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Probing impact of COVID-19 on life expectancy

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*Coronavirus has slashed living condition by two years, reversed trend of people living longer than their parents, grandparents, say experts

There have been reports all over the world that the Coronavirus disease (COVID-19) has led to a drop in life expectancy. Several studies suggest that the pandemic has led to the neglect of other diseases and consequently rise in mortality and morbidity.

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Simply put, life expectancy is how long, on average, members of any given population can expect to live. This is different from lifespan, which is the maximum length of time any member of the species can survive.

According to studies, although lifespan has changed very little – if at all – global life expectancy has soared by more than 40 years since the beginning of the 20th century. This was achieved through a combination of scientific discoveries and public health measures that drove down infant mortality.

However, medical experts are unanimous that the coronavirus pandemic is causing some substantial increase in mortality in Nigeria and populations across the world. They said the pandemic has overwhelmed health systems, leading to increased morbidity and mortality. They said the increase in mortality has the potential to cause a decline in life expectancy in Nigeria and elsewhere in the world.

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The medical experts said the COVID-19 pandemic is causing substantial increases in mortality across populations worldwide and has overwhelmed health systems in many countries, potentially leading to increases in morbidity and mortality beyond the direct impact of COVID-19 infection. They said these increases in mortality, both direct and indirect, have the potential to cause stagnations or declines in life expectancy.

According to the World Health Organisation (WHO), life expectancy refers to the average number of years that a newborn is expected to live if current mortality rates continue to apply. Life expectancy is a measure that is used to summarise the risk of death at different ages in a given population. For instance, life expectancy at birth in the United States is 78.6 years. This means that babies born today would live 78.6 years, on average, given current mortality rates.

Rising life expectancies are seen as signs of progress.

What is the life expectancy of an average Nigerian today? A consultant clinical pharmacist and public health specialist, Dr. Kingsley Amibor, told The Guardian: “The average life expectancy for Nigerians in 2020 is 54.81 years. This represents an increase of 0.58 per cent in 2019. This is a projection of the United Nations (UN) Organisation, and does not reflect the impacts of the Coronavirus disease (COVID -19) pandemic.”

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Are the figures going up or down? Amibor said: “In Nigeria, life expectancy was 54.49 years in 2019, 54.18 years in 2018 and 53.73 years in 2017. The figures represent an increase since 2016, for instance there was a 0.84 per cent increase from 2016 value, 0.83 per cent increase from 2017, 0.58 per cent increase from 2018 and 2019 respectively. The final figures for 2020 may represent a slight decrease because of the impact of COVID-19, luckily for Nigeria; the reduction may not be significant because of low case fatality for COVID-19 recoded in Nigeria, which is about two per cent. Nigeria ranks as one of the lowest life expectancy figures in Africa (54.81 years, while a country like Tunisia also in Africa records 76.79 years).”

What is the relationship between lowering life expectancy and COVID-19? The clinical pharmacist said: “Global average life expectancy increased by 5.5 years between 2000 and 2016 (Nigeria inclusive), the fastest increase since the 1960s. Those gains reverse the declines during the 1990s when life expectancy fell in Nigeria and Africa because of the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) epidemic. The 2000-2016 increases can be explained by improvements in child survival and expanded access to anti retroviral drugs (ARVs) for the treatment of HIV.

“Life expectancy saw a steady rise in low-income countries including Nigeria by as much as 21 per cent between 2000 and 2016, due largely to improved access to services to prevent and treat HIV, malaria, and tuberculosis, as well as a number of neglected tropical diseases such as guinea worm. Additionally, improved maternal and child healthcare led to a reduction of child mortality by almost 50 per cent, between 2000 and 2018.

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“The coronavirus pandemic is causing some substantial increase in mortality in Nigeria and populations across the world. The pandemic has overwhelmed health systems, leading to increased morbidity and mortality. The increase in mortality has the potential to cause decline in life expectancy in Nigeria and elsewhere in the world.”

What should be the ideal figure or situation? Amibor said: “Research has shown that countries with higher per capita incomes have longer life expectancies, owing to the ability and willingness of wealthier nations to invest in healthcare, infrastructure, and environmental governance, thereby increasing life expectancy and reducing fatality rates. This explains the large difference between life expectancy in Nigeria and those of developed nations. Research suggests that, in general, a 100 per cent increase in per capita income under similar conditions equates to an increase in life expectancy of one - three years.”

What are recommendations on how to improve the life expectancy of Nigerians? The clinical pharmacist said: “There is a school of thought that a one per cent Gross Domestic Product (GDP) regression will cause a retrogression across society in medical care, infrastructure, and environmental governance, and this could lead to a reduction in the average life expectancy of about 10 days. Efforts must be made to boost GDP of Nigeria for us to experience a continuous increase in life expectancy.

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“With regards to the coronavirus pandemic, control efforts at preventing the spread of the virus in Nigeria must be sustained. In the absence of a cure, preventive measures such as observance of social distancing, hand hygiene, use of hand sanitisers, and proper wearing of facemasks must be sustained. There is a need for enforcement of guidelines.

“In responding to the novel coronavirus, cancer, cardiovascular disease, and other diseases that threaten lives, we must also give comprehensive consideration to social and medical resources, and strike a balance that is conducive to protecting lives. One step is for the health authorities in Nigeria to implement active strategies to reduce the death rate, which will lead to higher life expectancy values. Not just for COVID-19, but other causes including infant mortality, HIV/AIDS, malaria, tuberculosis, poverty, malnutrition, road traffic accident, and other causes. Noncommunicable diseases such as heart disease, strokes, diabetes, hypertension, and cancers caused 70 per cent of all deaths in 2016, about 85 per cent of non-communicable disease deaths occurred in low-income countries, including Nigeria.”

Amibor said for Nigeria to join the league of nations with high life expectancies like the United States, United Kingdom, and others, the country must tackle killer diseases and make a conscious effort to reduce brain drain among healthcare professionals including medical doctors, pharmacists, and nurses, because this brain drain has the potential to worsen health indices, as fewer healthcare workers are available to meet the health needs of Nigerians.

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He added: “Of recent, suicide rates have increased in Nigeria and this is not good enough. Talk about deaths from terrorism, all of these must be addressed for life expectancy to increase in Nigeria.

“Efforts must be made to address poverty and malnutrition. Vaccination of Nigerian children against killer diseases such as Diphtheria, whooping cough, and others must be sustained irrespective of COVID-19. Attention should also be paid to the prevention and control of diarrhoeal diseases, influenza, and pneumonia, which are the leading causes of death in Nigeria.

“There is a need for improved government funding of the healthcare sector in Nigeria, in line with the Abuja Declaration of 2001. Unemployment, which has seen a steady increase for some time now, will need to be tackled positively. Other lifestyle factors that affect mortality such as unhealthy diet, inadequate exercise, tobacco use, excessive use of alcohol, risky behaviors, food safety, workplace safety and obesity will need to be looked into.

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“When all these and more are put in place, we are bound to experience higher life expectancy values in Nigeria.”

In fact, a study published in Daily Mail UK Online revealed the pandemic has knocked nearly two years off the average life expectancy for men and women.

The shocking figures reverse the trend of people living longer than their parents and grandparents.

Life expectancy in England and Wales had been steadily improving for the last 50 years, before stagnating over the past decade.

But experts from Oxford University said the coronavirus crisis – which has seen nearly 54,000 excess deaths – has put it back to 2008 levels.

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Even this may be an underestimate of the real toll of COVID-19 on the nation’s health. Many excess deaths seen in the first half of the year – from diseases and conditions including Alzheimer’s, stroke, diabetes, asthma, influenza, and pneumonia – may really have been due to undiagnosed coronavirus.

COVID-19 has cut life expectancy for women from 83.5 years in 2019 to 81.8 years for those born in the first half of 2020, and from 79.9 years to 78 years for men.

Lead researcher Jose Manuel Aburto, of the Department of Sociology at Oxford University, said: “We have provided estimates of life expectancy for 2019 and the first half of 2020, which show that life expectancy dropped a staggering 1.7 and 1.9 years for females and males respectively between those years.

“To put this in perspective, male and female life expectancy in the first half of 2020 regressed to the levels of 2008. It is likely that our estimates of excess deaths and life expectancy are underestimated.”

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Life expectancy at birth is used as an indicator of population health and can shed light on the cumulative burden of a pandemic.

The study shared on an academic website prior to publication in a peer-reviewed journal, used official data on all-cause mortality from the Office for National Statistics from March 2 – the first time a COVID-19 death in England and Wales was registered – to the end of June.

Researchers compared this data with previous trends, looking at excess death and life expectancy and lifespan inequality.

Of the 53,937 excess deaths identified, 54 per cent were among men.

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Lifespan inequality is another measure of population health based on social deprivation and its impact on mortality.

Between 2005 and 2019, lifespan inequality declined slowly from 13.8 to 13.5 years for women and from 15 to 14.7 for men, but in the first half of 2020, it fell sharply to 12.9 years for women and 14 years for men.

“Quantifying excess deaths and their impact on life expectancy at birth provides a more comprehensive picture of the full COVID-19 burden on mortality. Whether mortality will return to or even fall below the baseline level remains to be seen,” the researchers said.

The future impact on life expectancy is unclear due to a possible second wave of the virus.

Its long-term health effects could also lead to earlier deaths. But if the most vulnerable people have already died, it is possible that we may see fewer deaths than expected for the rest of 2020.

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However, even if death rates fall 10 per cent below the expected baseline for the rest of the year, coronavirus will still have knocked an average of 4.4 months off the life expectancy of a woman and 6.6 months off a man’s life. By age group, 15 to 44-year-olds accounted for only 290 excess deaths above the expected level, while among the 45-64 group, the figure was 5,786.

The older age groups were hit hardest. Those aged 65 to 74 saw 7,514 excess deaths, 75 to 85 saw 15,091, and the 85-plus group had 25,255 excess fatalities.
But has the true death toll been exaggerated?

Elsewhere, with over 170,000 COVID-19 deaths to date, and 1,000 more each day, America’s life expectancy may appear to be plummeting. But in estimating the magnitude of the pandemic, University of California, Berkeley, United States (U.S.), demographers have found that COVID-19 is likely to shorten the average U.S. lifespan in 2020 by only about a year.

Seeking to put current COVID-19 mortality rates into historic, demographic, and economic perspective, UC Berkeley demographers Ronald Lee and Joshua Goldstein calculated the consequences of U.S. lives lost to COVID-19 in 2020 using two scenarios. One was based on a projection of 1 million deaths for the year, the other on the more likely projection of 250,000 deaths.

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Their findings, published online last week in the Proceedings of the National Academy of Sciences, concluded that one million deaths in 2020 would cut three years off the average U.S. life expectancy, while 250,000 deaths would reduce lifespans by about a year.

That said, without the societal efforts that have occurred to lessen the impact of COVID-19, there could have been two million deaths projected by the end of 2020, a reduction of the average U.S. lifespan by five years, the researchers pointed out.

Their estimated drop in life expectancy is modest, in part, because 250,000 deaths is not a large increase on top of the three million non-COVID-19 deaths expected for 2020, and because older people, who typically have fewer remaining years of life than others do, represent the most COVID-19 fatalities, the study notes.

Still, while COVID-19 mortality rates remain lower than those of the 1918 Spanish flu pandemic, the coronavirus epidemic could be just as devastating as the longer-lasting HIV and opioid epidemics if mitigation efforts fail, the researchers said.

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“The death toll of COVID-19 is a terrible thing, both for those who lose their lives and for their family, friends, colleagues and all whom their lives touched. Those are real people, not abstract statistics,” said Lee, a UC Berkeley professor emeritus of demography and associate director of the campus’s Center for the Economics and Demography of Aging.

Among the other findings by the researchers include:
*One million COVID-19 deaths in the U.S. in 2020 would be the equivalent of U.S. mortality levels in 1995, adding three years to each American’s biological age, albeit temporarily.

*The age gap (old versus young) for people dying from COVID-19 is marginally wider than during pre-pandemic times, while the male-female gap is slightly narrower. The researchers found similar death-by-age patterns across several countries.

*The economic cost of lives lost to COVID-19 in the U.S. is in the trillions of dollars. According to standard government measures, the demographers estimated that the loss of 1 million lives in 2020 would amount to between $10.2 and $17.5 trillion, while the amount for 250,000 deaths would range from $1.5 to $2.5 trillion.

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Another study, which examined the impact of the COVID-19 pandemic on life expectancy in Madrid, Spain, was published in the Journal of Public Health.

The researchers wrote: “Our results suggest a decline in life expectancy at birth of 1.9 years among men and 1.6 years among women, which corresponds to the levels of 2009 (Fig. 1). These estimates can be considered conservative, as we have assumed that mortality for the rest of the year would follow the expected mortality for previous years. There are reasons to believe that there will be excess mortality, at least in the following weeks, as the COVID-19 epidemic is still ongoing in the region. Moreover, the significant medium-term impact of the disruption of the healthcare system could result in a higher death toll in the following months because of chronic conditions that have not been controlled during the peak of the pandemic. On the other side, a decline mortality rate attributable to a harvesting effect is also possible, as observed after severe flu seasons. The relative strength of both phenomena will determine whether the life expectancy decline we have estimated will be more or less intense by the end of the year.”

They concluded: “In conclusion, we have shown that the COVID-19 pandemic has the potential to severely affect annual life expectancy in Madrid. Continuing to monitor trends in life expectancy in Madrid and worldwide will provide valuable evidence on the total impact of the pandemic on mortality.”

Also, another study assessed the potential impact of COVID-19 on life expectancy. The study was published in IIASA Working Paper.

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The researchers noted: “The COVID-19 pandemic has caused a significant number of deaths worldwide. If the prevalence of the virus infection continues to rise, it can potentially have an impact on life expectancy. This paper provides first estimates of the potential impact of the COVID-19 pandemic on period life expectancy.”

The researchers found: “At 10 per cent prevalence rate, the loss in life expectancy at birth is likely above 1 year in North America and Europe and in Latin America and the Caribbean. In South-Eastern Asia and in Sub-Saharan Africa, one year lost in life expectancy corresponds to a prevalence of infection of about 15 per cent and 25 per cent, respectively. Given the uncertainty in fatality rates, with a prevalence of COVID-19 infections of 50 per cent under 95 per cent prediction intervals, life expectancy would drop by three to nine years in North America and Europe, by three to eight years in Latin America and the Caribbean, by two to seven years in South-Eastern Asia and by one to four in Sub-Saharan Africa.

“In all prevalence scenarios, as long as the prevalence rate of COVID-19 infection remains below one or two per cent, COVID-19 would not affect life expectancy in a substantial manner.”

They concluded: “In the regions with relatively high life expectancy, for a prevalence of infection threshold above one or two per cent, the COVID-19 pandemic will break the secular trend of increasing life expectancy resulting in a decline in period life expectancy. With life expectancy being a key indicator of human development, mortality increase, especially among the vulnerable subgroups of populations would set the country back on their path of human development.”

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