While research about COVID-19 has made good progress both in relation to symptoms and treatment, knowledge about the lasting effects of COVID-19, referred to as “long COVID”, is still in its infancy.
Months after a severe infection with the virus SARS-CoV-2, a significant number of people are still battling crushing fatigue, the consequences of damage to their lung, heart, immune system or brain as well as other symptoms of long COVID.
The scale of long COVID
The number of people affected by COVID-19 is unprecedented. Since 31 December 2019 and as of 19 November 2020, 56.4 million cases of COVID-19 have been reported worldwide (opens a new window), including 1.4 million deaths, according to the European Centre for Disease Prevention and Control (ECDP).
A study (opens a new window) posted on the preprint server medRxiv in August found that a month after being discharged from hospital following a COVID-19 infection, 74% of patients reported shortness of breath and 13.5% were still using oxygen at home.
An analysis by researchers at King’s College London (opens a new window) shows that one in 20 people with COVID-19 are likely to suffer symptoms for 8 weeks or more (so-called Long COVID), potentially adding up to many hundreds of thousands in the UK and millions worldwide.
The damage can be partially traced back to side effects of intensive treatments such as intubation, but there is also evidence suggesting that the conditions are linked to the virus itself. Either way, preliminary studies (opens a new window) and existing research into other coronaviruses suggest that the virus can injure multiple organs and cause some surprising symptoms.
COVID-19 often affects the lungs first, but in many cases, the lungs are not the worst-affected organ. An infection can leave patients with a weakened immune system, but it can also cause parts of the immune system to become overactive and trigger harmful inflammation throughout the body.
Patients with long COVID can show a wide range of symptoms (opens a new window), including breathlessness, a cough that won't go away, joint pain, muscle aches, hearing and eyesight problems, headaches, loss of smell and taste as well as damage to the heart, lungs, kidneys and gut. Mental health problems have also been reported including depression, anxiety and struggling to think clearly.
Researcher are still trying to understand the long term conditions COVID-19 can cause. While most severe COVID-19 infections often produce the worst long-term impacts, mild cases can still have life-changing effects such as a severe fatigue syndrome, arguably the most difficult to understand among the long term symptoms.
While the scale of long COVID is still unclear, the insurance industry has started to prepare for it. Insurance areas particularly affected are health insurance, life insurance and group income protection. The impact of COVID-19 will take time to reflect on insurers’ books but it could lead to a hardening of policy rates as well as changes in terms and conditions.
• Private health insurance
Standard policy terms and benefits of health Insurance policies allow for conditions/complications from COVID-19 to be assessed for available treatment. It is not yet clear if and to what extent such policies will cover Long COVID, because, as the name suggests, such a definition would indicate a chronic medical condition.
Standard insurers' terms do not include cover for chronic conditions unless specifically included as part of the plan design, thus cover may only be available where the chronic issue has an acute flare up. The longer term implications are still being analysed and assessed by the insurers in both the potential impact on the terms and benefits (additional exclusions, introduction of co-funded benefits) they wish to make available as well as the cost of providing the cover.
Delays in seeking treatment due to a fear of contracting the virus, are concerning for both the individual and for the healthcare providers, both the National Health Service (in the UK) and the private sector. Should diagnosis occur at a later stage, treatment tends to be longer, potentially more intrusive and more expensive to administer. Long term recovery could also be affected by such delays.
• Life insurance
Some life insurers have seen an impact from COVID-19, particularly in the blue collar environment, as many employees were not able to self-isolate in the working environment. Cases often occur in combination with underlying conditions. As a result, underwriters may decide to be more selective with this particular group and develop a higher sensitivity to individuals who have a heightened risk of developing severe symptoms. Further, because some individuals may be avoiding treatment for other conditions (e.g. cancer or cardiovascular) due to fear of contracting the virus, may see their symptoms worsen, which could potentially lead to an early (avoidable) death. As a result this would increase the claims exposure for insurance providers and, depending on the scale of the issues, impact the cost of life insurance policies in future.
• Group income protection (GIP)
The potential cost for long term absence in the workplace brought on by Long Covid is a source of concern for employers. The group income protection (GIP) providers are, similarly to other insurance companies, still assessing the potential impact. However, GIP providers are currently stating that exclusions are not yet being considered. They are also promoting the existing services available through GIP policies to assist employers both in helping an individual employee back into the workplace (as soon as medically feasible) as well as through financial support.
Some providers have already signalled that they will offer direct help in form of tailored intervention to employers and employees based on their condition and circumstances with any post COVID-19 return to work planning.
This can include, among others:
an early intervention to provide help before the situation worsens,
supporting employees unable to work at full capacity,
helping employees regain their mental resilience and physical fitness to do their jobs,
helping design bespoke phased return to work plans to support durable recoveries.
As the numbers affected by Long COVID are unknown, but potentially significant, there is a possible future impact on the costs of such policies. Increase in claims and associated costs plus the issue of individuals not seeking treatment for conditions or later than they would have done pre COVID may result in GIP claims lasting longer and thus having a larger impact. This in turn would push up the cost of providing that cover.
As insurers get to grips with the long term implications of COVID-19, this may provide a platform of innovation for those insurers.
For further information, please contact:
Antony Thompson, Technical Lead, Employee Benefits
T: +44 (0)20 7933 2878 | E: email@example.com (opens a new window)