Balancing the health risks and benefits of lockdown measures

Piet Streicher PhD Engineering

South Africa is in a unique position where we must weigh up serious health risks exacerbated by lockdown measures with the protective factors of lockdown measures in terms of Covid-19. We cannot solely rely on WHO guidelines. The WHO guidelines for relaxing lockdown measures do not consider the negative consequences associated with them. Flattening the curve should not be a goal, but a strategy to balance risks. One strategy would be to flatten the curve sufficiently so that the healthcare system is able to cope. The curve should not be flattened any more than this level as it would then unnecessarily prolong the pandemic. A flatter curve implies having lockdown measures for a longer period which would exacerbate the health risks introducted by lockdown measures.

Figure 1: Flattening the curve also prolongs the pandemic. We are at an early stage of the pandemic.

The predicted deaths from Covid-19 need to be compared to other life-threatening factors. South Africa is likely to have approximately 11 000 deaths from Covid-19 from April to September 2020 (own analysis: According to figures from the UNAids website, South Africa lost 71 000 lives to HIV in 2018.

Dr Glenda Gray a member of the Ministerial Advisory Committee (MAC) and chairperson of the South African Medical Research Council (SAMRC) has questioned the lockdown strategy of the government based on risks around malnutrition and missed appointments by HIV patients. Gray told News24 in her personal capacity, “We are seeing children with malnutrition for the first time [at Chris Hani Baragwanath Academic Hospital]. We have not seen malnutrition for decades and so we are seeing it for the first time in the hospital.”

In an interview with News24 late on 16 May 2020, Health Minister Zweli Mkhize defended the government’s lockdown strategy and said no region or district in the country can claim to conform to the World Health Organisations’ six criteria to have restrictions lifted. He called the criticism by Dr Gray “unfair”.

The World Health Organization (WHO) has set out six criteria to help countries decide when to lift lockdowns. WHO said that countries should look at lifting the lockdowns when:

  • transmission is controlled
  • additional capacity in the health system is in place to trace, treat and isolate patients
  • outbreaks risks are minimized in special settings like nursing homes
  • preventive measures are in place like schools and work places
  • importation risks can be managed
  • communities are engaged to adjust to the new norm.

Dr Mkhize is correct in saying that not a single district in SA conforms to all six of these criteria. However, we can also state that not a single item on the WHO list considers the downsides of lockdown measures. If a country is overly strict in its lockdown measures the WHO criteria do not indicate this. For instance, the six WHO criteria do not consider a possibility wherein 10 000 people are in hospital with malnutrition and hundreds are dying from hunger.

Dr Mkhize is correct in stating that we cannot lift the lockdown measures abruptly and must do this in a phased approach. It is counterproductive to attack the government in a personal way when governments worldwide are doing the same. It is much more productive to understand the reasons for the decisions made and then to challenge the goals behind those reasons.

Dr Mkhize is not correct in silencing medical experts. Medical experts have a moral duty to inform the government and the public at large of the health risks related to the disease and the health risks introduced by the lockdown measures. Missed appointments by HIV patients and malnutrition admissions at hospitals as a result of lockdown measures are causes for concern.

It is critical that the government balances both the up and downsides of lockdown measures. These are difficult decisions to make. It is possible to make mistakes either way. It will help the government to clearly state all the downsides of lockdown measures to assure the general public that the government is indeed balancing all the relevant factors. This will go a long way in restoring trust with the general public.


Pegden, W. Chikina, M. 2020. A call to honesty in pandemic modelling.

In South Africa in 2018:

  • 71 000 people died from an AIDS-related illness.


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