By Marie Rosenthal, MS
Lenny Kravitz might be singing about love in “It Ain’t Over ‘til It’s Over,” but he could just as easily be considering SARS-CoV-2—a pesky virus that is still causing significant disease in the United States.
The CDC estimates from Oct. 1, 2024, through June 7, 2025, COVID-19 caused an estimated 9.8 million to 16.1 million illnesses, 2.4 million to 3.8 million outpatient visits, 270,000 to 440,000 hospitalizations and 32,000 to 51,000 deaths, according to Adam MacNeil, PhD, MBA, the deputy branch chief of the CDC’s Epidemiology, Respiratory Viruses Branch and acting director of the CDC’s Coronavirus and Other Respiratory Viruses Division.
Because COVID-19 is no longer a reportable disease in the United States and not everyone who contracts COVID-19 will be tested or seek medical care, it is impossible to know exactly how many people have gotten infected, so the CDC uses updated surveillance data, data from scientific reports and mathematical modeling to estimate the disease burden.
Much of the epidemiologic data presented came from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects and reports data from more than 300 acute care hospitals in 185 counties across 13 states—about 10% of the U.S. population. Hospitalizations reported to COVID-NET include all those where a positive COVID-19 test result was reported within 14 days before hospitalization. That testing is driven by clinical judgment and facility policies; most hospitals are no longer doing routine testing of every patient who walks through the door, explained Dr. MacNeil, who presented the epidemiologic data to the CDC’s Advisory Committee on Immunization Practices (ACIP) on June 25.
COVID-19 still has two peaks: in the winter and summer, he explained.
In addition, by comparing COVID-NET and FLU-NET data, which tracks influenza, the CDC found COVID-19 is still having a profound effect on the very young and very old. From July 2024 to April 2025, more infants 12 months of age and younger, and adults 75 years and older were hospitalized from COVID-19 than from influenza—even though this past influenza season was a severe one. Although hospitalizations continue to be higher among those 75 and older, followed by adults 65 to 74, infants 0 to 6 months old were the third most likely age group to be hospitalized from COVID-19, according to Dr. MacNeil.
“The rates of hospitalizations among infants less than 6 months are nearly identical to those aged 65 to 74 with cumulative rates of 268 and 266 per 100,000, respectively. Similarly, rates among children age 6 months to 23 months are nearly equal to those among adults ages 50 to 64 years,” he said.
Among infants younger than 6 months who were hospitalized recently for COVID-19, 22% were admitted to the ICU, 71% were healthy with no underlying medical conditions, and only 3.5% had a record of maternal COVID-19 vaccination during pregnancy.
“Fifty-four percent or more than half of children aged 6 months to 23 months hospitalized for COVID-19 had no underlying medical conditions,” Dr. MacNeil said.
COVID-19 vaccines are not indicated for infants younger than 6 months. However, up until May 2025, COVID-19 vaccines were indicated during pregnancy to protect the mother and the younger infant who could not be vaccinated. COVID-19 vaccination is now recommended for children 6 months and older under shared clinical decision-making, but no longer recommended during pregnancy—a unilateral decision made by Health and Human Services Director Robert F. Kennedy Jr., without input from the ACIP.
“Notably, no COVID-19 vaccine products are approved for the youngest infants under 6 months. Any protection for them must come from transfer of maternal antibodies either through vaccination during pregnancy or prior infection,” Dr. MacNeil explained.
COVID-19 Deaths
Deaths had a similar pattern, with most being among those 75 and older with declining numbers among younger adults. Among pediatric deaths, 29 children aged 5 to 17 years died from COVID-19 between July 2024 and June 2025; 16 children 24 months to 4 years died; and 45 children younger than 24 months died from COVID-19.
“Outcomes among hospitalized children can be severe with one in four admitted to the ICU,” Dr. MacNeil said. “The majority [89%] of COVID-19 vaccine-eligible children and adolescents who were hospitalized with COVID-19 had no record of receiving the most recently recommended COVID-19 vaccine,” he said.
The data demonstrate that COVID-19 and pregnancy can be devastating for pregnant people. Among 131 people who were hospitalized during pregnancy with a laboratory-confirmed positive SARS-CoV-2 test result and signs or symptoms of COVID-19, 50% had no underlying conditions. Sixty-eight percent were no longer pregnant at discharge—5% of those lost the baby; 11% had a preterm infant; 1% had a sick infant; and 83% had a healthy newborn. Only 5.% received the recommended 2024-2025 COVID-19 booster, and more than 90% had no record of vaccination since July 1, 2023.
Long COVID also continues to be a concern, according to Dr. MacNeil. National surveys that were conducted in 2023 estimated that 9.2 million adults and 0.3 million children had long COVID. Of those, “more than 3 in 5 adults and almost four in five children with long COVID reported activity limitations,” he told the ACIP (JAMA Netw Open 2024;7;[12]:e2451151; JAMA Pediatr 2025;179[4]:471-473).
By using case-control studies of people who were vaccinated compared with people who were never vaccinated or had not received boosters, Dr. MacNeil showed the vaccines provided additional protection from emergency or urgent care visits, hospitalizations, and critical illness across all age groups. (To see the data, click here).
Several of the ACIP members asked about the results from randomized controlled trials, which they called the gold standard for studies. However, the CDC statisticians explained that randomized controlled trials, which were conducted when the vaccines were being considered for authorization during the pandemic, were performed in largely naive populations. Today’s data are looking at the added value of multiple vaccinations or infections in a population that has some immunity from either vaccination and/or infection. So, randomized clinical trials would not be comparable to today’s COVID-19. The added benefit of boosters is between 30% and 50%, they said, and this demonstrates the real-world impact of vaccination rather than clinical trial data.
H. Cody Meissner, MD, a professor of pediatrics at Dartmouth Geisel School of Medicine, in Hanover, N.H., who was recently appointed to the ACIP panel by Mr. Kennedy, questioned whether the hospitalizations were really due to COVID-19 or for some other reason, but then tested positive for COVID-19. The CDC explained that the data come from two sources: laboratory confirmation of positive SARS-CoV-2 tests and people hospitalized for COVID-19. Although some of the positive tests could be people who were hospitalized for another reason, most hospitals are not routinely testing for COVID-19 anymore.
Dr. Meissner reminded the CDC that COVID-19 cases have decreased among all ages. “A quick point I want to make is that looking at the most recent CDC data on hospitalization rates among children 0 to 4 years of age, it’s less than one hospitalization per 100,000 children. And even if we look at children under 6 months of age, looking at that same table it’s 1.6 hospitalizations per 100,000—so my point is this is a very rare illness in young children as well as in adults.”
Andrew T. Pavia, MD, FIDSA, a pediatric infectious disease specialist at the University of Utah, in Salt Lake City, who spoke at a briefing sponsored by the Infectious Diseases Society of America, took issue with Dr. Meissner’s assessment. Although all hospitalizations are down, they are still too high, especially for children.
“CDC presented data showing that the rates of hospitalization in children under 5 remain very high, and the rates of hospitalization for kids under 6 months of age were as high as those for people over 65. Dr. Meissner raised the question, are those kids really being hospitalized for COVID? The CDC responded showing that within the networks where they actually are able to review the charts of children hospitalized for COVID, they were able to separate out those who are hospitalized for COVID,” Dr. Pavia said. “So yes, the data really did show that children under 6 months were dying of COVID still and being hospitalized for COVID, as well as obviously some being hospitalized for other reasons but testing positive for COVID.”
