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Title page 1

Contents 8

Highlights 2

Letter 10

Background 12

Response to Public Health Impacts 13

Response to Economic Impacts 14

Updates to Key Indicators Examining Public Health and Economic Effects of the COVID-19 Pandemic and Information on Relief Funding, Spending, and Fraud Cases 15

Public Health 15

Economic Conditions 20

COVID-19 Relief Funding, Spending, and Fraud Cases 24

Progress Made Addressing GAO Recommendations from the COVID-19 Pandemic Response, but Opportunities for Improvement Remain 32

Actions to Address GAO Recommendations Demonstrated Improvements in the COVID-19 Response 33

GAO Recommendations that Remain Open Underscore Opportunities for Further Improvement in the COVID-19 Response and Preparedness for Future Emergencies 37

Conclusions 44

Agency Comments 44

Appendix I: GAO Contact and Staff Acknowledgments 48

Tables 8

Table 1. Major Spending Areas Under COVID-19 Relief Funding as of March 31, 2025 25

Table 2. Largest Unexpired Unobligated Balances Under COVID-19 Relief Funding as of March 31, 2025 27

Table 3. Prior GAO Matters for Congressional Consideration to Ensure Transparency and Accountability for COVID-19 and Beyond that Remain Open and Unimplemented... 42

Figures 8

Figure 1. COVID-19 Relief Laws 13

Figure 2. Weekly Number of U.S. COVID-19-Associated Deaths, March 2020 Through March 2025 16

Figure 3. Annual Rate of U.S. COVID-19-Associated Deaths, 2020 Through 2024 17

Figure 4. Weekly Rate of COVID-19 Hospitalizations, March 2020 Through March 2025 18

Figure 5. Examples of Signs, Symptoms, and Conditions Associated with Long COVID 19

Figure 6. Percentage Change in Inflation Indicators from the Previous Month, March 2019 Through March 2025 22

Figure 7. Labor Market Trends, March 2019 Through March 2025 24

Figure 8. Prison Sentences for Defendants Convicted of Fraud-Related Charges Involving COVID-19 Relief Programs, as of March 31, 2025 30

Figure 9. Court-Ordered Restitution for Defendants Convicted of Fraud-Related Charges Involving COVID-19 Relief Programs, as of March 31, 2025 31

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