Peter Serati rolled down the car window and opened his mouth as a lab worker reached in to take a swab at a drive-in coronavirus testing centre in Johannesburg, South Africa’s largest city. Working swiftly behind a face mask and protective goggles, the tester took swabs from Serati’s wife and daughter on the back seat before neatly sealing the sample tubes into ziplock bags. There are around 50 coronavirus testing sites in South Africa, the second-most affected country on the continent after Egypt, with 202 cases recorded to date. South Africa’s public healthcare facilities are poorly equiped to handle an epidemic. Public hospitals are under-funded and overcrowded on the best of days, with staff already stretched to their limit. As a result, the government has partnered with the private sector to scale up its response and more than 6,000 people have been tested so far. In Gauteng, South Africa’s most populous province, private laboratories have set up drive-in centres to limit waiting times and avoid contact with other patients. The results come back within 48 hours. But speed and convenience come at a steep price. Testing costs 900 rand ($52) for a basic swab — a fee unaffordable for many South Africans. Health insurance schemes typically reimburse COVID-19 tests only if the result is positive. For Serati, who works in IT, the decision to get tested privately was a no-brainer. A parent at his daughter’s school tested positive last week and the child has since developed a cough. The hard part, he explained, was convincing a doctor to prescribe the swab test. “They said we didn’t show enough symptoms,” said Serati, who consulted three different doctors. ‘Flooded’ hospitals Teacher Letsebogo Ramalfo, 36, was referred to a lab after a colleague caught the virus and he himself came down with a cough. He said he decided to go private because he did not trust public hospitals to test properly. “They don’t have these swabs, they say they are finished,” said Ramalfo. “When I called, they told me that… there is no need for you to come, it might just be a flu.” At the government Charlotte Maxexe Johannesburg Academic Hospital, patients often spend hours in poorly-sanitised waiting rooms. Spokeswoman Lungiswa Mvumvu said the hospital was “flooded” by people seeking COVID-19 testing on Monday — after the number of confirmed cases surged and President Cyril Ramaphosa declared a state of “national disaster”. “Remember that we also have all our other daily functions,” Mvumvu told AFP, adding that panicked patients had overwhelmed the emergency department. Hospital staff have since placed nurses at the main entrance to screen patients. Suspected cases are given a face mask and directed to crammed, clunky lifts that haul them up to the testing unit. A nurse told AFP that between 200 and 300 people had turned up for testing on Wednesday. Most had been turned away for lack of symptoms. Hygiene before testing “Our public healthcare system will struggle to cope with millions of people presenting themselves for testing without due course,” Ramaphosa warned this week. Testing in South Africa is so far reserved for people with clear symptoms, recently returned from a highly-affected country, or who have had contact with confirmed cases. The World Health Organization (WHO) has called on all countries to loosen the criteria and roll out mass testing. “We would like to encourage… a very focused screening and case finding strategy whereby any people with suggestive symptoms… would be tested,” said WHO Africa director Matshidiso Moeti, acknowledging that the lack of test kits was a “global challenge”. Restrictions on testing are a worry for many South Africans who fear contamination from asymptomatic patients. “It has been on the rise and we just think it’s safer to know whether we have it or not,” said Lina Moganedi, 25, who after visiting a drive-in centre for information on the process. “Everyone needs to know whether they have this disease or not.” Health Minister Zweli Mkhize stressed that the only way to “flatten the curve” of infection was preventative measures, starting with hygiene. “Please heed the call to follow precautionary measures,” he appealed on Friday. “It is not with testing one patient that the virus will be prevented.”