In this chapter of the second report, we explore the challenges faced in limiting the transmission of the virus among populations who already live precariously and so are inevitably at risk in their everyday lives. Social structures such as class, culture, gender, race, disability and citizenship all impact on individuals, their families, and communities. In South Africa inequalities have been sustained despite political commitment to transformation, resulting in the “massification” of poverty and inequality and vast extension of vulnerability. As we illustrate, such inequalities already result in uneven health risks and outcomes. Health policies related to containing the pandemic exacerbated these inequalities. We show how vulnerability derives from social structures which distribute power unequally, where people cannot access state services or where they lack adequate support. Stringent or inadequate policy measures at times increased risks of contagion, unemployment, and food and housing insecurity. These factors contributed to social unrest which was impacted by and expanded new vulnerability. Vulnerability as it pertains to a category of persons is thus not fixed, nor located in particular attributes such as disability or being aged, but is a social condition that is shared widely.