(SA) imposed a 21-day lockdown from 26 March to 16 April 2020, through the disaster management Act (57/2002) and amended regulations [Section 27(2)] 1 , to contain the spread of the coronavirus in the country. During the lockdown only essential goods have been allowed on sale 2. Tobacco and nicotine products were designated as non-essential goods and their sales prohibited. About 22% of South Africans aged ≥15 years use various tobacco products 3. A systematic review of five Chinese studies published in Tobacco Induced Diseases, found that the odds of a COVID-19 case becoming more severe and leading to death are higher among people with a history of smoking 4. SA has one of the highest prevalence of tobacco product use in Africa 5 and presently has the highest number of COVID-19 cases in the continent, putting the country at risk of being hard hit by the COVID-19 pandemic if nothing is done to curb the spread of the virus and protect vulnerable citizens. As of 8 April 2020, SA had conducted 63776 COVID-19 tests, had 1845 confirmed cases and 18 resulting deaths 6. The COVID-19 pandemic could particularly be problematic for SA given the high prevalence of diabetes, tuberculosis and HIV in the country, compounded by substance use problem even among vulnerable populations 7. The co-use of substances, especially by persons in vulnerable groups, could increase the risk of developing complications from COVID-19 if infected. Cigarette smoking affects both smokers and those exposed to secondhand smoke (SHS) 8. During the lockdown ban, family members and neighbors in apartment complexes who share the same space with tobacco users will also be protected from exposure to SHS since people are not expected to go outside their building to smoke during the lockdown. Experts have predicted that the South African economy is in for a bumpy ride and may shrink as a result of the COVID-19 pandemic 9 and the associated measures that have been taken to protect citizens during this time. The government has received criticism from some pro-tobacco advocates and academics for the sales ban on tobacco products and alcohol during the lockdown 10 , but this move is heroic and should be viewed as taking a double shot at protecting citizens from COVID-19, given the vulnerability of many South Africans to the disease. There are also concerns about the implications on mental health when people are forced to give up their addictions during the lockdown 10. It is understandable that tobacco and nicotine product users will be dealing with the mental stress of restricted movements in addition to giving up their addictions, but of more importance is that they become aware that the lockdown ban provides a good opportunity to quit tobacco use.

Current South African tobacco control law allows for 25% designated smoking areas in some indoor public places. This study investigates non-smokers’ exposure to second-hand smoke (SHS) in workplaces, homes, cafés/restaurants, and shebeens (local bars) using data from the 2017 South African Social Attitude Survey. Factors associated with any level of exposure were explored using multiple-variable-adjusted logistic regression analysis. The sample of 3063 participants (16+ years old), comprised 51.7% females and 78.5% Black Africans. The current smoking prevalence from this study was 21.5%. About 47% of non-smokers reported exposure to SHS in at least one location. Females were significantly less likely to be exposed to SHS in all locations except at home compared to males. Adjusted logistic regression analysis showed that females, adults aged 45–54 years, 55–64 years, and 65+ years were significantly less likely to be exposed to SHS (AOR = 0.63, 0.60, 0.55, and 0.24, respectively) than males and those aged 16–24 years. Those who identified as Coloureds were significantly more likely to be exposed to SHS (AOR = 1.69) than Black Africans. This study found that nearly half of non-smokers reported exposure to SHS. A 100% smoke-free policy consistent with the World Health Organisation (WHO) Framework Convention on Tobacco Control would protect more people from exposure to SHS in South Africa.

The South African government imposed one of the strictest lockdowns in the world as part of measures to curb the spread of COVID-19 in the country, including a ban on the sale of tobacco products. This study explored news media coverage of arguments and activities in relation to the South African lockdown tobacco sales ban. We collected media articles published between 26 March to 17 August 2020, which corresponded to the period of the sales ban. Data were sourced via google search and snowball identification of relevant articles. Thematic analysis of data was conducted with the aid of NVivo. We analysed a total of 305 articles relevant to the South African tobacco sales ban during the lockdown. Six major themes were identified in the data: challenges associated with implementing the ban, litigation, and threats of litigation to remove the ban, governance process and politicization of the ban, pro and anti-tobacco sales ban activities and arguments and reactions to the announcement lifting the ban. The initial reason for placing the ban was due to the non-classification of tobacco products as an essential item. Early findings of a link between tobacco smoking and COVID-19 disease severity led to an extension of the ban to protect South Africa’s fragile health system. Pro-sales ban arguments included the importance of protecting the health system from collapse due to rising COVID-19 hospitalization, benefit of cessation, and the need for non-smokers to be protected from exposure to secondhand smoke. Anti-sales ban arguments included the adverse effect of nicotine withdrawal symptoms on smokers, loss of jobs and the expansion of the illicit cigarette markets. Litigation against the ban’s legality was a strategy used by the tobacco industry to mobilize the public against the ban while promoting their business through the distribution of branded masks and door-to-door delivery which goes against current tobacco regulations. The media could serve as a veritable tool to promote public health if engaged in productive ways to communicate and promote public health regulations to the general population. Engagement with the media should be enhanced as part of health promotion strategies.

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