Dr Morgan Mkhatshwa, Head of Operations at Bonitas

Every year, seasonal influenza (flu) kills around 11,500 people in South Africa alone. To date, Covid-19 has resulted in around 50,000 deaths in South Africa. While the true mortality of Covid-19 will take some time to fully understand, the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%. For seasonal flu, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of healthcare.

How has Covid-19 impacted on the flu virus?

The Covid-19 pandemic has, however, had a significant impact on the 2020 flu season where decreased flu activity has been reported. This is most likely related to lockdown and additional hygiene measures. Bearing in mind that The World Health Organisation (WHO) has recommended flu vaccines for 2021, circulating flu viruses evolve constantly so an accurate prediction for the upcoming season is challenging.

Should you still have a flu vaccine in 2021?

Dr Mkhatshwa recommends you do. Flu vaccines have been shown to reduce the risk of influenza illness, hospitalisation and death. Not only will flu vaccinations reduce the risk of getting flu but is an important conservation measure for scarce health care resources which remains a concern with the ongoing the Covid-19 pandemic.

The flu vaccine should be given sufficiently early to provide protection for the coming winter. A protective antibody response takes about two weeks to develop. As there is limited evidence on the safety and effectiveness of receiving these vaccines simultaneously, Dr Mkhatshwa recommends waiting at least 14 days between having the Covid-19 and flu vaccinations.

How are Covid-19 and flu viruses similar?

WHO says, “Firstly, Covid-19 and influenza viruses have a similar disease presentation. That is, they both cause respiratory disease, which presents as a wide range of illness from asymptomatic or mild through to severe disease and death.

“Secondly, both viruses are transmitted by contact, droplets and any material that can carry infection. As a result, the same public health measures, such as hand hygiene and good respiratory etiquette (coughing into your elbow or into a tissue and immediately disposing of the tissue), are important actions all can take to prevent infection.”

What are the essential differences between Covid and flu?

Flu is an acute viral respiratory infection, transmitted by the influenza virus. There are three types of influenza, namely Influenza A, B and C. Influenza C is less common and produces milder disease. WHO says there are important differences between the two viruses and how they spread. This has important implications for the public health measures that can be implemented to respond to each virus.

The two are essentially different viruses with SARS-CoV-2 being a newly discovered coronavirus that causes Covid-19.

The speed of transmission

This is an important point of difference between flu and the coronavirus. Influenza has a shorter incubation period and can spread faster than Covid-19. Further, transmission in the first three to five days of illness, or potentially pre-symptomatic transmission, is a major driver of transmission for influenza. Although with Covid-19, people can be infected by someone 24-48 hours before the onset of symptoms – this is not the major driver of transmission.

The severity of illness

While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For Covid-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than that of flu.

Who is at risk?

The Department of Health (DoH) together with the National Institute for Communicable Diseases (NICD) targeted the following groups for the 2021 campaign:

• Healthcare workers
• Individuals age >65 years
• People with comorbidities like heart disease, diabetes or lung disease
• Pregnant women
• People living with HIV and AIDS

What are the signs and symptoms?

In terms of symptoms, Covid-19 and flu can have varying degrees of signs and symptoms, ranging from none (asymptomatic) to severe symptoms. Common shared include: Fever or feeling feverish/chills, cough, shortness of breath or difficulty breathing, fatigue, sore throat, runny or stuffy nose, muscle pain or body aches, headache, some people may have vomiting and diarrhea, though this is more common in children than adults.

Other signs and symptoms of Covid-19, different from flu, may include change in or loss of taste or smell. A Covid-19 test will confirm the diagnosis.

Does the flu shot give me a mild flu?

According to the Centre for Disease Control (CDC), “A flu shot cannot cause flu. Flu vaccines given with a needle are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious, or with no flu vaccine viruses at all. The most common side-effects from the shot are soreness, redness, tenderness or swelling where the shot was given. Serious allergic reactions to flu vaccines are very rare.”

Still not convinced?

Flu viruses spread very quickly from person to person.

• Even if the flu vaccine is not 100% effective against the current flu strain it will reduce your chances of getting the flu and, if you do get it, it will be a great deal milder.
• More importantly, by having the flu vaccine you will protect others, via what is called ’herd immunity’. Others may be vulnerable family members such as small babies and the elderly as well as those who are immune compromised.

While the world focuses on Covid-19, social distancing, wearing a mask and handwashing or sanitisation can help protect you from both Covid-19 and flu.

The impact of Covid-19 has been felt and experienced on many levels. Lockdown meant a strain on food security, household finances, chronic health issues and the depletion of emotional wellness among South Africans. By 2021, many South Africans have been touched personally by Covid-19 with either having lost someone to the disease or known people that contracted the virus. South Africans are constantly navigating through the different stages of grief specified in the Kübler-Ross model, with a quarter of citizens accepting Covid-19 as part and parcel of the new normal.  
As an industry, pharmacies took the lead with four pharmacy brands in the top 10 overall ranking. The medical aid industry was thriving and performing above the Ask Afrika Orange Index® benchmark, displaying a positive response to the market. Both these industries as a collective showed a 14% increase in customer satisfaction, 9% for pharmacies and 4% in the medical aid industry.  

BestMed performed exceptionally well, winning the medical aid industry and ranking 13th overall in 2020.  BestMed has also outperformed competitors, with an 11% difference between BestMed and the poorest performer in the industry.   

With a longitudinal view, BestMed has been improving their service from 2018, celebrating an 6,24% increase in satisfaction scores from 2019 – 2020.   

Key to a winner’s status is good performance on different service constructs. The Ask Afrika Orange Index® measured customer satisfaction around the following service constructs:

• FCR – First call resolution
• Trust
• Customer effort
• Fairness
• Reputation and;
• Emotional satisfaction

Within the medical aid industry first call resolution (FCR) remained a strength when it comes to customer service compared to emotional satisfaction, which is still a challenge for most industries and brands. BestMed shared the first place with regards to emotional satisfaction with Medihelp and in 2020 BestMed was the leader of the pack with regards to being a trusted medical advisor. 

Customers expect a consistent service experience across channels or service platforms albeit digital and/or human. In 2020, BestMed managed to achieve 80%+ satisfaction levels for services across their service touchpoints. 

Looking towards the future building a loyal customer base among medical aid members, key loyalty drivers are trust, relationship building, the reputation of the company and CSR initiatives to give back to the community it serves. Within the midst of the traumatic Covid-19 pandemic, emotional satisfaction remains crucial, especially in the medical aid industry where members rely on their medical aid to be the trusted and supportive advisor during difficult times.

For more information on customised Orange Index report and sponsorship opportunities please contact:

Sarina de Beer, Managing Director, Ask Afrika (Pty) Ltd, Email: az.oc.akirfaksa@reebed.aniras

Web portal: www.askafrika.co.za

About Ask Afrika

Ask Afrika is a decisioneering company. We support our clients’ decisions through facts. Typically, our clients’ require information around social research and philanthropy, experience measures and consulting, and brand dynamics. 

Social research decisions are required around HIV/Aids and more recently, Covid-19. Educational and early childhood development, fair-trade shopping, media and financial research are some of the areas we love to work in. NGOs, public- and private sector clients choose to work with us to get the pulse of the nation. 

Besides being decisioneers in brand and customer experience research, Ask Afrika is well known for creating some of the most useful, go-to industry benchmarks, including the Ask Afrika Orange Index®, the Ask Afrika Icon Brands®, the Ask Afrika Kasi Star Brands and the Target Group Index (TGI). Ask Afrika’s knowledge of brands is extensive. The Target Group Index (TGI) survey, which measures psychographics, service, products, media and brands, has been used by the majority of the top 50 advertisers and media owners in South Africa for nearly two decades.

Our clients operate across various industries, including retail, telecoms, finance, and the public sector. We offer tailor-made and ready-to-use offerings for all our clients regardless of the size of project.

In addition to being brave, agile, vibrant and experimental, we apply deep thinking to every research project. Our aim is to be great at everything we do and to make a meaningful impact.

Partner with Ask Afrika in order to confidently make game-changing business decisions that grow your business.

Email: az.oc.akirfaksa@tcennoc  

Image credit: United Nations Covid-19 Response on Unsplash

The global gold standard method to diagnose Covid is the reverse transcription polymerase chain reaction (RT-PCR) test. It is currently the most accurate way to detect SARS-CoV-2, the virus that causes Covid-19. 

Will your medical aid pay for the test?

According to Lee Callakoppen, principal officer of Bonitas Medical Fund, “Funding is in accordance with the Council for Medical Schemes (CMS) guidelines, all clinically appropriate and referred diagnostic testing for suspected Covid-19 cases will be funded as a Prescribed Minimum Benefit (PMB) condition.” 

Bonitas pays for up to three Covid-19 diagnostic tests from risk, whether the result is positive or negative. However, this is subject to the member or beneficiary being referred by a registered healthcare practitioner (doctor or nurse). This referral is dependent upon whether the member is showing symptoms, has been in contact with anyone who has Covid-19 and prior to hospitalisation. 

It should be noted that laboratories will not normally accept walk-ins for testing and require a referral or request from a healthcare practitioner. This is to ensure that we don’t test unnecessarily and jeopardise the availability of these tests for those who really need them.

“Despite the PCR being arguably the most accurate laboratory methods for detecting, tracking and studying the coronavirus, there are limitations in its widespread use,” says Callakoppen. “These include access to the test kits; the complexity of performing them; the need for specialised staff to administer them; potential global shortages; high costs; the requirement for laboratory equipment and the delayed turnaround times. For this reason, testing should only be done when it is clinically necessary.” 

What about rapid antigen tests? 

Immunoassay devices that detect the SARS-CoV-2 antigen within 15-30 minutes have also been promoted as a possible solution when access to PCR tests is a challenge. An antigen – detected in the blood or any other fluid – is any substance that makes the immune system produce antibodies. Viruses and bacteria are antigens. However, these tests are not as accurate as the PCR tests and have shown variable performance during evaluations, with sensitivities ranging from 0 to 94%. Test specificity has been high, but sensitivity has been erratic, which we need to bear in mind.

Why is specificity and sensitivity critical? 

Sensitivity is the percentage of true positives (e.g. 90% sensitivity = 90% of people who have the target disease will test positive). Specificity is the percentage of true negatives (e.g. 90% specificity = 90% of people who do not have the target disease will test negative). These allow you to rule conditions in or out but not definitively diagnose a condition.

What does the Council for Medical Schemes (CMS) say?

The CMS currently still advocates the PCR test to diagnose Covid-19. The World Health Organisation (WHO) has also previously advised that the role of these rapid antigen tests must be evaluated and are “not currently recommended for clinical diagnosis pending more evidence on test performance and operational utility”. However, the WHO has now approved the use of antigen tests (and this is the South African approach as well) as an alternative to the more expensive PCR tests. This is, however, in certain defined scenarios such as testing confirmed people in communities where infections have been detected, screening of high-risk groups and individuals and for contact tracing purposes. They have also provided conditional recommendations for the use of these tests such as screening at ports of entry, routine screening for employees at their place of work, schools, prior to certain urgent medical procedures, etc.

The challenge with these tests is that they are most accurate in patients between five and seven days after showing symptoms – therefore the timing of testing becomes critical in order to ensure accuracy of the result.

What about rapid antibody tests?

Many countries, including South Africa, are using antibody or serology tests such as the ones offered at various drive-throughs. These can detect whether someone has previously been infected and estimate how widespread the infection is but they are not recommended for diagnosis of Covid-19. 

For this reason, these are not funded by Bonitas Medical Fund as the use for these tests is limited for purposes of government surveillance and research rather than diagnosing Covid-19. If individuals want to know whether they have previously had Covid-19, for their own information, this test would be able to confirm that – but it is not used to identify whether you currently have the infection.

If these tests are done too soon after the infection, they produce incorrect results as the antibodies (IgM and IgG) will not be detectable. There is also no scientific evidence that it provides any immunity to another Covid infection. 

“What is clear is that laboratory testing plays a vital role in the diagnosis and the prevention of the spread of the virus,” says Callakoppen. “Nevertheless, it is important to understand that the timing and correct use of the different types of tests is crucial to gain the best results. We reimburse up to three PCR or rapid antigen tests done in or out of hospital for our members and recommend that this protocol for testing remains, until further research is conducted and evidence provided.”

Lee Callakoppen, principal officer, Bonitas Medical Fund

Using our hospital dashboard for the full 2019 year, direct hospital costs were 43% of the total scheme expenditure. These excluded doctor and allied services while a patient was in-hospital.

The increase in the use of day hospitals

Internationally there is a trend in increased day surgery for multiple reasons including:

• Improved anaesthesia (with quicker recovery period)
• Improved pain control (anaesthetic blocks and improved medication)
• Instrumentation and procedures (keyhole surgery).

Cost saving initiatives

Private medical aids are struggling to keep up with rising healthcare costs, which usually outpace inflation by 3+%. They are continually looking for ways of reducing costs and keeping premium increases as low as possible without prejudicing the quality of healthcare or financial stability of the fund.

We negotiate special rates through our hospital networks and designated service providers (DSPs) and encouraging members to use managed care initiatives. Encouraging members to use day hospitals is another way in which we can save on costs. That said, the strategy amongst acute hospitals is to reduce the tariffs for day surgery to the level of day clinics to prevent a market shift away from their facilities.
Examples of price differences

Other advantages of day hospitals

• Patient satisfaction
• No overnight stay – patients are admitted, operated on and discharged on the same day
• Child-friendly wards and facilities – day hospitals are the ideal alternative for children requiring same day surgery as the trauma of overnight stays are eliminated

,li>Lower risk of infection – due to the fact that patients return home on the same day, the risks of cross infection are reduced, which results in a shorter recovery

• Mortality and major morbidity is extremely low (1%)
• Improved surgery scheduling – decrease in waiting lists

Why is take up not higher?

• Day hospitals clearly have marked advantages but the reason take-up is not that high, is there are some perceived disadvantages of using them. One which is the geographical access – specifically in areas like the Eastern Cape.
• There is concern around procedure complications and the need for a patient to have advanced care. But legislation is strict around day hospitals and they have to be located within five kilometres of an acute hospital for exactly this reason.
• The issue of doctor access is another factor inhibiting the rapid increase in use. Many doctors have their consulting rooms close to an acute hospital and are unwilling to travel further. Equipment may be limited in day hospitals but the increasing list of procedures which can be performed in day hospitals speaks to this challenge being overcome.

This is probably why the percentage of day cases, split between acute hospitals and day hospitals, is still biased toward acute hospitals. Currently the split of day cases being done in acute hospitals is 74% and 26% in day hospitals. This implies that 74% of all procedures which could be performed in a day hospital are currently performed in acute facilities.

Safety is foremost

Not all patients can go to day hospitals. It should be noted that this percentage will be lower as some patients would have anaesthetic and comorbidity risks and from a safety perspective may rather have the procedure performed in an acute hospital where overnight facilities are available. Additionally, not all day clinics are adequately equipped to do some procedures and, as such, the true percentage will be lower.

Will day hospital use be enforced?

The Day Hospital Association of South Africa has proposed that medical aids enforce day hospital use in the future but also caution that there are some cases which cannot be carried out in day hospitals.

There are some procedures for which this is not suitable. High risk patients who require more intensive post-surgery care would require acute/conventional hospitals. But the benefits of day hospitals should definitely be considered by all patients when undergoing a procedure.

Don’t miss BizTrends2021 – 8 keynote speakers forecast trends shaping business in our region! Register now!