In episode 37 of Inside Covid 19, on a day when South Africa’s confirmed infections rose above 19,000, Discovery’s chief actuary Emile Stipp and Prof Guy Richards, a critical care expert from Wits, assess the country’s tough road ahead; we revisit the Maritzburg ventilator-making company and find out its offer to produce the much needed life-saving equipment is being drowned in a sea of red tape; there are baby steps for a travel sector that was paralysed by coronavirus lockdowns; and an analysis of the role of super-spreading events like music concerts and soccer games. – Alec Hogg
In the Covid-19 headlines today:
- After two relatively slow days, South Africa’s new coronavirus cases rose by 1,134 Thursday, the second highest daily increase thus far. A further 30 deaths were registered, the highest for a single day, taking the total to 369. Globally, a total of 331,000 mortalities have now been registered, with Mexico emerging as a new hotspot with 424 on Thursday, the highest in one day for any country. Although the rate of growth in infections has been falling in both countries, Covid-19 deaths are still high in the UK, which registered 338 yesterday; and the United States, with 320. These two countries have been the hardest hit with 95,000 mortalities in the US and 36,000 in Britain. Lockdown-free Sweden, whose alternative approach is being closely monitored, appears to be well past the worst with 40 deaths, around a quarter of the daily peak reported in mid-April.
- The South African Reserve Bank has announced another 50 basis point reduction, to 3.75%, in the country’s key interest rate, the Repurchase or Repo rate. Commercial banks immediately followed suit, further reducing the cost of borrowing across a struggling economy. The SARB’s decision, however, was not unanimous with three members of the Monetary Policy committee prevailing against the two who wanted a cut of only 25 basis points. The latest reduction follows 100 basis point cuts in both March and April. The bank said it expects South Africa’s economy to contract by 7% in 2020, slightly worse than the negative 6.1% it forecast last month, with widespread job losses expected.
- Although mortalities and infections have peaked in many countries, the economic fallout from the Covid-19 crisis continues to grow. In the US, 2.4m workers filed for jobless benefits last week taking the total job losses in the past nine weeks to 38m. New weekly claims, however have been declining since the peak of 6.9m during March and all 50 states have started to re-open their economies. In Europe, Germany and France are asking the EU to issue $550bn in new debt to finance a recovery fund. Euroland’s economy is expected to contract by 9% this year, with a full recovery expected to take some years.
- After this week’s news that many South African townships are ignoring lockdown regulations and apart from wearing masks are continuing life as before, trade union Solidarity reports that thousands of its members have signed a public statement demanding that they be allowed to return to work. The union’s chief executive Dirk Hermann says Solidarity members at the ArcelorMittal steel plant in Vanderbijlpark showed up for work en masse today with protective masks and hand sanitisers, part of Solidarity’s campaign to put pressure on government to allow those who can work safely to be allowed to do so.
Emile Stipp is the chief actuary of Discovery. He is in London at the moment. We know Emile that Discovery Vitality is a massive organisation in the UK but how come you ended up that side of the water?
I spend typically half my time in London and half in South Africa. I was in London when the lockdown was implemented I’ve been here for a few weeks in desperate need of a haircut.
How different is it to being in London today to what you have from colleagues back home?
I think it is quite different because here we are in the thick of the epidemic. So we are experiencing the effects of Covid itself. In South Africa I think what people are experiencing is the effects of lockdown not the epidemic itself but it was certainly noticeable here in London how not only is it a very strange place for the whole city closed down but also you hear the sirens, you’re just aware of the fact that there are people going to hospital. The media reports are also worrying because the effects of the epidemic are certainly visible.
The effects also on the mind no doubt. Here in South Africa we’re only around 300 deaths whereas in the UK it’s 30,000. Presumably we end up there at some point?
That is the difficult thing. If one looks forward it’s so hard to say how it plays out in different countries. One thing that would be interesting to your viewers is if you look at 20 January 2020 that was the first day on which South Korea reported their first coronavirus case. 21st of January was the first day on which the United States recorded their first confirmed case. Look how different it is now. In South Korea we have 263 people that have died. In the United States it’s 93,000. The difference in all of that it’s almost purely attributable to the government’s response. South Africa went into lockdown very early. That’s a very good thing because it saved many lives. In the UK government waited too late and for that reason there was a lot of community transmission and for that reason it’s very hard to control. The big question now is what happens from this point onwards. So as South Africa emerges from lockdown. How does it play out. But certainly if you’ve been in the environment where it is an experience that is not to be taken lightly, I think people should be careful. And if they’re vulnerable they should avoid getting infected at all costs.
It’s a big debate as you know in South Africa about the economic costs versus the health costs. The unique perspective that you’ve got sitting over there and being the chief actuary of Discovery will give you insights perhaps the rest of us can benefit from. How are you reading it?
The two are related so I don’t think it’s one versus the other necessarily. Firstly excess deaths have an economic cost as well, one should not forget that. At the same time there’s a very interesting study that was released based on the NHS in the UK, which was fascinating and that’s probably the biggest study that we’ve seen so far. What they looked at was what were the factors that were predictive of death for people who got Covid and got admitted. They looked at 17 million patient records and analysed about 6,000 deaths. One of the factors that stood out clearly was deprivation, basically people’s socioeconomic conditions. The extension of lockdown worsens that that, it does have a cost. Those also tend to have worse covered outcomes. Certainly there’s a tradeoff. But it’s very difficult to make these decisions because I think it also depends on how you can manage the disease once you emerge from lockdown. So is contact tracing available, what does one do with that if you can track where other people who have come into contact. To what extent can you actually help them isolate and stop spreading the disease. All of those are big questions and depends on so many factors. So I wouldn’t want to be in the position of having to make a decision. I think it really is very hard.
A Gordian knot. Impossible to unravel. But as far as individuals are concerned you’ve got the Discovery Resilience Index which is very helpful for those of us who are trying to do what we can to build a shield for ourselves against this horrible virus. How did you come about doing that?
What we’ve done is to look at our data as it emerges basically in South Africa and in the UK. We also read a lot of international studies emerging and at the moment we’re still within our insured populations. We have only a small number of hospital admissions relative to the whole population. What was interesting to me though is that typically you’d have to wait for quite a lot of data before you construct a model and before you try to make predictions on the basis of it. But even with the limited data we could see some very clear indicators. So it confirmed what has been reported worldwide, which is that it’s very dependent on age. So the risk of admission if you get Covid it certainly goes up significantly with age. But what we also observed is things such as body mass index playing a big role. So the more your body mass index is within the right range the lower your risk. If you have chronic conditions particularly diabetes, that also plays a role and the one benefit that we have in our data because of activities that we do actually have people’s real exercise data. So what we could also see is that engagement and Vitality programs so the extent to which people exercise, have a healthy lifestyle. All that lowers risk. So what you have is if you compare a male in the age range between 40 and 49 to somebody in the same age range between 60 and 69. What our data shows in South Africa is that by having a healthy lifestyle, if you’re in that age range you can lower your risk to 20 years younger, more or less. What’s interesting is that even in the UK with a different set of data and completely different circumstances we observed similar trends. That gives us more confidence in saying that this does seem to be real. As the data develops and as we have more information, we will continuously update these models. What will change over time is the activities but the message will remain the same. So the bottom line is that if you do have chronic conditions you should be especially careful and if you’re older you should be careful. However the way to reduce your risk is to maintain a healthy body weight, exercise and eat healthy. All of those factors do seem to make a significant difference.
Is there an amount of exercise that you could be doing or a body mass index which is giving you those 20 years?
You should keep your BMI below 30. That’s the sort of observation you make in the data. And in terms of exercise it’s almost linear. Remember I said we don’t have that much data but what we can tell at this stage for instance is if you exercise more than four times a week, half an hour at a time you know the sort of normal guidance as to what counts as an exercise session. That’s more than four times a week then certainly you can meet that requirement or basically reduce your risk to to almost 20 years younger.
And eating?
What we’re looking at is a sort of composite index of your healthy food basket. It’s all about avoiding unhealthy foods, confectionary and unhealthy carbs. What is good is if there is a lot of vegetables, healthy protein and healthy carbs in your diet than what is a higher percentage than the average.
Is there an App or some way that people can input their own Discovery Resilience numbers?
Yes. So we are doing a few things. One is that out of our data we have already identified people that are particularly vulnerable and also if one of their family members have been infected with Covid because we get the testing results we have been calling out and advising people about being careful. Now the other thing I should mention is that both in our own data and also internationally, if you do suffer from other conditions for instance cancer, then it’s very important to try and stay safe.
In the background for the very high risk individuals we have been trying to communicate with them almost on a one-to-one basis. What we are doing though is publishing this resilience index. We’re hoping to have it out on our website fairly soon and as far as the data develops we will update it all the time but we certainly think that people should get the advice. It may not statistically be a perfect model yet but what harm is there and telling people to be careful if you fall into one of these categories.
Emile what do you think the best way will be to handle this pandemic going forward?
In theory the best place to do contact tracing is when people come into contact with the disease that you isolate. That’s what South Korea did. They never actually went into lockdown. They just cancelled public events. The economy sort of carried on but what they did whenever someone came into contact with somebody that tested positive they were not even allowed to isolate at home, they were put in a hospital to isolate there. Because they did that early, it was possible to do that. Now it’s too late for many Western countries and even for South Africa, things are very difficult.
So in the absence of contact tracing, with isolation the only alternative that you have is social distancing, not having public gatherings and then trying to say that for vulnerable people to try and protect them as much as possible. So people in old age homes was a big issue here in the sense that they didn’t report deaths in care homes until quite late into the epidemic. So the only alternative is to say that people with chronic conditions and older people that until there’s a vaccine it’s not really safe for them to go out and be in contact with the rest of society. What we have found far more useful is to look at countries that have managed the epidemic well and those that haven’t. What’s different between them? When you look at their relative ages how can you then tell what would happen going forward. So I’ll give you a quick example of this because both these countries are close to us. So if you just do the back of the envelope calculation on where the UK is in the epidemic now. The UK is older than South Africa so you would expect a higher number of deaths in the UK. Our estimate of the national mortality rate for Covid-19 in the UK is 1.1%. South Africa is 0.38%. Quite significantly lower. But if you look at that and if you make these sort of adjustments as of yesterday, if we were at the same stage of the epidemic as the UK we would have had about 11,000 deaths in South Africa. That tells you how well South Africa has managed the epidemic up until now. Given how many people have died right at the moment, so it doesn’t mean that we won’t get to that 11,000 stage, it’s just that we’ve had far more time to prepare for it. I think there were some really good decisions made to go into lockdown in South Africa early rather than letting all the politics play out as it has in other countries.
The president keeps telling us that the early move saved lives. Can one quantify that yet?
Well I think that’s fair. That’s where these sort of epidemiological models come into it. So there is a mathematical relationship between the reproduction rate and the total number of people who die. So that’s sort of keeping the curve low or squashing the curve that everybody has been talking about and it’s easy to demonstrate that from just the mass of of an epidemics spread.
So certainly so far definitely lives have been saved. I think the question though is whether we can keep the reproduction rate low. So if as a society together with the government we can achieve that then certainly there will be many lives saved in the process. If not then basically we will we will trend towards the experience in other countries. It obviously does come at a cost to keep the reproduction rate low, and it depends on so many other factors whether it can be achieved in practice but I think still that the possibility is there.
