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| Echoes of AIDS Epidemic as South Africa Fights Coronavirus | Echoes of AIDS Epidemic as South Africa Fights Coronavirus |
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| CAPE TOWN — Gita Ramjee, a renowned virologist who worked relentlessly to prevent H.I.V. infection in women in South Africa, died on Tuesday of Covid-19-related complications. Professor Ramjee, 49, who had recently returned to Durban from London, was the fifth person to have died of the coronavirus in the country, where more than 1,300 infections have been reported. | CAPE TOWN — Gita Ramjee, a renowned virologist who worked relentlessly to prevent H.I.V. infection in women in South Africa, died on Tuesday of Covid-19-related complications. Professor Ramjee, 49, who had recently returned to Durban from London, was the fifth person to have died of the coronavirus in the country, where more than 1,300 infections have been reported. |
| The first victims of the coronavirus pandemic in South Africa, like Professor Ramjee, are from the more privileged and globally mobile strata of society. And Covid-19 is even being spoken of in black communities as a “white man’s disease.” | The first victims of the coronavirus pandemic in South Africa, like Professor Ramjee, are from the more privileged and globally mobile strata of society. And Covid-19 is even being spoken of in black communities as a “white man’s disease.” |
| Professor Ramjee was among the first wave of scientists to study the impact of AIDS on society’s most vulnerable, and her research on sex workers in the 1990s has a lesson for us all. She understood that the AIDS epidemic would hit poor people disproportionately in South Africa, one of the most unequal countries on earth. It did. And so will the coronavirus. | |
| South Africa is still in the incubation period of the pandemic and is expected to reach the peak around early May. The country’s president, Cyril Ramaphosa, ordered a 21-day lockdown starting on March 26 in an effort to prevent the spread of the contagion. We may leave our homes only if we are essential workers, if we need food or medication, or if we must collect our social welfare grants from the state. | South Africa is still in the incubation period of the pandemic and is expected to reach the peak around early May. The country’s president, Cyril Ramaphosa, ordered a 21-day lockdown starting on March 26 in an effort to prevent the spread of the contagion. We may leave our homes only if we are essential workers, if we need food or medication, or if we must collect our social welfare grants from the state. |
| Mr. Ramaphosa ordered the lockdown, using the country’s Disaster Management Act, on the basis of modeling that suggested we would have 87,900 deaths at a 10 percent infection rate. Absent an effective lockdown, that would be a best-case scenario. But this model was extrapolated from data from Wuhan in China, and South Africa has a different health profile: a high population with compromised immunity and susceptible lungs because of AIDS and tuberculosis. | Mr. Ramaphosa ordered the lockdown, using the country’s Disaster Management Act, on the basis of modeling that suggested we would have 87,900 deaths at a 10 percent infection rate. Absent an effective lockdown, that would be a best-case scenario. But this model was extrapolated from data from Wuhan in China, and South Africa has a different health profile: a high population with compromised immunity and susceptible lungs because of AIDS and tuberculosis. |
| Fatality rates here can be much higher, than, say the 4 percent of infected persons in China or the nearly 12 percent in Italy. And New York’s shortage of beds is dwarfed by what we could face: There are only around 7,000 critical-care beds in this country of 60 million people, and a desperate shortage of testing kits and protective gear for health workers. | Fatality rates here can be much higher, than, say the 4 percent of infected persons in China or the nearly 12 percent in Italy. And New York’s shortage of beds is dwarfed by what we could face: There are only around 7,000 critical-care beds in this country of 60 million people, and a desperate shortage of testing kits and protective gear for health workers. |
| Even before Covid-19, the country was in an economic crisis, with 29 percent of its people unemployed. A third of South Africa’s 58 million people depend on social grants rather than wages for income, and in some parts of the country, one salary feeds 12 to 15 mouths. | Even before Covid-19, the country was in an economic crisis, with 29 percent of its people unemployed. A third of South Africa’s 58 million people depend on social grants rather than wages for income, and in some parts of the country, one salary feeds 12 to 15 mouths. |
| To prevent even more people from joining the ranks of the unemployed, Mr. Ramaphosa has announced a solidarity fund already worth $300 million, with seed funding from the country’s richest families. Among its goals is assistance for small businesses and self-employed people, and the procuring of medical supplies. | To prevent even more people from joining the ranks of the unemployed, Mr. Ramaphosa has announced a solidarity fund already worth $300 million, with seed funding from the country’s richest families. Among its goals is assistance for small businesses and self-employed people, and the procuring of medical supplies. |
| In his televised addresses, the South African president has deeply impressed South Africans with his empathy and purposeful style. The decade-long kleptocratic rule of Mr. Ramaphosa’s predecessor, Jacob Zuma, precipitated an economic crisis, hobbled the state’s capacity and eroded public trust. | In his televised addresses, the South African president has deeply impressed South Africans with his empathy and purposeful style. The decade-long kleptocratic rule of Mr. Ramaphosa’s predecessor, Jacob Zuma, precipitated an economic crisis, hobbled the state’s capacity and eroded public trust. |
| In our fractious society, this distrust infects the relationship between people and the law, at a time when those enforcing it have more power than at any time since the apartheid-era “state of emergency” in the late 1980s. | In our fractious society, this distrust infects the relationship between people and the law, at a time when those enforcing it have more power than at any time since the apartheid-era “state of emergency” in the late 1980s. |
| Videos of soldiers frog-marching and whipping citizens have been circulating on social media, and three people have been allegedly killed by law enforcement officials after altercations about disobeying the lockdown. The attitude of some of Mr. Ramaphosa’s lieutenants has not helped. Questioned at a briefing about police heavy-handedness, the hawkish police minister Bheki Cele promised, “You haven’t seen anything yet.” | Videos of soldiers frog-marching and whipping citizens have been circulating on social media, and three people have been allegedly killed by law enforcement officials after altercations about disobeying the lockdown. The attitude of some of Mr. Ramaphosa’s lieutenants has not helped. Questioned at a briefing about police heavy-handedness, the hawkish police minister Bheki Cele promised, “You haven’t seen anything yet.” |
| And necessary though the lockdown regulations might be, they struggle to take into account the reality of life for so many South Africans. According to 2016 data, only 44.4 percent of people had access to water inside their dwelling, and only 60.6 percent to a flush toilet connected to the sewage system. At least four million people — 15 percent of the population — live in densely packed, informal urban settlements with communal taps and toilets. | And necessary though the lockdown regulations might be, they struggle to take into account the reality of life for so many South Africans. According to 2016 data, only 44.4 percent of people had access to water inside their dwelling, and only 60.6 percent to a flush toilet connected to the sewage system. At least four million people — 15 percent of the population — live in densely packed, informal urban settlements with communal taps and toilets. |
| I spoke yesterday to a community leader in the Wetlands settlement in the township of Masiphumelele, near my home. “We are trying hard to self-distance,” Lubabalo Nompunga told me. “But we need to eat, we need to wash, we need to go to the toilet. All of this requires being outside.” And, he added, as many of his neighbors live five or six or even more to a tiny, unventilated corrugated shack, might it not actually be safer if people were to socially distance outdoors? | I spoke yesterday to a community leader in the Wetlands settlement in the township of Masiphumelele, near my home. “We are trying hard to self-distance,” Lubabalo Nompunga told me. “But we need to eat, we need to wash, we need to go to the toilet. All of this requires being outside.” And, he added, as many of his neighbors live five or six or even more to a tiny, unventilated corrugated shack, might it not actually be safer if people were to socially distance outdoors? |
| Mr. Nompunga told me that although the president had promised water tanks for informal settlements to help fight the virus, by the fifth day of the lockdown they had failed to arrive at Wetlands. | Mr. Nompunga told me that although the president had promised water tanks for informal settlements to help fight the virus, by the fifth day of the lockdown they had failed to arrive at Wetlands. |
| He also reported that Cape Town’s law enforcement officers, who rarely visit the township, had forcibly shut down the informal corner stores in the settlement, contrary to Mr. Ramaphosa’s regulations. This compelled his neighbors to walk a greater distance for supplies and to shop in greater numbers. | He also reported that Cape Town’s law enforcement officers, who rarely visit the township, had forcibly shut down the informal corner stores in the settlement, contrary to Mr. Ramaphosa’s regulations. This compelled his neighbors to walk a greater distance for supplies and to shop in greater numbers. |
| It does not help that the monthly payday came on the first day of the shutdown and that this week South Africa’s 17 million welfare grantees gathered en masse at pay points throughout the country. Very many would have traveled in overcrowded minibus taxis to get there. | It does not help that the monthly payday came on the first day of the shutdown and that this week South Africa’s 17 million welfare grantees gathered en masse at pay points throughout the country. Very many would have traveled in overcrowded minibus taxis to get there. |
| For most of them — and their families — this is the sole means of income. The general response, to reporters at least, was a resigned shrug: What choice do we have? | For most of them — and their families — this is the sole means of income. The general response, to reporters at least, was a resigned shrug: What choice do we have? |
| The very conditions that make it so difficult to practice and enforce social distancing in places like Wetlands also will cause the virus to spread even more quickly here once it enters the community. | The very conditions that make it so difficult to practice and enforce social distancing in places like Wetlands also will cause the virus to spread even more quickly here once it enters the community. |
| Because South Africa is starkly different from the countries where the pandemic spread earlier, models from elsewhere are of limited use to us. The upside is that Mr. Ramaphosa’s early lockdown has bought us valuable time and his government, together with the private sector, is working to procure more beds and scaling up screening and isolation strategies. | |
| The AIDS crisis in South Africa taught us that the severity of an epidemic is linked to social determinants such as poverty, gender inequality and violent conflict. In Gita Ramjee’s memory, let us not forget this as we reckon with Covid-19 in the country and the rest of the continent. | The AIDS crisis in South Africa taught us that the severity of an epidemic is linked to social determinants such as poverty, gender inequality and violent conflict. In Gita Ramjee’s memory, let us not forget this as we reckon with Covid-19 in the country and the rest of the continent. |
| There is another unnerving echo of the AIDS crisis right now. As with safer-sex promotions, public-health messaging about social distancing is hard to absorb — and to act upon — when you are poor or disempowered. It is harder still when you don’t yet see the effects of illness all around you. | There is another unnerving echo of the AIDS crisis right now. As with safer-sex promotions, public-health messaging about social distancing is hard to absorb — and to act upon — when you are poor or disempowered. It is harder still when you don’t yet see the effects of illness all around you. |
| And by the time you do see them, it’s too late. | And by the time you do see them, it’s too late. |
| Mark Gevisser is the author of “Lost and Found in Johannesburg” and the forthcoming “Pink Line: Journeys Across the World’s Queer Frontiers.” | Mark Gevisser is the author of “Lost and Found in Johannesburg” and the forthcoming “Pink Line: Journeys Across the World’s Queer Frontiers.” |
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