The COVID-19 pandemic in South Africa was part of the pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
On 5 March 2020, Minister of HealthZweli Mkhize had confirmed the spread of the virus to South Africa, with the first known patient being a male citizen who tested positive upon his return from Italy.[4] On 15 March 2020, the President of South Africa, Cyril Ramaphosa, declared a national state of disaster,[5] and announced measures such as immediate travel restrictions and the closure of schools from 18 March.[6] On 17 March, the National Coronavirus Command Council was established,[7] "to lead the nation's plan to contain the spread and mitigate the negative impact of the coronavirus".[7][8] On 23 March, a national lockdown was announced, starting on 27 March 2020.[9] The first local death from the disease was reported on 27 March 2020.[10] On 21 April, a 500 billion randstimulus was announced in response to the pandemic.[11] Ramaphosa announced that from 1 May 2020, a gradual and phased easing of the lockdown restrictions would begin, lowering the national alert level to 4.[12] From 1 June, the national restrictions were lowered to level 3.[13][14] The restrictions were lowered to alert level 2 on 17 August 2020.[15] From 21 September 2020, restrictions were lowered to alert level 1.[16]
In December 2020, the country experienced a 2nd wave of COVID-19 infections,[17] mostly with infections from the SARS-CoV-2 Beta variant.[18] The lockdown was tightened from an adjusted level 1 to an adjusted level 3 starting on 29 December 2020. The lockdown was lowered from an adjusted level 3 to an adjusted level 1 starting on 1 March 2021.[19] On 17 February 2021, the national COVID-19 vaccination program was officially rolled out.[20]
On 8 May 2021, local cases of variants of concern Delta (first detected in India, which has a higher transmissibility than the dominant strain, Beta) and Alpha were reported.[21] On 31 May 2021 the country was moved from adjusted level 1 to an adjusted alert level 2, due to a 3rd wave of infections,[22] mostly with infections from the Delta variant.[18] On 15 June 2021 the country was moved to alert level 3.[23] On 28 June 2021, the country was moved to adjusted level 4, with the Delta variant fast becoming the dominant strain in the country.[24] On 9 July 2021, sixteen months into the pandemic, doctors in Johannesburg described the system there as beyond its breaking point, with insufficient beds and barely enough oxygen.[25] On 25 July 2021 the country was lowered to adjusted level 3.[26] On 13 September 2021, an adjusted alert level 2 took effect,[27][28] and on 1 October 2021 more restrictions were eased by moving to adjusted alert level 1.[29]
On 26 November 2021, the World Health Organization (WHO) classified the Omicron variant, first identified in Botswana[30] but first reported to the WHO by South Africa, as a variant of concern.[31]Several countries announced travel bans from South Africa and its neighboring countries. The country was entering its 4th wave by 1 December 2021,[32] mostly with infections from the standard BA.1 subvariant of the Omicron variant.[18] On 4 February 2022 it was announced that South African scientists had replicated the Moderna COVID-19 vaccine.[33] Further easing of restrictions came into effect on 23 March 2022, including dropping the requirement to wear masks outdoors though still required indoors in public vehicles and spaces, allowing proof of vaccination or a COVID-19 test not older than 72 hours as an alternative for entering certain venues, and reducing distancing to 1 metre except in schools.[34][35] On midnight 4 April 2022, the National State of Disaster was terminated, though some transitional provisions remained in place for a period of 30 days.[36]
A limited 5th wave[37] from late-April 2022 was mostly from infections from the BA.4, BA.5, and BA.2 subvariants of the Omicron variant.[18] Deaths were more decoupled from cases, likely due to high levels of population immunity from infection and/or vaccination.[38] Eminent risk declined by mid-June 2022, and on 22 June 2022 all remaining health regulations regarding COVID-19 were ended.[37]
During the first two years, 2020 and 2021, excess deaths were estimated at 292.3 per 100000 population.[39] As of 2 January 2023[update] there have been 341123 excess deaths of persons older than 1 years from natural causes since 3 May 2020,[40] with 85%–95% of these excess deaths attributable to COVID-19, and the remaining 5%–15% probably mainly due to overwhelmed health services.[41] In May 2023, it was announced by the WHO Director-General that COVID-19 was no longer a Public health emergency of international concern.[42]
Since the first patient with COVID-19 was confirmed in South Africa on 3 March 2020[43] the country has experienced five waves of the pandemic.[44][45]
On 30 March 2020, the government announced its intentions of initiating an enhanced screening and testing programme.[50] On 3 April 2020, the NICD made alterations to its testing guidelines to further allow for anyone who presented with relevant COVID-19 symptoms to be tested (previously there were additional requirements such as history of foreign travel or recent contact with a confirmed case).[51] By the start of April, 67 mobile testing units had been established and 47000 people had been tested, some in drive-through facilities.[52]
On 8 April, the National Health Laboratory Service (NHLS) detailed its testing capacity through the country. The NHLS would be able to perform approximately 36000 tests per day.[53]
Many private clinical pathology laboratories were also conducting tests. The CEO of the NHLS, Dr Kamy Chetty, said that by 9 April 2020 the majority of tests had been done in the private sector as the initial cases had been linked to international travellers who were likely to be on private medical aids.[54]
By 9 April 2020, South Africa had conducted 68874 tests at 1.2 tests per thousand, considerably lower than for example Turkey (3.3), the United Kingdom (3.6), and South Korea (9.7).[55] However, the ratio of positive tests to total tests conducted was significantly lower than most countries. By 10 April, the number of tests had increased to 73028, making the average number of tests per day in the first 10 days of April roughly 3300. The chair of the board of the NHLS, Eric Buch, stated that it had a capacity of 15000 tests per day and would welcome doing more tests.[54]
On 14 April, Stavros Nicolaou, head of Business for South Africa's healthcare working group and Aspen Pharmacare executive, said that South Africa had the capacity and kits to do 25000 tests a day.[56]
By 23 April the total number of tests was 143570.[57] The number of daily tests increased: for the first 14 days of April the daily average number of tests was 3394; for the next 9 days the daily average was 6283. The rate of positive tests versus total tests remained less than 3%. The Minister of Health released figures that showed that of all the tests done up to 23 April 62% had been done in the private sector and 38% in the public sector. However, that ratio was changing as the public sector increased capacity. The public sector performed 63% of the new tests reported on 23 April 2020.[58]
By 27 April, 185497 tests had been performed on South African residents, with the public sector doing the majority of the tests. Provincial test coverage varied by over a factor of 8. The number of tests per 100000 residents (based on 2019 population estimates) was Northwest 66, Limpopo 69, Mpumalanga 101, Northern Cape 111, Eastern Cape 247, KwaZulu-Natal 270, Free State 284, Gauteng 439, and Western Cape 541 (national average 317). A surveillance programme was started to monitor community transmission (as opposed to tests done on people who displayed symptoms or who had been in contact with COVID-19 patients). In the three arms of the programme 812 tests had been done and two positive cases had been detected.[47]
By 28 June, the total number of tests was 1567084. The private sector had now overtaken the public sector, in terms of tests completed. The private sector had done 804248 test with the public sector only doing 762836.[59]
By 11 July, 2108570 had been done with the private sector still doing the most tests.[60]
On 17 March 2020, the South African Health Products Regulatory Authority announced that it would expedite review of treatments, vaccines and clinical trials.[62]
By mid-March, isolation measures gathered pace, and on 15 March 2020, President Cyril Ramaphosa declared a national state of disaster, prohibiting gatherings of more than 100 people.[6]
On 17 March, Ramaphosa, supported by Deputy President David Mabuza, convened the inaugural meeting of the National Command Council on COVID-19,[7] or as it was subsequently called, the National Coronavirus Command Council,[64] "to lead the nation's plan to contain the spread and mitigate the negative impact of the coronavirus".[8]
Parliament suspended all activities as of 18 March.[66] and the African National Congress (ANC) and Democratic Alliance (DA) postponed their elective conferences.[67] The Commission for Conciliation Mediation and Arbitration (CCMA) cancelled all scheduled cases from 18 March 2020 and prohibited walk-in referrals of new cases – in lieu of electronic referrals.[68]
After panic buying, some retailers put limitations on the number of certain items customers could buy.[80] On 19 March, Minister of Trade and IndustryEbrahim Patel signed a government gazette that enforces price controls on essential items and that could see price gougers punished with measures including a R10 million fine, a fine equivalent to 10% of a firm's turnover, or 12 months in prison.[81]
On 3 June, Minister Dlamini-Zuma extended the state of disaster, which was to lapse on 15 June, three months after its announcement, to 4 July citing "the need to continue augmenting the existing mitigation measures undertaken by organs of state to address the impact of the disaster."[82][83] On midnight 4 April 2022, the National State of Disaster was terminated, though some transitional provisions remained in place for a period of 30 days.[36]
During the announcement on the lifting of level 5 lockdown measures on 23 April, Cyril Ramaphosa announced that the sale of tobacco would be permitted again, this statement was contradicted on 29 April by Minister Dlamini-Zuma. The resulting uncertainty over tobacco sales during level 4 lockdown caused British American Tobacco to file an urgent court appeal[84] which was dropped on 6 May[85] and reopened by 29 May.[86] The ban raised concerns by the Human Sciences Research Council and South African Revenue Service that it would encourage the growth of illicit tobacco sales[84] thereby growing the power and influence of organised crime.[87] The ANC Women's League defended Dlamini-Zuma's statement amid accusations that she was receiving financial support from illicit tobacco traders.[88] By 4 May, Ramaphosa confirmed the continuation of the ban during level 4.[89] The Democratic Alliance accused Dlamini-Zuma of lying to the public over the strength of support for the tobacco ban and called for her removal from office.[90][91] On 11 December The Western Cape High Court ruled that the tobacco sales ban was unconstitutional.[92]
During the level 5 lockdown period, the sale of alcohol was banned; so as to reduce pressure from alcohol-related incidents putting additional pressure on hospitals.[93] The ban was controversially reimposed on 12 July amid concerns that the ban was leading to the growth of illicit alcohol sales.[94] Two years later the Supreme Court of Appeal found that there "was no scientific justification for the continued ban on the sale of tobacco products: there is no evidence that short-term quitting has clinical significance for Covid-19 severity and outcome."[95]
The uncertainties around the length of the lockdown, its intensity, and concerns over the erosion of civil liberties has drawn criticism from a number of notable individuals and political parties in South Africa. Former finance minister and senior ANC member Trevor Manuel questioned the rationality of the way in which government implemented the lockdown[96] whilst expressing concern that the lockdown endangered the South African Constitution.[97][98] The DA challenged the use of the military to enforce night curfews, criticised the ban on e-commerce and restrictions on exercise hours,[99] and filed a court challenge over the constitutionality of the lack of parliamentary oversight in the National Disaster Management Act.[100] The Freedom Front Plus filed an application to the Gauteng High Court challenging the constitutional validity of the National Disaster Management Act.[101] The Economic Freedom Fighters criticised the relaxation of some of the May 2020 lockdown regulations as an example of giving into industry pressure by allowing them to reopen.[102]
The number of passengers ferried per trip in minibus taxis was criticised during the lockdown restrictions, in July 2020. The Colleges of Medicine of South Africa stated that allowing minibus taxis to operate at 100 percent occupancy, for short journeys, was a possible danger to public health and contradicted some lockdown restrictions.[103] Initially in the first stage of the lockdown period minibus taxis were required to operate at 70 percent occupancy, provided passengers wore masks and windows were opened.[103] This 70% occupancy requirement was noted as being flouted by taxi operators.[104][105]
Medical screening was performed prior to departure, four South Africans who were showing signs of coronavirus were left behind to mitigate risk. Only South Africans who tested negative were repatriated.[109]
Test results cleared all the South Africans, including the flight crew, pilots, hotel staff, police and soldiers involved in the humanitarian mission who, as a precautionary measure, all remained under observation and in quarantine for a 14-day period[106][107] at The Ranch Resort.[110][109][111]
On 27 April 217 Cuban medical health specialists (mostly doctors) arrived in South Africa to assist with the pandemic response at the invitation of the South African government[112][113] and were deployed across the country.[114]
Their arrival and the reported R429 million cost paid to the Cuban government was controversial.[112] The South African Medical Association stated that their deployment was premature as many South African doctors and nurses had not yet been deployed as part of the pandemic response.[113] The South African Internationally Trained Health Professionals Association criticised the government for not instead using unemployed South African medical graduates.[112] The Democratic Alliance stated that government should first prioritise using local healthcare professionals.[115] The Daily Maverick questioned the high cost paid for the doctors.[112] The United States government criticised their deployment and payments made for their services as a form of human trafficking[116] whilst the Cuban embassy rejected allegations of profiting from the deployment of its doctors[117] and stated that criticism was part of a "smear campaign".[112]
On 5 August 2020, the World Health Organization (WHO) deployed a "surge team" made up of 43 experts including David Heymann, who headed the international response to the 2003 SARS epidemic, to help the national and provincial responses to minimize the spread and impact of COVID-19.[121]
On 8 August 2020, the department of health released a COVID-19 contact tracing app. The app aims to reduce infections in the second and third waves of Covid. the app is available on Google Play, the App Store and The Huawei App Gallery.
Greenmarket Square in Cape Town seven days before (left) and on the first day (right) of the COVID-19 national lockdown. After the lockdown the market stall traders that normally setup on the square everyday are not present and only people exempt from the lockdown (security personnel and municipal employees) can be seen.
On 23 March 2020, President Cyril Ramaphosa addressed the nation and announced a 21-day national lockdown effective from midnight 26 March through to 16 April,[9] with the deployment of the South African National Defence Force (SANDF) to support the government.[9] On 9 April the President announced a two-week lockdown extension, until the end of April.[122] Exempt from the lockdown are people deemed necessary to the effective response to the pandemic such as:
health workers, pharmacy and laboratory personnel, emergency personnel;[123][124]
security services (police officers, military personnel, and private security
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