As the lockdown enters its ninth week, an unforeseen casualty has been the private ambulance industry. The sector - which supports more than 400 companies and over 13,000 medics - has been roiled by a sharp dip in revenue as a result of the Covid-19 pandemic, with many firms placing staff on short time and others mothballing usually busy ambulances. Private ambulance services transport the sick and injured for a fee, with revenue streams intrinsically linked to house calls, road accidents and workplace and sporting injuries. But with the decline in road accidents and a new-found fear of hospitals, medics said the survival of their companies is uncertain. The South African Private Ambulance & Emergency Services Association (Sapaesa) this week warned that many companies faced closure. "If the South African economy continues in its downward spiral in response to the current lockdown, a number of private ambulance services in South Africa face imminent closure," said Sapaesa CEO Oliver Wright. When the peak of Covid-19 infections hits SA, there may be a dire shortage of ambulances available to assist patients who need to be hospitalised, said Wright.Paul Herbst, of IPSS Medical Rescue, said the lockdown has resulted in a 60% drop in revenue. The ambulance service, based in Ballito in KwaZulu-Natal, has parked off half its ambulance fleet. "We have had to place some of our staff on short time. Things have started to improve in level 4 but nowhere near where we were before the lockdown," he said. Eric Nicholls, of Johannesburg-based service Vitalmed, said that his medics averaged 600 call-outs a month before the lockdown. "The first three weeks was manageable, but the reality is that our call rate has been cut in half. Now we're down to around 250 calls attended to," he said. "We have seen people with symptoms of heart attacks who had been at home for several days because they were just too scared to go to hospital."Nicholls said the rising cost of personal protective equipment (PPE) has compounded the financial woes. "The price of the PPE has doubled and tripled in some cases. In December, 20 N95 masks would cost us R200. The same box of masks today costs nearly R1,000."Gloves are the new gold rush . we have seen the prices skyrocket," he said. Wright said that there are about 410 private ambulance services, which operate an estimated 2,000 ambulances - and employ about 13,325 people."A large number of private ambulance services in South Africa will not be able to afford to operate past the end of June," he said. Leon Fourie, of Durban-based Life Response 24/7, said that they had downscaled from 11 ambulances to six . "If it goes on like this, a lot of our staff will have to go on UIF [Unemployment Insurance Fund]. We have carried them as long as we can," he said. "Our caseload has dipped, not only road accidents but medical cases as well because people are terrified to go to hospital. "We had a case this morning where an elderly man with asthma and difficulty breathing didn't want to go to hospital. People would rather take the risk and stay at home," said Fourie. The pinch has also been felt by major industry players ER24 and Netcare911, which operate national networks. ER24 spokesperson Werner Vermaak said call volumes had been slashed. "We attended to approximately 35,000 emergency incidents in December 2019 and 33,000 emergency incidents in January 2020. In April 2020, we attended to only about 14,000," he said. Netcare911's Craig Grindell said the company remains "active" despite the lockdown. Wright said many ambulance services have already had to retrench some workers. "The result of the pending closures of a number of private ambulance services means that once the virus is well established in South Africa, there will also be a dire shortage of ambulances available to assist these patients during their time of need," said Wright...