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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.
π️π️ 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 LinkΓΆping 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.
π️π️ 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.”
π« 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.
π΅ 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.
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
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.
πΎ 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.
π‘️ 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









