Important update: Healthcare facilities

CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more

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Recommendations for Fully Vaccinated People
COVID-19 Homepage

UPDATE

Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.

UPDATE

The White House announced that vaccines will be required for international travelers coming into the United States, with an effective date of November 8, 2021. For purposes of entry into the United States, vaccines accepted will include FDA approved or authorized and WHO Emergency Use Listing vaccines. More information is available here.

UPDATE

Travel requirements to enter the United States are changing, starting November 8, 2021. More information is available here.

Estimated COVID-19 Burden

Updated Aug. 12, 2022

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CDC is developing new methods and data sources for estimating the burden of COVID-19 to build a framework reflecting our evolving understanding of the virus.

Estimated COVID-19 Infections, Symptomatic Illnesses, Hospitalizations, and Deaths in the United States
What Can Be Learned from Estimates of COVID-19 Infections, Illnesses, Hospitalizations, and Deaths in the United States
Why CDC Estimates COVID-19 Infections, Illnesses, Hospitalizations, and Deaths
How CDC Estimates COVID-19 Infections, Symptomatic Illnesses, and Hospitalizations
How CDC Estimates COVID-19 Deaths
Limitations

To better reflect the full burden of COVID-19, CDC provides estimates of COVID-19 infections, symptomatic illnesses, hospitalizations, and deaths using statistical models to adjust for cases that national surveillance networks do not capture for a number of reasons. These estimates and the methodologies used to calculate them are published in Clinical Infectious Diseases and The Lancet Regional Health – Americas. These estimates will be updated periodically.

Estimated COVID-19 Infections, Symptomatic Illnesses, Hospitalizations, and Deaths in the United States

CDC estimates that from February 2020–September 2021:

1 in 4.0 (95% UI* 3.4 – 4.7) COVID–19 infections were reported.

1 in 3.4 (95% UI* 3.0 – 3.8) COVID–19 symptomatic illnesses were reported.

1 in 1.9 (95% UI* 1.7 – 2.1) COVID–19 hospitalizations were reported.

1 in 1.32 (95% UI* 1.29 – 1.34) COVID-19 deaths were reported.

These estimates suggest that during this period, there were approximately:

146.6 Million

Estimated Total Infections

124.0 Million

Estimated Symptomatic Illnesses

7.5 Million

Estimated Hospitalizations

921,000

Estimated Total Deaths

Last Updated: October 2, 2021

Table 1: Preliminary estimated COVID-19 cumulative incidence, by age group — United States, February 2020-September 2021^†
Age group	Estimate	95% UI*	Estimate	95% UI*	Estimate	95% UI*	Estimate	95% UI*
	Infections		Symptomatic Illness		Hospitalizations		Deaths
0-17 years	25,844,005	21,361,986 – 31,614,224	22,030,307	19,108,000 – 25,701,942	266,597	224,715 – 315,966	645	501 – 1,141
18-49 years	75,179,070	62,681,393 – 90,520,720	64,029,542	56,477,718 – 73,348,809	1,996,830	1,719,541 – 2,334,921	60,355	56,641 – 64,388
50-64 years	27,407,088	22,869,356 – 32,921,158	23,378,591	20,628,625 – 26,697,449	2,009,141	1,771,585 – 2,304,508	159,489	154,920 – 164,453
65+ years	18,012,882	14,527,427 – 22,761,991	14,626,141	12,913,173 – 16,745,092	3,232,213	2,864,006 – 3,683,201	700,882	688,959 – 713,090
All ages	146,585,169	125,980,377 – 171,574,943	123,979,337	111,032,406 – 139,954,539	7,506,029	6,715,747 – 8,465,642	921,371	902,527 – 941,172

* Adjusted estimates are presented in two parts: an uncertainty interval [UI] and a point estimate. The uncertainty interval provides a range in which the true number or rate of COVID-19 infections, symptomatic illnesses, hospitalizations, or deaths would be expected to fall if the same study was repeated many times, and it gives an idea of the precision of the point estimate. A 95% uncertainty interval means that if the study were repeated 100 times, then 95 out of 100 times the uncertainty interval would contain the true point estimate. Conversely, in only 5 times out of a 100 would the uncertainty interval not contain the true point estimate.

^†These are preliminary estimates that may fluctuate up or down as more data become available and as we improve our understanding of the detection and reporting of COVID-19. CDC will continue to update these estimates periodically.

Table 2: Estimated rates of COVID-19 disease outcomes per 100,000, by age group — United States, February 2020-September 2021
Age group	Estimate	95% UI*	Estimate	95% UI*	Estimate	95% UI*	Estimate	95% UI*
	Infection rate per 100,000		Symptomatic Illness rate per 100,000		Hospitalization rate per 100,000		Death rate per 100,000
0-17 years	35,490	29,335 – 43,414	30,253	26,240 – 35,295	366	309 – 434	0.9	0.7-1.6
18-49 years	54,860	45,740 – 66,055	46,724	41,213 – 53,525	1,457	1,255 – 1,704	43.7	41.0 – 46.6
50-64 years	43,656	36,428 – 52,439	37,239	32,859 – 42,526	3,200	2,822 – 3,671	253.5	246.2 – 261.3
65+ years	32,363	26,101 – 40,895	26,278	23,200 – 30,085	5,807	5,146 – 6,617	1296.5	1274.5 – 1319.1
All ages	44,650	38,374 – 52,262	37,764	33,821 – 42,630	2,286	2,046 – 2,579	280.7	275.0 – 286.7

* Adjusted rates are presented in two parts: an uncertainty interval [UI] and a point estimate. The uncertainty interval provides a range in which the true number or rate of COVID-19 infections, symptomatic illnesses, hospitalizations, or deaths would be expected to fall if the same study was repeated many times, and it gives an idea of the precision of the point estimate. A 95% uncertainty interval means that if the study were repeated 100 times, then 95 out of 100 times the uncertainty interval would contain the true point estimate. Conversely, in only 5 times out of a 100 would the uncertainty interval not contain the true point estimate.

Percentage of COVID-19 infections, symptomatic illness, and hospitalizations, and deaths, by age group—United States, February 2020-September 2021

Estimating unreported cases, hospitalizations, and deaths helps to quantify the impact and severity of the COVID-19 pandemic on the healthcare system and society. Additionally, these estimates can inform how to direct and allocate healthcare resources; assist in planning for prevention and control measures, including vaccination; predict the future burden of COVID-19; and evaluate the potential impact of interventions.

The cumulative burden of COVID-19 is an estimate of the number of people who may have been infected, sick, hospitalized, or died as a result of a COVID-19 infection in the United States. Confirmed COVID-19 cases and deaths are nationally reported, but these cases and deaths likely represent only a fraction of the true number that have occurred in the population. COVID-19 infections, symptomatic illnesses, hospitalizations, and deaths might be underdetected and go unreported for a variety of reasons. For example:

Some people infected with SARS-CoV-2 never show symptoms (asymptomatic infection), so their infection will likely go undetected.
Case reports sent to CDC are often missing patient information, like age or hospitalization status, or are delayed.
Not everyone who is sick will seek medical care and/or be tested; and patients may not be tested for COVID-19 while hospitalized or if they die.
Even if a sick outpatient or hospitalized patient is tested, an infection with COVID-19 may not be accurately captured if, for example:
- the test was not completed correctly or within the appropriate timeframe for capturing infection;
- the test result was falsely negative for a COVID-19 infection due to the sensitivity of the test;
- the test result was falsely negative for a COVID-19 infection due to the quality or quantity of the specimen collected; or
- the confirmed COVID-19 case was never reported to the local and state public health agency and then to CDC.

For patients with COVID-19, death can occur several days or weeks after being tested and reported, and the death might be incorrectly attributed to a cause other than COVID-19 because of the time between testing positive and death.
COVID-19 may result in non-respiratory complications or it might increase the severity of chronic conditions, which can lead to death (e.g., sepsis, circulatory diseases, respiratory diseases, diabetes, or renal failure), and COVID-19 might be incorrectly omitted as a contributing cause of death on the death certificate.

Because current surveillance systems do not capture all cases or deaths of COVID-19 occurring in the United States, CDC provides these estimates to better reflect the larger burden of COVID-19. CDC uses these types of estimates to inform policy decisions and public messages.

To estimate COVID-19 infections, symptomatic illnesses, and hospitalizations, CDC uses a statistical model applied to confirmed cases of COVID-19, adjusted for missing age and hospitalization status. Several data sources and surveillance systems are used to identify and characterize potential sources of underdetection, which include:

SARS-CoV-2 test sensitivity is lower. People tested for SARS-CoV-2, the virus that causes COVID-19 disease, may not test positive even if infected with the virus due to the lower sensitivity of the test used. SARS-CoV-2 test sensitivity has been reported in the literature; a range of 79%-98% sensitivity for RT-PCR tests is used to account for false negative test results.

SARS-CoV-2 test is not ordered or not completed in a timely manner. Not all outpatients who seek care for acute respiratory illness (ARI) or inpatients hospitalized with ARI are tested for COVID-19, and not all ordered tests are correctly completed in a timely manner. CDC uses two data sources to approximate how many outpatients with ARI are not tested for COVID-19:
- IBM Watson Explorys Electronic Health Record database, a data repository of electronic health records from more than 39 health partners, 400 acute care facilities, and 400,000 unique providers; and
- COVID Near You (CNY), a website application launched by Harvard University in March 2020 where participants can submit information on self-reported symptoms, efforts to obtain health care, and COVID-19 testing.
Not all patients with symptoms seek care or testing services. Not all sick patients seek care or are tested for COVID-19, and therefore they are not included in national case reports. To approximate the number of symptomatic people who never sought medical care, researchers use data from COVID Near You (CNY) and Flu Near You (FNY) sites on health care seeking behaviors. While COVID Near You launched in March 2020, FNY has been collecting self-reported influenza participatory data since 2011.
Patients do not have symptoms. Some people infected with SARS-CoV-2 never show symptoms (they have asymptomatic infection). People with asymptomatic infection are very likely to go undetected. The percentage of asymptomatic infections is reported in the literature and varies by age group. In people 0-64 years old, a range of 5%-24% is used to estimate asymptomatic infections, and for people 65 years and older, a range of 5%-32% is used.

The statistical model used to adjust hospitalized and non-hospitalized case counts for the above sources of underdetection is based on methods that have been previously used to estimate the disease burden of influenza, detailed elsewhere. These methods are peer-reviewed and published in Clinical Infectious Diseases.

COVID-19 deaths are estimated using a statistical model to calculate the number of COVID-19 deaths that were unrecognized and those that were not recorded on death certificates and, as a result, were never reported as a death related to COVID-19.

To estimate these unrecognized COVID-19 deaths, all-cause deaths are obtained from the National Center of Health Statistics. Before applying the statistical model, reported COVID-19 deaths are subtracted by age, state, and week from all-cause deaths, so that these reported COVID-19 deaths are not included in the calculation of the expected deaths for the statistical model.

Then, to understand how many deaths may have not been recognized as being related to COVID-19, CDC uses a statistical model to estimate the number of expected deaths from all causes assuming that there was no circulation of COVID-19 (that is, those deaths expected in the absence of any COVID-19 illnesses). Researchers then use the model to predict the number of all-cause deaths that would have occurred taking into account information on COVID-19 circulation,. To obtain the number of unrecognized COVID-19 deaths, the number of expected all-cause deaths (without COVID-19 circulation) are subtracted from the number of predicted all-cause deaths (with COVID-19 circulation). The model is used to calculate estimates by state and age (for six age groups: 0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years).

Once investigators estimate unrecognized COVID-19 deaths, they add documented COVID-19 deaths to the unrecognized deaths to obtain an estimate of the total number of COVID-19-attributable deaths. These methods are peer-reviewed and published in The Lancet Regional Health – Americas.

These estimates of COVID-19 infections, symptomatic illnesses, hospitalizations and deaths are subject to several limitations, either from the data inputs used or some statistical assumptions made in the methods. A detailed discussion of these limitations can be found in Clinical Infectious Diseases and The Lancet Regional Health – Americas. CDC continues to explore data sources and statistical methodologies for estimating COVID-19 disease burden and will refine estimates over time.