Q&A With Dr Osterholm About COVID & Pandemics

This is an excellent interview. Note the final paragraphs of Dr Osterholm's response. We have the COVID vaccine, yet people don't take advantage of it, and that's really selfish and self-defeating.

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From CIDRAP 7-31-26:

COVID is still here. Is the pandemic?
Laine Bergeson, 7-31-26

It’s been three years since the World Health Organization declared an end to the COVID-19 public health emergency, but COVID still circulates worldwide. Does that mean the pandemic is still going on, just in a non-emergency phase? Or has COVID become an endemic virus, like the flu?

CIDRAP News talked with Center for Infectious Disease Research and Policy (CIDRAP) Director Michael Osterholm, PhD, MPH, to understand what defines a pandemic, if we’re still in one, and what gives a pathogen pandemic potential.

CIDRAP News: What exactly is a pandemic? 

Michael Osterholm: There’s no magic answer to that question. From my perspective, I usually say the only examples we have in modern history are viral infections that are transmitted via the respiratory route, like the flu and COVID, because the dynamics of transmission make it a worldwide threat, and “worldwide threat” is important in defining a pandemic. A pandemic is not just something that happens in one localized area.

Plagues weren’t viruses, but, in the modern world, a pandemic is almost always a viral infection.

CIDRAP News: Why? 

Michael Osterholm: Antibiotics could be an important part of why bacterial viruses aren't as big of a threat today. But what’s really at the heart of it is what flu and COVID represent today in terms of risk—that is, slight changes in the virus result in increased susceptibility. And when there's a major change in the virus, you virtually have no protection.

For a good example, look at influenza. Each flu pandemic was caused when there was a major shift in the genetics of the virus, so virtually no one was immune. If you look at COVID, it was very much the same thing. 

CIDRAP News: Why were SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) not pandemics? 

Michael Osterholm: Because they are not readily transmitted. We were able to bring them under control, basically with standard control measures that you would use for respiratory illness. And that's good news because the case-fatality rate for SARS and MERS is between 15% and 35%. For COVID, the case-fatality rate was 1% to 1.5%.

CIDRAP News: So pandemics have less to do with severity and more to do with how transmissible a virus is? 

Michael Osterholm: Both how transmissible it is and risk are important. For example, if you have a common cold virus for which we have no previous immunity suddenly spread around the world, most of us would not consider that a pandemic in the sense that it's not a severe illness. So there’s an implied status of severe illness.

CIDRAP News: What’s the difference between a pandemic and an epidemic? 

Michael Osterholm: Epidemic relates back to the issue of transmission. For example, we have a major epidemic of Ebola going on right now, which surely has a high case-fatality rate. It's a very serious illness, but it's not readily transmitted via the respiratory route. 

CIDRAP News: When does a pandemic start and end? 

Michael Osterholm: The start of a pandemic is much easier to declare because it’s like a suddenly emerging out-of-control forest fire.

When you get to the point where you have these isolated fires all over the place, but they're not really burning too much, you can say that's when the pandemic is over. And that's a much harder one to call.

CIDRAP News: Is the COVID pandemic still going on? 

Michael Osterholm: No, I think we can safely say that we are now adjusting into a more routine cycle of infection. And you can argue that in several ways. First of all, there's a much greater stability to the virus that we see now with so much background immunity in the population.

It’s similar to previous influenza pandemics, which were the hallmark pandemics we had prior to COVID. Clearly, they were situations where once a large portion of the population either got infected and died or got infected and recovered, there was a level of protection that, over time, basically won out over the virus itself.

That's why you still see the virus circulating, but in a way that, genetically, our body's immune systems are largely able to take on. So again, if you look at the flu pandemics of the past, in every instance they just kind of faded away over time and became a background endemic disease.

And today we are in a much more steady-state existence with COVID because of our preexisting immunity and the relative lack of genetic change to the virus. We haven't watched it go from the ancestral strain to Alpha, Beta, Delta, Gamma, or Omicron, like we did in those first four years.

CIDRAP News: I’m thinking about some of the notable pandemics that preceded the COVID pandemic. Is the AIDS pandemic still going on? 

Michael Osterholm: AIDS is an unusual one in that it has its foot in both the pandemic and non-pandemic camps—and what I mean by that is that not everyone was at risk for HIV. If you didn’t have a sex partner who was infected, you did not have blood exposure, then you weren't at risk for this. 

So if 80% of the world is immune to it or not likely to be exposed, is that going to be a pandemic? But it still is widespread within each geographic region of the world, so it gets a little cloudier there. 

So there are those who say HIV is not a pandemic, and those who say it is, or it was, a pandemic, and I agree with those who say it is. But you could claim either one. 

CIDRAP News: What gives a pathogen pandemic potential, and what future pandemics are experts most worried about? 

Michael Osterholm: A virus with respiratory transmission potential for which, upon a genetic change, could mean many, if not almost all, the population is susceptible. That's why I coined the term “angel” or “virus with wings,” because basically the virus has to be in that mode to rise to the level of a pandemic. 

Many other diseases surely can be a problem, but only that defines dynamic transmission in the community. 

Also, it's got to be a disease that is sustainable around the world. Take cholera, for example. In some places, cholera can be a very serious epidemic. But it's not going to ever be a problem in Minneapolis-St. Paul [Minnesota].

CIDRAP News: What public health or preparedness lessons can we take away from the COVID pandemic? 

Michael Osterholm: How poorly prepared we are for a future pandemic. There was no official review following up after COVID, so I feel like we've learned very little from the pandemic. And we're hurting badly in terms of vaccine protection and preparedness. 

And the one advance we have is mRNA technology, yet we see a large segment of the population refuses to accept that vaccine. 

Illegal Alien Invasion in Spain. This Used To Be Us.

 

The frightening news footage of 60,000 illegal aliens -- NOT "migrants" -- storming into that Spanish enclave could have been America, had we not elected Donald Trump and closed our borders.

From what I could see, these were mostly men of military age, just like what we had to contend with.

If Spain is smart, they will deport all of these invaders immediately, unless they want their crime rate to explode, have their own citizens live in fear, and are forced to pay for the usual "free stuff" that unwelcome illegals feel entitled to.

Just watch the video. If the Democrat Socialists should win the White House in 2028, this is our future. 

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ABC News 7-31-26 

Some 60,000 migrants have entered Spain’s Ceuta from Morocco in the past 24 hours, Ceuta’s president says

CEUTA, Spain -- About 60,000 migrants have entered Spain’s Ceuta from Morocco in the past 24 hours, Ceuta's president said on Friday. That is equivalent to 70% of the city's regular population.

At least 34 migrants have died attempting the crossing.

“The situation that Ceuta is going through is absolutely unsustainable,” Juan Jesús Vivas told journalists.

Spain's Prime Minister Pedro Sánchez visited Ceuta on Friday and condemned the border breach which he described as “a violation of Spain's territorial integrity.”

Sánchez blamed human smugglers for the crisis, saying they “deceive so many young people, and ultimately lead many of them to their deaths — whether in the ocean or, as in this case, at Spain’s border in the autonomous city of Ceuta.”

Spain’s interior ministry, which had initially refused to share estimates from the border, released its own figures shortly after Vivas’ spoke, estimating that some 50,000 people had crossed from Morocco since Thursday. It added that half had already returned to Morocco, and shared footage of migrants walking back through a border fence door.

The border crisis boiled over with security forces clashing with migrants on the Moroccan side of the border.

Video footage of the border early on Friday showed hundreds of migrants gathered on a hill overlooking Ceuta being dispersed with tear gas by Moroccan forces, while others continued to swim to the Spanish territory.

Rachid Sbihi, who leads a local workers association representing Civil Guard officers, described the situation as a “serious humanitarian crisis,” saying thousands of migrants, including unaccompanied children, were left sleeping in parks and on sidewalks, while others roamed the streets aimlessly. “It’s chaotic.”

Morocco’s Interior Ministry did not immediately respond to a request for comment on the migrant figures released by the Spanish authorities.

European Commission President Ursula von der Leyen said the “images coming from Ceuta are unacceptable.”

“We cannot allow anyone to come to our Union without abiding by our rules,” she said in an online statement on Friday. “Dangerous crossings must stop immediately. Smuggling networks must be dismantled. And returns must be swift, as our rules allow.”

Some of the 34 people who died had drowned, Sbihi said, but some were also killed in a stampede to cross the breakwater fence at Tarajal beach, an urban beach near a border checkpoint with Morocco. The waters near the border fence were littered with buoys, shoes and other belongings left behind.

Dr Fauci Didn't Create COVID

I just have to say that I find it disgraceful that Dr Fauci has become the scapegoat for the COVID pandemic, thanks to years of attacks by Rand Paul.

A reminder: COVID came from China. It was a novel virus, and there were  no vaccines in 2020 to prevent it. . Millions of people died horribly because COVID is an airborne disease. Nobody could have known how to prevent it

Desperate times call for desperate measures. I thought the lockdown was a good idea in order to keep people from infecting one another and spreading the disease even further.  Wearing masks was also a good idea, as were measures like social distancing. What was the alternative? To keep going as if nothing were happening and as if nobody were dying?

Fortunately, the COVID vaccine was ready in 2021 as a major accomplishment through Operation Warp Speed. By getting everyone vaccinated, we could lower the risks of getting and spreading COVID. 

And as you plainly see today, COVID is at very low levels because so many people now have the immunity we lacked in 2020.

How Dr Fauci can be blamed for trying every possible option during a medical emergency is a mystery to me. This vendetta has got to stop.

Your Local Epidemiologist: The Dose - 7/28/26

Here's another helpful issue of The Dose, by Dr Katelyn Jetelina.

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Measles record (and hot questions), foodborne illness summer, Covid-19 summer wave, and more

The Dose (July 28)

Katelyn Jetelina

Jul 28, 2026

Well, folks, it sure feels like we’ve entered a new phase of health status in the U.S.

It’s hard to keep track of what food is safe to eat and where. (It’s also expensive to eat, and 4 million Americans are losing access to food.) We also just hit a measles record, which means more medical bills are piling up and more kids are missing school. The milestone is prompting a whole lot of great questions on Twitter, from whether this is caused by illegal immigrants to what would have happened if Kamala Harris was president.

But there is good news: There are things we can do. From individual actions, like the first people volunteering for an Ebola vaccine clinical trial just because they care, to the effort of many public health workers to slow down the explosive diarrhea outbreak.

Here’s your “disease weather report” and what it means for you.

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Foodborne illness summer may be slowing

Cyclosporiasis cases keep adding up, with states tallying over 14,000 suspected cases. This is an insane number of cases compared to previous years, when we would see 3,000-4,000 cases annually. (But still lower risk compared to other bugs that give you diarrhea, like norovirus).

FDA is investigating six outbreaks. They haven’t said why they know all these outbreaks are separate, but my hunch is genetic testing. Through DNA, you can tell if parasites are related or not. This is what we know:

• By far, the biggest outbreak is tied to iceberg lettuce. This has confirmed cases across 9 states, but the recall covers 28 states after checking shipments.

• The other Cyclospora outbreaks are much murkier. FDA is doing traceback analyses (looking at receipts, etc.) to figure out what food is causing it and where. We don’t know anything other than one outbreak has at least 72 confirmed cases. I would expect more recalls.

• North Carolina has racked up 561 cyclosporiasis cases. State officials say parsley and cilantro (and lettuce) keep showing up in patient interviews, but haven’t recalled anything yet.

I believe we are going to see a national downtrend soon. The largest outbreak is being caused by lettuce. And there’s only so long that lettuce is good for. It’s hard to see where we are in the outbreak, though, because data are imperfect. Case data are very sensitive to who is testing and how. For example, there are so many cases in Michigan that some hospital systems have run out of testing supplies. This has created a backlog, so several hospitals are now only testing the most high-risk patients who are hospitalized or have weak immune systems so they can get treatment.

But, lab test positivity rates are falling even though testing is still focused on high-risk people—which should be positivity keeping rates high—so the real decline may be even bigger than the numbers suggest. This is still preliminary data, but a hopeful sign we are turning a corner.

Test positivity rate for gastrointestinal pathogens. Source: Biofire annotated by Your Local Epidemiologist

What this means for you: We aren’t out of the woods yet. If you’re in the 27 states (see map below because it’s almost impossible to keep track), continue to avoid iceberg lettuce. There may be more recalls soon as answers hopefully come with the other outbreaks.

There’s also a Salmonella outbreak tied to more than 19 million white and brown cage-free eggs. Nearly 100 people are sick, and 26 hospitalized. Midwest Poultry Services recalled more than a million cartons sold at Kroger, Brookshire’s, and smaller grocery stores in Texas, Louisiana, Oklahoma, Arkansas, Mississippi, and New Mexico.

What this means for you: If you are in one of these states, check your fridge. Toss any carton with plant code P-1950 or 0840962 and a Julian date between 157 and 184 (best-by dates July 20 through Aug. 17).

Figure by Your Local Epidemiologist using Claude.

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Covid-19 cases are very low, but rising

We are slipping into a summer Covid-19 wave. Levels are still very low in absolute terms, but they’re climbing across all metrics. The West is the leader, but emergency department rates are climbing almost everywhere.

For the last two summers, the summer Covid-19 wave has outpaced the winter one. Given how small this past winter’s bump was, that bar won’t be hard to clear again. Whether Covid is becoming a summer virus is a fascinating, still-unanswered question.

Percentages of tests positive for Covid-19 in the U.S. Figure from EPIC.

In the spring, an external FDA committee recommended a new 2026-2027 vaccine formulation for the Covid-19 vaccine. It’s supposed to be available as early as mid-August. News around this has been surprisingly quiet.

What this means for you: If you’re over 65 and never got your spring Covid-19 vaccine, the time is now. I wouldn’t wait for the updated fall vaccine. You can get this before the winter wave, which is usually in November.

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Measles hits a 35-year record

The U.S. reached 2,318 cases this year, which is a 35-year record, with five months still left to go in the year. This total has been driven by 35 separate outbreaks (defined as 3 or more cases), but most cases come from a spillover outbreak from last year in South Carolina as well as ongoing spread in Utah this year.

Sure, compared to other countries, this case count isn’t that bad. Canada and Mexico’s tallies are much higher. And, thankfully, no one has died this year in the U.S. (which is lucky, as we would have expected 2-3 deaths by now). But health isn’t just about life and death.

Those 2,318 cases mean:

• 151 hospitalizations

• ~44,300 school days missed1

• Many losing immunity to other viruses

• ~2 kids with permanent hearing loss

• ~1 kid will die in 10 years from brain disease

• $204 million in costs

All of this is preventable. This signal measles is sending us is big: the U.S. is moving backward in health, not forward.

What this means for you: If you’re up to date on vaccines, you are very well protected. Ninety-three percent of cases are among the unvaccinated.

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Spotlight: Measles questions

I posted about measles on Twitter yesterday, and got so many hot questions. Some are hostile, some are genuinely curious, and some (I think most) are a mix. Here are the top three questions answered, because you’re likely seeing them (or curious about them) too:

1. Wouldn’t we have the same number of measles cases right now if Kamala Harris was president? Yes, I think so. The unvaccinated people getting infected right now made their decisions to not vaccinate years ago, not because RFK is the Health Secretary. But in the next couple of years, it will matter.

2. Isn’t this due to illegal immigrants? This is a common perception, but data show us that 3 in 4 index measles cases are U.S. citizens who travel abroad and bring it back to their community, and then it spreads like wildfire. Those pockets are getting bigger. Here’s a previous YLE deep dive on that.

3. If you really cared about this, you’d be trying to understand why measles is rising around the world, not just in the U.S. I actually spend a lot of time thinking about this. I think it’s due to the combination of general amnesia (vaccines are a victim of their own success), low trust in institutions and governments, the information landscape, increasing income disparities, and many other factors.

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Question grab bag: Wildfire smoke

“Did the wildfire smoke (which got up to the hazardous category) harm the greens in our garden? Are they still edible? Sure would like your advice!”

Wildfire smoke is mostly particulates; the gases don’t linger. So the real concern is deposition onto garden greens, which washes off fairly easily. Since Canada’s wildfire was pure wildfire smoke, it didn’t stick around.

Urban wildfires are a different story, though, like the one in Los Angeles last year. Those burn buildings, cars, and other materials, so the smoke carries heavy metals. Studies after the L.A. fires actually found the soil enriched with metals, which can then be taken up by plants.

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Good news

• First person gets new experimental vaccine for Ebola. A group of 50 healthy volunteers is testing the new Ebola vaccine being developed in the U.K. The strain causing the outbreak in the D.R.C. is resistant to previously developed vaccines and treatments, so new versions are quickly being created to try to stop the outbreak.

  • The first person to participate in this trial told BBC what motivated him: “I had wanted to volunteer for the Covid vaccine trial but was unable to because of work commitments. After seeing news from DR Congo I thought I’d like to do my bit.” Which just makes me smile.

• El Salvador eliminates trachoma as a public health problem. Trachoma is the most common cause of infectious blindness, and it is heavily associated with poverty and lack of access to basic health services. El Salvador is the first country in Central America and the second country in the Americas to eliminate it. (WHO)

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Bottom line

We may be entering a new phase for health in the U.S., which is extremely disappointing, but there are things each of us can do to keep ourselves, our family, and our community healthy.

Love, YLE

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Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members.

Dr Ruth Report 7-26-26

Here's the latest info-packed report from Dr Ruth Ann Crystal.

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Dr. Ruth Report, 7/26/26

Ruth Ann Crystal MD

Jul 27, 2026

COVID levels are starting to creep up, especially in the South. Using data from 7/11/26, Mike Hoerger calculated that 1 in every 243 Americans was actively infectious with COVID, with about 200,000 new COVID infections daily across the states. On Twitter, he notes an increase in COVID positivity in Mexico, and an uptick starting of SARS-CoV-2 in wastewater in South Korea, Ireland, Denmark.

According to the CDC, American wastewater levels of COVID have increased from very low (light blue) to low (green) in some states. But, CDC modeling shows that COVID cases are increasing in 37 states, declining in 0 states, and are stable in 11 states.

According to CDPH, COVID activity in California is low, but is slowly increasing. If you are 65 years old or older, or if you are immunocompromised, it may be a good idea to get a COVID booster at a local pharmacy sometime soon. Since there are no new variants causing COVID at this time, the pharmacy will offer the same vaccine that was given last winter.

Also, if someone thinks that they have a “summer cold”, it may be COVID. Remember, home rapid antigen tests often won’t be positive until about 2 to 3 days after symptoms start. NPR wrote this about what to do about the latest COVID uptick.

From: CDC SARS-CoV-2 in wastewater

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Acute COVID infections, General COVID info

Viral syncytia evolve to resist interferon | Nature 7/20/26

• NIH researchers working with cell lines, human airway tissue cultures, and mouse models demonstrated that SARS-CoV-2 spreads through the merging of cells into multinucleated syncytia, a mechanism that shields the virus from both interferon responses and antibody neutralization. These fused cellular masses use host ribosomes to pump out viral proteins, allowing the pathogen to propagate without releasing free viral particles into the surrounding tissues, so the immune system does not see them.

Complement augments antibody neutralization of SARS-CoV-2 variants | Science Translational Medicine 7/22/26

• Institut Pasteur researchers studying 93 participants found that complement proteins C1q and C3 substantially strengthened the ability of antibodies to neutralize new SARS-CoV-2 variants. Rather than destroying the virus directly, C3 coated viral particles and worked through antibody Fc regions to amplify neutralization activity against variants that might otherwise evade immune defenses.

IFNγ at the crossroads of systemic protection and brain vulnerability to coronavirus infection | BioRxiV 7/23/26

• Scientists from the University of Buenos Aires studied 35 infected mice and found that interferon gamma (IFNγ) suppressed a mouse coronavirus in peripheral organs while simultaneously allowing the virus to accumulate at higher levels in the prefrontal cortex and hippocampus. This reveals a fundamental conflict within the immune response, where IFNγ protects the body while rendering specific brain regions more vulnerable to coronavirus infection.

Vaccines

Multiorgan Outcomes Following BNT162b2 mRNA Vaccination vs SARS-CoV-2 Infection: A 30-Million-Person Real-World Cohort Analysis | npj Vaccines 7/20/26

• A study of more than 30 million people shows again that it is much safer to get the COVID vaccine than a COVID infection. SUNY Upstate Medical University researchers analyzed data from more than 30 million people and found that SARS-CoV-2 infection was associated with 3 to 5 times greater cardiovascular risk compared to the BNT162b2 mRNA vaccine, with certain elevated risks persisting beyond nine months after infection. The BNT162b2 vaccine showed no excess cardiovascular or multiorgan risk in the same analysis.

Long COVID

🧠 Neurologic Manifestations of Long COVID Affect Adult Females More Severely Than Males | Annals of Clinical and Translational Neurology 7/21/26

• A new study from Northwestern Medicine of 2,329 patients from its Neuro COVID-19 Clinic shows that women have worse neurologic Long COVID symptoms than men. “Females suffer from a higher symptom burden of Neuro-PASC [brain fog, dizziness, headache, numbness, and pain] and had worse subjective quality of life and objective cognitive function. These results highlight the importance of timely diagnosis and targeted interventions in female patients who are often negatively affected by gender bias in medicine.”

Northwestern Medicine study finds women experience more severe neurological symptoms of long COVID than men | Northwestern

• “We think that the reason women are more frequently and severely affected by long COVID than men is because long COVID is an autoimmune disease, and women are more prone to autoimmune diseases than men, including multiple sclerosis and rheumatoid arthritis,” Dr. Koralnik said.

🧠 Understanding neuroinflammation in post-COVID-19 syndrome: biological mechanisms, diagnostic biomarkers, and therapeutic prospects | Translational Psychiatry (Preprint) 7/21/26

• Experts from King’s College in London reviewed evidence linking Long COVID neurological symptoms to viral proteins persisting in the skull, meninges, and brain tissue alongside activated glial cells and compromised brain barrier integrity. The authors propose a local sleep disruption model, though they acknowledge it remains theoretical rather than clinically established.

From: https://www.nature.com/articles/s41398-026-04286-x

🧠Pathogen effects on the brain: the case of SARS-CoV-2 spike protein and neuro COVID | Frontiers Neurology Review 7/12/26

• In a new review, researchers propose that persistent Spike protein reservoirs in the meninges drive Long COVID neuropsychiatric symptoms by activating mast cells and microglia in a feedforward inflammatory loop. This crosstalk disrupts the blood brain barrier and dysregulates the HPA axis, offering a mechanistic explanation for brain fog and cognitive impairment affecting up to half of infected patients.

Figure 1: SARS-CoV-2 Spike protein can exist in a meningeal “reservoir”

These two articles made me think of the impressive 2024 article from the Erturk lab showing:

Persistence of spike protein at the skull-meninges-brain axis may contribute to the neurological sequelae of COVID-19 | Cell 12/2024 Erturk lab

Long-term SARS-CoV-2 Persistence in Syrian Hamsters | bioRxiv 7/21/26

• Viral persistence: Brazilian researchers detected SARS-CoV-2 RNA in the lungs, brain, spleen, and thymus of 96 Syrian hamsters for up to one year following infection, with viral proteins still present in lung and thymus tissue at that endpoint. No evidence of active viral replication was identified in any of the reservoir tissues examined.

Rapid recruitment for a remote long COVID clinical trial | Lancet Infectious Disease 7/23/26

• Scripps Research’s Julia Moore Vogel reports that the Long COVID Treatment Trial Tirzepatide (LoCITT-T), launched in October 2025, enrolled all 1000 participants in under two months through fully remote eligibility screening, diagnosis documentation, and consent. Enrollment jumped most sharply after a public webinar with live Q&A, suggesting direct engagement drives recruitment even in decentralized trials.

Access to potential long COVID drugs dwindles as trials falter | Chemical & Engineering News 7/21/26

• In a 53 participant trial by Argenx, efgartigimod (Vyvgart) failed to outperform placebo as a treatment for Long COVID associated POTS when evaluated across the full study population. Researchers suggest that identifying patients with autoantibody driven disease through improved biomarkers could isolate a subgroup more likely to respond to FcRn blockade therapy.

Altered TRPM3‐Dependent Cytosolic and Mitochondrial Calcium Influx in Natural Killer Cells of Post‐COVID‐19 Condition Patients | European J Immunology 7/22/26

• Researchers from Griffith University examined 16 participants and found that natural killer cells in people with Long COVID showed diminished calcium transport into both the cytosol and mitochondria via the TRPM3 channel. This signaling impairment appears to compromise the immune system’s capacity to destroy infected or abnormal cells while also interfering with how those cells regulate their energy supply.

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Measles

CDC Measles update:

• As of July 23, 2026, 2,318 confirmed measles cases were reported in the United States in 2026.

• For the whole year of 2025, there were 2,289 cases of measles. We have already surpassed that number and there are still 5 months left to this year.

Measles cases reach 35-year high in US | CIDRAP 7/22/26

• The Johns Hopkins measles tracker reported 2,295 US measles cases so far in 2026, the highest count since 1991, with outbreaks still active in Virginia and Pennsylvania. Johns Hopkins epidemiologist William Moss says under-vaccination driven by disinformation is fueling sustained transmission.

Ebola in Democratic Republic of Congo (DRC)

According to DRC officials as of July 24, 3,075 Ebola confirmed cases have been recorded in DRC, including 755 patients still in isolation or hospitalization, 556 people recovered, and 1,354 deaths. The case fatality rate is 44.0%, while the contact tracing rate stands at 76.4%.

Ebola virus persistence and the hidden cost of immune privilege | Nature Microbiology 7/23/26

• Using human brain organoids, researchers discovered that Ebola virus can survive and spread directly between brain cells for a minimum of 120 days, exploiting the central nervous system’s status as an immune privileged environment. Microglia respond to this persistent infection by sustaining chronic inflammation, which may damage neurons and offer a biological explanation for why some patients relapse following initial recovery.

Cross-Reactive Bundibugyo Antibody Responses after Receipt of Licensed Ebola Vaccines | NEJM 7/22/26

• The PREVAC Study Team found cross-reactive antibody responses in vitro against the Bundibugyo virus (BDBV) in the sera of people who had been vaccinated with the existing Zaire ebolavirus (EBOV) vaccines. “As expected, BDBV responses remained consistently lower than homologous EBOV responses but were detectable after vaccination.” Vaccination with the Zaire virus specific vaccine may offer some protection.

The world’s first Bundibugyo Ebola vaccine has entered human trials: here’s why it matters | GAVI 7/23/26

• A new Phase I trial to establish safety has just started for a new Bundibugyo-specific Ebola vaccine called ChAdOOx1 BDBV.

Other news

A fully integrated smart ring for daily biochemical monitoring | Nature (UCSD) 7/23/26

• A new smart ring from UC San Diego engineering can monitor glucose, ketones, lactate, alcohol, uric acid, and vitamin C levels in sweat continuously for up to 12 hours. Tested in Type I diabetic patients and in healthy controls, the glucose readings were as accurate as commercial glucose monitors.

Photo by David Baillot/UC San Diego Jacobs School of Engineering

Asthma Control Before and After Changing Gas Stoves to Electric Stoves | JACI 7/3/26

• Indoor air quality can affect health. Cleveland researchers replaced gas stoves with electric induction stoves in homes of 85 people with poorly controlled asthma. Asthma control scores improved significantly and Emergency Department visits and hospitalizations fell from 11.8% to 3.5%. The new electric stoves were also preferred by 98% of participants.

Gut microbial trimethylamine N-oxide generation promotes risk of atrial fibrillation via muscarinic receptor-mediated autonomic dysfunction | JCI 7/24/26

• Cleveland Clinic researchers analyzed plasma from 5,090 cardiac catheterization patients and found elevated TMAO, a gut bacteria byproduct of red meat digestion, independently linked to higher atrial fibrillation (AF) risk. Mouse studies showed TMAO promotes AF by inhibiting muscarinic receptor 2, driving autonomic dysfunction and atrial remodeling, while a microbial inhibitor blocking TMAO production delayed AF onset.

Localized PD-1 CAR T therapy reprograms neuroinflammation | Cell 7/22/26

• In a mouse model of multiple sclerosis, PD-1 targeting engineered CAR T cells blocked brain inflammation by eliminating pathogenic CD4 T cells (PD-1 positive T follicular helper like cells) and by delivering IL-10 locally which quieted microglia inflammation and restored motor function.

Rapper Pitbull Sets World Record For Largest Gathering Of People In Bald Caps | Today 7/11/26

• “A whopping 22,141 of the rapper’s fans [in bald caps], affectionately referred to as the “Bald-E’s,” showed up to London’s BST Hyde Park festival to pull off the feat.”

Have a great week,

Ruth Ann Crystal MD

Ban Mandani From NY 9/11 Observances

I agree with this, and I've been saying the same thing since he's been in office.  By every word and action, he has shown his contempt for America, for New Yorkers, for Americans, and for Jews. He's the wrong man to represent our country to mark that horrific day.

Mayor Giuliani and former President George W. Bush, who did and said all the right things that day and in the days afterward, are the right men.

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New York Post 7-25-26

Exclusive | Families of 9/11 victims want to ban Mamdani from sacred 25th anniversary ceremony at Ground Zero: 'unwelcome guest'

Rich Calder 

Families of 9/11 victims are demanding NYC Mayor Zohran Mamdani be banned from the 25th anniversary of the attacks at Ground Zero, branding him an apologist for Islamic terror whose presence would be an insult to the memories of nearly 3,000 people murdered.

“Our objection is based on his public record — his failure to meaningfully acknowledge the horror of that day, and his employment of, support for, or association with individuals who have minimized 9/11, defended terrorists, or even suggested America ‘deserved’ the attacks,” said Giovanni Galante – whose 29-year-old wife Grace Catherine Galante was among 2,977 innocents killed by al-Qaeda terrorists.

Galante, 55, is one of the organizers of a petition drive that has collected over 1,100 signatures in a little over a week, including from at least 300 victims’ families.

“This day is sacred to us,” said the Brooklyn-born real estate agent who now lives in Florida. 

“It is not political, and it is not a platform for those connected to such views. His presence would be deeply hurtful and inappropriate — like an unwelcome guest at a deeply personal ceremony.”

Galante and other petition organizers hope to gather enough signatures to convince local lawmakers and the ceremony’s organizers, the nonprofit 9/11 Memorial & Museum, to keep Mamdani away from the silver-anniversary ceremony planned for the former Twin Towers site in Lower Manhattan.

The petition posted on Change.org cites an array of concerns about Mamdani, who is the city’s first Muslim mayor and has promoted his religion since taking office in January. They include:

• Mamdani’s refusal to condemn the “globalize the intifada” rallying cry for violence against Jewish people.
• His palling around on the mayoral campaign last year with Imam Siraj Wahhaj, a notorious, gay-hating Brooklyn imam who once urged followers to participate in gun-free jihad and “march through the city of New York.” Wahhaj was an unindicted co-conspirator in 1993 World Trade Center bombing.
• His appointment of Ramzi Kassem as the city’s chief counsel. Kassem has defended Ahmed al-Darbi — an al-Qaeda terrorist who pleaded guilty in a 2002 plot to bomb a French oil tanker – and Mahmoud Khalil, the radical lead organizer of the 2024 anti-Israel tentifada at Columbia University.
• The mayor’s endorsement of fellow Democratic Socialist of America member Aber Kawas for a state Senate seat — despite her once describing 9/11 as a terror attack that “a couple of people did” and expressing sympathy for Ahmed Ferhani, who pleaded guilty in 2012 to plotting to blow up a Manhattan synagogue.
• Hizzoner’s endorsement of Darializa Avila Chevalier for Congress. Mamdani has called the DSA insurgent the “perfect candidate” despite her radical past, which includes once calling the U.S. “a f—ing disgrace” and boasting she desecrated the American flag by using it like a napkin to wipe her filthy hands.

• Mamdani defending al-Qaeda fiend Anwar al-Awlaki — and blaming America for turning the prostitution-loving cleric into a terrorist, according to some of his 2015 social media posts that resurfaced last year. Al-Awlaki became a prominent imam at mosques in San Diego and Virginia, eventually interacting with three of the heinous 9/11 hijackers there, U.S. officials have said.
• Mamdani’s dad, Mahmood Mamdani, a chaired professor of African history and colonialism at Columbia University, has expressed sympathy for suicide bombers.

“Given these concerns, we respectfully ask that the organizers carefully consider whether Mr. Mamdani’s participation would align with the intention of the ceremony and the expectations of the families most directly affected by the tragedy,” the petition says.

“The 25th anniversary should remain centered on remembrance, unity, and an unambiguous rejection of the violence and extremism that defined that day.”

Organizer Cheri Sparacio, whose 35-year-old husband Thomas was killed on 9/11, quipped there are  “so many other examples” why it would be “disrespectful” for Mamdani to attend the ceremony that “we couldn’t fit them on the list.”

Firefighters take a brief break while digging through the remains of the former Twin Towers on Sept. 11, 2001. AFP via Getty Images

They include Mamdani’s longtime association with vile left-wing influencer Hasan Piker, who once said “America deserved” the Sept. 11, 2001 terror attacks, and Mamdani’s outlandish claim that he and other fellow Muslims were also victims of 9/11 because it supposedly triggered a horrible wave of “Islamophobia,” added Sparacio, of Staten Island.

Monica Iken-Murphy, whose 37-year-old husband Michael Iken was killed on 9/11 and was a leading advocate in the creation of 9/11 Memorial & Museum, said she signed the petition but insisted it’s not about Mamdani’s politics. 

Only politicians involved in the healing “process from the start” — such as ex-NYC Mayors Michael Bloomberg and Rudy Giuliani, former U.S. Sen. Hillary Clinton and longtime 9/11 family advocate and City Council Speaker Julie Menin — should join 9/11 family members in attending “this pivotal 25th anniversary ceremony,” she said.

“I don’t want families to feel uncomfortable,” said Iken-Murphy, also a founding trustee on the 9/11 Memorial & Museum’s board. “Others can come a different day, but let the families have their time.”

When asked about the petition drive, Julie Wood, a spokesperson for the 9/11 Memorial & Museum, said the nonprofit has “intentionally worked to keep the commemoration free of politics because remembering those we lost on 9/11 should never be a partisan issue.”

“Government officials from across the political spectrum, including every sitting president, governor, and mayor since 9/11, have attended the ceremony simply to bear witness — they do not deliver remarks and are asked to remain in a designated area,” Wood said.

Mamdani spokesperson Jeremy Edwards said the mayor still plans to attend the ceremony – despite the petition drive.

“Mayor Mamdani will proudly honor the families, survivors and first responders forever impacted by these devastating attacks by standing alongside them at this year’s 9/11 Commemoration, reaffirming that we will never forget the solemn day felt by all of us who call this city home,” said Edwards. 

Galante and other organizers said they plan to contact the NYC Council for help in their ban-Mamdani crusade.

Menin did not return a message seeking comment, but Queens Councilwoman Joann Ariola told The Post she’s ready to assist.

“This is a mayor who has endorsed candidates and has been endorsed by individuals who openly said that ‘America deserved 9/11,’ so I completely understand why families of those who lost loved ones would not want him there,” she said.

New York's Worst Mayor

Why did this antisemite run for Mayor at all if he isn't interested at all in helping New York City and its residents?

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As 15th Person is Pushed Onto Subway Tracks, Mamdani Rants About Israel

Grim milestone in New York City's descent into hell.

July 22, 2026 by Daniel Greenfield

New York City, where the media insists crime is down, experienced another grim milestone with the 15th person pushed into the subway tracks so far this year.

Saritha Komatireddy, who is running for New York State Attorney General on a public safety platform, tweeted that, “This is the fifteenth subway push this year. A 70-year-old woman was just shoved onto the subway tracks by a stranger who walked up behind her at a station in Midtown Manhattan.”

The perpetrator was a ‘parolee’, the type of criminals whom pro-crime officials like Gov. Hochul and Attorney General Letitia James have fought for and the kind whom Mamdani celebrated the World Cup with at Riker’s Island, and is of course a repeat offender.

The ex-con has racked up 14 prior arrests, including for robbing an MTA worker in 2025 and for criminal sale of a controlled substance.

His last known address is a homeless shelter in Bedford-Stuyvesant, Brooklyn, cops said.

Most recently, Smith was arrested for burglary on June 16 after stealing cleaning solutions from a residential building in Chelsea, which he snuck into through a service entrance, cops said.

The story is typical enough. And while New York City racked up its 15th subway push, the Pakistani Muslim squatting in Gracie Mansion was busy making videos ranting about Israel and Prime Minister Benjamin Netanyahu.

While New York City goes to hell, Mamdani remains obsessed with his Jihad against Israel.

Your Local Epidemiologist: The Dose, 7-21-26

Here's the latest edition of Dr Katelyn Jetelina's The Dose. She's right: we're just not getting a break.

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Covid-19 waking up, Cyclospora marches on, and measles is close to hitting a milestone
The Dose (July 21)  

Public health continues to feel like a game of whack-a-mole. We’re sure not getting a break.

Here’s your disease “weather” report, covering where Covid-19 is waking up and how measles is about to make headlines (again). There is also a spotlight on the ongoing Cyclospora outbreak, which deserves an award for the most opaque and confusing outbreak ever, leaving consumers in the dark.

Here’s what’s going on and, most importantly, what it means for you.

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Disease weather report

Covid-19 is quietly waking up

Right on cue, Covid-19 is starting to stir, just as it does every summer around mid-July. Several data signals are pointing the same way nationally: levels of spread and infection are still very low, but they’re beginning to climb.

Regionally, the clearest signal is in the West, where emergency department visits, test positivity rates, and wastewater data are all rising, along with anecdotal reports. The South and Midwest are showing early signs of an increase too, though the signal there is less consistent across data sources.

A map of where Covid-19 is growing. Source: CDC

How big will this wave get? That’s the biggest question. Each successive wave has been smaller than the last, which is good news. But that trend isn’t guaranteed to hold, especially since it’s been a while since our last wave and a lot of people’s immunity has had time to fade.

What this means for you: If you’re over 65 and never got your spring Covid-19 vaccine, the time is now.

Measles milestone coming up

As of July 19, 2026, the U.S. has reported 2,278 measles cases this year—already nearing the total for all of 2025 with five months still to go. At this pace, 2026 is on track to set a new 33-year record. Expect headlines soon.

The outbreaks peppered across the U.S. include:

• Pennsylvania has the fastest-growing outbreak (111 cases), which began in April.

• Utah: is in its 12th month of ongoing spread. At this point, measles is endemic in the state.

• Arizona: a small but new cluster of cases after they just declared the last outbreak over.

• Wyoming: Very small but expanding outbreak.

What this means for you: 96% of measles cases continue to be among the unvaccinated. If you’re up to date on vaccines, you’re very protected. If you have an infant under 12 months and are near an outbreak, ask about getting them vaccinated early.

Cyclospora cases continue to increase

The United States now has over 11,000 cyclosporiasis cases across 46 states, which is close to triple the number of cases in a typical year. You can easily see how insane this outbreak is compared to previous years, with a massive spike in diarrhea complaints at doctor visits.

Percentage of doctor visits due to diarrhea over time. Source: PopHIVE; annotated by Your Local Epidemiologist

Several outbreaks are running at once. Some states are seeing a low simmer from travelers picking it up abroad and bringing it home, like in California. New York seems to have traced its above-normal case counts to cilantro (which seems to be over, but it’s honestly very unclear).

The Midwest is its own beast. Michigan hit 6,148 cases as of yesterday (over 1,000 added just this weekend, 102 hospitalized) compared with a typical year of ~50 cases total. I was hoping the daily Michigan update would show this outbreak slowing down, but it’s not yet. Ohio’s past 2,000 and climbing, which is similarly unusual.

The recall for iceberg lettuce is far wider, with 27 states named. This is due to a combination of the complexity of food distribution networks and continued uncertainty around where people are most impacted. (See more below.)

When will this end? No one knows. Either the contaminated food works its way out of circulation, or it takes a few weeks, the temperatures get cool, and the parasites no longer mature on produce (basically killing themselves off.) It’s hard to tell from the data alone if this outbreak is coming to a close given that it’s significantly delayed.

What this means for you: If you’re in the 27 states, avoid all shredded iceberg lettuce. If you’re high-risk (pregnant, over 65, or immunocompromised), I would remain careful around produce with crevices (like raspberries).

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Spotlight: This Cyclospora outbreak is a real mess

If you feel lost trying to follow this story, and are confused about what’s actually been impacted, where, and how, you’re not alone. This is one of the most opaque, confusing, and unclearly communicated outbreak responses I’ve ever seen. Most of what we know has come out through press releases or leaks, leaving us to piece things together and read between the lines.

Taylor Farms is still the likely source of the outbreak

You probably heard that the FDA’s initial finding linked to a Taylor Farms product was a “false positive.”

Over the weekend, the FDA announced that a lettuce sample from Taylor Farms tested positive for Cyclospora. Within 24 hours, the FDA reversed itself, calling the result a false positive. This is rare, but it can happen. Taylor Farms quickly deleted its own social media posts about its bagged lettuce and boasted the FDA had apologized to them.

But the FDA still says Taylor Farms is “overwhelmingly” linked to the outbreak. There are two reasons for this:

1. The false positive was on lettuce coming from Mexico that was NOT part of the recall. If that was a true positive, then we would need a larger recall.

2. Not finding the parasite in one lab sample doesn’t mean it isn’t there.

To find the culprit, investigators don’t rely on a single lab test. They look at all sorts of data sources. Interviews with hundreds of sick patients pointed clearly to Taco Bell (more than 90% of interviews mentioned Taco Bell). And the FDA’s traceback, using invoices, shipping records, and receipts, narrowed the source down to one farm in central Mexico that supplies Taylor Farms de Mexico. Taylor Farms said it provides less than 1% of the iceberg lettuce sold in the U.S., yet it’s linked to far more than 1% of the cases. This is very strong data suggesting it’s Taylor Farms, and specifically, shredded lettuce.

A positive lab test would have been the nail in the coffin. But finding this parasite is like finding a needle in a haystack. It’s microscopic, contamination levels are often very low, and scientists usually can’t grow more of it in the lab to confirm what they find. A false positive is a small setback, but not a reversal of how scientists got us here for the past few weeks.

We know that this farm doesn’t just supply Taco Bell

Distribution networks are complex, and suppliers don’t just serve one fast-food chain; they supply grocery stores and food service operations in bulk, too. Taylor Farms provides up to 160 million servings of produce to stores and restaurants every week.

Buried in Taylor Farms’ own recall notice was a list of the retailers and outlets it distributed to, written in coded language, leaving everyone else to decode it themselves. Below is a table someone put together from that. It’s still unclear whether this list is complete, or whether Taylor Farms lettuce ends up in other bagged salads that don’t carry the Taylor Farms name. Given that uncertainty, the safest move right now is to avoid iceberg lettuce altogether.

We also don’t know how this outbreak started yet. This information is helpful for accountability and fixing systems in the future, but more immediately, it will help us know if it’s just lettuce or cross-contaminated with other produce.

Why is this so hard?

Watching this unfold has been like watching a train wreck. What we are all experiencing is a perfect storm with a few factors colliding:

1. Cyclosporiasis is a hard-to-investigate parasite. Symptoms can take up to 2 weeks or more. (Can you remember what you ate 12 days ago?) This work is laborious, and confirming it requires specialized lab testing. Often, a source is never identified.

2. Federal food safety agencies are stretched thin. Neither the FDA nor the CDC has a permanent director right now, and both agencies have lost staff and lab capacity and undergone major reorganizations, some actively happening when the largest outbreak in history occurred. Their centralized role is critical to help stitch together what is happening in the states.

3. The private company linked to the outbreak is muddying the waters with its PR approach. For example, in the Taylor Farms voluntary recall, they listed customers where this lettuce was sent, but in coded language. Typically, this information would have been shared with lot numbers, source names, and much more clarity on where else this lettuce went, beyond Taco Bell. There have been questions about Taylor Farms linked to this administration and Trump White House officials as well.

What this means for you: If you’re in the 27 states, avoid all shredded iceberg lettuce. If you’re high-risk (pregnant, over 65, or immunocompromised), I would remain careful around produce with crevices (like raspberries) until we are sure there is no cross-contamination happening, too.

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Good news

Big thanks to Ms. Lillian Pollack, a summer YLE intern, for helping keep track of all the good things that happen in public health, too. We can’t forget about this. Here is the latest:

• The Ugandan Ebola outbreak is ending. Ugandan hospitals discharged their last Ebola patient on July 16th. They are currently in a 42-day waiting period before the outbreak can officially be declared over, but there are no known cases of Ebola in Uganda anymore. (BBC)

• New cholesterol-lowering prescription received FDA-approval. The FDA just approved a new and highly effective drug for cholesterol management. Instead of treatments that can require lifestyle or dietary restrictions or come in an injectable format, this new prescription, called enlicitide or brand-name Lipfendra, is an easier-to-manage pill. (NYT).

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Bottom line

This world often feels random, but public health is predictable, and when it’s predictable, it’s preventable. Stay healthy out there.

Love, YLE

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Your Local Epidemiologist (YLE) comprises a team of experts, ranging from physicians to immunologists to epidemiologists to nutritionists, working together with one goal: to “translate” ever-evolving public health science so that people are well-equipped to make evidence-based decisions. The YLE suite of newsletters reaches over 475,000 people across more than 132 countries. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members.