of laboratory-confirmed cases was 38 years (interquartile range 29–51 years), and children aged <10 years accounted for 3% (156/4996). on 30 april 2020, ramaphosa received a consignment of personal protective equipment (ppe) donated by global internet group naspers on 30 april. 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. 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. they also estimated that there could be insufficient icu beds by june or july. the scientists stated that these estimates were subject to deviations and were based on simple and pessimistic assumptions. by the end of the month, there had been 683 deaths, with 27,036 new cases and 16,809 recoveries. june 2020 police patrolling in shopping mall areas to see if citizens are following safety measures (pretoria, june 2020). testing of 330 pupils and staff at makaula senior secondary school in kwabhaca resulted in 204 positive tests. 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. 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. 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. 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. 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. these represented, by the second week of july, a 59% increase in natural deaths compared to the same time period in previous years 11,175 (65%) of these excess estimated natural deaths were in those above age 60 years. excess natural deaths were covid-19 related either directly or indirectly through delayed diagnosis and treatment of other conditions. unnatural deaths, from car accidents and murders, were 20% lower than expected. 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. 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. 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. 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. an initial non-representative seroprevalence survey indicated that approximately 40% of some cape town residents had been infected with sars-cov-2. 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. the national state of disaster was extended by one more month. 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. october 2020 on 18 october, minister of health zweli mkhize announced that he had tested positive for the covid-19. the national state of disaster was extended by another month. for two consecutive weeks, excess natural deaths were above the normal expected rate. these excess deaths were far below the july excess death peak. 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. 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. 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. second wave: december 2020 – april 2021 december 2020 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. on 7 december, the government said that end-of-school parties known as "rage parties" are super spreader events. 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%. 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. on 18 december, minister of health zweli mkhize said scientists had discovered a new variant of coronavirus, called 501.v2 variant. on 27 december, the number of confirmed cases reached 1 million. 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. 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. modelling by who's regional office for africa suggests that due to under-reporting, the true number of infections in 2020 was around 17 million. january 2021 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. 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 on 13 january the government said it had arrested 7,000 people since the end of december for not wearing face masks. 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. 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. they also announced a full vaccination plan as well as a platform to manage the mass vaccination of the country. there were 396,600 new cases in january, 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. february 2021 on 1 february, 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. on 7 february, 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 501.v2 variant severe acute respiratory syndrome coronavirus 2, also known as b.1.351 lineage. the vaccination programme was announced to be put on hold. on 17 february, the national covid vaccination program was officially rolled out, beginning at khayelitsha district hospital in the western cape province where healthcare workers, the president and minister of health were given shots of the janssen vaccine. on 17 february 2021, the national covid-19 vaccination program was officially rolled out. on 28 february, the president addressed the nation, announcing relaxation of restrictions with a move from adjusted alert level 3 to adjusted alert level 1. there were 59,632 new cases in february, taking the total number of confirmed cases to 1,513,393. the death toll rose to 49,993. the number of recovered patients increased to 1,430,259, leaving 33,141 active cases at the end of the month. march 2021 on 5 march 2021, the number of people fully vaccinated against covid-19 surpassed 100,000 in the country. the south african medical research council estimated more than 150 000 excess deaths during the pandemic by 20 march 2021, with 85–95% of these excess natural deaths attributable to covid-19, and the remaining 5–15% probably mainly due to overwhelming of the health services. on 30 march 2021, president ramaphosa, addressed the nation ahead of the easter holiday. he gave information on covid-19 vaccination progress, announced temporary restrictions on offsite holiday alcohol sales and the easing of measures around religious gatherings. there were 34,764 new cases in march, taking the total number of confirmed cases to 1,548,157. the death toll rose to 52,846. the number of recovered patients increased to 1,474,319, leaving 20,992 active cases at the end of the month. april 2021 on 13 april 2021, minister of health zweli mkhize announced the suspension of janssen covid-19 vaccine (johnson & johnson) use following health concerns raised by the food and drug administration (fda). on 28 april 2021, the janssen vaccines suspension was lifted, and given the full approval for use by saprah. there were 33,053 new cases in april, taking the total number of confirmed cases to 1,581,210. the death toll rose to 54,350. the number of recovered patients increased to 1,505,620, leaving 21,240 active cases at the end of the month. third wave: may 2021 – october 2021 may 2021 by 1 may there were 157542 excess deaths of persons older than 1 years from natural causes since the start of the pandemic,