OPINION: On COVID-19, science and the politics of data
OPINION by Nyiko Mabunda and Busani Ngcaweni
Coronavirus (COVID-19) is the very definition of a disrupter of health systems, governance and life itself.
It has opened a Pandora’s box of misinformation, hyperbole and plain fake news, as the scramble for the latest, up-to-date data and information on the virus and its spread continues.
For electronic media junkies, the cold rush to break news is breaking the canon of verifying information with other sources before push notifications announce the arrival of yet another breaking news. This is further exacerbated by the tragedy of social media news consumers tending not to read beyond the headline.
Oh! The danger of a single story (source) is upon us!
The social landscape that was until just a few months ago dominated by influencers, social-media celebrities, covetous charismatic pastors in polyester suites, slay queens and professional opinion peddlers has been redrawn, with most of the former forced into hibernation.
Oh heavens, this global-cleansing ceremony is just too cruel!
In the midst of this pandemic, politicians and medical scientists – and as expected, academics too – have stepped into the breach and have suddenly displaced our intrepid influencers as the primary authorities and purveyors of truths.
What a reset.
At a time when so much is uncertain, and there is common appreciation of the unprecedented nature of the pandemic, and thus a lack of precedence when it comes to the "best" response, some in the academy and in the political benches are pulling what may be generously described as political caricature, and at worst, infra dig catfights to remain current.
Of course, the easiest way to get noticed is not to work with government as it attempts to navigate what President Cyril Ramaphosa has consistently characterised as "uncharted waters", but to eviscerate the well-reasoned and scientifically supported national response plan.
Not a day goes by without one or another "open letter" from actuaries, data modellers, medical scientists and economists finding its way to the breaking news platforms. In some instances, this happens even before these letters reach the inboxes of intended recipients at the iconic establishment tucked at the apex of Meintjieskop Hill, the Union Buildings.
The narrative is generally the same; a plea for the president to "do something about COVID-19 and the economy", accompanied by some form of statistical projections. The inference seems to be that they are correct, and the army of scientific, economic and other advisers working with the Department of Health and government at large, are not.
We have seen this play itself out spectacularly over the past week in a number of notable instances.
Firstly, the call from the interim leader of the official opposition, in his weekly "announcement of national importance" on YouTube, for the entire lockdown to be lifted. He even went to court.
Secondly, the dismissal of the lockdown as a failure by Wits University academic and professor, Alex van den Heever; a sentiment echoed by a group of concerned academics from Stellenbosch University who have called on the president to "unlock now and save lives". We will leave commentary on the latter’s demographic profile to those who trade in such statistics. We are just mere observers of state craft, public policy and its discontents.
They are following firmly in the footsteps of the tobacco lobby which made it their mission, through their allies in the mainstream media and academia, to single out and vilify Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma, whose department is delegated to guide the nation during the national lockdown in terms of the Disaster Management Act of 2002. Let us leave it to Black Twitter to process them, especially those in Parktown who called the president a mampara for not allowing the sale of cigarettes.
And then we have the spat between South African Medical Research Council Professor Glenda Gray and the Department of Health. She viciously attacked the very Ministerial Advisory Council (MAC) she sits on, pointing to possible tensions and conflicts between scientists within the council.
Even after Health Minister Zweli Mkhize’s attempt to set the record straight, she persisted to address the minister via media statements, making what we now know to be political caricature, as her claims about rising cases of malnutrition at the Chris Hani Baragwanath Hospital in Soweto are without a shred of evidence.
Anecdotes and hearsay are preserves of social media commentators and breaking news foot soldiers, not medical scientists.
The other common thread in these open letters is the near entire absence of consideration of what lifting the lockdown abruptly would mean for the health and very lives of the millions in the ranks of the urban and rural poor. The eloquent scientific caution attributed to Shameem Jaumdally of the University of Cape Town’s Lung Institute is completely ignored.
It is debatable whether persons of such stature and influence should be breaking rank and publicising divisive views that could cause confusion at a time of a global crisis.
The bigger issue is whether the so-called truths they claim to be self-evident are in fact the gospel, and why government should give their personal views greater currency over others. After all, these scientists know that the journal editor (read government) makes the ultimate decision on which article to publish, your pride in your manuscript notwithstanding. Does this not expose a sense of entitlement which comes with being a member of a certain class where no one dares question your views?
Lest we forget, this disease is only five months old and the world has fluid information on how to manage the pandemic. There are currently no definitive experts on COVID-19. For this reason, those who lay claim to being the ultimate authorities on the pandemic or expect that their research backgrounds render everything they say to be a standard of the ISO, should moderate their expectations.
It is only the collective wisdom (read: rigorous scientific evidence) and courageous leadership that will save humanity from COVID-19. To borrow from another Wits academic, Mzukisi Qobo, some of the most effective decisions will be unpopular, but they are inevitable if we are to triumph against COVID-19.
As if we are reading Maxim Gorky’s The Life of a Useless Man, there comes a time in the life of bourgeois society where the concerns of the working class become endnotes – a matter of attention after all the cliff-hangers in the epic of life and death.
The locus in most of the so-called open letters to the Meintjieskop Hill is problematic; saving South Africa means saving the economy instead of saving South Africans.
Just look within the main opposition, the interim leader in his vlog seems to contradict the very science the Western Cape provincial government has professed it is being guided by.
The Western Cape provincial government states in its official pages: “The nationwide lockdown is necessary to fundamentally stop the spread of the coronavirus in South Africa, by disrupting the chain of transmission. It will stop the spread of the COVID-19 and save South African lives.”
The logic for the nationwide lockdown is sound, by our own and also the global standard.
Presentations by the MAC on COVID-19 have argued that to flatten the infection curve, government had to institute the national lockdown, not to eradicate the virus, but to slow its spread and buy the country enough time to prepare the health sector.
Every discerning South African will agree that the president was correct in placing the country under the nationwide lockdown; a decision that resulted in the prevention of more than 80,000 infections (according to MAC predictions) and an untold number of deaths.
Like the interim leader of the official opposition, Van den Heever too appears to have misread both the intent and effects of the lockdown. Gray joins this line-up, even if it means being economical with facts.
It is not surprising that Van den Heever, a vociferous critic of the National Health Insurance, would argue against the lockdown and advocate for free economic activity über alles.
He knows that the wealthy can easily fortify themselves against COVID-19 while the poor cannot. Therefore, the argument goes that the lockdown is illogical and the economy should open so that those with means can spend and amass more wealth, while the poor, upon whose backs that wealth is generated, continue to be exposed to the highest risk as they use mass transit means of getting to work.
In pushing for the hasty lifting of the lockdown, the good professor and the Stellenbosch brigade would do well to look at what has happened in Iran, Germany, South Korea, China, Lebanon and Saudi Arabia, who are locking down again after reopening their countries.
A simple global comparison would show that initially, all countries experience a slow growth, which increases as soon as community transmissions become a factor and the second wave which follows the lifting of the lockdown. It is critical therefore to time the lifting of the lockdown to ensure that the health system is not overrun by an exponential spike.
The incident with Gray points to a more worrisome state of affairs in which she is by no means unique.
Like in all professions, there are rivalries within the scientific community when it comes to prestige, recognition, research funding and the like. As was evidenced during the HIV pandemic and beyond in both South Africa and globally, the contest between scientists to be right off the bat when it comes to publishing their research or discovering vaccines and cures, is a high stakes game. It is also a lucrative one and depending on your profile, can secure you millions of dollars in research funding, and some favourable change in your pocket.
Money does talk among scientists too, not just for self-employed social media celebrities.
Only the most cynical among us would conclude that the scientists who sit on the MAC are motivated by anything less than altruism. But that research and data making spectacular and scary predictions can be beneficial for the producers and their knowledge networks is entirely possible and should be considered.
All of the personalities mentioned above quote extensively from what they call data to make their case. This makes as clear a case as ever on why the mass release of data that has not been rigorously reviewed, critiqued, analysed and located within the necessary context, is a slippery slope.
All decisions must be evidence-based and data must be verifiable for proper analysis, and located within the correct context. All comparisons should be cognisant of the nuances of comparing data collected from urban provinces, metros and rural districts.
Furthermore, those who are decrying the alleged secrecy around COVID-19 data and government’s reticence to release every single projection or data set put before the National Coronavirus Command Council (NCCC) would do well to remember the stigma suffered by HIV-positive people in our country for years.
Have they considered what must be done to prevent a similar injustice befalling COVID-19 positive people if government released street level data en masse?
Their argument that it will help people protect themselves to avoid high prevalence areas is effectively a public call for stigmatisation.
“Don’t jog past that house, the granny inside has coronavirus... don’t buy bread in that shop, the owner died of COVID-19.”
We have already seen instances wherein the Chinese people in some places are referred to as "corona", and in the free world there are leaders, including United States President Donald Trump, who called COVID-19 a Chinese Virus. The fact is, even your own daughter and son can return from the supermarket with this disease and infect the whole office – hence the call to stay at home.
This stigma and scaremongering is exactly the inevitable outcome if street level data, in the absence of context, is published for mass consumption.
The Bhekisisa Centre for Health Journalism, an independent media organisation that specialises in narrative, solutions journalism focusing on health and social justice issues across Africa, recently commended government on its transparency in handling the pandemic.
In comparing experiences of South African journalists with those of their African counterparts, South Africa is said to be ahead in terms of daily updates on testing, confirmed cases and on economic measures. Just this week, again, the United Nations acknowledged our efforts to arrest the devastating effects of the virus.
As a science, qualitative and quantitative data is known to be and can be subjective. It can be used to support one or another supposition that would otherwise not necessarily be grounded in objectivity.
It is important therefore that an objective comparative analysis of intra- and inter-countries responses should not be simplistic.
It should include the underlying issues affecting public health systems, differences in socio-economic factors, population demographics, the burden of disease and the private healthcare sector’s willingness to collaborate and leadership approaches.
This is critical because this pandemic cuts across all sectors and will affect health, agriculture and food production, livelihoods and economic activity, education, water and sanitation, among others.
The multi-sectoral approach adopted by KwaZulu-Natal and Gauteng, for example, includes monitoring the effect of co-morbidities on the infection and death rates. Even the Western Cape is processing data sector by sector.
As scientists race against time crunching numbers on co-morbidities, evidence already shows that most deaths occur among people with pre-existing conditions. This is the case globally, hence more black people are dying in the US and in England because of their marginal economic status.
Given that both pulmonary tuberculosis (TB) and COVID-19 affect the lungs, countries like South Africa with high TB burdens should pay closer attention to people living with TB and TB survivors.
KwaZulu-Natal, with the highest burden of HIV prevalence, knows this well, hence it is reviving its multi-sectoral approach which was developed through Operation Sukuma Sakhe.
These points are made to illustrate that responses need to be structured in response to societal realities. Realities we continue to face when determining the next phase of our national response.
Laissez-faire economics has always been the mainstay of some of those who oppose government.
Their discredited mercantilism is dangerous since it does not consider the impact of market failures, and it tends to entrench inequality, monopoly and exploitation of the vulnerable. In line with this thinking, only the markets can address issues like land dispossession and inequitable access to healthcare.
The reality, however, is that this democracy is not a dividend of the market forces and such forces will not produce the democratic dividend of economic justice. The state must intervene on behalf of all South Africans, especially the poor and working class.
The tenor of some of the calls for the immediate lifting of the lockdown by the petitioners can generously be read to be tantamount to inciting the people to rise against themselves, in the process accelerating their own demise. It will only serve to cement the second-class status of the majority of South Africans who are always at the receiving end of all man-made disasters - from colonialism, to apartheid and the excesses of globalisation. This will make us waste this "good crisis" by not completely overhauling the economic structure of the country to reduce these massive inequalities.
Navigating the days, weeks and months ahead needs cool heads who put the people before profits. As many have said, economies do recover, but lives lost cannot.
The collective leadership should therefore be given space to listen to informed expert advice and to the concerns of the people of this country; advice that is not clouded by sectarian interests that will result in the death of millions of South Africans.
The new normal of the post-COVID-19 era requires a society equipped with tools that enable it to predict the future and plan for new unprecedented scenarios.
The various socio-economic relief programmes announced by government have shown an understanding of the need to prioritise the protection of lives, gradual re-opening of the economy and to contain run-away unemployment numbers.
The risk-based phasing approach is a logical thing to do, guided by already established principles of physical distancing in all spaces, mass screenings, testing and contact tracing and the management of co-morbidities.
The discontent that has resulted from mixed messages and excesses committed during the lockdown must be remedied and corrected. The president has committed government to doing so, and to consulting with stakeholders as the country prepares to go to level 3.
COVID-19 is a leveller; the reset button has been pressed. Outliving this pandemic will depend on how the political leadership converts science into effective public policy responses, while the social influencers reconnect with reality, and hopefully devise strategies to reinvent themselves in the world of physical distancing.
For our part, we will watch and comment, in our personal (and curious) capacities. Yes, we said it, we are not official spokespersons.
Let a thousand flowers bloom!
Nyiko Mabunda is director for social sector policy in the office of the Gauteng premier.
Busani Ngcaweni is co-editor of 'We are No Longer at Ease: The Struggle for #FeesMustFall'. Follow him on Twitter: @busani_ngcaweni