Covid-19’s rampage through South Africa is hitting Gauteng and its 15 million people hard: the province is now the epicentre of infections, as Health Minister Zweli Mkhize predicted at the weekend.

On 30 June, Gauteng reported 2,946 new cases and 36 deaths, the highest yet. 

Doctors report that hospitals are beginning to fill up and oxygen is running low. Over 80% of the province’s population rely on public health facilities, and state hospitals and clinics are coming under increasing strain.

In the battle against the coronavirus, oxygen is life and many infected patients need it. The virus impacts the respiratory system and, in the most serious cases, is associated with Acute Respiratory Distress Syndrome (ARDS). 

Doctors have told Daily Maverick that oxygen stocks are running low and that the testing system, already under strain, is malfunctioning. 

When it comes to the province’s outlying districts, Dr  Francois Venter said he is getting reports of “poor turnaround times for testing”. 

“It can take between 14 and 21 days for test results to come back in the outlying clinics. If a test is not turned around in four days, there’s no point in doing it,” said Venter. 

A report from the Gauteng government said that 1.4-million tests had been carried out province-wide by 24 June. 

“At the moment, several things are going wrong which indicates system strain,” Venter told Daily Maverick. He said this strain is reflected in delayed test results (which in turn affects the speed at which positive cases can be moved to quarantine sites and contacts can be traced); ambulances being turned away from hospitals; low oxygen stocks; and the disruption of services where porters and nurses refused to work and where personal protective equipment (PPE) is regarded as insufficient. 

By 30 June, Gauteng had recorded 39,841 Covid-19 cases and 10,534 recoveries. Johannesburg is the centre of concern in Gauteng, with a whopping 19,529 cases; while Tshwane has recorded 6,184 cases; Ekurhuleni has 8,429 cases with Sedibeng and the West Rand recording the lower numbers of infections. 

On 28 June, Health Minister Zweli Mkhize predicted how the virus would travel: “We believe that within the coming days, Gauteng will emerge with the highest Covid-19 numbers. Factors contributing to this trend are inward migration, increased congregation which spurs cluster outbreaks, and the level to which people are able to adapt to new behaviours such as social distancing and the wearing of masks.”

In the cruel toss-up between limiting movement by lockdown (to keep infection rates down) and keeping the economy going so people can earn enough to eat, the numbers in Gauteng reveal the severity of the dilemma.

Soon after lockdown Level 3 opened up over 80% of the economy on 1 June, the Gauteng caseload shot up as people returned to work and began moving around again. With the opening of long-distance taxi routes this week, this raises the spectre of the province becoming a national super-spreader. 

Gauteng is a province of transients with people moving into and out of it daily. 

Gauteng Health MEC Bandile Masuku is flagging the need for an “intermittent lockdown”, but that decision rests with the cabinet’s national command council, his spokesperson Kwara Kekana told Daily Maverick.  Kekana has recovered from an earlier Covid-19 infection.

With Gauteng responsible for 30% of national GDP, this is another tough decision as closing the economy here will delay a national recovery from the deepening recession.

“The demand for oxygen has increased greatly over the last 14-day period.  As of yesterday (30 June), we had a total of 2,981 people admitted at hospitals, both in the public and private sectors. There are 144 people on ventilators, and 464 on oxygen in the ICU and high care units. In the general wards, 1,087 are on oxygen and 1,286 on room air.”

The province has a total of 8,301 beds available, but this is unlikely to be enough at the peak of the anticipated surge, and early reports suggest some hospitals are already running out of beds.

The department is stepping up referrals to isolation and quarantine sites and opening more facilities, and is scrambling to ensure oxygen supply and oxygen points in wards, said Kekana.

Two doctors who spoke to Daily Maverick said oxygen supplies should have been secured months ago as the requirement was entirely predictable, given that the lockdown was put in place to prepare the health system. DM