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,[18] travelling via Dubai, O. R. Tambo International Airport in Kempton Park, Gauteng[19] and King Shaka International Airport in Durban to Hilton.[20] 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][21][22] and the patient went to Grey's Hospital in Pietermaritzburg.[23]

On 7 March, it was announced that a woman from the same travel group from Italy, returning to Gauteng, also tested positive.[24]

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.[25] 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 The first local transmission and first case in the Free State province was also announced, but withdrawn later in the day by the NICD who confirmed that the case's test result was in fact negative.[26] This brought the total cases to 16.[27][28][29]

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.[30] 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.[31] On the next day, 18 March, the first confirmed case of local transmission in Mpumalanga was announced by government labs.[32]

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.[33]

On 20 March, the Free State province recorded seven cases, becoming the sixth of South Africa's nine provinces to be infected.[34] Of the seven cases, five were from abroad (Israel, France and Texas) who had congregated in Bloemfontein for a prayer breakfast attended by 859 people.[35][36] The Eastern Cape reported its first case one day later.[37]

O. R. Tambo International Airport instituted isolation of foreigners on arrival and returning them to their countries of origin.[38]

Following a funeral on 21 March in KwaDwesi attended by 1200 mourners, at least 45 persons (31 women and 14 men) contracted COVID-19 and at least one person died.[39]

On 23 March, a national 21-day lockdown was announced by President Ramaphosa to begin on 27 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.[40] The country's first death was announced on 27 March.[41]

There were 1,353 confirmed cases in March. Five patients died and 31 recovered, while 1,317 remained active cases at the end of the month.[42]

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.[43] Pick-up trucks dispensed free hand sanitizer in Alexandra in early April.[44]

Following a funeral in Zwide on 4 April, at least nine mourners contracted COVID-19.[39]

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.[45]

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.[46]

On 10 April, Mkhize recommended that the general public use cloth facemasks when going out in public.[47][48]

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.[49] He also described the country's 8-stage plan to combat the coronavirus.[50] This included criteria for extending or easing the lockdown.[51]

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.[52] 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).[53]

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).[54]

On 30 April 2020, Ramaphosa received a consignment of personal protective equipment (PPE) donated by global internet group Naspers on 30 April.[55] There were 4,294 new cases in April, raising the total number of confirmed cases to 5,647. The death toll rose to 103. The number of recovered patients increased to 2,073, leaving 3,471 active cases at the end of the month.[56]

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.[57] They also estimated that there could be insufficient ICU beds by June or July.[57] The scientists stated that these estimates were subject to deviations and were based on simple and pessimistic assumptions.[58] By the end of the month, there had been 683 deaths, with 27,036 new cases and 16,809 recoveries.[59]

Testing of 330 pupils and staff at Makaula Senior Secondary School in KwaBhaca resulted in 204 positive tests.[60]

In June, there were 118,526 new cases, raising the total number of confirmed cases to 151,209. The death toll rose to 2,657. The number of recovered patients increased by 56,734 to 73,543. At the end of the month there were 75,009 active cases.[61]

As of 3 July 2020, the median age of those who had died was 61 years and males had a 1.5 times greater death rate compared to females.[62]

On 12 July, in an address to the nation, President Ramaphosa announced that the anticipated surge in COVID-19 cases had arrived. The state of disaster was extended until 15 August 2020 and the alcohol ban was reintroduced along with a new curfew from 21:00 until 4:00.[63][64] Resumption of alcohol sale and distribution had led to increased pressure on hospitals from road traffic accidents, trauma and violence which happened mostly at night.[64]

On 22 July, the South African Medical Research Council (SAMRC) and the University of Cape Town's Centre for Actuarial Research estimated that 17,090 excess natural deaths had taken place between 6 May and 14 July 2020 in South Africa.[65][66] These represented, by the second week of July, a 59% increase in natural deaths compared to the same time period in previous years[65] 11,175 (65%) of these excess estimated natural deaths were in those above age 60 years.[65][66] Excess natural deaths were COVID-19 related either directly or indirectly through delayed diagnosis and treatment of other conditions.[66] Unnatural deaths, from car accidents and murders, were 20% lower than expected.[65]

On 23 July, President Ramaphosa announced the re-closure of all public schools for four-weeks from 27 July to 24 August 2020 and the extension of the academic year into 2021.[67][68]

In July, there were 341,974 new cases, raising the total number of confirmed cases to 493,183. The death toll tripled to 8,005. The number of recovered patients increased by 252,628 to 326,171. At the end of the month, there were 159,007 active cases.[69]

On 15 August, President Ramaphosa addressed the nation announcing the passing of the COVID-19 peak, the lowering of restrictions to level 2 and the extension of the national state of disaster by another month.[70]

There were 285,067 new cases in August, raising the total number of confirmed cases to 627,041. The death toll increased to 14,149. At the end of the month there were 71,969 active cases.[71]

An initial non-representative seroprevalence survey indicated that approximately 40% of some Cape Town residents had been infected with SARS-CoV-2[72]

On 16 September, the President made a national address where he announced the further lowering of restrictions to level 1, beginning from 21 September 2020.[13] The national state of disaster was extended by one more month.[73]

There were 45,531 new cases in September, bringing the total number of confirmed cases to 672,572. The death toll rose to 16,667. The number of recovered patients increased to 606,520, leaving 49,655 active cases at the end of the month.[74]

On 18 October, Minister of Health Zweli Mkhize announced that he had tested positive for the COVID-19.[75]

The national state of disaster was extended by another month.[76]

For two consecutive weeks, excess natural deaths were above the normal expected rate. These excess deaths were far below the July excess death peak.[77]

There were 52,880 new cases in October, raising the total number of confirmed cases to 725,452. The death toll rose to 19,276. The number of recovered patients increased to 654,182, leaving 51,994 active cases at the end of the month.[78]

On 11 November, President Ramaphosa addressed the nation where he announced extension of the state of disaster by another month until 15 December 2020. Relaxation of international travel, shop trading hours restrictions along with continued COVID unemployment support were announced.[79] There were 64,552 new cases in November, raising the total number of confirmed cases to 790,004. The death toll rose to 21,535. The number of recovered patients increased to 731,242, leaving 37,227 active cases at the end of the month.[80]

On 3 December, the President addressed the nation. He noted a resurgence of COVID-19 in some districts of the Eastern and Western Cape provinces. Nelson Mandela Bay Metropolitan Municipality was identified as a coronavirus hotspot; restrictions were tightened for this area. The national state of disaster was extended until 15 January 2021.[81]

On 7 December, the government said that end-of-school parties known as "rage parties" are super spreader events.[82]

On 9 December, the Minister of Health announced that the country had entered the second wave of infections. The country was now recording over 6000 cases per day from fewer than 1000 cases per day at the end of September. The average proportion of positive COVID-19 tests had risen from 10% to 18%.[14]

On 14 December, the President announced in an address to the nation, the closure of some beaches, lowering of the number of people that can attend gatherings and the tightening of other measures to curb the second wave.[83]

On 18 December, Minister of Health Zweli Mkhize said scientists had discovered a new variant of coronavirus, called 501.V2 Variant.[84]

On 27 December, the number of confirmed cases reached 1 million.[85]

On 28 December 2020, President Cyril Ramaphosa addressed the nation again and announced that the country would go back into a partial lockdown level 3 for 14 days to reduce the speed of the second wave during the festive season. This introduced a curfew from 9 pm to 6 am, the ban on sale and transport of alcohol, closure of public amenities like beaches, lakes and dams and the compulsory wearing of masks in public[86]

There were 267,157 new cases in December, raising the total number of confirmed cases to 1,057,161. The death toll rose to 28,469. The number of recovered patients increased to 879,671, leaving 149,021 active cases at the end of the month.[87]

A vaccine rollout strategy was announced on 3 January 2021, with doses for 10% of the population already secured and more on the way. During the first phase, frontline healthcare workers would be vaccinated.[88]

On 11 January, President Ramaphosa addressed the nation. He announced the continuation of current pandemic alleviation measures, vaccine rollout developments and the extension of the state of disaster[89]

On 13 January the government said it had arrested 7,000 people since the end of December for not wearing face masks.[90]

In the week ending 17 January, 130,000 new cases and 4,000 deaths cause public and private hospitals to be overrun. The 501.V2 variant has been found in all nine provinces as well as in foreign countries, but experts are unsure if the rise in cases is related to the new variant or to a lack of compliance with health guidelines during the holiday period. Several countries have banned flights from South Africa, and all 20 of the country's land entry points have been closed until February. South Africa lost 2.2 million jobs in the second quarter of 2020, and GDP is expected to show a 6.1% decrease for the year. In total, South Africa has registered more than 1.3 million coronavirus confirmed infections and at least 36,851 related deaths.[91]

On 27 January the Department of Health announced the emergency use approval of the AstraZeneca Vaccine and that the transportation of one million doses would be delivered from India on 1 February with a further half a million doses in late February.[92] They also announced a full vaccination plan as well as a platform to manage the mass vaccination of the country.[93]

There were 396,600 new cases in December, raising the total number of confirmed cases to 1,453,761. The death toll rose to 44,164. The number of recovered patients increased to 1,299,620, leaving 109,977 active cases at the end of the month.[94]

On February 1, President Ramaphosa announced the arrival at O. R. Tambo International Airport of the first batch of COVID-19 vaccines produced by the Serum Institute of India. Although South Africa would remain at alert level 3, easing of restrictions effective the next day was announced because the peak of the second wave had passed. In his address to the nation, Ramaphosa also mentioned that the South African Cabinet had approved the proposal to nominate the Cuban Medical Brigade for the 2021 Nobel Peace Prize for its role in sending over 3 700 members around the world to help fight COVID-19.[95]

On February 7, it was announced that the Oxford–AstraZeneca COVID-19 vaccine did not work well in protecting clinical trial participants from mild or moderate illness caused by the severe acute respiratory syndrome coronavirus 2 501.V2 variant, also known as B.1.351 lineage. The vaccination programme was announced to be put on hold.[96]

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,[54] and by 7 February had conducted 42 such tests.[98]

By mid-March, state hospitals were offering free COVID-19 testing.[99]

On 30 March 2020, the government announced its intentions of initiating an enhanced screening and testing programme.[100] 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).[101] By the start of April, 67 mobile testing units had been established and 47000 people had been tested, some in drive-through facilities.[44]

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.[102]

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.[103]

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).[104] 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.[103]

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.[105]

By 23 April the total number of tests was 143570.[52] 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.[106]

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.[54]

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.[107]

By 11 July, 2108570 had been done with the private sector still doing the most tests.[108]

On 17 March 2020, the South African Health Products Regulatory Authority announced that it would expedite review of treatments, vaccines and clinical trials.[109]

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.[110]

A COVID-19 vaccine trial was launched in Gauteng province, towards the end of June 2020 in collaboration with the Jenner Institute, University of Oxford and AstraZeneca.[111][112]

A second vaccine trial was launched during mid August 2020 in collaboration with a US Maryland based biotechnology company, Novavax, with funding from the Bill & Melinda Gates Foundation.[113]

A third vaccine trial launching in September 2020 by Johnson & Johnson/Janssen.[112]

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,[114] "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.[115]

Parliament suspended all activities as of 18 March.[116] and the African National Congress (ANC) and Democratic Alliance (DA) postponed their elective conferences.[117] 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.[118]

Schools were closed on 18 March 2020,[5] resuming in early June.[119] Most universities suspended classes around this time as well.[120][121][122][123][124][125] 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.[126][127][128][129]

After panic buying, some retailers put limitations on the number of certain items customers could buy.[130] 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.[131]

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."[132][133]

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 26 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.[134] 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;[135][136]
• security services (police officers, military personnel, and private security[137]);[135][136]
• 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[135][136]
• those working in industries that can not be economically shut down (such as mines and steel mills).[137]

During the lockdown, all gatherings except for funerals were prohibited.[138] Restaurants, taverns, bottle stores and all other stores not selling essential goods were to close during the lockdown period.[137] 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.[139] 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.[140]

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.[141]

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).[138]

All borders of the country are closed during the lockdown, except for designated ports of entry for the transportation of fuel, cargo, and goods.[138]

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.[142]

The lockdown resulted in fewer 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.[143] 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.[144] 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.[145]

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] From 17 August, the national restrictions were lowered to level 2.[12] From 21 September, the restrictions were at level 1.[73]

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.[159] Trauma related hospital admission decreased by two-thirds.[160] By the end of the first seven days of the lockdown a total of 2,289 people had been arrested for violating lockdown orders.[161] Minister Cele announced, on 13 November, that from July to September, compared to 2019, many different crimes ranging from contact and property crimes to sexual offences all declined because of national lock-down.[162]

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.[163]

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.[164]

The use of force by police and SANDF personnel was controversial with multiple reports of excessive force in enforcing the lockdown.[165][166][167][44] 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".[168]

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.[169][170] 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.[168] 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.[171]

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.[172] 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.[173][174] 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.[175]

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.[176]

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[177] which was dropped on 6 May[178] and reopened by 29 May.[179] 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[177] thereby growing the power and influence of organised crime.[180] The ANC Women's League defended Dlamini-Zuma's statement amid accusations that she was receiving financial support from illicit tobacco traders.[181] By 4 May, Ramaphosa confirmed the continuation of the ban during level 4.[182] 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.[183][184] On 11 December The Western Cape High Court ruled that the tobacco sales ban was unconstitutional.[185]

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.[186] The ban was controversially reimposed on 12 July amid concerns that the ban was leading to the growth of illicit alcohol sales.[187]

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[188] whilst expressing concern that the lockdown endangered the South African Constitution.[189][190] The DA challenged the use of the military to enforced night curfews, criticised the ban on e-commerce and restrictions on exercise hours,[191] and filed a court challenge over the constitutionality of the lack of parliamentary oversight in the National Disaster Management Act.[192] The Freedom Front Plus filed an application to the Gauteng High Court challenging the constitutional validity of the National Disaster Management Act.[193] 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.[194]

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.[195] 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.[195] This 70% occupancy requirement was noted as being flouted by taxi operators.[196][197]

On 14 March 2020, 112[198][199] South Africans were repatriated from Wuhan, China, and placed under observation and in quarantine at The Ranch Resort near Polokwane.[200]

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.[201]

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[198][199] at The Ranch Resort.[202][201][203]

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[204][205] and were deployed across the country.[206]

Their arrival and the reported R429 million (equivalent to US$23 million) cost paid to the Cuban government was controversial.[204] 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.[205] The South African Internationally Trained Health Professionals Association criticised the government for not instead using unemployed South African medical graduates.[204] The Democratic Alliance stated that government should first prioritise using local healthcare professionals.[207] The Daily Maverick questioned the high cost paid for the doctors.[204] The United States government criticised their deployment and payments made for their services as a form of human trafficking[208] whilst the Cuban government rejected allegations of profiting from the deployment of its doctors[209] and stated that criticism was part of a "smear campaign".[204]

South Africa received donation of personal protective equipment like medical masks from China and ventilators from the United States.[210][211][212]

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.[213]

Volunteers in Philippi, Western Cape 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.[214] 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.[215] It is estimated that the government would experience a revenue shortfall for 2020 of between R70 and 100 billion.[216] This resulted in the South African government announcing a R500 billion stimulus package thereby accelerating deficit spending from 6.8% to over 10% of GDP for the 2020 financial year.[216] In late July it was announced that South Africa would be taking out a R70 billion IMF loan[217] increasing the country's total debt to GDP ratio to 83%.[218] Trade unions and the EFF were critical of using the IMF to take out the loan whilst the DA and other opposition political parties voiced concern over corruption when using the borrowed funds.[218]

The Johannesburg Stock Exchange lost 15% of its value in the week ending 13 March 2020, its worst week in 21 years.[219] 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%.[220] On 14 April, a further reduction to 4.25% per year was made.[221] 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.[222] In May it was estimated that the state will lose R285-billion in tax revenue for the financial year 2020/21 due to the pandemic and resulting lockdown.[223]

Within the first month of the lockdown three million South Africans had lost their jobs contributing to an increase in food insecurity and poverty.[224] By mid-July wide spread food shortages were reported across the country and in rural Eastern Cape in particular.[225] In December 2020 it was reported by Finfind and the Department of Small Business Development that 42.7% of small businesses in South Africa had closed due to the economic impact of the lockdown.[226][227]

Corruption has had a significant negative impact on efforts to fight the pandemic by inflating the costs of government procurement whilst eroding public confidence in government institutions.[228][229][230] Years of corruption prior to the pandemic has reduced the capacity of the country's health service.[231] Incidences of police corruption also increased during the lockdown period as security officials used their expanded positions of power to extort bribes from members of the public.[232] Concerns were raised that funds from a COVID-19-related R70 billion IMF loan[217] to South Africa would be lost through corruption.[233][234] On 7 August President Ramaphosa announced that ministerial committee would be set up to investigate COVID-19 corruption in state tenders.[230][235]

Sicuro Safety and Hennox Supplies were fined after admitting to inflating its prices of face masks by 900%. A company supplying the Gauteng government was found to be charging double the price for sanitiser and four times the normal price of surgical face masks. Officials in the Kwazulu-Natal government were suspended for making "massively overpriced" purchases of PPE and blankets.[228] In late July President Ramaphosa announced that measures would be implemented to combat corruption in the delivery of food parcels and the procurement of exorbitantly priced goods.[231] The Special Investigation Unit (SIU) stated that it was investigating a number of suspicious transactions and alleged acts of corruption from the R500 billion COVID-19 Relief Fund.[236] A number of government officials implicated in allegations of COVID-19-related corruption include Ace Magashule,[237] the wife of Bandile Masuku,[238] and the husband of presidential spokesperson Khusela Diko.[239][229] Magashule,[237] Diko[240] and Masuku[241] have denied any involvement in COVID-19 related procurement corruption allegations.

An investigation into COVID related fraud at the City of Johannesburg found that over 1,500 employees of the City improperly received COVID-19 related social relief and grants.[242]

Major sporting codes suspended their activities, including Super Rugby,[243] 2019-20 Pro14 season,[244] Varsity Rugby,[245] Craven Week,[246] Premier Soccer League,[247] Athletics South Africa,[248] Sunshine Tour golf,[249] Wimpy Lifesaving South Africa national championships[250] and Parkrun.[251] The Cape Epic cycle tour,[252] the 2020 Two Oceans Marathon[253][254] and the 2020 Comrades Marathon[255] were cancelled. 2020 Cape Town Rugby Sevens, 4–6 December 2020, were cancelled.[256][257]

Live events cancelled or postponed included the Mangaung African Cultural Festival (MACUFE),[258] Bloem Show,[259] AfrikaBurn,[260] Cape Town International Jazz Festival,[261][262] Klein Karoo Nasionale Kunstefees,[263] Splashy Fen Festival,[264] Rand Show,[265] National Arts Festival (changing to virtual),[266] SciFest Africa (postponed to 9–15 September),[267] WWE Live South Africa (postponed until September),[268] Comic Con Cape Town,[269] and Matric Rage festivals in Johannesburg, Jeffreys Bay and Plettenberg Bay.[270] South African tours were postponed by the Lighthouse Family,[271] Boyz II Men[272] and BeBe Winans.[273]

Trade and agricultural shows postponed or cancelled included HuntEx,[274] DecorEx Cape Town & Durban,[275] Tyrexpo (postponed to 4–6 August 2020),[276] Power & Electricity World expo (postponed until 20–21 August),[277] the Pietermaritzburg Royal Show, SA Cheese Festival, Qualité Awards Dinner, and Agri-Expo Western Cape Youth Show.[278]

The Zion Christian Church cancelled its annual Easter pilgrimage.[279] 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.[280] Chief Rabbi Warren Goldstein suspended Synagogues.[281] Traditional circumcision schools in the Eastern Cape were suspended.[282]

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.[283] 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.[284] 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.[285]

South Africa's oldest pub, The Perseverance Tavern, closed down during the pandemic due to the economic impact of the extended alcohol sales ban.[286][287]

On 5 August, members of the entertainment, restaurant, fitness, and events industries staged a socially distanced national protest by lighting buildings red. The #LightSAred campaign was staged so as to highlight the negative economic impact of the COVID-19 lockdown measures on these industries.[288][289][290]

A number of liquor stores and food stores were targeted by looters in the Cape Town suburbs of Elsies River, Delft South, Samora Machel,[291] Manenberg, Sherwood Park, Nyanga Junction, and Gatesville.[292][293] On 21 July, a truck carrying COVID-19 specimens was hijacked at a clinic in Motherwell, Eastern Cape and found abandoned 500 metres away.[294][295]

Model-based simulations indicate that the 95% confidence interval for the time-varying reproduction number R _t was higher than 1.0 until mid-July,[348] exceeding 1.0 again after late October 2020.[349]