Assisting Clients in the Fight Against Infectious Illness

Headlines like “Ebola raises specter of outbreak in U.S.” are terrifying to see. Indeed, the World Health Organization (WHO) states that “the current outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined.” The infection, which was first identified in Guinea, has since spread through Sierra Leone, Liberia, Nigeria, and finally to Senegal.

The situations in Guinea and Sierra Leone are particularly grim, in large part because of the nearly nonexistent healthcare infrastructure in those countries following decades of war and political instability. No vaccine exists for any of the five known strains of Ebola virus, and its mortality rate is approximately 50%. The Centers for Disease Control and Prevention (CDC) case counts put the number of people infected with Ebola in 2014 at more than 8,600 people, and the number of deaths at over 5,000.

Infection Disease Risks in the United States

Despite the hype, the risk of contracting Ebola in the United States is extremely low. Instead, several other infectious diseases raise considerably more concern here:

• Seasonal Influenza (Flu). Possibly because flu is so common in the United States, many people don’t worry about it. However, the virus can be quite serious, especially in women who are pregnant, children, the elderly and those with existing conditions (e.g., obstructive pulmonary disease, asthma, certain neurological conditions, heart disease, those who are morbidly obese). Although an annual flu vaccination exists, the Centers for Disease Control and Prevention (CDC) estimates that 5–20% of Americans are infected with seasonal flu and 200,000 are hospitalized with related complications in the United States each year. CDC posts a Weekly U.S. Influenza Surveillance Report, which shows that this year, at least, the flu season is off to a slower-than-average start.
• Enterovirus D68 (EV‑D68). EV‑D68 has been around for years, first identified in Califoia in 1962. But this year, the virus has spread rapidly and widely across the nation. According to CDC, “From mid-August to November 6, 2014, CDC or state public health laboratories have confirmed a total of 1,116 people in 47 states and the District of Columbia with respiratory illness caused by EV‑D68.” The overwhelming majority of cases have been in children, many of whom had asthma. Eleven deaths have been reported as of the date of this CDC report.
• Middle East Respiratory Syndrome (MERS). First identified in Saudi Arabia in 2012, two cases have been reported in the United States, both in 2014. Although the cases are unrelated, both patients had recently retued from trips to Saudi Arabia. MERS is a severe, acute respiratory illness, and the CDC reports that about 30% of those confirmed as infected have died.
• Chikungunya. This mosquito-transmitted virus is characterized by fever, headache, muscle pain, joint swelling, and in some cases, rash. No vaccine or medication to treat chikungunya exists, and people traveling to areas known to have had outbreaks of the virus are encouraged to use mosquito repellant to help prevent contracting the disease. According to CDC, “2006–2013, studies identified an average of 28 people per year in the United States with positive tests for recent chikungunya virus infection.  All reported cases were related to travelers visiting or returning to the United States from affected areas, mostly in Asia.” In 2014, CDC saw cases of travelers returning from the Caribbean, and 11 cases appear to have originated in Florida.

Outlook for the United States Healthcare System

The United States healthcare system has some work to do when it comes to managing and treating infectious disease. The CDC has established and disseminated procedures and protocols for healthcare workers who treat patients with infectious diseases. Rigorous preventive measures can greatly reduce the spread of infectious disease. In addition, the Centers for Disease Control and Prevention just announced that thirty-five hospitals in the United States are now designated as Ebola treatment centers with additional hospital inclusions to follow.

Similarly, given that viruses such as Ebola, MERS, and Chikungunya are primarily introduced to the United States by returning travelers from affected areas, the cost to the insurance industry for non-healthcare workers contracting these diseases through exposure to infected individuals on air and public transportation must be considered as well.

A more direct impact on the insurance industry comes from the cost of new and experimental drugs in development to prevent and treat these highly infectious viruses. In many cases, these are not U.S. Food and Drug Administration (FDA)–approved therapies and the treatment costs can be expensive.

Bloomberg News estimated that the cost of treating an Ebola patient in the United States was $1,000 an hour, based on the case of Thomas Eric Duncan, a Liberian man here on a tourist visa that died of the disease in a Dallas hospital on Oct. 8. The cost of his care at the Dallas-area hospital, where the man had been a patient since Sept. 28, has been estimated at more than $500,000.

PartnerRe recommends treating infectious disease cases as you would any situation with the potential for high claims. Among the strategies is notifying PartnerRe as soon as you know about a potential case, keeping in mind that alternative insurance payers may be available and being aware that experimental drugs and non-approved uses of blood factor products could be involved. Notify us if you intend to allow charges for these types of treatments on an exception basis.

Finally, we recommend a pre-payment review of the hospital charges involved for Ebola patients. PartnerRe will be happy to assist with those efforts.

Assist America – Global Emergency Services Program – A Value Add for Our Clients

As part of our ongoing commitment to our employer clients, PartnerRe offers insurers a unique emergency services program from Assist America: the Global Emergency Services Program.

This program immediately connects employees to physicians, hospitals, pharmacies, and other services if they experience a medical emergency while traveling 100 miles or more away from their permanent residence or in another country.

With one call to the 24/7 Assist America Operations Center, employees can access:

• Medical consultation, evaluation, and referral services
• Assistance with hospital admissions
• Emergency medical evacuation
• Medical monitoring
• Assistance with prescription medications
• Transmission of emergency messages
• Visits from a designated family member or friend if the employee is traveling alone and will be hospitalized for more than seven days
• Care for minor children left unattended while the employee is incapacitated
• Retu of mortal remains
• Emergency trauma counseling
• Assistance with lost luggage or documentation
• Language interpreters and legal referrals

For most cases, the program includes coordination of medical repatriation. However, the U.S. State Department has placed specific restrictions on transport of Ebola patients. All repatriation of these patients must be arranged through the State Department and its exclusive air ambulance provider, Phoenix Air. Thus, Assist America is not able to provide transport for Ebola patients to return to the U.S. at this time.

However, for nearly any other assistance, the program can help save lives. For employees who travel, the program’s identification card may just be the most valuable thing they take with them.

For more information about the program and to offer it to your clients, contact the experts at PartnerRe.