Minnesota suffered more than 50,000 deaths in a year for the first time in recorded state history in 2020, mostly because of COVID-19 but also due to rising drug abuse and worsening racial health disparities.

A 15% increase in mortality from 2019 to 2020 demonstrates that the pandemic actually caused more deaths in Minnesota and wasn’t just a substitute cause for people who were likely to die anyway.

“COVID hasn’t just replaced the usual causes of mortality,” said Kris Ehresmann, state infectious disease director.

The increase of at least 6,483 deaths from 2019 to 2020 far exceeded the roughly 875 that Minnesota expected based on aging and disease trends.

Drug overdoses, alcohol poisonings and suicides — collectively known as “deaths of despair” — fueled 11% of this excess in 2020, according to a Star Tribune analysis of almost all death certificates for the year. Overdoses were the primary driver of this increase, while the number of suicides remained unchanged.

The pandemic accounted for 86% of the excess deaths, cutting many lives unexpectedly short. Minnesota so far has recorded 50,313 death certificates for 2020.

Retired machinist and avid golfer David Ihla wasn’t in perfect health — suffering from diabetes and hypertension at age 75 — but he looked forward to a long retirement pursuing a fourth hole-in-one and maybe, just maybe, seeing the Vikings in the Super Bowl.

David Ihla died of COVID-19 at 75. Photo provided.

“He was a healthy guy,” said his wife, Mary Ihla. “I mean, we thought it would be me that would die from it. I’ve had cancer. I have diabetes. … I had a heart attack.”

The Vietnam War veteran likely became infected during lunch at a local VFW. Both he and his wife were recovering from COVID-19 at their home in Blaine when he suffered blood clots and was placed on a ventilator at Mercy Hospital in Coon Rapids. Ihla died Nov. 16. He was buried in a Vikings jersey and received military honors and a rifle-volley salute in his hometown of Bottineau, N.D.

“David would have just been so happy about that,” his wife said.

Ehresmann said Minnesota and its leaders must accept some blame for the magnitude of this loss of life, though pandemics will always take a toll. The Spanish flu pandemic killed more than 10,000 Minnesotans in 1918-1919.

An aggressive lockdown of long-term care facilities this past summer increased protection of residents who have suffered 63% of the COVID-19 deaths in Minnesota, but after a wave of deaths in the spring. Pandemic fatigue led to reduced mask-wearing and social distancing in the fall, just as the reopening of schools led to more face-to-face interactions and a second, larger wave of COVID-19.

“There is no way you could expect this kind of pandemic and not see deaths,” Ehresmann said. “What’s concerning to me is there have been definite points in time when the number of deaths was well, well beyond what it needed to be.”

White people comprise 80% of Minnesota’s population and suffered 86% of the COVID-19 deaths — mostly because they are older on average and make up more of the nursing home population that has been vulnerable to the pandemic.

When adjusting for age, though, researchers at the University of Minnesota found much higher rates of both excess total deaths and COVID-19 deaths among minority groups. The rate of excess deaths in 2020 was 3.2 times higher among Black people than white people, according to U researchers JP Leider and Elizabeth Wrigley-Field.

And less of the excess mortality among people of color was due to COVID-19. Stroke and heart attack deaths did not increase overall in 2020, according to the Star Tribune analysis, but they increased 9% and 13%, respectively, among people of color in Minnesota. Homicides increased by 28% and cancer deaths increased 9% in this group as well.

Albasha Hume dedicated his life to preventing health disparities and helping members of minority groups and immigrants manage chronic diseases. The men’s health director at Open Cities Health Clinic in St. Paul had a demeanor that allowed him to freely discuss subjects such as mental health and sexual abuse that can be taboo to some immigrants, said Summer Johnson, the center’s chief of strategic development.

Albasha Hume, right, died of COVID-19 at 62. Photo provided.

“He just had such a welcoming and inviting personality that really bridged all cultures and backgrounds,” she said of Hume, who was an immigrant from Tanzania and a Seventh-day Adventist pastor.

Hume had worked from home to reduce his COVID-19 risk, but appeared lethargic last spring when he stopped into the center to be fitted for a mask. Five days later, he made a video call to Johnson to reveal he was in the hospital and receiving supplemental oxygen. That would be their last conversation. Hume was placed on a ventilator the next day and died weeks later on June 14 at age 62 of COVID-19 complications.

“He just embodied light and kindness and joy and was so full of life,” Johnson said. “To see him in that state, so weak and ill, was very, very difficult.”

Researchers expected disparities in COVID-19 deaths would be due to higher rates of chronic illnesses such as asthma and diabetes in minority populations, but Wrigley-Field said exposure risks played a bigger role. Minority members tended to work in lower-wage jobs that required face-to-face contact and elevated disease risks.

“Study after study in different parts of the United States suggest that actually the big driver … is just differences in who’s getting exposed to the virus,” she said.

Foreign-born Minnesotans also appeared to suffer elevated rates of excess death in 2020, regardless of race, the U researchers said.

Wrigley-Field also is studying why racial disparities appear worse for COVID-19 compared with the Spanish flu. A leading theory is that the second wave of both pandemics was worse, but that in 1918 minority members had little immunity built up and had just migrated from rural to dense urban settings. So they suffered more infections in the first wave, according to the theory, that evened out the mortality rate when more whites were hit in the severe second wave.

Minnesota’s surge in overall mortality in 2020 occurred despite a decline in other types of respiratory deaths. A state lockdown in early spring stunted last winter’s influenza season and a mask mandate and other restrictions this winter prevented the current flu season from gaining ground. The number of influenza deaths dropped from an average of 213 in the previous three years to 152 in 2020, though that could rise.

The lack of an increase in heart attack and stroke deaths was somewhat of a surprise. Health officials feared those numbers would go up because lockdown restrictions and COVID-19 fears would prevent people from leaving their homes to seek medical help.

“There is the direct impact of COVID, ‘I got COVID. I died from it,’ ” Ehresmann said, “and then there’s the ‘I’m older and I’m afraid of COVID and I haven’t sought health care for a whole year and I have underlying health conditions, and now I died in my sleep.’ ”

The U’s Leider said he suspects that some trends in certain types of deaths were distorted by a 23% increase in deaths that reportedly occurred at home in 2020 compared with the prior three years.

Reporting causes can be less reliable when deaths occur in private homes rather than in hospitals, he said.

COVID-19 accounts for only 14% of excess deaths occurring at home since March, and that is suspicious given the overall mortality trends, Leider said. “Either that means we are undercounting COVID deaths at home, or that the pandemic is driving other sorts of deaths of despair or deaths caused by delay or lack of access to care.”

What happens to mortality trends in future years is unclear. Wrigley-Field said the surge in deaths among elderly Minnesotans in 2020 could mean that fewer might die in the next couple years once the pandemic has been managed through vaccination or other means. On the other hand, COVID-19 has left lingering lung damage in many Minnesotans that could result in some deaths at earlier ages.