The COVID-19 pandemic brought a significant health crisis to the United States, resulting in a profound loss of life and placing immense strain on communities and healthcare systems nationwide.
How COVID-19 Deaths Are Counted
Tracking COVID-19 fatalities in the U.S. primarily involves the Centers for Disease Control and Prevention (CDC) and state health departments. The National Center for Health Statistics (NCHS), part of the CDC, collects vital statistics, including death records. Provisional death counts are based on death certificates processed by NCHS.
A death is counted as COVID-19 related if the virus is listed as a contributing cause on the death certificate, even if laboratory confirmation is not available. This includes cases where COVID-19 is reported as a “presumed” or “probable” cause. Death counts can vary between NCHS data and those reported by state and local health departments due to differing reporting methods and processing times. Death certificate information typically takes about two weeks longer to be reflected in daily updates compared to real-time surveillance systems.
Who Was Most Affected
COVID-19 fatalities in the U.S. showed clear demographic patterns, with certain groups experiencing disproportionately higher mortality rates. Older adults, particularly those aged 65 and above, faced the highest risks. Individuals with pre-existing health conditions, or comorbidities, such as heart disease, diabetes, obesity, and chronic obstructive pulmonary disease, also had a significantly increased vulnerability to severe outcomes and death.
Racial and ethnic disparities were also observed in COVID-19 mortality. Hispanic and Black individuals were overrepresented among deaths compared to their proportion in the general population. For instance, during May to August 2020, Hispanic individuals accounted for 24.2% of deaths and Black individuals for 18.7% of deaths, exceeding their population proportions.
Key Factors Impacting Fatalities
The emergence of new viral variants significantly influenced COVID-19 fatalities. The Delta variant, which became predominant in the summer of 2021, was associated with a sharp increase in hospitalizations, intensive care unit (ICU) admissions, and deaths among unvaccinated individuals. In contrast, while the Omicron variant, emerging in late 2021, led to record numbers of cases due to its high transmissibility, it generally appeared to cause less severe disease than Delta.
Vaccination status played a substantial role in reducing severe illness and death. COVID-19 vaccines offered high protection against severe disease, hospitalization, and death. Unvaccinated individuals were significantly more likely to become infected or hospitalized compared to those who were fully vaccinated.
The strain on healthcare systems also directly impacted fatality rates. Surges in COVID-19 admissions, particularly those overwhelming intensive care unit bed capacity, led to additional excess deaths. When ICU bed occupancy reached 75% capacity, an estimated 12,000 additional excess deaths occurred nationally within two weeks, and this number rose to approximately 80,000 when capacity exceeded 100%. This strain impacted not only COVID-19 patients but also those needing care for other conditions, as resources and staffing became limited.
Public health interventions, such as masking and social distancing, were implemented to mitigate viral spread and severe outcomes. These non-pharmaceutical interventions (NPIs) were associated with reductions in COVID-19 incidence and transmission. For example, physical distancing was linked to a 25% reduction in incidence of COVID-19. Collective efforts from NPIs and vaccination are estimated to have prevented millions of COVID-19 related deaths in the United States.
Beyond Direct COVID-19 Fatalities
The concept of “excess mortality” provides a broader understanding of the pandemic’s impact on overall death tolls. Excess mortality refers to the number of deaths from all causes that are above what would typically be expected in a given period.
During the first year of the pandemic, an estimated 646,514 excess deaths occurred in the United States, representing a 22% increase over expected fatalities. While approximately 83% of these excess deaths were directly attributable to COVID-19, other causes also saw increases. For instance, deaths from strokes were 7% higher than expected, and diabetes-related deaths were 16% higher. Increases in accidental fatalities, drug overdoses, and homicides also contributed to excess mortality, reflecting disruptions to healthcare access, mental health services, and societal structures.