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06 July 2020

The Big Picture – why this PANDA got irritable

PANDA Scientific Board

Published on 29 July 2020

A quick Google search confirms, ​pandas​ don’t generally attack humans and certainly don’t try eating them, but they have been known to get irritable and, however cuddly they look, they’ve got some pretty sharp teeth and claws.

We realise that in recent weeks we have become the irritable and potentially dangerous version of the PANDA, and we’d like to give some background to how we arrived at this point. From late April we have been worried that the cost of lockdown, measured in terms of impact on human lives, would significantly outweigh any benefits.

Our initial report attempted to quantify the impacts of increased poverty on life years lost and the results concluded that the total loss of life years from lockdown would dwarf even the most optimistic assumption of lives saved due to lockdown. It was clear to us that lockdown, in the South African context, will result in a net negative outcome.

We were fortunate that many people paid attention to this message, and the narrative of “lives versus money” eventually moved into “lives versus lives”, or the slightly watered down version, “lives and livelihoods”.

Since our first paper, a plethora of new reports and articles have emerged from around the world to support our conclusion. The latest report from ​The Telegraph​ suggests that in the UK, lockdowns could result in an additional 200,000 lives lost and a recent piece suggests that in that country there could be 35,000 additional cancer deaths due to missed cancer screenings alone. These are worrying figures for a country like ours beset by diseases like TB and HIV. We had barely been keeping our collective head above water through treatment clinics, where attendance has plummeted during lockdown.

UNICEF ​reports​ that lockdown-induced hunger could dwarf COVID-19 deaths and a separate ​report​ concludes that HIV, TB and malaria deaths (the latter not applicable to SA) will also worsen as a result of the crowding-out effect of lockdowns. The numbers in South Africa are also indicating increased rates of hunger, the impact of which will be felt for many years to come.

South Africa is on the way to a sovereign debt crisis and all that entails. In our context, the economy was essentially too weak to weather a lockdown to start with.

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Yet despite this mounting evidence, we remain in lockdown.

In late March 2020, a key part of the rationale for lockdown relied on, in retrospect, the overblown models from the modellers (up to 351,000 dead from COVID-19 in South Africa). From the start, we highlighted concerns with those models, and how they failed to explain real-world observations from countries ahead of us on the curve, but that fell on deaf ears. We mentioned that COVID-19 deaths in South Africa would most likely land in the region of 10,000 to 20,000. All the current data confirm this estimate. Put in the context of over 200,000 deaths annually from communicable diseases in South Africa (including almost 30,000 of those deaths happening to those aged 5 and under), the reaction we took as a country to COVID-19 was wholly disproportionate. We suspect that public buy-in for a lockdown based on 10,000 to 20,000 deaths would have been very much less than it was for a lockdown based on 351,000 deaths.

The overblown model projections were all the “science” the government needed to implement, and sustain for over a hundred days, what is one of the world’s harshest lockdowns, as confirmed by both the Oxford stringency index and Google mobility data. Whatever the modellers may have intended, their models ​were​ in fact used to lock the country down. This puts the modellers at the fulcrum of the lockdown and its consequences.

Another consequence of the doomsday projections was that they resulted in genuine public panic. When everybody believes they might die, or their children may die, it is very difficult to help them to behave rationally for better overall outcomes.

The precautionary principle, being balanced and conservative, hasn’t been applied in this case. The unintended consequences of lockdown should have been factored into the debate. It shouldn’t have been up to a group of citizens like PANDA to point this out. In the context of the wide variance in risk to different age groups and the age profile of our country, it is especially important that our resources should be dedicated to helping high-risk individuals take the appropriate precautions. The strong should protect the weak.

In May we were invited to assist, in a limited capacity, in advising the Western Cape government. We quickly pointed out, with confidence, that the model projections of the hospital bed and ICU demand for the province were grossly overstated. However, this put the decision-makers in a very difficult position. While an official model exists that says otherwise, they simply cannot take the risk of trusting PANDA and being caught with their pants down.

Since March, we have tried in earnest to engage directly with the modellers themselves. Our efforts in this regard are a matter of public record. We were summoned to a symposium by Minister Mkhize where we made all of these points to government and each of the modelling institutions. We asked for their models to be disclosed to us and the public so that they could be externally reviewed. We eventually resorted to submitting Promotion of Access to Information Act or PAIA applications. The response to those applications was dragged out to the latest possible legal limit and we received nothing. There have been multiple attempts to silence PANDA through professional intimidation, as evidenced by an appeal from certain academics to a major news platform last week.

We take no pleasure in being proven right in retrospect while millions of our fellow South Africans go to bed hungry, and the futures of millions of children are put in jeopardy by the repeated closures of schools. Given that we are still in lockdown, our work is not done.

Fast forward to early July. It is clear now that the Western Cape has passed its peak, as we predicted. The exponential and continuous growth in cases and deaths (and breaking the hospitals) never materialised in the Western Cape. The virus followed a predictable pattern as it did elsewhere in the world.

Rather than using the Western Cape experience as an opportunity to revise projections, the modellers doubled down claiming that it wasn’t over in the Western Cape and predicting a set of outcomes for the Western Cape (a long and flat curve) that had not occurred anywhere else in the world. We admit that we cracked and made some of the modellers and academics the “face” of this tragedy. We did this because we perceive them as complicit, but perhaps unfairly reached the conclusion that this perversion of science was deliberate and malicious.

Our reaction was intense and came from a place of incredible frustration and exasperation. In the face of mounting real-world data, the modellers keep feeding the fear and feeding our government the science it needs to justify their reaction as rational and maintain the crippling lockdown.

We realise through our recent perceived tone that we have alienated some who support what we are trying to achieve. But we also want those who have the power to end this lockdown to acknowledge what the stakes are and how their work is influencing the suffering of millions.

We want to focus our attention on helping this country move in the right direction. We have likely eased lockdown too late now, but relaxing lockdown today is still better than doing it tomorrow. We want the modellers to be our allies, not our adversaries. We want them to stand up to the demand to justify the government’s policies to date. We are willing to accept their good faith if that will be reciprocated. We are here to help.

We will continue to call out what we see as bad science. And we will continue to ask the difficult questions. Please take it from where it comes: a group of passionate South Africans who realise the importance of making the right decisions, with poor decisions having the risk of costing us our country.