Heart attack risk, depression and other mental health issues have soared among South Africans since the pandemic started.
Heart attack risk, depression and other mental health issues have soared among South Africans since the pandemic started.
New data was presented at the Hospital Association of South Africa’s annual conference last week, where the pandemic and implications for the proposed National Health Insurance were discussed.
The estimated Covid-19 death toll stands at 326 000 — and 1 500 healthcare workers succumbed.
Dr Ronald Whelan, the chief commercial officer at Discovery Health, which has the most comprehensive private sector database in the country, said depression-related claims among its 2.7-million members had risen by 24%, while heart attack risk had increased 1.5 times (but 3.5 times if admitted to hospital for Covid‑19). There was a 19% increase in already highly prevalent mental health issues.
Professor Crick Lund, honorary professor of public mental health at the University of Cape Town and professor of global mental health at King’s College, London, said this was in line with the 25% global increase in the prevalence of depression and anxiety as published recently in The Lancet medical journal. Lund said that South Africa’s pre-Covid prevalence of these conditions, with substance abuse thrown in, stood at 16.5%.
“The biggest issue at the moment is that our mental health policy (2013 to 2020) has expired. Nothing has happened since then, which is concerning. There’s been a massive impact on healthcare providers because of the extra Covid-related burdens they carried and are still carrying,” said Lund.
Group medical director at hospital group Netcare, Dr Anchen Laubscher, said the hospital sector was facing structural changes in the market and these needed practical integration.
“We want to start talking about those lessons we learnt about the different models of care, both infrastructural and institutional, that were made during Covid. We need to see which prevailed and build on these.”
Laubscher said knowledge and data-sharing across the industry had been good during the pandemic. “The different disciplines worked together. We all had to subject ourselves to the protocols and there was lots of academic input and track and tracing. We needed help with epidemiologists and public health specialists around how infections spread in hospitals and how to curb that spread. It was hugely beneficial,” she said.
“It was also extremely helpful to have contracts in place from a public liability point of view when public sector patients were transferred to our hospitals. It proved something like a national health insurance can work.”
Although the private sector had collaborated with the public sector to increase vaccinations by 10-million doses, the pandemic had led to an unprecedented shift in disease patterns, which highlighted unequal access to healthcare, Whelan said.
Not only had it increased the prevalence of fatal diseases but common side-effects 18 months after original infection included headaches, insomnia, shortness of breath, palpitations, and weakness in arms and legs or muscle weakness.
Negative changes in daily living conditions for clients who reported no difficulty before their Covid-19 infection included communicating, self-care, concentration, hearing and seeing.
The estimated cost contribution of Covid for this year was 11%, and the highest driver of medical costs would continue to be hospital admissions for Covid-related complications.
Whelan said 90% of breast, cervical and colorectal cancers had progressed beyond stage one and two since the pandemic hit.
Illustrating how Covid had highlighted healthcare inequities globally, Whelan cited the mainly white north versus the predominantly black south side of the US city of Chicago where life expectancy in the north was on average 20 years greater than in the south. There was a twice greater risk of dying if you lived in the latter area.
He showed a picture of a township cheek by jowl with a city, separated by one road, to illustrate South Africa, which has the world’s highest Gini coefficient (wealth inequality).
Whelan said value-based care initiatives were central to the reform of the health system and “good strides” were being made in the private sector.
“We see five levers on the pathway to universal healthcare. These are investment in primary health care, particularly prevention and screening; understanding and proactive engagement of population health risk; alternative low-cost and care delivery models; an accelerated move towards value-based care; and a clear and enabling regulatory environment that stimulates innovation,” he said.
He said Covid-19 had helped accelerate healthcare digitisation globally. In South Africa there was already a shift away from in-hospital treatment towards day clinics and home treatment, particularly with more complex procedures moving to day clinics, while there was an increase in home care for wound and IV therapy.
The trend was mirrored in mental health, where there was a shift to out-of-hospital treatment, with an increase in virtual consultations.
One hopeful sign in an otherwise dim environment for equitable healthcare access was the growth since 2010 in bank penetration. The “banked” population had grown from 54.4% in 2010 to 83.7% this year and was predicted to reach 89.8% in 2025. Financial literacy and access meant more access to healthcare.
Chief medical officer at Lenmed, Dr Nilesh Patel, told the conference there had been “positive energy” on collaborating with the government on service level agreements. But this was confined to the Western Cape, with hard-hit Gauteng failing to sign indemnity contracts enabling private hospitals to admit public sector patients, though they were willing and had capacity. “The Western Cape government was the first to sign but in Gauteng this didn’t translate into a signed contract,” Patel said.
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