The SA Medical Research Council (SAMRC) has released its model, used to justify the new alcohol ban, which projects that an eight-week ban would lead to an 18% reduction in trauma patients in hospitals and free up resources for Covid-19 patients.
The alcohol industry collectively asked the SAMRC on Monday for the modelling and calculations used by the health ministerial advisory committee (MAC) when it advised the government to ban alcohol again.
The eight-week time frame detailed in the model may give frustrated consumers an indication of how long they can expect to wait before they can buy alcohol again.
“We are happy to debate our numbers. They are defendable,” said Charles Parry, the MRC’S director at the alcohol, tobacco and other drug research unit.
Parry is adamant the model must be transparent — even though it wasn’t released before the ban was instituted.
In fact, the model presented to the government and the MAC argues that “sharing the model and the rationale behind the model is key to winning the public over”.
“It is imperative to maintain absolute transparency and inform the public of the rationale behind its decision to re-impose a ban or tighter restrictions,” it said.
After being given the go-ahead from ministerial advisory committee head Professor Salim Abdool-Karim on Friday morning to release his 6-page model, Parry wrote to the alcohol industry and said: “I have always been transparent as you will see from my tweets and in my interviews with the media. I am pleased to be able to do this now.”
However, there was no discussion with the industry prior to the ban being instituted last Sunday night. As a result, it was unforeseen by the industry, as well as small businesses like liquor outlets and shebeen owners, who are expected to be hardest hit.
The National Liquor Traders Council, representing 34,500 taverns, (the name given to legal licensed shebeens) wrote to President Cyril Ramaphosa this week fuming. “It was our expectation that as a president, who thrives on consultation, that we would at least have been consulted on such an important matter as this, which is literally our livelihood.”
The industry and the tavern owners feel the government needs to balance the aim of reducing trauma patients at hospitals with the cost to the economy and jobs reliant on alcohol production and sales.
Parry explains he was given the “remit” of modelling in a “day-and-a-half” what banning alcohol would do to alleviate the burden on hospital resources, but was not asked to examine the ban’s impact on the economy and jobs.
“We work in silos,” he said
Parry admitted that an approach that looks at all aspects of the alcohol ban is preferable.
“I would have assumed the national command control council would have an economics group looking at the financial implications,” he said.
Based on estimates
The alcohol industry is likely to try and pick apart the model, which is based on many assumptions, rather than actual hard data.
For example, the blood of gunshot, stabbing, and car accident victims is not tested at hospitals, so the percentage of how many trauma patients were drunk when hospitalised are estimates. Also, the estimates of alcohol-related injury comes from studies of patients at academic hospitals like Cape Town’s Groote Schuur Academic Hospital, which may see more severe injuries than smaller hospitals.
Parry is upfront about this, and says in some case, he has adjusted the numbers downward.
“Models are always based on assumptions [and] based sometimes on prior information”.
Some of the numbers used in the model, such as the total number of trauma cases seen in the country’s hospitals, date as far back as 1999 and have been adjusted for population growth to represent what it would be in 2020.
The model also states that not every alcohol-related patient seen in a casualty ward lands up staying overnight in hospital.
It’s clear the alcohol industry is gearing up for a battle. Already, the industry has already asked Parry if his model and data was peer-reviewed — a scientific process in which other experts test and critique assumptions.
Parry told the FM that it was not peer reviewed by a journal — which can take years — but it was heavily debated in the ministerial advisory committee and within the MRC.
He suggests that alcohol-related injuries should be notifiable in future, which would require doctors to legally report injured patients who had been drinking to the National Institute for Communicable Disease.
While this would give the government actual figures on alcohol’s impact on the health system, it is unclear how practical this is, as it would require hundreds thousands of alcohol blood tests to be conducted on injured patients.
Paying the price for government inaction
The consensus view from the MRC group, who did the modelling with Parry, was that a ban be proposed for eight weeks. Parry said, however, that he personally, believes that tighter restrictions on alcohol sale, rather than an outright prohibition, is the better approach.
While the purpose of the ban is to reduce patient numbers in hospitals, since some areas do not have the staff and other resources to cope with Covid-19 patients, not all provinces are suffering equally.
For example, Parry says the Western Cape isn’t short of hospital beds. The province’s premier, Alan Winde, said on Thursday that the epidemic had flattened and the numbers of Covid-19 hospital patients had decreased from the peak.
The MRC’s model says that if provincial liquor bans were in place, which would allow some provinces to sell booze but not others, the government would need to strengthen policing at provincial borders
The strains on the health system, however, relate to SA’s wider problem of alcohol abuse.
Parry says this is something the country should have addressed “years ago,” along with the violence and drunk driving problems related to it.
“It is impossible to deal with and fix in the middle of a pandemic,” he says.
It means that the tavern owners, and Western Cape residents, are paying the price for a weak and unprepared health system in Gauteng, the Eastern Cape and KwaZulu-Natal, which is now short of doctors, nurses and even oxygen to treat Covid-19.