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COVID's Impact on Mid-term Mortality
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In total, we see some likely favorable effects but net negative outlook in the mid-term.
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COVID's Impact on Mid-term Mortality
1.
COVID-19’s IMPACTS ON MID-TERM
MORTALITY In total, we see some likely favorable effects but net negative outlook in the mid-term. Why? © 2022 General Reinsurance AG COVID-19 ENDEMIC STATE Additionalexcessmortalityfrom COVID-19asinaverage fluseason: 0%-4%dependingoncountryandages Flumortality adjustedforCOVID-19- specificage-shapeandaccountedfor overlapwithflu Effective vaccinationandsuccessful medicationbroadly available, immunity afterrecovery,lowerfatalityrates similartoOmicronvariant fatalityrates Annualizedexcess mortalityas observedduring the pandemicdue to new variants andlowervaccine efficacy Wecalibrate seasonal flu-drivenexcess mortalityto predictCOVID-19 mortalityin arange of scenarios Pre-COVID-19 distribution of causes of deaths for high-and middle-income countries in 201915 What ifthe novelcoronavirus causes long termstructural improvementsinstate health systems? 1 Kidneyand Liver: In2019 theU.S.CDCfound1.5%ofdeaths witha direct relationtoalcoholabuse.6 Somecountriesreported increasesinhealth-endangering levelsofalcohol consumption.Inthelong runincidenceandmortalityof chronicliverdisease,livercancerorotheralcohol- relateddiseases isexpectedtoincrease. Diabetes: Between Marchand October 2020,the number of new patients initiatedon diabetes drugs in the UK decreased by 20% compared with 2019.7 In Canada, rates of in-person diabetes careassessment declined substantially.8 Treatment noncompliance has been shown to negatively affect survival.9 Prevalence of majorco-morbidities amongdeaths from COVID-19 in seniors and correspondingreduction in lifeexpectancy18 10%-20% of excess COVID-19 deaths among seniors were expected in the near future. ACCELERATED DEATHS China: More severe presentation of diabetes at hospital13 UK: Self-reported health-affecting alcohol consumption increased10 Germany: Increased case complexity of non-COVID inpatient stays12 U.S.:Ambulatory services temporary declined to 67%11 Italy: Frequency of out-of-hospital cardiac arrest was significantly higher during COVID-1914 endnote 1 CVD 33% Cancer 18% COPD 6% Kidney & Liver 5% Other 38% 3.5 yrs 33% 2.0 yrs 35% 7.8 yrs 15% 1.7 yrs 66% 3.1 yrs 17% COPD Diabetes Obesity Hypertension Dementia Mental health impacts22 Accelerated deaths among unhealthy Flexible work arrange- ments24 Long COVID Healthier behaviors Economic downturn23 Fatigued health care sector Technology medicine spurt25 Delayed medical treatment COVID-19 direct hit Missing cancers don't disappear.They are detected with a delay.Systemcapacity limits prevent immediate catch-up. Cancer mortality impact depends on the sizeof each delay cohort or catch-up speed. Cancer mortality is expectedto increaseby 7% for 2022.Nonetheless, expectedcancer mortality increase overall years is 1.5%(in the 5%catch-up scenario). It will takeuntil Feb. 2024 to work off the delayeddiagnoses. Relativecancersurvival (RR) is normal for theyellow cohort and reduced for the delayedcohorts.17 Additionalcancermortality for different scenarios16 Cancer detection delay16 Observed and expected cancer incidence (2021 with catch-up capacity)16 DELAYED MEDICAL TREATMENT / DETERIORATED HEALTH STATUS OUTLOOK FOR INSURED LIVES MODELLING IMPACT ON MORTALITY FROM CANCERDETECTION DELAY Consider scope and duration since underwriting as well as attained ages for existing portfolios All socioeconomic groups will continue to be affected by COVID-19 Higher mortality risk for older population and individuals with co-morbidities Relative excess mortality may well lie above population levels for certain portfolios and target groups Risk mitigation through underwriting and carefully adjusted guidelines for new business Additional tailoring of the above factors is needed for each market and portfolio Death toll differences–seasonal flu2 versus COVID-19 estimated deaths per 100,0003,4 Number of Hospital Beds5 What ifglobalspreadofefficient genomicsequencing from the pandemicprovides lift todiagnosis and/ortreatment ofotherrare diseases andcancer?26 2 What ifcombineduse of technology, patient willingness to share personalinformation,and tracking andtracingfinally pavethe way forscaledelectronichealth records? 3 What ifthe worldbets onmRNA vaccines, alsoagainst cancer,but it turns out toofferless long-term protectionanddownstreamside effects? 4