Without controlling COVID-19, excess mortality will remain high – Swiss Re

Four years after the peak of the COVID-19 pandemic, excess mortality from all causes continues to increase in many countries compared to pre-pandemic levels, according to a new report from the Swiss Re Institute.

The report, titled “The Future of Excess Mortality After COVID-19,” warns that without interventions, by 2033 excess mortality rates could remain 3% higher than pre-pandemic levels in the United States and 2.5% higher in the United Kingdom.

Paul Murray (pictured above), CEO of Life and Health Reinsurance at Swiss Re, highlighted that COVID-19 continues to have a significant impact on mortality. In 2023, the United States reported an average of 1,500 weekly COVID-19 deaths, a figure comparable to deaths from fentanyl or firearms.

“If this continues, our analysis suggests a likely scenario of excess mortality rising over the next decade,” Murray said.

However, he added that if COVID-19 is controlled through vaccination and other health measures, the mortality rate could return to pre-pandemic levels sooner. Long-term improvements in access to healthcare and healthy lifestyle choices are also expected to play a role in reducing mortality.

Excess mortality measures deaths above the expected level in a population, where the baseline is usually stable due to relatively stable long-term causes of death. Significant fluctuations in excess mortality are often associated with major events such as epidemics or medical breakthroughs, but these are usually short-term deviations from the baseline.

However, in the case of COVID-19, excess mortality rates remain high even years after the peak of the pandemic.

In 2021, excess mortality in the United States rose 23% above the 2019 baseline, while it increased by 11% in the United Kingdom. By 2023, excess mortality will have decreased but remains significantly higher than pre-pandemic levels, ranging between 3-7% in the US and 5-8% in the UK, according to projections from the Swiss Re Institute.

If current trends continue, the report estimates that excess mortality rates could stabilise at 3% in the US and 2.5% in the UK by 2033.

What causes excess mortality?

Respiratory diseases, including COVID-19 and influenza, have been identified as the primary cause of current and future excess mortality. Other important factors include cardiovascular disease, cancer, and metabolic conditions, the specific causes of which may vary depending on a country's reporting mechanism.

Murray called the direct impact of COVID-19 on cardiovascular mortality a major concern. COVID-19 has not only caused deaths from respiratory complications, but it has also contributed to heart failure and other cardiovascular diseases.

The pandemic has also had an indirect impact on healthcare systems, leading to delays in essential tests and surgeries. Many diseases, such as hypertension, went undiagnosed during the pandemic, leaving patients untreated and increasing their risk of death.

Advances in healthcare

The Swiss Re report also outlines a more optimistic scenario, where excess mortality could return to pre-pandemic levels as early as 2028. This will depend on the combined effects of medical advancements, including the development of personalised mRNA vaccines for cancer and weight-loss injections, as well as a reduction in the long-term impact of COVID-19 and an increase in the adoption of healthier lifestyle choices.

In this scenario, innovations in medical treatments, as well as improvements in access to healthcare, could help mitigate the long-term effects of the pandemic and bring mortality rates back in line with pre-pandemic expectations, Murray said.

Increased excess mortality presents challenges for insurers, as changes in the leading causes of death may impact risk assessments and pricing strategies. Swiss Re's analysis suggests that insurers may need to re-evaluate their underwriting practices, risk appetite and mortality assumptions in pricing and reserving.

Insurers can play an active role in reducing these risks by implementing targeted prevention programs for policyholders, helping to promote healthy behaviors and early detection of medical conditions. This approach can contribute to longer life expectancy and help manage the long-term effects of the pandemic on mortality.

What are your thoughts on this story? Please share your comments below.