Estimated Burden of COVID-19 Illnesses, Medical Visits, Hospitalizations, and Deaths in the US From October 2022 to September 2024
Emilia H. A. Koumans, Diba Khan, Imelda Trejo, Li Deng, Owen Devine, Sarah E. Smith-Jeffcoat, Sarah Hamid, Monica E. Patton, Emily Carter, Megha Aggarwal, Huong Thi Lan Pham, Kadam Patel, Michael Whitaker, Ryan E. Wiegand, Cria O. Gregory, Ismael R. Ortega‐Sanchez, Gordana Derado, A. Danielle Iuliano, Carrie Reed, A. E. Hall, Christopher A. Taylor, Fiona G Havers, Estimate of Burden of COVID-19 Workgroup, Bridget J. Anderson, Edwin J. Asturias, Natalie M. Bowman, Shua J. Chai, Helen Y. Chu, Kathryn Como‐Sabetti, Katherine Ellingson, Christina B. Felsen, Carlos G. Grijalva, Mary Hill, Breanna Kawasaki, Karen Lutrick, Yvonne Maldonado, Emily Martin, Arnold S. Monto, Kerry Grace Morrissey, Allison L. Naleway, Huong Q. Nguyen, Julie Plano, Suchitra Rao, Patricia Ryan, Daniel M. Sosin, Melissa S. Stockwell, Melissa Sutton, H. Keipp Talbot, Lucy S. Witt
Abstract
Importance: Since 2020, COVID-19 has dramatically impacted the US population and health care system. Reporting requirements, circulating variants, testing practices, and population immunity from vaccination and previous infections evolved as the COVID-19 pandemic progressed. Evidence-based public health policy and resource allocation decisions require current estimates of disease burden. Objective: To estimate the age group-specific burden of COVID-19-associated illnesses, outpatient visits, hospitalizations, and deaths in the US from October 2022 to September 2024. Design, Setting, and Participants: In this cross-sectional study, hierarchical Bayesian modeling, adjusting for underdetection of SARS-CoV-2 due to testing practices and test sensitivity, was applied to hospitalization data from the population-based COVID-19 Hospitalization Surveillance Network (COVID-NET) database, which includes 89 counties and jurisdictional equivalents in 12 states covering approximately 10% of the US population. Data from 94 363 participants from October 2022 to September 2023 (surveillance period, 2022-2023) and from 72 176 participants from October 2023 to September 2024 (surveillance period, 2023-2024) were included, and probabilistic mathematical multiplier models estimated counts of deaths, outpatient visits, and symptomatic illnesses incorporating literature and study-based multipliers. Data were modeled from April 2024 to September 2025. Exposures: COVID-NET patients with a laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test result within 14 days before or during hospitalization. Main Outcomes and Measures: Estimated national counts with 95% uncertainty intervals (UIs) of outpatient visits, illnesses, hospitalizations, and deaths by age group. Results: In 2022-2023, there were an estimated 43.6 million (95% UI, 25.3-64.0 million) COVID-19-associated illnesses, 10.0 million (95% UI, 7.0-13.1 million) outpatient visits, 1.1 million (95% UI, 0.9-1.4 million) hospitalizations, and 101 300 (95% UI, 73 600-132 500) deaths. In 2023-2024, there were an estimated 33.0 million (95% UI, 20.2-49.0 million) COVID-19-associated illnesses, 7.7 million (95% UI, 5.5-9.9 million) outpatient visits, 879 100 (95% UI, 738 600-1 039 000) hospitalizations, and 100 800 (95% UI, 64 000-140 400) deaths. In 2023-2024, people 65 years and older comprised 17.7% of the total US population but accounted for 47.9% (95% UI, 27.1-66.9) of COVID-19-associated illnesses, 64.3% (95% UI, 53.1-73.4) of outpatient visits, 67.6% (95% UI, 65.9-69.2) of hospitalizations, and 81.2% (95% UI, 70.2-90.6) of deaths. Conclusions and Relevance: In this cross-sectional study, despite declining from the first to the second surveillance period, the COVID-19 burden continued to have a large impact in the US, particularly among adults 65 years and older, underscoring the ongoing importance of prevention measures.