• Report suggests potential excess mortality in the general population of up to 3% for the US by 2033 and 2.5% in the UK, the longest period of elevated peacetime excess mortality in the US

• Key driver of excess mortality is the lingering impact of COVID-19; both as a direct cause of death, and as a contributor to cardiovascular mortality

• Reducing the impact of COVID-19 on elderly and vulnerable populations will be key to excess mortality returning to zero

Zurich, 16 September 2024 – Four years after the peak of the COVID-19 pandemic, many countries are still reporting elevated all-cause excess mortality compared with pre-pandemic levels. According to Swiss Re Institute's report The future of excess mortality after COVID-19, if the ongoing impact of the disease is not curtailed, excess mortality rates in the general population may remain up to 3% higher than pre-pandemic levels in the US and 2.5% in the UK by 2033.

Paul Murray, CEO L&H Reinsurance at Swiss Re says: "COVID-19 is far from over. The US reported an average of 1500 COVID-19 deaths a week for 2023 – comparable to fentanyl or firearm deaths.[1] If this continues, our analysis suggests a potential scenario of elevated excess mortality extending over the next decade. However, excess mortality can return to pre-pandemic levels much sooner. The first step is to get COVID under control, with measures such as vaccinations for the vulnerable. Over the longer term, medical advancements, a return to regular healthcare services, and the adoption of healthier lifestyle choices will be key."

Excess mortality is a measure of the number of deaths above an expected level in a given population. Typically, all-cause excess mortality should be around zero, as the major causes of death remain relatively stable over the long-term baseline assumption.

Fluctuations in excess mortality tend to be short-term, reflecting developments such as a large-scale medical breakthrough or the negative impact of a large epidemic. However, as society absorbs these events, excess mortality should revert to the baseline.

With COVID-19 this has not been the case and all-cause excess mortality is still above the pre-pandemic baseline. In 2021, excess mortality spiked to 23% above the 2019 baseline in the US, and 11% in the UK[2]. As Swiss Re Institute's report estimates, in 2023, it remained significantly elevated in the range of 3–7% for the US, and 5–8% for the UK.

If the underlying drivers of current excess mortality continue, Swiss Re Institute's analysis estimates that excess mortality may remain as high as 3% for the US and 2.5% for the UK by 2033.

The primary driving factor of both current and future excess mortality is respiratory disease (including COVID-19 and influenza), with other causes including cardiovascular disease, cancer and metabolic illnesses. The cause of death split varies by a country's reporting mechanism.

Optimistic scenarios require healthcare and medical advancements

Swiss Re's report examines an optimistic scenario where excess mortality rates return to pre-pandemic levels as early as 2028. In this scenario, medical advances, such as weight loss injectables and cancer developments such as personalised mRNA vaccines, combine with a drop in the impact of COVID-19 and healthier lifestyle choices.

Indirect impact of cardiovascular disease (CVD) mortality

The interplay between COVID-19 and cardiovascular death rates is significant for excess mortality. The virus itself has a direct impact because it contributes to causes of death such as heart failure. Further, COVID-19 has had an indirect impact via the disruption to healthcare systems – a factor which emerged in the pandemic years. This disruption has led to a backlog of essential cardiac tests and surgeries, meaning that conditions such as hypertension have been underdiagnosed and therefore not treated.

Implications for insurers

Excess mortality in the general population is an important indicator for insurers, as shifts in the major causes of death may require a reassessment of additional risk in their mortality portfolios.

The current levels of excess mortality are of concern. However, there are a range of tools available for insurers and reinsurers to manage this trend. Specific actions include adapting the underwriting philosophy, risk appetite, and mortality assumptions in pricing and reserving. Insurers can be proactive in targeting prevention programmes for policyholders, helping them in the joint effort to support longer, healthier lives.

[1] US Centers for Disease Control and Prevention (CDC) data: In 2021, during the peak of the pandemic, COVID-19 claimed 9 037 lives a week, this dropped to 1 453 average weekly deaths in 2023. In comparison, in 2023, synthetic opioids (fentanyl) claimed 1 437 average weekly deaths, and firearms resulted in 900 average weekly deaths.

[2] Human Mortality Database provides data on actual mortality rate, while Swiss Re Institute analysis forms baseline calculations