COVID-19 Watch Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report

Prepared by Epidemiology and Immunization Services Branch www.sdepi.org September 22, 2021

Cases Deaths Outbreaks 349,216 4,006 2,695

Data through 9/18/2021 Report Content Links Page 2: Summary Page 3: COVID-19 Infections by Vaccination Status Page 4: COVID-19 Hospitalizations by Vaccination Status Page 5: Daily COVID-19 Counts by Vaccination Status – Previous 3 Months Page 6: Weekly COVID-19 Counts by Age – Previous 3 Months Page 7: Selected Characteristics of COVID-19 Cases, Hospitalizations, and Deaths Page 8: Age-Adjusted COVID-19 Case Rates by Race/Ethnicity Page 9: Age-Adjusted COVID-19 Hospitalization Rates by Race/Ethnicity Page 10: Case Rates by Zip Code of Residence Page 11: COVID-19 Potential Exposure Settings Community Setting Outbreaks Page 12: Number of Vaccinations Administered and Cumulative Number of Persons Fully Vaccinated Percent Fully Vaccinated by Zip Code of Residence Page 13: COVID-19 Vaccinations by Race/Ethnicity and Health Equity Page 14: COVID-19 Cases in Children and Outbreaks in School Settings Page 15: COVID-19 Cases in Schools Page 16: COVID-19 Laboratory Test Positivity Rate – Previous 12 Months Emergency Department Data – Previous 12 Months Page 17: COVID-19 Pandemic at a Glance Page 18: Pandemic at a Glance: Summary of COVID-19-associated Deaths Epidemiology and Immunization Services Branch www.sdepi.org (619) 692-8499 Page 1 COVID-19 WATCH Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report Data through 9/18/2021

Figure 1. COVID-19 Confirmed and Probable Cases and 7-Day Rolling Average Case Rate by Date of Illness Onset*, San Diego County Residents, N=72,043 2,000 50 1,900 1,800 Since June 20, 2021: 45 1,700 Confirmed N=67,073 1,600 Probable N=4,970 40 1,500 1,400 35 1,300 1,200 30 1,100 1,000 25 Cases 900 800 20 700 600 15 500 Case Rate per 100,000 population 100,000 per Rate Case 400 10 300 200 5 100 0 0 6/20 6/27 7/4 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12 Probable Confirmed 7-day Rolling Average Combined Case Rate *When onset date is unavailable, specimen collection date, date of death, or date reported is used instead. **Probable cases are antigen positive tests received since August 1, 2020.

Table 1. Summary of Cases, Deaths, and Outbreaks by Date Reported

9/12 – 9/18/2021 9/5 – 9/11/2021 Cumulative

Cases 4,216 5,686 349,216

Avg Daily Cases 602 812 624

Deaths 64 28 4,006

Outbreaks 58 64 2,695

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COVID-19 Infections by Vaccination Status

Case rate for not fully Dates: 8/29-9/4/2021 vaccinated residents Not Fully Vaccinated* Fully Vaccinated** County Overall is 4 times higher Case Rate Case Rate Case Rate than fully vaccinated residents 47.3 13.0 27.6

Figure 2. 7-Day Rolling Average COVID-19 Case Rate by Vaccination Status in San Diego County Residents since March 1, 2021 90 80 70 60 50 40 30

Cases per 100,000 20 10 0

Date of Illness Onset*** Not Fully Vaccinated Residents Fully Vaccinated Residents All County Residents

Table 2. COVID-19 Cases Among San Diego County Residents by Vaccination Status Since March 1, 2021 Not Fully Vaccinated* Fully Vaccinated** Total Cases 67,333 (79.3%) 17,586 (20.7%) 84,919 Hospitalizations 2,245 (96.1%) 90 (3.9%) 2,335 Deaths 257 (86.2%) 41 (13.8%) 298

*Not fully vaccinated includes individuals with one dose of the two-dose series, no doses, or unknown vaccination status. Individuals less than 12 years of age who are not yet eligible for the vaccine are also included. **Cases who first tested positive (based on specimen collection date) greater than or equal to 14 days after receiving the final dose of COVID-19 vaccine. Percentages are among total cases, hospitalizations, and deaths for the time period. ***If case did not have symptoms or illness onset date is unavailable, the earliest of specimen collection date, date of death, or date reported is used instead. San Diego County Population from SANDAG 2019 Population Estimates (Prepared June 2020) = 3,351,784. The fully vaccinated population for each day is the cumulative number of county residents documented to have received the final dose of COVID-19 vaccine more than 14 days prior to that day. The not fully vaccinated population is the estimated total county population minus the fully vaccinated population.

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COVID-19 Hospitalizations by Vaccination Status

Hospitalization rate Dates: 8/22-8/28/2021 for not fully Fully Vaccinated ** County Overall Not Fully Vaccinated* Hospitalization Hospitalization vaccinated residents Hospitalization Rate is 34 times higher Rate Rate than fully vaccinated residents 1.72 0.05 0.77

Figure 3. 7-Day Rolling Average COVID-19 Hospitalization Rate by Vaccination Status in San Diego County Residents since March 1, 2021

2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 Hospitalizations perHospitalizations 100,000 0.2 0.0

Date of Hospital Admission Not Fully Vaccinated Residents Fully Vaccinated Residents All County Residents

*Not fully vaccinated includes individuals with one dose of the two-dose series, no doses, or unknown vaccination status. Individuals less than 12 years of age who are not yet eligible for the vaccine are also included. **Cases who first tested positive (based on specimen collection date) greater than or equal to 14 days after receiving the final dose of COVID-19 vaccine. San Diego County Population from SANDAG 2019 Population Estimates (Prepared June 2020) = 3,351,784. The fully vaccinated population for each day is the cumulative number of county residents documented to have received the final dose of COVID-19 vaccine more than 14 days prior to that day. The not fully vaccinated population is the estimated total county population minus the fully vaccinated population.

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Figures 4-6. Daily COVID-19 Counts by Vaccination Status – Previous 3 Months

1,800 1,600 1,400 1,200 1,000 800 600 400 Confirmed Cases 200 0 6/20 6/27 7/4 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12

45 40 35 30 25 20 15 10 Hospitalizations 5 0 6/20 6/27 7/4 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12 11 10 9 8 7 6 5

Deaths 4 3 2 1 0 6/20 6/27 7/4 7/11 7/18 7/25 8/1 8/8 8/15 8/22 8/29 9/5 9/12

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Figures 7-9. Weekly COVID-19 Counts by Age – Previous 3 Months

4,000 3,500 3,000 2,500 2,000 1,500 1,000 Confirmed Cases 500 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18

110 100 90 80 70 60 50 40 30 20 Hospitalizations 10 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18

35 30 25 20

Deaths 15 10 5 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending

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Selected Characteristics of COVID-19 Cases, Hospitalizations, and Deaths

Table 3. Confirmed Cases by Date Reported, Last Two Weeks vs. Cumulative

September 5, 2021 – September 18, 2021 February 14, 2020 – September 18, 2021

Confirmed cases 9,902 349,216 Median age 32 years 34 years Age range 0-100+ years 0-100+ years Male 4,846 (50%) 169,321 (49%) Confirmed Cases Female 4,929 (50%) 177,361 (51%)

Table 4. Confirmed Hospitalizations by Date of Admission, Last Two Weeks vs. Cumulative

September 5, 2021 – September 18, 2021 February 14, 2020 – September 18, 2021

Hospitalizations 212 (2.1%) 17,427 (5%) Median age 58 years 62 years Age range 15-95 years 0-100+ years Male 124 (58%) 9,345 (54%) Hospitalizations Female 88 (42%) 8,054 (46%) Sex is unknown for one hospitalization for the last two weeks and for 27 hospitalizations cumulatively. Note: Percentage hospitalized is calculated based on the total number of cases; information may be unknown in some cases. Hospitalization counts are likely underreported and may increase as additional information is obtained.

Table 5. Confirmed Deaths by Date of Death, Last Two Weeks vs. Cumulative

September 5, 2021 – September 18, 2021 February 14, 2020 – September 18, 2021

Deaths 55 4,006 Case Fatality Ratio N/A* 1.1% Underlying Conditions** 51 (93%) 3,829 (96%)

Deaths Median age 66 years 77 years Age range 22-100+ years 10-100+ years Male 31 (56%) 2,393 (60%) Female 24 (44%) 1,613 (40%) *Data are incomplete for this time period. **Refer to the graph on page 18 for more details.

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Age-Adjusted COVID-19 Case Rates by Race/Ethnicity

Figure 10. Age-Adjusted Rates of Confirmed Cases by Race/Ethnicity, San Diego County Residents

Hispanic / Latino 1,885

White 1,484

Black 1,846

Asian 763

NHPI* 4,174

AIAN* 1,359 Last 3 Months 3 Last Multiple Race 451

Total 1,519

0 400 800 1,200 1,600 2,000 2,400 2,800 3,200 3,600 4,000 4,400 4,800

Figure 11. Age-Adjusted Rates of Confirmed Cases by Race/Ethnicity, San Diego County Residents

Hispanic / Latino 14,073

White 5,789

Black 7,144

Asian 4,334

NHPI* 20,813

Cumulative AIAN* 5,352

Multiple Race 3,197

Total 8,282

0 2K 4K 6K 8K 10K 12K 14K 16K 18K 20K 22K

The black lines represent the 95% confidence intervals (error bars). Rates are not calculated for fewer than 20 events. *NHPI=Native Hawaiian/Pacific Islander, AIAN=American Indian/Alaska Native.

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Age-Adjusted COVID-19 Hospitalization Rates by Race/Ethnicity

Figure 12. Age-Adjusted Rates of Hospitalizations by Race/Ethnicity, San Diego County Residents

Hispanic / Latino 67

White 37

Black 66

Asian 19

Last 3 Months 3 Last NHPI* 219

Total 45

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300

Figure 13. Age-Adjusted Rates of Hospitalizations by Race/Ethnicity, San Diego County Residents

Hispanic / Latino 932

White 249

Black 530

Asian 264

NHPI* 1,284

Cumulative AIAN* 286

Multiple Race 221

Total 439

0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 The black lines represent the 95% confidence intervals (error bars). Rates are not calculated for fewer than 20 events. Hospitalization rates were not calculated for the last three months for Multiple Race and AIAN because these categories have fewer than 20 events. *NHPI=Native Hawaiian/Pacific Islander, AIAN=American Indian/Alaska Native.

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Figure 14. Confirmed Case Rate by Zip Code of Residence, 9/5/2021-9/18/2021, San Diego County (Countywide Rate = 295 per 100,000 Population) 19 19 Zip Cases by Code - Figure 15. Cumulative Confirmed Case Rate by Zip Code of Residence, San Diego County (Countywide Rate = 10,419 per 100,000 Population) Confirmed COVID

Rates calculated using 2019 population estimates from the San Diego Association of Governments. Rates not calculated for counts under 5 cases or populations less than 10,000. Zip code is zip code of residence, which may not be location of exposure. Case counts and rates for each zip code are updated routinely on the County of San Diego COVID-19 website.

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COVID-19 Potential Exposure Settings Figure 16. All Potential Exposure Settings Identified Among Confirmed Cases, San Diego County Residents Cases within last 3 months (N = 19,078) Cumulative Cases (N = 151,506)

28% Household* 35%

Community settings / 33% social gatherings*** 27%

26% Non-healthcare workplace** 27%

19% Travel 14%

13% School / Daycare 7%

5% Healthcare settings 6%

Potential exposure settings are places case-patients visited during their exposure period, not confirmed sources of infection. Persons may be exposed in multiple locations and types of settings, including the household, the workplace, educational settings, other community settings, and during travel. Community settings are defined as indoor or outdoor locations in which cases came within 6 feet of anyone who was not a household member for at least 15 minutes during the 2-14 days prior to symptom onset, even if the case wore a mask or facial covering. COVID-19 Community Setting Outbreaks

Figure 17. Community Setting Outbreaks* by Date Outbreak Confirmed Total Number of Community Outbreaks=460 70 59 60 53 54 49 51 49 50 46 40 35 29 30 20 9 10 11 10 5 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending *Community setting outbreaks are defined as at least three probable or confirmed COVID-19 cases within a 14-day period in people who are epidemiologically-linked in the setting, are from different households, and are not identified as close contacts of each other in any other case investigation. Examples include workplaces, adult and child daycare facilities, K-12 schools and colleges/universities, and day camps.

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COVID-19 Vaccinations

Figure 18. Number of COVID-19 Vaccinations Administered and Cumulative Number of Persons Fully Vaccinated by Week Among San Diego County Residents Vaccines Administered = 4,290,583 2,500,000 250,000 Persons Fully Vaccinated = 1,981,807 2,000,000 200,000 1,500,000 150,000 1,000,000 100,000

50,000 500,000 VaccinesAdministered

0 0 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Cumulative Cumulative Persons Fully Vaccinated Dec Jan Feb Mar Apr May Jun Jul Aug Sept 2020 2021 CDC Week and Calendar Month

The bars show vaccines administered, not individuals vaccinated. The line shows the cumulative number of persons fully vaccinated per the dose and schedule regimen for the vaccine received.

Figure 19. Percentage of the Total Population of San Diego County Residents Who are Fully Vaccinated, by Zip Code of Residence

Only includes vaccines that have been recorded in the San Diego Immunization Registry (SDIR). Some healthcare providers, including Veteran’s Affairs, the Department of Defense, some tribal entities, and prisons do not report to SDIR. See this dashboard, updated daily, for more detailed vaccine status information for San Diego County. Data source: San Diego Immunization Registry, SANDAG 2019 Population Estimates (Prepared June 2020).

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COVID-19 Vaccinations by Race/Ethnicity and Health Equity

Figure 20. Vaccination Status by Race/Ethnicity, San Diego County Residents Age 12 Years and Older 100%

29% 25% 80% 36% 51% 53% 5% 9% 60% 6% 99% 99% 7% 40% 7% 66% 65% 59% 20% 42% 40%

0% AI/AN Asian Black Hispanic or NHPI^ Other/Multiple White Latino Race^

Figure 21. Vaccination Progress by Healthy Places Index Quartile,* San Diego County Residents Age 12 Years and Older 800K 696,294 708,727 701,259 681,633 15.9% 600K 25.0% 26.6% 7.4% 25.4% 7.6% 8.5% 8.9% 400K

76.7% 67.4% 200K 64.9% 60.5% Numberof Individuals

0 Quartile 1 Quartile 2 Quartile 3 Quartile 4

Most Healthy Least Healthy

*The California Healthy Places Index ^The percentage and rate of the population vaccinated with at least one dose of COVID-19 vaccine may approach, or exceed, 99% or 999 per 1,000 San Diego residents aged 12 years and older. The most recent race/ethnicity populations are 2019 estimates, which may underestimate the current population. When these demographics are analyzed, the population estimates may not reflect social and environmental changes of a community, possibly leading to an under- or overestimate of a population. Individuals vaccinated by Veterans Affairs or Department of Defense are not included. COVID-19 vaccine is not approved for those under age 12 at this time. Data source: San Diego Immunization Registry, SANDAG 2019 Population Estimates (Prepared June 2020). Total population 12 years of age and older=2,833,418. Data through Epidemiology and Immunization Services Branch 9/18/2021 www.sdepi.org (619) 692-8499 Page 13 COVID-19 WATCH Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report

COVID-19 Cases in Children and Outbreaks in School Settings

Figure 22. COVID-19 Confirmed Cases for Ages 0-18 Years by Week of Illness Onset,* San Diego County Residents, N=14,267 750 700 650 600 550 500 450 400 350 300 250 200 150 100 50 0 6/26 7/4 7/11 7/18 7/25 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending 0-5 years 6-11 years 12-14 years 15-18 years

*When onset date is unavailable, specimen collection date, date of death, or date reported is used instead.

Figure 23. COVID-19 Outbreaks in School Settings (Tk-12th Grade) by Week of Illness Onset (N=63) 16 14 12 10 8 6 4 2 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending Sports Team (N = 9) Other (N = 54)

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COVID-19 Cases in Schools

Figure 24. Confirmed Cases Physically Present at K-12 Schools During Exposure Period* by Week of Illness Onset**, San Diego County Residents, N=1,859 400 350 350 313 300 243 250 200 143 150 112 102 88 94 100 57 45 43 22 30 36 35 50 4 18 9 1510 14 13 19 16 16 12 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending

Student (N = 1,566) Non-Student (N = 293)

*Cases are among students and non-students physically present at a K-12 school 2-14 days prior to symptom onset (or lab collection date if asymptomatic) with COVID-19. **If case did not have symptoms or illness onset date is unavailable, the earliest of specimen collection date, date of death, or date reported is used instead.

Figure 25. Confirmed Cases Physically Present at K-12 Schools During Communicable Period* by Week of Illness Onset**, San Diego County Residents, N=1,767 350 308 300 250 230 223

200 168 150 107 98 103 91 100 69 59 38 47 45 34 50 15 18 19 26 4 1 12 5 1411 11 11 0 6/26 7/3 7/10 7/17 7/24 7/31 8/7 8/14 8/21 8/28 9/4 9/11 9/18 Week Ending Student (N = 1,465) Non-Student (N = 302)

*Cases are among students and non-students physically present at a K-12 school 48 hours prior to symptom onset (or lab collection date if asymptomatic) with COVID-19. **If case did not have symptoms or illness onset date is unavailable, the earliest of specimen collection date, date of death, or date reported is used instead.

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COVID-19 Laboratory Test Positivity Rate – Previous 12 Months

Figure 26. COVID-19 Testing Volume and Positivity by Week of Specimen Collection, San Diego County 250,000 18 16 200,000 14 12 150,000 10 8 100,000 6

Number of Tests of Number 50,000 4 2 Positive Percent 0 0 1 2 3 4 5 6 7 8 9 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2021 CDC Week and Calendar Month Total Tests Performed % Positive

Includes PCR tests performed by COSD Public Health, hospital, and reference laboratories and reported via Electronic Laboratory Reporting (ELR) and line lists. Excludes invalid, indeterminate, and unsatisfactory results.

Emergency Department Data – Previous 12 Months

Figure 27. Percent of Emergency Department Visit Chief Complaints for ILI, Respiratory Symptoms, or COVID-like Illness* by Week, San Diego County 25

20

15

10

5 Percent of Visits ED Percent

0 1 2 3 4 5 6 7 8 9 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2020 2021 CDC Week and Calendar Month Respiratory Symptoms Influenza-like Illness COVID-like Illness*

Categories are not mutually exclusive. *COVID-like Illness includes fever and cough, shortness of breath, or difficulty breathing OR coronavirus diagnostic codes. Data through Epidemiology and Immunization Services Branch 9/18/2021 www.sdepi.org (619) 692-8499 Page 16 COVID-19 WATCH Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report

COVID-19 Pandemic at a Glance

Figure 28. COVID-19 Confirmed and Probable Cases by Week of Illness Onset*, San Diego County Residents, N=369,426 30,000

25,000

20,000

15,000

10,000

5,000

0 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept

2020 2021 CDC Week and Calendar Month Probable** Confirmed

*When onset date is unavailable, specimen collection date, date of death, or date reported is used instead. **Probable cases are antigen positive tests received since August 1, 2020.

Figure 29. COVID-19 Deaths by Week of Death San Diego County Residents, N=4,006 350

300

250

200

150

100

50

0 1 2 3 4 5 6 7 8 9 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept

2020 2021 CDC Week and Calendar Month 0-11 years 12-19 years 20-39 years 40-59 years 60+ years

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Pandemic at a Glance: Summary of COVID-19-associated Deaths

Figure 30. Age-Adjusted Rates of COVID-19-associated Deaths by Race/Ethnicity, San Diego County Residents, N=3,810*

Total Hispanic / Latino 231 Multiple Race White 63 NHPI** Black 113 Asian Asian 87 Black NHPI** 193 White Multiple Race 50 Hispanic / Latino Total 104 0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 Hispanic / Multiple White Black Asian NHPI** Total Latino Race Number of Deaths 1,746 1,416 166 413 32 24 3,810 Rate 103.76 49.76 193.28 86.84 113.31 62.87 230.80

The black lines represent the 95% confidence intervals (error bars). Rates are not calculated for fewer than 20 events. *Race/ethnicity are unknown for 196 deaths. **NHPI=Native Hawaiian/Pacific Islander, AIAN=American Indian/Alaska Native.

Figure 31. Common Underlying Conditions, COVID-19-associated Deaths

Hypertension 43% Diabetes 35% Cardiac Disease 27% Dementia/Alzheimer's 19% Chronic Kidney Disease 16% COPD/Asthma 12% Obesity 10% Immunocompromised 7% No Underlying Condition 3%

Persons may have more than one underlying condition. These data are abstracted from death certificates and available medical records and may not reflect a complete list of underlying conditions for each person.

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COVID-19 Watch Data Sources The following sources of data are used to produce this report: • COVID-19 case reports: Medical providers and laboratories report individual cases of PCR-confirmed and antigen-positive probable COVID-19 via fax or electronic laboratory reporting (ELR) to the County of San Diego Epidemiology Unit. • COVID-19 deaths: The County of San Diego requests that all deaths related to COVID-19 be reported for surveillance purposes. Medical facilities may report these deaths directly to the Epidemiology Unit or they may be identified by the Office of Vital Records through death certificate registration. The Epidemiology Unit compiles the data, and only reports deaths that can be verified by a death certificate. • Emergency Department Chief Complaint Data: Electronic emergency department data are reported to the Epidemiology Unit daily. The number of respiratory chief complaints and the number of total emergency department visits are used to calculate percentages for all respiratory-related visits and visits specific to influenza-like illness and COVID-like illness. • COVID-19 outbreaks: o Skilled Nursing Facilities: at least one case of laboratory-confirmed COVID-19 in a resident. o Non-SNF Institution/Congregate Settings: At least three probable or confirmed COVID-19 cases within a 14-day period in epidemiologically-linked residents and/or staff. o Community settings: At least three probable or confirmed COVID-19 cases within a 14-day period in people who are epidemiologically-linked in the setting, are from different households, and are not identified as close contacts of each other in any other case investigation. • COVID-19 vaccinations: Number of vaccinations registered in the San Diego Immunization Registry (SDIR) by participating providers. Some providers, including the VA, DoD, other military, some tribal, and prisons do not report to SDIR. • SANDAG population estimates, vintage 2019: Rates are calculated using 2019 population estimates from the San Diego Association of Governments. Rates are not calculated for counts under five cases.

The purpose of the weekly COVID-19 Watch is to summarize current COVID-19 surveillance in San Diego County. Data are preliminary and may change due to delayed reporting and additional information obtained during investigations.

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