What Is the Real Coronavirus Toll in Each State?

As the coronavirus pandemic cuts through the country, it is leaving behind large numbers of deaths that surpass those of recent history. A New York Times analysis of state data from the Centers for Disease Control and Prevention shows just how many lives are being lost in the pandemic in each place — as the virus kills some people directly, and other lives are lost to an overwhelmed health care system and fears about using it.

Our analysis examines deaths from all causes, beginning in mid-March when the virus took hold in the country and examines every state with reliable data. The death count so far is not uniform around the nation. Some places have seen staggering death tolls, while others have seen smaller aberrations from historic patterns. In some states, the number of deaths so far looks roughly in line with those in a typical year, suggesting that the virus and its effects throughout medicine and society have not yet had a major impact on survival.

New York City, long the epicenter of the U.S. outbreak, has experienced the most extreme increase in deaths, which surged to six times the usual number. Altogether, since mid-March deaths there are 23,000 higher than normal.

Where deaths are far above normal

All of these numbers are likely to be a substantial undercount of the ultimate death toll, since death counting takes time and many states are weeks or months behind in reporting.

But comparing recent totals of deaths from all causes can provide a more complete picture of the pandemic’s impact than tracking only deaths of people with confirmed diagnoses. Indeed, in nearly every state with an unusual number of deaths in recent weeks, that number is higher than the state’s reported number of deaths from Covid-19. Epidemiologists refer to fatalities in that gap between the observed and normal numbers of deaths as “excess deaths.”

Measuring excess deaths is crude because it does not capture all the details of how people died. But many epidemiologists believe it is the best way to measure the impact of the virus in real time. It shows how the virus is altering normal patterns of mortality where it strikes and undermines arguments that it is merely killing vulnerable people who would have died anyway.

Our charts show weekly deaths above or below normal in each state through the most recent week, with data the C.D.C. estimates to be at least 90 percent complete. Those determinations are based on states’ speed at reporting deaths in the past, and they mean that these state charts show death trends for slightly different time periods.

We supplemented the C.D.C. data with any coronavirus deaths that have been reported by The Times that have not yet been added to the C.D.C. database. Those totals were compared with a simple model of expected deaths based on the number of deaths in the past five years, adjusted to account for trends over time, like population changes. Public health researchers use such methods to measure the impact of catastrophic events when official measures of mortality are flawed.

Measuring excess deaths does not tell us precisely how each person died. It is likely that most of the excess deaths in this period are because of the coronavirus itself, given the dangerousness of the virus and the well-documented problems with testing. But it is also possible that deaths from other causes have risen too, as hospitals have become stressed and people have been scared to seek care for ailments that are typically survivable. Some causes of death may be declining, as people stay inside more, drive less and limit their contact with others.

Even in a normal year, it takes up to eight weeks for full death counts to be reported by the C.D.C. But this is not a normal year, and it is possible that because of the unusual number of recent deaths and the stresses they are placing on medical examiners and public health officials, the totals will take even longer than usual to become complete. We will keep updating the numbers regularly as new data becomes available.

Where deaths are slightly above normal

In a larger group of states, the increases in deaths were more modest during the early phase of the pandemic, but deaths are still higher than normal.

Where deaths look normal, so far

There are still some states that appear to have been largely spared from an unusual number of deaths during this period. In those places, the patterns of death look roughly similar to those in recent years. A few states in this category have seen their fortunes worsen in recent weeks, and they may begin showing excess deaths as more weeks of complete data are reported.

In some of these states, deaths are actually below the normal trend. That may be because of data reporting lags. But it could be because of the pandemic, too: Stay-at-home orders may be lowering death rates from car accidents in some places, or flu in others.

How excess deaths compare with the official coronavirus counts

In nearly every state with more deaths than normal, the total number of them exceeded the official number of measured Covid-19 deaths. Given the limitations on coronavirus testing in the United States, this gap is not a big surprise. Similar gaps have been found in other countries with high numbers of Covid-19 deaths.

Our analysis aims to show mortality statistics for as much of the country as possible, but there are some places that are so far behind in submitting death certificates to the C.D.C. that comparing their reported totals to historical trends would not show much. In Connecticut, for example, zero deaths have been reported to the federal government at all since February 1.

Several other states and Puerto Rico have less extreme data lags, but are far enough behind that the C.D.C. does not recommend relying on their recent death reporting. In Pennsylvania and Ohio, death reporting seems to be lagging far behind the normal rate all year, according to the C.D.C., even though their reporting is usually more timely, so we have omitted data from them as well. The complete list of missing places is: Alaska, Connecticut, Louisiana, North Carolina, Ohio, Pennsylvania, Puerto Rico, Rhode Island, South Dakota, Virginia and West Virginia.

Tracking the Coronavirus