African Reserves

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New research published in the South African Medical Journal has found compelling evidence that a blanket alcohol ban reduces the number of unnatural injury-related deaths, while curfews have less impact. Adele Baleta spoke with lead author Professor Tom Moultrie.

New research published in the SA Medical Journal (SAMJ) found evidence that an alcohol ban reduces the number of unnatural injury-related deaths while curfews have less impact.

Professor Tom Moultrie, senior author and director of the Center for Actuarial Research at the University of Cape Town, said the results show that the weekly number of unnatural deaths (road accidents, suicides and murders) was around 50 % lower than expected during the Level 5 hard lockdown from March to May 2020, and was 26% lower than expected when the sale of alcohol was banned with four to seven hour curfews.

Legal challenges

the SAMJ study comes as the alcohol industry braces for legal challenges to the government’s latest ban on the sale of alcohol under lockdown regulations. The 14-day restrictions as of Monday last week are the fourth time in 18 months that the government has banned the sale of alcohol in an attempt to curb the spread of the SARS-CoV-2 virus, currently driven by the Delta variant.

Nonprofit Vinpro, which represents around 2,600 local wine producers, goes to the High Court in the Western Cape on Wednesday when its demand for an urgent ban against the legality of the restrictions is to be heard.

South African Breweries (SAB) followed suit, filing documents Wednesday last week challenging the ban on administrative law grounds. This follows an earlier legal request by SAB to review and overturn regulations banning the sale of alcohol. This request is still pending.

While agreeing that legal and reasonable measures are needed to contain the virus, the alcohol industry maintains that the recent ban on alcohol sales is not backed by solid science.

Moultrie says the SAMJ study released Friday, which examines the estimated effect of various combinations of alcohol restrictions and curfews, was submitted and accepted in early May – weeks before the recent announcement of the ban on drinking. alcohol – and “the timing of court cases is a coincidence. ”. The SAMJ study used 68 weeks of data from January 2020 to mid-April 2021.

Strong reductions in deaths

Moultrie says the results suggest that a Level 5 lockdown with a total ban on alcohol sales reduces unnatural deaths by about 517 (49.4%) per week. A total alcohol ban with a four to seven hour curfew in place reduced unnatural deaths to around 300 (26%) per week, while a total ban with an eight to nine curfew hours reduced unnatural deaths to about 324 (32%).

Moultrie says the impact of a total alcohol ban on unnatural deaths diminishes with fewer curfew hours.

This finding differs markedly from an earlier study, funded by the alcohol industry (which is not published in any peer-reviewed journal), which argues that the reduction in unnatural deaths was due to curfews and no to alcohol restrictions.

“This document completely refutes that argument,” says Moultrie. “We say the effect is that of the availability of alcohol. This is magnified, to the extent that, as the duration of the curfew decreases, access to alcohol increases. In addition, when there are partial restrictions on alcohol, however long the curfew is, there is no noticeable effect. We never set out to engage with the alcohol industry newspaper, but I think the answers (results) are unequivocal, ”he says.

An abnormality

“The only anomaly we refer to in the document is the six-week period after the hard lockdown (May 31 to July 11, 2020) where there were partial restrictions on alcohol and no curfew, and we have found that there was still a significant reduction of 13% (144 deaths per week) in the number of unnatural deaths.

During this period, economic activity was still severely restricted and while there were restrictions on sales of alcohol for off-site consumption, there was still a complete ban on alcohol for on-site consumption (restaurants , bars and taverns).

“The 13% is statistically significant, but this effect is smaller than the effect of a total alcohol ban of 49.4%,” he says.

Researchers find it hard to note that while there is about a 50% (49.4%) reduction in the number of unnatural deaths under the full restriction of level 5 lockdown, they think it’s probably close. from the upper end of the likely impact. of any total ban on alcohol.

Moultrie says there are two reasons for this conclusion.

Initially, people were shocked and blinded by the alcohol ban and they had not switched to alcohol reserves. He says that with rumors of “family reunions” and impending lockdowns, people are taking their disposable income and rushing to bottle shops and stockpiling alcohol.

Moultrie says the other reason is the effect of illegal or illicit trade networks that have broken into the breach. “There is certainly enough anecdotal data on how people got hold of alcohol or cigarettes during that first Level 5 lockdown,” he says.

“These networks didn’t exist at the start, but then they evolved. We don’t have data from last week, but we saw that in January, after the announcement of strict alcohol restrictions on December 27, unnatural deaths dropped dramatically, but a little less than before. ”

The authors therefore caution that the observed effect of full restrictions may diminish over time, due to early reimposition of restrictions and the presence of illicit alcohol supplies.

Previous proof

SAMJ paper co-author Professor Charles Parry and others in a presentation hosted by the Minister of Health (now on special leave) in mid-2020, showed a 60% reduction to 70 % of hospital visits and admissions related to the initial ban below levels 4 and 5 of last year’s lockdown. Parry is the Director of the Alcohol, Tobacco and Other Drugs Research Unit at the South African Medical Research Council (SAMRC).

Moultrie cites a recent study from Tygerberg Hospital which he says showed results consistent with theirs.

“They saw about a 50% reduction in ICU trauma admissions during last year’s strict lockdown. Additionally, they found that there was no difference in trauma admissions during Level 3 lockdown with or without the sale of alcohol in 2020, compared to 2018. Research from Tygerberg Hospital shows that the partial restrictions had a limited impact on ICU admissions, ”he says.

“We need a different approach”

However, Moultrie adds, a complete sales ban is not a long-term solution. “We need a different approach. We need a national conversation that begins with “Hello, my name is South Africa, we have a collective drinking problem”.

“We need the collective recognition of all actors – all South Africans, the alcohol industry and government – that we have this problem and then we can start a serious discussion on how to reduce consumption. excessive drinking, unnatural deaths and the burden of alcohol consumption on health facilities, ”says Moultrie.

Issues to consider include the minimum unit price of alcohol, restrictions on the volumes of alcohol sold by reducing the size of alcohol containers, increasing the minimum age for consumption and restrictions on the marketing of alcohol. alcohol.

He says political decisions on these important issues are complex and require careful consideration.

“There are economic implications and we are not taking a fundamentalist approach… but it is clear that when the nation was surprised by a strict alcohol ban, the number of alcohol-related deaths and hospitalizations – and, we suspect, gender-based violence – are all affected in a positive way, ”he says.

The authors – the same team that produces the SAMRC Excessive Deaths report – conclude that the ability to “capture and make available near real-time cause-of-death data would be an important step forward in surveillance and response. to future epidemics of infectious diseases “.

Moultrie says the Home Office has a weekly report on excessive deaths, “but all we get in real time is whether or not the death is due to natural causes or not. What we don’t know is what people were dying of. We do not know, for example, whether the alcohol ban could have significantly reduced suicides or road accidents or homicides.

Data on the causes of death were not released until three years later, in what he described as a complex process. “We actually drive a car looking in the rearview mirror. The delay limits our ability to follow an epidemic in real time and establish the cause of unnatural deaths. “

The current paper-based death certificate system needs to move to an electronic data entry system, he says. SM / MC

Adele Baleta is a freelance science writer and member of the vaccine reluctance working group for the National Immunization Advisory Group.

This article was produced by Projector – public interest health journalism.

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