The alcohol ban that was reimposed at the weekend after President Cyril Ramaphosa noted that booze-related injuries were taking up valuable hospital space needed for Covid-19 patients has sparked an outcry – and fierce debate. In this interview with BizNews founder Alec Hogg, Ryan Noach – chief executive of Discovery Health – emphasises that he believes “the lesson here is that as a society, as South Africans, we have to find a more responsible way for legal alcohol to flow. We have to learn lessons at a societal level about how how to respond and how to act when alcohol is around.” – Editor
Dr Ryan Noach is the chief executive of Discovery Health. Ryan, there’s been lots of discussion from every side of the spectrum in South Africa about the liquor ban. What do you think about it?
Yes, interesting times, the announcement by President Ramaphosa on the amendments to the lockdown regulations. I must say, I understand that it’s a very contentious point and that some people are quite upset about this. On a personal level, as a clinician and looking at this, as the Department of Health would, what’s best for the country. I’m actually personally in support of this, and I think that it’s a sensible move.
Let me not say that without qualifying it, let me try and give a rational response. It was a very clear experiment during the Level 5 lockdown when alcohol was banned, to see what would happen to trauma units, to emergency care services, the ambulance services and to ICU’s in the absence of alcohol. As I’ve discussed with you previously, the hospitals just completely emptied out and we saw admission levels, at least 40% to 50% below what they typically are.
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A large part of that was no alcohol and no trauma-related admissions. The ambulance services during that period were absolutely dead quiet. Then when the alcohol ban was lifted, unfortunately, that changed almost overnight. Within a couple of weeks, anecdotally, the evidence shows that about 30% of the patients filling the hospital beds were alcohol-related or alcohol-induced trauma-related injuries.
Our evidence is still emerging on this, it’s not our own data but it’s compelling. The hospitals filled up with alcohol-related cases. Considering where the hospitals are today and the pressure that they’re under with many people unfortunately ill from Covid. Considering the pressure that the alcohol puts on the hospital beds it’s completely sensible, in my view, to stop the flow of alcohol again and try and make available every single doctor, nurse, emergency care resource and hospital bed that you can for the wave of Covid-19 related illness rather than alcohol-related trauma.
It says a lot about where the priority for the future should be. When Covid is perhaps behind us, because if 30% of beds are going to be taken up by alcohol-related injuries, then surely that’s got to be a focus area, a bigger focus area for the country.
I’m sure we are learning a lot from what’s going on. Generally speaking, the projections are another area of significant contention. Some people saying it’s being exaggerated, others believing that we’ve still got a huge wave to come. What do you actuaries telling you?
Just before I step to the projections, to respond to your last comment personally, I don’t believe in a prohibition.
I don’t believe it’s successful. I think it will do more harm than good and the alcohol industry creates a lot of jobs, contributes meaningfully to the fiscus, is a big part of our exports, supports the economy of one part of the country. That’s pretty meaningful.
I’m not at all in favour of a prohibition. I think the lesson here is that as a society, as South Africans, we have to find a more responsible way for legal alcohol to flow. We have to learn lessons at a societal level about how how to respond and how to act when alcohol is around.
That’s for me is the lesson and I’m personally not in favour at all of a prohibition. that would as I said earlier, do more harm than good anyway. To move on to your question about the projections. You’ll remember in our last conversation, we spoke about three scenarios that we had based on adjustments to the Actuarial Association of South Africa’s forecasts.
A low base scenario and a high scenario, we were hoping for the low, but running along on the base scenario at that point in time. The bad news today is that actually on our projections, we’re tracking against the high scenario at the moment. Our scenario on that scenario predicts something like 10 to 11 million infections in the country by October to November. Those gross infection numbers include all the asymptomatic infections. Many of those go unnoticed and don’t return positive test results, but as the total number of infections that is certainly the trajectory we’re on, sadly, at the moment.
Say that again, 10 million people, so roughly 20% of the population will be infected?
That is what our projections say is by the end of the year. Remember, as I said, there’s a very high asymptomatic rate. It depends which literature you read, but it seems to be somewhere between 40% to even as high in the latest Belgian study as 75% asymptomatic rate. Of all those infected people, probably half of them are totally asymptomatic. Don’t know they have it. They’ve been infected, but they don’t share any features or signs of it whatsoever.
From a morbidity perspective, from an illness perspective, it’s nowhere near those numbers. That is how we are tracking at the moment. On attack rate, which is the number of new infections every day, per 100,000 people in the country, we’re running way above where Europe was at its peak.
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We’re running at about 30 new infections per 100,000 people per day and Europe at its peak was at about 18. We are yonks ahead of where Europe and Italy were at its peak. The good news because one always looks for the good news and I’m inherently an optimist; it’s one of our values at Discovery. The good news is that our mortality rate is very low in comparison to the rest of the world and this is favourable.
What about the other emerging markets, how is South Africa comparing?
We’re unfortunately running up there with the fastest in the world. From an emerging market perspective, Brazil and India are ahead of us both on the attack rate, but also on the cumulative infection count. They are bigger populations than ours, but we’re behind them on prevalence terms.
The big four at the moment, in terms of the current outbreak, are the USA leading the charge, Brazil number two, India number three, and we’re in fourth place. We have seen a country like Chile also experienced a very high attack rate, but they’ve peaked and come down on the other side just as quickly. We all hope for the same kind of pattern that Chile has seen coming down on the other side of a very high attack rate.
What’s the number we need to watch most closely?
The compound daily growth rate is a very good indicator of how fast we’re growing what the doubling rate is. At the moment in South Africa, our compound daily growth rate is 5%.
The power of compound interest, that’s compound rate, so we’re running at 5%. We need to get out. Compound daily growth rate well below 1%. In order to do that, we need to get our attack rate all the way down below the 10 mark. We’re watching that attack rate carefully. If you look at the Western Cape, which could have peaked, we’re not certain yet, but it may well have already peaked. The attack right in the Western Cape went all the way up to 24 to 28.
Since then, it’s come all the way down to about 16 new infections per 100,000 lives. It looks like the Western Cape’s epidemic is slowing, although it’s been going horizontal for a few days now. We hope that we get a downward trajectory resuming, as we saw a week ago or so. If that’s the pattern in the Western Cape, that’s very reassuring for the rest of the country.
The good news is that the hospitals in the Western Cape, although they were overwhelmed and although the healthcare professionals in the front line faced crazy conditions and terrible times, they coped. Everybody got care, they almost cope better than other countries and cities that we’ve heard about in the world, and that’s amazing and says a lot for our infrastructure and our preparedness.
That’s good news. What about facilities in other parts of the country?
The facilities are under pressure everywhere at the moment, they are really full. I should say that the people in the front line are working under terrible conditions, long hours, dealing with very sick patients.
I think the good news from a Discovery Health medical scheme perspective is that we haven’t had a single member anywhere in the country that’s gone without absolutely brilliant care. Our projections and models notwithstanding us being on the highest trajectory, show that in all the major metropolitan areas, we should have sufficient capacity, including ICU capacity, to accommodate the ill members.
It’s a difficult thing to project exactly, because this disease is new and unpredictable, as we know. We can’t make any promises about it, but it does look favourable. What’s very much in our favour as country at the moment, is that different parts of the country are peaking at different times.
We’ve seen the Western Cape Peak first, then the Eastern Cape seems to have had the next worst epidemic. Gauteng is now having a massive explosion of Covid, on the heels of those two provinces and the hospital occupancy we’ve seen in the Western Cape has improved. In other words, hospitals are emptier than they were.
In a worst-case scenario, what we would absolutely do is we would move people to areas where they all hospital beds available. If in the Eastern Cape or the North West province where they are lower beds per capita of the population, we had to move people, we could move them to the Western Cape or to Pretoria respectively, where they are higher bed rates per capita and where we could find capacity. We would absolutely do that would probably move the non-Covid patients out of the ICU use to other ICU use in quiet hospitals. We would absolutely do that to free up beds.
It also comes back to the way we started with 30% of beds being alcohol-related, at least temporarily, if there’s no alcohol being distributed, that should make a big difference.
I hope so. If that lockdown experiment repeats itself, then that anecdote should be realised. Certainly to give the healthcare workers and the hospitals the best chance of not losing an unnecessary life anywhere in the country, ensuring that every single person gets access to the right care. In that respect, through that lens, notwithstanding the huge economic damage and the employment impact, which is severe and painful, this does seem like a prudent move in the short term. Just to repeat my position, I don’t believe it’s sustainable or appropriate in the medium to long term.
