Doctors, nurses, undertakers and civic activists want national and provincial interventions that address the reality of the dire situation in KwaZulu-Natal.
The grim reality of a second wave of Covid-19 infections in KwaZulu-Natal is perhaps best summarised by one of the province's biggest undertakers. "We are swamped. We are exhausted," said Nomfundo Mcoyi, whose staff at Icebolethu Funerals are frantically trying to manage the ghastly surge in business.
"Normally, we handle 150 to 200 burials around the province in a week. Last week we did 572. It is emotionally devastating. It is definitely Covid. I assure you, I estimate 400 of those 572 deaths are related to Covid."
Mcoyi says the stress is compounded by mulish responses from some officials and government departments. For example, a grave cannot be secured without a death certificate or a burial order, and the Department of Home Affairs' offices in Durban are often closed because of Covid-19 infection scares.
"If one person tests positive at home affairs the entire staff is quarantined. Bodies cannot pile up at hospitals. We collected 25 bodies in Durban in one night this week. We cannot keep them indefinitely, but we have to deal with queues at hospitals and home affairs. Families are grieving. They are short-tempered and angry because they cannot bury their loved ones."
Mcoyi says the government has extended business hours for the home affairs department for elections previously and it ought to do the same during the pandemic. "If it were a policy of no work, no pay, I am sure nothing would close."
Deluge of patients
Stephen Carpenter, a general practitioner in Pinetown, west of Durban, says the medical practice where he works has been inundated with patients since around 16 December. "On average, we are seeing about 100 to 120 people a day and about 75% of those cases are Covid-related or Covid anxiety-related."
Carpenter says his patients are worried about having been in contact with infected people and unsure whether they need testing. Of the total number of patients seen at his practice every day, about three or four are "very ill", with low oxygen saturation. While they may not be short of breath, some need to be hospitalised for oxygen therapy. But hospitals in and around Durban are full.
Carpenter says whereas previously doctors would call a hospital to arrange the admission of a patient, they now send the person directly to the facility. "It is pretty drastic. There are tents in the car parks and people sometimes have to wait two or three hours to be admitted."
The doctor, who had a mild dose of Covid-19 himself in July last year, likens the deluge of patients to the early days of the HIV and Aids pandemic when there was a sudden increase in the number of sickly people. While most people are not as sick with the coronavirus, Carpenter says, some have died, including seven of his patients. The mortality figures he has seen have corresponded with the statistics the government released.
According to Carpenter, there can be no doubt that medical staff are struggling to cope. He says infections or scares mean many frontline workers have to isolate themselves, which puts huge strain on the already under-resourced healthcare system. At some medical practices, emergency rooms, ambulance services and old age homes, this has meant that half or sometimes even fewer of the staff who were supposed to be on duty were in quarantine.
Apart from the practical challenges this presents, it contributes to significantly raised anxiety levels. Carpenter says his contact with other healthcare workers in both the public and private sectors shows "everyone is exhausted, but I have been quite impressed with the helpfulness of people. A lot of people have stepped up to the mark."
Extra staff a 'drop in the ocean'
Thami Zondi, the KwaZulu-Natal chairperson of the Health and Other Services Personnel Trade Union of South Africa, says its 18 000 members are taking strain and although only about 100 of them have reported being infected with Covid-19, he suspects many more are positive because testing is an expensive and fearful experience.
Zondi says the provincial Department of Health has to be credited with contracting more nurses and porters to cope with the demand. "But the hospitals were understaffed before, so the additional people are like a drop in the ocean," said Zondi.
"The situation is getting worse every day. We asked the department to meet with all unions so we can fight this invisible enemy together. This second wave is stronger and we need to protect our members with better staffing and better personal protective equipment. The department and private hospital management are not doing enough."
Zondi's counterpart at the National Education, Health and Allied Workers' Union (Nehawu), Ayanda Zulu, agrees. Nehawu has 41 000 members of whom more than 8 000 have tested positive. Zulu says "less than 100" Nehawu members have died.
"This is severe. It is worse than it is reflected in the media. The public health system has been under strain for years, mainly due to understaffing. Now there is more stress and strain. Hospitals are full. Many health workers are sick or in quarantine. The few staff who are on duty are sometimes not adequately protected and there is no psychological support. This thing is emotionally draining."
Zulu criticises the health department's failure to share information about the pandemic as well as operational information. "There is no clear plan [relating to the distribution of staff and resources]."
High infection, low recovery rates
KwaZulu-Natal premier Sihle Zikhalala said on 3 January that 98 health workers, most of them nurses, had died from Covid-19. According to the National Institute for Communicable Diseases, the province had more than 255 819 cases of infection by 11 January, or 20% of the national total. Gauteng was second at 27%. The provincial Department of Health said the recovery rate in KwaZulu-Natal was 69%.
Fears about the second wave of Covid-19, the virus' mutation and the unavailability of vaccines have compounded concerns about the government's ability to cope with the spread of the pandemic.
The KwaZulu-Natal Research Innovation and Sequencing Platform is based in Durban and attached to the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal. The platform's team members are among the scientists working around the clock to track the spread of the disease and learn more about the virus and its variants. Its founder, virologist Tulio de Oliveira, previously described the high infection rate of 26% as "very concerning" and said the number of infections was "just the tip of the iceberg because we are not testing very widely".
The World Health Organization recommends that the positivity rate be kept below 5%. The high infection rate has intensified worries around a shortage of medical facilities and personnel.
Charl van Loggerenberg, general manager of emergency medicine at the private hospital operator Life Healthcare Group, says there has been an increased demand for hospital beds and waiting lists have been longer, particularly in intensive and high-care units. Life Healthcare owns 49 hospitals and has 16 300 employees in South Africa, many of them in KwaZulu-Natal. "Capacity is based on a number of factors, not only patient numbers and bed numbers," said Van Loggerenberg.
He says Life Healthcare has been responding to the increased demand, but human resources and equipment are finite, putting constraints on the number of patients the group can treat. "We are making adjustments ... in response to the increasing demands placed on all hospitals in KZN. Increased admission times are experienced but we are attending to our patients as efficiently as possible."
Van Loggerenberg says hospitals are in constant contact with provincial health authorities to ensure that additional beds are available. "The second wave is most definitely affecting doctors, staff and other healthcare workers." The spread appears to have happened faster than in the first wave, he says, and staff are under "enormous stress and pressure".
Healthcare system overwhelmed
A trauma doctor at a private hospital says in his experience the healthcare system is showing signs of being overwhelmed. "Some health workers are at the point of mental breakdown. I have had to treat patients on the floor. We have oxygen stations in the car park. Inside, all you hear is this Covid cough. You are in full [protective gear] and you are sweating and terrified because your colleagues are dying. There is a shortage of nurses and staff. We can't admit any more patients and I get to choose who gets the oxygen - the gogo [grandmother] or the 35-year-old. It is beyond overwhelming."
Father Brett Williams, a Catholic priest whose parish is close to central Durban, says he still rings the church bells for mass even though the service is now online. He hopes doing so serves as a reminder of the physical presence of the church and brings comfort.
"We have faith and hope and we believe we will overcome with God's help. But fear is real and courage and hope don't make fear go away. It is present in all of us and it is exacerbated by loneliness. We are social beings and we are meant to be with one another."
Not being able to administer the sacraments and visit the sick or the dying is heartbreaking, says Williams. He adds that the church's response to the first Covid-19 wave was aimed at addressing loneliness, whereas the second wave demands grief and bereavement counselling.
Lacklustre government services
Raymond Perrier, who runs the Denis Hurley Centre, an inter-faith organisation that supports homeless people in downtown Durban, says the centre is feeding 300 people a day, almost double the number it fed last year, indicating the impact of Covid.
Perrier says the NGO sector relies on donations and is affected by the depressed economy. Most NGO workers do their jobs out of conviction rather than for financial reward, but they bristle at the lacklustre government services in a time of crisis.
"Government officials are still on full salaries and yet you find offices closed. For many, Covid has become a licence to do even less than they normally do. People selling cabbages on the side of the road to feed their families have a sense of urgency that is unfortunately not shared by most officials. They are not sharing the pain. What is their sacrifice? Politicians haven't taken a pay cut."
Verushka Memdutt, a civic activist and general secretary of the Market Users Committee, a body that represents 3600 traders in Durban, says the pandemic requires greater scrutiny of government decisions and an emphasis on sharing information. "They impose rules on us ... like we are a third party rather than a partner [in the fight against Covid-19]," she said.
A host of pandemic-related decisions by municipal officials seems "arbitrary and wrong" and are about control instead of safety. "Decisions must be reasonable and aimed at preserving lives and livelihoods, and information about how we manage things should be widely shared," said Memdutt.