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Bans needed to cope with tsunami of Covid-19 patients

Long-term public health expert LESLIE LONDON replies to an open letter to the President (published in Notes from the House, April) challenging the ban on tobacco and alcohol sales. He says this step is very much needed to lessen the burden of staff, and patients, arriving in droves at the doors of hospitals full of Covid-19 patients.

Mary de Haas makes some valuable points in her open letter to the President (22 May 2020). However, on one part, she is wrong – the part concerning the health rationale for banning tobacco and alcohol sales.

For sure the government departments have been inefficient and perhaps corrupt. (Though corrupt behaviour by public officials under Covid-19 hasn’t been obvious to me – inept, yes; unfeeling, yes; and sometimes brutal, yes, but corrupt isn’t the adjective that springs to mind.) Let’s say they have been inefficient in how they have handled lockdown regulations. And there is little doubt that the regulations have exacerbated hunger and food insecurity because the regulations were not planned properly and were rushed.

... the ban coupled with lockdown did vapourise the waves of trauma patients arriving at hospitals.

But on the matter of the restrictions on alcohol and tobacco, Mary is off point. These restrictions are not about “unhealthy consumption” or Nkosasana’s obsession with tobacco – it’s about what will lessen the burden of patients arriving at the doors of a hospital full of Covid-19 patients. To be sure, controlling sugar is a good thing, but it’s not going to make health care under Covid-19 any more manageable because it will take years to reduce the burden of diabetes through sugar interventions – by which time the Covid-19 epidemic will have killed either a lesser or larger number of people who would otherwise not have died if our hospital were not overflowing.

So that’s why government didn’t touch sugar now. That’s why pollution is a problem that needs to be addressed, but why it wasn’t top priority right now.

Mary does acknowledge that the ban coupled with lockdown did vapourise the waves of trauma patients arriving at hospitals but says the solution to that is to allow the public to buy alcohol freely and simply police the delinquents better. Somehow, she has turned a public health problem into a matter of individual choice. For an anthropologist and bioethicist who has “spent the past 40 years researching, writing and teaching – including to medical students – about South Africa,” I would have hoped to see more insight into what health workers at the coalface and communities feel about the issue.

Here’s one comment in an email exchange around the issue I was sent recently: “I have just spoken to an emergency doctor and her anger and anguish about the unbanning of alcohol during the pandemic was palpable. Their (public) hospital is already full with patients who are positive with Covid.” Today I saw a discussion on email amongst public health colleagues struggling to get coherent sense out of how we respond to the explosive epidemic in the Western Cape where members are asking for the alcohol ban to be reinstated – in desperation.

And as for communities ‑ the same very poor communities where alcohol is a livelihood source for poor people ‑ there are many members of those communities who welcomed the limited peace achieved by the ban, who could look forward to a night’s sleep uninterrupted by noise and disturbance, who would not have to clean up detritus from the shebeen next door or put up with violence on their doorstep. An activist from Mitchell’s Plain tells us that her experience of the lifting of the alcohol ban is tortuous.

Like Mary de Haas, I, too, would like to enjoy a glass of wine with my meal. I feel somewhat put upon that I can’t have that glass of wine when I am not an abuser, drunkard, thug, lout or inflicter of violence on my family, and I would not take advantage of availability to help spread Covid-19. But if that’s the price to pay for keeping violence out of our Trauma Units at hospitals, I could live with that and I did live with it for the past two months.

It's rather churlish to feel aggrieved that “moderate drinkers in their own homes are being punished because of the failure of organs of state to police roads and taverns properly”. In fact, blaming the police for not policing taverns is the most surprising aspect of what is a middle-class diatribe. Big industry has created an incredibly effective distribution channel to thousands of unlicensed taverns that operate beyond the plausible reach of law enforcement because of poverty and livelihoods survival. It is true police must enforce the law but it’s a problem that enforcement can never solve.

Real controls happen when Big Alcohol is not given free reign to market their products freely, when they can no longer target youth with misleading information, and when they can no longer circumvent everything the World Health Organisation (WHO) recommends as best buys on alcohol. The fact that there is legislation that is blocked for seven years thanks to industry influence in government is what Mary should get exercised over.

Nobody is saying prohibition is a long-term solution for the problem caused by alcohol nor does the WHO recommend it. But, by Mary’s own admission, it was a solution to reducing alcohol-related carnage clogging up our hospitals. That is what is at stake here ‑ whether to allow alcohol-related trauma to compete for desperately needed resources in our hospitals facing a Covid-19 tsunami. It is a cheap and misinformed shot to claim that the tobacco and alcohol bans had no grounds – they do. But Mary’s narrative fuels the misconceptions that industry is actively fomenting on social media.

So, on the point of the alcohol and tobacco bans, Mary is very off point. I say that as a public health professional and activist and a former member of the National Medical and Dental Association (NAMDA,) an organisation that Mary extols as part of pioneering primary health care during the UDF period. What I learned then does not make me any less willing to speak truth to power now. But it does teach me that protecting the dignity and life of the majority of South Africans should not revolve around the desires of those who can afford the safe purchase of a bottle of wine to claim the freedom to do so above all else.

Leslie London is a Professor of Public Health at UCT. He writes in his personal capacity.

Last modified on Monday, 08 June 2020 21:18

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