October 15, 2020

October 15, 2020

COVID Epidemiology and Influenza Surveillance Update – Alicia Budd (CDC)

Alicia provided a summary from the COVID and influenza reports through Week 40, ending October 3. She noted that the data sources for both reports may be found on the COVIDView and FluView websites. For influenza, Week 40 is of note because it is the first week of the 2020–2021 flu season. Flu activity in the U.S. remains very low. COVID activity indicators nationally through October 3 were either decreasing or stable, though there was some variation by region.

Virus Circulation

At clinical labs, less than 1% of specimens tested positive for influenza. This low level continues the pattern seen since early April. The small amount of influenza being seen is a mix of types A and B. For all age groups combined, the percent of respiratory specimens testing positive for SARS-Cov-2 decreased slightly in Week 40 (4.9%) compared to Week 39. A slight increase was seen in age groups 5–17 years and 65+ years. Region 4 (Southeast U.S.) saw a slight increase for SARS-CoV-2 during the week, but the other regions remained stable or decreased.

Syndromic Surveillance for Mild/Moderate Respiratory Symptoms

CDC looks at two different surveillance systems (outpatient and emergency department visits) to obtain this data. Information from a combination of primary care providers and emergency departments/urgent care facilities is used for influenza-like illness (ILI). The National Syndromic Surveillance Program (NSSP) Essence system uses data from emergency departments for both ILI and COVID-like illness (CLI). Nationally, the percent of visits for ILI and CLI remained stable for October 3, compared with the previous week. Although the ILINet data by age showed a slight increase in the 50–64 year age group, all other age groups remained stable. Regionally, the NSSP Essence data indicated the percent of visits to emergency departments for CLI visits remained stable or declined. However, three regions reported increased visits for ILI. During Week 40, one state (Iowa) reported a low level of ILI activity, while all other jurisdictions were at a minimal level. New for this year, CDC also is reporting ILI activity at a more local level. i.e., the core-based statistical area (CBSA). CBSAs group people together in areas where they tend to mix, including across state lines. For Week 40, almost 600 CBSAs had at least one ILINet provider reporting data for the week. More than 97% of CBSAs reported being at minimal level, while a few reported being at low level, 4 at moderate, and 1 at high.


FluSurvNet and COVIDNet look at population-based rates of lab-confirmed influenza and COVID hospitalizations. Since the 2020–2021 flu season has just begun, very few flu hospitalizations have been reported into FluSurvNet to date. CDC will begin to release this data when more numbers are included in the system. Since the beginning of the pandemic, the overall cumulative COVID hospitalization rate has been approximately 183/100,000.  Hospital rates were declining in July–August, but they appear to be holding steady over the last few weeks. More detailed information is available on COVIDNet Interactive.


A total of 189 Influenza-associated pediatric deaths occurred during the 2019–2020 season. Death certificate data from the National Center for Health Statistics (NCHS) indicates 7% of deaths during Week 40 had pneumonia, influenza, or COVID (PIC) listed as a cause of death, well above the epidemic threshold of 5.6% for the week. This season CDC will be monitoring both FluView and COVIDView to determine the percent of deaths due to PIC. This allows a better look at the impact of all these respiratory diseases. However, CDC also will report the number of death certificates mentioning each disease individually to determine the relative impact.


Last week’s COVIDView summarized the impact of this disease since the beginning of the pandemic. At a regional level, three general patterns of activity were noted. Regions 1, 2, and 3 (Northeast and Mid-Atlantic area) had the highest levels of COVID activity in April. This declined through June/July and remained relatively stable until recent weeks, when we are beginning to see an increase.  The second grouping of regions was seen in Regions 7 (central U.S.), Region 8 (mountain), and Region 10 (Pacific Northwest). These areas also saw their highest COVID levels in April, followed by a decline and then a second, pronounced peak in the summer. These areas have declined and remained relatively stable recently, except in the Pacific Northwest, which has seen some recent increases in activity. Finally, in Region 4 (Southeast), Region 6 (Central), and Region 9 (Southwest coast), the pattern showed highest levels in July. This area has been relatively stable, though showing increases in recent weeks.

FluView – Geographic Spread

For this season, CDC will not be reporting the map with the geographic spread of influenza. It was felt this would not be as valuable a tool this year due to the extent of COVID activity and the way the definitions overlap.

Flu Communication Activities/NFID Kickoff Update – Diana Olson (NFID)

Diana provided an overview on the results of the 2020 National Foundation of Infectious Diseases (NFID) Influenza/Pneumococcal Disease News Conference,  held in collaboration with CDC. This annual event marks the kickoff of the influenza season. This provided an opportunity to share why, during the COVID-19 pandemic, it’s more important than ever to be immunized against flu.

NFID Medical Director William Schaffner, MD moderated the event. The expert panel of presenters included Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases;  Federico Asch, MD, Director of Cardiovascular Core Labs and Cardiac Imaging Research, MedStar Health Research Institute; Patricia Whitley-Williams, MD, NFID President and Professor of Pediatrics, Chief of the Division of Pediatric Allergy, Immunology, and Infectious Diseases, and Associate Dean of Inclusion and Diversity at Rutgers Robert Wood Johnson Medical School; and Dan Jernigan, MD, Director of the Influenza Division at CDC.

Panelists shared final CDC flu vaccination coverage and burden data for the 2019–2020 influenza season and results from a new NFID survey on beliefs about flu and pneumococcal disease, as well as attitudes and practices around vaccination in the context of the COVID-19 pandemic. The survey results are available on an infographic and the NFID website.  Survey highlights include information that 46% of U.S. adults are worried about co-infection with flu and COVID-19. One-fourth (25%) of respondents said they would be more likely to be vaccinated if vaccine were offered in non-traditional settings such as drive-through clinics in addition to pharmacies and private practice offices. But only 59% of U.S. adults said they planned to be vaccinated against flu during the upcoming season. Nearly one in four high risk adults reported they did not plan to be vaccinated.

The event generated a great deal of attention from the media and the immunization community at large. There were almost 250 attendees at the virtual event. Key placements occurred in several top tier media outlets, resulting in over 2.7 billion impressions. A livestream was also available on CNBC. Nearly all media outlets included at least one of the NFID key flu prevention messages in their coverage.

Due to the virtual format, NFID was unable to hold a #LeadingbyExample flu shot clinic. However, many organizations posted photos of their leaders receiving flu vaccine, and the Associated Press shared coverage of the NFID staff being vaccinated. Partners generated nearly 5,000 social media posts using the hashtags #FightFlu and #PreventPneumo.

Diana encouraged all Summit partners to join the Leading By Example Initiative to show commitment to flu prevention by posting (in the online gallery) photos of organization leaders being vaccinated. She also noted that today NFID released a new report, Call to Action: The Dangers of Influenza and COVID-19 in Adults with Chronic Health Conditions, which underscores the importance of flu vaccination during the 2020–2021 season.

HHS Overview of Flu Immunization Communication Plan – Ann Aiken (CDC)

Ann is part of the Office of the Assistant Secretary for Health (OASH), which functions in a coordinating role to find ways to amplify the important flu prevention messages from CDC and other key partners. An additional goal is to conduct targeted outreach to help support these messages. During this year, the office has planned to target African American and Hispanic audiences.

For this season, HHS has released a toolkit, Boo to the Flu. This Halloween-focused campaign drives home the idea to try to get your flu vaccination before Halloween. This year the focus was on parents and young families. The toolkit includes social media graphics, pins, stickers, and posters. An animated graphic is also available for sharing. Some materials also are available in Spanish.

In addition, OASH has worked with the Office of Personnel Management to send an email to all government employees urging them to receive a flu vaccination. The agency also works with key officials/leaders to provide them with targeted messages for flu vaccine promotion.

On October 13 an Instagram Live Q&A session was held between the Surgeon General and six African American and Hispanic parents. The participants were given the opportunity to have their questions answered. Each person had their own style and questions which helped get messages to parents and bloggers. Following the event, HHS saw a 250% increase on several sections of their website.

Following Ann’s presentation, several partners provided information on additional resources that could be helpful in trying to reach vulnerable ethnic and racial minorities. Last week the Ad Council, CDC, and the American Medical Association released a No One Has Time for Flu campaign. CDC also has a wealth of helpful tools on its Communications Resource Center. These are often available in multiple languages. Additional campaign tools are available through The Public Good Projects. Ann also mentioned that everyone should consider signing up to receive CDC’s key flu messages.

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