By Dr Ruth Ann Crystal, MD
COVID in wastewater had started to decrease across the United States from the late summer wave, but now COVID is increasing again without the usual lull seen after a wave. Many states in the West, South, and Northeast have had high levels of SARS-CoV-2 in wastewater for over a month.
Flu A continues to rise nationally, and especially in the West. San Francisco’s test positivity for Influenza A is at a whopping 19.2%. These high numbers are not usually seen until late January. RSV is low but is just starting to trend up in the South according to WastewaterSCAN. Influenza B remains at very low levels.
All people age 6 months and older can receive the fall Flu vaccine. In California, about 25% of children have received a flu shot, compared to 49% of adults age 65+ according to CDPH. The CDC reports that children 0-4 years of age and kids and young people ages 5-24 years are being seen more frequently now for Influenza-like illness (ILI).
COVID Variants
Lack of ancestral SARS-CoV-2 imprinting promotes Omicron sublineage BA.3.2.2 infection in children | Nature Microbiology (Yunlong Cao’s lab) 10/26/26
Researchers from Yunlong Cao’s lab at Peking University found that children are more susceptible to the BA.3.2.2 COVID variant because they lack the antibody memory that earlier vaccination against the original Wuhan strain would have produced. For BA.3.2.2, classic imprinting provides superior protection and knowing this could help when planning pediatric COVID vaccinations.
Acute COVID infections, General COVID info
Metformin at the Time of COVID‐19 Infection and Risk of Long COVID: A Target Trial Emulation Study | Journal of Medical Virology 10/29/26
University of Minnesota researchers analyzed data from 9,660 COVID patients and found that Metformin started within six days of infection was associated with a 53% reduction in the risk of Long COVID or death. These observational findings align with outcomes from a prior randomized controlled trial showing that Metformin use during COVID infection reduced the risk of subsequent Long COVID.
A matched-cohort study of treatment-requiring autoimmune rheumatic diseases after COVID-19 | Nature 10/30/26
In a Japanese claims study of more than 764,000 matched pairs, people with prior COVID infection had nearly double the one-year incidence of treatment-requiring autoimmune rheumatic disease (0.21% vs. 0.11%). Hospitalizations connected to these conditions occurred at a rate nearly 19 times higher for people who had contracted COVID compared to those who had not. Absolute risk was low, but the authors urge clinical vigilance after infection.
Influenza A (H1N1) and SARS-CoV-2 Transmission in Airplanes: Quanta Profiles and Infection Control | Envir Sci & Tech 10/27/26
A new study from Hong Kong shows that airborne viral spread on planes is driven by being near a few superspreader passengers. Analyzing 40 flight outbreaks (14 H1N1 flu, 26 SARS-CoV-2), researchers found that risk was highest if seated near infected passengers. Doubling cabin clean air barely helped against close-range spread, but universal masking cut transmission sharply: surgical masks bring the trip reproduction number to 0.15, and N95s nearly eliminate it.
Ex vivo IL-1β, IL-6, TNF-α, and IL-8 responses 2 years after critical COVID-19 are associated with age and innate immune activation | Nature 10/24/26
A study from Slovenia of 117 people who had prior COVID infection “demonstrates that individuals who experienced critical COVID-19 exhibit both the hallmark features of pro-inflammatory cytokine responses during acute illness and heightened cytokine responsiveness within the studied cohort 2 years after recovery. Elevated ex vivo secretion of IL-1β, IL-6, TNF-α, and IL-8 in critical COVID-19 patients was associated with age and innate immune activation.”
TNF-α and IL-8 Are Helpful in the Prediction of Late Post-COVID-19 Venous Thromboembolic Disease—Single-Center Prospective Study | Int J Molec Sciences 10/19/26
Polish researchers studied 108 patients who had dyspnea (shortness of breath) and/or exercise intolerance after COVID infection. In those patients, 17% had venous thromboembolic (VTE) events, including pulmonary embolism and/or deep vein thrombosis, during their COVID infection and 23% had VTE after the acute phase of the infection. Elevated IL-8 and TNF-α levels later than 6 months from acute COVID infection were associated with increased risk of late VTE.
Antiviral treatments
Lipidated macrocyclic peptide S-880008 inhibits SARS-CoV-2 fusion by suppressing protomer dissociation at conserved spike sites | Nature 10/28/26
Japanese pharma company Shionogi developed a nasal antiviral compound called S-880008 that physically locks SARS-CoV-2 spike proteins into a state that cannot fuse with cells. In mice, the antiviral was effective across multiple SARS-CoV-2 variants, but the drug has not been tested in humans.
Long COVID
The Glymphatic–Meningeal Lymphatic System and Autophagy in ME/CFS and Long COVID: A Mechanistic Perspective | Int J Molec Sci 10/21/26
Ron Davis and colleagues propose that Long COVID and ME/CFS may interfere with two of the brain’s primary waste disposal mechanisms- autophagy and glymphatic clearance. When these systems falter, toxic proteins may build up in the brain, potentially driving brain fog, fatigue, and post-exertional malaise.
Researchers from Yale and Mount Sinai examined 90 participants (45 with Long COVID and 45 controls) and found that greater concentrations of HHV-6 DNA in saliva corresponded with more severe Long COVID symptoms, as well as anxiety and depression. Notably, Epstein-Barr virus in saliva did not show the same pattern, but “EBV may still play a role at earlier time points in the disease course, or in compartments not sampled in this study.”
Stress-inducible WASF3 regulates brain metabolism and cognitive function | PNAS
NIH researchers demonstrated that excess WASF3 protein disrupts mitochondrial energy production in mouse brain tissue, impairing metabolic function. Genetic removal of WASF3 in the mouse model restored metabolic activity and shielded cognitive performance under physiologically stressful conditions, pointing to a plausible biological pathway underlying brain fog symptoms observed in ME/CFS and Long COVID patients. In addition, sex differences in “several WASF3-associated metabolomic alterations were more pronounced in female mice.”
@AnilvanderZee Oct 28 tweet
Interesting follow-up from Hwang et al. on their earlier WASF3 findings in muscle. Study suggests that stress-related protein WASF3 may be linked to reduced energy production in the brain & to brain fog-like symptoms. In mice...let’s see about humans.
WASF3 disrupts mitochondrial respiration and may mediate exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome | PNAS 8/14/23
Understanding cognitive function in post-COVID-19 condition with fatigue: an interdisciplinary multimodal investigation | BioRxiv 10/24/26
Swedish scientists compared 34 Long COVID patients to 37 controls and found that Long COVID patients showed measurable reductions in brain white matter and myelin alongside changes in brain connectivity. Notably, standard cognitive assessments returned normal scores even as patients themselves reported substantial difficulties with thinking. The authors state that “cognitive difficulties in PCC may be better understood in terms of reduced network efficiency and cognitive endurance rather than loss of cognitive capacity”, although “this interpretation remains tentative and hypothesis‑generating”.
Low Dose Naltrexone for Post-COVID Fatigue Syndrome: A Randomized Controlled Trial | MedRxiV 10/26/26
Researchers from the University of British Columbia enrolled 160 Long COVID patients in a randomized controlled trial to evaluate whether low dose naltrexone (LDN) could relieve the debilitating symptoms of post-COVID fatigue syndrome (PCFS or Long COVID). After 16 weeks, LDN treatment produced no statistically significant improvements over placebo in fatigue, pain, physical activity levels, or overall quality of life.
Stem Cell Educator Therapy for Ex Vivo Immune Modulation of Peripheral Blood Mononuclear Cells in Patients with Long COVID | JoVE 10/27/26
In a small preliminary trial of 25 Long COVID patients without a control group, a stem cell educator (SCE) therapy using cord blood stem cells to reprogram immune cells led to 21 of 25 participants reporting relief from brain fog and fatigue along with measurable reductions in inflammatory markers IL-1β and CXCL16. Larger randomized control trials studies are needed to confirm the findings.
Orthostatic and exercise intolerance in post-acute sequelae of COVID-19 occur with intact sympathetic neural control and preserved cardiac reserve | Am J of Physiology, Heart and Circulatory Physiology 10/12/26
Researchers at the Baker Heart and Diabetes Institute found that 41% of 35 Long COVID participants could not tolerate being tilted upright, despite showing normal sympathetic nervous system activity and blood pressure responses. The team concluded that disrupted blood flow regulation, rather than autonomic dysfunction, may be the underlying driver of orthostatic and exercise intolerance in this population.
Long COVID burden in healthcare workers: a 12-month survey of 771 cases | Nature 10/28/26
Italian scientists followed 771 healthcare workers after COVID infection and found that 28% developed Long COVID, with 16% still experiencing symptoms at the one year mark. Fatigue, muscle pain, and cognitive difficulties were the most persistent complaints among those affected.
The role of the JAK/STAT pathway in the pathogenesis and treatment of post-COVID autoimmune syndromes | Frontiers in Immunology Review 10/26/26
Italian scientists reviewed evidence showing that sustained activation of the JAK/STAT signaling pathway contributes to chronic inflammation, autoimmune conditions, and dysautonomia in Long COVID patients. JAK inhibitors have demonstrated early therapeutic promise in addressing these mechanisms, though investigators conclude that larger clinical trials are necessary before broader treatment recommendations can be made.
Measles
As of October 29, 2026, 4,852 measles cases were reported in the United States in 2026.
Pa. measles vaccine messaging depends on word-of-mouth to reach the Amish community | Philadelphia Inquirer 10/26/26
Public health officials faced a hard problem in Pennsylvania’s measles outbreak: reaching Amish communities that avoid modern technology. Instead of using mass media, the state brought free pop-up clinics to fire halls, barns, and kitchens, spread through the “Amish Internet” of word-of-mouth. Since May, 223 clinics have vaccinated more than 6,000 people, and most who attend choose to get the shot.
Pennsylvania Department of Health Measles Dashboard:
On October 30, Pennsylvania reported 1,426 total measles cases, with 88 cases reported this week, and 5 measles-associated deaths.
Johns Hopkins US Measles Tracker:
There have been 497 new measles cases in the U.S. in the last 2 weeks alone.
Ebola in Democratic Republic of Congo (DRC)
Congo Ebola outbreak deaths top 5,000 as fear of continent-wide spread mounts | NBC 10/31/26
Bundibugyo Ebola has killed 5,026 people out of 10,351 infected in DR Congo, the second deadliest Ebola outbreak in history. “According to the Africa Centers for Disease Control and Prevention, about 80% of new cases are coming from outside the chain of monitored contacts”, meaning they are being missed by public health contact tracing.
Government Health News
‘It’s a mess right now’: RFK’s sweeping changes place new vaccines in limbo | Melody Schreiber for The Guardian 10/26/26
RFK Jr made sweeping changes to vaccine policy and replaced all experts on the Advisory Committee on Immunization Practices (ACIP) with his own cronies. A judge halted the ACIP changes, but Kennedy has not appointed new people to ACIP, so U.S. vaccine recommendations are in limbo and insurers do not have to pay for new vaccines like the new Moderna mRNA flu vaccine.
Kennedy to select MAHA-aligned researcher to head mental health institute, overruling NIH director | Science 10/23/26
Science reports HHS Secretary Robert F. Kennedy Jr. wants Stanford psychiatrist Shebani Sethi, a pioneer of diet-based “metabolic psychiatry,” to lead NIMH, overruling NIH Director Jay Bhattacharya’s pick of UCSF’s Vikaas Sohal. Sethi appears never to have held an NIH grant and was not among the search committee’s recommended candidates. Former NIMH director Joshua Gordon called the move “disturbing,” saying scientists, not politicians, should choose these leaders.
New World screwworm (NWS)
Arizona reports 1st animal case of New World screwworm after canine found to be infected | ABC 10/29/26
A dog in Arizona was discovered to be infected with the New World screwworm (NWS), a flesh-eating parasite spread by flies. Arizona is the third U.S. state to report an animal case of NWS and there is significant concern about it spreading to livestock.
Other news
How Binance’s $6.3 Billion Hack Went Down | NY Times 10/31/26
This week, North Korea hacked the largest cryptocurrency exchange Binance and stole $6.3 Billion, some of which has been recovered. In 2023, Binance pleaded guilty to money laundering violations and agreed to stop serving U.S. customers on its main platform. Its founder, Changpeng Zhao, pleaded guilty as well and was sentenced to four months in prison in 2024. “But last year, the company forged a business relationship with World Liberty Financial, the Trump family crypto start-up. President Trump granted a pardon to Mr. Zhao last October, paving the way for Binance to expand into the U.S. market.”
Amyloid-mediated RNA uptake by sperm for embryonic delivery | Molecular Cell 10/26/26
Amyloid fibrils in seminal fluid have been discovered to be RNA couriers. A prostate-derived peptide, PAP, can condense with RNA into fibrils that carry small RNAs which are taken up by sperm. In mouse IVF, amyloid fibrils delivered exogenous RNA to the embryo, where it was translated, and the chaperone clusterin was found to release RNA from the fibrils. The authors question whether amyloid fibrils could be used to deliver gene therapies instead of using viruses.
To keep rural healthcare workers, Missouri is helping cover their childcare costs | STL Today 10/31/26
“Missouri has awarded $1.46 million in federal Rural Health Transformation Program funding to expand childcare support for rural healthcare employers and help communities address shortages.”
Google just gave students access to hundreds of textbooks in Gemini Notebook — here’s how | Tom’s Guide 10/30/26
Gemini Notebook (previously known as Google’s NotebookLM) has just unlocked over 700 textbooks to be used for deep research sessions.
The actual sky of Van Gogh’s Starry Night: a multidisciplinary reconstruction | Nature 10/22/26
New research bridging art and astronomy shows that the sky painted by Vincent Van Gogh in his painting The Starry Night matches the stars seen in the dawn sky around July 22, 1889.
Ruth Ann Crystal MD
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