And his name that sat on him was Death, and Hell followed with him.
The “pale” horse is translated from the Greek chloros — the sickly, yellow-green hue of disease. It is accompanied often by the so-called Hippocratic change produced in the face by impending death or long illness, malnourishment, and the like.
As David Pack (Restored Church of God) confirms:
Coming on the heels of the first three horsemen, the pale horseman’s arrival portends that more hundreds of millions will perish through terrifying disease epidemics. The reference to “Death”—the end result of disease—and “Hell”—hades, meaning the grave—make this clear.
Look at this: Plague, pestilence, and disease in the Last Days
And consider the following, selected stories (there are many others and will be many, many more):