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Viral respiratory illness activity as of April 24 per the CDC:
RSV activity is elevated but has peaked in most parts of the country.
Seasonal influenza activity continues to decrease. Influenza A activity is low across all regions and influenza B activity continues to trend downward.
COVID activity is low in most areas of the country.
According to JP Weiland, “we are at the lowest transmission levels in almost 5 years”. He expects this lull in COVID transmission to last at least 6 weeks and he estimates that there are currently only about 90,000 new COVID infections per day in the United States.
According to the CDC through 4/18/26, wastewater levels of SARS-CoV-2 were moderate in Wyoming and West Virginia, and high in Mississippi. This translates to about 1 in 58 people infected with COVID in Wyoming and West Virginia, and 1 in 36 people in Mississippi per Mike Hoerger.
From: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html
4/20/26 Medical Microbiology and Immunology: Acute COVID-19 is associated with altered CD8 T-cells indicative of impaired ability to control Epstein–Barr virus reactivation https://buff.ly/nkauvdc
German researchers studied moderate to critical hospitalized COVID patients and found that their T cells were no longer able to control latent viruses like EBV. In the 61 patients studied, 68% to 73% had EBV reactivation and this was associated with CD8 T cell exhaustion as seen by reduced CD28 and increased CD57 expression. These findings suggest that acute COVID infection causes impaired antiviral control of latent viruses by T cells.
4/20/26 BioRxiV: SARS-CoV-2 spike protein-associated sialoglycoconjugates induce nanoscale filipodia to facilitate micro-size platelet clotting https://buff.ly/FAKgJvu
Researchers at Griffith University, using platelets from 9 donors, found that sugar molecules attached to the SARS-CoV-2 spike protein trigger platelets to extend projections called filopodia and then aggregate into microclots. The clotting effect was driven by sialic acid on glycan chains rather than the spike protein itself. This carbohydrate-mediated mechanism may help to explain COVID coagulopathy and vascular injury seen in Long COVID.
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4/20/26 Nature: Higher expression of SOX1, miR-155, and miR-21 in the colostrum of SARS-CoV-2-infected mothers https://buff.ly/wEa4iVZ
A Polish study of 19 people who had COVID during pregnancy vs. 21 healthy women who did not found that “SARS-CoV-2 infection during pregnancy induces changes in the molecular composition of early breast milk, promoting immunomodulatory (miR-155) and regenerative (miR-21, SOX1) molecules.” These immune signals modulate the newborn’s immune responses.
4/22/26 Pediatric Research: Endovascular profiles linked to neutrophil activation in children and young adults with long COVID https://buff.ly/82qJh0y
Researchers at Massachusetts General Hospital studied 84 children and young adults and found that those with Long COVID had significantly elevated fibrin amyloid microclot burden and markers of endothelial injury compared to healthy controls. In vitro assays showed that SARS-CoV-2 spike immune complexes trigger neutrophils to release extracellular traps (NETs), directly damaging blood vessel lining. They noted intravascular NETosis from activated neutrophils as a key driver of ongoing endovascular pathology in pediatric Long COVID.
4/23/26 Preprint (Kell and Pretorius): On the Correspondence of Diseases Showing Microparticles, Fibrinaloid Microclots and Disorders of the Microcirculation https://buff.ly/miIxfrD
In a preprint, researchers Kell and Pretorius propose that numerous chronic diseases share a common pathological signature: circulating microparticles and amyloid rich fibrinaloid microclots that disrupt microvascular blood flow. Their analysis points to a shared pathway of persistent inflammation and vascular injury.
From: https://www.preprints.org/manuscript/202604.1728
4/23/26 CIDRAP: Moderna’s combo flu-COVID vaccine receives European authorization https://buff.ly/PbRoyWf
The European Commission granted marketing authorization to Moderna’s mCombriax, the world’s first combination mRNA influenza and COVID-19 vaccine. A phase 3 trial showed a single dose produced statistically higher immune responses against three flu strains and SARS-CoV-2 in adults 50 and older, with no major safety concerns identified. Approval by the U.S. FDA is pending, with a decision expected in August 2026.
4/19/26 Nature: Antibody profiling and plasma proteomics in SARS-CoV-2 infection: a pilot study https://buff.ly/FkAYCSn
Tokyo University scientists tracked plasma antibodies and proteomics in a single person over 310 days, finding minimal proteomic shifts after vaccination but distinct, coordinated immune and inflammation changes after SARS-CoV-2 infection.
4/22/26 NEJM: Oral Nirmatrelvir–Ritonavir for Covid-19 in Higher-Risk Outpatients https://buff.ly/C81nxdP
In trials across the UK and Canada enrolling 4,232 predominantly vaccinated, high-risk adults, Paxlovid did not reduce hospitalization or death compared to placebo. The drug did shorten symptom duration and lower viral load, suggesting potential benefit for recovery even where it fails to prevent severe outcomes.
4/23/26 Physiological Reports: Impaired peripheral oxygen delivery during submaximal exercise in adults with long COVID https://buff.ly/J4umKr2
University of Derby researchers studied 56 adults with Long COVID using a 2-day submaximal CPET protocol combined with NIRS of the calf muscle and found reduced muscle oxygen delivery during mild exercise that worsened on day two of testing. Results suggest impaired peripheral oxygen extraction and delayed recovery, and not deconditioning, may be central drivers of post exertional malaise and fatigue in Long COVID.
Dr. Putrino announced this week that the Mount Sinai Long COVID trial of low dose Rapamycin will now be offering the medication to all study participants.
Phase I Open-Label Safety Trial of Pembrolizumab for Neurological Post- Acute Sequelae of SARS-CoV-2 (PD1-PASC I) https://buff.ly/Sge4Exd
The NIH has launched an open-label, Phase I trial of Keytruda (Pembrolizumab) for Neuro Long COVID. Keytruda is an immunotherapy that may help T cell exhaustion in Long COVID as it does in cancer therapy.
4/21/26 Journal of Translational Medicine: Identification of novel reproducible combinatorial genetic risk factors for myalgic encephalomyelitis in the DecodeME patient cohort and commonalities with long COVID https://buff.ly/jfpIDpq
Using the UK DecodeME cohort of 14,767 participants, researchers identified 22,411 reproducible genetic risk signatures for Myalgic Encephalomyelitis (ME) across three independent patient groups, with higher signature counts associated with 1.64 times greater odds of disease. Notably, 76 of 180 genes linked to Long COVID also mapped to ME, pointing to shared biological mechanisms and potential drug repurposing opportunities for both conditions.
4/23/26 CIDRAP: More California marine mammals confirmed to have H5N1 avian flu, as USDA tracks poultry outbreaks in Midwest https://buff.ly/Kq0gJNQ
Eleven additional marine mammals tested positive for H5N1 in California, bringing the ongoing outbreak total to 58 animals across four counties, including 57 sea lions and one otter, mostly in San Mateo County. Separately, four new commercial poultry facilities in the Midwest and Southeast reported H5N1 outbreaks, though the overall pace of detections has slowed compared to March.
David Cook / Flickr cc
4/6/26 BioRxiV (T. Peacock lab): Bovine H5N1 influenza viruses have adapted to more efficiently use receptors abundant in cattle https://buff.ly/UEorl2r
Researchers at the Pirbright Institute found that two mutations now common in dairy cattle H5N1 strains allow the virus to bind NeuGc, a sugar molecule present on cattle mammary cells but absent in humans and birds. This increases viral replication in bovine tissue and may facilitate cow-to-cow transmission.
CDC Measles updates (on Wed.): https://buff.ly/zbA8Vtv
As of April 23rd, 1,792 confirmed measles cases were reported in the United States in 2026.
South Carolina Department of Public Health (Measles): https://buff.ly/w688rud
The South Carolina Department of Public Health (DPH) reports no new cases of measles with the exception of an isolated case in Saluda County for which 41 people are in quarantine. The number of measles cases in the Upstate, SC outbreak remains at 997.
Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/
The Utah measles outbreak saw 197 cases in 2025 and 410 measles cases so far in 2026. There have been 31 newly reported measles cases in Utah in the last 3 weeks.
John Hopkins US Measles Tracker: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker
4/21/26 NBC: Pete Hegseth says the U.S. military will no longer require flu shots https://buff.ly/4tUJZc7
4/23/26 Dr BK. Titanji: Why Militaries Vaccinate https://buff.ly/drXft6O
This week, Pete Hegseth announced that the U.S. military will no longer require flu shots. Infectious diseases like the flu can spread like wildfire through the military, as soldiers live and work in close quarters. If many soldiers get sick at the same time, it could become a national security threat.
4/22/26 NY Times: C.D.C. Cancels Publication of Study Showing Benefits of Covid Vaccines https://buff.ly/Oi4TlTW
CDC Director Jay Bhattacharya blocked publication of a completed CDC study in the agency’s flagship journal, the MMWR, after it had already cleared internal scientific review. The study found COVID vaccines cut emergency room visits and hospitalizations by roughly 50% last winter, using a methodology long accepted for flu and COVID vaccine effectiveness research and published without objection in a flu vaccine study just weeks earlier.
4/25/26 NY Times: Trump Fires Board Members of Group That Oversees U.S. Science Funding https://buff.ly/vq7AjfA
“The dismissals from an independent board that oversees the National Science Foundation marked the president’s latest assault on scientific research organizations.”
4/21/26 Nature Medicine: Epigenetic fingerprints link early-onset colon and rectal cancer to pesticide exposure https://buff.ly/EFEReKw
4/20/26 Nature Medicine: Microbiome signature of Parkinson’s disease in healthy and genetically at-risk individuals https://buff.ly/3mjyfQL
A UK and France research group found that a gut microbiome signature typical of Parkinson’s disease can occur in both genetically at-risk individuals and in healthy people without known risk. These microbiome patterns are linked to disease progression in Parkinson’s patients and to early, prodromal Parkinson’s symptoms in both genetically and non-genetically at-risk individuals in the general population.
4/18/26 NBC: Pancreatic cancer mRNA vaccine shows lasting results in an early trial https://t.co/13GBL8ujOV
This is great news! “Scientists caution that more research is needed, but nearly all of the [Pancreatic Cancer] patients who responded to the personalized vaccine are still alive six years later.”
4/25/26 NEJM: Pulsed Field Ablation as Initial Therapy for Persistent Atrial Fibrillation https://buff.ly/AM07xtp
In a randomized trial for preventing recurrent atrial arrhythmias, “Among patients with persistent atrial fibrillation, the risk of recurrence of atrial arrhythmia was significantly lower among those who received pulsed field ablation (PFA) as first-line treatment than among those who received antiarrhythmic-drug therapy.”
This week, I received a Health Advisory from the California Medical Board and CDPH regarding risking Silicosis cases in countertop workers who work with quartz countertops. Cutting engineered quartz releases silica dust causing an accelerated, incurable lung disease called Silicosis, which is now a reportable disease. As of April 23, 2026, 547 countertop workers in California have been diagnosed with Silicosis since 2019, 30 of whom died and 58 of whom required lung transplants.
4/20/26 Nature Reviews Cardiology: Beyond GLP1: modulating multiple nutrient-stimulated hormone pathways to reduce cardiovascular risk https://buff.ly/Beibd0W
A new review in Nature looks at GLP-1 receptor agonists combined with other hormone related medications and how they reduce cardiovascular risk. Tirzepatide is a GLP1 and GIP receptor co-agonist, while Retatrutide is a GLP1, GIP and glucagon agonist that has been shown to reduce body weight by 24% in obese individuals.
Fig. 1: Potential complementary actions of multi-NuSH agents and ongoing cardiovascular outcomes trials.
CNN: Hot air balloon makes emergency landing in backyard
A hot air balloon with 13 people in its basket made an unexpected emergency landing in a family’s backyard in Temecula, California this week. After refueling, the balloon company flew the 80 foot balloon over the houses to the street, where they were able to deflate it safely and remove it. No one was hurt.
Photos by Hunter Perrin
Have a great week,
Ruth Ann Crystal MD
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