Hawaii has ranked first in the nation for its management of the COVID-19 pandemic, faring much better than other states on metrics such as pandemic-related deaths, vaccination rates and strains on hospital resources, according to an assessment by the Commonwealth Fund, which focuses on improving the quality and efficiency of the country’s health care system and improving access to care.

The report attributed the success of Hawaii and other high-ranking states to having stronger health care systems going into the pandemic. Other top states were Massachusetts, Connecticut and Washington.

Hawaii had the fewest “excess deaths,” according to data compiled between February 2020 and April 2022. The metric assesses the overall toll that the pandemic had on mortality and includes COVID-19 deaths as well as deaths from other causes that could be attributed to the pandemic, such as delayed health care.

In Hawaii there were 110 excess deaths per 100,000 people. By comparison, in Mississippi, which ranked the worst for excess deaths, there were nearly 595 deaths per 100,000 people. Nationally there were 344 deaths for every 100,000 people.

Hawaii’s rate translates to about 1,540 more people dying during the pandemic than what’s typical, based on data from prior years.

The state did not escape the overall increase in drug overdoses that affected the majority of states during the pandemic, with drug-related deaths increasing 15% in Hawaii. States including West Virginia, Mississippi and South Carolina, where overdose deaths increased by more than 50%, fared much worse.

Researchers from the Commonwealth Fund said that physical isolation, disrupted addiction treatment and increased stress during the pandemic likely contributed to the rise in overdose deaths, but that the increase in deadlier drugs such as fentanyl was likely a bigger culprit.

Hawaii also ranked first in the country for the lowest number of COVID-19 deaths among nursing home residents, with 19 deaths per 1,000 patients, compared with the U.S. average of 94 deaths.

The pandemic overwhelmed hospitals throughout the country. In Hawaii, particularly when the delta variant hit in August and September 2021, the state was not fully spared. The report measured the total number of days during the pandemic when at least 80% of ICU beds were occupied. Hawaii came in at 31 days and was 16th for the fewest number of days in which ICU beds were taxed. Texas and Alabama struggled the most, with ICU beds full or nearly full for more than 500 days during the pandemic.

The report found that Hawaii had zero days when there were critical staffing shortages, placing Hawaii first in the country. By comparison, Alabama had 516 days of staff shortages, while it was also struggling with overwhelmed ICUs.

The report and state scorecards can be found at bit.ly/39wCpF0.