The COVID pandemic has caused an unprecedented increase in mortality worldwide, leading to a decrease in life expectancy. A study last year found that 2020 saw a significant drop in life expectancy - by more than two years in the US and by one year in England and Wales.

But now a new study published in Nature Human Behavior shows that in 2021 life expectancy has recovered somewhat in most Western European countries, while Eastern Europe and the US have seen further declines in life expectancy. "Bulgaria is the most extreme example with a staggering loss of 3.5 years since 2019 (1.5 years in 2020 and two years in 2021)," Science Alert wrote.

The larger decline in Eastern Europe is likely due to the region avoiding some of the early waves of COVID in 2020, combined with lower vaccine uptake when 2021 did see large waves.

In 2021, only Norway surpassed pre-pandemic life expectancy, and everywhere it is worse than it probably would have been without the pandemic.

The outlook for 2021 is mixed, with the excitement of vaccine launches overshadowed by the overwhelming number of infections caused by a series of new and highly transmissible variants.

To assess the impact of these changes on life expectancy, a research team from Oxford University's Leverhulme Center for Demographic Sciences and the Max Planck Institute for Demographic Research collected data from 29 mostly European countries (plus Chile and the US).

Life expectancy is calculated based on deaths from all causes. Life expectancy is the number of years someone born today could expect to live if they lived their entire lives at the current year's (or 2021 in this case) death rate.

There is much greater variation between countries in the impact of the pandemic on mortality in 2021 than in 2020. Life expectancy has decreased in almost all countries except Denmark and Norway. But in 2021, life expectancy in some countries has improved compared to 2020, while in others it has worsened even more.

Despite the early introduction of vaccines, the US differed from Western Europe with an additional loss of almost three months in 2021 after losing more than two years in 2020. The US had a lower level of vaccine use and screening compared to Western Europeans their counterparts, which likely explains some of this gap in 2021. But life expectancy in the US has lagged behind that of European countries for many years, so some of this US disadvantage may reflect underlying health vulnerabilities that are exacerbated by the COVID pandemic.

While the majority of life expectancy losses in the US can be attributed to confirmed COVID deaths, the US has also seen a continued increase in drug overdose deaths.

Overall, in 2021, compared to 2020, the death rate shifted slightly towards younger people. This is likely due to better vaccine coverage and more precautions at older ages. In fact, countries with better vaccine coverage for people over age 60 perform better in terms of life expectancy. Death rates over age 80 in the US are even returning to pre-pandemic levels. But overall life expectancy in 2021 is worse due to the deterioration in under-60 mortality.

Recent declines in life expectancy have also been compared to historical crises that have resulted in significant deaths. Losses on the scale we saw during the pandemic have not been seen since World War II in Western Europe or since the collapse of the Soviet Union in Eastern Europe. At the same time, previous influenza epidemics have seen a relatively rapid recovery in life expectancy levels. The impact of COVID so far has been greater and more lasting, disproving the common claim that it is "just like the flu."

Countries such as Brazil and Mexico experienced large life expectancy losses in 2020 and are likely to continue to experience further losses in 2021.

The death toll from COVID in countries like India may never be accurately calculated due to data limitations, but we do know that the death toll has been significant.

While it is hoped that death rates will return to pre-pandemic levels (and even begin to improve again), persistent excess deaths in England and elsewhere in 2022 show that we have not fully recovered from the impact of the pandemic on mortality and the path to recovery remains uncertain.

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