Montgomery County public health officials announced the first presumed case of COVID-19 on March 10, 2020. In the year since, the county has confirmed tens of thousands more cases and has seen hundreds of resident hospitalizations and deaths related to the disease. A total of 46,794 county residents had contracted the disease as of March 10, 2021, a figure representing around 7.7% of the county's population of 607,391 as estimated in the U.S. Census Bureau's 2019 American Community Survey.

While nearly 44% of the county's cases are now in an unidentified status, at least half of the nearly 47,000 total have been confirmed to be clinically recovered. Based on data from the Montgomery County Public Health District, both newly identified and active cases peaked in the county from late 2020 into 2021. This January saw the most cases reported yet in a single month, with nearly 12,600, as well as the county's active case peak of 10,774. Hundreds of cases continue to be reported weekly, with the number of newly identified and active cases having dropped off since this January. As of March 10, 2,267 cases were listed as active in the county. Hospitalizations related to the disease have fluctuated throughout the year, with a peak of 95 residents hospitalized due to COVID-19 reported weeks ago on Feb. 22. According to data from the Southeast Texas Regional Advisory Council, total COVID-19 hospitalizations in Montgomery County facilities—regardless of patients' residence—peaked Jan. 12 this year with 286 confirmed or suspected COVID-19 patients in county hospitals. The number of COVID-19 patients in ICU beds peaked July 7 at 96. SETRAC data shows that both general and ICU bed availability in Montgomery County never surpassed the county's operational limits through the pandemic, although availability did approach that upper limit at times. Total general bed use including COVID-19 patients rose to the highest point Dec. 30 with 1,231 hospitalizations, representing 96.55% of the county's operational bed limit. Total ICU bed usage peaked Jan. 3 with 172 patients, representing 98.85% of the county's 174-bed operational limit. A total of 249 county resident deaths over the past year were confirmed to be related to COVID-19 since the first two fatalities were reported last April, according to the public health district. Last August proved to be the most deadly month of the pandemic in the county with 47 coronavirus-related fatalities, and this February saw the second-highest monthly death count with 33. Deaths of residents from their 20s to their 100s have been confirmed across the county since last spring, with the most recent two deaths reported March 9. Of municipalities with reported deaths related to COVID-19, Conroe has seen the most with 95 while Cleveland and Shenandoah have the least with one each. Tens of thousands of COVID-19 vaccines have been administered in Montgomery County since statewide vaccination efforts began in December. According to the Texas Department of State Health Services, the majority of both first and second vaccine doses allocated to county health care providers so far have been used with a total of 119,305 doses administered countywide. DSHS data shows that 9.87% of the county's 467,232 residents eligible for vaccination under U.S. Food and Drug Administration regulations—those age 16 and older—are now fully vaccinated against COVID-19.