‘The infrastructure can’t cope’: South African healthcare workers struggle to deal with third wave
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
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.
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
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
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
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’
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.”
An earthquake off the Russian peninsula of Kamchatka has triggered tsunami warnings in Japan, China, Hawaii, the US and central and Latin America.
The 8.8 magnitude earthquake occurred 12 miles below the surface of the water and around 80 miles southeast of the city of Petropavlovsk-Kamchatsky, northeastern Russia on Wednesday, according to the US Geological Survey.
First five waves hit Hawaii; Tsunami warnings latest
So far, it’s the most powerful on record since the 9.1 Japanese earthquake of 2011, which left more than 15,000 people dead, and the sixth strongest since records began.
Tsunamis have started to reach land in Japan and Hawaii, with urgent warnings being issued across the Pacific – from Asia to the US and Canada. Here’s what we know so far.
How did it start?
The earthquake struck at shallow depth 80 miles southeast of Petropavlovsk-Kamchatsky – a city of 165,000 people along the coast of Russia’s Avacha Bay, at around midday on Wednesday, local time (1am UK).
A map shows the epicentre of the tsunami off the coast of Kamchatka Peninsula
Waves were recorded of up to 4m (13ft) in Severo-Kurilsk on the Kuril Islands where a state of emergency has been declared.
Russia’s Tass news agency reported people running out into the streets, with balconies shaking, furniture and glass broken inside homes, and cars swaying on the street. Around 2,700 people were evacuated.
Electricity cuts were also reported across the peninsula.
Several people were injured and had to seek medical assistance, according to regional health minister Oleg Melnikov.
“Unfortunately, there are some people injured during the seismic event. Some were hurt while running outside, and one patient jumped out of a window. A woman was also injured inside the new airport terminal,” he said.
Severo-Kurilsk, Russia. Pic: Russian Academy of Sciences/Reuters
Powerful waves engulf coastal buildings in Severo-Kurilsk. Pic: Reuters
Where else have tsunamis hit so far?
Injuries have been reported in several countries, but there are no known deaths so far.
Beyond Russia, waves have started to reach Japan, Hawaii, and the US West Coast.
Tsunami waves off the coast of Japan. Pic: AP
Two million people have been evacuated along the country’s Pacific coast, with evacuation advisories in place in more than 220 municipalities, according to the Fire and Disaster Management Agency. Nuclear power plants have also paused activity.
One caused waves of 60cm (2ft) on the island of Hokkaido and another reached 50cm (1.6ft) at Ishinomaki port in the north of the country. In northern Iwate, 40cm (1.3ft) waves were registered at Kuji port.
The tsunami alert has been lowered for south of Fukushima but is still in place in the north.
People evacuated to the rooftop of a fire department building in Mukawa, Hokkaido. Pic: Kyodo/AP
A tsunami warning in Japan. Pic: Yomiuri Shimbun/AP
In Hawaii, people rushed to seek higher ground after waves measured 1.82m (6ft).
Earthquake sirens blared in the streets, with beaches closed and coastal areas evacuated. Maui airport was also closed, Hawaii Governor Josh Green added.
Evacuation orders were later lifted, with the Pacific Tsunami Warning Centre (PTWC) saying it was safe to return to coastal areas.
In Alaska, 30cm (1ft) waves were observed in the communities of Amchitka and Adak, according to Dave Snider, tsunami warning coordinator.
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A hotel overlooking Waikiki Beach in Hawaii on Wednesday. Pic: Reuters
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Tsunami warning for Pacific region
Where are the other warnings in place?
In China, the country’s tsunami warning centre has issued alerts for eastern coastal areas – particularly Shanghai and Zhejiang, which was already under alert from Typhoon CoMay, due to land on Wednesday.
States along the US West Coast have issued tsunami advisories, including Oregon, Washington State, and California, where waves have already hit.
Oregon’s Department of Emergency Management cautioned: “This is not a major tsunami, but dangerous currents and strong waves may pose a risk to those near the water.”
President Donald Trump posted on X: “A Tsunami Watch is in effect for Alaska and the Pacific Coast of the United States. Japan is also in the way. Please visit tsunami.gov/ for the latest information. STAY STRONG AND STAY SAFE!”
The Mexican Navy said that tsunami waves were due to hit Mexico’s northern coast at Ensenada near California, and could progress to Chiapas.
In New Zealand, the country’s disaster management agency issued warnings for coastal areas, which are likely to see “strong and unusual currents and unpredictable surges at shore”.
There is currently no need for official evacuation orders, it added, but people are being told to stay away from the coast.
The Pacific Island nations of Fiji, Samoa, Tonga, Micronesia, and the Solomon Islands have all issued warnings, as their low-lying topography puts them at particular risk.
The Philippines had a tsunami advisory in place but cancelled it after “no significant sea level disturbances or destructive tsunami waves” were reported after 7.25am local time (12.25am UK) on Wednesday.
What happens during a tsunami – and why are they so dangerous?
Tsunamis are a series of very long waves usually caused by an earthquake beneath the ocean’s surface. Although rare, they can also be triggered by landslides, volcanic activity, and sometimes by extreme weather above the ocean.
Unlike normal waves, which are driven by wind, tsunamis move through the entire ocean column – from the sea floor to the surface.
This means they can be incredibly powerful and fast – reaching plane-like speeds of around 500mph in the deepest parts of the ocean.
Their force means they can stretch across an entire ocean basin, impacting multiple countries. The 2004 Boxing Day tsunami caused damage in 17 nations.
Tsunamis become most dangerous when they reach land. The shallowness of the water sees the length of the waves decrease – but their height increase.
Tall waves can be very dangerous. It only requires six inches of water to knock someone off their feet and double that to sweep away a car.
Tsunami waves are also dangerous when they go back out to sea, carrying heavy debris with them.
An enormous 8.8 magnitude earthquake has hit off the far east of Russia – potentially the sixth largest on record.
The quake has triggered waves of up to 4m (13ft) in the Kamchatka Peninsula, where buildings were damaged and several people injured, officials said.
It has also led to tsunami fears across the Pacific, with warnings and alerts in place across Japan, parts of the US including Hawaii, California and Alaska, and the Philippines.
Follow live updates as widespread tsunami warnings issued
The US Geological Survey (USGS) said the earthquake was shallow at a depth of 19.3km (12 miles), and was centred about 125km (80 miles) east-southeast of Petropavlovsk-Kamchatsky, a city of 165,000 along the coast of Avacha Bay.
A powerful wave washes past a building located near the shore off the Kamchatka Peninsula in Russia. Pic: Reuters
Here we look at how it compares to some of the highest magnitude quakes recorded by the USGS.
Biobio, Chile (1960)
A 9.5 magnitude earthquake – known as the Valdivia earthquake or Great Chilean earthquake – struck in a central region of Chile in 1960.
It is the largest ever recorded earthquake, and resulted in more than 1,600 deaths in the country and beyond, most of which were caused by the resulting large tsunami.
Thousands of others were injured.
Alaska (1964)
A 9.2 magnitude earthquake hit Alaska’s Prince William Sound in 1964, lasting for almost five minutes and becoming the largest recorded earthquake in the US.
There were huge landslides and towering waves which caused severe flooding, and the event was followed by thousands of aftershocks for weeks.
More than 130 people were killed.
Sumatra, Indonesia
An area hit by both the huge earthquake and subsequent tsunamis in Indonesia. Pic: AP
A 9.1 magnitude earthquake and subsequent tsunami devastated Southeast and South Asia and East Africa in 2004.
It was the most disastrous earthquake in terms of fatalities, killing 230,000 people, including 167,000 in Indonesia, where entire communities were wiped out.
Tohoku, Japan
Another 9.1 magnitude earthquake struck off the coast of northeastern Japan in 2011, triggering a towering tsunami that smashed into the Fukushima nuclear plant.
This led to power and cooling systems being knocked out, and triggered meltdowns in three reactors.
More than 18,000 people were killed in the quake and tsunami. Some bodies have never been recovered.
Read more:
Quake and tsunami warnings: What we know so far
Powerful 8.8-magnitude earthquake causes tsunami
A tsunami engulfs a coastal region of northeastern Japan on 11 March 2011. Pic: Kyodo/AP
Kamchatka, Russia
A 9.0 magnitude quake resulted in a tsunami with 9.1m (30ft) waves hitting Hawaii in 1952, causing significant damage but no fatalities.
Biobio, Chile (2010)
A man clears rubble after earthquake hits Chile on 27 February 2010. Pic: Reuters
Central Chile was hit by a 8.8 magnitude earthquake in 2010, lasting for 90 seconds and setting off a tsunami.
More than 500 people were killed in the disaster.
Esmeraldas, Ecuador
An 8.8 magnitude earthquake resulted in a tsunami that killed about 1,500 people in Ecuador in 1906.
Its effects were felt for miles along the Central American coast and as far as San Francisco and Japan.
Alaska (1965)
A magnitude 8.7 quake struck Alaska’s Rat Islands in 1965, causing an 11m (35ft) high tsunami. It only resulted in relatively minor damage, including cracks in buildings and an asphalt runway.
Tibet
At least 780 people were killed when a magnitude 8.6 earthquake struck in 1950, destroying dozens of villages, including at least one that slid into a river.
Major landslides jammed the Subansiri River in India, and a deadly 7m (23ft) wave was created when the water eventually broke through.
Sumatra, Indonesia
A guard walks on the ruins of prison wall which collapsed in Indonesian city of Banda Aceh in 2012 quake. Pic: Reuters
An 8.6 magnitude earthquake struck off the west coast of northern Sumatra in Indonesia in 2012.
The quake caused little damage, but it did increase pressure on a fault that had been the source of the devastating 2004 tsunami.
World
Lesotho: In the country that Trump claims ‘nobody has ever heard of’, his name evokes fear and panic
A blanket of thick fog covers Lesotho’s capital, Maseru.
Winter in the southern African country feels colder than ever.
Thousands of garment workers have lost their jobs as the threat of US tariffs brings the textile industry to the edge.
Hundreds of thousands have been cut off from critical healthcare after the USAID withdrawal. Unemployed women stand outside the locked gates of factories asking for work.
HIV-positive mothers travel long distances to clinics for a limited supply of life-saving medicine, holding their babies wrapped in blankets.
Lives and livelihoods in Lesotho have been devastated by US President Donald Trump – a country he has said “nobody has ever heard of”.
The Basotho have certainly heard of President Trump. His name now evokes fear, worry and panic among many in the small nation his policies have targeted.
“People are scared of him, too much. When he says he will do something then he must do it,” says Maplape Makhele, a 32-year-old garment worker and mother of two.
“I have seen what he has done in South Africa and China. He doesn’t want to work with other countries.”
We spoke to Mpalape at her work station in the Afri-Expo Textiles factory while she sewed denim. This work was steady while Lesotho held the title of the “denim capital of Africa”.
Today, she is terrified of losing her job as the breadwinner of her family. More than 200 of her colleagues have already been laid off from the factory.
“We are close to only half operational,” says her boss Teboho Kobeli, the managing director of Afri-Expo Textiles Factories. He has cut around 500 jobs across three factories.
“We had been doing some US orders but now we have had to re-adjust ourselves,” he says. “There are a lot of job losses and I can see more jobs lost as of next month.”
Lesotho has declared a state of national disaster over high youth unemployment and job losses linked to US tariffs and aid cuts that will last until June 2027.
President Trump is expected to finalise tariffs on several countries including Lesotho and South Africa on August 1. In Lesotho, people are hoping for tariffs on the lower end at 10% but are preparing for a hit as high as 50%.
Any export duties will have an impact on industry here which has benefitted from 25 years of the Africa Growth and Opportunity Act (AGOA) duty-free trade agreement with the US.
“That is multilateralism – to trade with one another and leverage on each other’s strengths,” Lesotho’s minister of trade and industry Mokhethi Shelile tells us.
“We did not think an economy so advanced, the pioneer of multilateralism, to renege and turn back on that very principle that has made it so big.
“We are done talking [with the US]. We are waiting for a response, for a final solution from them. We are told it will come soon but we don’t know how soon.”
Mokhethi Shelile says ‘we are done talking’ with the US
We interviewed the minister at a celebration launching a government-sponsored factory expansion in Lesotho’s second city Maputsoe.
The factory is only 5km from the border gate into South Africa, its main export destination. Unemployed garment workers are huddled around the locked gates hoping to appeal to the trade minister for jobs.
Inside the warehouse, women furiously produced clothing for the South African market. Minister Shelile tells us that this regional trade is part of Lesotho’s solution but economists believe it is another dead end.
“I don’t think South Africa is an option for us given the problems that South Africa is going through itself,” says economist and former minister of mining Lebohang Thotanyana.
“South Africa has been hit by tariffs and is going to lose around half a million jobs as a result of the Trump effect.
“Some of those jobs on the citrus farms and automobile industry in South Africa were held by Basotho so it means they will be directly affected there as well.”
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Trade unionists in Lesotho’s capital Maseru have been speaking to laid off workers to explain the context of the devastating job cuts.
“It’s really hard for them because what the people want is the job,” says Ts’epang Nyaka-Nyaka, general secretary of the Economic Freedom Trade Union.
He is expecting his own wife to potentially lose her job at a factory exporting to American denim brand Levis. The two-thousand-member union is rapidly shrinking as more lay-offs are announced.
“They want the job – not the politics,” he says.
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