Four years after the peak of the COVID-19 pandemic, many countries continue to report elevated all-cause excess mortality rates compared to pre-pandemic levels, according to a new report from Swiss Re Institute.
The report, titled “The Future of Excess Mortality After COVID-19,” warns that without intervention, excess mortality could remain up to 3% higher than pre-pandemic levels in the United States and 2.5% in the United Kingdom by 2033.
Paul Murray (pictured above), CEO of Life & Health Reinsurance at Swiss Re, highlighted that COVID-19 continues to have a significant impact on mortality rates. In 2023, the United States reported an average of 1,500 weekly COVID-19 deaths, a figure comparable to fatalities from fentanyl or firearms.
“If this continues, our analysis suggests a potential scenario of elevated excess mortality extending over the next decade,” Murray said.
However, he added that excess mortality could return to pre-pandemic levels sooner if COVID-19 is brought under control through vaccination and other health measures. Long-term improvements in healthcare access and healthier lifestyle choices are also expected to play a role in reducing mortality rates.
Excess mortality measures deaths above the expected level in a population, where the baseline is typically stable due to relatively constant long-term causes of death. Significant fluctuations in excess mortality are often linked to major events such as epidemics or medical breakthroughs, but these are usually short-term deviations from the baseline.
In the case of COVID-19, however, excess mortality remains elevated years after the pandemic’s peak.
In 2021, excess mortality surged to 23% above the 2019 baseline in the United States, with the United Kingdom experiencing an 11% increase. By 2023, excess mortality had decreased but remained significantly higher than pre-pandemic levels, ranging from 3–7% in the US and 5–8% in the UK, according to Swiss Re Institute’s estimates.
If current trends continue, the report projects that excess mortality could stabilise at 3% for the US and 2.5% for the UK by 2033.
Respiratory diseases, including COVID-19 and influenza, are identified as the primary contributors to current and future excess mortality. Other significant factors include cardiovascular diseases, cancer, and metabolic conditions, with the specific causes varying based on a country’s reporting mechanisms.
Murray pointed to the direct impact of COVID-19 on cardiovascular death rates as a key concern. COVID-19 has not only led to deaths from respiratory complications but has also contributed to heart failure and other cardiovascular conditions.
The pandemic has also had an indirect effect on healthcare systems, with disruptions leading to a backlog of essential tests and surgeries. Many conditions, such as hypertension, were underdiagnosed during the pandemic, leaving patients untreated and at higher risk of mortality.
The Swiss Re report also outlines a more optimistic scenario where excess mortality could return to pre-pandemic levels as early as 2028. This would depend on the combined effects of medical advances, including the development of personalised mRNA vaccines for cancer and weight-loss injectables, alongside a reduction in the long-term impact of COVID-19 and increased adoption of healthier lifestyle choices.
Murray noted that in this scenario, improvements in healthcare access, combined with innovations in medical treatments, could help mitigate the long-term effects of the pandemic and bring mortality rates back in line with pre-pandemic expectations.
The elevated excess mortality rates present challenges for insurers, as changes in the major causes of death could affect risk assessments and pricing strategies. Swiss Re’s analysis suggests that insurers may need to reassess their underwriting practices, risk appetites, and mortality assumptions in pricing and reserving.
Insurers can also take a proactive role in mitigating these risks by implementing targeted prevention programmes for policyholders, helping to promote healthier behaviours and early detection of medical conditions. This approach could contribute to longer life expectancies and help manage the long-term impacts of the pandemic on mortality rates.
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