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Enhancing U.S. Surveillance of Laboratory Confirmed SARS-CoV-2, Influenza, and other Respiratory Viruses through a Network of Emergency Departments  - RECOVER CDC


Health care utilization and respiratory virus testing practices have changed due to the COVID-19 pandemic and may continue to change as the pandemic evolves and the degree of respiratory virus co-circulation varies. In anticipation of these systemic changes, the Centers for Disease Control and Prevention (CDC) is exploring the addition of emergency department (ED) illness and laboratory surveillance data to existing surveillance systems. The emergency department network (EDN) would fill an important gap in respiratory virus surveillance. Specifically, CDC is seeking to assess the feasibility of creating a national U.S. network by establishing the collection and reporting of weekly lab-confirmed respiratory virus surveillance data from ED patients and obtaining follow up information to determine patient disposition. These data will provide CDC and states with critical information necessary to determine rates of respiratory illness in ED settings and the percent of specimens testing positive for SARS-CoV-2, influenza, or other respiratory viruses in both hospitalized and non-hospitalized ED patients.


The project will review the records of all subjects that present to the emergency department of all ages, with chief complaints of ARI symptoms; provisionally cough and/or fever and predefined ED diagnoses (see Table 1). It is not possible to provide an exact estimate of enrollment, but we anticipate that 5-6% of all ED patients will meet the definition of an ARI, so at an ED with 100,000 visits, this will include approximately 5,000-6,000 patients.




The purpose of this project is to conduct surveillance for SARS-CoV-2, influenza, and other respiratory viruses among ED patients over a 3-year period.


This project has six (6) goals. 

  • Use clinician driven testing to determine the percentage of patients with various symptom presentation(s) that are positive for SARS-CoV-2, influenza, and other respiratory viruses. 
  • Estimate rates of outpatient illness by combining number of patients presenting with specific symptoms/syndromes and percent positivity with estimates of population served. 
  • Obtain information about ED disposition to fill a current gap and allow for more accurate use of virologic testing results in burden of disease estimates since testing practices likely vary based on disease severity/admission status. 
  • Determine the proportion of emergency department visits for influenza-like illness (ILI) or other agreed upon symptom presentation that are due to SARS-CoV-2, influenza, or other respiratory virus infections by combining data from clinician driven testing and weekly reports of the number of patients presenting with specific respiratory symptoms/syndromes. 
  • Ensure specimens are submitted to public health laboratories in compliance with jurisdiction specific specimen submission protocols. 
  • Explore the feasibility of providing data for the estimation of effectiveness of COVID-19 and influenza vaccines in preventing ED visits and hospital admission.

Multi-institutional Participation

Join this multi-institutional research initiative by contacting the research team for more information.

Daren Beam, MD

Alfred Wang, MD