Covid 19 – More than meets the eye

Neal David

The COVID-19 pandemic has thrown a spotlight on many overlooked facets of societies throughout the world, says the writer.

He states: “Much like the boiling frog fable, we have become so used to the profit-driven rules and motives that govern society that we are immune to the daily suffering of the masses, the unspeakable cruelty to animals, the depth of hatred that finds its way to the surface through social media channels, and the daily damage we inflict on our habitat.”

Late in the afternoon of September 14 2020 the lifeless body of Zaid Allie “Dara” lay face-down on the road outside the Staff Entrance of Hanover Park Community Health Centre, blood flowing onto the grimy tarmac from bullet wounds in his head. Police tape had been rapidly erected around the crime scene but it had little effect on the throngs of Hanover Park residents on either side of the tape who were craning necks and arms to catch both a glimpse of the gruesome scene and a snap of it on their phones. This marked a return to the background of inter-gang gun violence that has plagued Hanover Park for decades, and that was temporarily suspended by a partial truce between the gangs during the lockdown period.

Dara was a Dollar Kid, and in many ways his life typified Thomas Hobbes’ description of a “solitary, poor, nasty, brutish and short” existence. When Hobbes coined the phrase in Leviathan, written in 1651, he was describing his views on the untethered nature of the human species, and his wholly pessimistic view of it has justified centuries of repressive authoritarian rule in various guises. One wonders if his thinking could have projected far enough into the world we live in today; a world in which the prevailing neoliberal narrative has created vast populations of alienated and desperate humans who trade their lives for little bit of money? In this world, a mantle of consumerism has molded the mechanisms of control into a toxic combination of greed and self-preservation that threatens to leave everything, from the communities we live in to the planet we live on, in tatters.

The COVID-19 pandemic has thrown a spotlight on many overlooked facets of societies throughout the world. Much like the boiling frog fable, we have become so used to the profit-driven rules and motives that govern society that we are immune to the daily suffering of the masses, the unspeakable cruelty to animals, the depth of hatred that finds its way to the surface through social media channels, and the daily damage we inflict on our habitat. For a brief period in 2020, this malaise was shattered by a novel equal opportunity respiratory pathogen, Sars-CoV-2, the causative agent of a potentially fatal respiratory illness.

Evolutionary pressure reveals many ironies. This virus has evolved with a highly efficient airborne mechanism of transmission and low threshold of human infection; so low in fact that most people won’t know whether or not they are infected. These people are the most efficient vectors. Those who get sick and those who the virus will destroy are mostly old or victims of the travesty of modern food economics. They are unwitting participants in a system of global overconsumption.

In the Western Cape surge that took place in May and June 2020, 52 out of every 100 deaths were related to Diabetes Mellitus. The Department of Health developed a specialised response to assist diabetic patients who had been diagnosed with COVID-19 that ultimately lowered their overall mortality rate. But the prevalence of diabetes in our province, and the persistence of diabetes as the primary cause of natural death, ahead of both HIV and TB, with or without COVID, speaks to a deeper causative issue that can only be addressed by a fundamental shift in the socio-economic framework of (particularly) poor communities.

A brief consideration of the history of sugar is warranted. Granular sugar first became commercially available in the Ottoman Empire from about 1100 AD onwards. Western Europe developed a craving for it during the Crusades but lacked both the capacity to cultivate sugar cane and the technology to process it. Christopher Columbus changed all that. His voyages were financed by sugar barons who had exhausted the land available to them on the Canary Islands. Cane taken from the Canaries was planted in the Caribbean, and the West African slave labour model that had been used so successfully in the Canaries was replicated on a much larger scale. Within 50 years of Columbus’s first landing on the island of Hispaniola, a triangular trade had been established. Sugar and rum were transported from the Caribbean to Liverpool and exchanged for guns and money, and the weapons were transported to West Africa where they were used to destroy all opposition and capture survivors to be transported as slave labour to the cane fields. It is not an exaggeration to say that the system of globalized trade and human exploitation owes its origin in large part to the world’s appetite for sugar that developed in tandem with the industrial revolution.

It is ironic that 300 years later, the consequence of sugar consumption in the form of a Diabetes Mellitus epidemic is at the centre of another global health crisis – the COVID-19 pandemic, and that the intersection of these two conditions has targeted poor communities around the world, and this in turn has illuminated the nature of global capitalism and its consequences.

The tragedy of sugar in the modern food economy is that it accounts for a large slice of the daily calorie requirement of billions of people around the world. Sugar has seeped its way into the food pyramid most visibly in the form of granular sugar, but far more insidiously in the form of HFCS (high-fructose corn syrup) and multiple related additives that are essential ingredients in processed food products. Dependence on processed food has largely replaced traditional indigenous diets that have served their communities in a sustainable way for generations. The Mediterranean diet, for example, was originally developed by poor communities living on the European and African coastlines in order to support survival on a subsistence level. It depended on crops that could be yielded on small areas of land with water that was available but not necessarily plentiful. It depended on animal or fish protein that could be obtained regularly but in similarly small amounts. The result was a varied diet rich in fruit, nuts, and vegetables, together with some unrefined carbohydrates and protein that could be obtained from the environment without necessarily requiring the purchase of products that were not readily available.

The global food economy has subverted this situation entirely. Access to the Mediterranean diet today (consistently recommended by health professionals as the most beneficial) is the preserve of the wealthy, whereas poor communities who have become progressively disenfranchised by the global economy and who have lost their land and the resources that are required to produce healthy food, are largely dependent on the cheap and addictive calories that are sold back to them from the Big Food industry that makes its profit on a high-volume low-margin business model. This is an industry that has continued to leave destruction in its wake, much as Columbus’s cane fields did in the 1600s. The COVID-19 fallout is but one in a long line of examples.

When COVID-19 arrived in South Africa in early March 2020, the Western Cape was amongst the first provinces in SA to be heavily seeded with Sars-CoV-2. As an international tourist hub, Cape Town and the surrounding areas were heavily populated with travellers from Europe and Asia who may have arrived here with asymptomatic or pre-symptomatic infection. Additionally, many wealthy Capetonians typically take advantage of late season snow at ski resorts in northern Italy, France and Switzerland, and they were returning from their holidays with the virus on board. Every early case recorded in Cape Town in the first few weeks of the pandemic was labelled as “Imported”. It took about three weeks before we diagnosed the first case in a patient who had not travelled themselves and to their knowledge had no contact with anyone who had travelled. The first “Locally transmitted” case was a woman from Khayelitsha who tested positive for Sars-CoV-2 without any travel or known travel contacts.

From the onset of the pandemic in March through the anxious months of April and early May to the surge of mid-May to July, the virus mapped out the historic and deep-rooted inequalities of our society and demonstrated the tenuous viability of many of our social and economic constructs. The initial imported cases were indicated on sub-district maps by blue dots. Locally transmitted cases were entered onto our maps as pink dots. Blue dots filled the City Bowl and Atlantic Seaboard, and pink dots started to appear on the Cape Flats. Blue dots had space available to self-isolate without transmitting the virus to their families, and so they became fewer and fewer. Those who had come into contact with a blue dot but who lived in overcrowded areas that did not allow for physical distancing became isolated blue dots in the Cape Flats leading to large clusters of pink dots. Within a few weeks only pink dots remained on the Flats and in densely populated township areas near the coastline such as Du Noon, Imizamo Yethu and Masiphumelele, as a viral legacy of spatial apartheid.

The hard lockdown of April had a severe impact on poor communities who were unable to buffer against the sudden loss of daily income. The informal economy that supports many poor and unemployed people disappeared overnight, leaving them without any source of daily sustenance. Food security became a real and urgent problem in many of the city’s most deprived communities. In this environment we were pursuing a Community Screening and Testing (CST) campaign to find cases as early as possible and provide isolation facilities if these were required. I was tasked with coordinating this process from the DoH Head Office. We targeted pink dots in the most densely populated areas as it was here that the virus would be most likely to spread. We activated teams of Community Health Workers (CHWs) to do household screening and set up mobile testing sites in the areas that were being screened. Initially we identified early clusters that may have delayed the surge, but we crossed an invisible threshold in the process.

Our teams were offering CST to communities who required food. Our efforts were often unwelcome. At best we may have been seen as providing a service that was not speaking to the immediate needs of increasingly desperate communities. At worst our campaign could have been viewed as representing the interests of a repressive state, because the value of the process was increasingly tenuous. Apart from the relevance of CST in comparison with the immediate social welfare needs of these communities, delays in obtaining results were rendering our tests entirely futile. In retrospect, our sense of futility may have led to a more general emphasis on behaviour change. When we abandoned CST in favour of targeted testing of high-risk groups, generalised behavior modification to reduce risk of exposure became the cornerstone of our policy.

One of the more interesting reflections on COVID relates to observations and perceptions of our collective response to the authority of the state. The core behavioural changes that have impacted on the coronavirus transmission are the wearing of masks in public and maintaining physical distance and hand hygiene. In reality very few of these behaviours could be actively policed and they have depended largely on the motivation of the public and an understanding that the state has the authority to issue orders relating to behaviour that will be obeyed not merely because of the threat of censure, but out of a sense of collective responsibility. In the USA, the libertarian tendencies that inform their particular brand of capitalist dogma have had a profound effect on the way that Americans have responded to this call. In the age of Trump and American populism this issue has been the subject of a culture war, the symbols of which are weaponised and politicised to serve the interests of politicians at the expense of thousands of lives, who are disproportionately poor and disenfranchised and burdened with high-risk comorbidities such as diabetes as described previously. In this political season of discontent the libertarian call to arms is one in which masks and distancing are derided as un-American activities that threaten the liberty of true patriots. Masks and distancing are seen by the hard right as the sinister manifestation of communist ideologues, typically painted as evil forces in the American narrative.

Despite our lack of unity on almost every other level, South Africa has enjoyed a curious level of conformity in relation to the unifying message at the core of the State of Disaster regulations implemented initially on 27 March and that remain in force at a lower level into October. This is not to say that there has been no opposition to the regulations. Indeed, many South Africans have fiercely vocalised their distress at the consequences of lockdown regulations on livelihoods lost and freedoms curtailed, and our home-grown right-wing libertarians have taken their cue from the likes of Trump and Bolsonaro to ridicule the government with accusations of nanny-state policies. The state itself has not covered itself in glory due to contradictory policies and a failure to contain corrupt government officials who have fed themselves at the trough of emergency PPE and UIF funds, much to the disgust of all South Africans and anyone else with a pulse. Having said this however, my own sense is that the voices of dissent, so unlike those in the USA, have been somewhat muted and deferential to the views of experts who have followed the science and who have provided our Minister of Health, Zweli Mkhize, and President Ramaphosa, with data-led advice. It did take some time, but it appears to me that most communities in and around Cape Town gradually came to understand the behavioural approach to COVID that had been recommended and the individual responsibility that was required from all to reduce community transmission rates.

Even if the evidence of the impact of lockdown regulations is contested by sceptics, there is one compelling piece of evidence the cannot be overlooked. Seasonal influenza is a regular part of SAs disease burden, usually from mid-April through the winter months. It is usually accompanied by the Respiratory Syncytial Virus (RSV) surge in children and by a range of less severe respiratory infections such as common colds and other “flu-like” illnesses. In 2020, this season of non-COVID respiratory diseases was notably uneventful. In fact, outside of the Western Cape, no influenza cases had been reported by our NICD at all, and the few Western Cape cases represented a small fraction of those normally reported, and RSV had barely been detected by the end of August.

This in itself is evidence of remarkably reduced community transmission rates of normally prevalent respiratory pathogens and can be viewed as proxy evidence that the so-called non-pharmacological interventions (NPIs) to reduce coronavirus transmissions were reasonably widely adopted.

Adoption of NPIs reflects a symbolic triumph of collective ideological thoughts and actions over the self-serving individualism that is central to the capitalist narrative. It has been intriguing to note how broadly collective ideology has been embraced over this period by people who would normally eschew any suggestion of a Marxist perspective. What this year has demonstrated is that the capitalist model is a flimsy foundation on which to build a society. It is a model that is wholly unsuited to the kind of shock presented by a global pandemic and its flaws are likely to be laid increasingly bare by the future pressures on an unstable planet. Collective ideology allowed for the simple act of wearing masks primarily to protect those more vulnerable than oneself. It made all of us see each other as equals. It forced our government to provide, for the first time in the democratic era, a basic income grant to people without other means of support. The mandate is clear – the strong are required to protect the weak, the rich are required to support the poor, and the well amongst us must care for the sick. As Karl Marx wrote in his 1875 Critique of the Gotha Programme “From each according to their ability, to each according to their needs.”

It remains to be seen whether the spirit of socialism will prevail in a post-COVID era, but it has been such a tangible, palpable component of our response to the pandemic that it is hard to imagine anyone other than the “basket of deplorables” and their ilk who support the Trumps and Bolsonaros of this world returning to a non-collectivist status quo. Consider the moving words of a colleague, Dr Tasleem Ras, who was tasked with the management of the 850-bed field hospital facility that we commissioned in the CTICC – the Hospital of Hope:

“We as humanity need each other…..meaningful relationships are so integral to our human identity that in the absence of this, we are quite literally lost. This is not new knowledge, but the reason I elevate it in this piece is because it was through meaningful, collaborative, often conflictual engagements with others that we were able to achieve a truly remarkable feat. Had we adopted the opposite: an individualistic, ego-centred, materialistic vision of the Hospital of Hope, it might have become a place of despair and desolation. Thankfully through these engagements around a common good, we were inspired to achieve something that we honestly thought was beyond our reach.”

I have cited this quote because it is a beautifully rendered expression of a prevailing sentiment – that we will get through this together. It should be no surprise then that those who identify with the politics of the left will wonder why, if the thoughts and actions that have been inspired by the pandemic are good enough to save us now, they aren’t permanent fixtures? After all, it’s not as if we weren’t in a state of crisis before the pandemic, and it’s highly likely that this will be exacerbated in the post-pandemic period.

The answer to this puzzle seems to be that we are mired in a meritocratic system of personal advancement and our default position can be expected to revert to the ego-centred approach to life that Tasleem warns us about once the glow of collective action has faded and we’re all back on our individual feet.

In her book “Against Meritocracy – Culture, Power and Myths of Mobility” Jo Littler highlights a persistent and sinister myth of modern existence: that you can improve your situation in life if you just work hard enough. This narrative is paired with a second myth: that if we are provided with things (by the state) our desire to work hard and improve our lives will be impaired. In a profoundly unequal world replete with neoliberal hegemonic power constructs and inherited generational wealth this notion is both a delusion and an opiate. A delusion simply because it is patently untrue, and an opiate because it allows society to tell anyone who doesn’t make it that they only have themselves to blame. The problem is that most of us are irrevocably wedded to this myth and the inherent lie at the heart of it is so inconvenient that we ignore its very existence. How else would we raise our children? We prepare them for a world in which you get “nothing for nothing” and in which the worthiest of us survive and thrive while those with less talent will not. This allows those of us who aspire to achieve wealth and status to congratulate ourselves for our achievements and to justify our position in society even if it is attained on the basis of pre-existing gender, race and class privileges.

This meritocratic narrative is the bread-and-butter of capitalist societies and it ties all who live in them to the brutal and unfair rules that breed growing inequality. The roots of this thinking extend back to the pre-biblical era – what Noah Yuval Harari describes in Sapiens as the “Agricultural Revolution” that occurred around 10,000 BC and marked the transition of our species from hunter-gatherers into organised societies whose survival depended on cooperation of large numbers of people and competition between large groups of people for limited resources. Organised war and organised religion followed organised agriculture in fairly short order. But despite its ancient roots, Littler suggests that the daily meritocratic imperative became entrenched in modern life when the neoliberal wave of the 1980s swept through the Western world with Reagan and Thatcher leading the charge. The free-market was held up as the solution to any challenge that humanity would ever face and the lie that people would enjoy equal opportunities in this context somehow prevailed year after year, and from one election to another in that era of rampant materialism that also saw the collapse of the Soviet Union. It became popular at that time to cite Adam Smith’s The Wealth of Nations and the concept of the invisible hand of the market and the self-interest that drives it. Written in 1776 it would be sheer conjecture to try and imagine what Smith’s view of the modern economy would be, but my feeling is that the neoliberal appropriation of this idea is unjustified. Smith talks about tradesmen (the butcher, the baker, the brewer) and describes their “regard to their own interest” as “self-love”. In the context of a society then emerging from pre-ordained rule by feudal overlords, empowering workers to place a value on their own labour can hardly be equated to the “greed is good” neoliberal mantra that prevailed in the 1980s!

My concern, however, as we emerge tentatively from the lockdown period and into a post-COVID world is that the collectivism that has briefly prevailed in 2020 is likely to be superseded by the neoliberal ideology that has molded the modern world and is wrongly celebrated as the antidote to the hardships we have endured as a consequence of the global pandemic and the lockdown regulations that accompanied it.

We have had some indication of the direction that is likely to be followed. The protests against restrictions on alcohol sales, for example, in spite of a dramatic reduction in alcohol-related trauma in public hospitals when these were enforced, and the heavy drinking that followed when restrictions were lifted are indicative of a possible pattern of post-COVID thoughts and actions. Even now, with only weekend restrictions and a midnight curfew in place, the calls for more freedom on economic activity are loud and insistent. The nature of economic activity that is desired seems less important than the ability to claw back whatever material losses may have occurred. While this is understandable, it does signal a return to a darker world that prioritises monetary gain and the “fairy tales of eternal economic growth” as Greta Thurnberg put it in her address to the UN Climate Action Summit a year ago, over all other concerns.

The world that we may return to is one that values a rhino horn more than the magnificent animal that made it. Similarly for elephant tusks, tiger bones, and pangolin scales – ironically trade in the latter may in fact have contributed to the pandemic.[1] This world values palm oil plantations more than rainforests and the damage we inflict is secondary to what we perceive as our immediate gain, even if we are presented with mounting evidence that we cannot insulate ourselves against a habitat that we continue to harm. Ultimately this world values the labour of men or women more than the men or women themselves, as we value the goods we can extract from our habitat more than we value its health. In this worldview the poverty of society or of the planet is less important than our ability to protect ourselves from its effects.

It is curious that the US election is currently proceeding as a symbol of this dichotomy. A Trump victory would symbolise a very tangible rejection of all the potential lessons we may have learned about ourselves during the pandemic; about our inter-dependence on each other and on the environment, and about the failure of a market-driven economy to protect the society it serves in a time of need. A Biden victory would acknowledge these lessons but would be unlikely to change the landscape in a meaningful way. As Tom Blackburn, founding editor of New Socialist recently wrote in The Guardian[2]: “Without far-reaching change, it may be that another shift to the hard right is at best delayed by a few years. In spite of everything, a healthier, happier and fairer world is still possible, (my italics) though we can’t dither much longer if we are to build one. It will only materialize, however, if those who want it first recognise that back-to-normal centrism would offer no way forward.”

 Neal David is a public sector doctor in Cape Town. He works as a family physician at the Hanover Park Community Health Centre. This article is written in his personal capacity and in no way reflects the views of the Department of Health.

[1] Quammen, D; “Did Pangolin Trafficking Cause the Coronavirus Pandemic?” The New Yorker – Annals of Science, August 24, 2020

[2] Blackburn, T; “A Biden victory cannot bring normal back” The Gaurdian, Saturday 19th September 2020

More stories in Issue 122

Covid 19 – More than meets the eye

The pandemic intersects with several historical factors that include the tragedy of sugar, land dispossession and the subversion of the global food economy.

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