Authorities in South Africa appeared set to impose new restrictions on Sunday in a belated attempt to stem a rise in Covid-19 that is ravaging the country’s economic heartland.
The wave of infections has been driven by the spread of the more transmissible Delta variant, weak countermeasures and public fatigue with existing restrictions.
South Africa’s rising cases are part of a resurgence across Africa with a peak expected to exceed that of earlier waves as the continent’s 54 countries struggle to vaccinate even a small percentage of their populations.
The World Health Organization (WHO) has repeatedly appealed for vaccines for Africa, saying a “fast-surging” Covid third wave is outpacing efforts to protect populations, “leaving more and more dangerously exposed”.
“The third wave is picking up speed, spreading faster, hitting harder. This is incredibly worrying. With rapidly rising case numbers and increasing reports of serious illness, the latest surge threatens to be Africa’s worst yet,” Dr Matshidiso Moeti, the WHO regional director for Africa, said last week.
African countries have recorded 5.4m cases and almost 145,000 deaths, though unreliable data means the true numbers are thought to be much higher.
In South Africa’s Gauteng province, the most populous part of the country, Covid patients are waiting for hours, even days, on stretchers in A&E wards before being found a bed, officials at hospitals told the Guardian.
Unlike past waves, this time the hospital system is not coping, said Dr Angelique Coetzee, the chair of the South African Medical Association.
Repeated promises have been made to accelerate the faltering vaccination campaign in South Africa, but only 2.5m have been delivered to a population of 60 million. Though the increase in cases in Gauteng has exceeded a severe second wave six months ago, it has not yet reached its peak, experts believe.
President Cyril Ramaphosa is expected to announce new restrictions on public gatherings and alcohol sales when he addresses the nation on Sunday evening.
The rise in infections during the southern hemisphere winter was widely predicted, leading to angry criticism of provincial and national officials. In South Africa, outrage has been fuelled by a series of corruption scandals. The health minister has been suspended pending an investigation into graft allegations.
The official death toll from Covid in South Africa is 60,000, though excess mortality statistics suggest nearer 170,000 may have died from the disease since May last year.
There has also been widespread criticism of authorities for failing to recruit sufficient extra staff, reopen a major hospital in Gauteng closed after a fire two months ago, or follow advice from health officials to impose stricter restrictions on movement or behaviour. The much-publicised arrival of military doctors has been described by health practitioners as “a very late drop in a very big ocean”.
Lucky Mpeko, a director at QRS ambulance services, said hospitals in Gauteng were so full that many patients were being sent to medical facilities hours away in Mpumalanga and North West provinces.
“The normal practice is that a patient must be taken to the closest hospital to their home, but that has not been possible because hospitals are full, they do not have beds,” Mpeko said
“Even when you are allowed to bring a patient to a hospital, you will have queue for two or three hours while they try to find space for your patient.”
Cases on the continent have been rising fast since early May. Kenya, Namibia, Uganda and the Democratic Republic of the Congo have been badly hit and health systems are close to being overwhelmed.
Zambia’s health ministry has reported an “unprecedented” number of Covid deaths, piling pressure on mortuaries and an already weak health system.
With similar trends in Uganda, the health minister, Jane Ruth Aceng, blamed highly infectious variants for the new spread, which she said was different from the second wave with a large number of young people hospitalised.
Dr John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, said the continent was not winning its battle against the virus.
“The third wave has come with the severity that most countries were not prepared for. So the third wave is extremely brutal,” he said during a weekly online briefing.
The slow vaccination progress has been blamed on limited availability of shots after western countries bought them all, poor decision-making and multiple administrative failures.
Just over one in 100 people across Africa have been vaccinated, and out of 2.7bn doses administered globally, just under 1.5% have been administered on the continent.
Eight African countries have used all the stocks supplied to them by Covax, the UN-backed vaccine-sharing facility, and another 18 are close to exhausting their stocks, the WHO told reporters last week. Dozens more have less than half remaining.
Malawi exhausted its stocks in recent days, just as thousands were due their second shot.
“The lack of vaccines in a region with high levels of poverty and inequality means many people feel they are just waiting to die,” said Deprose Muchena, a regional director at Amnesty International.
However, several countries have failed to administer jabs from Covax before their use-by date because of logistical failures and vaccine hesitancy.
Malawi destroyed almost 20,000 expired AstraZeneca doses in May, while the DRC and South Sudan have returned more than 2m shots to the UN to avoid a similar scenario.