I want to ask a simple question—one that I think should trouble anyone who genuinely cares about public health:
Why are more people still dying than we would expect, years after the emergency phase of COVID has passed?
This question is one of the main reasons I continue to speak about COVID and its aftermath. Not because I want to relive the pandemic, but because when I look at the data, something doesn’t sit right.
There is a basic demographic principle known as mortality displacement, sometimes referred to as mortality debt. If a large number of frail or elderly people die during a crisis, those individuals cannot die again in subsequent years. What normally follows a major mortality shock is a compensatory period where deaths fall below baseline before eventually returning to expected levels.
That is what should have happened after COVID.
But it hasn’t.
What we should have seen — but didn’t
Using 2015–2019 as a baseline, the CDC’s all-cause mortality data allow us to examine weekly deaths across the United States without filtering by diagnosis, narrative, or cause. It simply asks: how many people died, from anything.
In 2020, we saw the expected spike. In 2021, another. These were the acute pandemic years. But by 2022, 2023, and now into 2024–2025, something unusual remains:
all-cause deaths have not returned to baseline.
In fact, in some recent periods, weekly deaths are higher than they were at comparable points before the pandemic. This is despite the fact that:
Acute COVID hospitalisations are far lower
Public health restrictions have ended
We are repeatedly told the crisis is “over”
If mortality displacement were operating as expected, deaths should now be below baseline. Instead, they remain persistently above it.
That is the red flag.
Provisional COVID-19 Mortality Surveillance >
Why this can’t be explained away easily
One might argue that this is just delayed reporting, seasonal variation, or demographic ageing. Those factors matter—but they don’t explain years of persistent excess, nor do they explain why the pattern has failed to normalise despite multiple cycles.
What concerns me most is not just that deaths remain elevated, but who is likely contributing to that elevation.
Early in the pandemic, excess mortality was dominated by older, frailer individuals. That made sense. But several years later, those cohorts should no longer be driving excess deaths at the same scale. The people most vulnerable to acute COVID have already, tragically, been removed from the population.
So the question becomes uncomfortable but unavoidable:
Who is still dying and why?
COVID as a vascular disease, not simply a respiratory one
To understand this, I think we need to abandon the idea that COVID was “just” a lung infection. Increasingly, the evidence points toward COVID behaving as a vascular disease with immune dysregulation at its core.
The lungs were simply the most obvious early site of damage. But the endothelium—the lining of blood vessels throughout the body—appears to be a central target. When that system is injured, the consequences don’t necessarily appear immediately. They accumulate.
Heart disease, stroke, kidney failure, neurological decline—these don’t always kill in days. Sometimes they take months or years.
From that perspective, persistent excess deaths are not surprising. They are exactly what one would expect if a large proportion of the population sustained subclinical but cumulative vascular injury.
Why “mild” reinfections may not be benign
Another assumption that deserves scrutiny is the idea that repeated infections are harmless simply because they are less dramatic. A disease does not have to cause respiratory failure to be lethal. It can shorten life quietly, by accelerating processes that were already underway.
If immune responses are repeatedly activated—whether through infection, immune priming, or both—without fully resolving underlying inflammation, the result may not be acute collapse, but chronic biological stress.
That kind of damage does not announce itself with daily case counts. It shows up later, in mortality curves that refuse to return to baseline.
Why persistent excess mortality matters more than narratives
Statistics are uncomfortable because they don’t care about stories. They don’t respond to reassurance. They simply record outcomes.
And the outcome we are seeing is this:
The emergency ended. The deaths did not.
That does not mean we panic. But it does mean we stop congratulating ourselves prematurely. Persistent excess mortality tells us that whatever we think “recovery” looks like, we haven’t achieved it yet.
If we ignore this signal because it is slow, unglamorous, and politically inconvenient, we risk repeating the same mistake that delayed recognition of COVID’s seriousness in the first place—only this time, the damage may be harder to reverse.
A final thought
If excess deaths remain elevated year after year, the problem is no longer the pandemic itself. It is the aftermath we have failed to understand.
And until we are willing to look honestly at that aftermath, the numbers will continue to tell a story we don’t want to hear.
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