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South Africa hoped it was through the worst of Covid-19. Then the Delta variant arrived



“It’s devastating, it’s rare destructive. We’re trained to save lives, but you return to the wartime mentality. You return to being stunned, you return to being blunted,” said a senior doctor at a large public hospital in South Africa’s largest city. .

“Patients are brought into cars with desperately ill patients who have been rejected from other hospitals without beds.”

Like many health workers that CNN has spoken to during the crisis here, they did not want to be identified for fear of retaliation from the government.

“The third wave has been far more devastating, far more overwhelming,” the doctor said.

Workers pictured at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa.

No more cheering

In the early days of the fight against Covid-19, South Africans cheered health workers in neighborhoods throughout this city. Since then, there have been more than 2.1 million confirmed cases in the country and over 63,000 deaths – making it one of the worst affected countries in the region per capita. Inhabitant. Excessive deaths suggest that tolls are much higher.

The applause stopped months ago, but the impact of Covid-19 is at its worst right now.

Sixteen months into the pandemic here, doctors describe a system that is beyond its breaking point – with inadequate beds and hardly enough oxygen. Sometimes the only time a bed opens is when a patient dies.

“There are patients who die while waiting to be seen while waiting to come to the ward. Because the resources are just overwhelmed by attacks from patients,” the doctor said, an assessment confirmed by paramedics and others. doctors.

Sometimes patients will die when they enter a hospital, regardless of the level of care, they say. But this wave means tough choices have to be made and the best care can not always be given.

The explosion of cases and deaths as well as renewed lockdowns throughout the region has come as a surprise to many public health experts. With low vaccination rates in South Africa, they expected a new wave, but some researchers thought the very worst was over.

After all, the South African region was hit by a first wave and abused by a second wave driven by the more contagious Beta variant discovered by South African researchers. The idea was that a level of immunity in a large part of the population could dampen future peaks.

The given caveat was always that a new variant could emerge, but few expected an even more transferable variant like Delta that would dominate so quickly.

“When you get a new variant, you can roughly think of it as getting a new virus. A lot of the progress you have made in being exposed to humans will be reduced,” said Dr. Humphrey Karamagi, Head of the World Health Organization. (WHO) Africa regions data, analysis and knowledge team.

First discovered in India and responsible for an overwhelming increase in cases and deaths on the subcontinent earlier this year, the Delta variant is now present in countries around the world.

South Africa is launching strict lock-in to combat the 'extremely severe' impact of the Delta variant

The variant has so far been detected in at least 10 African countries with a high prevalence in southern and eastern Africa according to the WHO.

On Thursday, WHO Regional Director for Africa Matshidiso Moeti said the variant continues to “gain momentum and new ground in countries.” New cases on the continent have risen for the seventh week in a row, while vaccination rates remain low, Moeti said.

“Africa has just marked its worst pandemic week ever,” she said. And the situation is getting worse.

“The next few months will be very difficult on the continent as we see the spread of the variant,” Moeti added.

The rapid spread of varieties on the continent poses a major threat to the African population, of which 16 million are fully vaccinated – less than 2% of the continent’s population, Moeti added.

Repulsive and dominant

Karamagi said Delta’s greater transmissibility and its ability to reinfect people with previous Covid infections helped drive the tip in the region. And while countries like the UK are seeing increases in Delta infection, their widespread vaccination coverage should provide some protection against serious illness.

Vaccination coverage is still unusually low on the African continent – fertile ground for a new variant like Delta.

Countries have been hit by the slowdown in vaccines from the COVAX vaccine alliance due to India’s decision to stop importing to the plant. And in the case of South Africa, a reluctance to enter into bilateral agreements with vaccine manufacturers early.
Countries in Africa fear that they may become the next India when vaccine supply declines

“It was surprising how quickly the Delta variant took over,” said Tulio de Oliveira, who until recently led the team at KRISP, a genomic monitoring center in Durban. “The growth seems to be much, much faster than the Beta variant. Within a few weeks here, it seemed to be the dominant and repressed Beta variant.”

Within hours of the variant’s discovery, the country’s Covid task force decided to put the country back in a strict lockdown, de Oliveira said. But by that time, Delta was already raging in the Gauteng province, much of the rest of the country and the wider region.

Asked by CNN about the lack of space in hospitals and deaths of patients while waiting for a bed, the Gauteng Department of Health responded by sharing presentations showing expanded bed space in the city over the past few months.

Private hospitals are also packed to capacity with surgeons and other non-physicians volunteering for rounds in the Covid-19 wards.

But doctors here blame a fire on one of the city’s largest hospitals and the decision to close one of its large field hospitals on Nasrec before the third wave as significant mistakes. Beds also need staff.

“Beds are just a piece of furniture, you need staff and oxygen, nurses and supplies,” said a doctor who helped set up Nasrec, talking about the condition of anonymity because they still work in the state sector.

Overcome natural barriers

In recent weeks, one of the hardest hit countries in the world has been Namibia, South Africa’s neighbor to the northwest and a tragic example of the power of the new variant.

By 2020, Karamagi and his team of computer scientists at WHO’s African headquarters in Brazzaville, Republic of the Congo, had predicted that Covid-19 would have a completely different trajectory in parts of the continent than in countries such as the US, Italy and the UK, where cities were put on knee.

Contrary to the grim predictions of a catastrophe in Africa, with Covid-19’s overwhelmingly weak health systems, their modeling suggested a mixed picture with some countries escaping the worst due to a young population and so-called “socio-ecological” factors.

People queue for Covid-19 test in Windhoek, Namibia.

Namibia seems to be an ideal example: a large country for its population of about 2.5 million with a generally warm climate and limited large-scale movement of people compared to other countries.

“Namibia has had three waves. The first two waves were quite small and health measures brought them under control. But this wave is very high. You can see the effect of the virus’ transmissibility,” Karamagi said.

The presence of the Delta variant was only confirmed by government researchers this week, but at the time it was one of the hardest hit countries on earth despite renewed lockdowns.

“At every hospital, you have 25 to 30 people on the waiting list. The system is congested, prominent people are dying because they can’t get a bed,” said Dr. Danie Jordaan, a well-known general practitioner working in the country. capital, Windhoek and the coastal city of Swakopmund.

“You’ve gotten to a point where they need to decide who’s going to make it. Older patients are being pulled out of the ICU, knowing that it will kill them to give anyone younger a chance,” he said.

In Windhoek, the State House is completely overwhelmed. Video clips seen and approved by CNN show corpses in white bags stacked three deep inside the facility.

“What they need to do now is use a rotation system, swap bodies stored in the freezers overnight, with those lying in the hallways in the morning and then do it again in the afternoon to prevent thawing,” a person who is familiar with the operations at said the mortar house to CNN.

Namibia’s presidential spokesman confirmed that the house in Windhoek was at full capacity.

“Our homes were designed to deal with deaths under normal circumstances and we are now dealing with extraordinary circumstances. This is not a challenge that is unique to us, COVID-19 has put pressure on healthcare systems across the globe,” said Dr . Alfredo Hengari and added that they have created additional capacity to deal with the emergency.

To create space when there is none

The situation is so bad in Namibia that doctors like Jordaan have to resort to treating patients at home. The same thing is happening in Gauteng, the epicenter of this wave in South Africa, but just on a much larger scale. And sometimes home care just isn’t enough to keep sick patients alive.

“Delta has caused a whole lot of chaos, a whole lot of patients suffer, their oxygen levels drop drastically daily – there are patients who suffer and there is no room in the hospital, there are no fans available. It is complete chaos,” he said. Mohammed Patel, a paramedic with Pulsate EMS.

Patel and paramedics throughout the city work with the charity Gift of the Givers. In its warehouse filled with food and emergency supplies, they send out to crises around the world, a team of oxygen generators fills the back of a pickup.

They distribute them to patients throughout the province to reduce the burden on hospitals. Covid-19 is unlike any emergency they have ever dealt with.

“The difference is when you go to a war zone or a natural disaster, you have an idea of ​​the level of damage, what the disaster is. But this is very unpredictable. We have never seen anything like it before,” said Dr. Yakub Essack, the medical coordinator for Gift of the Givers.

COVAX vaccines pictured arrive in Tunisia.

But with full-capacity hospitals in both the public and private sectors, the charity has gone a step further and in five days has built a clinic with 20 beds for patients who cannot find a bed.

Patel and his team go into a house in Lenasia, a suburb south of Soweto, to find a 67-year-old patient who tested positive for coronavirus 17 days ago. When he gets up to walk, an oximeter shows that his oxygen concentration level is falling in the 60s. Healthy adults should read in the nineties.

“We’re coming through you, OK,” Patel says to the patient. He is the first patient to arrive at the community center-come clinic attached to a mosque. Patel is convinced he will make it now.

But in hospitals in Johannesburg, patients are still struggling through this Delta wave, and doctors and nurses are suffering with them.

Doctors say that sometimes patients do not come into the wards, even with the best facilities.

But just this week, the doctor we spoke to said their hospital was struggling to wrap the bodies fast enough to free up space.

“Patients look at us, they trust us to do our best, but it’s not good enough. There’s a feeling, no matter how much I do, it’s going to be the same tomorrow and the next day and the next day and the next day, “they said.

CNN’s Bethlehem Feleke and Niamh Kennedy contributed to this story. Reporter John Grobler contributed with reporting from Windhoek.


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