Wrecking Ball: Why permanent technological unemployment, a predictable pandemic and other wicked problems will end

Wrecking Ball

Why Permanent Technological Unemployment,

a Predictable Pandemic and Other Wicked Problems

Will End South Africa’s Experiment in

Inclusive Democracy

Stu Woolman

NISC (Pty) Ltd: Makhanda, South Africa

First edition 2021

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DEDICATION

To my dear friend, George Abraham, for a decade of discussions about the pitched battle between the extractive, elitist political and economic institutions that dominate our lives and the rather riven and embattled democratic polities to which we both remain committed. With respect to the title of this work, as George would be quick to agree, it refers to far more than novel technological advances and their disruptive consequences. The title reflects a common pattern playing itself out across a host of domestic and global crises. About these commonalities, George has shared his granular understanding of the array of wicked problems surveyed in this book with generosity and without ego. I hope that this book does justice to his capacious imagination and his ability to impose some degree of explanatory order on an extremely chaotic world.

Because people who couldn’t imagine themselves capable of evil were at a major disadvantage in dealing with people who didn’t need to imagine, because they already were. … That evil wasn’t glamorous, but just the result of ordinary half-assed badness, high school badness, given enough room, however that might happen, to become its bigger self. Bigger, with more horrible results, but never more than the cumulative weight of ordinary human baseness. [In the end, there were] … no comets crashing, nothing you could really call a [full-scale] nuclear war. Just everything else, tangled in the changing climate: droughts, water shortages, crop failures, honeybees gone like they almost were now, collapse of other keystone species, every last alpha predator gone, antibiotics doing even less than they already did, diseases that were never quite the one big pandemic but big enough to be historic events in themselves. And all of it around people: how people were, how many of them there were, how they’d changed things just by being there.

William Gibson The Peripheral (2015)

Understanding is never ending and therefore cannot produce final results. It is the specifically human way of being alive; for every single person needs to be reconciled to a world into which he was born a stranger and in which, to the extent of his distinct uniqueness, he always remains a stranger. Understanding begins with birth and ends with death … Causality … is an altogether alien and falsifying category in the historical sciences. Not only does the actual meaning of every event always transcend any number of past ‘causes’ which we may assign to it, this past itself comes into being only with the event itself. Only when something irrevocable has happened can we even try to trace its history backward. The event illuminates its own past; it can never be deduced from it.

Hannah Arendt ‘Understanding and Politics’ Essays in Understanding (1954)

‘It ain’t over, til it’s over.’

Yogi Berra (1973)

‘But when it’s over, it’s over.’

Richard Adelstein (1985)

ACKNOWLEDGEMENTS

To the University of the Witwatersrand (Wits), and the Elizabeth Bradley Chair in Ethics, Governance and Sustainable Development, for affording me the time to poke around in areas of interest more closely aligned to the real world in real time, and Dean and Professor Wesahl Domingo of the Wits Law School for pushing me to finish and to share my work.

To Professor Firoz Cachalia, for his unstinting support, his comradeship, his unlimited intellectual curiosity, his willingness to talk for hours and hours until the last cappuccino and grappa are served so as to better my partial and inadequate understanding of South Africa and to temper my pessimism with hope; his modelling of personal, academic, moral and political integrity; and finally, his willingness to throw his weight as Director of the Mandela Institute behind me and this project.

To Professor Theunis Roux, who read two different versions of the manuscript, led a public panel discussion, provided copious notes and, after a final phone call, nudged me toward an institutional analysis of the suite of problems addressed in this work – a form of analysis that provides the book with greater explanatory power.

To Professor Penny Andrews for organising the first ‘book talk’ at New York Law School in November 2019 and thereby creating an incentive to finish a first draft.

To Wesleyan University and Professor Don Moon, for providing me with a room with a view as a visiting scholar, as well as the time to complete a large part of this work.

To Professor Richard Adelstein, of Wesleyan University, for whom I keep writing variations of the same book. He pushed me to think ‘big’, while also reminding me that ‘small is beautiful’. He – along with too many other Wesleyan professors who deserve mention – taught me to gaze beyond my own parochial horizons, and to treat all other sentient beings as possessed of intrinsic worth.

To Ruth Kruger, whose sustained and hard-nosed engagement with this book makes me appear far sharper than I truly am.

To Mike Schramm, my publisher, for believing that this book contains ideas worth sharing, allowing me to develop those ideas over time, and forcing me to get the book out there at the right time.

To Professor Jon Klaaren, for continuing to believe in my commitment to experimentalism, development theory and small wins – even if they may not generate the bigger wins that South Africa requires.

To Justine Neke, for cleaning up my act and making this particular performance so much better.

THE DEFINITION OF WICKED PROBLEMS, REPURPOSED

When I was just a boy, the mayor of the city of New York used to show up regularly at subway stops, and accost patrons in barber shops, to pose a simple question: ‘How’m I doin’?’ An avuncular manager of a sprawling diverse metropolis, Ed Koch engaged or schmoozed with his seven million fellow citizens to find out what they actually thought needed to be done. He didn’t pander. An optimistic, independent Democrat, elected to office in 1977, Koch stood up to landlords with respect to rent control. He fixed dilapidated bridges and streets. Affordable housing became a reality. Neighbourhoods began to bounce back. He stood up to unions where such fights were necessary to keep the city solvent. New York’s finances improved. However, despite his liberal reputation, his support for the death penalty generated a warranted wariness amongst some minority groups, while drawing more of the middle class into his sphere of influence. As a result, he won both the Democratic and Republican primaries in 1981 – a feat never before achieved by a mayoral candidate. Four years later, he captured 78% of the vote. That’s politics: in the most diverse city on the planet, he managed – for a decade – to overcome various problems of collective action. With widespread support, he steered a once bankrupt city back toward the production of public goods: improved infrastructure, better housing, proclamations that declared Gay Pride Week in 1983 and legislation that added sexual orientation to the city’s anti-discrimination law, and which ultimately extended employee benefits to the domestic partners of city employees.

But the crack vials in hallways, a tepid response to the nascent AIDS epidemic, and growing homelessness caused his popularity to wane. In 1990, Koch was replaced by New York’s first African-American mayor – David Dinkins – elected to address a host of other problems of collective action. While Koch succeeded, for a lengthy time, in bringing a city of seven million people with substantially disparate interests, needs, views and historical fortunes together to resolve challenging problems, ultimately his views and those of his constituency diverged. Redlining, poor public schooling, dilapidated, ill-conceived housing projects and other systemic forms of both public and private systemic discrimination against communities of colour, on the one hand, and the growing influence of the financial sector and other high-end service industries, the increased affluence of Manhattan inhabitants and the exorbitant costs of living that pushed many ‘city’ dwellers into outer boroughs, on the other, generated a host of problems for which the mayor was unsuited by disposition. Another mayor was given the mandate by the electorate to address such social problems. Most cities, states, provinces and nations face similar endogenous problems. Whether they address problems of collection action adequately depends largely upon the inclusivity of extant political and economic institutions and, as importantly, the entrenchment of the traditions and the practices upon which these political and economic institutions rest.

Wicked problems – what I have off-handedly called ‘problems of collective action on steroids’ – differ from run-of-the-mill problems of collective action (see Chapter II) in three fundamentally important respects.

First, many of the problems adumbrated below have the capacity to bring the world to a halt or to alter the human condition in such a destructive fashion that it no longer resembles civilisation as we currently understand it (however flawed it may be.) The following decalogue of plagues, which have proven impossible to resolve, could, on their own, or through interaction with one another that tends to accelerate each other, bring about a catastrophic end to this period of human existence:

•nuclear proliferation;

•climate change;

•natural resource scarcity;

•pandemics;

•the alteration of inclusive democratic institutions – in the minority of nations that count as full democracies or flawed democracies (70 of 200 states) – into extractive and elitist institutions;

•the manner in which artificial intelligence, automation and technological disruptions lead to:

–permanent technological unemployment,

–forms of social media that undermine our capacity to have meaningful engagement (about facts, and thus social issues) within, between and among nations,

–the demise of privacy (for which most individuals must be held accountable when they give it away for quick Facebook dopamine hits) and disturbing increases in the extent of public surveillance of individuals and communities by states that have adopted China’s near-perfect big brother technology,

–the use of technology to conduct cyberwarfare between nations or to undermine elections (that would otherwise be free and fair);

•the fragmentation of many a democratic nation state over the last 50 years so that it can no longer discharge:

–its ostensible purpose of providing basic public goods,

–its original purpose of mediating civil strife under the rule of law, its responsibility to contain non-state actors that undermine national sovereignty or distort their purpose (in what are relatively weak states),

–its responsibility to cabin the exercise of private power, especially by companies that possess so much pecuniary influence that they can operate outside ‘the lines’ of the various countries within which they operate;

•the fragmentation of multinational institutions designed to promote collaboration and diminish conflict;

•a reversal in prior declining levels of inequality and extreme poverty; and

•the cause-and-effect nature of many of the aforementioned problems on the deepening of autocratic rule in countries that have never known anything but autocracy and the rise of totalitarian rule in countries with traditions of democratic rule (or at least a brief taste of what democracy might mean).

Second, another decalogue distinguishes the nature of wicked problems from more run-of-the-mill problems of collective action. They are crises that may be impenetrable (so far as current scientific understanding goes) and insoluble (given the limited political, social and economic means at our disposal), and that possess many, though not necessarily all, of the following features:

•They lack a definitive formulation.

•No metric exists to identify the point at which a solution has been discovered.

•There may be better and worse outcomes as opposed to true or false results.

•An absence of adequate tests makes it difficult to vindicate a final optimal outcome.

•Some problems tend to require one-shot responses rather than allowing for trial and error.

•The complexity of a problem complicates our ability to assess whether all possible solutions have been identified.

•The specific nature of wicked problems often limits the usefulness of a solution to one wicked problem to another wicked problem.

•One wicked problem might actually be a function of another wicked problem; or worse still, wicked problems of different kinds might actually reinforce and accelerate one another.

•Significant discrepancies may obtain between explanations for and the extent of a wicked problem.

•Policymakers often have no margin for error given the gravity of the wicked problem as well as the possibility of severe unintended negative consequences that might flow from their proposed solutions.

Third, even if we had some partial solutions to the first decalogue of ‘horribles’, five more features characteristic of wicked problems make their resolution extremely difficult, if not fundamentally impossible. First and foremost, humanity lacks the centralised, global authorities needed to address these global problems (collectively). Those global institutions that do exist exercise virtually no binding authority or power. In other words, international authorities – such as the United Nations – remain incredibly weak and possess limited coercive power over 200 sovereign, nation-state members (their respective sub-publics, their unique constitutive associations) and their roughly eight billion individual citizens. Second, time is running out on solutions to such problems (e.g., nuclear proliferation and climate change now have us at 1 minute and 20 seconds on the Doomsday Clock created by the Bulletin of Atomic Scientists after World War II – the closest we’ve ever been to self-annihilation). Third, those charged with resolving wicked problems are often their primary cause. Fourth, human beings exhibit an irrational propensity for discounting existing dangers or imminent harms and thus push the requisite response into the future. Fifth, the persistence of wicked problems flow, in large part, not just from the absence of cooperation amongst nation-states, but from the nature of the roughly 200 nation-states on the planet. Of those 200 nations, only 20 or so can be deemed fully inclusive democracies. Another 50 have been described as flawed democracies. That head count leaves roughly 130 nations best characterised as authoritarian – and disinclined to follow modern conceptions of democracy and human rights. In addition, their extractive political and economic arrangements make them far less likely to cooperate with other nations – save on a transactional basis. They act generally in terms of their own cramped understanding of ‘national’ interest. In many such instances: ‘L’etat c’est moi.’ However, transactions between individual authoritarian states rarely provide the basis for addressing the existential threats identified above. Indeed, these states are, more likely than not, to exacerbate existing wicked problems and enter into conflicts with one another that accelerate these wicked problems. This propensity to undermine efforts to resolve wicked problems is largely a function of non-representative leadership that cares not a wit for matters that do not involve the consolidation of their grip on political power and the accumulation of wealth that follows from their hold on power.

Let’s return to New York for a moment, before we end this exercise and begin the book. If Ed Koch were to somehow pop out of a subway stop, and ask us – with respect to the various wicked problems identified above – How’m I doin’? – we’d likely look at him as if he were crazy. Though New York happens to a big, well-resourced city, ‘hizzoner’ hardly possesses the power to determine how we would address such wicked problems as nuclear proliferation, climate change and resource scarcity, global pandemics, novel technologies that disrupt employment, politics and privacy, or the fragmentation of nations states and multinational institutions. These exogenous problems certainly exacerbate the crises faced by New Yorkers (and cities around the rest of the world). However, they are not strictly endogenous emergencies that a mayor – pick your favourite city – enjoys the power to resolve. Of course, your favourite mayor might cooperate with other officials elsewhere. But that’s still a far cry away from securing the cooperation and the agreement on the way forward from the 200 nations and roughly eight billion other human inhabitants on the planet. At the moment, our answer to the mayor wouldn’t just be ‘not so good’. It would be ‘not even close’.

Prologue

Predicting SARS-CoV-2, Pandemic Mismanagement and How COVID-19 Has Accelerated Permanent Technological Unemployment

A. Schadenfreude, Virus X, COVID-19 and a Lack of Healthcare Capacity

Schadenfreude is not a good look for the beginning of a book.

Hannah Arendt and Dr Suess would surely agree. But you see …

I presented the penultimate draft of this work at New York Law School’s South Africa Reading Group on 22 November 2019.¹ My conclusion, at the end of that version, took the following threefold form. First, the wicked problem most likely to be keenly felt in the near term bore the moniker Virus X.² Both public health and/or pandemic experts³ as well as intelligence agencies⁴ had already reached a similar conclusion. Second, most countries were woefully underprepared for a new SARS/Coronavirus. Third, a worldwide pandemic might not only kill, directly, many millions of people, but it would likely kill or severely harm hundreds of millions of others through the acceleration of other wicked problems (e.g., a steep slide into extreme poverty, mass unemployment, and climate change.)⁵

Dr Wilmot James from Columbia University took issue with my three-fold contention. He stated that the experts – in medicine, epidemiology and state security – had set up systems designed (far more than adequately) to manage such a crisis. He alluded to the high score of the United States on the Global Health Security Index and a reasonable to middling score for South Africa. I insisted that these scores underestimated a range of other socio-political-economic pathologies as well as the manner in which ongoing human incursions into animal habitats were likely to make viral leaps a perpetual wicked problem.⁶ With respect to South Africa, these indices failed to take into account:

•weak, paralysed, hollowed out political structures that could not effectively steward the country;

•an economy in complete freefall that, as of November 2019, could not provide jobs for over 60% of youth;

•radical inequalities in wealth that leave the majority of the country living near the food poverty line, malnourished and extremely vulnerable to food insecurity and any downturn in the economy;

•radical inequalities in access to healthcare and the absence of adequate healthcare capacity should a pandemic surge;

•the devasting triple cocktail of:

–seasonal influenza (which afflicts 19% of South Africans annually, some 10.5 million people – along with a prior instance of SARS),⁷

–some 7.7 million South Africans living with HIV and AIDS (20.4% of the South African population aged 19–49),⁸ and

–approximately 500 000 active TB cases (80% of the overall population is TB positive and TB is the leading cause of death in South Africa);⁹

•a wholesale lack of competent nurses (and doctors) for frontline Intensive Care Units (ICUs) with only 3 000 beds in a country of 56 million;

•high levels of diabetes, hypertension, obesity and asthma;¹⁰

•a pulmonary pandemic caused by some of the most polluted air in the world (after China and India),¹¹ 100-fold changes in pollen (and fungus) that flows from significant climate change (greater humidity, rainfall and near-perpetual springlike conditions for foreign flora in near-constant bloom) and dust produced by greater desertification;¹² and

•no control of the active pharmaceutical ingredients (APIs)¹³ necessary to produce testing reagents (because China and India control the market and create supply chain bottlenecks).¹⁴

The authors of a recent pre-pandemic article on public health in South Africa – using Limpopo as a measuring stick – concluded that critical care and ICU facilities cannot meet the criteria for an acceptable level of treatment for all South Africans:

In sub-Saharan African (SSA) countries, the high level of critical illnesses is related to the increased burden of HIV and AIDS, malaria and trauma, and to manage these critically ill patients, resources are needed … In order to curb the demand and supply gap, changes concerning admission and referral practices and/or increased numbers of allocated ICU beds and skilled health care professionals are required. If the number of beds is not increased, not all deserving patients will be able to access ICU care. ICUs in tertiary and specialist hospitals are better equipped than those in the rural public hospitals … Intensive nursing is a speciality and requires further training in a high care setting and only a few registered professional nurses have been trained and some resign after training for greener pastures. The problem was also highlighted by the Minister of Health in Limpopo that as a rural province it is a struggle to attract specialists and senior doctors (Budget Speech 2017). According to the National Department of Health, there are currently over 44 000 funded posts in Limpopo. Of these only 35 450 are filled, leaving almost 10 000 vacant posts in the province. This translates into almost 25% of the workforce. A Human Sciences Research Council (HSRC) report showed the vacancy rate of doctors at 75% and nurses at 67% … Health facilities infrastructure in Limpopo is often aged and run down, dysfunctional or inappropriate to the needs of patients. Most … facilities are … in a dilapidated state. The ICU at the regional hospital has only four beds … [It] is not functional. The South African Medical Association … in the province raised concerns that the procurement of basic equipment (i.e. casualty ventilators, arterial blood gas machines, …) moves at a slow pace which leads to rising morbidity and mortality from preventable conditions in regional hospitals. In addition, regional hospitals continue to exist without functional high care units. Challenges of resources in the province place health professionals under stress.¹⁵

The extreme shortage of skilled medical practitioners – competent nurses and doctors – was ultimately acknowledged by the government when the pandemic hit its first official peak of 650 000 infections in August 2020.¹⁶ Indeed, the government admitted that the shortage of specialised pulmonary ICU nurses constituted ‘a crisis’.

B. The Palpable Lack of Capacity to Manage the COVID-19 Pandemic

A document produced by the Department of Health, the Department of Trade and Industry and the National Coronavirus Command Council (NCCC) – leaked in March 2020 prior to President Ramaphosa’s three-stage outline of relief efforts, stimulus packages and stay-in-place orders – reflects similarly serious concerns about South Africa’s capacity to manage public health concerns effectively for an indefinite period of time.

This ‘flattened curve’ slide – now ubiquitous in terms of international use – offers insight into how overloaded, broken and dysfunctional the current healthcare system looked to concerned scientists, doctors, epidemiologists and public healthcare officials in South Africa in April 2020 (prior to any efforts to stem transmission).

South Africa’s risk-adjusted strategy for economic activity: What we knew in March 2020

From the outset, it recognised that even with a flattened curve, the health system lacked the ability to handle a pandemic. It’s one thing to (try to) increase testing and send persons into the field to attempt to assess (as opposed to actually test) the spread and the severity of SAR-CoV-2 related illnesses.¹⁷ It’s quite another for the state to claim that it will ‘try’ to increase the capacity of a broken healthcare system, both public and private, incapable of serving all South Africans adequately – when it knew (as it ultimately conceded in August 2020) that it could not be done. Take the wholesale absence of adequately trained nurses required to treat moderate to severe cases of COVID-19:

Nurses make up the largest group of healthcare providers in South Africa. The performance of any healthcare system is directly dependent on the quality of care afforded by these healthcare professionals. Yet in 2015, a report by the University of Witwatersrand revealed that over 60% of nurses admitted reporting that they felt too tired to work while on duty. According to the study, this could be linked to the 70% of South African nurses who admitted to ‘moonlighting’ or working overtime due to a massive skills shortage in this under-resourced sector … in 2010, there were an estimated 81,925 public sector vacancies for all categories of nurses in the country¹⁸ … [O]ne of the more easily definable shortages, is the shortage of nurses specialised in intensive care nursing where it is expected that patients in ICU would be cared for on a one-on-one ratio by specialist nurses.¹⁹

It’s actually impossible to overstate the difference between specialist nursing care in a developing nation – specifically, South Africa – and that level of care that one might receive for COVID-19 treatment in an inclusive (if flawed) democracy. But let’s try. Dr Daniela Lamas, a critical care physician, at Brigham and Women’s Hospital in Boston, speaks to the palpable difference between the quality of the medical facilities and the expertly trained nurses with respect to positive outcomes at top-end, urban hospitals, and much smaller infirmaries in less densely populated areas:

While even the best possible treatment couldn’t save everyone, those who survived did so because of meticulous critical care, which requires a combination of resources and competency that is only available to a minority of hospitals in this country. And now, even as we race toward the hope of a magic bullet for this virus, we must openly acknowledge that disparity – and work to address it. We are all familiar with the images of Covid-19 patients lying on their chests, and we know that prone positioning saves lives. But the simple act of turning a critically ill patient is physically strenuous and, if done hastily, treacherous. Breathing tubes and intravenous lines can become dislodged. The head must be repositioned every two hours … At my hospital, during the height of the pandemic, we formed a dedicated ‘prone team’ of respiratory and physical therapists who were available 24 hours a day. This spared the bedside nurses and kept patients as safe as possible. Even so, breathing tubes became kinked, and on at least one occasion, we had to urgently replace a breathing tube – a risky procedure. This is why in some hospitals, prone positioning might not have been offered at all. Indeed, the JAMA study found rates of prone positioning to range from just under 5 percent at one hospital to nearly 80 percent at another. Patients would have suffered as a result … Anyone who has cared for a coronavirus patient knows how quickly they can crash. Thick mucus blocks airways and endotracheal tubes. Oxygen levels plummet. Heart rhythms go haywire. As a doctor, I’ll admit that we are rarely the first to intervene in these moments of crisis. Instead, we rely on nurses and respiratory therapists. More times than I would like to count, I have watched with gratitude as their interventions – suctioning, repositioning a breathing tube, increasing the dose of medications to raise blood pressure – avert certain disaster. It is humbling to realize that had our nurses been spread too thin, these relatively small events would have turned catastrophic.²⁰, ²¹

Such concerns appear to have driven initial responses to the pandemic in South Africa. The country watched healthcare systems in congested metropoles such as Milan and New York City reach the breaking point as infection rates rose exponentially and whole hospitals turned into COVID-19 ICUs. The government decided that the de-densification of several townships and informal settlements would mitigate the transmission of COVID-19.²² Forced removals – even with consultation – did not pan out as planned.²³ Dr Francois Venter, an internationally renowned virologist and a leading member of the nation’s (first) COVID-19 task force, implied that the removals constituted a bit of misdirection:

We have the capacity to do large testing, but we’ve been bedeviled by the fact that the actual testing materials, reagents, haven’t been coming … We’re not as wealthy. We don’t have as many ventilators, we don’t have as many doctors, our health system was in a precarious position before coronavirus … The country is terrified.²⁴

Outside of hospitals, private healthcare providers and pharmacies that serve well off communities, tests were simply unavailable in April 2020 and the backlog became immense.²⁵ (By the end of May 2020, the government admitted that the logjam had grown to almost 100 000 tests.²⁶) Given the paucity of testing reagents and laboratory capacity, the government relied primarily on the ‘theatrics’ of screening. However, this approach possesses significant limitations. Merely checking for symptoms associated with COVID-19 did not provide accurate tracking information. A large cohort of the population that has been exposed to or has contracted COVID-19 has been asymptomatic or had only mild responses. (Even moderate to severe cases elude superficial screening.) It’s pointless to use occasional swab tests to account for all persons who have been infected. Only adequate testing, along with adequate tracing, can provide a full picture of the total confirmed cases, past and present, in the country.²⁷ Pooling of tests – also unavailable here – could provide another window into active cases within a community.²⁸ The government’s Trumpian response as infections peaked in mid-August? Let’s eliminate testing!²⁹

Given that most members of the public remain startling and frighteningly unfamiliar with the available science, efforts to contain the spread of the SARS-CoV-2 virus were initially challenged by the circulation of various dubious theories as to why South Africa might avoid the high levels of outbreaks witnessed in many northern countries. Some academics suggested that given that the youthful median age of 19 of sub-Saharan African populations, and the far higher median age of countries that had experienced high outbreaks in infections and fatalities, South Africans would be less susceptible to COVID-19. This author pointed out to a prominent virologist on the NCCC that the median age of South Africans actually fell closer to the world mean and not the average age in the rest of sub-Saharan African.³⁰ (The truth about age and COVID would turn out to be more complex once the data from around the world was in, and epidemiologists could work around the obscurantist machinations of the government.) Other experts hoped that universal TB vaccines would provide some degree of immunity.³¹ Another popular hypothesis held that increased sunlight ostensibly dampens the transmission of virus.³² None of these initial conjectures proved to have any explanatory power. South Africa’s initial good fortune flowed primarily from limited international travel from China and Europe to densely populated cities. The exception through June 2020 was Cape Town and the wider Western Cape region – an extremely popular tourist destination. However, the density of Gauteng and KwaZulu-Natal, and the ease of transmission, meant that Gauteng and KwaZulu-Natal ultimately outpaced the Western Cape in June 2020 and filled to capacity the limited number of public and private ICU beds in the province by the second week of July 2020. Apparently without an explanation for diminishing infections in August 2020, pundits and even medical practitioners-cum-experts punted another theory without any evidence – that South Africans had developed an immunity from exposure to prior coronaviruses. The cause for the decrease was readily apparent to some scholars. Tests decreased by 33% in a single week in early August 2020, and then fell to negligible numbers by the end of August 2020. Yet the extremely high positive result rate remained at a staggering 24%,³³ and led CSIR researcher Ridhwaan Suliman to state that: ‘[W]e’re not out of the woods until we increase testing, significantly reduce the positivity rate and gain a more informed understanding of where the virus is spreading.’³⁴

C. The Declaration of a State of Disaster under the Disaster Management Act

Instead of coming to grips with the specific problems that made pandemic planning in an underdeveloped nation extraordinarily difficult, the President declared a national state of disaster (on 15 March 2020).³⁵ The government (concentrated in the hands of the NCCC) subsequently placed the entire country in a national lockdown for a three-week period from 26 March 2020, and then, in mid-April, extended the ‘hard’ lockdown until 1 May 2020.³⁶

D. The Hammer and the Dance – South African Style

South Africa’s initial commitment to manage the spread of the pandemic through a risk-adjusted lockdown strategy echoed Tomas Pueyo’s description of ‘The Hammer and the Dance’.³⁷ Pueyo calls the lockdown – extreme social distancing³⁸ and limited/essential economic activity – ‘the Hammer’. It’s a strong suppression strategy. ‘The Dance’ reflects the movement toward openness that follows decreases in new infections, hospitalisations and fatalities. After easing off a bit, and then opening up some of the restrictions on social and economic activity:

… [t]hen you see what that does to death rates. And once the death rates go up, you have to go back and leave the dance floor and go into lockdown again. And it repeats again and again. And it’s dance in, dance out, dance in, dance out. And, basically, that’s what the epidemiological models show we have to do.³⁹

This mixed model of public health concerns, married to a pragmatic but subtle psychological understanding of how individuals, communities and economies respond to lockdowns, became the model for a substantial number of nations that had the political will to take on the pandemic’s dual threats simultaneously. As the chart below demonstrates,⁴⁰ South Africa ‘formally’ committed itself to ‘the Hammer’ and ‘the Dance’ as its playbook for the pandemic. Only ‘formally’: not as a rule of law that constitutes a commitment by the governors to the governed that possesses real purchase. ‘Formally’, as in a tuxedo, elegant, rather good-looking, but an empty suit when placed back on the rack.

SOUTH AFRICA’S RISK-ADJUSTED STRATEGY FOR ECONOMIC ACTIVITY: AN ALERT SYSTEM WITH LEVELS OF RESTRICTION [MARCH 2020]

This strategy has not only been employed effectively by most low-income countries with weak healthcare systems – for example, Vietnam and Rwanda. This aggressive approach has also been successfully employed by high-income nations with strong healthcare and intelligence agencies – such as South Korea, New Zealand, Singapore and Taiwan. The ostensible ‘hope’ here was that the initial five-week lockdown would enable the country to test more broadly and identify hot-spots so that the country’s limited resources could be focused on the suppression of outbreaks and limiting transmission between highly infected and mildly infected parts of the country. As the chart below suggests, over the first month this effort appeared to be successful.

EPIDEMIOLOGY AND SURVEILLANCE IN SOUTH AFRICA

The government claimed that it was buying itself time to:

•purchase equipment required for a delayed wave;

•ramp up testing capacity so that infected individuals and communities could be identified and isolated;

•increase production of masks, personal protective equipment (PPE), ventilators, and any other critical devices to reduce the fatality rate;

•suppress some of the initial carnage created by simultaneously suppressing the beginning of the country’s abnormally high winter rates of influenza;

•attempt to stockpile pharmaceuticals necessary for treatment of other diseases and illness, especially HIV and TB; and

•train health workers for both fieldwork and serious infections that require admission to hospitals – and perhaps use the time for enhanced instruction for frontline healthcare workers who would ultimately face the difficulties associated with the treatment of COVID-19.

As we have already glimpsed, and shall see in full, the South African government accomplished none of these aims.

After five weeks, the government lifted ‘the Hammer’ slightly. People, communities and, most importantly, the economy were given a little space to dance. However, for ‘The Hammer and the Dance’ to be truly effective, this relationship requires sustained commitments to trial and error, reflexivity and feedback mechanisms.⁴¹ One must be prepared to reinstate lockdowns when transmission and hospitalisation rates rise. Several nations and states have done so after second and third waves or infection spikes. As we shall see, by August 2020 South Africa simply stopped testing and providing accurate information. It repeated its see no evil response through the end of December 2020.⁴²

A superficial read of the timeline from the 26 March 2020 declaration of a Level 5 State of Disaster to the 1 May 2020 announcement of a move down to Level 4 suggests that the South African government’s decision-making aligned with Pueyo’s model. According to extremely unreliable data,⁴³ the lockdown appeared to slow transmission and warrant an easing of restrictions in movement and on economic activity. The subsequent length of time then spent at Level 4 would ostensibly be determined by whether South Africa remained within the level’s express public health criteria. A palpable decrease in viral spread and an increase in the readiness of frontline health workers and hospitals to treat moderate to severe cases would warrant a move to Level 3, assuming that the results of testing, tracing and isolating outbreaks also justified such a movement. However, a sudden rise in the spread, a failure to increase preparedness and test results, or fieldwork that signified an enhanced threat might warrant a return to Level 5.

On 13 May 2020, without any meaningful explanation or the publication of supportive data, and with the SARS-CoV-2 virus spreading rapidly through the Western Cape, the President declared that most of the country would move to Level 3 at the end of May 2020. (He simultaneously stated that the relaxation of restrictions would be more slowly phased in where transmission of SARS-CoV-2 remained high: but that too did not happen.) Perhaps this move – made without the transparency the President promised during the speech itself – should have come as no surprise. As the NCCC’s name for the slides suggests – Risk-adjusted strategy for economic activity – each level clearly concerns itself with far more than merely saving lives. The name also reflects the creation of a novel political institution that would consolidate power amongst a tiny coterie of officials and leave 50% of South Africans unemployed and hungry.

Given the rather early pronouncements by public health officials that the country ought to move to Level 1 – because it was not following ‘The Hammer and The Dance’ playbook – it’s difficult to believe that all the President’s expert economists, virologists and epidemiologists had reached what they believed to be justifiable conclusions as to how much various important sectors of the economy would rebound under the global recession that had taken root. Is it possible that pragmatic public health approaches and pragmatic economic analytics just happened to dovetail at that particular moment? For example, what if the demand for platinum were only one-third to half of current capacity? Despite the importance of South Africa’s precious metals for numerous industries, commodities’ prices imploded as factories shuttered worldwide and demand (especially from China) fell off a cliff.⁴⁴ The full opening of the mining sector at Level 4 came with apparent caveats: social distance spacing should curtail what most mining operations could do. While open cast mines might be 100% operational, other mines may operate at 50% in theory – and 33% in practice – as a result of actual contraction in demand and a precipitous drop in price. Social distancing requirements would merely serve as a mask for the underlying economic drivers of mine activity. On the other hand, the 100% opening up of agriculture ostensibly flowed from South Africa’s precarious food supply chain. However, the global food supply chain did not break. Despite initial hiccups that led to a failure to move livestock or perishable foodstuffs to market due to the contamination of plants with SARS-CoV-2, no food shortage occurred.

Again: This narrative would make perfect sense had it not been followed by a call by some of the President’s most prominent economic and public health advisors (the architects of South Africa’s own ‘Hammer and Dance’) on 15 May 2020, to move the country to Level 2 (allowing all activity but international (leisure) travel to resume) and subsequently to Level 1 without any of the meaningful public health or economic goals for navigating COVID-19 having been met.⁴⁵ A number of explanations make sense of their surprise announcement. First, the President had referred to his reliance on unnamed international and domestic experts in his 13 May speech. This Trump-like Twitter of information caught his existing experts off-guard. Second, the information that the experts themselves possessed suggested that the South African government had failed to follow ‘the Hammer and the Dance’s’ indicia for staged reopening of social and economic activities. The President’s advisors publicly declared that:

(1) ‘South Africa is not achieving the testing or report levels to contain the spread through diagnosis and contact tracing. This [strategy] gets harder as infection rates rise. Without this [strategy], it is unlikely that the country will stay ahead of the epidemic.’ (2) ‘The 63% of HIV positive South Africans on antiretroviral drugs do not appear to be at increased risk.’ (3) ‘[S]ubstantial health costs … [had been created by the lockdown, including] … ‘the undermining … of immunizing children … and … the impaired provision of health services to those with comorbidities such as diabetes, tuberculosis … and hypertension.’ The rest of the collateral damage of COVID-19 – severe food shortages due to unemployment and a failure to timeously deliver the new and increased grants – had also come to pass.⁴⁶

The serious questions regarding the ability of the healthcare community to respond to the pandemic – as well as other pre-existing responsibilities (HIV and TB, as well as to regular mammograms and tests for diabetes) – were raised by numerous experts beginning in May 2020. They repeatedly reiterated these warnings over the ensuing months. Their warnings were buttressed by distressing facts on the ground. Quite early on, a large number of private hospitals were closed due to COVID-19 outbreaks amongst healthcare professionals and a number of patients:

Netcare’s St. Augustine’s hospital has been closed since early April, with Netcare Kingsway doing the same in mid-April. Netcare Ceres was also closed for a week. Mediclinic Morningside in Johannesburg was closed for several weeks for new admissions. Life Healthcare has not indicated any closures related to Covid-19 cases. Some other private hospitals within the groups, such as Netcare Parklands, have closed emergency departments temporarily. Dr Anchen Laubscher, group medical director of Netcare, says they are keeping the National Institute for Communicable Diseases (NICD) and the Department of Health in the loop but cannot disclose the number of infected staff members. Mediclinic Chief Clinical Officer Dr Stefan Smuts says that ‘a small portion of staff members have tested positive for Covid-19’. According [to an article by Moneyweb], 11 patients, and 79 staff members, including healthcare workers, allied health professionals [9 doctors], and support staff, have tested positive at Mediclinic Morningside. The closures are primarily to allow for sanitation, testing and isolation of staff, and to get clearance from the Department of Labour to reopen. Smuts says: ‘This allows Mediclinic to conduct a detailed period of assessment and deep sanitation in accordance with the necessary protocols.’⁴⁷

Such serious flaws in South Africa’s second world level of private healthcare reinforced doubts about the ability of South Africa’s public hospitals to provide adequate care for seriously ill COVID-19 patients, even under flattened curve conditions. These inexcusable lapses in execution occurred while South Africa’s reported numbers of infected persons still remained extremely low.

An infectious disease specialist and a member of the Ministerial Advisory Committee on Health, Professor Shabir Madhi, argued that the lockdown had not been effective – good on paper; extremely poor in practice. In an interview with Mark Heywood, Madhi offered the following observations:⁴⁸

•‘Continuing the lockdown will not stop the wave of community transmissions from hitting South Africa’;

•‘Continuing [the lockdown] will prolong the … damage that it is causing’, because ‘[p]eople are battling to access basic medical tests for South Africa’s biggest killer, TB’ and ‘there’s been a 50% reduction in tests for TB, in addition to delayed results’;

•‘Hospitals are starting to see cases of malnutrition’;

•The state has failed to ‘test sufficiently; it has employed the wrong type of testing and the slow release of results had snatched away government’s chances to significantly slow community infections’;

•The government’s current response was ‘setting us up for greater mortality from non-COVID related illnesses’;

•While public health officials have followed a playbook adopted by other countries, the government has employed an ‘unsustainable test-and-trace strategy’ in which ‘test results take up to two weeks to be released’ – ‘the number of contacts that must be traced … creates impossible workloads for health workers’.

Dr Mahdi’s fears were confirmed on 29 May 2020. After a range of widely conflicting numbers on the backlog of testing was reported (from 30 000 to 80 000), Health Minister Zweli Mkhize issued a statement that read:

The acting director general was indeed correct when he stated that the backlog was around 80 000. This [statement] … confirm[s] that the exact figure of specimens that have not been processed is 96 480 as at 25 May 2020.⁴⁹

This candid admission was followed by yet another. The Health Department confirmed that the country had only 2 309 ICU beds. According to President Ramaphosa himself, that figure left the country perilously short of the 25 000 to 35 000 ICU beds that he had committed to creating in order to cope with the severe COVID-19 infections that were expected to peak between August and early September 2020.⁵⁰ Those epidemiological calculations matched those that experts had projected in March (prior to the lockdown). Recall that one of the primary purposes of the lockdown was to buy the government time to prepare itself for a large-scale outbreak. Not only did the government fail to test or trace in a manner that would give an accurate picture of the spread of the virus and active COVID-19 cases; it also failed to use the previous three months to prepare for the first peak of the first wave of infections. Shortly after these stunning admissions, the government announced that SARS-CoV-2 infections had reached 200 000. A month later, South Africa shattered the 500 000 mark. By mid-August, the country had recorded 650 000 ‘official’ infections: a number, given our limited testing, that would prove quite disingenuous. This woefully inadequate response suggests either that the public health concern dimensions of ‘The Hammer and The Dance’ were never compelling drivers of government policy or that the government had a callous disregard for human life. It’s hard to divine any concerted health initiatives that significantly stemmed transmission.⁵¹ By mid-August 2020, with more than 650 000 confirmed infections, the President proudly announced that the country could move to Level 2.

As of September 2020, South Africa had not – based upon publicly available evidence – come close to a demonstration either of readiness to deal with the pandemic or that the high viral spread had significantly diminished. Instead, as Statista demonstrated,⁵² when South Africa was compared to Chile and Peru – as each overtook South Africa in terms of official infections in August 2020 – the difference was a function of the fact that Chile and Peru continued to test at the same rate, whereas South Africa virtually suspended testing. Does a plausible explanation exist that makes sense of the government’s failure to follow ‘The Hammer and the Dance’ in a manner that doesn’t reflect a standard South African modus operandi of cooking the books?

The move to Level 4 recognised, expressly, the need to reopen the most important sectors of the economy – finance, mining, agriculture – both in terms of food security and forms of activity required to prevent the collapse of the economy.

SOUTH AFRICA’S RISK-ADJUSTED STRATEGY FOR ECONOMIC ACTIVITY: ALERT SYSTEM LEVEL 4 [MARCH 2020]

As I detail in Chapter IV, South Africa already had ongoing depression levels of unemployment (30% overall, 60% for youth) prior to the pandemic. Those socially unsustainable levels were exacerbated by a second technical recession in two years and a final downgrade (in early March 2020) by Moody’s to sub-investment status for South Africa’s sovereign financial instruments. The levels of risk-adjusted strategy for economic activity from Level 4 to Level 3 and thereon down, as well as a significant increase in social grants, reflected a genuine need to keep the majority of South Africans from starving and to keep what remained of the economy afloat.⁵³ The move to Level 2 – even with the world’s fifth highest numbers of infections at the time – revealed a brute reality of South African life. Too many citizens (50%) continue to live at or below the food poverty line. The choice between starvation and infection makes manifest the thorough-going failure of political and economic institutions run by a paralysed, still extractive, non-inclusive state. As one author noted in August 2020:

The extension of the corruption game, played by an ever-increasing cohort in both the public and private sectors, to the procurement of vital equipment to fight the Covid-19 pandemic, had one surprising consequence. It caused a reaction from the ruling party. But as is the standard South African move, a new body was proposed by way of an inter-ministerial committee and the possible establishment of Scorpions Version 2.0 … Why is it that, come a crisis, the default position is always to establish a new unit or summon a new group of experts to develop a policy document, no different from the last? The sensible approach is surely to capacitate the existing institutions with adequate resources, or, if management is the problem, place them under new and competent leadership? But that is simply not done by the ruling party, and the result is that at present there is hardly an institution of government that operates with a modicum of efficiency.⁵⁴

Thus, the Hobson’s choice between starvation and infection was entirely of the state’s own making. The persistent failure by this flawed democracy to create inclusive political and economic institutions plays a significant role in this work’s overall analysis – see Chapter II. However, it’s worth detailing here what went wrong when an extractive, elitist set of political and economic institutions had to confront a pandemic qua wicked problem.

The government has struggled, mightily, to expand social welfare grants beyond children and the elderly to the excluded middle that finds itself unemployed and in need of support.⁵⁵ The new disbursements would, if made permanent as part of a Basic Income Scheme (again, see Chapter V regarding this possibility), be an extremely desirable and necessary revision of the social contract. However, leaving disbursement to the Ministries responsible for grants courted disaster.⁵⁶ Whether the government could, through the South African Social Security Agency (SASSA), the Department of Social Development (DSD), the Unemployment Insurance Fund (UIF) and the Department of Basic Education (DBE), deliver both enhanced old grants and new grants did not look promising.⁵⁷

As of August 2020, history had repeated itself – no longer as farce, but now as tragedy.⁵⁸ SASSA and other government structures responsible for social welfare had been playing ‘three card monte’ with relief money targeted for those who live at or below the extreme poverty line of $1.90/day. (Not surprisingly, the government chose that disbursement by multiplying it by 30 – R600/month.) The DBE – responsible for critical food schemes in school – decided that feeding the most vulnerable children was no longer in its domain. The DBE or perhaps the NCCC decided – without any public discussion (transparency) – to charge the DSD with the responsibility for the feeding scheme. Meanwhile, no one in a position of authority could agree on who deserved new grants, or how they would be issued. Neither SASSA, the DBE, the DSD nor the UIF, with all the power, the capacity and the political competence that they wield, appeared to know how to deliver either the old grants or the new grants. Of the inoperable novel grant relief system, Jeremy Seekings wrote as follows:

Under the lockdown it has been difficult to get information on what the national government has been doing … The spokespeople for the national Department of Social Development and the South African Social Security Agency … appear to have been locked down even more than the rest of us. On 25 June, almost exactly three months into the lockdown, the DSD and SASSA reported to the Parliamentary Portfolio Committee on Social Development … Much less food has been distributed to poor people under the lockdown than in the preceding months, largely because of the absurd suspension of the national school feeding scheme by the Department of Basic Education … On the ground, there is chaos. The DBE says that it could not provide school meals over the past three months because lockdown regulations and legal restrictions prevented it. This raises the question: Why didn’t the government amend the regulations or amend the legal restrictions? Who is responsible? In its court papers, the DBE passes the buck for feeding schemes to the DSD. If schools were closed, the DSD became responsible. And, the DBE adds, the DSD had extra budget. The DSD is keeping quiet. In its presentation last week, it said nothing about its failure to feed children … The presentations … also covered the roll-out of the special Covid-19 Social Relief of Distress grant announced by President Ramaphosa in April. Back then the plan was to roll out grants to eight million people for six months, targeting people whose informal livelihoods had collapsed or who were already unemployed without access to any existing social grant or other income … The latest data (as of 22 June) show that SASSA received more than seven million non-duplicated and complete applications. Of these, a total of 3.2 million applications had been approved, meaning that they had been checked against other databases (social grants, UIF, NSFAS, PAYE) to ensure that applicants had no other easily demonstrable income. SASSA told the committee that close to two million applicants had been paid … Of the 3.3 million applications that had been declined, almost two-thirds (2.1 million) were because the applicant appeared on the Unemployment Insurance Fund (UIF) database … SASSA has said that as many as 85% of these 2.1 million applications may have been rejected wrongly. It says that it will sort this out. When? Four months into the lockdown? Five months? Six months? Who is responsible for this situation? SASSA, DSD or the UIF? No one wants to take responsibility. SASSA also shared … projected costings over six months. The budget for the special Covid-19 SRD grant was slashed to R3.5-billion over six months: … a fraction of the R17-billion budget apparently envisaged in the president’s announcement in April. The revised budget provided for a total of two million grant payments over May and June combined. By October, the number of anticipated grant payments would [be] 2.7 million … less than one third of the figure of eight million payments per month imagined back in April … The difference appears to be due to the poor rollout of the special Covid-19 grant.⁵⁹

Four dysfunctional organs of state incapable of coordinating an emergency response over almost six months placed millions of citizens in a perpetual state of food deprivation. A supine Parliament, an inert President and other organs of state must have been aware that:

From November 2019 to the end of March 2020, SASSA delivered zero food parcels in six provinces despite the fact that, according to the State of Food Security Report 2019, almost a third of South Africans experience severe food insecurity, which means the household has either run out of food or in some cases, has gone days without eating a single meal.⁶⁰

Not surprisingly, as of September 2020, SASSA requested that its responsibilities for the new grants be outsourced. Its team of 14 could not manage the influx of requests by email or phone.

Despite such rank incompetence, the COVID-19 Relief Grant has received significant attention and even praise from abroad. According to a November 2020 Brookings Institute Working Paper:

As of mid-October, 18.5 million COVID-19 grants were distributed to 6 million unique individuals since May, resulting from more than 9 million applications. Given the eligibility criteria for the COVID-19 grant and a few assumptions pertaining to takeup, we estimate that the grant has the potential to reach up to 10 million individuals. Together, with the existing Child Support Grant that already reaches 13 million children and 8 million caregivers along with other grants reaching about 5 million recipients, President Ramaphosa’s package has the potential to provide much-needed support to about 36 million people, or 61 percent of the South African population. The significant reach of the social assistance component – at just under two-thirds of the country’s population – is to be commended.⁶¹

That looks great. However, the Brookings Institute and closely connected authors at the University of Cape Town provide a more accurate picture when they employ the expanded definition of unemployment. When one’s calculations are informed by the expanded definition – those that want to work but are not actively searching for a job as they have lost hope; or want to work but there are no jobs in the area; or were unable to find work that required their skills – the actual success of the COVID-19 Relief Grant looks somewhat different. According to a UCT November 2020 Working Paper, if one uses the expanded definition of unemployment, then ‘only 0.33’ of the relief grants reached their intended beneficiaries.⁶² Although far from optimal, even this lower figure explains why, despite the rank incompetence of a panoply of government agencies, South Africa staved off mass hunger and malnutrition through the first year of the pandemic.⁶³ No mean feat. Whether the state can do so again in 2021, without house money, remains to be seen.

E. Imitation is Not a Sincere Form of Flattery – South Africa’s Liquidity Trap?

At the same time the government undertook this flawed effort at stemming the transmission of SARS-CoV-2, it devised a stimulus and relief package to the tune of R800 billion.⁶⁴ It did so by moving about various parts of its existing budget – slashing expenditure in a number of sectors, rather cagily engaging in the restructuring/closure of some state-owned enterprises (SOEs) and the flattening wages in the public sector – in order to:

•keep the finance and banking sector from collapsing and small to medium-sized businesses with an annual turnover of less than R300 000 from going under permanently; and

•increase existing grants and to create new grants designed to counter hunger and social unrest in the country’s most vulnerable communities.⁶⁵

After much hemming and hawing, the Minister of Finance Tito Mboweni finally indicated that South Africa would pursue loans from lenders of last resort to cover expected government shortfalls and stave off, at least temporarily, the collapse of the entire economy.⁶⁶, ⁶⁷

The ‘stimulus’ package mimicked those offered abroad. However, the government did not ask whether its hand-outs and loans would actually sustain businesses or create multiplier effects. In conditions of high anxiety and long-term uncertainty, people and firms will often sit on the disbursements or piles of