How should South Africa combat Omicron in the days to come?
The emergence of the Omicron variant has concerning implications for South Africa and, indeed, the world. In the last two weeks, South Africa’s daily confirmed cases of COVID-19 have been climbing at a staggering rate, with the rolling 7-day average rising from just 327 case per day as of the 17th of November all the way to 1541 as of the 27th of November.
A five-fold increase in just ten days defies belief; no rise on that scale has occurred at any previous time throughout the pandemic. This may, in part, be explainable by testing complacency between waves and an element of panic now. Another possibility is that infections grew first in sections of the population with limited access to testing, and are now spilling over into population segments that are more frequently tested.
Even if things are not quite as bad as they look, they are nevertheless very bad and so South Africa has little option but to take action, and quickly. That is a decidedly grim prospect. South Africa sits upon an economic knife edge, and is still reeling from violent unrest just months ago.
Another strict lockdown would be economically devastating, would likely result in protests, and would most certainly have far less compliance than our first one did. The economic effects would damage people’s willingness and ability to comply with future mitigation measures, so there are epidemiological trade-offs besides just the economic and social ones. Harsh or punitive measures will be poorly received and, with the limitations on our ability to enforce measures, we will have to carefully balance the costs and benefits of each step that we take.
Overall philosophy: incentivize rather than penalize
Consequently, we should focus on rewarding positive behaviours rather more so than on punishing negative ones. Another aspect of this is that simply cutting off access to certain activities doesn’t necessarily guarantee that people will resort to lower-risk alternatives instead. It is likely that past rounds of beach and park closures put more people into malls and restaurants, riskier environments for transmission. People are going to spend time with each other, particularly during the festive season; that is just human nature. Attempting to prevent that entirely is ill-advised so the best approach is to acknowledge that it will occur and instead try to direct it toward low-risk transmission settings. In other words, don’t close beaches or parks, and don’t restrict outdoor gatherings aggressively — rather allow those to take place in the knowledge that they are a far safer alternative to indoor gatherings.
Ventilation and CO2 meters
Indoor gatherings must needs be reduced, as they represent the riskiest setting for COVID transmission, but where they cannot be avoided, emphasis must be placed on ventilation. The practice of using indoor CO2 meters as a proxy for the amount of respiratory contact taking place between people has been implemented in many countries internationally, but not here. We need them now.
One month VAT moratorium on online purchases
A one-month (or somewhat longer) VAT moratorium on online purchases would serve three purposes. Firstly, it would serve as an incentive to avoid crowding in shops, a particular risk in the lead-up to Christmas and, secondly, it would serve as an avenue for direct economic stimulus at a crucial time. Thirdly, it would provide an incentive for modernization and streamlining of business practices.
Tuesday/Thursday shutdowns as alternative to strict lockdown
This is a proposal initially raised in March 2020, and at present I would suggest it as a more palatable alternative to full lockdown, should one appear to be necessary. Research has shown that 3- or 4-day workweeks do not significantly reduce overall employee productivity. However, 2 fewer days in the workplace and in non-essential activities would directly reduce transmissions commensurately. Two additional days being available for accessing essential services would also serve to reduce the density of people accessing those activities. Hence, transmission during non-essential activities would be reduced by approximately 2/7ths while the density of people at essential activities would be roughly halved.
This would, in principle, serve as a measure for significantly lowering transmission rate for a period but without the severe economic damage (and harsh epidemiological trade-offs) associated with a strict lockdown.
Stuff we shouldn’t do: restrict activities that are minor contributors to overall transmission
Travel bans are only effective in circumstances where one location has a disease whereas the other is entirely free of it. When both locations have a particular disease (or variant), the cost-benefit on travel bans simply doesn’t justify them. Traveling doesn’t quantitatively increase inter-personal contact all that significantly, and travelers also generally represent quite a small fraction of the overall population at any given time so, even if there is some increase in transmissivity, the contribution to total transmission remains small. On the other side of the equation, travel is a high economic value activity and something that people value immensely, with tremendous loss and grievance when plans are cancelled. International travel bans are not justified except to exclude a variant that is not present in a destination, and provincial travel bans simply aren’t justified.
I mentioned previously that banning low-risk activities like beaches and parks is likely to actively increase transmission but, more broadly, banning something that a person wants to do will not result in them shrugging and just sitting on their hands at home. They will either find an illicit way to do the thing they wanted to do in the first place, or they will find something else to do, which may or may not carry risk of transmission. The overall benefit, therefore, of banning activities is quite poor, except in instances where those activities are known to be of an exceptionally high risk. We need to apply this principle universally in order to maximize the benefits that we get for each measure that we do apply. Make no mistake; people’s capacity and willingness to comply with measures are finite and precious commodities, and must be used as efficiently as possible.