Trends in Number and Distribution of COVID-19 Hotspot Counties - United States, March 8-July 15, 2020

Abstract

The geographic areas in the United States most affected by the coronavirus disease 2019 (COVID-19) pandemic have changed over time. On May 7, 2020, CDC, with other federal agencies, began identifying counties with increasing COVID-19 incidence (hotspots) to better understand transmission dynamics and offer targeted support to health departments in affected communities. Data for January 22-July 15, 2020, were analyzed retrospectively (January 22-May 6) and prospectively (May 7-July 15) to detect hotspot counties. No counties met hotspot criteria during January 22-March 7, 2020. During March 8-July 15, 2020, 818 counties met hotspot criteria for ≥1 day; these counties included 80% of the U.S. population. The daily number of counties meeting hotspot criteria peaked in early April, decreased and stabilized during mid-April-early June, then increased again during late June-early July. The percentage of counties in the South and West Census regions* meeting hotspot criteria increased from 10% and 13%, respectively, during March-April to 28% and 22%, respectively, during June-July. Identification of community transmission as a contributing factor increased over time, whereas identification of outbreaks in long-term care facilities, food processing facilities, correctional facilities, or other workplaces as contributing factors decreased. Identification of hotspot counties and understanding how they change over time can help prioritize and target implementation of U.S. public health response activities.

FIGURE 1

Number of COVID-19 hotspot alerts, by county and number of days meeting hotspot criteria for (A) March 8–April 30, (B) May 1–31, (C) June 1–July 15, and (D) entire period — United States, March 8–July 15, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Each county is shaded according to the number of days that the county met hotspot criteria, with shading in 7-day increments.

FIGURE 2

Daily number of COVID-19 hotspot alerts, by urbanicity, and 7-day average of new reported cases — United States, March 8–July 15, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * According to CDC’s National Center for Health Statistics urban-rural classification scheme for counties. Large central metro counties: in metropolitan statistical areas (MSAs) of ≥1 million population that contain all or part of the area's principal city. Large fringe metro counties: in MSAs of ≥1 million population and do not qualify as large central. Medium metro counties: in MSAs of 250,000–999,999 population. Small metro counties: in MSAs of <250,000 population. Micropolitan counties: in micropolitan statistical area. Noncore counties: not in metropolitan or micropolitan statistical areas. ^† No hotspots were detected during January 22–March 7, 2020.