From the Editor: Coronavirus Chronicles
By Jing Lang and Dirk Nieder
Reinsurance News, April 2021
I got to know Dirk Nieder the way one knows things about a colleague through years of working together, by a kind of osmosis of information. When I first started volunteering for the SOA Reinsurance Section, Dirk was already a co-editor for Reinsurance News. In late 2019, due the Reinsurance Section’s need to produce more issues of its newsletter, I was invited by Ronald Poon-Affat to join the editorial panel and the three of us became the three musketeers, each in a different time zone, shouldering the responsibility of sourcing alternating issues.
During our first editors touch-base in 2020, Dirk announced he had just landed in Tokyo. This surprised me as the COVID-19 outbreak was in a red-hot state in China, rippling to neighbouring countries. Even though Dirk was scheduled to visit his local teams in Asia, I had assumed he would have reconsidered given the epidemic. But, since he was already there, we decided to capitalize on his unique point of view and write about it. Two weeks after we had submitted the article and at which point the epidemic had turned into a pandemic, I got another note from Dirk: “So, I am back in Taipei.” I widened my eyes in disbelief. It felt like I was dealing with a rebellious teenager who relishes seeking out dangerous and uncertain situations, rather than the regional director of a global reinsurer.
For the next 12 months, Dirk was batted like a shuttlecock between various Asian countries and Germany. Through our regular emails, I enjoyed a front row seat to his journey.
Jan. 2, 2021
When I entered Japan at the beginning of November, I had to provide two negative corona tests: a PCR-test and a saliva-based antigen test. The PCR-test required a tissue sample from my throat. When the nurse extended the cotton swab deep into my throat, it triggered retching and I felt the urge to throw up. In comparison, the saliva-based test required on arrival in Tokyo—I just had to spit saliva into a small vial—was so much more pleasant. I am very grateful for the efforts of Dr. Andrew Brooks and his colleagues to develop a saliva-based corona test, and I am wondering why such tests are not used more widely.
When I returned to Germany for Christmas, corona tests or quarantine were not required for travellers arriving from Japan. But senior residences had introduced new visit requirements. One of my close relatives is living in a senior residence. Her residential home requires a negative COVID Rapid Antigen Test before every visit. And did this hurt! The administration instructions require that the tissue sample is taken with a swab which is inserted into the nostrils until resistance is encountered, and then the swab is slowly rotated. But in practice, when I thought the swab could not be extended further, there is another measured push and it feels as if the swab poked right into my brain. After the procedure was exercised through one nostril and you know how it feels, the same procedure is repeated for the other nostril. The poking leaves a pain which does not subside for several seconds. Could this leave some permanent brain damage?
Anxiety and anticipation are essential ingredients of suffering. I caught myself reliving the test procedure before each visit to the senior residence and asking myself if I really need to visit her. Of course, it is a stupid question!
The border entry requirements in Japan follow a three-pronged approach: one must demonstrate a negative COVID-19 result completed within 72 hours of the departure flight, another COVID-19 rapid test is administered upon arrival at the airports, followed by a 14-day self-quarantine. It is because of these strict requirements that the local economy was able to stay partially open. “I can't wait to have sushi at a restaurant!” Dirk remarked on the eve of his impending freedom in mid-November. Unlike Dirk who has standards, all I cared about was the fried chicken in Lawson—the 7-Elevens of Tokyo. “Yes, I can see a Lawson outside my window,” He confirmed.
The 14-day quarantine policy in Japan is not as strictly enforced as in other Asian countries. Dirk noted in Taiwan, your mobiles are tracked to ensure you are staying at home. And if you think you can get creative by leaving your cell phone at home, you get phone calls periodically that you must answer within a reasonable amount of time, and if you don’t, you’ll get a visit by the local police. It’s also not uncommon for overseas visitors to Asia to be stored in a government specified hotel where you are locked in the room for two weeks.
Jan. 8, 2021
Not all countries can control home quarantine requirements as strictly as Taiwan or can lock up people in government specified facilities, which enforced compliance. Based on studies of the Norwegian population, only 42 percent of individuals comply with quarantine requirements. A study of the adult population in Israel found that the compliance rate for household quarantine was less than 57 percent if no financial compensation was provided. And the self-reported adherence to “test, trace and isolate” behaviours in the United Kingdom was only 18.2 percent. The effectiveness of a 14-day quarantine policy depends, of course, heavily on compliance: 98 percent of infectious days would be screened out in a fully compliant scenario based on a study sponsored by the airline industry. In a scenario which is based on the above-mentioned compliance rates and which is more likely to reflect reality, only 25 percent of infectious days would be screened out.
The value of a COVID-19 test taken three days before departure is not much better in a non-compliance scenario: only 36 percent of infectious days would be screened out. The cruise industry learnt that pre-boarding testing is not enough—passengers tested positive on board despite demonstrating negative PCR tests taken a few days prior to boarding the ship. Apparently, some passengers went celebrating between taking the PCR test and boarding the cruise. With self-isolation from the time of testing until the time of departure, the percentage of days screened out would increase to 69 percent if people comply.
The 14-day quarantine policy also made business travels virtually impossible. Imagine I want to visit my team in Singapore: I would have to quarantine for 14 days in Singapore, then I could see my team members for a few days in the Singapore office, and after my return to Japan I would have to self-quarantine again for 14 days. This adds up to almost 1 month of quarantine!
Could a three-day pre-departure testing followed by a fully monitored quarantine until departure, and a saliva-based rapid test on arrival not be as efficient? It should certainly find much wider acceptance, control of the quarantine should be much easier, and compliance is likely to be much higher.
In comparison, the border entry requirements in North America are much more relaxed until recently. In July 2020, my husband and I drove back from New York to Toronto since our work visa didn’t get renewed on time due to the pandemic. At the US-Canada land border, which was closed to non-essential travels, we were informed by the polite Canadian border agent that we must self-quarantine for two weeks, and if we defy the order, the penalty is one million dollars. Sold. Throughout the two weeks, each of us got three phone calls (one from Federal Health, two from Provincial Health) to check on our whereabouts, if we have any symptom and if we have someone to bring us groceries. More recently though (February 2021), both US and Canada have imposed negative COVID-19 result requirement for any international flights. So even though we are on year two of the pandemic, the sense of immobility has never been greater. I guess it was always the knowledge that we could go somewhere, and not necessarily going anywhere, that made us feel a sense of freedom.
Recently, I reread Viktor Frankl’s “Man’s Search for Meaning,” which by the way, all 60 e-copies are checked out from the Toronto Public Library and the estimated wait time is four weeks, which speaks volumes to the general mental state of the Torontonians. I suspect this can be extrapolated. Viktor Frankl was a psychiatrist and between 1942 and 1945 he survived four concentration camps including Auschwitz; his parents, brother and wife did not. The book was partly a memoir on his experience and what gives people the will to live is dependent on what meaning they feel their life provides.
While what we are living through is clearly not comparable to concentration camps, I too find myself feeling anxious from the general state of uncertainty: when will this end? When can we travel again? When can we return to normal life? It’s revealing that things we used to take for granted—going on vacation, team lunches, conference gatherings, the social fabric of everyday life can be so easily taken away from us.
Feb. 16, 2021
Hi Jing, today was a day to think about the value of life.
Today I saw the claims report of a 63-year-old male who had purchased a USD130,000 whole life insurance policy had hanged himself in January 2021. As the three-year suicide exclusion period had past, the life insurance company has to pay the sum insured.
It is not unusual to see suicides among our reported claims: The suicide rates in Japan are among the highest in the world, although the number of suicides has reduced in the last decade. This encouraging trend continued amid the early months of the COVID-19 pandemic. Monthly suicide rates declined by 14 percent from February to June 2020 which coincided with the first lockdown triggered by COVID-19. Generous government subsidies, reduced working hours and school closures are credited for this development. However, monthly suicide rates increased by 16 percent during the second wave from July to October 2020. This surge is largely attributed to a rise in suicides among women and young people.
Financial problems, job insecurity, lack of in-person communication and strained relationships have affected women disproportionally. Nomura Research Institute estimated that in December approximately 7 percent of part-time female unemployed due to the pandemic.
The younger generation, on the other hand, goes through an increasing feeling of isolation during the pandemic. Students in Japan are experiencing loneliness, emptiness and dissatisfaction during the time of the pandemic with online classes, anxiety over job hunting and economic difficulties according to the Japan Times. The feeling of loneliness is particularly strong among first-year students. In Germany, over 80 percent of adolescents in the age range 15–30 state, according to a survey conducted in November 2020, that they significantly limit their contacts during the pandemic. Over a third of German adolescents state that they feel lonely in the current situation.
Loneliness poses a significant health problem for many parts of the population with increased risks in terms of distress (depression, anxiety) and suicidal ideation.
To combat the pandemic-induced loneliness epidemic, on Feb. 13, 2021, Japanese Prime Minister Yoshihide Suga appointed a Minister of Loneliness to address loneliness and social isolation. This move follows the precedence of the United Kingdom which introduced this role in 2018. It hasn’t been a very popular job, as the appointment has changed three times already. Had I had a say in the naming, I would have proposed Minister of Connection. It is so much more productive to advocate the desired result than reinforcing the negative.
As researcher slash storyteller Brené Brown puts it, we are hardwired for connection, it’s what gives purpose and meaning to our lives. Even for introverts, even for actuaries, even for introverted actuaries like Dirk and myself. For the past year, I’ve been steadily consuming the relationship reserves I had built with my colleagues with little opportunity for replenishment. Working virtual is simply not the same as in person, and radical actions are required before our work relationships get distilled to only deliverables and deadlines.
How do you feel in the current pandemic? Do you feel more alone than before the start of the pandemic? What could make you feel better in the current situation? Please share your feelings with us in the following anonymous survey. (https://www.surveymonkey.com/r/C68XVJQ).
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.
Jing Lang, FSA, FCIA, MAAA, is product manager for iptiQ, an insuretech by Swiss Re. She can be contacted at firstname.lastname@example.org.
Dirk Nieder, FSA, is regional director, Gen Re, Life/ Health South East Asia and Japan. He can be contacted at email@example.com.