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Extreme fear or unfettered activity both unhealthy during COVID-19

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OP-EDS

Every time we drive our vehicles into the streets in South Africa, we embrace real risk. The Automobile Association of South Africa has previously quantified that risk as 1 in 101 (1%). Almost every facet of our lives is strewn with inherent risk. This concept is apparent in larger life decisions: the risk in making a career choice, the risk in choosing who we marry, the risk of emigration. It’s also equally apparent in smaller life choices: the risk in making a worthwhile investment, the risk of trying out a new restaurant on an important occasion, or of swapping smartphone brands!

Risk taking with our most valuable resources seems counter-intuitive. Surely, the greater the value, the less risk we should tolerate? Our children ought to grow up in risk-free environments. Yet, we know that risk is inseparably paired with opportunity. It’s a catalyst for growth, and a necessary ingredient for daily life. We gladly put our children through daily risks for their own development: contact sports, unaccompanied travel, and so on.

The COVID-19 pandemic, which is now developing a somewhat endemic flavour in South Africa in its 15th month (in the absence of mass-population vaccination), is no exception to this risk model. Perhaps COVID-19’s greatest challenge to the individual is to embrace risk responsibly. Let’s explore.

A basic tenet of Judaism is the value of preserving human life over all. The Torah commands us to “live by the mitzvot”, not die by them. This concept is translated into a strict principle – pikuach nefesh – in other words, any risk that threatens life must be extinguished. Even the mere possibility of a life-threatening risk is intolerable. When COVID-19 hit our shores in February 2020, the risk of death based on the experience in Wuhan was palpable. The government took the decision to shut down the country in deference to pikuach nefesh. Saving lives supercedes all. Even with strict lockdown measures, both nationally and communally, the loss of life and devastation over the next few months in South Africa became formidable.

The appropriate societal knee-jerk reaction was to tighten measures and remain socially isolated. In fact, preserving an approach of “hiding away until the pandemic is over” seemed achievable for most South Africans. However, as the indicators surfaced that this pandemic may indeed last a couple of years and as several months of social and economic dysfunction followed, it became more and more apparent that the “no risk” approach was damaging us economically, developmentally, spiritually, and socially. Ironically, after the first and second waves, we re-engaged in outside life with new case numbers significantly higher than they had been, even in the initial no-risk-tolerated pangs of the pandemic.

This was, perhaps, the juncture at which I noticed, as a GP, our community’s approach to COVID-19 becoming polarised. Individuals who had been personally affected by COVID-19 seemed to maintain strict measures of infection prevention. Those who hadn’t either chose to continue the same strict approach, or to deflect and nurture the importance of risk taking. The vast majority of patients felt that risk investment in their personal lives outweighed the risk of serious complications should they contract COVID-19, and pushed for resumption of “normal” life, in spite of not being vaccinated.

Balancing risk is the most important task incumbent upon every community member, especially at this perplexing time between a second and probably third wave. I strongly believe that, other than in exceptional high-risk individuals, aversion to all risk is detrimental to well-being. COVID-19, with its variants, vaccination challenges, and higher-than-ever worldwide infection rates, is here to stay for the short-term future at least. I have treated significant numbers of patients with mental-health challenges and neglected chronic diseases because of irrational risk aversion. Children need to develop friendships and learn the important formative skills of outside-world independence. Keeping them cooped up at home or preventing them from playing sport (for example) will damage their development. Grandparents need to spend time with their families, especially if COVID-19 prevails over the last years of their lives. Businesses need to take on expansion and new ventures. Treading water is a poor approach to build prosperity and preventing income loss.

I believe that advising patients to “stay home and save lives” is now inappropriate and detrimental (other than in extraneous circumstances). Furthermore, this approach creates a far bigger contingency in our society that swings to the other extreme and exercises no caution. The danger in this latter approach is far worse.

I also believe that throwing off masks, attending indoor packed events, and not limiting social-event sizes (for example) is just as inappropriate and unacceptable, especially in light of the possible increase in new cases.

It requires every family and individual to decide on an approach that will allow them to function in the long term without incurring unnecessary risk. Masks, hand sanitising, and social distancing still save lives. It’s up to each unit to decide on balanced measures like small social circles to mitigate risk, strict mask wearing in public places, outdoor socialising, individual family member isolation after inadvertent high-risk behaviour, and so on.

Although the answers aren’t always clear or even consistent, I firmly believe that every individual in our society has a personal responsibility to create for himself/herself a list of COVID-19 rules in an attempt to stay safe, prevent danger to others, but as importantly still to allow himself/herself the opportunity for growth. We imminently await a mass rollout of vaccination, but the reality is that never before has the world attempted such a widespread vaccination programme. It will take a long time. On an individual level, even after receiving a vaccine, risk still exists.

If you are someone who has either kept every one of your guards up since Level 5 lockdown or you have gone to the other extreme and are even doubtful about whether “COVID-19 poses much danger in South Africa anymore”, please think again. Find a balance. Embrace risk responsibly, and review your approach often.

  • Dr Daniel Israel is a family practitioner in Johannesburg.

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OP-EDS

Knee-jerk ban a zero-sum game

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Way back when I was in primary school, I had a good friend who grew up in a deprived household – at least, he felt deprived because his parents wouldn’t allow him to read comic books.

Batman, Superman, Archie, The Beano, Mad Magazine – they were all deemed to be of dubious literary merit and harmful to impressionable young minds.

Which is why, every day after school, on the pretence of doing his homework, he would come over to my place, where he would sit for hours, lost in a world of his own, reading comics.

As far as I know, my friend went on to become a decent and productive member of society. And if he didn’t, well, we can always blame the comics.

We learn from history that parents, teachers, and spiritual leaders have long believed it’s their duty to shield children from supposedly toxic media content, from rock ’n roll to heavy metal to hip hop to video games to TikTok.

Oddly, one rarely sees children warning each other against such things, which suggests either that they are capable of making up their own minds, or that they are too busy rolling their eyes at the grown-ups.

Be that as it may, the latest source of fretting in adult circles is the hit Netflix series, Squid Game, in which 456 down-on-their-luck players take part in a variety of seemingly innocent children’s games, with deadly consequences for 455 of them.

Objectively speaking, Squid Game is a superbly made show, with hyper-stylised aesthetics, audaciously imaginative set-pieces, and a cast of mostly likeable main characters with believable flaws and back-stories.

It also happens to mark the high tide of an extraordinary renaissance in South Korean popular culture, which has already given us Parasite, the Best Picture Oscar winner; K-Pop, the fiendishly catchy musical genre; and a stream of family dramas, historical epics, science fiction spectacles, and crime thrillers on Netflix.

That’s all very well, one might argue, but isn’t Squid Game terribly violent? Well, yes, I would argue back, but no more so than certain classical texts that spring to mind, such as the ancient Greek tragedy Oedipus Rex (parental guidance recommended), or Shakespeare’s Romeo and Juliet, which is riddled with scenes of gang warfare and poor life decisions by teenagers, yet it remains a staple on the high school set-work circuit.

The ultra-violence in Squid Game is cartoonish and over-the-top – rows of players mowed down by automatic gunfire from a giant robotic doll, for instance – and is far removed from the real-life violence one might see on CNN or a YouTube crime report.

Having said that, it’s not for nothing that Squid Game is rated “16” on Netflix. Nor is it too surprising that the Parents Television and Media Council, a United States-based lobby group, has warned parents to “take appropriate measures, whether by applying parental controls or more closely supervising their children on social media and gaming platforms, where content about or inspired by the series is being shared”.

Clearly, this is a matter for consideration and application in individual households — we are long past the days, thank goodness, when the state had to make such decisions on our behalf.

Either way, it seems to me that 16, or thereabouts, is a reasonable benchmark for the viewability of Squid Game by younger people.

At that age, in a culture of ubiquitous access to information in all its forms, one would hope that viewers would be able to distinguish between everyday reality, unreality, hyper-reality, surreality, and reality TV, and also that they will have been sufficiently schooled, on the brink of adulthood, to draw readings from the text and not take everything they see at face value.

A chief reason for the phenomenal success of Squid Game – it is the most popular show in the history of Netflix to date – is that it can be viewed in two different and complementary ways.

As pure, visceral entertainment, without weighing too heavily on the mind, or as an extended analogy for the ills of contemporary society in the age of the pandemic.

In much the same way that Parasite dabbles in what happens when the members of one social class cross the barrier into the next, Squid Game uses the plight of the downtrodden and debt-ridden to show us just how far people will go in the hope of making enough money to solve their problems and make their dreams come true.

The show’s running commentary on capitalism and inequality isn’t particularly deep, nor is it particularly original, but it does add a subtext that bears thinking about, and that renders the violence integral to the storyline rather than as something gratuitous.

That’s why I would say that schools, rather than warning parents to watch out for signs of Squid Game behaviour on the part of their children – “No! You may not have your friends around to play ‘red light, green light’!” – should use the show as a teachable moment.

With that “16” caveat firmly in mind, what might learners be able to learn from Squid Game, about inequity, imbalance, and the yawning divide between, say, Jeff Bezos and his workers back on earth? What would Squid Game look like if it were played in South Africa?

Who would take part, who would run the show, who would be best equipped to win? And to get back to the matter at hand, what can Squid Game tell us about the way violence is portrayed in popular culture and its possible effects on impressionable young minds?

The point is, everyone is already watching the show, or at least talking about it, so let’s put it on the syllabus, discuss it in the open, and remind ourselves, when all is said and done, that it’s really just a game.

  • Gus Silber is an award-winning journalist, editor, speechwriter, and author.

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OP-EDS

Why teens shouldn’t exercise after vaccination

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Tens of thousands of 12 to 17 year olds around the country presented for their COVID-19 vaccines this week. What advice should teens be given after being vaccinated?

The concern is that strenuous exercise in the week after a vaccine, while the immune system is mounting a response, may predispose teenagers and young adults to the very rare complications of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the thin membrane that surrounds the heart).

Myocarditis and pericarditis occur at a rate of 65 per million doses of Pfizer vaccine, more frequently after the second dose. To put it into perspective, the rate of myocarditis in patients infected with the SARS-CoV-2 virus is 450 cases per million infections. Cases that have occurred after vaccination have mostly been mild and resolved in a few days.

There are no official guidelines on exercise post vaccination. Out of caution, some countries, such as Singapore have advised adolescents and patients under 30 years of age to avoid strenuous physical activity (intense exercise) for one week after receiving a vaccine.

Hatzolah is advising patients to avoid strenuous exercise for one week post vaccine, and based on this, some schools in Johannesburg have suspended all sports for this week following a mass vaccination campaign at schools.

My advice to teens is to avoid very strenuous activity such as running, cycling, rugby, soccer, and other cardiovascular activity for five to seven days. Within this period, they should monitor their heart rates and how they are feeling when participating in milder activities.

If they have fever, excessive fatigue, or severe muscle pain, they should rest completely for a few days. These symptoms can be treated with Panado.

Should their resting heart rate be elevated above normal or their heart rate go up more than usual while exercising, they should rather rest for a longer period. Symptoms to watch out for in teenagers in the two weeks following vaccination include chest pain, shortness of breath, a fast, irregular heart rate, and fatigue. In the unlikely event that your teenager develops any of these, you should seek medical care.

For teens participating in competitive sports or intense training, the timing of the vaccine should be carefully considered. It’s best to plan for at least five days off intense training. This may sound inconvenient, but remember that the recommended rest time from exercise after testing positive for COVID-19 is two weeks after recovery.

Teens who are in quarantine or isolation following exposure are also not able to participate in sport. Vaccinating high school students will ultimately reduce the amount of time spent off school and off sport, making a one-week rest period easier to accept.

In a webinar for health professionals on 26 October, Professor Claudia Gray, a paediatrician from Cape Town, outlined five reasons why she believed that adolescents should be vaccinated against COVID-19.

  1. While mild disease is likely, it’s not guaranteed and one doesn’t know which previously healthy teenagers may be severely affected. The Delta variant has caused a higher number of infections in teenagers, with an increase in admissions to intensive care, teenagers needing ventilation, and death, which is “unacceptable in a disease that is modifiable by vaccination”;
  2. Complications such as multi-system inflammatory disease and long COVID-19 can be prevented;
  3. Transmissibility can be decreased, which has widespread repercussions for the community. Teenagers find it difficult to distance themselves physically from others and isolate;
  4. Vaccinating this group helps to prevent new and potentially more transmissible or more severe variants from evolving; and
  5. It gives us a chance to normalise our community – the more people vaccinated, the greater the chance of, for example, watching our children play sport again.

Esteemed critical-care professor at the University of the Witwatersrand, Professor Guy Richards, concurs with this, reinforcing the ways in which vaccines reduce transmission, including less spread from asymptomatic individuals and a shorter period of viral shedding in vaccinated patients.

Gray said that she timed the vaccination of her own adolescents before the weekend so that they could have a 48-hour complete period of rest from exams and sport, so that if they got a sore arm, headache, or fever, they would be able to rest. She advised that young males should avoid all exercise for two days, and avoid intense, strenuous exercise for five days. She reminded doctors that it takes three to four weeks to build up immunity, and said parents should consider vaccinating in time for teens to have immunity before the December holidays.

Though serious side effects following vaccines in adolescents are exceedingly rare, it’s wise rather to be cautious and invest in a few days of rest before undertaking strenuous exercise following vaccination.

  • Dr Sheri Fanaroff is a GP in private practice in Johannesburg.

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OP-EDS

The ballot is stronger than the barricade

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I recently looked back at some election results. Earlier in the year, the Democratic Alliance (DA) clung onto a Pretoria West seat by three votes in a Tshwane by-election in the nation’s capital. Had the African National Congress (ANC) won that by-election, it would have marched forward to this election with a lot more momentum.

That DA win gave the party’s activists in Pretoria a lot of encouragement. I remember in the early 2000s, the ANC beat the DA by four votes in a Stellenbosch by-election to win a seat off the DA.

We should be cynical. So many of our politicians who have the privilege of being elected to council, provincial legislature, and parliament don’t go beyond the call of duty to serve the country or their constituents. Too many try to enrich themselves rather than bringing good to the areas where they live. Many of our cities and towns look jaded.

Many South Africans believe more can be achieved through blocking the roads and shutting down the cities or towns. Politicians running for office rarely if ever honour their electoral promises. The minute they are elected, they are perceived to disappear. Thus, a service delivery protest can be far more beneficial than begging the councillor to do the job.

Earlier this year, taxi drivers and farmers worked together in the Free State town of Ficksburg to block the road to prevent trucks from passing to and from the Lesotho border to protest against the deteriorating road conditions.

We saw similar nation-building activity in Koster in the North West, where a cross section of local residents and farmers were given permission by the courts to resuscitate the collapsed water and sewerage supply and run these key plants for the municipality. We saw it after the July insurrection, when residents of KwaZulu-Natal and Gauteng took to the streets with brooms and bin bags to clean the areas which were devastated by the looting.

If the state, province, and municipalities cannot protect our businesses, manage our water supply, or maintain our roads, then why should we vote? We can and will sort things out for ourselves. We don’t need to rely on the police to protect our families and businesses. We’ll buy a generator and put up a JoJo tank. There’s no point in voting as it will make no difference. We’ll do our best to protect our family and our community and won’t bother ourselves with the continued decline of our ward and city.

For me, national and provincial elections can often feel like a version of The Emperor’s New Clothes. There are grandiose plans, ambitious policies relating to finance, the economy, and foreign affairs. They could easily be mistaken for a charade. Local government, by contrast, is much more tangible. This has to do with your weekly refuse collection, water supply, the roads in your neighbourhood, and the upkeep of your park. Effective local government allows our community to leave the comforts of our home, synagogue, communal institution, and favourite shopping centre and allows us to become citizens. We are more likely to use public spaces and more likely to collaborate with people from different backgrounds to us.

Who are we voting for?

The Independent Electoral Commission has made copies of your ballot available for inspection on its website. Open Cities Lab has created an app which does the same but also tells you how old the candidate is and whether they are standing in only one ward. For instance, in ward 73, (Houghton Norwood), 36-year-old Bhekinkosi Mchunu is running for the KwaZulu-Natal based Justice and Employment Party. He’s also standing in 134 other wards. I wonder how much he knows about my ward and its challenges, and hope residents of other wards would have the same concerns.

I notice that the African Christian Democratic Party’s candidate, the 49-year-old Bronwyn Kassen, is more modest in her run for office. She is running in my ward and is on the ballot in Florida in the west of the city, Craighall Park, and Bryanston Bordeaux. I implore you to do research on the candidates on your ballot, and see whether they live in your area and whether they understand what the critical issues will be over the next five years.

You will be getting two ballot papers if you live in a metro (major city). The second ballot is the proportional ballot. Think carefully which party will best represent you, your concerns, and your aspirations over the next five years.

Your mood might be down, you are jaded by too many disappointments. However, Monday is a public holiday. Take your family, take a book, and go stand in line with the residents of your neighbourhood. Stop and look at all the party volunteers trying for one last time to get your attention and remind you why you should vote for them.

When you step into that ballot box on Monday, know that as per the Pretoria West and Stellenbosch example, your vote can indeed make a difference. Know that you are voting because you do care about your ward and city being better over the next five years rather than at best remaining in its current state or at worst sliding backwards.

Know that your vote can be the difference between an energetic candidate on the proportional ballot getting elected or not. Your vote could possibly be the one which ensures that a key coalition partner gets an additional say in the stewardship of the city. Let’s all go out and vote and celebrate the potential of our wards and cities.

  • Wayne Sussman writes on elections for ‘Daily Maverick’.

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