Thursday, April 30, 2020

Learning from the past

South Africa has one of the most stringent lock downs due to the COVID-19 pandemic. For the past five weeks, we have been in Level-5 lock down, which has closed all but essential businesses, prohibited us leaving our homes except for medical reasons and shopping for food. The sale of alcohol and cigarettes is forbidden, as is the transportation of alcohol (which has had a huge negative impact on our wine industry). Like everywhere else, the impact on businesses and employees has been devastating, and some predictions call for at least 50% unemployment as the country emerges.

For the most part, people have accepted the strict measures, even though some haven’t been able to follow them due to the desperate search for food. The overarching fear is that the virus will spread in the huge Black townships, where people are living in crammed quarters, in unhygienic conditions. Many of these are already compromised because of HIV.

So,what led to the country being so proactive so quickly?

I think three things contributed to the decision: first, in the last hundred years, the country has suffered two devastating epidemics; second, the quality of doctors in general is very good, and the country has a long history of having outstanding epidemiologists; and third, we have a president who has led the country, keeping it informed, empathising with the hardships people are enduring, but demanding adherence for the good of all.

The Spanish flu epidemic, which started in the United States and rapidly spread to Europe via crowded troopships, hit South Africa harder than most. It was the fifth hardest hit, both as a result of the return of Black troops and a poor understanding of what the virus was all about.

In September 1918, two troopships arrived in Cape Town from England carrying over 2,000 black South African Labour Corps soldiers. On the way to South Africa, they had a stopover in Freetown, Sierra Leone, where the flu was already raging. Within days of leaving there, cases of flu appeared on both ships. When they arrived in Cape Town, thirteen of the soldiers were still laid up.

Members of the SA Labour Corps on the Western Front
As a precautionary measure, the local medical officer had the sick troops placed in isolation The rest of the men were put under quarantine at a military camp. Those that didn’t show symptoms were sent home three days later via the large rail network. Within days, flu cases started appearing all over the country.

By the end of October, six weeks after the ships arrived, between 300,000 and 500,000 people had died--between five and seven percent of the population. There was fear and panic throughout the country because nobody knew what was going on and, worse, nobody knew what to do. Gallows humour became common in newspapers. One, in Johannesburg, reported: "The average Joburg man did not run away from the germs — he fought them courageously. Retiring to bed with a bottle of brandy, and an adequate supply of ammoniated quinine and aspirin, and a pile of the latest novels, he challenged the flu to a 10 rounds contest."

And lost!

In the early 1920s, Reuben Thlakele Calusa, a South African composer, wrote several influenza-linked songs. Here is one, translated by ethnomusicologist, Austin Okigbo. It is titled Influenza 1918.

In the year nineteen eighteen
We’re killed by the disease called influenza
Which finished our beloved relatives
Mothers, fathers, sisters and brothers
In other households no one was left
It took young women and men
It chose the beautiful ones
It even took the good-looking men
It took the teenagers
It took even the young maidens
It took the engaged ladies
It took the strummers [bridesmaids]
Even the grooms
It was like there was a black cloud over the earth.

The one good thing about the Spanish flu was that it disappeared as quickly as it had appeared. By the end of November, it had gone. Six months later the government realised that it had to play a role in the health of the country and created the first Ministry of Health.

Fast forward to the end of the century. By 2000, HIV/AIDS was ravaging South Africa, and efforts to treat and contain it were not helped by an inept approach by the government. Deputy President and later President Thabo Mbeki was a denialist. His Minister of Health, Manto Tshabalala-Msimang, advocated a diet of garlic, olive oil and lemon to cure the disease. Although many scientists and political figures called for her removal, she was not removed from office until Mbeki himself was removed from office. It is estimated that these policies led to the deaths of over 300,000 South Africans.

In addition, the country rejected the offer of free or inexpensive retrovirals to treat HIV. The whole episode was a disaster. However, when Jacob Zuma became president, the country’s approach to HIV/AIDS transformed and now anti-retroviral treatments are available to everyone. The problem is still huge (for details click here), but it is largely under control.

So, two devastating epidemics provided a backdrop to the COVID-19 situation. A combination of a president, Cyril Ramaphosa, who was willing to listen and act, epidemiologists who understood the ramifications of the virus, and a fear of what would happen if the virus spread through the townships, led to the current lock-down rules. 

As elsewhere, the financial hardships have been horrible. Some current estimates are that a quarter of all South Africans have no money and no food. And there have been a number of incidents of the looting of food trucks. Even a huge injection of funds by the government, in an attempt to get some money to the unemployed, has not been enough. And enormous efforts by NGOs and others to bring food to the starving, will fall short. 

The police and military protect food deliveries

Who can blame people for trying to get food?
But the numbers are still looking good – just over 4,000 confirmed cases and 102 deaths. Testing continues to ramp up and will be crucial as time passes. The goal of the lock down has been to flatten the curve, so the country can prepare for the inevitable spike, which is expected in August or September. Everyone expects the situation to worsen considerably between now and then, but hopefully the country will be as ready as it can be.

The country hopes to be prepared when the spike occurs.
Tomorrow, the country moves to Stage 4, which relaxes the tight control a little bit. I’ll be able to exercise outside the home between 0600 and 0900, which will be a boon, even though I have become quite accustomed to lying in bed until 0800. Sale of alcohol and cigarettes remains banned. However, some businesses can open either gradually or fully, and restaurants can open to prepare food for delivery only.

I am so pleased that I don’t have to make these decisions on when and how to relax restrictions. And I am much more confident in how South Africa is trying to cope than I am in some other countries' approaches.


  1. Interesting thought that we've truly learnt from the past. If we had the medical management of the Spanish flu, plus the appalling political mismanagement of HIV, everyone in South Africa would catch the virus until the epidemic ran its course. The truth is we're very lucky.

  2. Thanks for that report, Michael. Another truth we're all sadly learning in this part of the world is that those do not learn from history are doomed to...doom us all. Stay safe.