Health professionals warn that things will get much, much worse.
The dreaded and highly contagious Delta variant of the Sars-CoV-2 virus is spreading across the country and is probably the driving force behind the massive increase in Covid-19 cases in Gauteng in recent weeks.
And the worst is still to come – the exponential growth of infections in South Africa’s most densely populated province is still to hit the rest of the country.
“It’s bad. People are going to die by the score because there are no [hospital] beds for them,” Dr Angelique Coetzee, chairperson of the SA Medical Association, warned on Friday.
Professor Koleka Mlisana, co-chair of the ministerial advisory committee, warned at an “emergency media conference” held by the health department yesterday afternoon: “It is a matter of days before we will see an increase in figures in the other provinces as well.”
The Delta variant – one of four variants of concern worldwide – is twice as contagious as the original Sars-CoV-2 virus that originated in Wuhan, China. It is also significantly more contagious than the Beta variant, which has so far driven infections in South Africa.
In addition, it seems that the immunity you have if you previously had Covid-19 does not provide good protection against the variant, said Professor Tulio de Oliveira, director of the genomics observation laboratory Krisp.
“This [Delta variant] carries a higher risk of reinfection [among people who have already had Covid-19].”
The good news is that the Delta variant is not necessarily deadlier. Preliminary data from the UK, where the Delta variant has been responsible for more than 90% of new infections, show that this variant is not necessarily more lethal than others. It also appears that vaccines still offer good protection against it.
The big problem is that less than 5% of South Africans had received at least one dose of a vaccine by this weekend. Almost one in seven Britons has already been vaccinated.
According to De Oliveira, the Delta variant has already been identified in Gauteng, along the Garden Route in the Western Cape and in KwaZulu-Natal after it was first reported in South Africa in April.
“Last week, we sequenced the genomes of 68 samples from KwaZulu-Natal from 30 places hundreds of kilometres apart. And 48 of these genomes were Delta,” said De Oliveira. “The new variant is not only increasing in infection numbers, it is starting to dominate infections in South Africa.”
India was caught off guard earlier this year when new infections shot up from about 15 000 a day at the end of March to a high of 391 000 a day in the first week of last month.
Health services in that country are overwhelmed, with masses of people dying at home and outside hospitals because they could not get medical help.
“Gauteng will look like India in a week or two,” said Professor Francois Venter, an expert in communicable diseases at Wits University, when referring to hospitals’ ability to handle a tidal wave of patients.
“Do not get sick. There will not be a bed for you. The few beds that are still there are going to fill up quickly. I am afraid that people do not realise how serious the situation is.”
Gauteng hospitals are already full to the brim and the number of new Covid-19 infections continues to rise. A new record – 11 777 new cases in a day in Gauteng alone – was reported on Friday.
To put this into context, in the Western Cape, where infections are also rising, about 1 000 new cases have been reported daily in the past week.
Things are also much worse than during the second wave. On the crest of the second wave in Gauteng, 5 291 people a day fell ill.
On Wednesday, the positivity rate shot up in Gauteng to 37% compared with a national average of 24.9%, Dr Mary Kawonga, chairperson of the Gauteng Covid-19 command board, said on Thursday.
According to the World Health Organisation, an epidemic is “under control” if this rate is 5%.
By yesterday, there were already 6 259 Covid-19 patients in Gauteng hospitals, of whom 1 191 were in intensive care, according to data from the National Institute for Communicable Diseases. In the Western Cape, there were 359 patients in high care on Friday. Even this relatively small number is 28% higher than a week ago.
Figures in Gauteng hospitals increased by 1 081 within a week. More than half of the 11 149 Covid-19 patients in hospitals nationwide are in Gauteng – more than double what was recorded on the crest of the second wave. At the peak of hospitalisations during the second wave, there were 5 526 Covid-19 patients in hospitals in Gauteng.
“Our hospitals were able to handle the volumes during the first and second waves, but there are already more people in hospital now and it will increase even more drastically,” said Venter.
Dr Cloete van Vuuren, head of internal medicine at 3 Military Hospital in Bloemfontein, says hospitalisations start to rise about two weeks after people test positive and deaths start to rise three weeks after an increase in infections. He also warns that Covid-19 patients often have to stay in hospital for a long time, which means beds will not be available again soon.
“It’s bad, people are going to die by the score because there are no beds for them,” said Dr Angelique Coetzee.
According to her, many patients who should be in hospital are already being treated at home.
Doctors have to make difficult decisions every day about who they can help.
“I had a 39-year-old patient who was very ill. There were three other, older patients between him and the high care bed he needed, plus the patient who was in that bed at the time,” said Dr Jacques Koning, a physician at the Netcare Montana Hospital in Pretoria.
“Only that patient’s age saved him. I signed the other four’s death certificates.”
Patients are already being transferred to hospitals in other provinces.
“Today we transferred some ICU patients from Johannesburg to Durban because we can’t continue caring for them in the emergency department and theatres. We have seen this crisis in other parts of the world, but now it is unfolding right in front of us,” Dr Frans Skosana, a pulmonologist at Netcare Olivedale Hospital in Randburg, tweeted on Friday.
Dr Richard Friedland, head of Netcare, went so far as to say that Gauteng should be subject to level 5 lockdown restrictions and all schools should close. He had already said on Monday on talk radio station 702 that hospitals had to work since last Wednesday as if they were dealing with a “mass trauma event” such as a train accident.