RYAN NOACH: Focus must remain on curbing second wave and rebuilding economy
Health-care system has coped well, but we cannot afford to let down our guard
While the number of global Covid-19 cases continues to rise, there are signs that SA has effectively navigated the peak of the local epidemic. Our health-care system has coped well, with satisfactory health outcomes and low mortality rates. But we cannot afford to let down our guard.
Our focus must remain on measures aimed at curbing a second wave of infection and rebuilding our economy. Critical to achieving these ends is our understanding of this disease locally and globally.
In the UK and US, almost two months passed between the first confirmed case of Covid-19 and full lockdown. SA’s early lockdown came only 18 days after our first confirmed case of Covid-19 on March 6.
The clinical and epidemiological benefits of this are demonstrable and have translated into lower fatality rates than many countries globally. While we remain concerned about the dire economic impact of the lockdown, there are strong epidemiological reasons to thank our effective national response.
Through Discovery Health’s detailed actuarial modelling on mortality rate trends we estimate that by the end of 2020 up to 16,000 SA lives will have been saved due to our health-care system being well prepared, our ability to deploy improved medical treatment protocols, and our lockdown-related nonpharmaceutical interventions. These combined to change the pattern of Covid-19 spread and the outcomes throughout SA. This is an outstanding achievement.
Due to the early lockdown our health-care system had time to prepare for the peak of the pandemic. We also benefited from global learning about evidence-based treatment modalities — such as the benefits of corticosteroids, high-flow nasal oxygen and anticoagulants in treating severe cases of Covid-19, having time to learn from others’ hardship that early ventilation of Covid-19 pneumonia is associated with poor outcomes. It is clear that nonpharmaceutical interventions such as limiting people’s movements with enhanced hygiene protocols also limited the severity of our flu season and associated burden on the health-care system.
Covid-19 is still a new disease, only having been described for the first time in January. We are continually learning more about it. What has confounded experts is its true penetration, considering how contagious it is. Global evidence shows that an extraordinary number of Covid cases remain undiagnosed, with an estimated rate of asymptomatic cases varying in the literature from 40%-75%.
National statistics indicate that by September 14 SA had conducted almost 4-million tests and experienced almost 650,000 confirmed infections, with almost 15,500 deaths related to Covid-19. Our country has a case fatality rate of 2.4% from Covid-19.
The excess natural deaths reported by the SA Medical Research Council, in the period coinciding exactly with the SA Covid-19 outbreak, gives us a sense of the real impact of the pandemic in SA. It allows us also to work backwards to understand the true number of infections. We have extrapolated from the Medical Research Council’s data that about 13.8-million South Africans have been infected with Covid, which is one quarter of the population.
The effects of poverty or delayed non-Covid treatments would not result in such a pattern in excess deaths. Our analysis converges with recent seroprevalence studies and subsequent statements by health minister Zweli Mkhize and Shabhir Madhi of the ministerial advisory committee, that 12-million South Africans have been infected with Covid-19.
We cannot afford to be complacent. Analysis of our data reveals patterns of Covid transmission rates influenced by behaviour that are critical to carry forward.
Discovery’s data shows infection rates among members aged 20-40 — economically active people — are 1.7 times higher than for people aged 60 and over. Within this group the highest infection rates are among those working in the health-care and servicing sector, where face-to-face interaction and direct exposure is highest. As expected, older members, those with low Vitality engagement (high body mass index and low activity levels,) and those living with chronic illnesses, face the highest risk of severe Covid illness. Our members over age 60 have a 22%-34% elevated risk of being admitted to hospital on contracting Covid-19.
The most prevalent chronic conditions increase risks of Covid-19 related hospitalisation, and the more chronic conditions people live with the higher their risk. But we can offset these elevated risks of severe Covid illness associated with ageing and lifestyle-related chronic conditions through physical activity. Discovery’s Vitality Resilience Index reveals that engaged Vitality members experience a 37% lower mortality risk than non-engaged members.
Our positive reflection on the epidemiological and clinical aspects of the progress of the pandemic after our country’s early lockdown must not detract from the challenging economic impacts, as evidenced in the most recent GDP data. We must take the necessary steps to reduce our risk of experiencing a second wave of infection and accelerate the path to rebuilding the economy.
Our research demonstrates that there are several proactive steps we should all take as we move into Covid alert level 1:
- Continue to adhere to evidence-based, nonpharmaceutical interventions such as social distancing, mask-wearing and general hygiene protocols.
- Embrace technologies designed to optimise our health in the time of Covid-19 — from virtual doctors’ consultations to use of the national department of health’s recently launched Bluetooth contact-tracing app, Covid Alert SA.
- Engage in physical activity to live a healthy lifestyle and to reduce our risks should we contract Covid-19.
- Access health care responsibly, when we need it, to ensure adequate routine care for chronic illness.
- Undertake regular cancer screening tests.
• Noach is CEO of Discovery Health.
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