Increased deaths from fungal infections during the COVID-19 pandemic—National Vital Statistics System, United States, January 2020–December 2021

Abstract

Background

COVID-19–associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying from fungal infections during the COVID-19 pandemic.

Methods

Using NVSS’s January 2018–December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100,000 population) of fungal deaths by fungal pathogen, COVID-19 association, demographic characteristics, and year.

Results

Numbers and age-adjusted rates of fungal deaths increased from 2019 (n = 4,833, rate 1.2, 95% confidence interval [CI]    1.2–1.3) to 2021 (n = 7,199, rate: 1.8, 95% CI = 1.8–1.8); of 13,121 fungal deaths during 2020–2021, 2,868 (21.9%) were COVID-19–associated. Compared with non-COVID-19–associated fungal deaths (n = 10,253), COVID-19–associated fungal deaths more frequently involved Candida (n = 776 [27.1%] versus n = 2,432 [23.7%]) and Aspergillus (n = 668 [23.3%] versus n = 1,486 [14.5%]) and less frequently involved other specific fungal pathogens. Fungal death rates were generally highest in non-White and non-Asian populations. Death rates from Aspergillus infections were approximately two times higher in the Pacific US census division compared with most other divisions.

Conclusions

Fungal deaths increased during 2020–2021 compared with previous years, primarily driven by COVID-19–associated fungal deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in COVID-19 patients, especially in certain racial/ethnic groups and geographic areas.