Getting the facts straight – The alcohol ban and COVID-19 beds

Organisation: Position: Deadline Date: Location:

It is difficult to accept government meddling in personal lifestyles, even when decisions are based on solid evidence, writes MedicalBrief. The outrage that followed the imposition of an second alcohol ban in South Africa is prompted by the spectre of mass job losses, economic damage – as well as by flawed evidence.

While many South Africans believed alternatives to an outright ban of liquor in April 2020 could have been found, it was largely accepted in the spirit of the national fight against COVID-19 – as a valid government attempt to prepare the health system for the coming coronavirus storm.

Not so with the second ban, as it quickly became clear that the government had listened to only parts of the SA Medical Research Council’s research into and recommendations regarding the impacts of alcohol-related trauma on hospitals.

A range of other experts have since challenged the ‘evidence’ supporting the alcohol ban. Here we collect together shortened versions of articles on the topic published by Business Day, News24 and BusinessTech.

 

Liquor ban – Government taking a sledgehammer to crack a nut

When President Cyril Ramaphosa announced on 12 July the government’s decision to yet again ban the “sale, dispensing and distribution of alcohol”, he cited the spike in COVID-19 infections and defended the decision by saying: “This is a fight to save every life, and we need to save every bed.”

It is widely assumed that alcohol-related injuries deprive COVID-19 sufferers of hospital beds, writes Michael Fridihon for Business Day.

However, when the Western Capeʼs infection rate was at its peak Keith Cloete, the provincial head of health, said ‘no’ when asked by Cape Talkʼs John Maytham whether the province had not been able to treat any COVID patient in a general or high-care ward because essential beds were being occupied by victims of alcohol-related trauma.

Statistics relating to the effect of alcohol-attributable trauma on the hospital system are remarkably broad, and frequently unsubstantiated, Fridihon writes. He cites Police Minister Bheki Cele’s statement in June 2020 that 600,000 people “die through alcohol” in SA every year.

Professor Charles Parry, the director of the alcohol, tobacco and other drug research unit of the SA Medical Research Council, concluded from a modelling study that “about 62,300 adults died from alcohol-attributable causes in SA in 2015”.

Flawed models

While Parry acknowledges that blood-alcohol content samples are not routinely taken from trauma patients, he says, with remarkable precision, that alcohol-related trauma cases take up 13.5 beds per day in public hospitals.

Modelling studies, such as the flawed Imperial College London projections relating to COVID-19 in the United Kingdom, are not the same thing as hard facts, Fridihon points out in Business Day.

Projecting 62,300 adult deaths attributable to alcohol annually is not the same thing as counting the dead, which Stats SA does in startling detail.

Total reported deaths in SA in 2016 came to 456,612, fewer than minister Celeʼs 600,000 alcohol-related deaths. Of these, non-natural deaths – which include trauma and road accidents, but also suffocation and suicide – totalled 51,242. Traffic deaths accounted for 6,435 and deaths from assault and violence 7,568. However, within the 51,242, there are roughly 17,000 classified as “accidental exposure to other and unspecified factors”, which might well include some assault and traffic deaths.

Parry estimates that at least 40% of trauma cases have an alcohol component. If we take his figure, use it for the known road and assault deaths, and apply it, generously, to the deaths due to “unspecified factors”, we have 40% of 31,000 deaths. This gives us 12,500 alcohol-related non-natural deaths per year.

In addition, there are 12,500 alcohol-induced cirrhosis deaths annually. Add this to the 12,500 from accidents, assaults and other non-natural causes, and the figure comes to about 25,000 alcohol-attributable deaths in SA per year, according to Fridihon in Business Day.

This is quite close to how the World Health Organisationʼs online database on alcohol, the Global Information System on Alcohol and Health, would calculate the number using its index of 6.4% of 456,612 total deaths — though this is also a model, not an actual count — with 29,223 deaths attributable to alcohol.

Alcohol and hospital beds

Is it possible to work these numbers back to hospital beds and occupation in high-care facilities? Asks Fridihon. A study published in 2014 in the SA Journal of Surgery titled “An Audit of Trauma-Related Mortality in a Provincial Capital”, drawing on the trauma cases in all of Pietermaritzburgʼs hospitals for 2010 and 2011, provides some illuminating conclusions. It reveals that 5% of the trauma cases required attention in ICU and 10% were fatal. It concluded that Pietermaritzburg had “a high rate of trauma-related mortality and an immature trauma system, resulting in a significant number of preventable deaths”.

Even if we apply these same elevated ratios to the trauma-related deaths detailed by Stats SA, the estimated 12,500 alcohol-attributable deaths would translate into 125,000 admissions per year to the 400 state hospitals. Thatʼs an average of 312 per hospital per year, or less than one a day. Assuming a five-day hospital stay, this comes to four beds per hospital.

 

Does the data support the alcohol ban? 

Evidence justified the South African government’s original decision to lift the ban on alcohol sales from 1 June 2020, writes international expert on alcohol policy Dr Marjana Martinic for News24. Data suggests that restricted mobility during the Level 5 lockdown led to fewer cases in hospitals, not only the alcohol ban. It is now important for the government to calmly assesses its options and heed evidence and advice from leading scientists.

Martinic writes in an opinion article published on 25 July that the rationale for the alcohol ban was a significant decline in trauma admissions during the initial lockdown, notably from road traffic crashes and interpersonal violence, both of which rose once the alcohol ban was lifted. Banning alcohol again would, the argument goes, dramatically reduce hospital admissions so that priority can be given to COVID patients.

It is hard to argue with providing relief to the healthcare system, and equally hard to argue with the need to address South Africa’s high rates of interpersonal violence and road traffic crashes, and its pattern of heavy drinking, particularly among younger males.

What is less clear-cut, argues Martinic in the News24 article, is whether a renewed ban on alcohol sales will open up needed hospital beds.

Restricted mobility 

Data points to a decrease of more than 50% in the overall hospital admission rate in recent months, coinciding with the severe lockdown measures imposed. Among these were a 40% decline in non-elective procedures and a 60% drop in surgical interventions.

These figures are very much in line with trends seen in other countries that did not prohibit the sale of alcohol.

Common sense would suggest that, where physical movement and congregating are limited, the likelihood of traffic crashes and violence drops. According to data collected from smartphones, the mobility of South Africans during the first lockdown (and alcohol ban) decreased by 80%. Put simply, restricted mobility means restricted opportunity for harm.

Data from the Medical Research Council does show that, following a drop at the beginning of the crisis, South Africa’s mortality rate has increased. But closer examination suggests that the increase was independent of the availability of alcohol, and began in April: five weeks before the first alcohol ban was lifted.

There has also been some inconsistency in available data.

Chris Hani Baragwanath Hospital in Johannesburg, for example, reported a 30% increase in trauma admissions in May 2020, a month during which alcohol was not on sale. And there is always a question about how “alcohol-related” cases are defined and the difficulty in attribution of trauma and violence, the News24 article continues.

See link to the full report below.

* Dr Marjana Martinic is an international expert on alcohol policy. She holds a PD in neuroscience from Harvard and Northwestern universities and led the science and policy work of the think tank ICAP and the organisation IARD, dedicated to reducing alcohol misuse worldwide. She is widely published on alcohol issues and has served as an independent scientific advisor to the European Commission, on the OECD Task Force on Illicit Trade, and on the International Council on Alcohol and Addictions.

 

Why South Africa’s alcohol ban gets it wrong – Experts

While South Africa saw a massive decline in trauma cases in hospitals during level 4 and level 5 lockdown, medical experts from the universities of the Witwatersrand and KwaZulu-Natal are hesitant to give all the credit to the alcohol sales ban, reported BusinessTech on 26 July.

Instead, it’s more likely that the reduction of trauma cases was as a result of restricted movement under the ‘hard’ lockdowns, which prevented people from interacting and getting into trouble and kept more people off the roads.

Speaking to Rapport, the experts said that the better move from the government in recent weeks would have been to again look at tighter restrictions on movement and around the sale of alcohol, rather than an outright ban.

Evidence from Chris Hani Baragwanath

Using the example of Chris Hani Baragwanath in Johannesburg, Rapport investigated the number of trauma cases reported during lockdown. In March, before the lockdown came into effect, the hospital recorded 2,217 trauma cases.

In April, under lockdown level 5, this dropped to 1,151 cases. In May, under lockdown level 4 – where restrictions on movement were loosened – this increased to 1,623.

In June, when restrictions on movement were loosened significantly, and the sale of alcohol was again allowed, trauma cases at the hospital increased by over 1,000 cases, the paper said.

Further, it was noted that South Africa’s drop off in trauma cases under hard lockdown was in-line with other countries which also implemented tight lockdowns, but did not ban alcohol.

“It’s evident that where physical movement and coming together are involved, the chances of car accidents and violence are higher,” the experts said.

“According to tracking data recorded by smartphones, the movement of South Africans during hard lockdown decreased by 80%. Simply put, this means that limited movement presents fewer opportunities for trauma.”

Alternatives

The views from the university experts reflect some views of the SA Medical Research Council, which made presentations to the government ahead of the latest alcohol ban, offering alternatives.

While the SAMRC’s modelling showed a massive improvement in bed availability because of the alcohol ban, it recognised that there would be significant push-back from South Africans to such a move. It recommended a host of alternatives to the ban.

See link to the full report below.

 

Does the data support the alcohol ban?[/link]

 

Liquor ban – Government taking a sledgehammer to crack a nut

 

Liquor ban – Government taking a sledgehammer to crack a nut

 

Why South Africa’s alcohol ban gets it wrong: Experts

 

Why South Africa’s alcohol ban gets it wrong: experts

 

Liquor ban – Government taking a sledgehammer to crack a nut

https://www.businesslive.co.za/bd/national/2020-07-22-news-analysis-liquor-ban-government-taking-a-sledgehammer-to-crack-a-nut/

 

 

 


Receive Medical Brief's free weekly e-newsletter



Related Posts

Thank you for subscribing to MedicalBrief


MedicalBrief is Africa’s premier medical news and research weekly newsletter. MedicalBrief is published every Thursday and delivered free of charge by email to over 33 000 health professionals.

Please consider completing the form below. The information you supply is optional and will only be used to compile a demographic profile of our subscribers. Your personal details will never be shared with a third party.


Thank you for taking the time to complete the form.