The data presented in this report show a rapid reduction in the overall U.S. COVID-19–related mortality rate in March 2022. From April through September 2022, COVID-19–related mortality rates remained relatively stable; to date, this has been the longest interval during the pandemic in which the COVID-19–related mortality rate was <22 deaths per 100,000 population for all age groups. However, during this period, 2,000–4,500 COVID-19–related deaths were reported weekly. Further, a higher number of overall (all-cause) deaths occurred compared to the number that would be expected based on previous years of data (excess deaths).

Although overall COVID-19–related mortality rates declined, adults aged ≥65 years continued to have the highest mortality rates. During April–September 2022, the proportion of COVID-19–related deaths accounted for by adults aged ≥85 years increased to ~40% despite accounting for <2% of the U.S. population. COVID-19–related deaths among children remained rare. Although racial and ethnic disparities in COVID-19–related mortality have decreased over the course of the pandemic, disparities persisted. COVID-19 vaccines continued to reduce the risk of dying from COVID-19 among all adult age groups, including adults aged ≥65 years, with the greatest protection observed among older adults who received ≥2 booster doses.

COVID-19 was reported as the underlying cause of death for most COVID-19–related deaths. However, a higher proportion of COVID-19–related deaths had COVID-19 listed as a contributing cause of death during January–September 2022 compared to previous years of the pandemic. This finding was observed among persons dying in hospitals and, to a greater extent, in non-hospital settings such as long-term care facilities and hospice facilities, where a higher proportion of COVID-19–related deaths occurred than earlier in the pandemic. The reasons for these changes are unclear but might signal that 1) people who died outside of the hospital had other health conditions where the severity of those conditions was exacerbated by having COVID-19; 2) people infected with SARS-CoV-2 might have be hospitalized for another condition, but COVID-19 contributed to their death; or 3) that people who survived infection with SARS-CoV-2 continued to suffer COVID-19–related long-term health effects that contributed to their death.

Risk of dying while hospitalized for COVID-19 declined steeply during March–April 2022 and remained lower through August 2022 compared to rates observed during June 2021–February 2022. Risk of in-hospital death was highest for patients hospitalized for COVID-19 with ≥5 underlying medical conditions, patients with disabilities, and patients aged ≥80 years. In-hospital death among persons aged 18–49 years hospitalized with COVID-19 during May–August 2022 was rare (1% of COVID-19–associated hospitalizations); most of these patients were unvaccinated. The proportion of patients hospitalized primarily for COVID-19 that had an indicator of severe disease (e.g., required intensive medical intervention) also declined. Less severe COVID-19 disease among hospitalized patients could contribute to the lower rate of in-hospital deaths observed. Decreased use of intensive medical interventions among patients who died in-hospital with COVID-19 could also reflect the increased occurrence of deaths among older people with multiple comorbidities who might not have tolerated or benefited from such interventions or, who did not agree to intensive medical intervention.

Early treatment with COVID-19 medication can reduce the risk of COVID-19–related hospitalization and mortality among patients at risk for severe COVID-19.4-7 Use of outpatient COVID-19 treatment increased in 2022, particularly during April–July 2022 when nirmatrelvir/ritonavir (Paxlovid), an oral antiviral medication, became widely available. During this period, Paxlovid was the most commonly used outpatient COVID-19 medication among all age groups, with some differences in use by patient age, race and ethnicity, and type of immunocompromising condition.

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