‘The infrastructure can’t cope’: South African healthcare workers struggle to deal with third wave

Published

4 years ago

July 25, 2021

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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.”

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

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.

“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.”

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 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.

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.”

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.”

World

Women’s Euros: Extreme heat warnings in place as tournament kicks off

Published

1 hour ago

July 1, 2025

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Women's Euros: Extreme heat warnings in place as tournament kicks off

The Women’s Euros begin in Switzerland today – with extreme heat warnings in place.

Security measures have had to be relaxed by UEFA for the opening matches so fans can bring in water bottles.

Temperatures could be about 30C (86F) when the Swiss hosts open their campaign against Norway in Basel this evening.

Players have already seen the impact of heatwaves this summer at the men’s Club World Cup in the US.

It is raising new concerns in the global players’ union about whether the stars of the sport are being protected in hot and humid conditions.

FIFPRO has asked FIFA to allow cooling breaks every 15 minutes rather than just in the 30th minute of each half.

There’s also a request for half-time to be extended from 15 to 20 minutes to help lower the core temperature of players.

FIFPRO’s medical director, Dr Vincent Gouttebarge, said: “There are some very challenging weather conditions that we anticipated a couple of weeks ago already, that was already communicated to FIFA.

“And I think the past few weeks were confirmation of all worries that the heat conditions will play a negative role for the performance and the health of the players.”

Football has seemed focused on players and fans baking in the Middle East – but scorching summers in Europe and the US are becoming increasingly problematic for sport.

While climate change is a factor, the issue is not new and at the 1994 World Cup, players were steaming as temperatures rose in the US.

There is now more awareness of the need for mitigation measures among players and their international union.

FIFPRO feels football officials weren’t responsive when it asked for kick-off times to be moved from the fierce afternoon heat in the US for the first 32-team Club World Cup.

FIFA has to balance the needs of fans and broadcasters with welfare, with no desire to load all the matches in the same evening time slots.

Electric storms have also seen six games stopped, including a two-hour pause during a Chelsea game at the weekend.

This is the dress rehearsal for the World Cup next summer, which is mostly in the US.

The use of more indoor, air conditioned stadiums should help.

There is no prospect of moving the World Cup to winter, as Qatar had to do in 2022.

And looking further ahead to this time in 2030, there will be World Cup matches in Spain, Portugal and Morocco. The temperatures this week have been hitting 40C (104F) in some host cities.

FIFA said in a statement to Sky News: “Heat conditions are a serious topic that affect football globally.

“At the FCWC some significant and progressive measures are being taken to protect the players from the heat. For instance, cooling breaks were implemented in 31 out of 54 matches so far.

“Discussions on how to deal with heat conditions need to take place collectively and FIFA stands ready to facilitate this dialogue, including through the Task Force on Player Welfare, and to receive constructive input from all stakeholders on how to further enhance heat management.

“In all of this, the protection of players must be at the centre.”

World

Trump’s USAID cuts could lead to 14 million deaths, report warns

Published

12 hours ago

July 1, 2025

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Trump's USAID cuts could lead to 14 million deaths, report warns

Around 14 million people could die across the world over the next five years because of cuts to the US Agency for International Development (USAID), researchers have warned.

Children under five are expected to make up around a third (4.5 million) of the mortalities, according to a study published in The Lancet medical journal.

Estimates showed that “unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030”.

“Beyond causing millions of avoidable deaths – particularly among the most vulnerable – these cuts risk reversing decades of progress in health and socioeconomic development in LMICs [low and middle-income countries],” the report said.

USAID programmes have prevented the deaths of more than 91 million people, around a third of them among children, the study suggests.

The agency’s work has been linked to a 65% fall in deaths from HIV/AIDS, or 25.5 million people.

Eight million deaths from malaria, more than half the total, around 11 million from diarrheal diseases and nearly five million from tuberculosis (TB), have also been prevented.

USAID has been vital in improving global health, “especially in LMICs, particularly African nations,” according to the report.

Established in 1961, the agency was tasked with providing humanitarian assistance and helping economic growth in developing countries, especially those deemed strategic to Washington.

But the Trump administration has made little secret of its antipathy towards the agency, which became an early victim of cuts carried out by the Department of Government Efficiency (DOGE) – formerly led by Elon Musk – in what the US government said was part of a broader plan to remove wasteful spending.

In March, US Secretary of State Marco Rubio said more than 80% of USAID schemes had been closed following a six-week review, leaving around 1,000 active.

The US is the world’s largest humanitarian aid donor, providing around $61bn (£44bn) in foreign assistance last year, according to government data, or at least 38% of the total, and USAID is the world’s leading donor for humanitarian and development aid, the report said.

Between 2017 and 2020, the agency responded to more than 240 natural disasters and crises worldwide – and in 2016 it sent food assistance to more than 53 million people across 47 countries.

The study assessed all-age and all-cause mortality rates in 133 countries and territories, including all those classified as low and middle-income, supported by USAID from 2001 to 2021.

World

Thai PM Paetongtarn Shinawatra suspended amid outrage over leaked phone call

Published

15 hours ago

July 1, 2025

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Thai PM Paetongtarn Shinawatra suspended amid outrage over leaked phone call

Thailand’s prime minister has been suspended after a leaked phone call with a senior Cambodian politician caused outrage.

An ethics investigation into Paetongtarn Shinawatra is under way and she could end up being dismissed.

The country’s constitutional court took up a petition from 36 senators, who claimed dishonesty and a breach of ethical standards, and voted 7 to 2 to suspend her.

The prime minister’s call with Cambodia’s former leader, Hun Sen, sparked public protests after she tried to appease him and criticised a Thai army commander – a taboo move in a country where the military is extremely influential.

Ms Shinawatra was trying to defuse mounting tensions at the border – which in May resulted in the death of one Cambodian soldier.

Thousands of conservative, nationalist protesters held a demo in Bangkok on Saturday to urge her to step down.

Her party is clinging on to power after another group withdrew from their alliance a few weeks ago over the phone call. Calls for a no-confidence vote are likely.

Deputy prime minister Suriya Juangroongruangkit will take over temporarily while the court looks into the case.

The 38-year-old prime minister – Thailand‘s youngest ever leader – has 15 days to respond to the probe. She has apologised and said her approach in the call was a negotiating tactic.

The popularity of her government has slumped recently, with an opinion poll showing an approval rating of 9.2%, down from 30.9% in March.

Ms Shinawatra comes from a wealthy dynasty synonymous with Thai politics.

Her father Thaksin Shinawatra – a former Manchester City owner – and aunt Yingluck Shinawatra served as prime minister before her – in the early to mid 2000s – and their time in office also ended ignominiously amid corruption charges and military coups.