A snapshot of the coronavirus looking at 1% of South Africa’s population

Medical aid group Bonitas has provided a snapshot of how the coronavirus epidemic in South Africa has impacted its members.

The company said that its fund represents over 700,000 lives which is roughly 8% of South Africa’s total medical aid membership and 1.2% of the national population.

Projections by the National Institute for Communicable Diseases (NICD), a consortium of experts advising South Africa’s government, show potentially 12 million to 13 million Covid-19 infections in the country by November.

Peak infection is expected to occur between July and mid-August, according to the consortium’s model.

Detected cases would be around 3.7 million cases by November, the NICD said.

“The World Health Organisation (WHO) says its Covid-19 data to date suggests that 80% of infections are mild or asymptomatic, 15% are severe infections, requiring oxygen and 5% are critical infections, requiring ventilation.

“While projections about the actual number of cases up until November 2020 vary daily, 12 to 13 million infections are predicted for South Africa. It is also predicted that roughly 3.7 million will be symptomatic with varying in degrees of severity,” Bonitas said.

Lee Callakoppen, principal officer of Bonitas Medical Fund, said that the company has seen approximately 10,000 members being tested with 282 confirmed positive. In relation to the hospitalisation rate, the fund has seen a total of 120 admissions, with a positive recovery totalling 32.

“Unfortunately, we have sadly lost 16 of our members to the virus,” Callakoppen said.

He said that projections are highly uncertain at this time, but the group’s actuarial team has estimated around 30% or 215,851 members of the Bonitas population are at risk of contracting Covid-19, based on co-morbidities.

Of these, 30% are based in Gauteng, 19% in KZN and 15% in the Western Cape.

The conservative financial impact to the Scheme could potentially exceed R450 million, in addition to annual claims cost which amounts to R15 billion annually.

Counting the Costs

Callakoppen said the key cost-drivers are hospital admissions, additional cost for Personal Protection Equipment (PPE) to ensure healthcare workers and patients are protected, pathology test costs as well as home care and healthcare support to members in the workplace as the economy re-opens.

There is a high level of uncertainty around the level of care that would be required for the Bonitas population over the course of the pandemic, but the medical scheme projects that Covid-19 cases will be managed as follows:

• 20% requiring hospitalisation;
• 5% requiring treatment in ICU;
• 60% requiring treatment at home;
• 20% are asymptomatic or do not require treatment.

Hospitalisation can be as high as six days in a general ward, eight days in high care, and up to 15 days in ICU, Bonitas said.

The role that chronic conditions play

It is undisputed that co-morbidities will affect the outcome of patients who contract Covid-19. Statistics from Italy, one of the countries worst hit, shows that 98.8% of those who died had at least one comorbidity. Almost three-quarters had hypertension while a third had diabetes, Bonitas said.

“It is no different in South Africa. Minister of Health, Dr Zwelini Mkhize, warned early on in the pandemic that South Africa has a significant burden of non-communicable diseases or chronic conditions with diabetes and hypertension topping the list,” it said.

The availability of beds

“There are currently 957 ICU and High Care beds in the private sector‘and 2,238 in the public healthcare sector,” said Callakoppen.

“Prior to the Covid-19 outbreak, occupancy in state hospitals was around 80%, with about 50% of critical care beds available for use in private hospitals. Based on these figures, less than 3,000 critical care beds are theoretically available for use for all South African citizens. About half of those (1,500) are intensive care beds, the remainder High Care.”

Bonitas said that occupancy of critical care beds for non-Covid-19 patients however, reduced in April as hospitals and doctors encouraged cancellation/postponement of elective procedures, or shifting these to an outpatient setting, where feasible, to free up capacity.

Occupancy is likely to remain suppressed in the short-term, although to a lesser extent as there have been calls for certain necessary elective procedures to continue from May.

“It should not be noted that epidemiological models, such as those produced by the Actuarial Society of South Africa (ASSA) model the rate of infection across the entire population, including asymptomatic cases, which might not be picked up in a medical scheme environment, nor will these cases lead to direct claims for the Fund.

“The ASSA model currently assumes that 75% of actual infections will be asymptomatic. There are a wide range of views globally as to the true proportion of asymptomatic cases. The sensitivity of the model output to this assumption means any projections are still highly uncertain at this stage,” said Callakoppen.