GAO-20-708, COVID-19: Brief Update on Initial Federal Response to the Pandemic

Issuer: Government Accountability Office
Document type: Brief
Date: 2020-07-31

Brief — GAO-20-708, COVID-19: Brief Update on Initial Federal Response to the Pandemic, dated 2020-07-31, issued by Government Accountability Office.

Full text

GAO-20-708
www.gao.gov
United States Government Accountability Oﬃce
Report to the Congress
August 2020
COVID-19
Brief Update on Initial Federal
Response to the Pandemic

United States Government Accountability Office

Highlights of GAO-20-708, a report to the
Congress

August 2020
COVID-19
Brief Update on Initial Federal Response to the
Pandemic
What GAO Found
In response to the national public health and economic threats caused by
COVID-19, four relief laws making appropriations of about $2.6 trillion had been
enacted as of July 31, 2020. Overall, federal obligations and expenditures
government-wide of these COVID-19 relief funds totaled $1.5 trillion and $1.3
trillion, respectively, as of June 30, 2020. GAO also obtained preliminary data for
six major spending areas as of July 31, 2020 (see table).
COVID-19 Relief Appropriations, Obligations, and Expenditures for Six Major Spending Areas,
as of July 2020
Spending area
Appropriationsa
($ billions)
Preliminary
obligationsb
($ billions)
Preliminary
expendituresb
($ billions)
Business Loan
Programs
687.3
538.1
522.2c
Economic
Stabilization and
Assistance to
Distressed Sectors
500.0
30.4
19.2c
Unemployment
Insurance
376.4
301.1
296.8
Economic Impact
Payments
282.0
273.5
273.5
Public Health and
Social Services
Emergency Fund
231.7
129.6
95.9
Coronavirus Relief
Fund
150.0
149.5
149.5
Total for six
spending areas
2,227.4
1,422.2
1,357.0
Source: GAO analysis of data from the Department of the Treasury, USAspending.gov, and applicable agencies. | GAO-20-708
aCOVID-19 relief appropriations reflect amounts appropriated under the Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat.
178 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); and Paycheck Protection Program and Health Care Enhancement
Act, Pub. L. No. 116-139, 134 Stat. 620 (2020). These data are based on appropriations warrant information provided by the
Department of the Treasury as of July 31, 2020. These amounts could increase in the future for programs with indefinite appropriations,
which are appropriations that, at the time of enactment, are for an unspecified amount. In addition, this table does not represent
transfers of funds that federal agencies may make between appropriation accounts or transfers of funds they may make to other
agencies.
bObligations and expenditures data for July 2020 are based on preliminary data reported by applicable agencies.
cThese expenditures relate to the loan subsidy costs (the loan’s estimated long-term costs to the United States government).

The CARES Act included a provision for GAO to assess the impact of the federal
response on public health and the economy. The following are examples of
health care and economic indicators that GAO is monitoring.
Health care. GAO’s indicators are intended to assess the nation’s immediate
response to COVID-19 as it first took hold, gauge its recovery from the effects of
the pandemic over the longer term, and determine the nation’s level of
preparedness for future pandemics, involving subsequent waves of either
COVID-19 or other infectious diseases.
For example, to assess the sufficiency of testing—a potential indicator of the
system’s response and recovery—GAO suggests monitoring the proportion of
tests in a given population that are positive for infection. A higher positivity rate
can indicate that testing is not sufficiently widespread to find all cases. That is,

View GAO-20-708. For more information,
contact A. Nicole Clowers, (202) 512-7114 or
clowersa@gao.gov.
Why GAO Did This Study
As of August 20, 2020, the U.S. had
over 5.5 million cumulative reported
cases of COVID-19, and 158,000
reported deaths, according to federal
agencies. The country also continues
to experience serious economic
repercussions and turmoil. Four relief
laws, including the CARES Act, were
enacted between March and July 2020
to provide appropriations for the
response to COVID-19.
The CARES Act includes a provision
for GAO to report bimonthly on its
ongoing monitoring and oversight
efforts related to COVID-19. This
second report examines federal
spending on the COVID-19 response;
indicators for monitoring public health
and the economy; and the status of
matters for congressional
consideration and recommendations
from GAO’s June 2020 report (GAO-
20-625).
GAO reviewed data through June 30,
2020 (the latest available) from
USAspending.gov, a government
website with data from government
agencies. GAO also obtained, directly
from the agencies, spending data, as
of July 31, 2020, for the six largest
spending areas, to the extent available.
To develop the public health indicators,
GAO reviewed research and federal
guidance. To understand economic
developments, GAO reviewed data
from federal statistical agencies, the
Federal Reserve, and Bloomberg
Terminal, as well as economic
research.
To update the status of matters for
congressional consideration and
recommendations, GAO reviewed
agency and congressional actions.

Highlights of GAO-20-708 (Continued)

higher positivity rates can indicate that testing has focused on those most likely to be infected and seeking testing
because they have symptoms, and may not be detecting COVID-19 cases among individuals with no symptoms.
Although there is no agreed-upon threshold for the test positivity rate, governments should target low positivity rates. The
World Health Organization recommends a test positivity rate threshold of less than 5 percent over a 14-day period. As of
August 12, 2020, 12 states and the District of Columbia had met this threshold (38 states had not). Resolve to Save Lives,
another organization, recommends a threshold of less than 3 percent over a 7-day period, and 11 states and the District
of Columbia had met this threshold (39 states had not) as of August 12, 2020.
GAO also suggests monitoring mortality from all causes compared to historical norms as an indicator of the pandemic’s
broad effect on health care outcomes. Mortality rates have tended to be consistent from year to year. This allows an
estimation of how much mortality rose with the onset of the pandemic, and provides a baseline by which to judge a return
to pre-COVID levels. According to Centers for Disease Control and Prevention data, about 125,000 more people died
from all causes January 1–June 13 than would normally be expected (see figure).
CDC Data on Higher-Than-Expected Weekly Mortality, January 1 through June 13, 2020

Note: The figure shows the number of deaths from all causes in a given week that exceeded the upper bound threshold of expected deaths calculated
by CDC on the basis of variation in mortality experienced in prior years. Changes in the observed numbers of deaths in recent weeks should be
interpreted cautiously as this figure relies on provisional data that are generally less complete in recent weeks. Data were accessed on July 16, 2020.
Economy. GAO updated information on a number of indicators to facilitate ongoing and consistent monitoring of areas of
the economy supported by the federal pandemic response, in particular the COVID-19 relief laws. These indicators
suggest that economic conditions—including for workers, small businesses, and corporations—have improved modestly
in recent months but remain much weaker than prior to the pandemic.
In June and July initial regular unemployment insurance (UI) claims filed weekly averaged roughly 1.4 million (see figure),
which was six and a half times higher than average weekly claims in 2019, but claims have decreased substantially since
mid-March, falling to 971,000 in the week ending August 8, 2020. Increasing infections in some states and orders to once
again close or limit certain businesses are likely to pose additional challenges for potentially fragile economic
improvements, especially in affected sectors, such as the leisure and hospitality sector.
National Weekly Initial Unemployment Insurance Claims, January 2019–July 2020

Note: See figure 5 in the report.
As GAO reported in June, consistent with the urgency of responding to serious and widespread health issues and
economic disruptions, federal agencies gave priority to moving swiftly where possible to distribute funds and implement
new programs designed to help small businesses and the newly unemployed, for example. However, such urgency
required certain tradeoffs in achieving transparency and accountability goals. To make mid-course corrections, GAO
made three recommendations to federal agencies:

Highlights of GAO-20-708 (Continued)

•
To reduce the potential for duplicate payments from the Paycheck Protection Program (PPP)—a program that
provides guaranteed loans through lenders to small businesses—and unemployment insurance, GAO
recommended that the Department of Labor (DOL), in consultation with the Small Business Administration (SBA)
and the Department of the Treasury (Treasury), immediately provide information to state unemployment agencies
that specifically addresses PPP loans, and the risk of improper unemployment insurance payments. DOL issued
guidance on August 12, 2020, that, among other things, clarified that individuals working full-time and being paid
through PPP are not eligible for UI.
•
To recoup economic impact payments totaling more than $1.6 billion sent to decedents, GAO recommended that
the Internal Revenue Service (IRS) consider cost-effective options for notifying ineligible recipients of economic
impact payments how to return payments. IRS has taken steps to address this recommendation. According to a
Treasury official, nearly 70 percent of the payments sent to decedents have been recovered. However, GAO was
unable to verify that amount before finalizing work on this report. GAO is working with Treasury to determine the
number of payments sent to decedents that have been recovered. Treasury was considering sending letters to
request the return of remaining outstanding payments but has not moved forward with this effort because,
according to Treasury, Congress is considering legislation that would clarify or change payment eligibility
requirements.
•
To reduce the potential for fraud and ensure program integrity, GAO recommended that SBA develop and
implement plans to identify and respond to risks in PPP to ensure program integrity, achieve program
effectiveness, and address potential fraud. SBA has begun developing oversight plans for PPP but has not yet
finalized or implemented them.

In addition, to improve the government’s response efforts, GAO suggested three matters for congressional consideration:

•
GAO urged Congress to take legislative action to require the Department of Transportation (DOT) to work with
relevant agencies and stakeholders, such as HHS, the Department of Homeland Security (DHS), and
international organizations, to develop a national aviation-preparedness plan to ensure safeguards are in place to
limit the spread of communicable disease threats from abroad, while also minimizing any unnecessary
interference with travel and trade. In July 2020, DOT collaborated with HHS and DHS to issue guidance to
airports and airlines for implementing measures to mitigate the public health risks associated with COVID-19, but
it has not developed a preparedness plan for future communicable disease threats. DOT has maintained that
HHS and DHS should lead such planning efforts as they are responsible for communicable disease response and
preparedness planning, respectively. In June 2020, HHS stated that it is not in a position to develop a national
aviation-preparedness plan as it does not have primary jurisdiction over the entire aviation sector or the relevant
transportation expertise. In May 2020, DHS stated that it had reviewed its existing plans for pandemic
preparedness and response activities and determined it is not best situated to develop a national aviation-
preparedness plan. Without such a plan, the U.S. will not be as prepared to minimize and quickly respond to
future communicable disease events.

•
GAO also urged Congress to amend the Social Security Act to explicitly allow the Social Security Administration
(SSA) to share its full death data with Treasury for data matching to help prevent payments to ineligible
individuals. In June 2020, the Senate passed S.4104, referred to as the Stopping Improper Payments to
Deceased People Act. If enacted, the bill would allow SSA to share these data with Treasury's Bureau of the
Fiscal Service to avoid paying deceased individuals.

•
Finally, GAO urged Congress to use GAO's Federal Medical Assistance Percentage (FMAP) formula for any
future changes to the FMAP—the statutory formula according to which the federal government matches states'
spending for Medicaid services—during the current or any future economic downturn. Congress has taken no
action thus far on this issue.

GAO incorporated technical comments received the Departments of Labor, Commerce, Health and Human Services,
Transportation, and the Treasury; the Federal Reserve; Office of Management and Budget; and Internal Revenue Service.
The Small Business Administration commented that GAO did not include information on actions taken and controls related
to its loan forgiveness program or its plans for loan reviews. GAO plans to provide more information on these topics in its
next CARES Act report.

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GAO-20-708
Contents
Introduction................................................................................................................................... 1
Background.................................................................................................................................... 5
Major Findings.............................................................................................................................. 8
Federal COVID-19 Funding and Spending.......................................................................................... 8
Key Health Care and Economic Indicators....................................................................................... 14
Status of GAO’s June 2020 Recommendations and Matters for Congressional Consideration................... 30
Agency Comments and Our Evaluation............................................................................... 34
Congressional Addressees....................................................................................................... 35
Contacts........................................................................................................................................ 37
Tables
COVID-19 Relief Appropriations, Obligations, and Expenditures for Six Major Spending Areas, as of July
2020..............................................................................................................................................1
Table 1: Time Frames for Reporting and Certifying COVID-19 Relief Spending Data.................................. 9
Table 2: COVID-19 Relief Appropriations, Obligations, and Expenditures for the Six Largest Spending Areas,
as of May, June, and July 2020....................................................................................................... 10
Figures
CDC Data on Higher-Than-Expected Weekly Mortality, January 1 through June 13, 2020............................ 2
National Weekly Initial Unemployment Insurance Claims, January 2019–July 2020.................................... 3
Figure 1: Reported COVID-19 Cases per Day in the United States, as of August 20, 2020........................... 5
Figure 2: Reported COVID-19 Cases August 13-19, 2020, by State, per 100,000 Population........................ 7
Figure 3: CDC Data on Higher Than Expected Weekly Mortality, January 1 through June 13, 2020............. 21
Figure 4: Indicators for Areas of the Economy Supported by the Federal Pandemic Response, 2015-2019 and
March 2020-July 2020................................................................................................................... 24
Figure 5: National Weekly Initial Regular Unemployment Insurance Claims, January 2019–July 2020.......... 26
Figure 6: Real Personal Consumption Expenditures for Health Care, Seasonally Adjusted, June 2019–June
2020........................................................................................................................................... 28
Figure 7: Health Care Sector Employment, Seasonally Adjusted, July 2019–July 2020.............................. 29

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Abbreviations
BLS
Bureau of Labor Statistics
CDC
Centers for Disease Control and Prevention
COVID-19
Coronavirus Disease 2019
DATA Act
Digital Accountability and Transparency Act of 2014
DHS
Department of Homeland Security
DOT
Department of Transportation
Federal Reserve
Board of Governors of the Federal Reserve System
FMAP
Federal Medical Assistance Percentage
HHS
Department of Health and Human Services
HS
Harmonized Schedule
ICU
intensive care unit
IRS
Internal Revenue Service
NCHS
National Center for Health Statistics
NHSN
National Healthcare Safety Network
OMB
Office of Management and Budget
PPP
Paycheck Protection Program
PUA
Pandemic Unemployment Assistance
SAO
Senior Accountable Official
SBA
Small Business Administration
SNAP
Supplemental Nutrition Assistance Program
SSA
Social Security Administration
Treasury
Department of the Treasury
UI
unemployment insurance
GAO’s Mission
The Government Accountability Oﬃce, the audit, evaluation, and investigative arm of Congress, exists
to support Congress in meeting its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people. GAO examines the use of public
funds; evaluates federal programs and policies; and provides analyses, recommendations, and other
assistance to help Congress make informed oversight, policy, and funding decisions. GAO’s commitment
to good government is reﬂected in its core values of accountability, integrity, and reliability.
Copyright
This is a work of the U.S. government and is not subject to copyright protection in the United States. The
published product may be reproduced and distributed in its entirety without further permission from

Page iii
GAO-20-708
GAO. However, because this work may contain copyrighted images or other material, permission from
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Page 1
GAO-20-708
Introduction
August 31, 2020
Congressional Committees
The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in catastrophic loss of life
and substantial damage to the global economy, stability, and security. Worldwide there were
22,256,000 reported cases and 782,000 reported deaths due to COVID-19, as of August 20, 2020;
within the United States, there were 5,507,000 cumulative reported cases and 158,000 reported
deaths.1 The United States also continues to experience serious economic repercussions and
turmoil. As of July 2020, there were about 16.3 million unemployed individuals, compared to
nearly 5.9 million individuals at the beginning of the calendar year.2
In response to the far-reaching public health and economic crises, Congress and the
administration have taken a series of actions. For example, in March 2020, Congress passed,
and the President signed into law, the CARES Act, which provides over $2 trillion in emergency
assistance and health care response for individuals, families, and businesses aﬀected by
COVID-19.3
The CARES Act includes a provision for us to conduct monitoring and oversight of the federal
government’s eﬀorts to prepare for, respond to, and recover from the COVID-19 pandemic,
including monitoring and oversight of the use of funds made available.4 We are to report on,
among other things, the eﬀect of the pandemic on the public health, economy, and public and
private institutions.
According to the provision, GAO is to submit bimonthly reports on its ongoing monitoring and
oversight eﬀorts related to the COVID-19 pandemic. We issued our ﬁrst report on June 25, 2020.5
1Reported 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.
2Bureau 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.
3Pub. 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.
4Pub. L. No. 116-136, § 19010, 134 Stat. at 579-81.
5GAO, COVID-19: Opportunities to Improve Federal Response and Recovery Eﬀorts, GAO-20-625 (Washington, D.C.: June 25,
2020).

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In addition to these bimonthly reports, we will issue other reports that focus on speciﬁc aspects
of the federal government’s eﬀorts to respond to COVID-19. As of August 20, 2020, we had 75
audits underway related to the pandemic examining a variety of issues, including vaccines and
therapeutics, COVID-19 testing, small business programs, the Strategic National Stockpile, use
of the Defense Production Act, the response of the Department of Veterans Aﬀairs to COVID-19,
child welfare and education, worker safety, and homeowner and renter protections. We continue
to actively coordinate our audits with other accountability organizations, including the Pandemic
Response Accountability Committee, federal inspectors general, and state and local auditors.6
To provide the most up-to-date information on the federal government’s initial response from
March through July 2020, we are issuing today’s report. This report provides information on (1)
total appropriated funds as of July 31, 2020, and the latest spending information available; (2)
indicators for monitoring the public health system’s preparedness for, response to, and recovery
from COVID-19, and indicators for key areas of the economy targeted by federal eﬀorts; and (3)
the status of recommendations we made to executive agencies and matters for congressional
consideration in our June report.
Our September report will provide a comprehensive review of key federal actions to prepare for,
respond to, and recover from COVID-19, including actions to address testing, medical supplies,
vaccine and therapeutic development, the Paycheck Protection Program (PPP), and unemployment
insurance. Based on the review, the report will include recommendations for federal agencies.
For this report, we obtained a listing of all appropriation warrants issued by the Bureau of the
Fiscal Service to the respective federal agencies for the four COVID-19 relief laws.7 We compared
each appropriation amount to the respective law or other supporting documentation. We
determined that the data were suﬃciently reliable for our purposes. We analyzed centralized,
government-wide data on federal spending for the pandemic from USAspending.gov as of June
30, 2020, the most recent data available. USAspending.gov is a publicly available website that
includes detailed data on federal spending for nearly all accounts across the federal government,
maintained by the Department of the Treasury (Treasury). We also sought July 31, 2020, spending
data from the six areas with the largest appropriations in the four COVID-19 relief laws and
present this information to the extent it was available.
To update the indicators that we identiﬁed in our June 2020 report and to identify additional
indicators for monitoring the public health system’s preparedness for, response to, and recovery
from COVID-19, we reviewed selected research published in June and July 2020 by organizations
with public health and policy researchers who are knowledgeable about the use of COVID-19
data to support decision-making, such as the Harvard Global Health Institute and the Edmond
J. Safra Center for Ethics at Harvard, and Resolve to Save Lives. We also reviewed Department
of Health and Human Services (HHS) documents, such as HHS’s COVID-19 guidance for hospital
6The 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.
7The 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.

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reporting and the Centers for Disease Control and Prevention’s (CDC) guidance on contact tracing
workforce and programs.
8
We assessed the reliability of data on the number of higher than
expected deaths from CDC’s National Center for Health Statistics, which we intend to use for
monitoring and reporting, by reviewing relevant documents and published reports that use these
data and obtaining additional information about the data from CDC oﬃcials. We found that the
data were suﬃciently reliable for our purposes. Finally, we interviewed oﬃcials from HHS and
organizations including the Harvard Global Health Institute and the National Association of County
and City Health Oﬃcials.
To identify indicators for monitoring the economy, we ﬁrst reviewed the federal responses to
the pandemic, in particular the COVID-19 relief laws, and identiﬁed ﬁve key provisions intended
to support the economy, corresponding to ﬁve diﬀerent areas of the economy: labor markets,
households, small business credit markets, corporate credit markets, and markets associated with
state and local government ﬁnances. We identiﬁed these key provisions based on their relative
size, in dollars, as well as their potential economic eﬀects. We then identiﬁed economic indicators
corresponding to those ﬁve areas of the economy in order to provide a timely, general sense of
how those areas of the economy were performing. In addition, we identiﬁed two indicators of the
economic condition of the health care sector.
To identify potential indicators, we reviewed a number of sources, including prior GAO work,
releases from federal statistical agencies, information from the Board of Governors of the Federal
Reserve System (Federal Reserve) and relevant federal agencies responsible for the pandemic
response and oversight of the health care system, data available on the Bloomberg Terminal,
and input from internal GAO experts. To understand the relative importance of the key factors
that could inﬂuence economic activity during the pandemic, such as supply and demand, the
severity of the pandemic, and the impact of mitigation measures, we have begun to identify and
review empirical research on these topics. We assessed the reliability of the data we intend to
use for monitoring and reporting on areas of the economy supported by the federal pandemic
response, in particular the COVID-19 relief laws. We took a number of steps to determine the
reliability of proposed data sources and indicators, including reviewing relevant documentation,
reviewing prior GAO work, and interviewing data providers. The quality of some available data and
collection methods have been inﬂuenced by the COVID-19 pandemic. Nevertheless, we found that,
collectively, the indicators were suﬃciently reliable to provide a general sense of how these areas
of the economy are performing.
To update the status of recommendations made to agencies and matters for congressional
consideration made in our June 2020 report, we interviewed agency oﬃcials and monitored bills
in Congress. We report the status of relevant bills that had, at a minimum, been reported out of a
committee of jurisdiction as of July 2020.
We conducted this performance audit from June 2020 to August 2020 in accordance with generally
accepted government auditing standards. Those standards require that we plan and perform
the audit to obtain suﬃcient, appropriate evidence to provide a reasonable basis for our ﬁndings
8Department 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).

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and conclusions based on our audit objectives. We believe the evidence obtained provides a
reasonable basis for our ﬁndings and conclusions based on our audit objectives.

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Background
Since early July, the United States had approximately 50,000 to 65,000 reported new COVID-19
cases per day, on average.9 Figure 1 shows the reported U.S. COVID-19 cases per day as a 7-day
moving average.
Figure 1: Reported COVID-19 Cases per Day in the United States, as of August 20, 2020
Note: 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
9Cases 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.

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infected may have not been tested or may have not sought medical care. The data presented in the ﬁgure were last updated
on August 20, 2020. The 7-day moving average of new cases (current day plus 6 preceding days divided by 7) was calculated to
smooth variations in daily counts.
The total number of cases nationwide, while useful in assessing the magnitude of the outbreak,
can mask the severity of the outbreak in certain locations, including locations where the number
of cases are increasing (often referred to as hotspots). Since the ﬁrst case was reported in the
United States, the severity and timing of outbreaks have varied across the nation. For example,
from late March through early June, some states in the Northeast had higher numbers of reported
cases than others. Subsequently, the outbreak slowed in that region while some states in the
Southeast and Southwest saw increases in reported cases from late June through July. The number
of reported new cases has varied geographically. Figure 2 shows reported cases per 100,000
population by state from August 13 to August 19, the most recent data available at the time of this
analysis.

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Figure 2: Reported COVID-19 Cases August 13-19, 2020, by State, per 100,000 Population
Note: 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. The data presented in the ﬁgure were last updated on
August 19, 2020. Rates were calculated using population estimates from U.S. Census Bureau, 2018 American Community Survey
1-Year Estimates, as the number of cases per 100,000 population.

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Major Findings
Federal COVID-19 Funding and Spending
As of July 31, 2020, about $2.6 trillion had been appropriated to fund response and recovery
eﬀorts for—as well as to mitigate the public health, economic, and homeland security eﬀects of
—COVID-19.
10
The Business Loan Programs, Economic Stabilization and Assistance to Distressed
Sectors programs, unemployment insurance, Economic Impact Payments, the Public Health and
Social Services Emergency Fund, and the Coronavirus Relief Fund represent $2.2 trillion, or 85
percent, of the total amounts appropriated.11
As of June 30, 2020, the most recent date for which government-wide information was available,
the federal government had obligated a total of $1.5 trillion and expended $1.3 trillion of the
COVID-19 relief funds as reported by federal agencies on USAspending.gov.12 The Oﬃce of
Management and Budget (OMB) directed federal agencies to report obligations and expenditure
data on a monthly basis for posting on USAspending.gov, to provide monthly attestations on the
ﬁnancial data, and to certify the data quality on a quarterly basis beginning with the June 2020
reporting period.13 As shown in table 1, OMB’s prescribed certiﬁcation time frames are consistent
with pre-COVID-19 quarterly reporting. Agencies will provide monthly attestations over their
ﬁnancial ﬁles, and quarterly government-wide spending information as of July 31, 2020, certiﬁed in
mid-November 2020.
10An appropriation provides legal authority for federal agencies to incur obligations and make payments out of the U.S.
Treasury for speciﬁed purposes.
11The Small Business Administration’s Business Loan Program account includes activity for the Paycheck Protection
Program and certain loan subsidies.
12An 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.
13Speciﬁcally, 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).

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Table 1: Time Frames for Reporting and Certifying COVID-19 Relief Spending Data
Period covered by COVID-19 agency
reporting to USAspending.gov
Time frames for agency reporting
Deadline for agencies to certify data
reported
April, May, June 2020
July 17–30, 2020
August 14, 2020
July 2020
August 19–28, 2020
August 2020
September 18–29, 2020
September 2020
October 19–November 16, 2020
November 16, 2020
Source: Fiscal year 2020 Digital Accountability and Transparency Act of 2014 (DATA Act) Monthly Reporting Window Schedule published by the Department of the Treasury. |
GAO-20-708
Note: USAspending.gov is a publicly available website that includes detailed data on federal spending for nearly all accounts
across the federal government and is maintained by the Department of the Treasury.
Because July 2020 monthly data have not been reported and certiﬁed on USAspending.gov,
we collected preliminary obligation and expenditure data for the six largest areas, to the
extent practicable, as of July 31, 2020.
14
For these six largest spending areas, agencies
estimated obligations totaling $1.4 trillion and expenditures totaling $1.4 trillion. Table 2 shows
appropriations, obligations, and expenditures of COVID-19 relief funds by these spending areas.
14Obligations 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.

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Table 2: COVID-19 Relief Appropriations, Obligations, and Expenditures for the Six Largest Spending Areas, as of
May, June, and July 2020
Total
appropriations
($ billions)
Reported cumulative obligations
($ billions)
Reported cumulative expenditures
($ billions)
Spending area
July 31, 2020a
May 2020b
June 2020c
Preliminary
July 2020d
May 2020b
June 2020c Preliminary
July 2020d
Business Loan
Programs
(Small Business
Administration)
687.3
528.9
534.4
538.1
9.9
506.3e
522.2e
Economic
Stabilization and
Assistance to
Distressed Sectors
(Department of the
Treasury)
500.0
22.1
22.2
30.4
2.2
11.2e
19.2e
Unemployment
insurance
(Department of
Labor)
376.4
107.1
202.4
301.1
101.8
197.1
296.8
Economic Impact
Payments
(Department of the
Treasury)
282.0
267.4
270.7
273.5
267.4
270.7
273.5
Public Health and
Social Services
Emergency Fund
(Department of
Health and Human
Services)
231.7
87.9
110.5
129.6
66.0
79.7
95.9
Coronavirus Relief
Fund (Department
of the Treasury)
150.0
146.6
149.5
149.5
146.6
149.5
149.5
Total for six
spending areas
2,227.4
1,160.1
1,289.7
1,422.2
594.0
1,214.4
1,357.0
Source: GAO analysis of data from the Department of the Treasury, USAspending.gov, and applicable agencies. | GAO-20-708
aCOVID-19 relief appropriations reﬂect amounts appropriated under the Coronavirus Preparedness and Response
Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Families First Coronavirus Response Act, Pub. L.
No. 116-127, 134 Stat. 178 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); and Paycheck Protection Program and
Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020). These data are based on appropriations warrant
information provided by the Department of the Treasury as of July 31, 2020. These amounts could increase in the future for
programs with indeﬁnite appropriations, which are appropriations that, at the time of enactment, are for an unspeciﬁed
amount. In addition, this table does not represent transfers of funds that federal agencies may make between appropriation
accounts or transfers of funds they may make to other agencies.
bObligations and expenditures data for May 2020 are based on agency-reported data from the Department of the Treasury
as of May 31, 2020. Some amounts diﬀer from our June 2020 report (GAO-20-625) because they are based on more current
information that has been made available since then.
cObligations and expenditures data for June 2020 are based on data from USAspending.gov as of August 19, 2020.
dObligations and expenditures data for July 2020 are based on preliminary data reported by applicable agencies.
eThese expenditures relate to the loan subsidy costs (the loan’s estimated long-term costs to the United States government).

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The following provide information on what has been happening in each of the six programs since
our last report:
• Business Loan Programs. The Small Business Administration’s (SBA) Business Loan Programs
received $687 billion in appropriations and had obligated $538.1 billion of these funds as
of July 31, 2020. SBA’s Business Loan Program account includes amounts for the PPP and
for subsidies for certain SBA loan programs. Most of the appropriations went to the PPP,
which is a loan guarantee program in which loans are guaranteed at 100 percent by SBA, are
low-interest (1 percent), and will be fully forgiven if the borrower meets certain conditions.
As of July 31, 2020, SBA reported that lenders had made about 5.1 million PPP loans, up
from 4.6 million loans as of June 12, 2020.15 SBA stated that its loan guarantee expenditures
were $522.2 billion as of July 31, 2020, which represents the estimated cost to the federal
government to satisfy the loan guarantee obligations to lenders.16 The amount SBA ultimately
spends largely depends on the number of loans actually forgiven. When the loans are forgiven,
payments will be made to the lenders.
• Economic Stabilization and Assistance to Distressed Sectors. The Economic Stabilization
and Assistance to Distressed Sectors programs received $500 billion in appropriations.17
Most of these appropriations—about $454 billion—relate to support for lending facilities
administered by the Federal Reserve. Since early June 2020, ﬁve additional emergency lending
programs (or facilities) supported through CARES Act appropriated funds became operational,
resulting in a total of seven CARES Act facilities being operational as of July 31, 2020. As of that
date, Treasury had committed $195 billion, or about 43 percent, of the $454 billion from the
CARES Act available to support the facilities and disbursed $102.5 billion of that commitment,
up from $55 billion in early June.18 Most of the $19.2 billion of expenditures also relate to this
program. Budget expenditures related to the lending facilities administered by the Federal
Reserve represent the loan subsidy costs (the loan’s estimated long-term costs to the United
States government) of the facilities to the federal government. The subsidy cost is calculated
as the estimated net present value of both cash disbursements made to the facilities and cash
received from the facilities when the facilities are terminated. Treasury estimates, on a net
present value basis, that cash disbursed to the facilities will exceed the cash received from the
facilities by $18 billion, as of July 31, 2020.
The Economic Stabilization and Assistance to Distressed Sectors program also includes an
appropriation of $46 billion in loans, loan guarantees, and other investments to provide
15Totals 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.
16Under 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.
17CARES 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.
18To 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.

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liquidity to the aviation sector and businesses critical to maintaining national security,
including non-aviation sector businesses. As of July 2020, Treasury had made one loan for up
to $700 million to a business designated as critical to maintaining national security, and had
also signed letters of intent with 10 passenger carriers to provide loans that could total over
$20 billion.
• Unemployment Insurance. Between May and July 2020, obligations for regular
unemployment insurance increased from $107.1 billion to $301.1billion, and expenditures
increased from $101.8 billion to $296.8 billion. In May 2020, 9.4 million initial unemployment
claims were processed. In July 2020, states processed 6.7 million initial unemployment
claims.19
• Economic Impact Payments. Both cumulative obligations and cumulative expenditures for
economic impact payments—direct payments to individuals and households to mitigate the
eﬀects of the pandemic—increased from $267.4 billion in May 2020 to $273.5 billion in July
2020. The vast majority of the 164 million economic impact payments disbursed by Treasury
and Internal Revenue Service (IRS) had been disbursed by May 22, 2020. Those who received
payments in June and July 2020 were individuals who ﬁled their taxes up until the extended
tax ﬁling season deadline of July 15, individuals who previously ﬁled a paper return that IRS
was unable to process due to certain functions being shut down during the pandemic, and
individuals who did not ﬁle taxes but used the IRS’s non-ﬁler portal to claim their economic
impact payment.20
• Public Health and Social Services Emergency Fund. Payments to health care providers for
costs related to COVID-19 or lost revenues are one of the activities supported by Public Health
and Social Services Emergency Fund appropriations, through what is known as the Provider
Relief Fund. Payments to providers totaled $65.2 billion as of May 31, 2020, and increased to
$92.4 billion by the end of July. After initially making general relief payments to health care
providers in April, HHS subsequently began allocating more funding to areas particularly
aﬀected by the COVID-19 outbreak, including rural health care facilities, high-impact hospitals
(those hospitals with a high rate of COVID-19 inpatient admissions), safety net hospitals, health
care providers that participate in Medicaid and the Children’s Health Insurance Program,
skilled nursing facilities, Indian health care providers, and dental providers.
• Coronavirus Relief Fund. As of July 31, 2020, Treasury had received $150 billion in
appropriations and had provided $149.5 billion in direct assistance to states, localities,
tribal governments, the District of Columbia, and U.S. territories to help oﬀset costs of their
response to the COVID-19 pandemic. The approximately $2.9 billion in additional obligations
19May 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).

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and expenditures since the end of May were payments to tribal governments that Treasury
made in June.
Clear and transparent reporting of COVID-19 relief spending data and related information is
an important tool for Congress, agency oﬃcials, and the public in monitoring and assessing
implementation of the COVID-19 relief laws. Toward that end, the CARES Act contains several
requirements for federal agencies and nonfederal entities receiving federal awards for the
timely reporting of covered funds.
21
In April 2020, OMB issued guidance to direct agencies and
recipients on how to implement CARES Act reporting requirements. This guidance included making
some modiﬁcations to the existing framework of reporting requirements under the Federal
Funding Accountability and Transparency Act of 2006, as amended by the Digital Accountability
and Transparency Act of 2014 (DATA Act).
22
Among these modiﬁcations was the requirement
that agencies use predeﬁned codes to designate the funds associated with the appropriations
enacted in the COVID-19 relief laws and enable tracking at the award level and as displayed on
USAspending.gov.23
In an eﬀort to help ensure the quality of data reported on USAspending.gov, OMB’s DATA Act
guidance directs each agency to identify a Senior Accountable Oﬃcial (SAO) who must provide
a quarterly assurance that the agency’s internal controls support the reliability and validity of
the agency account-level and award-level data.
24
OMB and Treasury still require quarterly SAO
certiﬁcations of data quality. In addition, agencies that receive COVID-19 related funding that are
reporting on a monthly basis are also required to provide monthly attestations for their ﬁnancial
ﬁles beginning with the June 2020 reporting period. These attestations state that the monthly data
followed the agency’s normal practices and procedures, and that the SAO will certify the data at
the end of the quarter.
Previous work by GAO and agency inspectors general has identiﬁed several challenges related
to the quality of the data contained on USAspending.gov. Among these is the need to more fully
disclose the limitations of data displayed on USAspending.gov.
25
We previously recommended
21Pub. L. No. 116-136, §§ 15010, 15011, 134 Stat. at 533–42.
22Federal 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).
23OMB Memorandum M-20-21.
24Oﬃce 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.
25For 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).

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that Treasury disclose known data quality issues and limitations on USAspending.gov.26 Treasury
has recently disclosed some data limitations for COVID-19 related spending. 27 These disclosures
are an important step toward more fully identifying and disclosing known data limitations on
USAspending.gov. Systematic expansion of such disclosures across the website could help users of
the data better understand potential quality issues with particular data elements and sources, and
how to appropriately interpret the data. In the absence of such information, users are unable to
consider these diﬀerences in their assessment of how to use and understand the data provided.
We will continue to monitor this issue and conduct work related to the quality of data reported on
USAspending.gov and the related issues of data governance and data use.
Key Health Care and Economic Indicators
As we noted in our June 2020 report, indicators can be powerful tools to assess the federal
government’s response to the COVID-19 pandemic. GAO’s indicators are intended to assess the
nation’s immediate response to COVID-19 as it ﬁrst took hold, gauge its recovery from the eﬀects
of the pandemic over the longer term, and determine the nation’s level of preparedness for future
pandemics, involving subsequent waves of either COVID-19 or other infectious diseases.
Four Indicators Help to Monitor Areas of the Health Care System’s
Response and Recovery
To date, we have identiﬁed four indicators that can help to monitor the status of the U.S. health
care system’s response to and recovery from the COVID-19 pandemic, as well as its preparedness
for future outbreaks. These indicators are (1) the positivity rate for COVID-19 testing, (2) contact
tracing performance, (3) the proportion of intensive care unit (ICU) beds available, and (4) the
number of higher than expected deaths from all causes. Given the evolving knowledge about
COVID-19, we focused on new information about the potential indicators that we identiﬁed in our
prior report, such as recommended thresholds for governments to target. We plan to work with
the National Academies of Sciences, Engineering, and Medicine (National Academies) to establish
approaches for monitoring these and other potential indicators, such as identifying data sources
and thresholds as appropriate.
Positivity Rate for COVID-19 Testing
The proportion of COVID-19 viral tests in a given population that are positive for infection (the
positivity rate) is one indicator of the suﬃciency of testing. Viral tests provide data on ongoing
26GAO, 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).
27These 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.

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GAO-20-708
infections, while antibody tests provide data on prevalence of past infections. A higher positivity
rate indicates that not enough testing is being conducted to ﬁnd all cases. That is, a higher rate
indicates that testing has been focused on those most likely to be infected and seeking testing
because they have symptoms, and may not be detecting COVID-19 cases among individuals with
no symptoms. This is important because presymptomatic (infected individuals who will go on to
develop symptoms) and asymptomatic individuals can transmit COVID-19.
Although there is no agreed-upon threshold for the test positivity rate for COVID-19, governments
should target low positivity rates. Examples of recommended positivity rate levels for COVID-19
include the following:
• In May 2020, the World Health Organization recommended that governments target a test
positivity rate of less than 5 percent over a 14-day period. As of August 12, 2020, 12 states and
the District of Columbia had met the World Health Organization recommended threshold of
less than 5 percent over a 14-day period (38 states did not), according to data reported publicly
by states.
28
In June and July 2020, several organizations also included the positivity rate as
a key indicator in their new guidance to help governments assess progress in reducing the
incidence of COVID-19.
29
For example, Resolve to Save Lives recommended that governments
target a positivity rate of less than 3 percent based on a 7-day average and that they monitor
positivity rates by age and race.
30
As of August 12, 2020, 11 states and the District of Columbia
had met the threshold of less than 3 percent over a 7-day period (39 states did not), according
to data reported publicly by states.
31
• Similarly, in July 2020, the Harvard Global Health Institute and the Edmond J. Safra Center
for Ethics published a framework—developed in collaboration with a network of research,
policy, and public health experts—that includes targets for positivity rates that depend
on a government’s goal to achieve “mitigation” (i.e., reduce the incidence of COVID-19) or
“suppression” (i.e., eliminate the incidence of COVID-19 almost entirely) through the use
28These 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.
29See: 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).
30Resolve 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.
31These 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.

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of testing, contact tracing, and isolation.
32
Harvard oﬃcials told us they established these
targets based on the World Health Organization’s recommendation and positivity rates
observed in other countries that have made progress in working toward suppression (e.g.,
South Korea, Germany). Harvard oﬃcials explained that these goals are part of a continuum,
with the ultimate goal of suppression, and that governments should work toward a goal
that is achievable. For example, governments that are faced with serious outbreaks in their
communities should ﬁrst work toward a goal of mitigation before suppression. Under the
framework, it is suggested that governments target a positivity rate of about 10 percent for
mitigation or a positivity rate of less than 3 percent for suppression.
33
The extent to which governments can reduce the positivity rate is partly dependent on the
available resources to perform testing and contact tracing. 34
This is because a more intensive
use of testing and contact tracing is needed to identify infected individuals and take steps to help
prevent further disease transmission. By helping to reduce disease transmission, more intensive
testing and contact tracing may lead to a lower positivity rate over time as more people being
tested are less likely to be infected.
As stated in our June 2020 report, we determined that the testing data that CDC reported did
not provide suﬃciently reliable information on the amount of COVID-19 viral testing occurring
over time because the data were incomplete and inconsistent. For example, some states were
combining viral and antibody tests in their reporting to CDC. However, we also reported that
CDC had taken steps to improve the reliability of testing data, and we will continue to review the
reliability of these data.
35
We plan to work with the National Academies to establish an approach
for monitoring this potential indicator, such as an appropriate way to geographically deﬁne the
positivity rate (e.g., national, state, county).
32Harvard 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).
33Further, 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.
34For 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.
35CDC 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.

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Contact Tracing Performance
Contact tracing is a critical tool to contain community outbreaks of COVID-19. It is a process
in which trained public health oﬃcials attempt to limit disease transmission by identifying
infected individuals, notifying their “contacts”—all the people they may have transmitted the
disease to—and asking infected individuals and their contacts to quarantine, if appropriate.
36
After identifying an infected individual, public health oﬃcials interview the individual to identify
recent contacts. They also ask the individual and their contacts to take containment measures, if
appropriate (e.g., a 14-day quarantine for COVID-19) and coordinate any needed care and testing.
To be most eﬀective, test turnaround time and time to trace contacts must be rapid. Further,
contact tracing must be implemented with other measures, such as social distancing, to eﬀectively
limit disease transmission.
37
When the level of community spread has become uncontrolled,
however, stay-at-home orders combined with other measures may be required, as well as surge
levels of testing and contact tracing resources.
In June and July 2020, several organizations recommended that governments track performance
indicators for contact tracing to help them assess the eﬀectiveness of their contact tracing
programs and overall progress in reducing the transmission of COVID-19.
38
In addition, they
recommended several thresholds for governments to target. For example, in July 2020, Resolve
to Save Lives recommended that governments monitor on a weekly basis the percentage of new
COVID-19 cases that were linked to already-known cases (based on contact tracing data) and
that they achieve a target of at least 50 percent. Resolve to Save Lives and other organizations
have emphasized the importance of monitoring both contact tracing and testing performance
concurrently because contact tracing eﬀectiveness depends on testing turnaround and capacity.
Similarly, CDC issued interim contact tracing guidance for state and local health departments
in June 2020, and it states that state and local health departments should regularly collect and
monitor performance indicators to assess program outcomes and identify and address issues.
39
For example, CDC provides examples of speciﬁc measures that health departments may track,
such as the number of contacts of infected individuals identiﬁed through contact tracing that
were subsequently tested for COVID-19. In addition, CDC’s guidance states that state and local
health departments should consider setting targets for their performance indicators. According
to CDC oﬃcials, state and local health departments that receive funds are required to report to
36Digital 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).
37See GAO, Science & Tech Spotlight: Social Distancing During Pandemics, GAO-20-545SP (Washington, D.C.: May 13, 2020).
38Harvard 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).
39Centers for Disease Control and Prevention, Health Departments: Interim Guidance on Developing a COVID-19 Case
Investigation & Contact Tracing Plan (June 19, 2020).

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CDC data on six performance measures related to contact tracing.
40
For example, CDC oﬃcials
told us that state and local health departments are to report the proportion of close contacts
of infected individuals who are notiﬁed within 24 hours of health departments initiating follow
up.41 CDC oﬃcials added that close contacts are identiﬁed through interviews with infected
individuals. CDC oﬃcials told us each of the six measures are to be reported on a monthly or
quarterly basis, beginning August 14, 2020, and that CDC plans to use the measures to monitor
progress in reducing the transmission of COVID-19. There are no national data on contact tracing
performance.
As discussed in our June 2020 report, a suﬃcient contact tracing workforce is critical in responding
to a pandemic, such as COVID-19. We also reported that there are no national data on the
number of contact tracers. In April 2020, the National Association of City and County Health
Oﬃcials recommended a benchmark of 30 contact tracers per 100,000 population.
42
However,
association oﬃcials told us this was an early estimate and it did not account for variation in state
and local needs. The association subsequently worked with George Washington University to
develop a workforce estimator that would account for this variation. While other organizations,
such as Johns Hopkins Bloomberg School of Public Health and Harvard Global Health Institute
and Harvard’s Edmond J. Safra Center for Ethics, have recently highlighted the importance of
a suﬃcient contact tracer workforce, they emphasized that the recommended baseline varies
among state and local health departments and in relation to changes in the incidence of COVID-19
and local and state testing capabilities. Harvard oﬃcials told us that the recommended baseline is
a moving target, for example, that would signiﬁcantly increase with community outbreaks.
CDC has provided funds to help state and local health departments expand their contact tracing
capacity, which may include hiring additional contact tracers.
43
In addition, to support surge
staﬃng needs in health departments, CDC awarded funds to the CDC Foundation to hire and place
public health professionals—including contact tracers—in state, local, territorial, and tribal health
departments. As of July 30, 2020, CDC oﬃcials told us that the CDC Foundation had hired and
placed about 300 such professionals, of which more than half were contact tracers.
40According 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.
41The 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).
42This equates to about 98,460 contact tracers needed to cover the U.S. population.
43As described earlier, these funds were provided with amounts appropriated under the Paycheck Protection Program
and Health Care Enhancement Act.

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Proportion of Intensive Care Unit Beds Available
Tracking the proportion of staﬀed ICU beds that are available at regular intervals over time
oﬀers insight on changes in our health care system’s capacity to care for the sickest patients with
COVID-19 (i.e., those that may require respiratory support on a ventilator to survive). In addition to
COVID-19, the upcoming ﬂu season could increase demand for hospital resources—for example,
about 490,000 hospitalizations associated with the ﬂu occurred during the 2018–2019 ﬂu season,
according to CDC estimates.
44
Given that several states reported record increases in the number
of new COVID-19 cases in July 2020, and that ﬂu cases will likely increase starting in the fall, the
proportion of staﬀed ICU beds remains an important indicator to monitor.
CDC and several organizations included this indicator in recent reports that included guidance
to help inform response decisions at diﬀerent levels of government and provided diﬀerent ways
to geographically deﬁne it (e.g., states, hospital referral regions), and they diﬀered in whether
to recommend a threshold.
45
For example, CDC recommends that states and local jurisdictions
monitor the indicator based on a threshold of 70 percent ICU bed occupancy (i.e., 30 percent
of its staﬀed ICU beds are available). That is, an ICU bed occupancy rate of less than 70 percent
indicates that a hospital likely has suﬃcient capacity to accommodate a certain level of additional
patients. In comparison, the Bloomberg Philanthropies and Johns Hopkins Bloomberg School of
Public Health recommended that cities monitor this indicator by ZIP code but do not specify a
threshold.
One way to present data on ICU bed occupancy is to determine the number of states that met
the 70 percent threshold on a given day, and then calculate the average of that daily result over
some period of time, such as a week or month. For example, from July 1 to July 7, 2020, a daily
average of 39 states met the 70 percent threshold of ICU bed occupancy (i.e., 30 percent or more
of their staﬀed ICU beds were available), according to data from CDC.
46
We plan to work with the
National Academies to further reﬁne this indicator, such as by developing a threshold for ICU bed
availability and ways to geographically deﬁne it (e.g., national, state, hospital referral region) for
the purposes of monitoring.
Since our June 2020 report, HHS revised its guidance for hospitals to report COVID-19
data—including ICU bed availability—in an eﬀort to help coordinate federal reporting and ensure
ﬂexibility in data collection. As of July 15, 2020, hospitals are to report these data directly to HHS
through TeleTracking, or states may submit these data on behalf of hospitals to HHS Protect.47 For
ICU bed availability, hospitals are to include in their reports all staﬀed ICU beds (including overﬂow
44The 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.
45Hospital referral regions refer to markets where people generally go to the same hospitals.
46This metric is based on data that hospitals voluntarily reported to CDC’s National Healthcare Safety Network on daily
ICU occupancy.
47HHS 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.

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and surge ICU beds that are staﬀed). Prior to July 15, hospitals also had the option to report these
data through CDC’s National Healthcare Safety Network (NHSN).
48
According to HHS, this change
will help the agency more quickly update the type of data it collects, for example, by adding data
elements on the kinds of COVID-19 treatments that are being used.
As of July 20, 2020, under its revised reporting process, HHS provides hospital utilization
data—including the proportion of staﬀed ICU beds that are available within each state—from
all participating hospitals on its new HHS Protect Public Data Hub website.
49
According to data
published on July 30, 2020, about 92 percent of hospitals nationally reported at least one data
element within the past 7 days, and the percentage of those hospitals reporting varied by state,
from about 68 to 100 percent.
50
However, the percentage of hospitals that are reporting the
proportion of ICU beds available on a daily basis is unclear. Prior to the revised reporting process,
CDC provided hospital utilization data on its NHSN website, which included only the hospitals that
reported through NHSN. We plan to monitor the transition to and implementation of HHS’s new
data collection and reporting system, such as any eﬀects on transparency.
Higher than Expected Deaths from All Causes
Mortality rates have tended to be consistent from year to year. As stated in our June 2020 report,
the number of deaths from all causes during the pandemic compared to historical counts provides
a potential indicator of the impact of deaths from COVID-19, as well as the pandemic’s broad
eﬀect on deaths from other causes. The full eﬀect of COVID-19 goes beyond those infected
with the disease. That is, it has aﬀected access and utilization across the continuum of health
care services, from primary care visits to emergency treatment of heart attacks, for example. Of
particular concern are the potential eﬀects of COVID-19-related disruptions of the health care
system on mortality.
Examining higher than expected deaths can also address the imperfect reporting of COVID-19
deaths where the cause of death was unknown or misdiagnosed.
51
Several researchers and
professional organizations have recently underscored the importance of monitoring this indicator
48CDC’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.
49HHS 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.
50This 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.
51For 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).

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to understand the eﬀects of the pandemic on mortality.
52
Between January 1, 2020, and June 13,
2020, about 125,000 more deaths occurred from all causes than would normally be expected,
according to data from CDC’s National Center for Health Statistics (see ﬁg. 3).53
Figure 3: CDC Data on Higher Than Expected Weekly Mortality, January 1 through June 13, 2020
Notes: The ﬁgure shows the number of deaths from all causes in a given week that exceeded the upper bound threshold of
expected deaths calculated by CDC on the basis of variation in mortality experienced in prior years. See CDC’s National Center
for Health Statistics webpage on excess deaths for further details on how CDC estimates this upper bound threshold: https://
www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm, accessed on July 16, 2020. Changes in the observed numbers of
deaths in recent weeks should be interpreted cautiously as this ﬁgure relies on provisional data that are generally less complete
in recent weeks.
The Economy Remains Weak but Indicators Suggest Modest
Improvement in Key Areas Supported by the Federal Pandemic
Response
The national economy and areas of the economy supported by the federal pandemic response
have improved modestly in recent months but remain much weaker than prior to the pandemic.
By the end of May 2020, the majority of states had eased the stay-at-home orders and certain
restrictions on nonessential businesses that they had introduced at the onset of the pandemic.
Contemporaneous gains in employment were driven by individuals returning to work in leisure
and hospitality, retail trade, and health care.
52For 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.

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Aggregate economic conditions in the United States also improved in June and July based on the
Federal Reserve Bank of New York’s Weekly Economic Index, which combines high-frequency
economic data from a wide range of sources.54 Nevertheless, the index suggests a large drop
in economic activity relative to a year ago. Similarly, U.S. gross domestic product fell at a 32.9
percent annual rate in the second quarter of 2020, the fastest rate on record, and was 9.5
percent lower than a year ago. As we noted in June, the impact of the pandemic on the economy
will reduce federal tax revenues while the ﬁscal response from the COVID-19 relief laws and
heightened demands on federal social programs will increase expenditures.55 Federal debt held
by the public increased from $19.8 trillion in May to $20.6 trillion in July—up over $3 trillion since
February—while 3-month Treasury interest rates increased 3 basis points from 0.13 percent to
0.16 percent from May to June but returned to 0.13 percent in July.56
Increasing infections in some states and orders to once again close or limit certain businesses
are likely to pose additional challenges for potentially fragile economic improvements, especially
in aﬀected sectors, such as the leisure and hospitality sector. More generally, economic activity
during the pandemic will evolve based on a complex interaction of supply constraints, patterns
of consumer demand, the severity of the pandemic, the eﬀectiveness of mitigation measures,
and when and how states and localities reopen—or restrict—various parts of their economies.57
Emerging empirical research on these topics, which we plan to monitor and review in greater
depth to better understand changes in national and regional economic activity, should provide
insight into the relative importance of these various factors and how they interact.58
Both imports to and exports from the United States fell in May but rose signiﬁcantly in June as
other areas of the economy continued to recover. Trade in transportation and travel services in
June 2020 continued to be substantially below their levels from a year ago. Travel exports in June
2020, for example, were 73 percent lower than in June 2019. COVID-19-related imports continued
to rise in May and June while COVID-19-related exports were roughly constant.59 Measures of
economic and ﬁnancial stress in advanced and emerging market economies improved in June
relative to May but remained elevated compared to 2019.
54Daniel 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).
55GAO-20-625.
56A basis point is 1/100th 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.
57The 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.
58See 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).
59World Customs Organization, HS classiﬁcation reference for Covid-19 medical supplies, 2nd edition (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.

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Indicators of areas of the economy supported by the federal pandemic response improved in June,
but labor market indicators remained far from prepandemic levels (see ﬁg. 4).60
60We 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.

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Figure 4: Indicators for Areas of the Economy Supported by the Federal Pandemic Response, 2015-2019 and
March 2020-July 2020
aInitial unemployment claim totals include initial regular unemployment claims submitted during the month but may
understate emerging unemployment of workers who qualify for the Pandemic Unemployment Assistance (PUA) program. The
PUA program generally authorizes up to 39 weeks of unemployment insurance (UI) beneﬁts to individuals not otherwise eligible
for UI beneﬁts, such as self-employed and certain gig economy workers, who are unable to work as a result of COVID-19. Claims
weeks are included in the month where the majority of the week falls. For example, the weekly average for April 2020 includes
the claims week ending May 2.
bThe employment-to-population ratio represents the number of employed people as a percentage of the civilian
noninstitutional population 16 years and over and is subject to misclassiﬁcation errors with respect to consistently identifying
workers as employed and absent from work or unemployed on temporary layoﬀ.
cHigher levels of the Consumer Credit Default Composite Index indicate more defaults on consumer loans, including auto loans,
bank cards, and mortgages. The Consumer Credit Default Composite Index could be subject to seasonal variation but is not
seasonally adjusted.
dLower levels of the Small Business Health Index indicate higher utilization of credit, delayed payments on credit, and more
small business failures. The Small Business Health Index is published under license and permission from Dun & Bradstreet and
no commercial use can be made of these data.

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eCorporate bond spreads are option-adjusted spreads on dollar-denominated investment grade corporate bonds and are
measured in basis points or 1/100th of a percentage point. Higher spreads reﬂect higher perceived risk among corporate
borrowers by investors.
fSpreads on municipal bonds are calculated relative to interest rates on Treasury securities based on the Bloomberg-Barclays
Municipal Bond Index and are measured in basis points or 1/100th of a percentage point. Higher spreads reﬂect higher
perceived risk among municipal borrowers by investors.
gExpenditures are in real (inﬂation-adjusted) dollars using chained (2012) dollars and are seasonally adjusted at annual rates.
Labor markets. The labor market showed some signs of improvement as the employment-to-
population ratio increased from a historic low of 51.3 percent in April to 55.1 percent in July.61
Gains in employment were primarily driven by individuals returning to work in leisure and
hospitality, government, and retail trade. However, new state orders to restrict certain business
activities in some states may slow growth in employment in impacted industries. Employment
levels remain below their prepandemic levels, as the employment-to-population ratio in July was
6 percentage points lower than in February 2020.62 Percentage declines in the employment-to-
population ratios from February to July were larger for Black and Hispanic workers compared to
White workers, and were also larger for those without a bachelor’s degree.
In four states, the employment-to-population ratio was less than 50 percent. Moreover, the
number of initial regular unemployment insurance (UI) claims ﬁled weekly in June and July 2020
averaged roughly 1.4 million, which was six and a half times higher than average weekly claims
in 2019 (see ﬁg. 5). While the number of initial regular UI claims ﬁled weekly has decreased
since March when the pandemic began, falling to 971,000 in the week ending August 8, 2020,
the persistently high level of claims indicates that economic disruption from the pandemic and
signiﬁcant stress in some areas of the labor market continue.
61The employment-to-population ratio represents the number of employed people as a percentage of the civilian
noninstitutional population 16 years and over.
62From 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.

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Figure 5: National Weekly Initial Regular Unemployment Insurance Claims, January 2019–July 2020
Notes: National initial regular unemployment insurance (UI) claims data are seasonally adjusted and include the 50 states,
the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Figure includes data retrieved on August 20, 2020, and
covers weekly claims from January 5, 2019, through August 8, 2020. Recent initial UI claims totals may understate emerging
unemployment due to capacity issues that may have limited or delayed successful claim ﬁling in many states. Initial
unemployment claims totals may also understate emerging unemployment of workers who qualify for the Pandemic
Unemployment Assistance (PUA) program, as states have diﬀerent processes for processing claims under this program since its
implementation in May 2020. The PUA program generally authorizes up to 39 weeks of UI beneﬁts to individuals not otherwise
eligible for such beneﬁts, such as self-employed and certain gig economy workers, who are unable to work as a result of
COVID-19. According to the Department of Labor, in some states, workers eligible for PUA may ﬁrst submit an UI claim, but in
other states, these workers can apply directly for the PUA program, and PUA claims are not counted as initial regular UI claims.
Due to outstanding and unresolved data issues speciﬁc to the PUA program, this graphic does not include separate initial PUA
claims.
Household ﬁnancial conditions. The Consumer Credit Default Composite Index—a timely
measure of households’ ability to make scheduled payments—continued to improve in June.63
While subindexes for mortgages, auto loans, and bank cards improved in June relative to May,
defaults on bank cards remained higher than a year ago. Relatively high bank card defaults
could indicate that households are prioritizing payments on some liabilities over others or that
households that disproportionately rely on credit cards have experienced more ﬁnancial hardship
since the onset of the pandemic. In addition, preliminary data on households participating in the
Supplemental Nutrition Assistance Program (SNAP) rose by about 17 percent in April compared to
March—suggesting a signiﬁcant increase in the demand for food assistance.64 Federal Pandemic
Unemployment Compensation beneﬁts expired at the end of July, which could inﬂuence eligibility
for SNAP as well as demand for food assistance.
63The 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.
64SNAP (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.

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Small business credit markets. The Small Business Health Index—a timely measure of the
ﬁnancial condition of small businesses—improved in May, but dropped in June. In addition,
subcomponents of the index measuring delinquency on certain ﬁnancial obligations were
still on the rise, suggesting that small businesses had increased diﬃculty making scheduled
payments.65 As of June 2020, small businesses in the retail and automotive sectors had the largest
deterioration in their sector-level indexes since January, with increases in business failures and
growing delinquencies driving the changes.
Corporate credit markets. Spreads on investment grade corporate bonds improved in June and
July relative to April and May, suggesting that perceived risk among corporate borrowers has fallen
and that access to credit for corporations has improved.66
State and local government ﬁnances. Spreads on municipal bonds also improved in June and
July relative to April and May, suggesting that perceived risk among municipal borrowers has fallen
and access to credit for state and local governments has improved.67 State and local government
employment, another indicator of state and local government ﬁnances, improved based on growth
in local educational employment.
Monthly change in personal consumption expenditures for health care. The COVID-19
pandemic has taken a severe toll on the health care sector, not only through the sharp rise
in demand for services for COVID-19 patients but also through the disruption of services
for non-COVID-19 patients. Early in the pandemic, state stay-at-home orders and federal
recommendations to postpone nonessential medical procedures contributed to declines in
hospital/facility stays and patient visits for non-COVID-related conditions or impairments. States
began easing COVID-related restrictions in late April, and by the end of May, most had relaxed
or ended stay-at-home orders. Some states began reimposing certain restrictions, such as
bar closures, in June or July. This indicator, based on data reported by the Bureau of Economic
Analysis, reﬂects these developments.
As shown in ﬁgure 6, seasonally adjusted real (inﬂation-adjusted) personal consumption
expenditures for health care dropped by $365 billion (16 percent) between February and March
and then another $530 billion (28 percent) between March and April, with large drops in spending
65The 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.
66Spreads 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.
67Spreads 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.

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for both outpatient and hospital services.68 Personal consumption expenditures for health
care rose in May and again in June, with increases in spending for both outpatient and hospital
services, but remained well below prepandemic levels. New stay-at-home orders or other
measures to address increasing numbers of cases in some areas of the country may slow growth
in spending.
Figure 6: Real Personal Consumption Expenditures for Health Care, Seasonally Adjusted, June 2019–June 2020
Note: Expenditures are in real (inﬂation-adjusted) dollars using chained (2012) dollars and are seasonally adjusted at annual
rates.
Monthly change in health care employment. As the COVID-19 pandemic spread throughout
the United States, and hospital stays and patient visits for non-COVID-related conditions or
impairments declined, many health care establishments such as private physician oﬃces
curtailed services and laid oﬀ staﬀ. Declines in health care employment lagged those in health
care spending, with employment declining substantially in April while personal health care
expenditures fell sharply the previous month. Even when facing revenue losses, employers may
have retained staﬀ for a number of reasons—for example, to avoid the future costs of hiring and
training new staﬀ when patient visits resume or, in the case of hospitals, to care for individuals
68Personal consumption expenditures, a component of gross domestic product, is the value of goods and services
purchased by, or on behalf of, U.S. residents.

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with COVID-19. Financial support provided by the COVID-19 relief laws to assist providers facing
increased health-care-related expenses or lost revenue attributable to COVID-19, known as the
Provider Relief Fund, may also have helped some providers retain staﬀ.69
According to data from the Bureau of Labor Statistics (BLS) Current Employment Statistics Survey
of establishments, seasonally adjusted employment in the health care sector dropped by almost
1.6 million between February and April 2020, largely due to declines in employment in ambulatory
health care establishments—including dentists’ oﬃces, which accounted for 35 percent of all job
losses in health care during that period (see ﬁg. 7).70 BLS data show recovery in health care sector
employment in the following 3 months, including in dentists’ oﬃces, which regained almost nine
in 10 of the jobs lost in March and April.71 However, employment in this sector was still below
prepandemic levels as of July.
Figure 7: Health Care Sector Employment, Seasonally Adjusted, July 2019–July 2020
Note: June and July 2020 data are preliminary.
69Speciﬁcally, 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.
70Employment 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
71As of August, June and July employment data were preliminary.

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Status of GAO’s June 2020 Recommendations and Matters for
Congressional Consideration
As we reported in June, consistent with the urgency of responding to serious and widespread
health issues and economic disruptions, federal agencies gave priority to moving swiftly where
possible to distribute funds and implement new programs designed to help small businesses
and the newly unemployed, for example. However, such urgency required certain tradeoﬀs in
achieving transparency and accountability goals. To make mid-course corrections, GAO made
three recommendations to federal agencies:
Recommendations
Unemployment insurance. We recommended that the Secretary of Labor, in consultation
with SBA and Treasury, immediately provide information to state unemployment agencies that
speciﬁcally addresses SBA’s PPP loans, and the risk of improper payments associated with these
loans. DOL issued guidance on August 12, 2020, that clariﬁed that individuals working full-time
and being paid through PPP are not eligible for UI, and that individuals working part-time and
being paid through PPP would be subject to certain state policies, including state policies on
partial unemployment to determine their eligibility for UI beneﬁts. Further, the guidance clariﬁed
that individuals being paid through PPP but not performing any services would similarly be subject
to certain provisions of state law, and noted that an individual receiving full compensation would
be ineligible for UI.
Economic impact payments. Treasury and IRS sent almost 1.2 million economic impact
payments totaling $1.6 billion to deceased individuals. In June 2020, we recommended that IRS
consider cost-eﬀective options for notifying ineligible recipients on how to return payments.
IRS agreed with this recommendation. Treasury and IRS have taken steps to implement this
recommendation and are considering further actions. Currently, IRS has instructions on its website
requesting that individuals voluntarily mail the appropriate economic impact payment amount
sent to the decedent or incarcerated individual back to IRS, for both electronic and paper check
payments. The envelopes in which paper checks were sent also have a checkbox to indicate if
the recipient is deceased, which then could be mailed back to the Bureau of the Fiscal Service.
Treasury has also held and canceled payments to decedents along with those that have been
returned.
According to a Treasury oﬃcial, of the $1.6 billion in economic impact payments sent to decedents,
nearly 70 percent have been recovered. However, we were unable to verify that amount by the
time we ﬁnalized our work on this report. We are working with Treasury to determine the number
of payments sent to decedents that have been recovered.
Treasury was considering sending letters to request the return of outstanding checks and the
repayment of amounts already paid by direct deposit or by checks that have been cashed.

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However, Treasury has not moved forward with this eﬀort because, according to Treasury,
Congress is currently considering legislation that would clarify or change the eligibility
requirements of the payments, including payments to the deceased and incarcerated.
Paycheck Protection Program. We recommended that the Administrator of the Small Business
Administration develop and implement plans to identify and respond to risks in the PPP to ensure
program integrity, achieve program eﬀectiveness, and address potential fraud, including in loans
of $2 million or less. As of August 2020, SBA has begun developing oversight plans for the PPP but
has not yet ﬁnalized or implemented them.
Speciﬁcally, SBA is currently working with Treasury to ﬁnalize plans for reviewing PPP loans.
For example, SBA oﬃcials told us that a contractor would use an automated review tool to ﬂag
potentially questionable loans over $2 million and that the contractor would conduct manual
reviews of ﬂagged loans. According to SBA oﬃcials, SBA would then complete the reviews with
a combination of contract and federal staﬀ, and another contractor would perform a quality
assurance review on a sample of loans. However, as of August 14, 2020, SBA was still working with
Treasury to ﬁnalize the speciﬁc review procedures its contractors and staﬀ would follow.
Matters for Congressional Consideration
In addition, to improve the government’s response eﬀorts, GAO suggested three matters for
congressional consideration.
Aviation preparedness. In our June 2020 report, we urged Congress to take legislative action to
require the Secretary of Transportation to work with relevant agencies and stakeholders, such
as HHS, the Department of Homeland Security (DHS), members of the aviation and public health
sectors, and international organizations, to develop a national aviation-preparedness plan to limit
the spread of communicable disease threats and minimize travel and trade impacts. We originally
made this recommendation to the Department of Transportation (DOT) in December 2015.72 As of
August 2020, no aviation-preparedness plan had been developed.
Although DOT supports the inclusion of aviation in a comprehensive pandemic preparedness plan,
it maintains that other federal agencies should lead such planning eﬀorts. DOT has reiterated that
because HHS and DHS are responsible for communicable disease response and preparedness
planning, respectively, these departments should lead any eﬀorts to address planning for
communicable disease outbreaks, including for transportation.73
72GAO, 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).
73DOT 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

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However, in May 2020, DHS stated that it had reviewed its existing national, sector, and modal
plans for pandemic preparedness and response activities and determined that it is not best
situated to develop a national aviation-preparedness plan. It noted that DOT, along with
HHS and DHS, would be the appropriate leads. In June 2020, HHS stated that it is not in a
position to develop a national aviation-preparedness plan because it does not have primary
jurisdiction over the entire aviation sector or the relevant transportation expertise. Also, the
National Response Framework—a guide to how the nation responds to all types of disasters and
emergencies—identiﬁes DOT as the lead federal agency for coordinating the management of
transportation systems and infrastructure during domestic threats or in response to actual or
potential incidents.74
Several recent developments indicate progress to respond to this recommendation. For example,
in May 2020, the House of Representatives passed H.R. 6800, referred to as the HEROES Act, which
would require DOT, in coordination with HHS, DHS, and other appropriate federal departments
and agencies, to develop a national aviation preparedness plan. The legislation directs the plan
to incorporate all elements referenced in the recommendation from our December 2015 report.
The plan would also be required to provide for an adaptable and scalable framework to help align
individual airport and airline plans, as well as improve coordination among appropriate federal,
state, and local governments.
In addition, in May 2020, the Senate Committee on Commerce, Science, and Transportation
favorably reported S. 3681, Restoring Safety in the Skies Act of 2020. This bill would require HHS,
DHS, and DOT to form a joint task force on air travel during and after the COVID-19 public health
emergency, and includes a provision for the task force to develop operating procedures to manage
future anticipated public health crises aﬀecting air travel. The task force would be focused on
COVID-19 and the immediate aftermath of the pandemic, not future communicable disease
threats.
In early July 2020, DOT, HHS, and DHS issued guidance to airports and airlines for implementing
measures to mitigate the public health risks associated with COVID-19.75 Among other things,
the document establishes the principles for implementing public health measures in the aviation
sector and identiﬁes risk mitigation measures that should be applied for the entire passenger
journey in the air transportation system, such as social distancing and contact tracing. While this
guidance is a positive step, DOT has not taken action to develop an aviation preparedness plan
for future communicable disease threats that incorporates all of the elements referenced in our
2015 report, such as protocols for responding to the threat and coordination among stakeholders.
Without such a plan, the United States will not be as prepared to minimize and quickly respond to
future communicable disease events.
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.
74The 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.
75Departments 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).

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GAO-20-708
Full access to death data. In our June 2020 report, we urged Congress to amend the Social
Security Act to explicitly allow the Social Security Administration (SSA) to share its full death data
with Treasury for data matching to prevent payments to ineligible individuals.
In June 2020, the Senate passed S.4104, referred to as the Stopping Improper Payments to
Deceased People Act. If enacted, the bill would allow SSA to share these data with Treasury’s
Bureau of Fiscal Service to avoid paying deceased individuals.
Fiscal assistance through Medicaid. In our June 2020 report, we urged Congress to use our
Federal Medical Assistance Percentage (FMAP) formula for any future changes to the FMAP—the
statutory formula according to which the federal government matches states’ spending for
Medicaid services—during the current or any future economic downturn. Our past work has
found that during economic downturns—when Medicaid enrollment can rise and state economies
weaken—the FMAP formula, which is based on each state’s per capita income, does not reﬂect
current state economic conditions. In addition, past eﬀorts to provide states with temporary
increases in the FMAP were not as timely or responsive as they could have been. No congressional
action has been taken to date.

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GAO-20-708
Agency Comments and Our Evaluation
We shared a draft of this report with multiple agencies for review and comment.76 Agencies
provided the following comments:
Small Business Administration. In an email on August 14, 2020, SBA provided substantive
comments on the report. SBA commented that the language in this report on PPP did not mention
controls in place during the application process, rules and guidance that the agency had issued, or
actions it had taken to create a portal for submitting loan forgiveness applications. SBA also stated
that we had not included all of the information provided to us in interviews on its plans for loan
reviews. As our goal was to provide a brief overview of actions SBA had taken in response to the
recommendation in our June 2020 report that focused on SBA’s reviews of approved PPP loans,
we did not make any changes to this report. We plan to provide more detailed information on the
status of SBA’s plans for loan reviews and the loan forgiveness process in our next report on the
CARES Act.
Technical comments. The following agencies provided technical comments, which we
incorporated as appropriate: Departments of Labor, Commerce, Health and Human Services,
Transportation, and the Treasury; the Federal Reserve; Oﬃce of Management and Budget; and
Internal Revenue Service.
We are sending copies of this report to the appropriate congressional committees, the Director
of the Oﬃce of Management and Budget, White House Coronavirus Task Force, and other
relevant agencies. In addition, the report is available at no charge on the GAO website at https://
www.gao.gov.
If you or your staﬀ have any questions about this report, please contact me at (202) 512-5500
or dodarog@gao.gov. Questions can also be directed to Kate Siggerud, Chief Operating Oﬃcer,
at (202) 512-5600, A. Nicole Clowers, Managing Director, Health Care, at (202) 512-7114 or
clowersa@gao.gov or Orice Williams Brown, Managing Director, Congressional Relations, at (202)
512-4400 or williamso@gao.gov. Contact points for our Oﬃces of Congressional Relations and
Public Aﬀairs may be found on the last page of this report.
Gene L. Dodaro
Comptroller General of the United States
76We 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.

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GAO-20-708
Congressional Addressees
The Honorable Richard C. Shelby
Chairman
The Honorable Patrick J. Leahy
Vice Chairman
Committee on Appropriations
United States Senate
The Honorable Lamar Alexander
Chairman
The Honorable Patty Murray
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
The Honorable Ron Johnson
Chairman
The Honorable Gary C. Peters
Ranking Member
Committee on Homeland Security and Governmental Aﬀairs
United States Senate
The Honorable Nita M. Lowey
Chairwoman
The Honorable Kay Granger
Ranking Member
Committee on Appropriations
House of Representatives
The Honorable Frank Pallone, Jr.
Chairman
The Honorable Greg Walden
Republican Leader
Committee on Energy and Commerce
House of Representatives
The Honorable Bennie Thompson
Chairman
The Honorable Mike D. Rogers
Ranking Member
Committee on Homeland Security
House of Representatives
The Honorable Carolyn B. Maloney
Chairwoman
The Honorable James R. Comer
Ranking Member
Committee on Oversight and Reform

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House of Representatives

(104461)
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GAO-20-708
Contacts
Report Director(s)
A. Nicole Clowers
Managing Director, Health Care, (202) 512-7114, clowersa@gao.gov
Congressional Relations
Orice Williams Brown, Managing Director, williamso@gao.gov, (202) 512-4400
Public Aairs
Chuck Young, Managing Director, youngc1@gao.gov, (202) 512-4800
Strategic Planning and External Liaison
James-Christian Blockwood, Managing Director, spel@gao.gov, (202) 512-4707
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