Long Covid is causing a significant increase in deaths

The Covid-19 pandemic has receded, but the continuing impact is so severe that it has been given a name of its own – ‘long Covid’, with these ongoing health problems linked to the pandemic causing higher-than-normal mortality rates.

The South African Medical Research Council (SAMRC) is still publishing excess mortality figures, which show that excess deaths due to normal causes are higher than they should be.

Long Covid-related deaths

Four waves of Covid-19 infections and deaths are clearly visible in the above graph, although the fourth wave during December 2021 was much less severe than the first three.

Since then, weekly deaths have been noticeably higher than scientists’ normal forecasts.

An analysis of claims for medical benefits and deaths by Discovery Employee Benefits proves that so-called long Covid exists. Discovery has seen a definite spike in cardiometabolic and cancer claims following the pandemic.

“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 cardiometabolic- [heart and nervous system] and cancer-related conditions are now strikingly high in this post-Covid world,” says Guy Chennells, head of product at Discovery Employee Benefits.

“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.

“Claims for cardiometabolic conditions have more than tripled since 2020, with a 200% increase in claims recorded over the past year.”

Three key drivers

Chennells says there are three key drivers – all consequential from Covid – that are causing 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 the heightened risk of blood clotting conditions,” he says.

“This certainly contributes to the greater number of cardiovascular-related claims we’re seeing in our data, but behaviour change which began during the pandemic is also contributing to these illnesses.”

Representative analysis

One can argue that these figures can be taken as a representative research sample of at least a large segment of the SA population.

Through its group risk products, Discovery Employee Benefits insures over half a million people working at some 3 000 employer entities countrywide. The retirement funds division is younger, but covers 60 000 individuals across 500 employer groups.

The annual claims data and related information show that general health checks declined by as much as 50% during the pandemic, compared with screening levels recorded during 2019.

It is during these health checks that key cardiometabolic risk factors, such as cholesterol and blood pressure, may be picked up and patients are encouraged to manage them.

“Exercise levels dropped by 12% during Covid,” says Chennells, adding that while this figure has been improving, it is still below pre-pandemic levels.

Discovery has seen a dramatic uptick in death claims resulting from cancer, compared with pre-Covid levels, with cancer deaths increasing from two per month recorded by Group Risk in 2018 to six 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,” says Chennells.

“In terms of income continuation benefit claims, there has also been a decline in cancer incidence recorded. That corresponds to an increase in cancer deaths, which continue to track higher than expected.

“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.”

Higher deaths

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

In March 2020, when the first lockdown started, Discovery Group Risk recorded a three-month rolling average of 87 deaths per month. This figure spiked to 249 deaths per month by August 2021 during the third wave of the Covid-19 outbreak.

In the three-month period to July 2022, it had yet to return to pre-Covid levels. The average was still above 111 deaths per month.

This elevated trend holds true for both unnatural and natural deaths. The former is trending above levels seen during and before the coronavirus pandemic, while natural deaths have declined markedly since the pandemic, but have still not returned 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. 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 data reveals that crime-related deaths recorded this year are 170% higher than 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.

“The incidence of suicides has also 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 lockdowns, suggesting a link to the tragic hardships many endured in isolation and with job and income loss,” says Chennells.

He says that while 75% of all suicides are committed by men in normal times, the figure increased to 90% of all suicides recorded during the Covid waves.

This is most likely because men are generally the main breadwinners in the family and experienced unprecedented strain and economic hardship.

Natural deaths

Chennells says everybody is asking the same thing: Have things returned to normal?

He says group risk data usually shows that natural deaths increase with age.

However, since the start of Covid-19, natural deaths have increased more rapidly in the 35 to 50 age band and decreased in people older than 50 years.

The proportion of natural deaths among those aged 35 to 50 has risen from 40% in 2019 to 45% in 2022.

For those above the age of 50, the proportion of natural deaths has dropped from 43% to 37%.

“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.

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-19.

The data shows that gym visits are returning to normal, but are still significantly lower, at just 60% of pre-pandemic levels across all age groups.

Time to adopt or revive a few good habits

Among older generations, step counts recorded by wearable devices and recorded exercises have increased – offsetting the decline in gym sessions to an extent, says Chennells.

But for younger generations this appears not to be the case, with “a very marginal rise in step counts and recorded workouts” that has not compensated for the decline in gym visits.

“The close relationship between health-related behaviours and mortality proves that there is much the younger and working age groups can do to offset the currently heightened risk,” says Chennells, stopping short of telling those in their 30s and 40s to eat more healthily and exercise more.

“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,” he adds.

“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.”