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Dr Angelique Coetzee is a GP in the South African capital Pretoria, where she has run a family clinic for the past 33 years.

But she has never known anything like COVID-19.

She said: “If you have never been in such a situation, you can’t imagine what it is like. We’ve been dealing with 30 or 40 positive cases every day. The pressure is extreme.

“If you look at a country like Australia where they have a few cases, well I would see their national caseload in a couple of days. Can you imagine?”

When we first spoke in June, Dr Coetzee seemed on the verge of tears.

She said: “If I speak to you now, that means someone with COVID will not been seen – and there is no point trying to message. I don’t have time to answer.”

Dr Angelique Coetzee is a GP in the South African capital Pretoria
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Dr Angelique Coetzee is a GP in the South African capital Pretoria

South Africa has found itself in the grips of a Delta variant-driven “third wave” of infection.

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The caseload has been brutal, outstripping the first two waves by a factor of three.

The country’s acting health minister says this surge has now peaked in the province of Gauteng, where the cities of Pretoria and Johannesburg are situated but Dr Coetzee says her personal and professional burden has barely changed.

She said: “We have been seeing fewer patients on a daily basis this week but the weather is colder and COVID-19 patients are turning up with pneumonia so we are seeing sicker patients than we have been during the last three or four weeks.”

South Africa’s beleaguered public-run health system has struggled to cope with wave after wave of the virus.

Lacking sufficient beds and qualified staff, city hospitals used casualty departments as holding centres where patients wait for space to free up – sometimes for days.

South Africa's healthcare system has been struggling with staff shortages during the pandemic
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South Africa’s healthcare system has been struggling with staff shortages during the pandemic

“This is the third wave we have experienced, comes less than six months (after the second) and the infrastructure can’t cope,” said Dr Coetzee.

“Most patients need oxygen and I try to admit them to hospital but because of (capacity) problems I have had to treat them at home. We have been waiting for 24 to 48 hours before we could get them cylinders, dealing with the stress of trying to manage patients without oxygen with the knowledge that if we don’t make a plan they are going to die. All this while the surgery is full, full, full. It is so very stressful.”

The extreme working patterns and the mental pressures that come with it have been felt in unexpected ways.

“I have had colleagues who have had motor vehicle accidents. One was so tired after work that he drove his car into a tree,” she said.

“The second one was hit at a crossroads – and a lady doctor reversed into a garage door because she had forgotten to open it. The most bizarre things that happen in a short space of time but it shows you the pressure they are under.”

Community groups have been running ad-hoc clinics in South Africa during the pandemic
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Community groups have been running ad-hoc clinics in South Africa during the pandemic

Dr Coetzee has been operating on the very edge within a healthcare system that was been put under severe strain.

There are no support workers or home visits or specialist consultations for most people in South Africa.

Instead, GP’s like Dr Coetzee try to do it all.

“You become distant after a while but you try to carry on and on. I think that is the only way to survive it,” she said.

Yanga Booi is a 32-year-old nurse working at the intensive care unit at Thelle Mogoerane Regional Hospital in Vosloorus, on the outskirts of Johannesburg.

He says the hospital is poorly equipped and the staff have been insufficiently prepared during the pandemic.

He said: “The health system in South Africa did a complete spin when the pandemic hit our shores. We were put in the spotlight and given this false sense of heroism, but it wasn’t the right sort of attention because when we went to work, the hospital was in a worse state that than it was before.

“We were ill-prepared from the beginning, and we are still not prepared.”

The third wave has come as rioting and looting has taken place across the country
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The third wave has come as rioting and looting has taken place across the country

The hospital in Vosloorus provides beds and treatment but Booi says COVID testing at the facility is not reliable and patients are not properly isolated.

“We cannot be sure who has COVID because we get so many false negatives. It’s like we wait for people to get sick or drop dead, then look into the COVID thing,” he said.

“I remember admitting a patient who was negative on admission and so we didn’t isolate him. A few days later he died and we found out that he was positive.

“It’s a sad situation because the hospital does not have an isolated ICU ward for COVID patients. It’s a general ICU with isolation rooms and we admit COVID patients to it – some people have it and others don’t. We cannot be sure.”

Mr Booi says dozens of his colleagues have paid a terrible price over the course of three separate waves of infection in South Africa.

He said: “It is unfortunate that we have had to watch our colleagues dying from this… countless members of staff have gone, it’s not just nurses, it’s the doctors, it’s the clerks, it’s the porters.”

The 32-year old, who took up the profession when he was offered a government bursary, says he was “deeply afraid” when the pandemic arrived.

Yet 17 months later he has noticed a change in himself and others.

Yanga Booi said the country was ill-prepared for the pandemic
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Yanga Booi said the country was ill-prepared for the pandemic

He said: “The loss of life has caused us to grow a thick skin, just like when we came into the profession. Our first experiences with death were terrifying but then we got accustomed to people dying and that is what has happened with COVID.

“We are used to the virus we know it is here to stay and we must find ways to keep going.”

Dr Shabir Mahdi is dean of the faculty of health sciences at Witwatersrand University in Johannesburg and is a source of expertise and fearless criticism in a country that has struggled in all aspects of its pandemic response.

Dr Mahdi says the ferocity of South Africa’s third wave of infection came as a “huge surprise”.

He said: “The current resurgence far exceeds what we have experienced either in the first or second wave in the number of documented cases. In fact, the numbers of new cases diagnosed on a daily basis is three times what it was at the time of the peak of the first and second wave.”

Dr Shabir Mahdi said the third wave in the country came as a 'huge surprise
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Dr Shabir Mahdi said the third wave in the country came as a ‘huge surprise’

However, this eminent viriologist is unsparing in his criticism of the government’s response.

While the magnitude of the Delta-fuelled third instalment could not have been predicted, he says health officials knew another wave was coming at the beginning of South Africa’s winter season.

He said: “In a province like Gauteng where 25% of the population live, our hospitals are completely overwhelmed but at the same time, we have beds that are literally vacant in the same hospitals and we can’t actually use those beds because some official in some government department forgot that you actually need to have health care workers available to actually staff those beds.”

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Israel v Iran – Is escalation inevitable?

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Vietnam: Property tycoon Truong My Lan sentenced to death after country’s biggest fraud trial

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Vietnam: Property tycoon Truong My Lan sentenced to death after country's biggest fraud trial

A property tycoon has been sentenced to death in Vietnam after the biggest fraud trial in the country’s history.

Truong My Lan was sentenced on Thursday by a court in Ho Chi Minh City after being found guilty of embezzlement, bribery and violations of banking rules following a month-long trial, state media reported.

The 67-year-old chair of the company Van Thinh Phat (VTP) was accused of fraud amounting to $12.5bn – nearly 3% of the country’s GDP in 2022.

Lan and her accomplices were charged with illegally controlling the Saigon Joint Stock Commercial Bank (SCB) between 2012 and 2022 to siphon off funds through thousands of ghost companies and by paying bribes to government officials.

From early 2018 to October 2022, when the state bailed out SCB after a run on its deposits, Lan appropriated large sums by arranging unlawful loans to shell companies, investigators said.

The start of the trial featured prominently in state media, which showed pictures and footage of Lan in the courtroom surrounded by dozens of police officers.

Truong My Lan
Pic: AP
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Lan was sentenced after a month-long trial. Pic: AP

“Lan didn’t plead guilty and didn’t show remorse,” Thanh Nien newspaper cited the prosecutors as saying last month, while demanding the death penalty on the charge of embezzlement.

“The consequences are extremely serious and irreparable, and therefore, there must be a strict punishment for Truong My Lan and remove her from society,” it added.

The harsh sentence was due to the seriousness of the case, with the court saying Lan was at the helm of an orchestrated and sophisticated criminal enterprise that had serious consequences – with no possibility of the money being recovered, state media VnExpress reported on Thursday.

“We will keep fighting to see what we can do,” a family member told Reuters news agency, speaking on condition of anonymity. Before the verdict was issued, he had said Lan would appeal against the sentence.

A total of 84 defendants in the case received sentences ranging from probation to life imprisonment, reported Thanh Nien.

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VTP was among Vietnam’s richest property firms, with projects including luxury residential buildings, offices, hotels and shopping centres.

Lan’s arrest in October 2022 was among the most high-profile in an ongoing anti-corruption drive in Vietnam.

The crackdown, dubbed “blazing furnace”, has led to hundreds of senior state officials and high-profile business leaders facing prosecution or being forced to step down.

Former President Vo Van Thuong resigned in March after being implicated in the campaign.

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Nguyen Phu Trong, leader of the ruling Communist Party, has pledged for years to stamp out corruption in the country.

In November, he said the anti-corruption fight would “continue for the long term”.

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Risks of bigger war rising as Iran intends to hit back over suspected Israeli embassy strike – but Biden knows he can’t blink

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Risks of bigger war rising as Iran intends to hit back over suspected Israeli embassy strike - but Biden knows he can't blink

The risks of the Gaza war expanding into a much bigger regional conflict had seemed to have subsided. Not any longer.

Comments from Iranian and American leaders in the last 24 hours may be entirely predictable but they raise the prospects of escalation.

Iran knows it’s been directly attacked in the airstrike on its embassy in Damascus and unless it retaliates it is weakened.

And in this region that is dangerous.

So on Wednesday, celebrating the end of Ramadan, Iran’s supreme leader Ali Khamenei issued a stern warning that Israel must be punished and will be.

Middle East latest:
Iran attack on Israel could be imminent

Iran's Supreme Leader Ayatollah Ali Khamenei speaks during a meeting with members of the Air Force in Tehran, Iran 
Piv:WANA/Reuters
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Iran’s Supreme Leader Ayatollah Ali Khamenei. Piv: WANA/Reuters

The US president knows the attack presumed by most to have been the work of its ally Israel violated international law which declares embassies ‘inviolable’.

And Biden’s relations with the man who almost certainly ordered it, Israeli Prime Minister Benjamin Netanyahu, are rock bottom.

But the US president also knows any sign of weakness on his part is dangerous, too.

It would only embolden Iran to do its worst and that in turn would provoke Israel to do the same – potentially setting the entire region alight.

Joe Biden during a meeting with Israeli Prime Minister Benjamin Netanyahu.
Pic: AP
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Relations are strained between Biden and Netanyahu. Pic: AP

So Joe Biden has declared his ironclad support for Israel and raised the prospect of America becoming directly involved if war were to break out between its ally and Iran.

It is exactly the same calculus that led the US president to send two naval carrier groups to the waters off Israel in the wake of the 7 October attacks by Hamas to warn Iran – ‘don’t get involved’.

That move was successful. This time Biden may need to do more.

Read more:
Three sons of Hamas leader killed in Israeli strike
Key element in path to peace still missing

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Biden: ‘We want to address Iranian threat’

Iran has shown remarkable restraint holding back in this war despite frequent attacks by Israel on its assets and allies in Syria and Lebanon.

It has done so by claiming those attacks were not direct strikes on Iran itself.

The logic is clear. The ayatollahs are weak at home after the biggest uprising against its rule since its revolution and a regional war would be devastating.

But a direct attack on an embassy can’t be overlooked. The Iranians have made that clear.

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They believe they have to retaliate.

But by the same logic, they may try to calibrate their response to avert a regional conflagration.

The region watches and waits.

The balance of stability in the Middle East hangs on Tehran’s decision.

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