We now have U.S. fatality data for 2022, which should be mostly complete. Fatalities for the year still ran well above pre-pandemic levels but were down from 2020 and 2021.
Prior to the pandemic, there were about 2.8 million fatalities each year in the United States. For many years, fatalities have grown consistently at a little over 1 percent each year. There were slight variations, mostly based on the severity of flu seasons.
But in 2020, fatalities jumped by slightly over 19 percent to just under 3.4 million and then another 2.4 percent in 2021, taking total fatalities to nearly 3.5 million. In 2021 and 2022, there were about 1.1 million more fatalities above the number we would have had if fatalities had continued to increase at the pre-pandemic rate.
In 2022, total fatalities fell by just over 5 percent to 3.26 million. However, that is still about 11 percent or 328,000 deaths above what we would expect based on pre-pandemic rates.[1]
According to the CDC, about 245,000 people died in 2022 after being diagnosed with COVID. So, as in 2021, there were more excess deaths than fatalities related to COVID. This phenomenon has been observed in other countries as well and has prompted much discussion as to the cause of the excess deaths apparently unrelated to COVID. The most likely explanation is that the postponement of routine screenings for other diseases, such as cancer, is catching up with us.
One piece of good news is that most of the excess deaths in 2022 occurred early in the year as we were coming out of the winter flu season. During the spring and early summer, fatalities were back at or below baseline levels before ramping up with the fall/winter flu season. Hopefully this trend will continue in 2023 and we can finally get back to a “normal” fatality rate.
As I have mentioned in previous posts, there are two aspects of the pandemic that will ultimately affect our understanding of the fatality toll of COVID.
The first is mortality displacement. Mortality displacement is an epidemiological/demographic concept that describes the phenomenon where an extraordinary event delays or accelerates fatalities that would otherwise have occurred in another time period.
Because the vast majority of COVID victims have been elderly and/or ill, there likely has been a significant displacement of fatalities that would have otherwise occurred over the next several years. This is particularly likely with regard to the fatalities which occurred in nursing homes. The average life expectancy in a skilled nursing facility is less than two years.
Also, there was an unusually small increase in 2019. Therefore, we probably went into 2020 with a larger vulnerable cohort than normal.
I thought we might start seeing some effect of displacement by now. But other than a few brief weeks in the spring and early summer last year, that has not been the case. The seemingly never-ending emergence of new variants has kept the pandemic lingering for longer than previous epidemics. When you add what appears to be collateral fatalities indirectly caused by behavior changes in reaction to COVID, I am beginning to doubt we will see whatever mortality displacement has or will take place in the data. I am now expecting that there will be a gradual reversion to the mean and maybe a few years of even running slightly below the mean, but I am not certain we will see much more than that.
Second, epidemiologists and actuaries distinguish between “lives lost” and “years of life lost” (YLL). Years of life lost is a calculation which compares the age of the decedent to their life expectancy. For example, if an 84-year-old person died of COVID, the assumption would be that they lost 6.1 years of life, because that is the life expectancy of the average 84-year-old person based on the current life tables. Conversely, the life expectancy of a 5-year-old is 79.8 years, so a 5-year-old death is equal 79.8 YLL.
Again, because COVID fatalities have been very concentrated among the elderly, its toll in terms of years of life lost has been relatively less than for other pandemics. Most pandemics, and especially flu pandemics, tend to have a high fatality rate among children, as well as the elderly. Thankfully, COVID almost entirely spared children. So, we would expect YLL to be something substantially lower than the absolute increase in fatalities.