DINESH GOVENDER: Learning lessons from Covid

This week, as the spotlight is cast once again on SA’s purse, health-care spending is expected to continue its inevitable rise.

This increase will be driven by the surge in noncommunicable diseases such as diabetes, the direct consequences of Covid and its indirect "care gap" effect — people with serious illnesses who avoided timely treatment and preventive screenings as a result of the pandemic.

While we hope any future waves of Covid will be less severe, there is a simple lesson we can take from the pandemic: exercise has a remarkable and positive protective effect on people’s health.

In 2020, nearly 4-billion people in more than 90 countries were asked by their governments to stay home to contain the spread of Covid. Lockdown restrictions understandably aim to limit the pressure that explosions in Covid cases would have on health-care systems. But one of the unintended consequences of limiting movement has been an enormous drop in exercise levels.

We saw a 49% decline in physical activity points logged on the Vitality platform during the level 5 lockdown, from late March 2020.

We have always tried to address the four lifestyle habits — physical inactivity, poor nutrition, smoking and alcohol abuse — that lead to the four chronic conditions responsible for 60% of global deaths. But the pandemic has shown that such interventions have a meaningful preventive effect beyond the management of noncommunicable diseases, such as heart disease, and can address risks related to infectious diseases too.

The Covid mortality rate has been devastating, with more than 5.7-million global deaths recorded to date.

Throughout the pandemic, ours has been one of several voices pointing out the protective effect of physical activity against severe Covid outcomes. Until now, however, all the evidence has been based on self-reported data.

Recently, a study published by the British Journal of Sports Medicine, produced by Vitality in collaboration with Wits University’s sport & health research group and the University of Western Ontario, became the first to make this case based on directly measured physical activity data. The findings prove what we suspected, and go a step further.

The "Small Steps, Strong Shield" study shows that any form of regular physical activity, even at a level of 60 to 149 minutes of exercise a week — lower than the World Health Organisation’s recommended weekly guidelines — protects against severe Covid outcomes.

It definitively demonstrates that exercise, including brisk walking, has a distinct benefit in preventing hospitalisation, ICU admission, the need for ventilation and the risk of death.

The study reviewed the experience of 65,000 Vitality members in SA who contracted Covid, matched against their physical activity history (captured by smart devices, clocked gym attendance and participation in mass sporting events) in the two years before the hard lockdown.

The researchers found that, compared with low levels of activity, high engagement in physical activity was associated with a 34% lower risk of hospital admission, 41% lower risk of ICU admission, 45% lower risk of requiring ventilation and 42% lower risk of death.

Even those engaged in moderate activity had a 13% lower risk of hospital admission, 20% lower risk of ICU admission, 27% lower risk of ventilation and 21% lower risk of death compared with the low-activity group.

What this means for policymakers

Our concern is that the drop in physical activity levels may become entrenched for many. It is beyond question that we need to enhance our efforts to promote regular exercise as an adjunct to vaccination and other preventive measures, especially for those at high risk. We also need to continue to educate people about the benefits of physical activity in the context of communicable diseases.

There are ways for people to safely engage in physical activity, while securing the health and wellbeing of those around them. If we ever encounter future pandemics, reasonable concessions to consider include access to safe outdoor exercise spaces and well-ventilated and uncrowded indoor fitness facilities.

We need policies that promote physical activity as the powerful preventive measure it has proven to be. Perhaps that’s something for the government to consider, as it allocates its health-care spend.

Govender is CEO of Discovery Vitality