2020 Was Especially Deadly. Covid Wasn’t the Only Culprit.
The year 2020 has been abnormal for mortalities. At least 356,000 more people in the United States have died than usual since the coronavirus pandemic took hold in the country in the spring. But not all of these deaths have been directly linked to Covid-19.
More than a quarter of deaths above normal have been from other causes, including diabetes, Alzheimer’s disease, high blood pressure and pneumonia, according to a New York Times analysis of estimates from the Centers for Disease Control and Prevention.
Deaths attributed to other causes above normal
Some of these additional deaths may actually have been due to Covid-19, but they could have been undiagnosed or misattributed to other causes.
Many of them are most likely indirectly related to the virus and caused by disruptions from the pandemic, including strains on health care systems, inadequate access to supplies like ventilators or people avoiding hospitals for fear of exposure to the coronavirus.
40,000 extra deaths from diabetes, Alzheimer’s, high blood pressure and pneumonia
Research has shown that people with underlying health conditions such as diabetes, high blood pressure and heart disease are particularly vulnerable to severe illness and death if they contract Covid-19.
In several states, deaths attributed to diabetes are at least 20 percent above normal this year.
Deaths above normal from diabetes
United States
March 15 – Nov. 14
Deaths above normal
8,500
Percent above normal
15%
New Jersey
March 15 – Nov. 21
400
37%
Illinois
March 15 – Nov. 21
400
26%
New York City
March 15 – Nov. 21
300
24%
Louisiana
March 15 – Nov. 7
200
24%
Michigan
March 15 – Nov. 21
400
21%
Indiana
March 15 – Nov. 21
200
20%
Arizona
March 15 – Nov. 14
200
20%
Tennessee
March 15 – Nov. 21
200
20%
Florida
March 15 – Nov. 21
800
19%
Massachusetts
March 15 – Nov. 21
100
19%
Maryland
March 15 – Nov. 21
100
19%
Texas
March 15 – Nov. 21
800
18%
New York (excluding N.Y.C.)
March 15 – Nov. 21
300
18%
Pennsylvania
March 15 – Nov. 21
400
17%
Georgia
March 15 – Nov. 14
200
16%
Prolonged economic stress on families during the pandemic could also be contributing to increased deaths among those with chronic illnesses.
“You end up having to choose between your prescription medications or buying groceries or keeping a roof over your head,” said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, whose research in JAMA has also shown deaths from other causes to be higher than normal.
At least 10 states have seen deaths from high blood pressure — a common comorbidity like diabetes — rise even higher than the national percentage. These may include deaths from heart failure, kidney failure or stroke.
Many people who die from high blood pressure are also at high risk for severe Covid-19, so some of these deaths could be Covid-19 deaths that are missed, according to Robert Anderson, chief of the mortality statistics branch at the C.D.C.’s National Center for Health Statistics.
Deaths above normal from high blood pressure
United States
March 15 – Nov. 14
Deaths above normal
7,600
Percent above normal
11%
New York City
March 15 – Nov. 21
1,000
39%
Louisiana
March 15 – Nov. 21
200
27%
Michigan
March 15 – Nov. 21
600
24%
Mississippi
March 15 – Nov. 21
200
23%
Illinois
March 15 – Nov. 21
500
22%
New Jersey
March 15 – Nov. 14
200
22%
Georgia
March 15 – Nov. 7
500
20%
Maryland
March 15 – Nov. 21
200
18%
Texas
March 15 – Nov. 7
600
14%
Tennessee
March 15 – Nov. 21
200
13%
Indiana
March 15 – Nov. 21
100
12%
Pennsylvania
March 15 – Nov. 21
200
11%
Nationwide, deaths from Alzheimer’s disease, which usually affects older adults, are 12 percent above normal this year, with several Southern states seeing larger increases. This could be related to challenges in providing adequate care in nursing homes during the pandemic — deaths in nursing homes account for more than a third of the nation’s total coronavirus toll. The virus may have also aggravated some of these patients’ existing health conditions.
Other factors related to the pandemic like social isolation and challenges in getting emergency services could also have contributed to deaths, Dr. Woolf said.
Deaths above normal from Alzheimer’s disease and dementia
United States
March 15 – Nov. 14
Deaths above normal
21,300
Percent above normal
12%
New Mexico
March 15 – Nov. 21
200
29%
Louisiana
March 15 – Nov. 14
600
26%
Mississippi
March 15 – Nov. 14
300
22%
Texas
March 15 – Nov. 21
2,900
22%
Georgia
March 15 – Nov. 21
1,100
20%
Arizona
March 15 – Nov. 21
700
20%
South Carolina
March 15 – Nov. 21
600
20%
Colorado
March 15 – Nov. 21
400
19%
Maryland
March 15 – Nov. 21
500
18%
Nevada
March 15 – Nov. 21
200
17%
Michigan
March 15 – Nov. 21
900
17%
West Virginia
March 15 – Oct. 24
100
17%
Illinois
March 15 – Nov. 21
1,000
15%
Kentucky
March 15 – Nov. 21
400
15%
Florida
March 15 – Nov. 21
1,700
15%
Ohio
March 15 – Nov. 21
1,100
15%
New Hampshire
March 15 – Nov. 21
100
14%
California
March 15 – Nov. 21
2,300
14%
Virginia
March 15 – Nov. 21
600
14%
Indiana
March 15 – Nov. 21
500
13%
Puerto Rico
March 15 – Oct. 31
200
13%
New York City
March 15 – Nov. 21
200
13%
Nebraska
March 15 – Nov. 21
100
12%
Many of the higher than normal deaths from pneumonia are most likely Covid-19 deaths that were not identified as such, especially earlier in the pandemic when coronavirus tests were scarce. Chest X-rays from the virus and pneumonia also look especially similar, experts said.
New York City, an early epicenter of the pandemic, has seen pneumonia deaths reach about 50 percent above normal, more than double the percentage in the states with the highest rates.
Deaths above normal from pneumonia and flu
United States
March 15 – Nov. 14
Deaths above normal
3,000
Percent above normal
11%
New York City
March 15 – Nov. 21
400
50%
Tennessee
March 15 – Nov. 14
100
23%
Texas
March 15 – Nov. 21
300
19%
Michigan
March 15 – Nov. 14
100
18%
Florida
March 15 – Nov. 21
200
14%
Illinois
March 15 – Nov. 21
100
13%
As the pandemic has progressed, coroners and medical examiners have become better at recognizing the deaths caused by the virus.
Counting deaths takes time, and many states are weeks or months behind in their reporting. These estimates from the C.D.C. are adjusted based on how mortality data has lagged in previous years.
Dr. Woolf also warned that many people who are not captured in mortality statistics may still have adverse health outcomes.
“A person who survived the pandemic may end up deteriorating over the next few years because of problems that happened during the pandemic,” he said. This could include those who have missed routine checkups or have had delays in receiving proper treatment for an ailment.
Methodology
Total death numbers are estimates from the Centers for Disease Control and Prevention, which are based on death certificates counted by the centers and adjusted to account for typical lags in the reporting of deaths.
Only weeks in which the C.D.C. estimates the data to be at least 90 percent complete or in which estimated deaths are above expected death numbers are included. Because states vary somewhat in their speed in reporting deaths to the federal government, the data show death trends for slightly different time periods. Weeks in which reported deaths were less than 50 percent of the C.D.C. estimate were not included. Only jurisdictions with sufficient data were included for analysis of deaths by specific causes.
Expected deaths were calculated with a simple model based on the weekly number of deaths from previous years released by the C.D.C., adjusted to account for trends, like population changes, over time.
Excess death numbers are rounded.
Additional reporting by Josh Katz and Margot Sanger-Katz.