COVIDView Summary ending on May 9, 2020

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.

* Public health, clinical and commercial laboratory data combined.

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.

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

Public Health Laboratories

View Data Table

Clinical Laboratories

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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.

View Data Table

Additional virologic surveillance information: Surveillance Methods

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.

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

On a regional levelExternal, 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.

*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 experienced a decline in percentage of visits for ILI and CLI.

View Data Table

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 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).

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

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.

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.

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 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.

*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