This edition provides COVID-19 case and death trends at the state and national level through April 23, also including information for each US territory. Our key encouraging finding is that for two consecutive weeks the number of new confirmed cases has decreased nationwide (relative to the previous week).  The more disturbing finding is that these decreases have been modest in size, with a massive number of new confirmed cases still occurring.  This past week the nation averaged over 28,000 new confirmed cases per day.  This rate of new confirmed cases is far above where it stood four weeks ago.