"WastewaterSCAN shows that there are HIGH levels of SARS-CoV-2 across the nation now. WastewaterSCAN does not have data for 12 states.
"Unfortunately, despite the fact that we are in a COVID wave, the CDC’s NWSS wastewater reporting has become unreliable. On August 15, the CDC shifted the goal post and “recalibrated” wastewater virus reporting. It now takes a higher level of SARS-CoV-2 in wastewater to be considered Moderate, High and Very High. The CDC will also stop posting the raw data set of NWSS wastewater surveillance of SARS-CoV-2 as of September 12. This will make it even harder to know what is really going on with COVID infections in the United States.
"As of the time that I am writing this newsletter, neither JP Weiland or Mike Hoerger have updated their transmission modeling estimates yet for this week. Hoerger’s PMC data will update on Tuesday this week. Based on last week’s data and the continued steep incline of COVID Emergency Department visits seen, I would “guesstimate” that there are about 650,000 new COVID infections daily in America now, with about every 1 in 65 people currently infectious, although the numbers may be higher. COVID deaths, a later indicator of a COVID wave, are starting to increase as well, although not to the levels seen in past waves. The summer wave is expected to peak around the first or second week of September. I would recommend wearing a well-fitting KN95 or N95 mask indoors at the grocery or while traveling on airplanes.
From: https://x.com/CAPublicHealth/status/1961443941611442543
"Emergency Department visits continue to climb for COVID infections, especially in school age children and teens. This week, the CDC changed the vaccine recommendation- no longer recommending COVID vaccination of healthy children despite the fact that they are being infected most right now and could use the protection. Studies show that COVID infection causes developmental delays in babies and toddlers and neuropsychiatric disease in children age 5 to 19. Adding HEPA filters to classrooms and masking may be the best way for kids to avoid COVID unless vaccine recommendations change.
From: https://covid.cdc.gov/covid-data-tracker/#ed-visits_separated_by_age_group
"This week’s big news is that on August 27, RFK Jr announced on Twitter that the FDA changed COVID vaccine eligibility recommendations. I have summarized who will be eligible for the updated COVID vaccines in the table below.
"Although the CDC has greatly limited COVID vaccine eligibility, the CDC list of High Risk Conditions for severe COVID is still broad and includes physical inactivity, obesity, depression as high risk factors. Long COVID qualifies under physical inactivity and under disabilities for “limitations with self-care or activities of daily living”.
"At
this time, you may only need to check the box online or on a form
saying that you have a high risk condition in order to get the COVID
vaccine at the pharmacy. The CDC list of high risk conditions may change after the upcoming September ACIP meeting, so I would seriously consider getting a COVID vaccine before then.
*CDC list of High Risk Conditions for Severe COVID infection (as of 8/30/25)
"Unfortunately, the Vaccines.gov website has been not working since 8/27/25. Making it difficult to schedule a vaccine appointment will lead to fewer people being vaccinated. It is possible to make a vaccine appointment directly on pharmacy websites.
"Katelyn Jetelina (YLE) wrote this article entitled “Covid-19 vaccine license change: 12 Key Questions Answered” that I found very helpful.
"For healthy children or adults under 65, you may have to get a prescription for off-label vaccination. It depends on the state. The New York Times reports:
“The states where CVS is requiring a prescription are Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, New York, North Carolina, Pennsylvania, Utah, Virginia and West Virginia, along with the District of Columbia”.
COVID vaccines are no longer available at CVS in Massachusetts, Nevada or New Mexico per Axios.
“Walgreens appears to require prescriptions in Arizona, Colorado, Georgia, Indiana, Louisiana, Missouri, Montana, New Mexico, New York, Oregon, South Carolina, Utah, Virginia, Washington State, West Virginia and Wisconsin.”
From: https://www.axios.com/2025/08/29/cvs-covid-vaccines-kennedy-rfk
"Late Friday, the New Mexico Department of Health (NMDOH) secretary wrote a state order that removes federal restrictions in order to make COVID vaccines available for all New Mexicans. I hope that more states will do the same.
"The Infectious Disease Society of America (IDSA) responded to the FDA’s new COVID vaccine limits saying that it “ignores science and puts millions of lives at risk.” They urged doctors to vaccinate off-label, insurers to cover the cost of doses, and Congress to step in to widen access before the respiratory season. The COVID vaccines have been proven to be safe and effective and millions of doses have been given worldwide.
"Bernie Sanders wrote an op ed entitled Kennedy Must Resign in the NY Times stating, "Robert F. Kennedy Jr., the secretary of health and human services, is endangering the health of the American people now and into the future. He must resign." I agree.
"A single dose of Novavax JN.1 vaccine was found to induce a rapid and robust anti–SARS-CoV-2 immune response against JN.1, LP.8.1, KP.2, KP.3, KP.3.1.1, MC.1, XEC, MC.10.1, LF.7, LF.7.2.1, LF.7.7.2, NB.1.8.1, XFC, and XFG, with an acceptable safety profile.
COVID Variants
"The CDC’s variant tracker finally updated Friday on a new site. XFG is the dominant variant in the United States and has pushed NB.1.8.1 and LP.8.1 out. The new updated COVID vaccines should cover these variants.
"COVID variant hunters are watching the BA.3.2 variant that was first reported by Ryan Hisner in March as it has shown up in Perth, Australia and represents 15% of Perth cases in its first week there. BA.3.2 was first seen in South Africa earlier this year.
Acute COVID infections, General COVID info
"A review from Italy shows that Remdesivir is safe and effective treatment for patients with blood cancers and a COVID infection. It is important to start a 3-day course of Remdesivir as soon as possible after a positive COVID test in patients with hematologic malignancies, and treatment can be extended longer than 3 days in patients with severe COVID infection, especially if pneumonia occurs. The authors recommend consideration of combination antiviral therapy and/or multiple courses of therapy if relapse or persisting symptoms in blood cancer patients.
From: https://onlinelibrary.wiley.com/doi/10.1111/eci.70108
"Beijing researchers found that SARS-CoV-2 spike protein can activate dormant HIV reservoirs in patients on ART by triggering the mTOR pathway. This may complicate HIV management in co-infected patients.
"The SARS-CoV-2 virus was found to trigger macrophage foam cell formation that drives both scarring (fibrosis) and clotting (thrombosis). These mechanisms may underlie tissue damage and cardiovascular complications in COVID and may help explain long-term organ damage.
"Examination of post-mortem brain tissue from COVID-19 patients revealed severe inflammation, gliovascular failure, and microglial dysfunction, particularly in the medulla. These findings highlight blood-brain barrier breakdown and mitochondrial impairment as central mechanisms in COVID-related neurological injury and death.
Pediatrics
"Although children make fewer antibodies to SARS-CoV-2, the antibodies that they do make bind the virus more strongly (increased avidity) and engage Fc immune receptors better than those of adults. These qualities may make children’s antibodies more functional and may partly explain why children often fare better with acute infection.
"A preprint from Barcelona shows that children with Long COVID have reduced CCR6 expression in myeloid cells and broad immune dysregulation in T, B and NK cells. Low CCR6 in myeloid cells could distinguish pediatric Long COVID cases with 79% accuracy. These findings suggest impaired immune cell trafficking and altered inflammatory responses may underlie persistent symptoms in pediatric Long COVID patients.
Long COVID
"The Patient-Led Research Collaborative posted that they are reopening the CURE-ID Long COVID treatment survey and have requested for Long COVID patients to make a new report or update their existing one with information about treatments that have helped and those that did not help Long COVID symptoms.
"Researchers found that Long COVID can cause levels of disability and cognitive decline comparable to stroke or Parkinson’s disease. Symptoms such as fatigue, brain fog, and memory loss may represent significant neurological injury, underscoring the need to treat Long COVID as a serious chronic illness rather than a mild post-viral syndrome.
"A new review from Yale details how the complement system, a core arm of innate immunity, may fuel Long COVID by staying switched on long after infection. Normally a frontline immune defender, complement can turn destructive when dysregulated- damaging the endothelium, platelets, and red blood cells- while increasing chronic inflammation and clotting. Potential triggers include viral reservoirs, autoantibodies, endothelial injury, and reactivated latent viruses, all feeding into a cycle of vascular injury and immune activation. By linking immune overdrive to coagulation and microvascular dysfunction, complement emerges as a unifying pathway that could help explain the multisystem persistence of Long COVID symptoms.
Figure 2: Proposed drivers of complement activation in long COVID.
From: https://insight.jci.org/articles/view/194314
"A small University of Illinois study of 30 patients (20 with Long COVID and 10 recovered controls) showed that Long COVID patients have persistently high antibodies to viral envelope and nucleocapsid proteins, as well as immune cell imbalances, inflammation, and autoantibodies for at least 6 months. Abnormal immune cell imbalances persisted months after infection, suggesting a need for therapies targeting viral persistence, abnormal antibody responses, and autoimmunity.
"Scientists discovered that a fragment of the SARS-CoV-2 spike protein can accelerate aggregation of alpha-synuclein, the protein linked to Parkinson’s disease. This interaction also increased toxicity in neuronal models. The findings suggest a potential mechanism linking COVID infection to neurodegenerative processes.
From Dennis Goris https://x.com/DennisGoris/status/1961183630480597397
"CDC Director Dr. Susan Monarez was ousted this week after rejecting RFK Jr.’s push to spread false claims about vaccines, calling his directives “reckless.” Her firing, just days after a massive shooting at CDC headquarters, triggered a wave of resignations by top officials including Chief Medical Officer Dr. Debra Houry, and directors Dr. Demetre Daskalakis, Dr. Daniel Jernigan, and Dr. Jen Layden, further deepening the leadership crisis at the CDC. Dr. Monarez was replaced by Jim O’Neill, a political appointee with no scientific training who has promoted unproven COVID treatments like ivermectin, fueling fears that the CDC’s scientific mission is being completely dismantled.
"The four top officials who resigned in protest were saluted by a large crowd of CDC staff and alumni and by the Commissioned Corps public health responders.
From: https://x.com/samstein/status/1961147263427731813
From: https://x.com/sarahdespres/status/1961215010216317142
"Rhonda Abrams has an idea for California:
"Actually, California’s state bill 829 was introduced into the California Senate earlier this year, but has not gone to any committees yet. It would create a California Institute for Scientific Research (CISR) to fund biomedicine and climate science research and would expand the state’s CalRx initiative to increase vaccine access. To support this bill, contact your state senators here.
"The KFF reports that CDC grant clawbacks under the Trump administration disproportionately hit Republican-led states. Democratic states that challenged the policy in court retained most of their funding. The uneven impact is fueling political tensions over public health resources.
"A CDC program called FoodNet, run by the CDC with 10 states, has stopped monitoring for dangerous bacteria in food. They will continue to monitor for salmonella and Shiga toxin-producing E. coli (STEC), but will no longer check for campylobacter, cyclospora, listeria, shigella, vibrio and Yersinia, even after last year’s deadly listeria outbreak. This is a huge mistake.
"Doctor and ethicist Alyssa Burgart MD wrote a blog post offering 14 tips for healthcare workers for when ICE shows up at the hospital or clinic.
"A 7-year trial shows that a breast cancer pill from Lilly called Verzenio (abemaciclib) significantly improved survival in HR+, HER2- breast cancer which is the most common subtype and was found to offer meaningful benefits even in advanced disease.
"In women without standard modifiable cardiovascular risk factors (“SMuRF-less”), elevated high-sensitivity C-reactive protein (hsCRP) was strongly linked to higher heart disease risk. A new report recommends treating these patients with statin medications.
"Antibiotic-resistant Whooping Cough (Bordetella Pertussis) is emerging across the Americas according to the Pan American Health Organization (PAHO). Babies and young children are at highest risk and vaccination remains a key defense.
"A new review explains how antidepressants can reshape neuroimmune cytokine networks involved in mood. By reducing pro-inflammatory signals and boosting regulatory pathways, these drugs may influence both brain and immune function. Insights may inform new strategies for treating depression through immune modulation.
Fig. 3: Neurotransmitter receptor groups on immune cells and their interactions with antidepressants.
From: https://www.nature.com/articles/s41398-025-03532-y
"Researchers identified six essential sterols missing in bee diets and supplemented colonies accordingly. Treated colonies grew 15 times larger, showing a major boost in survival and productivity. The discovery could help counter global bee declines.
From: https://www.sciencedaily.com/releases/2025/08/250822073807.htm
"A black bear broke into a Lake Tahoe, California ice cream parlor and proceeded to sample all of the flavors. Police found him standing behind the counter as if he were going to serve a customer. Before he ran out the front door, he finished his favorite flavor- strawberry.
From: El Dorado County Sheriff's Office
https://www.nytimes.com/2025/08/22/us/bear-lake-tahoe-ice-cream-shop.html
"Have a great rest of your weekend,
"Ruth Ann Crystal MD"
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