/ 20 March 2020

Covid-19: Are we at a disadvantage compared to China and Singapore?

Zwelie Mkhize 1157 Dv
Answers are scant as Dr Zweli Mkhize remains on "special leave". (Delwyn Verasamy/M&G)


In his address to the nation on Sunday night, President Cyril Ramaphosa stated that the government has decided to take “urgent and drastic measures” in response to the threat posed to South Africans by the coronavirus. 

Government is to be commended for acting with urgency in respect of the possibility of a devastating epidemic. Schools have been closed, gatherings of over 100 people have been prohibited and restrictions imposed on opening times and the number of patrons allowed in clubs, restaurants and taverns. 

Some stringent measures have therefore been adopted. But these may fall far short of what is necessary. 

In the context of widespread economic hardship and a state characterised by uneven delivery, will South Africa be able to replicate the types of measures used in countries that have responded to the virus successfully? 

When compared to highly regulated societies such as China and Singapore, limited public orientation towards compliance with authority may mean that we are at a disadvantage in responding to this major public health crisis. 

On the positive side we are clearly fortunate in that the government has chosen to act at an early stage. By contrast with Italy, which closed schools and universities when there were already 1 577 identified cases, Ramaphosa announced the closure of schools when there were a far more modest 61. 

Understandably government’s measures may be shaped by uncertainty about the likely scale of a possible epidemic. In so far as the government has the interests of South Africans at heart, there must also be a high degree of ambivalence about implementing measures that will restrict business and work opportunities thereby further compounding the economic hardship that many are facing already. Tougher measures to contain the virus will be even more disruptive economically. 

With identified infections steadily increasing we may be getting closer to a point where the government needs to act more decisively. 

But how will South Africa control the spread of the virus? 

The Chinese response included vigorous measures to identify cases through extensive testing followed by the immediate isolation of those who tested positive. 

This was combined with the rapid tracking and quarantine of “close contacts” including those whom infected people had been in close proximity with at home, at work or while travelling. 

In his address on Monday, Minister of Health Zweli Mkhize indicated that the government was in the process of setting up tracing teams with private sector assistance. On Wednesday, Gauteng premier David Makhura said that the government is expanding the number of tracers. 

But, even if we get the vigorous rapid tracking and testing right, a major difficulty is likely to be the enforcement of quarantines. 

Mkhize has indicated that the government is in the process of establishing quarantine facilities for those whose “families do not have enough rooms or spaces”. Rigorous quarantine standards will have to be enforced in such facilities. 

If the epidemic reaches greater proportions, however, the government will need to be able to rely on people self-quarantining. A major problem will be ensuring that people who are self-quarantining are provided with the necessities, such as food and medicine, required for it to be viable for them to remain in quarantine. Another difficulty will be in ensuring that people isolate themselves from others.

In China, virus control measures have included subjecting as many as 70-million people to quarantine. The effectiveness of quarantine measures has been facilitated by the fact that Chinese society is already characterised by high levels of compliance with authority.

Where this has been inadequate, other mechanisms of social control and coercion, such as monitoring of compliance by neighbours and landlords, have also played a role in enforcing quarantine measures. 

Other countries have also relied on strong forms of coercion to enforce quarantine standards. A report in The Guardian indicates that in Singapore people who are supposed to be isolating themselves “can be called multiple times a day and asked to click an online link sharing their phone’s location. Officials also carry out spot checks in person to ensure compliance. Those who do not stay home can expect a fine of up to $10 000 or up to six months in prison”.

If there is reliance on self-quarantine in South Africa it will be necessary to establish an efficient system of support for people in quarantine. People with inadequate access to necessities will be particularly likely to violate quarantine regulations. 

But even if there is such support it is likely that there will be major difficulty in ensuring compliance with quarantine provisions. 

Along with efforts to trace and quarantine those who may be infected efforts to contain the virus internationally have focused on social distancing. A public health expert quoted in The Economist states: “Social distancing works best when it is put in place before an epidemic takes off.”

The measures put in place in South Africa so far should contribute to slowing the rates of infection. Nevertheless the prohibition of gatherings of more than 100, excludes vast numbers of other social gatherings, and may itself be unevenly enforced. “Discouraging” people from catching buses, trains, taxis and planes is also likely to have a limited effect. 

Schools are supposed to be high risk for the spread of infection and their early closure should be helpful. But it is not the same as enforcing sustained social distancing. If not meeting at school, young people will seek out other opportunities for interaction. 

As long as their parents and others in their communities continue to have a high risk of exposure to the virus, whether on public transport or at work, the risks of it spreading between children may not be reduced to the degree necessary. 

Social Development Minister Lindiwe Zulu has called on parents to “take responsibility” for their children, saying the government did not want children running around and spreading the virus. 

But in Italy, France, and Spain many people ignored injunctions to avoid crowded public places and to stay at home. As a result national lockdowns have been imposed. 

In Spain, for instance, a state of emergency has been declared, people have been ordered to only leave their homes to buy food, medicine or to go to work or hospital. The lockdown is being enforced by police who may stop and question pedestrians and people using vehicles on public roads.

On Monday, Mkhize indicated that a state of emergency could be declared if circumstances warranted it. But a lockdown in South Africa will also be difficult to enforce. 

Though there may be an initial period of compliance, this will be difficult to sustain. One of the fault lines in South African society is around compliance with the law and public co-operation with official edicts. Many people will quickly formulate strategies for circumventing restrictions.

Government is likely to struggle to ensure the consistent social distancing necessary to prevent an epidemic. And there is the dilemma for the government of seeking to confine people to their homes when so many are already facing severe economic hardship. 

South Africa’s status as an open democratic society, as well as the high levels of economic hardship, may mitigate against an effective response to the epidemic. 

As many have already recognised, broader social mobilisation in support of state measures will be essential if the state is going to secure the co-operation necessary for key anti-coronavirus measures. 

Social media is already crammed with information, of varying quality, about the pandemic. Intelligent use of social media will be necessary in order to establish trustworthy and accessible platforms for exchanging epidemic related information. 

But it will also be critical to engage in the physical world in which the spread of the coronavirus takes place. Alongside social media South Africa’s old tools of mobilisation —T-shirts, banners, pamphlets — will be important. As many people as possible will need to become Covid-19 awareness activists. 

This may involve engaging with people, in private and in public spaces, about their awareness of and compliance with protocols for safe conduct. This should emphasise their obligation to protect themselves and to try to ensure that they do not pass the virus on to others. 

David Bruce is an independent researcher specialising in policing and public security