Announcement

**Ronan Kelly** · April 4, 2020, 03:36 PM

Provisional Death Counts for Coronavirus Disease (COVID-19)

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Note: Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics as of April 3, 2020. Death counts are delayed and may differ from other published sources (see Technical Notes). Counts will be updated periodically. Additional information will be added to this site as available.

The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks.

The provisional data presented on this page include the weekly provisional count of deaths in the United States due to COVID-19, deaths from all causes and percent of expected deaths (i.e., number of deaths received over number of deaths expected based on data from previous years), pneumonia deaths (excluding pneumonia deaths involving influenza), and pneumonia deaths involving COVID-19; (a) by week ending date, (b) by age at death, and (c) by specific jurisdictions. Future updates to this release may include additional detail such as demographic characteristics (e.g., sex), additional causes of death (e.g., acute respiratory distress syndrome or other comorbidities), or estimates based on models that account for reporting delays to generate more accurate predicted provisional counts.

Pneumonia deaths are included to provide context for understanding the completeness of COVID-19 mortality data and related trends. Deaths due to COVID-19 may be misclassified as pneumonia deaths in the absence of positive test results, and pneumonia may appear on death certificates as a comorbid condition. Thus, increases in pneumonia deaths may be an indicator of excess COVID-19-related mortality. Additionally, estimates of completeness for pneumonia deaths may provide context for understanding the lag in reporting for COVID-19 deaths, as it is anticipated that these causes would have similar delays in reporting, processing, and coding. However, it is possible that reporting of COVID-19 mortality may be slower or faster than for other causes of death, and that the delay may change over time. Analyses to better understand and quantify reporting delays for COVID-19 deaths and related causes are underway. The list of causes provided in these tables may expand in future releases as more data are received, and other potentially comorbid conditions are determined.
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Table 1. Deaths involving coronavirus disease 2019 (COVID-19) and pneumonia reported to NCHS by week ending date, United States. Week ending 2/1/2020 to 3/28/2020.*

Data as of 4/3/2020


Total Deaths	1,150	446,778	86	24,741	469
02/01/20	0	56,061	94	2,991	0
02/08/20	0	56,209	94	2,985	0
02/15/20	0	54,463	92	2,863	0
02/22/20	0	54,017	93	2,833	0
02/29/20	5	53,697	93	2,831	2
03/07/20	16	52,506	91	2,826	5
03/14/20	41	48,577	85	2,730	17
03/21/20	300	42,750	74	2,642	121
03/28/20	788	28,498	50	2,040	324

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019. Previous analyses of 2015–2016 provisional data completeness have found that completeness is lower in the first few weeks following the date of death (7).

³Pneumonia death counts exclude pneumonia deaths involving influenza.
Table 2. Deaths involving coronavirus disease 2019 (COVID-19) and pneumonia reported to NCHS by age group, United States. Week ending 2/1/2020 to 3/28/2020.*

Data as of 4/3/2020

All ages	1,150	446,778	86	24,741	469
Under 1 year	0	2,396	63	19	0
1–4 years	1	489	74	23	1
5–14 years	0	713	71	26	0
15–24 years	0	4,036	78	73	0
25–34 years	8	8,424	83	189	3
35–44 years	33	12,076	85	388	8
45–54 years	75	23,299	77	983	26
55–64 years	123	56,398	83	2,824	50
65–74 years	265	87,567	88	4,778	91
75–84 years	331	110,592	88	6,590	145
85 years and over	314	140,788	84	8,848	145

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

³Pneumonia death counts exclude pneumonia deaths involving influenza.
Table 3. Deaths involving coronavirus disease 2019 (COVID-19) and pneumonia reported to NCHS by jurisdiction of occurrence, United States. Week ending 2/1/2020 to 3/28/2020.*

Data as of 4/3/2020

United States	1,150	446,778	86	24,741	469
Alabama	0	8,136	85	408	0
Alaska	0	589	78	23	0
Arizona	0	10,532	96	523	0
Arkansas	0	5,390	92	269	0
California	54	47,024	93	3,136	22
Colorado	21	7,020	98	334	11
Connecticut	0	0	0	0	0
Delaware	0	1,115	65	50	0
District of Columbia	0	924	84	58	0
Florida	38	37,346	97	1,899	12
Georgia	13	12,725	83	570	6
Hawaii	0	1,904	90	118	0
Idaho	1	2,389	93	110	1
Illinois	9	18,762	96	1,155	4
Indiana	0	10,635	87	599	0
Iowa	0	5,007	90	295	0
Kansas	3	4,441	89	240	1
Kentucky	0	6,181	70	389	0
Louisiana	44	6,801	82	258	18
Maine	0	2,640	99	178	0
Maryland	5	8,721	95	502	0
Massachusetts	6	9,893	89	663	3
Michigan	11	16,019	90	796	1
Minnesota	4	7,613	95	407	2
Mississippi	0	5,302	92	342	0
Missouri	6	10,051	84	486	4
Montana	0	1,491	79	66	0
Nebraska	0	2,476	79	159	0
Nevada	2	4,348	93	202	1
New Hampshire	1	2,200	98	109	0
New Jersey	43	13,210	96	694	24
New Mexico	0	2,765	79	155	0
New York⁴	180	17,731	96	1,343	98
New York City	579	10,970	110	1,012	205
North Carolina	0	3,060	18	151	0
North Dakota	0	1,115	89	74	0
Ohio	0	16,962	75	676	0
Oklahoma	0	5,781	78	365	0
Oregon	5	5,496	83	230	3
Pennsylvania	19	17,692	70	880	10
Rhode Island	0	1,494	78	50	0
South Carolina	1	8,428	94	369	0
South Dakota	1	1,281	86	70	0
Tennessee	0	12,379	92	715	0
Texas	6	32,459	84	1,825	2
Utah	1	3,305	97	168	0
Vermont	1	923	87	42	1
Virginia	4	11,757	94	459	1
Washington	92	9,805	93	561	39
West Virginia	0	2,563	62	140	0
Wisconsin	0	9,200	96	376	0
Wyoming	0	727	89	42	0

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

³Pneumonia death counts exclude pneumonia deaths involving influenza.

⁴Excludes New York City.
Technical Notes

Comparing data in this report to other sources

Provisional death counts in this report will not match counts in other sources, such as media reports or numbers from county health departments. Death data, once received and processed by National Center for Health Statistics (NCHS), are tabulated by the state or jurisdiction in which the death occurred. Death counts are not tabulated by the decedent’s state of residence. COVID-19 deaths may also be classified or defined differently in various reporting and surveillance systems. Death counts in this report include laboratory confirmed COVID-19 deaths and clinically confirmed COVID-19 deaths. This includes deaths where COVID-19 is listed as a “presumed” or “probable” cause. Some local and state health departments only report laboratory-confirmed COVID deaths. This may partly account for differences between NCHS reported death counts and death counts reported in other sources. Provisional counts reported here track approximately 1–2 weeks behind other published data sources on the number of COVID-19 deaths in the U.S. (1,2,3).
Nature and sources of data

Provisional death counts are based on death records received and processed by NCHS as of a specified cutoff date. National provisional counts include deaths occurring within the 50 states and the District of Columbia. NCHS receives the death records from state vital registration offices through the Vital Statistics Cooperative Program. Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period especially for more recent periods. Estimates of completeness are provided. Therefore, they should not be considered comparable with final data and are subject to change.
Cause-of-death classification and definition of deaths

Mortality statistics are compiled in accordance with World Health Organization (WHO) regulations specifying that WHO member nations classify and code causes of death with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on use of the classification. Causes of death for data presented in this report were coded according to ICD guidelines described in annual issues of Part 2a of the NCHS Instruction Manual (4).

Coronavirus disease deaths are identified using the ICD–10 code U07.1. Deaths are coded to U07.1 when coronavirus disease 2019 or COVID-19 are reported as a cause that contributed to death on the death certificate. These can include laboratory confirmed cases, as well as cases without laboratory confirmation. If the certifier suspects COVID-19 or determines it was likely (e.g., the circumstances were compelling within a reasonable degree of certainty), they can report COVID-19 as “probable” or “presumed” on the death certificate (5).

Pneumonia deaths are identified using underlying cause-of-death codes from the 10th Revision of ICD (ICD–10): J12–J18, excluding deaths that involve influenza (J08–J11).
Estimated completeness of data

Provisional data are incomplete, and the level of completeness varies by jurisdiction, week, decedent’s age, and cause of death. Until data for a calendar year are finalized, typically in December of the following year, completeness of provisional data cannot be determined. However, completeness can be estimated in a variety of ways. Surveillance systems that rely on weekly monitoring of provisional mortality data, such as CDC’s FluView Interactive mortality surveillance (6), estimate completeness by comparing the count of deaths in a given week of the current year to the average count of deaths in that same week of the previous 3 years. These estimates can be generated for specific causes of death, jurisdictions, and age groups, and updated on a weekly or daily basis. For the purposes of COVID-19 surveillance, completeness is approximated by comparing the provisional number of deaths received to the number of expected deaths based on prior years data. Percent of expected deaths provided in this data release are based on the total count of deaths in the most recent weeks of the current year, compared with an average across the same weeks of the three previous years (i.e., 2017–2019). These estimates of completeness are calculated by week, jurisdiction of occurrence, and age group.

It is important to note that the true levels of completeness are unknown, and the estimates provided here are only a proxy. In cases where mortality rates are increasing rapidly, particularly when excess deaths due to a novel cause are occurring, values for completeness for recent weeks may exceed 100% even when NCHS has yet to receive all available data. Conversely, if the number of deaths was elevated in prior years due to a severe flu season, for example, estimated completeness in the most recent weeks may be lower than the true value. To avoid relying too heavily on comparisons to a single week of a single prior year, estimates of completeness included in this release are based on the average counts in a given week across 3 prior years (e.g., the 12th week of 2017, 2018, and 2019).

Percent of expected deaths provided in this release are shown to provide context for interpreting provisional counts of COVID-19 deaths and deaths due to related causes. Where estimated values are high (e.g., greater than 100%), this suggests that mortality is higher in 2020 relative to the same weeks of prior years. Where estimated values of completeness are low, this could indicate that data are incomplete due to delayed reporting, or that mortality is lower in 2020 compared with prior years, or some combination of these factors.
Delays in reporting

Provisional counts of deaths are underestimated relative to final counts. This is due to the many steps involved in reporting death certificate data. When a death occurs, a certifier (e.g. physician, medical examiner or coroner) will complete the death certificate with the underlying cause of death and any contributing causes of death. In some cases, laboratory tests or autopsy results may be required to determine the cause of death. Completed death certificate are sent to the state vital records office and then to NCHS for cause of death coding. At NCHS, about 80% of deaths are automatically processed and coded within seconds, but 20% of deaths need to manually coded, or coded by a person. Deaths involving certain conditions such as influenza and pneumonia are more likely to require manual coding than other causes of death. Furthermore, all deaths with COVID-19 are manually coded. Death certificates are typically manually coded within 7 days of receipt, although the coding delay can grow if there is a large increase in the number of deaths. As a result, underestimation of the number of deaths may be greater for certain causes of death than others.

Previous analyses of provisional data completeness from 2015 suggested that mortality data is approximately 27% complete within 2 weeks, 54% complete within 4 weeks, and at least 75% complete within 8 weeks of when the death occurred (7). Pneumonia deaths are 26% complete within 2 weeks, 52% complete within 4 weeks, and 72% complete within 8 weeks (unpublished). Data timeliness has improved in recent years, and current timeliness is likely higher than published rates.
Comparing deaths from different states

Death counts should not be compared across states. Data timeliness varies by state. Some states report deaths on a daily basis, while other states report deaths weekly or monthly. Furthermore, health departments and state vital record offices may be affected by COVID-19 related response activities, which could further delay death certificate reporting. Currently, 63% of U.S. deaths are reported within 10 days of the date of death, but there is variation within states. Twenty states report over 75% of deaths within the first 10 days, while three states report fewer than 1% of deaths within 10 days.
Why are pneumonia deaths included in this report?

Pneumonia deaths are included to provide context for understanding the completeness of COVID-19 mortality data and related trends. Deaths due to COVID-19 may be misclassified as pneumonia deaths in the absence of positive test results, and pneumonia may appear on death certificates as a comorbid condition. Thus, increases in pneumonia deaths may be an indicator of excess COVID-19-related mortality. Additionally, estimates of completeness for pneumonia deaths may provide context for understanding the lag in reporting for COVID-19 deaths, as it is anticipated that these causes would have similar delays in reporting, processing, and coding.
Source

NCHS, National Vital Statistics System. Estimates are based on provisional data.
References

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020. Available from: https://doi.org/10.1016/S1473-3099(20)30120-1.external icon
Wu J, McCann A, Collins K, Harris R, Huang J, Almukhtar S. Coronavirus in the U.S.: Latest map and case count. New York Times. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html.external icon
National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Cases in the US. Centers for Disease Control and Prevention. 2020.
National Vital Statistics System. Instructions for classifying the underlying cause of death. In: NCHS instruction manual; Part 2a. Published annually.
World Health Organization. Emergency use ICD codes for COVID-19 disease outbreak. Available from: http://www9.who.int/classifications/icd/covid19/en/.external icon
National Center for Immunization and Respiratory Diseases (NCIRD). CDC’s FluView Interactive. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/flu/weekly/index.htm.
Spencer MR, Ahmad F. Timeliness of death certificate data for mortality surveillance and provisional estimates. National Center for Health Statistics. 2016.

Page last reviewed: April 3, 2020
Content source: CDC/National Center for Health Statistics National Vital Statistics System

Related Sites

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

**Ronan Kelly** · April 11, 2020, 07:34 AM

Provisional Death Counts for Coronavirus Disease (COVID-19)

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Note: Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics as of April 10, 2020. Death counts are delayed and may differ from other published sources (see Technical Notes). Counts will be updated periodically. Additional information will be added to this site as available.

The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks.

The provisional data presented on this page include the weekly provisional count of deaths in the United States due to COVID-19, deaths from all causes and percent of expected deaths (i.e., number of deaths received over number of deaths expected based on data from previous years), pneumonia deaths (excluding pneumonia deaths involving influenza), pneumonia deaths, and influenza deaths involving COVID-19; (a) by week ending date, (b) by age at death, (c) by sex, and (d) by specific jurisdictions. Future updates to this release may include additional detail such as demographic characteristics, additional causes of death (e.g., acute respiratory distress syndrome or other comorbidities), or estimates based on models that account for reporting delays to generate more accurate predicted provisional counts.

Pneumonia and influenza deaths are included to provide context for understanding the completeness of COVID-19 mortality data and related trends. Deaths due to COVID-19 may be misclassified as pneumonia or influenza deaths in the absence of positive test results, and these conditions may appear on death certificates as a comorbid condition. Thus, increases in pneumonia or influenza deaths may be an indicator of excess COVID-19-related mortality. Additionally, estimates of completeness for influenza or pneumonia deaths may provide context for understanding the lag in reporting for COVID-19 deaths, as it is anticipated that these causes would have similar delays in reporting, processing, and coding. However, it is possible that reporting of COVID-19 mortality may be slower or faster than for other causes of death, and that the delay may change over time. Analyses to better understand and quantify reporting delays for COVID-19 deaths and related causes are underway. The list of causes provided in these tables may expand in future releases as more data are received, and other potentially comorbid conditions are determined.
Download Datasets

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Data.CDC.gov (Export to CSV, JSON, XLS, XML)^[?]

Table 1. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by week ending date, United States. Week ending 2/1/2020 to 4/4/2020.*

Data as of April 10, 2020

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019. Previous analyses of 2015–2016 provisional data completeness have found that completeness is lower in the first few weeks following the date of death (8).

³Pneumonia death counts exclude pneumonia deaths involving influenza.

⁴Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

⁵Population is based on 2018 postcensal estimates from the U.S. Census Bureau (9)

Table 2. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by age group, United States. Week ending 2/1/2020 to 4/4/2020.*

Data as of April 10, 2020

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

³Pneumonia death counts exclude pneumonia deaths involving influenza.

⁴Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

⁵Population is based on 2018 postcensal estimates from the U.S. Census Bureau (9)

Table 3. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by sex, United States. Week ending 2/1/2020 to 4/4/2020.*

Data as of April 10, 2020

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

³Pneumonia death counts exclude pneumonia deaths involving influenza.

⁴Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

Table 4. Deaths involving coronavirus disease 2019 (COVID-19), pneumonia, and influenza reported to NCHS by jurisdiction of occurrence, United States. Week ending 2/1/2020 to 4/4/2020.*

Data as of April 10, 2020

NOTE: Number of deaths reported in this table are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period.

*Data during this period 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. This delay can range from 1 week to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

¹Deaths with confirmed or presumed COVID-19, coded to ICD–10 code U07.1.

²Percent of expected deaths is the number of deaths for all causes for this week in 2020 compared to the average number across the same week in 2017–2019.

³Pneumonia death counts exclude pneumonia deaths involving influenza.

⁴Influenza death counts include deaths with pneumonia or COVID-19 also listed as a cause of death.

⁵United States death count includes the 50 states, plus the District of Columbia and New York City.

⁶Excludes New York City.
Technical Notes

Comparing data in this report to other sources

Provisional death counts in this report will not match counts in other sources, such as media reports or numbers from county health departments. Death data, once received and processed by National Center for Health Statistics (NCHS), are tabulated by the state or jurisdiction in which the death occurred. Death counts are not tabulated by the decedent’s state of residence. COVID-19 deaths may also be classified or defined differently in various reporting and surveillance systems. Death counts in this report include laboratory confirmed COVID-19 deaths and clinically confirmed COVID-19 deaths. This includes deaths where COVID-19 is listed as a “presumed” or “probable” cause. Some local and state health departments only report laboratory-confirmed COVID deaths. This may partly account for differences between NCHS reported death counts and death counts reported in other sources. Provisional counts reported here track approximately 1–2 weeks behind other published data sources on the number of COVID-19 deaths in the U.S. (1,2,3).
Nature and sources of data

Provisional death counts are based on death records received and processed by NCHS as of a specified cutoff date. National provisional counts include deaths occurring within the 50 states and the District of Columbia. NCHS receives the death records from state vital registration offices through the Vital Statistics Cooperative Program. Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period especially for more recent periods. Estimates of completeness are provided. Therefore, they should not be considered comparable with final data and are subject to change.
Cause-of-death classification and definition of deaths

Mortality statistics are compiled in accordance with World Health Organization (WHO) regulations specifying that WHO member nations classify and code causes of death with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on use of the classification. Causes of death for data presented in this report were coded according to ICD guidelines described in annual issues of Part 2a of the NCHS Instruction Manual (4).

Coronavirus disease deaths are identified using the ICD–10 code U07.1. Deaths are coded to U07.1 when coronavirus disease 2019 or COVID-19 are reported as a cause that contributed to death on the death certificate. These can include laboratory confirmed cases, as well as cases without laboratory confirmation. If the certifier suspects COVID-19 or determines it was likely (e.g., the circumstances were compelling within a reasonable degree of certainty), they can report COVID-19 as “probable” or “presumed” on the death certificate (5, 6).

Pneumonia deaths are identified using underlying cause-of-death codes from the 10th Revision of ICD (ICD–10): J12–J18, excluding deaths that involve influenza (J09–J11). Influenza deaths are identified from the ICD–10 codes J09–J11, and include deaths with pneumonia or COVID-19 listed as a contributing cause of death.
Estimated completeness of data

Provisional data are incomplete, and the level of completeness varies by jurisdiction, week, decedent’s age, and cause of death. Until data for a calendar year are finalized, typically in December of the following year, completeness of provisional data cannot be determined. However, completeness can be estimated in a variety of ways. Surveillance systems that rely on weekly monitoring of provisional mortality data, such as CDC’s FluView Interactive mortality surveillance (7), estimate completeness by comparing the count of deaths in a given week of the current year to the average count of deaths in that same week of the previous 3 years. These estimates can be generated for specific causes of death, jurisdictions, and age groups, and updated on a weekly or daily basis. For the purposes of COVID-19 surveillance, completeness is approximated by comparing the provisional number of deaths received to the number of expected deaths based on prior years data. Percent of expected deaths provided in this data release are based on the total count of deaths in the most recent weeks of the current year, compared with an average across the same weeks of the three previous years (i.e., 2017–2019). These estimates of completeness are calculated by week, jurisdiction of occurrence, and age group.

It is important to note that the true levels of completeness are unknown, and the estimates provided here are only a proxy. In cases where mortality rates are increasing rapidly, particularly when excess deaths due to a novel cause are occurring, values for completeness for recent weeks may exceed 100% even when NCHS has yet to receive all available data. Conversely, if the number of deaths was elevated in prior years due to a severe flu season, for example, estimated completeness in the most recent weeks may be lower than the true value. To avoid relying too heavily on comparisons to a single week of a single prior year, estimates of completeness included in this release are based on the average counts in a given week across 3 prior years (e.g., the 12th week of 2017, 2018, and 2019).

Percent of expected deaths provided in this release are shown to provide context for interpreting provisional counts of COVID-19 deaths and deaths due to related causes. Where estimated values are high (e.g., greater than 100%), this suggests that mortality is higher in 2020 relative to the same weeks of prior years. Where estimated values of completeness are low, this could indicate that data are incomplete due to delayed reporting, or that mortality is lower in 2020 compared with prior years, or some combination of these factors.
Delays in reporting

Provisional counts of deaths are underestimated relative to final counts. This is due to the many steps involved in reporting death certificate data. When a death occurs, a certifier (e.g. physician, medical examiner or coroner) will complete the death certificate with the underlying cause of death and any contributing causes of death. In some cases, laboratory tests or autopsy results may be required to determine the cause of death. Completed death certificate are sent to the state vital records office and then to NCHS for cause of death coding. At NCHS, about 80% of deaths are automatically processed and coded within seconds, but 20% of deaths need to manually coded, or coded by a person. Deaths involving certain conditions such as influenza and pneumonia are more likely to require manual coding than other causes of death. Furthermore, all deaths with COVID-19 are manually coded. Death certificates are typically manually coded within 7 days of receipt, although the coding delay can grow if there is a large increase in the number of deaths. As a result, underestimation of the number of deaths may be greater for certain causes of death than others.

Previous analyses of provisional data completeness from 2015 suggested that mortality data is approximately 27% complete within 2 weeks, 54% complete within 4 weeks, and at least 75% complete within 8 weeks of when the death occurred (8). Pneumonia deaths are 26% complete within 2 weeks, 52% complete within 4 weeks, and 72% complete within 8 weeks (unpublished). Data timeliness has improved in recent years, and current timeliness is likely higher than published rates.
Comparing deaths from different states

Death counts should not be compared across states. Data timeliness varies by state. Some states report deaths on a daily basis, while other states report deaths weekly or monthly. Furthermore, health departments and state vital record offices may be affected by COVID-19 related response activities, which could further delay death certificate reporting. Currently, 63% of U.S. deaths are reported within 10 days of the date of death, but there is variation within states. Twenty states report over 75% of deaths within the first 10 days, while three states report fewer than 1% of deaths within 10 days.
Why are pneumonia and influenza deaths included in this report?

Pneumonia and influenza deaths are included to provide context for understanding the completeness of COVID-19 mortality data and related trends. Deaths due to COVID-19 may be misclassified as pneumonia or influenza deaths in the absence of positive test results, and pneumonia or influenza may appear on death certificates as a comorbid condition. Additionally, COVID-19 symptoms can be similar to influenza-like illness, thus deaths may be misclassified as influenza. Thus, increases in pneumonia and influenza deaths may be an indicator of excess COVID-19-related mortality. Additionally, estimates of completeness for pneumonia and influenza deaths may provide context for understanding the lag in reporting for COVID-19 deaths, as it is anticipated that these causes would have similar delays in reporting, processing, and coding.
Source

NCHS, National Vital Statistics System. Estimates are based on provisional data.
References

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020. Available from: https://doi.org/10.1016/S1473-3099(20)30120-1.external icon
Wu J, McCann A, Collins K, Harris R, Huang J, Almukhtar S. Coronavirus in the U.S.: Latest map and case count. New York Times. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html.external icon
National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Cases in the US. Centers for Disease Control and Prevention. 2020.
National Vital Statistics System. Instructions for classifying the underlying cause of death. In: NCHS instruction manual; Part 2a. Published annually.
National Center for Health Statistics. Guidance for certifying deaths due to COVID–19. Hyattsville, MD. 2020. Available from: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf.pdf icon
National Center for Health Statistics. New ICD code introduced for COVID-19 deaths. Hyattsville, MD. 2020. Available from: https://www.cdc.gov/nchs/data/nvss/coronavirus/Alert-2-New-ICD-code-introduced-for-COVID-19-deaths.pdfpdf icon
National Center for Immunization and Respiratory Diseases (NCIRD). CDC’s FluView Interactive. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/flu/weekly/index.htm.
Spencer MR, Ahmad F. Timeliness of death certificate data for mortality surveillance and provisional estimates. National Center for Health Statistics. 2016.
U.S. Census Bureau. Annual estimates of the resident population by single year of age and sex for the United States: April 1, 2010 to July 1, 2018. Available from: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2018_PEPSYASEXN&prodType =table.external icon

Page last reviewed: April 10, 2020
Content source: CDC/National Center for Health Statistics

Provisional COVID-19 Mortality Surveillance

https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm

National Center for Health Statistics

**Ronan Kelly** · April 11, 2020, 04:48 PM

Updated April 10, 2020

Download Weekly Summary pdf icon[10 Pages, 2 MB]

Key Updates for Week 14, ending April 4, 2020

This CDC report provides a weekly summary and interpretation of key indicators that have been adapted to track the COVID-19 pandemic in the United States. While influenza-like-illness (ILI) declined, it is still elevated and laboratory confirmed COVID-19 activity continues to increase as do COVID-19 severity indicators (hospitalizations and deaths).

Virus
Public Health, Commercial and Clinical Laboratories
Public health, commercial and clinical laboratories are all testing for SARS-CoV-2 and reporting their results. The national percentage of respiratory specimens testing positive for SARS-CoV-2 is increasing overall and for week 14 is distributed as follows:

18.5% at public health laboratories, and
7.7% at clinical laboratories.

Since the start of the outbreak, 17.6 % of specimens tested at commercial laboratories have been positive for SARS-CoV-2.

Outpatient and Emergency Department Visits
Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)
Two indicators from existing surveillance systems are being monitored to track outpatient or emergency department (ED) visits for potential COVID-19 illness.

Nationally, the percentages of visits for influenza-like illness (ILI) and COVID-19-like illness (CLI) are elevated compared to what is normally seen at this time but decreased compared to last week.

Recent changes in health care seeking behavior are likely impacting both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease
Hospitalizations
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, will be updated weekly. The overall cumulative hospitalization rate is 12.3 per 100,000, with the highest rates in persons 65 years and older (38.7 per 100,000) and 50-64 years (20.7 per 100,000).

Mortality
Based on death certificate data, the percentage of deaths attributed to COVID-19 increased from 4.0% during week 13 to 6.9% during week 14. The percentage of deaths due to pneumonia (excluding COVID-19 or influenza) decreased from 7.5% during week 13 to 7.2% during week 14.

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

CDC is modifying existing surveillance systems, many used to track influenza and other respiratory viruses annually, to track COVID-19.
Nationally, the percentage of laboratory specimens testing positive for SARS-CoV-2 continued to increase.
Visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 are elevated compared to what is normally seen at this time of year but decreased compared to levels reported last week. At this time, there is little influenza virus circulation so the elevated proportion of people presenting with these symptoms is likely due to COVID-19, but may be tempered by a number of factors including less ILI overall because of widespread adoption of social distancing efforts as well as changes in healthcare seeking practices.
The overall cumulative COVID-19 associated hospitalization rate is 12.3 per 100,000, with the highest rates in persons 65 years and older (38.7 per 100,000) and 50-64 years (20.7 per 100,000). Hospitalization rates for COVID-19 in older people are higher than what is typically seen early in a flu season.
Based on death certificate data, the percentage of deaths attributed to COVID-19 increased from 4.0% during week 13 to 6.9% during week 14. The percentage of deaths due to pneumonia (excluding COVID-19 or influenza) decreased from 7.5% during week 13 to 7.2% during week 14.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. At this point in the outbreak, all laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to be modified. The lower percentage of specimens testing positive in the clinical laboratories compared to the public health and commercial laboratories is likely due to the amount of COVID-19 activity in areas with reporting laboratories and a larger proportion of specimens from children.

65,917	225,850
36,468	95,137
	1,241,214
12,177 (18.5%)	32,437 (14.4%)
2,798 (7.7%)	7,095 (7.5%)
	218,454 (17.6%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

Data Table

Clinical Laboratories

Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be related to COVID-19. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in health care seeking behavior, including increasing use of telemedicine and recommendations to limit emergency department (ED) visits to severe illness, as well as increased social distancing. These changes affect the numbers of people and their reasons for seeking care in the outpatient and ED settings.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 14, 3.9% of patient visits reported through ILINet were due to ILI. This percentage is above the national baseline of 2.4%, but represents the second week of a decline after three weeks of increase beginning in early March. The percentage of visits for ILI decreased in all age groups. Nationally, laboratory confirmed influenza activity as reported by clinical laboratories decreased to levels usually seen in summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely driving the decrease in ILI activity.
Overall Percentage of Visits for ILI | Age Group ILI Data

* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 2.4% to 10.0% during week 14; all regions reported a decreased percentage of outpatient visits for ILI compared to week 13 but remained above their regions-specific baselines.
ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 14 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 14 (Week ending April 4, 2020)	Compared to Previous Week
Very High	8	-6
High	13	-4
Moderate	4	-1
Low	12	+5
Minimal	16	+6
Insufficient Data*	1	No change

The “very high” activity level was recently developed and will be reflected in other postings of the ILINet activity map when the map is updated on April 17, 2020.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments, and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple health care settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 14, 4.4% of emergency department visits captured in NSSP were due to CLI and 3.5% were due to ILI. This is the second week of decline in percentage of visits for ILI and the first week of decline in percentage of visits for CLI. All 10 HHS regionsexternal icon experienced a decline in percentage of visits for ILI and CLI.
Data Table

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 Influenza Hospitalization Surveillance Project (IHSP) states. COVID-NET-estimated hospitalization rates will be updated weekly.

A total of 4,001 laboratory-confirmed COVID-19-associated hospitalizations were reported by COVID-NET sites between March 1, 2020, and April 4, 2020. The overall cumulative hospitalization rate was 12.3 per 100,000 population, with the highest rates in those aged 65 years and older (38.7 per 100,000) followed by adults aged 50-64 years (20.7 per 100,000).

Additional hospitalization surveillance information: Surveillance Methods | COVID-Net interactive 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 April 9, 2020, 6.9% of all deaths occurring during the week ending April 4, 2020 (week 14) had COVID-19 listed as a cause of death, 7.2% had pneumonia (excluding deaths involving COVID-19 or influenza) listed as a cause of death, and 0.6% had influenza listed as a cause of death. The weekly percentage of deaths due to COVID-19 has increased each week since the start of the COVID-19 outbreak in the United States. The percentage of deaths due to pneumonia (excluding deaths involving COVID-19 or influenza) decreased during week 14 compared to week 13.
Data Table

NCHS data are also used to monitor the percentage of death occurring in a given week that had pneumonia and/or influenza (P&I) listed as a cause of death. When the percentage of P&I deaths exceeds the epidemic threshold, that indicates that significantly more P&I deaths occurred than would be expected at that time of year. During the most recent week for which these data are available (week ending March 28, 2020), 10.0% of deaths were due to P&I. This percentage is above the epidemic threshold of 7.1% for that week. The increase in P&I percentage is being driven primarily by an increase in non-influenza pneumonia deaths due to COVID-19.

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

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Page last reviewed: April 10, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral DiseaseshomeCoronavirus Disease 2019 (COVID-19)

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

**Ronan Kelly** · April 17, 2020, 07:02 PM

COVIDView Weekly Summary

Print Page
Updated April 17, 2020

Download Weekly Summary pdf icon[10 Pages, 2 MB]

Key Updates for Week 15, ending April 11, 2020

This CDC report provides a weekly summary and interpretation of key indicators that have been adapted to track the COVID-19 pandemic in the United States. While influenza-like illness (ILI) declined, it is still elevated and laboratory confirmed COVID-19 activity continues to increase as do COVID-19 severity indicators (hospitalizations and deaths).

Virus
Public Health, Commercial and Clinical Laboratories
Public health, commercial and clinical laboratories are all testing for SARS-CoV-2, the virus that causes COVID-19, and reporting their results. The national percentage of respiratory specimens testing positive for SARS-CoV-2 increased from week 14 to week 15 and is as follows:

Public health laboratories – increased from 17.3% during week 14 to 17.8% during week 15;
Clinical laboratories – increased from 10.6% during week 14 to 11.5% during week 15;
Commercial laboratories – increased from 20.6% during week 14 to 22.6% during week 15.

Outpatient and Emergency Department Visits
Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)
Two indicators from existing surveillance systems are being monitored to track outpatient or emergency department (ED) visits for potential COVID-19 illness.

Nationally, the percentages of visits for influenza-like illness (ILI) and COVID-19-like illness (CLI) are elevated but decreased compared to last week.

Recent changes in health care seeking behavior are likely impacting data from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease
Hospitalizations
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 20.0 per 100,000, with the highest rates in persons 65 years and older (63.8 per 100,000) and 50-64 years (32.8 per 100,000).

Mortality
Based on death certificate data, the percentage of deaths attributed to COVID-19, pneumonia or influenza increased from 17.8% during week 14 to 18.8% during week 15.

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

CDC has modified existing surveillance systems, many used to track influenza and other respiratory viruses annually, to track COVID-19.
Nationally, the percentage of laboratory specimens testing positive for SARS-CoV-2 continued to increase.
Visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 are elevated compared to what is normally seen at this time of year but decreased compared to levels reported last week. At this time, there is little influenza virus circulation. The levels of people presenting for care with these symptoms is likely due to COVID-19 but may be tempered by a number of factors including less ILI overall because of widespread adoption of social distancing efforts and changes in healthcare seeking behavior.
The overall cumulative COVID-19 associated hospitalization rate is 20.0 per 100,000, with the highest rates in persons 65 years and older (63.8 per 100,000) and 50-64 years (32.8 per 100,000). Hospitalization rates for COVID-19 in older people are higher than what is typically seen early in a flu season.
Based on death certificate data, the percentage of deaths attributed to COVID-19, pneumonia or influenza increased from 17.8% during week 14 to 18.8% during week 15.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. At this point in the outbreak, all laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to be modified. The lower percentage of specimens testing positive in the clinical laboratories compared to the public health and commercial laboratories is likely due to the amount of COVID-19 activity in areas with reporting laboratories and a larger proportion of specimens from children.

Public Health Laboratories

Data Table

Clinical Laboratories

Data Table

Commercial Laboratories

* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be related to COVID-19. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increasing use of telemedicine and recommendations to limit emergency department (ED) visits to severe illness, as well as increased social distancing. These changes affect the numbers of people and their reasons for seeking care in the outpatient and ED settings.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 15, 2.9% of patient visits reported through ILINet were due to ILI. This percentage is above the national baseline of 2.4% but represents the third week of a decline after three weeks of increase beginning in early March. The percentage of visits for ILI decreased in all age groups. Nationally, laboratory confirmed influenza activity as reported by clinical laboratories decreased to levels usually seen in summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely driving the decrease in ILI activity.

* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 1.3% to 8.3% during week 15; all regions reported a decreased percentage of outpatient visits for ILI compared to week 14 and five regions are below their region-specific baselines.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 15 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 15 (Week ending April 11, 2020)	Compared to Previous Week
Very High	2	-6
High	10	-4
Moderate	6	+2
Low	11	-1
Minimal	24	+9
Insufficient Data*	1	No change

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored. The coronavirus diagnosis code was added to the CLI definition this week after input from public health and community partners. This addition changed the magnitude of the percentage of visits for CLI but it did not change the trends.

Nationwide during week 15, 5.6% of emergency department visits captured in NSSP were due to CLI and 2.5% were due to ILI. This is the third week of decline in percentage of visits for ILI and the second week of decline in percentage of visits for CLI. All 10 HHS regionsexternal icon experienced a decline in percentage of visits for ILI and CLI.
Data Table

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 Influenza Hospitalization Surveillance Project (IHSP) states. COVID-NET-estimated hospitalization rates will be updated weekly.

A total of 6,485 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and April 11, 2020. The overall cumulative hospitalization rate was 20 per 100,000 population with the highest rates among adults aged 65 years and older (63.8 per 100,000) followed by adults aged 50-64 years (32.8 per 100,000).

Among 1,968 cases with information on race/ethnicity, 43.4% were non-Hispanic white, 32.0% were non-Hispanic black, 11.7% were Hispanic and 12.9% were other race, including unknown race.

	Overall	0-4 years	5-17 years	18-49 years	50-64 years	65+ years
	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
Non-Hispanic White	854 (43.4)	3 (60.0)	3 (33.3)	136 (29.2)	239 (37.5)	473 (55.6)
Non-Hispanic Black	630 (32.0)	0 (0.0)	6 (66.7)	158 (34.0)	229 (35.9)	237 (27.8)
Hispanic	230 (11.7)	2 (40.0)	0 (0.0)	107 (23.0)	82 (12.9)	39 (4.6)
Other	254 (12.9)	0 (0.0)	0 (0.0)	64 (13.8)	88 (13.8)	102 (12.0)

Among 886 hospitalized adults with information on underlying medical conditions, 90% had at least one reported underlying medical condition; the most commonly reported were hypertension, obesity, chronic metabolic disease and cardiovascular disease. Among 7 hospitalized children with information on underlying medical conditions, 71.4% had at least one underlying medical condition; the most commonly reported was asthma.

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 April 16, 2020, 18.8% of all deaths occurring during the week ending April 11, 2020 (week 15) were due to pneumonia, influenza or COVID-19 (PIC). This percentage is above the epidemic threshold of 7.0% for week 15 and has been increasing sharply since the end of February.

*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.
Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19 | Provisional Death Counts for PICpdf icon

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Page last reviewed: April 17, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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

**Ronan Kelly** · April 24, 2020, 07:00 PM

COVIDView Weekly Summary

Print Page
Updated April 24, 2020

Download Weekly Summary pdf icon[42 Pages, 2 MB]

Key Updates for Week 16, ending April 18, 2020

Levels of influenza-like illness (ILI) declined again and are below the national baseline but remain elevated in the northeast and northwest of the country. Levels of laboratory confirmed COVID-19 activity remained similar to, or decreased slightly, compared to last week. Mortality attributed to COVID-19 decreased compared to last week but remains significantly elevated and may increase as additional death certificates are counted.

Virus
Public Health, Commercial and Clinical Laboratories
The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories remained similar to, or decreased slightly from, week 15 to week 16 and is as follows:

Public health laboratories – increased from 17.8% during week 15 to 18.8% during week 16;
Clinical laboratories – decreased from 11.3% during week 15 to 9.6% during week 16;
Commercial laboratories – decreased from 22.8% during week 15 to 19.7% during week 16.

Outpatient and Emergency Department Visits
Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)
Two indicators from existing surveillance systems are being monitored to track outpatient or emergency department (ED) visits for potential COVID-19 illness.

Nationally, the percentages of visits for ILI and COVID-19-like illness (CLI) decreased compared to last week and levels of ILI are now below baseline.

Recent changes in health care seeking behavior are likely impacting data from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease
Hospitalizations
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 29.2 per 100,000, with the highest rates in people 65 years and older (95.5 per 100,000) and 50-64 years (47.2 per 100,000).

Mortality
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 23.6% during week 15 to 18.6% during week 16 but remained significantly above baseline. This percentage may change as additional death certificates are processed.

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 percentage of laboratory specimens testing positive for SARS-CoV-2 remained similar to, or decreased, compared to last week.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline and are below baseline in many areas of the country.
- The decrease in the percentage of people presenting for care with these symptoms may be due to decline in COVID-19 but may be tempered by a number of factors including less ILI overall because of widespread adoption of social distancing efforts and changes in healthcare seeking behavior.
- At this time, there is little influenza activity.
The overall cumulative COVID-19 associated hospitalization rate is 29.2 per 100,000, with the highest rates in persons 65 years and older (95.5 per 100,000) and 50-64 years (47.2 per 100,000). Hospitalization rates for COVID-19 in older people are higher than what is typically seen early in a flu season.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 23.6% during week 15 to 18.6% during week 16 but remained significantly above baseline. This is very elevated in the context of any influenza season. The percentage may change as additional death certificates are processed.
Declines in some key indicators used to track COVID-19 from one week to the next could change as additional data are received but also may be a result of widespread social distancing measures.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. At this point in the outbreak, all laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to be modified. The lower percentage of specimens testing positive in the clinical laboratories compared to the public health and commercial laboratories is likely due to the amount of COVID-19 activity in areas with reporting laboratories and a larger proportion of specimens from children.

72,345	401,159
47,983	213,427
455,162	2,550,201
13,636 (18.8%)	62,686 (15.6%)
4,585 (9.6%)	20,555 (9.6%)
89,482 (19.7%)	498,381 (19.5%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

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Clinical Laboratories

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Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be related to COVID-19. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increasing use of telemedicine and recommendations to limit emergency department (ED) visits to severe illness, as well as increased social distancing. These changes affect the numbers of people and their reasons for seeking care in the outpatient and ED settings.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 16, 2.2% of patient visits reported through ILINet were due to ILI. This percentage is below the national baseline of 2.4% and represents the fourth week of a decline after three weeks of increase beginning in early March. The percentage of visits for ILI decreased in all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories has decreased to levels usually seen in summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the decrease in ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 1.1% to 5.4% during week 16; all regions reported a decreased percentage of outpatient visits for ILI compared to week 15 and six regions are below their region-specific baselines.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 16 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 16 (Week ending April 18, 2020)	Compared to Previous Week
Very High	1	-1
High	7	-3
Moderate	3	-3
Low	8	-1
Minimal	34	+8
Insufficient Data*	1	No change

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 16, 4.7% of emergency department visits captured in NSSP were due to CLI and 1.8% were due to ILI. This is the fourth week of decline in percentage of visits for ILI and the third week of stable or declining percentage of visits for CLI. All 10 HHS regionsexternal icon experienced a decline in percentage of visits for ILI and CLI.

resize iconView LargerData Table

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 Influenza Hospitalization Surveillance Project (IHSP) states. COVID-NET-estimated hospitalization rates will be updated weekly.

A total of 9,483 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020 and April 18, 2020. The overall cumulative hospitalization rate was 29.2 per 100,000 population. The highest rate of hospitalization is among adults aged ≥ 65 (95.5 per 100,000), followed by adults aged 50-64 years (47.2 per 100,000) and adults aged 18-49 years (14.3 per 100,000).

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Among 2,803 cases with information on race/ethnicity, 43.7% were non-Hispanic white, 31.4% were non-Hispanic black, 12.4% were Hispanic, and 12.6% were other race, including unknown race.

	Overall	0-4 years	5-17 years	18-49 years	50-64 years	65+ years
	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
Non-Hispanic White	1,224 (43.7)	3 (50.0)	2 (18.2)	173 (27.0)	334 (38.1)	712 (56.2)
Non-Hispanic Black	879 (31.4)	0 (0.0)	6 (54.5)	211 (32.9)	305 (34.8)	357 (28.2)
Hispanic	347 (12.4)	2 (33.3)	2 (18.2)	162 (25.3)	121 (13.8)	60 (4.7)
Other	353 (12.6)	1 (16.7)	1 (9.1)	95 (14.8)	117 (13.3)	139 (11.0)

Among 1,393 hospitalized adults with information on underlying medical conditions, 90.2% had at least one reported underlying medical condition, the most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease.

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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 April 23, 2020, 18.6% of all deaths occurring during the week ending April 18, 2020 (week 16) were due to pneumonia, influenza or COVID-19 (PIC). This percentage is above the epidemic threshold of 6.9% for week 16 and represents the first week of a decline in PIC percentage since the end of February; however, data for week 16 are incomplete and the PIC percentage may increase as more death certificates are filed.

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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.
Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

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Page last reviewed: April 24, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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

**Ronan Kelly** · May 2, 2020, 06:31 AM

COVIDView Weekly Summary

Print Page
Updated May 1, 2020

Download Weekly Summary pdf icon[42 Pages, 2 MB]

Key Updates for Week 17, ending April 25, 2020

Nationally, levels of influenza-like illness (ILI) declined again this week. They have been below the national baseline for two weeks but remain elevated in the northeastern and northwestern part of the country. Levels of laboratory confirmed SARS-CoV-2 activity remained similar or decreased compared to last week. Mortality attributed to COVID-19 decreased compared to last week but remains significantly elevated and may increase as additional death certificates are counted.

Virus
Public Health, Commercial and Clinical Laboratories
The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories remained similar or decreased from week 16 to week 17. Percentages by type of laboratory:

Public health laboratories – decreased from 19.4% during week 16 to 17.1% during week 17;
Clinical laboratories – remained similar with 10.9% during week 16 and 11.0% during week 17;
Commercial laboratories – decreased from 19.5% during week 16 to 16.4% during week 17.

Outpatient and Emergency Department Visits
Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)
Two indicators from existing surveillance systems are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and COVID-19-like illness (CLI) decreased compared to last week. Levels of ILI are now below baseline for the second week.

Recent changes in health care seeking behavior are likely affecting data reported from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease
Hospitalizations
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 40.4 per 100,000, with the highest rates in people 65 years and older (131.6 per 100,000) and 50-64 years (63.7 per 100,000).

Mortality
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 23.6% during week 16 to 14.6% during week 17 but remained significantly above baseline. This is the second week of declines in this indicator, but this percentage may change as death certificates representing recent deaths are processed.

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 percentage of laboratory specimens testing positive for SARS-CoV-2 remained similar, or decreased, compared to last week.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline and are below baseline nationally and in many regions of the country. They remain elevated in the northeast and northwest.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness. Reported levels of activity may be decreasing because of widespread adoption of social distancing efforts and changes in healthcare seeking behavior.
- Little influenza virus activity has been reported in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 40.4 per 100,000, with the highest rates in people 65 years and older (131.6 per 100,000) and 50-64 years (63.7 per 100,000).
- Hospitalization rates for COVID-19 in adults (18-64 years) are higher than hospitalization rates for influenza at comparable time points* during the past 5 influenza seasons.
- For people 65 years and older, current COVID-19 hospitalization rates are similar to those observed during comparable time points* during recent high severity influenza seasons.
- For children (0-17 years), COVID-19 hospitalization rates are much lower than influenza hospitalization rates during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 23.6% during week 16 to 14.6% during week 17 which is still significantly above baseline. This is the second week of decline in this indicator, but the percentage remains high compared with any influenza season. The percentage may change as additional death certificates for deaths during recent weeks are processed.
Declines in some key indicators used to track COVID-19 from one week to the next could change as additional data are received but also may be a result of widespread social distancing measures.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.
...
https://www.cdc.gov/coronavirus/2019...iew/index.html

**Ronan Kelly** · May 9, 2020, 08:13 AM

COVIDView Weekly Summary

Print Page
Updated May 8, 2020

Download Weekly Summary pdf icon[43 Pages, 2 MB]

Key Updates for Week 18, ending May 2, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continues to decline. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are counted.

Virus
Public Health, Commercial and Clinical Laboratories
The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories decreased from week 17 to week 18. Percentages by type of laboratory:

Public health laboratories – decreased from 17.7% during week 17 to 13.2% during week 18;
Clinical laboratories – decreased from 10.3% during week 17 to 9.0% during week 18;
Commercial laboratories – decreased from 15.9% during week 17 to 13.2% during week 18.

Outpatient and Emergency Department Visits
Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)
Two indicators from existing surveillance systems are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and COVID-19-like illness (CLI) decreased compared to last week. Levels of ILI are now below baseline nationally for the second week and in all 10 surveillance regions.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease
Hospitalizations
Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 50.3 per 100,000, with the highest rates in people 65 years and older (162.2 per 100,000) and 50-64 years (79.0 per 100,000).

Mortality
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 21.0% during week 17 to 10.6% during week 18 but remained above baseline. This is the third week of a stable or declining percentage of deaths due to PIC, but this percentage may change as death certificates representing recent deaths are processed.

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 percentages of laboratory specimens testing positive for SARS-CoV-2 decreased compared to last week.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline and are below baseline nationally and in all regions of the country.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness, which could be in part a result of widespread adoption of social distancing in addition to changes in healthcare seeking behavior.
- There has been very little influenza virus activityin recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 50.3 per 100,000, with the highest rates in people aged 65 years and older (162.2 per 100,000) and 50-64 years (79.0 per 100,000). Hospitalization rates are cumulative and expected to increase as the COVID-19 pandemic continues.
- Hospitalization rates for COVID-19 in adults (18-64 years) are already higher than hospitalization rates for influenza at comparable time points* during the past 5 influenza seasons.
- For people 65 years and older, current COVID-19 hospitalization rates are within ranges observed during comparable time points* in recent influenza seasons.
- For children (0-17 years), COVID-19 hospitalization rates are much lower than influenza hospitalization rates during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 21.0% during week 17 to 10.6% during week 18 but remained above baseline. This is the third week during which a declining percentage of deaths due to PIC has been seen, but the percentage remains high compared with any influenza season. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.
...
https://www.cdc.gov/coronavirus/2019...iew/index.html

**Ronan Kelly** · May 17, 2020, 06:00 AM

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

Print Page
Updated May 15, 2020

Download Weekly Summary pdf icon[46 Pages, 2 MB]
Key Updates for Week 19, ending May 9, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continue to decline. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are counted.
Virus

Public Health, Commercial and Clinical Laboratories

The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories decreased from week 18 to week 19. Percentages by type of laboratory:

Public health laboratories – decreased from 13.1% during week 18 to 11.8% during week 19;
Clinical laboratories – decreased from 8.4% during week 18 to 6.9% during week 19;
Commercial laboratories – decreased from 13.0% during week 18 to 10.2% during week 19.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two indicators from existing surveillance systems are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and CLI decreased compared to last week. Levels of ILI are now below baseline nationally for the third week and in all 10 surveillance regions.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.
Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 60.5 per 100,000, with the highest rates in people aged 65 years and older (192.4 per 100,000) and 50-64 years (94.4 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 17.8% during week 18 to 12.8% during week 19 but remained above baseline. This is the third week of a declining percentage of deaths due to PIC, but this percentage may change as more death certificates are processed, particularly for recent weeks.

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 percentages of laboratory specimens testing positive for SARS-CoV-2 decreased compared to last week.
- While the number of specimens from children <18 years of age tested is low (<5% of all specimens tested in public health and commercial laboratories), the percentage of these testing positive for SARS-CoV-2 in this age group has either trended upward or remained relatively stable in recent weeks. Other age groups have seen declines in percent positivity during the same time period.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline. Outpatient ILI visits are below baseline nationally and in all regions of the country.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness, which could be in part a result of widespread adoption of social distancing in addition to changes in healthcare seeking behavior.
- There has been very little influenza virus activity in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 60.5 per 100,000, with the highest rates in people 65 years of age and older (192.4 per 100,000) and 50-64 years (94.4 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Hospitalization rates for COVID-19 in adults (18-64 years) are already higher than hospitalization rates for influenza at comparable time points* during the past 5 influenza seasons.
- For people 65 years and older, current COVID-19 hospitalization rates are within ranges of influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), COVID-19 hospitalization rates are much lower than influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 17.8% during week 18 to 12.8% during week 19, but remained above baseline. This is the third week during which a declining percentage of deaths due to PIC has been seen, but the percentage remains high compared with any influenza season. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.


National	10.2	Declining (5 weeks)	1.2	Below	Declining (7 weeks)	2.8	Declining (5 weeks)	12.8	Above	Declining (3 weeks)
Region 1	14.0	Declining (4 weeks)	1.4	Below	Declining (7 weeks)	4.7	Declining (4 weeks)	24.2	Above	Declining (2 weeks)
Region 2	13.9	Declining (5 weeks)	2.0	Below	Declining (6 weeks)	3.8	Declining (5 weeks)	30.0	Above	Declining (3 weeks)
Region 3	14.6	Declining (3 weeks)	1.4	Below	Declining (7 weeks)	4.0	Declining (4 weeks)	13.1	Above	Declining (3 weeks)
Region 4	6.6	Declining (6 weeks)	0.9	Below	Declining (7 weeks)	1.8	Declining (6 weeks)	7.2	Above	Declining (4 weeks)
Region 5	10.8	Declining (2 weeks)	1.2	Below	Declining (7 weeks)	3.7	Declining (5 weeks)	9.2	Above	Declining (3 weeks)
Region 6	7.1	Declining (5 weeks)	1.4	Below	Declining (7 weeks)	2.1	Declining (6 weeks)	7.4	Above	Declining (4 weeks)
Region 7	12.0	Declining (2 weeks)	0.6	Below	Declining (1 week)	1.6	Declining (7 weeks)	9.1	Above	Declining (3 weeks)
Region 8	7.2	Increasing (1 week)	0.8	Below	Declining (8 weeks)	3.0	Declining (6 weeks)	5.0	Below	Declining (2 weeks)
Region 9	7.3	Declining (3 weeks)	1.2	Below	No change	2.5	Declining (7 weeks)	7.4	Above	Declining (3 weeks)
Region 10	5.0	Declining (3 weeks)	1.1	Below	Declining (7 weeks)	1.6	Declining (7 weeks)	Insufficient Data for Week 19

* Public health, clinical and commercial laboratory data combined.
U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. At this point in the outbreak, all laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change. The lower percentage of specimens testing positive in clinical laboratories compared to public health and commercial laboratories may be influenced by COVID-19 activity in areas with reporting laboratories and by larger proportions of specimens obtained from children tested in these laboratories.

955,714	6,012,947
131,841	836,543
81,269	494,880
742,604	4,681,524
97,237 (10.1%)	945,395 (15.7%)
15,501 (11.8%)	124,473 (14.9%)
5,641 (6.9%)	45,312 (9.2%)
76,095 (10.2%)	775,610 (16.6%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

resize iconView LargerView Data Table

Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

resize iconView Larger

* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people and their reasons for seeking care in the outpatient and ED settings.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 19, 1.2% of patient visits reported through ILINet were due to ILI. This percentage is below the national baseline of 2.4% and represents the seventh week of decline after three weeks of increase beginning in early March. The percentage of visits for ILI decreased in all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories has decreased to levels usually seen in summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the decrease in ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.6% to 2.0% during week 19. Compared to week 18, the percent of outpatient visits for ILI was unchanged in region 9, but decreased in all other regions, and all ten regions are below their region-specific baselines.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 19 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 19 (Week ending May 9, 2020)	Compared to Previous Week
Very High	0	No change
High	1	-1
Moderate	2	No change
Low	2	-2
Minimal	48	+3
Insufficient Data*	1	No change

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 19, 2.8% of emergency department visits captured in NSSP were due to CLI and 0.9% were due to ILI. This is the seventh week of decline in percentage of visits for ILI and the sixth week of stable or declining percentage of visits for CLI. All 10 HHS regionsexternal icon experienced a decline in percentage of visits for ILI and CLI.

resize iconView LargerView Data Table

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 states participating in the Influenza Hospitalization Surveillance Project (IHSP). COVID-NET-estimated hospitalization rates are updated weekly.

A total of 19,637 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and May 9, 2020. The overall cumulative hospitalization rate was 60.5 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged 65 years (192.4 per 100,000), followed by adults aged 50-64 years (94.4 per 100,000) and adults aged 18-49 years (32.6 per 100,000).

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Within the 18-49 years and ≥ 65 years age groups, the hospitalization rates increased with increasing age.

Overall	60.5
0-4 years	3.0
5-17 years	1.4
18-49 years	32.6
18-29 years	15.4
30-39 years	32.0
40-49 years	55.6
50-64 years	94.4
65+ years	192.4
65-74 years	141.2
75-84 years	232.0
85+ years	352.0

Among 13,441 cases with information on race/ethnicity, 36.5% were non-Hispanic white, 40.0% were non-Hispanic black, 14.2% were Hispanic, and 9.3% were other race.

	Overall	0-4 years	5-17 years	18-49 years	50-64 years	65+ years
Race	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
Cases with available race	1,3441 (68.4)	29 (50.0)	46 (62.2)	2,987 (63.6)	3,947 (67.5)	6,432 (71.8)
Non-Hispanic White	4,908 (36.5)	7 (24.1)	8 (17.4)	568 (19.0)	1,159 (29.4)	3,166 (49.2)
Non-Hispanic Black	5,372 (40.0)	9 (31.0)	16 (34.8)	1,165 (39.0)	1,780 (45.1)	2,402 (37.3)
Hispanic	1,906 (14.2)	7 (24.1)	19 (41.3)	898 (30.1)	616 (15.6)	366 (5.7)
Other¹	1,255 (9.3)	6 (20.7)	3 (6.5)	356 (11.9)	392 (9.9)	498 (7.7)
Cases missing race²	6,196 (31.6)	29 (50.0)	28 (37.8)	1,708 (36.4)	1,904 (32.5)	2,527 (28.2)

¹ Other includes data on persons who are Asian, American Indian/Alaskan Native, Multi-race, and persons for whom race/ethnicity data is unknown; ² Cases with missing race include those for whom chart reviews have not yet been conducted to ascertain race; these data will be updated as additional race data become available

Among 3,734 hospitalized adults with information on underlying medical conditions, 91.7% had at least one reported underlying medical condition, the most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease.

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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 May 14, 2020, 12.8% of all deaths occurring during the week ending May 9, 2020 (week 19) were due to pneumonia, influenza or COVID-19 (PIC). This is the third week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 6.6% for week 19. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are filed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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. Given the amount of manually coded data available for deaths occurring during week 19, it is possible that when additional death certificates are processed, the week 19 PIC percentage may be greater than what was reported for week 18.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

View Page In:pdf icon 46 Pages, 2 MB
Page last reviewed: May 15, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral DiseaseshomeCoronavirus Disease 2019 (COVID-19)

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

**Ronan Kelly** · May 23, 2020, 06:07 AM

Updated May 22, 2020

Download Weekly Summary pdf icon[49 Pages, 3 MB]
Key Updates for Week 20, ending May 16, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continue to decline. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories decreased from week 19 to week 20. Percentages by type of laboratory:

Public health laboratories – decreased from 10.7% during week 19 to 8.5% during week 20;
Clinical laboratories – decreased from 6.4% during week 19 to 5.8% during week 20;
Commercial laboratories – decreased from 9.9 % during week 19 to 7.9% during week 20.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two indicators from existing surveillance systems are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and CLI decreased, compared to last week. Levels of ILI are below baseline nationally for the fifth week and in all 10 surveillance regions.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw further conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.
Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative hospitalization rate is 67.9 per 100,000, with the highest rates in people aged 65 years and older (214.4 per 100,000) and 50-64 years (105.9 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 18.5% during week 19 to 12.0% during week 20 but remained above baseline. This is the fourth week of a declining percentage of deaths due to PIC, but this percentage may change as more death certificates are processed, particularly for recent weeks.

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 percentages of laboratory specimens testing positive for SARS-CoV-2 decreased compared to last week.
- While the number of specimens from children <18 years of age tested is low (<5% of all specimens tested in public health and commercial laboratories), the percentage of these testing positive for SARS-CoV-2 in this age group has either trended upward or remained relatively stable in recent weeks. Other age groups have seen declines in percent positivity during the same time period.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline. Outpatient ILI visits are below baseline nationally and in all regions of the country.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness, which could be in part a result of widespread adoption of social distancing in addition to changes in healthcare seeking behavior.
- There has been very little influenza virus activity in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 67.9 per 100,000, with the highest rates in people 65 years of age and older (214.4 per 100,000) followed by people 50-64 years (105.9 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Hospitalization rates for COVID-19 in adults (18-64 years) are higher than hospitalization rates for influenza at comparable time points* during the past 5 influenza seasons.
- For people 65 years and older, current COVID-19 hospitalization rates are within ranges of influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), COVID-19 hospitalization rates are much lower than influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 18.5% during week 19 to 12.0% during week 20 but remained above baseline. This is the fourth week during which a declining percentage of deaths due to PIC has been recorded, but the percentage remains high compared with any influenza season. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.


National	7.9	Declining (6 weeks)	1.1	Below	Declining (8 weeks)	2.5	Declining (6 weeks)	12.0	Above	Declining (4 weeks)
Region 1	9.4	Declining (5 weeks)	1.2	Below	Declining (8 weeks)	4.0	Declining (5 weeks)	25.5	Above	Declining (4 weeks)
Region 2	9.4	Declining (6 weeks)	1.8	Below	Declining (7 weeks)	2.9	Declining (6 weeks)	25.1	Above	Declining (4 weeks)
Region 3	12.0	Declining (4 weeks)	1.2	Below	Declining (8 weeks)	3.4	Declining (5 weeks)	13.8	Above	Declining (2 weeks)
Region 4	5.8	Declining (7 weeks)	0.8	Below	No change	1.8	Declining (7 weeks)	6.2	Above	Declining (4 weeks)
Region 5	7.8	Declining (3 weeks)	1.3	Below	Increasing (1 week)	3.3	Declining (6 weeks)	8.8	Above	Declining (4 weeks)
Region 6	7.0	Declining (6 weeks)	1.2	Below	Declining (8 weeks)	2.0	Declining (7 weeks)	6.0	Below	Declining (5 weeks)
Region 7	9.5	Declining (3 weeks)	0.6	Below	No change	1.5	Declining (7 weeks)	7.2	Above	Declining (1 week)
Region 8	5.4	Declining (3 weeks)	0.7	Below	Declining (9 weeks)	2.8	Declining (7 weeks)	6.2	Below	Declining (3 weeks)
Region 9	6.0	Declining (4 weeks)	0.8	Below	Declining (8 weeks)	2.4	Declining (8 weeks)	7.2	Above	Declining (4 weeks)
Region 10	4.4	Declining (4 weeks)	1.1	Below	No change	1.5	Declining (8 weeks)	Insufficient Data for Week 20

* Public health, clinical and commercial laboratory data combined.
U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change. The lower percentage of specimens testing positive in clinical laboratories compared to public health and commercial laboratories may be influenced by COVID-19 activity in areas with reporting laboratories and by larger proportions of specimens obtained from children tested in these laboratories

1,133,420	7,362,526
163,905	1,031,408
85,445	626,747
884,070	5,704,371
88,975 (7.9%)	1,049,239 (14.3%)
13,912 (8.5%)	139,682 (13.5%)
4,983 (5.8%)	53,424 (8.5%)
70,080 (7.9%)	856,133 (15.0%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

resize iconView LargerView Data Table

Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 20, 1.1% of patient visits reported through ILINet were due to ILI. This percentage is low and below the national baseline of 2.4% and represents the eighth week of decline after three weeks of increase beginning in early March. Compared to week 19, the percentage of visits for ILI in week 20 decreased among adults 25 years of age and older, stayed the same in children and adults aged 5-24 years, and increased slightly in children 0-4 years of age. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories has decreased to levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the decrease in ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.6% to 1.8% during week 20. Compared to week 19, the percent of outpatient visits for ILI increased slightly in region 5, remained unchanged in regions 4, 7, and 10, and decreased in the remaining 6 regions. All ten regions are below their region-specific baselines.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 20 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 20 (Week ending May 16, 2020)	Compared to Previous Week
Very High	0	No change
High	1	No change
Moderate	2	No change
Low	2	-1
Minimal	48	+1
Insufficient Data*	1	No change

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 20, 2.5% of emergency department visits captured in NSSP were due to CLI and 0.8% were due to ILI. This is the eighth week of decline in percentage of visits for ILI and the sixth week of declining percentage of visits for CLI. Compared to week 19, all 10 HHS regionsexternal icon had declining percentages of visits for CLI during week 20; 7 regions also had declining percentages of visits for ILI while regions 4, 6 and 7 had no change in percent of visits for ILI from week 19 to week 20.

resize iconView LargerView Data Table

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 states participating in the Influenza Hospitalization Surveillance Project (IHSP). COVID-NET-estimated hospitalization rates are updated weekly.

A total of 22,060 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and May 16, 2020. The overall cumulative hospitalization rate was 67.9 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged 65 years (214.4 per 100,000), followed by adults aged 50-64 years (105.9 per 100,000) and adults aged 18-49 years (37.2 per 100,000).

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Within the 18-49 years and ≥ 65 years age groups, the hospitalization rates increased with increasing age.

Overall	67.9
0-4 years	3.5
5-17 years	1.7
18-49 years	37.2
18-29 years	17.8
30-39 years	36.8
40-49 years	62.8
50-64 years	105.9
65+ years	214.4
65-74 years	156.6
75-84 years	258.3
85+ years	396.4

Among 18,136 cases with information on race/ethnicity, 35.8% were non-Hispanic white, 34.9% were non-Hispanic black, 17.4% were Hispanic, and 11.8% were other race.

	Overall	0-4 years	5-17 years	18-49 years	50-64 years	65+ years
Race	N (%)	N (%)	N (%)	N (%)	N (%)	N (%)
Cases with available race	18,136 (82.2)	52 (76.5)	72 (79.1)	4,170 (77.9)	5,304 (80.8)	8,538 (85.5)
Non-Hispanic White	6,495 (35.8)	11 (21.2)	10 (13.9)	760 (18.2)	1,533 (28.9)	4,181 (49.0)
Non-Hispanic Black	6,331 (34.9)	10 (19.2)	24 (33.3)	1,362 (32.7)	2,108 (39.7)	2,827 (33.1)
Hispanic	3,162 (17.4)	22 (42.3)	32 (44.4)	1,451 (34.8)	981 (18.5)	676 (7.9)
Other¹	2,148 (11.8)	9 (17.3)	6 (8.3)	597 (14.3)	682 (12.9)	854 (10.0)
Cases missing race²	3,924 (17.8)	16 (23.5)	19 (20.9)	1,186 (22.1)	1,257 (19.2)	1,446 (14.5)

¹ Other includes data on persons who are Asian, American Indian/Alaskan Native, Multi-race, and persons for whom race/ethnicity data is unknown; ² Cases with missing race include those for whom chart reviews have not yet been conducted to ascertain race; these data will be updated as additional race data become available; NH=non-Hispanic

Among 4,247 hospitalized adults with information on underlying medical conditions, 92.1% had at least one reported underlying medical condition, the most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease.

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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 May 21, 2020, 12.0% of all deaths occurring during the week ending May 16, 2020 (week 20) were due to pneumonia, influenza or COVID-19 (PIC). This is the fourth week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 6.5% for week 20 and is high compared to any influenza season. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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. Given the amount of manually coded data available for deaths occurring during week 20, it is possible that when additional death certificates are processed, the week 20 PIC percentage may be greater than what was reported for week 19.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

View Page In:pdf icon 49 Pages, 3 MB
Page last reviewed: May 22, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral DiseaseshomeCoronavirus Disease 2019 (COVID-19)

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

**Ronan Kelly** · May 30, 2020, 06:22 AM

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

Print Page
Updated May 29, 2020

Download Weekly Summary pdf icon[47 Pages, 2 MB]
Key Updates for Week 21, ending May 23, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continue to decline or remain stable. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories decreased from week 20 to week 21; however, percent positivity increased slightly in two regions. National percentages by type of laboratory:

Public health laboratories – decreased from 8.4% during week 20 to 7.0% during week 21;
Clinical laboratories – decreased from 6.3% during week 20 to 5.6% during week 21;
Commercial laboratories – decreased from 7.8 % during week 20 to 6.9% during week 21.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two surveillance indicators are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and CLI decreased or remained stable at low levels, compared to last week. Levels of ILI are below baseline nationally for the sixth week and in all 10 surveillance regions for the past four to seven weeks.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.
Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 73.3 per 100,000, with the highest rates in people aged 65 years and older (229.7 per 100,000) and 50-64 years (113.4 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 15.9% during week 20 to 9.8% during week 21 but remained above baseline. This is the fifth week of a declining percentage of deaths due to PIC, but this percentage may change as more death certificates are processed, particularly for recent weeks.

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 percentages of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay decreased compared to last week; however, there are two developments in particular worth noting:
- The percent positivity increased slightly in two HHS surveillance regions (Regions 4 [the southeast] and 10 [the Pacific northwest]).
- While the number of specimens from children <18 years of age tested is low (<5% of all specimens tested in public health and commercial laboratories), the percentage testing positive for SARS-CoV-2 in this age group has either trended upward or remained relatively stable in recent weeks. Other age groups have seen declines in percent positivity during the same time period.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline or remain stable at low levels. Outpatient ILI visits are below baseline nationally and in all regions of the country.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness, which could be in part a result of widespread adoption of social distancing, in addition to decreases in healthcare seeking behavior.
- There has been very little influenza virus activity in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 73.3 per 100,000, with the highest rates in people 65 years of age and older (229.7 per 100,000) followed by people 50-64 years (113.4 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- This week’s report presents additional information on racial and ethnic disparities among reported COVID-19 hospitalizations. Non-Hispanic Black and non-Hispanic American Indian/Alaska Native populations have rates approximately 4.5 times that of non-Hispanic Whites, while Hispanic/Latinos have a rate approximately 3.5 times that of non-Hispanic Whites.
- Cumulative hospitalization rates for COVID-19 in adults (18-64 years) at this time are higher than cumulative end-of-season hospitalization rates for influenza over each of the past 5 influenza seasons.
- For people 65 years and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 15.9% during week 20 to 9.8% during week 21 but remained above baseline. This is the fifth week during which a declining percentage of deaths due to PIC has been recorded. The percentage remains above the epidemic threshold, and is now similar to what has been observed at the peak of some influenza seasons. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change. The lower percentage of specimens testing positive in clinical laboratories compared to public health and commercial laboratories may be influenced by COVID-19 activity in areas with reporting laboratories and by larger proportions of specimens obtained from children tested in these laboratories.

1,171,546	8,762,465
182,009	1,227,717
72,256	740,691
917,281	6,794,057
79,898 (6.8%)	1,145,733 (13.1%)
12,702 (7.0%)	153,579 (12.5%)
4,041 (5.6%)	60,520 (8.2%)
63,155 (6.9%)	931,634 (13.7%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

resize iconView LargerView Data Table

Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

resize iconView Larger

* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 21, 1.0% of patient visits reported through ILINet were due to ILI. This percentage is low and below the national baseline of 2.4% and represents the ninth week of decline after three weeks of increase beginning in early March. Compared to week 20, the percentage of visits for ILI in week 21 decreased slightly among all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories is at levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the low level of ILI activity.

resize iconView Larger

* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.4% to 1.5% during week 21. Compared to week 20, the percent of outpatient visits for ILI decreased or remained stable at low levels in all ten regions and all regions are below their region-specific baselines.

Note: In response to the COVID-19 pandemic, new sites will be enrolled in ILINet throughout the summer. This will result in an increase in patient visits and the percentage of visits for ILI may change in comparison to previous weeks. During week 21, new sites were added in Regions 1, 4, and 6. While these regions remain below baseline levels for ILI, these system changes should be kept in mind when drawing conclusions from these data. Any changes in ILI due to changes in respiratory virus circulation will be highlighted here.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 21 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 21 (Week ending May 23, 2020)	Compared to Previous Week
Very High	0	No change
High	1	No change
Moderate	0	-2
Low	2	No change
Minimal	49	+1
Insufficient Data	2	+1

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 21, 2.2% of emergency department visits captured in NSSP were due to CLI and 0.7% were due to ILI. This is the ninth week of decline in the percentage of visits for ILI and the seventh week of declining percentage of visits for CLI. Compared to week 20, all 10 HHS regionsexternal icon had declining percentages of visits for CLI during week 21; all 10 regions also had declining or stable percentages of visits for ILI.

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 23,811 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and May 23, 2020. The overall cumulative hospitalization rate was 73.3 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged 65 years (229.7 per 100,000), followed by adults aged 50-64 years (113.4 per 100,000) and adults aged 18-49 years (41.0 per 100,000).

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Within the 18-49 years and ≥ 65 years age groups, the hospitalization rates increased with increasing age.

Overall	73.3
0-4 years	4.1
5-17 years	1.9
18-49 years	41.0
18-29 years	20.1
30-39 years	40.7
40-49 years	68.5
50-64 years	113.4
65+ years	229.7
65-74 years	167.6
75-84 years	276.2
85+ years	426.7

Among the 23,811 laboratory-confirmed COVID-19-associated hospitalized cases, 19,775 (83%) had information available on race and ethnicity while collection of race and ethnicity data was still pending for 4,036 (17%) cases. Of the 19,775 cases with race and ethnicity data, 35.6% were non-Hispanic White, 34.1% were non-Hispanic Black, 17.9% were Hispanic/Latino, 4.5% were non-Hispanic Asian/Pacific Islander, 1.4% were non-Hispanic American Indian/Alaska Native, 0.2% were multiple race, and 6.3% had unknown race. In comparison, the COVID-NET catchment area population includes 58.8% non-Hispanic White, 17.7% non-Hispanic Black, 14.0% Hispanic/Latino, 8.8% non-Hispanic Asian/Pacific Islander, and 0.7% non-Hispanic American Indian/Alaska Native residents. Additional data on race and ethnicity by age are available.

COVID-19-associated hospitalization rates by race and ethnicity are calculated using hospitalized COVID-NET cases with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator. 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, 75-84, and ≥85 years. Age-adjusted hospitalization rates are highest in non-Hispanic American Indian/Alaska Native and non-Hispanic Black populations, followed by Hispanic/Latino. Non-Hispanic Black and non-Hispanic American Indian/Alaska Native populations have a rate approximately 4.5 times that of non-Hispanic Whites, while Hispanic/Latinos have a rate approximately 3.5 times that of non-Hispanic Whites.

Among 5,187 hospitalized adults with information on underlying medical conditions, 91.7% had at least one reported underlying medical condition, the most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease.

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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 May 28, 2020, 9.8% of all deaths occurring during the week ending May 23, 2020 (week 21) were due to pneumonia, influenza or COVID-19 (PIC). This is the fifth week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 6.4% for week 21. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

More Information

View Page In:pdf icon 49 Pages, 3 MB
Page last reviewed: May 29, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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

**Ronan Kelly** · June 6, 2020, 07:20 AM

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

Print Page
Updated June 5, 2020

Download Weekly Summary pdf icon[47 Pages, 2 MB]
Key Updates for Week 22, ending May 30, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) and the percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, continue to decline or remain stable at low levels. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The national percentage of respiratory specimens testing positive for SARS-CoV-2 at public health, clinical and commercial laboratories decreased from week 21 to week 22; however, percent positivity increased slightly in four regions. National percentages by type of laboratory:

Public health laboratories – decreased from 6.8% during week 21 to 6.0% during week 22;
Clinical laboratories – decreased from 6.0% during week 21 to 5.9% during week 22;
Commercial laboratories – decreased from 6.5% during week 21 to 5.9% during week 22.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two surveillance indicators are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and CLI decreased or remained stable at low levels, compared to last week. Levels of ILI are below baseline nationally for the seventh week and in all 10 surveillance regions for the past five to eight weeks.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.
Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 82.0 per 100,000, with the highest rates in people aged 65 years and older (254.7 per 100,000) and 50-64 years (126.2 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 13.7% during week 21 to 8.4% during week 22 but remained above baseline. This is the sixth week of a declining percentage of deaths due to PIC, but this percentage may change as more death certificates are processed, particularly for recent weeks.

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 percentages of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay decreased compared to last week; however, there are two developments in particular worth noting:
- The percent positivity increased in four HHS surveillance regions: Region 4 (the southeast), Region 6 (the south central, Region 9 (the west coast) and Region 10 (the Pacific northwest).
- While the number of specimens from children <18 years of age tested is low (<5% of all specimens tested in public health and commercial laboratories), the percentage testing positive for SARS-CoV-2 in this age group continued to either trend upward or remain relatively stable while other age groups have seen consistent declines in percent positivity in recent weeks.
Nationally, visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline or remain stable at low levels. Outpatient ILI visits are below baseline nationally and in all regions of the country.
- The decrease in the percentage of people presenting for care with ILI and CLI may be due to a decline in COVID-19 illness, which could be in part a result of widespread adoption of social distancing, in addition to decreases in healthcare seeking behavior.
- There has been very little influenza virus activity in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 82.0 per 100,000, with the highest rates in people 65 years of age and older (254.7 per 100,000) followed by people 50-64 years (126.2 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.5 times that of non-Hispanic White persons, while Hispanics or Latino persons have a rate approximately 3.5 times that of non-Hispanic White persons.
- Cumulative hospitalization rates for COVID-19 in adults (18-64 years) at this time are higher than cumulative end-of-season hospitalization rates for influenza over each of the past 5 influenza seasons.
- For people 65 years and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 13.7% during week 21 to 8.4% during week 22. This is the sixth week during which a declining percentage of deaths due to PIC has been recorded; however, the percentage remains above the epidemic threshold, and is now similar to what has been observed at the peak of some influenza seasons. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change.

1,054,626	10,337,330
175,585	1,426,171
88,660	922,190
790,381	7,988,969
62,403 (5.9%)	1,239,169 (12.0%)
10,529 (6.0%)	163,645 (11.5%)
5,206 (5.9%)	75,477 (8.2%)
46,668 (5.9%)	1,000,047 (12.5%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

resize iconView LargerView Data Table

Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 22, 0.9% of patient visits reported through ILINet were due to ILI. This percentage is well below the national baseline of 2.4% and represents the tenth week of decline after three weeks of increase beginning in early March. The percentage of visits for ILI in week 22 remains low among all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories is at levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the low level of ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.5% to 1.3% during week 22. All ten regions are at low levels and below their region-specific baselines.

Note: In response to the COVID-19 pandemic, new sites will be enrolled in ILINet throughout the summer. This will result in an increase in patient visits and the percentage of visits for ILI may change in comparison to previous weeks. During week 21, new sites were added in Regions 1, 4, and 6. While these regions remain below baseline levels for ILI, these system changes should be kept in mind when drawing conclusions from these data. Any changes in ILI due to changes in respiratory virus circulation will be highlighted here.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 22 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 22 (Week ending May 30, 2020)	Compared to Previous Week
Very High	0	No change
High	0	-1
Moderate	1	+1
Low	1	-1
Minimal	51	+2
Insufficient Data	1	-1

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 22, 1.8% of emergency department visits captured in NSSP were due to CLI and 0.6% were due to ILI. This is the tenth week of decline in the percentage of visits for ILI and the eighth week of declining percentage of visits for CLI. Compared to week 21, all 10 HHS regionsexternal icon had declining percentages of visits for CLI during week 22; all 10 regions also had declining or stable percentages of visits for ILI.

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 26,623 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and May 30, 2020. The overall cumulative hospitalization rate was 82.0 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged ≥ 65 years (254.7 per 100,000), followed by adults aged 50-64 years (126.2 per 100,000) and adults aged 18-49 years (46.7 per 100,000).

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Within the 18-49 years and ≥ 65 years age groups, the cumulative hospitalization rates increased with increasing age.

Overall	82.0
0-4 years	4.9
5-17 years	2.4
18-49 years	46.7
18-29 years	23.7
30-39 years	46.2
40-49 years	77.1
50-64 years	126.2
65+ years	254.7
65-74 years	185.7
75-84 years	307.5
85+ years	470.6

Among the 0-4 years and 5-17 years age groups, there appears to be a slight upward trend in weekly hospitalization rates, though these rates are limited by smaller case counts and may change as additional data are received. Weekly rates in the 18-29 years age group have been holding steady, while weekly rates have been declining in all other age groups.

Among the 26,623 laboratory-confirmed COVID-19-associated hospitalized cases, 21,282 (79.9%) had information available on race and ethnicity while collection of race and ethnicity data was still pending for 5,341 (20.1%) cases. Of the 21,282 cases with race and ethnicity data, 35.5% were non-Hispanic White, 33.5% were non-Hispanic Black, 18.2% were Hispanic or Latino, 4.7% were non-Hispanic Asian or Pacific Islander, and 1.5% were non-Hispanic American Indian and or Alaska Native persons. Persons of multiple races represented 0.2% of cases, and 6.4% of cases had unknown race and ethnicity. In comparison, the COVID-NET catchment area population includes 58.8% non-Hispanic White, 17.7% non-Hispanic Black, 14.0% Hispanic or Latino, 8.8% non-Hispanic Asian or Pacific Islander, and 0.7% non-Hispanic American Indian or Alaska Native residents. Additional data on race and ethnicity are available.

COVID-19-associated hospitalization rates by race/ethnicity are calculated using hospitalized COVID-NET cases with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator. Rates are adjusted to account for differences in age distributions within race/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. Age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons, followed by Hispanic or Latino persons. Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.5 times that of non-Hispanic White persons, while Hispanics or Latinos persons have a rate approximately 3.5 times that of non-Hispanic White persons.

Among 6,000 hospitalized adults with information on underlying medical conditions, 91.6% had at least one reported underlying medical condition. The most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease.

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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 June 4, 2020, 8.4% of all deaths occurring during the week ending May 30, 2020 (week 22) were due to pneumonia, influenza or COVID-19 (PIC). This is the sixth week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 6.3% for week 22. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

More Information

View Page In:pdf icon 49 Pages, 3 MB
Page last reviewed: June 5, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral DiseaseshomeCoronavirus Disease 2019 (COVID-19)

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

**Ronan Kelly** · June 13, 2020, 06:57 PM

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

Print Page
Updated June 12, 2020

Download Weekly Summary pdf icon[47 Pages, 2 MB]
Key Updates for Week 23, ending June 6, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) continue to decline or remain stable at low levels. The percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, increased slightly from last week. Mortality attributed to COVID-19 also decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The overall percentage of respiratory specimens testing positive for SARS-CoV-2 increased slightly from week 22 (6.0%) to week 23 (6.3%) nationally driven by increases in four regions. National percentages by type of laboratory:

Public health laboratories – decreased from 5.8% during week 22 to 5.0% during week 23;
Clinical laboratories – decreased from 5.5% during week 22 to 5.3% during week 23;
Commercial laboratories – increased from 6.1% during week 22 to 6.5% during week 23.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two surveillance indicators are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, the percentages of visits for ILI and CLI decreased or remained stable at low levels, compared to last week. Levels of ILI are below baseline nationally for the eighth week and in all 10 surveillance regions for the past six to nine weeks.

Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.
Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 89.3 per 100,000, with the highest rates in people aged 65 years and older (273.8 per 100,000) and 50-64 years (136.1 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 12.4% during week 22 to 7.3% during week 23 but remained above baseline. This is the seventh week of a declining percentage of deaths due to PIC, but this percentage may change as more death certificates are processed, particularly for recent weeks.

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, using combined data from the three laboratory types, the percentages of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay increased slightly compared to last week.
- The national increase was driven by increases in four HHS surveillance regions: Region 2 (North East), Region 4 (South East), Region 6 (South Central), and Region 10 (Pacific Northwest).
- While the number of specimens from children <18 years of age tested is low (<5% of all specimens tested in public health and commercial laboratories), the percentage testing positive for SARS-CoV-2 in this age group is higher than it is in the adult age groups.
While the number of COVID-19 cases reported to CDC is cumulative and continues to increase, nationally, the proportion of visits to outpatient providers and emergency departments (EDs) for illnesses with symptoms consistent with COVID-19 continued to decline or remain stable at low levels. Outpatient ILI visits are below baseline nationally and in all regions of the country.
- The low levels of people presenting for care with ILI and CLI may reflect low levels of COVID-19 and other respiratory illness, which could be in part a result of widespread adoption of social distancing, in addition to changes in healthcare seeking behavior.
- There has been very little influenza virus activity in recent weeks.
The overall cumulative COVID-19 associated hospitalization rate is 89.3 per 100,000, with the highest rates in people 65 years of age and older (273.8 per 100,000) followed by people 50-64 years (136.1 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.5 times that of non-Hispanic White persons, and Hispanic or Latino persons have a rate approximately 4 times that of non-Hispanic White persons.
- Cumulative hospitalization rates for COVID-19 in adults (18-64 years) at this time are higher than cumulative end-of-season hospitalization rates for influenza over each of the past 5 influenza seasons.
- For people 65 years and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 12.4% during week 22 to 7.3% during week 23. This is the seventh week during which a declining percentage of deaths due to PIC has been recorded; however, the percentage remains above the epidemic threshold. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change.

1,587,072	12,604,300
189,815	1,650,462
105,670	1,089,500
1,291,587	9,864,338
99,357 (6.3%)	1,379,860 (10.9%)
9,543 (5.0%)	174,716 (10.6%)
5,593 (5.3%)	83,910 (7.7%)
84,221 (6.5%)	1,121,234 (11.4%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

resize iconView LargerView Data Table

Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 23, 0.7% of patient visits reported through ILINet were due to ILI. This percentage is well below the national baseline of 2.4% and represents the eleventh week of decline after three weeks of increase beginning in early March. The percentage of visits for ILI in week 23 remains low among all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories is at levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the low level of ILI activity.

resize iconView Larger

* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.4% to 1.1% during week 23. All ten regions are at low levels and below their region-specific baselines.

Note: In response to the COVID-19 pandemic, new sites will be enrolled in ILINet throughout the summer. This will result in an increase in patient visits and the percentage of visits for ILI may change in comparison to previous weeks. During week 21, new sites were added in Regions 1, 4, and 6. While these regions remain below baseline levels for ILI, these system changes should be kept in mind when drawing conclusions from these data. Any changes in ILI due to changes in respiratory virus circulation will be highlighted in this report.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 23 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 23 (Week ending June 6, 2020)	Compared to Previous Week
Very High	0	No change
High	0	No change
Moderate	0	-1
Low	1	No change
Minimal	52	+1
Insufficient Data	1	No change

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 23, 1.6% of emergency department visits captured in NSSP were due to CLI and 0.6% were due to ILI. This is the eleventh week of declining or stable percentage of visits for ILI and the ninth week of declining percentage of visits for CLI. Compared to week 22, all 10 HHS regionsexternal icon had declining or stable percentages of visits for CLI during week 23; all 10 regions also had declining or stable percentages of visits for ILI.

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 28,987 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and June 6, 2020. The overall cumulative hospitalization rate was 89.3 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged 65 years (273.8 per 100,000), followed by adults aged 50-64 years (136.1 per 100,000) and adults aged 18-49 years (52.4 per 100,000).

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Overall	89.3
0-4 years	5.6
5-17 years	3.1
18-49 years	52.4
18-29 years	27.3
30-39 years	52.5
40-49 years	84.6
50-64 years	136.1
65+ years	273.8
65-74 years	198.7
75-84 years	329.3
85+ years	513.2

Among the 28,987 laboratory-confirmed COVID-19-associated hospitalized cases, 24,936 (86.0%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 4,051 (14.0%) cases. Of the 24,936 cases with race and ethnicity data, 34.2% were non-Hispanic White, 32.9% were non-Hispanic Black, 20.2% were Hispanic or Latino, 4.6% were non-Hispanic Asian or Pacific Islander, and 1.5% were non-Hispanic American Indian or Alaska Native persons. Persons of multiple races represented 0.2% of cases, and 6.4% of cases had unknown race and ethnicity. In comparison, the COVID-NET catchment area population includes 58.8% non-Hispanic White, 17.7% non-Hispanic Black, 14.0% Hispanic or Latino, 8.8% non-Hispanic Asian or Pacific Islander, and 0.7% non-Hispanic American Indian or Alaska Native residents. Additional data on race and ethnicity are available.

COVID-19-associated hospitalization rates by race/ethnicity are calculated using hospitalized COVID-NET cases with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator. Rates are adjusted to account for differences in age distributions within race/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. Age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons, followed by Hispanic or Latino persons. Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.5 times that of non-Hispanic White persons, while Hispanic or Latino persons have a rate approximately 4 times that of non-Hispanic White persons.

Among 6,693 hospitalized adults with information on underlying medical conditions, 91.5% had at least one reported underlying medical condition. The most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease. Among 128 hospitalized children with information on underlying conditions, 53.1% had at least one reported underlying medical condition. The most commonly reported condition was obesity.

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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 June 11, 2020, 7.3% of all deaths occurring during the week ending June 6, 2020 (week 23) were due to pneumonia, influenza or COVID-19 (PIC). This is the seventh week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 6.2% for week 23. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

More Information

View Page In:pdf icon 49 Pages, 3 MB
Page last reviewed: June 12, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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

**Ronan Kelly** · June 27, 2020, 06:01 AM

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

Print Page
Download Weekly Summary pdf icon[49 Pages, 2.45 MB]
Key Updates for Week 25, ending June 20, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) remain lower than peaks seen in March and April but are increasing in several regions. The percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, also increased from last week. Mortality attributed to COVID-19 decreased compared to last week but remains elevated above baseline and may increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The overall percentage of respiratory specimens testing positive for SARS-CoV-2 increased from week 24 (6.5%) to week 25 (7.6%) nationally, driven by increases in seven regions. National percentages by type of laboratory:

Public health laboratories – increased from 5.2% during week 24 to 6.1% during week 25;
Clinical laboratories – increased from 4.7% during week 24 to 5.2% during week 25;
Commercial laboratories – increased from 6.9% during week 24 to 7.9% during week 25.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two surveillance indicators are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, levels of ILI remain below baseline for the tenth week and in all 10 surveillance regions for the past eight to eleven weeks. However, several regions reported increases in percentage of visits for ILI and CLI.
Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 98.4 per 100,000, with the highest rates in people aged 65 years and older (297.6 per 100,000) and 50-64 years (148.6 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.5% during week 24 to 6.9% during week 25 but remained above baseline. This is the ninth week of a declining percentage of deaths due to PIC, but this may change as more death certificates are processed, particularly for recent weeks.

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

Overall, indicators used to monitor COVID-19 activity remain lower than peaks seen in March and April; however, increases are being seen in the percentage of specimens testing positive for SARS-CoV-2 and percentage of visits for ILI or CLI in multiple parts of the country, in some case for consecutive weeks.

Nationally, using combined data from the three laboratory types, the percentages of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay increased from week 24 (6.5%) to week 25 (7.6%).
- Increases were reported in seven of ten HHS surveillance regions, three of which (Region 4 [South East], Region 6 [South Central], and Region 9 [South West/Coast]) reported >10% of specimens positive for SARS-CoV-2.
- Three regions (Region 1 [New England], Region 3 [Mid-Atlantic] and Region 5 [Midwest]), reported a decrease in percentage of specimens testing positive for SARS-CoV-2.

The percentage of outpatient and emergency department visits for ILI are below baseline nationally and in all regions of the country. Most regions have remained stable, compared to last week; however, a few regions experienced an increase in the percentage of visits for CLI and/or ILI with the largest increases in Regions 4 (South East), 6 (South Central), and 9 (South West/Coast).
- Systems monitoring ILI and CLI may be influenced by recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing.
The overall cumulative COVID-19 associated hospitalization rate is 98.4 per 100,000, with the highest rates in people 65 years of age and older (297.6 per 100,000) followed by people 50-64 years (148.6 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Non-Hispanic American Indian or Alaska Native persons have an age-adjusted hospitalization rate approximately 5 times that of non-Hispanic White persons, while non-Hispanic Black persons and Hispanic or Latino persons each have a rate approximately 4.5 times that of non-Hispanic White persons.
- Cumulative hospitalization rates for COVID-19 in adults (18-64 years) at this time are higher than cumulative end-of-season hospitalization rates for influenza over each of the past 5 influenza seasons.
- For people 65 years and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points* during recent influenza seasons.
- For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.5% during week 24 to 6.9% during week 25. This is the ninth week during which a declining percentage of deaths due to PIC has been recorded; however, the percentage remains above the epidemic threshold. The percentage may change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change.

1,772,631	16,998,825
172,748	2,101,748
117,732	1,434,393
1,482,151	13,462,684
133,899 (7.6%)	1,677,604 (9.9%)
10,474 (6.1%)	199,744 (9.5%)
6,162 (5.2%)	96,572 (6.7%)
117,263 (7.9%)	1,381,288 (10.3%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

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Clinical Laboratories

resize iconView LargerView Data Table

Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 25, 0.8% of patient visits reported through ILINet were due to ILI. This percentage is well below the national baseline of 2.4%. The percentage of visits for ILI in week 25 remains low among all age groups but increased slightly for persons less than 65 years of age. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories is at levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the low level of ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.4% to 1.4% during week 25. All ten regions are at low levels and below their region-specific baselines; however, Region 4 (South East) increased from 0.9% during week 24 to 1.3% during week 25; Regions 7 (Central), 8 (West) and 9 (South West/Coast) also reported slight increases.

Note: In response to the COVID-19 pandemic, new data sources will be incorporated into ILINet as we move into summer weeks when lower levels of influenza and other respiratory virus circulation are typical. Starting in week 21, increases in the number of patient visits will be seen as new sites are enrolled and the percentage of visits for ILI may change in comparison to previous weeks. While all regions remain below baseline levels for ILI, these system changes should be kept in mind when drawing conclusions from these data. Any changes in ILI due to changes in respiratory virus circulation will be highlighted here.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 25 and the change compared to the previous week are summarized in the table below and shown in the following maps. The decreasing percentage of visits for ILI described above are reflected in this week’s ILI activity levels.

Activity Level	Number of Jurisdictions
Week 25 (Week ending June 20, 2020)	Compared to Previous Week
Very High	0	No change
High	0	No change
Moderate	0	No change
Low	1	+1
Minimal	51	-2
Insufficient Data	2	+1

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 25, 2.1% of emergency department visits captured in NSSP were due to CLI and 0.8% were due to ILI. This is the first week of an increasing percentage of visits for CLI and ILI nationally since activity peaked in early April. Compared to week 24, 3 of 10 HHS regionsexternal icon (Regions 4 [South East], 6 [South Central] and 9 [South West/Coast]) reported increases in the percentages of visits for both CLI and ILI during week 25. One additional region reported a slight increase in percentage of visits for CLI during week 25 (Region 8 [Mountain]) and 2 additional regions reported a slight increase in percentage of visits for ILI (Regions 3 [Mid-Atlantic] and 7 [Central]).

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 31,934 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020 and June 20, 2020. The overall cumulative hospitalization rate was 98.4 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥ 65 years age groups, the highest rate of hospitalization is among adults aged ≥ 65 years, followed by adults aged 50-64 years and adults aged 18-49 years.

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Overall	98.4
0-4 years	8.0
5-17 years	3.7
18-49 years	59.2
18-29 years	32.1
30-39 years	59.2
40-49 years	94.1
50-64 years	148.6
65+ years	297.6
65-74 years	216.3
75-84 years	358.2
85+ years	556.2

Among the 31,934 laboratory-confirmed COVID-19-associated hospitalized cases, 29,789 (93.3%) had information on race and ethnicity while collection of race and ethnicity was still pending for 2,145 (6.7%) cases. Non-Hispanic American Indian or Alaska Native persons have an age-adjusted hospitalization rate approximately 5 times that of non-Hispanic White persons, while non-Hispanic Black persons and Hispanic or Latino persons each have a rate approximately 4.5 times that of non-Hispanic White persons. Additional data on race and ethnicity are available.

Non-Hispanic White persons represent the highest proportion of hospitalized cases reported to COVID-NET, followed by non-Hispanic Black, 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 hospitalized cases as compared with the overall population of the catchment area. Prevalence ratios show a similar pattern to that of the age-adjusted hospitalization rates: non-Hispanic American Indian or Alaska Native persons have the highest prevalence ratio, followed by non-Hispanic Black, and Hispanic or Latino persons.


231.0	202.2	192.8	54.2	43.5
1.5%	32.6%	22.0%	4.7%	32.8%
0.7%	17.7%	14.0%	8.8%	58.8%
2.1	1.8	1.5	0.5	0.6

¹COVID-19-associated hospitalization rates by race/ethnicity are calculated using hospitalized COVID-NET cases with known race and ethnicity for the numerator and NCHS bridged-race population estimates NCHS bridged-race population estimates for the denominator. Rates are adjusted to account for differences in age distributions within race/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.

² Persons of multiple races (0.2%) or unknown race and ethnicity (6.2%) are not represented in the table but are included as part of the denominator.

³Prevalence ratio is calculated as the ratio of the proportion of hospitalized COVID-NET cases over the proportion of population in COVID-NET catchment area.

Among 8,089 hospitalized adults with information on underlying medical conditions, 91% had at least one reported underlying medical condition. The most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease. Among 158 hospitalized children with information on underlying conditions, 53.2% had at least one reported underlying medical condition. The most commonly reported were obesity, asthma, and neurologic conditions.

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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 June 25, 2020, 6.9% of all deaths occurring during the week ending June 20, 2020 (week 25) were due to pneumonia, influenza or COVID-19 (PIC). This is the ninth week of a declining percentage of deaths due to PIC; however, the percentage remains above the epidemic threshold of 5.9% for week 25. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

More Information

View Page In:pdf icon 49 Pages, 2.45 MB
Page last reviewed: June 26, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral DiseaseshomeCoronavirus Disease 2019 (COVID-19)

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

**Ronan Kelly** · July 3, 2020, 06:11 AM

CASES, DATA & SURVEILLANCE

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

Updated July 3, 2020
Print

Download Weekly Summary pdf icon[49 Pages, 2.45 MB]
Key Updates for Week 26, ending June 27, 2020

Nationally, levels of influenza-like illness (ILI) and COVID-19-like illness (CLI) activity remain lower than peaks seen in March and April but are increasing in most regions. The percentage of specimens testing positive for SARS-CoV-2, the virus that causes COVID-19, also increased from last week. Mortality attributed to COVID-19 decreased compared to last week and is currently at the epidemic threshold but will likely increase as additional death certificates are processed.
Virus

Public Health, Commercial and Clinical Laboratories

The overall percentage of respiratory specimens testing positive for SARS-CoV-2 increased from week 25 (8.1%) to week 26 (8.7%) nationally, driven by increases in seven regions. National percentages of specimens testing positive for SARS-CoV-2 by type of laboratory:

Public health laboratories – increased from 5.6% during week 25 to 6.3% during week 26;
Clinical laboratories – increased from 5.3% during week 25 to 5.8% during week 26;
Commercial laboratories – increased from 8.7% during week 25 to 9.3% during week 26.

Outpatient and Emergency Department Visits

Outpatient Influenza-Like Illness Network (ILINet) and National Syndromic Surveillance Program (NSSP)

Two surveillance indicators are being used to track outpatient or emergency department (ED) visits for illness with symptoms compatible with COVID-19.

Nationally, levels of ILI activity remain below baseline for the eleventh week and in all 10 surveillance regions for the past nine to twelve weeks. However, most regions reported increases in percentage of visits for ILI, which is atypical for this time of year. CLI also increased the past week.
Recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing, are likely affecting data reported from both networks, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19.

Severe Disease

Hospitalizations

Cumulative COVID-19-associated hospitalization rates since March 1, 2020, are updated weekly. The overall cumulative COVID-19 hospitalization rate is 102.5 per 100,000, with the highest rates in people aged 65 years and older (306.7 per 100,000) and 50-64 years (155.0 per 100,000).
Mortality

Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth week of a declining percentage of deaths due to PIC. The percentage is currently at the epidemic threshold but will likely change as more death certificates are processed, particularly for recent weeks.

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

Indicators used to monitor COVID-19 activity remain lower than peaks seen in March and April; however, there are increases in the percentage of specimens testing positive for SARS-CoV-2 and percentage of visits for ILI or CLI in multiple parts of the country, which have been sustained in some cases for multiple consecutive weeks.
Nationally, using combined data from the three laboratory types, the percentage of respiratory specimens testing positive for SARS-CoV-2 with a molecular assay increased from week 25 (8.1%) to week 26 (8.7%).
- Increases were reported in seven of ten HHS surveillance regions.
  - Four regions reported between 4% and 6% of specimens positive for SARS-CoV-2: Regions 2 [NY/NJ/Puerto Rico], 5 [Midwest], 7 [Central] and 10 [Pacific Northwest].
  - Two regions reported between 10% and 15% of specimens positive for SARS-CoV-2: Regions 4 [South East] and 9 [South West/Coast].
  - Region 6 [South Central] reported >15% of specimens positive for SARS-CoV-2.
- Three regions (Regions 1 [New England], 3 [Mid-Atlantic] and 8 [Mountain]) reported a stable or decreasing percentage of specimens testing positive for SARS-CoV-2.
The percentage of outpatient and emergency department visits for ILI are below baseline nationally and in all regions of the country; however, increases in the percentage of visits for ILI and CLI were reported in seven of ten HHS surveillance regions, with the largest increases in Regions 4 (South East), 6 (South Central) and 9 (South West/Coast).
- Systems monitoring ILI and CLI may be influenced by recent changes in health care seeking behavior, including increasing use of telemedicine, recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing.
The overall cumulative COVID-19 associated hospitalization rate is 102.5 per 100,000, with the highest rates in people 65 years of age and older (306.7 per 100,000) followed by people 50-64 years (155.0 per 100,000). Hospitalization rates are cumulative and will increase as the COVID-19 pandemic continues.
- Non-Hispanic American Indian or Alaska Native persons have an age-adjusted hospitalization rate approximately 5.7 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.7 times that of non-Hispanic White persons, and Hispanic or Latino persons have a rate approximately 4.5 times that of non-Hispanic White persons.
- Cumulative hospitalization rates for COVID-19 in adults (18-64 years) at this time are higher than cumulative end-of-season hospitalization rates for influenza over each of the past 5 influenza seasons.
- For people 65 years and older, current cumulative COVID-19 hospitalization rates at this time are higher than cumulative end-of season hospitalization rates for influenza for 4 of the 5 past influenza seasons; lower only than rates observed during the 2017-18 season.
- For children (0-17 years), cumulative COVID-19 hospitalization rates are much lower than cumulative influenza hospitalization rates at comparable time points* during recent influenza seasons.
Based on death certificate data, the percentage of deaths attributed to pneumonia, influenza or COVID-19 (PIC) decreased from 9.0% during week 25 to 5.9% during week 26, representing the tenth consecutive week during which a declining percentage of deaths due to PIC has been recorded. The percentage is currently at the epidemic threshold but will likely change as additional death certificates for deaths during recent weeks are processed.

*Number of weeks since 10% of specimens tested positive for SARS-CoV-2 and influenza, respectively.

U.S. Virologic Surveillance

The number of specimens tested for SARS-CoV-2 using a molecular assay and reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States are summarized below. All laboratories are performing primary diagnostic functions; therefore, the percentage of specimens testing positive across laboratory types can be used to monitor overall trends in COVID-19 activity. As the outbreak progresses, it is possible that different types of laboratories will take on different roles, and the data interpretation may need to change.

1,873,571	19,789,038
225,557	2,423,954
115,483	1,615,750
1,532,531	15,749,334
162,750 (8.7%)	1,927,728 (9.7%)
14,234 (6.3%)	217,831 (9.0%)
6,669 (5.8%)	106,653 (6.6%)
141,847 (9.3%)	1,603,244 (10.2%)

* Commercial and clinical laboratory data represents select laboratories and does not capture all tests performed in the United States.
Public Health Laboratories

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Clinical Laboratories

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Commercial Laboratories

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* Commercial laboratories began testing for SARS-CoV-2 in early March, but the number and geographic distribution of reporting commercial laboratories became stable enough to calculate a weekly percentage of specimens testing positive as of March 29, 2020.
View Data Table

Additional virologic surveillance information: Surveillance Methods

Outpatient/Emergency Department Illness

Two syndromic surveillance systems are being used to monitor trends in outpatient and emergency department visits that may be associated with COVID-19 illness. Each system monitors a slightly different syndrome, and together these systems provide a more comprehensive picture of mild to moderate COVID-19 illness than either would individually. Both systems are currently being affected by recent changes in healthcare seeking behavior, including increased use of telemedicine, compliance with recommendations to limit emergency department (ED) visits to severe illnesses, and increased practice of social distancing. These changes affect the numbers of people seeking care in the outpatient and ED settings and their reasons for doing so.
ILINet

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) provides data on visits for influenza-like illness (ILI) (fever [≥100^○F] and cough and/or sore throat) to approximately 2,600 primary care providers, emergency departments and urgent care centers in all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands. Mild COVID-19 illness presents with symptoms similar to ILI, so ILINet is being used to track trends of mild to moderate COVID-19 illness and allows for comparison with prior influenza seasons.

Nationwide during week 26, 1.1% of patient visits reported through ILINet were due to ILI. This percentage is well below the national baseline of 2.4% but is increasing, which is atypical for this time of year. The pattern of increasing percentage of visits for ILI was reported for all age groups. Nationally, laboratory-confirmed influenza activity as reported by clinical laboratories is at levels usually seen during summer months which, along with changes in healthcare seeking behavior and the impact of social distancing, is likely contributing to the low level of ILI activity.

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* Age-group specific percentages should not be compared to the national baseline.

On a regional levelexternal icon, the percentage of outpatient visits for ILI ranged from 0.5% to 1.9% during week 26. All ten regions are below their region-specific baselines; however, Region 4 (South East) increased from 1.3% during week 25 to 1.7% during week 26, Region 6 (South Central) increased from 1.4% to 1.9% and Region 7 (Central) increased from 0.6% to 0.8%; Regions 2 (NY/NY/PR), 5 (Midwest), 8 (Mountain), 9 (South West/Coast) and 10 (Pacific Northwest) also reported slight increases.

Note: In response to the COVID-19 pandemic, new data sources will be incorporated into ILINet as we move into summer weeks when lower levels of influenza and other respiratory virus circulation are typical. Starting in week 21, increases in the number of patient visits will be seen as new sites are enrolled and the percentage of visits for ILI may change in comparison to previous weeks. While all regions remain below baseline levels for ILI, these system changes should be kept in mind when drawing conclusions from these data. Any changes in ILI due to changes in respiratory virus circulation will be highlighted here.
Overall Percentage of Visits for ILI | Age Group ILI Data

ILI Activity Levels

Data collected in ILINet are used to produce a measure of ILI activity for all 50 states, Puerto Rico, the District of Columbia and New York City. The mean reported percentage of visits due to ILI for the current week is compared to 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 26 and the change compared to the previous week are summarized in the table below and shown in the following maps.

Activity Level	Number of Jurisdictions
Week 26 (Week ending June 27, 2020)	Compared to Previous Week
Very High	0	No change
High	0	No change
Moderate	0	No change
Low	1	No change
Minimal	52	+1
Insufficient Data	1	-1

*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.
National Syndromic Surveillance Program (NSSP): Emergency Department (ED) Visits

NSSP is a collaboration among CDC, federal partners, local and state health departments and academic and private sector partners to collect, analyze and share electronic patient encounter data received from multiple healthcare settings. To track trends of potential COVID-19 visits, visits for COVID-19-like illness (CLI) (fever and cough or shortness of breath or difficulty breathing or presence of a coronavirus diagnosis code) and ILI to a subset of emergency departments in 47 states are being monitored.

Nationwide during week 26, 2.7% of emergency department visits captured in NSSP were due to CLI and 0.9% were due to ILI. This is the second week of an increasing percentage of visits for CLI and ILI nationally since activity peaked in early April. Compared to week 25, 7 of 10 HHS regionsexternal icon (Regions 4 [South East], 5 [Midwest], 6 [South Central], 7 [Central], 8 [Mountain], 9 [South West/Coast] and 10 [Pacific Northwest]) reported increases in the percentages of visits for both CLI and ILI during week 26. One additional region, Region 1 (New England), reported a slight increase in percentage of visits for ILI during week 26.

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 33,277 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020 and June 27, 2020. The overall cumulative hospitalization rate was 102.5 per 100,000 population. Among the 0-4 years, 5-17 years, 18-49 years, 50-64 years, and 65 years age groups, the highest rate of hospitalization is among adults aged 65, followed by adults aged 50-64 years and adults aged 18-49 years.

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Overall	102.5
0-4 years	8.9
5-17 years	4.0
18-49 years	62.6
18-29 years	34.7
30-39 years	62.5
40-49 years	98.6
50-64 years	155.0
65+ years	306.7
65-74 years	222.5
75-84 years	370.1
85+ years	573.1

Among the 33,277 laboratory-confirmed COVID-19-associated hospitalized cases, 31,486 (94.6%) had information on race and ethnicity while collection of race and ethnicity was still pending for 1791 (5.4%) cases. Non-Hispanic American Indian or Alaska Native persons have an age-adjusted hospitalization rate approximately 5.7 times that of non-Hispanic White persons, non-Hispanic Black persons have a rate approximately 4.7 times that of non-Hispanic White persons, and Hispanic or Latino persons have a rate approximately 4.5 times that of non-Hispanic White persons. Additional data on race and ethnicity by age are available.

Non-Hispanic White persons and non-Hispanic Black persons represent the highest proportions of hospitalized cases 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 hospitalized cases as compared with the overall population of the catchment area. Prevalence ratios show a similar pattern to that of the age-adjusted hospitalization rates: non-Hispanic American Indian or Alaska Native persons have the highest prevalence ratio, followed by non-Hispanic Black, and Hispanic or Latino persons.


261.3	212.8	205.0	57.6	45.7
1.6%	32.5%	22.2%	4.7%	32.6%
0.7%	17.7%	14.0%	8.8%	58.8%
2.3	1.8	1.6	0.5	0.6

¹COVID-19-associated hospitalization rates by race/ethnicity are calculated using hospitalized COVID-NET cases with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator. Rates are adjusted to account for differences in age distributions within race/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, 85+ years.

² Persons of multiple races (0.2%) or unknown race and ethnicity (6.2%) are not represented in the table but are included as part of the denominator.
³ Prevalence ratio is calculated as the ratio of the proportion of hospitalized COVID-NET cases over the proportion of population in COVID-NET catchment area.

Among 8,672 hospitalized adults with information on underlying medical conditions, 91% had at least one reported underlying medical condition. The most commonly reported were hypertension, obesity, chronic metabolic disease, and cardiovascular disease. Among 180 hospitalized children with information on underlying conditions, 51.7% had at least one reported underlying medical condition. The most commonly reported were obesity, asthma, and neurologic conditions.

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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 July 2, 2020, 5.9% of all deaths occurring during the week ending June 27, 2020 (week 26) were due to pneumonia, influenza or COVID-19 (PIC). This is the tenth consecutive week of a declining percentage of deaths due to PIC. The percentage is equal to the epidemic threshold of 5.9% for week 26. Data for recent weeks are incomplete, and the PIC percentage may increase as more death certificates representing deaths during these weeks are processed.

Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Percentages of deaths due to PIC are 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.

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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.
View Data Table

Additional NCHS mortality surveillance information: Surveillance Methods | Provisional Death Counts for COVID-19

More Information

View Page In:pdf icon 49 Pages, 2.45 MB
Page last reviewed: July 3, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

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

Announcement

US - CDC: COVIDView 2020/2021 - Not offered for exactness - Offered for trend analysis only

US - CDC: COVIDView 2020/2021 - Not offered for exactness - Offered for trend analysis only

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