Locked & Loaded. South Africa readies itself for the battle against covid-19
South Africa has much to teach policymakers on the subject of a disease which is not in the mood to negotiate. I’m of course speaking about the HIV/Aids epidemic during Thabo Mbeki’s presidency. It’s not a particularly happy story, and it doesn’t end well — in fact, it doesn’t end at all.
But let’s have a go, shall we?
In 2018, the last year for which there are reliable statistics, 7.52 million South Africans were living with HIV (the largest number in the world), almost one in five South Africans between the ages of 15 and 49 were HIV-positive, and there were 115,167 Aids-related deaths. Remarkably, that is not as bad as the worst prognostications suggested it might get — expert (emphasis on expert) circumspection is always warranted when it comes to disease modelling — but it’s still pretty fucking bad. What’s more, it is the direct result of massive, systemic policy failure. There’s actual people with names that can be blamed for those deaths, not just Fate or the gods or Xi Jinping’s lab assistant.
After all, in 2002, when Mbeki was in the middle of his first term, Aids-related deaths in SA numbered over 215,000. That should’ve been enough to scare the bejesus out of even the coldest former Marxist-turned-Thatcherite. (Fellow skeptics liked to remind South Africans that the death toll for TB was worse, which was an epidemiological non sequitur.) And yet, the president’s approach was that of a man intellectually affronted by data and science that did not gel with his untutored medical opinions. His antipathy to what he considered Western (read: neocolonial) best practices exasperated even the lefties in the ANC, but let’s just cherry-pick one example:
“Can a virus cause a syndrome?” he famously asked his fellow lawmakers. While this syntactical game was not the dumbest ever played in South African Parliament, it was one of the more manifestly malevolent of the democratic era: Mbeki’s denialism had a massive impact on subsequent policy, and the officials he empowered were equally immune to a rational approach.
Enter Manto Tshabalala-Msimang, who served as Mbeki’s Health Minister between the years 1999 and 2008 — an unbroken near-decade of policy pratfalls and alcohol consumption that would have embarrassed Falstaff. She received her medical training in the Soviet Union and Tanzania in the 60s, and earned a Masters in Public Health in Belgium; in her case, this East/West/North/South educational potpourri resulted in lunatic, Putin-style contrarianism. She shared Mbeki’s obsession with off-piste HIV remedies, doing everything she could to play down the threat and bundling treatment into a more “holistic” public health approach. This, as she was repeatedly advised, was the dumbest possible response to an epidemic, and it wasn’t official ANC policy either.
Any South African will tell you: leaders bullshitting about a public health crisis are deadlier than the disease itself.
Viruses peter out. Human stupidity is indomitable.
What lessons, then, does Mbeki’s murderous face-plant teach us regarding Covid-19? To be clear, I’m not suggesting that the two diseases are covalent in any way whatsoever. (Condoms won’t help with Covid-19, kids.) But I am saying that the lessons learned from one plague can map an approach to another.
As if directly rebuking Thabo Mbeki, Cyril Ramaphosa and his roving crew of advisers are taking this new threat seriously — as in bring-out-the-guns seriously. That said, he and his coterie are as agile as a medieval Mughal army — locked in strategy sessions on their palanquins, they’re followed by advisers, courtiers, medicine-men, cooks, cavalry, infantry, circus performers, financiers, jesters and whores, trailed in turn by their slavering enemies.
They are not fast, they cannot pivot, they do not make frequent appearances. But when they arrive, the actionable items runneth over.
The purest technocracy South Africa has ever experienced has now delivered the most significant and game-changing decision since the ending of apartheid: the country is going into an at least three-week lockdown to try reduce transmission of the novel coronavirus.
The economy? Say goodbye to that shit, for what it was worth. (Not much, by the way.) As for actually dealing with the problem at hand? Well, there is no way to know now whether the most extreme curtailment measures will one day be considered absurd over-reactions. But with the entire Western world basically closed for business, and most epidemiologists, virologists and public health experts insisting that this is the Big One, the available information is more than enough from which to craft policy. “Policy” is not the same as “reaction”, and given how much time he’s been spending in consultations, it’s good to see that President Ramaphosa has now offered a comprehensive package that addresses both containment and the resulting economic implosion.
The alternative is to risk the lives of hundreds of thousands of our elderly, along with those who are immunocompromised or having an off-day lung-wise. And not just them: given that every ICU bed in an already under-resourced system will be occupied within weeks, it’s also the daily stream of attempted murder victims, car crash victims, domestic violence victims, cancer victims, heart attack victims, and victims of their own excess, to name but a few. This is not the slow-drip of HIV/Aids—once this Covid-19 thing peaks, it’s insta-death on a massive scale. South Korean-style mass-testing, contact-tracing and targeted isolation is not an option for us, sadly. And while US President Donald Trump appears willing to openly trade lives for the health of the economy, we’ve always preferred a more discreet approach to that sort of thing.
And so South Africa enters this new era locked down and, as always, loaded. Some of us will spend three weeks in gilded cages. Others in hovels. And this is where the Ramaphosacracy’s strategy gets a bit woolly. What makes the corona-virus and its long-term fallout so dangerous is that successive South African governments have always considered the majority of the population to be a disease. First during colonialism, then during apartheid, and now during this era of wonky neoliberal-socialist-rentier-capitalism, the overwhelming majority of South Africans have been treated like a pathogen, to be huddled into the margins, forgotten, or rather ignored. Tens of millions of people have been reduced to a source of cheap labour and — more importantly in a post-work economy — a subsistence consumer class.
There was plenty of time for Ramaphosa and his ANC comrades to address this problem: 25 years is a generation in economic terms, and enough runway to transform a country (or even just a city or regional economy) entirely. But not a single urban space in South Africa has been suitably altered since the end of apartheid. If anything, the gap between rich and poor has grown more distinct.
We should have fixed this. Now it’s too late. Where the HIV/Aids crisis was a failure of health policy, the potential Covid-19 crisis will be massively exacerbated by a decades-long failure in overall policy, and missed opportunities.
These inequities will be the death of us, and there’s a very good chance Covid-19 will make good on this promise. A military untrained in matters of urban containment has been deployed. They will now help police communities clustered in unsanitary informal settlements in which self-isolation is a bitter joke. Even in more established townships, the phenomenon of backyard shacks means that people are jammed into dense areas where communicable diseases thrive. Three weeks is an eternity under such conditions. Policing the lock-down is the greatest challenge an ANC-led government has ever faced, and they have a tendency to screw up even the small stuff.
Lock-down details will continue to emerge — for instance, how does one eat when stockpiling is not an option and spaza shops are shuttered? How do kids who are usually fed at school get the nutrition they require? Or an old one: how do you eat when you have no money? Ramaphosa’s economic plan has attempted to address this, and a ministerial press conference has filled in some holes — for instance, there are apparently plans to “de-densify” crowded areas when delivering water and sanitation. Suddenly, everything can and will be fixed in 48 hours. But there are massive holes that can’t be filled by the usual ANC drip-feed methodology. The potential downsides — including civil disobedience on a mass scale — cannot be minimized.
Perhaps because of the low bar set by his drooling, moronic predecessor and equally moronic contemporaries in the United States and elsewhere, Ramaphosa’s speech was greeted like it was the Sermon on the Mount. And indeed, it was a significant, country-changing address, historic in every sense of the term. But the age-old South African syndrome — a few rich people and many, many poor — has the potential to super-charge the Covid-19 virus. Just as lethally, it could compromise our recovery, turning us into a more deeply divided enclave state, if that’s even possible. (Spoiler: it is.)
Anyway, into the future we travel, mapless, but with a lifetime’s supply of toilet tissue. This is the astonishing moment when we get to live-stream the world being remade. “We would rather be ruined than changed,” wrote W.H. Auden. We’re both ruined and changed. Given the persistence of South Africa’s social and economic viruses and syndromes, this is not necessarily a calamity. DM