In total, we see some likely favorable effects but net negative outlook in the mid-term.

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