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Flu arrives to Pacific states; COVID wave seen in US, England, and Europe; Neuro-Long COVID and HHV-7; a 5th Pennsylvania measles death; Plague lab accident in Siberia; and much more.
Respiratory Illnesses
Ryan McCormick MD has made a new hyperlocal tracker for Influenza A and for COVID- you can put in your zip code and the tracker will give you information closest to you.
Regional wastewater levels for COVID, RSV, Flu A, Flu B per Wastewater SCAN:
COVID levels in the Northeast may reflect hot spots in Millbury, MA and Dover, NH, but most likely this curve will be recalibrated in the next few days and will appear less steep.
Flu
According to the CDC, Influenza A test positivity is increasing significantly in HHS Region 9 which covers California, Nevada, Arizona and Hawaii, as well as Pacific Islands such as Guam, American Samoa, N. Mariana Islands, Marshall Islands, and Palau. In California, test positivity for Influenza is moderate and is high in the Bay Area according to CDPH. Remember to get your Flu shot soon!
COVID
The PMC19 dashboard should update tomorrow, but as of today, it predicts that 1 in 92 people in the United States is currently infected with COVID equaling about 532,000 new infections each day. Levels of SARS-CoV-2 in wastewater are extremely high in SW Orange County, FL (Orlando) and in Millbury, MA according to WastewaterSCAN.
Mike Hoerger noted in a recent tweet, “There is a lot of uninformed armchair ‘analysis’ that waves of [COVID] infection “keep getting smaller” when the area under the curve (AUC) is actually staying about the same (less tall but wider, similar number of infections).”
The CDC noted this week on their website, “CDC competitively awarded a new wastewater testing contract to Verily Health, Inc. (Verily) on September 28, 2026. There will be a brief gap in wastewater data affecting ~200 sites as sampling, testing, and reporting are restarted.”
Acute COVID infections, General COVID info
ACE2-like Catalytic Activity in Anti-SARS-CoV-2 Spike Protein Monoclonal Antibodies | Pathogens 9/4/26
Researchers from UVA screened for and discovered four anti-spike antibodies that were catalytic and acted like ACE2 enzymes. They noted that this “supports the hypothesis that antibodies induced by SARS-CoV-2 infection could help mediate the pathogenesis of COVID-19 and Long COVID, and, more generally, the hypothesis that catalytic antibodies induced by infectious agents can contribute to disease pathogenesis.”
Pregnancy
Maternal vaccination against COVID-19, influenza, pertussis, and respiratory syncytial virus: a scoping review | npj Vaccines 9/29/26
In a scoping review of 635 publications, Austrian scientists found robust evidence supporting the effectiveness, safety, and immune benefits of vaccinating pregnant people against COVID, influenza, and pertussis. They noted that data on maternal RSV vaccination is more limited and warrants further investigation before firm conclusions can be drawn.
Pediatrics
Co-Designing an Online Narrative-Based Intervention for Breathing and Psychological Wellbeing for Adolescents With Post-COVID Syndrome | Clinical Child Psychology & Psychiatry 9/28/26
UK researchers worked with 7 teens to co-design a telehealth group for adolescents with Long COVID. “Young people directly influenced the content, structure, and delivery of the programme, helping to identify what was useful and what changes were needed. The final intervention consists of an online group session and supporting resources that were shaped by participants feedback. This co-designed intervention aims to help young people manage symptoms more confidently, improve their relationship with their bodies and breathing, and reduce feelings of isolation.”
Vaccines
Invivyd Announces Positive Topline Results from LIBERTY Phase 3 Study | Invivyd Press Release 9/29/26
Invivyd reports that in a 210 person Phase 3 trial, its COVID antibody VYD2311 caused fewer adverse events than the Pfizer mRNA COVID vaccine (56.5% vs 91.4% over six days) and did not blunt vaccine neutralizing titers. This is a company press release with preliminary data regarding safety and antibody levels. Efficacy data against COVID infection are still pending and will be presented later.
Long COVID
SARS-CoV-2-specific monoclonal antibody AER002 in Long COVID: an exploratory randomized phase 2a mechanistic trial | Nature 9/30/26
UCSF scientists enrolled 36 participants with Long COVID in a randomized trial testing long acting SARS-CoV-2 monoclonal antibody AER002 and found it did not produce meaningful improvement in overall symptoms or biomarkers. In a post-hoc analysis, participants with a lower baseline SARS-CoV-2 antibody level and higher drug exposure were more likely to perceive treatment benefit. Interestingly, exploratory imaging conducted after treatment revealed decreased T cell activation in the brain, spinal cord, and salivary tissue, pointing toward a possible biological mechanism worth investigating in larger trials.
Factors associated with persistent post-COVID-19 condition and functional limitation four years after SARS-CoV-2 infection | Nature Scientific Reports 10/1/26
Hannover Medical School in Germany followed 992 people with Long COVID and found that 77.4% continued to meet diagnostic criteria for Long COVID four years after their initial COVID infection. Of note, >95% of participants had a mild COVID infection initially and did not require hospitalization.
Former OpenAI Exec Fidji Simo’s $20 Million Plan To Solve Her Chronic Disease And Others | Forbes, 10/1/26
ChronicleBio, cofounded by tech executive Fidji Simo, who herself lives with postural orthostatic tachycardia syndrome (POTS), is deploying $20 million alongside artificial intelligence and large scale biological datasets to identify potential treatments for POTS, Long COVID, and other poorly understood chronic illnesses. The company’s approach centers on mining deep biological data to uncover therapeutic targets that have eluded conventional research methods.
Characterizing Host Inflammatory Bioprofiles in People With Postacute Sequelae SARS‐CoV‐2 Infection (PASC) | J of Immunology Research 9/29/26
Irish researchers measured 57 blood biomarkers mapping eight biological pathways in 356 people with Long COVID and found six inflammatory clusters that symptom-based groupings missed. One small cluster (19 people), marked by tissue damage, clotting, and axonal injury markers, had higher odds of cardiac and respiratory symptoms. The study lacked a non-PASC control group.
No detectable differences in peripheral blood immune profiles between patients with prolonged severe long COVID and convalescent controls | Nature 9/29/26
Erasmus MC researchers compared 52 people with severe Long COVID who were sick for a median of three years to 52 recovered controls. Immune cell counts, monocyte gene expression, serum cytokines, and interferon signatures in the blood did not differ. The authors suggest disease processes may be tissue-specific and therefore not seen in the blood.
🧠 High Frequency of HHV-7 Reactivation in Neurological and Neuropsychiatric Long COVID: A Retrospective Observational Study | Viruses 9/20/26
RED Laboratories in Belgium tested 30 people with neurological Long COVID and found that 77% were PCR positive for Human Herpesvirus 7 (HHV-7), versus 29% in a pre-COVID historical cohort. HHV-7-positive patients often reported neuropsychiatric symptoms, and in one patient followed longitudinally over time, viral load tracked with symptom severity. Latent herpesvirus reactivation may contribute to neurological Long COVID, but this study is hypothesis-generating and does not establish causation.
🧠 Microtesla magnetic therapy for cognitive impairment in long COVID: a randomized pilot study | Brain Communications 9/28/26
A randomized pilot study of 30 adults with Long COVID cognitive impairment tested an at home, transcranial Microtesla Magnetic Therapy (MMT) device. Home MMT was feasible, safe, and well tolerated. Active treatment showed some gains over sham in verbal learning, executive function, and emotional well being, but larger trials are needed.
🧠 Neurocognitive Indices of Long COVID: Dysregulated Engagement of Inhibitory Control and Oscillatory Slowing | NeuroSci 9/28/26
A small EEG study compared 18 young, previously healthy adults with Long COVID (mild, non-hospitalized infection, about 6 months out) to 20 pre-pandemic controls. Task performance was normal, but the Long COVID group showed weaker frontal theta activity during inhibition and error processing, plus slower resting alpha rhythms that persisted after adjusting for anxiety and depression. EEG slowing tracked with attention problems, poor sleep, and headaches.
🧠 Neurological Manifestations of Long COVID: Current Evidence, Emerging Concepts, and Future Perspectives | 9/15/26 J of Clinical Medicine
“This narrative review [from Croatia] provides a critical synthesis of current literature regarding the clinical presentations, potential mechanisms, and biomarkers associated with neurological involvement in Long COVID. Reflecting the high heterogeneity of the available evidence, it is important to note that no neurological biomarker or disease-modifying therapy has yet been clinically validated.”
🧠 Autoantibody landscapes in Long COVID with neurological symptoms show heterogeneity without a shared disease signature | JCI Insight 9/29/26
Researchers tested spinal fluid from 31 people with neurological Long COVID, and blood from 29 others with cognitive symptoms from a different cohort, for a shared pattern of autoantibodies against brain tissue. They found no common pattern. Each person’s results differed, and computer models could not tell the patients from controls. Small sample sizes and heterogeneity of samples from different cohorts mean some patients may still be affected.
🫁 Risk factors of post-COVID-19 symptoms, a cross-sectional study in patients with asthma and chronic obstructive lung disease | npj Primary Care Respiratory Medicine 9/29/26
In a Swedish study of 2,328 adults with asthma or COPD, 59% of the 494 with confirmed COVID infection reported Long COVID symptoms lasting over three months (55% asthma, 70% COPD). Severe acute infection, obesity, chronic pain, and anxiety or depression stood out as risk factors. Data were self-reported and cross-sectional.
Measles
As of October 1, 2026, 3,887 confirmed measles cases were reported in the United States in 2026. This week, a fifth measles death was reported in Pennsylvania, but the CDC site incorrectly reports “2*” deaths from measles.
Pennsylvania Department of Health Measles Dashboard:
As of October 2, Pennsylvania notes 977 confirmed measles cases with 102 new measles cases in the last 7 days. Less than 1% of cases were fully vaccinated. There have been 195 hospitalizations related to measles in Pennsylvania and 5 deaths.
Measles outbreaks could leave thousands vulnerable to infectious diseases for years | CIDRAP 10/2/26
“The measles virus hijacks the immune system, using specialized memory cells to make copies of itself before blowing them up”, [Dr. Michael] Mina said. By deleting the body’s memory of earlier infections, measles causes a condition called “immune amnesia.”...Immune amnesia “happens in 100% of measles-infected individuals to some degree,” Mina said.
Johns Hopkins US Measles Tracker
Measles cases in the last 2 weeks:
Mumps
San Diego State football team dealing with mumps outbreak | ESPN 10/1/26
Public health officials confirmed a mumps outbreak on the San Diego State football team, with 14 cases noted so far. Mumps can cause painful testicular swelling and sometimes infertility in young men. Two doses of the MMR vaccine protect against measles, mumps, and rubella.
The Plague (!)
Nearly 200 People Under Observation After Irkutsk Lab Worker Dies From Plague | The Moscow Times 10/2/26
The Moscow Times states that a 28 year old woman working in a lab in Siberia has died from pneumonic plague after breaking a test tube containing plague at an “anti-plague institute”. 197 people with whom she came in contact have been put in isolation.
Plague Fact Sheet from the WHO 9/29/26
Plague has three clinical forms, all caused by the bacterium Y. pestis.
Bubonic plague, the most common, follows an infected flea bite and causes painful swollen lymph nodes (”buboes”) that can become pus-filled sores. It rarely spreads between people but can progress to the lungs or bloodstream.
Pneumonic plague, the most virulent, attacks the lungs, incubates in as little as 24 hours, and spreads person to person through respiratory particles. It can be fatal, but recovery is likely if treated within 24 hours of symptom onset.
Septicaemic plague occurs when the bacteria multiply in the blood, can develop from either other form, and causes organ failure, tissue damage, and bleeding under the skin. It is fatal if untreated.
Plague has “a case-fatality ratio of 30% to 100% if left untreated. The pneumonic and septicaemic forms are invariably fatal unless treated early.”
Ebola in Democratic Republic of Congo (DRC)
According to the DR Congo Health Ministry of 9/29/26:
8,224 confirmed Ebola cases
851 patients in isolation/hospitalization
2,121 recovered
3,982 Ebola deaths
Case fatality rate: 48.4%
Contact tracing: 78.7%
Other news
The ‘missed disease’ that affects 190 million: endometriosis drug shows early promise | Nature 10/1/26
Washington State University researchers developed a modified form of niclosamide engineered to seek out the macrophages that drive endometriosis progression, reducing both pain responses and lesion size in a mouse model. Endometriosis affects 190 million people worldwide, and this targeted approach represents a potential non-hormonal treatment avenue but human studies are needed.
Original study:
2‐Deoxyglucose Dendrimer‐Enabled Niclosamide Delivery to FRβ‐Expressing Macrophages Alleviates Endometriosis Progression and Associated Hyperalgesia | Advanced Healthcare Materials 8/30/26
Washington State researchers attached a tiny branched carrier (folic acid-targeted dendrimer) to an anti-parasite drug called niclosamide to target FRβ-positive macrophages that drive endometriosis. In mice, one intraperitoneal dose of this non-hormonal medication shrank endometriosis lesions and eased pain. The treatment has not yet been tested in humans.
@ScienceMagazine 10/1/26
“Historically, medical research has relied heavily on male participants, with findings often generalized to women and children. If women’s health is discussed at all, it’s largely framed around reproduction. This special issue of Science highlights the research that is seeking to close the critical gaps in Women’s Health. Learn more: https://scim.ag/4hy8ACT “
Reframing menopause and menopause hormone therapy as opportunities for healthy aging | Science 10/1/26
This article in Science reframes menopause and menopause hormone therapy as opportunities for healthy aging. It moves the conversation beyond symptom relief alone and toward long term health in midlife and beyond, making the case that this life stage deserves a more proactive, prevention minded approach.
Microbiome signatures linked to cancer and treatment adverse events in a real-world cohort | Cell 9/29/26
Mayo Clinic researchers profiled the gut microbiomes of 1,364 patients with cancer and 287 healthy controls. Most microbiome changes were shared across cancers and largely tracked with comorbidities, not individual tumor types. Early onset cancers had distinct signatures, and low levels of Anaerostipes hadrus predicted 5FU induced diarrhea but not carboplatin diarrhea.
Researchers from China have found that “Cranial Bone Marrow (CBM)-originated inflammatory monocytes/macrophages (Mo/Macs) may serve as key inflammatory drivers of chronic traumatic brain injury (cTBI) and further show that fenofibrate represents a potential therapeutic strategy for cTBI treatment in older adults.”
Peripheral CXCR3 blockade mitigates T cell infiltration and neurodegeneration in a mouse model of tauopathy | Neuron 9/28/26
“These findings identify CXCR3-dependent chemotaxis as a critical signaling pathway for subtypes of T cells linked to tau-mediated neurodegeneration and highlight CXCR3 blockade as a potential disease-modifying therapeutic strategy for tauopathies.”
Cervical lymphadenectomy impairs brain lymphatic clearance and synaptic proteostasis | Neuron 9/29/26
Removing neck lymph nodes is linked to cognitive impairment in patients as brain health depends on lymphatic drainage to clear waste. In rodents, cervical lymphadenectomy (neck lymph node removal) impairs brain lymphatic drainage, and causes redox stress and protein microaggregation. The molecular and structural features are distinct from Alzheimer’s disease.
Global burden of cancer attributable to infections in 2024: a worldwide incidence analysis | Lancet Oncology Oct 2026
An estimated 2.3 million new cancers in 2024, about 12% of the global total, were attributable to infections. H. pylori (760,000) and HPV (750,000) led the list, and 77% of cases were in low and middle income countries. EBV now ranks fourth, strengthening the case for an EBV vaccine and for scaling up proven prevention tools.
‘We Didn’t Set Out to Make a Show for Animals!’ The Netflix Seal Cartoon That’s a Huge Hit With Pets | Guardian 9/22/26
Sealook, a South Korean animated series about a colony of seals, has become an unlikely favorite among dogs and cats. Its high contrast colors sit in the visual range pets can actually see, and clips of cats and dogs glued to the screen have gone viral on social media.
Photograph: Rich Pelley
I will be taking next week off from the newsletter. Have a great 2 weeks!
Take care,
Ruth Ann Crystal MD
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