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Ruth Ann Crystal MD, Sep 06, 2026
The Summer wave is expected to peak soon. Levels of SARS-CoV-2 in wastewater are much lower than in past waves, but they are still in the high to very high range in many places.
Michael Hoerger estimates 1 in 95 Americans have COVID, with very high rates in parts of the South and West. Much of Texas wastewater reflects 1 in 20 people being infectious with COVID. In California, Mike estimates 1 in 38 in Santa Clara County and 1 in 20 in Alameda County are infected. Oceanside San Francisco has the highest levels of SARS-CoV-2 in California wastewater now according to WastewaterSCAN, with Palo Alto being the second highest in the state. California emergency department visits for COVID have increased significantly, although they are lower than in past years. Since any COVID infection can lead to Long COVID, it is best to protect yourself by wearing a N95 mask, using air filters, and to stay home if sick.
Vaccines against COVID and the flu are available in many pharmacies now. This week, the American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Physicians (AAFP), and the Infectious Diseases Society of America (IDSA) put out this trustworthy summary infographic on the current Fall vaccination recommendations for Flu, COVID, and RSV.
Acute COVID infections, General COVID info
Researchers at the Institute for Systems Biology studied 12 COVID patients and found that DN2 B cells are a primary cellular source of autoantibodies from COVID infection, becoming primed for autoantibody secretion following TLR7/8 stimulation. Patients with elevated autoantibody levels showed stronger activation of T-bet and XBP1 molecular programs within these DN2 cells, a pattern that closely mirrors what has previously been observed in Lupus.
Antiviral innate immunity in myocarditis: mechanisms and emerging therapeutics | Experimental & Molecular Medicine 9/4/26
Houston Methodist Academic Institute researchers reviewing viral myocarditis found that the immune system’s timing is the deciding factor in patient outcomes. Interferon responses deployed early in infection can suppress the virus, but sustained innate immune activation past that window damages cardiac tissue, promotes scarring, and can culminate in heart failure.
Platelet-derived serotonin drives age-related lung pathology in SARS-CoV-2 infection | Science Immunology 8/29/26
Researchers at San Raffaele Scientific Institute studied platelets from 20 healthy donors and found that platelets from older individuals released greater amounts of serotonin. In SARS-CoV-2 infected mice, platelet serotonin promoted fibrin accumulation and impaired lung function. Mice engineered to lack the serotonin transporter specifically in platelets were shielded from this lung damage.
Mitochondria in SARS-CoV-2 infection: Immune interactions and molecular approaches in the Post COVID-19 condition | Genetics and Molecular Biology 8/29/26
Researchers in Brazil reviewed evidence showing that SARS-CoV-2 disrupts oxidative phosphorylation and interferes with the cellular process that clears damaged mitochondria, ultimately reducing ATP output in affected cells. They propose that mitochondrial deficits may underlie persistent fatigue and muscle weakness in Long COVID.
Transmission
Widespread SARS-CoV-2 infection in free-ranging Neotropical bats suggests repeated human-to-bat spillback | bioRxiv 9/3/26
Ecuadorian and Italian scientists tested 126 wild bats and detected SARS-CoV-2 RNA in approximately one third of the animals sampled. Five recovered viral genomes matched human SARS-CoV-2 lineages at greater than 99% genetic identity across multiple distinct clades, pointing to recurring transmission events from people back into bat populations rather than a single introduction.
Immunocompromised
Researchers in Spain examined 146 immunocompromised patients and found that 38% of those lacking sufficient SARS-CoV-2 antibodies still mounted T-cell responses, though those responses showed reduced polyfunctionality compared to stronger immune profiles. Corticosteroid use was specifically associated with diminished interferon gamma production, a finding with direct implications for deciding which patients may benefit from monoclonal antibody prophylaxis.
Pediatrics
Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026–2027: Technical Report | Pediatrics (American Academy of Pediatrics) 9/3/26
The American Academy of Pediatrics, drawing on evidence encompassing 2.4 million children, confirms that COVID vaccination meaningfully reduces both hospitalization rates and Long COVID outcomes in pediatric populations. Infants younger than 2 years continue to bear the greatest burden of severe disease, reinforcing the AAP’s recommendation for vaccination in this age group during the 2026 to 2027 respiratory virus season.
Vaccines
COVID-19 Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season | JAMA 9/2/26
A review drawing on evidence including a cohort of 4,718 healthcare workers found that receiving three to five mRNA doses compared to two during the Omicron period was associated with a 57% lower likelihood of self-reported post-acute COVID symptoms. These findings suggest that additional vaccine doses may meaningfully reduce the risk of Long COVID beyond the protection offered by the initial two dose series.
COVID-19 Vaccination and Risk of Post-COVID-19 Cardiovascular Disease: A Population-Based Cohort and Target Trial Emulation Study | European Heart Journal - Quality of Care and Clinical Outcomes 8/31/26
Researchers at the Baker Heart and Diabetes Institute analyzed data from 2,391,456 adults and found that receiving a COVID vaccine either before or after infection was associated with a reduced risk of cardiovascular complications following COVID. Notably, approximately 68% of this protective association operated through mechanisms beyond simply preventing the infection itself, suggesting the vaccine confers cardiovascular benefits through additional biological pathways.
Antiviral treatments
Nanobodies targeting SARS-CoV-2 papain-like protease exert dual antiviral and anti-inflammatory effects | Journal of Virology 8/29/26
Chinese researchers discovered two nanobodies, NbP1 and NbP2, that block the interface between SARS-CoV-2 PLpro and the human protein ISG15 which disrupts both viral replication and inflammatory signaling.
Long COVID
Gut Microbiota from Patients with Long COVID Persisting for 2 Years Result in Alterations in Mice that Resemble Post-COVID Symptoms | Probiotics and Antimicrobial Proteins 8/30/26
In a small study, Chinese scientists studied 11 people with Long COVID and 11 healthy controls from the same families who shared similar diets. They transplanted gut microbiota from people who had experienced Long COVID for two years into healthy mice. The mice subsequently developed lung inflammation, gut inflammation, and anxiety-like behaviors, providing experimental evidence in a mouse model that gut microbiota may play a causal role in producing Long COVID symptoms.
For Many Americans, Covid Is Still a Chronic, Disabling Disease. These Scientists Are Working Tirelessly to Bring Them Relief | Smithsonian Magazine 9/1/26
The Smithsonian Magazine wrote an in depth article featuring scientist Julia Moore Vogel from Scripps Institute, who is personally disabled by Long COVID, as well as Michael Peluso and Steven Deeks from the LIINC program at UCSF who are trying to identify mechanisms, biomarkers, and treatments for Long COVID.
Advances in the clinical application of stellate ganglion block for non-pain indications | Frontiers in Medicine 9/4/26
Researchers in China studied two patient cohorts of 52 and 41 individuals and found that stellate ganglion block, an injection of local anesthetics near a nerve cluster in the neck, reduced brain fog and fatigue associated with Long COVID. The authors propose that the procedure may work by modulating autonomic and neuroimmune signaling, though the findings are observational and do not establish causation.
Nirmatrelvir–ritonavir targeting viral persistence in post-COVID-19 condition (long COVID) in the USA (RECOVER-VITAL): a randomised, double-blind, placebo-controlled, phase 2 trial | The Lancet Infectious Diseases 9/1/26
A double-blind, placebo-controlled, randomized trial from RECOVER of 959 participants with Long COVID found that neither a 15 day nor a 25 day course of Paxlovid (nirmatrelvir and ritonavir) produced any measurable improvement in the cognitive, autonomic, or exercise related symptoms of Long COVID.
Beyond genes: EpiSwitch® and Orion platform-powered 3D genome architecture biomarkers reveal shared biology across ME/CFS, long COVID, PTSD, rheumatoid arthritis, and multiple sclerosis | Journal of Translational Medicine 8/22/26
Oxford BioDynamics analyzed data from 3.76 million participants across five genome wide association study datasets to compare the genetic underpinnings of ME/CFS, Long COVID, PTSD, rheumatoid arthritis, and multiple sclerosis. Although the specific genes involved showed minimal overlap between conditions, 3D genome interaction networks (the way that DNA is physically folded in the cell nucleus) for all five diseases converged on shared immune, interferon, and mitochondrial biological pathways. They noted “the downstream network perturbations converge on a shared core of immune and metabolic regulators—most notably the RUNX1-PPARGC1A-STAT1 axis.” The authors are careful to note that this is a hypothesis-generating network analysis, not proof of cause and effect.
Cigarette smoking history, e-cigarette use, and Long COVID: a population-based analysis | Internal and Emergency Medicine 8/29/26
University of Glasgow researchers analyzed data from 9,274 Scottish adults and found that former cigarette smokers faced elevated odds of Long COVID regardless of whether they had since switched to vaping, while people who had never smoked but currently vaped did not show the same elevated risk. The study design was observational.
Financial and Welfare Support: Voices from Businesses and Individuals | Scottish COVID-19 Inquiry 9/3/26
The Scottish COVID-19 Inquiry gathered testimony from more than 12,500 individuals and found that persistent post-COVID illness drove many people out of the workforce and forced them to deplete personal savings or rely on government benefits. Respondents reported that the exhaustion caused by long-term symptoms made it significantly harder to complete the complex paperwork required to access financial assistance, and they called for streamlined support systems.
When do infections lead to long COVID? Scientists close in on triggers and treatments for post-viral syndromes | Nature 9/3/26
Hundreds of millions of people worldwide are living with lasting health conditions traced back to prior infections, and researchers are now zeroing in on viral persistence, autoimmune responses, and immune dysregulation as the primary biological drivers. The scientific momentum generated by Long COVID has fundamentally reshaped how medicine approaches post-viral illness, though experts warn that effective treatments have yet to catch up with the expanding body of evidence.
Measles
As of September 3, 2026, 3,134 confirmed measles cases were reported in the United States in 2026. Of note, the CDC has not posted the deaths of 2 infants in Pennsylvania on the CDC website (see * below).
Johns Hopkins US Measles Tracker
Ebola in Democratic Republic of Congo (DRC)
Ministère de la Communication et Médias/RDC
📊 To date, 6,436 cases have been confirmed, including 1,495 recoveries and 3,095 deaths. 738 patients are currently in isolation or hospitalized. The case fatality rate stands at 48.1%, and contact tracing remains high at 88.5%.
Government Health News
Whistle-Blower Says Trump Officials Are Defying Court Orders on Voting by Mail | NY Times 9/1/26
“Potentially millions of American voters may not receive their mail-in ballot this election cycle in a timely manner, or at all,” the [U.S. Postal Service] official said in the report.”
DOJ makes new appeal for Supreme Court to allow mail voting changes | Politico 9/6/26
“The Trump administration on Sunday again asked the Supreme Court to allow it to restrict mail-in voting this election cycle...U.S. District Judge Indira Talwani on Friday indefinitely halted the Postal Service’s plan while lower courts decided on the policy.”
Other news
Markers of compromised gut epithelial barrier integrity increase during the menopause transition | JCI 7/9/26
In a study of 964 women, as women approach their final menstrual period (FMP) in menopause, their estrogen and progesterone drop, but markers of gut epithelial dysfunction (FABP2 and sCD14) increased by 2.6% for FABP2 and 0.8% per year for sCD14. “The menopause transition (MT) is associated with a rise in markers of compromised gut barrier integrity, suggesting that this pathway of inflammation, previously described in animal models, occurs in humans.”
Menopause and “leaky gut”: implications for midlife women’s health | JCI 9/1/26
“These findings provide the strongest evidence to date that menopause may promote gut barrier dysfunction and microbial translocation in otherwise-healthy women.”
Figure 1: Proposed model linking menopause-related ovarian hormone decline with gut barrier dysfunction and microbial translocation.
A Dual-Port, Smartphone-Linked, Pocket-Size Fluorimeter for Rapid Molecular Diagnostic Assays at Point of Care | IEEE Xplore (University of Illinois Urbana-Champaign) 8/31/26
The VPodDuo is a portable, pocket-size, smartphone-linked fluorimeter that is as sensitive in detecting Zika virus, MSSA staph aureus, HIV, a lung cancer cDNA, and another microRNA biomarker for lung cancer with the accuracy of larger and more expensive laboratory-based instruments.
The VPodDuo fluorometer is just larger than an AirPod case:
A blood-based test for detection of advanced adenomas and colorectal cancer (DENEB): a multicentre diagnostic accuracy study | Lancet Gastroenterology & Hepatology 8/10/26
“We developed and tested an exosome-based liquid biopsy using data from 1613 screening-eligible participants undergoing colonoscopy. The test detected 92% of colorectal cancers and 81% of advanced adenomas, while correctly identifying 85% of individuals without advanced neoplasia.”
First patient to have brain surgery with real-time AI assistance | BBC 8/26/26
48-year-old Rhys Hibbert, became the world’s first patient to undergo brain surgery with real-time AI assistance. UK Neurosurgeons used AI to analyze live endoscopic video, highlighting the location of critical nerves and vessels. They successfully removed an 11mm pituitary tumor while preserving his vision.
Lentiviral In Vivo CD19 CAR T-Cell Therapy in Neurologic Autoimmune Disorders | NEJM 9/3/26
Tongji Hospital researchers treated 16 adults with refractory neurologic autoimmune disorders using an in vivo CD19 CAR T cell approach delivered without prior lymphodepletion, finding that the engineered cells expanded successfully and achieved complete B cell elimination. By six months, clinical outcomes had improved and B cell reconstitution was characterized by a predominance of naive clones, a pattern consistent with broad immune system renewal.
Study links alpha-gal syndrome to severe allergic reactions after blood transfusion | CIDRAP 8/26/26
Alpha-gal syndrome (AGS), the tickborne disease that triggers an allergic reaction to red meat and animal byproducts, may present an additional complication for patients who need blood transfusions, according to a study published this week in JAMA. Patients with alpha-gal and type O blood may have severe allergic reactions after receiving platelet and plasma transfusions from a donor with type B or AB blood. The alpha-gal molecule and the B antigen turn out to have some structural similarities.
Human monoclonal antibodies targeting α-Gal restrict IgE engagement of α-Gal syndrome allergens | Journal of Clinical Investigation 9/2/26
NIH researchers studying 88 patients with alpha-Gal syndrome identified two human monoclonal antibodies capable of blocking IgE from binding to key alpha-Gal allergens. One of the two antibodies also reduced basophil activation triggered by allergen exposure, establishing a proof of concept for a more precise way to treat this condition.
Acute viral infection accelerates neurodegeneration in a mouse model of ALS | Nature Communications 8/31/26
Researchers at McMaster University studied 31 ALS model mice and found that a single influenza infection occurring before symptom onset was sufficient to accelerate the progression of paralysis, with spinal cord glial inflammation persisting long after the virus had been eliminated from the body. Treatment with oseltamivir provided partial protection of motor function in the affected animals.
Lyme Disease Risk Tied to Mice and Acorns, Not Deer | PNAS 8/30/26
Researchers at the Cary Institute analyzed data over more than 30 years and found that Lyme disease risk correlated with white-footed mouse populations and red oak acorn abundance rather than deer density. Years with high mouse numbers were followed by roughly 40% increases in nymphal tick populations, the life stage that poses the greatest transmission risk to humans.
Japan’s vending machines become free emergency supply stations during disasters | Vending Times 8/18/25
If an earthquake of magnitude 5 or more hits Japan, vending machines in Ako City will automatically open to dispense their contents for free. “Each machine holds up to 300 drinks and 150 emergency supplies, including food, masks, vitamins and portable toilets. They are located near public shelters to provide immediate relief before official aid can arrive.”
Critically Endangered Parrots Enjoy Baby Boom After Mating Frenzy | NY Times 9/2/26.
New Zealand’s kakapo bird just had its best breeding season on record. A bumper crop of rimu berries, their favorite food, triggered a rare mating boom that added 90 chicks and pushed the critically endangered parrot’s population to 325.
Have a great week,
Ruth Ann Crystal MD
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