly not attend at all.
These are all difficult decisions to have to make, and defy the eclectic cultures of our land, the very fabric of our humanity and our desire to support each other through trying times. But these personal and social sacrifices will go a long way to help our country flatten the ever growing number of new infections.
We all need to eat – food
As it stands, South Africa could see between 3-5 million jobs lost through the economic fallout related to Covid-19.
The number of people suffering from severe food insecurity has more than doubled, and as a result we anticipate that the level of malnutrition will increase.
Food is a basic human necessity, and sharing food (whether for economic and/or social reasons) is a common practice that boosts social cohesions and wellbeing. There is a poetic beauty in the activity of sitting together and eating, where one not only nourishes their body but also their soul. We are connected by sharing the same food and the stories told at meal times.
Given the mechanisms SAR-CoV-2 uses to spread, it becomes obvious that sharing food, or eating together is a potential source for transmission or acquisition of Covid-19. We cannot eat with masks on (at least not yet), and sometimes the options to physically distance are limited. Therefore, our ability to repel the virus through simple interventions is negated. Furthermore, through sharing utensils or eating from the same plate, we give the virus the opportunity to spread through potential salivary contamination of food.
Covid-19 has brought with it a wave of isolation and fear, which needs to be contained.
Spending time with others is vital for our mental wellbeing and sense of belonging. However, there are certain activities that we need to consider carefully as they can potentially be high risk by their very nature. Sharing food or a chat over coffee or lunch are possible points where we can contract or spread Covid-19 unwittingly.
We all need to work – the fare!
It is a non-negotiable and directly correlated with our social and economic survival as individuals and as a collective. How we travel to and from work carries with it a degree of risk, and it is important that we understand this risk so that we can make informed choices, and we can motivate for the political will to implement interventions that will help save lives and livelihoods.
Evidence suggests that risk of infection is highest when we are exposed to Covid-19 in a poorly ventilated space for an extended period of time. Take for example, the taxi industry. On any given day, approximately 15 million people make use of their services. Officially there are about 200 000 taxis on our roads.
This means that every driver is exposed to a large number of commuters and potentially infected individuals. In turn, passengers are also at risk. Non-pharmaceutical interventions such as mask wearing, hand hygiene and ensuring fresh air flow have been proposed to mitigate the risks on public transport routes.
However, weather conditions such as rain and cold, and access to face coverings are likely to influence whether some of these are enacted. Given that South Africa’s economy is hugely dependent on people utilising available public transport such as taxis, buses and trains, commuter transport is a vitally important intervention point to prevent the spread of Covid-19.
While arguments have been poised from both sides (for and against allowing 100% taxi loads), there are some critical, points that need to be highlighted:
1. The majority of South Africans have to use public transport as the primary means of travel between homes and work, with very few alternatives are available;
2. South Africa’s economy is built on the back of people dependent upon ongoing earnings;
3. Individuals who do not work are unlikely to be paid and therefore will become dependent on a strained grant system, if they are even deemed eligible to access it;
4. The suggested minimum physical distance as indicated by the WHO (prior to accepting that SARS-CoV-2 is airborne), was 1.5 metres. This means that bar the driver, only 2-3 passengers could be transported at any given time in order to meet this requirement. In a South African context, this makes the cost of transportation prohibitive. and results in a return to point 3 where people cannot work as they cannot afford transport;
5. It is economically unfeasible for a taxi to commute only 2-3 passengers per trip. In such scenarios, fares are increased to compensate for decreased passenger loads, but the need to recover costs for the micro-enterprise. The result being that people cannot afford transport and therefore cannot work;
6. Taxi drivers are themselves breadwinners and influencers within their communities. Their ability to support their community is directly linked to their ability to earn a living;
Thus, we can agree that there is a need for commuters to have access to taxis, and that taxis require some support in ensuring that they can safely transport passengers. And while in many respects the use of public transport is a social activity, it is also one that people have limited choices around.
We all need to connect
The sharing of social experiences is the glue that holds us together.
Currently the onus falls on individuals to know and understand risk in relation to activities they would like to, or have to take part in and weigh up their options.
For some, these options include choosing whether or not to attend a farewell for a loved one or a close friend, or meeting over dinner or sharing lunch to re-connect. For others the choice might be limited to whether a face covering is worn and windows are kept open.
I cannot decide for you, I can only encourage you to weigh up your options, consider carefully your needs and that of others, and make an informed decision on what preventative actions you take.
Whatever your personal and social sacrifice know that we are stronger together, even though right now, together might feel physically far apart.
- Dr Jenny Pheiffer-Coetzee is the founder and chair of the African Potential Foundation.
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