From the work available, viruses go through a number of stages: initiation, acceleration, growth, peak and exhaustion/resolution in the most basic terms. Efforts to mitigate, delay, contain and eventually control the spread have varying impacts and epidemiologists do a much better job at describing this. Here’s a note around how little is known about the SARS CoV 2, which causes COVID-19:
“We are uncertain about transmission in children, some communities are remote and unlikely to be exposed, voluntary social distancing by individuals and communities will have an impact, and mitigation efforts, such as the measures put in place in China, greatly reduce transmission. As an epidemic progresses, the effective reproduction number (R) declines until it falls below unity in value when the epidemic peaks and then decays, either due to the exhaustion of people susceptible to infection or the impact of control measures.” –Roy Anderson and Colleagues
Most countries are focused on mitigating the spread through social distancing, behavioural changes and enforcing travel bans. Regional travel bans in Chinazzi and colleagues’ paper are shown not to be as effective without behavioural changes in communities— those are social distancing and hygiene. However, the geographic spread of the virus can be contained be reducing unnecessary travel.
From the simulations from Roy and colleagues (shown above), it is clear that peaking can be high, or spread-out if social distancing is achieved. Health systems are overwhelmed when infections peak too high, hence the Minister of Health argued that it is important not to overwhelm the health system. However, bear in mind that the simulations made in their article do not necessarily account for health system inefficiencies, or spatial variations, in addition to the unique fabric of travel, living and socio-economics in Africa. Hence this piece attempts to bring some context to the mitigation efforts on the table. Early February was an important period as Nigeria, Botswana, Senegal and other countries started to structure responses to the virus. By March Keyna had moved to stop all international conferences. A rolling report from Africa News is particularly helpful in this regard, a point of note here is the 26 African countries have reported infections this past weekend.
Detection and Spread
Symptom based assessments are conducted at airports around the world, and the premise is to root those who are already infected. These protocols are supplemented by cleaning instructions and behavioural practices for airlines and airports. For public passenger transport, the UITP issued a brief notice, which focuses on safeguarding public transport operators through (a) readiness in operations, stock, and labour; (b) personal protection through cleaning routines and other organisational interventions and (c) reducing contact with passengers from customer service to ticket inspection.
Evidence from Roy M Anderson, and colleagues suggests that symptom based assessments are unlikely to be effective because 80% of those with an infection show mild symptoms to none at all. With an incubation period of 5 to 6 days, and peak infectiousness lasting 4.4 to 7 days there is a chance that infectiousness is 1 to 2 days before symptoms show up probably in the remaining 20%. The other issue is that the virus has in its early stages a basic reproduction number of 2.5, meaning one infected person infects 2.5 people on average. Therefore, given the many unknowns, using the symptoms based approach may only catch a minority of those who show symptoms at the time of screening— not the total number at the point of entry.
Lisa Brosseau wrote for the Centre for Disease Research and Policy with a focus on describing the other avenues COVID-19 may spread. In particular, she extends the “clean surfaces” argument to include the potential infection through aerosols, or small particles in the air which float around. Her argument hinged on a few non-peer reviewed articles, but it resonates with findings in the aviation industry. Some of reasons why airlines opted for increases in the number of doorways, was (a) to increase the rate at which passengers board the aircraft and reduce the time spent boarding passengers; (b) to encourage section based boarding to reduce the spread of diseases. However, one study does show that “there could be some relationship between the transport of expiratory aerosols and epidemiological observations of outbreaks during air travel”. In the context of public and private transport in Wuhan, Zheng and colleagues reveal that service frequencies of transport services and the spread of the virus are positively associated, more of one is more of the other— and it is important to contain travel in general. They say: “strong preventive measures should be taken in cities with shorter distances and more frequent public transportation connectivity within epicenter in order to contain the COVID-19 epidemic”. While the UITP encourages rear boarding for public transport, this is not possible in most of the current vehicles in SA. For air travel it matters to control and manage boarding and alighting in a manner that reduces contact between sections; but this does not resolve the proximity issue. Unlike with air transport Mohr and colleagues argue that the big challenge for public transport is contact tracing, and this limits the ability for any study to show the impact of PT and the spread of infectious diseases because of the limited information about passengers, and vehicle dynamics at the time of travel (with an infected person in the vehicle).
It follows therefore that there is a chance that the risks are higher than they are evident. Specifically because between the 2nd of March and the 15th, 10000 travellers from high risk zones arrived in South Africa’s airports. In December 2019, a low-risk period, about 5600 passengers with Chinese residence came to South Africa for holiday reasons largely— most of them through OR Tambo International. However, according to the Statistics South Africa’s Migration and Tourism report, 9.1% of the arrivals were from Asia (23 257), and 63.6% were from Europe (163 335). The challenge with the Chinese case is that: “before China declared the lock-down amidst the coronavirus about five million residents managed to leave Wuhan”. Many of which travelled to nearby Asian countries, a small minority may have made it to other countries. Over time, the risks increased across various other countries, which expanded the geographic scope of probable importation.
Containment and density
While we wait for future reports for January and February (coming in April and May) for tourism and migration from StatsSA, data from the NICD should suffice as the risk in China and Europe only increased during this period recently. In early February, reports indicate that many African countries were concerned about the potential presence of the virus, with John Nkengasong from the Africa Centres for Disease Control and Prevention saying that “It is very possible that there are cases that are going on the continent that have not been recognised”.
The biggest challenge for South Africa is probably related to accurate data and modelling about the probable importation of the virus from the total number of passengers arriving from at risk countries over time; and their social, and transactional contacts. In this instance, it becomes important to know where and who people are, and the importance of virtual profiles emerges. Schmidt and Cohen purport in their New Digital Age book that at some point “governments may determine, for example, that it is too risky to have citizens “off the grid”, detached from the technological ecosystem”. Under circumstances where 36 contact points could exist for each infected person on average, the capacity and scale to track and trace these individuals and their mobility and access diaries will be crucial. While a digital profile may help with transport services with good digital information, retail areas, and other transaction contacts or social encounters, it might miss the spatial structure of cities and towns.
On the recent Monocle podcast The Urbanist, Andrew Tuck titles it ‘Cities in quarantine’ and talks with Michele Acuto on what cities can learn from the outbreak. Tuck stimulates Acuto to reflect on density as the modus operandi in planning practice, and is challenged by epidemics and social distance— but Acuto argues that it is not about the density itself, but instead how it is managed. Lessons from the Ebola outbreak, he says raise a much neglected question: “how do you manage this when it spreads to more peri-urban and semi-organised settlements?” He also describes the spatial nature of viruses, and the risks associated with using notions such as ‘quarantine’ and ‘social distancing’ without accounting for the difference between the Global North, and the Global South.
Social distancing and passenger transport
Following one of the reports I’ve managed to get through from the National Cooperative Highway Research Programme, titled ‘A Guide for Public Transportation Pandemic Planning and Response’ a few major points are worth discussing specifically from Chapter 4 on preventing the spread of disease. They first of all highlight a broad series of measures that may be used to prevent the spread of a disease. These are adaptable, where possible. But they do emphasise that what matters is understanding the characteristics of the disease, and controlling for it. Cleaning and disinfecting transportation assets was also highlighted as a key aspect, but it is encompassed by appropriate training, a guiding policy with approved disinfectants distributed, and procedures to reduce the presence of particles which have the virus too. There are also medical interventions, which should be guided by medical professionals who recommend and provide detailed information about the specific treatment of transportation services.
In much of Africa, the use of smaller micro transit vehicles which service short to long distances in cities, townships and villages complicates the preventative guidelines. From the official press statement the primary recommendations from the Minister of Transport in South Africa is that:
- Minibus taxi and bus operators will be key to disseminating information and education about the virus and practically inform behaviour change;
- Taxi and bus industries will be consulted and these consultations may be informed by the Department of Health about the measures that need to be taken in the public transportation context;
- Another ‘controversial issue’ is the “random testing measures be implemented in the public transport environment, with particular emphasis on commuter rail”.
However, the during the presentation from the Minister of Health, the Minister of Transport also indicated that minibus taxis and taxi ranks will be disinfected, and cleaning practices encouraged. These are consistent with Alan’s piece on ‘Public transportation and infectious diseases’, but these responses do not go deep enough to set a longer-term agenda for prevention, occupational health and safety, and national security controls against threats and disasters.
The size of the challenge
From this long note, it is quite clear that there are as many unknowns as there are options to intervene. There are also areas we could have done better on in the transport planning and national security front. However, the main concern at this point is contact tracing and estimating various impact scenarios for this virus. Furthermore, the secondary concern is mitigating and acting within a short period of time through urgent partnering and deep collaboration for education and implementation. A tertiary issue is preparing for the next crisis long before it arrives.
There are a number of granular complexities that Transport Authorities and municipalities need to prepare for, and in this instance, a number of caveats may exposed. Particularly in the context of transportation infrastructure for public transport services like minibus taxis. In the best case scenario, transmission may be limited geographically and there will be little need for drastic interventions; however in the worst-case scenario disease control measures may be rendered dysfunctional due to the questionable integrity of the relationships between national transport entities and local authorities, custodians and operators. Social distancing in the context of South Africa’s passenger transport market is implausible unless if significant increases in capacity are imposed— but this too is not feasible. Furthermore, given the high density nature of public transport interchanges, cleaning and disinfecting them will require a more coordinated approach involving the street vendors, hawkers and the current car and taxi washing youth. The questions that may emerge include:
Who is responsible for the taxi ranks and bus terminals in respective areas?
How strong are the relationships between authorities and the associations?
What happens to these interventions after the virus has been cleared? What will the National Department of Transport do with the lessons learned about readiness to respond to infectious diseases, external threats and other matters of national security?
These are among the various issues that senior officials may need to account for when the next generation reflects on our their actions in the court of “public opinion”. Below are some recommendations for now and in future, one caveat is that I still need to ask around and do some research about the role of non-motorised transport in infectious diseases and threats.
Publish multi-lingual mitigation Standard Operating Procedures (SOPs) and guidelines that are evidence based to be distributed to all staff in public transport and metered taxi/ride-hailing sectors, and made available to public transport and metered taxi/ride-hailing users. These guidelines need to be brief, compact and durable. Train and educate conductors, marshals and associations directly through local representatives about the mitigation guidelines issued by the National Department of Transport. The guidelines should outline protective measures for transport operators, law enforcement in the transport industry and practitioners. They should also include appropriate medicaments for the treatment of materials and surfaces, and driving practices to reduce transmission (i.e. air circulation). These guidelines need to be available within 7 days + 7 days of distribution for each affected sector, to prevent the virus’ spreading, not react to it.
Coordinate local municipalities to in effect take a register and needs assessment of all formal and informal public transport facilities and structures. This register needs to indicate the taxi rank and bus terminal needs with respect to Occupational Health and Safety regulations, and also practical provisions for decent transport interchanges (i.e. shelter, abolition facilities, exterior hand-wash zones, cleaning teams, car wash bays etc.). This requires urgent task teams on the ground ready to prevent the outbreak, not react to it when it occurs. Officials should not use their current Integrated Transport Plans, but should practically assess the facilities themselves in order to appropriately roll-out sanitisation practices as per the guidelines and SOPs.
Fast-track the introduction a vehicle and operator register database with each vehicle having a number tag that passengers can visibly see inside and outside. This may help with local level tracking and tracing while there are few large-scale digital applications for public transport in SA. For long-run purposes, encourage the roll-out of such applications in a regulated, but decentralised fashion, with each regional structure having the capacity to choose the tool that is suitable for them.
Minimise migration and protect passengers who are changing their bookings and travel arrangements. Limiting migration may reduce the coverage of the disease and limit contamination of areas with limited resources and capacity to respond. Minimising migration comes with a trade-off between risking lower containment, and proximity to family support. The Road Traffic Management Corporation needs to be prepared to coordinate intra-regional travel assessments, to curtail the risk and monitor traffic (to the same extent as road safety campaigns in the festive season).
Fund research projects to investigate disease and threat resilience of the transport sector for passenger and freight transport. This should enable appropriate scenarios to be built to stress test the role of the transport industry in a contained, and ethically cleared environment (given the nature of the current issue). Through the evidence found in these studies, develop a transport response strategy, and amend the various policies affected by heterogeneous threats.
Thank you for getting this far in this piece, a PDF version of this report will be available soon. I’ll add the link here. The Podcast from the POWERFM Business show on this topic is also expected. Let me know what you think about these recommendations, maybe you have a few more.