The Changing Threat of COVID-19

February 23, 2024, 6:15 PM EDT

Updates on respiratory illness and vaccine-preventable diseases.

COVID-19 community transmission continues to surge periodically

Annually for the past four years, there have been at least two and sometimes three periods of high community transmission of SARS-CoV-2, the virus that causes COVID-19. For example, the percentage of SARS-CoV-2 tests that are positive, a key indicator of community spread, reached peak levels of 14.6% in August 2023 and 12.9% in January 2024, which is similar timing as the peak levels observed in earlier years. Differences in testing practices between time periods might influence these data, but these high levels of test positivity are consistent with high levels also seen in wastewater.

Hospitalizations and deaths from COVID-19 are decreasing

Despite periodic episodes of high transmission, severe outcomes from COVID-19 have substantially decreased since 2020 and 2021. Hospital admissions in the U.S. for COVID-19 have decreased by more than 60% from their peak in 2021, dropping from over 2.5 million that year to around 900,000 total in 2023.

The decline in deaths associated with COVID-19 is even more dramatic than the drop in hospitalizations. In 2021, over 450,000 deaths among Americans were associated with COVID-19, while in 2023, that number fell to roughly 75,000. This represents an 83% decrease since early in the pandemic. That said, the number of COVID-19-related deaths is still substantial, impacting families across the country. Based on preliminary data, COVID-19 still ranks as the 10th most common cause of death in the U.S. for 2023, a drop from 3rd in 2020 and 2021 and 4th in 2022.

Hospitalizations and deaths are decreasing despite periodic surges in COVID-19 infections

Although COVID-19 infections continue at a level similar to past years, the likelihood of a new infection causing hospitalization or death has decreased. While other factors are involved, the increase in the percent of the population with COVID-19 antibodies indicates that rising population immunity is partially responsible for the decline in severity. In January 2021, only 21% of people aged 16 years and older had COVID-19 antibodies. By the second half of 2023, 98% had antibodies from vaccination, prior infection, or both.  To date, more than 81% of Americans of all ages have received at least one COVID-19 vaccine dose. Prior vaccination and infection also generate immunity at the cellular level that can help protect against severe disease.

In addition, for those who do become infected with COVID-19, there are effective treatment options available. Antivirals like Paxlovid (nirmatrelvir/ritonavir), or Lagevrio (malnupiravir), if taken within 5 days of symptoms starting, can significantly lessen the severity of illness for patients at higher risk for severe disease.

Risks continue to be higher for older adults, infants, and people with pre-existing medical conditions

While COVID-19 hospitalization rates have declined across all age groups, certain groups continue to be hospitalized at higher rates, including older adults, infants, and people with underlying medical conditions or certain disabilities. During the first seven months of 2023, adults 65 years and older accounted for 63% of hospitalizations and 88% of in-hospital deaths from COVID-19. Of this group, 90% of those hospitalized had multiple pre-existing medical conditions. Additionally, infants under the age of 6 months have higher rates of COVID-19-associated hospitalization.

Prevention and treatment for COVID-19 remains a public health priority

While outcomes are improving, COVID-19 is still a public health threat and CDC continues to recommend using tools in the respiratory virus prevention tool kit that we know reduce the risk of severe disease. Existing data underscore the need for continued efforts to prevent severe illness from COVID-19, especially in older adults, people with pre-existing medical conditions, and infants.

CDC recommends that everyone aged 6 months and older get an updated 2023-2024 COVID-19 vaccine.  To help protect babies younger 6 months from hospitalization due to COVID-19, pregnant people can receive a COVID-19 vaccine at any time during pregnancy. Staying home when sick can help reduce the spread of respiratory illnesses, including COVID-19. Staying up to date on vaccination, seeking early testing and treatment, wearing masks, and improving ventilation indoors are all layers of protection you can choose to use to help reduce your risk of getting severely ill with COVID-19.