The Ongoing Impact of COVID-19 on health and mortality

While the worst appears to be behind us in terms of the climbing infections, high death rates and the economic impact of the global coronavirus outbreak, deaths due to cardio-metabolic (heart and nervous system) and cancer-related conditions are now strikingly high in this post-COVID world. This is according to annual Group Risk claims data released by Discovery Employee Benefits.

Discovery Employee Benefits insures over half a million individuals through its Group Risk benefits, working at approximately 3000 employer groups countrywide. The retirement funds division is younger, covering 60,000 individuals across 500 employer groups.

"Analysis of our annual claims data reveals a visible and concerning increase in the incidence of deaths associated with cardiovascular disease among our client base - that is, illnesses which affect the heart and blood vessels - as well as an increase in the incidence of deaths from cancer," says Guy Chennells, head of Product at Discovery Employee Benefits. "Claims for cardiometabolic conditions have more than tripled since 2020, with a 200% increase in claims recorded over the past year."

According to Chennells, there are three key drivers - all consequential from COVID - which are the causes for the increases being recorded in the claims data. These are 'long COVID'; a marked decline in individuals conducting annual health checks and screenings (termed a 'screening deficit'); and a reduction in individuals exercising regularly.

"International data suggests that 'long COVID' increases the risk of heart attacks and stroke disease because of theheightened risk of blood clotting conditions. This certainly contributes to the greater number of cardiovascular related claims we're seeing in our data," says Chennells, "But behaviour change which began during the pandemic is also contributing to these illnesses."

Health data shows that generalised health checks declined by as much as 50% during COVID compared to screening levels recorded during 2019. These health checks are where a person picks up and is encouraged to manage key cardiometabolic risk factors like cholesterol and blood pressure.

Furthermore, exercise levels dropped by 12% during COVID.

"Encouragingly, though, the exercise rates seem to be almost back to levels seen pre-pandemic," continues Chennells.

He adds that there has also been a dramatic uptick in death claims resulting from cancer, compared to pre-COVID levels, with cancer deaths increasing from just two deaths per month recorded by Group Risk in 2018, to six deaths per month in 2022.

"Our data shows a definite decline in people going for cancer screenings during COVID which corresponds to a drop in cancer treatments for all stages of cancer being recorded by the Discovery Health Medical Scheme (DHMS). This means that people aren't detecting their cancers as early as they otherwise would have, because they're screening less, unfortunately," says Chennells. "In terms of income continuation benefit claims, there's also been a decline in cancer incidence recorded. That corresponds to an increase in cancer deaths which continue to track higher than expected, even post-COVID. The implication being that there is a cohort of people who have not undergone cancer treatment due to identifying it too late, and instead of going through a difficult treatment and recovery process (supported by disability income benefits), these individuals have unfortunately passed on."

Natural Deaths continue to track at levels higher than those recorded pre-COVID

Linked to the three drivers of long COVID, a decline in wellness and cancer screenings and reduced levels of exercise, Group Risk data indicates that natural deaths are still tracking higher than they were prior to the pandemic.

In March 2020, as President Cyril Ramaphosa announced the first hard lock down to contain the coronavirus outbreak, Discovery Group Risk recorded a three-month rolling average of 87 deaths per month.

This figure then spiked at 249 deaths per month by August 2021 during the third wave of the coronavirus outbreak. In the three-month period to July 2022, it had yet to return to pre-COVID levels with 111 deaths per month recorded on average.

This elevated trend holds true for both unnatural and natural deaths with the former trending above levels seen during and before the coronavirus pandemic and the latter having declined markedly since the pandemic, but still not returning to pre-COVID levels.

Unnatural Deaths

"When it comes to unnatural deaths the three key trends that we're picking up are that suicides are still above the levels observed in our data pre-COVID, after having increased even more during the pandemic, while motor vehicle accidents are presently stabilising back to pre-pandemic levels. Most significantly, however, crime-related deaths have escalated quite dramatically in the past few years," says Chennells.

The Employee Benefits data reveals that crime-related deaths recorded this year are shockingly 170% higher than those recorded in 2018.

Chennells notes that there is a very close relationship between unemployment rates and violent crime.

"The correlation here reveals that unfortunately crime-related deaths have increased in line with the severe economic consequences of the coronavirus pandemic which precipitated abrupt declines of output in markets across the globe," he continues.

Also, the incidence of suicides has been tracking upwards steadily since 2017. Discovery Group Risk's suicide claims are 135% higher recently than they were in 2017.

"During the pandemic, our data indicates that suicides tended to spike in the periods immediately following the hard lock downs, suggesting a link to the tragic hardships many endured in isolation and with job and income loss," adds Chennells. "It's concerning to note, too, that most suicides, 75% in all, are committed by men. During the spikes recorded after periods of hard lock down, the proportion of suicides from men increased even further to 90% of all suicides recorded."

He comments that this is most likely because of men being the main breadwinners in the family experiencing unprecedented strain and economic hardships during the hard lock down phases.

Natural Deaths

"As we went through the various waves of the COVID-19 pandemic, almost everything changed for all of us.

The question now on everyone's lips is - have things returned to normal?

"In Group Risk, we always look at age as the primary driver of natural death which follows an obvious upward trend by age," explains Chennells. "But if you look at the proportions of deaths coming from the different age groups, since the start of COVID in 2020, natural deaths are increasing more rapidly in the 35 to 50 age-band and interestingly, it's been decreasing in the over 50s group of late."

In 2022, 45% of deaths had been recorded among the age group of 35- to 50-year-olds, while in 2019 this figure sat at 40%. For those above the age of 50, the proportion of deaths has dropped from 43% to 37%.

Curiously, says Chennells, the trend is unfolding most predominantly among higher earners and in higher income earning industries, with the average salaries of claimants increasing by 77% from 2017, whereas average salaries of all members with life cover only increased by 20% over the same period. Effectively this means that claim frequency has increased faster among higher income earners, putting further strain on insurance pricing.

While older members were more susceptible during the pandemic, this does not explain the trend we are seeing today in our 35 to 50 age cohort, says Chennells.

Instead, the data suggests that middle aged members are more fundamentally at risk due to declining health associated with behavioural changes and the ongoing effects of COVID on its survivors.

While gym visits are returning to normal, they remain significantly behind those seen pre-pandemic at just over 60% across age groups but step counts recorded by wearable devices and recorded exercises among older generations have increased, offsetting this imbalance.

For younger generations, this appears not to be the case as a very marginal rise in step counts and recorded workouts has not compensated for the commensurate decline seen in gym visits.

"Fortunately, as we have identified a close relationship between health-related behaviours and this continued elevation in mortality, there is much that can be done by the younger and working age groups to offset their currently heightened risk."

The effects of COVID continue to be felt due to a complex interplay between socio-economic hardships, changes in healthy behaviours and the potential 'long COVID' medical implications tied to SARS-CoV-2 infections.

"A key outcome from the 2022 claims data is that individuals need to start their health checks and annual screenings again. Exercising regularly is another crucial activity that needs to be reinstated into everyone's daily routines. These two actions will certainly improve the health and wellbeing of individuals, while simultaneously ensuring that any serious conditions can be detected early enough to be treated and even possibly cured. While people had little control over the impact of the pandemic on their lives and insurance risk, insured individuals and employers facilitating wellness interventions now hold the most important behavioural keys for unlocking a return to pre-COVID insurance risk," Chennells concludes.