One of the biggest challenges facing healthcare and insurance professionals during the Covid-19 pandemic is how to interpret the mortality, morbidity and treatment outcomes data being generated globally. They must consider hundreds of country-specific data sets alongside countless independent clinical studies that, although purporting to reflect similar statistical measures, are often wildly different. “We are probably in the second wave of pandemic [in developed countries] and at the peak of the first wave in many developing countries,” said Emile Stipp, chief actuary at Discovery. He added that the reported infection and mortality rates varied widely from one country to the next due to different testing protocols, among other factors. Stipp was presenting at a ‘Pandemic Progression Insights’ webinar.
The South African experience
The presentation coincided with an alarming spike in the number of new Covid-19 infections, especially in Europe; though early experiences point to a lower mortality rate than during the first wave. “There is evidence to support that mortality rates are different in the second wave in Europe,” noted Stipp, who proceeded to consider the healthcare outcomes following South Africa’s harsh lockdown, implemented from 27 March 2020. The intention with lockdown was to delay or flatten the Covid-19 infection curve and give both the private and public healthcare sectors time to prepare for the inevitable onslaught. Did the strategy work? And to what extent did we save lives?
An early assessment of the virus’ local progression suggests that South Africa bought enough time to make a significant difference. A crucial observation is that we never exceeded an ‘attack rate’ of 50 infections per 100000 lives; the level at which New York’s healthcare system was overwhelmed. “Our healthcare system, both public and private, coped much better with Covid-19 than many in the developed world,” opined Stipp. But he was quick to point out that we should not take the official Covid-19 deaths, just north of 15000 at the time of writing, at face value. Excess mortality statistics published by the South African Medical Research Council (SAMRC) show that South Africa has experienced 41400 more deaths than ‘average’ through the pandemic to date, with around 37300 of these deaths considered pandemic-related.
“Excess deaths include all causes of death … [and the number includes deaths] arising from the fact that people could not gain access to treatment for non-COVID conditions,” said Stipp. The SAMRC figures made it possible for actuaries to estimate the disease’s mortality rate and draw some telling conclusions. Top among these is that close to one in four South Africans may already have been infected by Covid-19. South Africa’s total infection rate is estimated at 22%, varying slightly from one province to the next. Gauteng infections were estimated at 24%; Eastern Cape at 33%; Western Cape at 20%; and KwaZulu-Natal at 19%.
The race to 100 cases and confirmed deaths
A comparison of the disease’s progression in South Africa and the United Kingdom proves telling. The first case in the UK was reported on 31 January 2020; the first death on 7 March; the 100th case on 6 March; and the 100th death on 19 March. Yet the UK only entered lockdown on 6 March. SA reported its first case on 6 March, our first death on 27 March, our 100th case on 19 March; and our 100th death on 30 April. Our lockdown started 27 March. “The fact we went into lockdown early in the epidemic has meant that the pandemic [took hold] later, and we could benefit from the fact that medical treatment improved by the time it hit us,” said Stipp. Hard lockdown, and its early implementation, made a significant difference to the course of the pandemic, with improved treatment outcomes and reduced severity among Covid-19 admissions.
The decline in mortality rates reported in offshore ICUs, which were 25% lower by the middle of July, mean that roughly 10000 lives could have been saved in a South African context. “Our current central scenario is that estimated mortality for the whole country will be roughly 51000 by 31 December 2020; by that point we [would have experienced] about 16000 fewer deaths than [initially forecast],” said Stipp, who added that South Africa benefited from the peak of the first wave arriving later; and that that delay was largely due to lockdown. The presentation focused specifically on the healthcare experience of the pandemic to date, avoiding the counterproductive argument about the trade-off between hard lockdown and longer term economic impacts.
“Our positive reflection of the epidemiological outcome does not seek to hide or avoid the discussion about the difficult economic aspects; we remain concerned about the recent GDP data and impact on the economy of the lockdown,” commented Dr Ryan Noach, CEO at Discovery Health. He concluded the presentation with six observations from the ‘big data’ analysis that has taken place to date. These include that as many as 13.1 million South Africans have been infected; SA has experienced favourable mortality outcomes due to its lower average age and better treatment outcomes; it is estimated that 10000 lives had been saved by 9 September, likely to swell to 16000 by year-end; out of hospital treatment and at-home care, coupled with remote monitoring, reduces both mortality and morbidity; the vitality resilience index is predictive of Covid-19 outcomes; and proactive action is recommended for essential healthcare such as cancer screening and treatment of chronic conditions.
Physical activity for the win
Discovery’s oft-repeated observations re exercise remain compelling. “We have made many positive findings from our [combined] 45 million ‘life years’ of data; we have extrapolated insights into how exercise and lifestyle relates to mortality and morbidity [in the current pandemic context],” said Dr Ronald Whelan, Chief Commercial Officer and head of Discovery’s Covid-19 Task Team. Discovery observed a 37% reduction in Covid-19 mortality risks as a result of being more physically active. The observations shared during the webinar form the basis of a ‘call to action’ for financial advisers to share with their clients.
Your clients should continue to practice behavioural modifications such as wearing masks and practising social distancing to help to reduce second wave infections. They should, where possible, participate in contract tracing and screening programmes, which are seen as an essential component for a safe return to work and the reopening of the economy. And finally, they should stick with their exercise and physical activity regimes, which are positively correlated with improved mortality and morbidity outcomes for Covid-19 and a range of other diseases.