U.S. ‘excess deaths’ during pandemic surpassed 1 million, with COVID-19 killing most but other diseases adding to toll
The U.S. has recorded more than 1 million “excess deaths” since the start of the pandemic, government mortality statistics show, a toll that exceeds the officially documented lethality of the coronavirus and captures the broad consequences of the health crisis that has entered its third year.
The excess deaths figure surpassed the milestone last week, reaching 1,023,916, according to Robert Anderson, chief of the mortality statistics branch of the Centers for Disease Control and Prevention’s National Center for Health Statistics. The center updates its estimate weekly.
Although the vast majority of the excess deaths are due to the virus, the CDC mortality records also expose swollen numbers of deaths from heart disease, hypertension, dementia and other ailments across two years of pandemic misery.
“We’ve never seen anything like it,” Anderson said. In 2019, before the pandemic, the CDC recorded 2.8 million deaths. But in 2020 and 2021, as the virus spread through the population, the country recorded roughly a half-million deaths each year in excess of the norm.
The virus emerged in China in late 2019 and began killing people there in January 2020. It did not spread significantly in the U.S. until that February, and not until the final week of March 2020 did it begin to send the excess deaths metric soaring.
The CDC’s excess deaths tracker shows in graphic detail the speed and intensity of that initial wave: Deaths had soared more than 40% above normal nationally in the second week of April 2020.
The lethality was concentrated in a few hotspots: In the second week of April, deaths in New York City were seven times the norm. But some regions had minimal change in mortality for many months.
The CDC mortality branch’s official count of deaths from COVID-19 stood at 911,145 as of Tuesday. The mortality researchers rely on death certificates, and that tally can be slightly lower than other CDC or academic trackers that rely on data from other sources.
Anderson said 91% of the deaths from COVID-19 tracked by his unit were attributed directly to the disease. In the other 9% of deaths, COVID-19 was listed as a contributing factor but not the primary cause.
The CDC documented 13 other, non-COVID-19 causes of death that were inflated during the pandemic compared with historical trends starting in 2013. For example, since the start of the pandemic, the category of ischemic heart disease has recorded an additional 30,000 deaths beyond what would be expected in a typical year. Deaths from hypertensive disease were nearly 62,000 higher than expected.
Anderson said the numbers carry a degree of ambiguity: Some heart attacks and hypertensive disease could have been associated with undiagnosed cases of coronavirus infections. The CDC’s analysis estimates 208,431 excess deaths from all the non-COVID-19 causes since the start of the pandemic.
At first glance, that number, plus the 911,000 COVID-19 deaths, would suggest the excess deaths were greater than 1.1 million. But Anderson notes that many of the people who died of COVID-19 were elderly, sick or very frail, and, even without a pandemic, some might not have survived across the two-year span of the pandemic.
“Some of those COVID-19 deaths are not, strictly speaking, excess deaths,” he said. The million-deaths figure highlights the broad reach of the pandemic beyond the direct lethality of the virus itself.
“The bulk of the excess deaths were a direct result of COVID-19 infections, but pandemics have major cascading impacts on all aspects of society,” said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.
He cited many health impacts beyond COVID-19, including a sharp rise in drug overdoses as people with opioid use disorder struggled to get treatment or used drugs in isolation, and a drop in cancer screenings, such as mammograms and colonoscopies. The CDC previously reported that more than 93,000 people died of drug overdoses in 2020, a record number that far surpassed deaths from homicide and traffic accidents combined.
The CDC has found that 74% of COVID-19 deaths occurred among people ages 65 and older. Anderson said many elderly and frail people found themselves isolated because of precautions against viral spread. During the initial wave of infections, when the country shut down, the quality of care for the most vulnerable populations probably suffered, Anderson said.
Deaths from Alzheimer’s disease exceeded the expected total by 66,000 during the course of two years, he said. “People with dementia, in isolation, they sometimes lose the will to live,” Anderson said.
Some critics of shutdowns have argued that they caused more harm than good. That has been a contentious issue since the first weeks of the outbreak in the U.S., when infections were doubling every few days and hospitals in hotspots like New York City were in danger of being overwhelmed.
The country largely shut down for 45 days, with schools going to remote learning, restaurants closing or going strictly to takeout and airports turning desolate. Many people essentially sheltered in place. That set up a secondary health crisis, as people canceled cancer screenings, ignored warning signs of heart problems or possible strokes and failed to receive the kind of medical care and support they needed.
Adalja said the excess deaths associated with the pandemic but not directly caused by the virus suggest that in a crisis such as this, the country should favor targeted rather than broad public health interventions.
The roller-coaster trendline of excess deaths as tracked by the CDC captures the multiple waves of infection that struck the U.S. since early 2020. There have been five waves total. At one point last March and April, the mortality numbers came very close to returning to normal.
The CDC records show a small, but distinct spike in deaths in late 2017 and early 2018 driven by an unusually severe flu season. But that was a tiny bump compared with what the CDC has seen since the start of the coronavirus.
Anderson said the CDC had to adjust its algorithm for estimating excess deaths last fall as the pandemic continued. Although the mortality branch has given a precise number for excess deaths, the data from the past couple of months is incomplete, he said. For January, for example, the CDC estimates that only about 85% of the death certificates have reached the agency, he said.
Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, said Tuesday that his published studies on excess deaths during the pandemic have consistently shown that 80% to 85% were caused by the virus directly.
The remainder can largely be attributed to disruptions caused by the pandemic, he said. “The economic and psychological stresses of the pandemic take their toll,” Woolf said.
The pandemic exacerbated existing health disparities and led to much higher mortality among Black and Hispanic people, particularly early in the crisis, research has shown. A Washington Post analysis last year found that at the time, in the 40-to-64 age bracket, 1 in 480 Blacks, 1 in 390 Hispanics and 1 in 240 American Indians had died during the pandemic compared with 1 in 1,300 Whites and Asians.
The U.S. on the whole has an unusually high rate of chronic health conditions such as obesity, diabetes and heart disease and has a long-recognized “health disadvantage” compared with other wealthy nations.
That disadvantage was exacerbated by a weak and scattershot response to the pandemic, Woolf said. Other countries that reacted more quickly or took more aggressive postures to control viral spread early on were able to limit their death toll as well as long-term economic impacts, he said.
“We did not handle it well. That’s glaringly obvious,” he said. “The other countries got hit by the same virus, but no country has experienced the number of deaths we have, and even if you adjust for population, we are among the highest in the world.”
The Washington Post’s Dan Keating contributed to this report.