What is already known about this topic?
Early in the pandemic, COVID-19 incidence was highest among older adults.
What is added by this report?
During June–August 2020, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. Younger adults likely contribute to community transmission of COVID-19. Across the southern United States in June 2020, increases in percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days.
What are the implications for public health practice?
Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce infection and subsequent transmission to persons at higher risk for severe illness.
As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in more than 6,800,000 reported U.S. cases and more than 199,000 associated deaths.* Early in the pandemic, COVID-19 incidence was highest among older adults (1). CDC examined the changing age distribution of the COVID-19 pandemic in the United States during May–August by assessing three indicators: COVID-19–like illness-related emergency department (ED) visits, positive reverse transcription–polymerase chain reaction (RT-PCR) test results for SARS-CoV-2, the virus that causes COVID-19, and confirmed COVID-19 cases. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19–like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. Census regions. During June–August, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range = 4–15 days), suggesting that younger adults likely contributed to community transmission of COVID-19. Given the role of asymptomatic and presymptomatic transmission (2), strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and subsequent transmission of SARS-CoV-2 to persons at higher risk for severe illness. ...
Increased prevalence of SARS-CoV-2 infection among younger adults likely contributes to community transmission of COVID-19, including to persons at higher risk for severe illness, such as older adults. Emphasis should be placed on targeted mitigation strategies to reduce infection and transmission among younger adults, including age-appropriate prevention messages (7), restricting in-person gatherings and events,**** recommending mask use and social distancing in settings where persons socialize,†††† implementing safe practices at on-site eating and drinking venues (9), and enforcing protection measures for essential and service industry workers.§§§§ Given the role of asymptomatic and presymptomatic transmission (2), all persons, including young adults, should take extra precautions to avoid transmission to family and community members who are older or who have underlying medical conditions. Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce their risk for infection and minimize subsequent transmission of SARS-CoV-2 to persons at higher risk for severe COVID-19.
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