The coronavirus disease 2019 (COVID-19) pandemic resulted in 5,817,385 reported cases
and 362,705 deaths worldwide through May, 30, 2020,
†
including 1,761,503 aggregated reported cases and 103,700 deaths in the United States.
§
Previous analyses during February–early April 2020 indicated that age ≥65 years and
underlying health conditions were associated with a higher risk for severe outcomes,
which were less common among children aged <18 years (
1
–
3
). This report describes demographic characteristics, underlying health conditions,
symptoms, and outcomes among 1,320,488 laboratory-confirmed COVID-19 cases individually
reported to CDC during January 22–May 30, 2020. Cumulative incidence, 403.6 cases
per 100,000 persons,
¶
was similar among males (401.1) and females (406.0) and highest among persons aged
≥80 years (902.0). Among 599,636 (45%) cases with known information, 33% of persons
were Hispanic or Latino of any race (Hispanic), 22% were non-Hispanic black (black),
and 1.3% were non-Hispanic American Indian or Alaska Native (AI/AN). Among 287,320
(22%) cases with sufficient data on underlying health conditions, the most common
were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%).
Overall, 184,673 (14%) patients were hospitalized, 29,837 (2%) were admitted to an
intensive care unit (ICU), and 71,116 (5%) died. Hospitalizations were six times higher
among patients with a reported underlying condition (45.4%) than those without reported
underlying conditions (7.6%). Deaths were 12 times higher among patients with reported
underlying conditions (19.5%) compared with those without reported underlying conditions
(1.6%). The COVID-19 pandemic continues to be severe, particularly in certain population
groups. These preliminary findings underscore the need to build on current efforts
to collect and analyze case data, especially among those with underlying health conditions.
These data are used to monitor trends in COVID-19 illness, identify and respond to
localized incidence increase, and inform policies and practices designed to reduce
transmission in the United States.
State and territorial health departments report daily aggregate counts of COVID-19
cases and deaths to CDC; these were tabulated according to date of report to examine
reporting trends during January 22–May 30. In addition to aggregate counts, individual
COVID-19 case reports were submitted via a CDC COVID-19 case report form** and the
National Notifiable Diseases Surveillance System (NNDSS).
††
Jurisdictions voluntarily report confirmed and probable
§§
cases from reports submitted by health care providers and laboratories. A laboratory-confirmed
COVID-19 case was defined as a person with a positive test result for SARS-CoV-2,
the virus that causes COVID-19, from a respiratory specimen, using real-time reverse
transcription–polymerase chain reaction testing. COVID-19 case data reported from
50 states, New York City, and the District of Columbia
¶¶
were analyzed to examine reported demographic characteristics, underlying health conditions,
clinical signs and symptoms, and severe outcomes, including hospitalization, ICU admission,
and death. Data were missing for age, sex, and race or ethnicity in <1%, 1%, and 55%
of reports, respectively.*** Cases reported without sex or age data were excluded
from this analysis as were cases meeting only the probable case definition, along
with persons repatriated to the United States from Wuhan, China, or the Diamond Princess
cruise ship. Cumulative incidence was estimated using 2018 population estimates. Because
of the high prevalence of missing race and ethnicity data, estimates of incidence
and proportions of underlying health conditions, symptoms, and severe outcomes by
race and ethnicity were not described. Analyses are descriptive and statistical comparisons
were not performed.
CDC received notification of the first case of laboratory-confirmed COVID-19 in the
United States on January 22, 2020.
†††
As of May 30, an aggregate 1,761,503 U.S. COVID-19 cases and 103,700 deaths had been
reported (Figure).
§§§
The 7-day moving average number
¶¶¶
of new daily cases peaked on April 12 (31,994) and deaths peaked on April 21 (2,856).
As of May 30, the 7-day moving average numbers of new cases were 19,913 per day and
deaths were 950 per day.
FIGURE
Daily number of COVID-19 cases
*
,
†
,
§
,
¶
(A) and COVID-19–associated deaths** (B) reported to CDC — United States, January
22–May 30, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
* From April 14, 2020, aggregate case counts reported by CDC included deaths attributable
to both confirmed and probable COVID-19 as classified by reporting jurisdictions,
using the Council of State and Territorial Epidemiologists position statement Interim-ID-20-01
(https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf).
† The upper quartile of the lag between onset date and reporting to CDC was 15 days.
§ The daily number of deaths reported by jurisdictions on April 14 includes 4,141
deaths newly classified as probable.
¶ Overall <1% of cases reported in aggregate to CDC were classified as probable.
** Overall 3.1% of deaths reported in aggregate to CDC were classified as occurring
in persons with probable cases.
The figure is a combination histogram, epidemiologic curve, and line chart showing
the daily number of COVID-19 cases (A) and COVID-19–associated deaths (B) reported
to CDC, in the United States, during January 22–May 30, 2020.
Among the 1,761,503 aggregate cases reported to CDC during January 22–May 30, individual
case reports for 1,406,098 were submitted to CDC case surveillance. After exclusions,
data for 1,320,488 (94%) cases were analyzed. Median age was 48 years (interquartile
range = 33–63 years). Incidence was 403.6 cases per 100,000 population (Table 1) and
was similar among females (406.0) and males (401.1).**** Incidence was higher among
persons aged 40–49 years (541.6) and 50–59 years (550.5) than among those aged 60–69
years (478.4) and 70–79 years (464.2). Incidence was highest among persons aged ≥80
years (902.0)
††††
and lowest among children aged ≤9 years (51.1). Among the 599,636 (45%) cases with
information on both race and ethnicity, 36% of persons were non-Hispanic white, 33%
were Hispanic, 22% were black, 4% were non-Hispanic Asian, 4% were non-Hispanic, other
or multiple race, 1.3% were AI/AN, and <1% were non-Hispanic Native Hawaiian or other
Pacific Islander.
TABLE 1
Reported laboratory-confirmed COVID-19 cases and estimated cumulative incidence,*
by sex
†
and age group — United States, January 22–May 30, 2020
Age group (yrs)
Males
Females
Total
No. (%)
Cumulative incidence*
No. (%)
Cumulative incidence*
No. (%)
Cumulative incidence*
0–9
10,743 (1.7)
52.5
9,715 (1.4)
49.7
20,458 (1.5)
51.1
10–19
24,302 (3.8)
113.4
24,943 (3.7)
121.4
49,245 (3.7)
117.3
20–29
85,913 (13.3)
370.0
96,556 (14.3)
434.6
182,469 (13.8)
401.6
30–39
108,319 (16.8)
492.8
106,530 (15.8)
490.5
214,849 (16.3)
491.6
40–49
109,745 (17.0)
547.0
109,394 (16.2)
536.2
219,139 (16.6)
541.6
50–59
119,152 (18.4)
568.8
116,622 (17.3)
533.0
235,774 (17.9)
550.5
60–69
93,596 (14.5)
526.9
85,411 (12.7)
434.6
179,007 (13.6)
478.4
70–79
53,194 (8.2)
513.7
52,058 (7.7)
422.7
105,252 (8.0)
464.2
≥80
41,394 (6.4)
842.0
72,901 (10.8)
940.0
114,295 (8.7)
902.0
All ages
646,358 (100.0)
401.1
674,130 (100.0)
406.0
1,320,488 (100.0)
403.6
Abbreviation: COVID-19 = coronavirus disease 2019.
* Per 100,000 population.
†
The analytic dataset excludes cases reported through case surveillance that were missing
information on sex (n = 19,918) or age (n = 2,379).
Symptom status (symptomatic versus asymptomatic) was reported for 616,541 (47%) cases;
among these, 22,007 (4%) were asymptomatic. Among 373,883 (28%) cases with data on
individual symptoms, 70% noted fever, cough, or shortness of breath; 36% reported
muscle aches, and 34% reported headache (Table 2). Overall, 31,191 (8%) persons reported
loss of smell or taste.
§§§§
Among patients aged ≥80 years, 60% reported fever, cough, or shortness of breath.
No other symptoms were reported by >10% of persons in this age group.
TABLE 2
Reported underlying health conditions* and symptoms
†
among persons with laboratory-confirmed COVID-19, by sex and age group — United States,
January 22–May 30, 2020
Characteristic
No. (%)
Total
Sex
Age group (yrs)
Male
Female
≤9
10–19
20–29
30–39
40–49
50–59
60–69
70–79
≥80
Total population
1,320,488
646,358
674,130
20,458
49,245
182,469
214,849
219,139
235,774
179,007
105,252
114,295
Underlying health condition§
Known underlying medical condition status*
287,320 (21.8)
138,887 (21.5)
148,433 (22.0)
2,896 (14.2)
7,123 (14.5)
27,436 (15.0)
33,483 (15.6)
40,572 (18.5)
54,717 (23.2)
50,125 (28.0)
34,400 (32.7)
36,568 (32.0)
Any cardiovascular disease¶
92,546 (32.2)
47,567 (34.2)
44,979 (30.3)
78 (2.7)
164 (2.3)
1,177 (4.3)
3,588 (10.7)
8,198 (20.2)
16,954 (31.0)
21,466 (42.8)
18,763 (54.5)
22,158 (60.6)
Any chronic lung disease
50,148 (17.5)
20,930 (15.1)
29,218 (19.7)
363 (12.5)
1,285 (18)
4,537 (16.5)
5,110 (15.3)
6,127 (15.1)
8,722 (15.9)
9,200 (18.4)
7,436 (21.6)
7,368 (20.1)
Renal disease
21,908 (7.6)
12,144 (8.7)
9,764 (6.6)
21 (0.7)
34 (0.5)
204 (0.7)
587 (1.8)
1,273 (3.1)
2,789 (5.1)
4,764 (9.5)
5,401 (15.7)
6,835 (18.7)
Diabetes
86,737 (30.2)
45,089 (32.5)
41,648 (28.1)
12 (0.4)
225 (3.2)
1,409 (5.1)
4,106 (12.3)
9,636 (23.8)
19,589 (35.8)
22,314 (44.5)
16,594 (48.2)
12,852 (35.1)
Liver disease
3,953 (1.4)
2,439 (1.8)
1,514 (1.0)
5 (0.2)
19 (0.3)
132 (0.5)
390 (1.2)
573 (1.4)
878 (1.6)
1,074 (2.1)
583 (1.7)
299 (0.8)
Immunocompromised
15,265 (5.3)
7,345 (5.3)
7,920 (5.3)
61 (2.1)
146 (2.0)
646 (2.4)
1,253 (3.7)
2,005 (4.9)
3,190 (5.8)
3,421 (6.8)
2,486 (7.2)
2,057 (5.6)
Neurologic/Neurodevelopmental disability
13,665 (4.8)
6,193 (4.5)
7,472 (5.0)
41 (1.4)
113 (1.6)
395 (1.4)
533 (1.6)
734 (1.8)
1,338 (2.4)
2,006 (4.0)
2,759 (8.0)
5,746 (15.7)
Symptom§
Known symptom status†
373,883 (28.3)
178,223 (27.6)
195,660 (29.0)
5,188 (25.4)
12,689 (25.8)
51,464 (28.2)
59,951 (27.9)
62,643 (28.6)
70,040 (29.7)
52,178 (29.1)
28,583 (27.2)
31,147 (27.3)
Fever, cough, or shortness of breath
260,706 (69.7)
125,768 (70.6)
134,938 (69.0)
3,278 (63.2)
7,584 (59.8)
35,072 (68.1)
42,016 (70.1)
45,361 (72.4)
51,283 (73.2)
37,701 (72.3)
19,583 (68.5)
18,828 (60.4)
Fever
††
161,071 (43.1)
80,578 (45.2)
80,493 (41.1)
2,404 (46.3)
4,443 (35.0)
20,381 (39.6)
25,887 (43.2)
28,407 (45.3)
32,375 (46.2)
23,591 (45.2)
12,190 (42.6)
11,393 (36.6)
Cough
187,953 (50.3)
89,178 (50.0)
98,775 (50.5)
1,912 (36.9)
5,257 (41.4)
26,284 (51.1)
31,313 (52.2)
34,031 (54.3)
38,305 (54.7)
27,150 (52.0)
12,837 (44.9)
10,864 (34.9)
Shortness of breath
106,387 (28.5)
49,834 (28.0)
56,553 (28.9)
339 (6.5)
2,070 (16.3)
13,649 (26.5)
16,851 (28.1)
18,978 (30.3)
21,327 (30.4)
16,018 (30.7)
8,971 (31.4)
8,184 (26.3)
Myalgia
135,026 (36.1)
61,922 (34.7)
73,104 (37.4)
537 (10.4)
3,737 (29.5)
21,153 (41.1)
26,464 (44.1)
28,064 (44.8)
28,594 (40.8)
17,360 (33.3)
6,015 (21.0)
3,102 (10.0)
Runny nose
22,710 (6.1)
9,900 (5.6)
12,810 (6.5)
354 (6.8)
1,025 (8.1)
4,591 (8.9)
4,406 (7.3)
4,141 (6.6)
4,100 (5.9)
2,671 (5.1)
923 (3.2)
499 (1.6)
Sore throat
74,840 (20.0)
31,244 (17.5)
43,596 (22.3)
664 (12.8)
3,628 (28.6)
14,493 (28.2)
14,855 (24.8)
14,490 (23.1)
13,930 (19.9)
8,192 (15.7)
2,867 (10.0)
1,721 (5.5)
Headache
128,560 (34.4)
54,721 (30.7)
73,839 (37.7)
785 (15.1)
5,315 (41.9)
23,723 (46.1)
26,142 (43.6)
26,245 (41.9)
26,057 (37.2)
14,735 (28.2)
4,163 (14.6)
1,395 (4.5)
Nausea/Vomiting
42,813 (11.5)
16,549 (9.3)
26,264 (13.4)
506 (9.8)
1,314 (10.4)
6,648 (12.9)
7,661 (12.8)
8,091 (12.9)
8,737 (12.5)
5,953 (11.4)
2,380 (8.3)
1,523 (4.9)
Abdominal pain
28,443 (7.6)
11,553 (6.5)
16,890 (8.6)
349 (6.7)
978 (7.7)
4,211 (8.2)
5,150 (8.6)
5,531 (8.8)
6,134 (8.8)
3,809 (7.3)
1,449 (5.1)
832 (2.7)
Diarrhea
72,039 (19.3)
32,093 (18.0)
39,946 (20.4)
704 (13.6)
1,712 (13.5)
9,867 (19.2)
12,769 (21.3)
13,958 (22.3)
15,536 (22.2)
10,349 (19.8)
4,402 (15.4)
2,742 (8.8)
Loss of smell or taste
31,191 (8.3)
12,717 (7.1)
18,474 (9.4)
67 (1.3)
1,257 (9.9)
6,828 (13.3)
6,907 (11.5)
6,361 (10.2)
5,828 (8.3)
2,930 (5.6)
775 (2.7)
238 (0.8)
Abbreviation: COVID-19 = coronavirus disease 2019.
* Status of underlying health conditions known for 287,320 persons. Status was classified
as “known” if any of the following conditions were reported as present or absent:
diabetes mellitus, cardiovascular disease (including hypertension), severe obesity
(body mass index ≥40 kg/m2), chronic renal disease, chronic liver disease, chronic
lung disease, immunocompromising condition, autoimmune condition, neurologic condition
(including neurodevelopmental, intellectual, physical, visual, or hearing impairment),
psychologic/psychiatric condition, and other underlying medical condition not otherwise
specified.
† Symptom status was known for 373,883 persons. Status was classified as “known” if
any of the following symptoms were reported as present or absent: fever (measured
>100.4°F [38°C] or subjective), cough, shortness of breath, wheezing, difficulty breathing,
chills, rigors, myalgia, rhinorrhea, sore throat, chest pain, nausea or vomiting,
abdominal pain, headache, fatigue, diarrhea (≥3 loose stools in a 24-hour period),
or other symptom not otherwise specified on the form.
§ Responses include data from standardized fields supplemented with data from free-text
fields. Information for persons with loss of smell or taste was exclusively extracted
from a free-text field; therefore, persons exhibiting this symptom were likely underreported.
¶ Includes persons with reported hypertension.
** Includes all persons with at least one of these symptoms reported.
††
Persons were considered to have a fever if information on either measured or subjective
fever variables if “yes” was reported for either variable.
Among 287,320 (22%) cases with data on individual underlying health conditions, those
most frequently reported were cardiovascular disease (32%), diabetes (30%), and chronic
lung disease (18%) (Table 2); the reported proportions were similar among males and
females. The frequency of conditions reported varied by age group: cardiovascular
disease was uncommon among those aged ≤39 years but was reported in approximately
half of the cases among persons aged ≥70 years. Among 63,896 females aged 15–44 years
with known pregnancy status, 6,708 (11%) were reported to be pregnant.
Among the 1,320,488 cases, outcomes for hospitalization, ICU admission, and death
were available for 46%, 14%, and 36%, respectively. Overall, 184,673 (14%) patients
were hospitalized, including 29,837 (2%) admitted to the ICU; 71,116 (5%) patients
died (Table 3). Severe outcomes were more commonly reported for patients with reported
underlying conditions. Hospitalizations were six times higher among patients with
a reported underlying condition than those without reported underlying conditions
(45.4% versus 7.6%). Deaths were 12 times higher among patients with reported underlying
conditions compared with those without reported underlying conditions (19.5% versus
1.6%). The percentages of males who were hospitalized (16%), admitted to the ICU (3%),
and who died (6%) were higher than were those for females (12%, 2%, and 5%, respectively).
The percentage of ICU admissions was highest among persons with reported underlying
conditions aged 60–69 years (11%) and 70–79 years (12%). Death was most commonly reported
among persons aged ≥80 years regardless of the presence of underlying conditions (with
underlying conditions 50%; without 30%).
TABLE 3
Reported hospitalizations,*
,
†
intensive care unit (ICU) admissions,
§
and deaths
¶
among laboratory-confirmed COVID-19 patients with and without reported underlying
health conditions,
**
by sex and age — United States, January 22–May 30, 2020
Characteristic (no.)
Outcome, no./total no. (%)††
Reported hospitalizations*,† (including ICU)
Reported ICU admission§
Reported deaths¶
Among all patients
Among patients with reported underlying health conditions
Among patients with no reported underlying health conditions
Among all patients
Among patients with reported underlying health conditions
Among patients with no reported underlying health conditions
Among all patients
Among patients with reported underlying health conditions
Among patients with no reported underlying health conditions
Sex
Male (646,358)
101,133/646,358 (15.6)
49,503/96,839 (51.1)
3,596/42,048 (8.6)
18,394/646,358 (2.8)
10,302/96,839 (10.6)
864/42,048 (2.1)
38,773/646,358 (6.0)
21,667/96,839 (22.4)
724/42,048 (1.7)
Female (674,130)
83,540/674,130 (12.4)
40,698/102,040 (39.9)
3,087/46,393 (6.7)
11,443/674,130 (1.7)
6,672/102,040 (6.5)
479/46,393 (1.0)
32,343/674,130 (4.8)
17,145/102,040 (16.8)
707/46,393 (1.5)
Age group (yrs)
≤9 (20,458)
848/20,458 (4.1)
138/619 (22.3)
84/2,277 (3.7)
141/20,458 (0.7)
31/619 (5.0)
16/2,277 (0.7)
13/20,458 (0.1)
4/619 (0.6)
2/2,277 (0.1)
10–19 (49,245)
1,234/49,245 (2.5)
309/2,076 (14.9)
115/5,047 (2.3)
216/49,245 (0.4)
72/2,076 (3.5)
17/5,047 (0.3)
33/49,245 (0.1)
16/2,076 (0.8)
4/5,047 (0.1)
20–29 (182,469)
6,704/182,469 (3.7)
1,559/8,906 (17.5)
498/18,530 (2.7)
864/182,469 (0.5)
300/8,906 (3.4)
56/18,530 (0.3)
273/182,469 (0.1)
122/8,906 (1.4)
24/18,530 (0.1)
30–39 (214,849)
12,570/214,849 (5.9)
3,596/14,854 (24.2)
828/18,629 (4.4)
1,879/214,849 (0.9)
787/14,854 (5.3)
135/18,629 (0.7)
852/214,849 (0.4)
411/14,854 (2.8)
21/18,629 (0.1)
40–49 (219,139)
19,318/219,139 (8.8)
7,151/24,161 (29.6)
1,057/16,411 (6.4)
3,316/219,139 (1.5)
1,540/24,161 (6.4)
208/16,411 (1.3)
2,083/219,139 (1.0)
1,077/24,161 (4.5)
58/16,411 (0.4)
50–59 (235,774)
31,588/235,774 (13.4)
14,639/40,297 (36.3)
1,380/14,420 (9.6)
5,986/235,774 (2.5)
3,335/40,297 (8.3)
296/14,420 (2.1)
5,639/235,774 (2.4)
3,158/40,297 (7.8)
131/14,420 (0.9)
60–69 (179,007)
39,422/179,007 (22.0)
21,064/42,206 (49.9)
1,216/7,919 (15.4)
7,403/179,007 (4.1)
4,588/42,206 (10.9)
291/7,919 (3.7)
11,947/179,007 (6.7)
7,050/42,206 (16.7)
187/7,919 (2.4)
70–79 (105,252)
35,844/105,252 (34.1)
20,451/31,601 (64.7)
780/2,799 (27.9)
5,939/105,252 (5.6)
3,771/31,601 (11.9)
199/2,799 (7.1)
17,510/105,252 (16.6)
10,008/31,601 (31.7)
286/2,799 (10.2)
≥80 (114,295)
37,145/114,295 (32.5)
21,294/34,159 (62.3)
725/2,409 (30.1)
4,093/114,295 (3.6)
2,550/34,159 (7.5)
125/2,409 (5.2)
32,766/114,295 (28.7)
16,966/34,159 (49.7)
718/2,409 (29.8)
Total (1,320,488)
184,673/1,320,488 (14.0)
90,201/198,879 (45.4)
6,683/88,441 (7.6)
29,837/1,320,488 (2.3)
16,974/198,879 (8.5)
1,343/88,441 (1.5)
71,116/1,320,488 (5.4)
38,812/198,879 (19.5)
1,431/88,441 (1.6)
Abbreviation: COVID-19 = coronavirus disease 2019.
* Hospitalization status was known for 600,860 (46%). Among 184,673 hospitalized patients,
the presence of underlying health conditions was known for 96,884 (53%).
† Includes reported ICU admissions.
§ ICU admission status was known for 186,563 (14%) patients among the total case population,
representing 34% of hospitalized patients. Among 29,837 patients admitted to the ICU,
the status of underlying health conditions was known for 18,317 (61%).
¶ Death outcomes were known for 480,565 (36%) patients. Among 71,116 reported deaths
through case surveillance, the status of underlying health conditions was known for
40,243 (57%) patients.
** Status of underlying health conditions was known for 287,320 (22%) patients. Status
was classified as “known” if any of the following conditions were noted as present
or absent: diabetes mellitus, cardiovascular disease including hypertension, severe
obesity body mass index ≥40 kg/m2, chronic renal disease, chronic liver disease, chronic
lung disease, any immunocompromising condition, any autoimmune condition, any neurologic
condition including neurodevelopmental, intellectual, physical, visual, or hearing
impairment, any psychologic/psychiatric condition, and any other underlying medical
condition not otherwise specified.
†† Outcomes were calculated as the proportion of persons reported to be hospitalized,
admitted to an ICU, or who died among total in the demographic group. Outcome underreporting
could result from outcomes that occurred but were not reported through national case
surveillance or through clinical progression to severe outcomes that occurred after
time of report.
Discussion
As of May 30, a total of 1,761,503 aggregate U.S. cases of COVID-19 and 103,700 associated
deaths were reported to CDC. Although average daily reported cases and deaths are
declining, 7-day moving averages of daily incidence of COVID-19 cases indicate ongoing
community transmission.
¶¶¶¶
The COVID-19 case data summarized here are essential statistics for the pandemic response
and rely on information systems developed at the local, state, and federal level over
decades for communicable disease surveillance that were rapidly adapted to meet an
enormous, new public health threat. CDC aggregate counts are consistent with those
presented through the Johns Hopkins University (JHU) Coronavirus Resource Center,
which reported a cumulative total of 1,770,165 U.S. cases and 103,776 U.S. deaths
on May 30, 2020.***** Differences in aggregate counts between CDC and JHU might be
attributable to differences in reporting practices to CDC and jurisdictional websites
accessed by JHU.
Reported cumulative incidence in the case surveillance population among persons aged
≥20 years is notably higher than that among younger persons. The lower incidence in
persons aged ≤19 years could be attributable to undiagnosed milder or asymptomatic
illnesses among this age group that were not reported. Incidence in persons aged ≥80
years was nearly double that in persons aged 70–79 years.
Among cases with known race and ethnicity, 33% of persons were Hispanic, 22% were
black, and 1.3% were AI/AN. These findings suggest that persons in these groups, who
account for 18%, 13%, and 0.7% of the U.S. population, respectively, are disproportionately
affected by the COVID-19 pandemic. The proportion of missing race and ethnicity data
limits the conclusions that can be drawn from descriptive analyses; however, these
findings are consistent with an analysis of COVID-19–Associated Hospitalization Surveillance
Network (COVID-NET)
†††††
data that found higher proportions of black and Hispanic persons among hospitalized
COVID-19 patients than were in the overall population (
4
). The completeness of race and ethnicity variables in case surveillance has increased
from 20% to >40% from April 2 to June 2. Although reporting of race and ethnicity
continues to improve, more complete data might be available in aggregate on jurisdictional
websites or through sources like the COVID Tracking Project’s COVID Racial Data Tracker.
§§§§§
The data in this report show that the prevalence of reported symptoms varied by age
group but was similar among males and females. Fewer than 5% of persons were reported
to be asymptomatic when symptom data were submitted. Persons without symptoms might
be less likely to be tested for COVID-19 because initial guidance recommended testing
of only symptomatic persons and was hospital-based. Guidance on testing has evolved
throughout the response.
¶¶¶¶¶
Whereas incidence among males and females was similar overall, severe outcomes were
more commonly reported among males. Prevalence of reported severe outcomes increased
with age; the percentages of hospitalizations, ICU admissions, and deaths were highest
among persons aged ≥70 years, regardless of underlying conditions, and lowest among
those aged ≤19 years. Hospitalizations were six times higher and deaths 12 times higher
among those with reported underlying conditions compared with those with none reported.
These findings are consistent with previous reports that found that severe outcomes
increased with age and underlying condition, and males were hospitalized at a higher
rate than were females (
2
,
4
,
5
).
The findings in this report are subject to at least three limitations. First, case
surveillance data represent a subset of the total cases of COVID-19 in the United
States; not every case in the community is captured through testing and information
collected might be limited if persons are unavailable or unwilling to participate
in case investigations or if medical records are unavailable for data extraction.
Reported cumulative incidence, although comparable across age and sex groups within
the case surveillance population, are underestimates of the U.S. cumulative incidence
of COVID-19. Second, reported frequencies of individual symptoms and underlying health
conditions presented from case surveillance likely underestimate the true prevalence
because of missing data. Finally, asymptomatic cases are not captured well in case
surveillance. Asymptomatic persons are unlikely to seek testing unless they are identified
through active screening (e.g., contact tracing), and, because of limitations in testing
capacity and in accordance with guidance, investigation of symptomatic persons is
prioritized. Increased identification and reporting of asymptomatic cases could affect
patterns described in this report.
Similar to earlier reports on COVID-19 case surveillance, severe outcomes were more
commonly reported among persons who were older and those with underlying health conditions
(
1
). Findings in this report align with demographic and severe outcome trends identified
through COVID-NET (
4
). Findings from case surveillance are evaluated along with enhanced surveillance
data and serologic survey results to provide a comprehensive picture of COVID-19 trends,
and differences in proportion of cases by racial and ethnic groups should continue
to be examined in enhanced surveillance to better understand populations at highest
risk.
Since the U.S. COVID-19 response began in January, CDC has built on existing surveillance
capacity to monitor the impact of illness nationally. Collection of detailed case
data is a resource-intensive public health activity, regardless of disease incidence.
The high incidence of COVID-19 has highlighted limitations of traditional public health
case surveillance approaches to provide real-time intelligence and supports the need
for continued innovation and modernization. Despite limitations, national case surveillance
of COVID-19 serves a critical role in the U.S. COVID-19 response: these data demonstrate
that the COVID-19 pandemic is an ongoing public health crisis in the United States
that continues to affect all populations and result in severe outcomes including death.
National case surveillance findings provide important information for targeted enhanced
surveillance efforts and development of interventions critical to the U.S. COVID-19
response.
Summary
What is already known about this topic?
Surveillance data reported to CDC through April 2020 indicated that COVID-19 leads
to severe outcomes in older adults and those with underlying health conditions.
What is added by this report?
As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions
were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%).
Hospitalizations were six times higher and deaths 12 times higher among those with
reported underlying conditions compared with those with none reported.
What are the implications for public health practice?
Surveillance at all levels of government, and its continued modernization, is critical
for monitoring COVID-19 trends and identifying groups at risk for infection and severe
outcomes. These findings highlight the continued need for community mitigation strategies,
especially for vulnerable populations, to slow COVID-19 transmission.