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South Africa is proposing plans to manage diseases like Covid

Why they’re flawed.
Countries face the reality of co-existing with COVID-19. Image: Charday Penn /GettyImages

At the onset of the Covid-19 pandemic the South African government published “special regulations” to contain the spread of the disease. These actions were taken under special powers granted by the Disaster Management Act.

In April 2022, South Africa’s President Cyril Ramaphosa announced an end to the crisis management mode the country had been in for two years. Now processes are underway to embed some of the special regulations into the country’s general health regulations related to notifiable medical conditions.

Notifiable medical conditions are conditions, diseases or infections that pose an immediate and significant risk to public health. The diseases are categorised based on the severity of the threat they pose. Each disease is designated a reporting time and a set of conditions aimed at controlling its spread. Novel influenza viruses such as SARS-CoV-2, and diseases such as viral haemorrhagic fevers, including Ebola and malaria, are already on the list.

The Department of Health has published proposed regulations and invited public comment to incorporate the Covid special regulations into the general health regulations.

We have concerns about the proposed regulations. These concerns are based on our involvement in the health care sector and regulatory issues relating to South Africa’s management of the Covid-19 pandemic.

Our first concern is that several proposed amendments could limit constitutional rights. Second, special regulations for a specific disease can’t be applied generally to all notifiable diseases. Finally, the proposed regulations resemble a haphazard cutting and pasting of the emergency regulations. It’s as though the drafters didn’t first read what’s already in place.

Below we highlight some of our concerns; our analysis is not an exhaustive detailed critique of the entire proposed regulation package.

Problem areas

Regulation 15 deals with mandatory medical examination, prophylaxis, treatment, isolation and quarantine of confirmed cases, carriers and contacts. The eight sub regulations in the proposal are redundant for the most part. Current regulations already set out several conditions that must be fulfilled before someone can be compelled by court order to undergo examination, admission to a health establishment or mandatory prophylaxis, treatment, isolation or quarantine. In our view, nothing additional is needed.

Two of the proposed regulations could be valuable additions if phrased differently. These relate to the designation of quarantine facilities and the criteria for self-quarantine and self-isolation. Criteria for self-isolation or self-quarantine include access to the internet as well as a private physician to report symptoms daily. But conditions in South Africa make it impossible for millions of people to comply with this because they don’t have access to the internet or a private physician. Regulation 15G also requires self-isolation or self-quarantine facilities to provide primary healthcare services, emergency medical services, and forensic pathology services. These requirements do take into account the fact that these services aren’t available when a person self-isolates at home.

Proposed regulation 15H deals with contact tracing. This section was copied directly from the Covid-19 regulations. Personal data collection and contact tracing are not a trivial matter. They involve constitutional rights, privacy and bioethics concerns. Constitutional rights can only be limited under exceptional conditions. The proposed regulations cannot exist outside the requirements of the Protection of Personal Information (POPI) Act.

When personal data, including DNA samples, are collected during a pandemic and kept for future research and teaching, the owners of the biological material and data should be protected against victimisation and exploitation. Protection may include:

  • Anonymising the data so that it cannot be linked to a particular individual.
  • Restricting the collection and use of genetic data to cases where explicit informed consent has been given and the intended use is specified.
  • Data subjects should be able to verify the accuracy of their data on file or request the deletion of their data if they so wish.
  • Researchers should be prevented from monetising data without patient consent.

There are other examples where Covid regulations have been directly copied over into the proposed regulations. These relate to public places and attendance of funerals and gatherings and travel regulations. These will simply create confusion when applied to all notifiable diseases.

What’s missing

There are opportunities to improve the existing general regulations based on lessons learned during the pandemic. But legislators should carefully consider the healthcare, legal and ethical implications, and citizens’ constitutional rights. These are protected under Section 27 of the country’s Constitution (the Bill of Rights).

Great care should be taken to ensure that wording is not obscure or ambiguous. It should not be the duty of the courts to, post facto, interpret acts and regulations. Overall, no regulation limiting any fundamental human right should be activated unless supported by clear evidence. This should be accompanied by a transparent risk and benefit analysis that shows such measures are necessary.

Rather than merely copying the Covid-19 regulations, the Department of Health should apply the lessons learned during the past two years to develop meaningful new ones. These should address the surveillance and control of notifiable medical conditions to prepare the country for future pandemics. In addition, the department should invest time to construct general regulations that allow broader interpretation.

A valuable contribution could be to clearly define how outbreaks, epidemics and pandemics would be dealt with on a town, city, district, provincial and national level. Transparent criteria should be defined for various levels of control. The criteria should be based on reasonable measures such as the number and severity of cases, hospitalisations and deaths per million population and the treatment capacity in that specific geographic area.The Conversation

Ignatius Michael Viljoen, PhD Candidate Cell and Gene Therapy Regulation. Institute for Cellular and Molecular Medicine,, University of Pretoria; Marietjie Botes, Post Doctoral Fellow, University of KwaZulu-Natal, and Michael Sean Pepper, Director, Institute for Cellular and Molecular Medicine & SAMRC Extramural Unit for Stem Cell Research & Therapy, University of Pretoria

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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For many decades now TB has been the leading cause of death in SA per annum and after decades there is still no plan to mange and control a CUREABLE infectious disease — What will change?????

TB kills about half a million South Africans every year. It is for the most part treatable and curable. I had TB last year and can confirm the treatment is not fun. I had nine months of taking a handful of pills each day and the pills probably make you feel worse than the TB. Mine was bit weird, as I went to hospital for something else and XRay showed I had 4 liters of liquid in my chest (next to not in my lungs). Imagine two 2liter Coke bottels in your chest! My oxygen saturation was very good at 97%, all in all weird that I had no TB symptoms – probably down to luck of my other lung being strong and not being overweight or diabetic. There are probably many people like me. We all have sleeping TB in our systems – a bad knock to your system wakes it up without any contact with an infected person.

My team consisted mainly of a state clinic as public health has more skill and experience. In fact my team was mainly one sister at the clinic as the TB doctors were overwhelmed caring for covid patients. She says the main problem is people do not stick to that harsh pill regime and drug resistant TB increases every year.

A solution would be a slow release weekly injection but this does not exist yet.

I would be very happy to see South Africa enter a prolonged period, where we actually recognize the fact that there are other serious diseases other than C–19. Where for the last 2 years that is literally all that has existed and everything else was put on the back burner, globally.

TB/ Diabetes/ Heart disease/ Cancer diagnosis and early treatments etc etc.

However, if you want people to participate constructively in this proposed new process, stop treating them like children. The government needs to address the severe and growing distrust in government. I think it is safe to say that over 2 decades we have been promised the earth and in many cases just been blatantly lied to. From SAA/ ESKOM/ DENEL/ TRANSNET/ Zondo and the latest being the mind boggling PPE tenders.

Be open with the public, shares the details and provide context for the details supplied and that these are the reasons you are instituting the following drastic measures. Without consultation there can be no trust and no hope of widespread acceptance, compliance.

The current attitude with the big 6 in the CCC – is do this because we say so, if you don`t we will arrest you. Naturally even the most trusting of individuals is going to find some absurd and nonsensical rules that cannot in any universe be explained.

Summary of the Oscar winners – muzzling from the entrance of an establishment to walk 20 meters to your table/ banning arbitrary clothing items/ banning cigarettes/ muzzling on a 1hr flight but once seated you can remove for literally 50 mins eating and drinking, whilst rubbing shoulders with 200 people at full capacity in an aluminium cylinder/ full capacity taxis literally throughout/ yet stand 2m apart in a bank with 5 other people/ obesity is an issue yet have no advisorys on poor eating habits and close gyms and beaches… the lists are endless.

It is these types of diktats and coercion that lets conspiracys breed like wildfire on the periphery. As an example the elderly and the immunocompromised, obese were disproportionately affected (but restrictions blanketed everyone including children who were barely affected). However, instead of giving us a breakdown of daily cases broken down for context. We are just given a number and told accept it we know better. This was not just in SA, elsewhere you had to really dig to find it. Informed consent does not just apply to medical procedure but also regulations you expect us to follow.

If you are going to take the same approach on including additional diseases to manage i would suggest you are going to have a very hard time. Having said that you need to open up your decision making process to the 2 years we have just had to endure. Rebuild trust first, importantly even admit mistakes this would be welcomed.

Our current environment is out of control with job losses, inflation and Eskom, not to mention crime. Future interventions, add more layers of bureaucracy and naturally more costs to the electorate who have no jobs or money to pay – restrictions makes job seeking harder.

Please be constructive and consult, or you will literally unravel the fabric of society that is barely being held together at the moment. Not even the elite benefit in such an environment.

These health regulations are pure lunacy. You would expect legislation like this in a totalitarian state like China.

South Africa tops the international list for the combination of the number of violent deaths per capita, road accidents per capita, diabetes per capita, TB cases per capita, AIDS per capita, and crimes against women and children.

These statistics are driven by issues that are preventable and controllable. They are lifestyle issues, except for a very small minority of TB and AIDS cases.

These statistics prove, that when it comes to the value of human life, South Africans couldn’t care less. A human life, even their own, means very little to them, compared to the international standard.

What are the odds for this incompetent and naive socialist ANC government to change that fact with legislation? The Zondo Commission has already proven that no law can force people to be accountable, responsible, and decent citizens if they are mindless hooligans.

End of comments.

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