South Africa's Multiple Epidemics

demise of a controversial industry in the Netherlands. The Dutch government is forcing all mink farms to close by March of next year. According to a report from news agency, A and P infected minks were found on forty two farms, triggering mass cullings of the furry mammals that are bred for their soft pelts. Before the outbreak, the mink industry in the Netherlands had been scheduled to close in twenty

four on animal welfare grounds. Peru has set another grim record by reporting the highest number of deaths per capita from the coronavirus, with twenty eight thousand, two hundred and seventy seven confirmed deaths from COVID nineteen, or just over eighty six for every one hundred thousand inhabitants. Peru overtook Belgium as the nation where the virus has been deadliest. That's according to data compiled by Johns Hopkins University, the I m F and Bloomberg. Peru has one of the

world's worst outbreaks by other measures too. Over the past seven days, no country in the world has posted more cases. The outbreak has been so bad that as much as a quarter of the twelve million people currently living in Lima may have already had the virus. According to a government study published last month, Officials war in the country's

real death toll may be close to double the official figure. Finally, a UK study has suggested all the children who have died from COVID nineteen in the country had quote profound underlying medical conditions. The report suggests that healthy school age patients are at very limited risk of severe disease outcomes. The report adds to previous indications that youthful patients suffer less from the disease than older people, but it did show that black or obese children are at a marginally

higher risk and now for today's main story. The coronavirus has swept through South Africa, but the country was already carrying a heavy burden of chronic and infectious diseases. Its health care system is fragile. So what happened when the country went into a strict lockdown to prevent the spread of COVID nineteen from overwhelming its medical facilities. Johannesburg based

reporter Janice Q explains. In the early hours of July thirty, protests from a heavy green countryside in South Africa's northeast set fire to some parts of the hundred and seventy bed Katherine Booth Hospital. Their complaints they didn't want COVID nineteen patients at the facility. It was the second protest in as many months after the local government Sate had wanted it to become the region's COVID hospital. Katherine Booth

is already dealing with many high risk patients. Our hospital has a lot of people suffering from hypertension, diabetes, HIV and TV. In fact, we our hospital that initiates medication for certain people who are resistant to certain drugs for TV, so that is a speciality. This is Dr Martinez Duplusy one of nine doctors who work at Katherine Booth. He joined the hospital in July twenty nine and usually works

in the outpatients department and in the emergency room. When South Africa started its initial strict lockdown in March, he largely became the de factor coronavirus doctor, doing most of the unside testing and making many of the calls on who should be admitted. While frequent slewness in getting COVID nineteen test results has made his job challenging, he's grateful that other than gowns, there haven't been any real shortages

in protective clothing. What is more concerned about is the tuberculosis, diabetic and hypertension patients that he hasn't seen in the past five months. After a few months, you realize that a lot of the familiar faces aren't they anymore. And coupled of that, people that present acutely in the hospital that has a chronic illness, so let's say hy pretensive

crisis or diabetic crisis. Um, you make the assumption and realization that a lot of these people passes away at home because they never yeah, they never make it to hospital. As South Africa entered its lockdown. Nurses had gone into the community to ask people a series of questions as a way of screening them for the coronavirus. At the same time, they told people to please only go to

hospital for an emergency. The idea was to reduce the number of people coming in so as to prepare for the expected influx of COVID nineteen patients, but the hospital mostly just emptied out, with occupancy dropping to less than half. The diversion of resources from HIV and TB programs to tackle the coronavirus outbreak is one of South Africa's significant losses. Together with the reluctance of people to visit health facilities for fear of contracting the disease, this has led to

collateral deaths. No one told them that they still need to follow up every month to collect their medication. South Africa has one of the world's biggest number of people infected with HIV and one of the world's largest number of tuberculoser sufferers. Together with extreme poverty, which exacerbates high obesity levels that have boosted the number of diabetes patients, it's understandable that the Health Minister took steps to mitigate the chances of hospitals being in indebted. But still the

strict and prolonged lockdown has a diet economic consequences. You know, if your need is really to put food on the table, that trump's you know, thinking about your diabetes teas care and the impact that that food may have on your blood sugars and those diets tend to be very high in carbohydrates, which then obviously impact significantly on on on poor glucose control. This is Dr za and Stevens, a specialist position an India chronologist at the Christian Barnard Memorial

Hospital in Cape Town. It's a private hospital named after the famous South African surgeon who conducted the world's first human heart transplant. It's also a stock reminder of South Africa's high inequality for country that boasted this groundbreaking surgery in nine. South Africa's history of four racial segregation during the Partet regime set its healthcare system on a destructive path.

We've got this two tiered health system in South Africa where we have a small group of people, probably about twenty of the population, who are cared for with in the funded healthcare sector, and then the overwhelming majority of the population being cared for by the state healthcare sector.

Katherine Booth has a TV war that is good for isolation, so the idea of using it as a COVID facility makes some sense still for the community of about three and fifty thousand people that it serves, many who have little disposable income. Having to find money to travel further to a different facility as a problem. So they're protesting

for their own health, which makes sense. Everyone has a right to get medical care, and to take that away by telling it in to a COVID hospital and telling you to drive an hour and a half or two hours to a different hospital, it's not feasible for the people in my communities. Even so, in late August, the local health authorities decided that Catherine Booth would be converted to a COVID hospital. That means besides those heading for the maternity ward, no new patients can be admitted unless

there are COVID patient. It's very time consuming to transfer sick people and our closest hospital is mar b and ha We which together with the dirt road, it takes about an hour hour and a half to get the patient there, But then you still need to book an ambulance and discuss the patient, so it takes about four to five hours for patients to get to the hospital. So it's very frustrating, as frustrating for us as frustrating for the patients. We still actually not sure how to

cope with all of this. It's not that the doctors and Katherine Bruth are being left all alone to figure it out. Through a research program, some doctors from the bigger hospitals are coming to help them manage the COVID patients. There are also more resources being provided. The Department of Health has started its biggest ever medical intern allocation program

with almost recruits at Katherine Ruth. Construction to build new wards have been fast tracked and since April, South Africa has a cured fleet of new mobile coronavirus screening and testing fans. The mobile testing like clinics, I think is a great idea. Some of the units even will say chronic mediation and then give own patients day chronic treatment. Across the country. There's also be incorporation between the public and private health sectors to an extent not seen before.

And here's with South Africa make it it's most significant COVID related when the virus is breaking down walls that could expedite the expansion of care. That was Janice Q. And that's it for our show today. For coverage of the outbreak from one twenty bureaus around the world, visit bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more

listeners find our global reporting. The Prognosis Daily edition is produced by topor foreheads Jordan gas Pure, Magnus Hendrickson, and me Laura Carlson. Today's main story was reported by ja This Cube. Original music by Leo Sidrian. Our editors are Rick Shine and Francesca Levi. Francesca Levi is Bloomberg's head of podcasts. Thanks for listening. H