This report covers the first four months of COVID-19 in the United States, before vaccines and most current treatments existed. It reflects the data and testing guidance of that time.
Through May 30, 2020, the COVID-19 pandemic had produced 5,817,385 reported cases and 362,705 deaths worldwide. The United States accounted for 1,761,503 cases and 103,700 deaths in the aggregate counts that states and territories sent CDC each day. Earlier analyses had shown that people aged 65 and older and people with underlying health conditions faced higher risk of severe illness, and that severe outcomes were less common in children.
CDC first learned of a laboratory-confirmed U.S. case on January 22, 2020. Alongside the daily totals, health departments sent individual case reports, and this analysis drew on 1,320,488 laboratory-confirmed cases reported that way from the 50 states, New York City and the District of Columbia. The findings were descriptive, and no statistical comparisons were made.
The curve
Daily COVID-19 cases (A) and deaths (B) reported to CDC, January 20–May 30, 2020, with 7-day moving averages. CDC.
The 7-day average of new daily cases peaked on April 12 at 31,994, and the average of daily deaths peaked on April 21 at 2,856. By May 30 those averages had fallen to 19,913 cases and 950 deaths a day, a decline that still showed ongoing spread in communities. CDC's totals matched closely with those of the Johns Hopkins University Coronavirus Resource Center, which counted 1,770,165 U.S. cases and 103,776 deaths on May 30.
Who was infected
- Overall rate: 403.6 cases per 100,000 people, similar for women (406.0) and men (401.1).
- Age: the median age was 48. Rates were highest among people 80 and older (902.0), higher among those in their 40s (541.6) and 50s (550.5) than in their 60s (478.4) and 70s (464.2), and lowest among children 9 and younger (51.1). The authors suggest the lower rate in people 19 and younger may reflect milder or symptomless infections that went undiagnosed.
- Race and ethnicity: known for only 45% of cases. Among them, 36% were non-Hispanic white, 33% Hispanic, 22% non-Hispanic Black, 4% non-Hispanic Asian, 4% other or multiple races, 1.3% non-Hispanic American Indian or Alaska Native, and under 1% Native Hawaiian or other Pacific Islander. Hispanic, Black, and American Indian or Alaska Native people make up 18%, 13% and 0.7% of the U.S. population, so these groups were disproportionately affected. That matched hospital data from COVID-NET.
- Pregnancy: of 63,896 women aged 15–44 whose pregnancy status was known, 6,708 (11%) were pregnant.
Symptoms
Symptom status was reported for 616,541 cases, and only 22,007 (4%) of them had no symptoms. Early testing guidance focused on people with symptoms, so symptomless cases were likely missed. Among 373,883 cases with details on specific symptoms, 70% had fever, cough or shortness of breath, 36% had muscle aches, 34% had headache, and 8% (31,191 people) lost their sense of smell or taste. Among people 80 and older, 60% had fever, cough or shortness of breath, and no other symptom was reported by more than 10%.
Underlying conditions and outcomes
Among 287,320 cases with information on underlying conditions, the most common were cardiovascular disease (32%), diabetes (30%) and chronic lung disease (18%), with similar shares among men and women. Cardiovascular disease was uncommon under age 40 but appeared in about half of cases aged 70 and older.
Of all cases, 184,673 (14%) were hospitalized, 29,837 (2%) were admitted to intensive care, and 71,116 (5%) died. Having an underlying condition made a large difference:
| With a reported condition | Without | |
|---|---|---|
| Hospitalized | 45.4% | 7.6% |
| Died | 19.5% | 1.6% |
That is six times the hospitalization rate and 12 times the death rate. Men were more often hospitalized (16% versus 12%), admitted to intensive care (3% versus 2%) and more often died (6% versus 5%) than women. Intensive care admissions were highest among people with underlying conditions in their 60s (11%) and 70s (12%). Death was most common among people 80 and older, whether they had underlying conditions (50%) or not (30%).
Limits and lessons
The data capture only a part of all U.S. infections: not everyone was tested, and people could not always be reached for case interviews. Race and ethnicity were missing from 55% of reports, although completeness rose from 20% to more than 40% between April 2 and June 2. Missing data also mean the true share of people with particular symptoms and conditions is likely higher than reported, and outcomes were known for only part of the cases (46% for hospitalization, 14% for intensive care, 36% for death).
The authors noted that the surveillance systems behind these numbers had been built over decades for other diseases and were adapted quickly to a vast new threat. The pandemic exposed the limits of traditional case surveillance for real-time information, and they called for continued modernization, better data on underlying conditions and race and ethnicity, and community mitigation measures to slow spread, especially among the most vulnerable.
Sources
- Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 69(24); posted as an Early Release on June 15, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm
- Johns Hopkins University, COVID-19 dashboard, as cited by the report: https://coronavirus.jhu.edu/us-map
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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