Debating Ideas is a new section that aims to reflect the values and editorial ethos of the African Arguments book series, publishing engaged, often radical, scholarship, original and activist writing from within the African continent and beyond. It will offer debates and engagements, contexts and controversies, and reviews and responses flowing from the African Arguments books.
In April 2020 Melinda Gates of the Bill & Melinda Gates Foundation said that she could not sleep at night because of the devastation she imagined the coronavirus might cause on the African continent, which lacked the capacity to protect itself from the deadly surge of the virus that was gripping the world. By the beginning of 2021, with a second wave infections in full swing in the global North and more than half a million deaths in America, the official death rate from Covid-19 in Africa was still modest by global standards, officially standing at just over 100,000. Estimates at the beginning of the pandemic had been that anywhere between 300,000 and 3 million would die in Africa.
This changed, however, when a new strain of the virus, known as the South African variant, grabbed international headlines at the end of 2020. The strain, which was said to come from the Eastern Cape province of the country, was believed to be more potent and, at least twice as infectious as the original virus. But, most worryingly, there was no guarantee that the approved vaccines in the global North would be able to neutralise the mutant strand from Africa. At the same time, other new variants were discovered in Britain, Brazil and elsewhere, but none seemed as dangerous as the South African one.
This discovery changed the discourse about the pandemic in Africa. Suddenly, the continent was no longer presented as an outlier, the place that the global pandemic had basically passed by, but rather as an incubator, capable of producing the most potent and infectious mutant in the world. This renewed global media attention on the continent, where the question of excess deaths and the failures of the data collection systems to generate accurate figures on the pandemic came into focus.
In this conversation, the Eastern Cape has been deemed “ground zero” for a highly infectious strain of the Covid-19 virus, which emerged towards the end of 2020 and became known as the “South African variant”. The region has borne the brunt of the pandemic’s lethal consequences, with the coronavirus claiming the lives of more than one in 300 people in the province, or 485 per 100,000 – a Covid-19 mortality rate that would be the world’s highest. Between May 2020 and February 2021, the region was the hardest hit province in the country with 11,000 official coronavirus deaths. However, over the same period, the figures of the South African Medical Research Council (SAMRC) show excess deaths in the region of over 31,000, as below.
In mid-February 2021, Adrian Gore, the CEO of medical aid provider Discovery Health in South Africa, claimed more than half the population might have already had the coronavirus in some form or another, rather than the 2% or 3% estimated by the government. Nationally, South Africa has had more than 138,000 excess deaths since the outbreak of the pandemic, while the official figure for Covid deaths is just under 46,200. This means that there are 91,500 death that are either undiagnosed or were caused indirectly by Covid 19. The results of a study published by the National Blood Service seem to confirm these higher figures. At the same time, projections from the Blood Service survey indicate that black people are five times more likely to be infected than white people, which is a reflection of class and race divisions in South African society; and that fully 63% of the Eastern Cape’s population has been infected. The article goes on to say that the province might be close to “herd immunity”.
So why were the infection rates so high in the Eastern Cape, and what is it about the region and its people that seems to make it particularly vulnerable to death from infection? Is this simply a bio-medical matter related to a potent new strand of the virus? Or is there something else about the sociology of the region and the way the pandemic has been managed there which helps explain the numbers?
A South African “hospital of horrors”
In her writing on health, Alice Street (2014) stated that the development reputation of countries and regions in the poorer parts of the world were often read off the wall of their hospitals. In rural Indonesia, where she did her fieldwork, Street said that local bureaucrats, international donors and investors often used the quality of equipment and bio-medical care at local hospitals as a primary indicator of development or modernity.
In the present global imagination of Covid-19, Livingston Hospital in the Eastern Cape became notorious in mid-2020 via the BBC and other international news agencies which described it as the “hospital of horrors”. A place where rats fed on piles of medical waste; mortuaries overflowed; and patients slept in overcrowded corridors. It is perhaps not surprising then that the global community quickly concluded in December 2020 that the Eastern Cape was the likely “ground zero” for a deadly new mutant, the South African variant.
It is not the first time that this impoverished South African province with a weak bio-medical health system has been scapegoated by elites and pathologized as a dangerous super-spreader of the virus. In fact, shortly after the announcement of new national Disaster Management regulations in March 2020, the South African Minister of Health, Dr Zweli Mkhize travelled to the Eastern Cape to reprimand the Provincial Minister of Health, Sindiswa Gomba, for failing to submit reliable data on testing and infection. The suggestion was that the incompetence of the provincial health department was threatening the health of the nation.
At around this time, the government also came to suggest that rural funerals and customary practices in the Eastern Cape, rather than urban congestion, township taverns and overcrowded taxis in the metros, posed a primary threat in driving up infection rates. There was virtual hysteria in the media about the need to shut down Transkei funerals and traditional ceremonies (while Christian church services were hardly mentioned). A harsh crackdown followed across the region, as the police swept through the countryside overturning beer drums, shutting down initiation schools and dispersing mourners at funerals.
The message seemed clear: the ignorant and essentially incompetent people of this largely rural province were threatening the progressive bio-medical approach adopted by the South African state and its leading medical advisors in response to Covid-19. The state discourse mirrored colonial-era arrogance under which rural people were presented not as citizens but as tradition-bound hordes or collectives which lacked modern rationality and individuality. Yet at no stage did the state question whether its Western, bio-medical, curative model based on hospital admissions and fancy tracking devices was appropriate or sensible in the Eastern Cape context.
At the same time, as the state busily copied best bio-medical practices from the global North (where infection rates were skyrocketing), it apparently failed to notice how well the preventative measures of many poorer nations were working. In addition, the state and its doctors did not stop to ask what rural people felt or thought about Covid-19, nor did they try to communicate with them in their local languages about the nature and impacts of the virus. It was simply assumed that, if South Africa were to keep up with the West, this rural province and its country folk would be an obstacle to progress, and needed to be hammered into shape by the police with the support of traditional leaders.
It is difficult to ascertain exactly why the ANC opted for such a Eurocentric approach and put so much faith in medical doctors and bio-medicine. One explanation, following Alice Street above, might be that South Africa was keen to show that it had the scientific expertise and capacity to keep pace with a modernist, “first-world-style” response to the pandemic; one which focused on using drugs, high-tech tracking and welfare packages.
The South African journalist and academic, Steven Friedman, wrote at the time that, in part, the government’s approach was as a result of a national ruling class in South Africa that had become besotted with everything Western, including suburban life and consumerism. Another view might be that in the wake of the ruling party’s denialist, home-grown response to the HIV and AIDS pandemic under former president Thabo Mbeki, which had undermined the country’s credibility on the international stage, the government was keen not to repeat the mistake and underestimate the power of Western bio-science.
So, instead of finding a set of engaged preventative strategies in parts of the country where the health system and infrastructure could not cope with the curative model, the state chose to shame and vilify the rural poor and mock them for their supposed incompetence. A startling example of the way the ANC modernists and medics turned on the majority was provided by their refusal to have anything to do with traditional healers, to whom the majority of the rural population turn for everyday preventative medicines and remedies.
Global and colonial prejudice
The apparent prejudice against the population of the rural Eastern Cape in government policy and the national discourse was compounded at the end of 2020 with the appearance globally of a so-called “South African variant” of Covid-19.
The emergence of this strain quickly saw the country being turned into a pariah state in the global community. In Britain, for example, where a local variant has been wreaking havoc, the media and political parties turned on the South Africa variant as a main danger, even though there were only a little over a hundred cases of the new strain in the country. Thinly veiled racism in the media pumped up the threat of the African strand, invoking an old colonial discourse of death and disease emanating from the “dark continent”. A similar discourse emerged in the global North around the “Brazil variant”, which is often discussed together with its South African twin.
French historian Florence Bernault (2020) writes that for Africa: “Covid-19 has brought out [the image of] an allegedly under-medicalised, pre-modern Africa”, which is seen as poverty-stricken, inherently under-developed and medically impotent in the face of disease. She, however, refutes this image, suggesting that preventative strategies across the continent have brought many epidemics under control, including that of the deadly Ebola virus in West Africa between 2010 and 2015. She notes that anthropological and social history research in Africa has shown that “dialogue and mutual consultation between communities, experts and researchers” can develop the trust needed to co-produce effective, lasting preventative strategies.
Bernault (2020) concludes by suggesting that “the arrogance of wealthy, formerly colonial nations is not only historically unacceptable, it is medically and politically counter-productive”. This analysis is key in trying to understand the high death rate in the Eastern Cape after a lockdown which was characterised by biomedical arrogance and state violence in March and April 2020.
It is not just that the discourse produced by the government in Pretoria sought to deflect blame and responsibility, and pathologise the weak, poor and the voiceless, but rather that the dominance of the bio-medical approach, which was deployed as the rationale for the state’s efforts, squeezed out other ways of knowing and understanding. Only knowledge that had been produced or verified in a laboratory seemed to matter. The views and logics proposed by scientists took precedence over the experiences of the people themselves, particularly of those living on the margins.
The sociology of “ground zero”
So, in the case of South Africa and the South African variant, it was asserted as part of the dominant view that because cases of the potent new mutant had been recorded in Port Elizabeth in December 2020, the Eastern Cape was necessarily “ground zero” for the new strain; although there is every possibility that the variant could have come into the region with migrants or co-existed across a number of regions.
In fact, the high and accelerating death rates in the province in December 2020 and January 2021 does not confirm that the new strain originated there, but merely that it seems to have spread across this region and killed more people here than anywhere else in the country. The question therefore becomes: Why did so many die in this region? Was it just because of the potency of some super-virus, the spread of which had been aided by an uneducated rural population? Or were there perhaps other important reasons?
For example, few analysts stopped to consider whether the high death rate in December and January might have had more to do with the culture of fear that had been created by official responses during the first wave, than any inherent additional power that may be ascribed to the mutant virus.
In this regard, a new policy report produced by the Human Sciences Research Council (HSRC) and Walter Sisulu University in South Africa shows how the vulnerability of rural poor in the former Transkei area of the Eastern Cape was exacerbated by the nature of the government lockdown measures which were imposed on them soon after the beginning of the outbreak.
The report, Closing the Gate: Death, Dignity and Distress in the Rural Eastern Cape, which was prepared for the Eastern Cape Socio Economic Consultative Council (ECSECC) and the Office of the Premier in the province, shows how the state victimised the rural poor and cultivated a culture of fear among them. This was achieved through the closure of hospitals and clinics and the mysterious disappearance of large swathes of the provincial bureaucracy from offices requiring “deep cleaning”. The sense of isolation was compounded when lockdown restrictions blocked the usual Easter flood of migrants back to the countryside, carrying information and gifts from the cities and providing an important source of labour at harvest time. Villagers reported that they had been abandoned to their fate and left trapped as the “gate [to the homestead] closed” (ukuvala isango) amid a rising infection rate.
The banning of customary practices and large family gatherings, which included funerals, exacerbated the sense of social isolation and exclusion in rural areas. Families turned inwards in the management of the pandemic, locked behind their own garden gates; often unable to access a local clinic or hospital; and without any medicine to help, except for the traditional herbs and remedies they collected themselves. Chiefs and headmen in these areas were conspicuous by their absence from community life during this first phase, at which time they generally supported the government’s hard-line and punitive approach.
In addition, popular dissatisfaction mounted as media reports revealed urban bureaucratic elites and tenderpreneurs in the region seem to have driven the institutional shut-downs and other safety measures for their own protection and profit, rather than in a genuine effort to save ordinary lives. The apparent moral bankruptcy of the civil service was revealed at the end of the first wave, when newspaper reports emerged of large-scale corruption associated with tenders for personal protective equipment (PPE). In this regard, the provincial Minister of Health, Sindiswa Gomba, was later sacked after pushing through a dodgy R10 million deal for medical scooters during lockdown and following accusations that she had helped siphon off millions of rand that had been raised for Nelson Mandela’s funeral in December 2013.
Against this background, the arrival of a second Covid-19 wave in November 2020 was accompanied by the retreat of the state from the management of rural life. Before new lockdown restrictions were imposed again in December, the President emphasised the need for communities and families to take responsibility for protecting themselves. The police were thus no longer closely monitoring funerals; raiding taverns; checking social distancing in shopping queues; or interfering with customary gatherings, which had reconvened. In this period, the Eastern Cape House of Traditional Leaders also backtracked on its support for hard-lockdown measures.
However, the easing of restrictions on rural social interactions was not accompanied by renewed faith in the government, or in an expansion of its capacity to assist and protect rural communities. It simply meant that fewer people felt the need to enact compliance in view of the new message from the government that rural folks should look after themselves. In fact, given the way they had been treated under the earlier lockdown, they were inclined to embrace an attitude of defiance, with many families now regrouping in the countryside.
But it was the arrival of hundreds of thousands of migrants from the cities, many in overcrowded taxis, as well as the hosting of numerous family reunions and social events in the rural areas that laid the foundation for the great increase in the numbers of cases in the province in December and January. Although reports indicate that many fewer people returned to their rural homes over the Christmas period than normally, the influx was sufficient to change the trajectory of infection.
Having adopted an attitude of defiance and resistance to government restrictions following their experiences of lockdown during the first wave of the virus, rural people were now able to avoid harsh state control and cultural indignity and were eager to strengthen kin relations and anchor their families in supportive social networks. This process of regrouping, in part caused by the way in which the first wave had been (mis)managed, combined with a deep fear of using provincial clinics and hospitals. The result was a wave of deaths that stunned the region.
The scarcity of oxygen tanks and potent drugs in rural areas, together with a deep fear of what happened in local clinics and hospitals, kept people at home. Indeed, hardly anyone went to hospital. So much so that, in December, doctors at a major state hospital in Bisho begged people to come in before it was too late.
Interviews from rural villages, as well as townships in the region, such as Mdantsane in Buffalo City, in December and January suggest that Covid-19, including the new strain, had spread rapidly. Now there was hardly a family in the region who had not lost close kin. Many said that the official death rates were a massive under-estimate of actual deaths. In January 2021, one 80-year-old man from Bizana said: “I have seen my fair share of death in my life due to poverty, apartheid and AIDS, but never anything like this this, where there are up to 10 to 12 funerals a week in villages, rather than two or three a month.”
In the rural areas, some families were burying multiple members in quick succession. In Engcobo, cases were reported of husbands and wives together with their sisters and brothers being buried days apart. In Bizana, two sisters, who were well-known traditional healers, were buried on 3 and 4 January, only to be followed three days later by a 26-year-old daughter on 7 January. One respondent said: “We will soon be talking of Covid orphans here in the way we once spoke of AIDS orphans.”
To understand, the lethal shock of the second wave in the rural Eastern Cape, which has subsequently fortunately retreated, it is important to place events there in the context of how the state managed the first wave, producing a climate of cultural repression, fear and isolation, as well as a fundamental distrust in the willingness or capacity of political elites to address people’s needs meaningfully or support local preventative efforts and strategies to combat the virus. The resulting post-lockdown sense of having been abandoned by the state and local leaders; a concomitant rejection of the government’s prescripts, including those on social distancing; and an urgent need to restore shattered kinship and social networks, fuelled the death rate in the second wave.
Alice Street, 2014, Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean hospital, Durham, NC: Duke University Press.