18,849 more Chicagoans have died over the past two years than what would be expected. It goes beyond COVID. Here’s what happened, and what the future may look like.

18,849 more Chicagoans have died over the past two years than what would be expected. It goes beyond COVID. Here’s what happened, and what the future may look like.

Written by and
Edited by Derek Kravitz

Over the past two years, nearly 19,000 more people have died in Cook County than what would have been expected — a figure that demonstrates the enormous toll of the pandemic since the virus claimed its first life here in March 2020.

While the virus itself killed nearly 1 million people across the U.S., the data also shows the pandemic corresponded with a spike in local deaths from other causes, including heart disease, drug overdoses and shootings, according to an analysis of county, state and federal statistics as part of an ongoing collaboration between the Sun-Times and the Documenting COVID-19 project at Columbia University’s Brown Institute for Media Innovation and MuckRock.

In a normal, pre-pandemic year in Cook County, between 40,000 and 42,000 people die, according to Illinois Department of Public Health data. But in 2020, that figure topped 52,000. In 2021 it remained high, at more than 47,000.

The additional deaths over the last two years, an estimated 18,849, amount to a city the size of west suburban Bellwood.

And the death count will likely stay at an unusually high level in 2022, with the first two months worth of data showing similar trends.

The Cook County numbers mirror what national studies have found but are still stunning nevertheless, experts say.

“Nineteen thousand excess deaths over two years in Cook County alone is a staggering number,” said Dr. William Parker, an assistant professor of pulmonary critical care medicine who is also assistant director for the University of Chicago’s MacLean Center for Medical Ethics.

He likened the impact to “a 777 crashing at O’Hare Airport and killing all the passengers inside twice a month.”

Nearly 75% of these deaths — some 13,970 people and counting — have been directly attributed to the virus, according to the U.S. Centers for Disease and Control Prevention.

But the rest have been linked to a variety of other causes, including hypertensive heart disease, diabetes and stroke. Many of those can also be chalked up to the impact of the pandemic, either because patients delayed treatment for preexisting conditions or the virus was undiagnosed or misdiagnosed.

Before the pandemic, no one would have predicted with any certainty that a looming mass-casualty event — a natural disaster, a terrorist event or a viral disease like COVID-19 — would cause so many deaths in such a short period of time.

“It would have been inconceivable” to imagine, said Dr. Paul Casey, chief medical officer at Rush University Medical Center.

What’s more, the excess deaths represent a step back after years in which the medical community had largely been focused on lowering fatalities from things like diabetes, hypertension and heart disease.

“We always like to think that with the scientific progression of medicine, we should be seeing less deaths and closing some of these gaps,” Casey said.

What’s more, the analysis shows that while most who died had comorbidities that contributed to their deaths, they likely would have led longer lives if not for the virus. Several studies have shown that COVID-19 has cut roughly 10 years of life from those it kills.

Reflecting that point: While nearly 74% of official Cook County COVID-19 deaths were among those aged 65 or older, nearly 3,800 COVID-19 deaths were for those between the ages of 15 and 64.

Diabetics and hypertensive patients Casey treated, many of whom had survived for decades with treatment, didn’t make it after contracting COVID.

“Those patients would not have died,” Casey said. “These are individuals that have lived with chronic disease for many years that were killed as a result of the pandemic.”

Spike in deaths from other causes

Another 25% of the excess deaths uncovered in the analysis — about 4,800 Cook County residents — died of other causes.

Some of these non-COVID deaths resemble the virus in some of their symptoms, public health experts say, including some of the Chicago area’s deadliest killers: hypertensive heart disease, diabetes and stroke.

But others — drug overdoses, shootings and motor vehicle accidents, to name just a few — have also increased over the past two years. These deaths particularly impacted younger residents.

Since 2016, drug overdose deaths in Chicago have surged, largely due to fentanyl, a synthetic opioid more potent and cheaper than heroin, being mixed in with other drugs.

But since 2019, opioid overdoses have started to rise in the Black community, said Dr. Ponni Arunkumar, Cook County’s chief medical examiner.

Those closely watching the trends say they are likely to continue, leading to more deaths in the coming years.

“This trend has been ticking up a great deal, especially on the West Side,” state Rep. La Shawn Ford, D-Chicago said of overdoses.

Ford started the West Side Opioid and Heroin Task Force in 2016 to tackle rising overdoses in the Black community. They distributed and trained people to use the overdose antidote Narcan.

But the last two years saw a worsening of the opioid epidemic when the public health system built to help users was disrupted.

“The pandemic really derailed the support people were getting for substance use disorder,” Ford said. “They were disconnected from care. They were told not to go to their doctors. Those people on MAT — medical assisted treatment [for methadone] — they lost access to their provider, which possibly caused them to go back to street drugs.”

The vast majority of Blacks who have died of accidental drug overdoses over the past two years — 1,600 and counting — were in their mid-to-late 50s (most white overdose deaths were among those in their 40s). And nearly 78% were men.

All told, the analysis found, hundreds of Black Cook County residents have died in the past two years from drug overdoses over what would be expected. And that number is still incomplete — it will only rise for the next several months as toxicology and other lab reports are completed.

Overall, one of the more uncomfortable truths of the pandemic still holds in Cook County for both COVID and non-COVID deaths: Black and Hispanic Chicago and suburban residents died at disproportionately higher rates than whites.

According to CDC data for Cook County that covers deaths in 2020 and 2021, all racial and ethnic groups showed increases in death rates. But while White death rates rose 10.6%, Black rates rose 31%, Asian rates rose 40% and Hispanic rates saw a 53.5% increase in the two-year span.

“The racial and ethnic disparities in deaths can be directly attributed to economic disadvantage and structural inequity in the distribution of healthcare resources,” Parker said.

Other racial differences seen in records

There’s also differences in how unexplained deaths are treated for white and Black residents.

When local doctors, medical examiners and those who fill out death certificates assign a cause of death for white Chicagoans in those uncertain cases, they are more likely to describe the death as related to “senile degeneration of the brain,” a vague term that epidemiologists say is unclear and shouldn’t be used, the data shows.

Senile degeneration of the brain deaths are concentrated with the elderly — 72% of these deaths over the past two years have been among people aged 85 or older.

In the case of many Black residents, where COVID or a similar cause might be suspected, deaths are described differently, using a code called R99 or “Other ill-defined and unspecified causes of mortality.”

Arunkumar, the medical examiner, said her office would “never” use either term in the death certificates it oversees. That means those terms are being used in nursing homes, clinics or by attending physicians.

The result is an unclear, and ultimately, inaccurate picture of who is dying of what in Chicago and its suburbs.

COVID changed how Cook County handled the dead

With such a huge spike in deaths, the pandemic, like many disasters that preceded it, changed how Cook County responded to death.

After the crash of American Airlines flight 191 on May 25, 1979, which killed 273 people, and a deadly heat wave in July 1995, which killed more than 700 people, officials took steps to not only increase outreach to particularly vulnerable populations, including the homeless and elderly, but also to prepare for an influx of bodies using refrigerated trucks and warehouses.

When the virus struck in 2020, the medical examiner’s office — like many around the country — knew little of how the virus spread and who was most at risk. At death scenes, investigators wore N95 masks.

“We didn’t know how infectious it was,” Arunkumar said. “We really didn’t have an idea of what was going on.”

Before the pandemic, the medical examiner’s office could hold only 300 bodies at a time, but in spring 2020 it needed room for as many as 2,000 at a time. A refrigerated warehouse was leased to store the overflow.

But with the initial surge in deaths, errors and missed COVID-19 deaths likely fell through the cracks.

“Early on, not many people were aware of the COVID virus and infection,” Arunkumar said. “Some of them may have just been rolled into natural deaths.”

In an attempt to get more accurate counts, the medical examiner’s office would “hold the cases for a bit,” Arunkumar said, performing post-mortem nasal swabs and X-rays to spot COVID infections.

Data collection on deaths has improved greatly throughout the pandemic, experts said, but more investment in public health is needed to forestall future crises, experts say.

“It points to the need to double down our efforts and not allow this to happen again,” said Casey, of Rush University Medical Center.

How We Reported This Story

Underlying causes of death are defined by the U.S. Centers for Disease Control and Prevention as the “disease or injury that initiated the chain of morbid events that led directly and inevitably to death.” In practice and for statistical purposes, there is a level of discretion and interpretation by certifiers in filling out this field.

What that means: The final cause of death can vary wildly depending on who signs a death certificate. As a result, we looked at both “excess deaths” in Cook County, which reflect the increase in deaths from all causes over historical trends, and specific cause of death data from the CDC.

For this project, data related to total deaths and excess deaths in Cook County was obtained from month-by-month counts from the Illinois Department of Public Health.

For data related to specific underlying causes of death, we looked at year-over-year CDC data for the first seven months of each year from 2018 to 2021, analyzing cumulative excess deaths and excess deaths by ethnicity for each cause. We also normalized the death rates with U.S. Census population figures to represent the number of deaths per million across ethnicity, gender and age groupings.

For more information on the Documenting COVID-19 project’s work on undercounted and misclassified deaths, read our “Uncounted” series with the USA TODAY network and our repository of CDC mortality data.