Pandemics, Professionalism and Actuaries
By Jay M. Jaffe
International News, March 2021
In December 2020, ACTEX Learning and I presented a special two-part webinar discussing professionalism topics in relation to COVID-19. The first half included a general description of professionalism including the reasons that actuaries and other professionals are required to earn professionalism continuing education (CE) credits. Briefly, CE is needed to keep current with changes relating to actuarial practice and to maintain the public’s confidence in any profession.
At the heart of professionalism is a code of conduct. Not unexpectedly, the actuarial codes of conduct from different actuarial bodies are very similar and cover topics such as professional integrity, conflicts of interest, communications, and confidentiality.
The current pandemic, COVID-19, is the deadliest health emergency since the 1918 Flu Epidemic. COVID-19 stands for coronavirus disease 2019 and is caused by a virus named SARS-CoV-2. SARS is severe acute respiratory syndrome and Cov-2 refers to Coronavirus 2.
To be clear, COVID-19 is a disease and is so named to enable discussion of disease prevention, spread transmissibility, severity, and treatment. On the other hand, SARS-CoV-2 is the virus itself and is named based on genetic structure and is the basis for diagnostic testing, vaccines, and medicines.
Pandemics are epidemics that occur worldwide and affect many people. COVID-19 meets these criteria and has resulted in millions of deaths and great economic disruption for many people. No matter what estimates of deaths or infected people are reported, it is very likely that the actual numbers are two to four times greater because of incomplete reporting of infected cases.
Pandemics are nothing new. For many centuries, public health tools have been used as a measure to try to control diseases. When COVID-19 began, the only tools available for control of the disease were public health initiatives including quarantine. The use of quarantine for preventing the spread of pandemics is centuries old. During the Plague, the Italian State of Venice required maritime travelers to stay for 40 days on islands in the Lagoon of Venice before they were considered disease free and could enter the city. In Italian 40 is quaranta and in English the confinement requirement became “quarantine.”
While the United States has experienced disasters in the past, COVID-19 has had a national impact. Many medical facilities are at or beyond their capacity to serve patients. In response to these conditions, the U.S. health care system has been forced to employ triage to handle the flow of infected people.
Triage is based on multiple factors but the one that seems to have been most important for COVID-19 patients is the extent of the medical resources that a patient will require. During COVID-19 there have been shortages not only of personal protective equipment (PPE), but other medical equipment needed to treat patients (e.g., ventilators). Medical personnel are working more than normal hours. The state of California even considered a lottery for allocating the drug remdesivir to COVID-19 patients. In late 2020 the limited availability of vaccines has been resolved by first allotting them to health care workers—really a triage system.
Triage is the ultimate professionalism. Triage is the point at which the medical staff decides who shall live and who shall die. Fortunately, actuaries are not faced with making this toughest of all decisions, but we should realize that our work impacts the lives of people in other ways. For example, our profession is involved with creating and managing health care programs. The U.S. actuarial Code of Conduct mentions that we have a responsibility to “serve the public” but it is not clear what we should be doing as professionals.
The face of U.S. health care policy for the past several decades has been Dr. Anthony Fauci. He is the Director of the National Institute of Allergy and Infectious Disease and early in his career was directly involved with the HIV/AIDS crisis.
Dr. Fauci delivered the 2016 commencement address at the Ohio State University. He presented five credos to the graduates that are directly related to professionalism:
- Be a perpetual student
- Expected the unexpected
- Embrace public service
- Lead by example
- Pursue happiness
While each of these credos should be considered by actuaries, the one that seems the most applicable is “expect the unexpected.” After all, we refer to ourselves as “risk managers” and with such a description, shouldn’t we expect the unexpected? While no one is going to hold an actuary to making predictions as to an exact time and impact of an event, our profession asks us to take appropriate steps not only to alert our constituents to potential events but to consider how to mitigate the impact of such events.
An important tool to expecting the unexpected is to create checklists or playbooks. The advance thinking that goes into preparing checklists is not expected to set in concrete a step-by-step process to follow but, rather, to anticipate much of what needs to be done in a time of crisis rather than relying on instinct or trial and error. If you are interested, there is an easy-to-read book by Atul Gawande titled The Checklist Manifesto that uses actual examples of how checklists are used and have saved lives.
COVID-19 is an example of a situation that is not only devastating now but that may have other and longer-range implications. At the present time we do not know the long-term impact on the health of those who have been infected by COVID-19. It is possible that even asymptomatic infected people may have health issues relating to COVID-19 at some point down the road. Further, in the future our experiences with COVID-19 will have to consider the effect of composite or composite perils such as evacuating people from hurricanes into crowded public shelters that could become super spreader facilities for the next COVID disease.
When there are complicated and serious decisions, sometimes it is important to keep focused on the basics. Several years ago, Dr. Russell Alexander, an epidemiologist at the University of Washington, was a member of the group addressing the 1976 Swine Flu epidemic. The group was making the decision whether to approve a vaccine that had not been fully tested. The group’s concern was to avoid giving a new, not fully tested vaccine that might do more harm than good. Dr. Alexander constructed the following question to help with this decision: what information might make you change your mind about a contemplated action? This is a strikingly simple question that you should keep in mind as you make decisions affecting your work as an actuary.
COVID-19 has changed where and how we work. Not going to an office surrounded by others will be a challenge for some or, at least, difficult under certain conditions. First, you may not have the opportunity for “water cooler” conversations. Connecting on Zoom with someone you have not personally met may not be as easy as compared to talking with a group that has been working together for a long time prior to COVID-19. For anyone who has either just started a new position or who is on-boarding a new colleague, the lack of the personal contact may require special attention to ensure a smooth transition of responsibilities. Non face-to-face interaction makes it even more important to carefully document your work in the absence of being able to open your old file which may no longer be accessible.
The COVID-19 experience may be the beginning of a new era. The miracle of several COVID vaccines in less than a year may have opened a new era not just in medicine but also in actuarial science. The mRNA technology that was used to develop the vaccines may be a game changer that actuaries need to understand because it probably has other applications besides developing COVID-19 vaccines. What other “medical miracles” might appear in the next few years that impact areas in which actuaries actively work? The point is that as actuaries we need to apply our skills not just using historical information but also imagining a new world where old data is no longer predictive.
COVID-19 has also made certain social issues related to areas in which actuaries work more visible. Actuaries are supposed to act in the public interest. We have seen that a pandemic impacts population segments differently and actuaries should think about using our skills to help “level the playing field.”
It was mentioned earlier in this article that there are codes of conduct that are actuarial organization specific. If you are an actuary working internationally, you need to become aware of conduct provisions for each organization to which you belong or that may apply to the countries in which you work. Hopefully, there will not be any conflicts between the codes that govern your work, but it is your responsibility to recognize and reconcile any differences.
Professionalism did not start with COVID-19, but it has brought many new situations to our attention. Professionalism is more than just adhering to rules and regulations and it is complex. As an individual (and an actuary), you need to construct your own “moral compass” and be prepared to make the tough personal and work-related decisions as they arise. While difficult decisions may not be a common occurrence during your careers, your moral compass will make it possible to act with confidence when something needs to be done.
Finally, while the actuarial profession has codes of conduct, remember that it is ultimately your personal conduct that determines your reputation as a professional.
Statements of fact and opinions expressed herein are those of the individual authors and are not necessarily those of the Society of Actuaries, the editors, or the respective authors’ employers.
Jay Jaffe, FSA, MAAA, is president of Actuarial Enterprises, Ltd., providing actuarial and marketing services. He can be reached at email@example.com.