COVID-19 responses: infrastructure inequality and privileged capacity to transform everyday life in South Africa

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Abstract

Throughout the early months of 2020, COVID-19 rapidly changed how the world functioned, with the closure of borders, schools and workplaces, national lockdowns, and the rapid normalization of “self-isolation” and “social distancing”. However, while public health recommendations were broadly universal, human capacity to accordingly transform everyday life has differed significantly. We use the example of South Africa to highlight the privileged nature of the ability to transform one’s life in response to COVID-19, arguing that the virus both highlights and exacerbates existing inequalities in access to infrastructure. For those living in urban poverty in South Africa, where access to basic infrastructure is limited, and where overcrowding and high density are the norm, it is frequently impossible to transform daily life in the required ways. The failure of global public health recommendations to recognize these inequalities, and to adapt advice to national and local contexts, reveals significant limitations that extend beyond this specific global pandemic.

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Most cited references 13

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Fair Allocation of Scarce Medical Resources in the Time of Covid-19

Ezekiel J. Emanuel, Govind Persad, Ross Upshur … (2020)

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Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements

Jason Corburn, David Vlahov, Blessing Mberu … (2020)

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

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Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19)

Giuseppe Lippi, Brandon M. Henry, Chiara Bovo … (2020)

As coronavirus disease 2019 (COVID-19) pandemic continues, an increasing number of countries and territories are adopting restrictive measures based on physical (“social”) distancing, aimed at preventing human-to-human transmission and thereby limiting virus propagation. Nationwide lockdowns, encompassing mass quarantine under stay-at-home ordinances, have already been proven effective to contain the COVID-19 outbreak in some countries. Nevertheless, a prolonged homestay may also be associated with potential side effects, which may jeopardize people’s health and thus must be recognized and mitigated in a way without violating local ordinances. Some of the most important undesirable consequences of prolonged homestay such as physical inactivity, weight gain, behavioral addiction disorders, insufficient sunlight exposure and social isolation will be critically addressed in this article, which also aims to provide some tentative recommendations for the alleviation of side effects.