By Daily Maverick• 20 April 2020
Ongoing ‘hard lockdown’ will likely cause far greater suffering in the short and long term than the pandemic itself. As medical doctors who are most at risk, we do not request the easing of the lockdown lightly. But we see far greater harm to our healthcare system and our economy by further delaying the inevitable spread of the virus.
Dear President Ramaphosa,
We, the undersigned doctors, admire the leadership you have shown in managing the outbreak of Covid-19. You have successfully galvanised unanimous support for the tremendous challenge facing us as a country and specifically as the healthcare profession.
It has given the medical community time to prepare for the predicted surge of seriously ill patients. The public has also been handed a clear indication of the gravity of the situation. It has not, however, eradicated the anticipated pandemic from our country, merely delayed it. While in Europe and North America, funding might be available to balance the number of severely ill with the number of hospital beds and ventilators, we do not see this as a viable option for South Africa.
Our healthcare system and the economy were already on their knees at the outbreak of Covid-19. The negative effects of keeping the country on the present “hard” lockdown – or even a relatively “light” lockdown – are innumerable. We appeal to you to lift the hard lockdown as soon as possible.
Many patients without Covid-19 are not getting the treatment they require due to the hospitals being emptied for Covid-19 patients. Many of these patients are avoiding hospitals and having their out-patient appointments cancelled. Disruptions in regular prevention programmes, such as immunisation schedules for infants or sexual and reproductive health promotion will undercut our few hard-won health gains since democracy. Together these are steadily building up a backlog of health care that is potentially a crisis in itself.
Doctors in South Africa have sadly had to become accustomed to the harsh realities of limited funding and limited beds for very sick patients. This means giving less than optimal care and even letting patients die as comfortably as possible on a regular basis. As a country we have bought into an international rhetoric which is a poor fit for local circumstances. We are lucky that the present Covid-19 virus does not predominantly kill young people as the flu virus of 1918 did. It does sadly kill many elderly, but this is still a relatively small percentage of the population; at this stage, we do not know the effects on people living with HIV who are not on treatment and those with TB. If at all, a vaccine is unlikely to be developed and distributed within less than 18 months. Our economy and our healthcare system will be destroyed if we wait much longer and as always, our poorest citizens will suffer the most.
Although current estimates of mortality are more than six times less than initially estimated, at 0.5%, we are approaching winter and there are myriad reasons why the pandemic will hit South Africans harder in winter months. We cannot afford to stay on “hard” lockdown any longer. Each week that we delay is likely to worsen the outcome of the pandemic.
As the health-related, social and financial side effects start to mount, we would strongly urge a return to work for most people.
Those who can work from home or in isolation should be encouraged to do so, but we feel it is critical that the fit and robust return to work, in a staggered fashion wherever possible. Close attention should be given to ensuring that public transport operators adhere to the revised regulations to minimise the transmission risk to their passengers. It might be prudent to keep certain forms of business closed, especially where people congregate, including bars, clubs and any meetings of groups of people, including faith-based gatherings. Restaurants may be allowed to prepare take-away food or arrange home deliveries.
Some restriction on the sale of alcohol during this crisis probably continues to make sense, as it probably reduces the burden on hospitals from alcohol-related traffic accidents and violence resulting in trauma. Limited household budgets may then be spent on food rather than alcohol. People withdrawing from alcohol may consult doctors for help.
Schools (and higher education institutions) that are able to teach via the internet, may continue to do so if they choose, but the vast majority of children cannot do this and their parents need to go back to work to earn money to feed them. Many of these children need to go to school to access food programmes.
All South Africans should be encouraged to continue washing their hands, maintaining physical distancing and taking other steps to slow the spread. Those that are most at risk, the elderly and the health-compromised, need to continue to try to socially isolate as much as possible and be helped to do so by their communities. Clear guidelines describing how access to different levels of healthcare interventions will be prioritised should be established and widely publicised in a transparent way. This will allow South Africans who are at risk to be forewarned and allow them to take extra precautions to reduce their risk of acquiring the virus.
We have a limited number of healthcare workers so prioritising their health is important. Personal protective equipment (PPE) for healthcare workers needs to be a national priority throughout the pandemic and we hope the government is actively encouraging local industries who can manufacture these to specification to do so immediately.
Last and by no means least, it may be well served to reassure the public, as there is an ill-founded fear that contraction of Covid-19 is fatal, and the misconception that a lockdown would purge us of Sars-CoV-2. This present fear has caused many people to discount the future of our country, which is currently at risk.
Sars-CoV-2 is here to stay. The truth is that people will die, but even more will recover. We will do our best as a country and medical fraternity to treat the infected patients, but we also need to start paying attention to the other illnesses which have continued to progress relatively untreated.
As those who are most at risk once the pandemic takes off in South Africa, we do not request this lightly. We see far greater harm to our healthcare system and our economy by further delaying the inevitable spread of the virus. Ongoing “hard lockdown” will likely cause far greater suffering in the short and long term than the pandemic itself.
Sars-CoV 2 and Covid-19 have given us a moment of pause to reflect on many things. We’ve examined our priorities. We’ve refocused on important issues like healthcare and support of the less privileged.
While we hope that lessons learnt will contribute positively to our new normal, it’s time to hit the play button again. If we start the wheels turning soon, we stand a chance of recovering. If we languish at the bottom of this pit, we will do irreparable damage to our future and those of our children.
Life needs to go on if we are to survive in any respectable form. DM
Signed: Graduates from UCT MBChB 1993 class: this letter’s argument was informed by extensive discussions and sharing of experiences and evidence from our WhatsApp class group with doctors working in South Africa and around the world.
In alphabetical order:
- Zunaid Barday, Nephrologist, Cape Town
- Ingrid de Beer, General Practitioner, Cape Town
- Martin Forlee, Vascular Surgeon, Cape Town
- Perrin Hansen, Paediatric Neurologist, Johannesburg
- Chris Hofmeyr, ENT Surgeon, Cape Town
- Riaz Ismael, General Practitioner, Cape Town
- Hilary Johnstone, Clinical Research, George
- Ebrahim Kader, Neuro and General Interventionalist, Cape Town
- Susan Le Roux, Emergency Medicine, Cape Town
- Tracy Kilborn, Paediatric Radiology, Cape Town
- Feizal Majiet, General and Occupational Medical Practitioner, Cape Town
- Shyam Makanjee, Opthalmologist, Cape Town
- Nicola Moll, General Practitioner, Sydney
- Thane Munting, Orthopaedic Surgeon, Cape Town
- Simon Pickstone-Taylor, Psychiatrist, Western Cape
- Jenny Potts, Specialist Physician and Rheumatologist, Port Elizabeth
- Neil Richards, Family Physician, Cape Town
- Jo Schlesinger, Family Physician, Cape Town
- Matthew Seftel, Haematologist, Winnipeg, Canada
- Nandi Siegfried, Public Health Physician, Cape Town
- Chantal Simonis, Consultant in Reproductive Medicine, Southampton, UK
- Kerstin Simons, Consultant Vascular Surgeon, Tutzing, Germany
- Paul Sinclair, Paediatrician, Cape Town
- Fred Tyler, Urologist, East London
- Janine Van der Walt, General Practitioner, Cape Town
- Kathleen Van der Westhuizen, General Practitioner, Cape Town
- Beth Welsh, General Practitioner, Cape Town