Where we stand with COVID-19 now

Posted By: Michael S Calderwood MD, MPH Latest News,

As we come to the end of the Public Health Emergency on May 11th, I thought that it might be time to summarize where things stand with COVID-19 as of May 1, 2023.

 A Look at the Numbers:

Sometimes it helps to remember where we have been. In the winter of 2020-2021, as we were just beginning to roll out the first COVID-19 vaccines, we reached a peak in the U.S. of over 133,000 patients hospitalized with COVID-19 on January 14, 2021, with close to 70% of ICU beds occupied by COVID-19 patients around that time. A year later, during the initial wave of the Omicron variant, hospitalizations in the U.S. rose to a peak of close to 155,000 patients hospitalized with COVID-19 on January 19, 2022, with around 64% of ICU beds occupied by COVID-19 patients at that time.

This year, hospitalizations peaked at 42,000-43,000 in the first week of January, a little over 72% lower than the year prior, with only 11% of ICU beds occupied by COVID-19 patients. At the peak of the 2020-2021 winter, it took only 5 weeks for 100,000 cumulative COVID-19 deaths in the U.S. By the peak of the 2021-2022 winter, it took 8 weeks for 100,000 cumulative deaths in the U.S. After reaching 1,000,000 deaths in May 2022, it took 248 days to reach 1.1 million deaths. This is not to minimize the over 1.1 million reported deaths from COVID-19 in the U.S., but this trend is very encouraging.


Worldwide, there have been 6.9 million COVID-19 deaths officially reported, with an estimate that true death toll is closer to 22 million. The pandemic’s true death toll | The Economist Here is a visualization compared with other pandemics:

Based on the estimate that 80% of COVID-19 testing is now done at home, with a positivity rate tracking close to PCR testing data, a back of the envelope calculation is that there were close to 4.6 million tests done in the past week, and over 239,000 new cases (5.2% of those who tested). If 80% of tests are done at home and not reported, ~13 per 10,000 tested positive in the past week in the United States, down from ~2 per 1,000 at the start of April 2023, and 7 per 1,000 in late December 2022/early January 2023.

To compare, 7 out of every 100 people in the U.S. were reported as testing positive for COVID-19 over a 6 week period from December 2021-January 2022 (early Omicron), and this does not include tests done at home and unreported. Unreported SARS-CoV-2 Home Testing and Test Positivity | Infectious Diseases | JAMA Network Open | JAMA Network

Over the past month, there were an average of 12,911 hospital admissions per week with COVID-19 and an average of 1,342 deaths per week attributed to COVID-19. Around 5% are hospitalized with (although not necessarily for) COVID-19. Mortality rate is down to 0.5-0.6%. At the population level last week in the United States, there was a 3 in 100,000 chance of being hospitalized with COVID-19, and a 4 in 1,000,000 chance of dying from COVID-19. These were the risks in a single week.

While COVID-19 remained the third leading cause of death in the United States in 2022, due to the early Omicron period, it is now down to the 8th leading cause of death in the past month:

Thankfully, the mortality associated with COVID-19 among those who are hospitalized has continued to decline with newer variants, increasing immunity, and better therapies.

This population immunity was described nicely in a recent paper. Changes in population immunity against infection and severe disease from SARS-CoV-2 Omicron variants in the United States between December 2021 and November 2022 | Clinical Infectious Diseases | Oxford Academic (oup.com)

For the 212 countries reporting data on vaccination rates and case fatality rates, high vaccination rates predict lower case fatality rates, and vaccine equity remains a large problem. Data pulled from https://ourworldindata.org.

The lasting impact of long COVID also remains unknown. In June 2022, it was estimated that 7.3% of the U.S. adult population (18 million people) reported experiencing long-COVID, with 1.8% (4.6 million) having day-to-day activities impacted “a lot.” The prevalence was reported as 50% less in those who had been boosted at least once. Epidemiology of Long COVID in US Adults | Clinical Infectious Diseases | Oxford Academic (oup.com)

Those with no known COVID-19 infection had a 20% decrease per month in neutralizing antibodies after vaccine dose #2 but a sustained level of neutralizing antibodies out to 250 days after dose #3. This is part of the reasoning for why the COVID-19 vaccine is expected to be an annual vaccine, much like the influenza vaccine. Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination and Infection on Neutralizing Antibodies: A Nation-wide Cross-sectional Analysis | The Journal of Infectious Diseases | Oxford Academic (oup.com)

 Changing Policies in Healthcare:

 Masks –

Asymptomatic Screening 

 Updated Vaccine Recommendations:

This is a question that I have received a lot recently. Per updates made on April 19, 2023 (CDC simplifies COVID-19 vaccine recommendations, allows older adults and immunocompromised adults to get second dose of the updated vaccine | CDC Online Newsroom | CDC):

  • CDC’s new recommendations allow an additional updated (bivalent) vaccine dose for adults ages 65 years and older and additional doses for people who are immunocompromised. This allows more flexibility for healthcare providers to administer additional doses to immunocompromised patients as needed.
    • Monovalent (original) mRNA COVID-19 vaccines will no longer be recommended for use in the United States.
    • CDC recommends that everyone ages 6 years and older receive an updated (bivalent) mRNA COVID-19 vaccine, regardless of whether they previously completed their (monovalent) primary series.
    • Individuals ages 6 years and older who have already received an updated mRNA vaccine do not need to take any action unless they are 65 years or older or immunocompromised.
      • Expectation that all will be recommended to get an updated booster in Fall 2023.

 Lessons Learned:

If you are interested in reading about the experience of infectious diseases physicians in battling this pandemic over the past three years, I recommend this paper that just came out on April 27, 2023: How Infectious Disease Experts Impacted the Coronavirus Disease 2019 (COVID-19) Response: Lessons From the Front Lines | Clinical Infectious Diseases | Oxford Academic (oup.com).