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COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration ― United States, May 11, 2023

Weekly / May 12, 2023 / 72(19);523–528


On May 5, 2023, this report was posted online as an MMWR Early Release.

Benjamin J. Silk, PhD1; Heather M. Scobie, PhD1; William M. Duck, MPH1,2; Tess Palmer, MPH3; Farida B. Ahmad, MPH4; Alison M. Binder, MS5; Jodi A. Cisewski, MPH4; Seth Kroop, MPA5; Karl Soetebier, MAPW2; Meeyoung Park, MPH6; Aaron Kite-Powell, MS2; Andrea Cool, MPH5,7; Erin Connelly, MPAff1; Stephanie Dietz, PhD2; Amy E. Kirby, PhD8; Kathleen Hartnett, PhD2; Jocelyn Johnston, MHS3; Diba Khan, PhD1; Shannon Stokley, DrPH9; Clinton R. Paden, PhD1; Michael Sheppard, MS2; Paul Sutton, PhD4; Hilda Razzaghi, PhD9; Robert N. Anderson, PhD4; Natalie Thornburg, PhD1; Sarah Meyer, MD9; Caryn Womack1; Aliki P. Weakland, MPH, MSW1; Meredith McMorrow, MD1; Lanson R. Broeker, MBA1,3; Amber Winn, MPH1; Aron J. Hall, DVM1; Brendan Jackson, MD1; Barbara E. Mahon, MD1; Matthew D. Ritchey, DPT2 (VIEW AUTHOR AFFILIATIONS)


What is already known about this topic?

Authorizations to collect certain public health data expire at the end of the U.S. public health emergency declaration on May 11, 2023.

What is added by this report?

Changes to the national COVID-19 monitoring strategy and COVID Data Tracker capitalize on marked improvements in multiple surveillance systems. Weekly COVID-19 hospital admission levels and the percentage of all COVID-19–associated deaths will be primary surveillance indicators. Emergency department visits and percentage of positive SARS-CoV-2 laboratory test results will help detect early changes in trends. Genomic surveillance will continue to help identify and monitor SARS-CoV-2 variants.

What are the implications for public health practice?

COVID-19 is an ongoing public health problem that will be monitored with sustainable data sources to guide prevention efforts.

On January 31, 2020, the U.S. Department of Health and Human Services (HHS) declared, under Section 319 of the Public Health Service Act, a U.S. public health emergency because of the emergence of a novel virus, SARS-CoV-2.* After 13 renewals, the public health emergency will expire on May 11, 2023. Authorizations to collect certain public health data will expire on that date as well. Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies remains a public health priority, and a number of surveillance indicators have been identified to facilitate ongoing monitoring. After expiration of the public health emergency, COVID-19–associated hospital admission levels will be the primary indicator of COVID-19 trends to help guide community and personal decisions related to risk and prevention behaviors; the percentage of COVID-19–associated deaths among all reported deaths, based on provisional death certificate data, will be the primary indicator used to monitor COVID-19 mortality. Emergency department (ED) visits with a COVID-19 diagnosis and the percentage of positive SARS-CoV-2 test results, derived from an established sentinel network, will help detect early changes in trends. National genomic surveillance will continue to be used to estimate SARS-CoV-2 variant proportions; wastewater surveillance and traveler-based genomic surveillance will also continue to be used to monitor SARS-CoV-2 variants. Disease severity and hospitalization-related outcomes are monitored via sentinel surveillance and large health care databases. Monitoring of COVID-19 vaccination coverage, vaccine effectiveness (VE), and vaccine safety will also continue. Integrated strategies for surveillance of COVID-19 and other respiratory viruses can further guide prevention efforts. COVID-19–associated hospitalizations and deaths are largely preventable through receipt of updated vaccines and timely administration of therapeutics (14).

Although COVID-19 no longer poses the societal emergency that it did when it first emerged in late 2019, COVID-19 remains an ongoing public health challenge. By April 26, 2023, more than 104 million U.S. COVID-19 cases, 6 million related hospitalizations, and 1.1 million COVID-19–associated deaths were reported to CDC and summarized on CDC’s COVID Data Tracker. COVID-19 was the third leading cause of death during 2020 and 2021§ and the fourth leading cause during 2022 (5). To mitigate the consequences of the pandemic, approximately 675 million COVID-19 vaccine doses were administered, including 55 million updated (bivalent) booster doses. Based on seroprevalence data, infection- and vaccine-induced population immunity in the United States was 95% by December 2021 (6). As a result, rates of COVID-19–associated hospitalizations and deaths have declined substantially since March 2022 (7). This report describes changes to the national COVID-19 surveillance strategy, data sources, and indicators that will be made after the public health emergency declaration expires; these indicators will be displayed as weekly or otherwise scheduled updates to CDC’s COVID Data Tracker.

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