From the perspective of reducing the negative public health effects of the coronavirus, national lockdowns will almost certainly—if adhered to—reduce the number of coronavirus transmissions while they are in place. The important question of when, and for how long, to implement them remains a matter of debate. But the main concern with such policies is their negative consequences for economic activity (businesses and workers) and other aspects of people’s well-being. While all countries will suffer on these dimensions, less wealthy and more unequal countries will experience greater relative harm and have fewer national resources available to offset this. Every state has to grapple with, and adequately answer, the question as to how they will offset the harms caused by lockdowns. And it is primarily these costs that make the question of viable “exit strategies” almost as pressing, and contested, as how individuals are expected to survive while they are in place.

There is not yet reliable evidence as to whether death rates vary significantly by socioeconomic status in South Africa or elsewhere. Given that the virus causes death among those with underlying health conditions and through respiratory mechanisms, there are very real fears that the proportion of deaths could be worse in a country like South Africa where HIV, tuberculosis and other diseases afflict a significant portion of the population. Yet it is also clear that personal wealth is no guarantee of recovery. So while lockdowns in countries like South Africa are sometimes rationalized as being for the benefit of the poorest and worst off, they arguably benefit the well off at least as much. However, when it comes to the downsides of drastic measures, whatever their direct public health merits, the already-poor and vulnerable are unquestionably the worst affected. Poverty and inequality research abounds in South Africa, so there is no shortage of statistical information and analysis of how stark the already-obvious divides are. A particular concern in the current context is the risk of hunger and starvation.

That means a lockdown without significant compensating social and economic policy measures amounts to an inequitable socialization of the cost of this public health intervention: the poor suffer relatively more than the rich for the same benefit to society. Besides being profoundly unjust, and exacerbating existing inequalities, this could also ultimately undermine the public health benefits in the longer-run of the pandemic.