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COVID -19–Associated Hospitalizations Update —
COVID -NET, July 2023– September 2024
Adults Ages ≥65 Years and Persons with Immunocompromising Conditions
Christopher A. Taylor, PhD
RESP -NET Hospitalization Surveillance Team
Coronavirus and Other Respiratory Viruses Division
Meeting of the Advisory Committee on Immunization Practices (ACIP)
October 23, 2024National Center for Immunization and Respiratory Diseases
1
COVID -NET is a population -based hospitalization
surveillance platform.
•RESP -NET: COVID -NET, RSV -NET, FluSurv -NET
•>300 acute -care hospitals
•98 counties in 13 states
-90 counties in 12 states for this analysis
due to incomplete data
•Approx. 10% of the U.S. population
•Positive SARS -CoV-2 test ≤14 days
before admission or during
hospitalization
•Screening or clinician -driven testing
•Clinical data: stratified random sample
2
COVID -19–Associated Hospitalizations
Among Adults Ages ≥65 Years
3
Adults ages ≥65 years comprise 2/3 of all COVID- 19–
associated hospitalizations among adults.
during this same period of October 2023 through August 2024, children and adolescents ages 17 years and younger comprised 4% of all COVID -19-associated hospitalizations. 40%10%20%30%40%50%60%70%80%90%100%Percent of adults hospitalized with COVID -19
Surveillance week end datePercent of weekly COVID -19–associated hospitalizations, by age group —
COVID -NET, March 2020 –September 2024
18–49 years 50–64 years 65–74 years ≥75 years≥75 years=50%
≥65 years=70%
Rates of COVID -19 hospitalizations are highest among
adults ages ≥75 years.
5020406080100120140160Rate per 100,000 population
Surveillance week end dateWeekly rates of COVID -19–associated hospitalizations — COVID -NET, March 2020 –September 2024
<6 months 6 months –4 years 5–11 years 12–17 years
18–49 years 50–64 years 65–74 years ≥75 years
Among adults, rates of COVID- 19–associated
hospitalizations increase with age.
6581624191410
02004006008001000120014001600
10/7/2023
10/21/2023
11/4/2023
11/18/2023
12/2/2023
12/16/2023
12/30/2023
1/13/2024
1/27/2024
2/10/20242/24/2024
3/9/2024
3/23/2024
4/6/2024
4/20/2024
5/4/2024
5/18/2024
6/1/2024
6/15/2024
6/29/2024
7/13/20247/27/2024
8/10/2024
8/24/2024
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9/21/2024R ate per 100,000 population
Surveillance week end dateCumulative rates of COVID -19–associated hospitalizations — COVID -NET,
October 1, 2023 –September 28, 2024
18–49 years 50–64 years 65–74 years ≥75 yearsAge groupRate ratio of
≥75 years
relative to
adult age
groups
18–49 24.4
50–64 8.7
65–74 3.4
≥75 1.0
Rates among adults ages
≥75 years are many times
higher compared to
younger adults.
Rates of COVID -19–associated hospitalizations among
adults ages ≥65 years have decreased over time.
* The 2019– 2020 surveillance period includes March 2020 –September 2021.
7050010001500200025003000
*2019 –2020
2020–2021
2021–20222022–2023
2023–2024
*2019–2020
2020–2021
2021–20222022–20232023–2024
*2019–2020
2020–20212021–20222022–20232023–2024
*2019–2020
2020–20212021–2022
2022–2023
2023–2024
*2019–2020
2020–2021
2021–2022
2022–2023
2023–202418–49 50–64 65–74 ≥75 ≥18R ate per 100,000 population
A ge group and surveillance periodCumulative rates of COVID -19–associated hospitalizations — COVID -NET, March 2020 –September 2024
Most adults ages ≥65 years hospitalized with COVID- 19
have underlying medical conditions.
•Among adults ages ≥65 years :
-19% are residents of a long -term care facility (LTCF)
-83% have ≥2 underlying medical conditions.
•Among adults ages ≥75 years :
-24% are residents of a LTCF
-86% have ≥2 underlying conditions
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission during October 2023 –May 2024.8
Adults ages ≥65 years remain at risk for severe
outcomes during COVID- 19–associated hospitalization.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 9Percent of outcomes and interventions among COVID -19–associated hospitalizations, by age group —
COVID -NET, October 2023 –May 2024
18–49 50–64 ≥65
L ength of stay , days (median) 2.9 3.4 3.5
L ength of stay , days (I QR ) 1.4–5.5 1.9–7.9 1.9–7.1
ICU adm ission 17.9% 21.5% 17.7%
Invasive m echanical ventilation 5.9% 12.8% 8.1%
In-hospital death 2.1% 11.3% 7.7%
During this period, 80% of all adults hospitalized with COVID -19 who died in -hospital were ages ≥65 years.
Fewer than half of adults ages ≥65 years hospitalized with
COVID -19 received any COVID -19 vaccine since September 2022.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 1075
7067
4753
2124 243733
4 6101715
01020304050607080
18–49 50–64 65–74 ≥75 ≥65Percent of adults hospitalized with C OV I D -19
A ge groupVaccination status among adults with COVID -19–associated hospitalization, by age group —
COVID -NET, October 2023 –May 2024
No record of 2022–2023 (bivalent) or 2023–2024 formula
R eceived 2022–2023 (bivalent), but not 2023–2024 formula
R eceived 2023–2024 formula
COVID -19–Associated Hospitalizations
Among Persons with
Immunocompromising Conditions
11
Immunocompromising conditions among patients
hospitalized with COVID- 19 include:
•AIDS or CD4 count <200
•Complement deficiency
•Graft vs. host disease
•HIV infection
•Immunoglobulin deficiency
•Immunosuppressive therapy*
•Leukemia**
•Lymphoma**
•Malignancy (solid organ)**•Bone marrow transplant
•Metastatic cancer**
•Multiple myeloma**
•Steroid therapy***
•Solid organ transplant
•Other conditions typically associated
with immunocompromised status
upon review
* Within the 12 months before admission
** Current/in treatment or diagnosed in the 12 months before admission
*** Within 2 weeks before admission. Does not include inhaled, intranasal steroids or intramuscular or intra -articular injection of steroids.12
About 1 in 6 (15.6%) persons hospitalized with COVID- 19
have an immunocompromising condition.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 1316314 162215
0%10%20%30%40%50%60%70%80%90%100%
Total 0–4 5–17 18–49 50–64 ≥65Percent of persons hospitalized with C OV I D -19
A ge group (years)Immunocompromising condition among persons with COVID -19–associated hospitalization, by age group —
COVID -NET, July 2023 –May 2024
Immunocompromising condition No immunocompromising condition
The most common immunocompromising conditions
among persons hospitalized with COVID- 19 include:
* Within the 12 months before admission
** Current/in treatment or diagnosed in the 12 months before admission
*** Within 2 weeks before admission. Does not include inhaled, intranasal steroids or intramuscular or intra -articular injectio n of steroids.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 1446
34
26
22
9
6
5
4
3
2
1
0.8
0.1
10 10 20 30 40 50
* Immunosuppressive therapy
** Solid organ malignancy
*** Steroid therapy
** Metastatic cancer
Solid organ transplant
** Lymphoma/Hodgkins/Non-Hodgkins
HIV infection
** Leukemia
Bone marrow transplant
Immunoglobulin deficiency
** Multiple myeloma
AIDS or CD4 count <200
Graft vs. host disease
Other immunocompromising conditionsPercent of persons hospitalized with C OV I D -19Prevalence of immunocompromising conditions among persons hospitalized with COVID -19 with
immunocompromised status — COVID -NET, July 2023 –May 2024
Prevalence of conditions among
the 16% of hospitalized persons
with immunocompromising
conditions
Few persons with an immunocompromising condition hospitalized with
COVID -19 received any COVID -19 vaccine since September 2022.
1567
191470
19
11
01020304050607080
No record of 2022–2023 (bivalent) or 2023–
2024 formula doseR eceived 2022–2023 (bivalent) dose, but no
2023–2024 formula doseR eceived 2023–2024 formula dosePercent of persons hospitalized with C OV I D -19
V accination statusVaccination status among persons hospitalized with COVID -19, by immunocompromising status —
COVID -NET, October 2023 –May 2024
Immunocompromising condition No immunocompromising condition
Time since receipt of most recent COVID -19 vaccine
varies little by immunocompromising condition status.
Limited to persons hospitalized with COVID -19 who received either a 2022– 2023 (bivalent) or 2023– 2024 formula COVID -19 vaccine s ince September 1, 2022. Data are limited to hospitalizations
where COVID- 19 is a likely primary reason for admission. 1621322
757
5619
961
010203040506070
≤30 days 31–60 days 61–120 days 121–180 days ≥180 daysPercent of persons hospitalized with C OV I D -19
Days since vaccinationTime since receipt of most recent COVID -19 vaccine among persons hospitalized with COVID -19, by
immunocompromising status — COVID -NET, October 2023 –May 2024
Immunocompromising condition No immunocompromising condition
Risk for severe outcomes during COVID -19–associated
hospitalization among children and adolescents varies little by
immunocompromising condition status.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 1719
6
0.923
5
0.6
0510152025
ICU admission Invasive mechanical ventilation In-hospital deathPercent of persons hospitalized with C OV I D -19Prevalence of outcomes and interventions among children and adolescents
aged ≤17 years hospitalized with COVID -19, by immunocompromising
condition status — COVID -NET, July 2023 –May 2024
Immunocompromising condition No immunocompromising conditionSample size with I.C. condition = 103
Risk for severe outcomes during COVID -19–associated
hospitalization among adults varies by immunocompromising
condition status.
Data are limited to hospitalizations where COVID -19 is a likely primary reason for admission. 1827
18
15 15
64
051015202530
ICU admission Invasive mechanical ventilation In-hospital deathPercent of persons hospitalized with C OV I D -19Prevalence of outcomes and interventions among adults ages ≥18 years
hospitalized with COVID -19, by immunocompromising condition status —
COVID -NET, July 2023 –May 2024
Immunocompromising condition No immunocompromising conditionSample size with I.C. condition = 512
Questions
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