If South Africa lifts its national alcohol ban, it could result in an additional 5 000 trauma admissions each week, warn experts in a new, unpublished study seen by Bhekisisa.
President Cyril Ramaphosa is expected to respond today to requests by Gauteng business owners to lift the country’s alcohol ban. But legal and public health experts warn lifting the moratorium on alcohol sales may come at a cost to South Africa’s coronavirus response.
The Gauteng Liquor Forum represents about 20 000 tavern and shebeen owners in the province. In an 11 April letter sent to Ramaphosa, the forum argues the alcohol ban not only falls outside the scope of the Disaster Management Act but has failed to meet its aims, namely stopping the spread of the new coronavirus. Plus, the body’s lawyers argue, the government did not hold public consultations on the moratorium. The group now says it will go to court to lift the ban if it must and instead resume the restricted trading hours in place before Ramaphosa instituted a national lockdown to curb new cases of the virus.
But legal and public health experts say that not only is the moratorium within the ambit of the Act, it may, in fact, already have freed up hospital beds and reduced the risk of people spreading the virus.
Safura Abdool Karim is a public health lawyer and a senior researcher at the University of the Witwatersrand’s Centre for Health Economics and Decision Science, called Priceless.
Under the Disaster Management Act, she says, government officials can skip the public consultation process required for most new legislation under South African law.
A national state of disaster, which can last three months, specifically allows for the government to suspend the sale, distribution and transport of alcohol in a disaster-stricken area. The government can also control traffic and communications, as well as take over buildings to help provide emergency accommodation.
But officials can only exercise these powers if their decisions yield benefits, such as providing relief or protection to the public or “dealing with the destructive effects of the disaster”.
The Gauteng Liquor Forum’s lawyers argue that statements made by senior Cabinet members suggest that the alcohol ban is being used to achieve ends unrelated to the fight against COVID-19, the disease caused by the new coronavirus. They do not, however, say what aims these might be.
Last week, Police Minister Bheki Cele said the liquor ban had contributed to a drop in crime rates during the lockdown. But the rationale behind the liquor ban isn’t to reduce crime — it’s to free up hospitals’ capacity to deal with coronavirus cases, Safura Abdool Karim explains.
As of Wednesday, South Africa had 2 506 confirmed cases of the new virus and 34 deaths.
Salim Abdool Karim is the chairperson of the ministerial advisory committee on COVID-19. In a presentation earlier this week, he said that although the lockdown had reduced new infections — South Africa was unlikely to avoid a boom in cases and deaths in the coming weeks.
Salim Abdool Karim is also the director of the Centre for the Aids Programme of Research in South Africa. He warned that an onslaught of new cases could overwhelm the country’s hospitals, and that tented field hospitals were being organised to ease the anticipated burden on facilities.
The country is currently ramping up its ability to cope with increased burials.
Legal expert Safura Abdool Karim says: “It really makes sense to try and [reduce] some of the burdens that alcohol consumption places on the healthcare system.”
The Gauteng Liquor Forum had not responded to requests for comment at the time of publication.
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Alcohol takes a huge toll on the country’s health system, says Charles Parry, who heads up the South African Medical Research Council’s (MRC) unit on alcohol, tobacco and other drugs.
In 2015, 62 300 deaths among South African adults were linked to alcohol use — most among lower-income groups, a study published in the journal BMC Medicine in 2018 found. That’s 171 people per day.
These deaths weren’t only the result of, for instance, drunk driving, but also included deaths attributable to diseases such as HIV, TB and heart disease for which drinking can be a risk factor.
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Although people from lower income groups were less likely to be drinkers, people in these income brackets carried a higher health burden due to alcohol, the study found. This phenomenon is seen internationally and is in part tied to inequality, explain researchers from the United Kingdom’s Institute for Alcohol Studies.
Parry cautions that because alcohol use can weaken the immune system, it may put heavy drinkers at a higher risk of contracting the new coronavirus and, if they do, developing serious COVID-19 symptoms.
Heavy drinkers, for instance, are more likely to develop tuberculosis and other respiratory diseases. When they do fall sick with these illnesses, people who drink may experience worse symptoms, warn researchers in a 2015 paper in the journal Alcohol Research: Current Reviews.
Although less than half of South Africans drink, up to one in two who do, do so heavily, shows the country’s most recent demographic and health survey and 2018 data from the World Health Organisation.
Parry says: “We are not a nation of moderate drinkers. Once we start, many drinkers don’t stop until they are intoxicated.”
South Africa’s alcohol ban drastically reduced trauma admissions at hospitals
In February, before the lockdown, South Africa saw about 35 000 weekly admissions to hospital trauma units around the country.
But since lockdown started, two-thirds of those admissions disappeared — including 9 000 of which would have been alcohol-related admissions, according to an unpublished modelling study. The research was prepared by Parry and his MRC colleague, Richard Matzopoulos, as well as University of Cape Town head of trauma services Andrew Nicol.
The mathematical model is based, in part, on data gathered from trauma units at Chris Hani Baragwanath Hospital in Johannesburg and Cape Town’s Groote Schuur Hospital. The model also assumes, for example, that restrictions on movement continue, leading to fewer cars and people on the road and that places such as bars and shebeens remain shut. It also factors in an increased risk of violence to women and children as alcohol bought in stores is consumed at home.
Should the alcohol ban be lifted, the study shows, hospitals will likely see some of those trauma cases return.
The researchers write: “We estimate that just under 5 000 alcohol-related admissions to trauma units will reappear in a given week if alcohol sales are permitted during lockdown.”
In other words, just over half of the 9 000 alcohol-related admissions that have disappeared since lockdown began on 26 March, will return, pushing up the number of admissions to hospital each week from between 12 000 and 13 000 to 17 000 and 18 000.
Today, the Gauteng Liquor Forum will be hoping to hear that Ramaphosa will allow taverns and shebeens to sell alcohol at their premises during restricted times.
It’s an attempt, forum lawyers say, to find “a proper balance between the interests of our clients and the need to prevent or alleviate the spread of the virus”.
This might be a stronger argument if the letter was coming from big liquor companies, says Priceless’ Safura Abdool Karim. In that case, she says, companies might argue the government should allow people to pick up a bottle of wine when they do their grocery shopping.
“Shebeens and taverns are places of socialisation,” she says. “People don’t just grab a drink and go home. They socialise with each other and may spend prolonged amounts of time with their judgement impaired.
“Allowing specifically shebeens and taverns to operate would severely undermine the lockdown.”
Joan van Dyk was a health journalist, senior health journalist and news editor at Bhekisisa between 2017 and 2023.
