COVIDView Summary ending October 31, 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.

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

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

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

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

Additional virologic surveillance information: Surveillance Methods

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

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

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

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

ILI Activity Levels

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

The number of jurisdictions at each activity level during week 44 and the previous week are summarized in the table below.

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

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

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

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

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

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

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

¹ COVID-19-associated hospitalization rates by race and ethnicity are calculated using COVID-NET hospitalizations with known race and ethnicity for the numerator and NCHS bridged-race population estimates for the denominator.
² For each age category, rate ratios are the ratios between crude hospitalization rates within each racial and ethnic group and the crude hospitalization rate among non-Hispanic White persons in the same age category.
³ The highest rate ratio in each age category is presented in bold.
⁴ Overall rates are adjusted to account for differences in age distributions within race and ethnicity strata in the COVID-NET catchment area; the age strata used for the adjustment include 0–17, 18–49, 50–64, and 65+ years.

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

¹ Persons of multiple races (0.3%) or unknown race and ethnicity (4.9%) are not represented in the table but are included as part of the denominator.
² Prevalence ratio is calculated as the ratio of the proportion of COVID-NET hospitalizations over the proportion of population in COVID-NET catchment area.

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

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

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

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

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

*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