Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
COVID-19 is an ongoing public health problem that will be monitored with sustainable data sources to guide prevention efforts.
An early release in the CDC’s May 5, 2023 Morbidity and Mortality Weekly Report (MMWR), COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration ― United States, May 11, 2023 to identify authorizations to collect certain public health data that expire at the end of the U.S. public health emergency declaration on May 11, 2023 and provide information on the 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.
Most COVID-19 surveillance data sources will continue to be available after the public health emergency declaration ends on May 11; the reporting cadence of some will change, and three will be discontinued (Table 1). Since December 15, 2022, daily reporting to CDC’s National Healthcare Safety Network (NHSN) of aggregate counts of patients with laboratory-confirmed COVID-19 admitted to acute care and critical access U.S. hospitals has been required. After the public health emergency ends on May 11, 2023, a switch to a weekly cadence of national reporting will affect data processing and introduce reporting lag. NSHN data on COVID-19 hospital admissions per 100,000 population will be the primary surveillance indicator to help guide community and individual decisions related to risk and prevention behaviors. These data have similar suitability for tracking local COVID-19 activity as do COVID-19 Community Levels (CCLs) and will be updated weekly on COVID Data Tracker at the county, state, regional, and national levels.
To continue facilitating access to national COVID-19 surveillance data, a first-phase, redesigned COVID Data Tracker website will launch on May 11, 2023. These data will continue providing an evidence base of information to guide prioritization of public health action. Numerous surveillance data sources and corresponding metrics and geographic levels will be updated weekly on COVID Data Tracker, with visualizations of trends and maps (Table 2). County-level hospitalization data will continue to include metrics on COVID-19–associated admissions and inpatient and ICU bed occupancy. Metrics for COVID-19–associated deaths (state-level), ED visits for COVID-19 (state-level), and percentage of positive SARS-CoV-2 test results (HHS region-level) will also be displayed. Metric levels will be anchored to levels of hospital admission rates used in the CCLs. The COVID Data Tracker will also continue to display SARS-CoV-2 variant proportion estimates and wastewater and traveler-based genomic surveillance data, as well as vaccination data and health care data on disease severity. In addition, availability of priority data will continue after May 11, 2023, for health equity, pediatric and special populations (e.g., vaccination coverage among persons who are pregnant and those with disabilities), health care settings (e.g., nursing home residents), and seroprevalence. SARS-CoV-2 infections remain nationally notifiable, and line-level COVID-19 case surveillance data will continue to be available, including public use data at https://data.cdc.gov.
After the expiration of the public health emergency on May 11, 2023, authorizations to collect certain types of public health data expire (Table 1). The COVID Data Tracker includes a page for accessing archived data. HHS can no longer require reporting of negative SARS-CoV-2 testing results via CELR reporting. This change removes the ability to monitor the national percentage of positive SARS-CoV-2 test results using the CELR data source. CELR data served as a useful early indicator of SARS-COV-2 transmission during the pandemic. However, since a peak of approximately 17.4 million NAATs performed weekly in January 2022, coinciding with the SARS-CoV-2 Omicron variant surge, the reported weekly volume of NAATs performed declined to less than 1 million by April 26, 2023. This decline is related in part to increased use of antigen tests as well as at-home testing. The CELR data have become more variable in quality or altogether unavailable in many jurisdictions over time. CDC’s COVID-19 Community Transmission Levels, which were derived, in part, from CELR data, also will be discontinued.
National reporting of aggregate weekly counts of COVID-19 cases and associated deaths, which CDC compiles using automated data extraction from jurisdictional websites and dashboards and direct submissions, will also be discontinued with the expiration of the public health emergency. This transition is consistent with many state and local health authorities’ decisions to discontinue public reporting of these data. Aggregate counts of COVID-19 cases have been useful for monitoring changing trends in incidence but have become less representative of actual rates of SARS-CoV-2 infections or levels of transmission over time, related to decreased laboratory testing, increased home testing, changes in reporting practices, and asymptomatic infections. Early in the pandemic, aggregate reporting from health departments provided more up-to-date counts of total deaths than did NVSS, but the timeliness of NVSS is now comparable with that of the aggregate counts. As part of the shift from reporting of aggregate death count data to use of NVSS data, date of death will be used rather than report date.
CCLs are based on a composite metric that includes COVID-19 hospital admission rates, inpatient bed utilization among patients with COVID-19, and case rates derived from aggregate reporting of case counts by jurisdictions. Because aggregate weekly case counts will end, CCLs also will end on May 11, 2023. Hospital admissions levels from NHSN closely align with CCLs and will replace the CCL metric. Monthly reporting of case, hospitalization, and mortality rates by vaccination status will end with the expiration of the public health emergency.
Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies continues to be a public health priority during the transition from the emergency phase of the COVID-19 response to routine public health practice.
This MMWR publication can also be found here – the Briggs COVID-19 Resource Center.