The federal government officially ended the COVID-19 public health emergency on Thursday, May 11, more than three years after the outbreak caused massive disruption in the U.S. Various pandemic-related rules and waivers will come to an end as a result.

As the public health emergency is lifted, Americans are taking a sobering look at the lives lost and what parts of the country were hit the hardest.

To find the states with the most deaths per capita from COVID-19, 24/7 Tempo reviewed data from the Centers for Disease Control and Prevention, last updated on May 10, 2023. States are ordered by the number of COVID-related deaths per 100,000 people. All data is from the CDC except population figures, which come from the U.S. Census Bureau’s 2021 American Community Survey, and were not used to calculate death and case rates. (Data for New York state was extrapolated from the CDC data for the state and New York City and is an estimate.) The CDC has noted that its ability to collect and share certain data will change due to the end of the emergency.

As of May 10, there have been 1,131,819 total deaths from COVID-19 in the United States, according to the CDC. The national death rate was 340 people per 100,000. Thirty states had death rates above the national average.

Eight of the 10 states with the highest death rates are in the South. Many Southern states saw a surge in cases in June 2020 after they relaxed COVID-19 restrictions too soon, according to Robert Redfield, a former director of the CDC. The Southwestern states of New Mexico and Arizona were also among the top 10.

States such as California, Michigan, and Rhode Island had some of the tightest restrictions during the outbreak, yet they had among the highest numbers of total deaths, cases per 100,000, and total cases. (Here’s a reminder that the rapidly spreading new Arcturus COVID strain has been detected in at least 20 states.)

Some of the least populous states – Vermont, Alaska, and Wyoming – had among the lowest total deaths, cases per 100,000, and total cases. Maryland had the lowest number of cases per 100,000, and Oregon was second.

Click here to see the states with the most deaths per capita from COVID-19

What does the end of the COVID-19 emergency mean for the country?

The government is revoking Title 42, a law that allows the U.S. to deny asylum and migration claims for public health reasons – though a federal judge in Florida has temporarily blocked the government from following through with its plan.

Work requirements for federal food assistance programs that were halted during the emergency will return in about two dozen states. (See the places where the most people use food stamps in every state.)

The government will stop covering the costs for COVID-19 vaccines. Instead the treatments will either be covered by private medical insurance or people may have to pay out of pocket. COVID-19 at-home tests may no longer be covered by insurance, and those on Medicare will no longer be able to get free eight rapid over-the-counter COVID-19 tests.

Patients will again have to spend three straight days in a hospital before they’re eligible to go to a skilled nursing facility.

The government will also reduce the frequency with which it tracks COVID-19. CDC surveillance will focus on deaths as opposed to cases, test positivity rates, and post-vaccination health check-ins.

In states where the governor exercised powers due to the declaration of a health emergency, those powers are also ended.