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  • September 2020
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The Evolution of a Crisis: A Medical Director’s View of COVID-19

  • Dr. Daniel D. Zimmerman
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Image of man gazing into the distance with COVID-19 mask
In Brief

Who would have thought there would be a pandemic like COVID-19? Almost everyone, RGA's Dr. Daniel Zimmerman writes in On the Risk. Insurers modelled this risk with tail stress tests, but the coronavirus still brought surprises, so agility and flexibility continue to be essential. Clinical knowledge from an insurance medical director also has never been more important.

History is a great teacher and we know clearly that pandemics are recurrent. One cannot exactly predict when one will occur, but it was always clear one would occur. The surprising aspect of the current pandemic, however, is that it is due to a coronavirus. Most experts would have predicted the next pandemic to be caused by an influenza virus.

Wisely, the insurance industry was well aware of the risk of another pandemic occurring. Insurers are mandated to perform stress testing and modeling for “tail” or “one-in-two hundred year” events including pandemics. This exercise not only entails projecting mortality and morbidity outcome extremes but serves as a basis for planning financial liquidity and capital needs. Insurers must be able to meet their financial obligations to their policyholders, especially during a pandemic.

Fortunately, insurers knew and were ready.

The Evolution of a Crisis

I have learned that a crisis evolves. Thinking back to January 2020 and what was known then and what is known now – there’s a stark difference. The learning journey is not necessarily linear and definitely not clean. There is no roadmap or GPS guide. The importance of agility, flexibility, and open-mindedness cannot be emphasized enough. What is right today could (and will likely) be wrong tomorrow. These lessons will surely be carried forward and will have great applicability on the wider industry.

Consider, for example, how at the beginning of the pandemic we all thought of COVID-19 as primarily a respiratory disease. While this remains true, we have since learned its manifestations include cardiac, renal, neurologic, hepatic, clotting, and glucose metabolism complications – just to name a few. We have yet to learn what long-term sequalae survivors may experience, especially those who had more moderate-to-severe disease. It will be very important for insurers to learn more about these outcomes as they will have implications for underwriting new business and potentially impact mortality and morbidity experience on inforce blocks of business.

Another example: transmission. As I look back at my notes and briefs from earlier in the year, I am reminded there was a time when we were not sure SARS-CoV-2 could be transmitted from human to human. Clearly, that question has been answered. Then, the debate ensued regarding modes of transmission: droplet vs. aerosols vs. fomite – while this is more resolved, questions regarding transmission remain. Through ongoing evolution of the pandemic crisis, countless other facts became better known and established.

At the time of this writing, many questions remain:

  • Does recovery from COVID-19 confer permanent immunity?
  • When (and if) will one or more vaccines become available? What happens if the general public doesn’t accept them or there are safety concerns?
  • Will herd immunity be achievable?
  • Could SARS-CoV-2 become a permanent, circulating virus?

Hopefully, through the evolution of a crisis, the answers to these questions and many others will soon be known. Keep in mind, the journey won’t be linear, and it won’t be clean.

New Roles for the Insurance Medical Director

The COVID-19 pandemic has touched everyone’s role in the insurance industry from chief executive officers to underwriters to claims analysts. While always viewed as a source of solid scientific evidence with the ability to translate clinical medicine into
“insurance” medicine, insurance medical directors have been called upon to go the extra mile since the beginning of the pandemic.

Companies have presented difficult questions to their medical experts, the answers to which have helped to drive and inform major mortality and morbidity policy decisions. Actuaries and pricing experts have asked for the doctor’s opinion on “most likely” or
“least likely” scenarios, thus providing weightings to complex models. Those questions addressed topics such as the likelihood, timing, and effectiveness of a vaccine, the impact on therapies, and the probabilities of a second (or third) wave occurring. Medical insights into trends and pandemic trajectory are also highly valued.

Certainly, no insurance doctor has a crystal ball, but she or he does have an ability to review multiple sources of information, assimilate it, assess it, and make educated recommendations which are then valued by the company. Also, while perhaps not typical, medical directors have likely been called upon by corporate leadership and boards of directors to provide the “medical and epidemiological” view of the pandemic and translate it into the insurance and business context. Finally, undoubtedly, many insurance doctors have been tapped to assist operational teams in business continuity planning as well as drafting and executing best practices for employee safety and wellness during the pandemic.

As we enter a “new normal,” given the rapid changes to insurance business processes as a result of the COVID-19 pandemic, insurance medical directors may well find a new role for themselves in the industry and their corporate structures.

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Dan Zimmerman
Dr. Daniel D. Zimmerman
Senior Vice President, Chief Science Advisor


Reprinted with permission of ON THE RISK, Journal of The Academy of Life Underwriting. (