The Covid-19 pandemic first peaked in Africa’s most industrialized economy in late July before infections tailed off. The country is in the midst of a second wave of the disease that began shortly before the festive season — which sees millions of people traverse the country to holiday destinations and home towns and villages.

Netcare Ltd., Life Healthcare Group Holdings Ltd. and Mediclinic International Plc, the country’s three biggest private hospital groups, which had spare capacity in most areas during the initial surge, all said they were confronting bed shortages.

In four of South Africa’s most populous provinces, “we have noted a substantial resurgence in Covid-19 patients and the health-care system is under significant pressure,” said Charl van Loggerenberg, Life Healthcare’s general manager of emergency medicine. Intensive care and high-care units are “particularly under severe strain” in the KwaZulu-Natal, Western Cape and Eastern Cape regions, he said.

Read more: South Africa Finds New Covid Variant Is Driving Second Wave

Besides admitting more Covid-19 patients, the hospitals are also having to administer additional treatment.

“We are seeing a significantly higher demand for oxygenation of sick patients versus the first wave,” Netcare’s Chief Executive Officer Richard Friedland said in an emailed response to questions. “We have seen more cases in both the Eastern Cape and Western Cape, and expect to exceed the number of cases seen in the first wave in KwaZulu-Natal this week.”

Hotspot Cases

The number of cases in South Africa’s economic hub of Gauteng, which was already on the rise, is expected to spike when holiday makers return in early January, Friedland said.

All three companies are recruiting more nurses, temporarily relocating staff to hotspot areas and making contingency plans to convert additional wards to accommodate Covid-19 patients. Non-essential surgical cases are largely being postponed.

While South Africa has reported a spread of new SARS-CoV2 lineage with multiple spike mutations, the current wave is equally impacting South Africans using the country’s public healthcare system, according to Gerrit de Villiers, a group general manager at Mediclinic. At this stage, guidance regarding treatment of Covid-19 cases hasn’t changed, he said.

There have been 930,711 confirmed coronavirus infections in South Africa so far, and 24,907 people diagnosed with the disease have died, according to the Health Department.