Deaths from the Covid-19 pandemic are causing an extraordinary jolt in the U.S., inflating the nation’s death rate to the highest level seen in nearly two decades.

Whether the U.S. will quickly snap back to pre-pandemic levels following a mass-vaccination effort remains to be seen. Daily Covid-19 deaths are on their way back down, but the disease is unlikely to disappear, and health experts say there could also be long-running effects from issues like missed cancer screenings, a surging rate of drug overdoses and health inequities exacerbated by the pandemic.

“I imagine there will be lingering effects after 2021 just because this has taken such a toll on people’s health, both directly and indirectly,” said Noreen Goldman, professor of demography and public affairs at the Princeton School of Public and International Affairs.

The U.S.’s age-adjusted mortality rate shot up by about 16% in 2020 from the year before, according to provisional data from the Centers for Disease Control and Prevention, marking the highest point since 2003. This also broke a 90-year streak in which the yearly death rate was always lower than it was 10 years earlier.

The age-adjusted mortality rate measures deaths in the U.S. per 100,000 people while taking into account the age distribution of the population. On a yearly basis, 2020’s death-rate surge was the biggest since the 1920s, when disease outbreaks often caused fluctuations, and the devastating 1918 flu pandemic before then.

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