Medical aid Discovery Health has published three scenarios that detail when and where a third wave of Covid-19 infections could impact South Africa.
Discovery said that the scenarios are based on an analysis of its 3.7 million medical scheme beneficiaries, around 7% of the country’s population.
“It is in our hands to save lives. Our personal behaviour, and that of the people around us, will be a large determinant of which scenario our country experiences,” said Ryan Noach, chief executive of Discovery Health.
“The loss of life described in scenario 3 is tragic and devastating. Let’s work together, keep each other honest and remain prudent as we try our very best as a country to experience Scenario 1, and avoid a severe third wave.”
Discovery said that its actuarial analysis forecasts the probability and impact of a third wave in South Africa in three scenarios:
- Scenario 1: Second wave run-off resulting in 9,000 new Covid-19 related deaths until the end of the year. As a result of prudent and diligent behaviour, the avoidance of super-spreader events, good personal hygiene and mask adherence, we maintain the current dynamic of lowered infection rates. In effect, we prevent a third wave.
- Scenario 2: Easter super-spreader events, in the absence of vaccines, resulting in an additional 76,000 Covid-19 related deaths. This wave starts in April and peaks in June or July. Easter super-spreader events drive high numbers of infections (including reinfections), leading to a third wave infection peak potentially larger than our first wave peak, but not quite as high as our second wave peak.
- Scenario 3: Easter super-spreader events, accelerated vaccine rollout resulting in an additional 35,000 Covid-19 related deaths. This wave also starts in April and peaks in June or July. However, acceleration of our vaccine rollout process from April onwards allows us to vaccinate high-risk groups by mid-Winter, resulting in higher levels of population immunity and lower consequent morbidity and mortality. Should the vaccine rollout only commence in June, and the Easter period turn out to feature super-spreader events, potential excess deaths increase to 58,000.
What determines which scenario wins out? Five paths for South Africa
1. We cannot let our guard down
Infections have, in the case of the past two waves, steadily increased at points where lockdown restrictions have eased, said Noach.
“The recent easing of restrictions and move to alert level 1 – just weeks ahead of the Easter break – may encourage people to feel more relaxed about the threat of exposure to Covid-19 and decrease their adherence to the preventive measures that curb the spread of infection.
“Until our vaccine rollout programme brings us to population immunity we must never assume that it’s safe to let down our guard.”
2. Mobility – especially at night – puts us at risk of infection
“Google mobility trends data, correlating with our Discovery Vitality Drive tracking data, shows that after months of stay-at-home measures, there was much higher social mobility, particularly at night, in the three weeks leading up to the peak of infections of the second wave.
“In fact, across the country, December 2020 mobility returned to levels last seen pre-Covid, during early 2020,” said Noach.
3. Super-spreader events must be avoided
“As mentioned, right now there is great concern that Easter-related social events – from religious to family gatherings, travel to popular and busy holiday destinations – will fuel Covid-19 super-spreader events. This concern is justified.
“We now know that our second wave of infection was fuelled in large part by social and post-matric celebratory super-spreader events that took place all over the country, and particularly in KwaZulu Natal, over the December break.”
Noach said that the consequence of these gatherings was a demonstrable spike – a 27% increase – in infections in the younger populations of the Discovery Health member base, infected during the second wave (data to 1 Feb 2021).
“Our data also show that young members who flew to these post-matric holiday destinations faced a 16 times higher risk of contracting Covid-19 in the first week of December than those who did not.”
Noach said that about 80% of Covid-19 cases are entirely asymptomatic, and an asymptomatic infection is most likely in young healthy people.
4. Vigilance over variants
In large part, the increased scale of the second wave compared to the first, was driven by the emergence of a new variant of the SARS-CoV-2 virus in South Africa in November 2020 – called the 501Y.V2 variant.
This form of the virus appears to have been more transmissible than strains of the virus that circulated in the first wave of infection. We have also demonstrated a higher proportion of hospital admissions during the peak prevalence of this variant, said Noach.
“As with any virus, the SARS-COV-2 virus (which causes Covid-19) is constantly changing. Viruses can mutate every time they reproduce themselves in their host (the infected person).
“So, new variants may emerge at any time, quite unpredictably, and even challenge the efficacy of vaccines. Preventing viral spread between people limits opportunities for the SARS-CoV-2 virus to mutate and also protects us from infection with any new, highly transmissible variants that may not yet be documented.”
Noach said that South Africans must therefore continue to remain vigilant and in so doing, limit the likelihood of future variants and, in particular, variants of concern with increased infectivity and lethality.
5. Accelerating access to vaccines
Noach said that the Covid-19 vaccine rollout is the single most important public health intervention of the century, both saving lives and accelerating economic recovery.
“Notwithstanding the complexity and scale of the national Covid-19 vaccine programme, we simply must move as quickly as possible to accelerate vaccination for all South Africans, especially for those at high risk. People over the age of 60 years and those living with multiple co-morbidities, must be prioritised.”
“Our data demonstrate unequivocally that these at-risk populations experience much more severe manifestations of the disease.”