COVID-19 – In conversation with Discovery Life’s Chief Medical Officer

The COVID-19 pandemic is an active global health concern, currently impacting more than 213 countries and territories. With more than 10 million known global infections since the outbreak began, SARS-CoV-2 (the 2019 coronavirus) is touching more lives at increasing scale.

Since this is a health challenge of considerable proportions, how we as a global population go about preventing infection and mortality rates in the future will be key. Together with protective measures, such as those offered by life insurance plans, ways to weather the challenges that come with it can be put in place.

As an insurance group, Discovery is well-positioned to understand the impact that a crisis such as COVID-19 can have on its members and policyholders, especially within areas of health and life insurance. What do we know? How can we better protect our current and foreseeable quality of life? Dr Van der Walt shares a few insights and thoughts with us.

What clinically-related research has Discovery done since the start of the pandemic in South Africa?

“Discovery Health and Discovery Life have worked together closely to identify who our high-risk clients and members may be. Using this information on our databases, we then sent out communication to individually inform them about COVID-19 and how to go about practicing effective prevention measures,” says Dr Van der Walt..

“We’ve also seen that a healthy lifestyle and engagement in the Vitality programme reduces the risk of COVID-19 complications, even in high-risk groups of people.”

Through Discovery’s developed model, using factors such as age, sex, member complexity profile (in other words any relevant high-risk health conditions or comorbidities under treatment), and a Vitality engagement measure, we can determine a possible risk profile on our members’ behalf. Using this, the Discovery Health and Discovery Life businesses can better guide members and policyholders through this period as a way to help lower potential risk of severe illness if they contract COVID-19.

Collectively, what the model has been able to show is that if a person fall ill, their risk of needing hospitalisation may increase considerably the older they are and depending how complex their medical health profile is (in other words if they suffer from any comorbidities). However, risk levels can also decrease considerably with healthy doses of physical activity. This is where the Vitality programme can be used to encourage members and policyholders to maintain a healthy lifestyle with good nutrition and exercise, which in turn reduces their relative risk.

What has Discovery Life done differently from a clinical perspective to ensure that our clients are protected during this time?

With general clinical information at hand, paired with our own knowledge of how our members and policyholders can best protect themselves, Discovery Life has been able to better assess the current needs of clients. This assessment has in turn helped to inform how products can be adapted and even created to provide protective buffers for clients.

“During the lockdown ‘lockdown cover’ was implemented to provide insurance protection for our clients whilst our nurses could not visit them to obtain medical evidence requirements,” says Dr Van der Walt.

“Since lockdown alert level 3 has been introduced, we have created ‘safe zones’ or ‘mini labs’ at our various franchises. Here, the highest standards of hygiene are maintained to mitigate risk to our clients or employees. Once medical evidence is obtained, underwriting can take place,” she adds.

What are some of the trends we’ve noticed in South Africa and the globe, post the outbreak?

One noticeable factor is that South Africa’s mortality rate is currently around 1.4%. With recent case numbers now over 471 000 (as at 29 July 2020), the country’s recovery rate of approximately 63% is also more or less in line with the global average. In recent days, South Africa has seen a significant spike in daily recorded cases, largely due to testing initiatives, as well as a gradual easing of lockdown restrictions.

“Fortunately, our case fatality rate in South Africa is well below the international statistic, but that does not mean that we can be complacent,” says Dr Van der Walt.

“Many countries have experienced second waves of infections or an increase in cases when lockdown has been eased,” she adds. 

Another noticeable factor relates to disease severity and the risk of complications due to illness. “The risk factors for complications once a patient contracts COVID-19 are now well known. These include male sex, older age, chronic heart problems, lung problems, chronic kidney disease, hypertension (high blood pressure), diabetes and obesity.”

Have these trends informed any specific decisions to better protect our clients?

When it comes to protection, little can do what well-practiced prevention measures can. “Prevention through social distancing, wearing of masks, hand washing and sanitising remains the best way to prevent the disease,” says Dr van der Walt.

“Strict hygiene protocols are in place wherever our clients are in contact with Discovery Life employees,” she adds.

Discovery Life has also gone as far as to assessing the current product range and identify if there are any other ways clients can be better protected on their plans. This is where the newly developed Multi-Organ Benefit was developed. Within the Severe Illness Benefit, this market-first benefit protects against, acute multi-organ failure due to an illness like COVID-19. Such a benefit provides additional financial protection where needed, over and above what a medical aid plan can provide through clinical care support.

Are there any pharmacological drugs being developed that you feel show real promise?

“Although there is no cure or vaccine at the moment, recent preliminary studies have shown that dexamethasone is able to reduce the fatality rate in severe cases,” says Dr van der Walt.

As one of several countries conducting trials, South Africa is seemingly keen on use of this corticosteroid medicine if further studies prove efficacy. Dexamethasone is an existing first-line treatment option for rheumatic diseases, skin problems, severe allergies, chronic obstructive lung disease, asthma and other health conditions. As an existing medicine, it is already available on the market, making is accessible fairly quickly should trials be able to demonstrate safety for use.

For now, preliminary trials have shown promise for COVID-19 patients already admitted to hospital, requiring medically supportive care. Those individuals specially requiring oxygen support or mechanical ventilation may safely benefit from this medicine, significantly reducing risk of severe complications that can be life threatening. It is one of the few medicine trialled that has shown to make a significant difference in a patient’s condition – reducing mortality of severely ill individuals by up to a third.

“Remdesivir is an anti-viral drug that is also showing promise,” adds Dr Van der Walt. “It also appears that non-invasive oxygen supply has a better outcome than invasive, mechanical ventilation.”

How do you foresee the pandemic affecting this country during the next three months?

News reports have indicated that South Africa indeed bought enough time to prepare for a peak of infections expected to be reached during winter. Certainly towards the end of June, the country has experienced a surge in case numbers – particularly in the Western Cape, Eastern Cape and Gauteng provinces. It would appear that the Western Cape has reached their peak of infections. Gauteng may very well be reaching a peak at present. Certainly in the days and weeks to come, we will be able to determine this a little more accurately as the data is assessed,” says Dr Van der Walt.

“It is up to every one of us to try and prevent contracting COVID-19 and continue to play our part in flattening the curve. This way we can prevent the hospitals and health services from getting overwhelmed,” she adds. 

In your view, will there be regular outbreaks of COVID-19 in the future?

“We will most probably have to live with this virus for the foreseeable future. Vaccines are currently being tested, but it will probably take a year before testing is completed, and only then can manufacturing be done on the global scale that is needed,” she says.

What are some of the key learnings from this period that we can use in the future?

“One of the biggest things I think we’ve learned is that we are all in this together. We all have to play our part on an individual level. All role players - government, private and public sector, organised labour and so on - have to work together to overcome this pandemic.”

“We have seen heartwarming outreach projects, as well as much more sharing and caring than ever before. It is now a time that’s more focused on ‘us’ and less ‘I’. We also have world renowned medical scientists and medical people in this country, all working together to find solutions for problems that we never thought were possible. We should take these learnings and build on them,” she adds.

With Discovery Life’s product range of protective insurance cover that is built on the business’s proven Shared-value Insurance model, adapting to the times and needs of people’s lives as it stands today is imperative. This creates relevance in people’s lives, as well as value for their quality of life.

Certainly the outbreak of COVID-19 has highlighted a need to reflect on the meaning of ‘quality of life’, and propelled us all to re-evaluate all the ways we can better protect ourselves, even when there is so much uncertainty about.