Only behaviour change can help us now, say experts

Hundreds of Sassa beneficiaries queue for grants, not knowing how many may be passing Covid-19 onto one another. Despite the enormous challenges in South Africa, experts are pleading with the public to practise social distancing, wear masks and wash hands frequently.
Hundreds of Sassa beneficiaries queue for grants, not knowing how many may be passing Covid-19 onto one another. Despite the enormous challenges in South Africa, experts are pleading with the public to practise social distancing, wear masks and wash hands frequently.
Image: Sandile Ndlovu

Only our own behavioural changes can save us now.

This was the clear message from experts in various health-related disciplines on Thursday, as the latest infection figures showed that there were now 58,568 confirmed cases of Covid-19 in SA - up by 3,147 a day earlier.

Speaking at a webinar hosted by the Wits Journal of Clinical Medicine on Thursday, experts highlighted that no epidemiological model can tell us what’s going to happen next, there is no “wonder drug” or vaccine at this stage, and neither the country nor the continent is in a position to be complacent.

“Covid-19 is going to be with us for a very long time but we need to shift our minds away from virology and infectious disease to behavioural change,” said Mark Tomlinson, a professor of psychology at Stellenbosch University.

He said he has been advising the City of Cape Town and the Western Cape - the province that has seen 77% of Covid-19 fatalities - that “changing behaviour is not easy” but there are some fundamental principles behind it.

He said being “punitive” or “legislative” in the approach did not help because “as coercion and force go up” you get a “breach in trust” - and then you “lose the most valuable asset there is, and that’s cooperation”.

Lessons from the Ebola outbreaks have shown that the public like to be involved in decision-making, he added. If people are shut out of that, they don’t generally change their behaviour.

“Adherence will also improve if local leaders, faith leaders and civic society leaders” are involved in spreading messages for behaviour change, he added.

Furthermore, it was shown that in Singapore during the SARS crisis, the government was “both rational and transparent”. By being open about their own uncertainty of what would happen next, they were able to shift policy without a backlash from the public.

Tomlinson said while we have already witnessed “remarkable changes in behaviour in South Africa”, more will be needed going forward, relying on what he called “the professors of the street - people who know their community needs and how to get there”.

Nephrologist Dr Dwomoa Adu from the University of Ghana warned that Africa could not afford to be complacent about the pandemic, despite certain stats that appear favourable.

“It is true that so far in Africa, the case fatality rate has been 2.4%, whereas in Europe it has been 8% and in America 5%. But it may be that there are more asymptomatic cases in Africa, though we don’t know why,” he said.

It could also be because only 3% of our population is over age 65.

Adu said the “rate of increase” was initially slower in Africa but the curve is now the same as in Asia and South America. The latter has proven disastrous - in Brazil in particular, where over 40,000 deaths have been recorded.

The bottom line, he said, is that “this is a strange new virus that gives no room for complacency”.

According to Guy Richards, a professor in critical care at Wits University, many of the drugs that have been touted as the next possible “wonder drug” have so far fallen very short of that title.

While some had shown “some limited positivity”, there is still no treatment for Covid-19. And with a vaccine still many months away, it is only behaviour that can flatten the curve.


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