Gauteng in the eye of Covid-19 storm as death bell tolls for SA

In the time it takes to read these first few lines, another four people in SA will have been diagnosed with Covid-19 as the disease comes closer to home, cutting a deadly swathe through the country and claiming an average of 70 lives a day.

Fatalities are surging in the Western Cape and Eastern Cape, and experts warn Gauteng will be the next frontline in the battle against the disease.

Hospitals and medical staff are at full stretch and makeshift mortuaries are being prepared. But even with the extra capacity, two questions are occupying experts' minds: how bad will it get, and are we ready?

Amid the rising death toll, millions of children are preparing for the second phase of school reopening next week, and the opening of the economy is picking up pace, with the release of rules for sit-down restaurants.

More than 6,000 new infections were reported on both Thursday and Friday, translating into about 266 cases an hour, or more than four a minute. The same two days registered 135 deaths, nearly three an hour.

National Institute for Communicable Diseases (NICD) modelling data shows Gauteng's fatalities - which reached 149 on Friday - potentially tripling every two weeks.

By tomorrow, the toll is expected to be 240, and by July 13 - two months ahead of SA's expected coronavirus pandemic peak in September - it is predicted to be 730.

In the past week, Gauteng's infections have almost doubled, from 17,261 to 31,344 by Friday. Gauteng health MEC Bandile Masuku said the National Health Laboratory Service in Gauteng was overwhelmed, with a backlog of 30,000 tests, and the department had asked private labs to assist.

Wits University health economist professor Alex van den Heever said Gauteng will reach the Western Cape's daily death figures - which for the past fortnight have averaged 50 a day - "within 10 days".

He said Gauteng might have a smaller number of cases overall, but at 1,500 daily infections its new cases are now exceeding the 1,400 per day in the Western Cape.

Gauteng's hotspots are the inner city and southern areas of Johannesburg, followed by Soweto, Protea Glen and Doornkop, according to the provincial command council.

Five isolation and quarantine sites have been built in Gauteng, but no field hospitals have been constructed, according to provincial health spokesperson Kwara Kwena.

Within two weeks, the bed shortage in the province is expected to reach 5,000.

Wits University vaccinologist professor Shabir Madhi said that within three weeks Gauteng will be where the Western Cape is now in terms of deaths and infections, and will then potentially overtake it.

Professor Martin Veller, dean of health at Wits, said because of limited test kit supplies, the number of infected people is likely higher than official figures. The NICD's weekly epidemiology report says: "Fatalities may be an underestimate because deaths are more likely to be reported if a patient with Covid-19 died in hospital, and deaths out of hospital may be missed."

Nationally, infections have increased more than fivefold in the past month, from 24,264 on May 26 to 124,590 on June 26, while deaths have more than quadrupled, from 524 to 2,340.

The Western Cape has the largest number of cases (57,941, 46%), followed by Gauteng (31,344, 25%) and the Eastern Cape (21,938, 18%).

By yesterday, the Western Cape had reported 1,696 Covid-19 deaths, and Cape Town is anticipating that 10,000 people will have lost their lives to Covid by the end of September.

"The city has assured us that mass burials will only be considered as an absolute last resort, if the fatalities exceed the capacities of mortuaries," said Lincoln Johnson, chair of the Western Cape region of the National Funeral Directors Association.

In Cape Town, Groote Schuur Hospital is stretched to breaking point, with 250-300 coronavirus patients a day and mostly full ICU beds.

"Almost the whole capacity of the hospital is geared over to Covid and we are just hanging in there," said a doctor at the frontline of critical care, who preferred not to be named. "We are stretched about as far as we can go."

Bed occupancy rates for Covid wards average 80% and are "close to 100% for ICU on most days", Groote Schuur said in its Covid-19 update on Thursday. Of the 2,086 Covid patients admitted, 251 have died.

"We do have survivors now. In the first few weeks it felt like everyone being admitted to ICU was dying," said the doctor. The hospital has extra high-care beds but lacks the nurses to increase the number, as planned, from 70 ICU beds to 100, he said.

Two ICU nurses shared the overwhelming demands on them on Facebook this week: "We used to have six beds in here, now we're sitting with 18 beds in the unit I'm working in. We've only had one patient that's actually left . We've been admitting constantly, it just goes on and on and on."

Two Cape Town anaesthetists, working in mostly private hospitals, have seen wards and ICUs steadily filling up with Covid-19 patients. "They are getting crowded and there are definitely staff shortages," said one doctor, who is distressed about the lack of protective equipment for nurses and other staff at some facilities.

"Some frontline staff are wearing homemade cloth masks. At one hospital I was given a sheet of green plastic with a hole for my head to go through as protection and no N95 mask, no visor," she said.

In the Eastern Cape, Madhi said health-care facilities were "under-prepared in terms of meeting the demands" of the population even before the pandemic.

Metros have "high-density populations" and "people are simply not adequately buying into the non-pharmaceutical interventions [distancing, masks and hand hygiene] as they should". What happens next will be "dependent on the behaviour of the people rather than government interventions".

Capacity to provide critical care is low and "aggressive preventative measures" are the only hope, with the likes of "youth leaders, community leaders and religious leaders" being co-opted.

A report by the Eastern Cape provincial command council predicts up to 6,000 deaths in the coming months and says the number of hospital beds will be insufficient "unless capabilities are exponentially and rapidly increased".

Professor Lungile Pepeta, dean of health sciences at Nelson Mandela University, said the official case count in Nelson Mandela Bay is about 5,500 but "the real figure" is probably about 30,000.

The effects of asymptomatic people fuelling the spread will soon be apparent.

"The lowest-hanging fruit is the prevention of the spread," he said, otherwise it will be a case of, "Sorry, we just don't have a bed for you… you will just be in a corner somewhere and you will perish."

Pepeta added: "We don't need high-level strategy meetings and an overhaul of the health system. It's too late for that - this is an emergency."

KwaZulu-Natal has registered only 5.7% of SA's Covid-19 cases and professor Salim Abdool Karim, chair of the health ministry's advisory committee, said: "The number of active Covid-19 cases in KZN is taking 18 days to double, whereas in Gauteng cases are doubling every nine days."

Abdool Karim said the country should prepare for multiple small peaks, and the worst of the pandemic is likely to dissipate in October or November.