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South Africa's Hospitals Bracing for Surge of Virus Patients

Associated Press

   JOHANNESBURG - The nurse started crying when describing her work at a
   Johannesburg hospital: The ward for coronavirus patients is full, so
   new arrivals are sent to the general ward, where they wait days for
   test results. Already 20 of her colleagues have tested positive.
   "A lot, a lot, a lot of people are coming in every day. With COVID-19,"
   said the nurse, who spoke on condition of anonymity because she is not
   authorized to speak to the media. "Each day, it becomes more difficult
   to cope."
   South Africa's reported coronavirus cases more than quadrupled in June
   -- though some of that is due to efforts to clear a testing backlog,
   the rate of increase of new cases is picking up. Its hospitals are now
   bracing for an onslaught of patients, setting up temporary wards and
   hoping advances in treatment will help the country's health facilities
   from becoming overwhelmed.
   The surge comes as the country has allowed businesses to reopen in
   recent weeks to stave off economic disaster after a strict two-month
   stay-at-home order worsened already high unemployment -- it reached 30%
   in June -- and drastically increased hunger. In Johannesburg, the
   largest city, health officials said they are considering reimposing
   some restrictions to try to slow the quickening spread of the virus.
   "We're seeing a spike in infections in Johannesburg. The number of
   people that we are diagnosing on a daily basis now is absolutely
   frightening," said Shabir Madhi, professor of vaccinology at
   Johannesburg's University of the Witwatersrand, who is leading a
   vaccine trial in South Africa in cooperation with Britain's University
   of Oxford. "Who we are finding positive now is an indication of who
   will be in hospital three weeks from now."
   The vaccine trial began last week, and Madhi said he's surprised by the
   high number of prospective participants who have been disqualified
   because they are positive for the virus.
   "It is hard to see how our hospitals will be able to cope," he said.
   "Our facilities are reaching a tipping point."
   COVID-19 has highlighted South Africa's inequalities, he said.
   "Everyone is at risk from the virus," he said. "But the poor, living in
   higher density areas, without good access to running water, access to
   health care, the poorest will suffer the most."
   South Africa, with 58 million people and nearly 40% of all the cases on
   the entire continent, has seen the number of confirmed infections rise
   from 34,000 at the start of June to more than 168,000 on Friday.
   Overnight it reported its largest daily number of new confirmed cases
   -- 8,728.
   As of Friday, 2,844 people had died, according to official statistics.
   But forecasts by health experts have warned that South Africa could see
   from 40,000 to more than 70,000 deaths from COVID-19 before the end of
   2020.
   Other African countries are watching warily as the country with the
   continent's best-equipped and best-staffed health system hurtles toward
   a peak that may overwhelm it.
   South Africa's health minister, Dr. Zwelini Mkhize, issued a sobering
   warning recently about an expected flood of cases, especially in urban
   centers as many return to work.
   "It is anticipated that, while every province will unfortunately
   witness an increase in their numbers, areas where there is high
   economic activity will experience an exponential rise," Mkhize said
   this week.
   Concerns about the virus spreading in the minibus taxis that millions
   of South Africans use to commute grew this week when the taxi
   association said the minivans would run at full capacity of up to 15
   passengers, despite government orders to carry just 70% capacity.
   For weeks Cape Town has been the country's epicenter of the disease,
   but Johannesburg is rapidly catching up.
   Mkhize said Gauteng province, which also includes the nation's capital
   of Pretoria, will quickly surpass Cape Town and will need more hospital
   beds.
   Gauteng hospitals already have 3,000 COVID-19 patients, the province's
   premier David Makhura told reporters Thursday. He denied reports that
   patients have been turned away and said bed capacity would be
   significantly increased by the end of July. He said the reopening of
   schools set for next week may be postponed and warned that restrictions
   may be reimposed to combat the surge.
   To increase its hospital capacity, South Africa has converted
   convention centers in Cape Town and Johannesburg, built wards in huge
   tents, and turned a closed Volkswagen car manufacturing plant into a
   3,300-bed treatment center. Still, finding staff to tend to those beds
   is a challenge: The factory remains empty for lack of health workers.
   In Khayelitsha township, one of Cape Town's poorest areas with some
   400, 000 residents, the district hospital has 300 beds. Anticipating
   increased demand on the overstretched facility, an external wing was
   created across the street. Built in a month, the new ward opened at the
   start of June with 60 beds. By this week only two beds were empty.
   "It's overwhelming," said Dr. Hermann Reuter of his work in the
   external ward, run by Khayelitsha District Hospital with assistance
   from Doctors Without Borders.
   Reuter said advances in treatment -- including giving patients oxygen
   masks and nasal inhalers earlier and turning them often in order to
   keep them off ventilators -- has yielded encouraging results, even
   though many are severely ill when they arrive. Crucially, many can be
   discharged in two weeks -- freeing up much-needed bed space, said
   Reuter, who normally runs community substance abuse clinics but
   volunteered to work in the field hospital.
   As South Africa heads into its coldest time of year, the media have
   warned of a "dark winter" over fears cases will peak in July and August
   in the Southern Hemisphere country. President Cyril Ramaphosa recently
   counseled the nation to prepare for tough times ahead, saying that many
   may find themselves "despondent and fearful" in the weeks and months to
   come.
   "It may be that things have gotten worse, but we are certain that they
   will get better," he said.
   For the nurse at the Johannesburg hospital, those dark days already
   appear to have arrived.
   "Nursing is a calling, and we are working to help people in this corona
   crisis," she said. "But we are becoming overwhelmed."