How to do social distancing in a shack

The global COVID-19 pandemic has affected every aspect of our lives: our physical and mental well-being, freedoms, employment, education and career trajectories – unequally – and thus has also exacerbated the racial, gender and socio-economic inequalities prevalent in our country.

This special issue, ‘How to do social distancing in a shack’, on COVID-19 in a South African context, addresses some of these effects, from the unfeasibility of some communities to comply with the restrictions of early lockdown, to the ethics of mandatory vaccination and our economic recovery over the decades to come. Edited by Professors Jonathan Jansen and Shabir Madhi, this special issue aims to bring together the best thinking in the social sciences and biomedical sciences to work through the complex challenges posed by COVID-19.

Despite COVID-19’s worldwide effects, experiences of the pandemic have been varied and context-specific. Ellison and colleagues show that economic vulnerability and poor service delivery were more important determinants of compliance with COVID-19 restrictions for shack-dwellers than housing quality and Van Wyk and Reddy explain why social distancing in a shack was not possible, highlighting how local contextual factors (re)shape the form of policy responses as well as their associated consequences. They motivate for a ‘politics of informality’ which can better inform policy as it is situational, contingent, and informed by the daily realities of the people thereby affected. Even within communities, experiences differed. Theron and colleagues further explore what places young adult township dwellers at risk for not complying with social distancing.

The COVID-19 interventions further aggravated pre-existing and rising unemployment and poverty levels. By 2021, only 42% of the working-age population in South Africa was employed. Altman shows that, after a rapid and significant fall caused by the policies to manage COVID-19, employment might only recover to peak 2018 levels by 2024–2026.

The pandemic has amplified the divide between the career-life prospects of learners with sufficient access to educational resources and support and those without such access. Maree proposes that ‘hope-, purpose-, and action’-enhancing counselling for self and career counselling can bolster the sense of agency, empowerment, dignity, and self-worth of learners in underprivileged contexts, thereby promoting career adaptability and improving their present and future employability. Similarly, Walters and colleagues show how the pandemic has deepened the systemic and institutionalised inequalities that female academics experience.

Gender inequalities were also evident in the media representation of scientists during the COVID-19 pandemic. Joubert and colleagues show that male academics were disproportionately featured as expert voices in the South African mass media, as were those experts in the field of health and medicine.

Pre-existing inequities predispose vulnerable groups to poor disease outcomes and more limited access to health interventions. Jassat and colleagues compared demographic characteristics and trends in hospital admissions and the health care they received. Using multivariable analyses, they found that black African patients, coloured patients, and patients of Indian descent had increased risk of in-hospital COVID-19 mortality compared with white patients. Admission to a public hospital was also associated with increased risk of mortality compared with admission to a private hospital.

In addition to reported COVID-19 deaths, Bradshaw et al. show that there were three times the excess deaths from natural causes in South Africa during 2020 and 2021. Although the causes of these deaths remain unknown, the strong temporal correlation between excess deaths and reported COVID-19 deaths within each province indicates that the majority of excess deaths were probably associated with COVID-19. Making use of death data from the National Population Register made it possible to track in near-real time the number of excess deaths in South Africa.

Although the global response to COVID-19 has demonstrated that some progress has been made in ensuring timely access to new medical interventions in Africa, Rees and colleagues argue that much more needs to be done to strengthen the global systems that enable equitable access to health technologies during public health emergencies. To this end, dos Santos et al. debate whether intellectual property protection of medical products and devices required to prevent, treat and contain COVID-19 should be waived, as proposed by South Africa and India, under the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights.

Vaccines are central to an appropriate response to protect public health, health systems and the economy. Moodley explores vaccine mandates in South Africa – a country with a high prevalence of HIV, vulnerable unvaccinated adults and children, and a fragile public health system – from an ethical perspective.