Covid-19: Not just another number – ubuntu in a time of war

“We are at war!” So said leaders of Germany, France, the UK, the US and South Africa as they declared hostilities against an unseen enemy that is staging a blitzkrieg on every nation.

As public health doctors, we have been accused of panicking, complacency, fear-mongering, issuing false reassurances and everything in between. We have been wrong and we have been right, and frequently undecided, but we have based our advice on the best available, fact-checked, information. Such is the nature of evidence-based medicine – we stumble from error to answer in an ever-narrowing path towards the truth.

We spend months with our medical students trying to teach them about context and complexity: a health system fraught with inequality; a disempowered majority beset by structural violence; a quadruple burden of disease preying disproportionately on those who can least afford it; and the paradox of shifting limited resources away from individualised lifesaving care to much more abstract life expectancy enhancing prevention methods.

Despite our best intentions and efforts, we get savaged by dissatisfied and cynical feedback every time. The students crave tangible clinical actions – lumbar punctures, sutures, intubations – failing to understand that these heroic procedures are largely reactions; costly manifestations of our failure to prevent.

So, what hope do we have, as the discipline of public health, teaching an entire country, in record time, that which we fail consistently to teach a select group of brilliant, curious and altruistic young minds?

Every hope, as it turns out, because the past two months have given us something that no amount of PowerPoint slides, group work or simulated cases ever could:

Context. We have seen what the virus can do. And what we should do. And the deadly cost of delays.

“This virus is presenting us with an unprecedented threat. But it’s also an unprecedented opportunity to come together as one against a common enemy – an enemy against humanity.” — Tedros Adhanom Ghebreyesus, WHO director-general, 18 March 2020

We are indeed a world and a nation at war. And if we don’t respond accordingly we will suffer serious casualties.

Infrastructure, jobs, economic growth, food security, social cohesion and life itself: which of those weigh most heavily for you? Look around; for every 20 people you see, at least one will not survive if all of you become infected. The faster all of us become infected, the more of us will die, as we run out of hospital beds, ventilators and healthcare providers.

This is not speculation, not #FakeNews, it is an epidemiological fact. There will be many exceptions, yes, but exceptions go both ways and, in the final analysis, the numbers never lie.

What if we could reduce the suffering? What if we could act now, suffer discomfort now – a lot of it – but save others in doing so? Save those we loved, we knew, we worked with – all those who we would otherwise have lost, but can’t yet name?

As public health doctors, we can’t name them either. We work with numbers. It is impersonal and lacks the instant gratification of healthcare provided effectively, but it is also far more objective and impactful at scale. We don’t care who the one or five or even 10% are who will die. We see every person as a number – anonymous and distant, but, very importantly, also truly equal.

Our numbers tell us, without any doubt, that our healthcare system will start collapsing if we can’t flatten the curve of contagion dramatically. Numbers will become names, and overworked and sleep-deprived doctors will have to start deciding which names live and which do not.

Do not take comfort from the people you know, the wealth you have accumulated, the toilet paper you have hoarded.  In war, all bets are off. You are just another number.

Except, you are most certainly not just another number. You are a thinking, caring, resourceful human being with immeasurable potential and capacity to adapt and change. And we need the very best of you. Immediately. The best family member, the best neighbour, the best colleague, the best stranger. We will soon be strangers no more.

Do what the experts tell you. Do it as if your life depended on it, because it really does. We would rank advice as follows: the NICD (National Institute of Communicable Diseases), our government (regardless of who you voted for), your healthcare provider and your support structures — providing it does not contradict any of the above.

And, in everything you do, put (YO)U back into ubuntu. This will differ depending on your context, your resources and your creativity. We are all born from survivors of wars. Apartheid, civil and world wars. We have survival, resourcefulness and a fighting spirit hardwired into our genes. And above it all, a deep sense of caring for each other.

Our parents and grandparents took strangers in as persecuted minorities, refugees or freedom fighters. They did so at great personal cost and risk, even at the pain of death. 

We know that this murderous pandemic, like TB and HIV that preceded it, will prey heavily on the vulnerable and the disadvantaged. It feasts on our divisions and our fears and it truly doesn’t give a crap about how much toilet paper you have.

The outbreak is shifting gears quickly from stage 1 (imported cases only) to stages 2 and 3 (local and community transmission), racing from wealthy travellers, flush with resources, to those who labour under persisting inequalities, breathing fresh death into modern colonialism.

Informal settlements will be the proverbial front line and the more people stay there, without the resources to self-isolate or even feed themselves, the more fiercely it will burn through our healthcare reserves, until all our safety nets are turned to ashes.

The virus counts on staying hidden until it is too late. And it relies heavily on us not caring enough.

Ill-gotten privilege has torn this country apart and voluntary redistribution can unite it again at its time of greatest need. This is not about race, class or politics, but survival. And justice; defined by how each of us uses the specific resources at our disposal to help as many of our fellow citizens as possible.

Sharing may sound like a radical idea, especially from a capitalist perspective in a time of peace, but it is the only way to survive in a time of war. Any feelings of paralysis, impotence or insignificance you may be experiencing are all artificial – as an outward-looking society, we are powerful beyond measure.

We call on all South Africans to join us as we pledge: “Put the (yo)u back into ubuntu”. This means we pledge to open our homes to employees who live in more crowded and dangerous environments as we all stop moving around. This means we will share travel resources (who needs two cars during quarantine?), shopping duties (especially for those at highest risk), food and, yes, even toilet paper.

We pledge to think of creative ways to support healthcare services, feeding schemes, unemployment funds and alternative accommodation and care options, including supervision for children of people providing essential services. And we pledge to show our neighbourly love by insisting on safe hands, faces, spaces and distances. Always.

Ubuntu is oft quoted and oft misunderstood, but it truly holds the answers:

I am because we all are.

I am cared for, because we are all cared for.

I am safe, because we are all safe.

Together we can beat this virus. Together this nation can do anything. DM

Authors: Drs Arne von Delft, Atiya Mosam, Shrikant Peters and Thato Mosidi — on behalf of Public Health Action Team (Phact)

Phact is a group of public health medicine doctors who have mobilised for the sake of social solidarity and health equity.