Covid-19 was the third-leading cause of death in the United States last year, surpassing accidental deaths, the Centers for Disease Control and Prevention reported Wednesday.
Only heart disease and cancer caused more deaths.
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What's more, the pandemic accelerated the U.S. death rate.
"In 2020, about 3.3 million deaths occurred in the United States. Overall, this represents a 16 percent increase in deaths from 2019," CDC Director Dr. Rochelle Walensky said at a news briefing Wednesday. Covid-19 deaths accounted for roughly 11 percent of deaths in 2020.
The report, from the CDC's National Center for Health Statistics, was based on death certificate data from January through December. Heart disease — long America's No. 1 killer — was the cause of approximately 690,000 deaths last year, according to the report. About 598,000 deaths were linked to cancer.
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Covid-19 was listed as a cause of death or contributing cause on approximately 375,000 such documents in 2020. (As of Wednesday, that number had risen to more than 540,000.) A small percentage listed Covid-19 as the only cause of death, while more than 97 percent listed Covid-19 along with other health problems.
A similar report from the CDC last year lead to concerns and even conspiracy theories that Covid-19 was not the true cause of death in the vast majority of cases.
But experts said those deaths would not have occurred had Covid-19 not made the victims' underlying conditions worse.
"From a physician who has taken care of these patients and signed way too many death certificates, I can tell you for a fact that patients died because of Covid-19," said Dr. Hugh Cassiere, director of critical care services at Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell Health, on Long Island, New York.
"These are people with underlying medical conditions, who, if they had not developed Covid-19, would still be alive," Cassiere said.
It has been well established that underlying health problems, such as obesity, kidney disease, high blood pressure and Type 2 diabetes, put a person at risk for severe outcomes of Covid-19.
A CDC study published this month found that nearly 80 percent of Covid-19 patients hospitalized in the U.S. were classified as either overweight or obese.
The new CDC report also confirmed that Covid-19 created a "plausible chain-of-event condition," meaning the infection directly caused other conditions, such as pneumonia or respiratory failure, listed on the death certificate.
"Overall, 70 percent to 80 percent of death certificates had both a chain-of-event condition and a significant contributing condition or a chain-of-event condition only," the report's authors wrote.
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Covid-19 death rates were higher among people over 85, men and racial and ethnic minorities, such as Hispanics, Black people and American Indian or Alaska Native populations.
"We continue to see that communities of color account for an outsized portion of these deaths," Walensky said. "Among nearly all of these ethnic and racial minority groups, the Covid-19-related deaths were more than double the death rate of non-Hispanic white persons."
Such inequity data "should give all of us pause," said Dr. Ezekiel Emanuel, chair of the department of medical ethics and health policy at the University of Pennsylvania. "It really is devastating."
And the true number of Covid-19 deaths may be much higher. "Limited availability of testing," the report's authors wrote, "might have resulted in an underestimation of Covid-19–associated deaths."