The waning of the pandemic led to fewer deaths in America in 2022 than in 2021, according to preliminary data from the Centers for Disease Control and Prevention. But heart disease and cancer deaths rose, and covid-19 remained remarkably lethal, killing more than 500 people a day.

The report shows an overall drop of 5.3% in the death rate from all causes, a signal that the country last year had exited the worst phase of the pandemic. Deaths from covid dropped 47% between 2021 and 2022.

But covid has not magically become like the flu or a new type of cold. Even though the population had built up high levels of immunity from vaccination and natural infection, covid was the fourth leading cause of death in 2022, behind heart disease (699,659 deaths), cancer (607,790), and “unintentional injury,” which includes drug overdoses (218,064). The CDC estimated that covid was the underlying cause of 186,702 deaths and a contributing factor in another 58,284.

Covid “has not gone away,” William Schaffner, an infectious-disease doctor at Vanderbilt University School of Medicine, said in an email after reviewing the report. “It continues to smolder in our communities, picking off the most fragile among us, just as lions in Africa strike the older and slower antelopes.”

By far the biggest killers remain heart disease and cancer. This was the third straight year the age-adjusted death rate from heart disease has risen, and the second straight year for cancer deaths. The death rate from all causes in the United States in 2022 was almost as high as the rate in 2020 and much higher than in 2019.

Some of the increase in heart disease and cancer deaths may be an effect of the pandemic. For example, cancer screenings declined as many people chose to postpone medical visits. Heart disease may have also been exacerbated by inflammation related to covid.

But there has been a well-documented erosion of health in the country for working-age people, a trend that predated the pandemic. Life expectancy historically has improved along with improvements in infant and maternal mortality rates, as well as better public health measures, including vaccinations, that limit the ravages of infectious diseases. But the gains in U.S. life expectancy plateaued after 2010, and it declined for several years mid-decade before ticking up slightly just before the coronavirus appeared.

The dismaying mortality numbers were due in part to the opioid epidemic, but other factors played a role, including a slowing of what had been positive trends in treating heart disease as the nation struggled with high rates of obesity and hypertension. Covid drove life expectancy even lower, to the same level as in 1996, according to CDC data released last year.

Against that recent history of poor health trends, the new CDC data is not encouraging.

“The increase should raise concerns that our recent history of substantial progress against heart disease has stalled, and even reversed,” Harlan Krumholz, a cardiologist at the Yale School of Medicine, said in an email after reviewing the CDC report.

“The findings are even more impressive since the nation has lost many older people who were most vulnerable to heart disease through the course of the pandemic,” Krumholz continued. “This may represent further evidence that the health of Americans continues to decline despite the enormous sum we spend on health care.”

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