[1]  Reported COVID-19 cases include confirmed and probable cases, as of April 14, 2020, if states report probable cases to CDC. According to CDC, the actual number of cases is unknown for a variety of reasons, including that people who have been infected may have not been tested or may have not sought medical care. National Center for Health Statistics (NCHS) provisional death counts include both confirmed and probable or presumed deaths. The counts reported are the total number of deaths received and coded as of the date of analysis and do not represent all deaths that occurred in that period. Provisional counts are incomplete because of the lag in time between when the death occurred and when the death certificate is completed, submitted to NCHS, and processed for reporting purposes. This delay is an average of 1 to 2 weeks and can range from 1 to 8 weeks or more, depending on the jurisdiction, age, and cause of death.

[2]  Bureau of Labor Statistics, Unemployment Level [UNEMPLOY], retrieved from FRED, Federal Reserve Bank of St. Louis, accessed August 7, 2020, https://fred.stlouisfed.org/series/UNEMPLOY.

[3]  Pub. L. No. 116-136, 134 Stat. 281 (2020). As of August 1, 2020, three other relief laws had also been enacted in response to the COVID-19 pandemic: the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020); and Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020). In this report, we refer to these four laws, each of which was enacted as of August 1, 2020, and provides supplemental appropriations for the COVID-19 response, as “COVID-19 relief laws,” and the supplemental funding appropriated by these laws as “COVID-19 relief funds.” This report does not address the Executive Order on homeowner and renter assistance, or Memoranda on payroll tax deferrals, student loan payment relief, or assistance for lost wages, issued on August 8, 2020.

[4]  Pub. L. No. 116-136, § 19010, 134 Stat. at 579-81.

[5]  GAO, COVID-19: Opportunities to Improve Federal Response and Recovery Efforts, GAO-20-625 (Washington, D.C.: June 25, 2020).

[6]  The CARES Act created the Pandemic Response Accountability Committee within the Council of the Inspectors General on Integrity and Efficiency to promote transparency and conduct and support oversight of covered funds and the COVID-19 response to (1) prevent and detect fraud, waste, abuse, and mismanagement and (2) mitigate major risks that cut across program and agency boundaries.

[7]  The Bureau of the Fiscal Service issues warrants to federal agencies, which are the official documents that the Department of the Treasury issues upon enactment of an appropriation that reflect the dollar amount authorized to be obligated and expended for the specified purpose and period of availability provided by law.

[8]  Department of Health and Human Services, COVID-19 Guidance for Hospital Reporting and FAQs for Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting (July 10, 2020) and Centers for Disease Control and Prevention, Health Departments: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan (June 19, 2020).

[9]  Cases reported by CDC include both confirmed and probable cases. A confirmed case is defined by meeting confirmatory laboratory evidence for COVID-19, i.e. a positive molecular test. A probable case is defined by one of the following: (1) meeting clinical criteria AND epidemiologic evidence with no confirmatory laboratory testing performed for COVID-19; (2) meeting presumptive laboratory evidence AND either clinical criteria OR epidemiologic evidence; or (3) meeting vital records criteria with no confirmatory laboratory testing performed for COVID-19. For more information on COVID-19 testing, see “Key Health Care and Economic Indicators” section.

[10]  An appropriation provides legal authority for federal agencies to incur obligations and make payments out of the U.S. Treasury for specified purposes.

[11]  The Small Business Administration’s Business Loan Program account includes activity for the Paycheck Protection Program and certain loan subsidies.

[12]  An obligation is a definite commitment that creates a legal liability of the U.S. government for the payment of goods and services ordered or received, or a legal duty on the part of the U.S. government that could mature into a legal liability by virtue of actions on the part of the other party beyond the control of the U.S. government. An expenditure is the actual spending of money, or an outlay. Expenditures include some estimates, such as estimated subsidy costs for direct loans and loan guarantees. Increased spending in Medicaid is not accounted for in the appropriations provided by the COVID-19 relief laws. USAspending.gov accessed on August 19, 2020.

[13]  Specifically, agencies that received COVID-19 relief funds were directed to report April, May, and June 2020 obligations and expenditures in July 2020, and certify the data quality by August 14, 2020, on USAspending.gov. Office of Management and Budget, Implementation Guidance for Supplemental Funding Provided in Response to the Coronavirus Disease 2019, OMB Memorandum M-20-21 (Washington, D.C.: Apr. 10, 2020).

[14]  Obligations and expenditures of COVID-19 relief funds as of July 31, 2020, are required to be reported to USAspending.gov by August 28, 2020, and certified by November 16, 2020.

[15]  Totals exclude loans that have been canceled. According to SBA, canceled loans may include, but are not limited to, duplicative loans, loans not closed for any reason, and loans that have been fully paid off.

[16]  Under the Federal Credit Reform Act, which is codified, as amended, at 2 U.S.C. §§ 661-661f, federal agencies making a loan guarantee must obligate the subsidy cost, which is the loan’s estimated long-term cost to the U.S. government, calculated on a net present value basis at the time when the guaranteed loan is disbursed by the lender. The subsidy cost excludes administrative costs and includes estimates of both payments made by the government, such as to cover loan forgiveness, defaults and delinquencies, and revenues received by the government, such as fees and penalties.

[17]  CARES Act. Pub. L. No. 116-136, § 4027, 134 Stat. at 496-97 (codified at 15 U.S.C. § 9061). This provision appropriated $500 billion for the Exchange Stabilization Fund established under 31 U.S.C. § 5302.

[18]  To implement these facilities, the Federal Reserve is using legal entities known as special purpose vehicles to purchase qualifying assets from or initiate lending to eligible institutions, and Treasury has also made equity investments in the special purpose vehicles with CARES Act funds.

[19]  May and June 2020 included 4 weeks, while July 2020 included 5 weeks.

[20]   IRS Notice 2020-23, 2020-18 IRB 742 (Apr. 27, 2020). Notice 2020-23 amplified relief provided in Notice 2020-18 and Notice 2020-20. 2020-15 IRB 590 (Apr. 6, 2020); 2020-16 IRB 660 (Apr. 13, 2020). The Secretary of the Treasury has statutory authority to postpone filing and payment deadlines for taxpayers affected by federally declared disasters. 26 U.S.C. § 7508A. On March 13, 2020, the President instructed the Secretary of the Treasury to provide relief from tax deadlines to Americans who have been adversely affected by the COVID-19 emergency, as appropriate, pursuant to 26 U.S.C. 7508A(a).

[21]  Pub. L. No. 116-136, §§ 15010, 15011, 134 Stat. at 533–42.

[22]  Federal Funding Accountability and Transparency Act of 2006, Pub. L. No. 109-282, 120 Stat. 1186; DATA Act, Pub. L. No. 113-101, 128 Stat. 1146 (reprinted in 31 U.S.C. § 6101 note).

[23]  OMB Memorandum M-20-21.

[24]  Office of Management and Budget, Additional Guidance for DATA Act Implementation: Further Requirements for Reporting and Assuring Data Reliability, OMB Memorandum M-17-04 (Washington, D.C.: Nov. 4, 2016). Specifically, the SAO must certify that the alignment among all submitted files is valid and reliable and that the data from the agency’s financial systems are valid and reliable. In addition, agencies are to include information about any data limitations in their SAO certification statements, which are then made publicly available on USAspending.gov.

[25]  For details on other challenges identified by GAO and agency inspectors general, including data accuracy, completeness, and timeliness, see GAO, DATA Act: Quality of Data Submissions Has Improved but Further Action Is Needed to Disclose Known Data Limitations, GAO-20-75 (Washington, D.C.: Nov. 8, 2019) and DATA Act: OIGs Reported That Quality of Agency-Submitted Data Varied, and Most Recommended Improvements, GAO-20-540 (Washington, D.C.: July 9, 2020).

[26]  GAO, DATA Act: OMB, Treasury, and Agencies Need to Improve Completeness and Accuracy of Spending Data and Disclose Limitations, GAO-18-138 (Washington, D.C.: Nov. 8, 2017).

[27]  These disclosures include information from specific federal agencies regarding how reporting issues may impact the accuracy or completeness of COVID-19 data displayed on the site. Examples include timing differences resulting in discrepancies in program totals listed on USAspending.gov when compared to other sources and the lack of information on the geographic distribution of payments for specific programs.

[28]  These data were collected from the websites of state/territory public health authorities by the COVID Tracking Project, which is a volunteer organization dedicated to collecting and publishing data concerning the COVID-19 outbreak in the United States. To determine the number of states that met the 5 percent threshold over a 14-day period, we identified states with a positivity rate of less than 5 percent based on a 7-day moving average for two consecutive weeks. A 7-day moving average (current day plus 6 preceding days) is used to smooth expected variation in daily counts of positive cases. An average of less than 7 days may not be representative of the ongoing COVID-19 experience because it does not account for certain fluctuations in the data, such as fewer cases being reported on weekends.

[29]  See: Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, COVID-19 Management Metrics for Cities: Guide for Mayors and City Leadership (June 2020); National Academies of Sciences, Engineering, and Medicine 2020, Evaluating Data Types: A Guide for Decision Makers using Data to Understand the Extent and Spread of COVID-19 (Washington, D.C.: The National Academies Press, June 2020); Resolve to Save Lives and Vital Strategies, Tracking COVID-19 in the United States From Information Catastrophe to Empowered Communities (July 2020).

[30]  Resolve to Save Lives is a public health organization focused on preventing deaths from epidemics, and it is part of Vital Strategies, a global public health organization that works with governments to help address public health challenges such as epidemics.

[31]  These data were collected from the websites of state/territory public health authorities by the COVID Tracking Project. The threshold positivity rate is calculated as an average over the 7-day period.

[32]  Harvard officials told us that the goal of developing the framework was to build consensus around key indicators and help policymakers effectively respond to COVID-19. Officials also explained that other strategies should be used concurrently, such as social distancing. See Harvard Global Health Institute and Edmond J. Safra Center for Ethics, Key Metrics for COVID Suppression: A Framework for Policymakers and the Public (July 1, 2020).

[33]  Further, the framework provides targets related to the composition of positive COVID-19 cases. For example, the framework recommends that about 60 percent of positive cases should come from individuals who were tested because they were identified through contact tracing (e.g., asymptomatic individuals), compared to individuals who were tested because they were symptomatic.

[34]  For example, achieving a sufficient level of testing depends, in part, on ensuring that all supplies required to conduct the tests are made available. As noted in our June 2020 report, challenges remain in ensuring adequate COVID-19 testing supplies. In mid-July 2020, the Food and Drug Administration issued the first emergency use authorization for a COVID-19 viral test for use with pooled samples. Pooled samples allow for fewer tests to be run overall, conserving testing resources, including supplies, and potentially allowing more samples to be evaluated faster.

[35]  CDC is the official federal source for testing data. As an example of CDC’s efforts to improve testing data, on June 4, 2020, HHS issued guidance that, pursuant to its new authority under the CARES Act, requires all laboratories to submit data on viral tests and other tests they perform to diagnose a possible case of COVID-19. Required data include those on point-of-care tests and those that identify whether a viral or antibody test was performed.

[36]  Digital contact tracing tools can facilitate contact tracing and may reduce the number of contact tracers needed. In addition, digital apps that trace proximity can identify and notify contacts faster, leading to faster quarantine. See GAO, Science & Tech Spotlight: Contact Tracing Apps, GAO-20-666SP (Washington, D.C.: July 28, 2020).

[37]  See GAO, Science & Tech Spotlight: Social Distancing During Pandemics, GAO-20-545SP (Washington, D.C.: May 13, 2020).

[38]  Harvard Global Health Institute and Edmond J. Safra Center for Ethics, Key Metrics for COVID Suppression: A Framework for Policymakers and the Public (July 1, 2020); Bloomberg Philanthropies and the Johns Hopkins Bloomberg School of Public Health, COVID-19 Management Metrics for Cities: Guide for Mayors and City Leadership (June 2020); Resolve to Save Lives and Vital Strategies, Tracking COVID-19 in the United States: From Information Catastrophe to Empowered Communities (July 2020).

[39]  Centers for Disease Control and Prevention, Health Departments: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan (June 19, 2020).

[40]  According to CDC officials, $10.25 billion in funds provided under the Paycheck Protection Program and Health Care Enhancement Act were obligated for awards to states, territories, and local jurisdictions through CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases cooperative agreement to help them expand their testing and contact tracing capacity, among other things.

[41]  The other five measures are (1) number of COVID-19 cases assigned for investigation, per staff person; (2) among COVID-19 cases prioritized for investigation, the proportion interviewed within 24 hours of being reported to staff; (3) number of close contacts of infected individuals assigned for follow up, per contact tracer; (4) among contacts notified by staff, the proportion tested for COVID-19 (at least once within 14 days of notification); and (5) number of new confirmed or probable COVID-19 cases identified among contacts in the contact tracing system (within 14 days of last exposure to the originating COVID-19 case).

[42]  This equates to about 98,460 contact tracers needed to cover the U.S. population.

[43]  As described earlier, these funds were provided with amounts appropriated under the Paycheck Protection Program and Health Care Enhancement Act.

[44]  The estimated number of flu hospitalizations varies from season to season. Since 2010, CDC estimates that flu has resulted in between 140,000 and 960,000 hospitalizations each year. Ventilators are critical for treating hospitalized flu patients in respiratory failure. A 2017 study estimated that about 20 percent of flu patients treated in ICUs required the use of ventilators.

[45]  Hospital referral regions refer to markets where people generally go to the same hospitals.

[46]  This metric is based on data that hospitals voluntarily reported to CDC’s National Healthcare Safety Network on daily ICU occupancy.

[47]  HHS Protect is a data platform that includes data from hospitals and other sources, such as the Census, and TeleTracking is a system that HHS uses to collect data for input into HHS Protect.

[48]  CDC’s National Healthcare Safety Network collects a range of data—including healthcare-associated infections, antibiotic resistance, and antibiotic use—from hospitals and other health care facilities.

[49]  HHS Protect Public Data Hub displays the percentage of hospitals reporting one or more elements into HHS Protect for the most recent collection date (during the last 7 days). See the Department of Health and Human Services, Percentage of Hospitals Reporting by State, HHS Protect Public Data Hub, accessed July 31, 2020, https://protect-public.hhs.gov/pages/covid19-module .

[50]  This estimate of hospital reporting includes data from the 50 states and the District of Columbia. Data from U.S. territories, such as Puerto Rico and American Samoa, were not included but are available from the HHS Protect Public Data Hub.

[51]  For more information about examining higher than expected deaths during the pandemic, see GAO, COVID-19: Data Quality and Considerations for Modeling and Analysis, GAO-20-635SP (Washington, D.C.: July 30, 2020).

[52]  For example, see National Academies of Sciences, Engineering, and Medicine 2020, Evaluating Data Types: A Guide for Decision Makers using Data to Understand the Extent and Spread of COVID-19; Steven H Woolf et al., “Excess Deaths From COVID-19 and Other Causes, March-April 2020,” Journal of American Medical Association (July 1, 2020); and Daniel M. Weinberger et al., “Estimation of Excess Deaths Associated with the COVID-19 Pandemic in the United States, March to May 2020,” Journal of the American Medical Association (July 1, 2020).

[53]   This total represents the number of deaths that exceeds the upper bound of normal variation as estimated using CDC’s 95 percent confidence interval. See CDC’s National Center for Health Statistics webpage on excess deaths for more details on the approach: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm, accessed on July 16, 2020.

[54]  Daniel J. Lewis, Karel Mertens, and Jim Stock, “U.S. Economic Activity during the Early Weeks of the SARS-Cov-2 Outbreak,” Federal Reserve Bank of New York Staff Report No. 920 (April 2020).

[55]   GAO-20-625 .

[56]  A basis point is 1/100^th of a percentage point. The 3 month Treasury interest rate is the constant maturity rate from the Federal Reserve’s H.15 Selected Interest Rates release.

[57]  The severity of the pandemic is likely to influence the pace of economic activity. Moreover, the nature of social interactions associated with growing economic activity could influence the risk of contagion, suggesting important feedback effects between the economy and the pandemic.

[58]  See for example, Asger Lau Andersen, Emil Toft Hansen, Niels Johannesen, and Adam Sheridan, “Pandemic, Shutdown and Consumer Spending: Lessons from Scandinavian Policy Responses to COVID-19,” (2020) and Adam Brzezinski, Guido Deiana, Valentin Kecht and David Van Dijcke, “The COVID-19 Pandemic: Government versus Community Action across the United States,” INET Oxford Working Paper No. 2020-06 (2020).

[59]  World Customs Organization, HS classification reference for Covid-19 medical supplies, 2 ^ndedition (April 9, 2020). The import and export values are based on Harmonized Schedule (HS) codes at the 6-digit level identified by the World Customs Organization and the World Health Organization. While these are a useful indication of trends in the imports and exports of COVID-19-related products, because HS 6-digit numbers are broad categories that cover more than one product, data at the HS 6-digit level may include a mix of COVID-19-related and non-COVID-19- related products. For this reason, the value reported may overestimate the imports and exports of COVID-19-related products.

[60]  We identified a number of economic indicators to facilitate ongoing and consistent monitoring of areas of the economy supported by the federal pandemic response. These six areas are labor markets, households, small business credit markets, corporate credit markets, markets associated with state and local government finances, and the health care sector. Key aspects of the federal response that are intended to support the economy include Federal Reserve lending facilities, some supported by funds appropriated under the CARES Act to Treasury’s Exchange Stabilization Fund; the Paycheck Protection Program; expanded unemployment insurance; recovery rebates; and payments to state, local, and tribal governments. To the extent that federal pandemic responses are effective, we would expect to see improvements in outcomes related to these indicators. However, while trends in these indicators may be suggestive of the effect of provisions of the COVID-19 relief laws over time, those trends will not on their own provide definitive evidence of effectiveness.

[61]  The employment-to-population ratio represents the number of employed people as a percentage of the civilian noninstitutional population 16 years and over.

[62]  From March through July, employment data from the Bureau of Labor Statistics (BLS) household survey, including the employment-to-population ratio, have been subject to misclassification errors with respect to identifying workers as employed and absent from work or unemployed on temporary layoff consistently. According to BLS, the degree of misclassification error declined considerably in June and July after BLS took steps to improve the reliability of the data after the May employment data were released. While BLS measures employment and labor force statistics in its household survey, it also measures an alternative measure of employment called nonfarm employment in its establishment survey. According to BLS, the establishment survey was not subject to the misclassification error, and employment variables from both data sets indicate increases in employment levels in July. See the “Coronavirus (COVID-19) Impact on June 2020 Establishment and Household Survey Data” in BLS’s Employment Situation Summary for more details.

[63]  The S&P/Experian Consumer Credit Default Composite Index measures the proportion of consumer credit account balances that enter default across auto loans, first and second mortgages, and bank cards each month. Although changes in these indexes over time should provide a general indication of changes in the financial condition of households, forbearance arrangements could affect how delinquencies are reported and therefore the measurement of consumer credit defaults in the near term.

[64]  SNAP (formerly the Food Stamp program) is the largest food assistance program and one of the largest safety net programs in the United States. Historically, the number of households that participate in SNAP has tended to decrease as household financial conditions improve. We report the number of households participating in SNAP based on monthly data reported by the Department of Agriculture’s Food and Nutrition Service. Changes in SNAP flexibilities could also influence SNAP participation. These preliminary data may be subject to revision given that some states issued new Pandemic Electronic Benefits Transfer benefits for school-age children through SNAP and therefore may have reported larger-than-actual SNAP participation.

[65]  The Small Business Health Index combines information on the timeliness of payments, failure rates, and utilization of credit of a large sample of active small businesses with fewer than 100 employees. The index tends to increase as economic conditions improve. We report this index and its subcomponents based on Dun and Bradstreet’s monthly index for the United States as a whole.

[66]  Spreads on corporate bonds relative to benchmark interest rates (e.g., Treasury interest rates) measure the premium corporate borrowers must pay to compensate lenders for taking on the risk of loss due to default (risk premium) and for foregoing investments in more liquid assets (liquidity premium). We report spreads on aggregations of dollar-denominated investment grade corporate bonds available via Bloomberg.

[67]  Spreads on municipal bonds relative to benchmark interest rates (e.g., Treasury interest rates) incorporate the favorable tax treatment received by municipal debt and may also reflect any premium state and local borrowers pay to compensate lenders for taking on the risk of loss due to default (risk premium) and for tying up their investment funds for a period of time (liquidity premium). We report spreads calculated based on the Bloomberg Barclays Municipal Bond Index. Spreads are calculated using yield to worst, which results in a conservative—that is, lower—estimate of potential returns on callable bonds.

[68]  Personal consumption expenditures, a component of gross domestic product, is the value of goods and services purchased by, or on behalf of, U.S. residents.

[69]  Specifically, the CARES Act appropriated $100 billion and the Paycheck Protection Program and Health Care Enhancement Act appropriated $75 billion for the fund. HHS began distributing funds in April.

[70]  Employment in ambulatory health care services fell from 7.9 million in February to 6.5 million in April, while total employment in health care fell from 16.5 million to 14.9 million in this period

[71]  As of August, June and July employment data were preliminary.

[72]  GAO, Air Travel and Communicable Disease: Comprehensive Federal Plan Needed for U.S. Aviation System’s Preparedness, GAO-16-127 (Washington, D.C.: Dec. 16, 2015).

[73]  DOT has pointed to Presidential Policy Directive/PPD-8 as part of its rationale for why other federal agencies should lead an aviation-preparedness plan to respond to communicable disease threats. This directive, published in March 2011, calls for the establishment of a risk-informed National Preparedness Goal to define the capabilities needed to respond to the nation’s greatest risks and a National Preparedness System, consisting of an integrated set of guidance, programs, and processes that will enable the nation to meet the goal. The directive states that the Secretary of Homeland Security is responsible for coordinating the domestic all-hazards preparedness efforts of all executive departments and agencies, but that it is not intended to alter or impede the ability of executive departments or agencies to perform their responsibilities under law and other Presidential guidance.

[74]  The National Response Framework includes Emergency Support Functions that describe federal coordinating structures that group resources and capabilities into functional areas most frequently needed in a national response. DOT is the coordinator and primary agency for Emergency Support Function #1 – Transportation.

[75]  Departments of Transportation, Homeland Security, and Health and Human Services, Runway to Recovery: The United States Framework for Airlines and Airports to Mitigate the Public Health Risks of Coronavirus (Washington, D.C.: July 2020).

[76]  We shared a draft of this report with the Departments of Labor, Commerce, Health and Human Services, Transportation, and the Treasury. We also shared a draft with the Federal Reserve, Small Business Administration, Office of Management and Budget, and Internal Revenue Service.