WINTER WELLNESS

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

South Africa’s winter season lasts roughly from May to August and brings more than just cold weather. Winter heralds a surge in respiratory illnesses, declines in vitamin D levels, disruptions to mood and sleep, and reduced access to outdoor activity — all of which can significantly affect a woman’s health.

While you cannot guarantee that you’ll be able to avoid 100% of all the viruses going around, you can significantly reduce your risk of contracting winter illnesses like colds, influenza (flu), and RSV through a combination of vaccinations, hygiene habits, and lifestyle adjustments.

WHY DO WE GET SICK MORE OFTEN IN WINTER?

Contrary to popular belief, cold weather itself doesn’t cause colds or flu—viruses do—but the season creates the ideal environment for these illnesses to spread:

Virus survival and transmission: Cold, dry air helps viruses like influenza and RSV remain stable and infectious for longer periods.
Indoor crowding and poor ventilation: Spending more time inside in close proximity to others allows respiratory droplets to pass easily from person to person, spreading viruses.
Weakened physical defences: Cold air dries out the nasal mucosa, making it harder for the body to trap and remove viruses.
Reduced immune function: Lower levels of vitamin D, caused by less sun exposure, can impair the immune system.
Lower body temperature: When the body is exposed to cold, it may use energy to stay warm rather than focusing on immunity, making people more susceptible to infection.

COMMON WINTER HEALTH ISSUES IN SOUTH AFRICA

Winter in South Africa brings a surge in respiratory illnesses, skin issues, and chronic condition flare-ups.

Common respiratory infections:

Flu (Influenza)

Cases start around May and are highly contagious. They are particularly dangerous for the elderly (half of all deaths), young children, and those with HIV. Symptoms include high fever, body aches, fatigue, and a dry cough.

Flu is a major health concern in South Africa, with the National Institute for Communicable Diseases (NICD) reporting that 7 000 to 12 000 South Africans die every year due to flu-related illnesses.
RSV (Respiratory Syncytial Virua)
Pneumonia
COVID-19

Common ENT-related illnesses include sinusitis, tonsilitis, ear infections, and voice loss (hoarseness).

Skin issues caused by cold, dry air include dry skin, eczema, chapped lips and nosebleeds.

Chronic conditions that are poorly affected by cold weather include asthma, arthritis, and cardiovascular issues (severe, cold weather can trigger heart attacks and increase high blood pressure).

HOW DO I PROTECT MY HEALTH THROUGHOUT WINTER?

1. Get your annual flu injection
The flu vaccine is your single most effective protection against flu. It does not cause the flu — it is made from inactivated virus particles that train your immune system to recognise and fight the real virus. Antibodies develop approximately two weeks after vaccination, so early immunisation before the season starts is strongly recommended.

Who should be vaccinated?

All women are encouraged to get vaccinated. The South African National Department of Health provides free vaccination to the following priority groups:

Pregnant women (at any stage of pregnancy)

Women aged 65 years and older

Women living with HIV or AIDS

Women with chronic conditions: diabetes, heart disease, lung disease (including asthma and COPD), tuberculosis, kidney disease, or obesity (BMI ≥40)

Residents of old-age homes and chronic care facilities

Healthcare workers

The Bonitas Be Better Benefit provides a flu vaccine for each member every year. Annual vaccination is essential, as the flu virus mutates and last year’s vaccine does not protect against this year’s strains. The Benefit also provides Covid-19 vaccines and boosters as directed by the National Department of Health, as well as a whooping cough booster vaccine every 10 years for members between ages 7 and 64.

If you have a severe egg allergy, you should consult your doctor before vaccinating. For the general population, however, adverse events are rare — occurring in only 0.5–1% of vaccinations. The most common side effects are mild: temporary soreness or redness at the injection site, and rarely a low-grade fever lasting 1–2 days.
2. Strengthen your immune system through nutrition
We often crave comfort food in winter and don’t always eat enough of the fruit and vegetables our bodies depend on. Approximately 70% of all immune cells are housed in the gut, making diet one of the most powerful tools for winter health. Quick fixes don’t work: the best way to support your immune system is with consistent good nutrition.

Key nutrients:

Vitamin C — supports the production of infection-fighting white blood cells. Found in citrus fruits (oranges, naartjies, lemons), bell peppers, broccoli, and strawberries.

Vitamin A — helps the body defend against viruses and bacteria. Found in orange-fleshed sweet potato, pumpkin, butternut, spinach, kale, and morogo.

Zinc — essential for immune cell development and signalling. Found in meat, shellfish, legumes, nuts, and seeds.

Vitamin D — regulates immune function and supports mental health (see number 3 for more detail). Found in fatty fish, eggs, and fortified dairy.

Iron — supports energy and immune defence. South African women are at elevated risk of iron deficiency. Found in red meat, legumes, dark leafy greens, and fortified cereals.

Practical winter eating tips

Embrace seasonal South African produce: pumpkin, butternut, sweet potato, citrus fruit, and dark leafy greens are nutrient-dense and affordable in winter

Add immune-supporting herbs and spices to soups and stews: garlic, ginger, turmeric, and rooibos tea are all locally available and scientifically supported

Frozen fruit and vegetables retain most of their nutritional value and are a practical, affordable alternative to fresh produce

Avoid heavily processed comfort foods that are high in refined sugars — these actively suppress immune function

Eat small, balanced meals regularly to keep blood sugar stable and energy levels consistent
3. Protect against vitamin D deficiency
Vitamin D deficiency is significantly more prevalent among women than men across Africa, and South Africa — due to its higher latitude — experiences lower solar UVB radiation during winter months, particularly in the southern provinces (Western Cape, Eastern Cape, Free State, and KwaZulu-Natal).

A 2024 study from Walter Sisulu University found a vitamin D deficiency prevalence of 28.5% among healthcare workers in the Eastern Cape — and noted that the true population-level prevalence is likely significantly higher.

Those at highest risk include:

Women living in the southern provinces during winter

Urban women who spend most of the day indoors (offices, public transport)

Elderly women (65+)

Women with darker skin tones (higher melanin reduces cutaneous vitamin D synthesis from sunlight)

Women living with HIV

Why vitamin D matters in winter

Bone health: vitamin D is essential for calcium absorption, reducing the risk of osteoporosis and fractures — particularly important for women approaching and post menopause

Immune function: vitamin D helps regulate immune responses; deficiency is associated with increased susceptibility to respiratory infections, TB, and influenza

Mental health: vitamin D promotes serotonin activity; low levels are linked to depressive symptoms and seasonal mood changes

Chronic disease risk: deficiency is associated with increased risk of diabetes, cardiovascular disease, and autoimmune conditions

What you can do to manage your risk:

Aim for 10–15 minutes of sun exposure to arms and legs between 10h00 and 15h00 during spring, summer, and autumn — this is often insufficient in winter months in the southern provinces

Discuss vitamin D testing (a simple blood test) with your doctor, especially if you fall into a high-risk category

Follow dosage guidelines of approximately 600–1 000 IU daily for adults as advised by health authorities — but always seek medical advice before starting supplementation

Eat Vitamin D-rich foods like fatty fish (sardines, mackerel, salmon), eggs, and fortified dairy products
4. Protect your mental health
Seasonal Affective Disorder (SAD) is a medically recognised subtype of major depressive disorder in which depressive episodes recur predictably during the same season each year, most commonly in autumn and winter. SAD disproportionately affects women — research suggests that approximately 70% of all SAD sufferers are women. It is also more common in those who have experienced puberty (the risk decreases after menopause), those with a family history of depression, and those who spend long hours indoors.

Warning signs of SAD:

Persistent low mood or sadness most of the day, nearly every day

Loss of interest in activities you previously enjoyed

Increased sleep (hypersomnia) or difficulty waking

Increased appetite, especially cravings for carbohydrates, leading to weight gain

Low energy and fatigue

Difficulty concentrating

Social withdrawal and isolation

In severe cases: feelings of hopelessness or thoughts of self-harm

IMPORTANT: When to seek professional help

If symptoms persist for more than two weeks and interfere with your daily life, consult your doctor or a mental health professional.

SADAG Helpline: 0800 456 789 (toll-free, 24 hours)

Evidence-based self-management strategies:

Physical activity: aim for at least 150 minutes of moderate activity per week (WHO recommendation); exercise outdoors during daylight hours whenever possible to combine physical and light benefits

Maintain a regular sleep-wake schedule to support circadian rhythm regulation

Keep social connections active — isolation worsens depressive symptoms

Cognitive Behavioural Therapy (CBT): currently regarded as the most effective psychological treatment for SAD

Vitamin D supplementation (see number 3) may help, as vitamin D promotes serotonin activity
5. Practice consistent respiratory and hand hygiene
Respiratory viruses, including flu, RSV, and the common cold, spread far more efficiently in winter because people spend more time in enclosed, poorly ventilated spaces. Proper handwashing with soap reduces respiratory illnesses in the general population by 16–21%.

Hand hygiene best practice:

Wash hands with soap and clean running water for at least 20 seconds

Key moments: before eating or preparing food, after using the toilet, after coughing or blowing your nose, after touching shared surfaces (door handles, phones, ATMs)

If soap and water are unavailable, use an alcohol-based hand sanitiser (at least 60% alcohol)

Avoid touching your eyes, nose, and mouth with unwashed hands — these are the primary entry points for respiratory viruses

Respiratory hygiene:

Cover your mouth and nose with a bent elbow or tissue when coughing or sneezing — dispose of used tissues immediately

Ventilate indoor spaces regularly, even in cold weather — open windows for short periods to reduce viral load in air

Maintain a distance from people who are visibly unwell

If you are sick, stay at home to protect others
6. Prioritise sleep and stay physically active
Sleep

Sleep is a cornerstone of immune function. Adults should get at least 7 hours of sleep per night. Insufficient sleep reduces the production of cytokines and antibodies — proteins your body needs to fight infection and inflammation. Poor sleep also exacerbates anxiety and depression, which are already elevated in winter for many women.

Maintain a consistent sleep schedule, even on weekends, to support your circadian rhythm

Limit screen exposure (phones, tablets, laptops) for at least 60 minutes before bed

Keep your bedroom at a comfortable, slightly cool temperature

Seek medical advice if you experience persistent insomnia or excessive daytime fatigue — these can be signs of underlying conditions including thyroid dysfunction, anaemia, or depression

Physical activity

The WHO recommends that adults engage in at least 150 minutes of moderate-intensity aerobic activity per week (e.g. brisk walking, cycling, dancing). Physical activity enhances immune function through improved circulation and reduced chronic inflammation.

Even a 30-minute outdoor walk during daylight supports both immune function and mood through natural light exposure and endorphin release

Cold weather does not prevent exercise — layering clothing appropriately is sufficient for most South African winter climates

Indoor alternatives for very cold days: yoga, resistance training, online exercise classes, or stair climbing
7. Use winter as a prompt for cancer screening
South Africa’s cervical cancer incidence rate was three times the global average in 2020. Nearly all cervical cancers are caused by persistent infection with high-risk human papillomavirus (HPV).

Start pap smear screening at age 21 (or earlier for women living with HIV)

Repeat every 3 years unless abnormalities are detected

The Bonitas Be Better Benefit provides a pap smear every 3 years, or 1 HPV PCR test every 5 years, for women aged 21 and 65.

The Benefit also provides the HPV vaccine for female members aged 9 to 26.

Women living with HIV have a six-fold increased risk of cervical pre-cancer and require more frequent screening.

Breast cancer screening

Monthly breast self-examination at home: know how your breasts normally feel and report any changes to your doctor

Once you turn 40, you should have regular mammograms. The Bonitas Be Better Benefit provides a mammogram every 2 years for women over 40.
8. Manage chronic conditions proactively
Winter significantly worsens many chronic conditions that are highly prevalent in South African women, including hypertension, diabetes, asthma, COPD, and HIV. Colder temperatures can raise blood pressure (as blood vessels contract to retain heat), increase blood glucose instability, and trigger asthma and respiratory exacerbations.

Before winter sets in:

Schedule a check-up with your doctor or clinic to review all chronic medications and ensure supplies are sufficient for the season

People living with HIV should ensure ART adherence — flu and other respiratory infections are significantly more severe in those with suppressed immune systems

Women with asthma or COPD should ensure they have a current action plan and adequate inhaler supplies

Diabetic women should monitor blood glucose more closely in winter, as illness and reduced activity affect control

Women with cardiovascular conditions should be especially vigilant about blood pressure monitoring in cold weather
9. Skin health and home safety
Cold, dry winter air strips moisture from the skin, compromising its barrier function. Intact skin is the body’s first line of defence against pathogens — cracks and dryness create entry points for infection.

Skin care

Moisturise hands and body daily, particularly after washing — winter hand-washing frequency increases dryness

Use a gentle, fragrance-free moisturiser to maintain the skin’s natural barrier

Chapped lips and nostrils are common winter entry points for respiratory viruses — use lip balm and nasal saline spray if needed

Indoor safety — carbon monoxide and heating

Carbon monoxide (CO) poisoning is a serious and preventable winter risk in South Africa. Many households use gas heaters, paraffin stoves, or braais indoors during winter, all of which can produce deadly CO gas in poorly ventilated spaces.

Never use a gas heater, paraffin stove, brazier, or braai inside a closed room or tent

Ensure adequate ventilation in all rooms where combustion appliances are used

Consider installing a carbon monoxide detector if using gas or paraffin heating

If you or family members experience sudden headaches, dizziness, nausea, or confusion when heating appliances are in use, move immediately to fresh air and call emergency services

WINTER HEALTH CHECKLIST

Before winter (April-May)

Annual flu vaccination
Cervical cancer screening (if due)
Mammogram (40+ years)
Chronic medication review with doctor
Vitamin D level check (if high-risk)
Blood pressure and glucose check

Throughout winter

Daily handwashing (20+ seconds)
Eat nutrient-dense, colourful foods
150+ min moderate exercise/week
7–8 hours’ sleep per night
Monitor mood — seek help if needed
Use heating appliances safely

WINTER WELLNESS

WINTER WELLNESS

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

WHY DO WE GET SICK MORE OFTEN IN WINTER?

COMMON WINTER HEALTH ISSUES IN SOUTH AFRICA

HOW DO I PROTECT MY HEALTH THROUGHOUT WINTER?

WINTER HEALTH CHECKLIST

FURTHER READING