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A third wave is coming, and South Africa needs to prepare.  Drawing on the experience of responding to the second COVID-19 wave in seven hospitals in three provinces, and also in Lesotho, MSF shares reflections on the importance of hospital preparedness for the next wave. The second COVID-19 wave hit South Africa hard. Between October 2020 and February 2021, 17% more people were infected than in the first 8 months of the epidemic, and more people died, 26,000 in total.   The rapid spread of the new dominant variant 501Y.V2, which differs from the original by up to twenty mutations and is twice as transmissible, likely caused a more severe second wave than was anticipated. Vaccines are now being rolled out to frontline healthcare workers in South Africa but it is likely that more widespread vaccine roll-out will not have occurred before a new surge in infections in a third wave begins after April/May. To avert more deaths and struggles to ensure adequate care to thousands of C

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