A few weeks ago, Ntombizandile Ntsodo received an alert from her Cape Town nursing agency that left her agitated: A local hospital was short of 46 caregivers for the upcoming 24-hour period, a result of the resurgent Covid-19 epidemic sweeping South Africa.
“I remember thinking where are the nurses? But you know it’s because some of them have caught the virus and are on quarantine,” the 26-year-old said by phone from Khayelitsha, a township on the outskirts of the city where she lives with her mother, sister and young niece.
“It puts a lot of pressure on those of us on the floor and we are fatigued, burnt-out, immune-compromised and many have lost family members to the very disease we are fighting,” she said.
A shortage of key workers is just one reason South African hospitals are facing unprecedented pressure from the ongoing resurgence of coronavirus cases, driven by a new variant that appears more infectious than earlier strains.
Admissions have far outstripped last year’s peak and oxygen and critical-care beds are in short supply.
There were almost 16,900 people suffering from Covid-19 in the country’s hospitals as of Jan. 14, according to data compiled by independent analyst Sugan Naidoo, who has been tracking the course of the virus in South Africa since late April.
That was about 25% higher than a week ago and compares to approximately 11,500 in mid-July, when the initial wave was at its zenith.
“I’m very worried there will be insufficient beds and in particular insufficient oxygen supplies to treat all the patients we’ll see at the peak,” said Jeremy Nel, head of infectious diseases at Helen Joseph Hospital in Johannesburg.
“Staff shortages are a major problem.”
While South African President Cyril Ramaphosa moved quickly to shut down society when cases first started rising in March, predictions that the economy contracted the most in almost 90 years have made it tough for him to expand restrictions.
The current coronavirus surge also began just as millions of people traveled around the country – and across land borders – for the festive season.
The most recent measures to contain the spread include a 9 p.m. curfew and a renewed ban on alcohol sales, in part to ease the pressure on hospital trauma wards from car accidents and drunken violence.
On Monday night, Ramaphosa reassured the nation that vaccines would be a “game changer” with 20 million doses on the way, though the government has only confirmed deals for 1.5 million.
That compares starkly with a rollout already underway in the UK, which is also experiencing severe pressure on hospitals after an outbreak driven by a new coronavirus variant.
On many South African hospital wards, the shortfall of health workers means they are being spread too thinly, according to Ntsodo, who has been working as a nurse in both private and public hospitals around Cape Town since April.
“People are becoming ill quickly and we are going all out and are tired,” she said. “The second wave has just been so rapid with patients deteriorating drastically in days.”
“I am finding myself saying, this person is now a candidate to go over to intensified, critical care, but it’s not available because there is no bed or no ventilator or high-flow oxygen machines have run out,” Ntsodo said.
“You have to get used to three lives lost on a 12-hour shift.”
The supply of personal protective equipment for workers is more stable now than in the middle of last year, but remains inadequate in some areas and hospitals, according to Nel.
“It was recently shown that some of the masks used to protect health workers offered inadequate protection when they were subjected to testing,” he said.
Meanwhile, medical-grade oxygen use is surging, leaving suppliers struggling to keep pace with demand. “The oxygen delivery, supply and piping systems are far from reassuring in many hospitals and clinics currently,” Nel said.
As with South Africa’s initial experience with the virus, each major province is suffering waves of cases at different times. Eastern Cape was first to hit alarming rates late last year, followed by neighboring Western Cape, where Cape Town is situated.
Last is Gauteng, encompassing the economic hub of Johannesburg, which is now seeing the largest increase of new hospitalizations and is expected to be some weeks off its peak.
“It’s important to acknowledge what an amazing job the South African health force is doing,” said Marc Mendelson, head of infectious diseases & HIV medicine at Groote Schuur Hospital in Cape Town.
“There is a lot of burnout, and mental health issues – health-care workers are under huge strain.”