Target poor populations with meaningful measures other than lockdown

American philosopher and educator John Dewey, once said: “A problem well stated is a problem half solved.” This is a helpful insight as we think further about how we extricate ourselves from the mess in which we’re mired because of Covid-19.

Thorax, a leading journal on respiratory medicine, recently published an article that examined data from a cruise ship on which there had been an outbreak of the coronavirus. The title of the article is, Covid-19: In the Footsteps of Ernest Shackleton. The subtext of the title refers to the course the cruise ship travelled. One of the key findings of the article was that 80% of the people on the ship who tested positive for the coronavirus were asymptomatic. Time magazine published a story about it on May 28. 

The reporter correctly captured the most compelling finding in the report — that 80% who were infected showed no symptoms. Extrapolating from the study, it is no great leap to conclude that the number of people infected by the coronavirus is probably significantly higher than currently documented

The problem with the story is it implies the study made other points that are not reflected in the journal article. One of those relates to physical distancing. One of the other key findings in the journal article is the “timing of symptoms in some passengers (on day 24 of the cruise) suggests that there may have been cross contamination after cabin isolation”. On a cruise, other than throwing passengers overboard, it is impossible to do more physical distancing that isolation in a cabin.  So, to infer that the article was a blow in favour of physical distancing is disingenuous. The reporter adds further that the journal article is a clarion call for more testing, how he arrives at this conclusion is anybody’s guess. Another of the clear findings of the journal article is “rapid Ab Covid-19 testing of patients in the acute phase is unreliable”.

I bring this up as a way of getting back to the point from which I started — Dewey’s insight. The corollary to Dewey’s point might be that a problem half stated is a problem that can’t be solved.

When I read about the study, the thing that struck me was, there should be a collective sigh of relief that 80% of the passengers that tested positive were asymptomatic. Why? The first thing is, if 80% of those infected are not showing symptoms, it means that Covid-19 is not the doomsday virus it has been cast as being. In other words, if the infection rate is exponentially higher, then the current mortality rate is exponentially lower. That is a good thing.

The only bad news here is for lockdown proponents. The findings would suggest that lockdowns are a solution in search of a problem. Twenty-first century realities render lockdowns irrelevant. A large percentage of the world’s population live in cities and are dependent on each other for almost everything needed to live day to day. So, stopping human contact is a practical impossibility. The best we can do is channel where that contact takes place. Also, in many places, such as the townships in South Africa, conditions are so congested that physical distancing was not being maintained. 

Second, because we travel so much in the 21st century, ring-fencing large portions of the planet effectively doesn’t work well either. A case in point is the time period between the first reported case of Covid-19 and when lockdowns actually started on a vast scale. In the three airports through which I transited in February on my way to South Africa — LA International Airport, Dubai International Airport, and OR Tambo International Airport in Johannesburg — more that 15-million people passed through these places during that period. When you count the 266 000 employees and the hundreds of millions of people these travellers touched in some way, shape, form or fashion, by the time we started with lockdowns to stop the virus from spreading, the horse was already out of the barn.

I’m not saying this to suggest that we do nothing in response to the coronavirus, I’m actually arguing the opposite. That is, instead of wasting time and money on a lockdown strategy that is unnecessary, not to mention poorly executed, let’s focus on fixing the problems Covid-19 has exposed. Problems that we should (and can) address.

If we embrace the obvious inference from the Thorax study, there are some clear paths forward to lowering the mortality rate from viruses such as the novel coronavirus. If we read the conclusion for what it says rather than what we want it to say, we can then have a real discussion about real problems that have real solutions.

For example, the infection rates and mortality rates in poorer groups are significantly higher than population at large. The correlation between higher incomes and better health outcomes is well documented. If we want to lower the risk profile for poorer people, the answer is pretty simple. We need to target low income and “no income” population groups (such as those in some South African townships) for job growth and development.

I’m not a sociologist or epidemiologist, but to those who are, let me say, do the research and give us a sense of how many lives in poor, black, and brown areas would be saved during such outbreaks if employment rates rise and obesity rates drop. My sense is that such analysis would make it clear there are things we can do that will really make a difference. In addition to jobs, greater food subsidies for the poor would enable them to make healthier dietary choices, which would lead to better health outcomes. 

Let’s think about other prevention strategies that would enable us to significantly reduce the rate of pain and suffering that outbreaks such as Covid-19 mean for populations on the margins.

What the coronavirus has exposed is that we’re willing to put our money where our priorities are. What the study punctuates is that maybe we ought to put our money where there’s the greatest need.

Ambassador Charles Stith served as president Bill Clinton’s envoy to Tanzania. He is the non-executive chair of the Johannesburg-based African Presidential Leadership Centre

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Charles R Stith
Charles Stith was former president Bill Clinton’s envoy to Tanzania and is currently the nonexecutive board chair of the African Presidential Leadership Centre, a Johannesburg-based NGO

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