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 Health Zweli 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. On 15 March 2020, the President of South Africa, Cyril Ramaphosa, declared a national state of disaster, and announced measures such as immediate travel restrictions and the closure of schools from 18 March. On 17 March, the National Coronavirus Command Council was established, "to lead the nation's plan to contain the spread and mitigate the negative impact of the coronavirus". On 23 March, a national lockdown was announced, starting on 27 March 2020. The first local death from the disease was reported on 27 March 2020. On 21 April, a 500 billion rand stimulus was announced in response to the pandemic. 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. From 1 June, the national restrictions were lowered to level 3. The restrictions were lowered to alert level 2 on 17 August 2020. From 21 September 2020, restrictions were lowered to alert level 1.
In December 2020, the country experienced a 2nd wave of COVID-19 infections, mostly with infections from the SARS-CoV-2 Beta variant. 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. On 17 February 2021, the national COVID-19 vaccination program was officially rolled out.
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. 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, mostly with infections from the Delta variant. On 15 June 2021 the country was moved to alert level 3. On 28 June 2021, the country was moved to adjusted level 4, with the Delta variant fast becoming the dominant strain in the country. 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. On 25 July 2021 the country was lowered to adjusted level 3. On 13 September 2021, an adjusted alert level 2 took effect, and on 1 October 2021 more restrictions were eased by moving to adjusted alert level 1.
On 26 November 2021, the World Health Organization (WHO) classified the Omicron variant, first identified in Botswana but first reported to the WHO by South Africa, as a variant of concern. Several countries announced travel bans from South Africa and its neighboring countries. The country was entering its 4th wave by 1 December 2021, mostly with infections from the standard BA.1 subvariant of the Omicron variant. On 4 February 2022 it was announced that South African scientists had replicated the Moderna COVID-19 vaccine. 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. 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.
A limited 5th wave from late-April 2022 was mostly from infections from the BA.4, BA.5, and BA.2 subvariants of the Omicron variant. Deaths were more decoupled from cases, likely due to high levels of population immunity from infection and/or vaccination. Eminent risk declined by mid-June 2022, and on 22 June 2022 all remaining health regulations regarding COVID-19 were ended.
During the first two years, 2020 and 2021, excess deaths were estimated at 292.3 per population. there have been excess deaths of persons older than 1 years from natural causes since 3 May 2020, with 85%–95% of these excess deaths attributable to COVID-19, and the remaining 5%–15% probably mainly due to overwhelmed health services. In May 2023, it was announced by the WHO Director-General that COVID-19 was no longer a Public health emergency of international concern.
Timeline
Since the first patient with COVID-19 was confirmed in South Africa on 3 March 2020 the country has experienced five waves of the pandemic.
Preparations and response After the World Health Organization (WHO) declared COVID-19 a Public health emergency of international concern on 30 January 2020, an emergency operation centre was immediately activated.
Testing
The National Institute for Communicable Diseases (NICD) started testing people in South Africa for SARS-CoV-2 on 28 January 2020, and by 7 February had conducted 42 such tests.
By mid-March, state hospitals were offering free COVID-19 testing.
On 30 March 2020, the government announced its intentions of initiating an enhanced screening and testing programme. 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). By the start of April, 67 mobile testing units had been established and people had been tested, some in drive-through facilities.
On 8 April, the National Health Laboratory Service (NHLS) detailed its testing capacity through the country. The NHLS would be able to perform approximately tests per day.
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.
By 9 April 2020, South Africa had conducted 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). 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 , making the average number of tests per day in the first 10 days of April roughly . The chair of the board of the NHLS, Eric Buch, stated that it had a capacity of tests per day and would welcome doing more tests.
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 tests a day.
By 23 April the total number of tests was . 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.
By 27 April, 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 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.
By 28 June, the total number of tests was . The private sector had now overtaken the public sector, in terms of tests completed. The private sector had done test with the public sector only doing .
By 11 July, had been done with the private sector still doing the most tests.
Genomic surveillance South Africa had created a sizable genomic surveillance consortium by May 2020. Due to this, scientists from Southern Africa, led by Tulio de Oliveira, discovered and confirmed the COVID-19 virus's Beta variant in 2020 and its Omicron variant in November 2021.
Clinical trials, vaccines and treatment
On 17 March 2020, the South African Health Products Regulatory Authority announced that it would expedite review of treatments, vaccines and clinical trials.
A team from 8 universities and 14 hospitals led by Helen Rees and Jeremy Nel from the University of the Witwatersrand participated in the World Health Organization Solidarity Clinical Trials that investigated medications.
State of disaster
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.
On 17 March, Ramaphosa, supported by Deputy President David Mabuza, convened the inaugural meeting of the National Command Council on COVID-19, or as it was subsequently called, the National Coronavirus Command Council, "to lead the nation's plan to contain the spread and mitigate the negative impact of the coronavirus".
On 18 March, Minister of Cooperative Governance and Traditional Affairs Nkosazana Dlamini-Zuma signed a government gazette limiting the number of patrons at pubs, clubs, and restaurants to 50.
Parliament suspended all activities as of 18 March.COVID-19: Parliament closes until further notice – EWN and the African National Congress (ANC) and Democratic Alliance (DA) postponed their elective conferences. 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.
Schools were closed on 18 March 2020, resuming in early June. Most universities suspended classes around this time as well. University of Pretoria, University of Cape Town, Stellenbosch University, Rhodes University, University of KwaZulu-Natal and Durban University of Technology graduation ceremonies were cancelled or postponed until further notice.
After panic buying, some retailers put limitations on the number of certain items customers could buy. On 19 March, Minister of Trade and Industry Ebrahim 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.
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." 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.
Tobacco and alcohol