Session 13A: 

Post-COVID-19 mortality 

assumptions for retirement plans 

and Social Security programs

Presenters: 

Steve Goss, ASA, MAAA

Chief Actuary, US Social Security Administration

Robert N. Anderson, PhD

Chief, Mortality Statistics, NCHS, CDC

George Rutherford, M.D., A.M.

University of California, San Francisco

Anne Case, PhD and Angus Deaton, PhD

Princeton University

Adrian Gallop, FIA

UK Government Actuary’s Department

October 27, 2022
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3
Mortality has been affected around the world by 

the COVID-19 Pandemic. What will follow? 

• Successive variants of the COVID-19 virus have sustained its impact 

even with the development of groundbreaking vaccines in record time.

• This pandemic will resolve to endemic but will have some lasting effects

• But our scope today is to look past the pandemic to prospects for 

future mortality: Will we move back to the modest trends of the last 

decade? Or to the rapid advances of the last century? 

• Future pandemics, medical advances, and our behavior will determine 

the course.

• We have today a remarkable group of scientists to provide their views 

and to discuss areas of contrast and agreement

4
United States Mortality 

declined rapidly through 

2009, but has since 

decelerated.

We have been 

overestimating 

improvement. 

Are we approaching 

human limits on 

longevity, with 

remaining diseases more 

difficult to address, in 

addition to the effects of 

our own behavior, like 

increased obesity? 

5

700

750

800

850

900

950

1,000

1,050

1,100

1990 1995 2000 2005 2010 2015 2020 2025

Age-Sex-Adjusted Death Rates (per 100,000)

Total, All Ages

2014TR

2017TR

2020TR

2021TR

2022TR

Actual
Is There an Omega? 

Highest attained age has changed little; it appears we are rectangularizing the survival 

curve

6
Centers for Disease Control and Prevention

Mortality Data from the National Vital Statistics System

Robert N. Anderson, PhD

Chief, Mortality Statistics Branch

Division of Vital Statistics

National Center for Health Statistics
Age-adjusted death rates and life expectancy at birth: U.S., 1900-2021

0

10

20

30

40

50

60

70

80

90

0

500

1,000

1,500

2,000

2,500

3,000

Age-adjusted death rate (per 100,000 population)

Age-adjusted death rate

Life expectancy

Notes: Data are from the National Vital Statistics System. Prior to 1933, data are for death-registration States only. Data for 2021 are provisional.

Life expectancy at birth (in years)
Age-adjusted death rates due to selected leading causes of death: U.S., 1900-

2021

0

100

200

300

400

500

600

700

Age-adjusted death rate (per 100,000 population)

Heart disease

Cancer

Unintentional injury Stroke

Notes: Data are from the National Vital Statistics System. Prior to 1933, data are for death-registration States only. Data for 2021 are provisional.
Age-adjusted death rates due to selected leading causes of death: U.S., 2000-

2021

0

50

100

150

200

250

300

Age-adjusted death rate (per 100,000 population)

Heart disease

Cancer

Stroke Unintentional injury

Chronic liver disease

Notes: Data are from the National Vital Statistics System. Prior to 1933, data are for death-registration States only. Data for 2021 are provisional.

COVID-19
Age-adjusted death rates due to selected causes of death: U.S., 2000-2021

0

5

10

15

20

25

30

35

Age-adjusted death rate (per 100,000 population)

Drug overdose

Suicide

Alcohol induced

Notes: Data are from the National Vital Statistics System. Data for 2021 are provisional.
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Excess deaths: United States, 2018-2022

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
Post-COVID-19 mortality assumptions 

for retirement plans and Social Security 

programs

George W. Rutherford, M.D., A.M.

University of California, San Francisco

Society of Actuaries Annual Meeting

Thursday October 27, 2022

Session 13A

14
Epidemiology of SARS-CoV-2-related mortality

• First of all, we are not post-COVID

• However, we have just seen the decline of the sixth wave of 

transmission in the World and in the U.S. and probably the start of the 

seventh in Europe

15

United States
Case counts are no longer predictive of actual 

incidence of SARS-CoV-2 infection in the U.S.

• Widespread use of home 

diagnostic kits has led to massive 

undercounting of symptomatic 

cases

• Sewage outfall data are now 

being used to track incident 

infection

16
SARS-CoV-2 variants have different mortality risks

• Original Wuhan strain had a case fatality 

rate of about 10% (first wave)

• Last year’s delta variant had a case fatality 

rate of 3.4% (South African data)

• This year’s omicron variant has a case 

fatality rate of 1.9%

• Differences are even greater when 

calculating infection fatality rate

• Vaccination, especially boosting reduces 

risk of hospitalization and mortality but is 

highly variable across the county

• The virus will continue to evolve in 

response to immune pressures, and 

newer variants may arise

Sigal A, Jassat W. 

Estimating disease 

severity of Omicron 

and Delta SARSCoV-2 infections. 

Nature Rev 2022; 

22:267-69.

17
So where are we?

• Rapidly evolving epidemic with newer 

variants and subvariant tending to less 

severe disease

• What we need to know

• What is the incidence of infection?

• What are the case fatality and infection 

mortality rates by variant and subvariant?

• What is the effect of vaccination on risk of 

infection and severe outcomes

• Will this fall’s bivalent vaccine be even better?

• How much immunity does naturally acquired 

infection provide and for how long (by variant)?

• And we haven’t even touched post-acute 

sequelae of acute SARS-CoV-2 infection (PASC, 

long COVID)

18
On forecasting mortality rates 

Anne Case and Angus Deaton, October 2022

19
GOING BACK TO THE PAST IS UNLIKELY TO WORK

• Because previous trends were broken BEFORE the pandemic

• LE at birth fell in three of the four years prior to the pandemic

• Deaths of despair rising rapidly

• Suicides, drug overdose, alcoholic liver disease

• Rate of decline in deaths from CVD slowed or flattened (obesity?)

• This was the engine of mortality decline in last quarter of 20th century

• Decline slowed for one-third of Americans with a four year college degree

• Rising for two-thirds without

• Forecasting this is a major source of uncertainty

• Still falling in some other countries: so can’t argue it has hit irreducible minimum

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less than BA

BA or more

50 100 150 200 250

deaths per 100,000

1990 2000 2010 2020

year

Cardiovascular disease mortality rates, men and women, ages 25-74

21
6.3 years

With a 4-year degree

Without a 4-year degree

All

2.6 years

52 54 56 58 60

Life expectancy at 25

1990 2000 2010 2020

Life expectancy at age 25, by education

Case and Deaton, PNAS 2021

22
Education IS becoming more important 

relative to race

Worse mortality for AA remains even when stratified by education

23
24
There was no pre-pandemic normal trend to 

return to

Disaggregation by cause of death, by education, or by race/ethnicity, adds insight and 

understanding but may not improve forecasts

25
Post-pandemic mysteries

• LE continued to fall in 2021

• Did not do better as in some other rich countries: poor vaccination performance?

• Suicide fell in pandemic

• Alcoholic liver disease and drug deaths rose rapidly during pandemic

• Also CVD deaths as we have seen in 2020 and more in 2021

• Some argue because of the pandemic

• We are skeptical, and these deaths may remain elevated in years ahead

• Suicide may also rise again

• Major uncertainty associated with deaths of despair in 2022 and beyond

• Depending on whether current increases will go away post-pandemic

26
Perspective from the UK Government Actuary’s 

Department

Adrian Gallop FIA

27
Age standardised mortality rates, 

Males & Females, E&W

28
Number of deaths registered by week, UK, week ending 

13 March 2020 to 30 September 2022

29

0

5,000

10,000

15,000

20,000

25,000

13 Mar 2020 13 Sep 2020 13 Mar 2021 13 Sep 2021 13 Mar 2022 13 Sep 2022

Deaths not involving COVID Deaths involving COVID-19 All deaths - Five-year average

Source: ONS
Cumulative standardised mortality rate compared 

to 2019

30

Source: CMI mortality monitor – week 38 of 2022 
Excess deaths by cause of death; 

weeks ending 6 May 2022 to 23 Sept 2022

Cause of Death Registered 

Deaths

Excess 

Deaths Excess %

Underlying 

Cause COVID

Non-COVID 

excess

Non-COVID 

excess %

Heart failure 27,127 4,751 21% 868 3,883 17%

Ischaemic heart diseases 37,026 5,391 17% 802 4,589 15%

Diabetes 24,044 3,415 17% 844 2,571 12%

Other circulatory diseases 72,641 8,459 13% 2,130 6,329 10%

Diseases of the urinary system 25,899 3,094 14% 919 2,175 10%

Cerebrovascular diseases 19,031 1,961 11% 369 1,592 9%

Chronic lower respiratory diseases 24,321 1,782 8% 1,159 623 3%

Cancer 63,376 1,739 3% 798 941 2%

Cerebrovascular diseases 19,031 1,961 11% 369 1,592 9%

Dementia and Alzheimer's 33,377 -251 -1% 881 -1,132 -3%

31

Source: Office for Health Improvement and Disparities
Potential effects

• Elevated cardiovascular risk 

following COVID infection

• Delays for urgent medical 

treatment e.g. ambulance 

response times longer than 

target, bed blocking

• Disruption to new diagnoses as 

well as the treatment of chronic 

conditions

• Waiting lists – 6.7m cf 4.4m Feb 

20

• Hidden health needs

32
Potential drivers for future mortality change

• Changes in bio-medical technology

• Effectiveness of health care systems 

• Behavioural changes related to health:

• Smoking prevalence 

• Lifestyles 

• Obesity

• Emergence of new diseases (eg HIV, SARS) 

• Antimicrobial resistance

• Re-emergence of old diseases (eg TB)

• Future economic conditions 

• Climate change

• Environmental change, disasters, wars 

• Changes in population composition; cohort effects, migrants 

33
Questions?
Appendix Slides: Steve Goss
Trends in Obesity: US 1971-2006 Sam Preston 2010

Must consider cumulative effects-- Increasing duration of obesity for aged in future 

36
Health Spending Cannot Continue to Rise at Historical Rates—

Effects on Mortality? Note Trustees’ projected deceleration

37

-1%

0%

1%

2%

3%

4%

5%

 1970-1980 1980-2010 2010-2040 2040-2070 2070-2085

Annual Percent Change in Medicare Cost per Beneficiary 

Relative to GDP per Worker: 2015 TR

37
The Remarkable Efficacy of MRNA Vaccination in COVID

38
Post-COVID Conditions: Both Positive and Negative Test

39
Evolving Trends in COVID Variants: More are Coming

40

From the 14-day 

period ending 

September 30 to 

the 14-day 

period ending 

October 13, 

reported new 

COVID 

infections rose 

by 43% in the 

UK, 52% in 

France, 74% in 

Sweden, 81% in 

Germany, 84% 

in Italy. Rose 

by 5% in 

Canada, but 

declined by 20% 

in the US.
Appendix Slides: Adrian Gallop
Long COVID

• Estimated 2.3 million people living in private 

households in the UK (3.5% of the 

population) experiencing self-reported long 

COVID (symptoms continuing for more than 4 

weeks after the first confirmed or suspected 

COVID-19 infection that were not explained 

by something else) as of 3 September 2022

• Of these 1.1 million (46%) had COVID at least 

one year previously, and 514,000 (22%) at 

least two years previously.

• 342,000 (15%) reported that their ability to 

undertake their day-to-day activities had 

been “limited a lot” due to Long COVID.

Source: ONS

42
Direct and indirect health impacts of COVID-19 in 

England

Area Findings

Direct mortality and morbidity 

impacts of Covid-19 

• Deaths and hospitalisations from Omicron much lower than previous 

waves

• Higher mortality in more deprived areas

Impact of Covid-19 on NHS 

critical care capacity 

• Omicron did not increase the number of Covid-19 positive patients in 

critical care beds. 

• Increases in staff absence may have led to increased pressure in critical 

care. 

43

Source: Direct and indirect health impacts of COVID-19 in England: emerging Omicron impacts, Aug 2022

Dept for Health and Social Care and ONS
Area Findings

Indirect impacts of Covid-19 

on population health due to 

living through a pandemic 

and restrictions 

• Primary care appointments and referrals were resilient during the Omicron 

wave of infection. However, lower overall activity across the pandemic has 

led to ‘missing’ appointments and referrals. 

• Reported incidence of some conditions has returned to pre-pandemic 

trends, other conditions are still persistently below the pre-pandemic trend. 

• Staff absences continue to put pressure on the NHS. 

• Supply constraints during the Omicron wave of infection have led to longer 

waits for elective and emergency patients in secondary care. 

• Elective activity remains below pre-pandemic levels. 

• Referrals to and people in touch with mental health services are higher than 

pre-pandemic level. 

Indirect impacts of Covid-19 

on the wider population in 

the long-run 

• Adult social care has suffered from pre-COVID pressures, including workforce 

pressures, which have been exacerbated by the pandemic

• Economic impacts from Omicron smaller than those seen during previous 

waves of infection. 

• Non-Covid-19 pressures mean wider economic climate remains fragile. 

44
Cancer - impact of delays in diagnosis and treatment 

during the pandemic 

Decreasing life expectancy Increasing life expectancy

Medical staff leaving profession Government pledge to increase nursing numbers

Backlog means later diagnosis/treatment meaning 

worse prognosis. Could impact for next 5-10 years

MRNA vaccines used for COVID trialled to treat cancer; 

in early stages

If patient education not improved not all will go to 

doctor, screening etc. Widen gap between socio 

economic groups

Hubs being set up to deal with backlog

Possible direct impact on cancer incidents could be 

increased e.g. lung fibrosis from COVID linked to lung 

cancer. Other cancers not yet linked but could be 20 

years before we know

Genetic testing/personalised care – further off for 

cancer, but innovations like this possible. But lack of 

money/staff could delay this.

Technology making screening/diagnosis/treatment 

more efficient

More self screening (screening rates didn’t decline 

during pandemic)

Less affected by recession as relatively cost effective

45
Potential drivers for future mortality change

Climate change

• UK typically has higher death rates in winter. 

• During five heat-periods between June and August 2022 the number of deaths was 6.2% above the five-year average.

• The average number of deaths per day was higher for heat-period days than 

non-heat-period days.

• Each heat-period peak, was followed by a fall in deaths to below the average over the following days; this suggests a short-term mortality displacement, where deaths among vulnerable individuals are ‘brought forward’ to within 

the heat-periods.

• Excess winter deaths higher than excess summer deaths so warming may 

lead to lower deaths overall, excluding other potential effects of global 

warming

46