Since coronavirus patients started showing up at South Africa's government-run Thelle Mogoerane Hospital, workers have scrambled to set up special isolation wards to treat them. They can't keep up. Video filmed inside the hospital shows patients with COVID-19, the disease caused by the new coronavirus, being treated in an ordinary ward, separated from other patients only by curtains.
"We have gross shortage of staff, it's chaos, it's crazy, nurses are testing positive as well and it's a mess, it's a mess", nurse Rich Sicina said outside the stark, modernist hospital in a southern Johannesburg township. A 30-bed isolation ward was set up in mid-April, but it filled so quickly that 18 critically ill patients were put in a regular casualty ward.
Kwara Kekana, spokeswoman for the department of health in Gauteng, the province containing Johannesburg, said that at the beginning of the pandemic, Thelle Mogoerane Hospital had dedicated wards for patients under investigation.
Five more COVID-19 wards have been added since then, but some patients are still spilling over in general wards, Sicina said. Until early May, nurses treated the patients protected only by a surgical mask and apron, he added.
Another nurse corroborated his account; she is not authorized to speak to media and declined to be named. Kekana said PPE has been available at the hospital since the beginning of the pandemic.
At least eight patients admitted for other complaints caught COVID-19 there, they said, along with 240 staff. Last week, they held a memorial service for two nurses who died. Kekana said she was not aware of the figure of 240 staff infected, but confirmed a memorial service for one nurse.
This is what President Cyril Ramaphosa tried to avoid when he imposed one of the world's strictest lockdowns in late March - when the country had recorded just 400 cases - to buy health workers time to prepare. The lockdown battered the economy of Africa's most industrialised nation, which was in recession before the pandemic, and Ramaphosa lifted many of them long before infections peaked to save livelihoods.
Four months later, South Africa faces a runaway epidemic that has overwhelmed public hospitals in a country where roughly half the population lives below the poverty line, according to the latest government figures from 2015.
The first cases identified in Johannesburg, the country's biggest city now at the outbreak's epicentre, were concentrated in Sandton, a wealthy northern suburb. In the greater Soweto area, cases increased 252% this month compared to 200% for the rest of Johannesburg.
With the number of cases approaching 500,000 - more than half of Africa's total and the world's fifth-highest - the country's harsh inequalities appear to have been its undoing, government advisers and independent experts said. The first cases were wealthy globe trotters who brought the virus in from Europe and Asia who could easily self-isolate, but not their domestic workers who may have been exposed and travel in communal taxis.
Once the virus reached South Africa's poor, densely populated townships - a legacy of decades of oppressive white minority rule - it spread like wildfire, overwhelming public hospitals already at breaking point.
"We've got huge socio-economic disparity within the population, we've got cultural issues in the population, we got a fragile healthcare system, so clearly we were not equipped", said Professor Yunus Moosa, chief infectious disease specialist at the University of KwaZulu-Natal and a senior member of the government's COVID-19 advisory panel.
Police and soldiers battled to enforce the lockdown in areas where people live in close quarters and depend on daily earnings to eat. Bustling markets in Soweto, Johannesburg's biggest township, were a stark contrast to nearly deserted streets in the city's more affluent suburbs.
The government has recruited health workers and is building field hospitals with partners to accommodate the overflow. It has also negotiated with private providers to take public patients if needed.
Mismanagement and looting of public funds, which have hollowed out public services for years, contributed to shortages of protective clothing and other vital supplies at some facilities, according to both the government and its critics.
Ramaphosa pledged a crackdown, saying on July 23 that authorities were investigating at least 36 corruption allegations in areas including COVID-19 procurement and relief programs.
Twenty-six years after apartheid ended in 1994, healthcare remains divided between a world class private system for those who can afford it, and an overburdened public one for the mostly Black citizens who cannot.
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