By David Hemson
- President Ramaphosa is weak and incapable of leadership
- People cannot be ordered to stay away from work if they have no money
- The SA labour movement will press its own demands
- The high prevalence of HIV/AIDS in the population will lead to runaway Covid-19 infection
- South Africa has a developed health system which will be resilient to the face of Covid-19
- South Africa will have the same kind of Covid-19 recovery programs as in advanced countries
South Africa, as many other countries, is in lockdown, but the social conditions are very different. From a few cases among the well traveled, Covid-19 is spreading throughout the 56 million population in South Africa. How will working people in conditions of desperate poverty and deepening unemployment survive the pandemic?
Six talking points about the current crisis are discussed: the evidence to many questions about South Africa in the Covid-19 crisis is presented under these talking points. South Africa has the resources to contain and mitigate the pandemic; the question is how this can be achieved and lead on to the goals of the SA revolution being met. Each point is carefully examined against the facts. The verdict: some are valid others not, and others, again, are half-truths which have to be carefully qualified. The facts on resources and scientific conclusions on the pandemics South Africa is experiencing need to be carefully assessed to understand the conditions for survival.
What is clear is that class issues are being raised sharply during the crisis. As the Abahlali baseMjondolo (homeless people’s movement), has stated on 22 March 2020: “Disasters are political. Disease is also political. Class determines who has medical aid and who does not, who has access to water, sanitation and safe means for heating and lighting and who does not.” Even though the labour movement is quiet, Covid-19 is leading to demands for these contradictions to be resolved.
President Ramaphosa is weak and incapable of leadership
The virus is shaking the foundations of South African politics. The country is emerging from a period of mismanagement and corruption which has left state-owned enterprises reeling from a crippling burden of debt. Before the pandemic, Ramaphosa represented a fairly weak presidency attempting the restoration of state finances. Within the ANC executive he has had a slim majority against the faction defending state capture.
By acting decisively and giving an authoritative speech before the lockdown, he has now won respect from large sections of the population traumatized by the sweep of the pandemic. Working adroitly to assemble political consent he appears presidential. In addressing the troops deployed to support the police he spoke as the Commander-in-Chief; he had the attention of the nation as the nation rallied to meet the crisis.
This rising political capital will be used to bring resources and focus to interventions. The immediate priority is the creation of a robust public sector and health system as an emergency measure and as a step towards a fully funded national health service. If the health crisis cannot be resolved the economy will continue to crash. Every crisis has, however, also led to concessions to capital.
The most likely development is that Ramaphosa will increasingly drive his own political direction and elevate himself above the ANC executive and win further support. However, given his background and orientation, he will drive towards support for corporations rather than welfare to working people. His Covid-19 program has paltry measures in support of the poorest in society.
Will he use this authority to strip power from the leading defenders of corruption and restore some integrity to the state? Despite his history of association with the massacre of striking miners, Ramaphosa has the express support of the labour movement, the SA Communist Party and the ANC membership. His new decisiveness is giving him command over the state; the question is what is to follow.
Verdict: Paralysis in the presidency is at an end as the nation rallies to face the crisis. This new authority is more likely to favour corporate interests than those of working people; the labour movement has to rally to defend its interests within the rush of interventions.
People cannot be ordered to stay away from work if they have no money
The majority of working people have little or no savings and depend on daily work to have food to eat. While having a 29% rate of unemployment and 50% of the population living in poverty, the entire population lives in lockdown without promise of provision. Despite this, the lockdown has to be supported as a war measure against the potential devastation of SA’s people and future. Demands have to be made for immediate redress through cash transfers and a program of radical change.
The current lockdown is enforced by the police and army, and the people have to obey. Street traders, casual workers of all kinds, car guards, taxi drivers, home helpers, market traders, regular workers; those with some cash reserves and those with nothing are locked in. Many, possibly most, will be away from work on a “no work no pay” basis. Unless they are already in the system, they are without social security support or unemployment benefits.
In the early days of the lockdown, crowds on the streets in poor communities have tested the resolve of the police and army. Over time this has eased; but as people live with emergency regulations, the daily growth in hunger will lead to demands for supplies of something more than the food parcels distributed by the ANC before elections.
This lockdown is in an urban society which varies considerably from the cities of China, Europe and the United States. The spatial planning of apartheid which segregated black people to the urban periphery has altered, but not substantially changed. Many city centres are now occupied by black people, with “townships” (state housing) many kilometres distant on the periphery. There are many small and substantial shack settlements sandwiched between these two extremes. Extensive suburbs provide for the white and some of the black middle class.
With the exception of the suburbs, in all three types of urban settlement there is overcrowding and a poor living environment. There are few parks, sports fields, or libraries in the townships, and none in shack settlements. The open areas are often strewn with rubbish, without grassed spaces to walk. These areas are certainly not excluded from South Africa’s extreme crime levels with high levels of murder and abuse of women and children. There is particular concern about a rise in domestic violence.
Many households are women-headed and multi-generational, often based on income from a grandmother’s pension and child allowances. Services in water, electricity and rubbish removal are frequently interrupted by poor service levels, or disconnections for non-payment. Rubbish collection is either absent or below the level of former white areas. Devastating fires in shack settlements are also not infrequent. People live under the constant threat of eviction.
Handwashing is a challenge, as access to water services is uneven. The highest level of service providing indoor plumbing is available to 46% of the population in middle class housing and many townships. Fetching and carrying for domestic use is needed for households with outdoor yard connections (29%) and communal taps (12%). These households have much less water and are without flowing water for hand washing.
Verdict: The poorest and most vulnerable communities are struggling for survival in the lockdown. They have limited access to food and water and to the paltry welfare being offered. There are potential firestorms as households are reduced to hunger and starvation over time.
The SA labour movement will press its own demands
The overcrowded and impoverished conditions of life could provide fertile ground for social explosions. It seems some employers are adopting a “no work, no pay” policy during the lockdown. Other employers are expecting workers to take their annual leave during the lockdown. For 85% of black working people (in agriculture, services, industry and transport), it will not be possible to work from home. There is desperation within the lockdown.
Despite this, the major trade grouping, COSATU, has been silent on the Covid-19 crisis. Sections of civil society and trade unions, however, have put forward an immediate programme for survival in a set of demands to make life possible during the current lockdown:
End all evictions and disconnections from water and electricity; shack settlements to be included in refuse removal; workers given paid leave; small traders included in relief and provided with guaranteed income; free food parcels, hand sanitizers provided; places for those tested positive to self-isolate; free availability of data for cell phones; the release from prison of those detained for making “illegal” connections; health facilities available to the undocumented. (Summarized from the SA Federation of Trade Unions, March 2020).
The current mood is reflected in civil society statements of “rebellion born of extreme desperation” and reports of a “death wish” among working-class youth facing long term unemployment. Fake news is gaining currency: that Covid-19 has been brought by China, or that this is a “white disease” which will not affect black people. There could be xenophobic outbursts. The first days of the lockdown have been marked unevenly, with compliance in middle-class areas and crowds queueing in the poorest areas without social distancing. There is some defiance and some compliance. Over time, starvation could lead to firestorms in these areas.
Verdict: Messages based on science have to be repeated and repeated again; fake news must be contested. Covid-19, social isolation and access to food and welfare has been poorly synchronized – this is leading panic or defiance in poor communities. Civil society and the labour movement should be explaining the issues and helping working people defend themselves against infection. The labour movement is under pressure from working people to develop a program for radical change.
The high prevalence of HIV/AIDS in the population will lead to runaway Covid-19 infection
South Africa is no stranger to pandemics. Its people suffered great losses in the 1918 flu epidemic, and a hundred years later has the largest concentration of HIV-positive people in the world as well as high levels of tuberculosis. The country also had a large-scale cholera epidemic in 2000-01, which was shorter lived but extensive in rural areas. The continuing HIV pandemic, tuberculosis and the year-long cholera epidemic severely tested the post-apartheid health system. There is some advantage: it has also helped prepare for the mass testing and emergency interventions now required.
The previous President Mbeki spread fake news about HIV; when he labeled ARVs (antiretroviral drugs) as “poisonous” this clouded treatment with controversy and racial innuendo. Life expectancy plummeted and is only now recovering. The mass treatment programmes for HIV and TB which have followed have been a priority in spending, leaving an infrastructure in place but fewer additional resources for this pandemic.
The epidemics of HIV and tuberculosis overlay each infected the same vulnerable communities and individuals. South Africa has the biggest HIV epidemic in the world, with 7.7 million people living with HIV and half of those HIV-positive also suffering from tuberculosis. HIV infection is increasing at a rate of 4,285/week and tuberculosis at 8,654/week. These diseases have peaked, but prevalence is at a high level; these epidemics are kept at bay rather than declining.
These destructive combinations have brought the unwelcome description of South Africa as the unhealthiest society in the world. This heavy burden of disease rests on the black working class, which suffers high unemployment, poor housing, and violent crime.
Massive interventions are at this stage partly effective, but not decisive, in reducing these debilitating epidemics. Despite this, the infrastructure of testing and treatment is a resource for responding to Covid-19.
Somewhat counter-intuitively, most experts think those on antiretroviral therapy whose viral loads are suppressed will be more resilient than those who are not on this therapy. The ARVs may make the body more resistant to infection and the spread of the virus if HIV medications are maintained without disruption. Such defense could account for 54% of those living with HIV, taking treatment and who have achieved viral suppression.
This leaves 46%, or 3.5 million of those living with HIV, who are untreated, with a potentially high viral load and low levels of immunity, a group which will be particularly vulnerable (Avert. 2020). Most of this group are the “missing men” who know they are HIV positive but decline to take the free ARV treatment. They may continue to be sexually active, have a high viral load and infect others. Since partners and networks of infection are not known, as these are not disclosed, there are gaps in treatment and continuing infection.
The millions who refuse treatment give some dimension to a problem that is not found in other African countries and is unique to South Africa.
Verdict: There is just some chance South Africa may be able to avoid a runaway pandemic. While it has the largest population living with HIV, the infrastructure for treatment of HIV/AIDS is a resource in the war against a new virus. The use of ARVs among most people who are living with AIDS adds to defence against Covid-19. All pandemics (HIV, TB and Covid-19 have to be tackled together.
South Africa has a developed health system which will be resilient to the face of Covid-19
At times South Africa has captured international attention for new medical interventions, such as heart transplants. A casual glance would show many high-quality hospitals in the metropolitan centres.
But health services are fractured by staggering inequality. In the post-apartheid era, class allocation of resources has accelerated private health infrastructure. As access to the full range of public health services opened to all citizens, public funding faltered, and private hospitals were built at an increasing rate. Health insurance companies such as Discovery based in South Africa grew rapidly and now range internationally.
For the rising middle class, health has become a private and personal vocation, supported by expensive medical insurance. The private healthcare system it supports opens access to private hospitals, gyms, doctors and other health professionals. This meets some 16% of the populations needs, and the overwhelming majority of health personnel follow this expenditure: about 79% of doctors work in the private sector. All medical training takes place in the public sector, but 70% of doctors go into the private sector.
Such huge dynamic disproportions distort the health services available to the majority: by comparison the public health sector has to meet the needs of 84% of the population with 21% of the doctors! There are radical divisions between the private urban and public rural hospitals; just under half the population live in rural areas, but only 3% of newly qualified doctors work there.
Health services show the blunt edge of reform; the new elite does not use public health facilities and has little concern for the actual conditions in clinics, hospitals and in the small private practices orientated to poor people. National budgets have consistently allocated less than the targeted 15% of the budget to health services. A regime of budgetary austerity (accompanied by profligacy and corruption in state enterprises) has further accentuated the public/private divide as the private sector rises in comparison.
The latest available statistics show that there are 407 public hospitals (with about 158 000 beds) and 203 private hospitals. The provincial health departments directly manage the larger regional hospitals. Smaller hospitals and primary care clinics are managed at district level. There are over 401,000 practising nurses in South Africa; their number has been limited by the closing of nursing colleges during the late 1990s in implementing the GEAR neoliberal programme. Unfortunately, the rising demand is not met (even in conditions of mass unemployment), as there is a high drop-out rate of candidates in training.
Despite these necessary truths, there are public hospitals and clinics which are competently managed and are committed to meeting the rising burden of disease. In the midst of demanding conditions, dedicated health workers are undertaking competent and caring work, often under very difficult conditions. The HIV and TB epidemics have had some advantage in preparation. These have prepared teams of doctors and nurses for mass testing and the emergency interventions now required.
Large public hospitals will be in focus as the pandemic grips South Africa. The Chris Hani Baragwanath Hospital is the third largest hospital in the world, and it is located to serve the concentration of population in Johannesburg. There have been critical reports on its management, but given its location in the centre of population in Johannesburg, it will be the key hospital in the defense against Covid-19. High levels of wastage, theft and corruption are reported in the public hospitals.
The immediate focus will be on the ICUs. Although there are offers of co-operation from private hospitals, how will the 4,960 critical care beds in the private sector reported in 2017, with 60% availability, be jointly coordinated with the fewer 2,240 critical care beds in the state sector, with 20% availability? How can this resource be equitably used when there are conflicting claims from members of medical insurance and from the majority of desperately ill non-members?
Verdict: The appalling inequalities in health provision are being highlighted by the pandemic; the promised cooperation by private hospitals with national initiatives will not meet the demand on health services. Resources have to be radically reoriented to their needs as the first line of defense in a national plan of action with powers of command over all available facilities. Treatment of HIV/AIDS has been built into the health system and trained personnel serve a defensive shield against three epidemics threatening to overwhelm the country.
South Africa will have the same kind of Covid-19 recovery programs as in advanced countries
The SA labour movement watches in awe as governments in advanced countries roll out “whatever it takes” recovery plans of trillions of dollars compared to a pathetic trickle at home. Decades of corruption have used up government surpluses and devastated public finances. SA’s subordinate position in the world economy and the government “junk” bond status have resulted in high interest rates for loans. In crisis, capital absconds to safe centres and to the dollar, draining the economy of resources.
The international Covid-19 crisis is devastating the lives of working people in South Africa as it is people world-wide. However, the economy, the people, the health systems are all more vulnerable than elsewhere. Every crisis from the Great Recession to the present disaster has also reinforced South Africa’s semi-colonial place in the world economy and deepened its dependence.
The most recent budget showed Ramaphosa’s commitment to meet budgetary and monetary constraints after an estimated one trillion Rand ($660 billion) vanished in corruption. Billions were allocated to stabilize state enterprises bankrupted by ANC deployees. SA bonds have been declared “junk”, leading to the currency sliding 50% over the past decade and sharply rising interest on loans. It is very unlikely that Ramaphosa will ignore these constraints, print money and expand state spending. Instead the SA government is planning to approach the IMF for relief.
Verdict: A comprehensive recovery programme will not be initiated by President Ramaphosa. Any loan from the IMF will come with terms and conditions against the interests of working people. The burden of the crisis will fall more heavily on working people even than in the advanced countries.