The coronavirus pandemic (COVID-19) has resulted in an unprecedented dislocation of society especially in South Africa. The South African government has imposed a number of measures aimed at controlling the epidemic, chief being a nationwide lockdown. This has resulted in income loss for firms and individuals, with vulnerable populations (low earners, those in informal and precarious employment, etc.) more likely to be adversely affected through job losses and the resulting income loss. Income loss will likely result in reduced ability to access healthcare and a nutritious diet, thus adversely affecting health outcomes. Given the foregoing, we hypothesize that the economic dislocation caused by the coronavirus will disproportionately affect the health of the poor. Using the fifth wave of the National Income Dynamics Study (NIDS) dataset conducted in 2017 and the first wave of the NIDS-Coronavirus Rapid Mobile Survey (NIDS-CRAM) dataset conducted in May/ June 2020, this paper estimated income-related health inequality in South Africa before and during the COVID-19 epidemic. Health was a dichotomized self-assessed health measure, with fair or poor health categorized as “poor” health, while excellent, very good and good health were categorized as “non-poor” health. Household per capita income was used as the ranking variable. Concentration curves and indices were used to depict the income-related health inequalities. Furthermore, we decomposed the COVID-19 era income-related health inequality in order to ascertain the significant predictors of such inequality. The results indicate that poor health was pro-poor in the pre-COVID-19 and COVID-19 periods with the latter six times the value of the former. Being African (relative to white), per capita household income and household experience of hunger significantly explained income-related health inequalities in the COVID-era, while being in paid employment had a nontrivial if statistically insignificant effect. Addressing racial disparities, tackling hunger, income inequality and unemployment will likely mitigate income-related health inequalities in South Africa during the COVID-19 epidemic.