COVID-19 pandemic in South Africa

On 1 March 2020, the first patient later confirmed with COVID-19 in South Africa, returned with his wife and 8 others from the Metropolitan City of Milan in Italy,[14] travelling via Dubai, O. R. Tambo International Airport in Kempton Park, Gauteng[15] and King Shaka International Airport in Durban to Hilton.[16] On 3 March, the patient reported with symptoms to a private general practitioner and isolated himself; the doctor isolated herself as well. On 5 March the Minister of Health, Zweli Mkhize, announced the first confirmed case, epidemiologists and clinicians from the National Institute for Communicable Diseases (NICD) were deployed to KwaZulu-Natal in response.[3][17][18] and the patient went to Grey's Hospital in Pietermaritzburg.[19]

On 7 March, it was announced that a woman from the same travel group from Italy, returning to Gauteng, also tested positive.[20]

On 11 March 6 new cases were reported, with 1 case from the same travel group from Italy, while the other 5 cases appear unrelated having travel histories to other European countries. The first case was confirmed in the Western Cape province.[21] 3 new cases were announced on 12 March, including the first case in Mpumalanga province. The first local transmission and first case in the Free State province was also announced, but withdrawn later in the day by the NICD who confirmed that the case's test result was in fact negative.[22] This brought the total cases to 16.[23][24][25]

On 15 March, the first local transmissions, not yet confirmed by government labs, were announced by President Cyril Ramaphosa.[5] and the following day, the first confirmed case from Limpopo province was announced.[26] The day thereafter, on 17 March, the first confirmed cases of local transmission were announced by government labs, 4 in Gauteng, 3 in KwaZulu-Natal, and 1 in the Western Cape.[27] On the next day, 18 March, the first confirmed case of local transmission in Mpumalanga was announced by government labs.[28]

On 19 March, the Health Minister suggested that two-thirds of the South African population could contract the virus, a prediction in line with Europe's estimates on population infection.[29]

On 20 March, the Free State province recorded seven cases, becoming the sixth of South Africa's nine provinces to be infected.[30] Of the seven cases, five were from abroad (Israel, France and Texas) who had congregated for a church gathering attended by 200 people.[31] O. R. Tambo International Airport instituted isolation of foreigners on arrival and returning them to their countries of origin.[32]

On 21 March, the confirmed number of cases reached 240 with the Eastern Cape reporting its first case, making it the seventh of the nine provinces to report a case.[33] On 23 March, a national 21-day lockdown was announced by President Ramaphosa to begin on 26 March to 16 April.[8] By 24 March all nine provinces had confirmed cases, with the first cases in the Northern Cape and North West announced.[34]

On 27 March, Mkhize announced the 1st confirmed death in South Africa from COVID-19.[35]

On 1 April, researchers from the NICD and South African National Bioinformatics Institute at the University of Western Cape released the genetic sequence of the SARS-CoV-2 from a South African COVID-19 patient.[36] Pick-up trucks dispensed free hand sanitizer in Alexandra in early April.[37]

On 9 April, it was announced that South Africa's cabinet members, which include the President, Deputy President, Ministers and Deputy Ministers would donate one-third of their salaries for three months to a solidarity fund.[38]

On 9 April, the St Augustine's Hospital in Durban was shut down following a localised outbreak of over 60 confirmed cases and four COVID-19 related deaths; by then 1,845 had tested positive for the virus nationally with total 18 deaths.[39]

On 10 April, health experts were surprised at the dramatic slow-down in the daily rate of new cases over the previous two weeks, however it was feared that this slow-down may trigger complacency.[40]

On 10 April, Mkhize recommended that the general public use cloth facemasks when going out in public.[41][42]

On 12 April, there was an increase of over 145 (7.1%) cases[43] including 23 officials and 3 prisoners at the East London Correctional Centre.[44]

On 13 April, chair of the Ministerial Advisory Committee on COVID-19 Salim Abdool Karim indicated that the lockdown had been effective in delaying transmissions.[45] He also described the country's 8-stage plan to combat the coronavirus.[46] This included criteria for extending or easing the lockdown.[47]

On 14 April, the number of confirmed cases grew by 143, with 70 of the new cases being from the Eastern Cape.[48][49]

By 23 April, when President Ramaphosa again addressed the nation the total number of cases had increased to 3953. Detailed figures released by the NICD showed that in April that the number of cases had taken distinct trajectories in different provinces.[50] In the two weeks from 9 to 23 April, the cases in the coastal provinces had a very high increase – Eastern Cape cases rose 583% from a low base, KwaZulu-Natal rose 108% and Western Cape 148%. North West (67%) and Gauteng (57%) had high increases, while the other provinces had much lower increases from 6% in the Northern Cape to 23% in Limpopo (all with low absolute numbers – 106 in the Free State and under 30 in each of the other provinces).[51]

As of 27 April 2020 23:59, the median age of laboratory-confirmed cases was 38 years (interquartile range 29–51 years), and children aged <10 years accounted for 3% (156/4996).[52]

On 19 May 2020, scientists advising the government estimated 475 confirmed COVID-19 deaths by the end of that month, and more than forty-thousand deaths by November.[53] They also estimated that there could be insufficient ICU beds by June or July.[53] The scientists stated that these estimates were subject to deviations and were based on simple and pessimistic assumptions.[54]

A COVID-19 testing tent at the Paarl Provincial Hospital

The National Institute for Communicable Diseases (NICD) started testing people in South Africa for SARS-CoV-2 on 28 January 2020,[52] and by 7 February had conducted 42 such tests.[56]

By mid-March, state hospitals were offering free COVID-19 testing.[57]

On 30 March 2020, the government announced its intentions of initiating an enhanced screening and testing programme.[58] 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).[59] By the start of April, 67 mobile testing units had been established and 47000 people had been tested, some in drive-through facilities.[37]

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.[60]

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.[61]

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).[62] 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.[61] On 12 April, Minister of Health, Dr Zweli Mkhize announced that the number of tests carried out in the previous 24 hours had increased to 5 032, with 3 192 carried out in public laboratories.[43]

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.[63]

By 23 April the total number of tests was 143570.[50] 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.[64]

By 27 April, 185497 tests have been performed on South African residents, with the public sector now 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.[52]

On 17 March 2020, the South African Health Products Regulatory Authority announced that it would expedite review of treatments, vaccines and clinical trials.[65]

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 Organisation Solidarity Clinical Trials that investigated medications.[66]

Shoppers practicing measures of social distancing whilst buying groceries in South Africa.

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.[5]

On 17 March, Ramaphosa, supported by Deputy President David Mabuza, convened the inaugural meeting of the National Command Council on COVID-19,[6] or as it was subsequently called, the National Coronavirus Command Council,[67] "to lead the nation’s plan to contain the spread and mitigate the negative impact of the coronavirus".[7]

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.[68]

Parliament suspended all activities as of 18 March.[69] and the African National Congress (ANC) and Democratic Alliance (DA) postponed their elective conferences.[70] 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.[71]

Schools were closed on 18 March 2020,[5] resuming tentatively in May,[72] with the June holidays shortened by a week and the September holidays shortened by 3 days.[73] Most universities suspended classes around this time as well.[74][75][76][77][78][79] 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.[80][81][82][83]

After panic buying, some retailers put limitations on the number of certain items customers could buy.[84] 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.[85]

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."[86][87]

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, President Cyril Ramaphosa addressed the nation and announced a 21-day national lockdown effective from midnight 27 March through to 16 April,[8] with the deployment of the South African National Defence Force (SANDF) to support the government.[8] On 9 April the President announced a two-week lockdown extension, until the end of April.[88] 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;[89][90]
• security services (police officers, military personnel, and private security[91]);[89][90]
• people regarded as necessary to the basic functioning of the economy (supermarkets, transportation and logistical services, petrol stations, banks, essential financial and payment services); and[89][90]
• those working in industries that can not be economically shut down (such as mines and steel mills).[91]

During the lockdown, all gatherings except for funerals were prohibited.[92] Restaurants, taverns, bottle stores and all other stores not selling essential goods were to close during the lockdown period.[91] Schools, already closed a week before the lockdown period, will not reopen until after the lockdown. Non-exempt people are only allowed to leave their homes during this period to access health services, collect social grants, attend small funerals (no more than 50 people) and shop for essential goods.[93] See the South African Government Gazette 25 March 2020 for a complete list of exemptions and non-exemptions during the lockdown period. South Africans were ordered not to take their dogs for a walk during the lockdown, though they may walk them around their house or apartment building.[94]

A billboard at the end of Long Street, Cape Town encourages people to stay at home during the lockdown period.

People may not be evicted from their place of residence during the lockdown.[95]

Movement between provinces, and between metropolitan and district areas are prohibited except for

• essential workers, to and from work;
• transportation of sanitised and disinfected cargo from ports of entry;
• the transportation of mortal remains; and
• the attendance of funerals (restricted).[92]

All borders of the country are closed during the lockdown, except for designated ports of entry for the transportation of fuel, cargo, and goods.[92]

International and domestic passenger flights are prohibited, except for flights authorised by the Ministry of Transport, for the evacuation of South African nationals in foreign countries, and for certain repatriations.[96]

The lockdown resulted in reduced deaths from road accidents and homicides. During Easter, from 9 April 2020 to 13 April, there were 28 fatalities from road accidents during the lockdown, compared to 162 in 2019.[97] During the lockdown, 432 murder cases were reported, compared to 1542 during the same period the previous year: 29 March 2019 to 22 April 2019.[98] Overall deaths for the year up to 21 April 2020 were "generally within the bounds of expectation" according to the Medical Research Council. Nonetheless for the 5 weeks before 21 April 2020, non-natural deaths including those from homicide and road traffic accidents were lower for both females and males.[99]

Easing of the national lockdown restrictions, based on a risk-adjusted strategy, started on 1 May 2020, becoming level 4.[10] From 1 June, the national restrictions were lowered to level 3.[11]

Minister of Police Bheki Cele announced, on 5 April, a reduction in cash-in-transit thefts thanks to increased road blocks and more visible policing. He also announced a reduced murder rate.[109] Trauma related hospital admission decreased by two-thirds.[110] By the end of the first seven days of the lockdown a total of 2,289 people had been arrested for violating lockdown orders[111] with over 17000 total arrests for various crimes.[112]

Minister of Communications and Digital Technologies Stella Ndabeni-Abrahams, on 8 April, was put on special leave for two months, one without pay, for violating lockdown regulations. A picture of her appeared on social media while having lunch at ANC NEC member Mduduzi Manana's home.[113]

Enforcement was done across the country with varying degrees of success. In the Eastern Cape it was reported in early April that little to no enforcement of the lockdown was implemented in at least some of the province's rural areas.[114]

The use of force by police and SANDF personnel was controversial with multiple reports of excessive force in enforcing the lockdown.[115][116][117][37] This included incidents of beatings and preventing people from filming police abuses leading the public advocacy group Right2Know to release a statement that the police had no right to prevent the public "from exercising their constitutional right to film and record incidents".[118]

By the fifth day, three people had died due to alleged excessive force by security officials enforcing the lockdown, equaling the number of people that had died of the virus in South Africa by that date.[118][119] By 3 April, the eighth day of the lockdown, the Independent Police Investigative Directorate (IPID) reported that they were investigating eight deaths involving the police since the start of the lockdown.[120][121] At the time, this exceeded the number of deaths in the country due to the pandemic. This was in-spite of President Ramaphosa's public call for police restraint.[118] By 12 April a total of nine people had died due to police and army action following the beating to death of a man in Alexandra by the army.[122]

The South African National Editors' Forum issued a statement expressing concern over police action denying the media access to sites when covering COVID-19 related stories.[123] On 27 April the Office of the United Nations High Commissioner for Human Rights expressed concerns about the heavy handed and highly militarised enforcement of COVID-19 related lockdown measures in a number of countries including South Africa.[124][125] By 30 April the government confirmed that a total of five people were alleged to have been killed by police within the first three weeks of the lock down along with 152 incidents of assault by police.[126]

The Pretoria High Court ordered the South African government to take steps to prevent police abuse during the lockdown, following the death of Collins Khosa, who died of injuries after being beaten by the police.[127]

During the announcement on the lifting of level 5 lockdown measures on 23 April President Ramaphosa announced that the sale of tobacco would be re-legalised, this statement was contradicted on 29 April by Minister Dlamini-Zuma. The resulting uncertainty over the legality of tobacco sales during level 4 lockdown caused British American Tobacco to file an urgent court appeal[128] which was dropped on 6 May[129] and reopened by 29 May.[130] 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[128] thereby growing the power and influence of organised crime.[131] The ANC Women's League defended Dlamini-Zuma's statement amid accusations that she was receiving financial support from illicit tobacco traders.[132] By 4 May President Ramaphosa confirmed the continuation of the ban during level 4.[133] 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.[134][135]

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[136] whilst expressing concern that the lockdown endangered South African Constitution.[137][138] The DA challenged the use of the military to enforced night curfews, criticised the ban on e-commerce and restrictions on exercise hours,[139] and filed a court challenge over the constitutionality of the lack of parliamentary oversight in the National Disaster Management Act.[140] The Freedom Front Plus filed an application to the Gauteng High Court challenging the constitutional validity of the National Disaster Management Act.[141] 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.[142]

On 14 March 112[143][144] South Africans were repatriated from Wuhan, China, and placed under observation and in quarantine at The Ranch Resort near Polokwane.[145]

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.[146]

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[143][144] at The Ranch Resort.[147][146][148]

On 27 April 217 Cuban doctors arrived in South Africa to assist with the pandemic response at the invitation of the South African government[149][150] and were deployed across the country.[151]

Their arrival and the reported R429 million (equivalent to US$23 million) cost paid to the Cuban government was controversial.[149] 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.[150] The South African Internationally Trained Health Professionals Association criticised the government for not instead using unemployed South African medical graduates.[149] The Democratic Alliance stated that government should first prioritise using local healthcare professionals.[152] The Daily Maverick questioned the high cost paid for the doctors.[149] The United States government criticised their deployment and payments made for their services as a form of human trafficking[153] whilst the Cuban government rejected allegations of profiting from the deployment of its doctors[154] and stated that criticism was part of a "smear campaign".[149]

Volunteers in Philippi, Cape Town packing food parcels to be given out to the needy during the COVID 19 pandemic lockdown. The lockdown had a seriously negative impact on South Africa's economy that hit the poor and unemployed especially hard.

At the beginning of the national shutdown on 27 March South African economists predicted that the pandemic could cause a 2.5% to 10% contraction of South Africa's total GDP in 2020.[155] The national lockdown and resulting economic slowdown reduced demand for electricity by more than 7500 MW thereby temporarily reducing the impact of the long running South African energy crisis.[156] It is estimated that the government would experience a revenue shortfall for 2020 of between R70 billion and R100 billion.[157] This resulted in the South African government announcing a R500 billion (US$26.9 billion) stimulus package thereby accelerating deficit spending from 6.8% to over 10% of GDP for the 2020 financial year.[157]

The Johannesburg Stock Exchange lost 15% of its value in the week ending 13 March 2020, its worst week in 21 years.[158]

On 19 March, the South African Reserve Bank governor, Lesetja Kganyago announced a reduction of the country's repo rate by 100 basis points or 1 percentage point to 5.25%.[159] On 14 April, a further reduction to 4.25% per year was made.[160]

On 22 March, Standard Bank announced a 90-day payment holiday for small and medium-sized business and students to try and shield them from the economic impact of the outbreak, starting from 1 April.[161]

Major sporting codes suspended their activities, including Super Rugby,[162] 2019-20 Pro14 season,[163] Varsity Rugby,[164] Premier Soccer League,[165] Athletics South Africa,[166] Sunshine Tour golf,[167] Wimpy Lifesaving South Africa national championships[168] and Parkrun.[169] The Cape Epic cycle tour,[170] the 2020 Two Oceans Marathon[171][172] and the 2020 Comrades Marathon[173] were cancelled.

Live events cancelled or postponed included the Mangaung African Cultural Festival (MACUFE),[174] Bloem Show,[175] AfrikaBurn,[176] Cape Town International Jazz Festival,[177][178] Klein Karoo Nasionale Kunstefees,[179] Splashy Fen Festival,[180] Rand Show,[181] National Arts Festival (changing to virtual),[182] SciFest Africa (postponed to 9–15 September),[183] WWE Live South Africa (postponed until September)[184] and Comic Con Cape Town.[185] South African tours were postponed by the Lighthouse Family,[186] Boyz II Men[187] and BeBe Winans.[188]

Trade and agricultural shows postponed or cancelled included HuntEx,[189] DecorEx Cape Town & Durban,[190] Tyrexpo (postponed to 4–6 August 2020),[191] Power & Electricity World expo (postponed until 20–21 August),[192] the Pietermaritzburg Royal Show, SA Cheese Festival, Qualité Awards Dinner, and Agri-Expo Western Cape Youth Show.[193]

The Zion Christian Church cancelled its annual Easter pilgrimage.[194] The Muslim Judicial Council (MJC) suspended Friday prayers, then closed mosques altogether on Sunday 22 March, but the call to prayer will still be given.[195] Chief Rabbi Warren Goldstein suspended Synagogues.[196] Traditional circumcision schools in the Eastern Cape were suspended.[197]

The City of Johannesburg closed all public facilities indefinitely including public swimming pools, recreational and civic centres, stadiums, libraries, sporting facilities, and the Johannesburg Zoo.[198] The Ethekhwini Metropolitan Municipality closed all of Durban's public facilities including swimming pools, beaches, libraries, community halls, and museums while restrictions have been put in place for the Durban Art Gallery and cemeteries to only allow 50 people at a time.[199] The City of Cape Town closed all public facilities indefinitely including public swimming pools, recreational and civic centres, stadiums, sporting facilities, and the nature reserves.[200]

A number of liquor stores and food stores were targeted by looters in the Cape Town suburbs of Elsies River, Delft South, Samora Machel,[201] Manenberg, Sherwood Park, Nyanga Junction, and Gatesville.[202][203]

• 31 March 2020 Gita Ramjee, scientist and researcher in HIV prevention.[204]
• 12 May 2020 Clarence Mini, chairperson of the Council of Medical Schemes, uMkhonto we Sizwe, AIDS activist.[205][206]
• 13 May 2020 Lungile Tom, eNCA camera operator.[207][208]
• 14 June 2020 Elsa Joubert, author.[209]

• Cumulative progression

Status as of 29 June 2020