Category

Current Affairs

female diversity

Women’s Day: Celebrating ever-growing strength in solidarity

By Current Affairs, Gender

On Sunday we celebrated Women’s Day, 64 years on since the historic march to South Africa’s Union Buildings in protest against the then Pass Laws. It’s hoped that our observance of Women’s Day brings to the fore the continued challenges faced by women in South Africa and to that end, globally. 

female diversity

Women’s Day 2020

For many women, South Africa’s lockdown has underscored the disposition of women in society, from increased vulnerability to domestic violence, to the “second shift”. On Sunday and during the month of August, we take stock of the gains women have made in securing a socially just world. While much has been achieved, the Development Works team is reminded that many challenges lie ahead. 

My Choice, Our Choice Campaign

This is highlighted in our team’s involvement, in an M&E capacity, in supporting the My Choice, Our Choice Campaign. The campaign focuses on addressing unsafe abortion practices in Southern Africa. Policies towards abortion continue to remain restrictive in many countries globally and where freedom of choice is withheld. 

The My Choice, Our Choice Campaign is focusing strategically on persuading policymakers to remove restrictions surrounding access to safe abortion, persuading men and boys to actively support women’s desire for autonomy over their bodies, and engaging adolescent girls and young women (AGYW) to become aware of their rights regarding pregnancy and abortion. While South Africa remains progressive in our policies towards abortion practices, many neighbouring countries continue to maintain restrictive policies. 

Let’s support the My Choice, Our Choice Campaign in advocating for freedom of choice and bodily autonomy.

Written by Susannah Clarke-von Witt

young women

nelson mandela

Mandela Day 2020: Is There A Magical Future On The Horizon?

By Community, Current Affairs, Legacy

Can we as Africans create a magical future where our continent achieves its full potential in difficult circumstances? 

We are all creating our own future by our actions and decisions every day. We are also collectively co-creating the future of our country and our continent. What is our mindset about the future  – are we creating this story in hope or in despair?

quote by robert breaault

Source: Quote Fancy

 Remembering Nelson Mandela, we remind ourselves that:

nelson mandela quote

Reflecting Back

Thinking of our previous blogs on scenarios for South Africa, we are reminded of three possible futures[1]:

Source: Ourfuturecities.co

Mandela Magic: A story of a country with a clear economic and developmental vision, which it pursues across all sectors of society in the face of stiff competition and high barriers to success.

Bafana Bafana: A story of a perennial underachiever, always playing in the second league when the potential for international championship success and flashes of brilliance are evident for all to see.

A Nation Divided:  A story of a South Africa that steadily gathers speed downhill as factional politics and policy zigzagging open the door to populist policies.

These scenarios may have been turned upside down with COVID-19 exploding all over the world!

COVID-19 virus

Source: MIT: Reopening Too Soon Could Cause “Explosion” of Coronavirus

Disruptive Change

Our understanding of disruptive change was rudely enhanced by our first-hand experience of the mother of all disruptions. Being on the receiving end of disruption is a big shock to most.

It may appear that COVID-19 will chew us up and spit us out. That sounds like a bad thing, right? But some things are better when crushed and transformed. Like coffee beans. Hard and bitter in their original format, but delightfully addictive when roasted, ground up and brewed in hot water.

meme about coffee

Doe Zantamata – Home

Considering that coffee is something that is so much better when roasted, crushed, and boiled, they are not fragile.  In fact, for coffee to become the best it can possibly be, it needs some pretty rough treatment – it can only become something special if it is exposed to adverse circumstances which enables it to reach its full potential. So, if coffee beans are not fragile, what are they then?

fragile and robust

Coffee beans are antifragile. And antifragile is what we need right now. It is more than robustness – it does not only withstand shock, it benefits from it. In his book, “ Antifragile: Things That Gain from Disorder”, Nassim Taleb defines antifragile as follows:

 

Is Africa Antifragile?

Thinking about Africa, the big question is whether Africa is antifragile? Will COVID-19 be what spurs Africa on to realise its full potential?  In his latest book, “Africa First. Igniting a Growth Revolution”, the Africa analyst, Jakkie Cilliers[3] contemplates the question: “What prevents Africa, with its bountiful natural resources, from translating that potential into prosperity?”

Through 11 scenarios he shows how the African continent can ignite a growth revolution that will change the lives of millions who were experiencing poverty and into employment. The book identifies key levers for sparking the growth revolution.

These are opportunities that technology offers to leapfrog into the future, fundamental transitions needed in agriculture, education, demographics, manufacturing, and governance. Considering the projected devastating impact of COVID-19 on poverty and unemployment, this roadmap for how Africa can “capitalise on its boundless potential” to “catch up with the rest of the world” could be worth considering.

The way in which we respond to the challenges posed during and after COVID-19 will determine if we choose to create our future via a path of despair or via a path of hope. Now, more than ever, it is in our hands, as Africans, to create the world we want to live in.

quote about fragility

Source: Quotefancy

By Fia van Rensburg

[1] South African Futures 2035, South Africa in ‘sweet spot’ for growth, South African Futures 2030: How Bafana Bafana Made Mandela Magic by Jakkie Cilliers

[2] Antifragility Definition

[3] Three possible futures for South Africa | Jakkie Cilliers | TEDxJohannesburg

[4] Africa First! Igniting a Growth Revolution

 

bonteheuwel

We Need More Heroes to Make our Dreams Come True

By Community, Current Affairs

This is part three of a 3-part blog on food security in the time of COVID-19 and climate change. We are juxtaposing recent developments against our rich treasure of scenarios that have created a vision for South Africa throughout the journey towards and into democracy. These scenarios remind us of the best possible dreams for the country and could give hope for the future. They provide a common thread that could pull us through the current challenges. At the same time the scenarios we have reviewed also provide valuable insights into what could prevent South Africa from taking the best possible course.

While the government has made some worthy efforts to address issues of food security, the inability to find creative solutions to ensure that the NSNP continues to reach its usual beneficiaries, cannot be regarded as a success. Section 27 has proposed a number of creative solutions in this regard, and have expressed their concern about the apparent lack of collaboration between the DBE and DSD: “We have noted that these current interventions are being funded through DSD’s Disaster Relief fund and Social Relief fund, at R900 million and R500 million, respectively. While we welcome the utilisation of DSD funds, we are baffled as to why the DBE is not contributing funds from the NSNP towards these efforts.”[1]

kid planting food

Who are the heroes?

Perhaps the lack of coordination and the inability to find swift and creative solutions is not so surprising after all. In our work as evaluators of government programmes, a recurring theme, over many years and across many sectors is indeed, the inability of the government to find joint, integrated solutions. This needs to change. There will in future simply not be enough resources to continue to work in silos.

The real heroes in the current food crisis are those who do not necessarily have power, status or money. The heroes are those who kept on working tirelessly and with dedication despite their own fears and needs. Existing feeding schemes and soup kitchens had to deal with increased demand, others pivoted on the crisis and reinvented themselves into new terrain of providing food packages to hundreds of recipients in record time.

The heroes are the NGOs, the churches, the women at the soup kitchens who kept on giving even though they did not know if they had enough to feed all who would turn up. The heroes are the young men and women who are investing their time in food gardens to ensure that there is enough to keep soup kitchens and feeding schemes running on a sustainable basis. What sets them apart is that they are doing all they can, often with limited means, and they keep on doing it every day, without any concern for “what is in it for me”. Government, and all political parties should take a leaf out of the book of these ordinary citizens, who made the difference in these difficult times, who stepped up to ensure that less children go to bed hungry, who made sure that those in dire straits can cling on to hope, and perhaps some dreams.

food security in cape town

We showcase some of these heroes here:

Tsepo Sejosengeo is a 26-year-old South African who has committed to serving his community during a challenging time. Tsepo head’s up an organization called Ukwazana Lwethu Youth Development that is based in Khayelitsha.  He channelled his efforts into helping his community, including opening a soup kitchen, which relies on the generosity of donors

The Bonteheuwel Development Forum has been working tirelessly for the past four months, putting their hearts and souls into delivering essential food relief in the Bonteheuwel community. Co-ordinated by Henrietta Abrahams, the group of volunteers deliver food to 17 blocks in the community. This effort of 34 feeding schemes manages to feed approximately 20,400+ people per week.

Souper Troopers supports 150+ regular feeding schemes which range from existing non-profits who were working in the area before the virus hit. There are thousands of heroes, from many communities and organisations, working tirelessly every day to feed people in the battle against hunger.

Climate change will not wait for Coronavirus to disappear

The food security issues that are magnified during this crisis is a reminder that there is no time to waste to get ready for the food security challenges that are expected due to climate change. Sub-Saharan Africa will bear the brunt of these challenges, and we should not think that climate change is politely waiting in the wings for the Coronavirus to disappear. Climate change will challenge food security, and it is creeping up on the world slowly, but surely and relentlessly.

Coronavirus has shown the world how dangerous it is to underestimate a threat when it is not yet tangible. It has also demonstrated what an avalanche caused by catalytic impact looks like. Hopefully, the current challenges will propel our government to take the lead to enable all actors in society to play their role, to work towards a common goal, which links up with the development world’s dream for a greener, fairer and more prosperous world.

By Fia van Rensburg

[1] Section 27

south african dream

A Reflection on the South African Dream and the Looming Nightmare of Food Insecurity

By Current Affairs, Heritage

Saying that 2020 did not turn out exactly as good as we hoped is probably a huge understatement. But all is not lost, and while it is a cliché that we cannot control events or actions of others, but we can control our reaction to events or actions of others. It is worth remembering that we do have choices. And now, more than ever, the choices of our governments, groups we are affiliated to, and our individual choices, will contribute to shaping our future. It is therefore worthwhile to consider the potential dangers of taking directions that could send us into an abyss of unnecessary misery.

This is part two of a 3-part blog on food security in the time of COVID-19 and climate change. We are juxtaposing recent developments against our rich treasure of scenarios that have created a vision for South Africa throughout the journey towards and into democracy. These scenarios remind us of the best possible dreams for the country and could give hope for the future. They provide a common thread that could pull us through the current challenges. At the same time the scenarios we have reviewed also provide valuable insights into what could prevent South Africa from taking the best possible course.

Checking reality against the dreams we had for our future

While we are all part of creating a new reality for our country (albeit consciously or unconsciously), day by day, as we respond to the new reality, it may be helpful to look back at what our dreams for our country looked like in the time before and shortly after the birth of our democracy, which promised a better future for all our people.

There is a common factor in all the scenarios that have been developed for the country by a range of think tanks and planners, from as early as 1991. All of them include a scenario that envisages inclusive approaches, where the country works together towards a common goal. Inevitably, within each set of scenarios, this is the one that foresees the best possible future.

diagram

Taking care not to avoid the nightmares about our future

Every set of scenarios include one or more scenarios that predict negative outcomes when the wrong choices are made. A summary of the less desirable scenarios provides rich food for thought when considering the issue of food security and hunger against the backdrop of recent events. For example:

  • The Mont Fleur Scenarios predict unfavourable outcomes when: responses to urgent issues are not adequate, e.g. when: realities are ignored (Ostrich); decisive action is not taken (Lame Duck); or unsustainable populist policies are pursued (Icarus).
  • The Dinokeng Scenarios shows how we cannot win when we “Walk Apart”. Under this scenario critical challenges facing the country are not adequately addressed, resulting in decreased trust in public institutions and ultimately in a cycle of resistance and repression. The “Walk Behind” scenario paints a picture where the state plays a strong central role in an attempt to accelerate service delivery to citizens, which discourages private initiatives by business and civil society, thereby risking a situation where the state amasses unsustainable debt, and/or becomes more authoritarian.
  • The less favourable Indlulamithi Scenarios include “iSbhujwa – An enclave bourgeois nation”, which describes a South Africa torn by deepening social divides, daily protests and cynical self-interest; and “Gwara – A floundering false dawn”, which paints a picture of a demoralised land of disorder and decay.
  • The Clem Sunter Coronavirus scenarios include some that point to severe negative economic impact, which in turn, will impact on food security and hunger. “The Camel’s Straw”, where the virus leads to a collapse of the world economy; and “Spain Again”, where a significant percentage of the world population perishes, similar to the Spanish flu which led to the death of between three and five percent of the world’s population. The “Much Ado About Nothing” scenario, which brushed the COVID-19 virus off as just a bad bout of the seasonal flu, has by now been rendered redundant by evidence on the spread and impact of the virus.

langston hughesWe need to hold on to our dreams

As South Africans, we cannot afford to let go of our dreams for our country. When facing challenges that seem to be insurmountable, it is dreams that will help us navigate the rough patches and boulders in the road. Dreams will also keep us focused, to remember what we are working towards, and it will give us strength and energy when the challenges seem too many, and the hurdles too steep to overcome.

Possibility thinking is necessary to ensure that we do not waste this COVID-19 crisis. Reflection on our dreams and nightmares can provide a useful frame for figuring out what path our responses to this crisis will lead us on.

Clearly, the working together scenarios are those that will create a better future, particularly now that we have had the opportunity to understand the practical implications of the links, and disruption of links between many stakeholders and systems. The current crisis has demonstrated how the complex relationships between agriculture, business, government, donors, non-profit and other community and faith-based organisations are needed to ensure that food security is achieved and maintained.

Walking together is the only option, and in the current crisis we are not “walking the road” together – we need to “walk the tightrope” together. This will require a careful and considerate balancing act, where all actors in society can play their role. The government cannot do this on their own, and the only way to stand up to the growing challenge of food insecurity and hunger would be to work towards the common goal of achieving food security for all who live in South Africa.

[1] The Mont Fleur Scenarios

[2] THE DINOKENG SCENARIOS – THREE FUTURES FOR SOUTH AFRICA

[3] SA Scenarios 

[4] Investec: Camel to Tightrope Road to Recovery

[5] Politics Web: The South African Dream Revisited

[6] Poets: Langston Hughs

box of tomatoes

The Challenge of Food Security Amidst COVID-19 and Climate Change

By Current Affairs, Heritage

As COVID-19 cases in South Africa surge past the 100,000 mark, the discourse on food and hunger is becoming louder and more agitated by the day. The growing dissonance shows up fragmented responses, dismal ineptitude at efficient collaboration and a concerning lack of agility. The extent of the cacophony is such that the right to provide food to people in need, and the right of children to receive food have already led to at least three court cases. How can this story be changed to one where South Africa works together to prevent and alleviate hunger and food insecurity?  

This is part one of a 3-part blog on food security in the time of COVID-19 and climate change. We are juxtaposing recent developments against our rich treasure of scenarios that have created a vision for South Africa throughout the journey towards and into democracy. These scenarios remind us of the best possible dreams for the country and could give hope for the future. They provide a common thread that could pull us through the current challenges. At the same time the scenarios we have reviewed also provide valuable insights into what could prevent South Africa from taking the best possible course.

Food, politics and the courts

Three months into the COVID-19 crisis, Equal Education, and school governing bodies, represented by the Equal Education Law Centre (EELC) and SECTION27 say that the rights of qualifying learners’ to basic nutrition, basic education and equality is violated by the failure of the Department of Basic Education (DBE) to find a way to continue the National School Nutrition Programme (NSNP) during the state of disaster1They want to compel the DBE to ensure that the programme continues while most children are not able to attend school. It is a sad statistic that for many of the 9 million children who benefitted from the NSNP before lockdown started on 26 March this year, the meal they received at school was the only daily meal they had access to. 

On 23 June, the Cape Town High Court had ruled2 that neither the National Department of Social Development nor the South African Police Service (SAPS) may prevent soup kitchens from operating during the COVID-19 national lockdown. This follows an interim ruling obtained by the Democratic Alliance (DA) and the 1000 Women Non-Government Organisation (NGO) from the same court that stated that “government cannot be allowed to prevent people from exercising their existing rights to distribute and receive food”.

The media spat about the case saw the NGO suggesting that government was attempting to centralise donations and tried to dictate to NGOs what to do, while the Minister emphasised that the intention of the government was to ensure that the necessary protocols were followed, and people’s dignity was protected, referring to chaotic scenes where people were jostling for food3

Earlier in May, the same court dismissed an application from the DA to prevent the Social Security Agency of South Africa (SASSA) from allegedly providing food parcels with the ANC at political events4

Food insecurity and hunger is not new but will grow

There has been a long-standing concern about what happens to children during school holidays, especially over the longer year-end period, when children are home for over five weeks.5 With the lockdown, this fault line, like many others, has been put under the spotlight. Why has this issue not been pushed to the top of the agenda earlier? Why have we never been concerned about millions of children going hungry in the summer school holidays and over the festive season, while food secure citizens in South Africa are able to indulge in the excesses of the festive season.    

The wrangling about who should provide food, and where and how it should be provided is taking place against a backdrop of an expected spike in food insecurity6, given chilling predictions of up to 4 million job losses as a result of COVID-19, the anticipated shrinking of the economy between 10% and 17%, and forecasts that the unemployment rate will soar to 35.31% by December 2020 (compared to an already high 28,70% in December 2019)7. Sadly, this means that, as the sun sets each day, more and more people, and children in particular, will go to bed hungry in South Africa. That is, unless decisive and urgent action is taken with the clear and sole intent to help the rapidly growing group of vulnerable persons in our country, and not to score political points. 

The severity of the crisis has been highlighted by Oxfam in a recent press release8: ”40 million people in Southern Africa are at risk of increased hunger and poverty due to the double threat of the coronavirus and consecutive climatic shocks…”. According to Oxfam, the 2019 drought has already rendered over 17 million people across Malawi, Mozambique, Zimbabwe, Zambia, and South Africa food insecure. 

Oxfam pointed out that food security is further threatened by the high number of people in sub-Saharan Africa (approximately 70%) who work in the informal sector. In South Africa, approximately 16% of people work in the informal sector, which means that they have “little or no employment benefits”. In addition, social stimulus packages do not necessarily include workers in the informal sector and other vulnerable groups like the over 4 million migrants and refugees in South Africa. 

The Food and Agricultural Organisation (FAO) identifies four dimensions to food security9.

 (Source: FAO) 

Already in 2017, South Africa was regarded as “food secure” at a national level, but food insecure at household level, because almost 20% of South African households had inadequate or severe inadequate access to food in 2017. Food security varied by province, household size, and population group of household head and by household size10:

  • Provinces reporting the lowest proportions of adequate food security were North West and Northern Cape.
  • Households headed by black Africans and coloureds were more likely to be food insecure.
  • Larger households were more at risk to have inadequate or severe inadequate access to food.
  • Households with no children or fewer children were more likely to have adequate access to food than those with many children.
  • In 2017, 6,8 million South Africans experienced hunger. The number has dropped from 13,5 million in 2002. 
  • With more than half a million households with children aged five years or younger experienced hunger in 2017, child hunger remains a problem in South Africa.

Hunger is a crisis, which demands action now

Hunger and food security should not be intellectualised or politicised. Hunger is real, and it is a crisis that cannot be ignored. According to Dr Tracy Ledger, a Research Associate in the Wits School of Social sciences, health data confirms that thousands of South African children are starving to death each year: “Tens of thousands of children under the age of five are admitted to hospital each year for severe acute malnutrition… About 1 500 to 2 000 of those children die in hospitals of starvation. Many more children in South Africa die out of the hospital than in hospital (up to 9 000) and the indirect effects of malnutrition are much higher…” 11 

To see this in context, consider that in the slightly more than three months since the first COVID-19 case in South Africa, approximately 2,000 people have died from the pandemic, something most of us are gravely concerned about.

Yet, in the “normal” pre-COVID 19 situation which we now idealise, we did not see a daily count of this tragedy. Media reports were few and far between, and for most of us, at least for the more privileged part of the population, this tragic situation remained on the periphery of our consciousness. COVID-19 and its devastating economic consequences will force us to acknowledge this crisis and do something about it. The number of people, including children, who will die from hunger, will unfortunately increase markedly unless decisive and quick action is taken.       

Economic hardship goes hand in hand with the food crisis

It is important to understand that South Africa is not alone in the fight against hunger. After decades of steady decline, world hunger has slowly been on the rise since 201512. The Food and Agriculture Organisation’s (FAO) “The State of Food  Security and Nutrition in the World report (2019)”13 connects rising hunger to economic downturns: “…economic shocks tend to be significant secondary and tertiary drivers that prolong and worsen the severity of food crises”, leading to increased employment and decreased wages and incomes, which in turn challenges to access to food, social services and healthcare.

Climate change is a threat to the entire food system 

Climate change is another threat to food security. Already in 2008, the FAO has alerted that climate change will affect food security through its impacts on all components of food systems, at a local, national and global level. “Climate change is real, and its first impacts are already being felt. It will first affect the people and food systems that are already vulnerable, but over time the geographic distribution of risk and vulnerability is likely to shift. Certain livelihood groups need immediate support, but everybody is at risk.”14

One thing that COVID-19 crisis has highlighted is the connectedness of systems, and how changes at one level of a system affect other levels of a system; or how changes in one system affects other related systems. For example, food may be available in the broader food system, but children may not have sustained access to nutritious food, despite having the NSNP in place, when the school calendar is interrupted. 

FAO quoteDecisive and comprehensive solutions are required

This, taken together with the inevitable economic hardship and increased food insecurity that is emerging in the wake of COVID-19 pandemic, should be a wake-up call to unite against this threat and to put selfish and political agendas aside. No child should die of hunger, and no household should be food insecure. 

Food security requires collaboration between different systems and across different levels of the system, as well as between different actors, i.e. government, civil society, the private sector, philanthropists and other funders. The problem is much too complex and too vast for any one actor to presume that they could tackle the problem on their own.  

Court cases on food parcels, feeding schemes and nutritional programmes show a lack of common purpose and action despite the opportunities provided by the current extraordinary situation for different actors to unite around a common purpose in the interest of the greater good of society. This is one of the opportunities in the crisis we should be embracing to co-create a different and a better society especially for the vulnerable and marginalised, who are easily overlooked.

By Fia van Rensburg

[1] Basic Education: Court bids to prevent school reopening pile up

[2] SABC News Facebook

[3] News 24: COVID-19 soup kitchens can no longer be policed or controlled court says

[4] DA to appeal ‘food parcels’ court ruling – The Mail & Guardian

[5] Op-Ed: How South Africa can feed its hungry children during the lockdown

[6] Covid-19: B4SA foresees up to 4 million job losses

[7] South Africa Forecast: Unemployment Rate [1980 – 2020] [Data & Charts]

[8] Coronavirus could increase hunger for over 40m in Southern Africa

[9] An Introduction to the Basic Concepts of Food Security

[10] The Extent of Food Security in South Africa

[11] 2017-06 – Ten to 20 South African children die of starvation every day

[12] UN – Issues Depth Food

[13] SOFI 2019

[14] FAO

reopening of schools

Prof. Shabir Madhi – COVID-19 and the Re-Opening of Schools

By Current Affairs, Education

In early May, Ronald Abvajee spoke with Professor Shabir Madhi, who is an esteemed sector expert in vaccinology. He holds a number of reputable positions including Professor of vaccinology at Wits, Director of the Medical Research Council Respiratory and Meningeal Pathogens Research Unit, South African Research Chair in Vaccine-Preventable Diseases, and Co-Director of the African Leadership Initiative for Vaccinology Expertise.

In the discussion, Professor Madhi spoke about the latest developments to date around COVID-19 in South Africa, and how it affects children and the re-opening of schools.

Pandemic in South Africa

Madhi noted that South Africa is still at a relatively early stage of the pandemic. While the increasing numbers already appear frightening, the peak is expected in July or August, with still a long road ahead thereafter. Further, the numbers currently reported are not accurate, and he surmises that we are probably only picking up 10-15% of infected cases.

This is due to not testing at scale and the result’s turnaround time (5-10 days) being too slow for quick action. Including isolating the testee, tracing their contacts, and isolating them. By the time someone knows their status, they are likely no longer infectious and it is too late to trace and isolate their contacts.

He also noted that there is no preventing people from eventually getting the virus. No respiratory virus has ever been eliminated with a vaccine. As such, he expected (assuming no vaccine) that within 2-3 years there will be multiple waves and at least two thirds (i.e. 60%) of the population are going to need to be infected for immunity to be developed. Making the virus less efficient in transmitting from one person to another. With this extended time in mind, he asserts that whatever decisions are made now will need to be followed for the next 2-3 years.

International evidence

Madhi advised that international evidence is showing that not everyone who has the virus actually becomes ill – reportedly 50-80% of those infected have not shown symptoms. Therefore most people who have the virus will be completely well. The majority of those who do become symptomatic will only have mild symptoms, appearing like the seasonal flu.

In the minority, approximately 26 people out of 1000 will require hospitalisation, and in 2-3 years, an estimated 5 people out of 1000 will die from the virus. These estimates however are sensitive to age (e.g. above age 65 years) and comorbidities (e.g. hypertension and diabetes).

Non-therapeutic interventions such as wearing masks and social distancing are about protecting these high risk groups from hospitalisations and death, and protecting the healthcare system from overburden and collapse.

 

figure 1

Figure 1. SARS-COV-2: What to expect in adult population over approx. 2 years

 

On the positive side, the Professor highlighted that out of the 3-4 million cases globally, only approximately 2500 children make up these cases. This is a very low proportion especially considering children make up 20% of the global population.

Yet, there are few children severely affected by the virus; there is no clear reason why. It is estimated that few if any children will die from COVID unless they have severe comorbidity. Madhi asserts that there is no escaping children getting infected, but they are not expected to contribute to hospitalisations and mortalities.

 

figure 2

Figure 2. SARS-COV-2: Estimates for children under 18 years of age

 

Schools Reopening

Schools were initially closed in early March given learnings from other respiratory viruses such as seasonal flu, for which children are effective transmitters. However, this was before international evidence emerged indicating that children are not vectors in the transmission of the virus and they play a minor role in infecting adults.

As indicated in Figures 3 and 4, evidence from the Netherlands indicates that infected children infect almost no one. In sum, not only are children not severely affected by the virus, but they are also not effective transmitters.

 

figure 3

Figure 3. Percentage of contacts that became infected, by age group of the patient

 

figure 4

Figure 4. Distribution of COVID-19 by age-group: Relationship of infector (transmitter) and infected (secondary case)

When schools are opened, there are some precautions that should be taken, but the pragmatics must be considered:

  • Children using public transport should wear a mask, and the driver should ensure that there is no talking in the vehicle (to prevent droplet spread).
  • Children should wear a mask if practical (less practical for children under the age of 5).
  • Hand sanitation products need to be available; not just waterless sanitiser, but water and soap to wash hands
  • The gathering of children needs to be minimised. There should be no assemblies.
  • Children’s movement should be minimised. They should be limited to a classroom to reduce traffic in between classes. Teachers should be moving from class to class.
  • Given that teachers are more likely to be infected and infectors of others (especially other teachers more so than children), they should be taking strict precautions in terms of wearing masks, hand hygiene (frequent hand washing and using sanitiser when changing classes), and maintaining physical distance (at least 1.5m) from learners and staff (avoid gathering in the staffroom). Further, if teachers have any symptoms, they must not attend school.

Final thoughts

In conclusion, Professor Madhi emphasised that children will indeed be infected; there is no escaping it. But they will not be infected severely and they are not effective transmitters. He asserts that the greatest risk to children in this time is thus not infection with COVID-19, but rather the harms associated with a lockdown. Including their families being pushed below the poverty line, poor food security, and fewer vaccinations.

He thus argues that keeping schools closed is not for the benefit of children. He expressed concern for children missing out on learning opportunities, especially young children whose cognitive development is at its prime, making it difficult for time out of school to be made up at a later stage. There are certainly trade-offs between keeping schools closed which serves more to protect the adult population, versus re-opening schools which safeguard the livelihoods of children.

To hear the full discussion with Professor Madhi, please visit MyHealth TV.

By Jenna Joffe

For more on COVID-19 and education, you can read Who Should Go Back To School First.

washing hands

Going “Back To Normal” Is Not An Option – COVID-19 And Local Government

By Community, Current Affairs

We will not “go back to normal”. It is time to reset to 00:00:00 and start building a better society. The question is how.

Going forward differently is essential. How that will happen is unclear.

“So no, I don’t want us to return to normal. I want us to use this as an opportunity to change, to create systems and social structures that create deep and lasting equity and a world where we work together for the common good. One can dream, right? If anything, this crisis should teach us that we are all connected.” – Anne Price1

Navigating the new normal

If anyone thought life would go “back to normal” after the lockdown ends, perhaps with some slight changes, they were wrong. Very wrong. The end of the initial extended lockdown will see us entering an uncertain period of phased restrictions and graded regulations, based on emerging evidence of where, when and how fast the COVID-19 virus spreads. 

At a time when most of South Africa’s middle and upper economic classes are coming to terms with the shock that life as we knew it is history, that times are tough now. And will be even tougher as the crisis unfolds, In its aftermath, those who are less fortunate and are familiar with economic hardship may hope that government responses to COVID-19 may be a shimmer of hope that a long-neglected service delivery crisis may be taken more seriously in future. 

Upscaled service delivery under the COVID-19 state of disaster

Under the current disaster management regulations, the burden on local government to respond quickly is evident. Amongst the plethora of other things that have to be implemented under the disaster management regulations, Municipalities are, for example, directed to provide water and sanitation services and to make immediate plans where these services are not generally available. Such as in high population density settlements, rural communities and informal settlements. And to provide “other appropriate means, like water tankers, boreholes and storage tanks in water constrained communities that have limited access to municipal water supply”2

Interestingly, a review by Van Niekerk (2014)3 of the South African Disaster Management Act No. 57 of 2002 and the National Disaster Management Policy Framework of 2005, pointed out that while this policy framework “placed South Africa at the international forefront by integrating disaster risk reduction into all spheres of government through a decentralised approach”, a state of good practice had not been achieved at the time.

Van Niekerk (2014) was of the view that the absence of clear guidelines to local municipalities was one of the weakest aspects of the Act and Framework. “A significant finding of the research is the emphasis placed by all respondents on the silence of the DMA and NDMF with respect to the exact role and responsibility of local municipalities in South Africa (van Niekerk, 2014: 871 – 872). 

Government response

Now, with an actual national state of disaster in action, Local Government is guided by Government Notices4 from the Department of Cooperative Governance and Traditional Affairs (COGTA), and the overarching guidance of the National Command Council under the leadership of President Cyril Ramaphosa.

The responsibility placed on Premiers, Members of Executive Councils (MECs) responsible for local government in the nine provinces and Mayors and Traditional Leaders institutes to implement the regulations, and SALGA’s responsibility to disseminate information, support municipalities and advocating for the interests of municipalities is highlighted in a recent Local Government Bulletin published by the Dullah Omar Institute5.

There has, however, been some questions regarding the composition and powers of the National Command Council6. “They7 said, among others, the command council ‘appears to us to constitute a centralisation of power that is impermissible under the Disaster Management Act’.”. The establishment and set-up of the command council was also questioned: “…problem is that the NCC only consists of 19 ministers; where are the remaining ministers?”.

Some concern has also been voiced about the powers given to Municipal Managers during the lockdown. According to De Visser and Chingwata8, the disaster regulations change the constitutionally regulated system of delegation in municipalities: “They (the regulations) instruct each municipality to make sure that all decisions that would normally require the approval of the council, a committee of the council, or the mayor (whether executive or not), will now be taken by the municipal manager.”

While the regulations only allow Municipal Managers to make decisions that “cannot wait until after the lockdown”, De Visser and Chingwata cautions that decisions taken by Municipal Managers under the current dispensation will have to be reported and ratified in the first Council or relevant Committee meeting. And that elected representatives have to continue to exercise oversight over the executive and the administration during the lockdown, and that the COVID-19 disaster should not ever become an “excuse to do away with democracy”. 

Cape Town town hall

Silver lining

Soon after the declaration of the state of disaster in March 2020, the South African Local Government Association (SALGA) has given municipalities a pat on the back, for “adhering to the range of directives issued by the Minister of COGTA in direct response to the COVID-19 pandemic”. And continued to “call on Executive Mayors and Mayors, working closely with the municipal troika, provincial and national government public office bearers, to play their role and assist the nation in curbing the spread of COVID-19.”9

In some media reports, the upscaled COVID-19 service delivery to under-serviced communities was hailed as “a silver lining” in the crisis. Others pointed out that “it is too soon to say whether – or the extent to which – the Covid-19 emergency makes immediately possible what has been impossible for the previous 26 years” (Rudin, 2020)10.

In the same article, Rudin refers to alarming figures in the Department of Human Settlements’ Master Plan, launched in November 2019: ”Buried on page 400 of her [Minister Lindiwe Sisulu’s] report was the admission: ‘The current percentage of the population receiving reliable water services [is] lower than it was in 1994.’ This means that more than 5.3-million households and 21-million people don’t have clean water, and 14-million people not having safe sanitation. Rectifying these shameful infrastructural deficits almost 26 years after apartheid would not only take a further 10 years but would cost R898-billion’, she said’.”

Sustainability of the current response may be unrealistic

The severity of the current crisis is such, both in terms of the extent of the crisis and the rapid pace at which it develops; and its potential direct impact on loss of life, that the government has no choice, but to do everything it can to assist vulnerable and under-serviced groups. In a highly uncertain situation, there is an appreciation for what is being done, but there are multiple questions on sustainability and the future.

There is no certainty on the duration of the additional support that is being provided at present. Will it last for the duration of the pandemic? And how long will it take for South Africa to get COVID-19 under control? Does the country have the resources to sustain this level of support during the pandemic? Are all vulnerable communities reached? 

Perhaps more importantly, are questions regarding the post-COVID-19 phase. It may not be possible to provide water trucks and portable sanitation for an indefinite period. But what then? How will the transition be mediated? 

municipal deliveries

Municipal service delivery, capacity and accountability crisis

The local government service delivery, capacity and accountability crisis has been with us for decades, and despite many capacity-development plans, turnaround strategies, and other initiatives, the situation remains dire.

When Auditor-General (AG), Kimi Makwetu released municipal audit results for the 2017/18 financial year mid-2019, the headlines read: “Auditor-general reveals shocking state of South Africa’s municipalities”11. This BusinessTech report highlighted various performance deficiencies regarding infrastructure, and pertaining to water and sanitation the following was noted: 

  • 48% of municipalities did not have a policy or an approved policy on water maintenance; 
  • 29% did not assess the condition of water infrastructure; 
  • Water losses were above 30% at 39% of municipalities; 
  • Water losses were not disclosed at 9% of municipalities;  
  • 49% of municipalities did not have a policy or an approved policy on sanitation and maintenance; and 
  • 31% did not assess the condition of sanitation infrastructure.

Audit outcomes

In addition to service delivery constraints, municipalities have been struggling with accountability and governance issues for many years. The same BusinessTech report quotes Makwetu as saying that “deteriorating audit outcomes shows that various local government role players have been slow in implementing, and in many instances even disregarded, the audit office’s recommendations…”. This means that “the accountability for financial and performance management continues to worsen in most municipalities”. 

The Auditor-General of South Africa (AGSA) audit of for the 2017/18 financial year showed significant regression in audit results12:

  • Out of the 257 municipalities and 21 municipal entities audited, the audit outcomes of 63 were worse than in the previous year, while only 22 improved; 
  • Only 18 municipalities have received clean audits, and this is 33 less than in the previous year; 
  • The percentage of unqualified opinions on the financial statements of municipalities decreased from 61% to 51%, and according to the AG but the quality of the financial statements “was even worse” than in the previous year; 
  • Only 19% of the municipalities were able to provide financial statements “without material misstatements”; and 
  • 65% of the municipalities that produced performance reports, had “material flaws” in their reports, and that these reports were, therefore “not credible enough for the council or the public to use”.

Accountability

In the committee discussion, it was mentioned that deteriorating accountability had a detrimental impact, not only on the financial health of municipalities but also on service delivery and municipal infrastructure maintenance. The committee discussion highlighted several factors that contributed to this situation, amongst them lack of consequences for transgressions and irregularities, and the high number of municipal managers and Chief Financial Officers (CFOs) who were in acting positions. 

Some municipalities are doing well. Some are consistently achieving clean audits despite having the same challenges as their under-performing counterparts; and the AG mentioned that best practices at well-performing municipalities included stable leadership, commitment to a strong control environment and effective governance. Such municipalities also took audit action plans seriously and proactively addressed audit findings and emerging risks. 

Municipal finances

Already before the COVID-19 crisis, various challenges with municipal finances were discussed in the NCOP Select Committee on Finance. Following a briefing from National Treasury on the state of local government and financial management (status as at 30 June 2018)13, National Treasury officials reported that more municipalities found themselves in “financial distress”: 125 municipalities in 2017/18 (almost half of all), compared to 95 in 2012/13.

This was due to more municipalities approving unfunded budgets, coupled with a seeming inability to collect revenue. The impact on municipal creditors was that municipalities were unable to pay them within the required 30-day period. In addition, “51% of municipalities had overspent their operating budget, and 36% had overspent their capital budgets.14”.

On the positive side, it was reported that “municipalities closed the 2018/19 financial year with a positive cash balance of R50.1 billion”, and that the major contributors were the metros and local municipalities. However, already then, with the exception of the metros, municipalities had been experiencing an increase in creditors, and this, together with non-payment by consumers were increasing financial pressures. 

calculator

Accountability in a state of disaster

Irrespective of these concerns, it can be agreed that the local government is at the forefront of responding to the implications of the social and economic implications of the crisis triggered by the pandemic. The need for local government to respond swiftly to a rapidly-changing landscape in the time of the pandemic puts the spotlight on accountability and emphasises the importance of a well-functioning local government sphere, and inter-governmental structures.

The need for accountability in a state of disaster should not be forgotten. In this regard, Van Niekerk (2014) pointed out that a robust monitoring and evaluation system should accompany the NDMC, covering all aspects of disaster risk management, with feedback loops that enable corrective actions. 

COVID-19 and recovery plans

By mid-May, three metropolitan municipalities Cape Town, Johannesburg and eThekwini , were applauded by the Chairperson of the Parliamentary Portfolio Committee on Cooperative Governance and Traditional Affairs for presenting their plans to combat the spread of coronavirus (Covid-19) in their cities, as well as their recovery plans to the committee. 

The committee recognised the cities’ efforts regarding initiatives to provide food and shelter to homeless people and to sanitise public spaces and transport hubs. At the same time, the responsibility of cities to be transparent and accountable for the spending of COVID-19 emergency funds was emphasised15.

Future prospects for local government

The COVID-crisis is showing us exactly how important local government is. However, it can be foreseen that the local government will be in a weaker financial state than before.  In some instances, the current crisis has presented sterling examples of joint efforts and collaboration across divisions of class, race, creed and many other divisions.

This is what gives hope in a time when it is not clear how the terrain of heightened need and expectations coupled with more limited resources will be navigated in future. Amidst these challenges, the opportunity exists to start afresh and create a new normal, which may be a more equal society, where access to basic services is permanently improved in an accountable manner. 

 

[1] There are words I really hate right now

[2] COGTA COVID-19 Disaster Response Directions, 2020

[3](PDF) A critical analysis of the South African Disaster Management Act and Policy Framework

[4] Government Notice 43291, 7 May 2020.

[5] Municipalities and COVID-19: A summary and perspective on the national disaster management directions

[6] Lawyers mull action on powers of Covid-19 National Command Council

[7] Advocates who questioned the powers of the COVIC-19 National Command Council

[8] Municipalities and COVID-19: What the national disaster management directions mean for municipal governance

[9] SALGA News

[10] Covid-19 has a silver lining – The Mail & Guardian

[11] Auditor-general reveals shocking state of South Africa’s municipalities

[12] Ibid.

[13] This briefing covers the same period as that referred to in the above-mentioned AGSA report.

[14] State of Local Government Finances and Financial Management: National Treasury briefing

[15] Three metros reveal Covid-19 response plans

boy reading a book in sunset

Nic Spaull Policy Brief – Who Should Go Back to School First?

By Current Affairs, Education

Nic Spaull is a Senior Researcher in the Economics Department at Stellenbosch University and a well-respected expert in the education sector in South Africa. He recently released a policy brief summarising the emerging international evidence as it pertains to the question of children going back to school.

His policy brief presents evidence on key considerations in answering this question, including the COVID-19 risks of illness and death in children, children as transmitters of the virus, and the social and economic costs of keeping children at home.

The emerging international evidence is presented from research conducted in China, South Korea, Spain, Italy, Switzerland, America, Germany, Japan, the Netherlands, and Iceland (who have tested the largest percentage of their population).

Children and COVID-19 risks

There appears to be a consensus among the emerging international research that children under the age of 10 years old are;

  1. Less likely than adults to catch COVID-19, either from other children or from adults;
  2. Less likely to transmit the virus, even when they are infected
  3. Are extremely rare found to get seriously ill or die from COVID-19

These trends were consistent across countries including those in North America, Europe, and Asia. While South Africa is still relatively early in the pandemic, the age-profile of infections and deaths has been consistent with international findings.

As of 2 May, no deaths were reported for persons under the age of 20. And of the positive cases, only 0.4% are aged 11-20 and 0.3% aged 0-10 years.

In sum, young children are low risk when it comes to being infected by the virus and in transmitting the virus.

reading a school book

Impacts of keeping children out of school

Children under the age of 10 are the highest child-care burden in their households. With these young children out of school and at home in need of supervision and care, caregivers are prevented from returning to work and earning an income.

Younger children also have limited capability to follow self-directed learning at home – they may not be able to read by themselves and they often require more active stimulation to learn. Spaull surmises that it is unlikely that any curricular learning is happening at home for the poorest learners in the country. Given what is known about the loss of learning during school holidays, limited access to computers, internet, and learning materials, and a lack of preparation for distance-learning.

See our blog about the digital divide in education.

Current efforts

While the Department of Basic Education (DBE) has been providing COVID-19 Learner Support” via TV and radio, it only targets ECD and Grades 10-12. In addition, it is only available for 1.5 hours per day. This ignores learners in Grades R-9, and households with multiple children in different age groups needing to share access to TV or radio.

Further, it does not appear that keeping children out of school necessarily contributes to flattening the curve. Spaull references a widely cited rapid systematic review on the effectiveness of school closures in limiting the spread of COVID-19. Where the authors conclude that data from China, Hong Kong, and Singapore suggest that school closures did not contribute to controlling the virus. He also cites another study from China that concluded that “social distancing alone, as implemented in China during the outbreak, is sufficient to control COVID-19.”

See our blog on what we can learn from other countries.

Children’s wellbeing is expected to improve if they could return to school, given the receipt of meals, peer interaction and caregivers being freed from childcare to work or relax, improving their mental health and caregiving abilities. In sum, keeping children out of school does not necessarily curb the spread of the virus, and instead, there are more apparent negative implications for their wellbeing, their caregivers’ wellbeing, and for the economy.

chalk board in a classroom

Spaull’s suggested evidence-based approach

Spaull states that “given the practical impossibility of continuing with meaningful learning from home – at least for the poorest 80% of learners, the emphasis for DBE should be making schools safe for learners and teachers to return.”

DBE has decided that schools will return as of 1 June 2020, and re-opening schools is in line with other countries that have had more severe outbreaks. However, DBE plans to start with Grade 7 and Grade 12 learners returning.

Spaull argues that emerging evidence should be followed – based on the evidence of children under the age 10 years being least susceptible to COVID-19 infection, illness, mortality, and transmission, they should be the first to go back. He suggests that in addition to Grade 12 learners, Grades R, 1, 2, and 3 learners should return (rather than Grade 7) and ECD sites should be reopened.

A phased-in approach is suggested with special precautions for teachers and close monitoring of infection rates of teachers and families of returning children. Spaull does, however, acknowledge the administrative complexities involved, including how to manage the risks for adults in the education system, possibly temporarily replacing high-risk staff (over the age of 60 and with pre-existing conditions).

Despite these challenges, the suggested approach would curtail risks to teachers and parents more so than if high school learners returned to school first, would allow many caregivers to return to work and earn an income, and in turn contribute to the functioning of the economy.

The following images have been taken from Spaull’s policy brief.

graph

graph of covid infections by age

graph of deaths from covid by age

By Jenna Joffe

wall of postcard face masks

What We Can Learn From Other Countries’ Responses to COVID-19

By Current Affairs

The COVID-19 pandemic has elicited a global response, unlike anything we’ve seen before. There are still no clear and definitive answers for how best to overcome the novel pandemic; the answers are constantly evolving and success is in part dependent on an individual country’s context and capacity.

However, amid some distressing trends, there are countries that are battling the virus more effectively than others. Squashing rapid infection rates, numbers of new cases in decline and serving as models to follow. As noted in Development Works Changemaker’s blog Evidence-Based Responses to the Coronavirus Chaos’ emergent evidence is being used to craft South Africa’s response to the Coronavirus crisis and this is a promising approach in tackling the virus.

While more and more evidence is continuously gathered by the world and sector experts, we can potentially learn from other countries’ best practices as we deal with a fast-changing complex issue.

Global practices

The practices listed below may already be implemented in South Africa or may not necessarily be applicable or possible in South Africa’s context. But they can still serve as thinking points and catalysts for other possible solutions.

sign that the world is closed

Taiwan

As of 21 April 2020, Taiwan’s number of COVID-19 infections sits below 450, a low number despite the country’s close proximity to China where the virus first originated. Experts believe that quick preparation and early intervention has helped spare Taiwan from facing the uncontrollable spread of the virus[1].

Quick response

The lessons learned by Taiwan during the SARS epidemic in 2003 is reportedly one key reason that the country has been more prepared for the virus than many other countries[2]. Taiwan was quick to respond by introducing travel bans soon after COVID cases began to rise in mainland China.

Taiwan took action earlier than most others; it was quick to first screen arrivals from China before closing its borders altogether and to initiate strict quarantine, health monitoring and contact tracing[3].

Community action

Private businesses and apartment communities have also started body-temperature monitoring and disinfection steps in a public area that have helped supplement government efforts[4]. The joint efforts of government and private companies—a partnership deemed “Team Taiwan” have also enabled the country to donate supplies to countries hard hit by the pandemic[5].

Importantly, Taiwan tackled the impending challenge of shortages in personal protective equipment (PPE) early. Taiwan predicted high demand for masks as early as late January, thus the government already began rationing the existing supply of masks then, and implemented a policy that citizens buy a specific number of masks from designated drug stores on a weekly basis[6].

Reportedly, the policy has been replicated in other countries including South Korea (another well-performing country in managing COVID) and France. Further, Taiwan invested approximately $6.8 million to create 60 new mask production lines, increasing the country’s daily mask production from 1.8 million to 8 million masks, an action now called “Taiwan’s Mask Miracle.” The wearing of face masks quickly became routine as early as January in many areas[7].

Data technology

The government has also been using data technology. It integrated the national health insurance database with its immigration and customs database[8]. By merging the databases, it was possible to gather citizen’s 14-day travel history and ask those who visited high-risk areas to self-isolate[9].

It also helps medical workers identify and trace suspected and high-risk cases, including the whereabouts of individuals in quarantine[10]. The Taiwanese government can track citizens through their phones, allowing them to ensure that individuals are adhering to the mandatory 14-day quarantine and are not violating the quarantine rules[11].

The government has also been making efforts to support those in quarantine, including delivering basic supplies (food or books) and implementing a welfare programme that provides a $30 daily allowance to those undergoing two-weeks or quarantine[12]. Experts suggest that this gives Taiwanese citizens greater incentive to report their symptoms honestly[13].

Over the past few decades, Taiwan has also invested in its biomedical research. This capacity has now been leveraged by way of working on a  mass-produced rapid diagnostic test for COVID-19 that can reduce the diagnostic time frame to as little as 20 minutes[14]. Should this be rolled out, it will be a game-changer in improving the number of individuals tested and immediately placed in quarantine before the virus can spread further.

Early leaders

While for many it is not entirely clear why more countries and the global health community did not follow Taiwan’s lead in early 2020, some of pointed out that it is likely due Taiwan not a member of the World Health Organisation (WHO)[15].

The island nation has been shut out from a number of international fora including the WHO as a result of Beijing’s geopolitical agenda to assert its “One China” policy against Taiwan’s President Tsai Ing-Wen’s mandate to assert democracy[16]. Had Taiwan had more of a presence and a voice on this global platform, potentially many lives could have been spared.

men wearing face masks

South Korea

South Korea is another nation standing strong in the face of the pandemic, taking action decisively and quickly. It was one of the first Asian countries to follow China’s lead in implementing widespread containment measures.

Comprehensive and innovative protective measures

According to experts, the country has some of the most comprehensive and innovative protective measures in place[17] and is why the number of new infections have slowed down. Even in the absence of stricter measures like lockdowns seen elsewhere. With the exception of closing schools and imposing a curfew in some cities[18].

The country’s testing campaign and intensive contact tracing have helped slow the spread of coronavirus[19]. The country acted early and reportedly has the most extensive, widespread and well-organised COVID testing program in the world, combining this with substantial efforts to quarantine infected individuals and trace and quarantine those they’ve been in contact with and potentially infected[20].

As an example, in March 2020, South Korea was conducting approximately 5200 tests per million citizens. In comparison to the United States, which had only conducted 74 tests per million citizens. The United States is one of the most infected nations globally with no trends of decline in sight.

Preparation is key

Similar to Taiwan’s lessons learned during the SARS epidemic, South Korea also learned the significant importance of preparedness from the outbreak of Middle East Respiratory Syndrome (MERS). Which saw the tracing, testing and quarantining of nearly 17,000 people and a negatively impacted economy[21].

The MERS experience revealed the major importance of testing to control any viral and fast-spreading epidemic[22] and helped the country to improve hospital infection prevention and control[23]. The experience led South Korea to use testing as a key in its coronavirus strategy, and it became a measure that seems to have set the country’s projections apart from others[24].

Information and communications technology

Another key to South Korea’s success is its use of information and communications technology[25]. Since the MERS outbreak, legislation was implemented that allowed the South Korean government to collect mobile phone, credit card and other data from individuals who test positive in order to determine their recent whereabouts and therefore allowing others to determine if they may have come into contact with an infected individual[26].

Government has also rolled out several smartphone apps that track quarantined individuals, gather data on their symptoms, send emergency texts about spikes in infections in the area, facilitate telemedicine, update on the number and type of masks available, and allow citizens to monitor their own symptoms and contact a doctor if needed.

In addition to contact tracing, technology has also helped the country to test widely and quickly share information with the public about the virus. Including how many people were infected in each geographic area and city in real-time.

Data literacy is essential during these uncertain times.

Commercial test kits

When news of the virus emerged in China, South Korea quickly worked to develop its tests and cooperated with manufacturers to develop commercial test kits. The first test was approved in early February when the country had only a few cases[27].

Other actions include a local monitoring team calling quarantined patients twice a day to check up on symptoms and ensure that the rules of quarantine are not violated. Those who violate quarantine face up to $2500 fines[28].

The country took an all-government strategy. The Prime Minister developed a task force of all government ministries as well as all regional and city governments; the approach ensured that different regions shared doctors and opened their hospitals to each other’s patients when resources ran low[29].

Open communication

The Foreign Minister also noted that being transparent and open with the public helped secure the people’s trust. “The key to our success has been absolute transparency with the public – sharing every detail of how this virus is evolving, how it is spreading and what the government is doing about it, warts and all.”[30]

Testing stations

One interesting measure South Korea takes is offering drive-through testing stations nationwide, an idea that has now been duplicated in the United States, Canada, and the United Kingdom.

Another novel concept employed is public “phone booths” used by a Seoul hospital for COVID-19 testing, providing easy access and quick testing for those concerned that they may have the virus[31].

On one side of the glass, the patient picks up a handset to have a consultation with a hospital worker connected on the other side of the glass. The health worker then puts their arms into rubber gloves embedded in the booth to swab a sample from the patient, and thereafter the booth is quickly disinfected for the next patient. In total, it is a seven-minute exam, allowing the hospital to test almost 10 times more than it could previously.

While the numbers evident thus far have certainly been promising for the country, whether South Korea’s success will be sustained is unclear, as reportedly new clusters are beginning to appear[32].

masks during coronavirus

Vietnam

The countries discussed above are well-resourced and are therefore well-positioned to make the more difficult decisions to mitigate the spread of coronavirus but concurrently negatively impact the economy. So what about countries that are poorer and developing?

Selective and proactive

One success story is Vietnam, which has shown how the virus can be contained with limited resources[33]. While Vietnam’s neighbours Taiwan and South Korea possess the financial resources for mass testing, Vietnam is driving selective but proactive prevention, deeming the country’s model to be an effective low-cost model[34].

As of 17 April, the country only had 268 confirmed cases (97 active and 171 recovered) with no deaths; an impressive containment given that the country shares a border with China where the virus originated[35].

Aggressive preparation

Vietnam prepared aggressively for the virus before its first case was identified and the country’s success in fighting the virus has largely been attributed to its proactive and rapid action[36]. The country’s early anti-COVID-19 measures included issuing urgent dispatches on outbreak prevention to government agencies, hospitals and clinics in January; and organising a National Steering Committee on Epidemic Prevention when the first case was identified[37].

Global isolation

There were also common policy actions including cancelling of all foreign flights and foreign entry (with any returning citizens subjected to medical checks and compulsory 14-day self-isolation)[38], extensive contact tracing and expanding production of medical supplies[39].

Since the first case was recorded, Vietnam limited movements where necessary, striking a balanced approach between overt caution with precision and fighting the virus and maintaining open economic policies[40]:

Schools were closed after the lunar New Year (with schools gradually adopting online teaching). High-risk villages and communes were initially locked down and the risks contained by enforcing checkpoints in and out of the localities and developing local medical facilities for testing and treatment.

The country was placed under limited lockdown effective April 1, which mandated self-isolation nationally, banning of all gatherings, closing borders and implementing a quarantine policy.

Open communication

Further, by proactively providing information to the public and being transparent, the Vietnamese government gained the confidence of its people and is viewed by the public as an effective source of communication leadership[41].

The Ministry of Health launched a website to share coronavirus-related information and just before the WHO declared COVID-19 a global pandemic, they launched the health declaration mobile application NCOVI to help citizens report their symptoms and follow the contact tracing operation[42]. Both platforms not only ease the medical process but also share accurate information rapidly and squash misinformation and fake news[43].

While the above-mentioned responses have certainly played a role in containing the spread of the virus, reportedly a key underlying factor is the government’s mobilisation of nationalism[44]. Vietnam has also leveraged its culture of surveillance to encourage citizens to report if they see any rule-breaking and have police administer fines to those who spread misinformation and fake news[45].

The government reportedly framed the virus as a foreign enemy and called the nation to come together to defeat it, mirroring the country’s history being long-threatened by foreign attackers[46]. Additionally, with large and well-organised military and security services, the country has been in a position to act decisively and swiftly.

coronavirus in singapore

New Zealand   

New Zealand has been showing an effective fight against the virus which has also been attributed to early and decisive action taken by the government[47]. The country identified its first case in February, and by early April, more citizens were found to be recovering than be infected, indicating a decline of the virus[48].

Streamlined strategy

Reportedly, the heart of New Zealand’s success has been due to a strategy including;

1) travel restrictions before any cases were detected in-country[49], including restricted access by those returning from mainland China, all international visitors self-isolating for 14 days, and finally fully closed borders to international visitors;

2) the government pushing early for a level 4 lockdown for at least four weeks, that has seen the shutdown of schools and non-essential jobs and services and prohibiting of many outdoor activities[50];

3) New Zealanders, including immigrants, have received recurring payments from the government to make it easier for individuals to stop working[51];

4) having scientific input into the policymaking process[52]; and

5) a Prime Minister who reportedly is a good communicator, the public have trust in her and therefore are more inclined to follow instructions[53].

It is reported that if New Zealand’s current trends continue, the country will be set to reopen its society quicker than Europe or the United States[54]. Experts report that the early and strict mitigation efforts, very good adherence by New Zealanders to the rules, and widespread testing have prevented an outbreak of the likes elsewhere[55].

As such, because there has been little evidence of community transmission, there have not been unmanageable numbers of patients overwhelming the healthcare system, making it easier to treat patients and ensure they see a full recovery.[56]

Australia

Australia has shown similar effectiveness to its neighbour New Zealand by implementing early mitigation actions[57].

Limiting travel

As early as January, Australia began limiting incoming travel from Wuhan, China where the virus first originated. In late January, the country recorded its first case, and within days the country recorded nine cases and initiated a mandatory two-week quarantine for those entering the country from China[58].

The Australian government initiated its emergency response to COVID-19 in late February, marking it a global pandemic earlier than the WHO; this enables the government to rapidly launch emergency funding and tax breaks and allowed hospitals to prepare for the wave of patients early on[59].

By mid-March, all travellers arriving in or returning to Australia were instructed to self-isolate for 14 days. The Prime Minister also restricted public gatherings to maximum two people by the end of March, and that individuals would only be allowed to leave isolation for essential shopping, medical reasons, exercise, or work[60].

Australia also rapidly expanded testing and implemented contact tracing measures to mitigate further viral spread[61].

The Road Ahead

There are several other countries not discussed here that are showing successes including Iceland, Croatia and India and provide further support for the lessons highlighted above. There are also numerous countries struggling to keep their heads above water in fighting the virus, including Italy, Spain and the United States. These countries provide their own lessons on what poor responses look like.

The country cases presented in this article have highlighted key acts and strategies in fighting the virus effectively; including quick preparation; early intervention; government support and welfare; leveraging technology for early detection, tracking cases, share of up-to-date information and shut down fake news; contact tracing; widespread testing and quick test turnaround times for early detection and treatment; case isolation and investment in a research capacity.

It should be noted however that the circumstances change every day globally and the success rates of some countries have changed. Early success does not necessarily guarantee against a resurgence later.

For example, Singapore was initially reported as a model country that vigorously undertook contact tracing, shut borders and implemented free testing and treatment for residents, while business remained open and a sense of normalcy was maintained[62]. However, in recent days the country has seen its caseload doubled and has exceeded 9000 cases[63].

As such, while the countries described above can certainly provide key lessons in the interim as our world leaders and sector experts navigate the novel coronavirus, things are always subject to change and only time will tell which countries are able to completely eradicate the virus.

Each country can only work towards using the most up-to-date evidence and advice to inform their actions and policies, while considering the nature of their very unique contexts before making rash decisions that could provide an effective band-aid in the short-term, but frightening consequences in the long term.

By Jenna Joffe

[1] Taiwan Coronavirus

[2] CNN: Taiwan Coronavirus response 

[3] FT

[4] Time: Finding Hope Coronavirus Pandemic

[5] Ibid.

[6] Taiwan Coronavirus

[7] CNN Coronavirus Mask Messaging

[8] JAMA Network

[9] Time: Coronavirus Taiwan

[10] Taiwan Coronavirus

[11] Ibid.

[12] Ibid.

[13] Ibid.

[14] Ibid.

[15] CNN: Taiwan Coronavirus Response

[16] Time: Coronavirus Taiwan

[17] Science and Health: Pandemic Response

[18] Business Insider – South Korea Controlled Its Coronavirus Outbreak 2020

[19] Daily Maverick: Over 100 Countries Ask South Korea For Coronavirus Testing

[20] Science Mag: Coronavirus Cases Have Dropped Sharply South Korea What’s Secret Its Success

[21] Ibid.

[22] We Forum: South Korea COVID-19 Containment Testing

[23] Science Mag: Coronavirus Cases Have Dropped Sharply South Korea What’s Secret Its Success

[24] We Forum: South Korea COVID-19 Containment Testing

[25] ICT Works: Korea Used ICT Flatten COVID-19 Curve

[26] Business Insider: How South Korea Controlled It’s Coronavirus Outbreak 2020

[27] Science Mag: Coronavirus Cases Have Dropped Sharply South Korea What’s Secret Its Success

[28] Ibid.

[29] Ibid.

[30] Ibid.

[31] Ibid.

[32] VOX – Coronavirus COVID-19 Pandemic Response South Korea, Philippines, Italy, Nicaragua, Senegal, Hong Kong

[33] We Forum: Vietnam Contain COVID-19 Limited Resources

[34] FT

[35] The Diplomat: The Secret To Vietnam’s COVID-19 Response Success

[36] We Forum: Vietnam Contain COVID-19 Limited Resources

[37] Vietnam News: Vietnam Suspends Foreign Entry Starting March 22

[38] Ibid.

[39] The Diplomat: The Secret To Vietnam’s COVID-19 Response To Success

[40] Ibid.

[41] Ibid.

[42] Vietnam Times: Health Declaration Mobile App Launched To Combat COVID-19 Epidemic

[43] The Diplomat: The Secret To Vietnam’s COVID-19 Response Success

[44] Ibid.

[45] We Forum: Vietnam Contain COVID-19 Limited Resources

[46]  The Diplomat: The Secret To Vietnam’s COVID-19 Response Success

[47] Live Science: New Zealand Coronavirus

[48] Ibid.

[49] Business Insider: Experts Australia New Zealand Examples How To Slow Coronavirus 2020

[50] Washington Post: New Zealand Isn’t Just Flattening The Curve It’s Squishing It

[51] Live Science: New Zealand Coronavirus

[52] Business Insider: Experts Australia New Zealand Examples how To Slow Coronavirus 2020

[53] Ibid.

[54] Live Science: New Zealand Coronavirus

[55] Business Insider: Experts Australia New Zealand Examples How To Slow Coronavirus 2020

[56] Washington Post: New Zealand Isn’t Just Flattening The Curve It’s Squashing It

[57] Business Insider: Experts Australia New Zealand Examples How To Slow Coronavirus 2020

[58] Ibid.

[59] USA Today: Coronavirus How Countries Across Globe Responding COVID-19

[60] Business Insider: Experts Australia New Zealand Examples how To Slow Coronavirus 2020

[61] Ibid.

[62] NY Times: Coronavirus Singapore

[63]  The Guardian: Singapore Coronavirus Outbreak Surges With 3000 New Cases In Three Days

wearing a mask for protection against corona

Evidence-Based Responses to the Coronavirus Chaos

By Current Affairs, Data Literacy

Whether we should have seen a disaster like COVID-19 coming, is up for debate. It’s too late now to pause on that point for too long. But we should at least try to learn from this so that we are better prepared in future. Not only for a similar pandemic but for the looming climate crisis.

Of more immediate relevance is how South Africa is using data to respond to the crisis, and what we can learn from other countries as we deal with a fast-changing complex problem.

What does the data tell us?

Is the way in which the government uses data to respond to the Coronavirus chaos an indication that South Africa will see better evidence-based policies in the future?  

Many South Africans are pleasantly surprised by the extent to which the government response to the Coronavirus is informed by evidence. More specifically, journalists and particularly health journalists have not always had good words for South African government responses to important health issues.

Now everything has changed. At least for the moment.

Unlikely cheers from the media and activists

Earlier in April, journalists wrote about how different the relationship with the government is now, during the COVID-19 crisis, compared to what it was like during the HIV crisis in the ’90s. They feel that the  South African government is now treating them with respect and as allies in the fight against the Coronavirus.

Many journalists have heaped praise on the government’s management of the crisis, to the extent that they themselves acknowledged that they are singing Kumbaya. Mia Malan[1] (Bhekisisa Centre for Health Journalism’s editor-in-chief and executive director) related how Professor Salim Abdool Karim (the calmly confident ally of South African Health Minister Zweli Mkhize, and chairperson of government’s advisory committee on Covid-19), was chastised, labelled as “poisonous” and told to “shut up and listen”, by the Mbeki-era Health Minister Manto Thsabalala Msimang at the height of the HIV-crisis.

His “sin” at the time, is now his virtue: using scientific facts as a basis for giving advice to the government, and for making public statements.

In the same article, Malan quotes Karim on how different the current relationship with the Minister of Health is. “With the coronavirus, our experience with government is exactly the opposite [of what we endured during the Mbeki and Tshabalala-Msimang era].

The minister has been contacting us, he wants to involve us, he is seeking the opposite of what Mbeki and Tshabalala-Msimang wanted… With HIV we were so slack with taking things up, we delayed mother-to-child-prevention of HIV and access to antiretroviral treatment. But with Covid-19 we’re proactive and we’re acting early…”[2].

Malan also says the same activists who have fought government previously on the HIV issue, are now “supporting and praising Cyril Ramaphosa’s early, evidence-based interventions.”[3] The source of the more constructive relationship and a new-found respect for government lies in transparency and access to data.

With HIV, government was seen as blocking access to data, while now, journalists are commending the government for facilitating a free flow of information. The health ministry has even set up a WhatsApp group to share the latest figures directly to journalist’s phones, and government’s actions thus far are regarded as an indication that they are heeding the advice of scientists and academics, to take the best possible decisions to ensure that COVID-19 can be managed as best as possible.

The dominant role of the “scientists and the health activists in the Covid-19 National Command Council”, was evident, according to Ferial Haffajee[4], who also noted that at least initially, “South Africa had bucked the trend of worst-case community transmission…and is on course to flatten the rate of infection and lower its peak by September”.

cyril ramaphosa

Appreciation for the quality of leadership

The applause for Ramaphosa and Mkhize’s leadership was also extended to the premiers of key provinces. Lester Kievit[5] of the Mail and Guardian pointed out: “The premiers of the three worst-affected provinces, Gauteng, the Western Cape and KwaZulu-Natal, have not wasted any time in showing they’re capable of leading and being the public face of the pandemic response in their provinces.”

Kievit continued to quote Sanusha Naidu, political analyst and lecturer at the University of Cape Town, who said that “the roles and importance of provincial government are coming to the fore during the pandemic in a manner that has not yet been seen in South Africa’s history”, even though it has unfortunately taken “a pandemic of this nature and this proportion to see this kind of leadership to emerge in South Africa.

Bill Gates also joined the praise singers in his interview with Trevor Noah on 4 April 2020[6]: “I was talking to President Ramaphosa today, who is not only [the] president of South Africa, he’s also the head of African Union… He is a very strong voice there, encouraging African countries to act quickly when the number of cases is still fairly low, which is true throughout sub-Saharan Africa right now.”

Some knew that a disaster like this was coming

Bill Gates was one of the few who saw this coming. In his 2015 TED Talk titled “The next outbreak? We’re not ready”, Bill Gates made a chilling prediction: “If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war – not missiles but microbes… We have invested a huge amount in nuclear deterrents, but we’ve actually invested very little in a system to stop an epidemic. We’re not ready for the next epidemic.”[7]

Despite this warning, enough had not been invested in the global health care system to prevent the next pandemic. According to Gates, “the Ebola outbreak exposed a shortage of specialists who were well trained to deal with the epidemic. This should have been used as a case study to prepare for the next one…The issue was not that we didn’t have a system that worked well enough, the problem was we didn’t have a system at all. We didn’t have a group of epidemiologists who would have gone, seen what the disease was and how far it had spread.”[8]

Gates says he hoped to raise awareness that would help the United States to get ready for “the next epidemic”, by implementing various preparations, which would have helped to respond quicker, more effectively and more efficiently to the current pandemic. He acknowledges that despite having epidemics like Ebola and Zika, the current situation is unprecedented: “…a respiratory pandemic that’s very widespread, really, we haven’t seen anything like this for 100 years.”[9]

The scale of the disaster is overwhelming

The reality was that no one was ready for COVID-19, says Professor Salim Abdool Karim. “Nobody ever thought that we would need to deal with something like this. We all thought we were going to deal with something like [the] flu.” And indeed, “nobody saw this coming” was a common sentiment amongst ordinary citizens in the days after the Coronavirus lockdown became the new reality in South Africa.

While “dozens of cases of pneumonia of unknown cause” were being treated in China by the 31st of December 2019, and a “new virus” was identified by researchers in China days later[10], nobody would have believed anyone who predicted that the world would be on lockdown three months later. In fact, for most people, a “closed off” country was a totally foreign concept.

Now it has become everyday life.

The acute reality of the extent to which our daily lives have become surreal in a matter of weeks, was evident by the 1st of April when there seemed to be general agreement that no April’s fool joke could upstage the bizarre reality of the world. And that April Fools’ Day jokes would simply not be appropriate.

The nature of the beast

It is not that the world did not plan for disaster, or that it did not foresee an epidemic – it is the nature, scale and the unpredictability of the current disaster that is problematic. It is airborne, highly contagious, not localised or contained to a country or certain geographic area – it is a tsunami that engulfs the world.

Disasters can take many shapes and forms, and often when thinking about disasters, we tend to think about natural disasters, like earthquakes, tsunamis, or disasters related to climate change.  Now we are faced with a medical disaster, which poses particularly wicked problems for scientists, economists, politicians and officials to solve.

The impossible choice of this crisis is one where decision-makers have to weigh up the cost of lives against the cost of containment measures to the economy.  The available data is incomplete, and there is not even a quick and simple way to determine how to attach weight to and weigh the choices that need to be weighed. Ultimately, the simple question “What are we willing to sacrifice economically to save a life?”[11], has no simple answer.

The well-known Cynefin model[12] comes to mind, and the descriptions of “unknowable unknowns” and “extremely volatile and urgent situation” in the “Chaotic” quadrant shows where South Africa and the world is at this time. We may be faced with a level of complexity that has not been experienced ever before.

It is both apt and ironic, that the proposed action in the chaotic quadrant is to “take swift and decisive action” and to “apply novel practices”. Novel practices indeed, to fight a novel virus, now known as the Coronavirus.

graph on coronavirusSource: Agility 11

The level of complexity that has to be taken into account in the management of the Coronavirus crisis is unprecedented.

Complexity in action

With the Coronavirus, a salient factor is that there is a continuous shift in what is known and what is not yet known, and importantly, what should be known. Adding to the level of complexity is that while there are commonalities, patterns and trends that emerge globally, countries in the world are vastly different in terms of many factors, a few of which are mentioned here:

  • Population size, density, and age profile;
  • Health system characteristics, coverage and access;
  • Health profile of the population in terms of the incidence of conditions such as diabetes, hypertension, HIV and Tuberculosis (TB);
  • Infrastructure aspects such as housing and transport systems
  • Economic system characteristics, resilience and pre-COVID-19 economic status

Countries also have varying levels of expertise in dealing with similar types of viruses.

In a recent presentation to the South African Minister of Health, Karim referred to South Africa’s unique epidemic trajectory (see Figure 1). The curve had turned quicker than even “best-performer countries like South Korea and Singapore and that community infection (the third stage after imported and local transmissions) are lower than expected.

But there is no time to get smug or complacent, because South Africa is not out of the woods yet. We may have bought time to spread out the disease over more months, and to prevent “small flames” from becoming “raging fires”[13].

graph of coronaFigure 1: South Africa: number of cumulative cases and number of days since the 100th case

Source: Daily Maverick/Business Maverick

Another factor that adds to the complexity, is that within countries, cases are not evenly spread. This is clear from the high number of cases in Wuhan, Lombardy, Madrid and New York[14], to name a few. In South Africa, the highest number of cases are in Gauteng and Western Cape provinces, and within these provinces, the concentration of cases is clearly higher in some suburbs than others, as is evident from the two maps below.

Just remember, that this is data that was presented to the Parliamentary Health Portfolio Committee on 10 April 2020, so by the time you read this, the patterns may have changed. It is also possible that clusters of cases occur in different types of populations, which may lead to different patterns in mortality rates.

covid cases in gauteng

Figure 2: COVID-19 cases in Gauteng on 10 April 2020

Source: National Department of Health[15]

covid cases in western cape south africaFigure 3: COVID-19 cases in the Western Cape on 10 April 2020

Source: National Department of Health[16] 

Learning and adapting on the trot

While there is agreement that there are no clear answers at the moment and that answers are changing all the time, there is some disagreement on what evidence should be used to plan responses, and also how this evidence should be used. Emerging data is used for decision-making, and one of the ways in which it is used is modelling.

Early in April, the National Institute for Communicable Diseases (NICD) confirmed that significant progress was made by groups commissioned to model and project the spread of the Coronavirus in South Africa[17]. Modelling was also used by other countries in the world to make projections that informed governments’ responses, regarding “procurement of emergency medical supplies as well as the building of additional hospital bed capacities in countries around the world”[18].

Modelling, however, is not foolproof, and some critics pointed out that it is simply not known how the virus may spread in circumstances unique to South Africa. Alex Welte (research professor at, and the former director of, the Centre of Excellence for Epidemiological Modelling and Analysis at Stellenbosch University) cautioned in a “GroundUp” article that “there is more we don’t know than we do”[19].

As is highlighted above, the issue of relevant and complete evidence is pertinent to ensure good decision-making. That is a luxury that does not exist at the moment. Whether the decisions made at the moment are the correct ones, will only be established later.

Paving the way for evidence-based policy making in future

Currently, decision-making on the Coronavirus crisis rests heavily on evidence produced by health scientists. There are, however, other groups that may gain more clout as the situation unfolds. For example, the business lobby will strengthen its appeals to the government to also protect the economy, and undoubtedly this lobby will also rely on evidence to give weight to their arguments.

DPME quoteEvidence decision-making can be a complex affair, and the same applies to evidence-based policy making. Although South Africa is committed to evidence-based policy-making (see the text box below), in reality, party-political ideology inevitably plays a role in policy-making.

DPME. Overview Paper, What is Evidence-Based Policy-Making and Implementation? Evidence-Based Policy-Making and Implementation October 2014[20]

It should be noted that the “evidence-policy” gap in the health sector is not unique to South Africa. Scholars[21] who researched the phenomenon has found that scientists could do more to provide “better evidence to reduce policy-maker uncertainty”, and concluded that successful evidence-based policymaking required “pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories” (Cairney and Oliver, 2017).

Despite the limitations of the current situation, documented literature on the “evidence-policy gap”, and some level of cynicism regarding South Africa’s track record with evidence-based policy-making, it is encouraging that emergent evidence is being used to craft South Africa’s response to the Coronavirus crisis. It may give the South African government the confidence to rely more on evidence-based policy making in future.

By Fia van Rensburg

[1] Malan, M. 2020. The facts beat the quacks: Our #Covid19SA vs. our #HIV response. Bhekisisa Centre for Health Journalism Article

[2] Ibid

[3] Ibid

[4]Haffajee, F. 2020. The new ‘Doctors Pact’ that could help flatten the Covid-19 curve. Daily Maverick. 14 April 2020.

[5] Kiewit, L. 2020. Fighting Covid-19: The rise of the premiers. Mail and Guardian 16 April 2020.

[6] Head, T. 2020. Bill Gates praises Ramaphosa – but billionaire bats away false claims. The South African News 5 April 2020.

[7] Carras, C. 2020. In 2015, Bill Gates predicted an epidemic would kill millions. Here’s what he says now. The Star 14 April 2020.

[8] Bhengu, C. 2020. In 2015, Bill Gates said the world was not ready for the next major virus.

[9] Carras, 2020.

[10] Taylor, D.B. 2020. A timeline of the Coronavirus Pandemic. New York Times. (14 April 2020).

[11] Hartford, T. How do we value a statistical life? The Financial Times Limited.

[12] The Cynefin model (pronounced kuh-NEH-vin), created by Dave Snowden, is a useful model of complexity. It defines four domains: Obvious (simple), Complicated, Complex and Chaotic.

[13]Haffajee, F. 2020. The new ‘Doctors Pact’ that could help flatten the curve. 14 April 2020.

[14]Klasa, A. (Ed.). 2020.Coronavirus tracked: the latest figures as the pandemic spreads. The Financial Times Limited. Accessed on 17 April 2020 at https://www.ft.com/coronavirus-latest

[15] Gauteng cases mapped. Source – National Department of Health presentation to Parliamentary health portfolio committee, 10 April 2020.

[16] Western Cape cases mapped. Source – National Department of Health presentation to Parliamentary health portfolio committee, 10 April 2020.

[17] Cowan, K. 2020. Coronavirus in SA: ‘Significant progress’ on modelling – but, for now, we will not know what it shows. News24. 1 April 2020. https://www.news24.com/SouthAfrica/News/coronavirus-in-sa-significant-progress-on-modelling-but-for-now-we-wont-know-what-it-shows-20200401

[18] Ibid.

[19] Ibid.

[20] DPME

[21] Cairney, P., and Oliver, K. 2017. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?. Health Res Policy Sys 15, 35 (2017).