An independent review of the South African Medical Research Council's (SAMRC's) 'Impact of Alcohol on Health Services in South Africa' report and its data inputs, has identified a number of study design and statistical modelling limitations owing to the lack of complete data presented, alcohol industry representatives state.

The South African alcohol industry calls on government to take note of the findings of the independent review initiated by the alcohol industry.

It also calls on government to engage with the industry to find an urgent solution to lifting the suspension on alcohol sales, which will enable the industry to return to some form of operational normality, says South African alcohol industry representative and South African Liquor Brand Owners Association spokesperson Sibani Mngadi.

The South African alcohol sector employs thousands of people and contributes to the livelihoods of millions of people. The suspension on alcohol sales has rendered many thousands of people in the entire value chain without the ability to earn a living.

South Africa is one of only four countries in the world to retain a complete prohibition on alcohol sales, and the industry believes urgent action from the National Coronavirus Command Centre will enable a rapid restart of the sector, allowing thousands of jobs to be saved and the industry to be positioned to continue to contribute to the government’s fiscus by way of taxation, value-added tax and excise duties, among other payments.

The SAMRC report indicated that an alcohol ban would directly reduce hospitalisations in South Africa – in order to free up capacity for Covid-19 treatment – representing a total reduction of 49 550 cases over an eight-week period. This total reduction in trauma unit cases would also be accompanied by a reduction in hospital overcrowding, which may be related to increased risk of coronavirus transmissions between patients and emergency room staff, as well as fewer resources, available staff, and hospital beds for coronavirus patients, the SAMRC report stated.

The review, however, found that the nature of the data used in the modelling was incomplete, with the alcohol industry stating that this makes it difficult to accurately determine the extent of the link between trauma admissions and alcohol abuse.

"The main motive for this finding is that the reason for each trauma is not captured by the hospitalisation data provided in the report. There is no information on whether the trauma cases resulted from alcohol use, or from any other cause. The model, therefore, may be able to predict the total number of potential trauma cases prevented; however, it remains uncertain as to the extent of the relationship between alcohol consumption and the number of trauma admissions in South African hospitals.

"Importantly, the estimate for the number of trauma unit presentations per year in South Africa is based on extrapolations from data that is two decades old. The initial estimate used for modelling the potential number of reduced trauma unit presentations is based on data from roughly 356 secondary and tertiary public hospitals in 1999.

"To calculate the number of trauma unit presentations across the same hospital type in 2020, the population growth between 1999 and 2019 was used as a multiplier. However, the review finds that it is not apparent whether the number of secondary and tertiary public hospitals operating in 2019 is accounted for, as a substantial increase or decrease in the number of operating hospitals, notwithstanding the capacity of each hospital, could impact the number of cases admitted," the industry states.

"Although the estimates per week for trauma presentations before lockdown and in Level 3 (80% of pre-lockdown trauma presentations) may be estimated using actual hospital-based data, it is not clear what evidence guided the expert opinion that 50% of trauma presentations were alcohol-related.

"In fact, the subsequent estimated multiplier is based on expert opinion as well. The study itself recognises that a reduced number of trauma presentations may be related to more restrictions on movement, work, exercise, and fewer vehicles on the road – all factors that exist at the end of lockdown and present challenges in modelling separately," the coalition says.

The industry coalition acknowledges that the need to control the spread of coronavirus is an absolute imperative. However, given the current data available, the extent of a causal relationship between alcohol sales and trauma case presentations is difficult to isolate, it notes.