The shadow of COVID-19, and how to shorten it

The bad news first: excess mortality that surged with COVID-19 could persist in countries including the US and UK for a decade. This means more people could die than anticipated, from multiple causes but influenced by lingering pandemic impacts. The good news? With the right measures, this pessimistic scenario is by no means inevitable.

In recent months, Swiss Re Institute (SRI) researchers have closely examined excess mortality, a measure of deaths above expected levels in a population. They explored post-pandemic mortality trends across nations, the differences and commonalities of the underlying factors, and how these may impact life and health insurers.

These findings, published in the report "The future of excess mortality after COVID-19" are sobering. Though the pandemic has faded, replaced by other day-to-day worries, COVID-19 continues to claim lives. The US reported an average of 1,500 deaths a week from the virus in 2023, comparable to deaths from fentanyl or firearms.

Looking ahead, the findings suggest COVID-19 could remain a major driver of excess mortality, both directly and indirectly, over the next decade. Under a pessimistic scenario that mirrors the current trajectory, excess mortality could be as high as 3% by 2033, marking the longest period of elevated peacetime mortality in US history. The UK outlook in this scenario is similarly troubling, with deaths a decade from now up to 2.5% above expectations.

Clearly, the pandemic continues to cast a long shadow. The SRI analysis has identified respiratory deaths driven by COVID-19 as the biggest contributor to excess mortality. Moreover, cardiovascular disease has also emerged as an unexpected cause of excess deaths. Studies suggest that the risk is elevated amongst those who contracted earlier variants and experienced a more severe form of COVID-19.

COVID-19 also has had indirect impacts, including deterioration in metabolic health due to lifestyle changes such as nutrition and physical activity during the pandemic, a shift that could contribute to higher mortality from non-communicable diseases. This virus has been particularly tough on people with comorbidities such as obesity and diabetes whose death rates far exceeded historical trends.

Additionally, pandemic-related healthcare disruptions, including delayed testing or treatments in particular for cardiovascular disease, may have worsened long-term mortality risk. Potential healthcare staffing challenges on the horizon could further intensify this more negative scenario, with the American Medical Association projecting a deficit of 200,000 nurses and 124,000 doctors in the US by 2030.

While the model developed by Swiss Re applies to general population mortality trends, these risks could also ripple through populations protected by insurers. While insured groups sometimes fare better in a health crisis, this isn't always so, as our experience with COVID-19 illustrated. Swiss Re’s L&H Reinsurance Business Unit, a major life reinsurer with the largest US mortality book of business and a substantial UK presence, absorbed USD 3.5 billion in COVID-19 related mortality claims.

Even so, this worrying scenario isn’t set in stone. Accompanying our analysis, we also developed a more optimistic model that suggests a much brighter future - a chance to shorten the pandemic's shadow, with mortality returning to expected levels as early as 2028.

In SRI's more favourable scenario, vulnerable groups, particularly the elderly, will benefit from continued vaccination with updated formulations tackling newer variants, reducing the likelihood of severe illness and death even in the current environment where this coronavirus is endemic. The calculus here is simple: limiting future infections and severe COVID-19 means fewer people will experience both direct and indirect impacts of this disease.

This more optimistic scenario also relies on strengthening healthcare systems that faced significant strain during the pandemic, with cardiovascular services returning to normalcy. Meanwhile, lifestyle improvements like broader adoption of healthy nutrition, increased physical activity, and better stress management can improve metabolic health, cutting risks for diabetes, cancer and heart disease that all can be exacerbated by COVID-19.

Finally, a slate of medical advancements such as personalised cancer treatments, alongside diabetes and weight loss injectables, hold great promise in restoring a more favourable mortality trajectory in which deaths return more quickly to expected levels. This would be true in a world without COVID-19, but it is likely even more true in a world shaped by the pandemic.

COVID-driven excess mortality – that which is being observed now, and what may be on the horizon – paints a daunting picture. To stay abreast of developments, life insurers should diligently monitor excess mortality and its underlying drivers for impacts on long-term performance of their portfolios and pricing.

They may have to adapt underwriting philosophies or risk appetites, should trends manifest themselves in insured populations.  

Fortunately, however, the future is still open. Despite challenges, prospects are intact for bending the curve in a positive direction as we look ahead to 2033. Ultimately, success means safeguarding the people in our communities, including ourselves.