By Mohamed Gibril Sesay and Patrick Hindolo H Walker
This is an argument for distancing the young from the elderly as a means of preventing high mortalities and morbidities from the COVID 19 disease caused by the new corona virus, or as it is officially known the SARS-CoV-2. It is also looks at assertions about blanket home or self quarantine, and total national lockdown and argues that these may work for the majority of Sierra Leoneans, who tend to be poor, have ‘hand to mot by day’ livelihoods and reside in crowded homes and communities.
A consensus is building all over the world: the CoVID 19, also called Corona here, is deadlier to two sets of people- the elderly (over 60 years) and those with underlying conditions or diseases like diabetes, heart problems, high blood pressure, and respiratory illnesses. We must let this inform decisions we take relating to how the disease is combatted in Sierra Leone- that is, should the disease come here.
Sierra Leone’s population is very young, with about 94% being below age 60, and little over 80% being below age 30. Persons above 60 years constitute a little above 5% of the population. Our age structure may spare us from the greater percentages of deaths caused by CoVID, than say Italy, where the high mortality rates are attributable to the fact that the country has the largest number of old people in Europe.
Another consensus is that the best way to combat the virus as at now is social distancing– people keeping away from each other to avoid the virus transmits itself through sneezing or coughing droplets from the sick to infect others. And social distancing has often been seen as best implemented through lock downs – closing schools, restaurants, and quarantining people at home. These actions are shutting down entire economies, with often dire economic repercussions. China’s economic growth in the first quarter of 2020 is projected to contract, the first time this has happened since the late 1970s; and there are fears that America may slide into recession and hundreds of jobs are being lost. The decision has been taken, huge economic loss is better than great loss of life. Only an imbecile would argue with that moral logic. The reasons for the closure of public spaces and work spaces is to make people stay at home, where because of the household patterns, family structures and living arrangements in those countries, homes have fewer people and interactions are limited. And as a result, social distancing is easily achieved in those countries during lockdowns. We are seeing these measures implemented in countries in the grip of the unfolding pandemic- America, Italy, France, Spain and others.
Presently, with the absence of a vaccine or cure, the virus’ reproduction rate, or the number of other persons an infected person could pass the disease to is 2.2. This is very exponential, if not brought below 1. Thus, the thinking is that, in the present absence of a cure for the disease, staying at home would help flatten the curve- not making large number of people sick at the same time, for should more people get sick at the same time, health systems may be overwhelmed. Therefore, if the rate of infection is more evenly spread over a longer period, hospitals could cope with the case load. The logic is, this virus, If you cannot beat it, slow it down. It is better for a thousand persons to get sick at different times and are treated than for a thousand persons to get sick in one day and burden health professionals with great moral questions relating to triage: making a decision to treat some people rather all those who are sick, like they say is traumatizing Italian doctors right now. Added to the social distancing measures implemented in China and western societies are admonitions for hyping up personal hygiene – wash your hands regularly, cough and sneeze into the elbow not palms. Great advise. Hygiene is good, be it in an epidemic or not.
But then let’s look at the social distancing recommendations. Let’s look at the how they say it should be done. Are those ways of achieving social distancing, as implemented in the West and China feasible in Sierra Leone? How do you enforce social distancing in a country with crowded households, large extended families, “hand-to-mouth” livelihood systems, hand go, hand kam haggling and marketing norms, communal toilets, and multi-generational homes? How? Lockdowns to ensure social distancing could work in countries without the sorts of household and community situations we have in Sierra Leone, but how feasible are they in Sierra Leone? The experts say that for lockdowns to be effective, the lockdown periods usually last for weeks. How could that be done here in a country where, with few exceptions, people don’t have the means to stock supply in homes to take them through such extended periods of not going out? A country with “hand-to-mouth” economies of subsistence occupations, where if you don’t go out in the morning you won’t have the means to eat at noon. How could you stock food for a week when you are not even sure of food for the evening? Homes in our countries, particularly so in urban centers, are not crowd-less spaces; and the science also tells us respiratory droplets containing the virus are majorly transmitted through intense social interactions, and sure — in crowded households of the types we have in our country, intense social contact or as we say, rub-skin is the norm.
Social distancing is surely a way to go to clamp down on the virus. But it seems as if types of total lockdowns and confinements to homes as means of achieving social distancing in the West may not work here for the overwhelming majority. True, the measures may work for the small number of households of the better off which have very few people. But the big risk is that since most decision makers and professionals at the national level belong to the category of the better off, they may tend to see that which works for them and their households as working for all. More so because, well, these sort of confinement to homes seems to be the emerging scientifically backed commonsensical thing to do in Western Societies and China, and we have a penchant for cognitively scripting these solutions hook, line and sinker, without nuancing them to suit our own situations.
However, the situation, given the differences in our household patterns and family structures, and caring norms may warrant an operationalization of social distancing in ways that work for us. The imperative then is what is it that can be done to achieve the sort of effective social distancing that protect people in Sierra Leone and similar societies from the virus and the disease it causes. Well, it should be more about separating the under 60s from the the over 60s; and those with underlying conditions from those without underlying conditions. Young people without underlying conditions may be hit by the virus, but they tend to recover at faster rates, and sometimes they are so asymptomatic that they don’t in fact know that they have the virus. And they may spread the virus to others unknowingly. It is the case then, that infectivity, or the transmission of the virus from host to host comes more from young people to others. Now, if they spread the virus to other young persons without underlying conditions, these other persons may get sick, but they also recover, in many cases even with minimal pharmacological and clinical interventions. However, where these young persons with the disease infect older persons, or younger persons with underlying conditions, these other persons get very sick, take very long time to recover, usually need more intensive and resource gobbling clinical care or die in far more overwhelming numbers. So the real trick then is to make sure that the young without underlying conditions do not infect the old and others with underlying condition. Social distancing then can be operationalized in ways that make the young live and work at a distance from the old and those with underlying conditions. And this may not mean locking all of them in their multigenerational and crowded households. For locking them up in multigenerational households and our oven unfenced and densely populated settlements still put at risk the elderly and those with underlying conditions that are at greater risks of the virus lethality. The aim, then, should be to prevent the young from freely mixing with the old; it is to separate the old from the young. How could this be done?
A number of ways. They include information about the risks posed by mixing of the elderly and the young; it includes preventing mixing of the the young and the old in places of worship and other public areas. But more importantly it includes creating “safe spaces” and zones for the old in various communities, settlements and and other places. These safe spaces could exist for a considerable time and services provided by agents of the state, communities and organizations who have been vetted as not having the virus. This protects the old, and allows for such activities of the very young as schooling to go on, and for workplaces to remain open, though with heightened awareness of steps to take to protect those places from the virus.
Sure, the possibilities of “safe spaces” for the elderly going awry exist- they could be badly run, it could lead to unbearable psychological and other hardships for the elderly, ( loneliness for instance) and may lead to stigmatization of the elderly- for safe spaces could also be interpreted by our slang loving people as cells or lock ups for the old. However, these could be ameliorated by proper management, toll free phone line communications among loved ones, controlled visits to safe spaces by loved ones while the quarantine lasts, and robust communications to ensure that positive information is ahead of what we may refer to as negative slang curve.
Social distancing should not mean locking down the whole population, the aim is to prevent the disease overwhelming society with sickness, deaths and livelihood meltdown. And separating the young without underlying conditions from the old and other young persons with underlying conditions may be the way to go should the virus hit our country. That may help us slow the spread of the virus to the most vulnerable, where its lethality is greatest. If you cannot beat it, slow it down; perchance, soonest, we pray, the thousands of scientist searching for a vaccine that prevents, or drugs that cure CoVID would have succeeded, and this global albalahu would pass over us.
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About the authors: Mohamed Gibril Sesay is a Senior Lecturer in the Sociology Department at Fourah Bay College, University of Sierra Leone, and Patrick Hindolo H Walker is Lecturer and Head of the Sociology Department at Fourah Bay College, University of Sierra Leone.