Writing for Kaiser Health News, Louis Jacobson examines how the United States has been impacted by Covid-19 as the pandemic stretches into its third year.

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Covid-19 deaths during the pandemic

After the coronavirus arrived and began spreading across the United States, Covid-19 quickly became one of the leading causes of death in the country. According to CDC data, Covid-19 was the third leading cause of the death in the United States in 2020, behind only heart disease and cancer. In addition, deaths were primarily concentrated among Americans ages 65 and older, with the most deaths occurring among those 85 years and older.

"The leading causes of death are relatively stable over long periods of time, so this is a very striking result," said William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University.

In addition, Covid-19 deaths have remained relatively steady over the course of the pandemic, although there have been peaks and valleys due to seasonal factors and the emergence of new variants like delta and omicron.

According to Jacobson, there have been five distinct peaks in Covid-19 deaths throughout the pandemic: the initial peak in April 2020, a summer spike in August 2020, a winter spike in January 2021, a spike during the delta surge in September 2021, and a spike during the omicron surge in January 2022.

Differences in Covid-19's impact

The Covid-19 pandemic has highlighted certain health disparities. In particular, CDC data shows that people of color were more significantly impacted by Covid-19, especially regarding hospitalizations and death.

According to Jacobson, experts believe these disparities in Covid-19 outcomes can be linked to historical disparities in income, geography, medical access, and educational attainment.

Arthur Caplan, a professor of bioethics at New York University's Grossman School of Medicine, said there were "some effort[s] to correct the disparities," but these efforts were merely "band-aids on a system that remains broken."

There were also distinct differences in how different U.S. states fared during the pandemic. Adjusting for population, the states with the highest Covid-19 death rates per 100,000 people were Mississippi, Arizona, New Jersey, Alabama, Louisiana, Tennessee, West Virginia, Michigan, Arkansas, and Massachusetts.

In comparison, the states with the lowest Covid-19 death rates per 100,000 were Vermont, Hawaii, Utah, Maine, Alaska, Washington, Oregon, New Hampshire, and Nebraska.

"For all the grumbling you hear about federal mandates and enforcement, you can't help but look at this list and see that the pandemic has been handled state by state," Caplan said.

How the U.S. compares to other countries

Compared to other countries, particularly other wealthy, industrialized nations, the United States has largely had a middling pandemic performance.

According to data from Johns Hopkins University, the United States' Covid-19 death rate is 282.88 per 100,000—higher than many of its peer nations, including the United Kingdom, France, Germany, Italy, and Canada. The countries that have a higher death rate than the United States are mostly medium-size and middle income, such as Brazil, Croatia, Hungary, and Peru.

In addition, the United States' Covid-19 vaccination rate (65.59%) is higher than the world average (54.39%), but trails almost every other high-income country in the world.

Overall, Brook Nichols, an infectious-disease mathematical modeler at Boston University said the fact that the United States has both a lower vaccination rate and higher Covid-19 death rate than other high-income countries makes her "wonder how we might have done as a country if our pandemic response had not been so politicized and polarized." (Jacobson, Kaiser Health News, 3/7)