The COVID-19 pandemic has presented a unique number of challenges for governments across the globe. Some of these challenges have centered around ensuring the safety of its citizens and implementing strategies that examine how best to curb the spread of infection within the general population. By implementing preventative measures, governments could ensure a delay in the increase of infection and a delay to the peak of the number of infections so as to provide their health infrastructure with an ample amount of time to prepare for this.
One such method of prevention has been looking at changing many fundamental behaviours within the population to ensure that the risk of infection was reduced dramatically. Daily actions and behaviours within a number of spheres have been changed, and these changes have been reinforced by government to ensure they continue to provide the necessary support in curbing the rate of spread within the population. This article seeks to explore the changes across behaviours and social interactions and the impact this has had on reducing the spread of the disease.
The need for behavioural change
With how rapidly COVID-19 is evolving, there is a need for effective and appropriate interventions that ensure the spread of infection is adequately managed within the population. The reaction of the Government has determined the share of spread across its’ nation.
Governments that have responded swiftly and who communicated the dangers of COVID-19 effectively to its general population have been successful in the relative suppression of the devastation caused by COVID-19. Betsch, Wieler, & Habersaat (2020) have found that communication strategies embodying characteristics such as consistency, fairness, empathy, and sincerity are useful in conveying the urgency of safety measures being implemented by government and as such ensures that the risk being posed by COVID-19 is adequately perceived by the general population. This then ensures that adequate measures are taken.
The communication strategy implemented by the South African government and South African department of health at large has ensured that the risk being posed by the COVID-19 pandemic has been conveyed. These governing bodies have also ensured that the correct measures have been taken to ensure the virus has not spread exponentially. A thorough and wide-spreading communication strategy was used to keep South African citizens informed routinely on current regulations and strategies within lockdown. This strategy has ensured that all citizens have taken the necessary measures and curbed the necessary interactions to ensure the safety of themselves and those around them.
Behavioural changes such as routine sanitization and the consistent wearing of masks in public have ensured a controlled and relatively limited peak of the virus. Several provinces, such as the Western Cape and Gauteng, have seen a decrease in the number of daily cases, and the recovery rate of the nation has averaged around 70%. South Africa has also seen a relatively low death rate when compared to its compatriots such as the United States of America and Brazil, both of whom have experienced challenges in effectively implementing behavioural changes within their respective populations.
The insight provided by Tarrataca, Dias, Haddad, & Arruda (2020) has shown that contradictory messages and communication from the Brazilian government have led to many serious issues that have been a catalyst in the spread of diseases. Concerns around under-reporting of positive cases and deaths have led to a loss of faith on the part of Brazilian citizens in its’ government.
The inconsistency on the part of the Brazilian government has led to several challenges arising, such as the lack of adherence to measures such as social distancing and sanitization. The inadequate reporting of testing and positive cases has made predictions around the impact of COVID-19 on Brazil’s population unreliable and guesswork at best (Tarrataca et al., 2020). The portrayal of public health services on the part of the media and the reserved approach of its’ government has led to Brazil having the second-highest number of cases and deaths in the world.
The types of changes to behaviour
In order for there to a significant impact on the curb of spread of COVID-19, changes to behaviour are needed to occur in a number of different spheres.
Changes to Hygiene and Sanitization
The current evidence around how COVID-19 has spread, points to the presence of the virus in respiratory droplets, or transmission through physical contact with another individual (WHO, 2020). Transmission of the virus occurs as a result of hands that have been contaminated with the virus come into contact with fluids emanating from the eyes, mouth, or nose. Hands that have been contaminated can also cause indirect transmission that has come into contact with surfaces that have not been disinfected after touching (WHO, 2020).
This then argues the importance of consistent caution around hand hygiene and ensuring they are disinfected continuously to prevent the spread of infection. The WASH principle, which stands for water, hygiene, and sanitation (World Vision, 2018), has been seen as a critical measure in the prevention of the disease. The thorough washing and sanitization of hands ensure the minimal spread of the virus when coming into contact with others.
Sanitizing agents have become a necessity during the COVID-19 pandemic. Sanitizing products such as liquid sanitizers and wipes have been a significant factor in minimizing the rate of spread. Products such as hand sanitizers also include high ethanol content, which acts as an effective disinfecting agent. The consistent sanitization and disinfection of surfaces ensure that the virus is effectively removed from an environment, thereby eliminating the risk of infection.
The use of sanitizing sprays on items purchased from stores and deliveries collected from an external source also ensures that the virus is not spread exponentially. As the virus can also be spread as an aerosol, deep disinfecting within the area of contact of someone who has tested positive. Government regulations around the disinfection of workplaces and public spaces require that the area be deep cleaned after coming into contact with an infected individual (Department of Health for the Republic of South Africa, 2020). By doing this, it minimizes the risk of infection for individuals who will come into contact with these areas.
An item that was seen as unnecessary before the COVID-19 pandemic has become an absolute necessity currently. Face masks have been recognized as one of the most critical methods in counteracting the virus. One of the main and most obvious benefits of wearing a mask is that it reduces the amount of the virus being distributed by those who are already infected with the virus (Department of Health for the Republic of South Africa, 2020).
Face masks also act as a deterrent for individuals and reduce their risk of infection significantly. In order for the face mask to offer the necessary protection against the virus and prevention of infection, they need to be worn correctly, and the right type of mask needs to be used. According to WHO (2020), valve masks offer little by way of prevention as an individual who is infected and wearing this mask expels respiratory droplets through the valve, which increases the risk for the individuals around them. Healthcare workers and other essential workers are also encouraged to wear a mask at all times as a means of reducing their risk of infection.
Changes to Social Behaviours
During the COVID-19 pandemic, social distancing has become an important tool in ensuring that the virus does not spread significantly within the general population. The term social distancing refers to the need of an individual to keep the necessary distance from others to ensure their safety and the safety of those around them (The Department of Health for the Republic of South Africa, 2020). Social distancing also means avoiding public spaces as far as possible such as malls and recreational spaces. By doing this, it ensures minimal contact with individuals who are infected, areas that could be contaminated, and protecting the safety of individuals who are particularly vulnerable to the disease (WHO, 2020).
Social distancing also refers to avoiding physical contact with other individuals. This includes social greetings such as handshakes and hugging. It also means keeping a relative amount of distance from another person when in a public setting to avoid coming into close contact with these individuals. These measures of social distancing have been instrumental in curbing the rate of spread and also ensuring the protection of vulnerable individuals (WHO, 2020). These measures work to ensure that how the virus is spread is curbed or minimized as far as possible and, in conjunction with consistent hygiene and sanitization, ensures that the individual is protected from the infection as far as possible.
Repercussions of Non-Compliance
Failure to adhere to these safety measures has dire consequences for the individual as well as those around them. Not sanitizing hands regularly could result in illness and could also lead to spreading it to individuals around them (Hofman &Goldstein, 2020). There are several movements across the globe that have been protesting the use of face masks during the COVID-19 pandemic as individuals do not see the value masks pose in preventing the spread of the disease. Protests of this nature have grave repercussions as individuals within these protests are putting their own lives as well as the lives of the people around them at risk for infection (Blunt, 2020).
These protests are often informed by misinformation and miscommunication on the essential benefits being provided by face masks and, as such puts, large groups of people of risk at a time as protocols for dealing with the pandemic are not followed. By not wearing a mask, individuals who are affected are able to infect the individuals around them through respiratory droplets freely, and it exponentially multiplies the risk of infection (Blunt, 2020).
The non-adherence to regulations and protocols that have been put in place to ensure the safety of the general public has several severe consequences and affects more than one individual when broken. These guidelines ensure that the spread of disease is minimized as far as possible and keeps individuals who are at risk for more severe symptoms safe, particularly from individuals who may test positive for the virus but may be asymptomatic. Thus, measures such as face masks, consistent sanitization, and social distance have become an essential part of the daily lives of individuals not just in South Africa, but globally and adherence yields rewards. This is clear in South Africa’s gradual peaking of cases and relatively low death rate.
The impact of social, behavioural change on vulnerable populations
One issue that has been highlighted extensively during the COVID-19 pandemic is the impact this has on populations who are at high risk of severe symptoms of infection due to underlying pre-existing conditions and co-morbidities. Several of them have been seen as a higher risk and will be covered in this portion of the article.
Firstly, Tuberculosis is a respiratory disease that often leads to a decreased capacity of lung function and weakens the body’s response to fighting off infection. Many forms of TB are drug-resistant and are a co-morbidity found in individuals living with HIV (Boffa, Mhlaba, Sulis, Moyo, Sifumba, Pai, & Daftary, 2020). It was found that of the current TB population in South Africa, 60% were also living with HIV (Boffa et al., 2020). Their reduced immunity and weakened lung capacity would, therefore, increase the probability of more serious COVID-19 symptoms being experienced, and thus places this group at risk.
Due to the influx of COVID-19 and the prioritization of treatment for patients with this virus in all branches of healthcare, it could mean that other illnesses and conditions such as TB could be deprioritized by the health system and could thus lead to an interruption of treatment for individuals currently living with TB (Boffa et al., 2020). This could then mean that these individuals return to their communities without receiving treatment, which may lead to long-standing effects on the community, and these vulnerable populations well after COVID-19 has been controlled (Adepoju, 2020).
According to Avert (2020), individuals living with this disease and who are taking their treatment as recommended are not at high risk for severe symptoms of COVID-19. This then makes people living with HIV at less risk for severe symptoms when compared to other more vulnerable populations. Consistent use of treatment in the form of anti-retroviral medication and other immunity-boosting treatment ensures that individuals living with HIV are able to combat the virus effectively should they become infected.
In contrast, individuals living with HIV who have not been consistently using treatment are at risk and, as such, more vulnerable to more severe symptoms of COVID-19 (Avert, 2020). This is more of a reality for HIV positive individuals living with a high viral load and has recently been infected with illnesses such as Tuberculosis. These previous infections then reduce the body’s ability to fight off COVID-19 infection effectively and make individuals who meet these conditions at greater risk to hospitalization for their COVID-19 symptoms or succumbing to their COVID-19 symptoms.
Obesity has become a significant area of concern for South Africa as over half of all South Africans are currently living with obesity or are overweight. Obesity, as a condition, is complex and challenging to manage. It is prevalent in any individual who’s body mass index score is above the recommended bracket for their age, gender, and height. Obesity is often accompanied by a number of complications and other health conditions that arise as a result of the body’s inability to effectively manage the amount of body fat across various vital systems and organs (The National Department of Health for South Africa, 2020).
It is these complications and the body’s inability to effectively fight infectious diseases like COVID-19 that makes individuals living with obesity extremely vulnerable to severe symptoms that are associated with COVID-19. Technical components such as medical machinery being ill-equipped to examine an individual living with obesity effectively also complicates the contraction of COVID-19. These symptoms may not be accurately tracked or monitored as a result, and this could lead to the severity of symptoms worsening of the individual, eventually succumbing to their symptoms (Qingxian, Chen, Wang, Luo, Liu, Wu, He, Wang, Liu, Liu, Chen, & Xu, 2020). Therefore, individuals living with obesity have to exercise extreme caution in their interactions with others and use all safety measures when going into public spaces.
Diabetes is a group of diseases that are linked to excessive amounts of glucose or sugar being found within the bloodstream; it occurs as a result of a malfunction within the pancreas, which produces insulin (Krishnasamy & Abell, 2018). Insulin is necessary for the production of glucose. When the pancreas malfunctions, there is either a deficiency of insulin or the body is unable to use insulin well effectively. As a result, insulin is unable to effectively breakdown glucose ingested from food sources (Krishnasamy & Abell, 2018). This can result in high glucose levels within the bloodstream, which is extremely harmful to an individual living with Diabetes. Different variations of Diabetes have different effects on the glucose levels found within the body, and varying degrees of severity, and as such also impacts on the severity of the symptoms of COVID-19 being experienced.
While having diabetes does not increase the risk of contracting COVID-19, it does have an impact on the severity of the symptoms being experienced by an individual who has diabetes (Murphy, 2020). Symptoms tend to be more severe in individuals living with diabetes as individuals with raised glucose levels within the bloodstream suppress an effective response from the immune system and, as such, make individuals more prone to infections like COVID-19 (Murphy, 2020). Recent research has also found that individuals who have become infected with COVID-19 have also experienced insulin resistance and as such extreme vigilance in monitoring blood glucose levels is required (Murphy, 2020). As such, individuals living with diabetes have to exercise extreme caution and diligence in managing their condition and try to minimize exposure to the virus.
Hypertension, or more commonly referred to as high blood pressure, is a condition in which the force of the blood against artery walls is too high, which then affects how hard the heart has to work to pump blood throughout the body. When hypertension persists for extended periods, this leads to health issues such as cardiovascular and neurological issues (Felman, 2019). Hypertension can be a genetic condition but is also often caused by factors such as stress and lifestyle habits (Felman, 2019).
The mortality statistics from countries such as Italy and China have shown that a large percentage of individuals who succumbed to their COVID-19 symptoms also experienced hypertension as an underlying condition (Fang, Karakiulakis, & Roth, 2020). There are several significant links between the severity of COVID-19 symptoms and hypertension. The first being that individuals with hypertension have a weakened immune system and, as such, are unable to effectively fight off the virus (Fang et al., 2020). Secondly, hypertension is also correlated to age and is often found in older individuals; this group is also more susceptible to more severe symptoms of COVID-19 and has also been heavily impacted by the virus. Lastly, recent research suggests pharmaceutical treatments used for hypertension could also affect how severe the symptoms of COVID-19 are within an individual who has hypertension (Fang et al., 2020). Hypertension, unlike most under most underlying conditions, is treatable and can be managed with healthy lifestyle changes and regular monitoring of their blood pressure.
As people age, their body’s ability to produce an effective response to disease decreases. Several underlying conditions also arise that impact the body’s immune system and other vital systems. There is also a decreased rate of new cell production, and as such the number of white blood cells present in the body is limited (Liu, Mao, Liang, Yang, Lu, Chai, Wang, Zhang, Li, Zhao, He, Gu, Ji, Li, Jie, Li, Li, Lu, Zhang, & Song, 2020).
Given that age is associated with changes within a number of vital functions within the body, it is, therefore, more likely for an individual who is advanced in age to experience more severe COVID-19 symptoms. Liu et al. (2020) also postulate that age is negatively correlated to the number of white cells within the bloodstream of an individual and, as such, affects the outcome of COVID-19 symptoms adversely. The study conducted by Liu et al. (2020) found that severe symptoms such as fever and pneumonia occurred more frequently in older individuals, and these individuals were more likely to succumb to their symptoms.
In order to ensure the safety of individuals who are more advanced in age, it is recommended that social distancing from their younger relatives, who are more likely to be asymptomatic, be implemented as far as possible, and public outings are avoided or initiated with extreme caution.
The Impact of COVID-19 on our state of mind
COVID-19 has presented a new evolution in how we live as a community. Measures such as lockdown were taken to ensure the safety of the global population. This meant that individuals were living in isolation and with limited social interactions for extended periods of time. This state of living has impacted on the mental wellness of a number of individuals within South Africa and across the globe in a negative way. The new ways in which individuals have had to go about their daily lives has also caused several negative emotions to arise as many people struggle to adapt to the new way in which society functions. Anxiety around contracting the virus has, and the impact it has had within all spheres of life has become the norm.
These changes to the mental well being have also impacted the physical well being of individuals such as loss or changes in sleep patterns and eating habits, which in turn worsens other pre-existing health conditions (WHO, 2020). Mental health conditions such as anxiety and depression have become more pronounced and are being experienced by more individuals both within South Africa and on a global scale. Torales, O’Higgins, Castaldelli-Maia & Ventriglio (2020) have found that individuals who become infected with the virus and go into self-quarantine also experience a number of mental conditions such as depression and anxiety due to the extended periods of separation they endure away from their loved ones.
Anxiety has also become prevalent, particularly around issues related to the financial implications of COVID-19 (WHO, 2020). Most individuals are experiencing growing concern and panic for their livelihoods as extended lockdowns globally have placed a severe amount of strain on small to medium enterprises (WHO, 2020). South Africa has been able to provide emergency relief funds, unemployment grants, and food packs to individuals that have had their livelihood impacted by COVID-19. Many support groups have also arisen to give emotional respite to individuals whose mental health has been affected negatively by COVID-19. It is during these trying times that the spirit of “Ubuntu” is most significant as by keeping apart, people are keeping each other safe, and it is these philosophies which have helped South Africans deal with the impact COVID-19 has had on their mental wellness (Sambala, Manderson & Cooper, 2020).
The Impact COVID-19 has had on everyday behaviours.
COVID-19 has negatively affected every sphere of life. Simple everyday activities such as travelling to school or work and visiting family or friends have become an activity that needs to be engaged in with extreme caution as the risk of infection is currently an ever-present factor within the daily lives of everyone globally.
Schools within South Africa have remained closed for most of the lockdown period, and learners have tried to engage in their curriculum for the year through online interaction with their teachers and to use their learning materials at home. While the mortality rate within children is relatively low, the concern arises from how frequently the virus presents as asymptomatic within children (van der Berg, 2020).
As such, it is easier for children to spread the disease to adults who could experience more severe symptoms of the virus. Children who were also reliant on feeding schemes within their schools have had to go without meals for extended periods, and van der Berg (2020) found that the extended absence from school has also caused a significant amount of emotional distress to children. The extended loss of school days for children in most grades has meant a considerable game of catch up for teachers. The benefit of this, however, is evident in the low number of cases reported amongst children and teachers alike and has also minimized the risk of infection amongst children with underlying co-morbidities (van der Berg, 2020).
Something else that has changed considerably is how individuals interact with public transport. Despite taxis and buses being able to operate at full capacity, the significant concern for the risk of infection has impacted the number of people who choose to use public transport. Zhen, Chan, Schoonees, Apatu, Thabane & Young (2020) have found that there is a higher risk of infection within public transport. Ventilation was cited as the most common reason for the risk of infection as well as close physical contact with other individuals and poor hygiene practices.
These issues of contention can be easily remedied, however, as issues around ventilation can be improved by ensuring the use of open windows and air vents. The consistent use of hand sanitizer upon entering and leaving public modes of transport also minimizes the risk of infection as well as the continuous use of a face mask when within the vehicle to ensure that contact with the virus is reduced.
The impact of social distancing on the Spanish flu
The Spanish flu, also known as the 1918 flu pandemic, was caused by the H1N1 influenza A virus, a deadly strain of influenza. There were two waves; the first wave presented symptoms that were similar to a common cold, such as having a sore throat, headache, or fever. In contrast, the second wave proved to be more deadly as discolouration of parts of the body, spontaneous bleeding from the nose or mouth, impaired vision and many other disturbing symptoms with the most severe being fluids within the lungs that had an extremely high probability of death (Yang, Petkova & Shaman, 2013).
The Spanish flu lasted for over two years and killed anywhere between 17 million to 50 million people, with over 500 million infections globally. As cases increased at an exponential rate, much like COVID-19, governments across the globe began to implement a version of lockdown within their countries with public spaces such as schools and churches being shut down (Strochlic & Champine, 2020). Like the current pandemic, there was no vaccine readily available, and public health interventions were seen as the first line of defence, these interventions included methods used currently such as closing down public spaces and placing the necessary restrictions on movement and transport (Strochlic & Champine, 2020).
Face masks also became mandatory as well as other forms of protective gear such as gloves. Data collected from that period in history showed that cities within countries that acted swiftly were able to reduce their transmissions significantly while cities that were slower to implementing regulations and protocols to curb the spread suffered heavy losses (Strochlic & Champine, 2020).
In choosing to lock down the country early, South Africa has achieved the same effects as cities that closed down early during the Spanish flu and have managed to avoid a catastrophic rise in infections and deaths. Implementing lockdown early ensured that the general public was protected, and an open communication strategy ensured that the South African public has understood the need for a significant change to their behaviour within certain spheres. These changes in behaviours then curbed the spread of infection and provided the necessary protection to vulnerable populations and the general population alike.
Social, are behavioural change has proven to be instrumental in the battle against COVID-19 and continues to play a role in how South Africans interact with one another as lockdown begins to ease. By continuing to engage in sanitization practices and the wearing of face masks as well as maintaining a physical distance with one another, the spread of infection will continue to decrease and will eventually become a learning lesson to future generations.