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  • #31
    1. CASES, DATA & SURVEILLANCE
    COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


    Updated Oct. 23, 2020


    Download Weekly Summary pdf icon[907 KB, 10 pages]

    Key Updates for Week 42, ending October 17, 2020


    Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September, driven primarily by activity in the Southeastern and Central parts of the country. COVID-19 related hospitalization rates and pneumonia, influenza and COVID (PIC) mortality for the most recent weeks may increase as more data are received.


    Download Chart Data excel icon[XLS – 2 KB]
    Virus: Public Health, Commercial and Clinical Laboratories


    Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 5.6% during week 41 to 6.3% during week 42. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in most of the country except the Mid-Atlantic (Region 3; stable) and Pacific Northwest (Region 10; slight decrease).
    Mild/Moderate Illness: Outpatient and Emergency Department Visits


    Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) or COVID-like illness (CLI) has been increasing slowly since mid-September and remained stable (change of ≤0.1%) in week 42 compared with week 41. In ILINet, the percentages of visits for ILI decreased slightly among those less than 25 years of age and remained stable for those 25 years and older. The Midwest (Region 5), South Central (Region 6) and Mountain (Region 8) regions reported an increase in at least one illness indicator during week 42 compared with week 41.
    Severe Disease: Hospitalizations and Deaths


    Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased, driven primarily by an increase in rates among adults aged 50 years and older. Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 42 was 7.6% and, while declining, remains above the epidemic threshold. Hospitalization rates and PIC mortality for the most recent weeks are anticipated to increase as additional data are reported.

    All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
    Key Points
    • Nationally, several surveillance indicators of COVID-19 related activity are showing increases in SARS-CoV-2 virus circulation and related illnesses.
      • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have increased or remained stable in recent weeks. Hospitalization data for the most recent weeks may change as additional data are reported.
      • The percentage of deaths due to PIC have been declining since late July; however, in mid-September the percentage leveled off. Data for the most recent weeks currently show a decline, but that is likely to change as additional death certificates are processed.
    • At least one indicator used to monitor COVID-19 activity is increasing in eight of the ten HHS regions, and many regions are reporting increases in multiple indicators.
      • The percentages of specimens testing positive for SARS-CoV-2 increased in eight regions.
      • The percentages of visits for ILI, CLI or both increased in three regions.
      • For some indicators and regions, the increases have been small but consistent from week to week over the last several weeks, while other indicators have increased more rapidly in some regions.
    • The overall cumulative COVID-19-associated hospitalization rate through the week ending October 17, 2020 was 193.7 hospitalizations per 100,000 population.
      • Since the week ending September 26 (MMWR week 39), weekly hospitalization rates have increased for all age groups combined, driven primarily by an increase in rates among adults aged 50 years and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.
      • The age-adjusted hospitalization rate for Hispanic or Latino persons was approximately 4.5 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.4 and 4.3 times those of non-Hispanic White persons, respectively.
    • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

    U.S. Virologic Surveillance


    Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 64,364,628 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

    Nationally, during week 42, 2,284,045 specimens were tested for SARS-CoV-2 for diagnostic purposes and 144,789 (6.3%) were positive. This is an increase compared with week 41, during which 5.6% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




    *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
    View Data Table


    The national increase in percent positivity was driven primarily by increases in Regions 4 (Southeast), 5 (Midwest), 6 (South Central), 7 (Central) and 8 (Mountain); this increase was reported among all age groups in these regions. Smaller increases were reported in Regions 1 (New England), 2 (New Jersey, New York and Puerto Rico), and 9 (South/West Coast). The highest percentages of specimens testing positive for SARS-CoV-2 were seen in Regions 4 (Southeast, 7.3%), 5 (Midwest, 8.7%), 6 (South Central, 9.8%), 7 (Central, 11.1%) and 8 (Mountain, 9.3%), the same regions reporting the largest increases in percentages of specimens testing positive during week 42 compared with week 41.

    Additional virologic surveillance information: Surveillance Methods


    Outpatient/Emergency Department Illness


    Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.

    Nationally, the overall percentage of visits to outpatient providers or EDs for ILI or CLI has been increasing slightly since mid-September but remained stable (change of ≤0.1%) during week 42 compared with week 41. During week 42, the percentages of ED visits captured in NSSP for CLI and ILI, were 2.6% and 1.0%, respectively; 1.2% of visits reported through ILINet were for ILI. The percentage of ILI visits to ILINet providers remains below the national baseline (2.4% October 2019 through September 2020; 2.6% since October 2020) for the 26th consecutive week and is slightly lower than typical for this time of year, compared with prior influenza seasons.

    resize iconView LargerView Data Table


    The percentages of visits for ILI decreased slightly during week 42 compared with week 41 among those 0–4 years and 5–24 years but remained stable (change ≤0.1%) in the adult age groups (25–49 years, 50-64 years and ≥65 years).

    resize iconView LargerView Data Table


    On a regional levelexternal icon, seven of ten regions reported a stable (change of ≤0.1%) or decreasing percentage of visits to EDs and outpatient providers for ILI and CLI during week 42 compared with week 41. However, two regions (Region 5 [Midwest] and 8 [Mountain]) reported an increase in percentages of visits to EDs for CLI and one region (Region 6 [South Central]) reported an increase in the percentage of visits to outpatient providers or EDs for ILI. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all 10 regions.
    ILI Activity Levels


    Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, and New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

    The number of jurisdictions at each activity level during week 42 and the previous week are summarized in the table below.
    Activity Level Number of Jurisdictions Number of CBSAs
    Week 42
    (Week ending
    Oct. 17, 2020)
    Week 41
    (Week ending
    Oct. 10, 2020)
    Week 42
    (Week ending
    Oct. 17, 2020)
    Week 41
    (Week ending
    Oct. 10, 2020)
    Very High 0 0 0 0
    High 0 0 1 3
    Moderate 0 1 4 6
    Low 1 1 28 30
    Minimal 53 52 541 533
    Insufficient Data 0 0 355 337
    *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

    Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

    Hospitalizations


    The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

    A total of 63,152 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and October 17, 2020. The overall cumulative hospitalization rate was 193.7 per 100,000 population.

    Overall weekly hospitalization rates among all ages combined first peaked during the week ending April 18 (MMWR week 16), followed by a second peak during the week ending July 18 (MMWR week 29). Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased for all ages combined, driven primarily by an increase in rates among adults aged 50 years and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.

    resize iconView Larger
    Among the 63,152 laboratory-confirmed COVID-19-associated hospitalizations, 59,573 (94.3%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,579 (5.7%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons was approximately 4.5 times the rate among non-Hispanic White persons. Rates for non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons were approximately 4.4 and 4.3 times the rate among non-Hispanic White persons, respectively.



    When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 7.1 times higher among Hispanic or Latino persons aged 0–17 years; 7.8 times higher among Hispanic or Latino persons aged 18–49 years; 5.8 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 3.5 times higher among non-Hispanic Black persons aged ≥65 years.

    Age Category Non-Hispanic
    American Indian or Alaska Native
    Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
    Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
    0—17 years 13.6 3.5 20.2 5.2 27.8 7.1 8.4 2.2 3.9 1
    18—49 years 297.5 7.6 209.6 5.4 305.9 7.8 61.9 1.6 39.0 1
    50—64 years 696.5 5.8 581.3 4.9 663.4 5.6 181.0 1.5 119.5 1
    65+ years 811.7 2.5 1143.6 3.5 884.8 2.7 354.3 1.1 329.4 1
    Overall rate4 (age-adjusted) 390.6 4.4 381.2 4.3 398.8 4.5 115.9 1.3 88.9 1
    1 COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
    2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
    3 The highest rate ratio in each age category is presented in bold.
    4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, and 65+ years.

    Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations as compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
    1.3% 32.0% 23.2% 5.1% 33.0%
    0.7% 17.9% 14.1% 8.9% 58.5%
    1.9 1.8 1.6 0.6 0.6
    1 Persons of multiple races (0.4%) or unknown race and ethnicity (5.0%) are not represented in the table but are included as part of the denominator.
    2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

    For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults for in-depth chart review; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,141 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.8% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension, obesity, metabolic disease, and cardiovascular disease. Among 256 children hospitalized during March 1–May 31 with information on underlying conditions, 51.1% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity, asthma, and neurologic disease.

    Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

    Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


    Mortality Surveillance


    The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on October 15, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 42 was 7.6% and, while it is declining compared with the percentage during week 41, it remains above the epidemic threshold. Since the second peak at the end of July, the percentage of deaths due to PIC have been declining; however, in mid-September the percentage leveled off for two weeks. Data for the most recent three weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed.

    Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

    resize iconView Larger


    *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
    View Data Table


    Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
    More Information
    View Page In:pdf icon 907 KB, 10 pages
    Last Updated Oct. 23, 2020

    https://www.cdc.gov/coronavirus/2019...iew/index.html

    Comment


    • #32
      1. CASES, DATA & SURVEILLANCE
      COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


      Updated Oct. 30, 2020
      Print
      Download Weekly Summary pdf icon[953 KB, 11 Pages]
      Key Updates for Week 43, ending October 24, 2020


      Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) remained at approximately equal levels from mid-September through mid-October. Both COVID-19 related hospitalizations and PIC mortality for the most recent weeks may increase as more data are received.


      Download Chart Data excel icon[XLS – 2 KB]
      Virus: Public Health, Commercial and Clinical Laboratories


      Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 6.6% during week 42 to 7.1% during week 43. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in all ten HHS regions.
      Mild/Moderate Illness: Outpatient and Emergency Department Visits


      Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) or COVID-like illness (CLI) has been increasing since mid-September; CLI increased and ILI remained stable (change of ≤0.1%) in week 43 compared with week 42. Five HHS regions (Regions 1 [New England], 2 [New Jersey/New York/Puerto Rico], 5 [Midwest], 7 [Central] and 8 [Mountain]) experienced an increase in at least one indicator of mild/moderate illness in week 43 compared with week 42.
      Severe Disease: Hospitalizations and Deaths


      Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 18 years and older. Based on death certificate data, the percentage of deaths attributed to PIC for week 43 was 8.2% and, while declining, remains above the epidemic threshold. Hospitalization rates and PIC mortality for the most recent weeks are anticipated to increase as additional data are reported.

      All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
      Key Points
      • Nationally, several surveillance indicators of COVID-19 related activity are showing increases in SARS-CoV-2 virus circulation and associated illnesses.
        • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have increased since September. Hospitalization data for the most recent weeks may change as additional data are reported.
        • After declining for several weeks during the late summer, the percentage of deaths due to PIC have remained approximately level from the week ending September 19 through the week ending October 10. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
      • At least one indicator used to monitor COVID-19 activity is increasing in each of the ten HHS regions, and many regions are reporting increases in multiple indicators.
        • The percentages of specimens testing positive for SARS-CoV-2 increased in all ten regions.
        • The percentages of visits for ILI, CLI or both increased in five of ten regions.
        • For some indicators and regions, the increases have been small but consistent from week to week over the last several weeks; other indicators have increased more rapidly in some regions.
      • The overall cumulative COVID-19-associated hospitalization rate through the week ending October 24, 2020 was 199.8 hospitalizations per 100,000 population.
        • Since the week ending September 26 (MMWR week 39), weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 18 years and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.
        • The age-adjusted hospitalization rate for Hispanic or Latino persons was approximately 4.4 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.3 and 4.2 times those of non-Hispanic White persons, respectively.
      • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

      U.S. Virologic Surveillance


      Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 65,014,028 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

      Nationally, during week 43, 2,646,697 specimens were tested for SARS-CoV-2 for diagnostic purposes and 187,480 (7.1%) were positive. This is an increase compared with week 42, during which 6.6% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




      *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
      View Data Table


      The percentages of specimens testing positive for SARS-CoV-2 increased in all ten HHS regionsexternal icon. The regions with the highest percent positivity during week 43 were in the central part of the country, Regions 6 (South Central, 11.3%), 7 (Central, 12.9%) and 8 (Mountain, 10.9%); these three regions also reported the largest increases in percent positivity during week 43 compared with week 42.

      Additional virologic surveillance information: Surveillance Methods


      Outpatient/Emergency Department Illness


      Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.

      Nationally, the overall percentage of visits to outpatient providers or EDs for ILI or CLI has been increasing since mid-September and increased (CLI) or remained stable (change of ≤0.1%) during week 43 compared with week 42. During week 43, the percentages of ED visits captured in NSSP for CLI and ILI, were 3.0% and 1.1%, respectively; 1.2% of visits reported through ILINet were for ILI. The percentage of ILI visits to ILINet providers remains below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 27th consecutive week and is slightly lower than typical for this time of year, compared with prior influenza seasons.

      resize iconView LargerView Data Table


      For those 0–4 years of age, the percentage of visits to ILINet providers for ILI increased during week 43 compared with week 42. For all other age groups (5-24 years, 25–49 years, 50–64 years and 65 years and older), the percentage remained stable (change of ≤0.1%).

      resize iconView LargerView Data Table


      On a regional levelexternal icon, five regions (Regions 1 [New England], 2 [New Jersey/New York/Puerto Rico], 5 [Midwest], 7 [Central] and 8 [Mountain]) experienced an increase in at least one indicator of mild/moderate CLI or ILI in week 43 compared with week 42. The remaining five regions reported a stable (change of ≤0.1%) percentage of visits to EDs and outpatient providers for ILI and CLI during week 43 compared with week 42. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all 10 regions.
      ILI Activity Levels


      Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, and New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

      The number of jurisdictions at each activity level during week 43 and the previous week are summarized in the table below.
      Activity Level Number of Jurisdictions Number of CBSAs
      Week 43
      (Week ending
      Oct. 24, 2020)
      Week 42
      (Week ending
      Oct. 17, 2020)
      Week 43
      (Week ending
      Oct. 24, 2020)
      Week 42
      (Week ending
      Oct. 17, 2020)
      Very High 0 0 0 0
      High 0 0 1 1
      Moderate 0 0 0 4
      Low 1 1 26 28
      Minimal 52 53 554 568
      Insufficient Data 1 0 348 328
      *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

      Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

      Hospitalizations


      The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

      A total of 65,143 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and October 24, 2020. The overall cumulative hospitalization rate was 199.8 per 100,000 population.

      Overall weekly hospitalization rates among all ages combined first peaked during the week ending April 18 (MMWR week 16), followed by a second peak during the week ending July 18 (MMWR week 29). Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased, driven primarily by an increase in rates among adults aged 18 and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.

      resize iconView Larger
      Among the 65,143 laboratory-confirmed COVID-19-associated hospitalizations, 61,542 (94.5%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,601 (5.5%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons was approximately 4.4 times the rate among non-Hispanic White persons. Rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.3 and 4.2 times the rate among non-Hispanic White persons, respectively.



      When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 7.0 times higher among Hispanic or Latino persons aged 0–17 years; 7.7 times higher among Hispanic or Latino persons aged 18–49 years; 5.6 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 3.4 times higher among non-Hispanic Black persons aged ≥65 years.

      Age Category Non-Hispanic
      American Indian or Alaska Native
      Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
      Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
      0—17 years 13.6 3.3 20.9 5.1 28.6 7.0 8.4 2.0 4.1 1
      18—49 years 307.3 7.6 215.1 5.3 311.8 7.7 64.6 1.6 40.5 1
      50—64 years 704.5 5.6 593.4 4.7 680.4 5.4 189.7 1.5 126.0 1
      65+ years 828.5 2.4 1168.2 3.4 904.8 2.6 368.5 1.1 347.3 1
      Overall rate4 (age-adjusted) 398.8 4.3 389.8 4.2 407.8 4.4 120.8 1.3 93.5 1
      1 COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
      2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
      3 The highest rate ratio in each age category is presented in bold.
      4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, and 65+ years.

      Non-Hispanic White persons and Non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations as compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
      1.3% 31.7% 22.9% 5.2% 33.6%
      0.7% 17.9% 14.1% 8.9% 58.5%
      1.9 1.8 1.6 0.6 0.6
      1 Persons of multiple races (0.4%) or unknown race and ethnicity (4.9%) are not represented in the table but are included as part of the denominator.
      2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

      For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults for in-depth chart review; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,278 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.7% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension, obesity, metabolic disease, and cardiovascular disease. Among 264 children hospitalized during March 1–May 31 with information on underlying conditions, 50.8% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity, asthma, and neurologic disease.

      Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

      Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


      Mortality Surveillance


      The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on October 15, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 42 was 7.6% and, while it is declining compared with the percentage during week 41, it remains above the epidemic threshold. Since the second peak at the end of July, the percentage of deaths due to PIC have been declining; however, in mid-September the percentage leveled off for two weeks. Data for the most recent three weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed.

      Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

      resize iconView Larger


      *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
      View Data Table


      Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
      More Information
      View Page In:pdf icon 953 KB, 11 Pages
      Last Updated Oct. 30, 2020

      https://www.cdc.gov/coronavirus/2019...iew/index.html

      Comment


      • #33


        COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


        Updated Nov. 6, 2020


        Download Weekly Summary pdf icon[887 KB, 11 pages]
        Key Updates for Week 44, ending October 31, 2020


        Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased during the first two weeks of October. Both COVID-19 related hospitalizations and PIC mortality for the most recent weeks may increase as more data are received.


        Download Chart Data excel icon[XLS – 2 KB]
        Virus: Public Health, Commercial and Clinical Laboratories


        Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 7.2% during week 43 to 8.2% during week 44. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in all ten HHS regions.
        Mild/Moderate Illness: Outpatient and Emergency Department Visits


        Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) or COVID-like illness (CLI) has been increasing since mid-September; CLI increased and ILI remained stable (change of ≤0.1%) in week 44 compared with week 43. Five regions reported an increase in at least one indicator of mild/moderate illness.
        Severe Disease: Hospitalizations and Deaths


        Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 18 years and older. Based on death certificate data, the percentage of deaths attributed to PIC for week 44 was 8.1% and, while declining compared to week 43 (11.8%), remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased during the first two weeks of October. Hospitalization rates and PIC mortality for the most recent weeks may increase as additional data are reported.

        All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
        Key Points
        • Nationally, several surveillance indicators of COVID-19 related activity are showing increases in SARS-CoV-2 virus circulation and associated illnesses.
          • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have increased since September. Hospitalization data for the most recent weeks may change as additional data are reported.
          • After declining for several weeks during the late summer, the percentage of deaths due to PIC remained approximately level from the week ending September 19 through the week ending October 3 and increased for the first two weeks of October. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
        • At least one indicator used to monitor COVID-19 activity is increasing in each of the ten HHS regions, and many regions are reporting increases in multiple indicators.
          • The percentages of specimens testing positive for SARS-CoV-2 increased in all ten regions.
          • The percentages of visits for ILI, CLI or both increased in five of ten regions.
          • For some indicators and regions, the increases have been small but consistent from week to week over the last several weeks; other indicators have increased more rapidly in some regions.
        • The overall cumulative COVID-19-associated hospitalization rate through the week ending October 31, 2020 was 207.1 hospitalizations per 100,000 population.
          • Since the week ending September 26 (MMWR week 39), weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 18 years and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.
          • The age-adjusted hospitalization rate for Hispanic or Latino persons was approximately 4.3 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.2 and 4.1 times those of non-Hispanic White persons, respectively.
        • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

        U.S. Virologic Surveillance


        Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 68,363,929 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

        Nationally, during week 44, 2,890,895 specimens were tested for SARS-CoV-2 for diagnostic purposes and 238,214 (8.2%) were positive. This is an increase compared with week 43, during which 7.2% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




        *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
        View Data Table


        The percentages of specimens testing positive for SARS-CoV-2 increased in all ten HHS regionsexternal icon. The regions with the highest percent positivity during week 44 were in the central part of the country, Regions 5 (Midwest, 12.3%), 6 (South Central, 11.7%), 7 (Central, 17.6%) and 8 (Mountain, 12.0%). Three of these regions (Regions 5, 7, and 8) also reported the largest increases in percent positivity during week 44 compared with week 43.

        Additional virologic surveillance information: Surveillance Methods


        Outpatient/Emergency Department Illness


        Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.

        Nationally, the overall percentage of visits to outpatient providers or EDs for ILI or CLI has been increasing since mid-September and increased (CLI) or remained stable (change of ≤0.1%; ILI) during week 44 compared with week 43. During week 44, the percentages of ED visits captured in NSSP for CLI and ILI were 3.4% and 1.1%, respectively; 1.3% of visits reported through ILINet were for ILI. The percentage of ILI visits to ILINet providers remains below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 28th consecutive week and is slightly lower than typical for this time of year compared with prior influenza seasons.

        resize iconView LargerView Data Table


        For all age groups, (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older) the percentage of visits for ILI remained stable (change of ≤0.1%) in week 44 compared to week 43 but has been slowly increasing since mid-August for those 0–4 years and since September for the other age groups.

        resize iconView LargerView Data Table


        On a regional levelexternal icon, five regions (Regions 1 [New England], 3 [Mid-Atlantic], 5 [Midwest], 7 [Central] and 8 [Mountain]) reported an increase in at least one indicator of mild/moderate CLI or ILI in week 44 compared with week 43. In addition, one region (Region 4 [Southeast]) experienced a decrease in CLI, one region (Region 2 [New Jersey/New York/Puerto Rico]) experienced a decrease in ILI, and the remaining three regions (Regions 6 [South Central], 9 [South West/Coast] and 10 [Pacific Northwest] reported a stable (change of ≤0.1%) percentage of visits to EDs and outpatient providers for ILI and CLI. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all 10 regions.

        ILI Activity Levels

        Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, and New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

        The number of jurisdictions at each activity level during week 44 and the previous week are summarized in the table below.
        Activity Level Number of Jurisdictions Number of CBSAs
        Week 44
        (Week ending
        Oct. 31, 2020)
        Week 43
        (Week ending
        Oct. 24, 2020)
        Week 44
        (Week ending
        Oct. 31, 2020)
        Week 43
        (Week ending
        Oct. 24, 2020)
        Very High 0 0 0 0
        High 0 0 2 1
        Moderate 1 0 4 1
        Low 1 1 38 27
        Minimal 52 53 544 567
        Insufficient Data 0 0 341 333
        *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

        Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

        Hospitalizations


        The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

        A total of 67,508 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and October 31, 2020. The overall cumulative hospitalization rate was 207.1 per 100,000 population.

        Overall weekly hospitalization rates among all ages combined first peaked during the week ending April 18 (MMWR week 16), followed by a second peak during the week ending July 18 (MMWR week 29). Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased, driven primarily by an increase in rates among adults aged 18 and older. Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.

        resize iconView Larger
        Among the 67,508 laboratory-confirmed COVID-19-associated hospitalizations, 64,670 (95.8%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 2,838 (4.2%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons was approximately 4.3 times the rate among non-Hispanic White persons. Rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.2 and 4.1 times the rate among non-Hispanic White persons, respectively.



        When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 6.6 times higher among Hispanic or Latino persons aged 0–17 years; 7.4 times higher among Hispanic or Latino persons and non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 5.4 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 3.3 times higher among non-Hispanic Black persons aged ≥ 65 years.

        Age Category Non-Hispanic
        American Indian or Alaska Native
        Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
        Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
        0—17 years 13.6 3.0 22.0 4.9 29.9 6.6 8.8 2.0 4.5 1
        18—49 years 320.0 7.4 223.2 5.1 323.3 7.4 69.0 1.6 43.4 1
        50—64 years 725.8 5.4 616.2 4.6 708.7 5.2 199.5 1.5 135.2 1
        65+ years 874.8 2.4 1214.9 3.3 954.3 2.6 384.1 1.0 371.0 1
        Overall rate4 (age-adjusted) 415.5 4.2 405.1 4.1 425.9 4.3 127.0 1.3 100.0 1
        1 COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
        2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
        3 The highest rate ratio in each age category is presented in bold.
        4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, and 65+ years.

        Non-Hispanic White persons and Non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations as compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
        1.3% 31.7% 22.9% 5.2% 34.2%
        0.7% 17.9% 14.1% 8.9% 58.5%
        1.9 1.8 1.6 0.6 0.6
        1 Persons of multiple races (0.3%) or unknown race and ethnicity (4.9%) are not represented in the table but are included as part of the denominator.
        2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

        For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,375 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.6% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension, obesity, metabolic disease, and cardiovascular disease. Among 264 children hospitalized during March 1–May 31 with information on underlying conditions, 50.8% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity, asthma, and neurologic disease.

        Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

        Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


        Mortality Surveillance


        The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on November 5, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 44 was 8.1% and, while it is declining compared with the percentage during week 43, it remains above the epidemic threshold. The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained approximately stable from the week ending September 19 through the week ending October 3, and increased during the first two weeks of October. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed.

        Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

        resize iconView Larger


        *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
        View Data Table


        Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
        More Information
        View Page In:pdf icon 887 KB, 11 Pages
        Last Updated Nov. 6, 2020

        https://www.cdc.gov/coronavirus/2019...iew/index.html

        Comment


        • #34
          1. CASES, DATA & SURVEILLANCE
          COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


          Updated Nov. 13, 2020
          Print
          Download Weekly Summary pdf icon[844 KB, 11 pages]
          Key Updates for Week 45, ending November 7, 2020


          Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased during the first three weeks of October. Both COVID-19 related hospitalizations and PIC mortality for the most recent weeks may increase as more data are received.


          Download Chart Data excel icon[XLS – 2 KB]
          Virus: Public Health, Commercial and Clinical Laboratories


          Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 8.4% during week 44 to 10.5% during week 45. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in all ten HHS regions.
          Mild/Moderate Illness: Outpatient and Emergency Department Visits


          Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) or COVID-like illness (CLI) has been increasing since mid-September; CLI and ILI increased in week 45 compared with week 44. All ten surveillance regions reported an increase in at least one indicator of mild/moderate illness.
          Severe Disease: Hospitalizations and Deaths


          Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 50 years and older. Based on death certificate data, the percentage of deaths attributed to PIC for week 45 was 8.9% and, while declining compared to week 44 (12.3%), remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased during the first three weeks of October and are expected to increase for the most recent weeks as additional data are reported. The hospitalization rate for the most recent week is expected to be higher as additional data are reported.

          All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
          Key Points
          • Nationally, all surveillance indicators included in COVIDView are showing increases in SARS-CoV-2 virus circulation and associated illnesses and deaths.
            • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have been increasing since September. The hospitalization rate for the most recent week is expected to be higher as additional data are reported in future weeks.
            • The percentage of deaths due to PIC has been increasing since the beginning of October. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
          • At least one indicator used to monitor COVID-19 activity is increasing in each of the ten HHS regions, and many regions are reporting increases in multiple indicators.
            • The percentages of specimens testing positive for SARS-CoV-2 increased in all ten regions.
            • The percentages of visits for ILI, CLI or both increased in all ten regions.
            • For some indicators and regions, the increases have been small but consistent from week to week over the last several weeks; other indicators have increased more rapidly in some regions.
            • Two regions (Regions 7 [Central] and 8 [Mountain]) have a least two surveillance indicators that were higher during week 45 than at any other time during the pandemic.
          • The overall cumulative COVID-19-associated hospitalization rate through the week ending November 7, 2020 was 217.2 hospitalizations per 100,000 population.
            • Since the week ending September 26 (MMWR week 39), weekly hospitalization rates have increased. Overall increases have been driven primarily by an increase in rates among adults aged 50 years and older. Weekly hospitalization rates among children have had a two-week sustained increase from October 24 (MMWR week 43) to November 7 (MMWR week 45). Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.
            • The age-adjusted hospitalization rate for Hispanic or Latino persons was approximately 4.2 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.1 and 3.9 times those of non-Hispanic White persons, respectively.
          • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

          U.S. Virologic Surveillance


          Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 71,827,520 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

          Nationally, during week 45, 3,128,187 specimens were tested for SARS-CoV-2 for diagnostic purposes and 328,119 (10.5%) were positive. This is an increase compared with week 44, during which 8.4% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




          *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
          View Data Table


          The percentages of specimens testing positive for SARS-CoV-2 increased in all ten HHS regionsexternal icon. The regions with the highest percent positivity during week 45 were in the central part of the country, Regions 5 (Midwest, 16.2%), 6 (South Central, 13.7%), 7 (Central, 23.5%) and 8 (Mountain, 15.5%). These regions also reported the largest increases in percent positivity during week 45 compared with week 44.

          Additional virologic surveillance information: Surveillance Methods


          Outpatient/Emergency Department Illness


          Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.

          Nationally, the overall percentage of visits to outpatient providers or EDs for ILI or CLI has been increasing since mid-September. During week 45, the percentages of ED visits captured in NSSP for CLI and ILI were 3.9% and 1.2%, respectively and, compared to week 44, increased (CLI) or remained stable (change of≤0.1%; ILI). In ILINet, 1.5% of visits reported were for ILI and, while increasing compared with week 44 (1.3%), remains below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 30th consecutive week. This level of ILI is typical for ILINet during this time of year.

          resize iconView LargerView Data Table


          For those 5–24 years, the percentage of visits for ILI increased during week 45 (1.9%) compared with week 44 (1.7%). For all other age groups, (0–4 years, 25–49 years, 50–64 years, 65 years and older) the percentage of visits for ILI remained stable (change of ≤0.1%). All age groups have experienced an increasing percentage of visits for ILI since September.

          resize iconView LargerView Data Table


          On a regional levelexternal icon, all ten regions reported an increase in at least one indicator of mild/moderate CLI or ILI in week 45 compared to week 44 and eight regions (Regions 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], 5 [Midwest], 6 [Southwest], 7 [Central], 8 [Mountain], 9 [South West/Coast], and 10 [Pacific Northwest]) reported an increase in at least two indicators. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in 9 regions; however, Region 7 (Central) reported ILI activity above baseline due to increased COVID activity.

          ILI Activity Levels

          Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, and New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

          The number of jurisdictions at each activity level during week 45 and the previous week are summarized in the table below.
          Activity Level Number of Jurisdictions Number of CBSAs
          Week 45
          (Week ending
          Nov. 7, 2020)
          Week 44
          (Week ending
          Oct. 31, 2020)
          Week 45
          (Week ending
          Nov. 7, 2020)
          Week 44
          (Week ending
          Oct. 31, 2020)
          Very High 1 0 1 0
          High 0 0 1 2
          Moderate 0 1 4 5
          Low 4 1 40 38
          Minimal 49 52 540 556
          Insufficient Data 1 0 343 328
          *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of influenza activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

          Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

          Hospitalizations


          The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

          A total of 70,825 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and November 7, 2020. The overall cumulative hospitalization rate was 217.2 per 100,000 population.

          Since the week ending September 26 (MMWR week 39), overall weekly hospitalization rates have increased, driven primarily by an increase in rates among adults aged 50 and older. Weekly hospitalization rates among children have had a two-week sustained increase from October 24 (MMWR week 43) to November 7 (MMWR week 45). The hospitalization rate for the most recent week is expected to be higher as additional data are reported in future weeks.

          resize iconView Larger
          Among the 70,825 laboratory-confirmed COVID-19-associated hospitalizations, 67,259 (95%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,566 (5%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons was approximately 4.2 times the rate among non-Hispanic White persons. Rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.1 and 3.9 times the rate among non-Hispanic White persons, respectively.





          When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 6.5 times higher among Hispanic or Latino persons aged 0–17 years; 7.3 times higher among Hispanic or Latino persons aged 18–49 years; 5.2 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 3.1 times higher among non-Hispanic Black persons aged ≥65 years.

          Age Category Non-Hispanic
          American Indian or Alaska Native
          Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
          Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
          0—17 years 19.5 4.0 23.3 4.8 31.9 6.5 9.6 2.0 4.9 1.0
          18—49 years 329.7 7.2 226.9 4.9 334.6 7.3 72.0 1.6 46.1 1.0
          50—64 years 744.4 5.2 625.7 4.4 735.5 5.1 208.1 1.4 143.7 1.0
          65+ years 916.9 2.3 1237.3 3.1 1009.5 2.6 400.3 1.0 393.1 1.0
          Overall rate4 (age-adjusted) 430.9 4.1 412.2 3.9 444.6 4.2 132.5 1.2 106.2 1.0
          1 COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
          2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
          3 The highest rate ratio in each age category is presented in bold.
          4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, and 65+ years.

          Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
          1.3% 30.7% 22.8% 5.2% 34.9%
          0.7% 17.9% 14.1% 8.9% 58.5%
          1.9 1.7 1.6 0.6 0.6
          1 Persons of multiple races (0.3%) or unknown race and ethnicity (4.8%) are not represented in the table but are included as part of the denominator.
          2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

          For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,426 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.6% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension, obesity, metabolic disease, and cardiovascular disease. Among 265 children hospitalized during March 1–May 31 with information on underlying conditions, 50.9% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity, asthma, and neurologic disease.

          Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

          Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


          Mortality Surveillance


          The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on November 12, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 45 was 8.9% and, while it is declining compared with the percentage during week 44, it remains above the epidemic threshold. The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained approximately stable from the week ending September 19 through the week ending October 3, and increased during the first three weeks of October. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed.

          Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

          resize iconView Larger


          *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
          View Data Table


          Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
          More Information
          View Page In:pdf icon 844 KB, 11 Pages
          Last Updated Nov. 13, 2020

          Comment


          • #35

            1. CASES, DATA & SURVEILLANCE
            COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


            Updated Nov. 20, 2020


            Note: Due to the Thanksgiving holiday, the week 47 COVIDView report will be released on Monday, November 30, instead of Friday, November 27.​

            Download Weekly Summary pdf icon[844 KB, 11 pages]

            Key Updates for Week 46, ending November 14, 2020


            Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased throughout the month of October. Both COVID-19 related hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


            Download Chart Data excel icon[XLS – 2 KB]
            Virus: Public Health, Commercial and Clinical Laboratories


            Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 10.8% during week 45 to 11.9% during week 46. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in nine of the ten HHS regions.
            Mild/Moderate Illness: Outpatient and Emergency Department Visits


            Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) and COVID-like illness (CLI) has been increasing since mid-September; CLI increased in week 46 compared with week 45, while ILI remained stable. All ten surveillance regions reported an increase in at least one indicator of mild/moderate illness.
            Severe Disease: Hospitalizations and Deaths


            Since the week ending September 19 (MMWR week 38), weekly hospitalization rates among all age groups combined are increasing. Based on death certificate data, the percentage of deaths attributed to PIC for week 46 was 10.7% and, while declining compared with week 45 (14.4%), remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased throughout October and are expected to increase for the most recent weeks as additional data are reported. Hospitalization rates for the most recent week are also expected to increase as additional data are reported.

            All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
            Key Points
            • Nationally, all surveillance indicators included in COVIDView are showing increases in SARS-CoV-2 virus circulation and associated illnesses and deaths.
              • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have been increasing since September. Hospitalization rates for the most recent week are expected to increase as additional data are reported in future weeks.
              • The percentage of deaths due to PIC has been increasing since the beginning of October. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
            • At least one indicator used to monitor COVID-19 activity is increasing in each of the ten HHS regions, and many regions are reporting increases in multiple indicators.
              • The percentages of specimens testing positive for SARS-CoV-2 increased in nine of the ten regions. Region 7 (Central) reported a slight decline in percentage of specimens testing positive for SARS-CoV-2 during 46 compared with week 45.
              • The percentages of visits for ILI, CLI or both increased in all ten regions.
              • Three regions (Regions 5 [Midwest], 7 [Central] and 8 [Mountain]) have a least two surveillance indicators that were higher during week 46 than at any other time during the pandemic.
            • The overall cumulative COVID-19-associated hospitalization rate through the week ending November 14, 2020, was 228.7 hospitalizations per 100,000 population.
              • Since the week ending September 19 (MMWR week 38), weekly hospitalization rates among all age groups combined are increasing. The weekly hospitalization rate among adults 65 years and older is approaching the peak weekly rate observed during the week ending April 18 (MMWR week 16). Data for the most recent weeks may change as additional admissions occurring during those weeks are reported.
              • The age-adjusted hospitalization rate for Hispanic or Latino persons was approximately 4.1 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.0 and 3.7 times those of non-Hispanic White persons, respectively.
            • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

            U.S. Virologic Surveillance


            Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 75,643,495 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

            Nationally, during week 46, 3,435,511 specimens were tested for SARS-CoV-2 for diagnostic purposes, and 407,928 (11.9%) were positive. This is an increase compared with week 45, during which 10.8% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




            *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
            View Data Table


            The percentages of specimens testing positive for SARS-CoV-2 increased in nine of the ten HHS regionsexternal icon. Region 7 (Central) reported a slight decrease during week 46 compared with week 45. The regions with the highest percent positivity during week 46 were in the central part of the country, Regions 5 (Midwest, 17.4%), 6 (South Central, 14.7%), 7 (Central, 23.5%) and 8 (Mountain, 18.2%).

            Additional virologic surveillance information: Surveillance Methods


            Outpatient/Emergency Department Illness


            Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

            Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI have been increasing since mid-September. During week 46, the percentages of ED visits captured in NSSP for CLI and ILI were 4.9% and 1.3%, respectively and, compared to week 45, increased (CLI) or remained stable (change of≤0.1%; ILI). In ILINet, 1.5% of visits reported were for ILI, remaining stable compared with week 45 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 31st consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

            resize iconView LargerView Data Table


            For those aged 5–24 years, the percentage of visits for ILI reported in ILINet decreased during week 46 (1.7%) compared with week 45 (1.9%). For all other age groups, (0–4 years, 25–49 years, 50–64 years, 65 years and older) the percentage of visits for ILI remained stable (change of ≤0.1%). All age groups have experienced an increasing percentage of visits for ILI since September.

            resize iconView LargerView Data Table


            On a regional levelexternal icon, all ten regions reported an increase in the percentage of visits for CLI during week 46 compared to week 45, and four regions (Regions 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], 9 [South West/Coast], and 10 [Pacific Northwest]) also reported an increase in percentage of visits for ILI. The remaining six regions reported a stable (change of ≤0.1%) or decreasing percentage of visits for ILI during week 46 compared with week 45 but have had a generally increasing trend in visits for ILI since September. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

            ILI Activity Levels

            Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

            The number of jurisdictions at each activity level during week 46 and the previous week are summarized in the table below.
            Activity Level Number of Jurisdictions Number of CBSAs
            Week 46
            (Week ending
            Nov. 14, 2020)
            Week 45
            (Week ending
            Nov. 7, 2020)
            Week 46
            (Week ending
            Nov. 14, 2020)
            Week 45
            (Week ending
            Nov. 7, 2020)
            Very High 0 1 0 1
            High 0 0 3 3
            Moderate 0 0 6 5
            Low 2 3 56 41
            Minimal 52 51 515 554
            Insufficient Data 1 0 349 327
            *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

            Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

            Hospitalizations


            The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

            A total of 74,573 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and November 14, 2020. The overall cumulative hospitalization rate was 228.7 per 100,000 population.

            Since the week ending September 19 (MMWR week 38), weekly hospitalization rates among all age groups combined are increasing. The weekly hospitalization rate among adults 65 years and older is approaching the peak weekly rate observed during the week ending April 18 (MMWR week 16). The hospitalization rates for the most recent week are expected to increase as additional data are reported in future weeks.

            resize iconView Larger
            Among the 74,573 laboratory-confirmed COVID-19-associated hospitalizations, 71,211 (95.5%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,362 (4.5%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons was approximately 4.1 times the rate among non-Hispanic White persons. Rates for non-Hispanic American Indian or Alaska Native persons and non-Hispanic Black persons were approximately 4.0 and 3.7 times the rate among non-Hispanic White persons, respectively.





            When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 6.0 times higher among Hispanic or Latino persons aged 0–17 years; 7.2 times higher among non-Hispanic American Indian or Alaska Native persons 18–49 years; 5.0 times higher among non-Hispanic American Indian or Alaska Native persons and Hispanic or Latino persons aged 50–64 years; and 3.0 times higher among non-Hispanic Black persons aged ≥ 65 years.

            Age Category Non-Hispanic
            American Indian or Alaska Native
            Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
            Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
            0—17 years 21.4 3.9 24.3 4.4 33.2 6.0 10.4 1.9 5.5 1.0
            18—49 years 358.0 7.2 236.2 4.8 348.8 7.0 75.1 1.5 49.7 1.0
            50—64 years 779.0 5.0 655.5 4.2 767.1 5.0 217.7 1.4 154.7 1.0
            65+ years 979.9 2.3 1285.3 3.0 1064.9 2.5 424.7 1.0 425.1 1.0
            Overall rate4 (age-adjusted) 459.3 4.0 429.3 3.7 465.4 4.1 139.5 1.2 114.6 1.0
            1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
            2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
            3 The highest rate ratio in each age category is presented in bold.
            4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

            Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
            1.3% 30.2% 22.5% 5.2% 35.6%
            0.7% 17.9% 14.1% 8.9% 58.5%
            1.9 1.7 1.6 0.6 0.6
            1Persons of multiple races (0.3%) or unknown race and ethnicity (4.9%) are not represented in the table but are included as part of the denominator.
            2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

            For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,438 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.6% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension, obesity, metabolic disease, and cardiovascular disease. Among 265 children hospitalized during March 1–May 31 with information on underlying conditions, 50.9% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity, asthma, and neurologic disease.

            Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

            Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


            Mortality Surveillance


            The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on November 19, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 46 was 10.7% and, while it is declining compared with the percentage during week 44, it remains above the epidemic threshold. Among the 2,187 PIC deaths reported for week 46, 1,260 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and two listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

            The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained approximately stable from the week ending September 19 through the week ending October 3, and increased throughout the month of October. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

            resize iconView Larger


            *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
            View Data Table


            Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
            More Information
            View Page In:pdf icon 956 KB, 11 Pages
            Last Updated Nov. 20, 2020

            https://www.cdc.gov/coronavirus/2019...ata/covidview/

            Comment


            • #36

              COVIDView Summary ending November 21, 2020


              Updated Nov. 30, 2020


              Download Weekly Summary pdf icon[989 KB, 10 pages]
              Key Updates for Week 47, ending November 21, 2020


              Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September; however, the percentage of specimens testing positive for SARS-CoV-2 decreased slightly during week 47. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased during October and early November. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


              Download Chart Data excel icon[XLS – 2 KB]
              Virus: Public Health, Commercial and Clinical Laboratories


              Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, decreased from 12.0% during week 46 to 10.6% during week 47. Percent positivity decreased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 decreased in eight of the ten HHS regions.
              Mild/Moderate Illness: Outpatient and Emergency Department Visits


              Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) and COVID-like illness (CLI) has been increasing since mid-September; CLI increased in week 47 compared with week 46, while ILI remained stable (change of ≤0.1%). Eight of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness.
              Severe Disease: Hospitalizations and Deaths


              The overall weekly hospitalization rate is at its highest point in the pandemic, with steep increases in individuals aged 65 years and older. Based on death certificate data, the percentage of deaths attributed to PIC for week 47 was 11.3% and, while declining compared with week 46 (15.2%), remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased for five weeks from early October through early November and are expected to increase for the most recent weeks as additional data are reported. Hospitalization rates for the most recent week are also expected to increase as additional data are reported.

              All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
              Key Points
              • Nationally, the surveillance indicators included in COVIDView have been showing increases in SARS-CoV-2 virus circulation and associated illnesses and deaths in recent months.
                • The percentage of specimens testing positive for SARS-CoV-2 has been increasing since September but decreased slightly during week 47 compared with week 46.
                • The percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have been increasing since September. Hospitalization rates for the most recent week are expected to increase as additional data are reported in future weeks.
                • The percentage of deaths due to PIC has been increasing since the beginning of October. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
              • At least one indicator used to monitor COVID-19 activity is increasing in eight of ten HHS regions, and many regions are reporting increases in multiple indicators.
                • The percentages of specimens testing positive for SARS-CoV-2 increased in two of ten regions – Regions 9 (South West/Coast) and 10 (Pacific Northwest).
                • The percentages of visits for ILI, CLI or both increased in eight of ten regions – Regions 1 (New England), 2 (New Jersey/New York/Puerto Rico), 3 (Mid-Atlantic), 4 (Southeast), 6 (South Central), 8 (Mountain), 9 (South West/Coast) and 10 (Pacific Northwest).
                • During the past 2 weeks, three regions (Regions 5 [Midwest], 7 [Central] and 8 [Mountain]) have had a least one surveillance indicator that was higher than at any other time during the pandemic. However, during week 47 compared with week 46, all three of these regions reported a decline in percentage of specimens testing positive for SARS-CoV-2, and two of these regions (Regions 5 [Midwest] and 7 [Central]) also reported stable or declining indicators for mild to moderate respiratory illness (ILI and CLI).
              • The overall cumulative COVID-19-associated hospitalization rate through the week ending November 21, 2020, was 243.8 hospitalizations per 100,000 population.
                • The overall weekly hospitalization rate is at its highest point in the pandemic, with steep increases in individuals aged 65 years and older. All COVID-NET sites have reported increasing hospitalization rates in recent weeks. Rates for the most recent weeks are expected to increase as additional admissions occurring during those weeks are reported.
                • The age-adjusted hospitalization rates for Hispanic or Latino persons and non-Hispanic American Indian or Alaska Native persons were approximately 3.9 times that of non-Hispanic White persons. Age-adjusted hospitalization rates for non-Hispanic Black persons were approximately 3.6 times those of non-Hispanic White persons.
              • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

              U.S. Virologic Surveillance


              Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 79,948,333 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

              Nationally, during week 47, 3,769,481 specimens were tested for SARS-CoV-2 for diagnostic purposes, and 399,197 (10.6%) were positive. This is a decrease compared with week 46, during which 12.0% of specimens tested were positive. The percentages of specimens testing positive decreased among all age groups.




              *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
              View Data Table


              The percentages of specimens testing positive for SARS-CoV-2 increased in two (Regions 9 [West South/Central] and 10 [Pacific Northwest]) of the ten HHS regionsexternal icon. The regions with the highest percent positivity during week 47 were in the central part of the country, Regions 5 (Midwest, 14.4%), 6 (South Central, 14.2%), 7 (Central, 19.3%) and 8 (Mountain, 16.4%); all reported a decline in percent positivity in week 47 compared with week 46.

              Additional virologic surveillance information: Surveillance Methods


              Outpatient/Emergency Department Illness


              Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

              Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI have been increasing since mid-September. During week 47, the percentages of ED visits captured in NSSP for CLI and ILI were 5.9% and 1.4%, respectively and, compared to week 46, increased (CLI) or remained stable (change of ≤0.1%; ILI). In ILINet, 1.6% of visits reported were for ILI, remaining stable (change of ≤0.1%) compared with week 46 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 32nd consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

              resize iconView LargerView Data Table


              The percentage of visits for ILI reported in ILINet during week 47 remained stable (change of ≤0.1%) compared with week 46 for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older). All age groups have experienced an increasing percentage of visits for ILI since September.

              resize iconView LargerView Data Table


              On a regional levelexternal icon, eight regions (Regions 1 [New England], 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], 4 [Southeast], 6 [South Central], 8 [Mountain], 9 [South West/Coast], 10 [Pacific Northwest]) reported an increase in the percentage of visits for CLI during week 47 compared to week 46, and three regions (Regions 2 [New Jersey/New York/Puerto Rico], 4 [Southeast], 9 [South West/Coast]) also reported an increase in percentage of visits for ILI. The remaining seven regions reported a stable (change of ≤0.1%) or decreasing percentage of visits for ILI during week 47 compared with week 46 but have had a generally increasing trend in visits for ILI since September. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

              ILI Activity Levels

              Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

              The number of jurisdictions at each activity level during week 47 and the previous week are summarized in the table below.
              Activity Level Number of Jurisdictions Number of CBSAs
              Week 47
              (Week ending
              Nov. 21, 2020)
              Week 46
              (Week ending
              Nov. 14, 2020)
              Week 47
              (Week ending
              Nov. 21, 2020)
              Week 46
              (Week ending
              Nov. 14, 2020)
              Very High 0 0 0 0
              High 0 0 2 4
              Moderate 1 0 15 6
              Low 2 3 42 58
              Minimal 51 52 524 534
              Insufficient Data 1 0 346 327
              *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

              Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

              Hospitalizations


              The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

              A total of 79,501 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and November 21, 2020. The overall cumulative hospitalization rate was 243.8 per 100,000 population. The overall weekly hospitalization rate is at its highest point in the pandemic, with steep increases in individuals aged 65 years and older. All COVID-NET sites have reported increasing hospitalization rates in recent weeks. The hospitalization rates for the most recent week are expected to increase as additional data are reported in future weeks.

              resize iconView Larger
              Among the 79,501 laboratory-confirmed COVID-19-associated hospitalizations, 76,621 (96.4%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 2,880 (3.6%) cases. When examining overall age-adjusted rates by race and ethnicity, the rates for both Hispanic or Latino persons and American Indian or Alaska Native persons were approximately 3.9 times the rate among non-Hispanic White persons. Rates for non-Hispanic Black persons were approximately 3.6 times the rate among non-Hispanic White persons.





              When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 5.7 times higher among Hispanic or Latino persons aged 0–17 years; 7.0 times higher among non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.9 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 2.9 times higher among non-Hispanic Black persons aged ≥ 65 years.
              Age Category Non-Hispanic
              American Indian or Alaska Native
              Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
              Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
              0—17 years 21.4 3.1 26.3 3.8 36.9 5.3 11.1 1.6 7.0 1.0
              18—49 years 399.9 6.7 259.9 4.4 381.5 6.4 84.3 1.4 59.3 1.0
              50—64 years 869.4 4.6 725.2 3.9 876.4 4.7 244.3 1.3 187.0 1.0
              65+ years 1148.2 2.2 1430.8 2.7 1279.9 2.4 492.7 0.9 525.2 1.0
              Overall rate4 (age-adjusted) 521.0 3.7 475.5 3.4 533.7 3.8 158.8 1.1 140.0 1.0
              1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
              2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
              3 The highest rate ratio in each age category is presented in bold.
              4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

              Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
              1.3% 29.7% 22.1% 5.1% 36.4%
              0.7% 17.9% 14.1% 8.9% 58.5%
              1.9 1.7 1.6 0.6 0.6
              1Persons of multiple races (0.3%) or unknown race and ethnicity (5.0%) are not represented in the table but are included as part of the denominator.
              2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

              For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,441 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.6% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (59.0%), obesity (46.2%), metabolic disease (42.9%), and cardiovascular disease (34.2%). Among 265 children hospitalized during March 1–May 31 with information on underlying conditions, 50.9% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (43.2%), asthma (13.2%), and neurologic disease (12.8%).

              Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

              Additional hospitalization surveillance information: Surveillance Methods | Additional rate data | Additional demographic and clinical data


              Mortality Surveillance


              The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on November 25, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 47 was 11.3% and, while it declined compared with the percentage during week 46 (15.2%), it remains above the epidemic threshold of 6.3%. Among the 2,000 PIC deaths reported for week 47, 1,181 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and five listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

              The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained stable from the week ending September 19 through the week ending October 3, and increased for five weeks from early October through early November. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

              resize iconView Larger


              *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
              View Data Table


              Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
              More Information
              View Page In:pdf icon 989 KB, 10 pages
              Last Updated Nov. 30, 2020

              Comment


              • #37

                COVIDView Summary ending November 28, 2020


                Updated Dec. 4, 2020


                Download Weekly Summary pdf icon[896 KB, 10 pages]
                Key Updates for Week 48, ending November 28, 2020


                Nationally, surveillance indicators tracking levels of SARS-CoV-2 virus circulation and associated illnesses have been increasing since September. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased during October and through mid-November. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


                Download Chart Data excel icon[XLS – 2 KB]
                Virus: Public Health, Commercial and Clinical Laboratories


                Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 10.7% during week 47 to 11.7% during week 48. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in nine of the ten HHS regions.
                Mild/Moderate Illness: Outpatient and Emergency Department Visits


                Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) and COVID-like illness (CLI) has been increasing since mid-September; CLI and ILI remained stable (change of ≤0.1%) during week 48 compared with week 47. Four of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness.
                Severe Disease: Hospitalizations and Deaths


                The overall weekly hospitalization rate is at its highest point since the beginning of the pandemic, with steep increases in adults aged 65 years and older. Based on death certificate data, the percentage of deaths attributed to PIC for week 48 was 12.8% and, while declining compared with week 47 (18.6%), remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased for seven weeks from early October through mid-November and are expected to increase for the most recent weeks as additional data are reported. Hospitalization rates for the most recent week are also expected to increase as additional data are reported.

                All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                Key Points
                • Nationally, the surveillance indicators included in COVIDView have been showing increases in SARS-CoV-2 virus circulation and associated illnesses and deaths in recent months.
                  • The percentage of specimens testing positive for SARS-CoV-2 has been increasing since September. While a slight decrease was reported during week 47 compared with week 46, percent positivity has increased among all age groups in week 48 compared with week 47.
                  • The percentages of visits to EDs or outpatient providers for ILI and CLI, and COVID-19-associated hospitalization rates have been increasing since September.
                  • The percentage of deaths due to PIC has been increasing since the beginning of October. The percentages for 46 and 47 now exceed the percentage of deaths due to PIC observed during the summer peak. Data for the most recent week currently shows a decline, but that is likely to change as additional death certificates are processed.
                • At least one indicator used to monitor COVID-19 activity is increasing in nine of ten HHS regions, and many regions are reporting increases in multiple indicators.
                  • The percentages of specimens testing positive for SARS-CoV-2 increased in nine of ten regions – Regions 2 (New Jersey/New York/Puerto Rico), 3 (Mid-Atlantic), 4 (Southeast), 5 (Midwest), 6 (South Central), 7 (Central), 8 (Mountain), 9 (South West/Coast), and 10 (Pacific Northwest).
                  • The percentages of visits for ILI, CLI or both increased in four of ten regions – Regions 2 (New Jersey/New York/Puerto Rico), 3 (Mid-Atlantic), 4 (Southeast), and 9 (South West/Coast).
                • The overall cumulative COVID-19-associated hospitalization rate through the week ending November 28, 2020, was 262.8 hospitalizations per 100,000 population.
                  • The overall weekly hospitalization rate is at its highest point since the beginning of the pandemic, with steep increases in adults aged 65 years and older. All COVID-NET sites have reported increasing hospitalization rates in recent weeks. Rates for the most recent weeks are expected to increase as additional admissions occurring during those weeks are reported.
                  • The rates for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.8, 3.7, and 3.4 times the rate among non-Hispanic White persons, respectively.
                • These surveillance systems aim to provide the most complete data available. Estimates from previous weeks are subject to change as data are updated with the most complete data available.

                U.S. Virologic Surveillance


                Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 83,949,946 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentages of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                Nationally, during week 48, of 3,005,511 specimens tested for SARS-CoV-2 for diagnostic purposes, 350,378 (11.7%) were positive. This is an increase compared with week 47, during which 10.7% of specimens tested were positive. The percentages of specimens testing positive increased among all age groups.




                *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
                View Data Table


                The percentages of specimens testing positive for SARS-CoV-2 increased in nine of ten HHS regionsexternal icon – Regions 2 (New Jersey/New York/Puerto Rico), 3 (Mid-Atlantic), 4 (Southeast), 5 (Midwest), 6 (South Central), 7 (Central), 8 (Mountain), 9 (South West/Coast), and 10 (Pacific Northwest). The regions with the highest percent positivity during week 48 were in the central part of the country, Regions 5 (Midwest, 14.8%), 6 (South Central, 15.2%), 7 (Central, 19.4%) and 8 (Mountain, 15.6%).

                Additional virologic surveillance information: Surveillance Methods


                Outpatient/Emergency Department Illness


                Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI have been increasing since mid-September, with the greatest increase occurring for the percentage of visits for CLI. During week 48, the percentages of ED visits captured in NSSP for CLI and ILI were 6.0% and 1.4%, respectively, and both remained stable (change of ≤0.1%) compared with week 47. In ILINet, 1.6% of visits reported were for ILI, remaining stable (change of ≤0.1%) compared with week 47 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 33rd consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                resize iconView LargerView Data Table


                The percentage of visits for ILI reported in ILINet during week 48 remained stable (change of ≤0.1%) compared with week 47 for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older). All age groups have experienced an increasing percentage of visits for ILI since September.

                resize iconView LargerView Data Table


                On a regional levelexternal icon, four regions (Regions 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], 4 [Southeast], 9 [South West/Coast]) reported an increase in at least one indicator of mild to moderate illness (CLI and/or ILI) during week 48 compared with week 47, and two of these regions (Region 3 [Mid-Atlantic] and 9 [South West/Coast]) reported an increase in all indicators. Five regions (Regions 5 [Midwest], 6 [South Central], 7[Central], 8 [Mountain] and 10 [Pacific Northwest) reported a decrease in at least one indicator of mild to moderate illness (CLI and/or ILI) Region 1 (Northeast) reported a stable (change of ≤0.1%) level of CLI and ILI during week 48 compared with week 47. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

                ILI Activity Levels

                Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                The number of jurisdictions at each activity level during week 48 and the previous week are summarized in the table below.
                Activity Level Number of Jurisdictions Number of CBSAs
                Week 48 (Week ending Nov. 28, 2020) Week 47 (Week ending Nov. 21, 2020) Week 48 (Week ending Nov. 28, 2020) Week 47 (Week ending Nov. 21, 2020)
                Very High 0 0 0 0
                High 0 0 3 5
                Moderate 0 0 14 16
                Low 5 2 56 40
                Minimal 47 53 511 551
                Insufficient Data 3 0 345 317
                *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                Hospitalizations


                The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                A total of 85,678 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and November 28, 2020. The overall cumulative hospitalization rate was 262.8 per 100,000 population. The overall weekly hospitalization rate is at its highest point since the beginning of the pandemic, with steep increases in adults aged 65 years and older. All COVID-NET sites have reported increasing hospitalization rates in recent weeks. The hospitalization rates for the most recent week are expected to increase as additional data are reported in future weeks.

                resize iconView Larger
                Among the 85,678 laboratory-confirmed COVID-19-associated hospitalizations, 82,640 (96.5%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,038 (3.5%) cases. When examining overall age-adjusted rates by race and ethnicity, the rates for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.8, 3.7, and 3.4 times the rate among non-Hispanic White persons, respectively.





                When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, the highest crude hospitalization rate ratios for each age group were as follows: 5.3 times higher among Hispanic or Latino persons aged 0–17 years; 6.7 times higher among non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.7 times higher among Hispanic or Latino persons aged 50–64 years; and 2.7 times higher among non-Hispanic Black persons aged ≥65 years.

                Age Category Non-Hispanic
                American Indian or Alaska Native
                Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
                Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
                0—17 years 25.3 3.4 27.3 3.7 37.6 5.1 11.9 1.6 7.4 1.0
                18—49 years 424.3 6.7 268.6 4.3 398.7 6.3 88.2 1.4 63.1 1.0
                50—64 years 935.8 4.7 755.3 3.8 920.3 4.6 259.0 1.3 198.6 1.0
                65+ years 1,211.3 2.1 1,479.6 2.6 1,379.5 2.4 528.4 0.9 565.3 1.0
                Overall rate4 (age-adjusted) 554.2 3.7 492.7 3.3 564.6 3.8 168.8 1.1 149.9 1.0
                1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                3 The highest rate ratio in each age category is presented in bold.
                4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

                Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                1.2% 28.8% 21.9% 5.1% 37.5%
                0.7% 17.9% 14.1% 8.9% 58.5%
                1.7 1.6 1.6 0.6 0.6
                1Persons of multiple races (0.3%) or unknown race and ethnicity (5.2%) are not represented in the table but are included as part of the denominator.
                2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,442 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.6% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (58.9%), obesity (46.2%), metabolic disease (42.8%), and cardiovascular disease (34.2%). Among 265 children hospitalized during March 1–May 31 with information on underlying conditions, 50.9% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (43.2%), asthma (13.2%), and neurologic disease (12.8%).

                Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

                Additional hospitalization surveillance information:
                Surveillance Methods | Additional rate data | Additional demographic and clinical data


                Mortality Surveillance


                The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on December 3, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 48 was 12.8% and, while it declined compared with the percentage during week 47 (18.6%), it remains above the epidemic threshold of 6.4%. Among the 2,094 PIC deaths reported for week 48, 1,397 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and three listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

                The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained stable from the week ending September 19 through the week ending October 3, and increased for seven weeks from early October through mid-November to a level that is higher than the July peak. Data for the most recent week currently shows a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine-coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine-coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

                resize iconView Larger


                *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                View Data Table


                Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
                More Information
                View Page In:pdf icon 896 KB, 11 pages
                Last Updated Dec. 4, 2020

                Comment


                • #38

                  Updated Dec. 11, 2020


                  Download Weekly Summary pdf icon[889 KB, 11 pages]
                  Key Updates for Week 49, ending December 5, 2020


                  Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses have been increasing since September; however, the percentage of emergency department (ED) visits for COVID-like illness (CLI) decreased slightly during week 49. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) has been increasing since October. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


                  Download Chart Data excel icon[XLS – 2 KB]
                  Virus: Public Health, Commercial and Clinical Laboratories


                  Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, increased from 12.1% during week 48 to 13.3% during week 49. Percent positivity increased among all age groups. Regionally, the percentages of respiratory specimens testing positive for SARS-CoV-2 increased in nine of the ten Health and Human Services (HHS) regionsexternal icon.
                  Mild/Moderate Illness: Outpatient and Emergency Department Visits


                  Nationally, the overall percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) and COVID-like illness (CLI) shows an increasing trend since mid-September; however, CLI decreased slightly during week 49 compared with week 48. Six of ten surveillance regions also reported a decrease in at least one indicator of mild/moderate illness this week; one region reported an increase.
                  Severe Disease: Hospitalizations and Deaths


                  Within the past month, all age groups have reached their highest weekly hospitalization rate since the start of the pandemic. Based on death certificate data, the percentage of deaths attributed to PIC for week 49 was 14.3% and remains above the epidemic threshold. The weekly percentages of deaths due to PIC increased for seven weeks from early October through mid-November and are expected to increase for the most recent weeks as additional data are reported. Hospitalization rates for the most recent week are also expected to increase as additional data are reported.

                  All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                  Key Points
                  • Nationally, the surveillance indicators included in COVIDView have been showing increases in SARS-CoV-2 circulation and associated illnesses and deaths in recent months.
                    • The percentage of specimens testing positive for SARS-CoV-2, the percentages of visits to EDs or outpatient providers for ILI and CLI, and hospitalization rates have been increasing since September. However, a slight decrease was reported in percentage of visits for CLI during week 49 compared to week 48.
                    • The percentage of deaths due to PIC has been increasing since the beginning of October and has exceeded the percentage of deaths due to PIC observed during the summer peak. Data for the most recent week currently show a decline, but that is likely to change as additional death certificates are processed.
                  • At least one indicator used to monitor COVID-19 activity is increasing in all ten HHS regions and in seven regions (Regions 3 [Mid-Atlantic], 5 [Midwest], 6 [South Central], 7 [Central], 8 [Mountain], 9 [South West/Coast], and 10 [Pacific Northwest]) at least one indicator is at the highest level since the start of the pandemic.
                  • The overall cumulative COVID-19-associated hospitalization rate through the week ending December 5, 2020, was 278.7 hospitalizations per 100,000 population.
                    • Within the past month, all age groups have reached their highest weekly hospitalization rate since the start of the pandemic. Rates for the most recent weeks are expected to increase as additional admissions occurring during those weeks are reported.
                    • The rates for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.8, 3.7, and 3.3 times the rate among non-Hispanic White persons, respectively.
                  • Estimates from previous weeks are subject to change as data are updated with the most complete data available.

                  U.S. Virologic Surveillance


                  Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 87,861,662 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                  Nationally, during week 49, of 3,490,096 specimens tested for SARS-CoV-2 for diagnostic purposes, 462,922 (13.3%) were positive. This is an increase compared with week 48, during which 12.1% of specimens tested were positive. The percentage of specimens testing positive increased among all age groups.




                  *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11 and commercial laboratory data beginning in week 14.
                  View Data Table


                  The percentage of specimens testing positive for SARS-CoV-2 decreased in one region (Region 7 [Central]) during week 49 compared with week 48; the remaining nine regions reported an increase in percentage of specimens testing positive. The regions with the highest percent positivity during week 49 were in the central part of the country, Regions 5 (Midwest, 15.8%), 6 (South Central, 15.8%), 7 (Central, 18.8%), and 8 (Mountain, 16.6%).

                  Additional virologic surveillance information: Surveillance Methods


                  Outpatient/Emergency Department Illness


                  Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                  Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI have shown increasing trends since mid-September, with the greatest increase occurring for CLI visits. During week 49, the percentages of ED visits captured in NSSP for CLI and ILI were 6.1% and 1.3%, respectively. This represents a decline in CLI compared with week 48 and a stable (change of ≤0.1%) level of ILI. In ILINet, 1.6% of visits reported during week 49 were for ILI, also remaining stable (change of ≤0.1%) compared with week 48 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 34th consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                  resize iconView LargerView Data Table


                  The percentage of visits for ILI reported in ILINet during week 49 remained stable (change of ≤0.1%) compared with week 48 for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older). All age groups have experienced an increasing percentage of visits for ILI since September.

                  resize iconView LargerView Data Table


                  On a regional levelexternal icon, one region (Region 2 [New Jersey/New York/Puerto Rico]) reported an increase in two indicators of mild to moderate illness (CLI and/or ILI) during week 49 compared with week 48. Six regions (Regions 4 [Southeast], 5 [Midwest], 6 [South Central], 7[Central], 8 [Mountain], and 10 [Pacific Northwest) reported a decrease in at least one indicator of mild to moderate illness (CLI and/or ILI) and three regions (Regions 1 [(Northeast)], 3 [Mid-Atlantic], and 9 [South West/Coast]) reported a stable (change of ≤0.1%) level of CLI and ILI during week 49 compared with week 48. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

                  ILI Activity Levels

                  Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                  The number of jurisdictions at each activity level during week 49 and the previous week are summarized in the table below.
                  Activity Level Number of Jurisdictions Number of CBSAs
                  Week 49 (Week ending Dec. 5, 2020) Week 48 (Week ending Nov. 28, 2020) Week 49 (Week ending Dec. 5, 2020) Week 48 (Week ending Nov. 28, 2020)
                  Very High 0 0 0 0
                  High 0 0 4 3
                  Moderate 0 0 13 15
                  Low 4 4 53 60
                  Minimal 49 50 547 543
                  Insufficient Data 2 1 312 308
                  *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                  Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                  Hospitalizations


                  The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                  A total of 90,874 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and December 5, 2020. The overall cumulative hospitalization rate was 278.7 per 100,000 population. Within the past month, all age groups have reached their highest weekly hospitalization rate since the start of the pandemic. The hospitalization rates for the most recent weeks are expected to increase as additional data are reported in future weeks.

                  resize iconView Larger


                  1Additional hospitalization rate data by age group are available.

                  Among the 90,874 laboratory-confirmed COVID-19-associated hospitalizations, 87,303 (96.1%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,571 (3.9%) cases. When examining overall age-adjusted rates by race and ethnicity, the rates for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.8, 3.7, and 3.3 times the rate among non-Hispanic White persons, respectively.





                  When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 5.1 times higher among Hispanic or Latino persons aged 0–17 years; 6.7 times higher among non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.7 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 2.6 times higher among non-Hispanic Black persons aged ≥65 years.

                  Age Category Non-Hispanic
                  American Indian or Alaska Native
                  Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
                  Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
                  0—17 years 25.3 3.4 27.3 3.7 37.6 5.1 11.9 1.6 7.4 1.0
                  18—49 years 424.3 6.7 268.6 4.3 398.7 6.3 88.2 1.4 63.1 1.0
                  50—64 years 935.8 4.7 755.3 3.8 920.3 4.6 259.0 1.3 198.6 1.0
                  65+ years 1,211.3 2.1 1,479.6 2.6 1,379.5 2.4 528.4 0.9 565.3 1.0
                  Overall rate4 (age-adjusted) 554.2 3.7 492.7 3.3 564.6 3.8 168.8 1.1 149.9 1.0
                  1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                  2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                  3 The highest rate ratio in each age category is presented in bold.
                  4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

                  Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                  1.2% 28.2% 21.8% 5.1% 38.0%
                  0.7% 17.9% 14.1% 8.9% 58.5%
                  1.7 1.6 1.5 0.6 0.6
                  1Persons of multiple races (0.3%) or unknown race and ethnicity (5.3%) are not represented in the table but are included as part of the denominator.
                  2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                  For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,437 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.7% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (58.9%), obesity (46.1%), metabolic disease (42.9%), and cardiovascular disease (34.2%). Among 266 children hospitalized during March 1–May 31 with information on underlying conditions, 51.1% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (42.9%), asthma (13.5%), and neurologic disease (13.2%).

                  Additional hospitalization surveillance information:
                  Surveillance Methods | Additional rate data | Additional demographic and clinical data


                  Mortality Surveillance


                  The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on December 10, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 49 was 14.3% and, while it declined compared with the percentage during week 48 (19.6%), it remains above the epidemic threshold of 6.5% and is expected to increase as more death certificates are processed. Among the 3,052 PIC deaths reported for week 49, 2,113 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and five listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

                  The weekly percentage of deaths due to PIC declined from a second peak at the end of July through mid- September, remained stable from the week ending September 19 through the week ending October 3, and increased for seven weeks from early October through mid-November to a level that is higher than the July peak. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine-coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine-coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

                  resize iconView Larger


                  *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                  View Data Table


                  Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
                  More Information
                  View Page In:pdf icon 896 KB, 11 pages
                  Last Updated Dec. 11, 2020

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                    • #40

                      1. CASES, DATA & SURVEILLANCE
                      COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


                      Updated Dec. 18, 2020


                      Due to the Christmas and New Year’s holidays, the week 51 COVIDView report will be released on Monday, December 28 and the week 52 COVIDView report will be released on Monday, January 4.

                      Download Weekly Summary pdf icon[878 KB, 11 pages]
                      Key Updates for Week 50, ending December 12, 2020


                      Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses declined slightly or remained stable during the week ending December 12, 2020. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) has been increasing since October. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


                      Download Chart Data excel icon[XLS – 2 KB]
                      Virus: Public Health, Commercial and Clinical Laboratories


                      Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, decreased from 13.4% during week 49 to 12.2% during week 50. Percent positivity decreased among all age groups. Regionally, the percentage of respiratory specimens testing positive for SARS-CoV-2 increased in one of the ten Health and Human Services (HHS) regionsexternal icon.
                      Mild/Moderate Illness: Outpatient and Emergency Department Visits


                      Nationally, the percentage of visits to outpatient providers or emergency departments (EDs) for influenza-like illness (ILI) and COVID-like illness (CLI) remained stable (change of ≤0.1%) during week 50 compared with week 49. Three of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness this week; the remaining seven regions reported a stable (change of ≤0.1%) or decreasing percentage of visits for ILI and CLI.
                      Severe Disease: Hospitalizations and Deaths


                      During November, the overall weekly hospitalization rates reached their highest point since the beginning of the pandemic. Rates appear to be declining in recent weeks; however, these rates are likely to change as additional data are reported. Based on death certificate data, the percentage of deaths attributed to PIC for week 50 was 13.3% and remains above the epidemic threshold. The weekly percentage of deaths due to PIC increased throughout October and November and is expected to increase for the most recent weeks as additional data are reported.

                      All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                      Key Points
                      • Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses increased from September through early December but declined slightly or remained stable during week 50.
                        • At least one indicator used to monitor COVID-19 activity is increasing in three HHS regions – Regions 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], and 9 [South West/Coast].
                      • The overall cumulative COVID-19-associated hospitalization rate through the week ending December 12, 2020, was 295.8 hospitalizations per 100,000 population.
                        • While overall weekly hospitalization rates reached their highest point since the beginning of the pandemic within the past month, rates for the most recent weeks appear to be declining. However, hospitalization rates for the most recent weeks are likely to change as additional data are reported for those weeks.
                        • The age-adjusted hospitalization rate for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.7, 3.5, and 3.2 times those of non-Hispanic White persons, respectively.
                      • The percentage of deaths due to PIC has been increasing since the beginning of October and has exceeded the percentage of deaths due to PIC observed during the summer peak. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
                      • Estimates from previous weeks are subject to change as data are updated with the most complete data available.

                      U.S. Virologic Surveillance


                      Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 91,254,070 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                      Nationally, during week 50, of 2,940,118 specimens tested for SARS-CoV-2 for diagnostic purposes, 359,362 (12.2%) were positive. This is a decrease compared with week 49, during which 13.4% of specimens tested were positive. The percentage of specimens testing positive decreased among all age groups.




                      *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11, and commercial laboratory data beginning in week 14.
                      View Data Table


                      The percentage of specimens testing positive for SARS-CoV-2 increased in one region (Region 9 [South West/Coast]) during week 50 compared with week 49; the remaining nine regions reported a decrease in percentage of specimens testing positive.

                      Additional virologic surveillance information: Surveillance Methods


                      Outpatient/Emergency Department Illness


                      Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                      Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI have remained stable or declined slightly since late November. During week 50, the percentages of ED visits captured in NSSP for CLI and ILI were 6.6% and 1.3%, respectively. This represents a stable (change of ≤0.1%) level of CLI and ILI compared with week 49. In ILINet, 1.6% of visits reported during week 50 were for ILI, also remaining stable (change of ≤0.1%) for the fourth consecutive week and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 35th consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                      resize iconView LargerView Data Table


                      The percentages of visits for ILI reported in ILINet for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older) have remained stable (change of ≤0.1%) since mid-November.

                      resize iconView LargerView Data Table


                      On a regional levelexternal icon, three regions (Region 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic] and 9 [South West/Coast]) reported an increase in at least one indicator of mild to moderate illness (CLI and/or ILI) during week 50 compared with week 49. The remaining seven regions (1 [New England], 4 [Southeast], 5 [Midwest], 6 [South Central], 7[Central], 8 [Mountain], and 10 [Pacific Northwest) reported a decreasing or stable (change of ≤0.1%) level of mild to moderate illness. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

                      ILI Activity Levels

                      Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                      The number of jurisdictions at each activity level during week 50 and the previous week are summarized in the table below.
                      Activity Level Number of Jurisdictions Number of CBSAs
                      Week 50 (Week ending Dec. 12, 2020) Week 49 (Week ending Dec. 5, 2020) Week 50 (Week ending Dec. 12, 2020) Week 49 (Week ending Dec. 5, 2020)
                      Very High 0 0 0 0
                      High 0 0 4 5
                      Moderate 1 0 8 13
                      Low 0 4 43 59
                      Minimal 51 49 566 556
                      Insufficient Data 3 2 308 296
                      *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                      Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                      Hospitalizations


                      The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                      A total of 96,444 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020 and December 12, 2020. The overall cumulative hospitalization rate was 295.8 per 100,000 population. While overall weekly hospitalization rates reached their highest point since the beginning of the pandemic within the past month, rates for the most recent weeks appear to be declining. However, hospitalization rates for the most recent weeks are likely to change as additional data are reported for those weeks.

                      resize iconView Larger


                      1Additional hospitalization rate data by age group are available.

                      Among the 96,444 laboratory-confirmed COVID-19-associated hospitalizations, 94,432 (97.9%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 2,012 (2.1%) cases. When examining overall age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.7, 3.5, and 3.2 times the rate among non-Hispanic White persons, respectively.





                      When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 5.0 times higher among Hispanic or Latino persons aged 0–17 years; 6.5 times higher among Non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.5 times higher among non-Hispanic American Indian or Alaska Native persons and Hispanic or Latino persons aged 50–64 years; and 2.5 times higher among non-Hispanic Black persons aged ≥ 65 years.

                      Age Category Non-Hispanic
                      American Indian or Alaska Native
                      Non-Hispanic Black Hispanic or Latino Non-Hispanic Asian or Pacific Islander Non-Hispanic White
                      Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3 Rate1 Rate Ratio2,3
                      0—17 years 27.3 3.4 29.2 3.7 40.1 5.0 12.4 1.6 8.0 1.0
                      18—49 years 440.9 6.5 286.2 4.2 420.8 6.2 93.6 1.4 68.3 1.0
                      50—64 years 975.7 4.5 807.9 3.7 978.8 4.5 278.1 1.3 216.6 1.0
                      65+ years 1,308.0 2.1 1,588.8 2.5 1,497.8 2.4 571.3 0.9 625.7 1.0
                      Overall rate4 (age-adjusted) 584.0 3.5 527.4 3.2 603.6 3.7 181.2 1.1 164.6 1.0
                      1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                      2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                      3 The highest rate ratio in each age category is presented in bold.
                      4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

                      Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                      1.2% 27.9% 21.5% 5.1% 38.7%
                      0.7% 17.9% 14.1% 8.9% 58.5%
                      1.7 1.6 1.5 0.6 0.7
                      1Persons of multiple races (0.3%) or unknown race and ethnicity (5.4%) are not represented in the table but are included as part of the denominator.
                      2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                      For underlying medical conditions, data were restricted to cases reported during March 1–May 31, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 8,452 sampled adults hospitalized during March 1–May 31 with information on underlying medical conditions, 90.7% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (58.9%), obesity (46.1%), metabolic disease (42.9%), and cardiovascular disease (34.2%). Among 266 children hospitalized during March 1–May 31 with information on underlying conditions, 51.1% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (42.9%), asthma (13.5%), and neurologic disease (13.2%).

                      Additional data on demographics, signs and symptoms at admission, underlying conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

                      Additional hospitalization surveillance information:
                      Surveillance Methods | Additional rate data | Additional demographic and clinical data


                      Mortality Surveillance


                      The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on December 17, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 50 was 13.3% and, while it declined compared with the percentage during week 49 (20.8%), it remains above the epidemic threshold of 6.6% and is expected to increase as more death certificates are processed. Among the 2,897 PIC deaths reported for week 50, 1,921 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and two listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

                      The weekly percentage of deaths due to PIC increased for eight weeks from early October through the end of November to a level that is higher than the July peak. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine-coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine-coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

                      resize iconView Larger


                      *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                      View Data Table


                      Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
                      More Information
                      View Page In:pdf icon 878 KB, 11 pages
                      Last Updated Dec. 18, 2020

                      Comment


                      • #41

                        1. CASES, DATA & SURVEILLANCE
                        COVIDView Summary ending on December 19, 2020


                        Updated Dec. 28, 2020
                        Print
                        Due to New Year’s holiday, the week 52 COVIDView report will be released on Monday, January 4.

                        Download Weekly Summary pdf icon[844 KB, 11 pages]
                        Key Updates for Week 51, ending December 19, 2020


                        Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses declined or remained stable during the week ending December 19, 2020. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) has been increasing since early October. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


                        Download Chart Data excel icon[XLS – 2 KB]
                        Virus: Public Health, Commercial and Clinical Laboratories


                        Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, decreased from 12.9% during week 50 to 12.1% during week 51. Percent positivity decreased among all age groups. Regionally, the percentage of respiratory specimens testing positive for SARS-CoV-2 increased in two of the ten Health and Human Services (HHS) regionsexternal icon.
                        Mild/Moderate Illness: Outpatient and Emergency Department Visits


                        Nationally, the percentage of visits to outpatient providers or emergency departments (EDs) for COVID-like illness (CLI) and influenza-like illness declined or remained stable (change of ≤0.1%), respectively, during week 51 compared with week 50. One of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness this week; the remaining nine regions reported a stable (change of ≤0.1%) or decreasing percentage of visits for ILI and CLI.
                        Severe Disease: Hospitalizations and Deaths


                        In recent weeks, overall weekly hospitalization rates have remained stable but elevated, after reaching their highest point since the beginning of the pandemic in late November. Rates for recent weeks are likely to change as additional data are reported. Based on death certificate data, the percentage of deaths attributed to PIC for week 51 was 13.0% and remains above the epidemic threshold. The weekly percentage of deaths due to PIC increased during October through early December and is expected to increase for the most recent weeks as additional data are reported.

                        All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                        Key Points
                        • Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses declined or remained stable during week 51 compared with week 50.
                          • At least one indicator used to monitor COVID-19 activity increased in three regions (Regions 2 [New Jersey/New York/Puerto Rico], 6 [South Central], and 9 [South/West Central]) during week 51 compared with week 50. The remaining seven regions reported a decreasing or stable level of SARS-CoV-2 virus circulation and mild/moderate illness during week 51.
                        • The overall cumulative COVID-19-associated hospitalization rate through the week ending December 19, 2020, was 313.3 hospitalizations per 100,000 population.
                          • Overall weekly hospitalization rates reached their highest point at 16.7 per 100,000 during the week ending November 21, 2020 (MMWR Week 47) and have remained elevated but stable since that time. Hospitalization rates for the most recent weeks are likely to change as additional data are reported for those weeks.
                          • The cumulative age-adjusted hospitalization rates for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.6, 3.5, and 3.1 times those of non-Hispanic White persons, respectively.
                        • The percentage of deaths due to PIC has been increasing since the beginning of October and has exceeded the percentage of deaths due to PIC observed during the summer peak. Data for the most recent two weeks currently show a decline, but that is likely to change as additional death certificates are processed.
                        • Estimates from previous weeks are subject to change as data are updated with the most complete data available.

                        U.S. Virologic Surveillance


                        Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 94,163,675 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                        Nationally, during week 51, of 3,098,030 specimens tested for SARS-CoV-2 for diagnostic purposes, 376,034 (12.1%) were positive. This is a decrease compared with week 50, during which 12.9% of specimens tested were positive. The percentage of specimens testing positive decreased among all age groups.




                        *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11, and commercial laboratory data beginning in week 14.
                        View Data Table


                        The percentage of specimens testing positive for SARS-CoV-2 increased in two regions (Regions 6 [South Central] and 9 [South West/Coast]) during week 51 compared with week 50; the remaining eight regions reported a decrease in percentage of specimens testing positive.

                        Additional virologic surveillance information: Surveillance Methods


                        Outpatient/Emergency Department Illness


                        Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                        Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI remained stable (change of ≤0.1%) or declined slightly during week 51 compared with week 50. During week 51, the percentages of ED visits captured in NSSP for CLI and ILI were 6.6% and 1.3%, respectively. This represents a decrease in CLI and a stable (change of ≤0.1%) level of ILI compared with week 50. In ILINet, 1.5% of visits reported during week 51 were for ILI, also remaining stable (change of ≤0.1%) compared with week 50 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 36th consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                        resize iconView LargerView Data Table


                        The percentages of visits for ILI reported in ILINet increased slightly in week 51 compared with week 50 for those aged 0–4 years and remained stable (change of ≤0.1%) for the remaining age groups (5–24 years, 25–49 years, 50–64 years, 65 years and older.

                        resize iconView LargerView Data Table


                        On a regional levelexternal icon, Region 2 (New Jersey/New York/Puerto Rico) reported an increase in at least one indicator of mild to moderate illness (CLI and/or ILI) during week 51 compared with week 50. The remaining nine regions reported a decreasing or stable (change of ≤0.1%) level of mild to moderate illness. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

                        ILI Activity Levels

                        Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                        The number of jurisdictions at each activity level during week 51 and the previous week are summarized in the table below.
                        Activity Level Number of Jurisdictions Number of CBSAs
                        Week 51 (Week ending Dec. 19, 2020) Week 50 (Week ending Dec. 12, 2020) Week 51 (Week ending Dec. 19, 2020) Week 50 (Week ending Dec. 12, 2020)
                        Very High 0 0 0 0
                        High 0 0 6 3
                        Moderate 0 1 6 10
                        Low 0 0 51 44
                        Minimal 54 53 531 578
                        Insufficient Data 1 1 335 294
                        *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                        Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                        Hospitalizations


                        The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                        A total of 102,132 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and December 19, 2020. The overall cumulative hospitalization rate was 313.3 per 100,000 population. Overall weekly hospitalization rates reached their highest point at 16.7 per 100,000 during the week ending November 21, 2020 (MMWR Week 47) and have remained elevated but stable since that time. Hospitalization rates for the most recent weeks are likely to change as additional data are reported for those weeks.

                        resize iconView Larger


                        1Additional hospitalization rate data by age group are available.

                        Among the 102,132 laboratory-confirmed COVID-19-associated hospitalizations, 99,797 (97.7%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 2,335 (2.3%) cases. When examining overall cumulative age-adjusted rates by race and ethnicity, the rate for Hispanic or Latino persons, non-Hispanic American Indian or Alaska Native persons, and non-Hispanic Black persons were approximately 3.6, 3.5, and 3.1 times the rate among non-Hispanic White persons, respectively.



                        When examining age-stratified crude cumulative hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, hospitalization rates were 4.8 times higher among Hispanic or Latino persons aged 0–17 years; 6.3 times higher among non-Hispanic American Indian or Alaska Native persons aged 18–49 years; 4.4 times higher among both non-Hispanic American Indian or Alaska Native and Hispanic or Latino persons aged 50–64 years; and 2.5 times higher among non-Hispanic Black persons aged ≥ 65 years.

                        29.2 3.2 31.5 3.5 42.9 4.7 13.4 1.5 9.1 1.0
                        463.4 6.2 304.4 4.1 442.1 5.9 102.3 1.4 75.1 1.0
                        1042.2 4.4 864.7 3.6 1035.5 4.3 305.4 1.3 238.7 1.0
                        1497.2 2.1 1700.2 2.4 1630.5 2.3 652.9 0.9 705.0 1.0
                        636.1 3.5 563.7 3.1 644.2 3.5 202.5 1.1 183.6 1.0
                        1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                        2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                        3 The highest rate ratio in each age category is presented in bold.
                        4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

                        Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                        1.2% 27.7% 21.1% 5.1% 39.2%
                        0.7% 17.9% 14.1% 8.9% 58.5%
                        1.7 1.5 1.5 0.6 0.7
                        1Persons of multiple races (0.3%) or unknown race and ethnicity (5.5%) are not represented in the table but are included as part of the denominator.
                        2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                        For underlying medical conditions, data were restricted to cases reported during March 1–September 30, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 15,128 sampled adults hospitalized during March 1–September 30 with information on underlying medical conditions, 90.0% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (56.5%), obesity (48.2%), metabolic disease (42.3%), and cardiovascular disease (32.7%). Among 787 children hospitalized during March 1–September 30 with information on underlying medical conditions, 50.8% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (37.8%), neurologic disease (12.9%), and asthma (10.7%).

                        Additional data on demographics, signs and symptoms at admission, underlying medical conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

                        Additional hospitalization surveillance information:
                        Surveillance Methods | Additional rate data | Additional demographic and clinical data


                        Mortality Surveillance


                        The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on December 23, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 51 was 13.0% and, while it declined compared with the percentage during week 50 (18.5%), it remains above the epidemic threshold of 6.7% and is expected to increase as more death certificates are processed. Among the 2,308 PIC deaths reported for week 51, 1,524 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and four listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

                        The weekly percentage of deaths due to PIC increased for nine weeks from early October through the beginning of December to a level that is higher than the July peak. Data for the most recent two weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine-coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine-coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data.

                        resize iconView Larger


                        *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                        View Data Table


                        Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
                        More Information
                        View Page In:pdf icon 878 KB, 11 pages
                        Last Updated Dec. 28, 2020

                        Comment


                        • #42

                          1. CASES, DATA & SURVEILLANCE
                          COVIDView Summary ending December 26, 2020


                          Updated Jan. 4, 2021
                          Print
                          Download Weekly Summary pdf icon[918 KB, 10 pages]
                          Key Updates for Week 52, ending December 26, 2020


                          Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses declined or remained stable during the week ending December 26, 2020; however, there were regional differences. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) has been increasing since early October. Both COVID-19-associated hospitalizations and PIC mortality for the most recent weeks are expected to increase as more data are received.


                          Download Chart Data excel icon[XLS – 2 KB]
                          Virus: Public Health, Commercial and Clinical Laboratories


                          Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, decreased slightly from 12.4% during week 51 to 12.3% during week 52. Percent positivity increased among two age groups (0–4 years and 5–17 years). Regionally, the percentage of respiratory specimens testing positive for SARS-CoV-2 increased in five of the ten Health and Human Services (HHS) regionsexternal icon.
                          Mild/Moderate Illness: Outpatient and Emergency Department Visits


                          Nationally, the percentage of visits to outpatient providers or emergency departments (EDs) for COVID-like illness (CLI) and influenza-like illness (ILI) remained stable (change of ≤0.1%) during week 52 compared with week 51. Three of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness (CLI and ILI) this week while the remaining regions reported a stable or declining level of mild/moderate illness.
                          Severe Disease: Hospitalizations and Deaths


                          In early December, the overall weekly hospitalization rate reached its highest point since the beginning of the pandemic and remains elevated. Rates in recent weeks have declined but these rates are likely to change as additional data are reported. Based on death certificate data, the percentage of deaths attributed to PIC for week 52 was 13.6% and remains above the epidemic threshold. The percentage of deaths due to PIC increased during October through early December and is expected to increase for the most recent weeks as additional data are reported.

                          All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                          Key Points
                          • Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation and associated illnesses declined or remained stable during week 52 compared with week 51; however, there were regional differences.
                            • Five regions (Regions 2 [New Jersey/New York/Puerto Rico], 3 [Mid-Atlantic], 4 [Southeast], 6 [South Central] and 7 [Central]) reported an increase in percentage of specimens testing positive for SARS-CoV-2 duriong week 52 compared with week 51.
                            • Three regions (Regions 2 [New Jersey/New York/Puerto Rico], 4 [Southeast] and 6 [South Central]) reported an increase in at least one indicator of mild/moderate respiratory illness during week 52 compared with week 51. These three regions and Region 9 [South/West Central] have also reported an increasing trend in the percentage of visits for CLI and/or ILI since October. The remaining six regions have reported a stable or declining trend in the percentage of visits for CLI and ILI.
                          • The overall cumulative COVID-19-associated hospitalization rate through the week ending December 26, 2020, was 326.7 hospitalizations per 100,000 population.
                            • Overall weekly hospitalization rates reached their highest point at 16.9 per 100,000 during week ending December 5, 2020 (MMWR Week 49) and remain elevated. Rates in recent weeks have declined but these rates are likely to change as additional data are reported.
                            • The cumulative age-adjusted hospitalization rate for both Hispanic or Latino persons and non-Hispanic American Indian or Alaska Native persons was 3.5 times that of non-Hispanic White persons, and the rate for non-Hispanic Black persons was approximately 3.1 times that of non-Hispanic White persons.
                          • The percentage of deaths due to PIC has been increasing since the beginning of October and has exceeded the percentage of deaths due to PIC observed during the summer peak.
                            • Data for the most recent three weeks currently show a decline, but that is likely to change as additional death certificates are processed. Due to the large number of deaths reported in recent weeks and the holidays, the change in recent weeks may be larger than usual.
                          • Estimates from previous weeks are subject to change as data are updated with the most complete data available.

                          U.S. Virologic Surveillance


                          Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 97,827,956 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                          Nationally, during week 52, of 2,133,153 specimens tested for SARS-CoV-2 for diagnostic purposes, 263,316 (12.3%) were positive. This is a decrease compared with week 51, during which 12.4% of specimens tested were positive. The percentage of specimens testing positive increased among persons 0–4 years and 5–17 years but decreased among all other age groups (18-49 years, 50-64 years, and 65+ years).




                          *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11, and commercial laboratory data beginning in week 14.
                          View Data Table


                          The percentage of specimens testing positive for SARS-CoV-2 increased in five regions (Region 2 [New Jersey/New York/Puerto Rico], Region 3 [Mid-Atlantic], Region 4 [Southeast], Region 6 [South Central] and Region 7 [Central]) during week 52 compared with week 51. The remaining five regions reported a decrease in the percentage of specimens testing positive.

                          Additional virologic surveillance information: Surveillance Methods


                          Outpatient/Emergency Department Illness


                          Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI; fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI; fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                          Nationally, the overall percentages of visits to outpatient providers or EDs for ILI and CLI remained stable (change of ≤0.1%) during week 52 compared with week 51. During week 52, the percentages of ED visits captured in NSSP for CLI and ILI were 7.1% and 1.3%, respectively. In ILINet, 1.6% of visits reported during week 52 were for ILI, also remaining stable (change of ≤0.1%) compared with week 51 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 37th consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                          resize iconView LargerView Data Table


                          The percentages of visits for ILI reported in ILINet in week 52 remained stable (change of ≤0.1%) compared with week 51 for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, 65 years and older). During the past four weeks, the percentage of visits for ILI decreased slightly among those 5–24 years and increased slightly among those 65 years and older.

                          resize iconView LargerView Data Table


                          On a regional levelexternal icon, three regions (Region 2 [New Jersey/New York/Puerto Rico], Region 4 [Southeast], Region 6 [South Central]) reported an increase in at least one indicator of mild to moderate illness (CLI and/or ILI) during week 52 compared with week 51; the remaining seven regions reported a stable (change of ≤0.1%) or decreasing level of mild to moderate illness. The percentage of visits for ILI to ILINet providers remained below the region-specific baseline in all regions.

                          ILI Activity Levels

                          Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                          The number of jurisdictions at each activity level during week 52 and the previous week are summarized in the table below.
                          Activity Level Number of Jurisdictions Number of CBSAs
                          Week 52 (Week ending Dec. 26, 2020) Week 51 (Week ending Dec. 19, 2020) Week 52 (Week ending Dec. 26, 2020) Week 51 (Week ending Dec. 19, 2020)
                          Very High 0 0 0 1
                          High 0 0 3 5
                          Moderate 1 1 9 8
                          Low 2 0 49 50
                          Minimal 49 54 531 554
                          Insufficient Data 3 0 337 311
                          *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                          Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                          Hospitalizations


                          The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                          A total of 106,532 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020 and December 26, 2020. The overall cumulative hospitalization rate was 326.7 per 100,000 population. The overall weekly hospitalization rate reached its highest point at 16.9 per 100,000 during the week ending December 5, 2020 (Week 49) and remains elevated. Rates in recent weeks have declined but these rates are likely to change as additional data are reported for those weeks.

                          resize iconView Larger


                          1Additional hospitalization rate data by age group are available.

                          Among the 106,532 laboratory-confirmed COVID-19-associated hospitalizations, 103,104 (96.8%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,428 (3.2%) cases. When examining overall cumulative age-adjusted rates by race and ethnicity, the rate for both Hispanic or Latino persons and non-Hispanic American Indian or Alaska Native persons was 3.5 times that of non-Hispanic White persons, and the rate for non-Hispanic Black persons was approximately 3.1 times that of non-Hispanic White persons.





                          When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 4.7 times higher among Hispanic or Latino persons aged 0–17 years; 6.2 times higher among non-Hispanic American Indian or Alaska Native or Latino persons aged 18–49 years; 4.4 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years; and 2.4 times higher among non-Hispanic Black persons aged ≥ 65 years.

                          29.2 3.0 33.3 3.5 44.2 4.6 14.1 1.5 9.6 1.0
                          484.8 6.0 321.4 4.0 455.0 5.7 106.5 1.3 80.4 1.0
                          1063.4 4.1 916.1 3.6 1077.6 4.2 320.5 1.2 257.2 1.0
                          1564.5 2.1 1813.1 2.4 1715.4 2.3 695.5 0.9 760.7 1.0
                          660.1 3.3 598.4 3.0 670.8 3.4 213.7 1.1 197.7 1.0
                          1COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                          2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                          3 The highest rate ratio in each age category is presented in bold.
                          4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.

                          Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                          1.2% 27.3% 20.9% 5.2% 39.5%
                          0.7% 17.9% 14.1% 8.9% 58.5%
                          1.7 1.5 1.5 0.6 0.7
                          1Persons of multiple races (0.3%) or unknown race and ethnicity (5.6%) are not represented in the table but are included as part of the denominator.
                          2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                          For underlying medical conditions, data were restricted to cases reported during March 1–September 30, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 15,401 sampled adults hospitalized during March 1–September 30 with information on underlying medical conditions, 90.0% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (56.3%), obesity (48.2%), metabolic disease (42.0%), and cardiovascular disease (32.7%). Among 808 children hospitalized during March 1–September 30 with information on underlying medical conditions, 51.5% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (38.4%), neurologic disease (12.9%), and asthma (10.9%).

                          Additional data on demographics, signs and symptoms at admission, underlying medical conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

                          Additional hospitalization surveillance information:
                          Surveillance Methods | Additional rate data | Additional demographic and clinical data


                          Mortality Surveillance


                          The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on December 30, 2020, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) for week 52 was 13.6% and, while it declined compared with the percentage during week 51 (14.2%), it remains above the epidemic threshold of 6.8% and is expected to increase as more death certificates are processed. Among the 1,848 PIC deaths reported for week 52, 1,215 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and three listed influenza, indicating that the current increase in PIC mortality is due primarily to COVID-19 and not influenza.

                          The weekly percentage of deaths due to PIC increased for nine weeks from early October through the beginning of December to a level that is higher than the July peak. Data for the most recent three weeks currently show a decline, but percentages for recent weeks will likely increase as more death certificates are processed. Weekly mortality surveillance data include a combination of machine-coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine-coded records. Due to the additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data. Because of the large number of deaths reported in recent weeks and the holidays, the delay in availability of manually coded records may be longer than usual.

                          resize iconView Larger


                          *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                          View Data Table


                          Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
                          More Information
                          View Page In:pdf icon 918 KB, 10 pages
                          Last Updated Jan. 4, 2021

                          Comment


                          • #43

                            1. CASES, DATA & SURVEILLANCE
                            COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity


                            Updated Jan. 15, 2021
                            Print
                            Download Weekly Summary pdf icon[962 KB, 10 Pages]
                            Key Updates for Week 1, ending January 9, 2021


                            Nationally, surveillance indicators tracking levels of SARS-CoV-2 circulation, associated illnesses, and hospitalizations decreased or remained stable but elevated during the week ending January 9, 2021. The percentage of deaths due to pneumonia, influenza and COVID-19 (PIC) increased during the most recent week after declining for three weeks. Recent declines in hospitalization rates and PIC mortality should be interpreted with caution as reporting delays increased during the holidays and the downward trends may change as more data are received.


                            Download Chart Data excel icon[CSV – 2 KB]
                            Virus: Public Health, Commercial and Clinical Laboratories


                            Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2, the virus causing COVID-19, decreased from 15.4% during week 53 to 14.5% during week 1. Percent positivity decreased among all age groups and in nine of ten Health and Human Services (HHS) regionsexternal icon.
                            Mild/Moderate Illness: Outpatient and Emergency Department Visits


                            Nationally, the percentage of visits to outpatient providers or emergency departments (EDs) decreased for COVID-like illness (CLI) or remained stable (change of ≤0.1%) for influenza-like illness (ILI) during week 1 compared with week 53. Two of ten surveillance regions reported an increase in at least one indicator of mild/moderate illness (CLI/ILI) this week while eight regions reported a stable (change of ≤0.1%) or decreasing level of mild/moderate illness.
                            Severe Disease: Hospitalizations and Deaths


                            In December, the overall weekly hospitalization rate reached its highest point since the beginning of the pandemic and remains elevated. Although reported rates in recent weeks have declined, these rates are likely to increase as additional data are reported. Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) for week 1 was 17.2% and it remains above the epidemic threshold. Longer delays in reporting of hospitalization and mortality data may occur due to the holidays.

                            All data are preliminary and may change as more reports are received. A description of the surveillance systems summarized in COVIDView, including methodology and detailed descriptions of each data component, is available on the surveillance methods page.
                            Key Points
                            • Holidays during weeks 52 and 53 and increases in the number of COVID-19 illnesses have affected data reporting and health care seeking behavior in multiple ways; therefore, data from recent weeks should be interpreted with caution because they may change more than usual as additional data for those weeks are received.
                            • Nationally, the overall percentage of respiratory specimens testing positive for SARS-CoV-2 decreased during week 1 (14.5%) compared with week 53 (15.4%). Percent positivity decreased in nine of ten HHS surveillance regions.
                              • For Region 1 (New England), percent positivity has increased for the most recent two weeks.
                              • Eight regions (Region 2 [New Jersey/New York/Puerto Rico], Region 3 [Mid-Atlantic], Region 4 [Southeast], Region 6 [South Central], Region 7 [Central], Region 8 [Midwest], Region 9 [South/West Coast], and Region 10 [Pacific Northwest]) had shown increasing trends in percent positivity for two or more weeks until seeing a decline during week 1 compared with week 53.
                              • Region 5 (Midwest) had a decreasing trend in percent positivity from mid-November through late December and has reported fluctuations in percent positivity during the past two weeks.
                            • Surveillance indicators of mild to moderate illness at the national level declined for CLI and remained stable (change of ≤ 0.1%) for ILI during week 1 compared to week 53 but had shown increasing trends from late September 2020 through early January 2021.
                            • The overall cumulative COVID-19-associated hospitalization rate through the week ending January 9, 2021 was 364.3 hospitalizations per 100,000 population.
                              • The overall weekly hospitalization rate reached its highest point at 17.6 per 100,000 during the week ending December 12, 2020 (Week 50), and it remains elevated. Although reported rates in recent weeks have declined, these rates are likely to increase as additional data are reported. Longer delays in data reporting may occur due to the holidays.
                              • When examining age-adjusted hospitalization rates by race and ethnicity, compared with non-Hispanic White persons, hospitalization rates were 3.3 times higher among Hispanic or Latino persons and Non-Hispanic American Indian or Alaska Native persons and 3.0 times higher among non-Hispanic Black persons.
                            • The percentage of deaths due to PIC increased from the beginning of October through early December (27.6%), when it exceeded the percentage of deaths due to PIC observed during the summer peak (17.2%) and approached the peak seen in April (27.7%).
                              • Nationally, the percentage of deaths due to PIC increased from week 53 (15.9%) to week 1 (17.2%), after a declining trend in the percentage of deaths due to PIC for the previous four weeks. The percentage of deaths due to PIC for these weeks are likely to increase as additional death certificates are processed.
                              • Due to the large number of deaths reported in recent weeks and the holidays, the change may be larger than usual.

                            U.S. Virologic Surveillance


                            Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 105,021,534 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

                            Nationally, 455,437 (14.5%) of 3,148,737 specimens tested for SARS-CoV-2 for diagnostic purposes were positive during week 1. This is a decrease compared with week 53, during which 15.4% of specimens tested were positive. The percentage of specimens testing positive decreased among all age groups.




                            *Note: Different laboratory types came on board with testing during different weeks. This graph includes public health laboratory data beginning in week 10, clinical laboratory data beginning in week 11, and commercial laboratory data beginning in week 14.
                            View Data Table


                            During week 1 compared with week 53, the percentage of specimens testing positive for SARS-CoV-2 increased in Region 1 [New England], but decreased in the other nine HHS regions.

                            Additional virologic surveillance information: Surveillance Methods


                            Outpatient/Emergency Department Illness


                            Two syndromic surveillance systems, the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) and the National Syndromic Surveillance Project (NSSP), are being used to monitor trends in outpatient and emergency department (ED) visits that may be associated with COVID-19 illness. Each system monitors activity in a slightly different set of providers/facilities and uses a slightly different set of symptoms that may be associated with SARS-CoV-2 virus infection. ILINet provides information about visits to outpatient providers or emergency departments for influenza-like illness (ILI: fever plus cough and/or sore throat) and NSSP provides information about visits to EDs for ILI and COVID-like illness (CLI: fever plus cough and/or shortness of breath or difficulty breathing). Some EDs contribute ILI data to both ILINet and NSSP. Both systems are currently being affected by changes in health care seeking behavior, including increased use of telemedicine and increased social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings. Syndromic data, including CLI and ILI, should be interpreted with caution and should be evaluated in combination with other sources of surveillance data, especially laboratory testing results, to obtain a complete and accurate picture of respiratory illness.

                            Nationally, the overall percentages of visits to outpatient providers or EDs remained stable (change of ≤0.1%) for ILI and decreased for CLI during week 1 compared with week 53. During week 1, the percentages of ED visits captured in NSSP for CLI and ILI were 7.5% and 1.3%, respectively. In ILINet, 1.7% of visits reported during week 1 were for ILI, which has remained stable (change of ≤0.1%) compared with week 53 and below the national baseline (2.4% for October 2019 through September 2020; 2.6% since October 2020) for the 39th consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

                            resize iconView LargerView Data Table


                            The percentages of visits for ILI reported in ILINet in week 1 decreased for two age groups (0–4 years and 50–64 years) compared with week 53. In the remaining age groups (5–24 years, 25–49 years, and 65 years and older), these percentages remained stable (change of ≤0.1%).

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                            On a regional levelexternal icon, two regions (Region 5 [Midwest]and 9 [South/West Coast]) reported an increase in at least one indicator of mild to moderate illness (CLI and/or ILI) during week 1 compared with week 53. The remaining eight regions reported a stable (change of ≤0.1%) or decreasing level of mild to moderate illness during week 1 compared with week 53; however, three of these regions (Regions 2 (New Jersey/New York/Puerto Rico), 4 (Southeast) and 6 (South Central) have reported an increasing trend in at least one of these indicators during recent weeks. The percentage of visits for ILI to ILINet providers during week 1 was above the the region-specific baseline in one region (Region 9 [South/West Coast]).

                            ILI Activity Levels

                            Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the U.S. Virgin Islands, the District of Columbia, New York City and for each core-based statistical area (CBSA) where at least one provider is located. The mean reported percentage of visits due to ILI for the current week is compared with the mean reported during non-influenza weeks, and the activity levels correspond to the number of standard deviations below, at, or above the mean.

                            The number of jurisdictions at each activity level during week 53 and the previous week are summarized in the table below.
                            Activity Level Number of Jurisdictions Number of CBSAs
                            Week 1 (Week ending Jan. 9, 2021) Week 53 (Week ending Jan. 2, 2021) Week 1 (Week ending Jan. 9, 2021) Week 53 (Week ending Jan. 2, 2021)
                            Very High 0 0 2 0
                            High 0 0 3 4
                            Moderate 0 0 12 15
                            Low 5 4 47 50
                            Minimal 49 50 544 547
                            Insufficient Data 1 1 321 313
                            *Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

                            Additional information about medically attended outpatient and emergency department visits for ILI and CLI: Surveillance Methods

                            Hospitalizations


                            The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations in select counties participating in the Emerging Infections Program (EIP) and the Influenza Hospitalization Surveillance Project (IHSP).

                            A total of 118,760 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and January 9, 2021. The overall cumulative hospitalization rate was 364.3 per 100,000 population. The overall weekly hospitalization rate reached its highest point at 17.6 per 100,000 during the week ending December 12, 2020 (Week 50) and remains elevated. Although reported rates in recent weeks have declined, these rates are likely to increase as additional data are reported. Recent data reporting delays might be increased due to the holidays.

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                            1Additional hospitalization rate data by age group are available.

                            Among the 118,760 laboratory-confirmed COVID-19-associated hospitalizations, 115,196 (97.0%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,564 (3.0%) cases. When examining age-adjusted hospitalization rates by race and ethnicity, compared with non-Hispanic White persons, hospitalization rates were 3.3 times higher among Hispanic or Latino persons and Non-Hispanic American Indian or Alaska Native persons, and 3.0 times higher among non-Hispanic Black persons.



                            When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 4.5 times higher among Hispanic or Latino persons aged 0–17 years, 5.9 times higher among non-Hispanic American Indian or Alaska Native persons aged 18–49 years 4.1 times higher among non-Hispanic American Indian or Alaska Native persons and Hispanic or Latino persons aged 50–64 years, and 2.3 times higher among non-Hispanic Black persons aged ≥ 65 years.

                            31.2 3.1 34.8 3.4 45.5 4.5 15.4 1.5 10.2 1.0
                            501.4 5.9 332.8 3.9 468.4 5.5 111.6 1.3 84.9 1.0
                            1129.9 4.1 955.4 3.5 1116.8 4.1 337.0 1.2 272.8 1.0
                            1665.5 2.0 1894.8 2.3 1806.3 2.2 731.2 0.9 812.6 1.0
                            696.3 3.3 623.6 3.0 698.1 3.3 224.6 1.1 210.3 1.0
                            1 COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
                            2 For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
                            3 The highest rate ratio in each age category is presented in bold.
                            4 Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, 65-74, 75-84 and 85+ years.



                            Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.
                            1.2% 27.0% 20.1% 5.1% 40.6%
                            0.7% 17.9% 14.1% 8.9% 58.5%
                            1.7 1.5 1.4 0.6 0.7
                            1Persons of multiple races (0.3%) or unknown race and ethnicity (5.7%) are not represented in the table but are included as part of the denominator.
                            2 Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

                            For underlying medical conditions, data were restricted to cases reported during March 1–September 30, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 16,658 sampled adults hospitalized during March 1–October 31 with information on underlying medical conditions, 90.0% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (56.4%), obesity (48.6%), metabolic disease (41.6%), and cardiovascular disease (32.6%). Among 971 children hospitalized during March 1–October 31 with information on underlying conditions, 52.0% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (37.7%), neurologic disease (13.4%), and asthma (11.4%).

                            Additional data on demographics, signs and symptoms at admission, underlying medical conditions, interventions, outcomes, and discharge diagnoses, stratified by age, sex, and race and ethnicity, are available.

                            Additional hospitalization surveillance information:
                            Surveillance Methods | Additional rate data | Additional demographic and clinical data


                            Mortality Surveillance


                            The National Center for Health Statistics (NCHS) collects death certificate data from vital statistics offices for all deaths occurring in the United States. Based on death certificate data available on January 14, 2021, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) increased during week 1 (17.2%) as compared with the percentage during week 53 (15.9%), remains above the epidemic threshold of 7.0% and is expected to increase as more death certificates are processed. Among the 3,337 PIC deaths reported for week 1, 2,486 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and two listed influenza, indicating that the recent increase in PIC mortality is due primarily to COVID-19 and not influenza.

                            The weekly percentage of deaths due to PIC has been increasing since early October to a level that is higher than the July peak and is approaching the April peak. Data for the past four weeks show a declining trend in the percentage of deaths due to PIC compared to the December peak, but that is likely to change as additional death certificates are processed. Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. The percentage of deaths due to PIC is higher among manually coded records than more rapidly available machine coded records. Because of additional time needed for manual coding, the initially reported PIC percentages may be lower than percentages calculated from final data. Additionally, due to the large number of deaths reported in recent weeks and the holidays, the delay in availability of manually coded records may be longer than usual and the change in data during recent weeks may be larger than usual.

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                            *Data during recent weeks are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS and processed for reporting purposes. It is possible that a death certificate includes both influenza and COVID as a cause of death; therefore, the number of influenza and COVID coded deaths may not be mutually exclusive.
                            View Data Table


                            Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19
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                            Last Updated Jan. 15, 2021
                            Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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