LANSING, Mich. — Deaths linked to COVID-19 have now surpassed 40,000 in Michigan since the pandemic began in 2020, the state health department reported.

More than 36,400 deaths have been confirmed while 3,676 were probably caused by COVID-19, the state said Tuesday on its coronavirus website.

There were 113 in the past week.

“Throughout the pandemic, we have seen deaths predominantly occurring in … those who are older, those who are unvaccinated, those who have comorbidities,” said Dr. Natasha Bagdasarian, the state’s chief medical executive.

“That has been something that we’ve seen nationally and in the state of Michigan,” Bagdasarian told the Detroit Free Press. “And that’s something that has held true for pretty much all the waves through the pandemic and since we’ve had the vaccine available.”

Most deaths since March have been occurring outside hospitals, said Dr. Daniel Kaul, professor of infectious diseases at the University of Michigan.

“That may be in extended-care facilities or people who may have multiple other medical issues going on and perhaps they’re in a hospice situation. … What’s occurring in hospitals feels completely different than it did in previous waves of COVID,” Kaul said.

Nick Derusha, public health officer in four Upper Peninsula counties, said vaccinations and booster shots can reduce the risk of death from COVID-19.

“Sadly, we have some folks that are choosing not to use tools that are now there and widely available,” said Derusha, who also is president of the Michigan Association for Local Public Health.