Amid the coronavirus pandemic, there were about 20 percent more deaths than expected across the U.S. between March and August, according to a new study published Monday. According to the report in the Journal of the American Medical Association, there were at least 1.3 million deaths in the U.S. between March 1 and Aug.1, an increase of approximately 225, 530 deaths. Of that 20 percent increase, researchers found that approximately two-thirds, or 150,541 deaths, could be attributed to COVID-19. The deaths were particularly high in 10 states, including New York, New Jersey, Arizona, Mississippi, and Michigan, which saw devastating surges of the coronavirus, the report found. The increase in overall deaths varied in each state—though New York experienced the highest surge, with deaths increasing by 65 percent. “States that experienced acute surges in April (and reopened later) had shorter epidemics that returned to baseline in May, whereas states that reopened earlier experienced more protracted increases in excess deaths that extended into the summer,” the report states.

In addition to COVID-19, the research found that there were increases in deaths related to heart disease, “driven by the spring surge in COVID-19 cases,”—and Alzheimer’s disease and dementia. The second increase in deaths across the U.S., JAMA reported, occurred between June 6 and July 25, or “coinciding with the summer surge in sunbelt states.” “Some states had greater difficulty than others in containing community spread, causing protracted elevations in excess deaths that extended into the summer,” the research said. The JAMA report, however, notes the study has limitations, including its reliance on provisional data, inaccuracies in death certificates, and several assumptions that were applied to the analytical model.