The burden of COVID-19 persists despite the declared pandemic public health emergency having expired May 2023, with the Centers for Disease Control and Prevention (CDC) reporting1 that the elderly continue to experience disproportionately greater number of illnesses, medical visits, hospitalizations and deaths.
"Continued analyses of the burden of COVID-19...are important for monitoring hospitalizations and deaths in age groups at highest risk as well as the impact of illnesses in the general population to inform public health policy and response, assess health care needs, and guide vaccine and therapeutic developments," state the report lead author Emilia Koumans, MD, Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC, and colleagues.
Koumans and colleagues conducted a cross-sectional study of the period from October 2022 to September 2024 to estimate age-group-specific burden of COVID-19 illness.They accessed data from the COVID-NET population-based surveillance of hospitalizations with laboratory–confirmed SARS-CoV-2.The multi-State catchment area in the surveillance comprises a population of approximately 34 million persons, approximately 10% of the US population.
As the severity of COVID-19 shifted with the emergence of the Omicron variant in January 2022, the investigators reviewed the literature published since January 2022, including CDC unpublished data, to develop age group-specific multipliers to extrapolate hospitalizations-to-outpatient visits and outpatient visits-to-illnesses.
"Multipliers prior to this period would not reflect contemporary frequencies of illness-related outcomes or health care-seeking behaviors," they explained.
What You Need to Know
Despite the pandemic emergency ending in 2023, adults aged 65 and older—just 17.7% of the U.S. population—accounted for over two-thirds of COVID-19 hospitalizations and more than 80% of deaths from 2022–2024, with roughly 1 in 100 older adults hospitalized.
Hospitalization rates in older adults are less than half of those seen at the pandemic’s peak, likely due to population immunity, yet infants under 6 months and the elderly still experience notable hospitalization rates, underscoring persistent vulnerability.
As immunity wanes and new variants emerge, continued monitoring and improved access to prevention and early treatment—especially for older adults and other high-risk populations—are essential to reducing severe disease, hospitalizations, and deaths.
Koumans and colleagues estimate that in 2022-2023 there were 43.6 million (95% UI, 25.3-64.0 million) COVID-19 associated illnesses, 10.0 million (7.0-13.1) outpatient visits, 1.1 million (0.9-1.4) hospitalizations and 101,300 (73,600-132,500) deaths.In 2023-2024 there were an estimated 33.0 million (20.2-49.0) associated illness, 7.7 million (5.5-9.9) outpatient visits, 879,100 (738,600-1,039,000) hospitalizations and 100,800 (64,000-140,400) deaths.
Although people aged 65 years and older comprised 17.7% of the total US population, they accounted for 47.9% (27.1-66.9) of COVID-19 associated illnesses, 64.3% (53.1-73.4) of outpatient visits, 67.6%(65.9-69.2) of hospitalizations, and 81.2% (70.2-90.6) of deaths.This corresponds, the investigators highlight, to approximately 1 of every 100 adults 65 years and older in the US hospitalized in the period 2022-2024 for COVID-19 associated illness.
The next highest hospitalization rates were in the age group of 0 to 5 months: with 33hospitalizations per 100,000 in December 2022 and 26 per 100,000 during December 2023.The rates were modeled separately, the investigators noted, as the infants were not eligible for US-approved COVID-19 vaccines.
The hospitalization rates in the elderly, while substantial, are less than half of those at the peak of the pandemic in 2021. Koumans and colleagues consider the causes of that decline to be multifactoral, with population immunity likely the largest factor.
"However, because vaccine-induced and infection-induced immunity wane over time, particularly if new variants emerge, risk of severe disease in certain groups such as young children and older adults may persist," Koumans and colleagues warn.
"Since vaccination and early treatment with antivirals may prevent severe COVID-19, improving access to and use of prevention and early treatment measures in high-risk populations remain critical," they advise.
Reference
1. Koumans EHA, Khan D, Trejo I, et al. Estimated burden of COVID-19 illness, medical visits, hospitalizations and deaths in the US from October 2022 to September 2024. JAMA Intern Med. 2026. Published online January 5. doi:10.110/jamainternmed.2025.7179.
