The pandemic’s hidden toll: millions of chronic conditions left undiagnosed

A BMJ-published study using anonymised records for nearly 30 million people in England found large pandemic-era drops in new chronic disease diagnoses — asthma down >30% and COPD down >50% in the first year, osteoporosis diagnoses down one-third (more than 50,000 fewer osteoporosis diagnoses between March 2020 and November 2024). Depression diagnoses fell nearly 30% in year one and have not fully recovered, while chronic kidney disease diagnoses have doubled since 2022 following updated screening guidance and new treatments. Persistent diagnostic backlogs and shifting care pathways (e.g., self-referral to talking therapy) imply rising untreated disease burden and potential downstream effects on healthcare providers, diagnostics manufacturers, insurers and pharmaceutical demand.

Analysis

Market structure: The immediate winners are diagnostic labs and imaging services (LabCorp LH, Quest DGX, GE Healthcare GE) and tele-mental-health platforms (Teladoc TDOC) that can monetize backlog testing and virtual therapy; expect lab volume to re-normalize with 6–12 month catch-up spikes of +10–30% vs pandemic baseline as deferred spirometry, DEXA and kidney screening are rescheduled. Losers include short-term pressure on primary-care revenue mixes and some antidepressant-focused pharma revenue (Pfizer PFE, Eli Lilly LLY) if talking-therapy substitution persists; insurers (UNH, Cigna CI) face margin risk from a near-term surge in claims but potential long-term benefit if earlier CKD detection reduces advanced care costs.

Risk assessment: Tail risks include regulatory shifts (NHS reallocation or quicker CKD-screen mandates), a negative SGLT2 CKD outcome, or reagent supply-chain constraints that could squeeze labs; assign >5% probability to disruptive regulatory change in UK/EU within 12 months. Timeframes: immediate (days–weeks) watch weekly lab volumes and telehealth referral growth; short-term (3–12 months) expect backlog monetization and 6–18% EPS beat potential in labs; long-term (2–5 years) structural acceleration in real‑world data analytics and routine screening expands addressable market by an estimated 5–10% CAGR. Hidden dependencies: reimbursement changes for virtual therapy and capacity constraints among specialists that can cap revenue realization.

Trade implications: Establish 2–3% long positions in LH and DGX (target +20–30% in 6–12 months) using 3–6 month call spreads to cap cost (buy 6mo 25–30% OTM calls, sell 12mo 60% OTM calls). Allocate 1.5–2% to AZN and 1% to LLY as 12–24 month core longs to capture SGLT2 CKD uptake (target 15–25% upside); hedge insurer exposure with 3–6 month UNH 5–10% OTM puts sized to 0.5–1% of portfolio. Add a 1% tactical long in TDOC via 6–9 month calls to play mental-health platform routing of undiagnosed demand.

Contrarian angles: Consensus downplays data platforms (IQV IQV) that enable real‑time detection; these are underpriced if payers adopt routine CKD surveillance—consider 1% swing allocation to IQV with 12–18 month horizon. The market may be underreacting to an osteoporosis catch-up: 50k missed diagnoses in England implies a multi-year uplift in bone‑drug demand—favor AMGN (1% long) over small-cap bone players. Watch for unintended consequence: specialist bottlenecks could force higher pricing/payer concessions, accelerating consolidation (M&A candidates: CVS, UNH) — size exposure accordingly.

Key Decisions for Investors

• Establish a 2–3% long position split equally between LabCorp (LH) and Quest Diagnostics (DGX) with a 6–12 month horizon; implement via debit call spreads (buy 6‑month 30% OTM calls, sell 12‑month 60% OTM calls) to target ~20–30% upside while capping premium outlay.
• Allocate 1.5–2% to AstraZeneca (AZN) and 1% to Eli Lilly (LLY) as 12–24 month core longs to capture SGLT2-driven CKD treatment expansion; add if quarterly Rx volume growth for SGLT2s >10% QoQ or new CKD label expansions are announced.
• Buy 3–6 month 5–10% OTM protective puts on UnitedHealth (UNH) sized to 0.5–1% of portfolio to hedge near-term insurer margin risk from a claims surge; if UNH put IV rises >25% sell to realize hedge gains.
• Establish a 1% tactical long in Teladoc (TDOC) using 6–9 month calls to play increased routing of depression care to digital platforms; add another 0.5% if monthly tele‑therapy referrals exceed pre-pandemic levels by >15% for two consecutive months.
• Initiate a 1% position in IQVIA (IQV) as a 12–18 month contrarian play on near‑real‑time medical data monetization; increase to 2% if NHS/CDC publishes formal CKD screening guidance within 30–60 days, indicating policy-driven testing growth.