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How inequality and poverty undermined South Africa's COVID response

07:47 08 August 2020 Author :  

JOHANNESBURG (Reuters) - When coronavirus patients started arriving at South Africa’s government-run Thelle Mogoerane Hospital, workers scrambled to set up isolation wards to treat them.

They can’t keep up. Video filmed inside the hospital and seen by Reuters shows patients with COVID-19, the disease caused by the new coronavirus, being treated in a general ward, separated from other patients only by curtains.

“There’s no space anywhere,” nurse Rich Sicina said outside the modernist, iron-roofed hospital in a southern Johannesburg township. “It’s a mess.”

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.

“Once we had a first positive case, a ward was created for confirmed positive cases,” she said, adding that it strictly followed South Africa’s national infection prevention guidelines.

The struggle is what President Cyril Ramaphosa wanted to avoid when he imposed one of the world’s toughest lockdowns in late March - when the country had confirmed just 400 cases - to buy health workers time to prepare.

But the measures 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 in order 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.

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 contributed to its undoing, government advisers and independent experts said.

The first cases were wealthy travellers who brought the virus in from Europe, Asia and beyond, they said.

“They could isolate in their mansions,” said Wolfgang Preiser, a virologist at Stellenbosch University. “The problem is that these places are maintained by a whole crowd of domestic workers. They were exposed, and they travelled home 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 quickly, said Yunus Moosa, chief infectious disease specialist at the University of KwaZulu-Natal and a senior member of the government’s COVID-19 advisory panel.

It overwhelmed public hospitals “already on the brink of collapse”.

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.

Mismanagement and looting of public funds, which have hollowed out public services for years, exacerbated shortages of protective clothing and other supplies at some hospitals, 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.

Other factors were less foreseeable: some epidemiologists think the virus was circulating before it was first detected in the eastern KwaZulu-Natal province in early March, including across the country in the tourist hotspot of Western Cape.

Global shortages of testing materials undid an ambitious screening policy.

“I understand people might ask if things could have been done better, but honestly, what more could we have done?” Moosa said.

“If we had a magic wand we could wave and turn our healthcare system into a world-class one overnight, then we would have done it.”

The World Health Organization says South Africa is a “wake-up call” for other African nations, where confirmed infections are lower but climbing.

“South Africa may unfortunately be a precursor, ... a warning for what will happen in the rest of Africa,” the WHO’s top emergencies expert Mike Ryan said.


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.

Provincial officials declined to release case figures for specific suburbs and neighbourhoods that could better explain how the virus spread, but there are clues.

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