My cousin, who is a doctor at a hospital in Johannesburg, is zen as anything. This was made apparent to me by a chirpy Whatsapp message at 2:00 one morning asking “Hey:)) u up? Wanna chat?” Although I was delighted to hear from him, I was on my way to bed (not because I normally go to bed at 2am but because bedtime has become a slippery beast during this time of suspended reality) and only semi-lucid, so I asked if we could talk the next day instead. I asked why he was still up – it was 3am where he was – and he replied “I’m in the emergency unit and haven’t had a patient for hours😀”.
When we finally spoke – which took numerous attempts to arrange, because, well, have you ever tried to pin down a doctor who works shifts? – he told me that things are eerily quiet for South African doctors at the moment. A lot of people are avoiding going to the doctor or to hospital because they are afraid of catching coronavirus, even though there have been very few cases of it (although they may yet arrive, of course). Private practices are laying off staff because there just isn’t work for them, although government hospitals have retained their staff. Both he and his sister are fortunate enough to have jobs at a government hospital (they’re even working together, which they’re tickled pink about).
I’ve heard that accident & emergency departments in the UK have been quiet too. This article, entitled “A sharp drop in accident-and-emergency admissions worries medics”, says that the fall in numbers can be partly attributed to better handwashing habits (leading to fewer gastrointestinal issues) and quieter roads (fewer accidents). But fear of catching coronavirus is also a factor. This fear is not keeping only the “worried well” at home; it is also keeping away people who should be going to A&E: there’s been a precipitous fall in emergency admissions for conditions that have nothing to do with better handwashing or quieter roads, such as cardiac problems, cancer and detached retinas. (I saw an NHS advert somewhere the other day that said, somewhat pleadingly, “We may be dealing with coronavirus at the moment but do remember that we are still here for you if you have a heart attack!”)
In South Africa, my cousin told me, another major reason for their quiet emergency units is that the sale of alcohol has been banned during the lockdown. Not rationed; not limited to certain times or certain shops: straight-up banned. Can you imagine being an alcoholic and suddenly being told from one day to the next that you can’t buy alcohol anymore? (Compare with the UK, where off-licences [liquor stores] were added to the list of “essential services” as soon as supermarkets ran out of alcohol, which my neighbours were most relieved about.)
My friend Ashley in Cape Town tells me that people desperate for a drink have been rioting and looting stores. Her colleague has a stash of alcohol left over from his wedding and is doing a roaring trade in it, and her neighbourhood Facebook group has become a virtual beverage market:
(The sale of cigarettes was banned during lockdown too, although the justification given was nebulous and changeable: “Being a smoker makes you a high-risk case if you get covid” [it does, but you’d have to stop smoking for months to become low-risk]; “Cigarettes are not ‘essential’ goods”; “In poor communities people share cigarettes, raising the risk of transmission of coronavirus”; and even “Smoking is bad for you and this is a good opportunity to stop”. Of course, there is now a booming black market in cigarettes too, and the government has caved in and lifted restrictions in a few municipalities.)
However, tough as it must be for alcoholics, the impact on injury numbers has been extraordinary.
“We not seeing domestic-violence injuries anymore,” my cousin told me. “Normally domestic violence is a huge issue here and we’re always treating injuries from it. But at the moment… Nothing. No road-accident injuries either, because the roads are so quiet and because nobody’s driving drunk.”
That was interesting, because I had heard that domestic violence had surged over here, now that so many people are trapped at home with their abusers. Perhaps there’s been a similar surge in South Africa but it’s been outweighed by the reduction in alcohol-fuelled domestic violence. Also, perhaps victims are finding it harder than usual to get to a hospital during the lockdown.
As for actual coronavirus cases, my cousin says that, even making allowances for the fact that government hospitals don’t test as much as private hospitals, the number of cases is surprisingly low. (That’s just in hospitals, though. I do wonder if there have been outbreaks in the shanty towns, where people live in overcrowded conditions and without access to adequate sanitation. Those are precisely the people without the means to get to hospitals, so that could skew the numbers.)
This article, entitled “What South Africa learned from AIDS”, makes some interesting observations on South Africa’s handling of the pandemic.
It says that the country is handicapped, in some ways, by its high levels of poverty and violence, largely legacies of apartheid and misgovernance.
On the flip side, though, its experience fighting the AIDS epidemic gives South Africa an advantage. In particular, policymakers learned to listen to doctors and scientists and act quickly on their advice (for example, South Africa’s lockdown was imposed just three weeks after the first case of coronavirus was reported; the UK, for comparison, waited nearly eight weeks). The country also learned the value of community outreach, sending people from house to house to provide guidance.
And South Africa has the means at its disposal to apply these lessons: world-class doctors and scientists with experience of fighting an epidemic, and vibrant NGOs with enthusiastic volunteers carry out community outreach.
I told my cousin about the above and he said that the AIDS epidemic may have left another useful legacy. HIV is still very present in South Africa, and a huge number of South Africans are on antiretroviral treatments (according to UNAIDS, in 2018 just over 20% of adults in the country were living with HIV, of whom 62% were on treatment). And antiretrovirals, being weapons against viruses, are being investigated as possible treatments for coronavirus.
Also, almost all South Africans get the BCG vaccine against tuberculosis at birth, and this is believed to boost the immune system generally, which would improve resistance to coronavirus. (We all got the BCG in Zimbabwe too. When my half-Argentinian friend Carla first saw the scar on my arm, she pointed at it, pointed at her own and squealed “The third-world badge!”)
I told my cousin what I had learnt about Cuban doctors (see the post I wrote about it) and he laughed and said “Yes, I know about Cuban doctors. We have loads of them here. They’re not very good.” Even so, he said, about 300 South African medical students a year go to train in Cuba. So maybe that negates the whole post I wrote. Or maybe not. Anyway, here’s a picture of Cape Town in lockdown: