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:
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.
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
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.
Share
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
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.”
Share
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
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
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
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.
Share
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
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