First wave: March 2020 – November 2020
March 2020
On 1 March 2020, the first patient later confirmed with COVID-19 in South Africa, returned with his wife and 8 others from the Milan, Italy, [1] travelling via Dubai, O. R. Tambo International Airport in Kempton Park, Gauteng [2] and King Shaka International Airport in Durban to Hilton. [3] 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 [4] On 15 March 2020, the President of South Africa, Cyril Ramaphosa, declared a national state of disaster, [5] [6] [7] and the patient went to Grey's Hospital in Pietermaritzburg. [8]
On 7 March, it was announced that a woman from the same travel group from Italy, returning to Gauteng, also tested positive. [9]
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. [10] [11] 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 The first local transmission and first case in the Free State province was also announced, but withdrawn later in the day by the NICD who confirmed that the case's test result was in fact negative. [12] This brought the total cases to 16. [13] [14] [15]
On 15 March, the first local transmissions, not yet confirmed by government labs, were announced by President Cyril Ramaphosa [16] and the following day, the first confirmed case from Limpopo province was announced. [17] [18] 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. [19] On the next day, 18 March, the first confirmed case of local transmission in Mpumalanga was announced by government labs. [20]
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. [21]
On 20 March, the Free State province recorded seven cases, becoming the sixth of South Africa's nine provinces to be infected. [22] 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. [23] [24] The Eastern Cape reported its first case one day later. [25]
O. R. Tambo International Airport instituted isolation of foreigners on arrival and returning them to their countries of origin. [26]
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. [27]
On 23 March, a national 21-day lockdown was announced by President Ramaphosa to begin on 27 March to 16 April. [28] The first local death from the disease was reported on 27 March 2020. [29] On 21 April, a 500 billion rand stimulus was announced in response to the pandemic. [30] By 24 March all nine provinces had confirmed cases, with the first cases in the Northern Cape and North West announced. [31] The country's first death was announced on 27 March. [32]
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. [33]
April 2020
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. [34] Pick-up trucks dispensed free hand sanitizer in Alexandra in early April. [35]
Following a funeral in Zwide on 4 April, at least nine mourners contracted COVID-19. [27]
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. [36]
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. [37]
On 10 April, Mkhize recommended that the general public use cloth facemasks when going out in public. [38] [39]
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. [40] He also described the country's 8-stage plan to combat the coronavirus. [41] This included criteria for extending or easing the lockdown. [42]
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. [43] 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. [44] 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). [45]
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). [46]
On 30 April 2020, Ramaphosa received a consignment of personal protective equipment (PPE) donated by global internet group Naspers on 30 April. [47] 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. [48]
May 2020
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. [49] They also estimated that there could be insufficient ICU beds by June or July. [49] The scientists stated that these estimates were subject to deviations and were based on simple and pessimistic assumptions. [50] By the end of the month, there had been 683 deaths, with 27,036 new cases and 16,809 recoveries. [51]
June 2020
Testing of 330 pupils and staff at Makaula Senior Secondary School in KwaBhaca resulted in 204 positive tests. [52]
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. [53]
July 2020
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. [54]
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. [55] [56] 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. [56]
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. [57] [58] These represented, by the second week of July, a 59% increase in natural deaths compared to the same time period in previous years [57] 11,175 (65%) of these excess estimated natural deaths were in those above age 60 years. [57] [58] Excess natural deaths were COVID-19 related either directly or indirectly through delayed diagnosis and treatment of other conditions. [58] Unnatural deaths, from car accidents and murders, were 20% lower than expected. [57]
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. [59] [60]
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. [61]
August 2020
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. [62]
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. [63]
An initial non-representative seroprevalence survey indicated that approximately 40% of some Cape Town residents had been infected with SARS-CoV-2. [64]
September 2020
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. [65] The national state of disaster was extended by one more month. [66]
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. [67]
October 2020
On 18 October, Minister of Health Zweli Mkhize announced that he had tested positive for the COVID-19. [68]
The national state of disaster was extended by another month. [69]
For two consecutive weeks, excess natural deaths were above the normal expected rate. These excess deaths were far below the July excess death peak. [70]
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. [71]
November 2020
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. [72] 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. [73]
