Morbidity and Mortality Weekly Report

Decreases in COVID-19 Cases, Emergency Department Visits, Hospital

Admissions, and Deaths Among Older Adults Following the Introduction of
COVID-19 Vaccine — United States, September 6, 2020–May 1, 2021
Athalia Christie, MIA1; S. Jane Henley, MSPH1; Linda Mattocks, MPH1; Robyn Fernando, MPH1; Amy Lansky, PhD1; Farida B. Ahmad, MPH1;
Jennifer Adjemian, PhD1; Robert N. Anderson, PhD1; Alison M. Binder, MS1; Kelly Carey, MPH1; Deborah L. Dee, PhD1; Taylor Dias, MPH1;
William M. Duck, MPH1; Denise M. Gaughan, ScD1; Brianna Casey Lyons, MPH1; A.D. McNaghten, PhD1; Meeyoung M. Park, MPH1;
Hannah Reses, MPH1; Loren Rodgers, PhD1; Katharina Van Santen, MSPH1; David Walker, MPH1; Michael J. Beach, PhD1

On June 8, 2021, this report was posted as an MMWR Early from CDC’s case-based surveillance system† as reported by
Release on the MMWR website (https://www.cdc.gov/mmwr). jurisdictional health departments. Daily ED visits for patients
Throughout the COVID-19 pandemic, older U.S. adults with a diagnosis of COVID-19§ (COVID-19 ED visit) were
have been at increased risk for severe COVID-19–associated obtained from the National Syndromic Surveillance Program.
illness and death (1). On December 14, 2020, the United States Daily admissions data on persons newly admitted to a hospital
began a nationwide vaccination campaign after the Food and with a laboratory-confirmed COVID-19 diagnosis at the time
Drug Administration’s Emergency Use Authorization of Pfizer- of admission (COVID-19 hospital admission) were obtained
BioNTech COVID-19 vaccine. The Advisory Committee on from the U.S. Department of Health and Human Services
Immunization Practices (ACIP) recommended prioritizing (HHS) Unified Hospital dataset.¶ Weekly COVID-19 death
health care personnel and residents of long-term care facilities, data were collected from CDC’s National Vital Statistics
followed by essential workers and persons at risk for severe System.** U.S. Census Bureau midyear 2019 population
illness, including adults aged ≥65 years, in the early phases estimates (as of July 1, 2020)†† were used to calculate vacci-
of the vaccination program (2). By May 1, 2021, 82%, 63%, nation, case, hospital admission, and death rates per 100,000
and 42% of persons aged ≥65, 50–64, and 18–49 years, population. ED visits were shown as visits with a COVID-19
respectively, had received ≥1 COVID-19 vaccine dose. CDC diagnosis per 100,000 ED visits reported.
calculated the rates of COVID-19 cases, emergency depart-
†
ment (ED) visits, hospital admissions, and deaths by age group CDC official counts of COVID-19 cases and deaths, released daily at https://
covid.cdc.gov/covid-data-tracker, are aggregate counts from reporting
during November 29–December 12, 2020 (prevaccine) and jurisdictions. Some jurisdictions electronically submit standardized
April 18–May 1, 2021. The rate ratios comparing the oldest age information for individual cases of COVID-19 to CDC via a case report form
groups (≥70 years for hospital admissions; ≥65 years for other developed for the CDC COVID-19 response (https://www.cdc.gov/
coronavirus/2019-ncov/php/reporting-pui.html) or via the CDC National
measures) with adults aged 18–49 years were 40%, 59%, 65%, Notifiable Diseases Surveillance System (https://www.cdc.gov/nndss/action/
and 66% lower, respectively, in the latter period. These dif- covid-19-response.html). Individual-level case report data were available for
ferential declines are likely due, in part, to higher COVID-19 approximately 80% of the aggregate number of confirmed cases.
§ The National Syndromic Surveillance Program collects electronic health data,
vaccination coverage among older adults, highlighting the including ED visits with confirmed COVID-19 diagnoses, from a subset of
potential benefits of rapidly increasing vaccination coverage. hospitals in 49 states (all but Hawaii) and the District of Columbia (71% of
nonfederal EDs in the United States). ED visits for COVID-19 are defined
CDC analyzed the age distribution of COVID-19 vaccina- as ED visits with any of the following: International Classification of Diseases,
tion during December 14, 2020–May 1, 2021. To visualize Tenth Revision codes U07.1 or J12.82 or Systematized Nomenclature of
trends before and after vaccine introduction, rates of reported Medicine codes 840539006, 840544004, or 840533007. https://www.cdc.
gov/nssp/overview.html
COVID-19 cases, ED visits, hospitalizations, and deaths by ¶ The HHS Unified Hospital dataset includes data reported by hospitals
age group are presented for September 6, 2020–May 1, 2021. registered with the Centers for Medicare & Medicaid Services. Data, including
Daily data about COVID-19 vaccine doses administered in the counts of new hospital admissions of patients with confirmed COVID-19 by
age group, are reported to HHS either directly from facilities or via a state
United States, including partial and full vaccination, were col- submission; on May 1, 2021, 98.5% of hospitals reported data. This analysis
lected by vaccination providers and reported to CDC through includes Veterans Administration, Defense Health Agency, and Indian Health
multiple sources.* Daily COVID-19 case data were obtained Services hospitals and excludes psychiatric, rehabilitation, and religious
nonmedical hospitals. https://www.hhs.gov/sites/default/files/covid-19-faqs-
hospitals-hospital-laboratory-acute-care-facility-data-reporting.pdf
* COVID-19 vaccine administration data are reported to CDC by multiple entities ** COVID-19 deaths include deaths for which COVID-19 was listed on the
using immunization information systems, the Vaccine Administration Management death certificate as a confirmed or presumed underlying cause of death or
System, pharmacy systems, or direct submission of electronic health records. (https:// contributing cause of death (ICD-10 code U07.1). https://www.cdc.gov/nchs/
www.cdc.gov/coronavirus/2019-ncov/vaccines/distributing/about-vaccine-data. nvss/vsrr/covid19/tech_notes.htm
html). Persons were considered fully vaccinated if they received the second dose in †† https://www.census.gov/data/tables/time-series/demo/popest/2010s-national-
a 2-dose COVID-19 vaccine series (Pfizer-BioNTech or Moderna) or 1 dose of the detail.html
single-dose Janssen (Johnson and Johnson) COVID-19 vaccine.

858 MMWR / June 11, 2021 / Vol. 70 / No. 23 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

To assess differences by age, CDC calculated the weekly During September 6, 2020–May 1, 2021, COVID-19 ED
proportion, rate, and rate ratio by age group for COVID-19 visits per 100,000 ED visits peaked among all age groups during
outcomes, including cases, ED visits, hospital admissions, the week of January 3–January 9, 2021, approximately 1 week
and deaths.§§ Trends were examined by plotting weekly after the peak in incidence (Figure 2). The weekly rate ratio of
rates by age group and rate ratios comparing persons aged COVID-19 ED visits among older adults to younger adults was
≥65 years (≥70 years for hospital admissions¶¶) with those highest in mid-January and then declined. Compared with the
aged 18–49 years during September 6, 2020–May 1, 2021. prevaccination period of November 29–December 12, 2020,
Differences in age group–specific average weekly proportions, COVID-19 ED visits per 100,000 ED visits during April 18–
rates, and rate ratios for COVID-19 outcomes were compared May 1, 2021, were 59% lower among all adults, with a larger
during two periods: November 29–December 12, 2020 (pre- change for persons aged ≥65 years (77%) than for other age
vaccine) and April 18–May 1, 2021 (most recent data avail- groups (Table). During November 29–December 12, 2020,
able, accounting for reporting lag); 95% confidence intervals and April 18–May 1, 2021, persons aged ≥65 years accounted
(CIs) and p values for these differences and for rate ratios were for 37.9% and 20.7%, respectively, of adult COVID-19 ED
constructed by applying the parametric bootstrap method to visits. The rate ratio of COVID-19 ED visits per 100,000
10,001 replicate pseudosamples (3). Analyses were conducted ED visits among persons aged ≥65 years to those among per-
using R software (version 4.0.0; R Foundation). These activities sons aged 18–49 years decreased 59% (p<0.001) from 1.99
were reviewed by CDC and were conducted consistent with (95% CI = 1.96–2.01) to 0.82 (95% CI = 0.80–0.84).
applicable federal law and CDC policy.*** Rates of COVID-19 hospital admissions peaked during the
COVID-19 vaccine administration increased from introduc- week of January 3–January 9, 2021, approximately 1 week
tion on December 14, 2020, to a peak 7-day moving average after case incidence peaked (Figure 2). The trend in the
of 3.3 million doses per day in mid-April before decreasing to weekly rate ratio of COVID-19 hospital admissions among
2.2 million doses per day by May 1, 2021 (Figure 1). Among older adults to younger adults followed a similar pattern as
persons aged ≥65 years, 25% had received ≥1 vaccine dose by ED visits. Compared with hospital admissions during the
February 6, 2021, 50% by March 3, 2021, and 82% by the prevaccination period of November 29–December 12, 2020,
end of the analysis period, May 1, 2021 (Figure 1). Among adult COVID-19 hospital admissions rates were 63% lower
persons aged 18–49 years, 7%, 10%, and 42% had received among all adults, with the largest change (78%) among adults
≥1 vaccine dose by the same dates, respectively. By May 1, aged ≥65 years, during April 18–May 1, 2021. Although
2021, 69% of persons aged ≥65 years and 26% of persons COVID-19 admissions remained highest among persons
18–49 years were fully vaccinated. aged ≥70 years, the proportion of adult COVID-19 hospital
COVID-19 incidence increased in all age groups during admissions among this age group decreased from 45.6%
September 6, 2020–January 2, 2021, and then decreased during November 29–December 12, 2020, to 27.6% dur-
(Figure 2). The weekly rate ratio of COVID-19 incidence among ing April 18–May 1, 2021 (p<0.001) (Table). The rate ratio
older adults to younger adults was highest in late December of COVID-19 hospital admission rates among persons aged
and then declined. Compared with the prevaccination period ≥70 years to those among persons aged 18–49 years decreased
of November 29–December 12, 2020, COVID-19 incidence 65% (p<0.001) from 9.60 (95% CI = 9.45–9.76) to 3.33
during April 18–May 1, 2021, was 69% lower among all adults, (95% CI = 3.26–3.41) (p<0.001).
and 79%, 71%, and 66% lower among persons aged ≥65, During September 6, 2020–May 1, 2021, weekly COVID-19
50–64, and 18–49 years respectively (Table). The proportion of death rates peaked between January 3–January 16, 2021, among
COVID-19 cases diagnosed in persons aged ≥65 years decreased all age groups and then decreased through May 1, 2021 (Figure 2).
from 16.0% to 10.7% (p<0.001). The rate ratio of COVID-19 The weekly rate ratio of COVID-19 deaths among older adults
incidence among persons aged ≥65 years to that among per- to those among younger adults was highest in mid-December
sons aged 18–49 years decreased 40% (p<0.001) from 0.68 and then declined. Mortality remained highest for persons aged
(95% CI = 0.67–0.68) to 0.40 (95% CI = 0.40–0.41) (p<0.001). ≥65 years; however, the proportion of COVID-19 deaths that
occurred among this age group decreased from 84.2% during
§§ Patient age was unknown for 8% of vaccinated persons, 0.7% of cases, 0.4% the prevaccination period of November 29–December 12, 2020,
of ED visits, 4% of hospital admissions, and <0.01% of deaths. to 68.0% during April 18–May 1, 2021 (p<0.001) (Table).
¶¶ Hospital admissions were submitted by predefined age group (<18 years,
18–19 years, 10-year age groups from 20–79 years, and ≥80 years) and could The rate ratio of COVID-19 death rates among persons aged
not be aggregated from single year of age as was done for cases, ED visits, ≥65 years to those among persons aged 18–49 years decreased
and deaths. 66% (p<0.001) from 66.93 (95% CI = 62.11–72.29) to 22.43
*** 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect.
552a; 44 U.S.C. Sect. 3501 et seq. (95% CI = 20.17–25.18).

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / June 11, 2021 / Vol. 70 / No. 23 859
 Morbidity and Mortality Weekly Report

FIGURE 1. Average daily* number of total COVID-19 vaccine doses administered and cumulative percentage of adults aged ≥18 years who
received ≥1 dose and who were fully vaccinated, by age group† — United States,§ December 14, 2020–May 1, 2021
At least 1 dose ≥65 yrs At least 1 dose 50–64 yrs At least 1 dose 18–49 yrs
Fully vaccinated ≥65 yrs Fully vaccinated 50–64 yrs Fully vaccinated 18–49 yrs
Average daily doses
100 3,500,000
Percentage ≥1 vaccine dose February 6 March 3 May 1
≥65 yrs 25% 50% 82%
18–49 yrs 7% 10% 42%
90
3,000,000

No. of COVID-19 vaccine doses administered (7-day moving average)

80
Cumulative percentage of persons vaccinated

2,500,000
70

60
2,000,000

50

1,500,000
40

30
1,000,000

20

500,000
10

0 0
Dec 14 Dec 28 Jan 11 Jan 25 Feb 8 Feb 22 Mar 8 Mar 22 Apr 5 Apr 19 May 1
Date of COVID-19 dose administration
Sources: COVID-19 Vaccination Trends in the United States, https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-Trends-in-the-United-States-N/rh2h-3yt2 and
COVID-19 Vaccination Demographics in the United States, https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-Demographics-in-the-United-St/km4m-vcsb;
accessed May 26, 2021.
* Based on 7-day moving average.
† Age was unknown for 8% of fully vaccinated persons.
§ Texas does not report demographic-specific dose number information to CDC, so data for Texas are not represented in cumulative percentage of population vaccinated.

Discussion stable or increasing. The ratio for COVID-19 deaths began

Weekly COVID-19 incidence among adults increased to decline in mid-December while rate ratios for COVID-19
during September 6, 2020–January 2, 2021. After this peak, incidence, ED visits, and hospital admissions began to decline
incidence, followed by rates of ED visits, hospital admissions, in late December to mid-January. Comparing the 2-week pre-
and deaths declined among all adult age groups. During vaccination period with 2 weeks in late April, declines were
September 6–December 14, 2020, before the commence- significantly greater among older adults, who had higher vac-
ment of vaccine administration, the rate ratios of COVID-19 cination coverage, than among younger adults, who had lower
outcomes among older adults to younger adults were either coverage. These age-stratified results provide ecologic evidence

860 MMWR / June 11, 2021 / Vol. 70 / No. 23 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

FIGURE 2. Weekly COVID-19 rates (A),*,†,§ emergency department visits for patients with a diagnosis of COVID-19 (B),¶ hospital admissions
with confirmed COVID-19 diagnosis (C),**,†† and COVID-19 deaths (D)§§,¶¶ among adults, by age group, and rate ratio for persons aged ≥65 or
≥70 years versus 18–49 years — United States, September 6, 2020–May 1, 2021

A. Weekly rate of COVID-19 cases, by age group, and rate ratio for persons B. Weekly ED visits for patients diagnosed with COVID-19 per 100,000 ED visits, by
aged ≥65 yrs vs those aged 18–49 yrs age group, and rate ratio for persons aged ≥65 yrs vs those aged 18–49 yrs

18–49 50–64 ≥65 Rate ratio 18–49 50–64 ≥65 Rate ratio

Weekly ED visits for patients diagnosed with COVID-19 per 100,000 ED visits
Percentage ≥1 vaccine dose Feb 6 Mar 3 May 1 Percentage ≥1 vaccine dose Feb 6 Mar 3 May 1
600 Dec 14 ≥65 yrs 25% 50% 82% ≥65 yrs 25% 50% 82%
0.8 Dec 14
vaccine administration 18–49 yrs 7% 10% 42% vaccine administration 18–49 yrs 7% 10% 42%
commences 12,000 commences 2.5
Weekly COVID-19 cases per 100,000 persons

0.7
500
10,000

Ratio ≥65 yrs vs 18–49 yrs

0.6 2.0

Ratio ≥65 yrs vs 18–49 yrs

400
0.5 8,000
1.5
300 0.4
6,000
0.3
200 1.0
4,000
0.2

100
0.1 0.5
2,000

0 0.0
Sep 12 Oct 10 Nov 7 Dec 5 Jan 2 Jan 30 Feb 27 Mar 27 Apr 24 0 0.0
End of reporting week Sep 12 Oct 10 Nov 7 Dec 5 Jan 2 Jan 30 Feb 27 Mar 27 Apr 24
End of reporting week

C. Weekly rate of hospital admissions with confirmed COVID-19 diagnosis, by D. Provisional weekly rate of COVID-19 deaths, by age group, and rate ratio
age group, and rate ratio for persons aged ≥70 yrs vs those aged 18–49 yrs for persons aged ≥65 yrs vs those aged 18–49 yrs
Weekly hospital admissions with COVID-19 diagnosis per 100,000 persons

18–49 50–64 ≥65 Rate ratio 18–49 50–64 ≥65 Rate ratio

Percentage ≥1 vaccine dose Feb 6 Mar 3 May 1 Percentage ≥1 vaccine dose Feb 6 Mar 3 May 1
Dec 14 ≥65 yrs 25% 50% 82% Dec 14 ≥65 yrs 25% 50% 82%
160 11 45 80
vaccine administration 18–49 yrs 7% 10% 42% vaccine administration 18–49 yrs 7% 10% 42%
Weekly COVID-19 deaths per 100,000 persons

commences commences
10 40
140 70
9
35
120 60
Ratio ≥70 yrs vs 18–49 yrs

Ratio ≥65 yrs vs 18–49 yrs

8
30
100 7 50

6 25
80 40
5 20
60 4 30
15
3
40 20
10
2
20 5 10
1

0 0 0 0
Sep 12 Oct 10 Nov 7 Dec 5 Jan 2 Jan 30 Feb 27 Mar 27 Apr 24 Sep 12 Oct 10 Nov 7 Dec 5 Jan 2 Jan 30 Feb 27 Mar 27 Apr 24
End of reporting week End of reporting week

See figure footnotes on the next page.

US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / June 11, 2021 / Vol. 70 / No. 23 861
 Morbidity and Mortality Weekly Report

FIGURE 2. (Continued) Weekly COVID-19 rates (A),*,†,§ emergency department visits for patients with a diagnosis of COVID-19 (B),¶ hospital
admissions with confirmed COVID-19 diagnosis (C),**,†† and COVID-19 deaths (D)§§,¶¶ among adults, by age group, and rate ratio for persons
aged ≥65 or ≥70 and 18–49 years — United States, September 6, 2020–May 1, 2021
Sources: CDC’s case-based COVID-19 surveillance system, accessed May 26, 2021 (A); National Syndromic Surveillance Program; accessed May 26, 2021 (B); U.S.
Department of Health and Human Services Unified Hospital dataset, accessed May 26, 2021 (C); National Vital Statistics System, accessed May 26, 2021 (D).
Abbreviation: ED = emergency department.
* COVID-19 cases per 100,000 persons.
† Case classifications for COVID-19 are described in https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2020-08-05 and https://www.cdc.gov/
coronavirus/2019-ncov/covid-data/faq-surveillance.html.
§ Demographic data are based on a subset of COVID-19 cases for whom case-level data have been reported by state and territorial jurisdictions, accounting for
approximately 80% of all cases reported to CDC. Patient age was unknown for 0.7% of cases.
¶ ED visits are shown as visits for patients with a diagnosis of COVID-19 per 100,000 ED visits reported. ED visits for patients with a diagnosis of COVID-19 are defined
as ED visits with any of the following: International Classification of Diseases, Tenth Revision codes U07.1 or J12.82 or Systematized Nomenclature of Medicine
840539006, 840544004, or 840533007. Patient age was unknown for 0.4% of ED visits.
** Hospital admissions with confirmed COVID-19 diagnosis per 100,000 persons.
†† Dataset includes data reported by hospitals registered with the Centers for Medicare & Medicaid Services. Data were reported to the U.S. Department of Health
and Human Services directly from facilities or via a state submission; on May 1, 2021, 98.5% of hospitals reported. This analysis includes Veterans Administration,
Defense Health Agency, and Indian Health Services hospitals and excludes psychiatric, rehabilitation, and religious nonmedical hospitals. Patient age was unknown
for 4% of hospital admissions.
§§ COVID-19 deaths per 100,000 persons.
¶¶ Deaths with confirmed or presumed COVID-19 as an underlying or contributing cause of death, with International Classification of Diseases, Tenth Revision code
U07.1. Provisional data are incomplete. Decedent age was unknown for <0.01% of deaths.

of the likely contribution of vaccination coverage to reducing recommended therapeutics (9), and the implementation and
COVID-19 outcomes. relaxation of community-level prevention policies in individual
These data are consistent with other preliminary reports jurisdictions. However, by analyzing the relative changes in
showing a reduction in COVID-19 cases and severe illness ratios comparing rates between older and younger age groups,
in populations with high vaccination coverage. An ecologic these results were less likely to be influenced by population
study from Israel found the ratio of COVID-19 patients aged effects that might have affected all age groups similarly. Finally,
≥70 years requiring mechanical ventilation to those aged no attempt was made to quantify the percentage of these dif-
<50 years declined 67% within 3 months of a nationwide vac- ferential rate ratio changes that were potentially attributable to
cination campaign prioritizing persons aged >60 years (4). In vaccination. The decline in the rate ratio for deaths between
separate studies analyzing Israeli surveillance data, COVID-19 older and younger adults, for example, began just after vaccine
incidence, hospitalizations, and deaths markedly declined introduction; therefore, vaccine coverage can account for only
across all age groups as cumulative vaccination coverage part of the decline. Time trend analyses, and other analytic
increased (5), and vaccine effectiveness of 46% for COVID-19 approaches, might enhance understanding of the impact of
infection, 74% for hospitalization, and 72% for death, was vaccination on population-level dynamics.
observed during 14–20 days after the first dose (6). A CDC From November 29, 2020, to May 1, 2021, COVID-19
evaluation at 24 hospitals found that receipt of COVID-19 incidence, ED visits, hospital admissions, and deaths declined
vaccine was 64% effective against COVID-19 hospitalization more in older adults, who had higher vaccination coverage,
among partially vaccinated adults aged ≥65 years and 94% than in younger adults, who had lower coverage. Despite suf-
effective among fully vaccinated adults aged ≥65 years (7). ficient vaccine supply and expanding eligibility, administration
The findings in this report are subject to at least five limita- of COVID-19 vaccines has steadily declined in adults since
tions. First, this was an ecologic analysis based on aggregated mid-April 2021. These results suggest that tailored efforts by
data that does not account for variability in reporting or state and local jurisdictions to rapidly increase vaccine cover-
vaccination coverage among jurisdictions, between rural and age among all eligible age groups could contribute to further
urban areas, or by race and ethnicity. Second, states and ter- reductions in COVID-19 cases and severe outcomes. Such
ritories adapted ACIP recommendations (8); therefore, the efforts include effectively communicating the benefits of vacci-
populations eligible and timing of each vaccination phase nation, ensuring equitable access and convenience, empowering
varied across jurisdictions. Third, the case, ED, and hospital trusted messengers, including primary health care providers, and
data are subsets of total outcomes, and all data are subject to engaging communities.
reporting inconsistencies and delays. Fourth, the analysis does
Acknowledgment
not account for concomitant effects, including the spread
of more transmissible SARS-CoV-2 variants, the general Chad Heilig, Center for Surveillance, Epidemiology, and
surge and subsequent decline in COVID-19 cases, the use of Laboratory Services, CDC.

862 MMWR / June 11, 2021 / Vol. 70 / No. 23 US Department of Health and Human Services/Centers for Disease Control and Prevention
 Morbidity and Mortality Weekly Report

TABLE. Number, proportion, rate,* and rate ratio of COVID-19 cases,† emergency department visits for patients with a diagnosis of COVID-19,§
hospital admissions with a confirmed COVID-19 diagnosis, and COVID-19 deaths¶ among adults aged ≥18 years, by age group, for selected
2-week periods — United States, November 29–December 12, 2020, and April 18–May 1, 2021
Change from November 29–December 12, 2020 to
April 18–May 1, 2021
Period, COVID-19 Rate ratio comparing older age
outcome, and Average weekly no. Average weekly groups with age 18–49 yrs Absolute change Relative change Relative change
age group (yrs) (% by age group) outcome per 100,000 (95% CI) ** in proportion in rate, % in rate ratio, %
November 29–December 12, 2020 (prevaccine administration)
Cases 964,697 (100.0) 378 N/A N/A N/A N/A
≥65 154,829 (16.0) 286 0.68 (0.67–0.68) N/A N/A N/A
50–64 225,715 (23.4) 359 0.85 (0.85–0.85) N/A N/A N/A
18–49 584,154 (60.6) 423 1.0 (referent) N/A N/A N/A
ED visits 108,689 (100.0) 6,409 N/A N/A N/A N/A
≥65 41,208 (37.9) 9,008 1.99 (1.96–2.01) N/A N/A N/A
50–64 28,537 (26.3) 7,513 1.66 (1.64–1.68) N/A N/A N/A
18–49 38,945 (35.8) 4,536 1.0 (referent) N/A N/A N/A
Hospital admissions 90,349 (100.0) 35 N/A N/A N/A N/A
≥70 41,178 (45.6) 112 9.60 (9.45–9.76) N/A N/A N/A
50–69 32,976 (36.5) 41 3.50 (3.45–3.56) N/A N/A N/A
18–49 16,195 (17.9) 12 1.0 (referent) N/A N/A N/A
Deaths 19,666 (100.0) 7.7 N/A N/A N/A N/A
≥65 16,557 (84.2) 30.6 66.93 (62.11–72.29) N/A N/A N/A
50–64 2,477 (12.6) 3.9 8.60 (7.92–9.38) N/A N/A N/A
18–49 633 (3.2) 0.5 1.0 (referent) N/A N/A N/A
April 18–May 1, 2021 (most recent data available at time of report, allowing time for reporting lag)
Cases 297,618 (100.0) 117 N/A N/A −69†† N/A
≥65 31,802 (10.7) 59 0.40 (0.40–0.41) −5.4†† −79†† −40††
50–64 64,796 (21.8) 103 0.71 (0.70–0.71) −1.6†† −71†† −17††
18–49 201,021 (67.5) 145 1.0 (referent) 7.0†† −66†† N/A
ED visits 46,308 (100.0) 2,628 N/A N/A −59†† N/A
≥65 9,580 (20.7) 2,093 0.82 (0.80–0.84) −17.2†† −77†† −59††
50–64 13,449 (29.0) 3,437 1.35 (1.33–1.37) 2.8†† −54†† −19††
18–49 23,280 (50.3) 2,550 1.0 (referent) 14.4†† −44†† N/A
Hospital admissions 33,600 (100.0) 13 N/A N/A −63†† N/A
≥70 9,260 (27.6) 25 3.33 (3.26–3.41) −18.0†† −78†† −65††
50–69 13,850 (41.2) 17 2.27 (2.22–2.32) 4.7†† −58†† −35††
18–49 10,490 (31.2) 8 1.0 (referent) 13.3†† −35†† N/A
Deaths 3,918 (100.0) 1.5 N/A N/A −80†† N/A
≥65 2,663 (68.0) 4.9 22.43 (20.17–25.18) −16.2†† −84†† −66††
50–64 952 (24.3) 1.5 6.89 (6.12–7.82) 11.7†† −62†† −20
18–49 304 (7.7) 0.2 1.0 (referent) 4.5†† −52†† N/A
Sources: CDC’s case-based COVID-19 surveillance system, National Syndromic Surveillance Program, U.S. Department of Health and Human Services Unified Hospital
dataset, National Vital Statistics System; accessed May 26, 2021.
Abbreviations: CI = confidence interval; ED = emergency department; ICD-10 = International Classification of Diseases, Tenth Revision; N/A = not applicable.
* COVID-19 cases, hospital admissions with confirmed COVID-19 diagnosis, and COVID-19 deaths per 100,000 persons and ED visits for patients with a diagnosis of
COVID-19 per 100,000 ED visits.
† The case classifications for COVID-19 are described in an updated interim COVID-19 position statement and case definition issued by the Council of State and
Territorial Epidemiologists on August 5, 2020 (https://ndc.services.cdc.gov/case-definitions/coronavirus-disease-2019-2020-08-05). However, some variation in
how jurisdictions implement these case classifications was observed. More information on how CDC collects COVID-19 case surveillance data can be found at
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/faq-surveillance.html.
§ ED visits for COVID-19 are defined as ED visits with any of the following: ICD-10 codes U07.1 or J12.82 or Systematized Nomenclature of Medicine codes 840539006,
840544004, or 840533007.
¶ Deaths with confirmed or presumed COVID-19 as an underlying or contributing cause of death with ICD-10 code U07.1. Provisional data are incomplete. Data from
May 2021 are less complete because of reporting lags.
** CIs and p values were constructed using the parametric bootstrap method using 10,001 replicate pseudosamples. CIs were formed using the quantiles of the
bootstrap distributions, and p values were based on the proportion of pseudosample values below the 0.025 or above the 0.975 quantile.
†† The change in measure from November 29–December 12, 2020, to April 18–May 1, 2021, was statistically significantly different (p<0.001).

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864 MMWR / June 11, 2021 / Vol. 70 / No. 23 US Department of Health and Human Services/Centers for Disease Control and Prevention