Authorities in South Africa have imposed new restrictions in a last-ditch attempt to stem a sharp 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.
President Cyril Ramaphosa said all gatherings, indoors and outdoors, would be banned for 14 days, along with the sale of alcohol, dining in restaurants, and travel to or from the worst-hit areas of the country. An extended curfew would also be imposed, and schools shut early for holidays.
“We have overcome two decisive waves but now we have a new hill to climb, a great challenge, a massive resurgence of infections … a devastating wave,” Ramaphosa said, speaking on national television on Sunday night.
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 said.
Unlike past waves, this time the hospital system was not coping, said Dr Angelique Coetzee, the chair of the South African Medical Association.
Calling on citizens to comply with social distancing measures, Ramaphosa underlined the increased transmission of the Delta variant and admitted that health systems were “buckling under the strain”.
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. Although the increase in cases in Gauteng has exceeded a severe second wave six months ago, it has not yet reached its peak, experts believe.
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-19 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 main 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 to 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 hospitalized.
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 the limited availability of shots after western countries bought most of them, 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.
But several countries have failed to administer jabs from Covax before their use-by date because of logistical failures and vaccine hesitancy.
Ramaphosa warned South Africans against false information on social media and asked them to avoid “spreading panic, fear and confusion” by circulating misleading posts about vaccines.
“They are safe, effective and they save lives,” he said.
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.