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Impact of the COVID-19 pandemic in the United States

As COVID-19 cases and deaths continue to rise globally, what lessons can we learn from examining excess deaths in the United States?

In 2021, I wrote an article titled “Covid-19: One year on…” that looked at the impact of the COVID-19 pandemic in terms of “excess deaths” in the United States. Excess deaths are the number of deaths that occur over and above the number that would have been expected if the pandemic had not occurred.  Pre-pandemic, 2.84 million people died in the United States in 2018, and 2.85 million people died in 2019. However, in 2020, 3.27 million people died, so compared to the previous two years, there were more than 400 thousand excess deaths in the first year of the pandemic in the United States.

Excess death, as a metric to gauge the impact of a pandemic, avoids the controversy of determining whether a person died from COVID. Additionally, it relies on data that health departments routinely report to the Centers for Disease Control and Prevention (CDC). Counting excess deaths also incorporates indirect effects of the pandemic, including deaths due to overwhelmed medical systems and individuals avoiding necessary medical care for fear of contracting COVID, among other reasons. Thus, examining excess deaths provides insight into the pandemic’s overall impact.

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Have the Number of Excess Deaths Subsided?

In May 2021, using the latest CDC data, an article titled “578,555 people have died from COVID-19 in the US, or maybe it’s 912,345 – here’s why it’s hard to count,” I estimated the number of excess deaths since the beginning of the pandemic had increased to more than 630,000. However, some readers were not convinced, with one reader commenting, “It’s also possible that COVID merely hastened the deaths of people that would have most likely died within months anyway. If this is the case, we should see a dip once COVID deaths slow.” As we approached the third anniversary of the pandemic, I wondered, “Could this person be right?”

The simple answer is no, at least not to date. As Figure 1 shows, we have had and continue to have excess deaths from the start of the pandemic through today. At no point in the past three years has the weekly number of deaths in the United States been less than what we would have expected had the pandemic not occurred.

Figure 1. Weekly deaths in the United States. 
Note: The blue line is the expected number of deaths without a major disease outbreak.  The red highlights deaths in excess of the expected number.

Figure 1 plots the past six years of CDC data from 2017 through 2022. Each bar in the plot is the number of weekly deaths in the United States. In a non-pandemic year, the weekly number of deaths varies from an estimated low of 51,000 in the summer to an estimated high of around 59,000 thousand in the winter. The blue line depicts this seasonal variation, which is calculated using the pre-pandemic data (years 2017-2019) and then projected through 2022, accounting for the US population increasing about 0.8% per year. The parts of the bars colored in red above the blue line shows the excess deaths.

The winter of 2017-18 is noticeable in the Figure 1. That was a very bad flu year, where the CDC estimates about 52,000 people died from the flu, compared to a typical year in which about 12,000 to 15,000  Americans die from the flu. In the figure, the red tops of the bars for the winter of 2017-18 sum to almost 42,000 excess deaths.  But what is most striking is the contrast between the 2017-18 flu season and the excess deaths from 2020-22 during the pandemic. The size and duration of excess pandemic deaths dwarfs the bad flu year.

Clearly evident in the figure is the spike from the initial outbreak in early 2020 as well as the winter surge in 2020-21, the fall surge in 2021, and then the winter surge in 2021-22. In addition, after that last surge, the figure shows that excess deaths have continued. Most strikingly, the excess deaths from 2020 through 2022 sum to more than 1.4 million people. That is one extra death for every in every 240 people in the United States and an astonishing 16 percent increase in the death rate. Indeed, over the last three years the United States has averaged more than 450,000 excess deaths per year, making the COVID-19 pandemic the third leading cause of death. While the number of excess deaths is now lower compared to past surges, there were still more than 84,000 excess deaths in the fall of 2022. So, even at the lower rate – the equivalent of more than 336,000 excess deaths in a year – the pandemic remains the third leading cause of death.

Where Are the Excess Deaths Occurring?

Figures 2a, b, and c are maps of the lower 48 states color coded by the number of excess deaths per 100 thousand people for 2020, 2021, and 2022. The 2020 map shows that the upper Midwest, central, and southern states generally had higher rates of excess death than many western, upper New England, and some mid-Atlantic states. New England, New York and New Jersey also stand out, where the initial outbreak was particularly severe, particularly in New York City.  

Figure 2a. Excess deaths per 100,000 people by state in 2020.
Figure 2b. Excess deaths per 100,000 people by state in 2021.
Figure 2c. Excess deaths per 100,000 people by state in 2022.

This pattern generally continued into 2021, though excess death rates rose across most of the country. Even so, the higher rates in many of the southern states, as well as Montana, Wyoming, and West Virginia, stand in contrast to the upper midwest states and New England. It will be difficult to isolate any single cause for this. Still, there seems to be a high correlation between excess deaths and the pandemic management policy differences between these regions. 

The good news is that in 2022, relative to 2021, excess deaths have come down across almost the entire country. One exception is Hawaii, where the excess death rate was the lowest of all the states in 2020 (30 per 100,000) and has risen in the subsequent years to 76 per 100,000, though this is still among the lowest rates in the country. Alaska also began with one of the lower rates in 2020, but in 2021 and 2022 has experienced excess death rates similar to Alabama.

The New Normal?

Three years after the start of the pandemic, the United States has returned to some semblance of normality, yet at the same time, the country continues to experience higher than normal death rates. While the spikes in excess deaths due to the waves of COVID that swept the country have abated over the past year, COVID remains the third leading cause of death, with perhaps as many as 1.4 million extra Americans having died during the pandemic over the past three years. It is a human toll with which we have yet to come to grips.

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Journal reference

Rigdon, S. E., & Fricker Jr, R. D. (2020). Monitoring the Health of Populations by Tracking Disease Outbreaks: Saving Humanity from the Next Plague. CRC Press.

Dr. Ron Fricker is the Vice Provost for Faculty Affairs at Virginia Tech and a Professor of Statistics. He has served as the Head of the Department of Statistics and the Interim Dean of the College of Science. Dr. Fricker holds a Ph.D. and an M.A. in Statistics from Yale University, an M.S. in Operations Research from The George Washington University, and a B.S. from the United States Naval Academy. He is a Fellow of the American Association for the Advancement of Science, a Fellow of the American Statistical Association, and a member of the Virginia Academy of Science, Engineering, and Medicine.