Respiratory Virus Activity Levels

Provides an update on how COVID-19, influenza, and RSV may be spreading nationally and in your state.

Activity Levels Update:
  • The amount of respiratory illness (fever plus cough or sore throat) causing people to seek healthcare is elevated across many areas of the country. This week, 27 jurisdictions experienced high or very high activity. This number remains stable compared to last week.
  • Nationally, emergency department visits with diagnosed COVID-19, influenza, and RSV are decreasing.
  • Influenza test positivity decreased slightly nationally but is increasing in the Northeastern, Mid-Atlantic, and Central parts of the country. COVID-19 and RSV test positivity decreased compared to the previous week.
  • Nationally, COVID-19 wastewater viral activity levels, which reflect both symptomatic and asymptomatic infections, remain at high levels, particularly in the South, but are trending downward in other areas.

Reported on Friday, February 23rd, 2024.

Level of Respiratory Illness Activity

Activity levels determined weekly based on the percentage of visits to enrolled outpatient healthcare providers or emergency departments for fever and cough or sore throat reported to ILINet. Visits can be attributed to a variety of respiratory pathogens that cause these symptoms. Activity levels reflect how the percentage in the most recent week compares to what that jurisdiction typically experiences during low circulation periods. Trend information for the percentages used to calculate activity levels can be found at: National, Regional, and State Level Outpatient Illness and Viral Surveillance (cdc.gov).


  • Source: U.S. Outpatient Influenza-Like Illness Surveillance Network (ILINet).
  • Additional information available at: Outpatient Illness Surveillance methods section.
  • This system monitors visits for respiratory illness that includes fever plus a cough or sore throat, (also referred to as influenza-like illness, or ILI), not laboratory confirmed infections; therefore, patient visits due to a variety of respiratory pathogens that cause similar symptoms may be captured.
  • The activity levels compare the mean reported percent of visits due to ILI during the current week to the mean reported percent of visits due to ILI during non-influenza weeks. The 13 activity levels correspond to the number of standard deviations below, at, or above the mean for the current week compared with the mean during non-influenza weeks.
  • This map uses the proportion of visits to enrolled outpatient healthcare providers or emergency departments for respiratory illness to measure the activity level within a state. It does not, however, measure the extent of geographic spread of respiratory illness within a state. Therefore, outbreaks occurring in a single city could cause the state to display high activity levels.
  • Data collected in ILINet may disproportionately represent certain populations within a state depending on enrolled providers, and therefore may not accurately depict the full picture of respiratory virus activity for the whole state.
  • The data presented in this map is preliminary and may change as more data is received.
  • Differences in the data presented by CDC and state health departments likely represent differing levels of data completeness with data presented by the state likely being the more complete.

Emergency Department Visits for Viral Respiratory Illness

Weekly percent of total emergency department visits associated with COVID-19, influenza, and RSV.


Percent of Tests Positive for Respiratory Viruses

Weekly percent of tests positive for the viruses that cause COVID-19, influenza, and RSV at the national level. Preliminary data are shaded in gray.


  • Sources: COVID-19 and RSV: National Respiratory and Enteric Virus Surveillance System (NREVSS), a sentinel network of laboratories located through the US, includes clinical, public health and commercial laboratories; additional information available at: https://www.cdc.gov/surveillance/nrevss/index.html. Influenza: Clinical laboratory test results from NREVSS and U.S. World Health Organization collaborating laboratories; more details about influenza virologic surveillance are available here: https://www.cdc.gov/flu/weekly/overview.htm.
  • Data for recent weeks in gray may be incomplete due to delays in reporting. These preliminary may change as more data become available.
  • Data represent laboratory tests performed, not individual people.
  • The data are from across the country in all regions.
  • The percent of tests positive is calculated by dividing the number of positive tests by the total number of tests administered, then multiplying by 100 [(# of positive tests/total tests) x 100].
  • COVID-19: The condition caused by infection with severe acute respiratory syndromic coronavirus type-2 (SARS-CoV-2).
  • RSV and COVID-19 are limited to nucleic acid amplification tests (NAATs), also listed as polymerase chain reaction tests (PCR).
  • Participating laboratories report weekly to CDC the total number of RSV tests performed that week and the number of those tests that were positive. The RSV trend graphs display the national average of the weekly % test positivity for the current, previous, and following weeks in accordance with the recommendations for assessing RSV trends by percent ( https://academic.oup.com/jid/article/216/3/345/3860464).
  • COVID-19 laboratory data are available for download here: https://data.cdc.gov/Laboratory-Surveillance/Percent-Positivity-of-COVID-19-Nucleic-Acid-Amplif/gvsb-yw6g
  • RSV laboratory data are available for download here: https://data.cdc.gov/Laboratory-Surveillance/Percent-Positivity-of-Respiratory-Syncytial-Virus-/3cxc-4k8q

COVID-19 Wastewater Trends

COVID-19 Wastewater Monitoring at the national and regional level. Preliminary data are shaded in gray.

Wastewater (sewage) can be tested to detect traces of infectious diseases circulating in a community, even if people don’t have symptoms. You can use these data as an early warning that levels of infections may be increasing or decreasing in your community. Wastewater trends may differ from some health outcome findings, such as hospitalization trends, as COVID-19 is causing severe disease less frequently than earlier in the pandemic.


This chart shows national and regional trends over time of the levels of SARS-CoV-2 (the virus that causes COVID-19) activity levels present in samples of wastewater taken from sites across the United States. Wastewater monitoring can detect viruses spreading from one person to another within a community earlier than clinical testing, and before people who are sick go to their doctor or hospital. It can also detect infections without symptoms. If you see increased Wastewater Viral Activity Levels of SARS-CoV-2, it might indicate that there is a higher risk of infection. See how to protect yourself from respiratory viruses like COVID-19.

The Wastewater Viral Activity Level shows changes in SARS-CoV-2 virus levels in wastewater compared to the baseline level for each wastewater treatment plant. National and regional data represent the median values across all wastewater treatment plants in the respective area. The Wastewater Viral Activity Levels are categorized into minimal, low, moderate, high, or very high as follows:

  • Less than 1.5 – Minimal
  • Greater than 1.5 and up to 3 – Low
  • Greater than 3 and up to 4.5 – Moderate
  • Greater than 4.5 and up to 8 – High
  • Greater than 8 – Very High

For more information, see Data Methods.

States and territories are grouped into the following U.S Census Bureau regions:

  • West: Alaska, Arizona, California, Colorado, Guam, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming (N=14)
  • Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin (N=12)
  • Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont (N=10)
  • South: Arkansas, Alabama, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia (N=17)