Kathy Davis passed away on March 24, 2020, having fallen ill shortly after an overseas vacation with her husband. The Iowa Department of Public Health later determined that the retired community college counselor from Dubuque was the first Iowan to die of the novel coronavirus.

One year later, the state’s official website shows that 5,689 Iowans have died of COVID-19. The real death toll is somewhat higher, since the process of confirming and reporting coronavirus deaths usually involves weeks of delay. In addition, some Iowans who died in the early weeks of the pandemic may not have had a positive test during their illness.

This post attempts to put Iowa’s coronavirus fatality numbers into context. But since statistics don’t convey the loss that thousands of families have experienced, I hope readers will take time to reflect on those who have passed. The Dubuque Telegraph-Herald’s Bennet Goldstein wrote about Kathy Davis and her widower Chuck’s journey of bereavement. The Carroll Times Herald’s Jared Strong covered the aftermath of a card game among friends in Crawford County. Newspaper reporters from around the state have profiled hundreds of the dead as part of the Iowa Mourns series, available on the Des Moines Register’s website. One of those featured was Jay Daniels, a longtime family friend whose funeral we couldn’t attend, due to COVID safety protocols.

Bereavement on this scale is hard to fathom, especially in a culture some might call “grief-illiterate,” where death is often “unseen and denied.” Even so, it’s worth looking at the numbers.

About one in every 555 Iowans who were alive before the pandemic have died of COVID-19.

We won’t have a precise death count for this past year anytime soon. It often takes four to six weeks, and sometimes months, for a COVID-19 fatality to be confirmed by the U.S. Centers for Disease Control (CDC) and added to coronavirus.iowa.gov. The 5,689 deaths we know about are equivalent to one in every 555 of Iowa’s population of 3,155,070, as estimated last June.

Since March 24, 2020, only five days have passed without at least one Iowan dying of COVID-19.

You may have seen many headlines touting “no new deaths” from COVID-19. Those reports were filed when the state hadn’t added any deaths to the website over the past 24 hours. The reporting confused many news consumers, who might reasonably assume no Iowans had died of the virus the previous day. But coronavirus deaths have often been reported in large batches, including fatalities that occurred on many different dates, after one or more days of “no new deaths” on the website.

A bar graph on the state’s deaths dashboard shows the number of Iowans who died on each day, based on the date on the death certificate. Only the following dates have zero recorded fatalities: March 25, April 6, June 21, June 24, and June 29.

November was the deadliest month, as the virus claimed 50 Iowans a day.

I used the state’s data to create this graph. I didn’t include any numbers from this month, because most of the deaths that likely occurred in the past several weeks haven’t been reported yet. You can see the huge spike in deaths during November. The deadliest day of the pandemic was November 19, when 75 Iowans died of COVID-19.

After the first peak in May, Iowa’s COVID-19 deaths slowed in June and early July, then steadily increased through the late summer and jumped sharply in the fall. More than 100 Iowans were dying every week in October, and that many passed away approximately every two days in November and early December.

To illustrate the acceleration, I calculated the number of days it took to add 100 to Iowa’s COVID-19 death toll and included those figures in an appendix at the end of this post. Here are the confirmed COVID-19 fatalities for each month since the beginning of the pandemic:

• March 2020: 11
• April 2020: 170
• May 2020: 383
• June 2020: 150
• July 2020: 176
• August 2020: 270
• September 2020: 261
• October 2020: 523
• November 2020: 1,507
• December 2020: 1,220
• January 2021: 709 (should increase slightly as CDC processes death certificates)
• February 2021: 256 (will increase substantially)
• March 2021: 52 (will increase substantially)

UPDATE: Iowa’s official website continues to attribute newly reported deaths to dates months in the past. As of April 4, the death toll stands at 525 for October, 1,510 for November, 1,279 for December, 714 for January, 274 for February, and 99 for March.

COVID-19 was Iowa’s third leading cause of death in 2020.

Data from the state’s website indicates that 4,671 Iowans died of COVID-19 during the 2020 calendar year. A database on the U.S. Centers for Disease Control’s website shows 4,818 COVID-19 deaths for Iowa during the 53 weeks considered part of 2020 (ending on January 2, 2021). I’m looking into that discrepancy. Either way, the virus would easily be the third leading cause of death for last year.

Heart disease and cancer have consistently been the top causes of death in Iowa, far exceeding any other condition. Unofficial weekly figures from that CDC database of weekly deaths suggest that 7,545 Iowans died of heart disease during 2020, and 6,290 died of cancer. Both figures are in the ballpark of total fatalities recorded for those health problems in recent years.

The virus is on track to be the among the top five causes of death in Iowa this year.

Since January 1, at least 1,017 Iowans have died of COVID-19, the state website shows. That’s enough to be the seventh leading cause of death over the course of a whole year, even if not one more Iowan dies after today.

Unfortunately, reported deaths for February and March are nowhere near final. Current hospitalization numbers (while down roughly 90 percent from the peak in November) suggest that at least 100 more Iowans will die of COVID-19 in the coming month. The state continues to report hundreds of new cases a day. Some percentage of those people will become severely ill. (UPDATE: As of April 4, at least 1,087 Iowans had died of the virus during the current calendar year.)

As the number of fully vaccinated Iowans increases, one hopes that far fewer Iowans will succumb to the virus this summer and fall. But more transmissible variants are spreading rapidly, and vaccine refusal rates appear to be high in some demographic groups. Those factors, combined with a seasonality effect common to coronaviruses, could lead to more surges in hospitalizations and deaths later in the year.

If Iowa’s COVID-19 deaths surpass 1,500 in 2021, the virus would be in the top five causes of death. If fatalities reach 2,000, the pandemic would likely become the state’s third leading cause of death for a second straight year.

COVID-19 was the primary cause of 9 in 10 Iowa deaths attributed to the virus.

Some deniers and conspiracy theorists have falsely claimed that few people have died of coronavirus, and that medical personnel have inflated the death counts in a scheme to collect more money. The CDC has found, and Iowa’s website confirms, that about 90 percent of those who died in the pandemic had COVID-19 as the “underlying cause” of death, while the remaining 10 percent of patients died of multiple causes, meaning that the virus was “a factor contributing to death.”

At this writing, 5,075 out of Iowa’s 5,689 total COVID-19 deaths (89.2 percent) are labeled “underlying cause,” while 614 deaths (10.8 percent) are listed as “contributing factor” deaths.

CDC data on causes of death by week does not show any suspicious drop in deaths from other widespread medical conditions last year, which would be the case if health care providers were fraudulently attributing deaths by other causes to COVID-19. On the contrary: Iowa’s excess deaths in any given month in 2020 (compared to 2019) roughly correspond to the number of coronavirus fatalities recorded during that month.

Iowa ranks 17th among the states in COVID-19 deaths per capita.

The New York Times website shows Iowa’s 5,689 deaths work out to about 180 deaths per 100,000 population. Only 16 states are doing worse in terms of per capita deaths. In about half of those, the virus spread widely before shutdowns and other mitigation measures went into effect in mid-March.

Charles Gaba created this visualization on March 18 for his ACAsignups blog, where he has been updating per capita case and death rates by state every week.

Iowa’s most densely-populated counties don’t have the highest death rates.

Intuitively, more densely populated urban areas should have higher per capita rates of COVID-19 cases and deaths. That isn’t the case in Iowa.

The most populous counties do have more total deaths than rural counties, but generally not more deaths as a share of the population.

The ten largest of Iowa’s 99 counties contain about 52 percent of the state’s population. According to the latest data, a combined 2,206 residents of Polk, Linn, Scott, Johnson, Black Hawk, Woodbury, Dubuque, Story, Pottawattamie, and Dallas counties have died of COVID-19–just under 39 percent of the state’s death toll. The New York Times website has a user-friendly table that can be sorted by total cases or deaths per capita.

Only three of the ten largest counties have per capita death rates above the statewide average (180 deaths per 100,000 population). Woodbury (Sioux City area) and Black Hawk (Waterloo/Cedar Falls) were both affected by massive outbreaks in meatpacking plants during the early months of the pandemic. Dubuque was an early hot spot as well.

The other seven counties in the top ten by population are below the statewide average for per capita deaths. In fact, the three counties with the lowest per capita death rates are Story (46 deaths, 47 per 100,000 population), Johnson (77 deaths, 51 per 100,000 population), and Dallas (93 deaths, 100 per 100,000 population). In all three of those counties, more than 50 percent of residents over age 25 have at least a bachelor’s degree, compared to just under 29 percent for Iowa as a whole. Perhaps their residents were more receptive to scientific advice about face coverings and social distancing. Johnson and Story counties both contain college towns, so their residents are considerably younger on average. Household income in Dallas County, home to fast-growing far western suburbs of Des Moines, is substantially higher than the statewide average.

Six Iowa counties are among the top 100 nationally for COVID-19 deaths per capita.

Every week, Gaba has been compiling tables showing the counties across the U.S. that have the highest rates of COVID-19 cases per capita and deaths per capita. The latest installment, based on data from March 18, shows the following Iowa counties in the top 100. All of these counties have per capita death rates more than double the statewide rate (180 deaths per 100,000). Although Gaba presents the data in terms of deaths per 10,000, I converted the figures to deaths per 100,000, to be consistent with the New York Times website.

• Harrison (51st nationally, 70 total deaths, 498 deaths per 100,000 population)
• Ida (69th nationally, 32 deaths, 466 deaths per 100,000 population)
• Ringgold (84th nationally, 22 deaths, 450 deaths per 100,000 population)
• Louisa (96th nationally, 48 deaths, 435 deaths per 100,000 population)
• Emmet (97th nationally, 40 deaths, 434 deaths per 100,000 population)
• Adair (99th nationally, 31 deaths, 433 deaths per 100,000 population)

All of these are rural and heavily Republican areas, where residents may have been more resistant to follow recommendations on masks and social distancing. Louisa was an early hot spot due to an April 2020 outbreak at the Tyson meatpacking plant in Columbus Junction.

Nursing home residents accounted for nearly 4 in 10 Iowa deaths.

At this writing, the state’s website shows 2,225 residents of Iowa long-term care facilities died of COVID-19. That’s about 39 percent of all deaths. The figure does not include hundreds of Iowans like Jay Daniels, who became infected while residing in assisted living facilities that don’t meet the state’s definition for “long-term care.”

The Iowa Department of Public Health refuses to disclose how many nursing home employees have died of the virus.

During the summer and fall, the White House Coronavirus Task Force warned Iowa officials that community transmission was leading to nursing home outbreaks and “many preventable deaths.” The task force repeatedly recommended stronger mitigation policies such as a statewide mask mandate, capacity restrictions on restaurants and bars, and limits on the size of social gatherings.

Older Iowans accounted for the vast majority of deaths.

The website indicates that 58.8 percent of Iowans who died of COVID-19 were at least 80 years old, and another 21.9 percent were between the ages of 70 and 79. About 12.6 percent of Iowans who died were aged 60 to 69. Only about 7 percent of those who died were under age 60, but that still works out to roughly 400 people–more than Iowa loses in vehicle accidents in a typical year.

Now that the majority of older Iowans have received at least one dose of a coronavirus vaccine, deaths in older age cohorts should substantially decrease. But it’s not yet clear whether vaccines will provide long-lasting immunity, or will remain effective against all COVID-19 variants of concern. In addition, some older Iowans may refuse to be vaccinated.

At least 22 educators or school staff have died of COVID-19.

Sara Anne Willette has been comprehensively tracking many data points related to the pandemic, including the spread of the virus in Iowa schools. One page on her Iowa COVID Tracker website is dedicated to coronavirus deaths in schools. She has published photos of most of the deceased and links to their obituaries.

I will end this post with a passage often read in Jewish services following the Mourner’s Kaddish, an Aramaic prayer recited for the dead: May the Source of peace send peace to all who mourn, and comfort to all who are bereaved.

---

Appendix: The pace of COVID-19 deaths in Iowa

Using daily deaths reported on coronavirus.iowa.gov, according to the dates on death certificates, I calculated how many days it took to add 100 deaths to the statewide total. I ended this tally in January 2021 because that is the last month for which we have reasonably accurate figures.

After the first confirmed coronavirus death in Iowa, 28 days passed before the total reached 100 deaths on April 21. After that, it took:

• twelve days to pass 200 (May 3)
• seven days to pass 300 (May 10)
• eight days to pass 400 (May 18)
• seven days to pass 500 (May 25)
• ten days to pass 600 (June 4)
• 22 days to pass 700 (June 26)
• 22 days to pass 800 (July 18)
• fifteen days to pass 900 (August 2)
• twelve days to pass 1,000 (August 14)
• eleven days to pass 1,100 (August 25)
• eleven days to pass 1,200 (September 5)
• twelve days to pass 1,300 (September 17)
• twelve days to pass 1,400 (September 29)
• eight days to pass 1,500 (October 7)
• five days to pass 1,600 (October 12)
• seven days to pass 1,700 (October 19)
• five days to pass 1,800 (October 24)
• six days to pass 1,900 (October 30)
• three days to pass 2,000 (November 2)
• three days to pass 2,100 (November 5)
• two days to pass 2,200 (November 7)
• three days to pass 2,300 (November 10)
• two days to pass 2,400 (November 12)
• two days to pass 2,500 (November 14)
• two days to pass 2,600 (November 16)
• two days to pass 2,700 (November 18)
• one day to pass 2,800 (November 19)
• two days to pass 2,900 (November 21)
• two days to pass 3,000 (November 23)
• two days to pass 3,100 (November 25)
• one day to pass 3,200 (November 26)
• two days to pass 3,300 (November 28)
• two days to pass 3,400 (November 30)
• one day to pass 3,500 (December 1)
• two days to pass 3,600 (December 3)
• two days to pass 3,700 (December 5)
• two days to pass 3,800 (December 7)
• two days to pass 3,900 (December 9)
• two days to pass 4,000 (December 11)
• two days to pass 4,100 (December 13)
• three days to pass 4,200 (December 16)
• three days to pass 4,300 (December 19)
• three days to pass 4,400 (December 22)
• three days to pass 4,500 (December 25)
• three days to pass 4,600 (December 28)
• five days to pass 4,700 (January 2)
• three days to pass 4,800 (January 5)
• three days to pass 4,900 (January 8)
• three days to pass 5,000 (January 11)
• five days to pass 5,100 (January 16)
• six days to pass 5,200 (January 22)
• five days to pass 5,300 (January 27)

Top image: Rabbi David Kaufman (left) resides over the funeral of Jay Daniels in May 2020. No one other than Jay’s son Ross Daniels and daughter-in-law Amy Ward were able to attend. Photo published with permission from Ross Daniels and Amy Ward.