Detection of Real-Time Changes in Direction of COVID-19 Transmission Using National- and State-Level Epidemic Trends Based on <i>R</i> Estimates — United States Overall and New Mexico, April–October 2024

Public health practitioners rely on timely surveillance data for planning and decision-making; however, surveillance data are often subject to delays. Epidemic trend categories, based on time-varying effective reproductive number (R_t) estimates that use nowcasting methods, can mitigate reporting lags in surveillance data and detect changes in community transmission before reporting is completed. CDC analyzed the performance of epidemic trend categories for COVID-19 during summer 2024 in the United States and at the state level in New Mexico. COVID-19 epidemic trend categories were estimated and released in real time based on preliminary data, then retrospectively compared with final emergency department (ED) visit data to determine their ability to detect or confirm real-time changes in subsequent ED visits. Across the United States and in New Mexico, epidemic trend categories were an early indicator of increases in COVID-19 community transmission, signifying increases in COVID-19 community transmission in May, and a confirmatory indicator that decreasing COVID-19 ED visits reflected actual decreases in COVID-19 community transmission in September, rather than incomplete reporting. Public health decision-makers can use epidemic trend categories, in combination with other surveillance indicators, to understand whether COVID-19 community transmission and subsequent ED visits are increasing, decreasing, or not changing; this information can guide communications decisions.