The CDC's national picture changed shape this week, and the change is in the direction of spread rather than severity. According to the agency's epidemic trend estimates, as of July 22, COVID-19 infections are growing or likely growing in 37 states, not changing in 11, and declining in zero.
That last figure is the one that matters. For most of this year, there has been somewhere in the country where transmission was falling. Right now, by the CDC's model, there is not.
The context that makes this useful rather than frightening is the second half of the same surveillance package. Overall acute respiratory illness, the metric that captures everything from the common cold to severe infection in emergency department visits, remains at low or very low levels nationally, and CDC wastewater monitoring lists influenza A and RSV at very low levels across the country.
Why This Matters
Two things can be true at once, and this week they are. Transmission is expanding almost everywhere, and the burden on hospitals and emergency rooms is still light.
For a typical household, that combination points to a specific and limited set of decisions rather than a general alarm. It means someone in the house is more likely to catch COVID in August than in June. It also means that for most healthy adults and children, the likely outcome is a week of unpleasant illness rather than a hospital visit.
The households where the calculation is different are those with an adult over 65, an infant, a pregnant family member, or someone immunocompromised, and those planning travel or a large indoor gathering in the next several weeks.
What Changed Since MedicalDaily's Previous Report
MedicalDaily previously reported that COVID was growing in 27 states as the NB.1.8.1 subvariant took the lead and emergency department visits began rising, with national test positivity at 4.8% as of July 12. Earlier, in coverage of the CDC's summer outlook, the agency's models showed infections growing in only two states as of June 16.
The trajectory from 2 states to 27 states to 37 states in roughly five weeks is the new information. So is the disappearance of any state in the declining category. What has not changed is the severity picture, and that distinction is the point of this report.
What We Know So Far
The CDC updates its respiratory data on Fridays with the previous week's figures, which means every number here carries a reporting lag of several days and is subject to revision.
Flu and RSV epidemic trend updates for the 2025 to 2026 season ended on May 29 and will resume in the fall. COVID-19 trend data continues through the summer, so the COVID figures are the only live trend estimates in the package right now. Readers comparing this week's data to winter reporting should keep that in mind.
State health departments are reporting the same direction of travel. The California Department of Public Health said COVID activity has been gradually increasing across the state, noting that summer increases have occurred yearly since 2020 and that the rise is not unexpected. California officials described hospitalization rates as very low statewide while cautioning they are expected to rise in coming weeks, and said the percentage of emergency department visits and deaths attributed to COVID are both below the levels seen in the same period of the previous two years.
Where the Risk Is Highest
The CDC's 2026 COVID-19 Summer Outlook explains the regional pattern through population immunity rather than through any new property of the virus.
Regions that experienced substantial COVID activity during the 2025 to 2026 fall and winter season built more recent infection-derived immunity. Scenario modeling projects lower summer transmission and fewer hospitalizations in those areas, a group the CDC identifies as HHS Regions 1, 2, 3, 5, 7 and 8, covering much of the Northeast and Midwest.
The South and West did not have that winter wave. Less recent immunity, combined with people moving indoors to escape heat, is the mechanism the CDC describes for higher projected summer activity in those regions. Wastewater signals through July have tracked that expectation, running highest in western and southern states.
What the Data Show and What They Do Not
The epidemic trend model estimates direction, not volume. It tells you whether infections in a state are rising or falling. It does not tell you how many people are currently infected, and a state can move into the growing category from a very low starting point.
The model is built on emergency department visit data, so it can be affected by changes in who seeks emergency care and by reporting revisions. The CDC notes that recent weeks of laboratory data are preliminary.
Wastewater readings also do not always agree across systems. CDC's national wastewater level and independent monitoring networks have at times characterized the same period differently because they use different methods. Where sources disagree, the honest description is that both are measuring a genuine upward signal with different sensitivity.
Who Faces the Greatest Risk
Severe COVID outcomes remain concentrated in adults 65 and older, infants, pregnant people, and people who are immunocompromised, including those in cancer treatment or after transplant. People with chronic heart, lung or kidney disease and those with diabetes also face elevated risk of hospitalization.
Emergency department visits have been running highest among the youngest children in recent summer waves, which is worth knowing for families with a child in day care.
For healthy adults under 60 with no underlying conditions, the current data do not support treating this as a personal emergency.
Symptoms and Warning Signs to Watch For
Current COVID illness commonly presents as sore throat, cough, fatigue, headache, congestion, body aches, and fever. Loss of taste or smell is less common than it was in earlier years.
Most people can manage at home with rest and fluids. Trouble breathing, chest pain or pressure, confusion, inability to stay awake, bluish lips or a rapidly worsening condition are reasons to seek urgent care immediately.
What You Can Do Now
People at higher risk can ask a clinician now, rather than after symptoms begin, whether they are a candidate for antiviral treatment, since these medications work best when started early in illness. Having that conversation in advance shortens the delay when it matters.
Keeping a few tests at home is reasonable, and testing before visiting an older or immunocompromised relative is a low-cost precaution. Anyone unsure whether their COVID vaccination is current can ask a pharmacist or clinician.
What the current data do not justify is canceling routine plans, avoiding medical appointments, or treating a low national burden as a crisis.
Cost and Access
Most insurance plans and Medicare cover COVID vaccination without cost sharing, and many county health departments and pharmacies administer it at no cost. Vaccines.gov lists nearby locations.
Free or low-cost testing is available through many community health centers and local health departments, though availability varies considerably by county. Patients prescribed antivirals who face a high copay can ask their prescriber or pharmacist about manufacturer patient assistance programs.
What Happens Next
The CDC refreshes respiratory surveillance data every Friday, and epidemic trend estimates update alongside it. Flu and RSV trend reporting resumes in fall 2026. Whether the current expansion produces a meaningful rise in hospitalizations, as opposed to a rise in infections, should become visible in the hospitalization rate over the next two to four weekly updates. MedicalDaily will track those releases.
The Bottom Line
The newest confirmed fact is that the CDC's model now shows COVID growing or likely growing in 37 states with none declining, while overall respiratory illness stays low. The households most affected are those with an older, pregnant, infant, or immunocompromised member. The most reasonable step is an early conversation about antiviral eligibility rather than a change to daily routine. The central uncertainty is whether infections translate into hospitalizations, and the next data point arrives with the coming Friday update.
Developing Story Timeline
July 24, 2026: CDC posts its weekly respiratory data refresh; trend estimates through July 22 show 37 states growing or likely growing and none declining.
July 12, 2026: National test positivity reported at 4.8%, with growth estimated in 27 states.
June 16, 2026: CDC modeling showed infections growing in only two states.
June 2026: CDC publishes its 2026 COVID-19 Summer Outlook, flagging lower recent immunity in the South and West.
