Tuesday, July 21, 2026

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.

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).

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:

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.
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:

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.
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.
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.

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).

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

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.

Monday, July 20, 2026

Terror Attack At 26 Federal Plaza, NYC

Power Line has the headline right: "Liberal Terrorist Attacks Federal Building in New York."

In its inimitable style, the New York Post says "Armed loon sets off ‘incendiary device’ outside NYC fed HQ as terrorism task force probes anti-ICE attack".

On TV, they called it "a scare" and "a little flame". I have a feeling that the only thing Mamdani is "deeply disturbed" about is that the blast wasn't more powerful than it was.

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New York Post 7-20-26:

"An armed maniac lit an “incendiary device” Monday morning outside a building in Lower Manhattan Monday morning that houses federal immigration offices and courts, officials and law enforcement sources said.

"The terrorism task force was investigating the incident, including probing whether it was an anti-ICE attack, according to the sources.

"The suspect, a man identified by sources as a 43-year-old military veteran from Poughkeepsie, was taken into custody. He was not immediately charged.

"Officials said he started a blaze with gasoline and fireworks outside of 26 Federal Plaza around 8:30 a.m. and also threatened passersby with airsoft rifles.

"Wild video shows suspect hurl fireworks into flames outside NYC Federal Plaza

"The man was pulling a cart with “ICE off our streets” scrawled on the side that contained two long firearms, more fireworks and other items, sources said.

"Wild video shared on social media showed the raving suspect hurling fireworks into the flames right outside of the building’s front entrance, with one exploding loudly as police tackled him to the ground.

"Officials could later be seen quickly dousing the flames.

"Another clip showed several large fireworks and debris the suspect apparently left behind, including the anti-ICE sign.

"Four civilians were treated for minor injuries, according to FDNY. One person was taken to New York Presbyterian hospital and three others refused medical attention.

"Omer Bulla, the manager of a Worth Street parking garage right across the street from 26 Federal Plaza, said he and employees heard what sounded like a pair gunshots go off.

“I don’t know what happened,” he said. “It was loud. When we looked outside the police already took the guy.”

"The Jacob K. Javits Federal Office Building is home to New York’s ICE field office in Manhattan as well as offices for the US Department of Homeland Security, immigration court and other federal agencies.

"The historic building became a hotbed of arrests and detention during President Trump’s crackdown on illegal immigration last year.

“This morning an individual deployed an incendiary device outside of 26 Federal Plaza,” the FBI said in a statement.

“The individual has been taken into custody and the FBI New York Joint Terrorism Task Force is investigating the incident.”

Dr. Ruth Report, 7-19-26

I'm always so impressed at the amount of important medical information that Dr. Ruth Ann Crystal packs into each of her newsletters!

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Dr. Ruth Report, 7/19/26
The Cyclospora outbreak, wild fire smoke, COVID and Long COVID news

Ruth Ann Crystal MD, Jul 20, 2026

Lots of news this week about the Cyclosporiasis outbreak, wild fire smoke, and of course, COVID and Long COVID.

When government agencies designed to protect Americans against threats like foodborne illness are working correctly, you never have to think about them because potential disasters are detected early and are contained before they cause significant damage. Unfortunately, significant staff cuts at the USDA, FDA, and CDC appear to have contributed to the country’s worst Cyclosporiasis outbreak ever.

Last year in July 2025, the CDC scaled back surveillance of foodborne illnesses from eight pathogens to two: Salmonella and Shiga toxin-producing E. coli (STEC). FoodNet had been tracking six additional pathogens: Campylobacter, Cyclospora, Listeria, Shigella, Vibrio and Yersinia which were dropped last July.

Now, the worst Cyclosporiasis outbreak in U.S. history appears to be from lettuce produced by Taylor Farms. Yesterday, Taylor Farms and the CDC posted that grocery store lettuce was not affected, but then in their recall notice, Taylor Farms stated that the Cyclospora contaminated lettuce was distributed in 27 states (AL, AR, CT, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, MI, MO, MS, NC, NH, NJ, OH, OK, PA, SC, TN, TX, VA, and WI) to restaurants like Taco Bell, but also to grocery stores like Walmart under the Marketside brand.

Unfortunately, the Taylor Farms recall names 8 customer codes instead of full brand names. Sysco and Walmart’s Marketside brand have been confirmed while five other codes remain unidentified by the company. Food safety attorney Bill Marler posted his assessment of the product brand codes which I put in a table below.

References:

The CDC quietly scaled back a surveillance program for foodborne illnesses | NBC
DOGE downsized CDC’s Cyclospora lab last year | Wired 7/17/26
Bad air, bad lettuce | YLE Katelyn Jetelina 7/17/26
Taylor Farms Recall 7/17/26
Parasite-Linked Lettuce Was Sent to Walmart Stores and Food Distributors in 27 States | Consumer Reports 7/18/26
Taylor Farms Posted Its Own Recall. It Went to 27 States, Not 5 — and the List Includes Bags Sold in Grocery Stores. | Marler Blog 7/18/26

Air Quality

Wildfire smoke from Canadian wildfires caused dangerous air quality in many places, but is now improving. Up-to-the-minute information on local air quality can be found from citizen scientists at Purple Air. It is important to protect yourself from “unhealthy” levels (over 151 on the air quality index) as these can trigger lung inflammation and even heart attacks. Protection includes wearing a well-fitting N95 mask outdoors and using air filters indoors.

From Purple Air

COVID

COVID levels in wastewater are just starting to increase, but overall numbers are still quite low. CDC modeling demonstrates that as of July 15, 2026, COVID infections are increasing or likely growing in 18 states, declining in 3 states, and not changing in 28 states. The CDC wastewater map with data through July 11, shows that Texas has moderate levels of COVID in wastewater, while Florida, Nevada, and California have low levels (up from “very low”).

JP Weiland also notes a visible increase in SARS-CoV-2 in wastewater, but we are still at quite low levels and he believes that the summer wave will be limited. There are about 88,000 new COVID cases in the U.S. each day now.

In California, Alameda county and Sonoma county have some higher levels of COVID in wastewater per the CDC. SARS-CoV-2 levels are very low in most of Europe and the UK according to Bob Hawkins.

Seniors

Children’s Birthday Gatherings and SARS-CoV-2 Infection in Grandparents | JAMA Network Open 7/13/26

Danish researchers looked at over 1.1 million grandparents and found that COVID infection rates rose almost 10% following a grandchild’s birthday, climbing to 15% when the grandchild was preschool age. The findings point to small, informal family celebrations as a meaningful but often overlooked transmission setting for older adults.

Pediatrics

Functional Status and Long COVID Outcomes in Children | Sage Journals 7/14/26

Researchers from the Children’s Hospital of Philadelphia examined 651 pediatric patients and found that children with clinician confirmed Long COVID faced 3.5x greater odds of academic decline and 4.6x greater odds of new or worsening mental health symptoms.

Symptom variation up to two years post SARS CoV 2 infection in Children and Young People: results from the Children and young people with Long Covid (CLoCk) study | BMC Infectious Diseases 7/13/26

University College London researchers tracked 943 children and young people and found that Long COVID consistently presented as a cluster of multiple concurrent symptoms rather than any single defining complaint. Over two years of follow up, fatigue was the most persistent symptom, reported at every assessment by 73.5% of participants, with breathlessness and headaches also persisting.
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Long COVID

Loss of vesicular monoamine transporter 2 in striatum of long COVID and relationship to neuropsychiatric symptoms | eBioMedicine (The Lancet) 7/12/26

A new study provides evidence of dopamine system injury in the brains of people with Long COVID. CAMH researchers used PET scans on 24 Long COVID patients and 24 healthy controls, finding 16 to 20% lower VMAT2 binding, a marker of dopamine neuron density, in the striatum, a part of the brain that plays a central role in motivation, movement, learning, and cognition.

The location of the dopamine nerve damage matched specific symptoms: lower markers in the ventral striatum of the brain tracked with reduced motivation, changes in the dorsal putamen tracked with slower movement, and lower levels in the caudate tracked with worse memory. The authors concluded that dopamine boosting treatments should be tested in Long COVID patients to assess their impact on motivation, motor speed, and memory.

Fatigue after COVID 19 infection is associated with peripheral immunometabolic alterations affecting neuroimmune responses in the hippocampus | Translational Psychiatry 7/16/26

Researchers at King’s College London studied 38 individuals and found that serum from people experiencing more severe post-COVID fatigue provoked stronger IL-13 signaling and reactive astrocyte activity in human hippocampal cells in vitro. They concluded “our results suggest that fatigue after COVID-19 infection is associated with neuroimmune and metabolic changes in hippocampal cells, involving peripheral serotonin metabolism (5-HIAA) and cytokine signalling (IL-13).”

Neurological impairment in long COVID: implications for neurodegenerative disease | Journal of Translational Medicine 7/12/26

Researchers at Griffith University in Australia reviewed existing evidence identifying four biological mechanisms that may contribute to Long COVID cognitive difficulties: viral persistence, blood brain barrier disruption, immune cell infiltration, and microvascular injury. The authors concluded that a definitive causal relationship between these mechanisms and Long COVID brain fog has not yet been established.

Persistent neurological and behavioral alterations after SARS CoV 2 infection in an optimized K18 hACE2 mouse model | Frontiers in Microbiology 7/12/26

Spanish scientists examined 120 mice following SARS-CoV-2 infection and found that survivors exhibited enduring behavioral changes, immune disruption in both the brain and lungs, and measurable shrinkage of the Vagus Nerve. These effects persisted despite no detectable virus in brain tissue. This suggests that autonomic and immune injury, rather than direct viral invasion, drives post-COVID neurological damage.

Nirmatrelvir for acute COVID-19 to prevent long COVID (PANORAMIC Norway): a double-blind, randomised, placebo-controlled trial | Lancet Infectious Diseases 7/16/26

Researchers from the University of Bergen, Norway conducted a double blind, placebo controlled trial examining whether nirmatrelvir-ritonavir (Paxlovid) taken during acute COVID infection could reduce the likelihood of developing Long COVID. Among the 144 adult participants, those who received Paxlovid showed a meaningful drop in Long COVID rates at three months, from 43% in the placebo group down to 26% in the treated group. The authors caution that the modest sample size limits how broadly these conclusions can be applied.

Towards a long COVID prevention agenda | Lancet Infectious Diseases 7/16/26

UCSF scientists reviewed the 143 person Norwegian trial above that found that early Paxlovid treatment lowered Long COVID rates at three months from 43% to 26%. Longer follow up is needed to determine whether Paxlovid prevents Long COVID or just speeds up symptom resolution.

Dr. Resia Pretorius of Stellenbosch University posted a tweet this week and shared a table of over 20 blood biomarkers (fibrinogen, von Willebrand factor, complement proteins, and more) trapped in Long COVID fibrinaloid microclots. Seven of the proteins showed chemical modifications like glycation and oxidation. This may explain why standard clotting and inflammatory panels often look normal despite clinical evidence of microclotting, as normal blood levels may mask a functional problem if the protein is modified or is sequestered in clots.

Longitudinal assessment of SARS CoV 2 Spike and Nucleocapsid antigenemia in the ORCHESTRA Post COVID cohort | Clinical Microbiology and Infection 7/15/26

University of Antwerp researchers followed 200 participants and found that low levels of SARS-CoV-2 Spike and Nucleocapsid proteins lingered in the bloodstream of some individuals for up to 18 months after infection. However, the presence of these viral remnants did not reliably distinguish people who developed Long COVID from those who did not.

These results are similar to a recent Spanish study from June showing that “SARS-CoV-2 antigens circulate in plasma up to one year after infection in a minority of individuals, regardless of whether they develop Long COVID or not” as detected by the ultra-sensitive Simoa® assay at 6-12 months post infection.

Serological evidence of SARS CoV 2 exposure in marine mammals in the United States between 2020 and 2025 | PLOS ONE 7/14/26

Tufts researchers tested 1,017 marine mammals and found neutralizing SARS-CoV-2 antibodies in harbor seals, grey seals, and California sea lions. Nasal swabs detected no active infections, suggesting the animals had encountered the virus but were not currently spreading it.

SARS CoV 2 spike driven reactivation of latent herpesviruses as a mechanistic link to post viral diseases | Trends Open (Prusty lab) 7/14/26

Researchers from Latvia propose that persistent SARS-CoV-2 spike protein may reactivate three latent herpesviruses, HHV-6, HHV-7, and Epstein Barr virus (EBV), through interconnected mechanisms involving chronic inflammation, immune exhaustion, and mitochondrial stress. They review mechanisms of spike-mediated TLR activation and downstream metabolic dysfunction with NF-kB activation and IL-6 induction.

Therapeutic plasma exchange and immunomodulatory strategies in post-infectious syndromes: A review of immune dysregulation in PTLDS, long COVID, ME/CFS, and PANS/PANDAS | Transfusion and Apheresis Science 7/14/26 (Aug issue)

Dr. Gary Kaplan wrote a narrative review examining evidence that persistent inflammation, autoantibody production, and cellular immune dysfunction underlie post-treatment Lyme disease syndrome, Long COVID, ME/CFS, and PANS/PANDAS. These conditions share overlapping symptoms of fatigue, cognitive dysfunction, sleep disturbance, and neuropsychiatric features. The review evaluates the rationale for immunomodulatory therapies including IVIG, rituximab, and therapeutic plasma exchange across these overlapping conditions, arguing that identifying patients with measurable immune abnormalities through biomarker testing is essential to target treatments effectively.

Super resolution atlas of SARS CoV 2 infection reveals protease dependent organelle maturation, dsRNA landscapes, and intracellular structural proteins | Nature 7/13/26

COVID rebound: Using super-resolution microscopy, researchers from Stanford mapped the viral protein nsp5 inside SARS-CoV-2 replication vesicles at nanoscale detail. Nirmatrelvir (Paxlovid) left viral RNA and intact replication compartments behind after treatment. Once the drug was removed, viral replication quickly restarted, pointing to a hidden cellular reservoir as a likely cause of COVID infection rebound.

Recent SARS CoV 2 infections and increased antibody responses to viral antigens are associated with greater autoantibody reactivity | Journal of Autoimmunity 7/13/26

COVID infection can lead to autoantibodies. EPA researchers studying 302 people found that a recent COVID infection corresponded with a 10% increase in autoantibody reactivity, suggesting the virus may prime the immune system to mistakenly target the body’s own tissues. Elevated total IgG levels accounted for 54% of this association, and stronger antibody responses to the spike protein were also linked to broader patterns of self-directed immune activity.

Transcutaneous vagus nerve stimulation for long COVID associated autonomic dysfunction: mechanistic rationale and emerging clinical evidence | Clinical Autonomic Research 7/13/26

A review of transcutaneous auricular (ear) Vagus Nerve Stimulation (taVNS) use in Long COVID patients appears safe and the existing evidence suggests this approach may reduce excessive sympathetic nervous system activity and fatigue. However, so far studies have been small and larger studies would be needed to show direct mechanistic proof.

Emerging Trends in Post COVID Immune Dysregulation | Annals of Medicine & Surgery 7/12/26

Conclusion from this review: “Long COVID is a multi-system syndrome driven by a core set of primary immunological mechanisms: persistent immune activation with T-cell exhaustion, autoimmunity (particularly anti-cytokine and anti-interferon antibodies), and thromboinflammation. Secondary phenomena, including complement dysregulation, metabolic alterations, and endothelial dysfunction, likely represent downstream consequences or modifiers of these primary drivers rather than independent causes.

“Among the candidate biomarkers, autoantibody profiles and cytokine panels show the most promise for clinical translation: autoantibody testing could stratify patients for immunomodulatory therapy, while elevated IL-6, IL-10, TNFα, and IP10 may serve as monitoring tools for disease activity and treatment response. Early viral persistence (spike antigen, SARS-CoV-2 RNAemia, and EBV reactivation) identifies high-risk individuals who might benefit from antiviral strategies.”

ME/CFS

Association of Rapamycin treatment with the modulation of purine metabolism, reduced microglial inflammatory responses, improved mitochondrial energy metabolism, and alleviation of fatigue symptoms in ME/CFS | Journal of Translational Medicine 7/13/26

Simmaron Research enrolled 76 people with ME/CFS in a phase II observational pilot trial and found that 90 days of low dose rapamycin was associated with reduced fatigue and post-exertional malaise alongside decreased IMPDH2 enzyme activity, lower oxidative purine levels, and recovered mitochondrial reserve capacity. The trial did not include a placebo group, which limits how confidently the improvements can be attributed to the treatment itself.

Measles

CDC Measles updates (on Wed.): https://www.cdc.gov/measles/data-research/index.html

As of July 16, 2026, 2,260 measles cases were reported in the United States in 2026.

Ebola in Democratic Republic of Congo (DRC)

The DR Congo Health Minister reports that as of July 17, “2,267 confirmed [Ebola] cases have been recorded, including 722 patients in isolation or hospitalization, 444 people recovered, and 893 deaths. The case fatality rate stands at 39.4%, while the contact tracing rate has reached 83.6%.”

Government Health News

Hegseth’s testosterone mandate carries risks, raises questions | The Hill 7/19/26

The Endocrine Society advises against such routine testing without symptoms.

Other news

Biologists pinpoint how common virus triggers multiple sclerosis | Nature 7/15/26

Harvard and MGH scientists studying 60 people with Multiple Sclerosis (MS) found that the Epstein Barr virus (EBV) activates CD4+ T cells that appear to drive immune attacks on the myelin sheath protecting nerve fibers. Treatment with anti-CD20 therapy reduced those T cells by 2.5 times and also lowered EBV levels in saliva, providing the clearest mechanistic link yet between this EBV and MS onset.

Photo: Epstein–Barr virus triggers specific T cells in the immune system, which leads to an attack on nerve cells in the brain and spinal cord. Photo Credit: Steve Gschmeissner/SPL

CD4+ T cells reactive to Epstein-Barr virus late lytic antigens are enriched in individuals with multiple sclerosis | Science Transl Med 7/16/26

Untreated Multiple Sclerosis patients had twice the CD4+ T cell immune response to Epstein Barr virus (EBV) late lytic proteins compared to controls, pointing to active viral replication as a feature of the disease. Anti CD20 therapy both reduced this elevated T cell response and eliminated EBV shedding in saliva, linking ongoing EBV viral activity to MS.

First-in-human testing of a mutant KRAS vaccine for Pancreatic Cancer interception in high-risk cohorts | Cancer Discovery 7/16/26

Vaccine to prevent Pancreatic Cancer:

Pancreatic cancer arises from precursor lesions over more than a decade and is associated with mutant KRAS (mKRAS). A Phase I study of a peptide vaccine targeting six common KRAS mutations (mKRAS-VAX) in 20 people with hereditary Pancreatic cancer predisposition and an abnormal pancreas on CT scan was safe and showed that 90% of these individuals had a significant mKRAS-specific T cell response which may help prevent pancreatic cancer in high-risk people.

Unifying the hallmarks of major depression through neuroimmune–metabolic–oxidative (NIMETOX) dysregulation: a mechanistic systems framework | Cellular & Molecular Immunology 7/13/26

Researchers at the Sichuan Provincial Center for Mental Health conducted a review of scientific work since 1990 linking major depression. Their NIMETOX (NeuroImmune, METabolic, and OXidative stress) framework proposes that these converging disruptions can compromise the brain’s protective barriers and drive neuroinflammation as well as direct neuronal damage.

Low Back Pain: A Review | JAMA 6/15/26

A review of low back pain, a leading cause of disability worldwide with an algorithm of the diagnostic approach for nonspecific low back pain.

Army Vet’s $2 Million GoFundMe to ‘Pay It Forward’ | Military.com 5/1/26

Ed Bambas worked for 40 years at General Motors, but when the company went bankrupt in 2012, his pension and health insurance were replaced with a $350,000 lump sum. Medical costs for his late wife’s illness and her death in 2018 left him nearly bankrupt, forcing him back to work as a grocery cashier at age 80 just to make ends meet. At age 88, a viral video by influencer Sam Weidenhofer led to almost $2 million in GoFundMe donations from 67,000 donors for Ed to finally retire. Wanting to pay-it-forward, he donated $50,000 of it, $1,000 each, to a GoFundMe for 50 veterans in all 50 states through a campaign called “For Your Service.”

Sam and Ed pay-it-forward for veterans

This chaotic 2,000-pound seal has returned to sea – but leaves behind a conundrum | CNN 7/14/26

Neil the seal, a beloved 2,000-pound adolescent southern elephant seal, has swum back out to sea after another chaotic “haul-out” season on Tasmania’s roads and beaches. Normal male elephant seal behavior includes banging against other male elephant seals, but since there aren’t any in Hobart, he’s been banging against traffic cones and posts. Neil is a big guy, but is expected to reach about 8,000 pounds and 16 feet long, or as big as a pickup truck, when he is fully grown. Authorities are planning on how to keep both Neil and his adoring human fans safe when he next comes back to visit.

Teenager Neil the seal in a parking lot, photo credit: Rebecca Thomson

Have a great week,

Ruth Ann Crystal MD

Sunday, July 19, 2026

Complaining About The Jews At a NJ Town Council Meeting

Imagine the reaction if we were obsessed with, and spoke this way about, Muslims and blacks. There'd be 24 hour coverage on cable news; huge protest marches; and mass firings. Yet antisemites can disparage Jews this openly, and they get thousands of social media followers. At least the Mayor had this guy removed from the meeting, but it proves again that these people have tied their popularity to their hatred of Jews and of Israel.

I really dread the elections and the hateful rhetoric that will continue if the Democrats win their races, which they will win based on how antisemitic they are. How pathetic they are.

And as an aside, I hope the Jew-hating Mamdani chooses to be out of town and misses the commemorations of the 20th anniversary of the September 11 terrorist attacks. He has no right to speak.

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From Elder of Ziyon, 7-19-26.

Here's a new one: coding Jews as "deer" in a town council meeting

"NJ.com reports that an antisemite spoke at a Ocean Township meeting, ostensibly complaining about deer, which was really meant as an antisemitic screed, using "deer" as a dog whistle for Jews.

"Ocean Mayor John Napolitani said George used references to the township’s deer population as a metaphor for Jewish people, prompting the mayor to have him removed from a July 9 meeting.

"The dispute stems from a meeting George attended in June, when the activist — who describes himself on social media as a Christian, public speaker and anti-Zionist — urged the township to curtail herds of deer he described as “out of control.”

"In his statement, George suggested the township could move the deer to “Ocean County or upstate New York.”

“It’s impossible to distinguish one deer from another,” George said. “You can try to be friendly with them, but they’re extremely skittish.”

"At the meeting, Napolitani and other officials said they would consider ways to address George’s claims, treating his comments as a genuine concern about wildlife.

"Napolitani said after the meeting, he and his colleagues learned George’s references to deer were intended as a metaphor for Jewish people.

"The speaker is Jeff George, who calls himself "JerseyGoy" online.

"His Instagram and TikTok is filled with antisemitic garbage - often "anti-Zionist" as well.

"He has over 30,000 followers on Instagram.

"George has spouted much more explicit antisemitic screeds to other local councils. In March he told the Long Branch council that the Jews "control the military industrial complex, the news media, the music industry, Hollywood, big tech, big pharma, and all the big banks and banks around the world. They control the ultraprocessed food industry, specifically designed to make us all sick. They own and control all the smut and filth used to subvert Christian society. They were responsible for both world wars. They were responsible for the attacks on 9/11. They were responsible for the COVID pandemic and the poisonous injection that they falsely labeled a vaccine. They were responsible for Jeffrey Epstein and the child sex ringing operation that was used to control US politicians, celebrities, and billionaires through blackmail. And it is more than apparent that international organized Jewry controls our Congress, our president, this council, this mayor, and the mayor's corrupt brother, Congressman Frank Pallone. Whether it be through blackmail or bribery, I cannot be certain, but it is obvious you people have been compromised. Your allegiance is to a foreign nation and not to America. "

"Local council meetings have become a hotbed for antisemitism, introduced by anti-Israel speeches nationwide and now the right-wing antisemites are getting on the bandwagon."

Saturday, July 18, 2026

The Only One Who Should Be Arrested is Mamdani

When I saw this headline today, I saw red. Since when is it the goal of a Mayor to arrest the Prime Minister of Israel? Not only is Mamdani a deranged, brazen Jew-hater and anti-Israel proponent, but he's now openly "desperate" to get more publicity and admiration from his fellow antisemites. He probably considers arresting Bibi an achievement in comparison with the damage he's already done to NYC. There should be a recall effort to remove him from office.

The only war criminals are terrorists and murderers like Hamas, Al Qaeda, Hezbollah, and Iran, who seek to exterminate the Jews and destroy Israel.

With this dangerous and false rhetoric against Netanyahu, I fear for his life.

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Mamdani desperately seeking legal loophole to arrest Benjamin Netanyahu when Israel PM visits NYC

7-18-26 New York Post

Mayor Zohran Mamdani said he’s desperately seeking a legal loophole to arrest Israeli Prime Minister Benjamin Netanyahu for alleged war crimes when he visits in NYC in September.

The Pro-Palestine, Israel-hating, socialist pol said in an interview published Saturday that it’s unclear whether he has the authority to order the NYPD to arrest Netanyahu during the prime minister’s expected trip to the Big Apple for the U.N. General Assembly – but is in an “active conversation” with the city’s Law Department about the matter.

“I believe that Prime Minister Netanyahu belongs in The Hague,” Mamdani bluntly told The New York Times, referring to the United Nation’s International Court of Justice.

“He’s a war criminal who has been charged by the International Criminal Court. And what you will find is that it is an opinion that is held by many purely because of what his actions have wrought over these last many years.”

Mamdani – who has made accusing Israel of genocide in Gaza a focal point of a far-left ideology that his helped propel him into the national spotlight – vowed during last year’s campaign that, if elected mayoral, he’d have Netanyahu arrested if he ever set foot in NYC.

He cited the International Criminal Court’s 2024 arrest warrant for Netanyahu — which the U.S. doesn’t recognize.

However, Mamdani insisted during The Times interview that the city “won’t be writing our own laws” to lock up the prime minister, who is seeking re-election.

“Whatever the law allows me to do in New York City, that’s what we will do,” he said.

During the interview, Mamdani also complained about media coverage of his wife Rama Duwaji, who has come under fire for her long history of bashing the United States and Israel.

This includes since-deleted social media posts praising Palestinian terror groups and others attacking US service members for assisting the Jewish State.

The Syrian-American artist also once liked a social media post claiming Hamas’ rapes of Israelis during the Oct. 7, 2003 terror attack were a “mass hoax.”

“She is her own person,” Mamdani said. “She is an incredible artist, and yet so much of how she engages with the world is framed through her being my wife.

“Whatever the law allows me to do in New York City, that’s what we will do,” he said.

Netanyahu, however, remains unfazed by Mamdani’s threats.

In a recent radio appearance, he accused Mamdani of supporting Hamas.

“I think he should look at who he’s condemning, who he’s praising. He’s condemning Israel, the one democracy that stands shoulder to shoulder with American values,” the prime minister said during an interview this week with Sid Rosenberg on 77 WABC.

“Who does he champion? Hamas, that calls openly to massacre every Jew on earth, that conducted that horrible massacre [on Oct. 7, 2023], the worst massacre on Jews since the Holocaust.”

He also said Mamdani “doesn’t care” that “those who hate the Jews and Israel ultimately hate America.”

“And in fact, I think secretly, he hates America,” the prime minister said.

“And if anyone should be arrested, it is @NYCMayor Zohran Mamdani,” he said in a post on X.

Netanyahu is also expected to visit DC later this month to meet with President Trump.

He was initially scheduled to arrive this weekend but postponed the visit after Sen. Lindsey Graham’s funeral was pushed back to accommodate the flood of national and international dignitaries seeking to attend.

It would mark Netanyahu’s first trip to Washington since the Iran war began in February.

The Best Masks That Protect Against Wildfire Smoke (And COVID)

This is a great refresher about the best masks to protect yourself from the oppressive Canadian wildfire smoke. If you wore these at the beginning of the COVID pandemic, you already know how well these work.

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Your basic COVID mask won't protect you from wildfire smoke
Anthony Thompson, USA TODAY, 7-17-26

"As smoke from hundreds of Canadian wildfires continues to degrade air quality across parts of the Midwest, Great Lakes and Northeast, many Americans may be reaching for the disposable or cloth face masks left over from the COVID-19 pandemic.

"However, health experts say not every mask offers meaningful protection against wildfire smoke.

"Over 830 wildfires are burning across Canada, with more than 100 considered out of control. Smoke from fires in Ontario and other regions has spread into the United States, prompting air quality alerts for millions of people and creating hazy skies from Chicago and Detroit to Cleveland, New York City and Boston. While conditions in some areas are expected to improve gradually through the weekend, officials warn that smoky air may linger as long as the fires continue burning.

"The tiny particles carried in wildfire smoke are small enough to travel deep into the lungs, meaning the type of mask you wear, and how well it fits, can make a significant difference.

Which masks work best against wildfire smoke?

"According to the air quality technology company IQAir and guidance from the U.S. Environmental Protection Agency, the best protection comes from tightly fitted respirators rated N95, KN95 or FFP2.

"These masks are designed to filter at least 95% of airborne particles as small as 0.3 microns when fitted properly. That includes fine particulate matter known as PM2.5, the primary pollutant found in wildfire smoke that can penetrate deep into the respiratory system.

"Experts say a tight seal around the nose and chin is just as important as the filter itself. Air leaking around the edges of a mask reduces its effectiveness because unfiltered air can be inhaled through the gaps.

"The EPA also advises choosing a mask with two straps that go around the head, rather than ear loops, because they're designed to create a tighter seal against the face.

Why cloth and surgical masks aren't enough

"Basic cloth face coverings, scarves and many disposable surgical masks are not designed to filter the tiny particles found in wildfire smoke, according to IQAir.

"While those masks can help reduce the spread of large respiratory droplets during illnesses such as COVID-19, they generally do not create a tight seal around the face and allow smoke particles to leak through the sides.

The best way to protect yourself

"The EPA says wearing a respirator should not be the first line of defense against wildfire smoke.

"Instead, the agency recommends staying indoors, limiting outdoor activity, reducing physical exertion and using HEPA air cleaners when smoke levels are elevated. People who must spend extended time outside in smoky conditions may benefit from wearing a properly fitted N95 or P100 respirator.

"Respirators can make breathing more difficult, particularly for people with heart or lung conditions. The EPA advises anyone with those conditions to talk with a doctor before using one. Anyone who becomes dizzy or has trouble breathing while wearing a respirator should move to cleaner air and remove the mask.

"The agency also notes that respirators are not sized for children and generally cannot provide the tight seal needed to reduce smoke exposure

Why wildfire smoke is a health concern

"Wildfire smoke contains fine particulate matter that can irritate the eyes, nose, throat and lungs, causing coughing, wheezing and shortness of breath. Prolonged exposure has also been linked to inflammation, cardiovascular problems and worsening symptoms for people with asthma or other respiratory conditions.

"People considered most vulnerable include older adults, young children, pregnant people and those with heart or lung disease.

"With wildfire smoke expected to continue impacting parts of the United States as Canadian fires burn, health officials say choosing the right mask, if one is needed, is more important than simply wearing any face covering."

Friday, July 17, 2026

Your Local Epidemiologist 7-17-26

An update on important medical news from Dr Katelyn Jetelina:

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Bad air, bad lettuce

The public's health can't catch a break

Katelyn Jetelina, Jul 17, 2026

Yes, I know it’s a summer Friday afternoon, but I wanted to pop in with two important health updates that might be useful as you head into the weekend. If you’re in the Midwest or Northeast, you’ve probably already noticed it just by looking out the window: air pollution is at extremely high levels right now. We also just got an update on the source of the cyclosporiasis outbreak.

Here’s what it all means for your health. I’ll keep it quick.

Air pollution is at extremely high, dangerous levels

Air pollution levels in Chicago, Detroit, New York, and DC are the worst in the world right now. We are starting to see it on the West Coast too. All from wildfire smoke. I called my friend, Dr. Joseph Allen—a professor of exposure assessment science—to help break this down for you.

This is very dangerous for everyone’s health — not just people with high-risk conditions. Wildfire smoke contains tiny particles less than 2.5 microns in diameter (PM_2.5) that can enter the lungs and irritate our respiratory linings, as well as toxic gases. Once wildfire particles hit your lungs, your body reacts like it’s under attack: it triggers inflammation and puts stress on blood vessels that spreads beyond the lungs into the bloodstream. That inflammation makes blood clot more easily and can destabilize plaque in your arteries, which is why breathing bad air can trigger a heart attack, not just breathing problems.

The more smoke inhaled, the higher the risk to your health. For every 10 micrograms per meter (μg/m3) increase, the heart attack risk increases by 2.5%. So if baseline air pollution in DC is 10 and it’s currently 160, the increased risk of heart attacks is close to 40%. In some places, air quality ranges from 300 to 900. You can do the math, but this is not good.

Here's another way to think about risk, though the comparison isn’t perfect: spending an hour in "purple" air quality is roughly equivalent to smoking half a pack of cigarettes.

Some people are at higher risk than others (like pregnant women, older adults, children, and people with pre-existing respiratory or heart conditions), but once it reaches “unhealthy” levels (over 151 on the air quality index), everyone should take action:

Keep checking air quality; it will ebb and flow over the next few days. My go-to is Purple Air, but you can also download the EPA’s AirNow mobile app. Dr. Matt Willis had a great look at air quality apps in our California newsletter last week—check it out here.
Yes, an N95 mask works if you need to go outside during unhealthy levels. The “95” means at least 95% removal efficiency of particles like those in wildfire smoke. Research found that N95s reduced hospitalizations from wildfire smoke by 30%. In other words, it offers some protection, at least in the short term, while running to the grocery store. Cloth, paper, and tissue masks will not filter out the smoke.
Air pollution can get inside our buildings; in fact, we breathe more outdoor air pollution indoors because we spend so much time indoors. There are several things we can do:
1. Have good filtration for the particles and gases. HEPA filter units are good for cleaning the air in individual rooms, while MERV 13 or higher filters are good for entire HVAC systems. You can also create a low-cost air cleaner for inside your house (see picture below). There are portable air cleaners that can capture both particles and gases (but these get expensive).

b. Run your system 24/7, even if it’s on “fan only” mode, if you have a central system. If not, the air isn’t passing through filters.

c. Get an indoor air quality monitor that measures PM2.5. Then you can compare your indoor levels to what’s outside to be sure your filtration is working properly.

d. When this mess is all done, make sure you change your AC filter. Many filters rely on electrostatic charge, and because wildfire smoke is charged, it can reduce the filter’s effectiveness significantly because it ‘depletes’ the charge.

Finally, some clues for an explosive diarrhea outbreak

The number of people getting sick continues to rise in the Midwest, and we are finally starting to get clarity on the likely culprit: shredded iceberg lettuce. The federal government named Taco Bell. The FDA reports that in epidemiological investigations (i.e., patient interviews), Michigan found that roughly 90% of people who got sick reported eating at Taco Bell in the prior 10 days.

Source: Health Security Operations Center

However, I find it very hard to believe it’s just Taco Bell, and I am hearing from the public and investigations that this isn’t the case. Produce distributors don’t just supply one fast-food chain; they typically supply many retail grocery and food service bulk. It’s incredibly unusual that the federal government didn’t name the supplier. However, the Washington Post reported yesterday that the culprit is Taylor Farms. Taylor Farms feeds up to 160 million servings of produce to stores and restaurants each week.

What does this mean to you? Avoid shredded iceberg lettuce in these hotspot states, and I am personally avoiding it beyond Taco Bell.

I’m hopeful the circulation of these products is close to (or possibly even out) of circulation, given lettuce’s shelf life, but we don’t have data showing that yet. We also don’t know whether there’s cross-contamination, so if I were at high risk (like a pregnant woman) in this area, I would remain cautious about certain other produce. Hopefully, we see this outbreak finally calm down soon.