Our new podcast – Inside Covid-19: Global infections pass 300 000, deaths over 13 000 – Ep 1

Welcome to Episode One of Biznews.com’s new daily podcast that will keep you updated on the Covid-19 latest developments. In addition to the latest news, in this episode Discovery Health CEO Ryan Noach helps better understand the virus and how SA’s leading health insurer is responding; there’s heartening news from the US about an old malaria drug that is proving effective against this novel coronavirus; NinetyOne’s CEO Hendrik du Toit explains why investors should approach this as they would a world war; and leadership guru Robin Sharma offers some sage philosophical advice. – Alec Hogg

It’s really good to have Ryan Noach – the chief executive of Discovery Health – Ryan coronavirus or Covid-19, there’s so much confusion about how serious it is, where it comes from. Maybe you can give us a little bit of background on what a coronavirus is.

Sure. Coronavirus is actually not a new human infection. There are now – including this new coronavirus outbreak – 7 known coronaviruses that infect humans. 4 of them are actually extremely common Alec, most of our kids will have contracted them or will contract them at some time. They’re in the schools, they are ubiquitous, they’re everywhere. They’re endemic as we call it from a clinical point of view and they cause the common cold predominantly. The next three though are much more serious. So this particular coronavirus outbreak, the virus is actually called SARS CoV2. SARS standing for Severe Adult Respiratory Syndrome and CoV coronavirus, this current outbreak. The two that happened before this were the SARS outbreak which is SARS CoV1, that we all know of as SARS and the MERS outbreak – which a few people have heard of – but actually in fact was also a coronavirus outbreak. MERS stands for Middle East Respiratory Syndrome.

So what makes these so serious?

Well these are actually zoonotic infections. What that means is that it’s contracted originally from an animal and then into a human, caught by human and what’s worrying about them is the community transmission or the human-to-human transmission that can occur. So although it originally comes from an animal it’s transmitted human-to-human and as we’ve seen it can spread very widely. So what you might want to know is why is this epidemic of such a different scale in proportion to the SARS epidemic that we all know about?

Just to stop you there briefly. SARS we know had a very high mortality rate, MERS even worse, but thankfully much smaller numbers that were infected. So it looks like – this time around – the mortality rate is a little lower and maybe you can explain why, but the infection is on an exponential scale.

Yes. Good question. Let me start with the infectious part of it first. All these three coronaviruses – SARS, MERS and Covid-19, have got slightly different characteristics. So if you take SARS for example, the reproductive rate of that coronavirus infection was actually higher than the current Covid-19 outbreak. What that means is that for every person that was infected with SARS, about 3 people would catch that infection from the index case. Whereas in this Covid-19 disease, it is about 2.5. So 2.5 people for every case. You can compare that – just as a reference point – to the common flu or influenza virus which is at about 1.5. So the number of people that catch it was higher with the SARS virus than it is with Covid-19, but both are higher than the influenza.

So why then was SARS not as contagious as this?

The answer seems to be the following: SARS was transmissible only by symptomatic individuals. In other words only once you started showing the symptoms, were you infectious. With this Covid-19 disease, it appears now – in the early stages – that actually many asymptomatic people, and the majority of people who catch it or asymptomatic, they are transmitting the disease. And that’s why we’ve seen this global pandemic spread across the world like like wildfire.

What are you doing at Discovery to protect your members against it? I know that the website is full of information but what happens next from your perspective?

We’ve taken a very strong leadership position. You would have seen a lot of material from us and we’ve taken some very bold steps. The first was we recognised that there’s a lot of misinformation out there. And we wanted to create one single source of factual information where people can get real time, dynamic, reliable information that’s fact-based. So we went live on our website, an information hub – it’s on the Discovery web page, there’s a link from the home page directly to that – and we have had an unprecedented number of hits there. You need not be a member to access that website anybody can access it. And we feel like we’re being very responsive dealing with the misinformation.

The second step that we took very quickly – with amazing support from our regulator – we extended the benefits in all of our health plans. So from the Discovery Health medical scheme any member that’s on the medical scheme – on all plans – immediately as of almost 2 weeks ago now, had full cover for confirmed coronavirus Covid-19 infections, both out of hospital and in hospital. Full coverage for the diagnostic testing, the treatment, the consultations and if necessary the hospitalisation. We led with that, the Discovery Health medical scheme has the advantage of being financially in a very good position with solvency above the statutory requirement, with about R20bn cash reserves and those reserves are there for catastrophic situations. This is typically one of those situations. The third thing that is very important in our response, has been reaching out to particular segments of members and clients and helping them with their responses. So in this group, large employer groups who are facing business continuity challenges who needed guidance around what to do with their employees, who to send home, who’s high risk in the employee base that should be sent to work from home on a mandatory basis, just advice on what to do when they’ve got somebody in the office environment who may have tested positive. How do they handle that, what action should they be taking? The employers that we continue to support very actively and some big employers with thousands of employees that are needing to make really large scale decisions. The other thing that’s become very relevant is all of the members – who are either elderly or living with chronic diseases – they specifically need very important information about this disease and they must take the social distancing and spatial separation very seriously. So we’ve reached out to all of those clients individually.

Do you feel that South Africans are now starting to take it as seriously as the president wants us to?

I’m scared that we’re not. Although I’ve seen a marked difference in traffic patterns, in the number of people that you see out there in the shopping centres and so on. I think that there is still a bit of a laxadasical mindset and I think we need to heed the president’s words and enforce the social distancing very sternly.

Just to go back to something that you mentioned earlier to close off this conversation, are there any early warning signals on infection so that you know not to go into a public place or is the safest thing just to stay at home and social distance from day one?

I think that is the safest thing at the moment for your own safety and others. The signs or symptoms of the disease are most commonly a fever, so if you want to be vigilant you can take check your temperature twice a day and if it’s about 38 it’s very likely you’re contracting an infection and at this stage it may well be Covid-19. It’s also characterised by a sore throat together with a dry cough. About 70% of patients are experiencing that. It’s a hacking cough together with the sore throat. Some people are experiencing gastrointestinal symptoms – that seems to be a minority – and the thing to worry about particularly, at 3 to 4 days after contracting the disease, is shortness of breath. That may be a sign that you’re actually developing pneumonia as a result of Covid-19 and you should urgently get health professional support if you do experience that.

So if you’ve got none of those symptoms if you have normal temperature, if you are not coughing and certainly you’re not short of breath, you’re exercising as per normal Are you okay to go to work?

Well, at the moment I can only speak for our employees. We’ve sent the majority of our workforce to work from home. We feel that it’s responsible to protect them and those around him. If you have to go to work and it’s essential that you venture out then you must and if you don’t have any of those symptoms and you’re completely asymptomatic, hopefully you don’t have an infection. I guess there’s a part of us – in the clinical community – that are actually hoping that there are lots of asymptomatic people and why this would be good news is the mortality rates that are being reported are obviously a factor of the number of deaths divided by the number of reported infections. But if there’s lots of asymptomatic people walking around who are in fact infected, well then the good news would be that the mortality rate of this disease is much lower than is being reported.

And what about summer versus winter?

There are very clear guidelines from virologists that the virus survives outside the body longer in the wintertime for two reasons. The first is that the virus is deactivated by ultraviolet light and obviously there’s much more of that in the summer and secondly the virus survives in saliva droplets and those saliva droplets tend to evaporate much quicker in hotter conditions. And so for two reasons it seems very likely that winter will lead to a much faster spread than summer. The faux mites, the inanimate objects where these larger droplets survive, are less likely to transmit the disease in summer than in winter. That is the guideline. But please this shouldn’t give you a false sense of security that we are safe because we’re at the end of summer. It’s not the case. We are seeing spread in the summer period and one must remain vigilant and careful.

There are also two views on how to handle Covid-19, the one view being slow it down flatten the curve as they have now picked up in the United States, the other one is to infect the herd and you get over it quickly. Although the UK did go that route, they seemed to have changed their minds on it, what school of thought are you in?

I’m not an epidemiologist or a virologist and so I’m actually not the expert on this. I’m reading a lot and being advised by good public health specialists. Our view is that containment and suppression is currently definitely the right strategy. That is what the view that our government and our National Institute of Communicable Diseases is taken and I think what’s very heartening about this particular strategy – and we should gain some positivity and optimism from it – is that in the Chinese, South Korean, Singaporean and Japanese experiences, those 4 highly disciplined nations, we’ve seen that a containment strategy absolutely stops the infection rate, slows it down dramatically in the case of China, 3 days ago not a single reported infection but their containment strategy has been really onerous and substantial. People are housebound. So our current thinking – and supported by our country’s National Institute of Communicable Diseases – is let’s flatten the curve, suppress infections, contain any further spread and protect people and lives. Hopefully we learn things about this disease, how to treat it and potentially a vaccine comes around that we can act medically on to protect people.

Are we learning much from China. I know you at Discovery have got a very close relationship with Ping An, of course South Africa is a member of BRICS – close relationships too – is that helping?

Yes it is. I understand that the president’s office has got a hotline to the Chinese experts who are helping advise the president’s office through the Department of Health, around some of the containment strategy specifically, but certainly some of the success of the Chinese story. We have some expats in China, as you know we are a minority shareholder of a health insurer in China – and we learned great lessons from them. It’s quite extraordinary to see how the Chinese have responded, they’ve almost changed their way of life with amazing digital services and innovations that have been spawned through this. It may be a whole podcast on its own to chat to our team in China to hear about what the Chinese response has been.

I’m looking forward to that one as well. Good talking with you, we’ll be in touch in the days and weeks ahead. Maybe to close off with, are you in the camp that says that South African government has handled this well so far?

Yes I certainly am. I think that our National Institute of Communicable Diseases has given very good communication and guidance. I think our cabinet and the president took an early and emphatic decision to enforce containment – much earlier than many other countries – which I must say is a very profound and good step. That’s definitely given us a window to prepare in case we develop rampant community spread because most of our infections to date – the 250 that you spoke of earlier – still the vast majority of those are imported infections from people who’ve flown in with the disease and contracted it elsewhere. So I think at this stage we’ve done a great job. The truth is you’re seeing it around the world. Developed and emerging markets that any health system tends to be overwhelmed by an epidemic of this proportion. And so obviously there is reason to be concerned.