In Episode 21 of Inside Covid-19 we look the end of a lockdown that costs SA R13bn a day, considering how that’s likely to happen; also, the Stanford University prof whose research suggests Governments have massively overreacted to the virus; a counter of sorts from SA’s leading scenario planner Clem Sunter; and on a lighter note, how man’s best friend may end up saving the world from a confused post lockdown future – with sniffer dogs being trained to identify those who are Covid-19 positive. – Alec Hogg
First in the Covid-19 headlines today:
- The Stanford University report published on Friday continues to cause ripples around the world, raising questions about the true mortality rate of Covid-19 – and whether Governments panicked by shutting down economies to combat a virus that kills only slightly more than seasonal flu. Our Biznews colleague Linda van Tilburg has cut the highlights from medicine professor and economics fellow Dr Jay Bhattacharya’s recent interview with a Stanford colleague; and we’ll also have input on the matter in this episode from South Africa’s leading scenario planner Clem Sunter.
- The impact of Covid-19 on the shuttered airlines sector was brought home today by global giant United Airlines warning that it will report a $2.1bn loss for the three months to end March, its largest since 2008. As things have got worse since then, United will be applying to the US Treasury for a $4.5bn bailout. Here at home South African Airways is teetering on the brink after Government turned down a request for a R10bn bailout and the airline’s business rescue practitioners offered retrenchment packages to all its staff. Trade unions are resisting the mass retrenchment offer.
- South Africa’s process of testing for Covid-19 is gathering momentum with more than 6,500 added yesterday taking the total to just over 114,700. Of those tested, 124 were found to be positive, raising the country’s confirmed infections to 3,158, a daily increase of 4%. Two more Covid-19 deaths were recorded Sunday, taking the national total to 54, equivalent to 0.36% of those tested and 1.7% of confirmed infections. On a brighter note, the first shipment of Naspers-sourced Personal Protective Equipment arrived in the country from China today consisting of 275,000 KN95 masks and 100,000 face shields. This is the first part of a R1.5bn commitment by Naspers, its partner Tencent and the Chinese Government, with the PPEs to be used to protect health workers.
Well, the big story all over the world at the moment is what happens to a country when it emerges from lockdown. Ron Whelan is the Discovery Health Chief Operating Officer and the last time we spoke, Ron – you accurately predicted that the lockdown would be extended until the end of April. So now, of course, the question is what happens next?
Thank you for the compliment Alec. It’s one of the few predictions we probably got right over the last six – eight weeks or so. Covid-19 has been such a challenge for all of us – such a dynamic thing to manage. I think we’ve probably reached the end of the line in terms of your hard lockdown and I use the words ‘hard lockdown’ here very selectively. I think when you begin to look globally – it’s not a binary ‘in lockdown / out of lockdown’. It’s a gradual resumption of some level of normal activity. When you look at Germany – it’s a gradual easing of restrictions, Spain – gradual easing of restrictions. New Zealand’s really interesting in that they’ve got a 4 level response – their highest level response is level four, which is your hard lockdown (similar to where South Africa is at the moment). They’re easing their lockdown back down to a level three and a level three basically brings you back to a softer lockdown -a new normal. Effectively, we’re not going back to normal any time soon. We’ve probably got a pretty rough three or four months ahead of us. So we haven’t peaked from an epidemic perspective and it’s anyone’s guess on which trajectory we’re going to follow over the next three to four months – hopefully South Africa continues to contain this epidemic and keep on a low trajectory. There’s a risk that we’re going to increase the infection rate. So, for at least the next three, four, five months – we’re into a new normal. We think the new normal will have many of the same restrictions that we’ve got now in terms of social distancing, restrictions on your mass gatherings and public gatherings. There’ll be increased emphasis on tracking and tracing, there’ll be increased emphasis on testing and then, of course, all of the preventive elements will stay in place over the next three to four months.
Does it mean that people will be able to go back to work?
You would know that the mining sector, for example, is back to 50 percent capacity this week and I think we will gradually see the opening up of manufacturing and various other sectors of the economy over the next few weeks. But I don’t think it’s going to be as binary as switching it all back on immediately – there will definitely be restrictions around social distancing and gatherings and we’re seeing that in many of the other countries as well. For example – where they are allowed to open – you are only allowed a certain number of patrons in restaurants, shops are only allowed a certain number of people in their shops. There’s strict temperature monitoring going into retail locations. I think we’re moving into a gradual relaxation of restrictions with continued emphasis around healthcare interventions. This is a process rather than a switch on / switch off – what’s called a risk adjusted strategy and the government alluded to it last week. What a risk adjusted strategy basically means (in simple words) is a suppress and lift strategy. What that means is when infection counts here begin to go up – if new infections are greater than 100 a day – you put more restrictions in place. So what you do is you watch the average number of new infections daily and as soon as the average number of new infections daily go greater than somewhere between 90 and 100 (for a sustained period) – you then apply increasing restrictions around movement and mobility and increase the social distancing and spatial separation. As soon as the infections then drop below that magic number of 90 to 100 (and ideally you want to get them to below 50 or 60) – you then lift the restrictions again and we’ll end up in this dynamic suppressant phase probably over the next four to five months or so. And that’s all it means for us to keep this low trajectory in place.
Surely, it depends on how many people you’re testing? For instance, I had a look in the latest numbers and the tests were 6,500 of which about 145 were positive. Now, if the tests go to 25,000 – at pretty much any percentages – you’re going to get more than 100 people who are going to be registering positive or am I missing a point here?
Exactly right. The current testing level is at somewhere between five and six thousand a day and we’ll begin to ramp that up over time. This is a rough rule of thumb and we will adjust the thresholds as you ramp up the testing. What you’re trying to do is you’re trying to make sure that you are quickly moving in to contain any clusters of outbreaks across your communities. You’re kind of keeping your finger on the pulse of increasing infections in any particular area – as soon as you’re seeing a rise in infections then you’re imposing your increased restrictions again.
That makes a lot of sense. So the 25,000 a day (which appears to be the target at the moment) – once that starts coming in, there’ll be a realistic number of the new infections and where they do break out. It’s almost like in the body – you can focus on fixing that infection.
Exactly and Prof Karim alluded to it in his presentation last week. He speaks about it as small fires, and what you’re trying to do is contain those small fires. If you don’t contain the small fires – they coalesce and then you end up in a big outbreak similar to what we’re seeing in Italy, New York and in the US (to some extent now). So, it’s a question of keeping on top of those small fires over the next four to five months.
It’s very sensible but we are also getting so much noise from the science around the world. On Friday we had a Stanford University – an eminent – professor of medicine and economics telling us that the infection rates are, from his research and from the studies they’ve done, actually not much higher than a normal seasonal flu (or the mortality rates, rather). Then, of course, we’ve got the whole BCG story – which you and I have discussed as well. Where do you go for your information?
Like you say, there is a ton of information out there and in many ways – we are learning all of the time. Across the globe there are scientific papers being put out and there’s anecdotal evidence from hospitals and different public health systems across the globe. There is a mass of information. At Discovery – we have a full clinical excellence team that just scans the globe daily to look for the latest available clinical information (and that is); your treatment information, vaccine information, information around your mortality trends and incidence trends. Obviously, we’re staying as close as we can to any emerging technologies that give us any information on how best to manage this. We rely extensively on our clinical excellence team and related to that – we’re doing a lot of in-depth actuarial modelling – predicting what the medium to long term trends will look like. It’s a question of pulling those pieces of information together to create the best possible picture of the situation.
And what does it look like now – how well has South Africa done? I’ve seen some spectacularly good graphs from various places around the world. In fact, we flattened the curve sooner even than South Korea.
Yes, South Africa has done an amazing job. Credit to everyone involved in the response here – government, the private sector, the public at large. I think that the public needs to take a lot of credit for flattening the curve over the last four weeks in South Africa – that really has been an amazing job. And you’re right; the curves are flatter than the initial stages of Australia and Korea and South Africa has beaten all of our initial forecasts for April (we are delighted that all of our forecasts have been wrong for April). That’s given us time to respond to this – to prepare our response to the epidemic. The reality is that we will still have infections. This is a flattening of the curve over a sustained period of time – it’s not a question of getting over an initial hump. We’ve actually got to sustain this momentum over the next four to five months (at least). People will continue to get infected (similar to seasonal flu). People will begin to build up herd immunity. Every year we get a different strain of flu and that’s why we get re-infected by flu – because it’s a slightly different strain. So, we will build up herd immunity over time. The challenge with Covid is that these infections are on top of an existing disease burden that comprises a range of chronic diseases (it also comprises trauma and accidents and cancer – all of the things that go on top of that). Covid comes on top of all of these diseases. That’s the real challenge. If you look at the stats coming out of London and New York, as an example – the real challenge those healthcare systems are facing is that the death rate is 30 percent higher than it was previous years. That’s where the challenge comes in; if you’ve got 30 percent more hospital admissions, 30 percent more ICU admissions, 30 percent more deaths – that’s where Covid puts a significant burden on our healthcare system. And that’s the reason to keep it as low as possible and gradually build up your herd immunity (but this is going to take many, many months for us to drive through). That all said, there are a number of variables at play here and, as you rightly mentioned, it’s still not clear how infectious it is, what portion of the population will get infected by Covid over time, or what the actual mortality rate is. It is not 100 percent clear. We’re obviously getting lots of stats and we’ll get increasing numbers (coming out of the US experience now, in particular) that will help us understand this better.
Ron Whelan with some very sensible insights. He is the Chief Operating Officer of Discovery.
