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A new virus not previously been identified in humans arrived on the scene towards the end of last year – novel coronavirus (COVID-19) was detected in the Chinese city of Wuhan.

In the wake of this being revealed, the World Health Organization (WHO) swiftly declared a public international health emergency at the end of January this year, as infections spread rapidly.

Since then an increasing number of cases has been confirmed outside of China, including in South Africa, with the situation evolving – and deteriorating – rapidly.

The fact that rapid urbanisation and increasing international travel can cause epidemic outbreaks to be global phenomena rather than simply local occurrences, makes it imperative for all countries to take the necessary measures to counter the threat.

South Africans have been asked by the government not to panic as authorities are well prepared to fight against and contain the outbreak.

First line of defence against the COVID-19 pandemic is surveillance: monitoring human and animal populations to identify outbreaks and contain them quickly. Now that South Africa has around 709 confirmed cases of coronavirus infection (at the time of writing), we are at the crossroads: coronavirus has not yet reached (or at least we don’t know if it has reached) epidemic proportions in our country. Despite Government’s efforts to fight and contain the outbreak, significant gaps, challenges and an “unevenness” exist regarding pandemic preparedness. Progress towards preventing the spread of coronavirus has been “uneven”, and many parts of the country have been unable to meet basic requirements for compliance in a variety of spheres.

When epidemics or pandemics occur, they usually hit the poor first and the hardest. We have known this for a while with gaps being exposed in the areas of timely detection of disease, availability of basic medical care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including co-ordination and response mobilisation. In a country with high inequality like South Africa, these gaps are especially evident in resource-limited settings of townships and informal settlements, with the incumbent potential of very serious implications for what could happen in a coronavirus outbreak in congested areas.

With the above in mind, there is an opportunity to pre-empt the worst of the coronavirus impact through concerted action to reach those “furthest behind”. It is thus my belief that the coronavirus outbreak is also a Town Planning issue with planners able to influence the trajectory of this virus.

In the light of this variable, the current strategy South Africa is employing is not sufficient to contain the virus – the strategy indeed needs to be recalibrated and we must start moving beyond national strategies and prioritise interventions in outlying/rural areas. Many of these locations are remote, with health facilities and other services difficult to reach or even inaccessible for poor people. Urban informal settlements are hotspots for the spread of diseases, and so targeting these areas of extreme poverty through health interventions alongside the provision of proper water and sanitation services and other forms of sustainable developments would offer a longer-term solution to preventing the spread of the outbreaks and reducing or preventing deaths.

All of this points to a critical need to situate the response to the coronavirus in wider risk-informed development strategies, to ensure the inclusion of those ‘furthest behind’, who may otherwise face the worst effects of the pandemic in the months ahead.

Despite growing international and national attention, COVID-19 surveillance remains weakest in marginalised areas which are often short of water with poor sanitation infrastructure and health facilities. People living in such areas struggle to get clean drinking water and washing their hands regularly is a luxury they seldom enjoy.

Thus in poor and marginalised communities, outbreaks of the virus are likely to go undetected for a longer time and smoulder and spread. In such circumstances, we will all be doomed – coronavirus does not discriminate. 

Regardless of where a pandemic starts, once underway, the poor tend to bear the brunt because of weaker health systems and poor infrastructure in their areas with a limited capacity to handle surges in cases.

This is the situation South Africa faces with the coronavirus pandemic.

Among advice offered by authorities to help contain the scourge is for people to avoid public places such as markets or big public gatherings. However, the very nature of marginalised communities, such as informal settlements, involves overcrowding. Authorities thus need to give urgent attention to these areas which are ticking time bombs as the virus continues to spread its tentacles.

Efforts must thus urgently target poor and marginalised communities whose livelihoods are already precarious and where the potential for the virus to spread like wildfire is enormous. Without vigorous efforts to secure equitable access to basic health services for everyone, we could suffer the worst pandemic in the history of South Africa.

Dr Hangwelani Hope Magidimisha-Chipungu is the SARChI Chair for Inclusive Cities (NRF-SACN) and UKZN’s Academic leader for Planning and Housing.