Long Covid - Into the Third Year.

As the COVID-19 pandemic reaches the end of its third year, and as COVID-related mortality in North America wanes, long Covid and its disabling symptoms are attracting more attention. Some individuals report symptoms lasting more than 2 years, and a subset report continuing disability. This article will provide an update on long Covid, with a particular focus on disease prevalence, disability, symptom clustering and risk factors. It will also discuss the longer-term outlook for individuals with long Covid.

Long Covid - Into the Third Year.

As the COVID-19 pandemic reaches the end of its third year, and as COVID-related mortality in North America wanes, long Covid and its disabling symptoms are attracting more attention. Some individuals report symptoms lasting more than 2 years, and a subset report continuing disability. This article will provide an update on long Covid, with a particular focus on disease prevalence, disability, symptom clustering and risk factors. It will also discuss the longer-term outlook for individuals with long Covid.

Critical Illness at 40: Still a Thorn in the Medical Director's Side.

Critical illness insurance was introduced 40 years ago. Medical directors continue to be challenged and frustrated with the complexities that critical illness claims offer. This article provides insights into the continued issues and possible solutions.

ChatGPT: How Closely Should We Be Watching?

ChatGPT is about to make major inroads into clinical medicine. This article discusses the pros and cons of its use.

From Benign to Malignant: The Arrival of Pituitary Neuroendocrine Tumors (PitNETs).

Pituitary adenomas were recently reclassified as "neuroendocrine tumors," and are now considered to be cancers. The evolution and justification for this change are described. Critical illness policies, which currently provide coverage of pituitary adenomas under the "Benign Brain Tumor" provision must now be modified to reflect this new taxonomy. This change also prompts questions about the use of the words 'benign' and 'tumor' in critical illness policies.

Metabolic Muddle. MASLD and MASH on the Horizon.

NAFLD (non-alcoholic fatty liver disease) and NASH (non-alcoholic steatohepatitis) are time-honored acronyms, with widely popular acceptance. Experts now recommend discarding them in favor of MASLD for "metabolic dysfunction-associated steatotic liver disease" and MASH for "metabolic dysfunction-associated steatohepatitis." The reasons for this change are explored and an argument about why the change is confusing, is advanced. Should these acronyms become clinically popular, risk assessment manuals will require updates.

Long COVID - One Year On.

Long COVID is now a recognized complication of acute COVID-19 infection. As the COVID-19 pandemic moves into its third year, the prevalence of Long COVID continues to increase. Many individuals report symptoms lasting longer than a year, and a subset of this group is unable to work. This article will provide an update on Long COVID, with a particular focus on distinguishing it from other clinical entities. It will review several proposed disease mechanisms and will attempt to anticipate the impact on disability insurance.

Long COVID - An Early Perspective.

A new syndrome called "Long COVID" has emerged amongst the survivors of acute COVID-19 infection. Its protracted and debilitating nature will almost certainly result in many short and long-term disability claims. Insurers need to understand the nature of Long COVID, including its definition, its prevalence, its natural history, and underlying risk factors. This article will summarize current knowledge of Long COVID and provide a perspective on its evolution and its impact.

Navigating a Pandemic: The Unique Role of the Medical Director.

The sudden emergence of the COVID-19 pandemic in early 2020 presented a unique challenge for medical directors of life insurance companies. Company leadership required quick answers about many issues, but two in particular: 1) the magnitude of the pandemic's impact on the insured lives portfolio and 2) the underwriting of new applicants during a pandemic. This article will describe the experiences of a global team of reinsurance medical directors during a pandemic. It may also serve to provide guidance for medical directors facing a similar challenge in the future.

COVID-19 and Mental Health: Should We Expect an Increase in Disability?

Disability due to mental health disorders has been increasing in many countries over the past years. The COVID-19 pandemic may worsen this trend because of 3 different, and at times overlapping, pathways. This article describes each pathway, and by drawing on the experience of previous coronavirus epidemics and recent recessions, attempts to estimate the likelihood that claims due to mental health disorders will increase.

Liquid Biopsies and Critical Illness Insurance: Uncomfortable Bedfellows?

Liquid biopsies hold great promise for the diagnosis and treatment of cancer. Earlier recognition of recurrent and metastatic disease and better treatment choices based on liquid biopsies seem achievable in the near future. However, earlier cancer diagnosis, the most heralded application, will remain the most challenging. The impact of liquid biopsies on life insurance will be positive. The impact on critical illness insurance will be more nuanced. It will depend on 2 factors: the success of liquid biopsies as cancer screening tests and the ability of an insurer to use "genetic information" during risk selection. In jurisdictions where use is prohibited, critical illness insurance, as presently designed, may not be sustainable.

The Medical Underwriting of Transgender Individuals.

As more transgender individuals apply for life insurance, it is important to understand the many health issues that are particular to this population. This article reviews the pathophysiology, diagnosis and treatment of gender dysphoria- the dominant medical problem of transgender individuals. It also reviews the frequent co-morbidities in the transgender population and finishes with a review of the small number of studies that have examined long-term mortality.

Pancreatic Cysts.

Pancreatic cysts are more common than before, largely because of widespread abdominal imaging. Pancreatic cystic neoplasms (PCN) are relevant to risk selection on 2 counts: they constitute more than 50% of all pancreatic cysts and, in contrast to the other 2 cyst types, are capable of malignant transformation. The majority of PCNs are benign at time of diagnosis and will follow a benign course. The challenge is to identify those PCNs that are malignant or will undergo malignant transformation with time. The purpose of this article is to provide pointers that can help meet this challenge while also summarizing the ongoing debate about their optimal management.

Templated fabrication of periodic arrays of metallic and silicon nanorings with complex nanostructures.

Here we report a scalable colloidal templating approach for fabricating periodic arrays of metallic and silicon nanorings with complex nanostructures. Non-close-packed monolayer silica colloidal crystal prepared by a simple spin-coating technology is first used as template for making periodic arrays of mushroom-like composite nanostructures consisting of silica spherical caps and polymer stems. Subsequent metal sputtering and reactive ion etching lead to the formation of ordered asymmetric nickel nanorings which can be further utilized as etching masks for patterning periodic arrays of symmetric silicon nanorings. Moreover, periodic arrays of metallic and silicon concentric double nanorings can be fabricated by using the asymmetric nickel nanorings as templates. We have also demonstrated that gold concentric double nanorings show strong surface-enhanced Raman scattering (SERS) with a SERS enhancement factor of ∼9.5 × 10(7) from adsorbed benzenethiol molecules. The SERS enhancement and the electric field amplitude distribution surrounding gold concentric double nanorings have been calculated by using finite element electromagnetic modeling. This new colloidal templating technique is compatible with standard microfabrication and enables wafer-scale production of a variety of periodic nanorings with hierarchical structures that could find important technological applications in plasmonic and magnetic devices.

Highly Sensitive Troponin and Critical Illness Insurance: Have the Goalposts Moved Again?

An elevated cardiac troponin is a sine qua non for the clinical diagnosis of myocardial infarction. The sensitivity of troponin assays has improved repeatedly since troponin entered clinical use in the late 1990s. Its most recent iteration, "highly sensitive" troponin will shortly enter clinical use in North America. It is able to detect amounts of troponin 10 times smaller than the current assay. As a result, more myocardial infarctions will be diagnosed. This may have an impact on the number of critical illness claims for heart attack.