Over 100,000 South Africans have probably died of Covid-19

Paramedics are facing a relentless stream of Covid-19 patients. (Illustration: Lisa Nelson)

Between 3 May 2020 and 16 January 2021, the number of excess deaths in South Africa was more than 106,000. This is the estimate of the latest weekly Medical Research Council mortality report. These excess deaths are, either directly or indirectly, due to the Covid-19 epidemic.

First published in GroundUp 

Some of those deaths may be because people with other diseases were squeezed out of the health system or were too afraid to seek medical help. But as we’ve explained several times before, the vast majority of these deaths were very likely caused directly by Covid-19. This is supported by the likelihood that there were a lower number of deaths from flu and other infectious diseases last year.

The Health Department’s confirmed Covid-19 death toll is a bit over 40,000. This undercount is primarily because many people die without having been diagnosed with Covid-19.

There were over 16,000 excess deaths in the week ending 16 January, worse than the grim record set the previous week. To put this into perspective, that’s more than 2,000 excess deaths daily, more than double the worst weeks of the HIV epidemic in the mid-2000s, though the high Aids mortality went on for year after year (and is still too high at about 150 to 200 daily). Also, people with HIV on average die much younger than people with Covid-19.

This graph from the latest MRC mortality report shows the escalating number of excess deaths during the second Covid-19 surge in South Africa.

In the worst week of the first Covid-19 wave in July, there were about 6,500 deaths. In other words, the second wave peak will be at least double that. As of the week ending 16 January, it is not clear yet if the peak of the second wave has been reached.

The latest MRC report includes a detailed explanation of the methodology used. The MRC has actually been providing two estimates of excess deaths. One is based solely on historical data and is 106,787 for all causes of death. A slightly higher estimate adjusts for a drop in mortality during the first lockdown in March 2020 and this is 112,280 natural deaths (excluding accidents and homicides).

The table below lists the number of excess natural deaths per province between 3 May and 16 January (from the MRC), the estimated number of people per province as of 2020 (per Statistics South Africa’s 2020 mid-year population estimates) and the deaths per 100,000 people (our calculation). The number of deaths per 100,000 for the whole country is approximately 188. Taking the global Covid death data at face value this would make South Africa the second-hardest hit country in the world, but in fact this is almost certainly not the case, as most countries underestimate their Covid-19 deaths. (Also, some of the excess deaths may not be due to Covid.)


Province Excess Population Perr 100k
Eastern Cape 29,102 6,734,001 432
KwaZulu-Natal 26,260 11,531,628 228
Western Cape 13,129 7,005,741 187
Free State 5,058 2,928,903 173
Northern Cape 2,137 1,292,786 165
Limpopo 8,266 5,852,553 141
Mpumalanga 6,157 4,679,786 132
Gauteng 18,934 15,488,137 122
North West 3,236 4,108,816    

The data is extremely grim. There is no task more important for the South African government now than to obtain and distribute one or more of the three Covid-19 vaccines that have been shown in clinical trials to be effective and sufficiently safe (hopefully in the next few weeks there will be at least one more proven vaccine to choose from). DM


"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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  • Frightening that the excess deaths in the Eastern Cape are higher than any other province, and the excess deaths per 100,000 of population are twice any other province!

  • The operative words here are ‘may’ and ‘estimate’. There are simply too many unanswered questions to take these figures seriously. What is the statistical error on these figures? The story unfortunately does not mention it.
    There is an argument for over counting. There is also strong arguments for under counting. No-one will really get a good understanding of what is going on.

    • “Death” is among the most reliably measured events in South Africa and elsewhere – corpses do not simply disappear and they are being captured. Cause of death, on the other hand, is captured notoriously unreliably. I spent some time looking at how cause of death is reported in South Africa and there are many reasons why it would be captured incorrectly (not just Covid-19 but also other, especially medical, causes): two different versions of the paper form are in circulation, unclear classification of primary and secondary cause of death, medical staff completing the form are often unfamiliar with the patient, in rural areas traditional leaders are allowed to complete the form, those authorised to complete the form are often untrained in completing it, everything is captured on paper and then recaptured digitally at least once etc.
      I do not see any other explanation for the extreme rate of excess deaths than the pandemic that is causing havoc in our country.
      By the way, there is no statistical error to report when you are reporting on a complete population (in this case all deaths in South Africa).

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