The potential impact of public health care denial on the transmission dynamics of COVID-19 in South Africa

When the demand for public health care increases, governments often prioritize citizens over foreign nationals. In South Africa, limited resources and socio-economic inequalities pose unique challenges to epidemic control. The overcrowding and increasing demand for public healthcare have led to protests by some community groups, which have led to the denial of healthcare to migrants. Denying treatment to some infected individuals has the propensity to lead to an increase in the size of an epidemic. We introduce a novel epidemiological model that incorporates health care denial as a dynamic factor influencing the transmission of COVID-19. It incorporates healthcare denial as a key parameter influencing the progression and recovery rates of infections. The study presents a novel framework for understanding the intersection of healthcare access denial and the transmission dynamics of COVID-19. While much of the existing literature has focused on the direct effects of healthcare interventions on pandemic control, this research uniquely emphasizes the role that restricted access to healthcare services, whether due to policy decisions, resource shortages, or system inefficiencies, can exacerbate the spread of infectious diseases. The treatment class of the model is partitioned to account for individuals denied treatment at public healthcare facilities. Analytical results establish conditions for the existence and stability of both disease-free and endemic equilibria, with the basic reproduction number R₀ explicitly derived to quantify transmission potential under varying healthcare access scenarios. Sensitivity analysis reveals that increasing denial of care can significantly elevate R₀, resulting in higher infection peaks, prolonged epidemic duration and greater cumulative mortality. Numerical simulations further illustrate the non-linear relationship between treatment accessibility and outbreak severity. The findings highlight that equitable healthcare provision is not only a public health necessity but also a critical determinant for reducing the COVID-19 burden. Policy implications stress the integration of inclusive healthcare strategies to ensure epidemic resilience and minimize transmission risks, especially in vulnerable populations. Strategies that will accommodate every infected person who goes to the hospital for treatment should be adopted to reduce the disease burden.