May 11, 2023

End of COVID-19 Emergency Prompts Changes in CDC Monitoring Strategy

Monitoring the impact of COVID-19 and the effectiveness of prevention and control measures remains a priority for CDC despite the end of the national public health emergency on May 11, 2023, according to the agency’s May 5 Morbidity and Mortality Weekly Report (MMWR). Most sources of public health surveillance data for COVID-19 will remain available through a redesigned version of CDC’s COVID Data Tracker, which is set to launch today, the MMWR explains. CDC notes that authorizations to collect some data on COVID-19 will expire with the public health emergency. Other data sources will receive increased focus, some new sources will be added, and the frequency of reporting for some sources will change.

The U.S. Department of Health and Human Services declared the national public health emergency on Jan. 31, 2020, in response to the appearance of the novel SARS-CoV-2 virus. It was subsequently renewed 13 times. Throughout this period, CDC collected data on the presence and transmission of COVID-19 across the U.S. from a variety of sources. Since Dec. 15, 2022, these sources have included the National Healthcare Safety Network (NHSN), which required daily reporting of aggregate counts of patients admitted with laboratory-confirmed COVID-19 to acute care and critical access hospitals across the country. After May 11, NHSN data will continue to be available on the COVID Data Tracker and will provide “the primary surveillance indicator to help guide community and individual decisions related to risk and prevention behaviors,” CDC states. However, NHSN data will now be updated weekly instead of daily.

Another key change in CDC’s monitoring strategy is that data on COVID-19 mortality are now primarily sourced from the National Vital Statistics System (NVSS). The MMWR reports that processing of death certificate data from NVSS has become much timelier since the early stages of the pandemic, when NVSS data lagged behind other sources. The relaunched COVID Data Tracker will include an indicator showing the weekly percentage of deaths associated with COVID-19 among all deaths reported to NVSS, which is comparable to a corresponding influenza mortality indicator.

CDC will no longer report three types of data collected during the public health emergency: negative SARS-CoV-2 testing results via COVID-19 electronic laboratory reporting (CELR), national weekly totals for COVID-19 cases and associated deaths, and COVID-19 Community Levels (CCLs). While CELR data provided useful indication of SARS-CoV-2 transmission during the pandemic, the MMWR explains that CELR data has become reduced in quality or unavailable in many jurisdictions. CELR had reported SARS-CoV-2 nucleic acid amplification tests, the use of which has declined partly due to increased COVID-19 antigen and at-home testing. Similarly, aggregate counts of COVID-19 cases and deaths reported by health departments have become less representative of actual rates for SARS-CoV-2 infection or transmission levels, CDC says. NVSS data now provides a more up-to-date report of deaths from COVID-19. CCLs will also be discontinued, as these metrics were based partly on both CELR data and total weekly case counts. According to the MMWR, hospital admission levels from the NHSN closely align with CCLs. Discontinued data sources will be archived on the COVID Data Tracker.

The updated COVID Data Tracker will continue to provide data, metrics, and transmission levels within geographic areas, with trend visualizations and maps. The tracker will also continue to display estimated proportions of SARS-CoV-2 variants based on wastewater and genomic surveillance data, as well as data for vaccination, disease severity, health equity, priority populations, seroprevalence, and a range of other metrics. All changes to COVID-19 data sources and metrics, as well as their accessibility through the COVID Data Tracker, are summarized in two tables published in the MMWR.

“Although COVID-19 no longer poses the societal emergency that it did when it first emerged in late 2019,” the MMWR states, “COVID-19 remains an ongoing public health challenge.” About 1,000 deaths associated with COVID-19 were reported per week as of early April 2023. However, the MMWR asserts that deaths are largely preventable with updated COVID-19 vaccinations and timely administration of treatment. More information about changes in CDC monitoring after the end of the public health emergency may be found in the full MMWR.

According to a statement released on May 5, 2023, by the World Health Organization, the organization’s director-general has determined COVID-19 to be “an established and ongoing health issue which no longer constitutes a public health emergency of international concern.” The director-general’s position agrees with that of the WHO International Health Regulations Emergency Committee, which cited decreasing trends in deaths, hospitalizations, and intensive care unit admissions associated with COVID-19 in its recommendation to transition to long-term management of the pandemic.