COVID the Equaliser or Divider?

May 2021 –COVID-19 has been characterised as a “great equaliser” that transcends wealth, fame, prestige or age, and others have touted the vulnerability of disadvantaged groups, whether it be from an economic impact or lack of access to healthcare.  We take a data driven approach to the topic and have previously shown how COVID-19 economics disproportionately impacted both the lowest and highest income groups. As both groups are largely self-employed, they are more directly exposed to the economy without the relative safety of earning a salary.  Our recent data indicates the economic impact of (COVID-19 induced) lockdown has washed through the system and incomes across segments are largely back to pre-COVID levels.

With economic recovery well underway, albeit to still rather pedestrian long-term growth levels, focus is on prioritising vaccination of our population while managing the impact of the third and any other potential waves, triggered by mutation of the virus and evolving behaviour. In this context, it is useful to analyse how severely COVID has impacted different population groupings. Our data reflects analysis of over 8 million individuals banking with us and compares pre-COVID mortality with rates during peak months. We don’t measure COVID-19 deaths, just the level of and change in mortality during the different periods.

Our first analysis focusses on age, which is widely accepted to be the dominant driver of mortality – the graph below shows the increase in mortality was confined to those above the age of 40 with the largest absolute increase in mortality between 60 and 80 years of age and the highest relative increase between 50 and 70 years (70-80% relative increase). This matches international experience, confirming age as major driver of mortality (note we don’t measure co-morbidity, but it often correlates with age). Interestingly, our data shows mortality on those below 30 years of age decreased with COVID-19 related deaths more than matched by a decrease in other causes of death.

Mortality rate
Source: FirstRand

This data strongly supports government’s plan to use age as prioritisation criteria for the vaccine roll-out programme. It also indicates a level of risk in the working population for above 50 year olds and to a lesser extent above 40 year olds, making prioritisation of roll-out to these groups critical to move towards normalising working environments and limiting impact to our economy.

Mortality by gender shows a very equal picture with a slightly higher absolute increase in males, but slightly higher relative increase in females with both genders at almost similar (increase in) risk.

Mortality rate by gender
Source: FirstRand

A very interesting view is obtained by analysing provincial data – as we’ve seen the spread of COVID-19 is highly impacted by geographical population concentrations and travel patterns, having peaked first in the Western Cape before moving into the rest of the country.  The graph below shows Eastern Cape (doubling of mortality) and KZN (70% increase) as outliers.  Clearly the management of the epidemic and of healthcare services at local level impacts on outcomes.

Mortality by province
Source: FirstRand

The final analysis we show is perhaps the most interesting and unexpected of all – the graph below shows mortality outcomes by income segment.  It is instructive to compare the large difference in mortality for the pre-COVID period, which shows significantly lower mortality for high income earners (above R450k p.a.) than for low-middle earners (below R450k p.a.), undoubtedly impacted by access to quality healthcare and likely general lifestyle choices.  Our data shows a significant equalising impact of COVID, with middle to affluent and even wealthy groups showing significant increases in mortality (doubling to tripling).

Mortality by annual income
Source: FirstRand

In conclusion, our data shows the mortality impact of COVID-19 has largely been on the elderly and middle aged, has impacted some provinces more than others and has not spared any income groups, with a disproportionate impact on middle to upper income earners, who normally have much better mortality outcomes – a significant ‘equaliser’ in that respect. The data strongly supports government’s age-based vaccine roll-out plan and shows the importance of provincial epidemic and healthcare management, as well as the importance of taking precautions even if, or perhaps especially if you have money.