COVIDView Summary ending on January 30, 2021

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.

Based on data reported to CDC by public health laboratories and a subset of clinical and commercial laboratories in the United States, 114,175,816 specimens were tested for SARS-CoV-2 using a molecular assay since March 1, 2020. The percentage of specimens testing positive for SARS-CoV-2 each week, based on week of specimen collection, are summarized below.

Nationally, 230,277 (9.7%) of 2,375,248 specimens tested for SARS-CoV-2 for diagnostic purposes were positive during week 4. This is a decrease compared with week 3, during which 11.2% of specimens tested were positive. The percentage of specimens testing positive decreased among all age groups.

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

During week 4 compared with week 3, the percentage of specimens testing positive for SARS-CoV-2 decreased in all HHS regions.

Additional virologic surveillance information: Surveillance Methods

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

Nationally, the overall percentages of visits to EDs decreased for CLI and remained stable (change ≤0.1%) for ILI during week 4 compared with week 3. During week 4, the percentages of ED visits captured in NSSP for CLI and ILI were 5.1% and 1.0%, respectively. In ILINet, 1.1% of visits to outpatient providers or EDs reported during week 4 were for ILI, decreasing compared with week 3 and below the national baseline for the 42^nd consecutive week. This level of ILI is lower than is typical for ILINet during this time of year.

The percentages of visits for ILI reported in ILINet in week 4 remained stable (change of ≤0.1%) for all age groups (0–4 years, 5–24 years, 25–49 years, 50–64 years, and 65 years and older) compared with week 3. However, during the past three weeks there has been a slightly increasing trend among those 0–4 years and a slightly decreasing trend among the remaining age groups.

On a regional levelExternal, during week 4 compared with week 3, all ten regions reported a decreasing level of CLI and a stable (change of ≤0.1%) or decreasing level of ILI.

ILI Activity Levels

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

The number of jurisdictions at each activity level during week 4 and the previous week are summarized in the table below.

*Note: Data collected in ILINet may disproportionally represent certain populations within a state and may not accurately depict the full picture of respiratory disease activity for the whole state. Differences in the data presented here by CDC and independently by some state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

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

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 136,007 laboratory-confirmed COVID-19-associated hospitalizations were reported by sites between March 1, 2020, and January 30, 2021. The overall cumulative hospitalization rate was 417.2 per 100,000 population. For the past three months, since the week ending November 7, 2020 (MMWR Week 45), the overall weekly hospitalization rate has remained in an elevated plateau above earlier peaks in the pandemic. The hospitalization rates for the most recent week are expected to be higher as additional data are reported in future weeks.

¹Additional hospitalization rate data by age group are available.

Among the 136,007 laboratory-confirmed COVID-19-associated hospitalizations, 132,932 (97.7%) had information on race and ethnicity, while collection of race and ethnicity was still pending for 3,075 (2.3%) cases. When examining age-adjusted hospitalization rates by race and ethnicity, compared with non-Hispanic White persons, hospitalization rates were 3.6 times higher among non-Hispanic American Indian or Alaska Native persons, 3.2 times higher among Hispanic or Latino persons, and 2.9 times higher among non-Hispanic Black persons.

When examining age-stratified crude hospitalization rates by race and ethnicity, compared with non-Hispanic White persons in the same age group, crude hospitalization rates were 4.0 times higher among Hispanic or Latino persons aged 0–17 years,6.5 times higher among Non-Hispanic American Indian or Alaska Native persons aged 18–49 years,4.6 times higher among non-Hispanic American Indian or Alaska Native persons aged 50–64 years, and 2.3 times higher among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons aged  >65 years.

Non-Hispanic White persons and non-Hispanic Black persons represented the highest proportions of hospitalizations reported to COVID-NET, followed by Hispanic or Latino, non-Hispanic Asian or Pacific Islander, and non-Hispanic American Indian or Alaska Native persons. However, some racial and ethnic groups are disproportionately represented among hospitalizations compared with the overall population of the catchment area. Prevalence ratios were highest among non-Hispanic American Indian or Alaska Native persons, followed by non-Hispanic Black persons and Hispanic or Latino persons.

¹Persons of multiple races (0.3%) or unknown race and ethnicity (5.6%) are not represented in the table but are included as part of the denominator.
² Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

For underlying medical conditions, data were restricted to cases reported during March 1–November 30, 2020, due to delays in reporting. During this time frame, sampling was conducted among hospitalized adults; therefore, weighted percentages are reported. No sampling was conducted among hospitalized children. Among 17,452 sampled adults hospitalized during March 1–November 30 with information on underlying medical conditions, 90.9% had at least one reported underlying medical condition. The most reported underlying medical conditions were hypertension (56.1%), obesity (49.1%), metabolic disease (42.1%), which includes diabetes, and cardiovascular disease (33.2%). Among 1,369 children hospitalized during March 1–November 30, 2020 with information on underlying conditions, 52.7% had at least one reported underlying medical condition. The most reported underlying medical conditions were obesity (37.4%), neurologic disease (12.9%), and asthma (11.7%).

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

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

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 February 4, 2021, the percentage of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) during week 4 was 28.4%; it remains above the epidemic threshold of 7.1%. This percentage is expected to increase as more death certificates are processed. Among the 6,424 PIC deaths reported for week 4, 5,648 had COVID-19 listed as an underlying or contributing cause of death on the death certificate and four listed influenza, indicating that the recent increase in PIC mortality is due primarily to COVID-19 and not influenza.

The weekly percentage of deaths due to PIC reached the highest point in the pandemic during the week ending January 9, 2021 (32.7%), and exceeded the previous peak (27.7% in April 2020) for nine consecutive weeks through the current week. Data for the past three weeks show a declining trend in the percentage of deaths due to PIC compared to the December peak, but this percentage is expected to change as additional death certificates are processed. Weekly mortality surveillance data include a combination of machine coded and manually coded causes of death collected from death certificates. Prior to week 4 (the week ending January 30, 2021), the percentages of deaths due to (PIC) were higher among manually coded records than more rapidly available machine coded records. Improvements have been made to the machine coding process that allow for more COVID-19 related deaths to be machine coded, and going forward, the percentage of PIC deaths among machine coded and manually coded data are expected to be more similar. The data presented are preliminary and expected to change as more data are received and processed but the amount of change in the percentage of deaths due to PIC should be lower going forward. Weeks for which the largest changes in the percentage of deaths due to PIC may occur are highlighted in gray in the figure below and should be interpreted with caution.

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

View Data Table

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