Is the acknowledged decline in hospital trauma admissions during the various lockdowns a result of the ban on alcohol, restrictions on people’s movement or a combination of both? Research (conducted on behalf of the alcohol industry) suggests the answer lies somewhere in between.
Amended lockdown regulations over the Easter weekend saw the number of people
who could attend religious and other gatherings more than double to 250 people indoors
and 500 outdoors, and, while shebeens and restaurants remained open, the offsite sale of liquor was prohibited for four days.
The apparent lack of a scientific basis for these decisions prompted the South African
Liquor Brands Association to release research it commissioned several months ago.
The researchers set out to interrogate the widely held view that there is a clear causal link
between the three alcohol bans (excluding the recent Easter ban) and the visible and, at
times, startling decline in hospital trauma admissions that occurred at the same time.
This decline has led to the widely held belief that the level of trauma admissions can be
causally linked to the different levels of alcohol restrictions.
The researchers do not believe that this logic holds, however.
They argue that this theory fails to address the fact that alcohol restrictions coincided with
other restrictions that may also have had an impact on trauma admissions — not least of
which was the level of lockdown.
In fact, the researchers found that the measured association between alcohol restrictions
and trauma admissions in 2020 becomes statistically insignificant when an adjustment for
the simultaneously imposed curfew is made.
The data analysis was led by independent data expert Ian McGorian of Silver Fox
Consulting, in collaboration with Prof Mike Murray from the University of KwaZulu-Natal’s
School of Mathematics, Statistics and Computer Science, with financial support from Distell.
They examined publicly available data sources, such as SA Police Service annual reports,
data from the Medical Research Council, Google mobility data and Sentinel data, which is
publicly available data on hospital admissions and releases — although when the
researchers began their analysis, just five Western Cape hospitals, namely Mitchells Plain,
Groote Schuur, George regional hospital, Tygerberg and Heideveld, were making their trauma data publicly available.
The analysis was peer-reviewed by Prof Graham Barr from the department of statistical sciences at the University of Cape Town.
Key findings included the fact that trauma cases in South Africa under lockdown dropped
60%. Other countries without an alcohol ban also experienced a similar phenomenon,
including the UK (-57%), Ireland (-62%), Italy (-56.6%) and the US (-54%), raising
questions about the efficacy of bans on alcohol.
The researchers also noted that while alcohol is often cited as the leading factor in violent
crime, the SAPS’ annual report of 2019-2020 shows that alcohol is confirmed in only a
small percentage of cases: 5.4% of sexual offences, 5.3% of assaults, 6.7% of murders,
6.9% of attempted murders and 11.9% of assault with intent to cause grievous bodily harm.
South African Liquor Brand Owners Association (SALBA) chairperson Sibani Mngadi said
the industry was acutely aware of the realities and harms associated with the
irresponsible consumption of alcohol by some consumers, as well as the pressure frontline
healthcare personnel experienced during surges of Covid-19.
The analysis was not intended to dispute this, but rather open a constructive dialogue on facts, towards finding holistic solutions.
Prof Charles Parry, director of the alcohol, tobacco and other drugs research unit at the
South African Medical Research Council, questioned the methodology used. “This appears
to be a report… not a published research paper. Its biggest flaw is it lacks the
methodological detail needed to adequately assess the methodology applied.”
“We understand that the government carries the daunting responsibility
to save lives in the face of a disease that has claimed too many already,” he says. “We accept that we have a responsibility to help eliminate the abuse of alcohol and the social ills that go with it, knowing, also, that we can’t achieve this alone. Effective enforcement of existing regulations is a big part of the equation.”
At the same time, he notes, the whole alcohol value chain, from retailers to glass manufacturers, had been damaged by the alcohol bans and the same would potentially be true of more stringent liquor regulations.
It is critical to have an objective analysis of the data being used to justify such actions, and any restrictions should be evidence-based.
The analysis showed the assumption that alcohol was a leading cause of trauma admissions was not supported by the data — using official, publicly available statistics for anyone to scrutinise.
While Salba plans to release further data and analysis in time,
some experts contacted by SA TIMES NEWS were sceptical.
“The link between alcohol and trauma is well established and we saw distinct drop-offs during the alcohol bans,” says trauma surgeon Prof Timothy Hardcastle.
To compare the drop-off in South Africa to other countries without an alcohol ban is misleading, he adds. “These are countries where the policing is far stricter; where controls on the sale of alcohol are in place, or huge surcharges implemented on alcohol, making it less affordable.”
Prof Charles Parry, director of the alcohol, tobacco and other drugs research unit at the South African Medical Research Council, questioned the methodology used. “This appears to be a report… not a published research paper. Its biggest flaw is it lacks the methodological detail needed to adequately assess the methodology applied.”
On the subject of causation
, which requires that for A to cause B, a variety of criteria must be met, Parry notes that both instruments — the liquor sales bans and the restrictions on mobility — are causally related to trauma presentations.
“The fact that another intervention affects the outcome (trauma presentations) does not invalidate an intervention (the temporary liquor sales ban) from also causally impacting on that outcome,” he says.
However, recognising that Mediclinic serves a private rather than a public market, its chief clinical officer, Dr Gerrit de Villiers, notes that following the withdrawal of the alcohol ban in February 2021, “we have seen a steady but not immediate increase in trauma-related emergency centre cases and admissions to our Mediclinic hospitals.
“The reintroduction of full trading hours for alcohol sales has not had any significant effect on trauma cases.”
Minimising transmission remains a key factor in managing the effects of the pandemic
and everyone needs to play their part in preventing further spread, he adds.
Far from attempting to provoke an argument, Distell CEO Richard Rushton says the industry is simply asking that an objective view be taken of the data in order to facilitate more meaningful dialogue with decision-makers.
“We are all on the same side and we want to help find solutions. We are very clear that alcohol abuse is unacceptable and causes harm. Our view is that the focus must be on finding ways to deal with high-risk drinkers, rather than using blunt instruments that penalise all South Africans.
“Any proposed new regulations need to be evidence-based, Lockdowns, rational and target problem areas.”