A researcher works in a lab developing testing for COVID-19 at Hackensack Meridian Health Center for Discovery and Innovation in New Jersey in 2020. New Jersey was the first state hit by high COVID-19 death rates in 2020 but now is the only state to have fewer deaths than before the pandemic. Photo by Kena Betancur.

By Tim Henderson
Indiana Capital Chronicle

U.S. — Several months after President Joe Biden ended the national emergency for COVID-19, preliminary health data indicates the historic degree to which the pandemic increased death rates nationwide — not just because of the virus itself, but also through the pandemic’s reverberating effects on society.

Deaths from vehicle crashes, homicides, suicides and overdoses spiked in many states during the national health emergency that began in January 2020. Deaths of despair, which include people who died by suicide or from an accidental overdose, reached their highest numbers during the first year of the pandemic. And even as fewer cars were on the roads during shutdowns, vehicle fatalities jumped.

Yet after historic increases during the pandemic, deaths in most of the country are nearing a return to pre-pandemic levels, according to a Stateline analysis of preliminary federal statistics.

Still, in the first half of this year, the death count in some states and the District of Columbia was much higher than it was during the first half of 2019. The District’s death count was 35% higher than before the pandemic, and in six states the count was at least 15% higher: Arizona, Delaware, Nevada, Tennessee, Texas and Utah.

Nationally, death counts for the first six months of 2023 are about 7.7% higher than they were for the same period in 2019, before the pandemic, the analysis found. That’s just a bit above the 6.7% increase to be expected anyway; counts routinely inch up annually with the United States’ aging population.

Before the pandemic, the historical trend since 1900 was for the number of deaths to rise a little every year as the population got larger and older, and for age-adjusted death rates to go down and life expectancy to rise every year due to advances in health and medicine.

COVID-19 played havoc with that pattern, bringing historic spikes in both death counts and death rates. Between 2019 and 2020, the number of U.S. deaths from all causes jumped 19%, a 100-year record. The current U.S. death toll from the virus is more than 1.1 million people, according to the World Health Organization.

The year-over-year spike in death rates between 2019 and 2020 surpassed that of the 1918 flu epidemic. In 2020, the death rate rose 17% to 835.4 per 100,000 people, compared with a 12% jump between 1917 and 1918. The death rate peaked at 879.7 in 2022.

Life expectancy in the United States dropped 2.7 years by 2021, the biggest dip in almost 100 years.

States where COVID-19 hit first, such as New Jersey and New York, are the closest to complete recovery.

Public health experts debate why deaths might be stubbornly high in some areas of the country — as in Arizona, where death rates rose the most between 2019 and 2022, and where increases in deaths continue to be high in preliminary 2023 data.

There’s some evidence that COVID-19 deaths have gone unrecognized, and that the chaos from the pandemic caused still more deaths by shutting sick people out of hospitals packed with COVID-19 patients.

Nationally, only about 62% of the increase in death rates between 2019 and 2022 is directly attributed to COVID-19, according to the Stateline analysis. But that might be an undercount because COVID-19 was not always detected as a cause, according to Boston University School of Public Health research published in January.

In the pandemic, unexplained or “excess deaths” tended to peak earlier than COVID-19 deaths did, suggesting that many deaths really were undetected COVID-19 deaths.

COVID-19 cases were more likely to be misclassified in Arizona, the Rocky Mountain states, the South and rural areas, than in New England and in mid-Atlantic states such as New Jersey and New York, the article said.

As deaths peaked in New Jersey in 2020, a report from the New Jersey Hospital Association said two trends suggested people were dying from lack of hospital care as well as COVID-19: an increase in deaths at home from conditions usually treated in hospitals, and a decrease in hospital admission for life-threatening emergencies like heart attacks and strokes.

New Jersey, despite being the first state hit hard by COVID-19 in 2020, is now the only state with fewer deaths in early 2023 compared with the first six months of 2019. Eight other states saw increases of about 2% or less, including New York, another of the states slammed early in the pandemic.

The other seven states with death rates falling back to normal are Connecticut, Illinois, Maryland, Mississippi, South Dakota, West Virginia and Wyoming.

COVID-19 is listed as a contributing cause of only 1,143 deaths in New Jersey so far this year, down from more than 14,000 in the same time frame in 2020. Similarly in New York, COVID-19 deaths were down to 2,685 from more than 32,000 early on.

But even Arizona is slowly returning to normal death patterns, despite spikes in February, April and May, according to an analysis by Allan Williams, an Arizona epidemiologist who collaborates on state reports. COVID-19 deaths in the state are down to fewer than a thousand so far this year, compared with about 7,000 at the peak during the same time period in 2021.

The state-by-state difference in COVID-19 deaths has been studied and discussed by experts for years. COVID-19 had the biggest cumulative impact on Arizona from 2020 to mid-2022, according to a study published this March in The Lancet, which concluded some states did better than others in extending health care access equitably and in convincing residents to get vaccinated.

Hawaii, which took an early hit economically when tourism from Asia stopped even before the pandemic hit the United States, has been one of the least-affected states in terms of deaths.

A White House Council of Economic Advisers analysis last year calculated that if deaths in the whole country followed Hawaii’s pattern, another 780,000 people would have survived the pandemic. Hawaii and New England states got high marks for health care during the pandemic, though Hawaii is facing new challenges from COVID-19 as well as wildfire deaths on Maui.

The Council of Economic Advisers study also suggested that lower rates of health insurance were associated with more deaths. Health insurance rates have been rising and reached an all-time high last year, the latest figures available. Among those states with death counts that are at least 15% higher this year than they were during the first six months of 2019, Arizona, Texas and Nevada were also in the top 10 for uninsurance rates as of 2021, and Tennessee was 11th.