Even though COVID-19 is a crisis everyone around the world experiences, every region is different with varying needs and associated measures to fight the pandemic. One way to enhance understanding of these unique situations and implications of proposed solutions is to consider citizen evidence alongside science research and global experiences. This not only creates a more comprehensive evidence base but also minimises the risk of marginalisation and ignorance of the public challenges to meet basic needs.
The South African government decided to institute a countrywide lockdown as a public health measure to reduce the spread of the novel coronavirus, COVID-19. This was a decision that was first implemented from 27 March and later extended up until the end of April, with the gradual lifting of the lockdown guided by a risk-adjusted strategy. But what was the initial decision to send the country into lockdown based on? And was this decision a good one, given South Africa’s particular set of needs and resources?
Evidence synthesis studies (mainly evidence from observational and modelling studies) suggests that limiting people’s physical interactions by physical distancing is effective in stopping or slowing down the spread of COVID-19. This allows healthcare systems to buy more time to be ready for spikes of new infections which require hospitalisation. Physical distancing is the deliberate increase of the physical space between people to avoid spreading illness.
Several countries around the world have issued ‘stay at home’ orders and, in a vast number of African countries, some form of lockdown controls have also been implemented. However, a different question to ask is whether lockdown interventions that seem to work in other countries are a good fit here in South Africa?
Every region is different and needs different measures
Some scholars have suggested that Africa, and more precisely, South Africa, is unique in interestingly relevant ways from the rest of the world. Even if lockdown resulted in a causal effect of curbing down person-to-person transmissions of COVID-19 in the other parts of the world, this alone does not warrant our full confidence in the intervention’s suitability to South Africa’s unique set of needs.
From Seoul to Gugulethu, there is no place on earth with an identical set of contextual factors even through this pandemic. Philosopher Nancy Cartwright famously warns that there is a long way from “it works there” to “it will work here”. And I think that she is right. There is a lot more that goes into the prediction about health interventions like issuing a countrywide lockdown based on causal knowledge that a similar intervention was/is successful in other places.
In terms of evidence-informed decision-making (EIDM), it’s important then to think about not only implementing policies but also about the potential implications of such policies given the specific contextual factors of the places where these policies are being implemented. For instance, what could be the unintended consequences of a lockdown? How do we ensure that our efforts to save lives do not end up costing our people their livelihoods?
Perhaps one way is to ensure that scientific evidence is paired with citizen evidence. Citizen evidence provides insights into the lived experiences, the anticipated anxieties, and the practical realities of citizens living through policy decisions. I think that we should have learned the importance of this through the HIV epidemics.
Citizen evidence on lockdown measure
In South Africa, media reports suggest that citizens’ experiences of lockdown are, at least currently, far more negative than of the physical manifestation of the virus, obviously for those who have recovered. An estimated 5 million people stay in informal settlements in South Africa. The idea that a family of six – most times more – can remain within their home of sometimes as little as 9 square metres all day and all night is not only unrealistic but also untenable.
We have seen stories about people with the need to find something to eat in many South African communities, a much more urgent need than avoiding infection. This desperation is demonstrated time and again in how people huddle closely together in queues, sometimes physically pushing one another, to receive free food parcels.
Local news channels reveal a spike in domestic violence in the period since the lockdown came into effect. As part of that gloomy feature of South Africa, gender-based violence is a reality and lockdown has cultivated a conducive environment for that reality to flourish.
Grief over new burial measures is also increasing in communities. Those losing loved ones to both the virus and other causes are denied customary and cultural send-offs. All this is done to limit the numbers of people coming together as the virus spreads rapidly in close crowds.
These accounts of citizens’ experiences reveal the real-world problems faced by our township communities, something that I argue was not considered adequately in rolling out of lockdown measures. What we need now (in addition to the health monitoring of new cases of COVID-19) is rigorous and widespread monitoring of the social and economic impacts of the pandemic (and the impacts of our mitigation strategies), and a thorough collection of citizen evidence to inform the next steps.
We cannot ignore the complexity of ways in which the lockdown has been experienced by citizens. And we cannot ignore that the lockdown may have come with unintended and severe consequences. What we can do is ensure that we use evidence – both scientific and citizens’ experiences – to ensure that we do not more deeply entrench the marginalisation and inequality that already plague our nation. As the first step in this direction, the HSRC has put together a survey to collect data to inform context-specific health and wellbeing frameworks for mitigating the pandemic. This is a move in the right direction for South Africa’s fight against COVID-19.
About the author
Likhwa Ncube works in the field of evidence-informed decision-making (EIDM). His focus is on increasing knowledge and understanding of EIDM in Africa. Likhwa is a program officer for understanding the art and science of EIDM at the Africa Evidence Network (AEN), housed at the Africa Centre of Evidence (ACE).
The author is solely responsible for the content of this article, including all errors or omissions; acknowledgments do not imply endorsement of the content. The author is grateful to Nasreen Jessani for guidance in the preparation and finalisation of this article. As well as to Siziwe Ngcwabe, Precious Motha, and Aziza Modise for their feedback on a previous version of this article. The author would also like to thank Natalie Tannous for her editorial support.