BLUEPRINT FOR ENDING LOCKDOWN

 The public debate on strategies to tackle COVID-19 often unhelpfully positions health and economic considerations in a diametric fashion - as trade-offs. In fact, economic policy has health consequences and health policy has economic consequences.

The two need to be seen as parts of a coherent whole.
In the case of South Africa, the country currently faces three interrelated problems. These are the public health threat from the COVID-19 pandemic, the economic and health effects of the lockdown, and a range of intractable economic problems not directly due to the current pandemic. These include high unemployment, low economic growth and falling per capita income.

Any potentially viable response to COVID-19 needs to address all three aspects in concert. This is particularly important as the country plans for the next stage of its response after the lockdown. Focusing only on the health challenges and not paying attention to the economic issues will result in significantly higher economic costs, and will also undermine the health imperatives. A protracted lockdown won’t necessarily have the effect of ridding the country of the virus, but it will result in unacceptably high health and economic consequences.

The initial lockdown was prudent and is likely to have lowered the risk of community spread of the virus. But the true number of COVID-19 cases is difficult to quantify. A limited number of tests have been done, and community-wide screening for suspected infectious cases has been delayed.

The available evidence on the pandemic suggests that any initial containment of the disease through a lockdown will be short-lived. Also, it’s likely to result in a rebound of cases in the absence of aggressive community-wide screening, isolation of the identified cases and quarantine of their close contacts for at least 14 days. On top of this, South Africa may find itself permanently harmed by the simultaneous destruction of both the demand and supply sides of the economy under an extended generalised lockdown. This will have other unintended long-term health and economic consequences. For example, an extended lockdown could result in the undermining of other health services, such as the immunisation of children. The economic effects of a lockdown, too, are severe.

containment

Globally, attention is turning from initial containment through generalised lockdowns to short- and medium-term risk-based public health and economic strategies. Removal of the lockdown without appropriate health and economic measures will result in an excess mortality from COVID-19, resulting in further economic hardship

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South Africa’s health and economic strategy beyond the current lockdown must be designed to ensure good healthcare and be economically sustainable. We argue that the country needs to transition to a risk-based strategy which offers effective health protection and allows for the resumption of some economic activity. This approach has been advocated by researchers in both Germany  and the Indian state of Kerala.

First, mitigate the rapid spread of the virus, while allowing for natural immunity in the population to increase gradually. Secondly, strengthen healthcare systems to ensure optimal treatment for as many patients as possible, both those with COVID-19 and those with other serious illnesses. Thirdly, protect individuals at high risk; and fourthly, make economic activities possible with measures in place to manage the health risks associated with these activities. A health strategy based on an extended generalised lockdown is economically unsustainable. It is also damaging to public health. Instead, we need a unified health and economic strategy that allows for some economic activity while inhibiting the uncontrolled spread of the virus. This requires a number of health and economic measures to be implemented in a coordinated manner.

First, to reduce the rate of infections, the country must have ready the capability of mass virus testing and efficient contact tracing before the end of April 2020. This must be accompanied by a comprehensive approach to social distancing. Relying solely on screening of symptomatic individuals will not effectively reduce the rate of infection because high viral loads of SARS-CoV-2 in the upper airway occur in pre-symptomatic and possibly asymptomatic people.

Test turnaround times must result in identification of infected individuals within 12 to a maximum of 24 hours. This must be followed by immediate isolation and contact tracing. Isolation of infected individuals and contact quarantine must last for at least 14 days, either at home, if suitable, or in designated isolation and quarantine facilities.

To do this, the country will need excellent data on the extent and location of any community outbreaks of the virus. Such data will be generated by mass testing, and accurate information about the ability of certain sectors of the economy to reopen safely and in compliance with the health protocols. The health and economic strategy will thus need to be implemented in a dynamic fashion, responding to the latest evidence.

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