There were more deaths recorded in New Hampshire in 2020 than in any year in recent history, a bleak result of a pandemic that has upended how residents of the state live and die since COVID-19 first emerged locally last March.
The sharp rise in fatalities is due in large part to the hundreds of people who died from the coronavirus. But it's also fueled, statisticians and public health experts say, by residents likely delaying necessary health care or lifesaving medical attention.
According to figures from the New Hampshire Division of Vital Records, 13,585 residents died last year, a jump of 840 deaths from the previous year.
It can be difficult to predict the number of fatalities in any year. But University of New Hampshire Senior Demographer Ken Johnson said even before COVID-19 emerged, it was “almost inevitable that the number of deaths was going to rise” in 2020. Johnson pointed to an aging population, along with so-called "deaths of despair" from overdoses and suicides, as non-COVID reasons for a rising trend in death tallies.
“But certainly it would not have risen to the number it was had it not been for the COVID epidemic,” said Johnson.
According to statistics released by the state health department, 811 residents died of COVID-19 in 2020. With that official death toll, the coronavirus became one of the leading causes of death in the state, outpacing other common fatal illnesses including heart attacks or Parkinson’s disease.
The number of COVID-19 deaths recorded last year was more than double the number of drug overdose fatalities. The coronavirus killed more people than pneumonia, motor vehicle accidents and suicide combined.
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The virus also altered where people in New Hampshire are dying.
Death certificates in the state track the location of death, allowing researchers to watch for trends. After holding fairly constant during the past five years, the number of fatalities recorded at home spiked in 2020.
Medical providers cautioned early in the pandemic that they were seeing a steep decline in non-COVID patients arriving at emergency rooms, signaling that some residents with serious conditions — from heart attack to stroke — may have been delaying care due to fears of catching the virus, and perhaps were dying at home. There was also a decline in deaths recorded inside hospice facilities.
Researchers are continuing to track so-called “excess deaths” recorded during the pandemic, which the Centers for Disease Control and Prevention define as “the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods.”
“The causes of excess deaths really fall into two buckets: one is misidentified COVID-deaths,” said Lauren Rossen, a health statistician at the National Center for Health Statistics, a division within the CDC. This could include people who died of COVID-19 who were never tested for the virus, or those who, for whatever reason, the virus wasn’t noted on their death certificate.
The other category of excess deaths are labeled as “indirect,” according to Rossen. These could include residents who failed to seek medical attention for a heart attack because of fear of catching the virus in a hospital or other lifestyle changes that resulted in more deaths during the pandemic.
The CDC currently places the number of excess deaths in the United States somewhere between 538,615 and 635,579. The agency’s same model shows 535 to 1,365 excess deaths for New Hampshire. (The low end of that forecast is below the number of official COVID-19 deaths recorded by state health officials because of reporting lags at the National Vital Statistics System.)
With 1,237 COVID-19 deaths reported in New Hampshire through March 31, the CDC’s estimate suggests the state has not suffered as many excess deaths as some other states, including California, Texas and Florida.
“In terms of what we are seeing across other states, where maybe undercounting was a bigger concern, particularly early on last year, it seems like New Hampshire does not necessarily have that problem,” Rossen said.
New Hampshire's official COVID-19 death toll is updated daily by the Department of Health and Human Services. According to State Epidemiologist Dr. Benjamin Chan, the state’s tally is based on official death certificates, which list a cause or contributing cause of death.
“Are we capturing 100% of people that have died of COVD-19? Probably not, especially if COVID-19 wasn’t listed on a death certificate as a cause of death,” Chan said. “But there are not hundreds of deaths that are out there that were caused by COVID-19 that we are not capturing, we don’t believe.”