On 20 April 2020, the KZN Premier Sihle Zikalala announced that self-isolation would no longer be permitted in the province. Instead, mandatory
isolation in state-designated isolation sites would be enforced.
While mandatory isolation is legal, this policy change marks a dangerous departure from the country’s current position on home-based self-isolation.
The South African Medical Association and the Democratic Nursing Organisation of South Africa, have slammed the Premier’s stance. Afriforum has threatened legal action against the KZN government if they go ahead with mandatory isolation in state-designated facilities.
The Premier has apparently retracted his threat of mandatory isolation in a correspondence sent to Afriforum’s lawyers. However, no public retraction has been issued by the KZN government, creating uncertainty on the issue.
The Premier thus needs to come clean publicly as a matter of urgency: where does the province really stand on self-isolation?
What the Premier said t o justify his stance on mandatory isolation in state-designated facilities.
He said: “There’s a leakage in the system in so far as self-isolation is concerned, in that those who are self-isolating, far from strict supervision, may interact with others and infect them”.
The KZN MEC for Health, Nomagugu Simelane-Zulu, echoed this sentiment, attributing the rise in cases to “those self-isolating, claiming to be self-isolating,
roaming around interacting with families”.
The KZN government has provided no evidence to prove that the spread of Covid-19 in the province is due to defaulting self-isolators. While this suspicion
may be valid in some instances, it is not necessarily true in all cases.
Emerging evidence indicates that people who are infected with Covid-19 may show no symptoms, but can be a significant source of infections to others. Such people could also be driving infections in KZN, not just defaulting self- isolators.
Transparency is a cornerstone of democracy and public health decision-making. To date, the Premier has provided no details about where people infected with Covid-19 will be isolated. Addington Hospital and Clairwood Hospital have been mooted as possible isolation sites in the Durban Metro area, with dedicated beds reserved for Covid-19 patients at both hospitals.
But with hundreds of infected people in KZN, and cases expected to rise when the lockdown ends, these hospitals will quickly reach their capacity if all infected people are isolated in state facilities. If people are going to be isolated in other facilities (for example, unused halls), the KZN government needs to provide urgent clarity on a range of issues.
For example, where are the designated isolation facilities located?
What is their current condition?
How will the security of isolation facilities be assured?
Will patients be separated by sex?
Will infected couples be separated?
Will infected children be separated from their parents?
I f so, where will they be isolated?
Will children be separated by sex and age groups?
Where will the elderly be isolated?
Will the special needs of the elderly be catered for?
Where will the mentally impaired be isolated?
Their removal from families is likely to cause them considerable stress. As such, will they have dedicated mental health specialists assigned to their care?
The same applies to the elderly with mental impairments such as dementia and Alzheimer’s disease. Will they have dedicated mental health specialists assigned to their care?
Will the special needs of the physically impaired be catered for? For example, will isolation facilities have appropriate bathroom and ablution facilities for such persons? If an infected person is the sole caregiver of others, who will ensure the welfare of their dependants when they are isolated away
Does the KZN government have adequate human resources for isolation (and quarantine) facilities?
Being infected with COVID-19 is not a crime. Isolation facilities should not be equated with prisons. Basic rations thus do not apply. As such, will isolation facilities cater for special dietary requirements of patients? For example, many patients will require vegetarian, vegan, Kosher, Halaal, lactose-free,
and gluten-free meals.
Does the KZN government have a budget for the procurement of such services at such short notice?
Have the service providers been vetted?
Will all Covid -19 patients be tested for other infectious diseases, such as TB, to ensure there is no cross-infection at isolation
These and related issues require urgent clarification.
Where mandatory institutional isolation may be justified
It may certainly be necessary and in the interests of public health to remove an infected individual from their dwelling to safeguard the health of others residing there – say, for example, where all members of the household live in a single room informal dwelling.
However, where an individual is able to self-isolate and does so responsibly, they pose little or no infection risk to others. In such instances, mandatory institutional isolation would be unreasonable and ineffective in containing the spread of Covid-19.
Mandatory isolation risks stigmatizing those infected with Covid -19, and could drive the disease underground, especially if isolation facilities have poor conditions and inadequate security.
Mandatory hospital isolation should be decided on a case-by-case-basis, be evidence-based, and reserved for those with the highest probability of poor outcomes.
In a pandemic scenario, people with mild respiratory symptoms and who can responsibly self-isolate, can help reduce the burden on the health system. The use of state-designated isolation facilities for such patients is an inefficient and unsustainable use of scarce resources.
South Africa cannot afford to waste resources at this critical time. Neither can we afford uncertainty.
Therefore, in the interests of transparency, come clean a.s.a.p., Mr Premier.
It’s the responsible and accountable thing to do in these alarming times.
* Jerome Amir Singh is the Head of Ethics at the Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, and Adjunct Professor in the Dalla Lana School of Public Health, University of Toronto, Canada. He is the Director of the Ethical, Legal, Social Issues (ELSI) Advisory Services on
Global Health Research and Development, and serves as an advisor to, amongst others, WHO, UNICEF, UNAIDS, MSF (Doctors With Borders), the HIV Prevention Trial Network, and the Bill and Melinda Gates Foundation. He writes in his personal capacity.