This week, South Africa would have seen the end of its initial three-week nationwide lockdown, which was implemented by government as a result of the COVID-19 global pandemic. However, two weeks have been added to the initial three weeks as concerns continue to grow about the spread of the virus across South African communities.
The past 21 days have been strenuous, both mentally and physically, for many South Africans, the majority of whom have done their best to adhere to the strict conditions of the lockdown. Already in the early days of the lockdown, most companies were expressing loss of revenue that would impact on their ability to pay salaries going forward, despite temporary relief measures in place for businesses. No doubt that this, along with challenges related to limited liberties, are weighing heavily on the mental health of individuals who don’t know what possible outcome awaits them, should the restrictions be lifted at the end of April.
According to the United Nation (UN)’s brief on 27 March 2020, medical experts have warned that it is just a matter of time before the African continent sees a massive increase in cases. The UN cautioned that the continent needed protection from the spread of COVID-19, which would bear disastrous consequences to human life “and unprecedented social and economic damage”. The UN’s Secretary-General, António Guterres, told member countries that developing countries faced the greatest long-term risk and urged the organisation to “play a key role in coordinating multilateral efforts not only to fight the outbreak but also to mitigate the subsequent economic blow”. Local authorities have also warned that growth in the number of cases in South Africa is inevitable, with an expectation that this will peak when current lockdown measures are eventually lifted. On 13 April 2020, the National Department of Health (NDOH) made it clear that while the government’s interventions and the lockdown have slowed the spread of the virus and bought us time, “the country cannot escape the worst of this epidemic”. The forecasts into how the virus might spread and behave come with encouragement for individuals to adopt new habits for hygiene and when engaging with fellow human beings in the future. The next two weeks should serve as a reflection of what habits we need to adjust to and what habits to leave behind.
All this is happening during a time when individuals are isolating, experiencing strict movement restrictions and barely coping with physical distancing. Approximately three weeks ago, when the South African government announced the 21-day lockdown, people expressed feelings of uncertainty and mental anxiety. It is, therefore, not a surprise that the two-week extension announced by President Cyril Ramaphosa on the 8th of April 2020 - without any grace period - has been received with mixed feelings. The president’s announcement was followed by an elaborate outline of the progress the country has made since the initial lockdown that started on the 27th of March 2020 and of measures in place to help soften the harsh impact this extension will have on individuals and the economy.
According to an article published in the JAMA Internal Medicine on 10 April 2020, steps to mitigate the spread of the COVID-19 virus, such as restricting usual day-to-day behavioural patterns and functioning of the population, while necessary, will undoubtedly have consequences for mental health and well-being in both the short and long term. The authors of the article have added that such consequences should not be taken lightly and have advised that immediate efforts aimed at prevention and direct intervention are needed to address the impact on population-level mental health.
As we reflect on the current lockdown extension, we are reminded that mental health care users’ (MHCUs) vulnerability places them among those who are at a higher risk of contracting COVID-19. The South African Federation for Mental Health (SAFMH) would like to remind MHCUs to remember that mental healthcare remains an essential service during the lockdown. It is true that we all have a responsibility to adhere to the lockdown regulations to avoid contracting and spreading COVID-19, and staying at home aids precisely with this. However, the World Health Organisation’s (WHO) Director-General, Tedros Adhanom Ghebreyesus, on 13th April 2020 urged countries to “ensure that where stay-at-home measures are used, they must not be at the expense of human rights”.
Since the start of the lockdown, SAFMH has received messages of distress from MHCUs who have found themselves stranded in situations that are compromising their mental well-being, while others have been seeking mental healthcare services they can access. SAFMH cannot stress enough the importance of access to medication for MHCUs to avoid relapses and a deterioration in the mental health wellbeing during this time. The WHO (2020) confirmed that the pandemic’s impact on public health, as well as its socio-economic impacts, have “disproportionately affected the vulnerable” as many populations - especially in developing countries - were already experiencing a lack of access to essential health services prior to the pandemic.
According to the President of SAFMH, Doctor Lochandra Naidoo, “coping with panic and claustrophobia and poor tolerance is as much of a challenge as the lockdown extension itself. Peoples' safety, health and family are threatened. These fears spread as rapidly as the virus. We must avoid information overload, prepare for our fears without overestimation, seek support, keep active and eat healthy, while we help others.”
Dr Naidoo urged South Africans to stay safely at home and comply with all the COVID-19 and lockdown regulations. The heads of mental health organisations have also added that mental health resilience must be encouraged during this period, while also reminding citizens that there is life after COVID-19.
President Ramaphosa, in his national address, promised that government will observe the human rights of all people during this time. However, even when the lockdown is eventually lifted, there is no doubt that the virus that has already infected 1.7 million people across the world (according to WHO data) will forever change our daily habits and how we engage with people around us. As people across the globe prepare for life after the lockdown, WHO on the 14th April 2020 published its updated strategic advice for countries to take into consideration when lifting the restrictions. The advice covers individuals, communities, governments and companies’ approach in stopping the COVID-19:
Individuals - WHO advises people to make hand washing, social distancing, covering their mouths when sneezing or coughing, isolating themselves when sick, as some of the behaviours they should adopt to protect themselves and others.
Communities - Members of communities should be empowered to make sure service and aid responses are based on the feedback communities provide on their experiences and are based on local contexts. According to WHO (2020), critical measures to stop COVID-19 can only happen with the support of affected communities.
Governments - Must provide leadership, coordinate a multi-party response and ensure that the message of any response reaches individuals and communities “through communication, education, engagement, capacity building and support”. At the same time, governments should ensure it strengthens the capacity to scale up the public health system to “find and test, isolate, and care for confirmed cases, and identify, traces, quarantine and support contacts”. On top of providing support to the health system for better patient care for those infected with COVID-19, governments should also maintain other essential health and social services for all.
Private companies - On top of maintaining a stable food chain and other essential services, WHO says “private companies can provide expertise and innovation to scale and sustain the response, most notably through the production and equitable distribution of laboratory diagnostics, personal protective equipment, ventilators, medical oxygen and other essential medical equipment at fair prices, and the research and development”.
Fitch Ratings (2020). Fitch Downgrades South Africa to 'BB'; Outlook Negative. Accessed at https://www.fitchratings.com/research/islamic-finance/fitch-downgrades-south-africa-to-bb-outlook-negative-03-04-2020
Fin24 (2020).Coronavirus | SA business alliance expects 1 million job losses, economy to contract by 10%. Accessed at https://www.fin24.com/Economy/South-Africa/coronavirus-sa-business-alliance-expects-1-million-job-losses-economy-to-contract-by-10-20200414
Galea S, Merchant RM, Lurie N (2020). The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. doi:10.1001/jamainternmed.2020.1562
National Department of Health (2020). SA’s Covid-19 epidemic: Trends & Next steps. Accessed at https://storage.googleapis.com/stateless-bhekisisa-website/wordpress-uploads/2020/04/09870782-salim-abdool-karim-13-april-coronavirus-presentation.pdf
The Presidency (2020). Message by President Cyril Ramaphosa on COVID-19 pandemic. Accessed at http://www.thepresidency.gov.za/speeches/message-president-cyril-ramaphosa-covid-19-pandemic-0
United Nations (2020). Defending Africa from COVID-19; UN and Governments brace for virus spread. Accessed at https://www.un.org/en/un-coronavirus-communications-team/defending-africa-covid-19-un-and-governments-brace-virus-spread
United Nations (2020). Rapid Suppression of COVID-19 Transmission ‘Must Be Our Common Strategy’, Secretary-General Stresses in Virtual Briefing to Member States Accessed at https://www.un.org/press/en/2020/org1706.doc.htm
World Health Organisation (2020). COVID‑19 Strategy update 13 April 2020. Accessed at https://www.who.int/publications-detail/covid-19-strategy-update-13-april-2020
World Health Organisation (2020).WHO Director-General's opening remarks at the media briefing on COVID-19 - 13 April 2020. Accessed at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19--13-april-2020
(Project Leader – Info & Awareness, SAFMH)
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