One in three South Africans tested is infected with the coronavirus, according to Adrian Puren, acting executive of the National Institute of Communicable Diseases (NICD), who spoke to Daily Maverick.

Since moving back to Level 3 lockdown, South Africa has recorded a cumulative 1,113,349 cases of Covid-19 and 171,765 active cases, reported the NICD on 4 January 2021 — an increase of 12,601 new cases since the previous day. The positivity rate stood at 33.7%

As of 4 January, KwaZulu-Natal reported 66,900 active cases, the Western Cape 44,343, Gauteng 31,188, the Eastern Cape 5,084 and North West 5,704. A further 434 Covid-19 deaths were reported on 3 January. 

“There are likely multiple reasons that gave rise to the resurgence, including a combination of increased mobility across various provinces, [an] increase in superspreader events reported and a decrease in compliance with non-pharmaceutical interventions,” said Puren.

Then there is the new Covid-19 variant, thought to be associated with increased transmissibility and initially identified as the dominant lineage in the coastal regions of KZN and the Eastern and Western Cape, adding to the “volatile cocktail” of events leading to the resurgence, he said.

Now, there is increased pressure on hospitals and oxygen supply, given increased admissions, according to Puren. And, says Dr Akhtar Hussain of the South African Medical Association (Sama), “all” hospitals are understaffed, not only because of the heavy workload, the number of staff who have contracted the virus also reduces the available workforce.

As of 29 December, 436 of the 43,124 healthcare workers have died from Covid-19, said Popo Maja, spokesperson for Deputy Health Minister Mathume Phaahla. There was no new updates on this number yet.

“A death of one staff member is one too many,” said Maja, who also acknowledged that this affects their families. “The department is certainly concerned about the health workers falling ill and some of them unfortunately dying.”

In the public and private sectors, the number of beds available for Covid-19 response is 114,421, of which 5,616 are in ICUs, according to Maja, who said that “the hospitals are currently coping with regards to the ICU beds”.

But Hussain queried this: “If there is such a number of beds available, why are patients being turned around, not getting admission?

“Some days there are no beds available in the private sector as well. Even in the government sector the waiting list is long. You have to wait long to get an ICU bed.”

Overburdened hospitals

Hospitals are overburdened because of bad planning for the second wave, according to Sama chairperson Dr Angelique Coetzee.

According to Coetzee, in anticipation of the resurgence hospitals should have planned better to ensure there were enough staff — particularly adequately trained people to work in ICU — and sufficient oxygen supply. She said dismantling a number of field hospitals after the first wave put added strain on hospitals.

No field hospitals means healthcare workers can’t move stabilised patients out of hospital to make space for ICU patients, she said.

“We should be more practical and stop running only to regulations. We need to make sure there are regulations, but it needs to be accountable.”

Oxygen supply problem and field hospitals

Maja told Daily Maverick the problem with oxygen supply has been stabilised but the situation needed constant monitoring.

“[The supplier] Afrox has made arrangements to increase the supply of the oxygen in the affected provinces and currently there are no major problems with oxygen supply,” he said.

Field hospitals had been scaled down, while some, including the Cape Town International Conference Centre’s Hospital of Hope, were closed when the first wave receded, although some had been reactivated.

The provinces with functional field hospitals are KZN (four), the Eastern Cape (one), North West (four), Gauteng (one) and the Western Cape (one), which is in the process of adding 744 beds, Maja said. 

Although there are resurgence metrics in place that will indicate when the surge can be declared over, estimating the peak of the second wave is not as straightforward, according to Puren. However, it was expected that peak infections would be reached at different times across the country.

Puren agrees with most healthcare experts that it is critical for South Africa to acquire a vaccine as soon as possible, to ease the burden of new infections and “likely” further resurgences.

Vaccine news

In a 3 January press briefing, Health Minister Zweli Mkhize said the government is in negotiations to procure vaccines through bilateral deals by February. (Photo: health.economictimes.indiatimes.com / Wikipedia)

In a 3 January press briefing on the country’s vaccine rollout strategy, Health Minister Zweli Mkhize said the government is trying to do this and is in negotiations to procure vaccines through bilateral deals by February.

The government initially said a vaccine through the Covax initiative for 10% of the population would arrive only in the second quarter of 2021. 

No deals had been finalised to move up the arrival time, the minister said. 

The candidates include the two-dose Pfizer-BioNTech vaccine and the Oxford University and Moderna jabs. The single-dose Johnson & Johnson vaccine is also being considered but has yet to be approved by regulators. According to Dr Anban Pillay, health department director-general, this vaccine would be “a real advantage” because it is a single dose, making it easy to administer and more cost-effective to deliver.

The vaccine would be rolled out in three phases. 

In the first phase, it will be distributed to frontline healthcare workers, in the second to those working in essential services, the elderly and South Africans living with comorbidities, while the final phase would target about 22 million people. This should result in 67% of the population vaccinated in an effort to achieve herd immunity.

But, according to Coetzee, it is still unlikely that the average South African will see a vaccine before the middle of the year. 

“South Africa is at the back of the line for the vaccine… We will have to wait,” she said. 

According to her, the problem is that South Africa did not start negotiations to secure a vaccine when other countries had done so six or seven months ago. In addition, the country needs to vaccinate a substantial percentage to achieve herd immunity. “We are about 60 million people in South Africa, if not more.”

The schools will go on

Schools will still reopen as scheduled on 25 January for teachers and 27 January for pupils, according to Elijah Mhlanga, spokesperson for the Department of Basic Education.

“Schools are safe because we enforce compliance and monitor adherence to protocols, unlike in social settings where nobody monitors. Parties and funerals are more dangerous places than schools,” he said.

Since schools closed on 15 December, about 200 teachers have died from Covid-19, Mhlanga told Daily Maverick.

 “[The department] needs to provide equipment and basic services that will ensure that learners and teachers are safe. The experience of last June will be utilised to get the country to comply,” he said.

The marking of matric scripts began on 4 January, as planned, in 181 centres around the country, according to the department’s new directions for matric marking.

More than 4,500 markers would mark the 14 million scripts over 18 days. 

Marking is meant to take place with strict adherence to physical distancing in marking centres and screening at the entrances. Markers are expected to sanitise regularly, with not more than 50 people in a particular area during meal and tea times. Each centre is to have a Marking Centre Compliance Officer, as well as health practitioners on-site or within easy reach of the centre.

“Marking personnel that display any symptoms that are listed in the Covid-19 protocol will be retained in a temporary isolation room until they have been advised by a health professional. Markers that have been tested positive must not report to a marking centre and a failure to disclose their health status will constitute a misconduct,” Mhlanga said. 

 Travelling back home

The first two weeks of January traditionally see a lot of general movement as most South Africans return home from local summer holidays, says Kirby Gordon, spokesperson for domestic airline FlySafair.

According to the Tshifhiwa Tshivhengwa, CEO of the Tourism Business Council of South Africa, most people left Gauteng, mainly during the second half of December, to visit family and friends. 

This made up the majority of travellers returning from the Eastern Cape, Limpopo, North West and other provinces. This influx is also true for those crossing South Africa’s borders, said Minister of Home Affairs Aaron Motsoaledi on 30 December. The department expected “abnormal” volumes of travellers from 2 to 14 January. 

The minister said an additional 160 officials would be deployed to monitor the six busiest land ports: Beitbridge Border Post with Zimbabwe, Lebombo Border Post with Mozambique, Oshoek Border Post with Eswatini, Maseru Bridge with Lesotho, Ficksburg with Lesotho and Kopfontein with Botswana. The Kosi Bay Border Post between KZN and Mozambique also opened on 1 January, having closed in March 2020.

About 259 port health officials, deployed by the Department of Health, would be stationed at all ports to ensure that only travellers with a valid negative Covid-19 test were allowed into the country. Otherwise, travellers would need to take rapid antigen tests at their own expense. They could also expect roadblocks and vehicle control points. 

The bulk of interprovincial travel will be from the coastal regions back into the interior. But Gordon said airline passenger numbers are down on 2020.

“If I look at all domestic airlines in South Africa we are seeing between 25,000 and 30,000 passengers flying per day in SA,” said Gordon. “Last year these numbers were more like 40,000 to 45,000. This reduction is certainly a factor of fewer flights being available, but even so, if we look at the loads, aircraft this year are less full than they were last year.”

According to him, a data tool from the Centre for Aviation shows there are about 22,400 seats per week being operated out of East London, Port Elizabeth and Mthatha airports combined. “I’d say you can estimate that about 65% of those seats are occupied.”

Besides flying in permitted hours in terms of the new curfew times, air-travel regulations have not changed drastically since the move to Level 3. Passengers are still required to wear masks throughout the journey and pass a temperature screening before entering the airport terminal, Gordon said. Interprovincial land travellers need to adhere to curfew hours as well. 

“We still run all the same procedures that we did then, with all the same strict cleaning protocols in place.”

Until late November 2020, domestic travellers were required to complete health declaration forms for Port Authority Health. These are no longer required, Gordon said. 

The impact on the economy

The consequences of the second wave and move to Level 3 for the GDP and job losses are yet to be determined, said Martin Kingston, vice-president of Business for South Africa, a business lobby group representing most of local business’s response to Covid-19. 

The group predicted in 2020 that the country would take about three years to see pre-Covid levels of real GDP and recover the jobs that have been lost in the course of 2020, Kingston said. 

“That situation has clearly been exacerbated by the second wave and the need to move up to Level 3,” he said. It can be assumed that this time frame to get back to pre-Covid levels will be extended, explained Kingston. 

“There will be a meaningful impact on economic growth and jobs for as long as we are at Level 3 and we need to find a way in which we can find some measure of relief to the individuals and companies that are now taking very significant strain, which was already the case in the context of the pandemic in 2020,” said Kingston.

With the onset of the second wave and the new restrictions in place, businesses will see a decline in revenue, which will have an impact on employment, according to Kingston. The only way to minimise this will be for businesses to manage costs efficiently and take all steps possible to maintain employment, he said. A big part of managing costs is to ensure that they are not overborrowing by taking on too much debt.

Businesses would also need to “stringently” observe return-to-work protocols, particularly in terms of health and safety. These included keeping people physically distant and limiting numbers at work at any one time.

“The only way the country is going to be able to combat the challenge of the pandemic – which is likely to be with us for 2021 until such time that we are going to be able to vaccinate the majority of the population to achieve herd immunity – is by ensuring that we harness the resources from all social partners – business, labour, and civil society – led by government,” said Kingston.

He said it was only through such an integrated approach that structural reform in the economy could be implemented at the same time to drive sustainable inclusive economic growth and meaningful job creation. DM