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

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 (PM2.5) 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:

  1. 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.

  2. 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.

  3. 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).

Source: Yale School of Public Health

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.

Bottom line

The world of public health never gets boring. 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.

Get Ready For Politically Correct Typing!

You've heard of Spell Check? I call this new feature Woke Check, and I would disable it immediately. Sorry, but I don't need you to "correct" the everyday words I've always used that you somehow find offensive. 

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Microsoft Word’s Woke New Feature Will Help You Always Be Inclusive Of ‘Every Gender’ 

Daily Caller, 7-16-26 

"Microsoft Word introduced a new “inclusiveness” feature to look for supposed bias in documents — including language it deems not representative of “all genders.”

"Clarity, formality, conciseness and now inclusiveness are all categories of “refinements” Microsoft offers under the editing tool on Word. The woke tool suggests changes to make word choice “inclusive of all genders,” like changing “chairman” to “chairperson” and “mankind” to “humankind” or “humanity,” among many others, as a Consumers’ Research video shows.

“It’s hardly surprising that Microsoft has an ‘inclusiveness editor’ for Word documents so that users are forced to comply with woke madness. Suggesting users change common words like ‘mankind’ and ‘firemen’ to be more gender-neutral is not a true grammatical error; it is a targeted ideological tactic to remove the very notion of gender from society,” Will Hild, executive director of Consumers’ Research said in a statement to the DCNF."

Thursday, July 16, 2026

Dems Proudly Accounce They Voted To Block Aid To Israel

I saw them on the Capitol Steps this morning. The usual Jew-haters were there including Ilhan Omar and Rashida Tlaib.  If you didn't know better, you'd think they were announcing a cure for cancer rather than announcing another anti-Israel measure.  If AOC runs for President, she can boast about her "achievement".

See the last paragraph and note how this anti-Israel representative, Casar, attacks Netanyahu and of course fails to mention October 7. 

These people are despicable. 

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Excerpt from CNN 7-16-26

Over 100 House Democrats vote to block billions of dollars in military aid to Israel, reflecting growing schism in party 

"More than 100 House Democrats voted to block billions of dollars in military aid to Israel — an ultimately unsuccessful effort that highlighted the growing division in their party on the issue.

"On Wednesday 103 Democrats voted in support of an amendment to block aid that had been proposed by GOP Rep. Thomas Massie, a persistent critic of President Donald Trump who has been skeptical of US support for Israel. One Republican also signed on. But the measure ultimately failed 104-314. 98 Democrats voted against it and 10 voted present, meaning they did not weigh in on the issue.

"Even the top three lawmakers in House Democratic leadership split on the issue. House Minority Leader Hakeem Jeffries and House Democratic Caucus Chair Pete Aguilar voted against it, while House Minority Whip Katherine Clark voted for it.

"Progressive Democrats celebrated the seismic shift in their party where, for the first time, the majority of House Democrats voted to block billions in military aid to Israel. Two years ago, only 37 Democrats voted to block aid to Israel when presented with a similar vote.

“Think about this just for a moment. Starting today, a majority of Democrats in this building refused to vote to send billions of dollars in weapons to the Israeli military,” Democratic Rep. Greg Casar, the leader of the Congressional Progressive Caucus, said following the vote. “That sends a strong message to Netanyahu that the days are over of an unaccountable blank check to his wars and his war crimes, at least from the Democratic Party”.

Wednesday, July 15, 2026

The Democrat Socialists of American Platform Is a War On America

I saw their platform shown on the news earlier, and if this doesn't make you show up to vote in droves and vote for the Republicans, then you get what you deserve.

Here's the link to the discussion on today's Fox News show, "Outnumbered". 

I refuse to click on the DSA website, but here are a few items from their platform as shown on the news:

*Eliminate the Presidency 
*Eliminate the Senate
*Medicare for All
*No Bills
*No Debt
*Defund the Department of War
*Eliminate Cash Bail
*Amnesty for All Illegal Aliens 
*No Aid To Israel 

This is Obama's radical transformation of the United States plus his redistribution of wealth -- on steroids.

The GOP had better put up a good fight, and so should any normal Democrats who might be out there.

Your Local Epidemiologist 7-15-26: Cyclosporiasis Q&A

Dr Katelyn Jetelina answers important questions about the cyclosporiasis stomach virus that's been making people sick across America with no end in sight. I've given up lettuce until further notice.

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Top 10 Cyclospora questions

The cyclosporiasis foodborne outbreak continues to grow, and individuals are left to figure out how to weather this storm until government systems catch up. So we are getting flooded with questions! The YLE team compiled answers to the top 10 to bring the nuance you may be looking for.

Note: This post builds on a previous YLE post that explained what’s going on. If you missed that, start here.

1. Can you just tell me what not to eat?

Unfortunately, it’s not that easy, because a source hasn’t been confirmed. So risk falls on a spectrum and risk tolerance varies.

This is how I’m thinking about it:

Skip bagged salads, salad kits, and boxed salads from the grocery store, and avoid them at restaurants and fast food places, too. Michigan’s warning on Monday (unusual to go public before the FDA) is a strong signal of what they’re seeing. Whole heads of lettuce are fine if you strip the outer 2-3 layers, since that’s where contamination is most likely to sit.

Michigan’s investigation has yet to pinpoint a company or rule out other foods. Two dozen other states are still under active investigation. So avoiding other foods is reasonable. In previous outbreaks, the culprits were raspberries, fresh herbs (basil, cilantro), onions, and snap/snow peas. I would still avoid these, especially if you’re high risk (pregnant, older, or immunocompromised).

Stick to produce you can peel or cook. (If you have frozen berries from January, you should be in the clear as this outbreak likely started in May.)

2. How long do I need to cook produce for? Does freezing work?

Cooking food to an internal temperature of 158°F is the only thing known to kill Cyclospora. This means sautéing raw spinach for about 1.5 minutes. (Turn your salad into a stir fry!)

Microwaving doesn’t work as well because heat spreads unevenly; research shows 45 seconds wasn’t enough to kill Cyclospora, so go longer and check that every part, not just the surface, is steaming hot.

Freezing isn’t reliable because a typical home freezer isn’t cold enough to kill the parasite. Research shows you’d need -20°C (-4°F) for at least 2 days, or a commercial deep freeze at -70°C for an hour, well below what most kitchen freezers hit.

Washing helps a little, but not entirely, because these microscopic parasites love to hide in the grooves and crevices. They also hide from home remedies people suggest, like lemon juice.

3. Is local produce better than big distributors?

The risk is much lower. In fact, there has never been a documented cyclosporiasis outbreak linked to a local farm.

That said, Cyclospora lives in soil and contaminated water, so a local farm could be affected if it shares a water source with a large commercial farm. Cyclospora can also enter the food supply at a packing, processing, or distribution facility, where outbreaks get amplified—a local farm would be safer on this front, too. My hunch is that the real culprit here isn't the farm itself, but distribution, but we don't yet know yet.

Figure by Your Local Epidemiologist, adapted from Dr. Kristen Panthagani at You Can Know Things

4. How much precaution should we be taking in California (or other states), where very few cases have been reported?

Distribution networks are complex, but all states are now actively looking for cases. That makes me more confident that states with low case counts (that stay low) aren’t linked to whatever is driving the outbreaks in Michigan, Ohio, New York, and elsewhere.

All states have some cyclosporiasis cases, but that’s expected: it reflects multiple outbreaks happening at once. California, for example, has cases, but not more than in past years—actually fewer. About 95% of California’s cases have involved people who picked up the parasite while traveling outside the U.S.

For what it’s worth, I live in California, and I’m not eating lettuce but being liberal with the other foods. I don’t have time for weeks of exploding diarrhea, but my guard is a little more down than it would be if I lived in Michigan or New York.

Source: PopHIVE

5. How do I know what bug I have?

Many bugs can cause diarrhea. Norovirus is a common virus that spreads year-round and causes similar symptoms, but is highly contagious, while Cyclospora is a parasite that is not contagious from person to person.

To differentiate between the two at home, it really comes down to symptoms and timing. If symptoms show up within a day or two and pass quickly, think norovirus. If it lasts more than a week and then it comes and goes for weeks, that’s likely cyclosporiasis. Antibiotics help with cyclosporiasis, so it’s worth getting tested (although I hear the test is expensive).

Table by Your Local Epidemiologist.

6. How does this end?

Once the product is out of circulation. That can happen naturally (e.g., clean salad gradually replaces infected salad), through intervention (stores pull it), or as the season shifts toward fall, since cooler, drier conditions make it harder for the parasite to mature.

I don’t know how long it will take to end. No one does. But the Cyclo season typically ends in September when the parasites can no longer mature as efficiently.

7. There is no federal guidance for us physicians. When am I supposed to test and how?

It’s absolutely insane how long the federal Health Alert Network (HAN) notice was delayed, but it finally came out yesterday. Michigan’s provider bulletin is absolutely fantastic. If you’re a clinician, read that.

8. Can our animals get this?

No. Cyclospora only infects humans and spreads solely through the fecal-oral route. Researchers have tried to infect chickens, dogs, mice, rabbits, monkeys, and several other species in lab studies, and it hasn’t taken. So feeding your salad to your chickens is fine.

9. How easily is it transferred within a restaurant kitchen, like if a cook has unknowingly handled contaminated lettuce or something for someone else’s order and then touches your food? Or via cooking utensils/equipment/shared prep surfaces?

If the produce arrives at a restaurant already contaminated and is infectious (which takes about 2 weeks on a head of lettuce, for example), and then that lettuce touches a cutting board, knife, or bin used for other food, the parasite can be transferred. It was great news to see Taco Bell move quickly last week.

10. Is there any hope of CDC or any of our government agencies tracking down the source of this outbreak? Does the EIS have the resources to find the source?

I’m confident that the federal scientists are doing the best job they can do with what they have. Cyclo is difficult to investigate because it takes so long to cause symptoms (do you remember what you ate 10 days ago), it takes an enormous amount of resources to pinpoint; some foods, like at Mexican restaurants, have many ingredients; making it challenging to pinpoint a single ingredient; and testing options are limited. There were definitely outbreaks in the past where no source was found.

Local and state public health departments are also working their tails off. But public health, and specifically parasitic teams, have been chronically underfunded. They are holding on by scotch tape, and now, with the largest cyclosporiasis outbreak in history, they are overwhelmed. While resources can be pulled from elsewhere, public health departments are also dealing with record cases of measles and whooping cough on top of travel-related Ebola and the World Cup, and everything else. It’s a lot.

Communication, guidance, timeliness, and transparency are what the federal government is falling short on. There has been very little communication, and what has been said is that these outbreaks happen all the time. This is not normal, and saying so without communicating what the public should actually do is unhelpful to the point of gaslighting.

Bottom line

There are steps you can take to reduce your risk during this big foodborne outbreak while the systems around us catch up. I will be back when we know more. Keep your questions coming!

Love, YLE

Tuesday, July 14, 2026

Your Local Epidemiologist - The Dose, 7-14-26

Here's Dr. Katelyn Jetelina with the latest medical news.

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Cyclospora keeps climbing, a bad West Nile season, truck spraying, and good news
The Dose (July 14)

Katelyn Jetelina and Marisa Donnelly, PhD, Jul 14, 2026

The YLE team is back from summer break, tanned (some of us), rested (debatable with small kids), and ready to jump right back in.

I know a lot of you have questions about the Cyclospora outbreak. The YLE team is collecting them all, and tomorrow I’ll pick the top 10 for a deep dive. As of this morning, there is still very, very little communication from HHS, which is pretty insane.

In the meantime, here’s what’s going on with health this week, including other bugs like ticks and mosquitoes. Expect trucks to be spraying insecticide soon, and let’s celebrate an enormous public response to a new proposed federal rule.


Disease weather report

Cyclospora keeps climbing

Cyclospora cases continue to climb. Some of this is expected, since more people are now aware of it and testing for it, but it is still an undercount, given that many people wait out the sickness at home.

The total number of cases is hard to pin down. This is because data in the U.S. is decentralized (local health departments report to states, states report to the CDC), so you will likely see numbers all over the place. If we scrape for state-level data, the most cases (2,640) are in Michigan, followed by New York (470). A local health department in Northwest Ohio is reporting 661 cases.

Figure from the Health Security Operations Center

While there are cases in over 30 states, the U.S. sees cases every year, often from different outbreaks. A key question is whether the number exceeds expectations and, if so, why. In some states, this is certainly the case. For example, the number of infections in Michigan is 31 times higher than in previous years, and in New York, it’s three times higher. In some states, like California, rates are not higher than normal.

Michigan’s health official announced yesterday that preliminary findings indicate lettuce or packaged salad greens as a likely source. The investigation has yet to pinpoint a company or rule out other foods. Two dozen other states are still under active investigation. Zero word from FDA.

What this means for youContinue to avoid bagged and boxed salads at grocery stores and restaurants. I’m still sticking to produce that can be peeled or vegetables with smooth surfaces, like cucumbers, until more data comes in.

Ticks are backing off

We’re well on our way down for tick season. Activity tends to drop off as we move deeper into the heat of summer.

Source: CDC; Annotated by Hannah Totte at Your Local Epidemiologist

Why? Ticks are prone to drying out, so in peak summer heat they retreat into moist, shaded leaf litter rather than questing (climbing grass to grab a host), which reduces host-seeking activity even if the tick population hasn’t shrunk. This dip also lines up with the tick life cycle: nymphs, responsible for most Lyme transmission, peak in late spring/early summer, then quiet down in the hottest weather before adults pick back up in fall.

Mosquitoes taking over

As ticks recede, mosquitoes take over and with them, the rare diseases they can carry. The most common one in the U.S. is West Nile.

Peak mosquito season is still about a month out, but the CDC is already flagging an unusually early surge in West Nile virus (WNV) activity this year. They have flagged 48 cases across 23 states detecting the virus, which is more than five times the historical average for this point in the season.

Source: CDC. Annotated by Hannah Totte at Your Local Epidemiologist

What this means for you: Most people infected with WNV never even know it because ~80% have no symptoms. But older adults and those who are immunocompromised can develop serious neurological illness. Start being consistent with using an EPA-registered repellent (with DEET or picaridin), dumping standing water around your home, and using screens at dusk and dawn. You may also start seeing mosquito spraying trucks. (See more below.)

Heat blanketing the North

This week, a large swath of the northern U.S. is facing the most extreme heat risk category. If you’re in the purple or red areas, everyone is at risk and needs to take action. Heat kills more people in the U.S. than any other weather event.

Source: NOAA; Annotated by Hannah Totte at Your Local Epidemiologist

What this means for you: Check on elderly neighbors and relatives, hydrate before you’re thirsty, and move strenuous outdoor activity to early morning or evening if you can. Here are 6 things to know about heat-related illness from the YLE team.

World Cup Health Security Center Update

We’re nearing the end of the World Cup tournament (the final is on July 19!), and there have been no major outbreaks tied to the games, aside from heat-related illness. A few teams reported minor illnesses among players.

Measles remains the primary focus of monitoring. There are a number of cases passing through major airports (far more than in any other year), particularly near the World Cup games. While it will be very hard to track, we could very well see outbreaks across the world following the World Cup.


Spotlight: Why is that truck spraying my street?

With mosquito activity picking up and the U.S. having a particularly bad start to the season, you may start noticing spraying trucks in your neighborhood. Where they go is driven entirely by your local public health or vector control department’s surveillance data. Departments set traps to collect mosquitoes, send batches to a lab, and test them.

When lab tests consistently yield positive results, insecticide is then sprayed in the affected area. The spraying itself does two things:

  1. Kill flying adult mosquitoes by spraying very small amounts of adulticides into the air. This spray is a fine mist that acts as a fogger.

  2. Kill larvae by applying larvicides directly to the water where mosquito larvae have been detected. This helps kill more hard-to-reach areas.

People rightfully have many questions about whether these insecticides are safe for humans. They are safe because the dose and where they are applied are very purposeful. These insecticides work by overstimulating insect nerve cells until they’re paralyzed, but insect nerves are far more sensitive to the chemical than ours, and mosquitoes are tiny, cold-blooded, and can’t break the chemical down the way we can. So the same dose that’s fatal to them is far too small to hurt a person. How these insecticides are used also matters. Adulticide sprays are released as low-volume mist, and the droplets disperse and degrade quickly, resulting in very low human exposure. Larvicides are placed directly in standing water and target larvae through mosquito-specific biological mechanisms.

A 2025 review of community mosquito-control spraying found no causal relationship between adult mosquito-control applications and adverse human health impacts when applied appropriately, with estimated exposure levels far below regulatory concern.

People with asthma and other respiratory conditions are particularly concerned. But an older study in New York City found no increase in asthma visits, including among children, after West Nile spraying.

What this means for you: Reducing WNV is important, and spraying is safe. I’ll stay indoors during spraying when I can but won’t lose sleep over it. Check with your local public health or mosquito control department for the schedule—they’re supposed to publish one.


Good news

  • More than 341,000 comments were submitted on the OMB’s proposed rule that could, quite literally, break science in the U.S. This is an enormous public response by any standard; public comment on federal rules almost never gets anywhere close to that volume. Way to show up for science discovery in the U.S.! Comments are now closed, and it’s time to see how the federal government responds.


Bottom line

From salad choices to mosquito bites to heat safety, this world just never gets boring. 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 13, 2026

Dr. Ruth Report, 7-12-26

Here's another very important newsletter from Dr. Ruth Ann Crystal, M.D.

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Dr. Ruth Report 7/12/26
OMB, Explosive diarrhea, COVID, and more

Ruth Ann Crystal MD, Jul 13, 2026

Last week, I told you about a proposed change to an OMB rule that could affect federal funding for Meals on Wheels for seniors, community health programs, scientific research and much more. I made a free online tool to make it easy to write your comment on the proposed changes to OMB rule in less than 5 minutes at https://ombcomment.netlify.app/.

The tool was made to get you to a strong, personal first draft fast, so that you can submit your comment before the July 13 deadline tomorrow.

How The OMB Rule Could Hurt You And Your Town | Dr. Judy Stone in Forbes

I Built You a Tool That Helps You Write Your Federal Comment in 2 Minutes |

Cyclosporiasis

You may have heard about an outbreak of Cyclospora which causes watery, and sometimes explosive, diarrhea for days to weeks. Symptoms typically start about a week after eating contaminated produce such as raspberries, fresh basil, or lettuce, but unfortunately the source has not yet been determined. The CDC has not given guidance on this outbreak, but we do know that there have been more than 3,000 confirmed cases in 31 states, with Michigan being hit the hardest. The case count is probably much higher, as most people do not need to seek medical care for Cyclospora. Until we know the source, it may be best to avoid raspberries and bagged lettuce as the parasite hides in tiny crevices of produce. In general, most cases of diarrhea are self limited and are often caused by something else like Norovirus, but if you get watery diarrhea that lasts longer than a few days, an antibiotic called Bactrim can be used to treat Cyclospora.

2023 USDA Report on Cyclospora cayetanensis

“The fruits and vegetables most frequently related to Cyclospora infections were: raspberries (34%), basil (31%), cilantro (10%) and salad mixes (10%). Sugar snap peas, lettuce, blueberries, blackberries, carrots, mangos, mint, scallions, mixed vegetable trays, and fruit salads were also associated with cyclosporiasis outbreaks (in some investigations, a single food vehicle was not identified).”

Explosive foodborne outbreak | Katelyn Jetelina YLE 7/11/26

Dozens hospitalized with cyclosporiasis as cases of gastrointestinal illness spike in 31 states | 7/10/26 NBC News

COVID

COVID levels are low through most places across America, but we are starting to see an uptick in Southern Florida, Central Texas, and Palo Alto, California. The Palo Alto finding may just be a blip, but you can follow it here on WastewaterSCAN.

It is wise to wear a mask indoors when the level of SARS-CoV-2 is above 100 PPMoV in wastewater. Here are the hot spots above 100 PPMoV according to WastewaterSCAN (omits 12 states, but is up to date):

  • Key Biscayne, FL 370 PPMoV

  • St Petersburg, FL 204 PPMoV

  • Woodlands, TX 173 PPMoV

  • Palo Alto, CA 140 PPMoV

  • Atlanta, GA 119 PPMoV

  • Tallahassee, FL 111 PPMoV

These numbers are high, but they are nowhere near what we have seen during COVID waves where levels of SARS-CoV-2 virus in wastewater can easily reach over 1,000 PPMoV.

Using the CDC and Biobot data, Mike Hoerger estimates that as of July 4, every 1 in 250 Americans was actively infectious with COVID. Here is his COVID map with data from 7/4/26.

Acute COVID infection

Antiviral therapy and interleukin-6 blockade associated with lower thrombotic risk in hospitalized COVID-19: a target trial emulation | 2026-07-06 Nature

  • Researchers in Spain analyzed outcomes among 2,524 patients hospitalized with COVID-19, finding that remdesivir and tocilizumab (Actemra) were each independently associated with reduced thrombotic events beyond what standard anticoagulation alone provided. Corticosteroids, by contrast, showed no similar protective association against blood clot formation in this population.

Gut barrier integrity biomarkers are associated with increased inflammation and predict disease status in hospitalized COVID-19 patients | July 4, 2026 Nature Scientific Reports

  • University of Minnesota scientists studied 173 hospitalized COVID patients and found elevated levels of lipopolysaccharide binding protein (LBP) and soluble CD14 in the blood, indicating that bacterial products were crossing the gut barrier (“leaky gut”) and entering systemic circulation. These two biomarkers tracked closely with levels of inflammation and were predictive of how severely ill patients became during hospitalization.

Pediatrics

SARS-CoV-2 Reinfection: A Possible Contributing Factor to Long COVID in Children and Adolescents | 2026-07-02 Frontiers in Pediatrics

  • Researchers at the Mexican Social Security Institute studied 349 pediatric patients and found that 11.8% developed Long COVID after SARS-CoV-2 infection. Among children older than 8 years, reinfection was associated with greater odds of Long COVID, though only 9 reinfection cases were documented in the cohort.

Post-acute sequelae of COVID in children: Pulmonary assessment using impulse oscillometry and the effect of vaccination | 2026-07-07 Pediatrics & Neonatology

  • A Chinese study of 209 pediatric patients with respiratory symptoms after COVID and found that impulse oscillometry detected airway abnormalities in 74.6% of them, with small airway disease representing the predominant pattern.

Long COVID

Dr. Michal Tal posted on Twitter that her lab is making a website where people can upload capillaroscopy selfie images to get key features quantified. She shared these images of capillaroscopy findings.

Vagal cholinergic denervation of the gastric mucosa in Long-COVID-19: in vivo evidence of structural autonomic dysfunction | Int J of Infectious Diseases 7/9/26

  • Italian researchers studied stomach biopsies from 12 Long COVID patients and 8 controls and found direct evidence that Long COVID causes measurable loss of cholinergic nerve fibers within the stomach lining. In Long COVID patients, nerve fiber density was half of normal in the fundus and the antrum, with cholinergic fibers affected most. Lower nerve density tracked with worse heart rate variability, higher NT-proBNP, and higher D-dimer. Structural damage to vagus nerve pathways as shown in the gastric mucosa may account for persistent autonomic dysfunction observed in many Long COVID patients.

Harshi Peiris PhD posted a Twitter thread with emerging evidence on butyrate-producing bacteria F. prausnitzii and how it is low in COVID, Long COVID, and other diseases. Low F. Prausnitzii leads to low butyrate which can lead to a weakened gut barrier, increased inflammatory signals in the blood, and eventually brain fog symptoms from microglial activation. I chose to use organic kiwi in our LC-02 synbiotic in order to boost F. Prausnitzii and Roseburia species which produce anti-inflammatory butyrate.

👁️👁️ Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy | 2026-07-08 Nature Communications

  • Mild COVID can lead to long-term hidden eye problems. Swedish scientists from Linköping University found that people who experienced persistent eye problems (ocular pain, light sensitivity, reduced/blurred vision, and difficulties in reading) after mild COVID infection showed measurable corneal nerve fiber loss, diminished pupil reflex responses, and activated immune cells present in their tears. The findings suggest that prolonged eye symptoms in post-COVID patients may be driven by T cell mediated neuroinflammation affecting both the peripheral nervous system and autonomic function.

👁️👁️ Ocular Symptoms in Long COVID: A Cross-Sectional Study | 2026-07-08 Ophthalmology and Therapy

  • Yale University researchers examined 595 individuals living with Long COVID and found that 57% reported developing new vision related symptoms. “Ocular symptoms were defined as self-reported new-onset blurring or loss of vision, dry eyes, or floaters/flashes of light attributed to Long COVID.”

🫀 Cardiac Findings in RECOVER Autopsies | 2026-07-01 USCAP 2026 Annual Meeting

  • The RECOVER initiative examined 74 autopsy cases and detected actively replicating SARS-CoV-2 within heart muscle cells in 11 of those cases, with 82% of that group showing cardiac symptoms consistent with Long COVID. Researchers also identified accompanying immune and structural changes in the cardiac tissue, supporting SARS-CoV-2 viral persistence in tissues.

Implications of RNA virus persistence for post-acute sequelae and chronic inflammatory syndromes | 2026-07-07 Nature Immunology

  • A new review in Nature Immunology shows that many RNA viruses (RSV, coronaviruses like SARS-CoV-2, influenza and parainfluenza viruses, measles, chikungunya, and lethal viruses like Ebola virus and the henipaviruses) are capable of leaving residual RNA or proteins in body tissues and within circulating immune cells after the acute phase of infection has resolved. When the immune system fails to fully eliminate this lingering viral material, it may drive chronic inflammation that contributes to post-acute conditions such as Long COVID.

Autoantibodies could trigger neurological symptoms of long COVID | Nature Reviews Neurology 7/9/26

  • A review of the recent article from Yale published in Cell shows a causal link between Long COVID autoantibodies and the neurological symptoms. “Passive transfer of IgG from patients with long COVID to healthy mice produced signs of fatigue, pain and heat sensitivity, resembling the symptoms reported by patients… The recipient mice [also] showed evidence of intraepidermal nerve fibre damage in the skin.”

Temelimab versus placebo in patients with post-COVID condition | 2026-07-07 eBioMedicine

  • Twenty-four weeks of treatment with Temelimab, a monoclonal antibody targeting the HERV-W ENV protein, showed no measurable advantage over placebo in Long COVID patients.

Macrophage-specific targeting of histone demethylases with small-molecule inhibitors suppresses inflammatory response in vivo | 2026-07-07 Journal of Biological Chemistry

  • University of Pittsburgh researchers discovered that lung macrophages from Long COVID patients showed elevated levels of histone demethylase enzymes, pointing to an epigenetic mechanism underlying persistent inflammation. In a mouse model, small molecule inhibitors reprogrammed inflammatory gene activity in macrophages and reduced expression of IL1b and iNOS following immune stimulation.

Postacute COVID-19 and Health Care Utilization and Spending in Medicare Beneficiaries | 2026-07-07 JAMA Network Open

  • A cohort study of 937,077 Medicare patients found that healthcare utilization and spending spiked immediately following a COVID diagnosis, but declined in subsequent months. However, patient-reported symptom scores remained high, indicating that billing claims data substantially undercount the ongoing burden of Long COVID.

Chronic stress primes TLR3-mediated systemic inflammation to produce persistent post-viral fatigue syndrome-like symptoms in mice | 2026-07-06 Brain Research (IBRO Neuroscience)

  • In mice, chronic stress prolonged TLR3 immune activation which led to a prolonged fatigue illness resembling post-viral fatigue syndrome with elevated IL-6 and CXCL10. Treatment with minocycline (an antibiotic and microglial activation inhibitor) reduced both fatigue behaviors and inflammatory markers, implicating neuroinflammation as a central mechanism.

🎵 Material-specific quarantine durations for SARS-CoV-2 inactivation on musical instruments and music-related materials | July 3, 2026 bioRxiv

  • Researchers at Aix-Marseille University tested music instruments and found that SARS-CoV-2 remained infectious on metals and ABS plastic for up to 3 days, while porous materials such as reeds and printed scores retained viable virus for 6 to 7 days.

Efficacy and safety of rivaroxaban, colchicine, and famotidine–loratadine with specialist supportive clinical care for fatigue in patients with post-COVID-19 condition in the UK: a multisite, open-label, randomised controlled trial | Lancet 7/8/26

  • The STIMULATE ICP trial randomized 778 UK Long COVID patients across 12 clinics to colchicine, rivaroxaban, famotidine plus loratadine, or no drug for 12 weeks. Colchicine and antihistamines added a small benefit which went away after stopping the medications. Rivaroxaban showed no added benefit.

ME/CFS

Gastrointestinal symptoms correlate with core clinical features and systemic inflammation in myalgic encephalomyelitis/chronic fatigue syndrome | Journal of Translational Medicine 6/19/26

  • Columbia University researchers assessed symptoms in 116 ME/CFS patients vs 80 controls. Gastrointestinal symptoms tracked with fatigue, cognitive trouble, pain, and sensory sensitivity, and correlated with higher CRP. Patients with more flu-like symptoms had stronger antibody responses to gliadin and bacterial lipopolysaccharide indicating a leaky gut barrier.

Measles

CDC Measles update:

  • As of July 9, 2026, 2,231 confirmed measles cases were reported in the United States in 2026.

Ebola in DR Congo

According to the Minister of Communication in DR Congo, as of July 10th:

  • 1,830 confirmed Ebola cases, including 780 patients currently under care, 284 recoveries, and 648 deaths. The contact tracing rate stands at 78% which means that contacts are unknown for at least 400 confirmed Ebola patients.

Ebola workers strike as CDC head says agency’s response will last months | 7/8/26 CIDRAP

  • Unfortunately, some doctors and nurses treating Ebola patients haven’t been paid in months and are striking. This will certainly not help the situation.

First patients enrolled in record-breaking Ebola treatment trial in DRC | Guardian 7/12/26

  • The first patients have been enrolled in a trial of Remdesivir and MBP134 (a monoclonal antibody) to treat the Ebola Bundibugyo virus in DRC. Both drugs have been shown to be effective in animal models and now will be tested in a randomized trial to see whether they reduce mortality for Bundibugyo.

Government News

As Montana’s Medicaid work requirements roll out, cancer patients fear they’ll lose coverage | NBC 7/8/26

  • Montana became the second state to enforce Medicaid work requirements starting July 1, ahead of the federal 2027 deadline. “New Medicaid guidelines in Montana leave cancer patients vulnerable, with requirements that they must work, attend school or volunteer for 80 hours a month to maintain coverage, unless they qualify for an exemption.” Paperwork burdens and unclear medical frailty rules have been confusing for patients.

Other News

GLP-1 and MASH: When weight loss isn’t the whole story | 2026-07-08 Cell Metabolism

  • A new MASH (fatty liver) mouse model study shows that semaglutide reduced liver fat accumulation, inflammation, and fibrosis through GLP-1 receptors located specifically on intrahepatic blood vessel cells, independent of the drug’s weight loss effects.

👾 Phage intervention improves colitis and response to corticosteroids by attenuating virulence of Crohn’s disease–associated bacteria | 7/8/26 Science Translational Medicine

  • McMaster University scientists identified Phage HER259, which disarms adherent invasive E. coli linked to Crohn’s disease by switching off its FimH adhesin. In mouse models this reduced colitis and boosted low dose budesonide’s effect.

🌡️ Deaths in Belgium increased by 39% during June heatwave | Euronews 7/3/26

  • Belgium recorded 1,222 excess deaths, a 39% rise, between June 18 and 29 during a severe heatwave. More than half of those who died were 85 or older. France saw a 29% jump in deaths the same week, with 2,025 additional deaths nationwide.

Prenatal Acetaminophen (Paracetamol) Use and the Risk of Autism and/or Attention-Deficit/Hyperactivity Disorder Among Sibling-Matched Cohorts | JAMA Internal Medicine 6/29/26

  • The University of Hong Kong analyzed 708,020 mother child pairs and built sibling matched cohorts of 124,333 children assessed for autism and 97,285 for ADHD. Prenatal paracetamol (acetaminophen) exposure showed no added risk for either condition across dose, timing, and usage pattern.

This 22-year-old engineer 3D prints dentures to give low-income Americans their smiles back | CNN 6/22/26

  • Connor Gibson, a 22 year old engineer at Remote Area Medical, taught himself dentistry and 3D printing to build the first mobile denture lab in the United States. What once took three months now is completed in a single clinic weekend and patients are smiling with their new free custom dentures.

Remote Area Medical

Have a great week,

Ruth Ann Crystal MD