By David Hemson
The mantra of the World Health Organisation is “test, test, test” combined with a strategy of social distancing and hand washing. The procedure is that those tested positive are required to cooperate in contact tracing; those named are also then quarantined.
Containment would not be possible without such intrusive questioning. Such a strategy has not succeeded in HIV-Aids treatment as it has been contested as an intrusion on privacy even though it would lead to much greater effectiveness in reducing infection.
The liberation struggle in South Africa drove people to be deeply distrustful, to be defiant, of the state. “Ungovernability” characterised the culture of resistance then and into the post-apartheid period. This tradition and denialism could be a factor in the poor response to the key strategy of interviewing the “zero patient” to identify networks of infection. This is how those infected have been isolated.
A catch-up strategy is late
In the coming period there will be a drive among treatment groups in clinics and hospitals to reach this group and develop a defensive shield against Covid-19 infection. The urgency of this intervention could also help health services reach the service targets for HIV/Aids; unfortunately this “catch up” strategy is late.
Identifying networks in Covid-19 is critically important to tracing and isolating the infected. The question is whether the flurry of daily contacts between people living in poor communities can be unpacked, separated and identified and the pandemic contained and ended. There is resistance to tracing in HIV interventions. It is also very difficult to trace infections in dense settlements. If tracing fails, the alternative offered is broad interventions hoping that “herd immunity” is achieved as infection sweeps through communities.
The course of seasonal influenza may offer something of an indication of the profile of mortality and hospitalisation. Flu kills between 6,000-11,000 annually. About half of those deaths are among seniors, and about 30% in people living with HIV. These also represent groups with the highest rates of hospitalisation. Existing conditions will make Covid-19 worse. According to an authoritative source, people living with HIV are eight times more likely to be hospitalised for pneumonia resulting from influenza than the general population and are three times more likely to die from it.
There are no general models of infection and hospitalisation publicly available in South Africa. As in other African countries it is anticipated that the slow initial rates of infection will rise exponentially and put extreme pressure on weak health systems. Through heroic interventions, African health workers with international support have controlled the spread of Ebola. Unfortunately Covid-19 appears to be more infectious, if less deadly.
The challenge of lockdown
The current lockdown is enforced in an urban society which varies considerably from the cities of China, Europe and the United States. The spatial planning of apartheid which segregated black people to the urban periphery has altered, but not substantially changed. Many city centres are now occupied by black people with “townships” (state housing) many kilometres distant on the periphery. There are many small and substantial shack settlements sandwiched between these two extremes. Extensive suburbs provide for the white and some of the black middle class.
With the exception of the suburbs, in all three types of urban settlement, there is overcrowding and a poor living environment; there are few parks, sports fields or libraries in townships and none in shack settlements. The open areas are often strewn with rubbish without grassed spaces to walk. These areas are certainly not excluded from South Africa’s extreme crime levels with high levels of murder and women and child abuse. Many households are women-headed and multi-generational often based on income from a grandmother’s pension and child allowances. Services in water, electricity and rubbish removal are frequently interrupted by poor service levels or disconnections for non-payment. Rubbish collection is either absent or not at the level of former white areas. Devastating fires in shack settlements are also not infrequent.
Hand washing is a challenge as access to water services is uneven. The highest level of service providing indoor plumbing is available to 46% of the population in middle-class housing and many townships. Fetching and carrying for domestic use is needed for households with outdoor yard connections (29%) and communal taps (12%). These households have much reduced consumption and do not have flowing water for hand washing.
Areas ruled by gangsters
A social activist recently described the conditions which school children will now be experiencing:
“A number of children return from schools that mirror their neighborhoods – with pit toilets and no water, libraries, laboratories or sports-fields. They live in areas ruled by gangsters who peddle drugs and rape schoolchildren. They lack access to clean water to drink or wash with. They have few books or toys. Their homes are not in safe, wide-open spaces. Fresh air, clean water and nutritious meals are not guaranteed. There is no space to self-isolate in crowded homes where infection spreads like wildfire. Those who take care of them are often grandparents, who are most susceptible to Covid-19, yet have little access to emergency treatment or hospitalisation in far-away, over-extended public hospitals.”
These are the conditions which children and their parents will be locked into, cheek by jowl with their neighbours. Power outages are not infrequent as the mismanaged electricity provider, Eskom, fails to maintain supply. There will not be much relief from isolation, most houses don’t have internet hubs; although most people have cell-phones, data access is expensive. This is hardly a rich environment for tutoring children or keeping in touch with family. There will be a strong temptation to escape enclosure particularly in the one-roomed shacks.
Social support for shack settlements
The growth of shack settlements has been a desperate response to delayed public housing; they were thrown up to find some accommodation at a place as close to possible work. These settlements are at the centre of the dispossessed; some 3.6 million people or 14% of the total population live in shacks. Many are in floodplains, near the stench of waste disposal areas or in crevices between private housing. Local governments wage war against them to destroy the structures, evict the people and disconnect their “informal or illegal” connections to water and electricity. Again, these connections are acts of desperation even if they can lead to a failure of services. The dispossessed of the shacklands are represented by local community leaders, interconnected nationally by the Abahlali baseMjondolo (Shack Dwellers) Movement.
The question is what provision can be made for these communities. During the cholera epidemic of 2000-2001 the SA Military Health Service (SAMHS) was deployed and set up mobile hospitals and 70 rehydration centres in remote rural areas. This was a high-cost intervention with ambulances, hospitals and medication. Helicopters were used to transport medical teams and patients. On average a thousand patients were treated a day; in total some 98,000 cases were seen. This intervention brought down mortality quite dramatically.
The question is whether the military will be deployed to police poor communities or provide services. Will we now see mobile hospitals set up in sports fields near shack settlements and in densely populated rural areas to meet the needs of the dispossessed? Or will its role be that of force and constraint?
The basics for survival
Sections of civil society and trade unions have put forward an immediate programme for survival in a set of demands to make life possible during the current lockdown:
End all evictions and disconnections from water and electricity, shack settlements must be included in refuse removal, workers given paid leave, small traders included in relief and provided with guaranteed income, free food parcels, hand sanitisers provided, places for those tested positive to self-isolate, free data available for cell-phones, the release from prison of those detained for making “illegal” connections, health facilities available to the undocumented.
The current mood is reflected in the possibility of “rebellion born of extreme desperation” and reports of a “death wish” among working-class youth facing long-term unemployment. The labour movement has, for a period, been quiet in the face of the economic downturn.
The overcrowded and impoverished conditions of life could provide fertile ground for social explosions. It seems some employers are adopting a “no work, no pay” policy during the lockdown. Others are expecting workers to take their annual leave during the lockdown. For 85% of black working people (in agriculture, services, industry and transport) it will not be possible to work from home. There is desperation within the lockdown.
The prevailing mood is, however, uncertain. There is broad acceptance of the need for the lockdown but also a keen awareness of the use of the police and army historically in repression. There is also concern about the existing high levels of abuse of women and children rising in closed conditions. In desperate times there could be swings between solidarity and xenophobia against undocumented black people.
Accumulating crises and a socialist way out
The international Covid-19 crisis is devastating the lives of working people in South Africa as it is worldwide. However, the economy, the people, the health systems are all more vulnerable than elsewhere. Every crisis, from the Great Recession to the present disaster has also reinforced South Africa’s semi-colonial place in the world economy and deepened its dependence.
The labour movement watches in awe as governments in advanced countries roll out “whatever it takes” recovery plans of trillions of dollars compared to a pathetic trickle at home. Decades of corruption have used up government surpluses and devastated public finances and SA’s position in the world economy and likely defaults have resulted in high interest rates for loans. In crisis, capital absconds to safe centres and to the dollar, draining the economy of resources.
The virus is shaking the foundations of South African politics. The country has just been starting to emerge from a period of mismanagement and corruption which has left state-owned enterprises reeling from a crippling burden of debt. Before the pandemic Ramaphosa represented a fairly weak presidency attempting the restoration of state finances. By acting decisively and giving an authoritative speech before the lockdown, he has now won respect from large sections of the population traumatised by the sweep of the pandemic. Working adroitly to assemble political consent he appears presidential.
Robust public health system needed
This rising political capital will be used to bring resources and focus to interventions. The immediate priority is the creation of a robust public sector and health system as an emergency measure. If the Covid-19 health crisis cannot be resolved the economy will continue to crash. Every crisis has, however, also led to concessions to capital.
All the unfinished business of the SA revolution is now outlined against the dark sky of disease; the stalled housing programme, indecisive health investment, mass unemployment and declining incomes, rising poverty, and the stark inequality of economy and society. The weak support offered to the newly unemployed and struggling families touches on these issues but without leading to resolution.
The question is how the labour and social movements will rise to put a bold public health initiative, mass housing programme and job creation back on the political agenda; progress towards the once-promised stage of socialism. This crisis has to re-energise the creative energies of working people as in the victorious struggle against apartheid.
April 15, 2020
From the website newframe.com. the original can be found here
