Healthbeat

Measles concern at Newark airport. NYC fire safety. What to know about medspa peptides.

2026-05-01T16:13:38+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Despite my allergy-induced congestion and mildly itchy eyes (yes, pollen is still quite high), I’ve been LOVING the weather this week. I hope you’ve all had a chance to get outside and enjoy it (and remember to do your tick checks 😉).

For public health news this week, I’m covering a measles exposure at Newark Airport and a local pediatric emergency room, the importance of closing doors for fire safety, and peptides being sold at New York City medspas. With the seasonal change, I’m taking a break from reporting on respiratory viruses, but I’ll be back if anything important comes up. Okay, let’s get to it.

Measles exposure at Newark Airport

New Jersey has reported a possible measles exposure at Newark Airport last week. Anyone who visited these locations during these dates and times may have been exposed:

Newark Liberty International Airport, Terminal B. April 14, 5:30 a.m.-9 a.m. Monitor for symptoms until May 11.
Pediatric Emergency Department, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, New Jersey. 11:15 p.m. April 17 through 3:15 a.m. April 18. Monitor for symptoms until May 11.

Potentially exposed people should contact their health care practitioner if they develop measles symptoms, which usually start like a cold and progress to a rash.

So far, no cases have been identified following these two exposure events. If you do develop symptoms, it’s important to call your doctor or clinic before you visit in person so special precautions can be taken to prevent further spread.

What this means for you:

The best thing to do is to make sure you and your children are vaccinated.
- Kids under 6 months old. Not yet eligible for the measles, mumps, rubella vaccine. If mom was vaccinated, then babies under 6 months should have some protection from immunity passed from mother to baby. This immunity wanes within the first 6 months.
- Kids 6 months to 1 year. Early vaccination can be considered, especially if there’s upcoming travel planned. However, since this is an isolated case in New Jersey and not an outbreak (which is defined as three or more cases), health officials aren’t specifically recommending early vaccination.
- Kids 1 year and older. Follow the standard MMR vaccine schedule, typically administered at 1 year and again between ages 4 and 6.
- Adults. If you have not been vaccinated or are unsure of your vaccination status, it’s a good idea to discuss getting a shot with your doctor.

I’ve seen a lot of people asking about titer tests to confirm immunity. While titers measure antibodies in the blood, they do not account for T cell and B cell immunity, which also offer protection. The main reason to get titers would be as a matter of insurance coverage for a booster, as some plans won’t cover the cost unless titers to one of the MMR viruses come back negative. We can’t give medical advice, but if you’re concerned about whether you are still immune, ask your doctor about getting your titers checked or getting a booster.

To dive deeper, YLE National has a great measles FAQ post.

Building fire codes and violations can mean life or death — here’s how to check yours

Tragically, two people died in a five-alarm fire in the Bronx last week. This week, FDNY investigators said that the outcome could have been different if doors weren’t left open during the fire, allowing it to spread and the stairwell to fill up with smoke, where the two victims were found.

This is not the first time New York City has seen this scenario play out. The January 2022 Twin Parks fire in the Bronx — the deadliest New York City fire in decades, which killed 17 people — was also linked to doors that failed to close, allowing smoke to fill the stairwell of a 19-story building.

I probably learned these lessons when I was in elementary school during fire drills, but nothing sticks like seeing the tragic outcomes play out in real time. The lesson is stark, yet simple: A closed door is a fire barrier. It buys time and saves lives.

What to do:

Heaven forbid there’s a fire in your building, close every door behind you when evacuating — don’t prop building entrances or stairwell doors. And remember: If your apartment door feels hot, do not open it — seal gaps with towels, go to a window fire escape, and signal for help if you need it.
This week, walk your building’s fire escape route so you know it before you need it.
If self-closing doors in your building are broken, report it to your super or call 311. (You can also look up previous building violations and complaints here.) Self-closing doors on stairwells are a legal requirement. Doing this prompted me to talk to our super about a stairwell door that wasn’t fully closing.
Now is also a great time to check your smoke detectors and make sure the batteries still have juice.
This is the kind of risk where preparation genuinely changes outcomes.

NYC medspas are offering clients experimental peptides that have not been FDA-approved

Peptides are getting a ton of attention.

I’ve seen them all over my social media, often promoted by wellness influencers for faster recovery, better skin, and reduced inflammation. But it’s no longer just online. They’re showing up in New York City medspas now, too.

A recent Gothamist report found that Apollo House, a medspa near Union Square, offers a “peptide stack membership” that includes injections of BPC-157, TB-500, and GHK-Cu. These are marketed for healing, recovery, and anti-aging. But they have never been Food and Drug Administration-approved for these uses, and the human evidence for their injection is limited. Several other medspas offer similar packages.

I’m not going to do a full peptide deep dive here, as YLE National just covered that last week. If you want to understand what peptides are and where they stand with FDA, I recommend starting there.

For New Yorkers, there are a couple of issues at play.

New York has already raised concerns about medspas. A recent investigation found unlicensed medical procedures, sanitation violations, expired or unlabeled products, and other safety issues in medspas across the city. (I covered that here.)

When you add on this peptide layer, it gets even murkier. Gothamist reported that the New York state department that oversees compounding pharmacies (special pharmacies that custom-make drugs for patients and often market peptides) has not issued guidance on peptides or where the FDA stands on them.

This is concerning when these peptides are being used in medspas in ways that aren’t FDA-approved. This means that New Yorkers are being left to sort through the noise on their own, trying to sort fact from fiction about the safety of peptides.

We’re also hearing of people self-sourcing and injecting peptides from overseas wholesalers or online vendors, marketing them for “research purposes, not for human consumption.” This can be even more concerning because it may happen without clinical oversight or a reliable way to determine what is actually in the purchased vial.

I want to be clear that I don’t mean to fearmonger. Not all peptides are dangerous. Insulin and GLP-1 medications like semaglutide (Ozempic) are peptides with clinical trial data and FDA approvals for specific use cases. The concern is the growing gray market for unapproved injectable peptides, which leaves purity, dosing, clinical oversight, and potential long-term effects to chance.

What this means for you:

Do not self-inject peptides sourced online or from overseas vendors. There is no way to verify the purity, dosing, or potential for harmful effects.
If you are curious about peptides, discuss them with your primary care clinician. It’s better to talk to a clinician who knows your history than someone at a wellness spa who doesn’t have that context. And if you’re already using peptides, it’s a good idea to tell your doctor.
Watch for updates. I’ll be keeping an eye on the FDA advisory committee meeting in July and sharing anything I learn.

Bottom line

You’re caught up on New York’s public health news. If there are other topics you’d like to see covered here, please drop me a comment here. See you next week!

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

NY health update: Declining MMR vaccinations, high Black maternal death rates, fish safety, and spring health alerts

2026-04-24T15:55:34+00:00

Before I jump into this week’s newsletter, I have to give a shoutout to my mom, who just ran the Boston Marathon. Watching her train so hard, get up at the crack of dawn, and then run 26.2 miles with 30,000 other runners was incredible. I’m so proud of her.

And congratulations to everyone else who left it all on the course last weekend. The videos of runners helping other runners over the finish line, people giving everything they had, and the volunteers, medics, and coordinators making sure everyone stayed safe and cared for — wow. Man, I love runners.

Okay, back to this week’s New York Dose. I’m covering new data on childhood MMR vaccination, what New York is doing to reduce Black maternal mortality, an environmental win for people fishing the Lower Hudson, and a few spring health updates, including what I’m doing to get ready for warm weather.

NYC childhood MMR coverage is down

New York has long had some of the highest vaccination rates in the country. But even here, cracks in that strong foundation are starting to show. In New York City, new data suggest routine childhood vaccination is being delayed. In March, the city reported that about one in three 2-year-olds had not received all doses of the seven recommended vaccines, prompting officials to launch a new campaign in response.

This is the kind of shift that can seem small on paper, but it’s exactly how vulnerability builds quietly over time.

One of the clearest warning signs is measles, mumps, rubella coverage. In 2024, 93% of New York City children ages 24 to 35 months had received at least one MMR dose by their second birthday. In 2025, that dropped to 89%.

Percent of New York City children ages 24-35 months who received at least one measles, mumps, rubella vaccine by their second birthday.

That matters, especially right now. As of this month, New York state has confirmed eight measles cases this year. Nationally, we’ve seen how quickly measles can spread in communities with lower vaccination rates (YLE national has covered that here). And in 2019, New York City experienced a major outbreak, with 649 cases in a largely unvaccinated community in Williamsburg.

Even small percentage-point drops matter. In a city as large as New York, they translate to thousands more children vulnerable to measles if the virus is introduced.

This is one of those issues that can feel abstract until it isn’t. Delayed vaccination leaves young children vulnerable during the exact years when some vaccine-preventable diseases can hit hardest. Measles is extraordinarily contagious, and community protection depends on keeping coverage high.

Black mothers in New York state die from pregnancy-related causes at 4x the rate of white mothers

Black Maternal Health Week (April 11–17) just wrapped up across the state, and unfortunately the numbers underlying it are striking. The week exists in part to address some of the most persistent and devastating disparities in American medicine: Black women are substantially more likely to die from pregnancy than mothers of other races. State data estimate that Black women died of pregnancy-associated causes about four times more often than white women in New York. In New York City, it’s about five times higher.

That gap is shocking, and frankly, unacceptable. But New York is taking steps to reduce Black maternal mortality by putting several policies in place to help.

Here are some programs in New York aimed at reducing maternal deaths:

Postpartum coverage now lasts a full year. New York Medicaid and Child Health Plus extended postpartum coverage from 60 days to 12 months, helping more families stay connected to care during a period when serious complications can still happen.
Doula care is covered by Medicaid. New York Medicaid covers doula services during pregnancy and up to 12 months postpartum, including prenatal visits, labor and delivery support, and postpartum care. Eligible New Yorkers can find participating doulas in the Medicaid program here.
New York became the first state in the country to offer paid prenatal leave. Since Jan. 1, 2025, New York has required private-sector employers to provide pregnant workers with 20 additional hours of paid prenatal leave for pregnancy-related medical care. This is the first law of its kind in the country, and it is separate from other leave options.

The paid prenatal leave policy is especially important. It gives workers paid time off for things like OB visits, testing, monitoring, and other pregnancy-related appointments. And that matters, because barriers to prenatal care are often not about willingness, but can be about whether someone can afford to miss work. It may mean choosing between a clinic visit and food for dinner, a co-pay and prenatal vitamins, an ultrasound, and keeping the air conditioning on. Policies that reduce the financial cost of getting care are one of the clearest ways to reduce barriers to care.

What you can do to access benefits:

If you’re pregnant or recently postpartum and on Medicaid, confirm that your coverage extends for a full year after pregnancy.
If you want labor or postpartum support, check whether you’re eligible for a state-covered doula through New York’s Medicaid doula directory.
And if you work in the private sector, ask your HR department about your paid prenatal leave rights.

For the first time in 50 years, you can eat striped bass you catch from the lower Hudson River

New York state recently updated its fish consumption advice and says you can now eat some fish from the Lower Hudson River for the first time in 50 years. The updated advisory reflects decades of cleanup on the Hudson to lower polychlorinated biphenyls (PCBs — a toxic synthetic chemical) contamination enough to meet health guidelines.

The biggest update is for striped bass: Pregnant women and children under 15 can now eat one meal per month, and the general population can eat up to four meals per month from the Lower Hudson. But some fish, including carp and small-mouth bass, are still off-limits because of PCBs, so it’s still important to check the specific guidance before eating what’s caught.

For example, there are new advisories on forever chemicals known as PFOS, which apply to Lake Ontario, Lake Erie, Lake George, Lake Champlain’s Cumberland Bay, Seneca Lake, and others. So, if you fish or your family fishes, check the local updated guidance before eating your catch.

New York fish advisory regions.

This change is a good reminder that public health wins can be slow, and often unglamorous (no offense to the fish). But the fact that we have cleaner water, better environmental regulation, and long-term monitoring for these chemicals — and can see our progress firsthand — is worth celebrating.

Pollen and tick updates

Some quick notes on spring health.

Tree pollen is ramping up, with some parts of the state now experiencing high levels. For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen makes it worse.

Reducing pollen exposure comes down to a couple key behaviors:

Avoid pollen outside. Check local pollen counts (like on pollen.com) and limit outdoor activity during early morning and on high-wind, dry days. The best time to go outside is after it rains, which helps clear pollen from the air.
Avoid pollen inside. Remove shoes before entering your home, wipe down pets, change after being outside, shower especially before bed to rinse off pollen, keep windows and doors closed, and run a HEPA filter.

For a deeper dive, check out my recent post on pollen.

We’re also in the thick of tick season. From now until about October, ticks will be active across New York, including in New York City. If you’re heading to parks, wooded areas, or anywhere with brush and tall grass, use repellent, and do tick checks on yourself, kids, and pets.

Emergency department visits for tick bites in the Northeast so far this year (green) compared to last year.

Last quick segment. I know the weather has been all over the place, from gorgeous 88-degree afternoons, back to the icy rain we have this week, but I wanted to get a couple things on your radar as we get closer to more warm days.

First, the program that provides free air conditioners is now accepting applications across New York state. This is important because extreme heat is New York’s most deadly weather.

To see if you qualify to get a free air conditioner through the Essential Plan Cooling Program, check out the qualifying conditions and application here.

Second, now is a good time to check the expiration date of your sunscreen. The active ingredients that block UV rays in sunscreen degrade over time, reducing effectiveness, increasing sunburn risk, and potentially causing skin irritation or rashes. It’s a good idea to make sure what you have on hand isn’t expired, and replace it if needed.

Bottom line

You’re all caught up on New York public health news. Have a great weekend, and I’ll see you next week!

Love,

Your NY Epi

Pollen and ticks on the rise, changes to the Essential Plan, and NY bills to protect vaccines

2026-04-03T17:26:55+00:00

There’s a ton going on in the world of New York health, so let’s jump right into it.

Pollen is here. Ugh.

Is anyone else starting to notice the little tree buds and green sprouts starting to pop up? And despite the confusing false spring/second winter chaos weather we’ve been experiencing in New York, daily temperatures have been warming. That means we can expect local pollen counts and allergies to increase over the next several weeks, along with those cute little sprouts.

Most U.S. communities see three pollen waves — trees, grass, weeds. New York is currently in the tree pollen season. This is relevant because individual allergy sensitivity can vary by pollen type.

If you feel like allergies have been starting earlier or lasting longer, you aren’t imagining it. Over the past few decades, allergy seasons in New York have gotten worse, partly due to climate change and warming temperatures. Earlier this month, the 80-degree day we had in New York City was record breaking — the earliest 80-degree day we’ve had on record.

The length of the average allergy season has now grown by over three weeks since 1970, with higher pollen counts.

Longer and more intense pollen seasons can exacerbate allergies and respiratory conditions for New Yorkers. While simply annoying for many of us, seasonal allergies can actually be dangerous for many with asthma — every spring, emergency department visits for asthma spike.

For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen season really takes off. There are also many actions we can take to reduce pollen exposure and prevent it from entering your home:

Check local pollen counts.
Leave shoes at the door and change clothes after outdoor activities.
Wipe off furry animals after they’ve been outside.
Shower before bed.
Keep windows closed during peak pollen times (midday).
Run air conditioning or HEPA filters.
Dust and vacuum regularly.

Dr. Zach Rubin, an allergy doctor, joined YLE on the America Dissected podcast last year and gave great tips on managing allergies:

To relieve sinus symptoms, it can help to rinse your nose with saline water (like with a neti pot), but only using distilled or sterilized water. I’ve found neti pots to really help.
For medications, second-generation antihistamines like cetirizine (Zyrtec) tend to have fewer side effects than diphenhydramine (Benadryl). As always, talk with your doctor or pharmacist for more information on medications.

Alpha-gal, aka meat allergy, from ticks is increasing in NY

Alpha-gal syndrome, the red meat allergy caused by lone star tick bites, is rising in New York, and Long Island is a hot spot. The Centers for Disease Control and Prevention estimates that 96,000 to 450,000 people in the United States may have been affected since 2010, and cases have been increasing. Suffolk County stands out: CDC data suggest it accounts for about 4% of suspected cases nationwide.

Symptoms can include:

Hives
Stomach pain
Vomiting or diarrhea
In more severe cases, anaphylaxis, which is life-threatening

Reactions can begin 2–6 hours after eating red meat or other mammal-derived products, which can make it harder to link consuming meat with the reaction.

It used to be that alpha-gal syndrome was mostly found in people who spent a lot of time outdoors or in the woods (like hikers, hunters, farmers, and outdoor workers). But now, many communities are reporting it to be more common, even in people who don’t spend much time in rural outdoor spaces.

So how does a tick bite turn into a meat allergy? After feeding on mammal blood, the lone star tick carries a sugar molecule called alpha-gal in its gut. When it bites a person, trace amounts of that sugar slip into the body through its saliva. Because humans don’t naturally carry alpha-gal, our immune system may treat it as foreign and start making antibodies against it (i.e., have an immune response to the sugar molecule). Later, when that same person eats red meat or other mammal products, the immune system recognizes alpha-gal again — and can trigger an allergic reaction, often several hours after a meal.

What else to know:

How long does it last? It’s considered a chronic disease, persisting indefinitely. For some, sensitivity fades after 1–5 years without new tick bites.
Is there a blood test? Yes. A specific blood test can measure IgE antibodies to alpha-gal. It’s the most reliable diagnostic tool available today.
Why is it hard to track? Cases are not nationally notifiable, so public health officials don’t get complete real-time data.

The best protection against alpha-gal syndrome is the same as with Lyme disease: Prevent tick bites in the first place.

Health policy updates

Changes to the Essential Plan and what it means for insurance coverage

But first, where are my “Pitt” fans at?

Remember how earlier this season there was a construction worker (Orlando) who came in with diabetic ketoacidosis after rationing his insulin because he couldn’t afford it? While the acid built up in his blood was life-threatening, he was terrified of what the hospital bill would be. He worked multiple part-time jobs, none of which provided insurance, and he made just above Medicaid’s income cutoff. He was fully employed, but still couldn’t afford health insurance.

This story hit close to home for New York.

New York’s Essential Plan was built for people in this exact situation: those who don’t get insurance through work but earn just over the limit to qualify for Medicaid. It now covers 1.7 million New Yorkers, up from 380,000 when it launched in 2016.

But the program is now shrinking. After budget cuts from the “Big Beautiful Bill Act” (HR 1), New York asked the Center for Medicare and Medicaid Services for permission to switch the current Essential Plan to an older structure. (I wrote about it last month.) CMS just approved that request last week (which to be honest, was a pleasant surprise). This means that income-based eligibility for the Essential Plan will now drop from 250% of the federal poverty level, to 200% on July 1, 2026. This change preserves Essential Plan coverage for about 1.3 million New Yorkers statewide, but about 500,000 are expected to lose it.

For single adults, this means that the income cutoff falls from ~$40,000/year to ~$32,000/year. For a family of four, that threshold drops from ~$83,000 to ~$66,000. People making just above the new thresholds will now likely be pushed to the marketplace to pay for insurance, where coverage can cost far more ($10,000-$12,000 per year out of pocket) with higher deductibles that many families simply can’t afford.

While this is bad news, it could have been a whole lot worse. If CMS didn’t approve New York’s workaround, the entire Essential Plan could have shut down. This move doesn’t save everyone’s coverage, but it did prevent a total collapse.

Here’s what to do:

Check your pay stubs: If your income is between $32,000 and $40,000 as a single adult or ~$66,000 to 83,000 for a family of four, watch your mail closely.
New York has started notifying affected New Yorkers, and coverage changes will begin July 1.
Visit NY State of Health to explore your options, or call the helpline at 1-855-355-5777.

Something to watch: New vaccine bills in NY

Gov. Kathy Hochul and New York lawmakers are moving forward with two bills that would further protect vaccines in New York, as federal vaccine policy has become unstable.

The first bill focuses on insurance coverage for vaccines. It would require state-regulated insurers to fully cover the costs of vaccines recommended by the Advisory Committee on Immunization Practices or recommended by the state’s health commissioner. The goal is to make sure that insurance coverage continues even if federal ACIP recommendations change.

This bill would require private insurers and state-sponsored insurance to cover the cost of these vaccines. So far, it does not make any changes to vaccines covered by Medicaid or the Vaccines for Children program, both of which are still linked only to ACIP recommendations.

The second bill is about broader immunization guidance. It would remove references to ACIP in multiple state laws, like school immunization requirements, the recommended schedule for newborns, and pharmacist vaccine administration rules. Like the first bill, it shifts guidance toward the New York state health commissioner. This could be good, but it could also be risky in the future — politics change, and there’s no guarantee that future commissioners will be as evidence-forward as ours is right now.

The proposed bills build on the executive order Hochul put forward in the fall to preserve vaccine access, and would put those actions into state law. It’s a good step. These bills are also an example of how vaccine access is increasingly becoming a hyperlocal issue. But the bills still need to pass through the state legislature, so they aren’t set in stone yet.

Bottom line

You’re all caught up on New York public health news! Enjoy this weather, and consider stocking up on tissues and bug repellent. :)

Love,

Your NY Epi

What to know about screening for breast cancer

2026-03-27T13:30:00+00:00

Next month, I turn 35. With guidance in the United States saying most women at average risk shouldn’t start routine breast cancer screening until age 40, it honestly hasn’t been top of mind for me. I’ve thought of breast cancer as something to think about for “later me.”

But recently, that has changed.

Last year, a friend of mine was diagnosed with breast cancer. At 34 years old. It was shocking to say the least. Thankfully, chemo worked incredibly well, and her latest test didn’t detect any cancer cells. Hallelujah.

Then, this past week, Amanda Peet, born and raised in New York City, wrote a moving essay in the New Yorker about being diagnosed with breast cancer while also caring for her dying parents. Susie Wiles, White House chief of staff, recently announced her diagnosis. Two years ago, my aunt survived breast cancer. So did a good friend’s wife.

With each of these stories, I started realizing that while “start at 40” sounds simple, it’s really guidance for people with average risk. And not everyone is at average risk.

So, I started reading. Here’s what I’ve learned, and why some women may want to talk to their doctor or a clinic about getting screened earlier than 40.

Breast cancer is common in New York, and early detection matters

Breast cancer is the most common cancer among women in New York state. Every year, about 16,700 women in New York are diagnosed with breast cancer, and about 2,500 women die from it.

Female cancer rates by type of cancer in New York state.

It is estimated that 1 in 8 women will develop breast cancer during her life.

Men also get breast cancer, but it is very rare. About 160 men are diagnosed with breast cancer each year in New York state.

While breast cancer is serious, outcomes and survival are much better than they used to be, thanks to earlier detection and better treatment.

At the same time, breast cancer is not just one disease — outcomes depend on the cancer subtype, its biology, and the stage at diagnosis. That’s why screening matters so much: Earlier detection can mean less aggressive treatment and better odds.

There are important differences in who gets diagnosed, what type of breast cancers are prevalent, and access to treatment. White women are more likely to get breast cancer than Black women, but once they have the disease, Black women are more likely to die from it. Black women are also more likely to be diagnosed with aggressive breast cancers — Black women under 50 have double the rate of triple-negative breast cancer compared to White women. (YLE covered new research into mRNA vaccines for TNBC earlier this year.) Disparities in access to treatment likely also play a role.

This is all to say that breast cancer is common, outcomes are not equal, and early detection matters a lot.

The real question: What makes someone higher risk?

When to start screening hinges on risk level. For women who are at average risk, the U.S. Preventive Services Task Force recommends mammograms every other year from ages 40 to 74. (The age to start screening at 40 instead of 50 was changed in 2024, and YLE covered it here).

But some women really should be screened earlier. Some may need extra screening, like an MRI in addition to mammograms. And for some women, the conversation should start as early as 30 years old.

The following factors can raise risk, and should be used to prompt a conversation about early screening with health care practitioners:

Family history of breast, ovarian, pancreatic, or prostate cancer in a parent, sibling, aunt, or uncle. (All these cancers have been associated with a higher risk of breast cancer.)
Known BRCA1, BRCA2, or other inherited gene mutation. (More on these genes below.)
History of chest radiation at a young age, like radiation therapy for Hodgkin lymphoma.
Possible dense breasts (more on this below), but this is not always an automatic trigger for early screening. (Should be paired with family history and other of the above risk factors).

Although older age is a major risk factor, we are seeing breast cancer rates increase in younger women.

Hypotheses for why breast cancer is increasing in younger women includes delaying having children (affects hormone levels and breast cells), increasing obesity, less movement and activity, increased alcohol use, and environmental exposures causing endocrine disruption.

Put simply, age alone does not determine risk. It’s also important to know that risk factors don’t explain everything — cancer can occur in a person with no family history, genetic predisposition, or other known risk factors. That means it’s super important for everyone, including those at “average risk,” to stay up to date with screening.

This five-minute risk assessment tool or this more comprehensive tool can help contextualize your personal risk. These aren’t perfect — they can’t tell who will and won’t get cancer. Rather, they should be used as a starting point for a conversation with a health care practitioner.

What about the BRCA genes?

BRCA1 and BRCA2 are genes that produce proteins that suppress tumors. When the genes have a mutation, the mutation prevents proper repair of DNA, significantly increasing the lifetime risk of developing breast, ovarian, and other cancers. Everyone has these genes, but mutations cause them to malfunction. Mutations in these genes can be inherited.

Variation in BRCA1/BRCA2 genes account for 5-10% of all female breast cancers. These variations are rare (about 1/400 women) but higher in some groups, like those with Ashkenazi Jewish heritage.

This is to say that while many cases of breast cancer are a result of BRCA gene mutations, the vast majority are not. Understanding overall risk, beyond these genes, is important.

What is dense breast tissue?

This is one of those things that I’ve heard about, but am only recently understanding.

Dense breast tissue is actually quite common — nearly half of women over 40 who get mammograms have it. Having dense breasts means that there is more glandular and fibrous tissue, and less fatty tissue in the breasts.

The reason it matters for breast cancer is two-fold:

It slightly increases the risk for breast cancer, and
It makes it harder to identify tumors on mammography results because dense tissue and tumors both appear white, meaning tumors can be easier to miss.

You can’t tell on your own whether you have dense breasts.

When you start getting mammograms, the facility conducting the exam will tell you if you have dense breasts (they are legally required to). If results are positive for dense breasts, the next step is to discuss with your health care practitioner if follow-up ultrasound or MRI are needed for extra breast cancer screening.

Another common question about screening: mammogram radiation

Yes, mammograms use radiation, because they are a type of low-dose X-ray. But the amount is small. A typical mammogram exposes someone to about 0.4 millisieverts (mSv) of radiation, which is about the same amount of natural background radiation a person would get over roughly seven weeks of everyday life.

This is the kind of question a lot of people have but feel almost silly asking. It’s not silly. If we’re asking people to do screening, they deserve honest answers about any trade-offs. For most women who are due for breast cancer screening, the benefit of catching cancer earlier outweighs the small risk from the radiation exposure.

What happens if the mammogram is positive?

If something is seen on a mammogram, that doesn’t automatically mean you have cancer.

In fact, only about 1 in 10 women called back for more testing are diagnosed with breast cancer. Most abnormalities in a mammogram are not cancer, and often result from harmless factors like dense breast tissue or cysts.

Anything that looks suspicious on a mammogram will get further follow-up tests to determine if it’s cancerous. This could be a diagnostic mammogram (in greater depth than a screening mammogram), an ultrasound, an MRI, and in some cases a biopsy.

The American Cancer Society has a good walkthrough on getting called back after a mammogram.

Accessing free screening in New York

If access is a barrier for you, free screening is available through the New York State Health Department. Call 1-866-442-CANCER (2262) to be connected to a Cancer Services Program near you. You can also visit the U.S. Food and Drug Administration’s website to find a mammogram location.

Bottom line

Don’t panic, but don’t assume guidance is one-size-fits-all. Screening and early detection enable the best outcomes.🎗💗

Love,

Your NY Epi

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

2026-03-19T14:45:00+00:00

There’s a lot going on this week in New York health news, including a city campaign trying to encourage conversations about vaccines, a win for vaccine access at the federal level, and a new program for PFAS testing in private wells. Let’s jump in.

NYC launched a new vaccine campaign. Here’s what it gets right, and where it misses.

The NYC Health Department has launched a new $1 million, four-week vaccine campaign: “Ask Questions, Get Answers, Vaccinate.”

When a friend first shared it with me, I was genuinely stoked. A campaign trying to create a feedback loop between institutions and local communities?! Yes, please! That’s exactly what we need right now —more health departments meeting people where they are, addressing real confusion, and empowering New Yorkers to make evidence-based decisions. Something that closes the distance between officials and the communities they serve.

But after looking into it further, and seeing the price tag, I was honestly pretty bummed.

The campaign will run across TV, radio, print, LinkNYC kiosks, and on transportation hubs, with a focus on neighborhoods with lower vaccination rates. Medical practitioners participating in the Vaccines for Children program will also receive posters and handouts to share with families. The city also launched a webpage that answers common vaccine questions and links to additional resources (which are pretty good FAQs).

The intent was there. And, it’s really important to acknowledge that people have questions about vaccines. That is a good thing.

How to win the war of narratives in global public health

But if you dig deeper, the campaign falls short in a couple of important areas:

The cost. A four-week ad campaign is not the same as long-term trust-building, and it’s expensive ($1M!), especially for its length, at a time when public health departments are scraping for pennies.
Telling people to “talk to your doctor” assumes they have a doctor they trust and can access. One in three Americans don’t have a primary care physician. It also assumes that clinicians themselves feel equipped and empowered to respond to these questions in a short 12-minute visit. What we’re hearing at YLE is that many clinicians need more support in this area.
This also doesn’t move us toward the affordability that the new health commissioner is prioritizing. Telling someone to see a doctor is, for many people, telling them to take time off work, find child care, and potentially take on debt.
There doesn’t appear to be much of a feedback loop. Good communication is not just sharing information; it also means listening and asking for feedback.
It misses some of the places where many families are actually getting health information now, especially social media.

If I had $1 million to spend, it wouldn’t be on a short-term advertising campaign. What is needed is something far more structural: direct public access to the health department and supporting trusted community messengers with the tools, staff, knowledge, and partnerships to reach families where they’re at, sustainably. I would also like to see greater investment in open communication channels for families to share their questions, concerns, and experiences back to the health department, instead of information flowing only top-down.

This could look like:

Hosting listening session in neighborhoods with lower vaccination rates.
Partnerships with community-based organizations, schools, and faith leaders.
Regular surveys and summaries of questions and concerns from New Yorkers.
Clinician training and tools for talking about hot-button topics.
Online and social media monitoring to know what is circulating in real time.

Being trustworthy happens over time, through a set of actions taken over and over and over again. Some of those actions include repeated conversations in communities, schools, clinics, and neighborhood spaces, through relationships.

What this means for you: If you have questions about vaccines, drop them in the comments here, and we will get back to you! And maybe we can send them to the health department as well.

New York is offering free PFAS testing and money to fix contaminated wells

If you own or rent a home with a private well in Westchester, Suffolk, Dutchess, Putnam, Orange, or Ulster County, this is for you.

New York state launched a new program on March 9 that offers free private well testing for PFAS, often called “forever chemicals.” If contamination is found above the state threshold, the state will also help pay to address it.

PFAS (per- and polyfluoroalkyl substances) are a group of manmade chemicals that persist in the environment and in the body. They’ve been used for decades in products like nonstick cookware, firefighting foam, and food packaging. They’re also linked to some health issues, including kidney and testicular cancer, thyroid disease, immune suppression, and pregnancy complications.

This matters especially for people with private wells because private well water does not get the same routine oversight as public drinking water systems. Private household wells are not regulated under the federal Safe Drinking Water Act, and government agencies usually do not monitor or treat private well water—that’s the responsibility of the owner. Sources of PFAS in well water can come from runoff from manufacturing, landfills, wastewater, contaminated soils, or fertilizers.

Here are the details for the new program:

Testing is free for eligible households in six counties.
If PFOA or PFOS (specific types of PFAS) levels are at or above 10 parts per trillion, New York’s drinking water standard, residents may qualify for financial help.
Eligible households can receive up to $5,000 for a PFAS treatment system, or up to $10,000 to connect to public water.
Renters are eligible too, not just homeowners.
Funding is first-come, first-served, with $1.5 million available per county.

Dutchess and Putnam County applications are open now. Orange, Suffolk, Ulster, and Westchester are expected to open in the coming months.

What this means for you: If you live in one of these counties and use a private well, this is a concrete opportunity to check for contamination and get financial help if a problem is found. Apply or learn more here.

A judge blocked RFK Jr.’s ACIP overhaul —what it means for New York

A judge blocked Health and Human Services Secretary Robert F. Kennedy Jr.’s overhaul of the Advisory Committee for Immunization Practices and the related changes to the childhood vaccine schedule. While this is a win for Americans, it likely doesn’t change much day to day for New Yorkers. That’s because New York had already moved to preserve prior vaccine recommendations, protect access, and require insurance coverage, creating a buffer against much of the federal disruption. (I’ve covered this previously.)

In practical terms, the ruling mostly restores nationally what New York had already protected locally.

The bigger issue here is continued confusion: Back-and-forth changes to vaccine guidance are hard for families, clinicians, and schools to follow, even when access is protected. For a deeper dive into the ruling and what it means nationally, read Katelyn Jetelina’s YLE National piece from Tuesday.

Bottom line

The bottom line this week is that the city’s new campaign to improve communications around vaccines has a lot of room for improvement, the state PFAS well-testing program is a clear example of environmental health in action, and the court decision on ACIP was a win for federal vaccine policy but doesn’t practically affect New Yorkers. You’re all caught up — see you next week!

Love,

Your NY Epi

How to support families through the trauma of deportation

2026-01-30T17:36:41+00:00

The actions and impacts of immigration enforcement have been weighing heavily on my mind this week, and I know I’m not alone in feeling that. YLE founder Katelyn Jetelina’s post earlier this week deeply resonated with me. Reports of ICE raids and deportations don’t just affect the individuals directly targeted. They ripple outward, with real consequences for community health and well-being.

I’m sharing updates from a piece I wrote last year on the health effects of immigration enforcement and raids, along with PDF guides and resources below on how to support families. Our team has compiled these resources for caregivers, educators, and clinicians supporting children, students, and patients during these stressful times.

Immigration enforcement and Immigration and Customs Enforcement raids can cause intense stress for entire families — children and caregivers alike. These guides focus especially on supporting kids and patients, but if you’re feeling overwhelmed or unable to use every suggestion here, that is not a sign of failure. It’s a reflection of the extraordinary pressure you’re under. Know that you are doing your best in impossible circumstances.

Please feel free to print, share, display, or use the guides in whatever way is most helpful to you and your community.

Here is the original post, with some updates. And thank you to MK Haber and Maria Zoco for their support on these guides.

The ripple effects of deportations

Immigration is inextricably linked to public health. Regardless of one’s political stance, understanding the health consequences and downstream effects of immigration enforcement activities is crucial for protecting community health. It’s important to understand the data and look at the bigger picture — that’s what I’m here to do.

What are ICE raids?

ICE stands for the U.S. Immigration and Customs Enforcement, a federal law enforcement agency whose mission is to enforce immigration laws within the United States and investigate activities like human trafficking, smuggling, and visa fraud.

“ICE raids” are operations conducted by ICE officers to find people who don’t have legal immigration status or have broken immigration laws. When ICE raids happen, undocumented immigrants are often detained and deported.

ICE raids have profound health effects on individuals and communities

There is a direct health impact of trauma. (More on that in a moment.) But fear alone can lead people to avoid seeking health care, such as not calling 911 during emergencies or delaying treatment until an illness becomes severe. Hospitals and ERs are critical locations for catching and treating diseases early. When care is delayed, treatments are more costly and more deadly.

In 2023, after Florida passed a law to require hospitals to ask for immigration status, 66% of noncitizens reported increased hesitation to go to the hospital (compared to just 27% of citizens).
After a similar law was passed in Alabama, visits to county public health clinics among Latino adults decreased by 25%.

But this doesn’t just impact the health of individuals who are undocumented, it affects the health of the communities as well.

Infections have the chance to spread more widely. In Los Angeles, research shows that patients who fear immigration authorities are about three times more likely to delay seeking care for tuberculosis. Without treatment, TB is contagious and can lead to severe illness or death.
Mental health impacts, like toxic stress, are not limited to undocumented immigrants; it can affect the community at large. A 2008 raid at an Iowa factory resulted in the detention of 400 people, spreading news throughout the state. A study found that in the 37 weeks following the raid, there were more Hispanic babies born with low birth weight due to stress in mothers across the community, while birth weights in babies born to white mothers remained stable.
Delayed care among extended families and communities who step up and offer support. In one study, a clinician described an example: “(My patient)…from Uganda with HIV/AIDS and end-stage renal disease was unable to consistently keep appointments for dialysis because she needed to work to support her sister’s two children after (her) sister was arrested by immigration.”

Children are especially vulnerable

There are many “mixed” status families. But families tend to behave according to the person with the least documentation — and they may forgo services that children who are U.S. citizens are eligible for.

Traumatic events like watching a parent or classmate get arrested and deported can have lasting effects on children. Even outside of acute events like raids, the prolonged stress from fear of deportation, potential family separation, and difficulty accessing essential services like health care and education can lead to toxic stress in children.

Toxic stress is the prolonged stress response in the brain and body (e.g., increases in heart rate, blood pressure, and stress hormones like cortisol). It has long-lasting effects because it can prevent normal development of neural connections in the brain.

We are hearing of families who are afraid to take their kids to school out of fear of deportation. Missing school can deprive students of more than just learning — for many, schools are one of the primary ways kids access nutritious meals, mental health services, social support, and other essential services.

These challenges are compounded by the short- and long-term financial impacts on families who lose a primary income provider due to deportation or detainment, as well as the heightened risk of children being placed in the child welfare system.

How can we support children?

Children going through immigration and separation experiences need extra support. This document from the National Child Traumatic Stress Network gives recommendations for caregivers to address the needs of children going through these events. Some key points include:

Create a safe and supportive environment: Speak calmly, reassure children, and provide comforting actions like hugging (with permission) or reading.
Address emotional and behavioral needs: Children may exhibit behaviors like irritability, clinginess, or withdrawal. These could be signs of trauma, not “bad behavior.” Encourage calming or enjoyable activities like drawing, games, or music.
Foster family and cultural connections: Support contact with family members when possible (e.g., visits, calls, or video chats). Avoid speaking negatively about family. Try to celebrate and honor cultural traditions and foods.
Provide trauma-informed care: To help manage stress, teach calming exercises like slow breathing or muscle relaxing. Limit exposure to distressing media while providing accurate, age-appropriate information about their situation.
Create a family preparedness plan: Make a plan for child care, know your rights, talk to your children, write down any important instructions like medications or allergies, and inform family members and emergency contacts.

What can educators do?

All children should have access to education. In New York, the State Education Department and the governor and attorney general’s offices have offered guidance for New York schools to help continue providing equal access, regardless of immigration status. Key points include:

Protecting student information
- The Family Educational Rights and Privacy Act prohibits disclosing personally identifiable information without parental consent (except in some legal circumstances). Student information should not be shared with law enforcement unless required by law (e.g., a lawfully issued subpoena/court order) or permitted under a FERPA exception.
- Avoid collecting immigration or citizenship status information, and anonymize such data when collected for specific programs.
- Do not collect (or ask for) Social Security numbers.
Responding to law enforcement requests
- ICE or law enforcement should only be allowed into non-public areas of schools (e.g., classrooms) when there is a judicial warrant. For any ICE request, involve district counsel immediately.
Supporting families affected by immigration enforcement
- Encourage families to update emergency contact information, including secondary contacts.
- Schools may recommend legal and advocacy organizations to help plan and establish standby guardianship.

What can clinicians do?

Many immigrant and undocumented people may be hesitant to seek medical care. Clinicians, whose primary role is to ensure patient safety, can take actionable steps to support these communities within the clinical setting. There are different laws for every state, but here are guiding principles for New York:

Ensure confidentiality and reassure patients that their immigration status within medical records is confidential under HIPAA (Health Insurance Portability and Accountability Act) and should not be disclosed, except as required by law.
- Avoid collecting or documenting any non-required immigration-related information, especially within patients’ medical records. (This is required in Texas and Florida, but not in New York.)
- Stop asking for Social Security numbers.
Address barriers to care.
- Offer telehealth options or home visits if possible.
- Help patients set up home delivery of medications.
- Connect families with resources and support, including mental health resources.
Know the legal landscape and understand patients’ rights, such as their right to emergency health care regardless of immigration status, and communicate these rights to patients.
- Stay informed about policy, like New York’s Executive Order 170, which prohibits inquiring about or disclosing immigration status unless legally required.
Train staff to respond to ICE or law enforcement inquiries. If ICE does show up:
- Obtain the officer’s information (name, badge number, etc.).
- Ask for any supporting documents (e.g., judicial warrant or subpoena). Make copies or take photos of these.
- Immediately call the hospital’s Risk Management Office or immigration liaison. They can contact proper legal channels and advise on the next steps.
- If officers take action before immigration liaisons can be contacted, take videos and photos of any enforcement actions.
- Do not try to actively help a person hide from ICE.

Providing compassionate, trauma-informed care is always critical, especially for patients who may have experienced fear or discrimination due to their status. The Trauma-Informed Care Implementation Resource Center has toolkits.

It’s also important to recognize clinician well-being and burnout. Witness to Witness is a peer support program designed by and for clinicians who care for patients affected by trauma, migration, violence, and systemic inequities.

Bottom line

Immigration raids have big impacts on the public’s health—both individually and for communities. As a community, we can take action to lessen health impacts. When we protect the health and well-being of our most vulnerable community members, we protect everyone’s health.

Love,

Your NY Epi

Blood supply shortage, Legionnaires’ disease in Harlem, a cold snap, and respiratory viruses

2026-01-23T15:39:12+00:00

This is a packed week for New York health news. From an urgent call for blood donations and Legionnaires’ disease cases in Harlem, to a Code Blue warning for freezing temperatures and the ongoing virus season, here’s your New York Dose.New York is facing a blood supply shortage. Your donation matters.

The American Red Cross and regional partners, including the New York Blood Center, are raising the flag that the local blood supply is critically low, with donations down to nearly 40% below hospital demand in parts of the state. Types O (the universal donor type), A‑, and B‑ are especially needed.

Why this matters

Hospital care — including emergency trauma response, childbirth, surgeries, cancer treatment, and chronic disease management like for sickle cell anemia — depends on a steady blood supply. National data show someone in the United States needs blood every 2 seconds, and nearly 29,000 pints are required daily. If hospitals don’t have enough blood on hand, clinicians may need to make hard decisions about who gets blood transfusions and who has to wait.

The challenge with having enough blood on hand is that it’s perishable —red blood cells last 42 days and platelets only five days. Winter holidays, bad weather, and a more severe flu season this year are resulting in fewer blood donations and cancelled blood drives. Even without these seasonal challenges, only about 3% of age‑eligible Americans donate blood each year.

How can we improve this system?

Addressing blood shortages requires innovation as well as better infrastructure. Strategies being explored to be less reliant on the limited donor supply include:

Blood substitutes designed to temporarily carry oxygen when donated blood isn’t available. But these substitutes can’t replace blood entirely — they don’t clot, lack immune functions, and aren’t widely available.
Lab-grown red blood cells show promise, especially for rare blood types. They are in the early stages of trials, but scaling the technology and science to meet hospital demand will be a big challenge.
Advances in medical procedures that require less blood, and better inventory systems that reduce waste and expiration, will reduce the amount of blood needed.

Despite innovations and improvements, community blood donations remain the backbone of the blood supply and are essential to hospitals.

What you can do now

Schedule a donation appointment through the Red Cross, New York Blood Center, or other local blood centers.
Encourage family and friends to donate — one donation can help up to three people.
Regular, year‑round donations help prevent seasonal shortages.

You can make a huge difference — donating blood literally saves lives.

Legionnaires’ disease under investigation in Harlem residential complex

City health officials are investigating two cases of Legionnaires’ disease at 3333 Broadway in Harlem, one of New York City’s largest residential buildings, home to about 10,000 people. Both cases occurred in the past year and were not fatal. Clusters like this raise concerns about water system exposure — especially following last summer’s Harlem outbreak that sickened more than 100 and killed seven (which I covered here).

While tests are being run, the building’s management and public health agencies have advised residents who are at higher risk for Legionnaires’ disease — those who are 50 and older, people with compromised immune systems or chronic diseases like diabetes or asthma, or who smoke — to do the following:

Use cold water for drinking and bathing.
Take baths or sponge baths instead of showers to avoid breathing in mist.
Boil water if hot water is needed.

If you live or work in the affected building and develop flu-like symptoms, contact a health care provider and mention this exposure. Early antibiotic treatment greatly improves outcomes.

What this means and why it matters

Even with only two cases, this situation raises several big issues:

It’s not surprising the residents are scared and upset. Seven people died in last year’s Harlem outbreak. Asking residents to take cold baths and avoid showers during a January cold snap is not realistic, especially in a building where many are older or have chronic illnesses. The communication and assistance for affected residents are lacking.
This is a health equity issue. Harlem has some of the highest rates of asthma, diabetes, and poverty in New York City, all of which increase Legionnaires’ risk. Communities here deserve rapid, culturally responsive public health action, not lagging testing and unattainable guidance. The city should prioritize better and faster Legionella inspections in Harlem and the surrounding areas, in particular.
There are policy gaps. While New York City requires regular Legionella testing for cooling towers, there is no law requiring routine testing of building plumbing systems (e.g., hot-water plumbing and domestic taps), even in large residential buildings like this one. Building water systems can be a source of Legionella, and in New York City, buildings aren’t tested for the bacteria until after two cases occur in the same building within a year. It’s important to note, though, that most big outbreaks in New York City have been linked to cooling towers.

A bill at the New York City Council (Intro. 434) would require large residential buildings to implement Legionella testing and water management plans for domestic water systems, but it has stalled. I’ll be paying attention to see if it picks up momentum again — I think that increased testing of large residential buildings has the potential to reduce the risk of these Legionnaires’ clusters.

Cold temps this weekend and a Code Blue

A strong cold snap is in the forecast this weekend, bringing “feels like” temperatures close to 0°F across New York and in New York City this weekend. Extreme cold can cause real health risks — from hypothermia and frostbite to worsening of chronic heart and lung disease, especially among older adults and people experiencing homelessness.

Tips to stay safe

Keep children and pets inside when temperatures drop.
Check in on older neighbors and people with chronic health conditions.
If you use a space heater, make sure to follow the manufacturer’s guidance to avoid fire hazards.

Code Blue

A Code Blue Weather Emergency notice is issued in New York City when the temperature drops below freezing (32°F or lower) between 4 p.m. and 8 a.m. — which will be the case this weekend. No one will be denied shelter in New York City during a Code Blue. Should you see a vulnerable person out in the cold, call 311, and an outreach team will be dispatched to offer assistance.

The ripple effects of ICE in communities

It’s heart-wrenching to watch communities live in fear — families unsure if they’ll be able to safely pick up their kids from school, loved ones waiting anxiously for family members to come home.

Immigration and Customs Enforcement raids and activity have increased across the United States, including here in New York. A new ICE processing and detention facility is slated to open just 50 miles north of New York City, a large facility opened last year in Newark, New Jersey, and ICE continues to hold contracts with several upstate county jails.

I wrote about the ripple effects of ICE enforcement on communities’ health and well-being last year, and it’s just as relevant today. The impacts go far beyond immigration policy. They reach deep into the health, safety, and stability of families and neighborhoods. But there are ways we can support each other — neighbors, educators, and clinicians play a huge role in mitigating harmful health effects. I cover ways we can support families and communities carrying the burden in the piece here.

Infectious disease ‘weather report’

Flu: The good news is that flu has decreased for the past couple of weeks in New York. The bad news is that this has still been a really bad flu year. In the first week of January, we saw the highest number of flu hospitalizations in a single week ever recorded in New York. In New Jersey, a young child died of a flu infection last week.

Flu cases in New York City.

I’ve been hearing a lot of chatter about the flu vaccine this year and questions about whether it was a good match. Although the circulating flu strain (subclade K) emerged after the vaccine formula was selected, effectiveness data from Europe in the fall showed that the vaccine still offered meaningful protection against hospitalization, even with the circulation of subclade k, with estimates of 70%–75% effectiveness in children and 30%–40% in adults.

RSV: RSV cases in New York are holding steady, but the good news is that emergency department visits are declining, which means less pressure on clinics and hospitals. This has been a milder RSV season in New York.

RSV cases in New York City.

Covid: Covid slightly increased in New York the past week, but overall the burden remains low. In New York City, only a very small percentage of hospitalizations are due to Covid — it isn’t a major driver of severe illness right now.

Covid cases in New York City.

No change to child vaccine schedule in New York

In case you missed it, the Northeast Public Health Collaborative announced that it is continuing to recommend the American Academy of Pediatrics’ Recommended Child and Adolescent Immunization Schedule, despite changes to the federal vaccine schedule (YLE founder Katelyn Jetelina covered those changes here).

Bottom line

You’re all caught up on New York health news. Stay warm, and see you next week!

Love,

Your NY Epi

Universal child care, NYC nurses’ strike, ACA subsidies, and the flu

2026-01-16T18:46:54+00:00

There’s a lot happening in New York health right now — from universal child care plans and the New York City nurses’ strike to rising health care premiums and continued flu. Let’s jump right in.

Hochul and Mamdani announce a plan for universal child care in New York

Last week, Mayor Zohran Mamdani and Gov. Kathy Hochul announced a joint plan to bring truly universal child care to New York City and extend it across the state.

Why this matters

Access to high-quality child care has been shown to benefit children’s and parents’ health and well-being:

High-quality early care and education programs are associated with positive developmental outcomes for children, including early learning, cognitive and language development, stronger school readiness, and emotional skills.
Child care has been associated with improved maternal mental health, including protection against symptoms of depression, by reducing stress and caregiving burden on parents.
Expanded access has also been shown to increase maternal employment and economic stability — important components of health equity. One assessment found that mothers’ labor force participation in New York City increased by 7.5% after universal pre-K for 4-year-olds was implemented.

It’s important to note that the quality of the care is what’s most important, not necessarily where the care takes place. High-quality care and education can take place at child care centers or inside the home, and with community-based caretakers or family members.

What’s the plan?

The joint plan to expand child care in New York City and the rest of the state is mostly driven by funding additional child care facilities and increasing staffing levels.

In New York City, the additional funding would help make 3k (child care for 3-year-olds) access truly universal. Right now, many families qualify for 3k but don’t have spots available in their neighborhoods, requiring them to commute unfeasible distances or find/pay for other child care. The funding would increase facilities and staffing in New York City.

The proposal would also launch a new “2-Care” program in the city, providing free child care for 2,000 2-year-olds in high-need areas beginning this year. The program would then be expanded citywide over four years, with the state fully funding it for the first two.

The state’s goals are to expand child care to all 4-year-olds (also called pre-k) statewide by fall 2028, and help counties build pilot programs to offer affordable child care. Hochul said the broader statewide plan would increase affordable child care to nearly 100,000 additional children through a mix of universal pre-K expansion, new community-based care programs, and broader eligibility for child care subsidies.

The plan also includes:

Increasing state funding for pre-k seats to at least $10,000 per child
Expanding child care subsidies, with most eligible families paying no more than $15 per week
Raising income eligibility to about $114,000 for a family of four

How will it be funded?

The governor has committed a $1.7 billion investment to expand child care across the state. If the legislature approves the budget, total child care and pre-k funding will be $4.5 billion for fiscal year 2027. The current proposal uses funds that already exist and would not currently require increased taxes. However, a plan for long-term funding of the expansion has not been proposed.

What happens next?

To accomplish the goals of universal child care in New York, there are a couple of big milestones ahead:

The state legislature still needs to approve Hochul’s funding requests, although the strategy of using existing state funds rather than raising taxes makes it more likely to go through.
The child care workforce will then need rapid growth, including hiring and training teachers, and improving the infrastructure of the current fragmented system of schools, day care centers, and private home caregivers.
The plan will also need long-term funding. If the program is successful, will taxpayers and lawmakers be willing to sustain its funding? Additionally, how will changes in federal funding affect New York programs? ($10 billion in federal funding for child care subsidies is currently frozen, including in New York, and being debated in the courts.)

Making child care truly universal in New York has great potential to improve the health of children and parents. I’ll be watching its progress closely and reporting back.

~140,000 New Yorkers now face higher health care costs

Remember the 43-day government shutdown in the fall? (Feels like years ago already, I know …) One of the issues at the center of the debate was whether to extend health insurance subsidies under the Affordable Care Act. While the government eventually reopened, Congress never reached an agreement, so the enhanced subsidies expired on Dec. 31.

Now, 140,000 New Yorkers, and millions of Americans across the country, are seeing their health insurance costs substantially increase.

I did a deep dive on ACA subsidies in November, but here’s a quick refresher:

Under the ACA, coverage in New York is tiered based on income, anchored to the Federal Poverty Level. Before 2021, anyone making just $1 over 400% of the FPL — roughly $60,000 for an individual or $124,000 for a family of four — got zero financial help through the ACA. This was called the “subsidy cliff.” It disproportionately affected those who don’t get insurance from an employer and don’t qualify for Medicaid or Medicare. This includes many self-employed or freelance workers, small business owners, farmers, and early retirees, among others.

In 2021, the pandemic relief package removed the subsidy cliff, allowing anyone to get financial help if their premiums were greater than 8.5% of their income. But when the ACA subsidies expired at the end of last year, the cliff came back.

Hochul’s office estimates the average health care cost for a New York couple who previously qualified for ACA subsidies is now up 38%, meaning an additional $238 per month. That’s nearly $3,000 more per year for couples. It also varies across New York; Mohawk Valley has seen the steepest increase at 49%.

(Data from Gov. Kathy Hochul’s office.)

Despite the increases, there are some signals that Congress may be moving toward getting these subsidies back up. Earlier this month, the House passed a bill to reinstate and extend the ACA subsidies another three years; this moved to the Senate for consideration, where negotiations are ongoing. (A similar bill was voted down just last month.)

If you have questions about your New York coverage options, premiums, or eligibility, call 1-855-355-5777 or visit nystateofhealth.ny.gov. The deadline to enroll in a Qualified Health Plan (i.e., if you aren’t eligible for Medicaid, Medicare, the Essential Plan, or Child Health Plus) is Jan. 31.

I’ll also keep watching this and share updates as they come.

NYC nurses strike: What’s happening and what it means for you

This week, nearly 15,000 nurses across some of New York City’s major hospitals — Montefiore Medical Center, Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, and NewYork-Presbyterian — went on strike. This is the largest health care strike in New York City’s history.

Why are they striking?

The union is calling for:

Legally enforceable nurse-to-patient staffing ratios, so that nurses aren’t overwhelmed with too many patients, increasing safe patient care.
Higher wages to keep pace with inflation and retain staff amid worsening nursing shortages.
Increased hospital security to reduce workplace violence, which has risen in New York City health care settings.

The hospitals have pushed back on the demands, stating they would cost billions of dollars over the next three years and that they can’t afford the increases in light of health care funding cuts from the One Big Beautiful Bill Act. They also say these funding issues will be exacerbated as more New Yorkers lose health insurance, resulting in more uncompensated medical care.

What this means for patients

The New York State Nurses Association is encouraging patients to continue seeking care at the hospitals. In preparation, hospitals have brought in travel nurses and temporary staff, and Hochul issued an executive order to temporarily suspend certain licensing and practice restrictions so that clinicians who are licensed and in good standing elsewhere can work in New York without penalties, allowing hospitals more flexibility to keep adequate staffing. Still, hospitals may resort to transferring patients to other hospitals if capacity is strained.

How long will it last?

The last major New York City nurse strike in 2022 lasted three days. This one is much larger with the potential to cause more disruption to hospital systems — the longer it continues, the more pressure hospitals may face to delay non-emergency procedures and divert incoming patients.

Why it matters

Staffing ratios are a public safety and health equity issue. Studies show that safe nurse staffing is linked to lower patient mortality, shorter hospital stays, and better health outcomes. A 2002 JAMA study showed that:

Hospitals that staff 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than a 1:4 nurse-to-patient ratio.
The odds of patient death increase by 7% for each additional patient the nurse must take on at one time.

Ensuring nurses have the time and bandwidth to adequately care for their patients is vital.

I’ll keep you updated if anything changes.

Infectious disease ‘weather report’

Flu: It looks like flu may have peaked in New York, but levels remain very high across the state and New York City. Even with recent declines over the past two weeks, we’re still at levels close to the peak of the 2023-24 season. In short: Flu is still widespread in New York.

Flu cases in New York City.

I wouldn’t be surprised if we saw flu pick up again — that happens in some seasons. Because flu will still circulate into February and March, it’s not too late to get your flu shot.

RSV: Remains high but may have plateaued. (I know I said that last week, but the data is holding.) The good news is that RSV this season is lower than in the past two years.

RSV cases in New York City.

Covid: In good news, Covid is still low across the state. State case data show that it may have peaked, and at a lower level than the late-summer surge we saw earlier this year.

Covid cases in New York this season and last season.

Bottom line

There’s a lot going on in the New York health policy world, with many evolving situations that I’ll keep a close eye on.

From an infectious disease standpoint, flu is still the biggest concern right now. Staying cautious, especially in crowded indoor settings, is still a smart move, particularly for those at higher risk (older adults, people who are immunocompromised, pregnant, etc.).

Love,

Your NY Epi

Higher life expectancy tops 15 health wins in New York

2026-01-09T16:36:21+00:00

If you know someone who works in health, chances are they banged their head against a wall at least once in 2025 — myself included. The past year brought the largest measles outbreak in decades and a tidal wave of false information on vaccines, including from the highest levels of government. Just days into 2026, the Department of Health and Human Services overhauled the recommended childhood vaccine schedule — not because of new science, but because of politics.

To put it simply, we’ve been through a health gauntlet.

But, despite the chaos, there’s a lot to still celebrate.

Across New York, health workers, policymakers, and supporters kept showing up, day in and day out, working toward a healthier New York, regardless of what was said on the news. That is worth celebrating.

I’ve put together a few milestones from the past year. It’s not exhaustive (there’s always important work happening behind the scenes that doesn’t make headlines), but here’s a roundup of some of the key wins that made New York a healthier place in 2025. I’ve also got your regular infectious disease weather report at the end.

1. New York City life expectancy reached a record high.

New York City’s average life expectancy hit 83.2 years, surpassing the city’s HealthyNYC goal years ahead of schedule. This milestone reflects progress across several issues, including things like chronic disease management, overdose prevention, and Covid-19 treatment and vaccination, among others.

New York City life expectancy.

2. New York City had a significant reduction in overdose deaths.

New York City had a 28 % drop in overdose deaths in 2024 — the largest decline in nearly a decade. Staten Island experienced the most dramatic drop, tied to localized interventions and broader access to naloxone and treatment.

3. Youth tobacco use declined in New York state.

Tobacco use among high school students across the state continued to fall to record lows, showing the effectiveness of prevention efforts.

4. New York strengthened vaccine access and regional collaboration.

In 2025, New York City and the state continued to expand vaccine access through:

Joining and helping lead the Governors Public Health Alliance, a 14-state effort to safeguard vaccine infrastructure, and the Northeast Regional Public Health Alliance.
Passing new state laws that guarantee Covid-19 vaccine access for all New Yorkers, despite changes in federal vaccination recommendations.
Continuing to recommend the hepatitis B vaccine birth dose for all newborns.

5. Investment in public health data infrastructure.

New York City launched a new Vaccination Data Explorer to help identify immunization gaps and inform outreach, and updated its respiratory illness dashboard. At the state level, New York also updated its respiratory virus reports and rolled out a new Heat Illness Risk tool to monitor extreme heat threats across the state.

6. Progress in medical debt relief and medication cost reductions.

Financial wins in 2025 included:

New York City relieved $80 million in medical debt for New Yorkers with low incomes.
New state laws eliminated cost sharing for asthma inhalers and eliminated co-pays for insulin under state-regulated plans.

These changes will improve access to live-saving medications and help reduce long-term health disparities tied to chronic illnesses like asthma and diabetes.

7. New York City opened a clubhouse to help New Yorkers with serious mental illness.

The Venture House clubhouse opened in Brooklyn to support people living with serious mental illness. Its goals are to provide community and social connections, supported employment and education, and recovery services through a supportive community of peers.

8. New York hospitals accomplished several medical milestones.

A patient was cured of sickle cell anemia at Cohen Children’s Medical Center using a groundbreaking new therapy.
Northwell Northshore University Hospital doctors performed a rare triple transplant — heart, kidney, and liver — on a Long Island patient that saved his life.
A pediatric heart transplant saved the lives of three kids at New York Presbyterian Morgan Stanley Children’s Hospital. When one child received a full heart transplant, parts of her former heart were able to be transplanted for two other children in need.

9. New state laws and research centers in New York advanced maternal and reproductive health.

Those who are pregnant or trying to become pregnant are now guaranteed 20 hours of paid leave for prenatal care.
New York state laws expanded protection for reproductive health care clinicians and patients, including privacy safeguards on prescriptions for abortion medications.
A new endometriosis research center was opened at the Cold Spring Harbor Lab on Long Island.

10. New York state surpassed the national breast cancer screening goal.

Some 81.9% of New York women were up to date on screenings, higher than the national goal of ~80.3%.

11. Improved air quality and citywide composting in New York City.

A new study showed that air quality in Manhattan improved following the implementation of congestion pricing. In the first 6 months of the program, PM2.5 (particulate matter in the air, associated with major health issues like asthma) dropped by 22% in the Congestion Relief Zone.
Citywide composting across all five New York City boroughs kicked off in 2025. The program helps build environmental resilience, reduce food waste sent to landfills, and reduce rats getting access to food scraps. It also provides compost back to city residents who can use it for gardening. Compost pick-up sites and events are located throughout the city from April to September.

12. NY SWIMS funded water safety and pool access.

Over $200 million was distributed through the NY SWIMS program to expand access to safe public swimming facilities across the state — supporting physical activity and reducing drowning risk.

13. The Wadsworth Center was recognized for national leadership in laboratory health science.

The Wadsworth Center, New York’s public health laboratory, was named a National Influenza Reference Center. Its director, Dr. Kirsten St. George, received a national award for her contributions to public health innovation, including expanding New York public health surveillance to incorporate wastewater monitoring and sequencing data to track new variants and outbreaks.

14. Albany began lead pipe replacement.

The state is funding a $129 million project to replace lead service lines in Albany, addressing a critical environmental health risk.

15. New York worked to increase temporary housing and meal access for those in need.

The construction of a new emergency shelter in Buffalo broke ground.
In Syracuse, a community-led program delivered a record-breaking number of free Thanksgiving meals to families in need. This was their 138th year serving Thanksgiving meals.

These victories are a testament to what’s possible when data, policy, and communities come together to improve health. Here’s to building on this progress in 2026 and beyond.

Quick infectious disease ‘weather report’

Flu: The flu has been intense this year! My partner and I got it this past weekend. But there’s some good news — data from New York show that we may be turning a corner.

In New York City, the latest data through Dec. 27 show that influenza is actually declining, i.e., we may have passed the peak.

Percent of emergency department visits due to the flu.

New York state shows the same — positive tests for influenza are declining. But we still see very high and increasing hospitalizations for flu, meaning we are still in the thick of the season.

RSV: Potentially at the peak. In New York City and New York state, emergency department visits and hospitalizations for RSV are still increasing, but the number of cases in New York state is starting to decline.

Covid: The same is true for Covid — the number of emergency department visits in New York City and New York state are still going up, but the number of cases is going down.

To sum it all up, declining case numbers for respiratory illnesses doesn’t mean we’re out of the clear. Influenza transmission is still really high, and many people are still being hospitalized. Don’t let your guard down yet. It’s still a good idea to keep masking in crowded, indoor spaces, especially if you are at higher risk for severe illness (immunocompromised, pregnant, older, etc.).

Bottom line

Even amid major federal disruptions to health guidance and policy, New Yorkers did what New Yorkers do best — we kept moving forward. And we have a lot to show for it. So here’s to building on that progress and improving health even further in 2026. Happy New Year!

Love,

Your NY Epi

New York health update: Nuts recalled, measles nearby, medspa red flags, flu rising

2025-12-19T15:56:47+00:00

How beautiful was New York this weekend with the snow?! I hope you all enjoyed it, stayed warm, and didn’t have any slips (I had to catch myself a couple times on ice.)

As we head into the holidays and many of us travel to be with loved ones, there’s some health news to keep in mind. This week, I’m covering a recall of mixed nuts, measles in Connecticut, health violations at medspas, and circulating respiratory viruses before YLE slows down for a holiday break. As always, drop us any comments on what you’re interested in hearing more about.

Let’s jump in.

Salmonella and Wegmans mixed nuts recall

Time for a pantry check: Wegmans grocery store is recalling two mixed nuts products for potential Salmonella contamination, sold in New York and eight other states and Washington, D.C. Products were sold between Nov. 3 and Dec. 1. No illnesses have been reported so far.

Products recalled:

Wegmans Deluxe Unsalted Mixed Nuts 34-oz. tub, Family Pack
- UPC 077890421314
- Lot 58041
- Best by Jul. 28, 2026
Wegmans Deluxe Unsalted Mixed Nuts 11.5-oz. bag
- UPC 077890421352
- Lot 58171
- Best by Aug. 10, 2026

Recalled mixed nuts from Wegmans.

Routine testing by the supplier found one lot of raw pistachios to be positive for salmonella. The company then initiated a recall after determining these pistachios had been further used in the production of the Deluxe Mixed Nuts products.

What to do:

Don’t eat them. Return for a refund or discard them.
If you ate them and get fever, diarrhea, vomiting, or belly pain, most people can recover at home. But call your clinician sooner if you’re pregnant, over age 65, immunocompromised, or if your symptoms are severe/dehydrating.

Medspas are everywhere. Here’s how to check if yours is legit

Medical spas (or “medspas”) — those day spa-like clinics offering beauty services — are popping up everywhere. While they might feel like day spas, offering services like manicures or facials, many of their other procedures — Botox, fillers, IV drips, etc. — require providers to have a medical license. So before you visit one for a holiday season facial or a new treatment, it’s a good idea to make sure you know what you’re getting into.

A recent investigation into 15 New York City medpas (all of which had been flagged by consumers or agency staff as potentially problematic) found several health and safety violations, many of which could put customers and employees at risk.

Percentage of medspas receiving violations by type.

If you plan to visit a medspa, there are a couple of steps you can take to make sure standards are being met:

If you are getting something that qualifies as a medical procedure (a rule of thumb is anything that breaks the skin or goes inside your body), check that your provider has a valid license. You can verify it through New York’s official database. Medical procedures must be performed by a licensed medical professional — like an MD, DO, PA, or RN — and in a licensed medical setting. It’s the law. All 15 of the investigated medspas were offering medical procedures without proper licensing.
Check the business’s license. An “Appearance Enhancement Business” license covers cosmetology-type services (like facials, manicures, and hair salon services), but it does not cover injectables or other more invasive medical services, such as Botox, IV drips, or liposuction.
Look for medical “green flags”:

A real medical intake (history, meds, allergies), informed consent, and a plan for complications.
Clear labeling and unopened product (especially for injectables).
Clean room setup (hand hygiene, sharps container, sterile supplies).

Over half of the investigated medspas had serious sanitation and hygiene issues; some offered foreign or unregulated medications, and others used expired or potentially fraudulent products.

Report concerns. To file a complaint against a medical practitioner in New York, you can contact the New York State Department of Health’s Office of Professional Medical Conduct for doctors/PAs or the New York State Education Department’s Office of Professional Discipline for other professionals (licensed or unlicensed).

Measles in Connecticut (and what it means for New York)

Connecticut just confirmed its first measles case in more than four years in an unvaccinated child under 10 in Fairfield County. The child had recently traveled internationally with family. Contact tracing by the health department is underway, and people who may have been exposed are being notified. The health department said unvaccinated or under-vaccinated (with fewer than two doses of MMR) children and adults, including those with vaccination exemptions, will need to be out of school for 21 days.

Measles is one of the most contagious viruses — it can linger in the air for up to two hours after an infected person leaves a room, and 9 out of 10 unvaccinated people exposed will get infected. It also isn’t “just a rash” and can cause severe illness: In children under 5 years old, 1 in 5 cases are hospitalized. In severe cases, measles can cause pneumonia and brain swelling.

What to do (in Connecticut, New York, and anywhere else):

Check MMR status for everyone in your household. Two doses are about 97% effective at preventing measles.
If you think you or your child were exposed and develop symptoms, call your doctor/urgent care. Make sure to call before showing up in person so that proper precautions can be taken to avoid exposing others.
Watch for symptoms: fever/cough/runny nose/red eyes, then rash that often starts at the hairline and moves downward.

It’s not too late to get vaccinated, especially if you will be traveling internationally or to any U.S. region with a measles outbreak.

The recommendation is:

Being fully vaccinated with the MMR vaccine at least two weeks before departure.
If the trip is less than two weeks away and the traveler is not immunized, getting one dose of MMR is advised.

As always, consult with your medical provider to discuss what’s right for you and your family.

Infectious disease ‘weather report’

Flu: Increasing sharply. The most recent data show that cases and hospitalizations in the state have increased by 29% and 75%, respectively. Emergency department visits and hospitalizations for the flu in New York City are also rising, with the largest increases among kids under 18.

Hospitalizations for respiratory viruses in New York.

RSV: Also increasing across the state, mostly in kids under age 4. Statewide, hospitalizations increased by 18%.

Covid: Slowly increasing in New York.

As we head into the holidays, when many of us will be traveling to see loved ones, flu is top of mind. To reduce the spread of illness, consider masking in indoor crowded spaces — I’ve been wearing mine on the train, in the airport, and at grocery stores — and reducing contact with others if you’re feeling sick.

Bottom line

You’re all caught up on New York public health news! I hope the holidays bring you peace, joy, rest, and all the cookies.

Love,

Your NY Epi

HIV cases rising in New York City in wake of pandemic disruptions in testing and care

2025-12-12T16:55:44+00:00

New York City is seeing an unsettling trend: New HIV infections are rising. The city was one of the earliest and hardest-hit of the HIV crisis. By the 1980s, thousands of New Yorkers were dying of HIV-related illnesses. Deaths peaked in the early 1990s, with ~7,500 New Yorkers lost each year in 1993 and 1994.

In the early years, government funding for HIV research was slow, in part because of stigma against the populations most affected, particularly gay men and people who inject drugs. In response to devastating losses, New York communities mobilized. Activist groups like ACT UP and GMHC led protests and demonstrations demanding faster research, more funding, and equitable care. Their efforts reshaped public health policy and laid the groundwork for today’s HIV treatment and prevention. But looming federal cuts are now threatening to undo some of this progress.

New York has since been lauded for its continued efforts in the prevention and reduction of HIV. But even the best systems can’t withstand prolonged stress, and recent data show some cracks. Key questions include: Why now? And how do we protect years of progress?

What is HIV, and where do we stand with treatment and prevention?

HIV (human immunodeficiency virus) is a virus that attacks and destroys the infection-fighting CD4 cells of the immune system, making it harder for the body to fight off other infections and some cancers. Without treatment, HIV can gradually destroy the immune system and lead to AIDS (acquired immune deficiency syndrome), the most advanced stage of HIV infection.

While there’s no cure for HIV, we have effective treatments and medications that can prevent infection:

Antiretroviral therapy (ART) reduces the amount of HIV in the body to levels that are essentially undetectable. When the virus is undetectable, it cannot be transmitted through sex (undetectable = untransmittable). ART allows people to live long, healthy lives, but timing matters. Starting ART early, before immune cells decline, leads to stronger immune recovery and longer life expectancy.
Pre-exposure prophylaxis (PrEP) can be taken before sex, injection drug use, or other potential HIV exposures. It reduces the risk of infection from sex by about 99%, and infection from drug use by about 74%.
Post-exposure prophylaxis (PEP) can be taken within 72 hours of potential exposure to reduce the risk of infection, but it’s less effective than PrEP.

These treatments and medications are truly remarkable for HIV prevention and treatment, but early testing, diagnosis, and access to care are essential.

Where we stand today

Thanks to breakthroughs in ART, new cases in New York dropped significantly after their peak in 1993. And since then, the downward trend in both new cases and deaths due to HIV has mostly continued.

History of the HIV epidemic in New York.

But that has recently changed — in 2024, for the second year in a row, New York City HIV cases increased.

Why are infections rising again?

Even in a state with some of the strongest HIV prevention programs in the country, New York was not immune to the ripple effects of the Covid-19 pandemic. The recent rise in HIV cases appears to be strongly tied to disruptions in prevention, testing, and care during the pandemic.

During the early stages of the pandemic in 2020, HIV testing plummeted across New York, and it still hadn’t returned to pre-pandemic levels by 2022.

Total HIV testing among NYS Department of Health AIDS Institute-funded providers in New York State.

Two-thirds of HIV testing clinics in New York City shut down in the early months of the pandemic. Community outreach at bars, nightclubs, and other venues also stopped. At the city level, only one of the NYC Health Department’s eight sexual health clinics remained open throughout the pandemic. To try to fill the gaps, the city health department created a sexual health hotline and launched programs to mail STI and HIV test kits and prevention supplies to residents. These were important adaptations, but they weren’t enough to close the gaps.

New PrEP prescriptions and total PrEP prescriptions (including among those already taking it) also dropped substantially during the first 6 months of the pandemic. There were fewer clinic visits, prescription refills, and conversations between providers and patients about PrEP.

Behind these statistics are deeper, structural issues. Housing instability, stigma, lack of adequate health insurance or employment, and unmet needs also continue to limit access to HIV services. Among those newly diagnosed in 2024 and interviewed by the NYC Health Department, 48% reported a lack of health insurance, 37% reported housing insecurity, and 13% reported food and nutrition needs.

While the pandemic didn’t create these problems, it did make them worse. Those problems show up in the data about who is getting infected and where infection rates are increasing.

There were 1,791 people newly diagnosed with HIV in New York City in 2024, a 5.4% increase from 2023. This follows a similar 6.9% rise the year before. In the rest of New York state, there were 734 new cases in 2024, no change from the year before.

HIV continues to reflect deep social and racial disparities:

85% of new diagnoses were among Black and Latino New Yorkers, who make up only 50% of the city’s population.
42% lived in high- or very high-poverty ZIP codes at the time of diagnosis.
75% of new cases were among men, 20% among women, and 4% among transgender women. Less than 1% identified as transgender men or another gender identity.

New York City communities that have the highest poverty rates (dark yellow/brown) also saw the highest rates of HIV diagnoses (dark pink).

But there are some bright spots, too. Screening is working better in some groups. Transgender women and youth ages 13–29 were more likely to be diagnosed during the earliest stage of infection, suggesting early detection is improving for these populations.

Access to care is also improving: 87% of people diagnosed with HIV in New York City are receiving care, and among those, 90% are virally suppressed.

Unfortunately, proposed federal funding cuts to HIV programs threaten to widen disparity gaps.

What federal HIV budget cuts mean for New York

Proposed federal budget cuts for FY 2026 could damage key programs in New York, especially in communities facing the highest risk.

These programs are on the line:

CDC HIV Prevention Program: The House budget bill proposes eliminating all $755.6 million in federal funding, including over $41 million for New York City. These funds support HIV surveillance, testing, and outreach. Without it, our ability to track and contain HIV will be weakened.
Ending the HIV Epidemic initiative: Congress could eliminate the entire $220 million budget for EHE. New York City is a priority site, and these funds currently support PrEP access, mobile testing, and same-day care.
Ryan White HIV/AIDS Program: The bill proposes a $525 million cut, including the elimination of programs that fund HIV care in community health centers, provider training, and support services for women, infants, children, and youth. Thousands of New Yorkers rely on Ryan White for care, housing, and case management.
Medicaid: Proposed changes would cut nearly $1 trillion from Medicaid over 10 years. In New York, almost half of all people with HIV depend on Medicaid.

Taken together, these cuts don’t just reduce funding, they remove the infrastructure that supports our entire HIV response. Right now, these programs are temporarily funded at last year’s levels under a short-term continuing resolution (which ended the government shutdown), but Congress will have to vote on the full FY 2026 budget in the coming months, putting them back on the chopping block. If enacted, New York could backslide on decades of progress, increasing disparities and seeing a resurgence of preventable infections.

Bottom line

New York has made incredible progress in the fight against HIV, but that progress is not guaranteed. Rising infection rates, persistent disparities, and looming federal funding cuts put us at risk of sliding backward. Continued investment in testing, early access to ART, and prevention are essential to keep moving forward.

Love,

Your NY Epi

New York state to require insurers to cover inhalers. NYC life expectancy rises.

2025-12-05T20:00:00+00:00

There’s a lot to cover and celebrate this week in New York public health. From improving New York City’s life expectancy to a new state law ensuring inhaler coverage, public health and policy are quietly working behind the scenes. But there’s still plenty of work ahead. Let’s jump in.

Insurance has to pay for inhalers in NY

No one should struggle to breathe because they can’t afford it, but that’s been the reality for many New Yorkers with asthma. The cost of inhalers varies widely, from $35 with insurance to over $500 if uninsured, and depending on the type (e.g., daily preventative vs. emergency relief inhaler). Starting in 2027, though, that reality will shift for many. Last week, Gov. Kathy Hochul signed into law a bill that will require state-regulated health plans — including those on the Affordable Care Act marketplace — to cover the cost of asthma inhalers fully.

Why this matters

Nearly 2 million New Yorkers (about 10% of the state) live with asthma. In New York City, the problem is even greater, especially in neighborhoods with higher pollution levels due to heavy traffic and industrial zoning. In the Bronx, for example, the neighborhood of Mott Haven has become known as “Asthma Alley” because of its concerningly high rates of childhood asthma.

Mott Haven has nearly double the rate of asthma-related emergency room visits for kids 5-17 years old (266.2 per 10,000) compared to city averages (143.7 per 10,000). And these are some of the highest asthma-related emergency room visit rates in the country. (For comparison, the national average asthma-related emergency room visit rate is 36.6 per 10,000 for kids aged 0-18.)

New York City asthma emergency department visits (ages 5-17) in 2023 by community district.

Access to free inhalers is more than a convenience — it’s a lifeline. This is especially true for low-income families living in neighborhoods with high air pollution, who are least likely to afford consistent care. Mott Haven is one of these neighborhoods: a community with many families earning low incomes, surrounded by three major highways and industrial warehouses, resulting in higher air pollution.

While this new law is a major step forward for health equity, it’s still a band-aid: It doesn’t address why asthma rates are so high in the first place. Until we tackle the upstream causes, like air pollution, housing quality, and environmental justice, New Yorkers will continue to need more inhalers.

The state has taken similar steps to make treatments accessible for other chronic conditions, such as capping insulin costs under state-regulated plans. Though this piecemeal approach raises a bigger question: Is the best solution to pass drug-by-drug legislation? Do we need individual bills for every lifesaving medication New Yorkers depend on, and that many families struggle to pay for? This approach is reactive, and many experts argue that broader reforms may be more effective at addressing the underlying root drivers of high drug pricing.

New York City just beat its own health goal, 5 years early

In 2023, the city launched HealthyNYC following a dramatic drop in life-expectancy — from 82.6 years in 2019 to 78 years in 2020, mainly due to the Covid-19 pandemic. The initiative aims to raise life expectancy to 83 years by 2030. But according to new data released last week, we’ve already passed that goal: Life expectancy in New York City is now 83.2 years — the highest in our city’s history since we began tracking.

What drove this change?

Covid-19 deaths dropped by over 90% from 2021 to last year. This alone added years back to New Yorkers’ lives. Other leading causes of death, like heart disease, diabetes, suicide, and homicide, also declined.

But not every number went in the right direction. Deaths from screenable cancers (think breast, colorectal, cervical) rose slightly — up 0.7%. These are cancers we can often catch early or prevent through routine screening, yet outcomes worsened last year in the city.

Additionally, major health inequities persist:

Screenable cancer deaths are still highest among non-Hispanic Black New Yorkers, and especially men.
Heart and diabetes-related deaths are most common in non-Hispanic Black communities.
Homicide and overdose rates disproportionately affect Black and Hispanic communities.

What’s working?

Some of the programs helping to improve life expectancy include:

The Public Health Corps, connecting high-risk communities to care.
Citywide media campaigns and vaccine outreach.
Distribution of 300,000+ naloxone kits and harm reduction services.
New investments in opioid treatment programs like Relay.
Doula and nurse home visiting programs for 20,000+ families.
Action centers focusing on neighborhoods with the highest premature death rates.

With the HealthyNYC initiative codified into law, these efforts won’t disappear with a new mayor or budget cycle — the city will keep working on improving these metrics. But these successes aren’t the finish line. There’s still a big question: How do we not just live longer, but live better? Some city leaders say the next chapter should focus on healthspan — the years of life spent in good health — not just lifespan. It’s also crucial that we continue to double down on closing health inequities across neighborhoods and populations.

Infectious disease ‘weather report’

Flu: Flu continues to increase quickly. The most recent data show that cases and hospitalizations in the state have increased by 117% and 99%, respectively. In New York City, emergency department visits for the flu rose by 142%.

Hospitalizations of respiratory viruses in New York.

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, hospitalizations increased by 21%, while emergency department visits in New York City went up by 71%.

Covid-19: Cases and hospitalizations are holding steady at low levels in both the city and across the state.

The New York state wastewater program recently launched a helpful update to its dashboard. They now color-code sites by whether they are increasing, decreasing, or stable for Covid-19.

Right now, most sites across the state have either stable or decreasing Covid-19 wastewater values. Sixteen sites, though, are reporting increases, with the largest spikes seen in Seneca and Tioga.

HIV diagnoses have gone up in NYC

A new report shows that last year, 1,791 people were diagnosed with HIV in New York City, up 5.4% compared with 2023. And huge inequities remain: 86% of people newly diagnosed with HIV were Black or Latino/a, and 91% of newly diagnosed women were Black or Latina. Among people newly diagnosed with known transmission category, 65% were men who have sex with men, 82% of whom were Black or Latino.

Upstate updates

If you are looking forward to ice fishing this winter, make sure to check the conditions of the ice before you go out. A minimum of three to four inches of solid ice is the general rule for safety. For more information and to learn about specific fish species in ice fishing, check out the New York Department of Environmental Conservation page.
A raccoon tested positive for rabies in Deansboro. This is a reminder to avoid touching wildlife. If you see any acting strangely (acting mad, shy, getting unusually close, or drooling or foaming at the mouth), stay away, and call your local animal control officer for help. (Find contact information on your city’s website).
Monroe County launched MonroeAlert, an emergency notifications system for residents to get alerts about critical situations in their community. Residents can sign up to receive alerts via text message, email, phone call, or mobile app about emerging issues like severe weather, public safety incidents, travel restrictions, and shelter information.

Bottom line

New York is making real progress, from adding years to our lives to making breathing a little easier for those with asthma. But equity and prevention must stay front and center. Our communities should strive to live better, in addition to living longer.

Love,

Your NY Epi

A flu surge, NYC overdose decline, and a shift in emergency mental health services

2025-11-21T17:00:00+00:00

There’s a lot to cover before the holiday next week, so let’s jump right in.

Infectious disease ‘weather report’

Flu: Flu is increasing quickly. The most recent data show that cases and hospitalizations in the state have increased by 78% and 53%, respectively. In New York City, emergency department visits for the flu rose by 104%.

Cases of respiratory viruses in New York.

Earlier this week, YLE National reported on a new flu virus mutation that could potentially lead to a bad flu year in the United States. We don’t know exactly how things will play out, but the bottom line is that flu vaccination remains our best protection.

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, hospitalizations increased by 70%, while emergency department visits in New York City went up by 40%.

Covid-19: Cases and hospitalizations are decreasing in both New York City and across the state.

As we head into Thanksgiving, when many of us will be traveling to see loved ones, flu and RSV are top of mind. To reduce the spread of illness, consider masking in indoor crowded spaces — I’ll be wearing mine on the train and in the airport — and reducing contact with others if ill.

Good news: Overdose deaths are declining in NYC — but progress is uneven

For the first time in years, New York City saw a significant drop in overdose deaths — a 28% decrease last year from 2023 — but that still totals 2,192 deaths: far too high.

Last year, 78% of overdose deaths in New York City involved an opioid, a reduction from 83% in 2023. Fentanyl remains the leading driver, involved in 73% of deaths, but that’s also down from 80% in 2023.

One success story is Staten Island, which saw the steepest drop in overdose deaths. A possible reason: the implementation of a hot-spotting strategy. Officials analyzed emergency medical services and hospital data to identify where overdoses were happening most. Then they deployed peer counselors to those areas with the life-saving opioid overdose-reversing medication naloxone (also known as Narcan), support services, and treatment referrals.

Over the summer, a hot-spotting program based off Staten Island’s was launched in the Bronx, as well. This is greatly needed as the Bronx still has the highest overdose death rate compared to other boroughs. I’ll be keeping an eye on the program’s progress and any outcomes reported.

Despite the encouraging drop, overdose is still a leading cause of premature death in New York City. And huge inequities still exist. Overdose deaths in Black and Latino New Yorkers remain about twice as high as the rate among white New Yorkers.

There are still actions we can take to continue to reduce the risk of overdose death among our fellow New Yorkers:

Carry naloxone (Narcan)

All New Yorkers can receive free naloxone and training from registered Opioid Overdose Prevention Programs on how to recognize the signs of an overdose and administer the medication.
Health Department vending machines: Locations can be found on this page.
Over-the-counter naloxone at pharmacies: Available without a prescription at most major chains (map here).
- Most insurance providers will cover all or part of the cost of naloxone, and New York state will cover copayments of up to $40.

There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit the 988 website for 24/7, confidential support.

Changes to the B‑HEARD program

Last week, Mayor Eric Adams announced a shift to B-HEARD — the Behavioral Health Emergency Assistance Response Division, a pilot program launched in 2021 to respond to 911 mental health emergency calls with trained medical and mental health teams. Under the new model, teams will move from two emergency medical technicians and a social worker to one nurse, a social worker, and an ambulance driver — all employed by NYC Health + Hospitals.

These teams are dispatched in cases of nonviolent but urgent behavioral health crises: suicidal ideation, substance misuse, acute mental health episodes, and similar situations.

In the triage process, 911 operators route mental health‑related calls based on criteria around safety and risk. If a situation is assessed as nonviolent and primarily behavioral health driven, it may be routed to B‑HEARD instead of the traditional law enforcement/emergency medical services response. The program operates in Northern Manhattan, the Bronx, Central and South Brooklyn, and Western Queens, from 9 a.m. to 1 a.m.

Let’s give it a closer look.

Why does this program exist?

Historically, almost all mental health 911 calls in New York City were routed to the New York City Police Department, sometimes alongside basic EMS responders. Some experts argue that this approach often lacks the de‑escalation skillset, therapeutic lens, and follow‑up needed for mental health emergencies.

There is evidence that when police are first responders in a mental health crisis, outcomes can be worse: Individuals in crisis may feel criminalized, unsafe, reluctant to seek help, and in worst cases may face use of force. For example, in the United States, people with untreated serious mental illness are estimated to be up to 16 times more likely to be killed by law enforcement during an encounter.

By deploying mental or behavioral-centered teams, B‑HEARD tries to reduce unnecessary police involvement, deliver more appropriate care at the scene, and connect people to community‑based follow‑up.

Has B‑HEARD been effective so far?

A city comptroller audit earlier this year found the program is promising in concept but hard to evaluate due to limited data and implementation gaps.

Key findings:

Between fiscal years 2022 and 2024, B-HEARD covered 96,291 mental health-related 911 calls during operating hours.
Only about 25% (just over 24,000 calls) resulted in a B-HEARD response.
Around 60% were deemed ineligible (some due to safety concerns, others because no EMS operators were available to screen).
Even among eligible calls, 35% never received a response for unknown reasons.
Critical process steps (assessments, follow-up referrals) were often incomplete or not documented.

On the positive side, among clients surveyed, the results were strong:

99 % said they were treated with respect.
96 % said the team helped them.

In short, the idea is promising, but the current program lacks data to properly evaluate its effectiveness at meeting its goals.

Why the change?

New York faces a shortage of EMTs and paramedics and has long ambulance response times. By freeing up EMS workers for broader medical emergencies, the city hopes to improve ambulance response times across the city.

New York City average end-to-end response times for ambulances for life-threatening emergencies was 12 minutes and 53 seconds during the week of Oct. 20 (the latest week available).

Importantly, during a behavioral health crisis, if additional medical backup is needed (e.g., someone becomes medically unstable), the driver/nurse team can summon an ambulance. The nurse offers stronger clinical capacity on‑scene than EMTs alone, potentially improving care and triage.

Looking ahead and my thoughts

With longer ambulance wait times, it’s a logical step to free up EMTs to shorten response times. And if there are enough nurses at NYC Health + Hospitals to redirect some to B-HEARD teams without disrupting hospital operations, having advanced medical support on the response teams could be beneficial. But the bigger question remains how effective this program has been at responding to mental health issues, while maintaining safety for those experiencing mental health crises and for first responders.

The other question at hand is the timing of this change. Adams has one more month on the job before Mayor‑elect Zohran Mamdani takes the helm on Jan. 1. Mamdani has signaled plans to expand B‑HEARD city‑wide beyond the pilot, and fold it into a new Department of Community Safety. Will these changes hold in Mamdani’s new administration? If not, will shoring up EMTs in New York City for one month make any real difference in ambulance wait times? Will the program go through another overhaul, potentially further limiting our ability to assess its effectiveness? These are the things I’ll be looking out for over the coming months, and I will report back with any updates.

Bottom line

As we head into the holiday, I’m feeling especially grateful for New York’s public health champions — the heroes and systems working behind the scenes to keep us safe. The encouraging decline in opioid deaths, expanded mental health outreach, and strong infectious disease surveillance systems are testaments to that.

To everyone working toward a healthier state: Thank you for all you do. Your work makes New York better, every single day.

I’m wishing everyone a restful Thanksgiving — indulge in that pie, wear those stretchy pants, and I’ll see you after our break next week!

Love,

Your NY Epi

ACA subsidy expirations: What they mean for New Yorkers

2025-11-14T14:54:54+00:00

If ACA subsidies expire, someone making just $1 over the cutoff could pay $5,000–$10,000 more per year for health insurance.

For those who are older, it could be even higher. Let’s break down what that means (and give an update on respiratory viruses at the end).

The longest government shutdown in U.S. history is over. Wednesday night, the president signed a bill that narrowly passed the House. The government is officially reopened.

But even as Washington moves to turn the lights back on after more than 40 days, another major fight over health policy looms. Republicans have promised to bring a separate vote in December on whether to extend the expanded Affordable Care Act subsidies, which are set to expire at the end of the year. These subsidies, introduced during the pandemic through the 2021 American Rescue Plan and extended by the 2022 Inflation Reduction Act, made health insurance more affordable for millions of Americans.

If they expire at the end of the year, health care will become more expensive for millions. But first, some background.

What’s ‘the marketplace’?

The marketplace (also called the exchange) is the online platform set up under the ACA where individuals can shop for, compare, and enroll in health insurance plans that meet specific government standards. It’s especially important for those who don’t get insurance through their jobs.

In New York, the marketplace is called the New York State of Health.
The ACA marketplace open enrollment period for 2026 coverage started Nov. 1 and runs through Jan. 15. Some states have different deadlines.

New York’s coverage framework: Who’s covered

Under the ACA, there are four tiers of coverage in New York based on income, using the percent of the Federal Poverty Level. These income thresholds are adjusted each year to reflect inflation. Here’s how it breaks down for 2025:

Income thresholds for ACA eligibility. (YLE)

Return of the ‘subsidy cliff’ and what the 400% FPL line really means

Before 2021, people who earned even just $1 over the 400% FPL got zero help, regardless of how expensive their insurance costs were. This was called the “subsidy cliff.” During the pandemic, the subsidy cliff was removed, letting anyone get help if premiums were unaffordable (greater than 8.5% of one’s income).

Now, with the new federal budget, the subsidy cliff is set to return next year. Those making just above 400% of the FPL — roughly $60,000 for an individual or $124,000 for a family of four — will be hit hardest if the expanded ACA subsidies expire. These middle-income families could see the steepest increases in their insurance costs.

A real-world example: a single adult in NYC

Take a hypothetical single adult living in New York City, making $63,000 per year — just over 400% of the FPL. Their employer doesn’t offer insurance. Today, with ACA subsidies, they would pay $446/month for a basic, silver plan from the marketplace ($5,335 annually). This is 8.5% of their income, capped by the federal limit.

Next year, without the subsidies, they would pay the full cost, around $867 per month ($10,404 annually). It almost doubles the price. This, compounded by the high cost of living in New York (with the average monthly rent for a studio apartment in New York City running about $2,500), could have serious consequences.

You can estimate your own insurance costs here through KFF.

For older adults, the costs hit even harder

Insurance premiums rise with age. Older adults tend to use more health care, more often, for more complex or chronic health issues, and insurers use age to price risk. A couple in New York City making $85,000 per year (402% of the FPL limit) would currently expect to pay about $602 per month ($7,224 annually) for a silver plan. Without the ACA subsidies, that would go up to about $1,734 ($20,808 annually)—almost triple the cost, and about a quarter of their total income. When accounting for rising premium costs, especially for older adults, it would likely be higher.

This couple could see annual insurance costs jump by more than $13,000 — a cost that would have significant implications for someone’s budget and any emergency cushion.

The takeaways

New Yorkers with the lowest incomes, who qualify for Medicaid or the New York Essential Plan (<250% FPL), will be insulated from these changes — this safety net is holding.
Many New Yorkers, especially older adults who don’t yet qualify for Medicaid (<65) and middle-income individuals without employer-sponsored health insurance, will face steep increases in insurance costs.
The “subsidy cliff” will return, causing those with incomes just above the threshold to face the highest cost increases.

If you’re unsure what you or your loved ones qualify for, visit nystateofhealth.ny.gov.

This debate isn’t over yet, so now’s a good time to understand what’s at stake. We’ll be watching closely.

Infectious disease ‘weather report’

Covid-19: Cases and hospitalizations are decreasing in both New York City and across the state. However, wastewater data (via Biobot and WastewaterSCAN) are showing signs of an increase in the Northeast and South. This could mean that we start seeing more cases and hospitalizations for Covid in the next few weeks.

Flu: Flu is increasing quickly. The most recent data show that cases and hospitalizations in New York have increased by 49% and 71%, respectively. In New York City, emergency department visits for the flu rose by 83%.

Cases of respiratory viruses in New York. (Figure from the NYSDOH Respiratory Surveillance Report.)

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, cases increased by 19%, while emergency department visits in New York City went up by 67%.

Data from the New York Department of Health shows that Covid vaccinations in the state are down by 30% compared to this time last year. Doses for those over 65, the group most vulnerable to severe illness, are down ~25%. With fewer New Yorkers getting vaccinated, our collective defenses are weaker.

As we head into the holidays, where many of us will pass through crowded airports and spend time with young and old family members, vaccination remains our best bet to protect ourselves and our loved ones.

It’s still a great time to get vaccinated. In New York, anyone over 3 years old can be vaccinated at a pharmacy. Kids under 3 need to get their Covid vaccines from a pediatric provider, like their pediatrician. Make sure to call ahead to ensure that the provider has pediatric doses of the Covid vaccine.

Bottom line

If Congress lets the expanded ACA subsidies expire, many middle-income New Yorkers, especially those just above the 400% federal poverty limit, could see their health insurance costs substantially increase. For older adults, this could hit even harder. Now’s a good time to stay informed about what’s being discussed in Washington.

Love,

Your NY Epi

NY youth tobacco use hits historic low. State of emergency for food aid.

2025-11-07T15:52:19+00:00

To each and every runner, volunteer, spectator, and crew member who participated in the NYC Marathon this past weekend, you are incredible. The sheer scale of coordination and determination to pull off this event shows us what New York is all about — grit, community, and dreams.

And it’s not just the runners. The marathon couldn’t exist without public investment — in parks, clean air, and safe roadways, as well as the labor it takes to keep the city moving. I want to give a special shoutout to the city sanitation department as well, as they did some heavy lifting to get the streets back in good shape for Monday.

Thank you to everyone who made this possible, and to those who lined the streets to cheer on Sunday. I’ll never forget the roar of the crowds. And how sore I was after. 😅

Now let’s get into this week’s Dose. We’ll cover updates to SNAP funding in New York, new data on declining tobacco use among teens, and respiratory viruses.

SNAP state of emergency in New York

Due to the ongoing federal government shutdown, a timeline for food aid for nearly 3 million New Yorkers is still unclear. Last week, Gov. Kathy Hochul declared a state of emergency to free up an additional $65 million in state funding for food pantries and hunger relief — enough to cover 40 million meals. The state also began mobilizing SUNY and Empire Corps teams to help food banks and expand the Supplemental Nutrition Assistance Program outreach on college campuses.

Then came a wave of legal pressure. On Oct. 31, two federal judges ruled that the SNAP freeze was unlawful. In response, the U.S. Department of Agriculture announced it would issue half of November’s SNAP benefits using contingency funds. But then, on Tuesday, President Donald Trump, in defiance of the two court orders, threatened to deny the assistance for the 42 million low-income Americans until the end of the shutdown.

Hours after that, White House press secretary Karoline Leavitt told reporters the administration would fully comply with the court and provide the partial food stamp payments. The back and forth on this continues - and has been exhausting, and only compounds the uncertainty many families are experiencing as they think about food for the next month.

Hochul’s emergency funds — $40 million for the Hunger Prevention and Nutrition Assistance Program and $25 million for Nourish NY — are filling some gaps. And these new emergency funds are on top of the $41 million in state funds for food assistance issued earlier last week, bringing the total state emergency funds to $106 million. But as Hochul emphasized, “No state can replace SNAP.” The federal program provides $650 million per month to New York residents. If half gets paid out with USDA contingency funds (~$325 million), and the state has committed $106 million, New York will have ~$431 million for SNAP in November — $219 million short of the need.

This isn’t only an economic issue. Nutrition insecurity worsens chronic disease, disrupts childhood development, and places enormous stress on mental health. Ensuring consistent food access is foundational to public health.

What you can do

If you’re a SNAP recipient: Monitor your EBT card closely and check otda.ny.gov for updates.
If you’re not: Volunteer or donate to your local food pantry. They need it now more than ever.
If you want to make your voice heard: Call your reps. Tell them hunger shouldn’t be a political tactic.

I’ll keep watching this story.

Tobacco use in New York hits a record low

Great news: Last month, a New York State Department of Health report revealed that youth tobacco use in the state has declined to its lowest level since the agency started measuring it 25 years ago. The agency found that fewer high school students reported using cigarettes, e‑cigarettes, or other tobacco products last year.

Tobacco use among high school students in New York state is the lowest it’s been.

Why it matters

If fewer young people pick up tobacco, fewer will carry nicotine dependence, lung disease, or cardiovascular risk into adulthood.
Lower youth uptake often predicts lower adult usage in the years ahead.
It shows that there is potential to move the dial.

The key here, though, is understanding what actually caused the reduction. I think the decline is likely due to a combination of new policies, outreach efforts, and educational initiatives. Over the past six years, several state policies have been implemented, including bans on flavored e-cigarettes, an increase in the minimum purchasing age, and restrictions on tobacco price discounts. The New York State Quitline also developed a program to help teens quit smoking called “Drop the Vape.”

While we won’t be able to determine the exact impact each of these changes had on reducing tobacco use among teens, gathering more data would help us better direct resources in the future.

Infectious disease ‘weather report’

New York state and New York City have rolled out updated, more user-friendly reports and dashboards to track viruses this season. The standout feature for both is the summary boxes at the top of each report showing which viruses are ramping up and causing the most disease.

Covid-19: Decreasing in both New York City and across the state. We are in a Covid lull, but likely not for long. Wastewater data (via Biobot and WastewaterSCAN) are showing early signs of a small uptick in the Midwest, a sign Covid might begin increasing elsewhere, too.

Influenza: Rising steadily across the state and city.

RSV: Also increasing across many counties statewide and in New York City, mostly in the youngest children.

Who’s most affected?

Infants and toddlers (ages 0-4) are seeing the highest rates of flu and RSV.
Covid is hitting both the youngest children and adults over 75 the hardest.

Respiratory virus cases by age group across New York state.

What you can do right now

Get vaccinated. It’s not too late. Flu, updated Covid, and RSV vaccines (for eligible groups — see this YLE National post) are all available. I’m getting my flu shot this week.
Layer protections. If you’ll be around young kids, older adults, or those who are immunocompromised, consider masking in crowded indoor spaces like the grocery store, airports, or on the train/subway.

Bottom line

From marathons to sanitation crews and food banks to virus tracking, there’s a web of systems and people keeping New York running. It’s a reminder that public health is public infrastructure. And we need to keep investing in it and ensuring it has what it needs to keep serving New Yorkers.

Love,

Your NY Epi

Where NYC’s mayoral candidates stand on city-run groceries

2025-10-24T14:00:00+00:00

I’m back on the New York health beat after a week of global biosecurity workshops at the World Health Organization and the United Nations (a huge thank you and shoutout to the Johns Hopkins Emerging Leaders in Biosecurity program!) — and a much-needed vacation. Conversations ranged from cross-border collaboration to public health surveillance and crisis communication.

But I’m still thinking about one moment in particular: standing in front of the UN inscription from the 1948 Universal Declaration of Human Rights. “All human beings are born free and equal in dignity and rights.”

Outside the World Health Organization in Geneva, Switzerland.

It was a powerful reminder that public health isn’t just global, it’s local. What we build here in New York echoes far beyond our borders. And the basics still matter. Dignity, rights, and health begin with access to the essentials: housing, health care, and food.

So let’s talk about food — specifically, city-owned grocery stores, which have come up repeatedly in the New York City mayoral race. Through FAQs, I’ll break down what they are, their track records in other cities, and where mayoral candidate s stand. (During the primary election, I broke down some of the health-related topics candidates supported or opposed here.)

And as a reminder, the city’s mayoral general election is less than two weeks away! Here are key dates to get on your calendars:

Voter registration deadline: Saturday
Vote by mail application deadline: Saturday
Early voting: Saturday-Nov. 2
Election Day: Nov. 4

Let’s jump in.

What are city-owned grocery stores?

City-owned groceries, sometimes called “city-run groceries” or “public option groceries,” are supermarkets owned or operated by a city. Because of city ownership and operation, these stores often don’t need to pay rent or property taxes, and can buy foods wholesale, reducing overhead costs and increasing savings for shoppers. Cities can also support them with free utilities or direct subsidies.

If the city itself owns the building or land, it’s automatically exempt from property taxes — publicly owned property used for a public purpose isn’t taxed under New York State law. When a municipality owns and operates a facility (like a library or firehouse), it doesn’t pay taxes to itself.

Why is this a public health issue?

A major goal of establishing city-owned groceries is to make food, and importantly nutritious foods, more accessible. Food prices in New York City have soared, rising faster than the national average, up 56% between 2012 and 2023, compared to 46% nationally. (Income has also increased in the city, but it’s not keeping up with climbing food costs.) At the same time, food insecurity — when someone doesn’t have enough to eat at least some of the time — affects 1.2 million New Yorkers in the city. This is up 76% since 2021, with 1 in 6 households with children lacking enough to eat. The figure is higher than the 55% increase seen nationwide.

In New York City, rates are highest in the Bronx, where 1 in 5 residents and 1 in 3 children experience food insecurity. Staten Island has the lowest, with 11.5% of residents experiencing this problem.

This isn’t just a big-city issue. Across New York state, 1 in 8 (12.5%) of residents lived in food insecure households from 2021 to 2023, including 1 in 6 children. On top of that, cuts to the Supplemental Nutrition Assistance Program in the “Big Beautiful Bill” — signed into law over the summer — will likely further exacerbate food insecurity in New York, as they reduce food assistance for low-income families.

But the issue runs deeper than not having the income to pay for enough food. Many neighborhoods don’t even have grocery stores. Several New York neighborhoods are considered “food deserts” — where it’s difficult to buy healthy, nutritious food at an affordable price. These deserts often occur when large grocery companies avoid investing in lower-income neighborhoods because they have less purchasing power compared to wealthier neighborhoods, despite high demand for groceries.

A way to measure this in New York City is to look at the ratio of bodegas to supermarkets across neighborhoods. The Bronx, which has the highest food insecurity in the city, has about 35 bodegas per 1 supermarket.

With these challenges in mind, mayoral candidates are proposing various solutions to address food insecurity and improve access to healthy, affordable food across the city.

What are the candidates proposing?

Mamdani

Zohran Mamdani, an assembly member and mayoral hopeful, has proposed opening five city-owned stores (one in each borough) at an estimated cost of $60 million. The idea is to place them in areas where private grocers won’t go, sell food closer to wholesale cost, and exempt them from rent and property taxes.

Cuomo

Former Gov. Andrew Cuomo has opposed city-owned groceries, and instead proposes a $250 million targeted subsidy program for about 350,000 New Yorkers whose income is just above SNAP eligibility (around 131% to 150% of the federal poverty line). Under his plan, benefits would scale by income — roughly $1,200 a year for a family at the low end.

His rationale is that aid should go directly to families, not into running a government grocery chain. He also believes that city-owned grocery stores could undercut or compete with small grocers and bodegas.

This puts Cuomo in contrast to Mamdani’s approach. He prefers benefits that follow families in specific income brackets, while Mamdani’s plan aims to shift the supermarket structure itself.

Sliwa

Republican candidate Curtis Sliwa has criticized the public grocery store model as government overreach. His proposal to combat food insecurity does not detail specific plans, but includes pushing for bridge funding to cover cuts to the SNAP program, reducing red tape for food distributors, and improving access to wholesale markets for small grocers.

Does NYC already have city-owned markets?

Yes. The city runs Essex Market on the Lower East Side, La Marqueta in East Harlem, and Moore Street Market in Williamsburg. These are smaller public markets rather than full-service supermarkets, but they provide a precedent. There are three other public retail markets, which are directly managed by the housed tenants.

The city’s Economic Development Corporation has tax and zoning subsidies granted to developers and grocers willing to open in so-called food deserts. In other words, public dollars already flow to the grocery sector in New York City — just indirectly.

Where else have city-owned groceries been tested?

Most city-owned grocery stores in the United States have been in rural communities:

St. Paul, Kansas, a town of 600, has a city-run grocery store that’s been in operation since 2008.
Baldwin, Florida, a town of roughly 1,400, operated its own supermarket after private chains left. The market closed last year due to lack of customer support.
Madison, Wisconsin signed a lease for a city-owned grocery store in late 2024, but it has not yet opened.

Some big cities are beginning to experiment with city-owned grocery stores.

Atlanta opened a city-owned grocery store this summer in a USDA-designated low-income, low-access neighborhood. During its first two months, it served over 20,000 customers. During its first month, fresh produce sales represented 11.6% of its sales, higher than the national average of 10%.
Chicago is exploring options for a public-run market, where multiple vendors could sell groceries and local produce.

Would city-owned grocery stores hurt small businesses?

Potentially. City-owned grocery stores could move customers from bodegas and small supermarkets. But supporters argue that city-owned stores should be strategically placed in true food deserts, where access to more grocery options is needed, and designed to complement, not compete with, neighborhood grocers. It’s not totally clear to me how they would be designed to not compete with bodegas or small grocery stores, though. I would like to see Mamdani clarify this.

Where would the money to fund this come from?

The short answer is that we don’t know. It could be reappropriated from FRESH funding, which already supports increasing availability of fresh foods in underserved neighborhoods. It could come from other city funds. Or possibly from new appropriations or tax revenue. No information has been provided on where funding for these new grocery stores would come from.

What are my thoughts?

Food insecurity is a serious and growing issue in New York. Too many families can’t afford nutritious food, or can’t access it where they live. It’s time for our leaders to step up. If that is through city-owned grocery stores, great, but we need clear and defined plans for how to pay for them, where they’ll be located, and how to minimize competition with small local businesses.

If the solution is through direct financial support to families, also great. But funding alone isn’t enough — we still need to ensure access. The problem won’t go away if we expect families to commute long distances to get groceries.

And New Yorkers are on board. Two-thirds of New Yorkers support city-owned grocery stores, with 85% reporting their grocery bills have gone up in the past year.

Personally, I lean slightly toward city-owned grocery stores because the proposal addresses both affordability and access.

Bottom line

We need to do something to reduce food insecurity. City-owned grocery stores could be a great option, but we need additional details on how they would be paid for, sustainability plans, and how to reduce competition with smaller markets and bodegas. Access to healthy food should not be optional — it’s a human right for all New Yorkers.

Love,

Your NY Epi

How the debate over health insurance subsidies affects New Yorkers

2025-10-10T14:27:01+00:00

From debates on health insurance subsidies and innovations in patient care during outbreaks, to rising concerns of mosquito-borne diseases, a lot is unfolding in public health. Let’s unpack what it means for New Yorkers.

Infectious disease ‘weather report’

Covid: All New York wastewater data are delayed. The Centers for Disease Control and Prevention dashboard isn’t updating during the federal government shutdown, the state dashboard paused reporting due to a lab transition, and New York City’s data download hasn’t been refreshed since July. In short, our early warning system is offline.

Right now, hospitalizations, our best proxy, are trending down, which is good news. Hospitalizations lag community spread, so we are likely well on our way down the summer wave.

New York state Covid-19 hospitalizations.

Flu: Flu reports haven’t kicked off yet, and with wastewater data paused, we’re relying on last week’s low activity. So far, no sign of an early start.

RSV: This is the one to watch. RSV season usually starts around now, but delayed CDC data means we don’t have as many signals to rely on. New York state will start publishing its weekly respiratory report soon (they always start in October), so that will give us insight. I expect cases to rise soon.

Now is still a great time to get your fall vaccines.

New York health insurance on the line

What the heck is going on?

During the height of the pandemic, Congress passed temporary health insurance subsidies through the 2021 American Rescue Plan and extended them in the Inflation Reduction Act of 2022. These subsidies expanded eligibility for the Affordable Care Act plans and increased financial assistance for people with lower incomes. The goal was to make health insurance more accessible.

Now, Congress is debating whether to let those subsidies expire at the end of this year, or renew them. This decision has become a sticking point in federal budget negotiations and the subsequent federal shutdown.

How will this affect New Yorkers?

About 140,000 New Yorkers across the state currently benefit from these enhanced ACA subsidies. If they expire, those New Yorkers would pay an average of $114 per month for coverage.

Because these subsidies help lower income families afford insurance, any increase in cost could be a serious financial burden. This would likely result in more people delaying or dropping coverage altogether.

When fewer people have health insurance, health problems are more likely to go untreated until they become emergencies. This is more expensive for everyone in the long run — treatment costs more for individuals, hospitals, and the health system.

Why would we ever reduce health insurance subsidies?

Simply put, to cut costs. The Congressional Budget Office estimates that extending ACA subsidies would increase the federal deficit by $350 billion over the next decade. But, they would also keep coverage for about 3.8 million Americans who might otherwise lose it.

It’s a tradeoff: shorter-term budget savings versus long-term health.

My take

It would be a mistake to let these subsidies expire. While it may look like big budget savings on paper, the reality is that it will shift costs elsewhere, including to local hospitals, state budgets, and families already under financial burden.

When coverage becomes more expensive, many make tough decisions: delaying treatment, skipping preventative care, or forgoing insurance entirely. This can push illnesses to later, costlier stages — more late-stage cancers, unmanaged chronic conditions, and more infectious disease spreading in communities.

This isn’t just numbers. It hits real families who are already juggling to pay rent, buy food, and pay medical bills. I don’t see anything about this that leads to a healthier New York.

Reimagining patient care and safety during outbreaks

Recently, I visited a demonstration at NYC Health + Hospitals/South Brooklyn that reimagines how we protect both patients and providers during infectious disease outbreaks. At the center of it: a clear plastic containment chamber fully equipped with a hospital bed and monitors inside. Inside, a patient can receive care from clinicians who work through glove ports — similar to a neonatal incubator — without the need for full personal protective equipment.

The containment chamber is being piloted by doctors at NYC Health + Hospitals to determine if it’s feasible and worth investing in. In the image above, clinicians are running a simulation as if a patient potentially has MERS-CoV, a high-risk respiratory virus.

This setup has two big benefits:

First, it dramatically reduces exposure risk for health care workers by fully enclosing the patient and their respiratory droplets.
Second, it allows patients to see and be seen by loved ones — a stark contrast to the isolation we witnessed during the height of Covid, when loved ones couldn’t enter hospitals or patients’ rooms.

During the exercise, doctors and nurses performed routine care and even practiced an intubation through the chamber’s walls. They showed that, with training, complex procedures could still be done safely and efficiently.

It’s early days for this technology, and it won’t replace all infection control measures. But innovations like this are part of a growing toolkit that prepares us for future respiratory outbreaks, while maintaining human connection.

A big thank you to Dr. Syra Madad and the incredible team at NYC Health + Hospitals for their work, and for including me in this simulation.

Question grab bag

Will outbreaks of dengue, chikungunya, or malaria become more common in the United States?

Short answer: Probably yes, but only sporadically.

This goes back to the long history the United States has with mosquito-borne diseases. In the early 1900s, malaria was widespread across the country. It was such a huge problem that the CDC was founded in 1946 specifically to control it.

Dengue and yellow fever (spread by a different mosquito species), also caused outbreaks in the United States, mostly in the South. Through large-scale vector (i.e. mosquito) control programs — like draining wetlands, improving housing, and widespread insecticide use (including DDT, which was widely used at the time but is now banned in most countries because of environmental damage) — malaria, dengue, and yellow fever were all eliminated as a locally transmitted disease by the early 1950s.

Fast-forward to today. The mosquitoes that transmit malaria (Anopheles species) and dengue and yellow fever (Aedes aegypti) still live here, but the pathogens themselves rarely enter local populations. Occasional local cases, like the malaria in Florida, Texas, and Arkansas in 2023, remind us that vector control programs work well, but aren’t perfect.

For chikungunya, the primary vector (Aedes albopictus) arrived in the United States in the 1980s, through used tires imported from Asia. They’ve since spread widely across the Southeast and parts of the East Coast.

Aedes albopictus mosquitoes are the primary vector of chikungunya virus.

These mosquitoes are resilient. The mosquitoes that transmit dengue, yellow fever, and more recently Zika can breed in tiny amounts of standing water — think bottle caps, potted plants, or gutters — and thrive in warm, humid, urban environments. Vector control programs have slowed their spread but can’t eliminate them entirely.

For any outbreak to occur, four things need to align:

The right mosquitoes must be present.
The virus or parasite must be introduced (often by travelers).
The climate must support mosquito survival and pathogen replication (the right temperature, humidity, and availability of standing water).
People and mosquitoes must come into contact.

While vector control efforts are still in place to keep these pests at bay, climate change and international travel will make these conditions easier to occur in more places in the United States. This means that we’ll likely see more localized outbreaks of dengue, chikungunya, or malaria, especially in warmer states like Florida, Texas, and Arizona. But widespread, sustained transmission remains unlikely thanks to strong vector control and public health systems.

That said, we need to stay vigilant. The key is to continue investing in mosquito control and community prevention, like removing or treating standing water, mosquito surveillance and testing, and using repellents.

What else to know

Onondaga County is offering free naloxone (Narcan) training courses in person or over Zoom. Schedule it here.

Oneida County is giving a limited number of free car seats to eligible families on Oct. 21. Call 315-798-5461 or email carseatsafety@oneidacountyny.gov if you need a new car seat to see if you qualify.

The New York Citizen Preparedness Training Program in Erie County is providing tools and resources to prepare for disasters, respond accordingly, and recover quickly. They have multiple workshops scheduled for October.

You’re all caught on this week’s New York public health news. I’ll see you next week!

Love,

Your NY Epi

What’s new in NY health: measles in Oswego wastewater, chikungunya in Long Island

2025-10-03T13:32:38+00:00

Is it just me, or does it all of a sudden feel like fall in New York this week? And I am all for it 🍁 There’s a lot to cover this week, so let’s jump right in.

Infectious disease ‘weather report’

Covid-19: Declining, but still elevated.

RSV: No activity yet in New York.

Flu: No activity yet in New York.

During this lull is the perfect time to get vaccinated — before respiratory viruses pick up.

A new Centers for Disease Control and Prevention report underscores why. Last flu season was especially severe, with one of the highest numbers of pediatric flu deaths in recent years. Nationwide, 109 children developed influenza-associated encephalopathy, a dangerous brain swelling caused by flu infection. In New York alone, 26 children died. And pediatric flu deaths here have been increasing.

Now is the time to get vaccinated and reduce the risk of severe infection. Katelyn Jetelina at YLE National wrote an excellent fall vaccine primer to help you navigate decisions.

Measles detected in Oswego County wastewater

The New York State Health Department issued an alert after measles was detected in wastewater in Oswego County. (The Wastewater SCAN group is testing for measles in Oswego and Ithaca, and New York City is running their own measles testing program.) This means there is at least one case in the community, even though no infections have been identified yet. The alert is to remind health care providers to stay alert for signs and symptoms of measles in patients.

Because measles is so contagious, you need ~93-95% of the population to be vaccinated to prevent an outbreak. In Oswego County, 87.8% of kids under 2 are vaccinated, leaving some susceptible to infection. In response, the health department is monitoring for cases.

The actual risk of an outbreak depends on the community surrounding the person infected. If the person shedding the virus is in a community with high vaccination rates, the risk is low. But if they’re in a pocket with lower coverage, the chance of spread is higher.

For now, no cases have been identified. I’ll be keeping a close eye on this.

For the public, the guidance hasn’t changed: Vaccination is the best protection. For more details, here are common FAQs on the measles vaccine from YLE National.

Measles symptoms usually start like a cold or flu (fever, cough, runny nose, etc.). A rash typically appears a few days later. If you’re sick and think you may have measles, call ahead before going to a clinic, urgent care, or ER so infection-control precautions can be taken.

Chikungunya in Long Island and a death due to EEE

Last week, a woman in Long Island tested positive on a preliminary screen for chikungunya, a virus spread by certain species of mosquitoes. What makes this case unusual is that she had no recent travel history. (Occasionally, travelers will return to New York after acquiring chikungunya abroad.) The New York State Health Department is running additional tests to confirm. If confirmed positive, this would be the first locally acquired case in New York.

Chikungunya is very rare in the United States. The last locally transmitted cases occurred in 2015, with small outbreaks in Florida and Texas. Globally, it’s much more common, particularly in the Caribbean and South America, and a major outbreak is ongoing in China this year.

Symptoms include:

Fever
Severe joint pain or swelling
Headache
Muscle pain
Rash

Why now? Evidence shows that climate change is expanding and shifting the range of the mosquitoes that can carry chikungunya. More frequent human travel and global shipping also help mosquitoes spread, as they can hitch rides on planes, boats, and even in luggage. While we won’t ever know if climate change directly caused this single case, it likely played a role. Epidemiologist Colin Carlson broke down how climate change may be:

Allowing the mosquito to survive in New York
Creating warmer conditions that support viral replication within mosquitoes
Driving larger global outbreaks, increasing the chance of introduction here in New York

As we move into fall and temperatures drop, the risk of more local cases decreases. The overall chikungunya risk in New York remains very low, but we’re still in mosquito season, so it’s best to avoid bites. Wear repellent (Deet or picaridin) or long sleeves, especially at dawn and dusk when mosquitoes are most active, and dump standing water around your home.

Sadly, the case of Eastern Equine Encephalitis virus we covered last week has died. We are sending our love to his family and loved ones.

CTE was confirmed in man who shot and killed four in Midtown NYC office building

Public health goes beyond microbes. Understanding the drivers of violence, and especially gun violence, is incredibly important in the United States.

The man who shot and killed four people in a Midtown Manhattan office building in July was found to have chronic traumatic encephalopathy during an autopsy. CTE is a degenerative brain disease caused by repeated head trauma and is seen most often in athletes and military veterans. It’s linked to impulsivity, depression, memory loss, cognitive decline, and suicidal thoughts. It can only be definitively diagnosed after death.

In a letter, the gunman claimed he developed CTE from playing football. He said his attack was directed at the NFL headquarters and claimed they hid the effects of CTE.

Did CTE cause the shooting?

We won’t ever know whether CTE fully explains this violent act, or if it was just one piece of a more complex picture involving mental health. The truth is, the link between CTE and violence isn’t well understood. One big reason is selection bias. Most brains studied for CTE are from people who showed noticeable symptoms or were involved in high-profile acts of violence. That means we’re missing the full picture. Many people may live with CTE without ever being violent.

CTE isn’t just about concussions

Research shows it’s the cumulative number and intensity of head impacts, not just concussions, that increase risk. Even minor hits, repeated over time, can damage brain cells and blood vessels, leading to microscopic bleeding and toxic protein build-up in the brain.

Prevention starts early

Changing how kids practice football, like reducing full-contact drills or encouraging flag football, can dramatically reduce risk. The Concussion Legacy Foundation estimates that a high school offensive lineman averages 734 head impacts a season with an average strength of 26 g. Because most hits occur in practice, if the number of practice hits were cut in half, like by switching to flag football from some drills, it could cut the overall number of head impacts kids experience by about a third. The fewer and softer the hits, the safer the brain.

Because CTE is only diagnosed after death, it’s incredibly hard to study, and many research gaps remain. But given the possible links to violence and severe mental health issues, it’s an urgent public health priority.

If you or someone you love is struggling after repeated head trauma, resources and help are available: The CDC’s Heads Up Program and the Concussion Legacy Foundation HelpLine can provide resources to those at risk of or struggling with brain injury.

CDC wants to know how you feel after vaccination

V-safe is a vaccine safety monitoring system that lets you tell CDC how you feel after vaccination by completing check-ins. It was created to monitor the safety of Covid-19 vaccines and has expanded to include RSV vaccines. The data collected through V‑safe helps the CDC communicate timely, transparent information about the safety of vaccines. You can sign up here to complete short check-in surveys by text or email following your vaccine.

Bottom line

You’re all caught up on New York health news! Now is the time to get fall vaccines before things start picking up again. See you next week, and I hope you enjoy this changing season!

Love,

Your NY Epi

Covid declining, no flu or RSV yet in New York. What to know about Tylenol and autism.

2025-09-26T15:30:00+00:00

It’s been a whirlwind week in public health. From shifting Covid-19 vaccine recommendations and a debate over Tylenol and autism, to declining Covid levels in New York and even a case of eastern equine encephalitis, there’s a lot to sort through. Here’s what you need to know this week.

Infectious disease ‘weather report’

Covid is past its peak in New York

Forecast: Moderate and declining as measured by wastewater data, signaling that we’ve made it through the worst of the summer surge.

New York state Covid-19 wastewater activity levels.

Covid hospitalizations are still elevated. Because wastewater is a leading indicator and has just started decreasing, we can expect hospitalizations to follow and begin decreasing in the next week or two.

New York state Covid-19 hospitalizations.

The flu

Forecast: No activity in New York yet.

All states, including New York, are at the minimal influenza-like illness level, and New York wastewater shows no flu activity.

I’m planning on getting my flu shot this week before I travel out of the country in early October.

RSV

Forecast: No activity in New York yet.

Wastewater and hospitalizations still show no RSV activity in New York.

Nationally, we moved from 0 hospitalizations per 100k to 0.1, which could be a very early sign that the season is starting or about to start.

Mosquito-transmitted viruses

Human infection of eastern equine encephalitis virus in Central New York

Last week a resident of Madison County was hospitalized with eastern equine encephalitis, a virus transmitted by some species of mosquitoes. This is the county’s first ever human EEE infection. EEE is rare in New York and the rest of the United States — last year, New York had its first human case since 2015 in a resident of Ulster County, who sadly died.

Most people infected with EEE won’t have any symptoms. But for those who develop symptoms, the illness can be severe and involve inflammation of the brain (encephalitis) and spinal cord (meningitis).

About one-third of people who develop severe illness die.
There is no specific treatment available.
People over age 50 or younger than 15 are at greatest risk.

EEE is rare in New York, but is more concentrated in Central New York this year.

Since 1971, only 13 human cases have been identified in the state, including the most recent one. Of these patients, seven died.

By this time last year, 14 counties across the state detected EEE in mosquitoes, mammals, or birds. So far this year, EEE has only been detected in four counties: Madison, Onondaga, Oswego, and Oneida.

Eastern equine encephalitis virus detections in mosquitoes, humans, and animals.

But more mosquitoes have tested positive so far this year compared to last. Even though there are fewer counties detecting EEE, the detections are more concentrated in a smaller area — there’s a hotspot in Central New York.

Prevention of EEE is the same as for West Nile virus: It’s focused on reducing the mosquito populations and avoiding insect bites.

West Nile virus is active across New York

The most recent data show mosquitoes tested positive in:

Erie
Nassau
Onondaga
Oswego
Rockland
Suffolk
NYC: all five boroughs

So far, the number of human infections seen this year is comparable to the average of the previous three years.

What this means for you:

Mosquito transmitted viruses are active right now.
Protect yourself by wearing repellent (Deet or picaridin), long sleeves, or staying indoors when mosquitoes are most active at dawn and dusk.
Dump standing water around your house to reduce mosquito breeding habitat.

Follow-up on ACIP meeting updates

I tuned into last week’s Advisory Committee on Immunization Practices meeting — and it was messy. Members openly said they weren’t sure what they were voting on, some votes had to be redone or skipped, and there was repeated confusion over whether certain issues even fell within ACIP’s jurisdiction.

That said, the outcome was more patient-friendly than many expected. Katelyn Jetelina covered the details in a recent YLE National piece here.

Here are the high-level outcomes:

Covid vaccines: ACIP shifted Covid vaccine recommendations to shared clinical decision-making for everyone aged 6 months and older. That means that the decision to vaccinate now falls to conversations between patients (or parents) and clinicians — whether your primary care provider, specialist, or pharmacist.

Depending on what state you live in, though, you may still need a prescription. ACIP’s guidance is now more broad than the Food and Drug Administration’s: FDA continues to classify the Covid vaccine as “off-label” for some groups (like healthy adults and children without underlying conditions). In some states, this ACIP/CDC vs. FDA mismatch could mean patients need a prescription to access the vaccine.

In New York, this discrepancy will not disrupt vaccine access. Gov. Kathy Hochul earlier issued an executive order that allows pharmacists to both prescribe and administer Covid-19 vaccines for people aged 3 and older without a patient-specific prescription. That law means that even under the new federal guidance emphasizing shared decision-making, folks in New York should still be able to get vaccinated conveniently, including via pharmacies.

What this means for New York: The executive order put forward earlier this month ensures continued access to Covid-19 vaccines in New York. The CDC basically recommended Covid-19 vaccines off-label (different from FDA’s recommendations). This off-label use means that pharmacists can’t administer them without special authority. In New York, the EO and standing order granted pharmacists that authority, even before the ACIP meeting, which means that you can get vaccinated at your local pharmacy. Most insurers — including Medicaid, Medicare, CHIP and major private insurers (AHIP, ACHP) — have also affirmed they will keep covering the vaccine.

New York joins the Northeast Public Health Collaborative

New York state and New York City joined Connecticut, Maine, Massachusetts, New Jersey, Pennsylvania, and Rhode Island in the Northeast Public Health Collaborative to share expertise and protect evidence-based public health. A cornerstone of the voluntary regional coalition is to collaborate on vaccine recommendations.

And they are already making moves. All states in the Northeast Collaborative have taken action through executive orders, legislation, or other means to decouple Covid-19 vaccine guidelines from federal rules, protecting access within their own states.

What we do and don’t know about autism and Tylenol

What was said at the presidential press conference earlier this week is not true: We do not have evidence that Tylenol causes autism. The largest and most rigorous study to date — a Swedish sibling study of over 2.5 million pregnancies — found no link between prenatal Tylenol use and autism when controlling for genetics and environment.

That said, the picture is more complicated. Some observational studies have reported associations between Tylenol use during pregnancy and autism. But others show that fever itself during pregnancy can increase risk, making it hard to know whether the risk comes from the medication, the underlying illness, or something else entirely.

The bottom line: This science is complex, and we don’t have a clear answer. What we do know is that the association is nowhere near as strong as it was described from the podium earlier this week. Many of the statements given were misleading or straight up false. On top of that, they also create stigma against our neurodiverse community members, and pregnant women who are doing the best they can to keep their babies and themselves healthy. Katelyn and Kristen Panthagani did a great job breaking it down here for YLE National.

For now, guidelines remain unchanged: Consult with your doctor, and if you need Tylenol during pregnancy, use the lowest effective dose for the shortest possible time.

Bottom line

You’re all caught up on New York public health news this week! And a happy 220th birthday to the NYC Department of Health and Mental Hygiene. 🥳

Love,

Your NY Epi

New York health update: Covid, vaccine recommendations, West Nile virus, a Legionella outbreak

2025-09-18T15:22:58+00:00

Infectious disease ‘weather report’

Ugh, even epidemiologists get Covid.

Recently, my partner and I both felt like we had “allergies” — itchy eyes, mildly scratchy throats, and some lung irritation. It was so mild that at first we didn’t even think to test. When we finally did, his turned positive instantly. Mine never did. But, based on the timing of symptoms, I’m pretty sure I caught it first and then cleared the infection by the time we tested.

Consider this my firsthand evidence that Covid activity is elevated in New York, and the data agree.

Wastewater data is showing an upward trend. I’ll note that the latest data is usually unstable as all the sites submit data, but it stabilizes after about two weeks. This likely explains what looks like a big drop near the end of August.

New York state Covid-19 wastewater activity levels.

That said, the recent rise in wastewater concentrations aligns with increased hospitalizations.

Everything else is quiet still:

Flu: Outpatient visits for flu-like illness haven’t started rising in New York yet, but I’m keeping a close eye on it. In other parts of the country, numbers have started to climb.

RSV: Still quiet.

I was planning on getting my fall Covid booster soon, but after just getting over Covid, I’m deciding to wait. Data show that after a Covid infection, delaying immunization by about ~6 months can increase its effectiveness. (YLE national covered the timing of Covid vaccines here). I’m getting my flu shot soon though!

Speaking of immunizations …

Updates to routine immunization eligibility are expected this week

There’s a lot happening right now around vaccine access and eligibility, both for Covid and routine immunizations.

Last week we covered New York’s steps to keep Covid-19 vaccination accessible, including executive and standing orders that allow pharmacists to vaccinate anyone over age 3 without a prescription. In practice, you may still need to check “yes” to the eligibility question on pharmacy websites when scheduling, but New York pharmacists have the authority to vaccinate you whether or not you have an underlying condition.

CVS appointment scheduler questions. Check “yes” that you would like to receive a Covid vaccine and are eligible.

Today, the Advisory Committee on Immunization Practices is starting a two-day meeting to vote on Covid-19, hepatitis B, and MMRV (measles, mumps, rubella, varicella) vaccine recommendations. There is a very real possibility that ACIP will vote against recommending some of them for certain ages. Such a decision would truly be unprecedented given overwhelming evidence supporting their safety and effectiveness. If that happens, the availability of these vaccines will be reduced.

I do expect New York state will step in to protect these vaccines. Gov. Kathy Hochul has issued an executive order and standing order to safeguard Covid-19 vaccine access (we covered it here), and I anticipate something similar if ACIP votes against hepatitis B or MMRV. Even so, a quick executive order can’t erase the confusion. Potentially conflicting messaging from federal and state departments will undoubtedly create uncertainty and confusion, making it harder for some to get vaccinated.

While I don’t think that Covid vaccines should be removed, most people in New York have a buffer of community immunity, and access to Covid vaccines through the executive order. If recommendations change, it will have the greatest impact on those who don’t have immunity, like young children, pregnant women, and people who are immunocompromised. But hepatitis B and MMRV are a different story. Removing these vaccines sets us back in the progress we’ve made in protecting babies, and puts kids and vulnerable populations at risk of serious, preventable diseases.

That’s why now it’s more important than ever to stay informed, and remember that vaccines remain one of the safest, most effective tools to protect babies, children, and everyone else from severe and preventable illness. I’ll be back next week with the implications for New Yorkers after we know with certainty what the ACIP votes will be.

We are in peak West Nile virus season

New York is seeing West Nile virus activity across the state. This is typical — September is when we often see the highest West Nile virus infections. This most recent data show mosquitoes tested positive in:

Erie
Nassau
Orange
Rockland
Suffolk
NYC: all five boroughs

A few mosquitoes in Oswego County also tested positive for Eastern Equine Encephalitis virus, which is rare but more dangerous than West Nile. So far, there have been 26 human West Nile cases across the state, and no cases of EEE.

In New York, it’s too early to tell if this is a normal year or not because this is the time of the year when West Nile cases typically really pick up.

Nationally, West Nile is 40% higher than normal. In New York, we’re getting close to last year’s total West Nile-positive mosquito pools (1,638 so far, compared to 2,167 last year), and the season usually runs until the first few freezes in November. So it’s too soon to tell how bad this year will be.

New York counties continue to use mosquito control to reduce risk. Many have conducted or plan to conduct aerial insecticide spraying, where a plane disperses chemicals to kill mosquitoes or prevent breeding. (You can check your local health department website for local schedules.) There are recent or upcoming events for New York City (Brooklyn and Queens this week).

To minimize exposure to insecticides during spraying:

Stay indoors
Bring pets inside
Close windows

Legionnaires’ disease in Westchester

Yes, another outbreak. This time Westchester County is investigating a spike in Legionnaires’ disease. So far this year:

38 people have been diagnosed
2 people have died

This is an increase — last year there were 24 cases total in the county. Across the state, excluding New York City, we are at 383 cases so far for this year.

Officials recently confirmed a cluster of five cases in Yonkers and said that cooling towers are being inspected in response. But we don’t know where the cases reside or where they could have been exposed. I’m concerned that not enough information is being shared, or shared quickly enough. Knowing which neighborhoods or ZIP codes are affected helps us assess personal risk. And clear, timely, and consistent communication from public health departments is essential, not just for managing outbreaks, but for building and maintaining community trust.

Legionnaires’ disease is a serious lung infection caused by breathing in tiny water droplets containing the Legionella bacteria. Symptoms usually start 2-10 days after exposure and can include:

Cough
Fever
Chills
Shortness of breath
Muscle aches
Diarrhea

Most healthy people exposed won’t get sick. Those at higher risk are adults over age 50, smokers, and people with chronic lung disease, diabetes, cancer, or weakened immune systems.

It’s not spread person-to-person because it doesn’t infect cells the same way a respiratory virus does (like Covid). You also can’t usually get it from drinking water — water rarely enters the lungs while drinking, and stomach acid likely kills it when ingested. In New York, and especially around New York City, outbreaks with cases across communities (like this one) are typically linked to cooling towers, which are separate from residential plumbing. This means that your tap water is not a risk.

Why has there been so much Legionnaires’ this summer?

The increase in Westchester Legionnaires’ cases follows the large outbreak in Central Harlem, where seven people died and 114 were diagnosed. We covered it here. And Legionnaires’ disease has been increasing nationally.

National Legionnaires’ disease rates have been increasing, though data after 2022 have not yet been published.

Several factors may be driving the increase in Legionnaires’ cases this summer in New York:

Warmer temperatures and higher humidity can promote bacterial growth in water systems. This has been one of the hottest summers on record for many parts of New York.
Potential lapses in regulation and inspection can allow Legionella to grow undetected, especially when buildings aren’t maintaining cooling towers properly. In New York, building owners are legally required to test cooling towers for Legionella every 90 days. During the Central Harlem outbreak, Gothamist reported that most of the towers linked to the outbreak were behind on testing and hadn’t been inspected by the city in over a year.
Increased awareness can lead to more identified cases. When large outbreaks happen, media and public health alerts can increase the chance that milder cases are caught. Doctors might be more on the lookout and the public may be paying closer attention to their symptoms, which are good things.
Climate change may also be playing a role, as longer and hotter warm seasons can create more opportunities for Legionella growth.

Grandparents for vaccines

Think Moms Against Drunk Driving, but for polio and measles. A new grassroots group of grandparents just launched to protect kids’ vaccine access. They’re driven by lived experience — remembering when these diseases ran rampant — and are elevating their stories.

Fueled by personal experiences, they are asking for support and stories. Learn more and join them here.

What else you need to know

Measles in NYC

The NYC Department of Health and Mental Hygiene has confirmed two adult cases of measles in Manhattan. They are investigating potential exposures at two unnamed restaurants in SOHO and the Lower East Side, and contacting those who may have been exposed. Reminder — if you are fully vaccinated, you are well protected.

Blue-green algae in Onondaga

Onondaga County has issued an advisory for a harmful algal bloom at Skaneateles Lake. These blooms, caused by overgrowth of blue-green algae (cyanobacteria), can cause skin rashes, stomach upset, or more serious illness if swallowed or inhaled. Before swimming at lakes or ponds, check local advisories and pay attention to posted signs. If you or your pet were exposed, rinse off really well and seek medical care if symptoms develop.

Bottom line

You’re all caught up on New York public health news this week!

Love,

Your NY Epi

How Hochul’s executive order affects Covid-19 vaccine access in New York

2025-09-11T17:19:17+00:00

Amid federal vaccine regulation upheaval, last week, Gov. Kathy Hochul signed Executive Order 52 to make Covid-19 vaccines more available to New Yorkers. This was one of the first moves across the nation to ensure better access to Covid-19 vaccines. But this is a temporary Band-Aid, and much more needs to be done. The overall message is this: You can now get a Covid-19 vaccine at New York pharmacies without a prescription.

What the heck is going on?

Right now, access to Covid-19 vaccines depends on your state. Many state laws, including New York, link vaccine access directly to guidance from the Food and Drug Administration or the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. But in June, the ACIP was replaced with members handpicked by Health and Human Services Secretary Robert F. Kennedy Jr., and they declined to vote on Covid-19 vaccine recommendations. Their next meeting is set for next week.

Until that happens, guidance is stalled, leaving state statutes tied to ACIP in limbo. In the meantime, there are a few things states can do depending on politics, legislature, etc.:

Change the legislation
Declare an emergency/executive order
Change the standing order (so pharmacists can prescribe)
Change the pharmacy board statutes

Last week, New York chose No. 2 and No. 3.

What exactly did the executive order do?

EO 52 declared a state of disaster emergency in New York effective Sept. 5 through at least Oct. 5, 2025. Declaring a state of emergency gives the governor the legal authority to temporarily change existing state regulations. In public health, states of emergency are typically declared to unlock faster action.

Within the state of emergency, the order broadened pharmacists’ ability to prescribe and administer Covid-19 vaccines to individuals age 3 and older without needing prescriptions from doctors.

The EO provides a temporary solution while New York works on long-term legislation to protect access to vaccines in the state. In other words, the law will need to change to decouple recommendations and pharmacy access from the federal government. No one ever saw the need for this before, but here we are.

This will not only help with Covid-19 vaccines, but other vaccines should the federal government continue to chip away at recommendations.

Why did New York take this step now?

There are two big reasons why New York took this step:

To broaden and protect access to vaccines. As I shared last week, current federal vaccine guidance effectively leaves many people under 65 without clear access to the Covid-19 vaccine. In practice, that looks like pharmacies, including big chains like CVS or Walgreens/Duane Reade, limiting who could get vaccinated. This executive order changes that in New York. It allows pharmacists to both prescribe and administer vaccines to anyone 3 and older, regardless of shifting CDC/ACIP recommendations.
To defend public health and science. Covid-19 vaccines remain our best protection against severe illness, and no new evidence says otherwise. Yet recent federal changes have limited their access. New York’s executive order is a safeguard against those limits, ensuring that the state government can make its own evidence-based recommendations, and help preserve access to care.

How does this impact vaccine access and equity?

More convenience and reduced barriers. Before the executive order, a prescription was required to get a Covid-19 vaccine at most New York pharmacies. Now, you can just go straight to the pharmacy, no prescription needed. This is important because 90% of Americans get their seasonal vaccines at pharmacies. Requiring a prescription would mean that many people likely wouldn’t get vaccines this year, but not everyone has time to get a prescription or even has a primary care provider.
Inclusivity: The executive order expands eligibility to cover children age 3 and older, pregnant people, and all adults, regardless of underlying conditions, groups previously squeezed out by federal restrictions. 
Strengthening the role of pharmacists: Parts of New York state, particularly rural communities and some neighborhoods in New York City, experience shortages of doctors or health clinics. Allowing pharmacists to provide and prescribe Covid-19 vaccines can be especially impactful in these underserved communities.

How does NY compare to other states?

New York is part of a growing trend of states stepping up to make Covid-19 vaccines more available in the midst of federal restrictions. It’s helping lead a regional coalition of New England states to coordinate health guidance. On the West Coast, California, Oregon, Washington, and Hawaii formed a West Coast Health Alliance to do the same.

Individual states are also taking action on their own. For example:

Massachusetts now requires insurers to cover vaccines recommended by the state.
New Jersey, Connecticut, Colorado, and New Mexico issued orders allowing pharmacists to give Covid vaccines without prescriptions.

With the Common Health Coalition, YLE recently broke down which states are moving forward — you can find that resource here (though things may change quickly as more states take action).

Conversely, some states are moving in the opposite direction. Florida, for instance, has rolled back routine school immunization requirements, raising concerns about long-term herd immunity in the state.

Will insurance cover vaccines?

This is a big “to be determined” for New York. Unlike Massachusetts, the New York executive order does not say anything about insurance coverage for Covid-19 vaccines. It’s safe to assume that if you have an underlying condition or if you’re over 65, insurance will cover the vaccine. This is because the vaccine is considered “on label.” For everyone else (who would be considered “off label”), it’s best to call your insurance provider and ask directly. Covid vaccines can run about $200 out of pocket without insurance.

What’s temporary, and what’s next?

The EO is in effect until Oct. 5 to give New York time to create more permanent vaccine protection legislation. At which point, the EO can be extended if new legislation hasn’t been put in place.

What’s my take on this?

We needed New York to act. In the absence of a stable CDC, state health leaders need to step up and fill the void. Hochul’s executive order is a big step in that direction. It enables continued, more equitable access to Covid-19 vaccines in New York, even amid federal uncertainty.

But the work can’t end here. Florida recently ended routine school immunization requirements, and similar rollbacks could spread to other states. This raises the risk of confusion not just about Covid vaccines, but about routine vaccines, too. We also know that the ACIP may be questioning other routine vaccinations in their upcoming meeting, Sept. 18-19. (I’ll be back with updates on that.) New York needs to be proactive about protecting all immunizations, not just Covid-19.

Does this solve the issue completely?

Not quite. There are a couple of important questions remaining:

Legal liability. Pharmacies and pharmacists need clarification on what legal protections they have when prescribing or administering Covid vaccines under this order because the recommendations differ from federal entities like the FDA and CDC.
Insurance coverage. It’s uncertain if Covid vaccines will be consistently covered by insurance.
Implementation. Each pharmacy will ultimately decide how its pharmacists will carry this out, which could affect access across the state if some choose to follow the more restrictive federal recommendations.

Bottom line

Pharmacies can now give Covid-19 vaccines without a prescription in New York. We’ll update you on outstanding questions, like which pharmacies are offering it, once we know.

Love,

Your NY Epi

What to know about Covid-19 vaccine access in New York

2025-09-04T14:10:29+00:00

Fall is right around the corner, and so are respiratory viruses. Each fall and winter, the big three viruses (Covid-19, flu, and RSV) cause hundreds of thousands of hospitalizations in the United States. The good news is that we have vaccines for all three that help prevent against severe disease.

For the flu and RSV, vaccines are business as usual. Eligibility is clear, and you can show up to most pharmacies or doctors’ offices to get vaccinated. (Check out YLE National’s fall vaccine guide to help determine which vaccines you or your child should get.)

But Covid vaccines are a different story this year. Chaotic government processes and upheaval have left Covid vaccine recommendations in limbo, especially in New York. This is a rapidly evolving situation, and while there’s still a good amount we don’t know, we’re here to help you stay grounded. We’ll share information as it comes in, and break down what it means for you as the respiratory virus season begins.

What changed last week regarding Covid-19 vaccines?

On Aug. 27, the Food and Drug Administration approved updated Covid-19 vaccines from Pfizer, Moderna, and Novavax but with limited eligibility. Specifically, they were approved for:

Adults 65 and older, and
Individuals under 65 with at least one high-risk health condition, listed here:

The FDA also revoked the Emergency Use Authorization for Pfizer’s vaccine in children under 5. This leaves only Moderna’s vaccine for children 6 months and older, but only for those who have an underlying condition or who see a doctor.

Why is this causing confusion?

It feels murky because we’re in a limbo period. While the FDA has approved the new vaccines, the Advisory Committee on Immunization Practices has not yet issued recommendations, and the Centers for Disease Control and Prevention hasn’t updated its guidance. ACIP and CDC won’t make changes until after the next ACIP meeting, which is scheduled for Sept. 18-19. Many states, including New York, require that the FDA and the CDC/ACIP approve vaccines before pharmacists are permitted to administer them.

This means that even though the updated Covid vaccines are FDA approved, not all pharmacies can actually offer them yet. It depends on each state’s individual regulations and the written protocols individual pharmacy chains have. In practice, this means that many patients who want Covid vaccines need to see their doctor or get a prescription to bring to a pharmacy. This creates barriers to vaccine access — in 2021, 80% of New Yorkers got their vaccines directly from a pharmacy. Nationally, it’s about 90%.

What’s the situation in New York specifically?

Covid-19 vaccine access via pharmacies depends on which pharmacy you go to:

Walgreens/Duane Reade: If you are over 65 or have an underlying condition (determined by self-attestation on the scheduling portal) you can make an appointment online for a vaccine at a Walgreens or Duane Reade in New York. But you need to have a prescription from a doctor and bring it to the appointment.
CVS: Not currently offering Covid vaccines to anyone in New York. CVS is being more conservative than Walgreens, likely because of how the pharmacy chain has written their protocols, but this isn’t totally clear. Until ACIP/CDC makes official recommendations, or New York changes its recommendations, I’m guessing Covid vaccines will stay on hold at CVS. However, you can make an appointment at CVS pharmacies in New Jersey or Connecticut if you are over 65 or have one of the high-risk conditions. It appears that some Minute Clinics in New York may be offering vaccines, but it’s not consistent.

There hasn’t been any formal guidance yet from the New York State Department of Health or the NYC Department of Health and Mental Hygiene. There have been reports that New York state and New York City are considering issuing their own vaccine recommendations, but no official announcements have been made.

What is the state doing about this?

New York and most other New England states recently met to discuss forming a regional health coalition to coordinate health guidance in response to instability at the CDC and ACIP. They discussed what to do when the CDC’s vaccine recommendations differ from the scientific consensus and whether New England states should follow the recommendations of professional medical societies instead. Organizations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have called for broader access to vaccines for children and pregnant individuals, which contradicts the current FDA restrictions.

But the hard truth is that New York should have seen this coming. Increasing instability in federal health has been ongoing for months and has widened cracks in our vaccine systems. New York state and city health departments have yet to issue local vaccine guidance or contingency plans. We need our local health leaders to step up and provide guidance in a way that the CDC and ACIP can’t right now. Without it, the burden of understanding and navigating the complex vaccine landscape falls on the individual, which is not something we should have to do alone.

What should New Yorkers do right now?

If you are over 65 or have a high-risk condition, you can make an appointment for a Covid shot at Walgreens/Duane Reade, but you need to have a prescription from a doctor. The closest CVS pharmacies currently giving Covid vaccines are in New Jersey or Connecticut.
If you have a high-risk condition, call your primary care provider to ask if they can vaccinate you or give you a prescription, and if they have the vaccine in stock. If you’re not in a high-risk group, it could still be worth checking in with your doctor. But you can also wait: More clarity is expected in the coming weeks as guidance and state policies catch up.
Stay tuned for more information from YLE following the upcoming ACIP meeting in mid-September. If they recommend the vaccines and CDC signs on, then we can expect more pharmacies to start vaccinating those who are eligible.
For those who can’t get their Covid vaccine right now, it’s still a good idea to get your flu shot, and pay attention to your health. If you are feeling ill, avoid social gatherings, wear a mask around others, and get lots of rest.

What else to know this week: Legionnaires’ updates

The Legionnaires’ outbreak in Central Harlem has officially ended. Over the course of the outbreak there were 114 confirmed cases, 90 hospitalizations, and seven deaths.

Final lab results identified the source: two city-owned cooling towers, including Harlem Hospital. Investigators confirmed this by matching the genetic fingerprint of the Legionella bacteria found in patients samples to those collected from the cooling towers.

In response to the outbreak, New York City has proposed new policies that would require building owners to test for Legionella every 30 days instead of 90, and increase the number of Health Department employees who conduct inspections and respond to outbreaks. I’ll be watching to see if these policies are implemented.

The city is also investigating a new, unrelated cluster of Legionnaires’ at an apartment complex in the Bronx. So far, four cases have been identified over the past several months. Unlike the Central Harlem outbreak, this cluster appears to be linked to the building’s internal plumbing, not cooling towers. This usually means that the risk of widespread transmission is lower.

Under city laws, the building owners are now required to evaluate the water system, test for Legionella bacteria, and take steps to control it to prevent future infections.

Bottom line

Vaccines remain the best option to prevent severe respiratory disease this season. Given the confusion surrounding Covid vaccine eligibility and availability, it’s best to consult your doctor about getting a shot.

Love,

Your NY Epi

It’s peak bug season in New York: Covid, measles, mosquitoes are thriving

2025-08-29T19:40:14+00:00

Before we begin, I want to touch on some news we received late Wednesday — Centers for Disease Control and Prevention Director Dr. Susan Monarez was abruptly removed, just weeks after the Senate swore her in. Immediately following, three of CDC’s most senior leaders (Drs. Deb Houry, Daniel Jernigan, and Demetre Daskalakis) resigned in protest, citing increased political interference. (You can read Demetre’s powerful resignation letter here.)

This type of leadership implosion at the CDC is not normal. And it definitely widens the vacuum in federal public health guidance that’s been growing over the past year. This instability at our nation’s top public health agency should concern us all. It raises questions about whom we should turn to in the face of health threats, whether it’s seasonal respiratory viruses or the next pandemic. I’m still wrapping my head around this, but I’ll be back with updates as it further unfolds.

For now, let’s get back to this week’s dose.

It’s peak bug season and Covid-19, measles, and mosquitoes are thriving across the state. But it’s not just the bugs: Recent events, from a tragic bus crash in upstate New York to the close of a Legionnaires’ outbreak, show how fragile our systems can be, and how directly that fragility impacts our health.

Here’s what you need to know this week.

Covid-19 ‘weather report’ and an update on fall vaccine availability and FDA approval

All regions of New York show that Covid-19 hospitalizations are elevated. Hospitalizations are still substantially lower than they were this time last year, but are increasing. Given what’s happening in other states, like Florida and Hawaii, we expect increases to continue.

New York City Covid-19 hospitalizations across race and ethnicity groups.

Risk is not spread evenly, and these groups are seeing the highest rates of hospitalization:

Central New York and the Finger Lakes have the highest rates, when adjusting for population.
75 and older age group has higher rates according to data we have in New York City. (We expect it to be the same elsewhere.)
Hispanic and Latino people have about twice the rate of hospitalization compared to white people. This likely reflects longstanding structural inequities, including greater exposure to risk (from factors such as relying on public transportation or working in more public-facing jobs), more crowded housing, and limitations in health care access, rather than differences in underlying health alone.

What does this mean for you? The best thing to do is wear a mask in crowded indoor areas. I’m going to wear one on the train and at the airport, for example. The Food and Drug Administration just approved fall Covid-19 vaccines, with some significant changes to who will be eligible. YLE National answered several questions on fall Covid-19 vaccines here.

Reflections on the Legionnaires’ outbreak

First, the good news: the Legionnaires’ outbreak in Central Harlem is ending, with fewer and fewer cases being reported after the identification of contaminated cooling towers.

Now, the bad news: Rarely in public health is something random. This outbreak revealed deep cracks in prevention systems in the area:

Cooling tower monitoring. As I explained a few weeks ago, building owners are legally required to test cooling towers for Legionella every 90 days, and the city aims to inspect each tower at least once per year. But, according to Gothamist, most towers linked to this outbreak were behind on testing and hadn’t been inspected by the city in over a year. And despite increases in funding, the number of inspectors has dropped by more than 30% over the past three years. Enforcement and staffing need attention.
Health equity. Central Harlem, a predominantly low-income and Black neighborhood, has high risk factors for Legionnaires’ disease among residents, like asthma and diabetes. The city should prioritize enforcement and staffing of inspections in Central Harlem and the surrounding areas, in particular.
Climate change. Legionella bacteria thrive in warm climates. We should expect Legionella to become more common with climate change and plan accordingly to stay ahead of it.
Risk communication. In the posts where I covered this outbreak, I tried to communicate that risk was low for most people. However, risk is unevenly distributed, and local communications about the outbreak fell short. Many in Central Harlem feared leaving their homes, and workers said they weren’t given adequate info to keep them healthy. We need timely and transparent communication, including guidance for those at greatest risk, that is grounded in trust and not just broad reassurance.

An outbreak of this size signals that the system failed somewhere upstream. Six people died, and dozens were hospitalized. Everyone deserves to step outside and breathe clean air without fear, regardless of ZIP code.

Mosquito-borne threats: malaria and West Nile

New Jersey, in partnership with the CDC, is investigating a case of malaria in a Morris County resident who may have been infected locally — the patient had not traveled internationally.

For local transmission to occur, two conditions must be met: 1. the right mosquito species (Anopheles), which is commonly found in New Jersey, New York, and most other states, and 2. the malaria parasite itself, which is usually absent here.

If confirmed, this would be big news. Every year, New Jersey reports around 100 malaria cases, almost all among travelers returning from abroad. The last time the state saw a locally acquired case was in 1988. The risk to the public is very low, but public health officials are likely moving quickly to test mosquitoes, treat the patient, and prevent any spread.

The results of mosquito testing will tell us if any local mosquitoes are positive for malaria, but the bottom line is that risk is very low. The best thing you can do is avoid mosquito bites:

Wear repellent (DEET, picaridin), especially at dawn and dusk.
Wear long sleeves.
Dump standing water around your home.

Conveniently, the same recommendations apply for preventing West Nile virus. On that note, the first two human cases of West Nile virus in New York City this year were detected in Queens last week. Now’s the time to break out that repellent!

Tragic Erie bus accident and blood supply

On Aug. 22, a tour bus returning from Niagara Falls overturned on Interstate 90 near Pembroke, killing five adults and injuring dozens. Hospitals quickly drew on local blood supplies, prompting ConnectLife, the area’s primary blood bank serving Erie County Medical Center and Kaleida Health hospitals, to issue an emergency appeal for blood donations.

Smaller cities often lack the blood reserve capacity of large, urban centers. This means mass casualty events can drain the supply overnight, especially for rare blood types or platelets, which have shorter shelf lives. While the emergency need for blood following this accident has likely passed, it’s a sobering reminder that routine blood donations are critical for ensuring readiness for unexpected medical crises.

Here’s where you can donate blood:

New York City: New York Blood Center.
Rest of New York state: American Red Cross Blood Donation Centers.

Measles in New Jersey

The New Jersey health department confirmed a measles case in Hudson County, linked to contact with a case from outside the state. Key details remain unclear:

Did the exposure/transmission occur in a public place?
Was the non-N.J. resident case associated with international travel or the result of domestic transmission?
Was either patient vaccinated?

What we do know: The Hudson County case rode PATH and the light rail during commuting hours while potentially infectious. Anyone on those routes may have been exposed. If you are fully vaccinated for measles, you are well protected. If you develop symptoms, contact your health care provider before arriving in person at the doctor’s office.

What else to know this week

Coming up: Free back-to-school vaccine clinics in Buffalo

The Erie County Department of Health is partnering with the University of Buffalo School of Nursing to provide free back-to-school vaccine clinics for Buffalo public school students. These free clinics are taking place as follows:

Sept. 12, 10 a.m.-2 p.m. at the Buffalo Public School 95 Waterfront, 95 Fourth St.
Sept. 18, 2 p.m.-6 p.m. at the Buffalo Public School 309 East Community High School, 820 Northampton.
Sept. 19, 2 p.m.-6 p.m. at the Buffalo Public School 363/415 Lewis J. Bennett/Middle Early College, 2885 Main St.

The vaccines offered include all required school immunizations: DTap/DTP/Tdap/Td; polio; MMR, hepatitis B, varicella, meningococcal, Hib, and PCV (pneumococcal). Students must be up to date on vaccines by Sept. 17 to remain in school, as required by New York State Public Health Law 2164.

Bottom line

From Covid and measles to malaria, Legionnaires’, and even blood shortages, this week’s headlines share a theme: Local preparedness matters. Global diseases, chronic inequities, and unexpected crises all land in our neighborhoods. Staying healthy depends on how much our systems — and our communities — are ready to respond.

Love,

Your NY Epi

7 things to know about New York City’s Legionnaires’ disease outbreak

2025-08-22T13:28:51+00:00

Due to the large, ongoing Legionnaires’ disease outbreak in New York City, we’re taking a closer look at the illness and its biology this week. While the outbreak data shared is specific to New York City, much of this information can apply to outbreaks elsewhere. For our readers outside of New York City, know that we’ll be back with state-level updates next week. Let’s dive in.

While the Legionnaires’ outbreak in New York City’s Central Harlem has slowed, it hasn’t stopped. As of Thursday, there have been 109 cases, with 9 currently hospitalized and 5 deaths. The affected ZIP codes include 10027, 10030, 10035, 10037, and 10039.

The most recent case developed symptoms on Aug. 12, which means we’re likely closer to the end of the outbreak. That’s good news. It means that mitigation efforts (like identifying and cleaning contaminated cooling towers) are working.

New York City Legionnaires’ disease outbreak: Cooling towers, regulations, and lessons from 2015

But we’re not entirely out of the woods — we still might have some cases trickling in. People who may have been exposed before the cooling towers were cleaned could still get sick several days after their exposure.

What does this mean for you? We still need to stay alert, especially if you are someone at higher risk for severe illness (more below).

Since the outbreak began, I’ve gotten a lot of questions about Legionella (the bacteria) and Legionnaires’ disease (the illness it causes). Here are your top seven questions answered.

1. What are the symptoms, and who is most at risk?

Symptoms usually start 2–10 days after exposure and can include:

Cough
Fever
Chills
Shortness of breath
Muscle aches
Diarrhea

Most healthy people exposed won’t get sick. Those at highest risk are adults over age 50, smokers, and people with chronic lung disease, diabetes, cancer, or weakened immune systems.

2. Can I get Legionnaires’ disease from drinking water?

No.

Legionnaires’ disease is caused by breathing in tiny water droplets containing Legionella bacteria. Water doesn’t enter the lungs when drinking unless someone chokes and accidentally inhales it.
Stomach acid also likely kills Legionella bacteria if swallowed, so drinking water (even if contaminated) won’t cause illness.

On top of all this, outbreaks in New York City are typically caused by cooling towers, which are on different plumbing systems than residential water, meaning drinking water will not be contaminated.

3. If it’s in the air, why don’t more people get sick?

The bacteria have to be inhaled in a concentrated enough dose to cause illness. Many people breathe in small amounts without getting sick because their immune systems clear the bacteria.

But older adults, people who smoke, and people with chronic lung disease (including asthma) or weakened immune systems are much more likely to develop severe pneumonia. For example, I don’t have any of the risk factors for severe Legionnaires’ disease, so I felt comfortable going on a run through Central Harlem during the outbreak. If I had asthma, I would have found a different area to run in.

4. If it affects the lungs, why can’t it spread from person to person?

In New York City, Legionnaires’ disease almost always comes from cooling towers (though elsewhere in the United States, outbreaks have been linked to sources like hot tubs). Unlike the viruses that cause Covid-19 or flu, Legionella bacteria don’t spread easily between people— only one person-to-person case has ever been documented worldwide.

Residents question health officials about why Harlem is a Legionnaires’ hotspot

The reason lies in the biology of the Legionella bacteria.

After someone inhales contaminated water droplets, the bacteria travel deep into the lungs and infect alveolar macrophages, a type of immune cell.
Legionella mostly stays put in the lung immune cells — it doesn’t colonize the throat or nose, and you don’t find it in mucus or saliva. This is different from the viruses that cause Covid-19 and flu, which replicate in the upper airways and are spread through coughing, sneezing, or even talking.

This is also reflected in the way people are tested for Legionnaire’s disease: Clinicians often need a lower respiratory sample because infections are typically deep in the lungs. In contrast, to diagnose Covid or the flu, a simple nose or throat swab usually works.

5. What is being done to control the outbreak?

New York City has some of the most intensive and sensitive Legionella monitoring in the world, and was the first city in the world to have a cooling tower inspection program. Every day, special software scans health data across the city for clusters of pneumonia-like symptoms. If a pattern is detected, the health department springs into action: Inspectors test cooling towers for Legionella, and any tower that tests positive must be cleaned, disinfected, and retested by the building owner. The goal is to stop ongoing exposure and prevent future cases.

6. Why wouldn’t a health department share the building addresses of the affected cooling towers?

The health department’s decision on whether to release specific addresses is based on a balance of risk vs. public benefit, and how far along the investigation is (e.g., if there are more cooling towers to test). For the recent Central Harlem outbreak, eventually the city did release information on the buildings with positive tests.

Knowing the address of a contaminated cooling tower shouldn’t really change how you act. That’s because Legionella bacteria from cooling towers can travel long distances in the air, sometimes up to several miles.

The health department likely worries that releasing an address can create a false sense of security. Someone might think, “I’m a few blocks away, so I’m safe,” when that’s not how this bacteria behaves. Risk doesn’t scale linearly with proximity, and public health decisions aim to protect everyone, not just those near a known source.

Instead, health departments focus on identifying and remediating the source quickly, which is the most effective way to reduce risk to the public.

7. What do I need to do?

If you live or work in a ZIP code with a Legionnaires’ disease cluster and develop symptoms, call your doctor right away.

If you have any of the risk factors (age 50 or older, smoke or used to smoke, have a chronic lung condition like COPD or asthma, or are immune-compromised), be on alert for any symptoms and seek medical care right away if you develop any. Also, reduce time in the area of the outbreak (which I know is hard) and spend less time outdoors. For anyone else without risk factors and with no symptoms, I don’t think you need to worry.

Bottom line

Legionnaires’ disease spreads through airborne water droplets, not by drinking water or through person-to-person spread. During outbreaks, spread is slowed by identifying and cleaning contaminated cooling towers. If you live or work in ZIP codes affected by a Legionnaires’ outbreak and develop flu-like symptoms, contact your doctor right away, especially if you are over 50 years old, have chronic lung conditions, smoke, or are immunocompromised.

Love,

Your NY Epi

West Nile virus, Covid, hand foot and mouth disease in New York — and tragedy at CDC

2025-08-15T16:00:00+00:00

This week’s dose is heavier than usual. I’ll cover the typical summer health updates (West Nile virus, Covid, and algal blooms) but am also sharing some reflections on the tragedy at the Centers for Disease Control and Prevention last week: a mass shooting. As a former CDC employee, this one shook me.

But before we jump in, we’re hiring! If you or someone you know is passionate about public health communication, apply here for our Managing Editor position.

West Nile Virus is being detected across New York state

We continue to see West Nile virus pick up across New York, which is typical for this time of year. This week, mosquitoes tested positive in Erie, Nassau, Onondaga, Rockland, Suffolk, and Westchester counties. In New York City, mosquitoes carrying the virus were found in all five boroughs. New York, Richmond, Bronx, Queens, and Kings counties also reported positive mosquitoes. A small number tested positive for Eastern Equine Encephalitis virus, which is rare but more dangerous than West Nile.

New York counties are ramping up mosquito control. Many have conducted or plan to conduct aerial insecticide spraying, where a plane disperses chemicals to kill mosquitoes or prevent breeding. (You can check your local health department website for local schedules.) Recent or upcoming events include Cattaraugus County (Aug 17–23), Onondaga County (last week), and New York City (Brooklyn and Queens this week).

If spraying is scheduled in your community, you can reduce exposure to chemicals by:

Staying indoors
Bringing pets inside
Closing windows

Covid continues to increase, though slowly

Due to delays on the CDC wastewater dashboard, most New York sites aren’t reporting public wastewater data, so I’m focusing on clinical data to understand trends in Covid activity.

All regions of New York, except for Mohawk Valley and North Country, show that Covid hospitalizations are increasing. Hospitalizations are still substantially lower than they were this time last year.

New York state Covid-19 hospitalizations.

If you are feeling sick and take an at-home rapid test, make sure to check the expiration date. Many tests had their expiration dates extended, but they are now approaching those dates. This guide by the North Carolina Department of Health has good instructions on how to check.

Reflections on the tragic CDC shooting

It was the last day of the summer course. The culmination of a month of daily, intensive training for this year’s class of Epidemic Intelligence Service Officers, a program I went through myself. EIS officers are CDC disease detectives, trained to investigate and respond to outbreaks and other urgent public health threats in the United States and around the world. Instead of celebrating, they spent hours sheltering in place on the CDC’s campus as a single shooter sent over 180 rounds of bullets into the windows of four buildings. Many are now afraid to even display their CDC parking decals on their cars for fear of being targeted in public.

There have been more than 260 mass shootings this year in the United States, nine of them in New York, and the effects of each one ripple across individual lives and entire communities. This week, I’m worrying about the long reach of this attack on my friends and colleagues at the CDC and on our entire public health system.

I have more questions than answers. Who will pick up the torch in the next pandemic if our frontline people burn out or leave? Where does this leave us in 10 or 20 years, or in the wake of another health emergency? Why is health leadership so silent on this? What does it say about our country if our government employees are afraid to go to work?

For those in public health here in New York, or elsewhere, I see you. You aren’t alone. Feel free to drop a comment or directly reply to this email; let’s process it together. For everyone else, check in on your people in public health. Thank them for their service.

I’m also donating to the fund for the family of the officer who lost his life protecting the CDC from the shooting. You can join me here: https://give.cdcfoundation.org/give/715122#!/donation/checkout.

What else you need to know this week

Algal blooms: Some New York freshwater beaches — like Sylvan Beach, Verona Beach Park, and Oneida Shores — were closed this week due to harmful algal blooms. These blooms, caused by overgrowth of blue-green algae (cyanobacteria), can cause skin rashes, stomach upset, or more serious illness if swallowed or inhaled. Before swimming at lakes or ponds, check local advisories, and pay attention to posted signs. If you or your pet were exposed, rinse off really well and seek medical care if symptoms develop.

Rabies vaccine campaign in Erie County: From Aug. 13 to 23, the U.S. Department of Agriculture will be dropping fish-scented bait packets containing oral rabies vaccine across Erie County by helicopter. When raccoons and other animals eat the bait, they become immunized against rabies. If you find a packet, don’t touch it. If you must handle it, wash your hands immediately. Keep an eye on kids and pets when outdoors during distribution, and keep pets leashed to keep them from eating the bait. See the distribution map here.

Rabies vaccine bait.

Hand, foot, and mouth disease in New York: Some doctors in New York are reporting that this year is an exceptionally bad year for hand, foot, and mouth disease. So if you feel like this is tearing through your kid’s daycare or preschool, you aren’t alone. HFM is a super common and very contagious virus that mainly affects children under 5. It’s usually mild, but symptoms can include fever, mouth sores, and skin rash. There isn’t a ton to be done about it. The best things to do are to keep things clean (wash hands and surfaces) and talk to your child’s health care provider if they develop symptoms.

Bottom line

This week we’re reminded of how vulnerable public health can be, and how much it relies on people who care about it deeply. If you are in public health, know that we are with you and are so so grateful for your work. If you’re not in public health, it’s a good time to check in on those who are.

Love,

Your NY Epi

Legionnaires’ disease outbreak grows in Harlem. Rabies, West Nile on the rise. What you need to know.

2025-08-08T15:00:00+00:00

We’re seeing movement on multiple infectious disease fronts in New York this week. The Legionnaires’ disease outbreak in Harlem has more than doubled. Rabies is elevated in some counties. And across the state, West Nile virus is rising with mosquito activity. This week’s post will cover what these mean for your health, and how to reduce your risk. Let’s dive in.

Legionnaires’ outbreak grows

The cluster of Legionnaires’ disease in Harlem we reported on last week continues to grow. As of Thursday, there were 73 cases, including three deaths. Affected ZIP codes are: 10027, 10030, 10035, 10037, and 10039. The risk to most is low, but if you live or work around these ZIP codes and have flu-like symptoms, it’s important to see a health care provider immediately for possible antibiotic treatment. If you do not have a health care provider, visit NYC Health + Hospitals.

Legionnaires’ disease symptoms include:

Cough
Fever
Chills
Muscle aches
Shortness of breath

Most people exposed to Legionella bacteria won’t show symptoms, but the bacteria is particularly risky for people who are over 50, people who smoke or who have chronic lung disease, and those with weakened immune systems. The most recent New York City Legionnaires’ report showed that among people infected in 2019-22, more than 90% had at least one chronic medical condition, and more than 50% were previous or current smokers. The most commonly cited medical conditions were diabetes and lung disease.

For outbreaks like this in New York City, the culprit is most likely a cooling tower. These usually sit on roofs and use water evaporation to cool the building. When bacteria-containing mist from a contaminated cooling tower drifts down, people can breathe it in and get infected. This means that residents in these ZIP codes can continue to drink tap water, bathe, shower, cook, and use their air conditioners.

That’s because cooling towers and drinking water tanks are different systems — it’s not the same water.

We’ve had several Legionella outbreaks here linked to cooling towers previously. Every year, there are hundreds of cases detected in New York City.

During the pandemic, cases actually declined compared to the previous couple of years. Masking and less movement around the city probably reduced exposure to mist from cooling towers, where Legionella can grow.

In 2015, one of the biggest outbreaks of Legionnaire’s disease in the United States was linked to a single cooling tower in the Bronx. That tower was responsible for 135 cases and 16 deaths.

In New York City, Legionnaires’ disease tends to be more common in Northern Manhattan and the Bronx. The reasons aren’t totally understood, but it’s likely due to a mix of factors, including lower maintenance of building systems like cooling towers (often tied to income and infrastructure disparities) and higher rates of chronic health conditions like diabetes, which can increase risk of severe infection.

So, how can we prevent outbreaks?

In New York, the best way to prevent outbreaks is to test and treat cooling towers. Legionella bacteria is actually quite common in the environment, and a positive test doesn’t always mean there will be an outbreak. Still, New York has a system. Under state law, all cooling towers must be:

Registered with the state
Tested for bacteria
Cleaned and disinfected after testing
Maintained under a long-term management plan

These requirements apply to all cleaning towers, including residential buildings, schools, office buildings, and businesses. When Legionella is detected, the tower must be cleaned and retested until it meets safety standards.

What does this mean for me?

While Legionella is common in the environment, most people exposed won’t get sick. But when conditions are right, and there are vulnerable groups living or working close to sources, exposure can lead to serious illness. If you live or work in one of the affected ZIP codes and have or develop flu symptoms, seek medical care as soon as possible. Early detection, proper maintenance, and rapid public health investigation are key.

Rabies in Nassau

Rabies is increasing in some New York communities. Nassau County just declared rabies an “imminent threat” in the county because of the increase in recent detections. Over the past year, 25 wild animals, including raccoons and feral cats, have tested positive for the virus in Nassau County — a sharp increase since it was declared eradicated in the county in 2016. In March, Suffolk County also noted an increase in rabies in raccoons.

In 2024, Westchester and Erie counties had the highest rabies detections of New York counties.

Rabies, nearly 100% fatal for humans, circulates in the wild animals around us. And while increases in rabies may sound scary, there are practical steps we can implement that make risk to humans pretty low.

What you can do

Ensure that your pets are up to date on rabies vaccines — in New York, state law requires it. All New York counties offer free rabies vaccination clinics. For more information, contact your local health department.
Do not touch or get close to wild animals, including feral cats. If you are bitten, immediately wash the wound with soap and water and contact your medical provider. Advise children to immediately tell an adult if they are bitten or scratched by an animal.
If you see a wild animal that doesn’t look well, or you encounter a dead animal, contact your local health department or 311 if you are in New York City. Rabies symptoms in animals include tiredness, confusion, difficulty moving, aggression, drooling, and chewing objects like wood, soil, or stones.

Getting vaccinated is crucial if a wild animal bites you. I learned that firsthand in college when a monkey bit me while I was traveling — and I’m thankful I got the shots.

Question grab bag: A reader asks, ‘What’s the risk of rabies from a dog bite? Do we treat bites from wild and domestic animals differently?’

Great question. When we talk about rabies in the United States, most of the risk surrounds wild animals, especially bats, raccoons, skunks, and foxes. Domestic dogs and cats can carry rabies, but it’s actually extremely rare in the United States. In New York, because vaccination is mandatory, rabies in domestic cats and dogs is nearly unheard of.

With that said, when a person is bitten by an animal, there are multiple factors that go into determining the best course of action for rabies treatment, including:

Vaccination status of the animal (if known)
Type of animal (wild vs. domestic)
Location of the bite: Bites to the head or neck or deeper bites can increase risk because they are closer to the central nervous system
If the animal can be quarantined and observed for illness
Local rabies levels and alerts (some areas have more local circulation)

The bottom line is that whenever someone is bitten by an animal, they need to contact a medical provider and public health as soon as possible to discuss the best course of action.

West Nile virus increasing in Long Island and rest of state

West Nile virus continues to heat up this summer with more mosquito detections across the state and in New York City.

West Nile virus detections in New York. (Figure from the New York State Department of Health. Annotations by YLE.)

Now is the time to be wearing mosquito repellent at dawn and dusk, or consider wearing long sleeves if it’s not too hot. Annoyingly, I had a mosquito fly into my loose pants last week and bite me on the shins, so I’m switching to repellent. Also, dump standing water around your home — it’s the perfect breeding habitat for these pests.

Bottom line

You’re all caught up! See you next week. :)

Love,

Your New York Epi

New York health update: gun violence in Midtown, increasing Covid, and Legionella

2025-07-31T19:00:00+00:00

It’s been a tough week in New York City. In this post, I break down the latest on gun violence, Covid trends across the state, and a new cluster of Legionnaires’ disease. Here’s what you need to know.

A mass shooting in New York City

Tragically, four New Yorkers lost their lives last Monday when a man opened fire in an office building in Midtown, New York City. My heart goes out to the families of those lost, and the New York Police Department, which lost an officer.

I was only 10 blocks away, getting ready to watch an outdoor movie, when alerts and frantic texts began. I became acutely aware of how crowded the plaza I was in was, heard helicopters overhead, and nervously checked my phone and scanned the crowd. I was fine, but scared the rest of the evening.

When I think about the context of last week’s tragedy, I’m left feeling profoundly confused, and frankly, angry. In a state with some of the strictest gun laws and lowest firearm mortality rates, in a city with declining gun violence and increasing removal of firearms from the streets, in an office building with security guards and bulletproof saferooms, and with the rapid and heroic response of the NYPD, we still had a mass shooting. Guns were brought across state lines. Multiple people died. This system is not working.

Gun violence in New York: the bigger picture

In 2023, the most recent year with complete data, the Centers for Disease Control and Prevention showed that almost 47,000 people died of gun-related injuries in the United States. In 2022, our state’s most recent data, there were 1,044 gun-related deaths in New York state.

The risk of gun violence depends heavily on which state you live in. Despite the recent New York City tragedy, data show that population-adjusted shootings are actually lower in New York compared to most other states.

But even at ~5 deaths per 100,000 people, the state loses roughly three New Yorkers to gunfire every day — far too many. And, while our rates are low relative to most other states, gun violence in New York state has increased in recent years.

While the New York state data reported to the CDC is delayed, early New York City data for 2025 show that gun violence is down this year compared to last. From January–May 2025, New York City recorded 264 shootings and 112 murders, while the NYPD removed more than 2,265 illegal guns off the streets. At this point, it’s hard to tell what the trend for New York state looks like over the past two years, but I’ll be back with updates when data is released.

What New York has done

Many attribute lower gun-related mortality in New York to our strict gun laws — some of the strictest in the country.

Since 1993, universal background checks have been in place to obtain a firearm in New York.
“Red flag” laws were instituted starting in 2019, which allow judges to temporarily suspend a person’s access to firearms with credible evidence that they might be dangerous to themselves or others. (Evidence can include information from family members, doctors, teachers, or other community members.)
Permits are required in New York to carry a handgun, and the state prohibits magazines holding more than 10 rounds of ammunition.

While these policies likely affect firearm death and injury in New York, attributing causation for these lower death rates is complex.

Did CTE play a role in the shooting?

The short answer is that we don’t know. CTE (chronic traumatic encephalopathy) is a brain disease caused by repeated head trauma, seen most often in athletes and military veterans. It’s linked to impulsivity, depression, cognitive impairment, and suicidal thoughts. The gunman in the recent tragedy claimed he had CTE from football. Because CTE can only be diagnosed after death during a brain autopsy, it is notoriously hard to study. We need further scientific research, especially because it’s been connected to other violent incidents.

There are resources available for those with suspected CTE:

CDC’s Heads Up Program and the Concussion Legacy Foundation HelpLine can provide resources to those at risk of or struggling with brain injury.

Aftermath and action

We talk about gun violence and mass shootings as public health issues because of their impact. Beyond immediate loss of life, they leave lasting and damaging effects on communities. Four years after the 2017 Las Vegas attack, 63% of surveyed survivors still met the criteria for post-traumatic stress disorder, and half had major depression. Today, a third of American adults say that fear of mass shootings prevents them from going to certain places or events. In 2025, there have already been 253 mass shootings across the country.

From a public health perspective, I think we need two things:

Better science. We need clearer data on CTE’s causes, diagnosis, and treatment.
Policy action. We need coordinated gun laws. As long as we have a patchwork of policies, guns will continue to move across state lines.

I’ll be calling my congressional reps this week to let them know how I feel. Find your local reps’ contact information here.

Also know that there are resources to support those who have experienced gun violence. The Sandy Hook Promise provides guidance and mental health resources for those coping with shootings.

Covid-19 is increasing in New York

Wastewater data is showing that Covid-19 is increasing in New York City and across the state, though on average levels remain low.

Concentrations of Covid-19 in wastewater in New York state.

The most recent data show hotspots in Suffolk and Nassau counties, where wastewater activity levels are very high and high, respectively.

Covid-19 hospitalizations also continue to increase, though they are still at pretty low levels.

Covid-19 hospitalizations in New York state.

Cluster of Legionnaires’ disease in Central Harlem

Last week, health officials quickly identified a cluster of Legionnaires’ disease in Central Harlem. So far, 22 people have been diagnosed across five ZIP codes: 10027, 10030, 10035, 10037, and 10039.

The cluster was identified using a super cool surveillance software that scans New York City’s health data daily. It looks for unusual spikes or patterns and alerts public health officials of any signals. You can think of it like a smoke detector, signaling when something changes so officials can investigate further.

Legionnaires’ disease is a serious lung infection caused by the Legionella bacteria. It spreads when people breathe in mist or small droplets that contain the bacteria, not through person-to-person contact or by drinking water. Common sources include cooling towers (which we have a lot of in New York City), hot tubs, and showers. This is not an issue with any residential building’s plumbing system. it’s safe for you to drink water, bathe, shower, cook, and use your air conditioner.

Most people exposed to Legionella bacteria will not get sick. But some groups are at higher risk for severe illness, especially:

Adults age 50 or older
People who smoke or who have chronic lung disease
Those with weakened immune systems
People taking medications that suppress the immune system

Symptoms can look like the flu: fever, cough, muscle aches, or shortness of breath. If you’ve spent time in the affected areas since late July and have any of these symptoms, seek medical care right away. Early treatment can prevent more serious complications.

The next steps for the city are to keep investigating the cluster and try to find the source. They have started testing cooling water towers for Legionella in the area. If they find a positive hit, they’ll remediate by intensely cleaning it to remove the bacteria.

Bottom line

That’s it for this week. As always, stay safe, stay healthy, and take care of each other. I’ll see you next week.

Love,

Your NY Epi

NY health update: West Nile virus, Covid uptick, air quality after congestion pricing

2025-07-25T13:11:25+00:00

It’s never a dull week in the world of New York public health. This week we’re reporting on the first West Nile Virus cases of the season, increasing Covid-19 levels in New York City, measles in New Jersey, the first peek at air quality data from congestion pricing, and celebrating a couple of public health wins. Let’s jump in.

West Nile Virus in humans in upstate New York

This week, New York state confirmed its first two human cases of West Nile Virus in 2025, reported in Erie and Onondaga Counties. While the numbers are still low, it’s an early sign the season is heating up.

Mosquito surveillance also found two new WNV-positive mosquito pools (groups of mosquitoes “pooled” for testing) in Rockland and Suffolk Counties.
New York City has reported 52 WNV-positive mosquito pools so far (including Richmond, the Bronx, and Queens).
There have been no WNV detections in horses or blood donors.

Mosquitoes in New York can also carry the virus that causes Eastern Equine Encephalitis, which is rarer and usually more serious than WNV. So far in 2025, they have only detected EEE in mosquitos in Onondaga County.

While risk to the general public remains low, now’s the time to double down on prevention. WNV and EEE are spread by mosquitoes — not people — so it’s all about bite protection:

Wear repellent (DEET, picaridin), especially at dawn and dusk. If you are using sunscreen, apply sunscreen first and insect repellent second.
Cover up: Wear long sleeves if it’s not too hot.
Dump standing water (think flower/plant saucers, buckets, fountains, toys that have been sitting outside, etc.) to eliminate mosquito habitats.

COVID is increasing in New York City

Wastewater data is showing that Covid-19 is starting to increase in New York City, signaling that the summer surge is underway.

New York City average Covid-19 wastewater concentrations.

On average, Covid-19 levels remain low across the rest of the state.

Wastewater Covid-19 concentrations in New York state.

We are noticing some hot spots though. Onondaga County has a very high Covid-19 wastewater level, while Warren County is high. And we’re starting to see this reflected in the increasing number of hospitalizations in New York. The good news is that they are still relatively low.

Update on New Jersey measles

The New Jersey health department is now reporting two measles cases in the state, though they are unrelated to each other. The cases are in Ocean County (which we highlighted last week) and in Hudson County.

Anyone who visited the following locations during the specified times may have been exposed. Potentially exposed people should contact a healthcare provider if they develop any measles symptoms, which usually start like a cold and progress to a rash.

If you do develop symptoms, it’s important to call your doctor or clinic before you visit in person so special precautions can be taken to prevent further spread. Reminder—if you are fully vaccinated, you are well protected.

Initial look at air quality following congestion pricing

Congestion pricing in Manhattan has been in effect since January. (We wrote about it here.) Last week, a report shared a first look at air quality data since the program’s start.

The report looked at data for fine particle air pollution (PM2.5) from locations inside and outside the tolling zone, three months before the tolling started (from October to December 2024) and three months after tolling began (from January to March 2025).

PM2.5 is important to track because long-term exposure increases risk of lung and heart disease, and short-term exposure increases risk of asthma.

Inside the zone: PM2.5 held steady or ticked down.
Outside the zone: Most monitors mirrored that trend, suggesting traffic — and pollution — aren’t simply shifting elsewhere. The lone exception, Hamilton Bridge, registered a rise even though traffic counts barely budged, so the cause remains unclear.

The initial data look good, but it’s for a short period of time, and PM2.5 is heavily influenced in the winter by heating and boiler use. We’ll need more data to draw conclusions on how effective this program is at reducing air pollution in New York City.

For some good news, here are some NY public health wins

DuPont settlement

After a decade-long legal battle, the chemical maker DuPont agreed to pay a $27 million settlement to the 3,000-person town of Hoosick Falls for contaminating local drinking water with PFOA, a “forever chemical” linked to cancer that lingers in the body for decades.

The suit began in 2016 when residents of Hoosick Falls found PFOA levels in their blood more than 30 times the national average. PFOA was used to make Teflon at a Hoosick Falls facility.

Following the finding of drinking water contamination, the manufacturing facility was declared a superfund site by the EPA. As part of the remediation, Honeywell and Saint-Gobain (other companies involved) agreed to pay $45 million, including funding the replacement of all drinking water lines in Hoosick Falls. The drinking line replacement was completed this March.

NYC doula program met its goals

New York City Mayor Adams and Health Commissioner Morse announced last week that several milestones had been reached for the NYC Citywide Doula Initiative. The program provides free access to home visits and doula support for moms and parenting families. A doula is a professional, trained childbirth assistant who provides non-medical support.

So far the program has:

Provided doula services to 1,128 new clients in 2024, exceeding its goal of 1,000.
Served 3,245 people over the last three years.
Not had a single maternal death among program participants.
Seen a 25% increase in doula coverage for NYC residents since 2022.
Served a large proportion of women of color, shelter residents, and non-English-speakers.

Families are eligible for free doula services through the program if they live in areas hit hardest by Covid-19 and other health and socioeconomic disparities.

Bottom line

You’re all caught up on New York public health news. See you next week!

Love,

Your NY Epi

How to protect against NYC summer health threats: Floods, mosquitoes, and ticks

2025-07-18T13:33:11+00:00

There’s a ton going on in the world of New York public health. This week we’ll cover measles, Covid, tick bites, and West Nile virus. Let’s dig in.

Flooding in New York

Extreme rainfall early this week paired with old sewer systems caused flooding in parts of New York and New Jersey. Central Park recorded its second-wettest hour in history, with over 2 inches of rainfall in an hour Monday night. Inundated roads and subway lines disrupted transportation. Sadly, two people in New Jersey died after being swept away in a river. The governor issued a state of emergency.

While the waters have since receded, this event once again revealed our community vulnerability to floods, and the need to be prepared. Just last month, the New York City Department of Health identified flooding as a top public health hazard for New Yorkers.

What can we do to prepare for floods in New York?

FloodHelpNY is an online resource hub for New York residents, created through the Governor’s Office of Storm Recovery, the Federal Emergency Management Agency and other partners. Enter your address to assess your specific flood risk.
Sign up for NYC Emergency Alerts or NOAA Weather Radio for notifications.

Flooding is NYC’s most pressing public health threat, new city report says

Be prepared to shelter safely during floods or extreme rain events. Move to higher ground — if you live in a basement apartment, be prepared to move to a higher floor during periods of heavy rain. Never drive or walk through floodwaters - just 6 inches can sweep a person away.

YLE national offered suggestions in a piece this week tied to the floods in Texas.

Measles in Ocean County, New Jersey

New Jersey is reporting a measles case in Ocean County. The health department is investigating the case, but so far there isn’t a ton of information. Contact tracing is underway, and people who may have been exposed are being notified. Potentially exposed individuals, if infected, could develop symptoms as late as July 22.

The recommendation to stay up to date with MMR vaccinations remains the same. New Jersey and New York state departments of health are also urging anyone not fully vaccinated to get the measles vaccine before traveling internationally or to any U.S. region with a measles outbreak.

They recommend:

Being fully vaccinated with the MMR vaccine at least two weeks before departure.
If the trip is less than two weeks away, and the traveler is not immunized, getting one dose of MMR is advised.

As always, consult your medical provider to discuss what’s right for you and your family.

In case you missed it, Katelyn Jetelina and Kristin Panthagani’s YLE National post last week contextualized why public health is raising alarms about record high measles cases in the United States.

Covid still low in New York

We still aren’t seeing much COVID activity in New York—welcome news for the summer! As always, I’ll share updates when I have them.

Tick bites are still very high in the Northeast

The Fordham Tick Index, which measures the risk of being bitten by a tick in the tri-state area (Southern New York, Connecticut, and Northern New Jersey) is 9 out of 10 — very high risk. The index is based on current and historical data from the Fordham’s Biological Field Station in Westchester County, New York.

We see this playing out in emergency department visits for tick bites in the Northeast, which have been higher this year than last.

In New York, we are most concerned about Lyme disease, which is transmitted by black-legged ticks (aka deer ticks). New York reports some of the highest numbers of Lyme disease in the country, with more than 9,000 cases annually. Lyme is found in every region of New York, including urban centers like New York City.

Tick populations have surged in the Northeast. Here’s how to keep you and your pets safe this summer.

Protecting yourself and family means avoiding ticks:

Use repellent that contains 20% or more DEET, picaridin, or IR3535 on exposed skin.
Treat clothing and gear with products containing 0.5% permethrin.
Walk in the center of trails and avoid brushing against tall plants.
Do tick checks after spending time outdoors. For kids, especially check under arms, in and around ears, in the belly button, and in their hair.
Toss your clothes in a hot dryer for 10 minutes to kill any hidden hitchhikers.
Treat dogs for ticks. Dogs are very susceptible to tick bites and may also bring ticks into your home.

If you find a tick attached to your skin, remove it promptly with tweezers and monitor for symptoms. Early treatment is key to preventing severe illness.

Mosquitoes test positive for West Nile virus in NYC

We are in the thick of mosquito season in New York, and we can expect the pests to hang around until about November when temperatures start to drop.

Most mosquitoes do not carry pathogens that can hurt us. Among those that do, the most common is West Nile virus, and even that is relatively rare. In 2024, 100 human cases were reported across New York state, including in New York City. While most people who get West Nile virus won’t show symptoms, the virus can be more dangerous for those who are over 60 years old or have immunocompromising conditions.

In New York City, the virus has been detected in mosquitoes in the Bronx, Queens, and Staten Island so far this season. There have been no human cases. We are still waiting for New York state to post their data and will be back with updates when that happens.

The best thing you can do is avoid mosquito bites:

Wear EPA-approved mosquito repellent outside, especially during peak mosquito activity time: dawn and dusk. If you are using sunscreen, apply sunscreen first and insect repellent second.
Avoid being outside when mosquitoes are most active (the morning and evening) — but this can be really hard.
If it’s not too hot, long sleeves and long pants can protect against bites.
Dump standing water (think flower/plant saucers, buckets, fountains, toys that have been sitting outside, etc.) to eliminate mosquito habitats.

There aren’t any spraying events currently scheduled, but I’ll be back with an update when that happens.

Bottom Line

You’re all caught up with New York health. See you next week!

Love,

Your NY Epi

Trump’s ‘Big Beautiful Bill’ slashes Medicaid: Here’s what it means for New York

2025-07-11T13:46:43+00:00

A few years ago, I found myself between jobs and couldn’t keep my health insurance. Living in the expensive Bay Area, fresh out of grad school, I was stressed about affording coverage out-of-pocket.

Thankfully, under the Affordable Care Act, I was able to get a government subsidy on health insurance through the state marketplace. But, even after the subsidy, my monthly premium for the most basic plan was ~$400 per month — a heavy burden when my income was $0 at the time.

I hadn’t planned to take time off or be uninsured, but when it happened, a social safety net — the ACA marketplace — caught me.

Now, that net is shrinking. On July 4, President Donald Trump signed the “One Big Beautiful Bill,” officially cutting $1 trillion in funding from Medicaid and reshaping the ACA marketplace. This will directly impact New Yorkers, but there is still action you can take.

Millions of New Yorkers will lose health insurance

The bill cuts Medicaid and the ACA by $1 trillion over 10 years. For a plain language breakdown on how this is happening and the national impact, see our earlier post.

In short, the bill will make it harder to get and keep Medicaid and ACA coverage in a number of ways.

Analyses estimate that 1.5 million New Yorkers will lose their health insurance coverage due to these changes. Locally, that translates to about 33,000 New Yorkers in Syracuse, ~40,000 in Buffalo, ~39,000 in the Adirondacks, and ~700,000 in New York City potentially losing their health care. You can see how this affects your New York district here.

In New York state, roughly 35% of residents depend on Medicaid, one of the highest shares of any state and far above the national average of about 20%. In New York City, just over half of residents are enrolled.

Medicaid enrollment is high in New York because:

Poverty is high. In New York City, 25% of residents live in poverty; statewide, the rate is 13.9% versus 12.8% nationally.
There are large, high-need populations, including those with disabilities, seniors needing long-term care, and immigrants.
Many New Yorkers lost jobs during the pandemic, losing work health care plans or the means to pay for insurance.
New York expanded eligibility, providing coverage for more New Yorkers.

Rural clinics and nursing homes in New York will have less funding

This won’t just impact individuals on Medicaid. It will have ripple effects into health care systems.

Rural hospitals, nursing homes, and clinics will be hit especially hard. In some regions, Medicaid makes up 40% of hospital revenue. Take the Adirondacks — 28% of residents, half of births, and two-thirds of nursing home residents in the region rely on Medicaid. Many in the region have seasonal or part-time work that doesn’t come with employer health insurance.

Already in New York state, nearly a third of rural hospitals are at immediate risk of closing due to low revenue. U.S. Sen. Edward Markey, a Massachusetts Democrat, listed 11 rural New York hospitals at risk due to the Medicaid cuts in this bill.

If Medicaid support shrinks, clinics already on the brink may close, leaving entire communities without local access to care. Even though a national rural health fund of $50 billion was added to the bill, hospital organizations say this likely won’t be enough when spread across the entire rural health infrastructure. Nationally, 338 rural hospitals, and many more clinics, are estimated to be at risk based on their reliance on Medicaid payments for the patients they serve.

Planned Parenthood serves 88,000 patients annually in New York, many in rural areas, providing reproductive and basic care like cancer screenings and blood pressure checks. The bill bans Medicaid payments to any non-profit providing abortions and receiving more than $800,000 in federal funds (though this is being debated in the courts). This would defund larger Planned Parenthood clinics in New York, where abortion remains legal, and could force 200 clinics nationwide to close.

Lastly, the bill withholds some funds to states like New York that provide non-emergency care to undocumented immigrants. While federal law requires hospitals to provide emergency care to everyone, New York provides additional care, like prenatal and elderly care, for undocumented residents.

Food assistance is being cut

In New York, a little over 12% of residents (2.4 million people) rely on the Supplemental Nutrition Assistance Program, a federal program that provides benefits to low-income people to purchase groceries. SNAP used to be referred to as food stamps and is the primary safety net for food insecurity in the United States. The Big Beautiful Bill cuts $186 billion from SNAP and expands work requirements for SNAP eligibility for adults up to age 64 (previously 54) and for parents of children 14 or older.

These changes could push millions off benefits, especially in rural New York, where jobs are often seasonal or scarce for older adults. The hardship of unemployment can be worsened by losing access to nutrition support. With food prices still high, cuts to SNAP risk deepening food insecurity across the state.

The bill will affect local economies

The effects from these bills are not restricted to access to medical care, they will also affect local economies. In New York state, hospitals and health systems are among the top 10 employers in every region.

It’s estimated that the bill will cut ~$8 billion from New York’s hospitals and health systems alone. These cuts could lead to 63,000 lost hospital jobs and related jobs, and result in $14.4 billion in lost hospital-generated economic activity. You can check estimated local economic impacts here.

What can we do?

Such huge policy changes can feel overwhelming. (They sure do to me.) But there are some things we can do to take action:

Help neighbors: Many will face new forms, deadlines, and confusing rules. In New York City, many community-based organizations can help with applications. (Filter for Medicaid or SNAP assistance organizations here.)
Keep kids covered: Check CHIP or the Child Health Plus program in New York. Kids often lose coverage when parents do, even if they still qualify, due to paperwork gaps or confusion.
Inform families: Nationally, kids aren’t auto-enrolled in free school lunch anymore, but all New York City public school students now get free lunch, no forms needed. These universal free meals will also be available across New York state starting this fall. Food banks and pantries in New York can be found through the Food Help NYC tool, calling 311, or through food assistance providers across the state.
Support: Donate to rural hospitals, food pantries, and care networks.
Call your reps: This was a policy choice, but we can still make our voices heard.
Spread the word: Many Americans don’t know that this bill cuts Medicaid and the ACA.

Bottom line

Honestly, this bill does a lot of damage to health safety nets. For tens of millions of Americans, the bill will have direct impacts on their lives. But unexpected events — layoffs, job transitions, injury, family issues — can happen to any of us. While there’s no easy answer to the problem of a shrinking social safety net, we can still do what New Yorkers do best: Take care of our communities.

Love,

Your New York Epi

NY health update: Zohran Mamdani’s proposals, help for asthma in the heat, Pride month resources

2025-06-27T11:00:00+00:00

With so much going on, taking breaks and recharging are key to preventing burnout. We’ll be taking next week off to do just that.

But before we sign off, here’s your dose of New York health news.

Zohran Mamdani wins NYC mayoral Democratic primary

Former Gov. Andrew Cuomo conceded to state Assemblyman Zohran Mamdani on Tuesday night. New Yorkers will vote in the general election in November to determine the next New York City mayor.

I highlighted some of Mamdani’s health-related plans in our Mayoral Primary Voter Guide earlier this month. To recap, Mamdani’s proposals include:

Establishing a Department of Community Safety, backed by $1.1 billion in funding, that aims to prevent violence and strengthen social safety nets. This program would invest ~$350M in mental health services, expanding preventive and ongoing mental care, as well as crisis intervention for severe mental illness through increasing the number of mobile crisis teams.
Creating city-funded grocery stores to improve healthy food access and combat food insecurity.
Providing new parents with baby baskets that contain essential goods and resources, like diapers and baby wipes, and information on newborn home visiting programs, breastfeeding, and postpartum depression.

We’ll be back with more info as we get closer to the general election.

Free AC program for those with asthma

We just made it through our first heat wave of the year, with temps across the state hitting 100°F. While next week looks cooler, more extreme heat is likely in the weeks ahead. In addition to last week’s heat safety tips, there’s now a new resource available to help New Yorkers manage heat-related health risks.

Last week, Gov. Kathy Hochul launched the Essential Plan Cooling Program, which offers free air conditioners to eligible New Yorkers. Specifically, it’s for those enrolled in the Essential Plan (New York’s Medicaid expansion) who also have persistent asthma. This program is different from the Home Energy Assistance Program. The application and additional details are available here.

Why asthma? Hot, humid weather is a known trigger of asthma symptoms. It also increases ozone in the air (smog), which can trigger asthma. Heat speeds up the chemical reaction that creates ozone, so air is often smoggier on hot days.

There are things you can do to prepare for the heat if you have asthma:

Check the air quality, temperature, and humidity using airnow.gov before you go outside. If air pollution or temperature is high, limit how much you’re out.
Stay hydrated. Drinking water can help cool the mucus in your lungs and airways.
Always have your medication on hand.
Use a HEPA air filter to reduce pollution indoors.
Prepare for power outages, which can be caused by excessive heat. If you use a nebulizer, oxygen concentrator, or other electronic medical device, have a backup plan with your health care team for what to do in the event of a power outage.

A win for SNAP

Over the weekend, a bill moving through Congress proposing to cut $128 billion in federal funding from the Supplemental Nutrition Assistance Program, formerly known as food stamps, failed to meet Senate requirements. This means the bill can’t move forward with the cuts — good news for the nearly 3 million people in New York who rely on SNAP to put food on the table.

The bill would have required states to shoulder at least 5% of SNAP benefit costs, substantially slashing federal support. Because the bill is moving through a special “budget reconciliation process,” it must follow certain rules. The Senate parliamentarian (essentially a non-partisan referee) evaluated the bill and determined that the SNAP cuts didn’t meet the criteria. They also determined that another part of the bill, a proposal to bar non-citizens from receiving SNAP benefits, didn’t meet the criteria. That means that immigrants who qualify for SNAP, regardless of immigration status, can still receive benefits.

In New York City alone, 1.8 million people rely on SNAP. Statewide, nearly 1 in 7 residents depend on it — 30% of recipients are children, and 21% are elderly people. Since the pandemic, the number of New Yorkers needing food assistance has mostly grown.

SNAP isn’t just a lifeline for feeding families, it also adds to the economy. Every $1 spent on SNAP generates an estimated $1.54 in economic activity. This means that the $7.4 billion spent on the program in New York annually generates about $11.5 billion in economic activity.

While this win is meaningful, it’s not final. Lawmakers will likely look for alternative means to fund tax cuts, potentially affecting SNAP down the line.

Medicare Advantage update for NYC retirees

Last week, New York City Mayor Eric Adams stated that ~250,000 retired city workers would not be switched from traditional Medicare to privatized Medicare Advantage plans. The original plan to switch city workers to private Medicare Advantage was proposed to save the city about $600 million annually. However, it garnered significant criticism.

Medicare Advantage is a type of Medicare plan offered by private insurance companies, approved by Medicare. While it can offer additional benefits like dental, vision, and hearing coverage, it has some drawbacks:

Limited networks. Fewer doctors and hospitals accept these plans.
Pre-approvals for care. Services often require prior authorization.
Potential for higher out-of-pocket costs. Plans may have lower up-front premiums, but can lead to higher out-of-pocket costs depending on the services needed.

Because of these drawbacks, many retirees raised concerns and pushed back against the Medicare Advantage plans. With this change, City Hall will now continue to look for other ways to save money on health care.

Pride month resources, and a mental health update

New York has been celebrating Pride for the past month, from the Capital Pride Parade in Albany to Rainbow City in Niagara Falls. And there’s still more ahead — the New York City annual Pride March and PrideFest are this Saturday.

To safely celebrate, the New York City and New York state health departments have put together resources and recommendations, including spending time with community, practicing safe sex (including PrEP and PEP), and checking in on mental health.

LGBTQ+ individuals often face unique mental health challenges, driven by factors like family rejection, discrimination, or social isolation. These stressors have tragically contributed to higher suicide rates in this community.

Since 2022, the national 988 suicide hotline has provided an option for LGBTQ+ callers to be connected to specially trained counselors who share similar life experiences to offer support. But last week, the federal government ended this specialized support to cut costs.

It’s important to know the 988 line is still active and available to everyone. But this loss in dedicated support for the LGBTQ+ community is a step in the wrong direction for addressing mental health a high-risk population.

For LGBTQ+-specific mental health services, the following hotlines are still available:

The Trevor Project provides national, 24/7 crisis care for LGBTQ+ young people. Call (866-488-7386), text (678-678), or chat from anywhere in the United States.
The Trans Lifeline is a national, English/Spanish hotline (877-565-8860) offering peer support phone service for trans people.
NYC Teenspace is a free mental health support program available to any teenager age 13 to 17 living in New York City. It connects teens to licensed therapists for ongoing support.
The NYC Anti-violence Project offers an English/Spanish hotline (212-714-1141) that can connect callers with trained counselors specializing in LGBTQ+ and HIV-affected mental health.

Covid-19 activity remains low in New York

The summer wave I’m expecting still hasn’t taken off in New York. Both wastewater and hospitalizations data show that Covid-19 activity is still low across the state. Though I do anticipate things will pick up soon.

I’ll be keeping a close eye on things and report back with updates.

Bottom line

You’re all caught up with New York health this week! See you after our break next week.

Love,

Your NY Epi

Hot — and humid — summer days are on New York’s horizon. How to keep cool.

2025-06-20T13:31:00+00:00

We’ll dive into the warm temperatures on New York’s radar, but first …

Me at the WNYC studio.

Have you voted yet? Last week, I shared a health voter guide for the NYC mayoral election. This week, I sat down with WNYC’s Brian Lehrer to discuss it. You can listen to our conversation here.

Okay, back to our scheduled programming …

Last weekend, I joined 9,999 other women to run a loop through Central Park for the Women’s Mini 10K. It was empowering and energizing, but wow was I struggling with the heat. I assumed the temperature must be in the 90s. The reality? Just 75°F.

The problem wasn’t the heat alone, it was the humidity. When moisture in the air is high, your body can’t cool itself as effectively. Sweat just sits on your skin instead of evaporating, making it feel much hotter than it is.

Next week, parts of New York could see high temps reach 100°F — the hottest day of the year so far. Because our bodies gradually adapt to heat as the summer progresses, we’re especially vulnerable in June. Early-season heat hits harder. There’s also truth to the old saying: It’s not the heat, it’s the humidity.

Let’s break down why heat and humidity matter — and what you can do to stay safe.

⚠️[Increasing Heat and Humidity!]: For early next week, we are looking at our first stretch of prolonged hot, humid weather beginning Sunday and lasting through at least the middle of next week. Stay tuned for forecast updates as we get closer at https://t.co/wTqdsomHTB pic.twitter.com/F7gU29rkQZ
— NWS New York NY (@NWSNewYorkNY) June 17, 2025

Back up: Why humidity feels so brutal

When it’s hot outside and/or we’re exerting ourselves, the body tries to cool itself down by sweating. But it’s not sweat alone that cools you down. The sweat needs to evaporate off your skin. The evaporation of a teaspoon of sweat could cool your entire bloodstream by 2 degrees F.

This is where humidity comes in. When there’s a lot of moisture already in the air, sweat can’t evaporate as effectively because the air can’t absorb more moisture, making it harder to cool down. The body’s cooling processes become less effective, and heat and humidity can become dangerous. Older people are more vulnerable to humid conditions because the body produces less sweat as we age.

Humidity and dew point describe how muggy it feels, but they measure different things:

Relative humidity — the percentage in your weather app — tells us how full the air is with water vapor relative to its capacity. But warm air holds more water, meaning 60% humidity on a hot day feels much stickier than 60% on a cool day.
Dew point is more precise. It measures the actual amount of moisture in the air. Technically, it’s the temperature at which air becomes saturated and dew forms. The higher the dew point, the more moisture is in the air, and the muggier it feels.

In short: The dew point is a better indicator. A dew point above 65°F feels sticky. Above 70°F, it becomes more uncomfortable and risky during a heat wave.

When I was running my race last weekend, the humidity hovered around 80%, with a dew point of 70°F.

Heat-related illness in New York

Every year, thousands of people across New York visit the emergency department for heat-related illness. In 2024, there were 3,213 heat-related emergency department visits in New York state, excluding New York City. From May 1, 2025, through Thursday, there have been 556 ED visits for heat in New York state (excluding New York City).

Emergency department visits for heat-related illness in New York state, 2025. The heat index is a combination of temperature and humidity, and is similar to the “feels like” temperature.

Heat illness can be severe. In New York City last year, seven people died directly because of heat, and 570 died because heat exacerbated underlying conditions, like heart disease. Those age 60 and over are most susceptible to heat-related illness.

New York is getting hotter. A new state dashboard aims to anticipate health risks.

Counterintuitively, people in New York who died from heat stress were most often exposed to dangerous heat inside their homes, not outside. Without air conditioning, indoor temperatures can be much higher than outdoors, especially at night, and can continue for days after a heat wave.

New York families with low incomes can apply for free AC units or fans through the Home Energy Assistance Program. In 2024, more than 25,000 households in New York state got access to cooling units through HEAP.

What you can do

The best thing to do is to try to stay cool and check in on neighbors who may not have air conditioning.

Know your risks. The Centers for Disease Control and National Oceanic and Atmospheric Administration dashboard tracks local heat risk scores that takes into account temperature, humidity, and other metrics that impact health. The risk score ranges daily from “No risk” to “Extreme” heat risk. Enter your ZIP code here.
Apply to get a free air conditioner or fan through HEAP, if you qualify. However, the future of HEAP’s program is uncertain. In April, all federal employees overseeing the national program that funds state-level HEAPs were laid off, and funds were frozen due to cuts at the Department of Health and Human Services. Applications will remain open only as long as state funds last — once they run out, no more households will receive cooling assistance.
Use a cooling space. Cooling centers can be found in New York City here and across the rest of the state here. Libraries, museums, or coffee shops are great options.
Keep your pets cool. They’re susceptible to heatstroke, too. Here are hot-weather safety tips for pets.
Watch out for hot playgrounds. Metal, turf, and black asphalt can cause burns on hot days.
Know what symptoms to look out for. Confusion, dizziness, and unconsciousness are serious signs of heatstroke that warrant calling 911.

Bottom line

It’s going to be a hot one. Stay hydrated, check on your neighbors, and don’t underestimate June heat — it can hit harder than we expect.

Love,

Your NY Epi

Your health, your mayor: A guide to how NYC’s election can impact residents’ well-being

2025-06-12T14:43:47+00:00

This article originally appeared at Your Local Epidemiologist New York co-published with THE CITY. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

The New York City mayoral primary election is fast upon us: Election Day is June 24, and early voting is from Saturday to June 22. Polls across the city will be open June 24 from 6 a.m. to 9 p.m.

Here at YLE, we recognize that policymakers impact everything that touches your life, but we thought it would be helpful to take a look at one piece of that pie: policies that impact our health.

This is a guide (not an endorsement) that may be helpful to your research before you hit the polls.

Let’s back up. What does the mayor have to do with health?

In New York City, the mayor impacts health through policy, budgetary control, and agency oversight. The mayor appoints the health commissioner and sets priorities on issues like chronic disease, overdose prevention, mental health, vaccines, and emergency preparedness. The mayor also proposes the city budget, including funding for public hospitals (New York City has the largest public hospital system in the United States), community health programs, and things like access to healthy food and housing, which are social determinants of health. The mayor’s priorities have a large impact on what issues get resourced.

I’ve outlined what I see as the most pressing public health issues for New York City, and how current mayoral candidates plan to address those issues. (One note: current Mayor Eric Adams is running as an independent and is not part of this primary — we’ll include his information later, before the final election.)

I chose three topics that affect the most New Yorkers, and have the greatest potential to improve overall health across the city. (This is not all-encompassing — narrowing these topics down was tough! 😅)

Maintaining Medicaid and public health funding

In New York City, 40% of all people, 60% of children, and 50% of births rely on Medicaid for their health care coverage — that’s more than 4 million people.

Congress is actively debating a bill that would cut Medicaid, resulting in an estimated 8.6 million people losing coverage nationally, including 1.8 million in New York state, the majority of whom are children, older adults, and people with disabilities.

Additionally, New York City used to receive significantly more state funding for essential public health services. Currently, the New York City public health budget accounts for ~2% of the city’s total budget, down from ~3% previously. And, since a law change in 2019, New York City has lost $90 million a year in Article 6 funding (state funding for local health departments to pay for essential public health services).

Concerns about cuts to Medicaid, federal health funding loom over NYC budget

What will the mayor do to prevent federal Medicaid cuts and advocate for public health funding? If Congress does cut Medicaid, what will the mayor do to ensure that New Yorkers maintain health care coverage and access to medical care?

What the candidates support

Most candidates acknowledge the importance of Medicaid and public health funding. Adrienne Adams, Michael Blake, and Brad Lander support expanding them through strategies like higher reimbursement rates, new funding streams, or wider eligibility criteria. Andrew Cuomo, Zellnor Myrie, and Scott Stringer focus on maintaining current funding levels and preventing federal cuts, but don’t propose expansions. Zohran Mamdani and Jessica Ramos have not taken clear positions in their mayoral platforms, though both have supported relevant legislation previously.

Reducing mental health issues and addiction

Rising mental health issues, especially among teens, and high overdose rates are crises in New York. Both were exacerbated by the Covid-19 pandemic.

In 2022, 13% of adult New Yorkers reported having depression and 1 in 4 reported having anxiety. In 2021, about 1 in 10 (9%) of New York City public high school students reported a suicide attempt, and 41% and 42% of Black and Latino teens, respectively, felt sad and hopeless. Amongst teen girls, 27% reported non-suicidal self-injury.

Overdose deaths declined 32% in New York state last year. Here’s what made the difference.

Overdose deaths in New York City declined in the first half of 2024. (We’re still collecting data on the second half, given a lag in death certificates.) However, the number is still extremely high: Every four hours, a New Yorker dies of a drug overdose, primarily due to fentanyl. In the first half of 2024, there were 1,184 overdose deaths in New York City — fewer than the 1,525 deaths during the same period in 2023. They occurred most frequently in the Bronx, Upper Manhattan, and Central Brooklyn.

How will the mayor combat the mental health and overdose crises? How will they ensure that all New Yorkers have access to mental health care and substance use recovery services?

What the candidates support

All candidates include policy plans that support expanding access to mental health care for at least some individuals. They all recognize the issue and support better mental health treatment, though some only focus on those with severe mental illness, while others focus on the general public.

Additionally, Adrienne Adams, Michael Blake, Andrew Cuomo, and Scott Stringer support expanding access to substance use disorder treatment and/or harm reduction.

Improving maternal health

Maternal mortality is a huge issue in New York. One woman dies of pregnancy-associated factors each week in New York City, on average. The majority of these deaths are preventable. And the risk is not uniform. Black women in New York City are three times more likely to die when pregnant (or soon after delivery) compared with white women. Disparities are also seen in infant health. The infant mortality rate for babies born to Black mothers is 2.4 times the average New York state rate. Unfortunately, there has been little improvement in these gaps over the past two decades. Mortality for Black pregnant women in New York has consistently remained higher than the national average for Black pregnant women.

How will the mayor improve the health and outcomes of our New York moms and babies? How will the mayor direct resources toward moms with the greatest need and highest risk?

What the candidates support

Several candidates propose expanding maternal health programs, especially to reduce racial disparities. Adrienne Adams, Michael Blake, Brad Lander, and Zellnor Myrie offer detailed plans to expand care, like increasing access to doulas, midwives, or nurse home visits. Andrew Cuomo and Zohran Mamdani support maintaining existing programs, while Jessica Ramos and Scott Stringer have not outlined clear approaches in their mayoral plans, though they both have previously supported policies to improve this issue.

The next New York City mayor will help shape the city’s health — not just through emergency response like we saw during the pandemic, but through long-term, structural decisions about who gets care and how. The issues presented here — Medicaid and public health funding, mental health and the overdose crises, and maternal mortality — are not new. But they are urgent. And how we address them now will echo for generations to come.

The good news is that all candidates recognize these problems to some degree. But their plans vary widely — from incremental reforms to systemic overhauls.

When you cast your vote this month, you’re not just voting for a person. You’re helping decide how New York prioritizes health and the systems that shape our well-being. Your voice has a lot of power.

I’ll see you at the polls.

Love,

Your NY Epi

Candidate deep dive: specific policy proposals and past record

Maintaining Medicaid and public health funding

Adrienne Adams: Adams supports expanding Medicaid eligibility and benefits where possible and increasing city and state funding to meet community public health needs.
- Past record: She has advocated protecting Medicaid in New York City and reinstating Article 6 funding for the city.
Michael Blake: He proposes expanding Medicaid and Medicare funding and using city resources to supplement them. He states he will push for Medicaid carve-outs and matching funds that keep behavioral health services fully funded, especially for undocumented New Yorkers, gig workers, and those falling through traditional coverage gaps.
- Past record: He co-sponsored a bill that would ensure that New Yorkers holding Temporary Protected Status or Deferred Action for Childhood Arrivals continue receiving Medicaid, even if their federal immigration status changes or ends.
Andrew Cuomo: He states he will campaign nationally to maintain Medicaid funding.
- Past record: When he was governor, he supported the Affordable Care Act Medicaid expansion, which created the Essential plan. This expanded coverage to 1.5 million New Yorkers across the state. However, in 2019, under his leadership, the state reduced New York City’s public health funding (Article 6), which has cost the city about $90 million annually since. In 2020, he also proposed cutting state Medicaid funding in New York by $2.5 billion.
Brad Lander: He opposes the federal cuts to Medicaid, having published analyses citing how impactful they would be for New Yorkers. Lander supports the New York Health Care Act, which aims to establish a single-payer health care system in the state.
- Past record: He has advocated for using additional revenue from the managed care tax to bolster Medicaid reimbursement rates.
Zohran Mamdani: He has not outlined a specific Medicaid policy, though his stance on maintaining health care access for working-class New Yorkers implies that he’s against Medicaid cuts. He’s also against moving retired New Yorkers to Medicare Advantage plans. These Advantage plans are often cheaper, but they may reduce the quality of care and have narrower provider networks, reducing access. Keeping people on Medicare plans instead of Advantage plans would prioritize access to care over potential cost savings for patients. He also advocated for the New York Health Care Act, which would provide universal healthcare in New York City.
- Past record: He has co-sponsored a bill that would maintain Medicaid coverage for workers on strike.
Zellnor Myrie: He opposes the federal cuts to Medicaid and supports the New York Health Care Act and expanding access to health care services, though details were not described.
- Past record: He has introduced legislation aimed at improving Medicaid reimbursement rates for safety-net hospitals.
Jessica Ramos: She has not outlined a specific Medicaid policy for her mayoral plan, but supports access to affordable, high-quality health care for all New Yorkers.
- Past record: She has introduced legislation aimed at improving Medicaid reimbursement for medical equipment and improving Medicaid reimbursement rates for safety-net hospitals.
Scott Stringer: He opposes cuts to Medicaid.
- Past record: He has conducted audits revealing inefficiencies in the city’s Medicaid reimbursement processes.

Reducing mental health issues and addiction

Adrienne Adams: She supports expanding community-based mental health programs through the city’s first Mental Health Roadmap. She also supports investing in health-based programs that divert people with substance use disorders from the justice system and toward treatment, with a focus on racial equity.
- Past record: She voted for the New York City Council’s plan to expand school-based mental health support, including a peer-to-peer mental health program.
Michael Blake: He supports improving neighborhood safety, community trust, and expanded access to culturally competent mental health care and wellness support across neighborhoods through his Health and Mental Health plan. He supports expanding mental health education in schools and increasing the availability of trauma-informed education and materials. Blake supports expanding Overdose Prevention Centers and harm-reduction strategies. These include using New York City opioid settlement funds to develop substance use treatment and implement involuntary commitment protocols paired with robust supportive services when all other options have been exhausted.
Andrew Cuomo: He supports expanding access to mental health and substance use disorder services, particularly for those who are homeless, including increasing the number of supportive housing units for the seriously mentally ill. He also supports prioritizing schools as key access points for youth mental health services and increasing the number of mental health workers in the city, like child psychiatrists. He also supports involuntary commitment and hospitalization of individuals who present dangers to themselves and others due to mental health issues and the inability to meet their basic needs.
- Past record: When Cuomo was governor, he passed multiple laws to reduce the opioid epidemic and increase access to treatment. Cuomo supports expanding access to substance use treatment, but mostly from the lens of severe mental illness.
Brad Lander: Lander’s mental health policy plans focus on those who are homeless and have severe mental illness. He supports expanding involuntary commitment and hospitalization, while emphasizing the importance of providing supportive housing to help reduce severe mental illness in New York City. He has not proposed policy to address mental health in general or for youth, nor to reduce substance use disorders and overdoses in New York City.
Zohran Mamdani: Mamdani’s plans aim to establish a Department of Community Safety that would invest ~$350M in mental health services, expanding preventive and ongoing mental care, as well as crisis intervention for severe mental illness. His plan proposes establishing a Community Mental Health Navigators program across all neighborhoods that will help connect community members to mental health professionals, and expanding Peer Clubhouses, Teenspaces, and Adolescent Skills Centers. His plans aim to increase the number of mobile crisis teams and mental health professionals who respond to mental health crises, either through 911 or 988 calls, and ensure that neighborhoods with higher call rates have additional crisis teams. Mamdani has not proposed any policy to reduce substance use disorders and overdoses in New York City.
Zellnor Myrie: He supports increasing Mental Health & Trauma Recovery Services, including a long-overdue full-service trauma center in the Rockaways, and expanding Black men’s mental health programs, including free therapy, mentorship, and career pathways for those impacted by violence. Myrie has not proposed any policy to reduce substance use disorders and overdoses in New York City.
Jessica Ramos: She plans to declare mental health a city emergency, which could open up additional funding streams. She has drafted an initiative called Harmony NYC that aims to expand mental health services. The plan includes implementing universal mental health screening in public schools, building 20 new mental health and wellness centers, and deploying 10 new mobile mental health teams in underserved neighborhoods. It also plans to expand supportive housing for the most severe cases of mental illness. She has also stated that involuntary commitment of those with severe mental illness is sometimes necessary. Ramos has not proposed any policy to reduce substance use disorders and overdoses in New York City.
Scott Stringer: He supports expanding the number of mental health professionals who work with police officers to respond to mental health crises, and increasing supportive housing for those with mental illness or substance use disorders.

Improving maternal health

Adrienne Adams: She called for New York City to confront maternal mortality as a public health crisis last October.
- Past record: She convened the City Council Maternal Health Steering Committee to tackle racial disparities in health care and led the passage of multiple laws that increase maternal health resources to combat maternal mortality disparities affecting Black and Latina women, including greater access to doulas, maternal mental health support, and guaranteed income for expecting mothers experiencing housing insecurity.
Michael Blake: He supports securing paid family leave for all workers, including policies that address disparities among Black and Latina women caring for newborns and other family members. He plans to expand and diversify the perinatal workforce (health staff who work with those about to deliver babies and just after) to improve maternal health outcomes, focusing on culturally competent care for Black women and other vulnerable populations. Blake also supports protecting access to reproductive rights.
Andrew Cuomo: He has stated he wants to establish programs to reduce maternal health disparities as part of his campaign, though he includes no details.
- Past record: While he was governor, the Taskforce on Maternal Mortality and Disparate Racial Outcomes was created to reduce maternal mortality and racial disparities. Following the task force, Cuomo committed to implementing their recommendations, including establishing a Maternal Mortality Review Board, creating an implicit racial bias training and education program for hospitals, creating a data warehouse on perinatal outcomes, and requiring insurance companies to cover maternal depression screenings.
Brad Lander: He has released a plan to reduce maternal mortality and associated disparities that includes doubling the doula workforce, increasing the number of midwives in New York City, expanding the Nurse Family Partnership home visiting program, and launching midwife-led birth centers. He supports increasing anti-bias training in hospitals and access to reproductive rights.
- Past record: During his time as comptroller, his analysis found that the NYC Doula Initiative, which increases access to doulas, improved birth and health outcomes for Black and Hispanic mothers.
Zohran Mamdani: He proposes providing new parents with baby baskets that contain essential goods and resources, like diapers and baby wipes, and information on newborn home visiting programs, breastfeeding, and postpartum depression. His plan does not detail other approaches to reducing maternal mortality.
Zellnor Myrie: He has put forward a plan to reduce Black maternal mortality by funding maternal health and birthing centers in majority Black neighborhoods and advocating to expand coverage of doula and midwifery services under Medicaid.
Jessica Ramos: Her mayoral plan does not detail approaches to reducing maternal mortality.
- Past record: She has co-sponsored bills aimed at reducing maternal mortality, including establishing a C-section review board as part of the Maternal Mortality Review Board, providing income to mothers in the last three months of pregnancy and the first 18 months of the child’s life, and expanding disability insurance for new mothers.
Scott Stringer: His mayoral plan does not detail approaches to reducing maternal mortality.
- Past record: As comptroller in 2015, Stringer recommended that all pregnant women should qualify for healthcare coverage and recommended that pregnancy be considered a qualifying event.

NY public health update: Wildfire smoke, new Covid variant, diabetes, and a fish consumption advisory

2025-06-05T16:58:07+00:00

There’s a ton going on in the world of public health. This week we’ll cover wildfire smoke in New York, an emerging Covid variant, updates to Covid vaccine eligibility, diabetes in New Yorkers, and an advisory on local fish consumption.

Wildfire smoke in New York

Smoke from wildfires in Canada has made its way down to New York and surrounding states.

Poor air quality from wildfire smoke poses health risks to everyone, but some groups are especially sensitive:

Older adults
Pregnant women
Children
People with pre-existing respiratory and heart conditions

Air quality is measured by sensors that detect the concentration of pollutants in the air. Results are reported as the Air Quality Index, which is a number between 0 and 500. The higher the AQI, the more polluted the air is, and the higher the health risk. When the AQI exceeds 50 (the yellow category), people who are more sensitive to poor air quality should reduce strenuous activity outdoors (like working out). Once the AQI tops 100 (the orange category), everyone should reduce strenuous activity outdoors.

You can easily check the air quality of your local area on some weather apps, like AirNow, or download the EPA’s AirNow mobile app. And for a deeper dive on wildfire smoke, check out our post from last year.

New Covid variant in NYC

A new Covid variant has been detected in international travelers who arrived to New York City airports this month, as well as other airports in the United States. The new variant, NB.1.8.1, is getting some attention because it’s the major variant associated with a surge in Covid cases in China.

The good news is that this variant doesn’t appear to be any more severe than other circulating variants — it’s not meaningfully better at evading the immune system. The reason China may be seeing more Covid cases is not entirely clear, but we do see that this variant grows faster than many other circulating variants in cell culture, meaning it may be more transmissible.

What does this mean for you?

In New York, and the rest of the United States, we can expect another Covid wave this summer, with things likely picking up in the next two to three weeks. We’ve had summer Covid waves the past four summers, so it’s expected at this point.

New York City average SARS-CoV-2 wastewater concentrations. Data from the New York City Wastewater Testing Program.

Wastewater data for New York City is delayed, with the most recent data available as of May 6. The most recent data show that Covid began increasing earlier in May, but it was still at low levels in New York City. I’ll be back with updates once we get more data.

Will the current vaccine be effective against this new strain?

We think so. The new NB.1.8.1 strain seems to evade antibodies similarly to the last two strains vaccines were developed for, JN.1 and KP.2, meaning that the current vaccine should offer protection against severe disease. If you are moderately or severely immunocompromised or over 65, and you got a Covid vaccine in the fall, you can talk to your doctor about getting a second dose. I got the fall vaccine last year, so personally, I am not going to get another shot until this fall. But, I will be paying close attention to the Covid data (and sharing it here) and will likely mask up on the train and in grocery stores once virus activity starts to pick up more.

Covid vaccines will still be available for kids and pregnant women in New York

In last week’s post, we covered new proposed guidelines for Covid vaccines that would make it harder for adults and kids without chronic conditions to get vaccinated if they want to. Late last week, the Centers for Disease Control and Prevention released recommendations based on the proposal.

The communication over the vaccine guidelines was a total mess and is still confusing as heck (YLE National covered it here). After it was initially announced that Covid vaccines would not be recommended for healthy kids and pregnant women, the CDC walked that back, and are now recommending that kids, pregnant women, and all adults can still get vaccinated if they and their doctor agree it’s appropriate (called shared clinical decision-making).

Covid vaccine eligibility as of now:

Age 65+: Vaccines are recommended.
Under age 65 with certain health conditions: Vaccines are recommended.
Adults, kids, and pregnant women may get the vaccine if they and their clinician agree it’s appropriate.

This is a win because little kids, particularly those under 6 months old, and pregnant women are still at high risk of severe Covid. Babies continue to make up the most emergency department visits for Covid (even more so than older adults). It also upholds medical freedom and the choice to get vaccinated if one wants to.

The CDC requires insurance to cover kids’ shots that are recommended by shared clinical decision-making. But for adults, insurance coverage is still up in the air. When ACIP (an independent group of advisers to the CDC) meets at the end of June to make their recommendations, they’ll vote on whether Covid vaccines should be recommended for healthy adults, and this will likely dictate insurance coverage.

Diabetes is high in NYC

The NYC Health Department released a report last week showing just how deeply diabetes, one of the most common chronic diseases, affects New Yorkers. In New York City, and the rest of the United States, diabetes is a leading cause of illness, disability, and death.

In 2022, about 11% of the New York City adult population (800,000 New Yorkers) had diabetes. Statewide, it’s similar — 11.4% of New Yorkers have diabetes.

And risk is not evenly spread. Diabetes is highest among older adults, with 26% of New York City adults over 65 having diabetes. The risk of diabetes increases with age — as people get older, the body’s ability to produce insulin declines, muscle mass decreases, and many will have reduced physical activity, all of which contribute to insulin resistance.

Asian/Pacific islander, Black, and Latino New Yorkers have nearly twice the rate of diabetes compared to white New Yorkers. Diabetes risk among racial and ethnic groups is a combination of genetic, environmental, and socioeconomic factors.

Poverty and access to healthy food play a huge role in diabetes risk. NYC residents in high poverty neighborhoods (15%) were almost twice as likely to have diabetes as residents in low poverty neighborhoods (8%). People from lower-income households may not have access to healthy food options (often more expensive) or opportunities to exercise regularly in their communities.

How do we fix this issue?

It’s a complex issue, but more funding and smart investments would help. Diabetes, like many other chronic diseases, is shaped by a person’s environment. Do they have time to cook? Safe spaces to exercise? Access to regular medical care? These are material and environmental conditions, not just personal choices.

Lifestyle interventions, like the National Institutes of Health’s Diabetes Prevention Program (which sadly lost its funding recently) can be very effective. Here’s what we as individuals can keep in mind to reduce risk:

Get regular checkups that include lab work — prediabetes can be reversed with early action.
Strive for a balanced diet — emphasizing protein, fiber-rich carbohydrate foods, and healthy fats.
Stay physically active — exercise benefits blood sugar, insulin sensitivity, and weight management.
Manage weight — if you are carrying excess weight, just losing 5%-10% of your body weight has been shown to have substantial benefits.

New York City’s Health Department has laid out a Citywide Diabetes Reduction Plan that calls for evidence-based programs, such as peer-led education, community health workers, support for healthy food, and self-management services.

Having a plan is great, but the NYC Diabetes Report highlights that the plan’s initiatives are not yet funded at levels needed to reach all New Yorkers who could benefit. We also need long-term solutions that enable people to afford healthier lifestyles. For example, Medicaid and Medicare reimbursement of diabetes prevention and self-management programs, as well as investments in efforts that address the root causes, such as housing, transportation, and food access.

We have the blueprint. Now we need the resources to scale it.

A big thank you to Megan Maisano, MS, RDN, for her expert insight and contribution to this section.

New York advisory on fish contamination

Did you know it’s striped bass season in New York? My dad used to take me fishing when I was little as a way to connect with nature. It’s a great family activity, but some fish can accumulate pollutants from their environment, which can be dangerous if consumed in high amounts.

Last week, New York State Department of Health announced an advisory on which fish from New York state bodies of water are safe to eat, and which ones should be avoided. Some fish in New York have high levels of chemicals that can be harmful, including mercury, polychlorinated biphenyls, and PFAS.

The state is divided into four different water regions, each with its own fish consumption guidelines.

There are different guidelines based on who you are, where you fish, what you catch, and how much fish you eat. Chemicals in fish can have a greater effect on children’s development and babies, so women of childbearing age (under 50) and children under 15 are advised to limit the kinds of fish they eat and how often they eat them. The chemicals from fish can also build up in the body and affect the development of future pregnancies, so women who may become pregnant should limit their consumption of riskier fish.

In addition to the New York-specific guides, the Food and Drug Administration also has recommendations on which fish are safe to eat for women and children.

What you can do

If you fish in New York, look up the guidance for your local fishing spot. Avoid eating the fish listed as not safe to consume. If you are eating out, you can ask where fish was sourced from.

Eating fish can be part of a healthy diet, providing key nutrients like high-quality protein, omega-3 fatty acids, and iron. And not all fish are risky to consume. Fishing can still be a fun activity for the family, but equipping yourself with knowledge of your local environment can help you make healthy decisions about how much fish to eat and from where.

Bottom line

You’re all caught up on New York public health this week. We’ll be back next week with some info on the New York City mayor’s election and how it could influence public health. Stay tuned!

Love,

Your NY Epi

New York public health update: Salmonella outbreak in cucumbers, measles at Shakira concert, Covid vaccines

2025-05-28T15:30:13+00:00

I hope you all had a restful Memorial Day weekend. For those honoring loved ones lost in service, my heart is with you, and I’m deeply grateful.

Let’s get into this week’s dose of New York public health news, what you can do, and why it matters.

Cucumber recall affecting New York

A multistate Salmonella outbreak has been traced to cucumbers grown in Florida. As of Friday, 26 people across 15 states — including New York— have fallen ill, with nine hospitalized.

The Food and Drug Administration has issued a nationwide recall of cucumbers grown by Florida-based Bedner Growers and distributed by Fresh Start Produce Sales.

The affected cucumbers were:

Sold between April 29 and May 19.
Distributed to various retailers, restaurants, and food service providers. In New York these include Albertsons, Walmart, and other grocery stores.
Added to sushi rolls, salads, and other veggie mixes.

What this means for you

If you have cucumbers, or cucumber-containing premade salads or sushi at home that was purchased between April 29 and May 19, it’s safest to throw them out. Sanitize any surfaces that may have come into contact with the cucumbers. If you are eating out, consider asking the restaurant if they’re aware of the recall before ordering foods with cucumbers.

Symptoms of Salmonella infection include diarrhea, fever, and stomach cramps, which typically appear 12 to 72 hours after consumption. The Centers for Disease Control and Prevention reports an average of 420 Salmonella-related deaths annually in the United States. Children under 5 years old, adults over age 65, and people with weakened immune systems are at highest risk for severe illness.

Measles exposures in New Jersey

New Jersey has reported two possible measles exposures in the past week: one at Newark Airport and one at the MetLife Shakira concert. Anyone who visited the following locations during the specified times may have been exposed. Potentially exposed people should contact a health care provider if they develop any measles symptoms, which usually start like a cold and progress to a rash.

Newark Liberty International Airport, Terminal B. May 12, 12:30-4 p.m. Monitor for symptoms until Monday.
MetLife Stadium at the Shakira concert. May 15, 7:30 p.m.-1 a.m. Monitor for symptoms until June 6.

So far, no cases have been identified following these two exposure events. If you do develop symptoms, it’s important to call your doctor or clinic before you visit in person so special precautions can be taken to prevent further spread.

With measles continuing to spread in Texas and other states — and more than 1,060 cases reported nationwide — it’s not entirely surprising to see exposures at large events like the Shakira concert. Around 55,000 people attended (and as a Shakira fan, I’m a little jealous).

What this means for you

If you went to the concert or were at Newark Airport during the exposure period, monitor your symptoms over the next two weeks. If you are vaccinated, you likely have little to worry about. Fortunately, the Shakira concert mostly had adults in attendance, and most adults are vaccinated against measles, which helps limit the risk of an outbreak.

Being fully vaccinated is still the best way to prevent getting measles. Here are common FAQs on the vaccine from YLE National.

Tuberculosis in Suffolk County

A tuberculosis case was reported at Sachem High School East in Suffolk County, Long Island. On May 15, more than 120 students and staff were notified via letter about potential exposure to an individual diagnosed with TB.

TB is an infectious disease that’s transmitted mainly through the air. It primarily affects the lungs and can be serious if untreated. Symptoms include persistent cough, fatigue, fever, and weight loss. Public health officials take any TB exposure seriously because the disease is relatively rare in the United States, and infections can cause serious illness.

Tuberculosis is on the rise in NYC. Here’s why — and what to know about the disease.

The Suffolk County Department of Health is offering free testing to those with prolonged contact with the infected person. For TB, prolonged contact means several hours in close proximity, not just passing them in the hallway. Unlike measles and other pathogens, TB infection generally requires a longer period of exposure. So it’s common to only test people who have had prolonged close contact. In college, I was tested for TB after spending several hours near someone in my dorm who was later diagnosed. (I tested negative.)

In 2024, there were 250 confirmed TB cases in New York state, a 19% increase from 2023. Suffolk County reported 52 TB cases in 2024, the highest in New York.

2024 tuberculosis cases in New York counties.

What this means for you

TB is treatable if identified, and it’s much better to get it treated before symptoms start. So if you got a letter from the county health department, getting tested is a good idea. This TB FAQ from the New York Health Department is helpful.

Update on Medicaid cuts

Last week, the House of Representatives passed multiple health care revisions as part of the budget reconciliation bill. According to analysis done by Gov. Kathy Hochul’s office, these bills have two significant implications for health care in New York:

A potential annual loss of nearly $13.5 billion for New Yorkers’ health care sector, and
Nearly 1.5 million New Yorkers could lose Medicaid coverage and become uninsured

The bills would cut over $7.5 billion in federal funding from the Essential Plan (New York’s Medicaid expansion) and shift almost $3 billion of other costs to New York state. This means that the state would have to take on those costs or reduce funding for health care. We cover this in more detail in our recent Medicaid deep dive here.

Another major change included in the bill is a new work requirement: Starting in 2029, adults without children who are not disabled need to prove they’re working at least 80 hours per month to qualify for Medicaid. Community service, work training programs, and going to school also qualify.

Work requirements for Medicaid are being proposed to reduce federal spending — by shrinking the number of people who qualify — and to encourage employment. There are a couple of important issues with this:

Administrative difficulties would reduce access. When work requirements for Medicaid eligibility were tested in Arkansas, over 18,000 people lost coverage, and 60% delayed medical treatment due to costs, without increasing employment in the state. The study found that most of those who lost coverage were working and still eligible for Medicaid, but struggled with new reporting requirements, paperwork, and red tape.
The health insurance-work feedback loop. Research shows that having health insurance improves someone’s ability to find and maintain work, while poor health is associated with job loss. Taking away someone’s health insurance could leave them without health resources, making finding or keeping a job harder.

From my perspective, no matter how you slice it, reducing Medicaid funding and adding work requirements will result in millions losing health care coverage. When people lose access to health care, they are more likely to wait until they are sicker to get care, and often depend on emergency rooms. This will increase health care costs for people.

What happens next?

The bills will move on to the Senate for debate and approval. Congress will vote on them later this summer. You can call your representatives to let them know how you feel about the budget proposals. Here are some tips. Find their contact information here. If you’re a Medicaid recipient, it will be important to keep up to date with the latest information and reporting requirements as this evolves, so your coverage doesn’t fall through the cracks.

Changes to Covid-19 vaccine availability

Big changes may be coming to Covid-19 vaccine access in the United States, including here in New York. Last week, FDA Commissioner Marty Makary and his new adviser, Vinay Prasad, proposed limiting new Covid vaccine access to only people over 65 or those with chronic conditions. That means if you’re generally healthy and under 65, you may not be eligible for a booster this fall, or your insurance may not cover the shot. For more details, see YLE National’s deep dive.

If the proposed FDA policy goes through, the eligible chronic conditions are as follows:

Conditions for Covid-19 vaccine eligibility under the new proposed guidelines.

Judging from the New York State Department of Health estimates of chronic disease rates and our age demographics, only about half of New Yorkers may still qualify for Covid vaccines if the proposed changes go through. But nothing is final yet. The decision also depends on what specific vaccine the FDA recommends, who the CDC recommends should get it, and if a new formula is needed if a new variant comes onto the scene.

We’ll be watching closely and providing updates. This could impact millions of New Yorkers — and your ability to stay protected this respiratory season.

Bottom line

You’re all caught up! See you next week. 🙂

Love,

Your NY Epi

Lead in New York’s drinking water: What to know and how to protect your household

2025-05-21T13:43:46+00:00

One night last fall, I stood at my kitchen sink in New York City, filling a water bottle from the tap. I had just read a local report about lead pipes in Syracuse that, in some neighborhoods, are still directly connected to homes. I kept wondering: What’s actually in our drinking water?

So I ordered a lead test. (Hot tip: Tests are free to residents in New York City.)

A few weeks later, the results came back — all within safety limits. But I couldn’t stop thinking about families who might not be so lucky, or may never think to check. Even today, in 2025, tens of thousands of homes across New York are still served by aging lead pipes. Exposure to lead, especially for kids and pregnant women, can cause lifelong harm.

This is why cities like Albany began replacing 2,500 lead pipes (~40% of homes there are still connected to lead pipes), Syracuse is replacing more than 3,000 lead pipes, and Buffalo plans to replace about 40,000 lead pipes. It’s why you’re hearing more about this in the news. And it’s why so many of you asked me to investigate it.

Let’s break down what’s happening, why it’s a concern, and what steps you can take to protect your household.

Lead 101 refresher

Lead is a heavy metal that was widely used in paint, gasoline, plumbing, and construction until the 1970s. After strong evidence showed the dangers of lead exposure, especially among kids, federal and state laws began phasing it out. The 1974 Safe Drinking Water Act was a turning point.

But while we’ve stopped using lead in construction, much of it is still around. Today, too many New York families are still exposed. In Montgomery County, for example, 50 out of every 1,000 children (or 1 in 20) have elevated blood lead levels (above 5 μg/dl). Statewide, about 1% of kids under age 6 had elevated levels in 2022. Above these levels, doctors should pay close attention to a child’s growth and development and screen for any issues.

Lead is especially harmful during critical development windows. Even small amounts can cause:

Brain and nervous system damage
Slowed growth and development
Learning and behavior issues (e.g., reduced IQ, ADHD)
Hearing and speech impacts
High blood pressure and brain, kidney, and reproductive health issues in adults

How lead gets into drinking water

Most lead exposure today comes from old lead paint and dust in homes built before 1978.

Drinking water is another potential (though less common) source, as the Flint, Michigan, crisis reminded us.

Lead can enter drinking water in two ways:

The source. Public reservoirs in New York are regularly tested and lead-free. Private wells in New York are rarely contaminated with lead at the source, but the Environmental Protection Agency doesn’t regulate them, so homeowners must test their own water.
The plumbing. This is the bigger problem. Lead can enter drinking water through corroded pipes, faucets, or fixtures, especially in homes built before the 1980s, when lead-based materials were still common. Even with a private well, your home’s plumbing may still pose a risk if it contains lead components.

In New York, lead found in drinking water mainly comes from old lead pipes, not the water itself.

What the state is doing

Despite lead being banned from new construction decades ago, the legacy of past use remains. That’s why New York is taking several steps to reduce exposure:

$340 million is being invested to replace lead service lines across New York.
New York schools must test and fix their drinking water if lead is found.
Cities, including NYC, treat water with phosphoric acid (a food additive) to coat pipes and reduce lead leaching.
A new 2025 law will require landlords in 25 New York communities to eliminate lead paint hazards.

This map shows the New York State Lead Rental Registry Program for rental units in 25 communities of concern. (Figure from the New York State Lead Rental Registry)

Still, much of the burden falls on families — testing their homes, navigating old infrastructure, and making fixes that take time, money, and effort.

What you can do

Lead exposure is a home-by-home issue. Even if public water mains are lead-free, the final stretch of plumbing —especially in homes built before 1986 — can contain lead pipes, solder, or fixtures.

Here’s how to protect your household:

Test your water. Certified tests cost $15-$50. In New York City, you can request a free kit.
Use a water filter or bottled water if your drinking water contains lead.
Use only cold water for drinking, cooking, and baby formula. Run the tap for 30 seconds until it’s cold — this flushes out water where lead may have built up. Boiling doesn’t remove lead.
Check for peeling paint. If you have young children, report peeling or damaged paint to your landlord. New York City landlords are required to fix lead hazards, and starting in 2025, this will apply statewide in 25 high-risk communities.
Boost nutrition. Certain foods help reduce how much lead the body absorbs:
- Calcium: milk, cheese, tofu, yogurt, and leafy greens
- Iron: beans, lean meat, fortified cereal, and peanut butter
- Vitamin C: oranges, grapefruit, tomatoes, and peppers
Get tested. Symptoms of lead poisoning are often silent. That’s why blood testing is the only way to confirm exposure. In New York, doctors are required to test all children at ages 1 and 2, and assess risk through age 6. Pregnant women should be screened at their first prenatal visit. Ask your employer about testing, or talk to your doctor if you work around lead.

Lead exposure is not equally distributed. Children from families with lower incomes are more likely to live in older homes and have elevated blood lead levels. This is another reason why universal screening is so important.

Bottom line

Lead exposure remains a serious but solvable problem. Cities across New York, like Albany, Buffalo, and Syracuse, are removing thousands of old lead pipes, and a new state law will hold landlords accountable for lead removal. You can also take steps, like testing your water, using only cold tap water for drinking and baby formula, and talking to your doctor about lead testing during pregnancy and early childhood. Being aware and knowing what steps to take can help make New York’s homes safer and healthier for everyone.

Love,

Your NY Epi

How to avoid ticks and mosquitos this spring in New York City

2025-05-14T12:54:50+00:00

Warm weather is finally here in New York, and it’s the perfect time to get outside. But we’re not the only ones enjoying the sun — mosquitoes, ticks, and pollen are becoming more active, too. A little awareness goes a long way in staying healthy while soaking up the warmer days ahead. But first, some good news.

Good news: New York will provide school meals for all kids

New York just became the ninth state to pass universal school meals. Starting in the fall, 2.7 million students across New York state will receive free breakfast and lunch each day at school. This is an incredible public health victory, propelled by a silver lining of the pandemic: increased knowledge of the importance of school meals for children.

As early as 2015, hundreds of New York City schools began giving free meals to all students, regardless of socioeconomic status. A 2021 study by the Urban Institute found that New York City students who qualified for free or reduced-price meals were more willing to participate in school meals once their school implemented free meals for all, and that there was less bullying and fighting schoolwide. Free school meals for all reduced the stigma and had positive effects for all students, regardless of their socioeconomic status.

This new statewide initiative will open the doors for students across the state and ensure that no kid goes hungry while at school.

Mosquitoes: Why to avoid them and how

From now until roughly November, when temperatures drop, we can expect mosquitoes to hang around. This month, New York City started treating standing water for mosquito larvae, which helps reduce the mosquito population and disease risk. Spraying usually happens later in the summer when mosquitoes are even more active. (We’ll update you when that’s scheduled.)

Most mosquitoes do not carry pathogens that can hurt us. Among those that do, the most common is West Nile Virus. In 2024, 100 human WNV cases were reported across New York state, including in New York City. While most people who get WNV won’t show symptoms, it can be more dangerous for those over 60 years old or who have immunocompromising conditions.

The best thing you can do is avoid mosquito bites:

Wear EPA-approved mosquito repellent outside, especially during peak mosquito activity time: dawn and dusk. If you are using sunscreen, apply sunscreen first and insect repellent second.
Avoid being outside when mosquitoes are most active (the morning and evening)—but this can be really hard.
If it’s not too hot, long sleeves and long pants can protect against bites.
Dump standing water (think flower/plant saucers, buckets, fountains, toys that have been sitting outside, etc.) to eliminate mosquito habitats.

Ticks: Why to avoid them and how

We are in peak tick season in the Northeast, and this season is looking worse than last.

In New York, black-legged ticks (aka deer ticks) are the most common carriers of pathogens. These tiny ticks can transmit Lyme disease and other infections. Cases typically rise in the warmer months, especially from May through August, when ticks are most active.

Lyme disease is the most common tickborne illness in the United States — and New York reports some of the highest numbers in the country with more than 9,000 cases annually. Symptoms usually start with fever, fatigue, and a bullseye rash, though not everyone gets the rash or can see it if skin is darker — thanks, PHunkle, for highlighting this diagnosis challenge!

While rural areas like the Finger Lakes and Central New York have long been hotspots, ticks are increasingly found in parks and green spaces across all five New York City boroughs. Even city dwellers aren’t immune.

Protecting yourself and family means avoiding ticks:

Use repellent that contains 20% or more DEET, picaridin, or IR3535 on exposed skin.
Treat clothing and gear with products containing 0.5% permethrin.
Walk in the center of trails and avoid brushing against tall plants.
Do tick checks after spending time outdoors. For kids, especially check under arms, in and around ears, in the belly button, and in their hair.
Toss your clothes in a hot dryer for 10 minutes to kill any hidden hitchhikers.
Treat dogs for ticks. Dogs are very susceptible to tick bites and may also bring ticks into your home.

If you find a tick attached to your skin, remove it promptly with tweezers and monitor for symptoms. Early treatment is key to preventing severe illness.

New York pollen: high

Pollen has struck me this week, and my nose is like a mini Niagara Falls. 🤧🌊 The data confirm what my nose tells me — New York pollen counts are high or medium-high throughout the state this week.

Allergies are a nuisance, but they can also be dangerous for those with asthma. In New York City, emergency department visits for asthma spike when pollen counts increase.

About 1 in 12 children in New York and an additional 1.5 million adults have asthma. For those with asthma, tracking pollen levels and reducing exposure can help with prevention. Talking with your provider about managing asthma symptoms during allergy season is also a good idea.

Dr. Zachary Rubin, an allergist and immunologist, has a helpful post on managing and dealing with allergies.

Bottom line

You’re all caught up! And a belated happy Mother’s Day to all the moms out there — you are deeply appreciated. My own mom, a public school science teacher, inspired my love of science and health, and her unwavering support carried me through. Thanks, Mom!

Love,

Your NY Epi

Three measles cases confirmed in Orange County, New York. Here’s what to know.

2025-05-09T15:58:53+00:00

Three unvaccinated kids under 5 have tested positive for measles in Orange County, New York, according to the state and local health departments. All three cases were linked to international travel and were identified after returning home.

The children are isolating, and so far, no community exposures have been reported. That means there’s no sign of community spread —welcome news for those most at risk, including immunocompromised individuals, infants under 1, and others who are unvaccinated.

TLDR: There is not a measles outbreak in New York at this time. If you’re up to date on your vaccines, you’re protected. Keep reading for more background and context.

Is this an outbreak?

No. A measles outbreak is defined as at least three connected cases, meaning cases who spent time together while infectious. Not all three Orange County cases are connected, so this is not yet officially an “outbreak.” We’ll know more in the coming days.

We don’t know if it will turn into an outbreak. The potential for an outbreak depends on a combination of luck, the swiftness of local public health teams, cooperation from people exposed, and local vaccination rates. Fortunately, the health department reports no other known exposures outside immediate family members. This likely means that when the kids started showing symptoms, they were quickly isolated and didn’t expose others — good news and less chance of an outbreak.

Community vaccination coverage also plays a big role. Orange County, where these patients with measles live, has one of the lowest coverage rates in the state — about 65% of 2-year-olds have one dose of MMR. This means 35% of the youngest kids in Orange County have no protection against measles.

Measles is highly infectious and can linger in the air for 2 hours. It can also take up to 3 weeks to develop symptoms after exposure. So we probably won’t know until the end of May whether these cases lead to additional infections.

What can you do?

If you’re up to date with vaccinations, you’re very well protected.

“Up-to-date” means:

Two doses of MMR or MMRV (MMR combined with varicella —chickenpox) by kindergarten.
If you were born before 1957, you are assumed to have had measles during its widespread era and are therefore fully protected.

One group who may need a booster is adults who received the inactivated vaccine between 1963 and 1967 (or aren’t sure which version they got). Most people at the time received the more effective live vaccine, but if you’re unsure, talk to your health care provider.

Here are the top 10 FAQs about your measles protection.

If you have a child under 12 months, they can get a vaccine as young as 6 months. But at this moment, this is not an outbreak and is not spreading across the community.

If you’re traveling soon, check your vaccination status

Families planning summer travel should plan to be caught up on MMR vaccines at least 2 weeks before travel. Recent cases in New York and New Jersey, including the Orange County cases, were due to international travel.

MMR Travel Vaccination Schedule.

Babies as young as 6 months should get one dose of the MMR vaccine if they are traveling abroad or to U.S. areas with outbreaks (like Texas or New Mexico). After travel, these babies should then continue to get their next two MMR vaccines on schedule for a total of three vaccines.

Bottom line

The best actions you can take now are to check your MMR vaccination status and consider vaccinations your family might need before travel. I’ll keep you updated as we learn more! We are also wishing these little ones a smooth and quick recovery.

Love,

Your NY Epi

How to survive peak pollen allergy season: New York public health update

2025-05-07T12:36:16+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Today’s Dose covers pollen allergies, 988 crisis line and AmeriCorps funding cuts, and New York City composting.

Peak pollen (and allergy) season is here in N.Y.

My itchy eyes and fatigue confirm the data: We’re at peak allergy season in New York.

Most U.S. locales see three pollen waves — trees, grass, weeds. New York is ending tree season and sliding into grass. Individual allergy sensitivity can vary by type of pollen. I’m a grass pollen girl myself. 💅🏻🌱

Over the past few decades, allergy seasons in New York have gotten worse, partly due to climate change. The average allergy season has grown by over three weeks since 1970, with higher pollen counts. Longer and more intense pollen seasons can exacerbate allergies and respiratory conditions for New Yorkers.

To reduce pollen exposure and prevent it from entering your home, there are a few things you can do:

Check local pollen counts.
Leave shoes at the door and change clothes after outdoor activities.
Wipe off furry animals after they’ve been outside.
Shower before bed.
Keep windows closed during peak pollen times (midday).
Run air conditioning or HEPA filters.
Dust and vacuum regularly.

Dr. Zach Rubin, an allergy doctor, joined YLE on our podcast America Dissected last week and gave great tips on managing allergies:

To relieve sinus symptoms, it can help to rinse your nose with saline water (like a neti pot), but only with distilled or sterilized water.
For medications, second-generation antihistamines like cetirizine (Zyrtec) tend to have fewer side effects than diphenhydramine (Benadryl). Always talk with your doctor for more information.

Funding threats to the 988 crisis line

988 is a free, confidential call, text, or chat line that links people in mental or emotional distress to trained local counselors 24/7/365. Since its launch in 2022, the New York 988 Lifeline has responded to more than 778,000 calls and about 139,000 texts. Counselors provide help for mental health struggles, emotional distress, alcohol or drug use concerns, or just someone to talk to. It’s funded by federal, state, and local dollars. However, funding for this critical safety net is being actively debated in New York City.

There are two looming funding threats:

City cuts: New York City cut ~$12 million from the nonprofit that answers local 988 calls, Vibrant Emotional Health. Without additional support, Vibrant has signaled that it could lay off up to a third of its staff in the coming months.
Federal cuts: A draft federal budget suggests cutting funding for specialized 988 services that support LGBTQ+ youth, a group at heightened risk for suicide. Some 988 counselors are trained to serve these populations and often have similar life experiences. Since 2022, 988 has responded to nearly 1.3 million calls, texts, or online chats nationally from LGBTQ+ people.

Why it matters

No changes have been made yet. 988 will remain a resource and continue supporting and linking those in crisis with trained counselors. There is also a line that LGBTQ+ youth can continue to reach out to outside of 988: the Trevor Project’s helpline.

But if the layoffs in New York go through, callers may wait longer, more may hang up before help arrives, and fewer counselors will be available, especially those trained to support high‑risk groups like LGBTQ+ youth.

AmeriCorps funding cuts

AmeriCorps is a national service program that provides participants with living allowances to serve community needs, mainly in education and public health — kind of like the Peace Corps for our communities. Last week, the federal government abruptly cancelled $400 million in funding for AmeriCorps, roughly 40% of its total funding. New York was hit hard: $30 million was cut from New York programs, leaving 1,200 AmeriCorps workers in New York without income and benefits, and halting programs providing critical resources for New Yorkers. In response, New York Attorney General Letitia James joined 24 other states in suing the federal government to stop the dismantling of AmeriCorps.

Why it matters

AmeriCorps supports more than 24,000 volunteers and members statewide who have provided critical services in vulnerable communities for decades.

The New York programs abruptly cut last week provided:

Community health education
Peer mental health services
Food for unhoused New Yorkers
Disaster preparedness training

AmeriCorps supports many upstream public health needs: nutritious meals that keep chronic diseases in check, tutors who help kids read on grade level (a predictor of lifelong health), and counselors who connect families to benefits before crises snowball. With these cuts, coverage will become even more patchy — some neighborhoods will keep services, while others may lose them entirely. The program also provides young Americans with an experience of serving their communities where their skills are needed most.

What you can do

The litigation may help restore these funds, but if it doesn’t, community organizations will need to fill the gaps. What can help right now is spreading the word, contacting governmental representatives, and if you’re able, donating to or volunteering with affected organizations — they are scrambling for resources.

Composting is so in right now

In a city of 8 million people, how we handle our garbage is a frontline public health service. When garbage and food scraps sit out, they attract rats, roaches, and the pathogens those pests carry. That’s why, every day, the NYC Department of Sanitation carts away roughly 24 million pounds of trash, recycling, and compostables. The city is making it a lot easier for residents to compost our food waste.

There are good reasons to compost:

To prevent food scraps from releasing methane into the atmosphere as they break down, contributing to climate change.
Separating food scraps from other garbage helps fight the city’s rat infestation by removing their food source.
Repurpose food scraps into compost soil that can be used in city green spaces. Residents and non-profits can get free compost soil from compost give-back sites in Queens, Brooklyn, and Staten Island, as well as pop-up sites across the city.

Compost is now picked up weekly on your recycling day — find your collection schedule here.

Starting last month, owners of buildings with four or more units must provide bins for food waste or face fines.

Another option is to use the city’s “Smart Composting Bins,” which can be opened with a QR code. I use this option — we store compost in the freezer to keep it from smelling or attracting bugs, then drop it off in a Smart Bin down the street.

Bottom line

You’re all caught up on New York public health news! See you next week :)

Love,

Your NY Epi

Medicaid on the line: What cuts could mean for New Yorkers

2025-05-05T16:15:33+00:00

A little more than a third of all New Yorkers across the state — 35% —get health care through Medicaid. Over the next couple of months, Congress will determine how much to cut the federal Medicaid budget, and with it, how many millions of New Yorkers will keep their health insurance or lose it. Let’s break it down.

Let’s back up: Medicaid 101

Medicaid is a joint federal-state health insurance plan that covers low-income kids, pregnant women, babies, adults with disabilities, and many seniors. It pays for emergency room visits, hospital stays, routine check-ups, prescriptions, and most long-term care.

It’s the nation’s biggest insurer — 1 in 5 Americans (~78 million) and nearly 2 in 5 children rely on it — and the largest source of federal dollars for states. It’s also gaining significant bipartisan support. A recent KFF poll found 77% of Americans support Medicaid.

The 2014 Affordable Care Act let states widen Medicaid eligibility, or “expand Medicaid.” Forty states — including New York — signed on, extending coverage to about 20 million low-income adults.

Congress is proposing major budget cuts that will likely affect Medicaid

The Senate and House are moving forward with a blueprint for a federal budget (a draft not set in stone) that outlines cutting $880 billion over 10 years from the House Energy and Commerce Committee, which manages Medicaid. Hitting that target would almost certainly require deep Medicaid cuts. (For context, federal Medicaid spending was ~$600 billion in 2024.)

How Washington could cut Medicaid:

Work requirements. Some propose requiring adults on Medicaid to be employed. This could cut spending by $100 billion over 10 years, but could cause ~1.5 million people to lose coverage. In Arkansas, after implementing a work requirement, 18,000 adults lost insurance, over 60% delayed medications due to cost, and there was no increase in employment.
Reducing the amount the federal government contributes to states for Medicaid. The federal government now covers 50-77% of a state’s Medicaid costs (50% for New York). Lowering that match shifts billions to state budgets or cuts benefits.
Reducing Medicaid expansion match. The federal government currently picks up 90% of the costs for expansion; trimming that share means states would pay more.

Medicaid cuts would affect New Yorkers

Roughly ~35% of New Yorkers depend on Medicaid — one of the highest shares of any state and far above the national average of about ~20%. In New York City, just over half of residents are enrolled.

Medicaid enrollment is high in New York because:

Poverty is high. In New York City, 25% of residents live in poverty; statewide, the rate is 13.9% versus 12.8% nationally.
There are large, high-need populations, including those with disabilities, seniors needing long-term care, and immigrants.
Many New Yorkers lost jobs during the pandemic, losing work health care plans or the means to pay for insurance.
New York expanded eligibility, providing coverage for more New Yorkers.

New York’s Medicaid program allows low-income adults with incomes up to 250% of the Federal Poverty Level to qualify ($37,650 for a single adult and $78,000 for a family of four in 2024). Coverage now also extends to undocumented seniors (65+), pregnant moms, and newborns— Medicaid funds nearly half (47%) of all New York births.

Exactly how New York will fare won’t be clear until Congress settles the budget, but with millions here relying on Medicaid, any cut will hit hard.

Cutting federal Medicaid funding could:

Reduce the number of people receiving health benefits
Eliminate certain health services from being covered
Reduce rates paid to healthcare providers for services they deliver
Drive up health care costs as providers absorb uncompensated care
Shift costs to state and city budgets

Gov. Kathy Hochul warns that as many as 1.8 million New Yorkers could lose coverage — a worst-case estimate, but even a smaller hit would ripple widely.

When coverage disappears, many will make tough decisions, like delaying or not getting care, or paying out of pocket. This can push illnesses to later, costlier stages — cancers can advance and become harder to treat, and untreated infections, like tuberculosis, have a chance to spread more widely. Those who do get treatment but can’t afford it can go bankrupt. Providers also feel the squeeze: lower Medicaid payments mean leaner budgets, salary cuts, or potential layoffs.

At the center of the debate: funding and fraud

Supporters of Medicaid cuts see this as a way to reduce federal spending. Without a doubt, health care is a big-ticket item for federal and state budgets. In 2024, New York state spent more than $101 billion on Medicaid, and its costs are climbing faster here than in most states.

While most Medicaid dollars are spent exactly as intended, fraud is a real issue. Fraud examples can include:

Sharing or “renting” Medicaid cards
Reselling medical equipment or medications provided through Medicaid
Billing for services never provided or intentionally billing for more expensive ones

In 2024, for example, eight people in Brooklyn were charged with committing fraud worth $68 million after they paid Medicaid recipients cash to falsify requests for services they never received.

These abuses leave lawmakers and the public appropriately angry. Medicaid fraud siphons funds meant to provide health care to vulnerable patients. The challenge is preventing bad actors without cutting access for people who rely on the program. Broad, sweeping cuts may reduce spending, but they do little to actually stop fraud.

What happens next?

Spring-summer 2025: Congressional committees draft bills that must hit the savings/budget cut targets in the budget proposal. The House Energy and Commerce Committee will aim to cut $880 billion, with large amounts likely from Medicaid.
Late summer 2025: Congress will vote on committee budget bills.
October 2025: The final bills land on the president’s desk for signature or veto.

What you can do

Check in on neighbors who may be on Medicaid or need help with renewal forms. A little paperwork can help keep someone insured. The New York State Medicaid Help Line is (800) 541-2831.
Call your senators and congressional representatives to advocate for the issues that matter to you. (Find their contact information here.) Some apps provide representative info as well as scripts for specific topics. You can also join a YLE webinar on Friday, May 2, to learn how to influence health policy. Find the details here.
Stay informed. I’ll be posting any updates on how this plays out in Congress.

Bottom line

Medicaid isn’t just a budget item, it’s a health lifeline for more than a third of New Yorkers. If the proposed $880 billion budget cut goes through on the federal level, many New Yorkers will likely lose their health insurance. But things aren’t set in stone yet as Congress still has to iron out the details. There’s still time to contact your representatives, and tell them what matters to your community—your voice has power.

Love,

Your New York Epi

FDA monitoring bird flu in raw milk cheese, and two NYC cats test positive for disease. Here’s what to know.

2025-03-26T11:00:00+00:00

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I’m back on the public health beat in New York after taking a vacation in Hawaii. (Take me back to snorkeling 🐠 and mai tais🍹please!)

A lot happened in New York public health this week. From bird flu in cats to rabies in raccoons, here’s what you need to know.

Bird flu in two New York City cats

Earlier this month, two cats from separate households in New York City tested positive for bird flu. Both died. The likely source of infection? Raw pet food.

The Food and Drug Administration has said uncooked and unpasteurized pet food from cattle or poultry — think raw meat, eggs, or unpasteurized milk — can make pets sick with bird flu. Both New York City cats that died ate raw, canned chicken from Savage Cat Food.

Since 2022, more than 100 domestic cats nationwide have been infected with bird flu, and their infections have been particularly bad. Most have died. (Though they may have been more likely to be tested because of serious illness). The risk of cat-to-human transmission is low but possible — in 2016, a veterinarian was infected with a different type of bird flu (H7N2) after treating a sick cat.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

For dog lovers, it’s worth noting bird flu doesn’t seem to be as common or severe in dogs. One study found signs of infection in hunting dogs with a lot of contact with waterfowl, but the dogs did not have serious symptoms.

What pet owners need to know

Avoid feeding pets, especially cats, raw meat, raw milk, or uncooked eggs.
Avoid letting pets roam where they are exposed to wild animals. Cats can get infected by exposure to wild birds, animals, or animal droppings.
Contact your veterinarian if your pet becomes ill after eating raw meat or dairy products. Call ahead so that the veterinarian can be prepared when you arrive.

New York and FDA monitoring for bird flu in raw milk cheese

New research from Cornell University and the FDA found bird flu survived the 60-day aging process in raw milk cheese. While no bird flu has been found in cheeses sold in retail markets, and no human cases have been linked to eating raw cheese, this raises questions about food safety.

Raw milk cheese is made with unpasteurized milk. In the United States, cheese from raw milk must be aged for at least 60 days to reduce pathogen risk. The aging process creates a more difficult environment for bacteria to grow (higher acidity, salty environment, less moisture). This study suggests that it’s not enough to rid cheese of active bird flu virus.

Monitoring will be key to ensuring that our cheese supply remains safe:

FDA will continue sampling at least 300 cheese products nationwide, including aged raw milk cheeses, as part of its ongoing surveillance system.
New York participates in the National Milk Testing Strategy led by the USDA. We’re one of 28 states testing raw milk for H5N1.

What you need to know

Most cheeses in our markets are made from pasteurized milk and are safe to consume. Raw milk products are higher risk, not just for bird flu but also for other bacteria that can make you sick.
Check labels to know if the cheese has been made with raw milk. There is no federal requirement to label whether raw or pasteurized milk was used, but many cheeses label it in the ingredients. Restaurants should also know, too, if you ask.

Rabies in Suffolk County

Rabies, nearly 100% fatal for humans, circulates in the wild animals around us. For the first time since 2009, rabies has been detected in Suffolk County raccoons: Two have tested positive since January.

In 2024, Westchester and Erie counties had the highest rabies detections of New York counties.

However, this shouldn’t be too worrisome for a few reasons:

1-Rabies is common in New York wild animals. New York state frequently leads the nation in the number of rabid animals. (A raccoon rabies outbreak hit New York in the ‘90s, spreading rabies in wild animals across the state.) Infections are most common in raccoons, bats, skunks, and foxes. Among domestic animals, cats are most frequently diagnosed in New York.

2-We have tools to help.

a. Wildlife: We reduce wild animal rabies by vaccinating wildlife. Many communities, including in New York, distribute baits containing oral rabies vaccine across parks and wooded areas (sometimes using helicopters). When raccoons and other animals eat the baits (which smell like fish), they become immunized, protecting them against rabies.

b. Pets that come into contact with wild animals are at greatest risk of rabies. All cats, dogs, and ferrets should be vaccinated for rabies—in New York, state law requires it. Unvaccinated dogs or cats that are exposed are required to be euthanized or isolated for up to 6 months under observation.

c. Humans: People who work directly with animals have occupational risk, and should be vaccinated for rabies. People who may have been exposed to rabies (through an animal bite or scratch) will need post-exposure prophylaxis of the vaccine (getting vaccinated after exposure).

Vaccination and post-exposure prophylaxis have made human rabies rare: We see just 1 to 3 cases in the United States annually. Still, animal bites are common. About 60,000 Americans need post-exposure prophylaxis following an animal bite annually. Thanks to vaccination, New York City hasn’t seen a single human rabies case since 1947.

What you can do

Ensure that your pets are vaccinated for rabies. All New York counties offer free rabies vaccination clinics. For more information, contact your local health department.
Do not touch or get close to wild animals, including feral cats. If you are bitten, immediately wash the wound with soap and water and contact your medical provider. Advise children to immediately tell an adult if they are bitten or scratched by an animal.
If you see a wild animal that doesn’t look well or encounter a dead animal, contact your local health department or 311 if you are in New York City. Rabies symptoms in animals include tiredness, confusion, difficulty moving, aggression, drooling, and chewing objects like wood, soil, or stones.

Getting vaccinated is crucial if a wild animal bites you. I learned that firsthand in college when a monkey bit me while I was traveling — and I’m thankful I got the shots.

Bottom line

The health of our furry friends plays a big role in our community health, even in urban centers like New York City. Consuming raw animal products (milk, meat, eggs, etc.) is risky for people and animals alike. And rabies remains a deadly threat to us and our pets. But keeping pets vaccinated, practicing good food safety, and talking to a provider if you’re exposed or bitten can protect you, your family, and your pets.

Love,

Your Local Epidemiologist

Dr. Marisa Donnelly, a senior epidemiologist with wastewater monitoring company Biobot Analytics, has worked in applied public health for over a decade, specializing in infectious diseases and emerging public health threats. She holds a PhD in epidemiology and has led multiple outbreak investigations, including at the California Department of Public Health and as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Marisa has conducted research in Peru, focusing on dengue and Zika viruses and the mosquitoes that spread them. She is Healthbeat’s contributing epidemiologist for New York in partnership with Your Local Epidemiologist, a Healthbeat supporter. She lives in New York City. Marisa can be reached at mdonnelly@healthbeat.org.

New York public health update: Fentanyl overdoses, bird flu on Long Island, changes to mental health laws

2025-03-12T21:00:00+00:00

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A lot going on in the world of public health — here’s some news New Yorkers can use.

Bird flu confirmed on Long Island

Last week, dozens of dead ducks, geese, and seagulls infected with bird flu washed up on Long Island beaches.

Bird flu has now been detected in birds in 44 of New York’s 62 counties. No cases of humans or cattle in New York have been reported.

Why it matters:

Bird flu spreads easily among wild birds and poultry, disrupting ecosystems and farms and posing risk to those who work with animals. It’s also making our eggs very expensive.

It’s particularly deadly for birds, reaching close to a 100% fatality rate. In January, a Long Island farm outbreak led to 100,000 ducks being culled. (This is a biosecurity measure to mass-kill animals so it doesn’t continue spreading on the farm.) While human risk remains low, awareness and precautions are key.

What you should do:

Do not touch dead or sick birds. If you see dead birds anywhere, assume they have bird flu. Several Americans outside of New York have been directly infected by sick birds. If you must dispose of dead birds, wear gloves, a N95 mask, and eye protection.
- Use a shovel or a garbage bag to pick up the bird, avoid direct contact with the carcass or carcass fluids.
Report sightings of dead birds to the Department of Environmental Conservation using this form.
If you have flu-like symptoms after exposure, call your doctor.

Fentanyl continues to drive the overdose epidemic in New York City

Last week, a 4-year-old child died from possibly ingesting fentanyl in a Brooklyn shelter.

This is a tragic reminder that fentanyl remains the leading cause of preventable overdose deaths in New York. In 2023, 2,444 New Yorkers died from a fentanyl-involved overdose — that’s one overdose death in NYC every four hours.

Quarterly overdose rates in New York City.

Though rates remain high, there are glimmers of hope. Our most recent data, from the first quarter of 2024 (overdose data is notoriously delayed), shows the fewest overdose deaths in New York City since 2020. This followed a downward trend that started in 2023.

The latest report, explained by Healthbeat, found 3,046 deaths in 2023 compared to 3,070 deaths in 2022, representing a 1% decrease. There were also fewer deaths in the first quarter of 2024 compared to the same time the previous year.

Overdoses remain particularly high in some New York communities hit hardest by the opioid crisis.

Overdose deaths are highest in the dark blue communities.

What you can do:

Carry Narcan (naloxone), a life-saving medication that reverses opioid overdoses.

All New Yorkers can receive free naloxone and training from registered Opioid Overdose Prevention Programs (OOPPs) on how to recognize the signs of an overdose and administer naloxone.
Health Department vending machines: Locations can be found on this page.
Over-the-counter naloxone at pharmacies: Available without a prescription at most major chains (map here).
- Most insurance providers will cover all or part of the cost of naloxone, and New York State will cover copayments of up to $40.

There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit the 988 website for 24/7, confidential support.

Mental health crisis care in New York: New proposals and their complexities

Involuntary treatment for mental illness is being actively debated in New York. Governor Kathy Hochul recently proposed expanding New York’s Mental Hygiene Law to help get people with mental illness access to treatment before they potentially become dangerous to themselves or others. Some advocacy groups say these changes undermine patients’ rights and could widen inequities in our mental health system.

This debate isn’t new. Every state allows short-term involuntary hospitalization for people experiencing severe mental health crisis, such as those at risk of suicide, often holding them for up to 72 hours to stabilize and arrange care.

The question New York is facing is where to draw the line between protecting individuals and preserving their autonomy while their mental state puts them or others at risk.

What would the proposals change?

The proposed updates focus on expanding intervention options and adjusting hospital procedures. Key provisions include:

Broadened commitment criteria: The rationale is to allow earlier intervention for those unable to meet basic needs due to mental illness before self-harm or harm to others occurs.
Hospital rules: Requiring hospitals to consider patients’ long-term history and the frequency and outcomes of past crises — not just their current state — for involuntary admission or discharge decisions.
Provider expansion: Authorizing psychiatric nurse practitioners, not just psychiatrists, to approve involuntary holds.
Strengthened outpatient oversight: Simplifying the renewal process for court orders under Kendra’s Law, which mandates continued outpatient treatment, including taking medication, after discharge.

The debate and pushback

Supporters argue these changes could prevent crises and get people the care they need sooner. However, critics, including some committees and civil rights groups, have raised several concerns:

Stripping individuals of freedom or bodily autonomy.
Lack of investment in street-level mental health workers.
Racial biases. Black and Hispanic populations have been disproportionately enrolled more than white people since the inception of Kendra’s Law.
Lack of evidence. Critics say it’s unclear whether involuntary treatment is better than peer support or peer-led mental health crisis response teams.

According to a report by the New York Lawyers for the Public Interest, as of Feb. 25, 3,674 people were under an active involuntary outpatient commitment order statewide, including 1,684 in New York City.

Moving forward

New York’s mental health problem is deeply intertwined with housing instability, economic hardship, and racial disparities. While these proposals attempt to address real and urgent issues, there is no one-size-fits-all solution. Regardless of the outcome of these changes, there is a clear need to improve mental health services for our most vulnerable New Yorkers.

If you see someone in crisis:

Don’t hesitate to seek assistance from a trained professional.
If there is no imminent risk of danger, call or text 988.
If someone appears to be an immediate danger to themselves or others, find a safe location and promptly call 911.

Bottom line

It may seem like the issues surrounding bird flu, the fentanyl overdose crisis, and mental health support have little in common. However, they are connected by our ability to take action to mitigate these concerns and improve community safety. We can contribute by reporting dead birds, carrying naloxone, or seeking help for someone in a mental health crisis.

Love,

Your Local Epidemiologist

What congestion pricing and measles mean for New York City’s public health

2025-03-05T14:00:00+00:00

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Congestion pricing and measles outbreaks are making national headlines. One could change the air we breathe, the other reminds us how tragic infectious disease outbreaks can be. Both have implications for New York. Here’s what you need to know.

Congestion pricing: It matters for your health

Manhattan’s congestion pricing is being debated at the federal level. While it makes its way through the courts, its downstream effects on New York City traffic directly and indirectly affect the health of New Yorkers.

There are significant benefits of reducing traffic through congestion pricing including:

Fewer traffic-related accidents
Safer streets for pedestrians and cyclists
Increased public transit, walking, or biking — increasing physical activity and overall health
Cleaner air

In other big cities, like London and Stockholm, congestion pricing programs directly reduced air pollution and improved health outcomes.

Manhattan congestion pricing relief zone.

One potential con is traffic diversion. In 2022, MTA found congestion pricing could lead to a 2.5% increase in truck traffic in the Bronx, specifically on the Cross Bronx Expressway. Increasing pollution even slightly could worsen health disparities.

How does traffic affect respiratory health?

Children and adults who live near high-traffic areas are disproportionately exposed to air pollution, putting them at greater risk for respiratory conditions, like asthma.

Traffic air pollution includes a lot of particles, including fine particulate matter (PM2.5) and ozone (smog), that irritate and inflame lungs, can worsen asthma, and cause other chronic illnesses like heart disease. In New York, long-term exposure to PM2.5 (from traffic and other sources, like buildings and construction) is estimated to cause ~2,000 deaths from lung and heart disease each year — accounting for about 1 out of every 25 deaths citywide.

The impact is especially severe in high-traffic neighborhoods, like parts of the Bronx, where childhood asthma rates are among the highest in the nation.

New York City asthma emergency department visits (ages 4 and under) in 2020 by community district.

Monitoring changes in air pollution will be key

Last week, the New York City DOHMH released a plan to monitor and evaluate changes to air quality following congestion pricing implementation. In fact, baseline data was already collected from monitoring stations across New York City in 2024. The baseline will be compared to air quality data over the next two years to assess the impacts of congestion pricing.

New York City Community Air Survey (gray dots) and real-time PM2.5 (red dots) monitoring sites where air quality from before and after congestion pricing will be assessed.

When the first air quality report is released at the end of this year, I’ll be looking out for any significant increases or decreases in PM2.5 and ozone across neighborhoods in New York. I’ll also be keeping a close eye on changes in asthma rates in the next year. (When Stockholm implemented congestion pricing, asthma rates in kids decreased within the first 7 months.)

Congestion pricing could impact public health and everyday life — New Yorkers spend about 117 hours stuck in traffic every year. But to see its true effects, we depend on data. Careful tracking and analysis will be crucial to understanding the policy’s outcomes.

Measles tragedy in Texas and what that means for New York

Tragedy struck a Texas family last week when a child died from measles — the first U.S. measles death in a decade. The child was unvaccinated and otherwise healthy. The Texas outbreak is now up to 158 cases, with 20 children hospitalized, many of them with severe breathing issues.

Measles can spread like wildfire — one person can expose an entire room two hours after they’ve left it.

Across the Hudson River from NYC, Bergen County, New Jersey, has reported three measles cases in unvaccinated children. Before being diagnosed, at least one of the cases visited a hospital and spent time in the waiting room. Anyone who visited the Englewood Hospital Emergency Department on Feb. 9 between 11:30 a.m. and 5:30 p.m. may have been exposed and should contact their health provider immediately.

Thankfully, no new measles cases have been associated with the New Jersey outbreak in the past week, but unfortunately, that doesn’t mean we’re in the clear. Given how long it takes for measles symptoms to develop, potentially exposed individuals, if infected, could develop symptoms as late as March 6. We need to stay on high alert.

RFK Jr. shifts stance on MMR vaccine

Over the weekend, Robert F. Kennedy Jr. emphasized the importance of measles vaccination in an op-ed, stating that the “MMR vaccine is crucial to avoiding potentially deadly disease.” While there were parts of the op-ed that missed the mark, I was somewhat reassured to see our HHS secretary state so clearly the importance of vaccines as preventable measles cases and tragic outcomes continue to rise across the U.S.

While 98% of children in NYC have received two doses of the MMR vaccine by kindergarten, we have two vulnerabilities. Measles outbreaks occur at the community or school level, and we have some pockets of much lower vaccination rates. Also, coverage among younger children is significantly lower. Only 81% of children aged 24-35 months have received their first dose.

There have been two measles cases in New York City so far in 2025. Now is the time to check your child’s vaccination status. It’s the best way to protect them — and our communities.

Bottom line

Policies that govern public health are being debated on the national stage, shining a spotlight on issues facing us in New York. As congestion pricing and the measles outbreaks continue to evolve, tracking the data will be key to understanding their impact. I’ll keep my ears to the ground and break down what it all means for our health.

Love,

Your Local Epidemiologist

New York public health updates: Measles outbreak nearby, DOGE cuts to 9/11 first responder program reversed

2025-02-26T12:00:00+00:00

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Here’s what happened this week in New York public health and why it matters.

Whiplash for the 9/11 first responder program

This week, the Department of Government Efficiency (DOGE) abruptly cut funding to an essential 9/11 first responder health program and fired 20% of its staff — only to reverse its decision two days later following political backlash.

When I think about what defines a New Yorker, one group immediately comes to mind: the first responders who ran head-first into the World Trade Center on Sept. 11, 2001. While 441 first responders made the ultimate sacrifice, thousands of survivors were exposed to significant amounts of dust, soot, and toxins from the fallen buildings. This has had a dramatic impact on their longevity:

Firefighters who responded to 9/11 had higher overall cancer rates, particularly prostate cancer (39% higher risk) and thyroid cancer (more than double the risk).
They were diagnosed at a younger age (around 56 vs. 59 years old) and were more likely to have cancer detected at an early stage.

Rates of prostate cancer in FDNY firefighters exposed to 9/11 (red), firefighters in other parts of the U.S. (navy), and the U.S. male population from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (green). Figure from the Career Firefighter Health Study.

We wouldn’t know this without the two-decade-long Career Firefighter Health Study, which tracks the long-term health impacts of 9/11-related diseases. It was funded through the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health. Cutting this program would limit our ability to understand and provide better treatments for the long-term health impacts our first responders and heroes suffer as a result of their bravery.

What this means to you: Speaking out against programs that are valuable to New Yorkers works. Funding cuts to federal institutions can impact important local efforts to support even the bravest among us. This week, I’ll be calling my representatives to let them know that as a constituent, I deeply value continued funding for the CDC, the National Institutes of Health, and research like that carried out in the Cancer Firefighter Health Study. You can find contact information for your local representatives here.

Measles outbreak in Bergen County, New Jersey

Bergen County, New Jersey, right across the Hudson River from New York City, is experiencing a measles outbreak. As of Sunday, three cases have been reported. The first case was identified on Feb. 9 in a resident with recent travel. Two additional cases were identified last week — both had close contact with the first case. All three cases were unvaccinated.

The New Jersey Department of Health is warning that people who visited the Englewood Hospital Emergency Department on Feb. 9 between 11:30 and 5:30 p.m. may have been exposed and should contact their health provider immediately. The virus spreads easily through the air when someone coughs or sneezes and can remain in the air for up to two hours after an infected person leaves the area. Given how long it takes for measles symptoms to develop (the incubation period), potentially exposed individuals, if infected, could develop symptoms as late as March 6.

It’s too early to say if this will become a large outbreak, but it’s significant for a few reasons:

Measles is a serious disease. In the ongoing outbreak in Texas (with 90 cases identified), about 1 in 5 kids have been hospitalized.
The three cases are unvaccinated. The vaccine is highly effective at preventing infection, but unvaccinated kids are likely to be infected if they’re exposed.
Hospital exposure increases the probability of spread, given medically vulnerable patients.

Two things will help, though: 1. These three cases were a family (so hopefully, we can keep it contained to their household). 2. New York has one of the highest vaccination rates in the country. This will stop onward spread from getting out of control, as long as it doesn’t hit some tightly-knit unvaccinated communities (which we do have).

New York has had major measles outbreaks in the past — in 2019, 649 people (mostly kids under 5 years old) in New York City were sickened, and 49 were hospitalized. This outbreak was in a largely unvaccinated community. So far in 2025, only one measles case has been identified in New York City, but with cases across the river in New Jersey and large outbreaks elsewhere in the United States, we need to be on high alert.

What this means to you: This is exactly the time to ensure all our children are protected with the measles shot. YLE national also had a few other tips.

Flu in New York: High but slowing down

While the flu has peaked and started declining in New York City, the Metro Area, and Western New York, it continues to increase in Central New York and the Capital District.

Regional influenza hospitalizations from the New York State Influenza Surveillance Report.

Despite some regional decreases, flu levels remain pretty high across the state — we are at about the same number of hospitalizations as during the peak of last year’s flu season. Many New Yorkers are still getting sick with the flu and needing to be hospitalized.

Statewide influenza hospitalizations from the New York State Influenza Surveillance Report.

What this means to you: With such high flu circulation, it’s a good idea to take protective measures against getting sick, like wearing a mask in crowded spaces (the subway, supermarkets, while traveling, etc.) and avoiding social interactions if unwell. Flu usually has a second peak later in winter due to flu B circulation (right now, most is flu A), and infections can go into March or April, so it’s not too late to get your flu vaccine at a local pharmacy or clinic.

ACIP meeting postponed: Something to watch

Next week’s national Advisory Committee on Immunization Practices meeting — where experts review and recommend national vaccine guidance — has been postponed. ACIP plays a crucial role in shaping the CDC’s official vaccine guidance, which in turn informs New York health departments to determine policies, insurance coverage, and vaccine availability across the United States. Delaying this meeting delays national guidance and policy updates on new meningococcal and chikungunya vaccines and new recommendations for flu and RSV vaccinations.

Thankfully, New York has its own state ACIP, serving as an additional layer to evaluate vaccines and provide guidance in our state. The next New York ACIP meeting is March 6. We’ll bring you any updates from that.

Even though New York has taken a strong stance on vaccination policy, such as eliminating non-medical vaccine exemptions, the state still relies on national ACIP for guidance and may adjust policy in response to the committee’s recommendations, including Medicaid and Medicare coverage and vaccine availability at pharmacies — making it harder for people in New York (and across the United States) to access newly recommended vaccines.

States like New York, should proactively consider the downstream effects of these federal delays, for example, potential impacts on the Vaccines for Children program, which provides no-cost vaccines for eligible kids. Finding sustainable ways to reduce reliance on federal funding and recommendations could safeguard against potential future disruptions.

Stay tuned for updates on this.

Bottom line

Rapid changes in our federal public health systems are directly impacting New York — from threats to 9/11 first responder programs to delays in vaccine recommendations. At the same time, as epidemiologists like to say, “the bugs have ears,” and vaccine-preventable diseases, including flu and measles, are active in our region. We’ll continue to keep you informed as we work to protect our communities.

Love,

Your Local Epidemiologist

New York’s public health system is largely protected from national level changes. Here’s why.

2025-02-20T12:00:00+00:00

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A lot is unfolding at the national level, including the recent firing of hundreds of federal health agency employees. Among those laid off were seven Centers for Disease Control and Prevention employees assigned to the New York City health department.

Public health departments in cities across the country (and especially large cities like New York) rely on CDC resources and staff to complete essential public health functions. When these positions are abruptly cut, it weakens the system—leaving gaps that can make us more vulnerable to emerging health threats. But, there are still many ways states can maintain strong systems. That’s because public health is largely local—states have constitutional authority to enact and implement policies that protect the health, safety, and rights of their residents.

This week alone, four major events highlighted this invisible state shield in action. Here’s what happened and why it matters to you.

1. Ebola quickly ruled out in New York City scare

On Sunday morning, two people seeking care at a New York City urgent care were transported to a hospital after fearing they had Ebola. This isn’t completely out of the realm of possibility given that an Ebola outbreak is underway in Uganda. New York is just a flight away, and communications have been frozen between the CDC and the World Health Organization. The United States doesn’t have clear visibility into global health threats.

However, within hours, it was confirmed that the patients did not have exposure to or a diagnosis of Ebola. Instead, they were treated for another health issue. New York is among the most prepared states when it comes to handling highly infectious diseases, like Ebola or Marburg. City hospitals train year-round, running drills and exercises to ensure they can quickly identify, isolate, and safely transport patients with potential of high-risk infections.

2. New York detected the new mpox virus for the first time

New York recently identified its first case of mpox clade I (fourth in the United States)—an important indicator that our disease tracking systems are working. This strain of mpox is notable because it has historically been associated with more severe disease, and is causing an outbreak in Central Africa.

A crucial part of this system is ensuring that doctors know the signs and symptoms to look out for and when to involve public health. The New York State Department of Health and NYC DOHMH periodically release health advisories to prepare clinicians and give them a heads-up on what to look out for.

The case identification followed New York’s strong infectious disease surveillance system:

The doctor was prepared and noticed this patient had signs and symptoms of mpox virus and a travel history to a country with an ongoing outbreak, increasing the suspicion that this patient had mpox.
The doctor alerted the public health department, which recommended mpox testing and providing safety precautions for the physician and patient to prevent transmission.
The patient began isolating while recovering to prevent transmission to others.
The public health department contacted the CDC for guidance and to facilitate testing.
Contact tracing and follow-up began and are ongoing while the patient recovers. So far, there have been no other mpox cases, and risk to the general public remains low.

3. A new Global Health Report

On Jan. 30, New York state started publishing a weekly Global Health Update Report. The report is unique—I’ve never seen another state publish a report on international infectious disease trends. It’s a challenge for most states to even maintain local data dashboards due to limited resources.

This weekly report summarizes domestic and international infectious disease outbreaks. Considering that New York City is one of the most internationally connected cities, staying aware of global health issues is particularly important for our state.

Bird flu detections in poultry flocks from the New York Global Health Update Report.

4. New York further protects doctors who prescribe abortion medication across state lines

Last week, Gov. Kathy Hochul signed new legislation to protect New York doctors from getting pulled into the crossfire of states’ abortion rights. The new law allows New York doctors to request pharmacies print their practice’s name and address, instead of the doctor’s personal information, on prescription abortion medication (mifepristone and misoprostol).

Wait, isn’t abortion legal and protected in New York?

Yes, in New York:

People of all ages have the absolute right to abortion through the 24th week of pregnancy.
After 24 weeks, abortion is permitted if a medical provider determines there are significant risks to the health of the pregnant person or fetus.

So, if abortion is protected in New York, why do we need this new law for abortion medication?

Put simply, to protect New York doctors from other states’ laws.

Following the overturn of Roe v. Wade, 19 states put abortion bans into effect. For those living in these restrictive states (more than half of women aged 18-49 in the United States), telehealth is filling in gaps in reproductive health care access.

Doctors in New York—and other states with reproductive health care protections—have been providing medical care, including prescribing abortion medications, to patients in restrictive states. These efforts have been critical for people who might otherwise struggle to access abortion care. To safeguard these providers, New York passed a telehealth shield law in 2023, protecting health care practitioners from legal actions by states that criminalize abortion. That protection is now being put to the test.

Louisiana and Texas, two states with near-total abortion bans, are targeting a doctor in New York who prescribed abortion medication to patients in their states. Louisiana—where doctors can face up to 15 years in prison, $200,000 in fines, and lose their medical licenses for prescribing abortion pills—has filed criminal charges against a doctor and is attempting to extradite her for trial. In response, Hochul made it clear that New York would not cooperate with the extradition.

In the wake of these charges, New York has taken further action with the new law. Allowing doctors to omit their personal names from abortion medication prescriptions will prevent states like Louisiana and Texas from identifying and targeting providers. This law strengthens New York’s existing shield laws and reinforces the state’s commitment to being a safe haven for reproductive health care. In New York, patients and providers will continue to be protected.

This case will be something to watch. States with dramatically different reproductive rights laws are clashing, and this has the makings of a case that will likely make it to the Supreme Court.

Bottom line

State laws don’t just shape health policy—they act as shields, protecting patients and providers when federal policies fall short. Whether it’s emerging infectious disease threats or reproductive rights, New York is showing how states can be frontline defenders of public health.

Love,

Your Local Epidemiologist

How federal funding cuts to research, services are impacting the health of New Yorkers

2025-02-12T12:00:00+00:00

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Federal changes are happening at lightning speed, and while they may seem high-level or far away, they can have direct and indirect impacts on New Yorkers' health — some in the short term, and definitely in the long term if courts don’t intervene.

In the past week, three have caught my eye for New Yorkers.

Real-world impacts of federal chaos for New Yorkers

With the executive orders, there are already short-term impacts to service programs in New York.

Your Local Epidemiologist (National) surveyed readers to collect insights on the personal and organizational impacts of federal changes. More than 3,000 people from 50 states, 3 territories, and several countries shared their first-hand experiences. (The survey is still open if you would like to contribute, and the full results so far are available here.)

New York was well-represented, with 58 respondents.

New Yorkers reported that the federal changes have impacted them and their organizations in various ways, like:

Funding for programs, including providing basic services (e.g., shelter, food, health care, safety), education, and workforce development. Almost half reported that funding was delayed, and about a third reported funding was cut.
Morale, with 2 of 3 respondents severely impacted.
Lost jobs or projects canceled altogether, threatened, or delayed.

This is especially concerning when we consider the groups they serve: 44% work with youth and adolescents, 37% with Black, Indigenous, and people of color, 35% with families, and 33% with infants and children.

Impacts from federal changes felt by New Yorkers responding to Your Local Epidemiologist’s national survey.

This survey makes one thing clear: Federal funding shifts and stop-work orders are impacting essential health programs across New York. These impacts to local communities directly result from policy and funding decisions being made at the highest level of government. The truth is, with an incoming Health and Human Services secretary and other federal health directors, new priorities in health funding are about to take shape, and we can expect more changes.

NIH limits overhead expenses to 15%

The new administration announced Friday that the National Institutes of Health would have a new “indirect costs” rate of 15%. Almost immediately, 22 states including New York filed a lawsuit challenging this rate. If the new rate is upheld in the courts, it will impact the New York economy, jobs, and innovation.

Indirect costs are also known as facilities and administration costs — money to keep research institutions running, through maintaining laboratories, heating and electricity, and providing administrative support, for example. When a researcher gets an NIH grant, say a $100,000 grant, the indirect rate is added to that, so 15% would be $115,000. Capping these funds at 15% is a big change — the current average indirect cost for universities is 30%, twice as much as the proposed cap. And many institutions, like research hospitals, rely on indirect expenses as high as 60-75%.

This big change would require universities to cut in other places, such as:

Internal budget cuts, like with hiring freezes
Limiting research volume
Higher tuition
Delayed or canceled infrastructure updates

Columbia, New York University, and Mount Sinai are among the top 20 NIH-funded institutions nationally. In New York, research institutions receive about $3.6 billion in NIH awards, supporting more than 29,000 jobs and almost $8 billion in economic activity in the state. These funds support crucial research into diseases like cancer, Alzheimer’s, obesity, Long Covid, and more.

These funding cuts aren’t happening in isolation but are reflecting shifts in federal health priorities, many of which are shaped by the leadership at the Department of Health and Human Services.

The HHS secretary heavily influences what gets funded

Until recently most of us may not have given a lot of thought to the secretary of HHS. In fact, I wasn’t all that clear about how big their influence is. Here’s what I learned, and why it matters who’s in that post.

The U.S. Senate is expected to vote (potentially as early as Wednesday) on the confirmation of Robert F. Kennedy Jr. as the incoming HHS secretary — a federal position overseeing many federal health agencies, including the Centers for Disease Control and Prevention, the NIH, and the Food and Drug Administration. An incoming HHS secretary typically pushes for a new agenda, prioritizing topics based on their policy goals. This shapes federal, state, and local public health funding. Large portions of New York’s public health budget depend on federal funds (especially for infectious disease surveillance, AIDS treatment and care, and Medicare services), so changes to federal health priorities will be felt by our state’s public health programs.

The budget for New York City’s Department of Health and Mental Hygiene, for example, relies on federal funding for about 17% of its $1.9 billion budget in 2025. Some budget cuts and fluctuations are expected. For example, from 2024 to 2025, the federal funds for infectious disease work in New York City were cut by $32.2 million. Large changes in priorities, however, will likely result in larger budget cuts. Combined with proposed cuts to NIH-funded research institutions, cuts to other organizations in New York that rely on federal funding will compound, limiting our collective resources to respond to public health threats in our state.

So, what can we do?

Contact your representatives. Call your senators and congressional representatives to advocate for the issues that matter to you. (Find their contact information here.)
Support local organizations. Volunteer, donate, or simply show appreciation for community groups working on the ground.
Share your stories with your community, YLE through our survey, your representatives, or via social media. Federal policy may feel distant, but personal stories from neighbors, friends, or colleagues bring its impact to life. Putting human faces to policy changes helps build awareness and keeps our legislators accountable.
Support one another. With so many changes, people may be worried about losing essential health services, facing layoffs, or feeling overwhelmed by the news. We need each other’s support and empathy right now.

Bottom line

There is a lot of change coming to federal institutions, and some will affect New York. Some people agree with these changes, some do not. But none of us are going through these changes alone, and when we lean on each other, we can help keep our communities strong.

Love,

Your Local Epidemiologist

Public health data chaos: How New York is protected from federal communications freeze

2025-02-05T15:10:40+00:00

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Have questions, comments, or ideas for future topics? Email me at mdonnelly@healthbeat.org. I would love to hear from you.

After navigating to the New York respiratory virus dashboards, where I usually start my analysis for these reports, I breathed a sigh of relief. The data were still being updated, and I could do my job: translating public health science for you.

Before we get into the state of affairs of respiratory illnesses, though, here is what is happening with data at the federal level and why New York has been spared the widespread closures of federal data sets we’ve seen this week.

Decentralized public health system

In the United States, our public health system is decentralized. This means that local and state health departments collect and own the data rather than the federal government. During the Covid-19 pandemic, limitations to this setup slowed our understanding of what was happening nationally — the Centers for Disease Control and Prevention had to knit all the local and state pieces together. However, with current uncertainties surrounding federal data sharing, this is a good thing, as it provides a sort of firewall.

All states have slightly different models of how this works.

Blue dots = county health departments; red dots = state health departments; blue arrows = data flow.

New York is a mostly decentralized state. Local health departments retain authority and are led by local government employees. They collect health data from their communities and share it with the state and then with the CDC. Data flow from the bottom up, and remain available to us regardless of what the feds do or don’t do with it. Importantly, states don’t have to send the majority of data to the CDC (really only hospitalizations).

While this is good news, there are some vulnerabilities associated with a potentially weakened CDC that epidemiologists like myself are paying close attention to:

During big outbreaks or public health emergencies, like a measles outbreak or hurricane, coordination across states and with the CDC is absolutely essential. We often rely on CDC expertise when new or rare diseases pop up.
Reduced funding for the CDC would affect local and state health department funding. Eighty percent of local and state public health funding comes from the CDC.
Not all states have the resources to maintain their own health dashboards, like in North Dakota, for example. Many rely on CDC’s dashboards, and without them, residents of those states could be left without critical public health information.

What this means to you and New York communities

New York can (and continues to) publish its data for New Yorkers without interference from federal government chaos. For example, dashboards for influenza, RSV, Covid-19, and wastewater remain unaffected.

With gratitude for the strength of our New York public health system, let’s dive into the most recent data on respiratory viruses.

The flu: High and increasing

The number of people with flu in New York is abnormally high for this time of year, and the increase is widespread across all state regions. With so much flu, New York hospitals are being pushed to their limits. In Rochester, for example, recent spikes in flu hospitalizations have pushed the Strong Memorial Hospital beyond its capacity.

Influenza hospitalizations from the New York State Flu Tracker.

New York’s flu season started later than last year’s, but it’s shaping up to be worse. Severe flu infections requiring hospitalization are the highest they’re been in three years and may not have peaked yet. Over the past two seasons, flu hospitalizations peaked before New Year’s Day.

We’re seeing the flu hit nursing homes and older populations hard. In the week ending Jan. 25, 41 outbreaks were reported in nursing homes — a 32% increase compared with the previous week. This is concerning because older residents are at much higher risk for bad flu outcomes: In a typical season, about 70-85% of flu deaths are among people age 65 or older (CDC Flu). Across the state, flu hospitalizations are highest in the 75+ age group.

Influenza hospitalizations by age from the New York State Flu Tracker.

With the flu so high, there are a couple of things we can do to protect our most vulnerable fellow New Yorkers, including:

Wearing a mask in crowded spaces (while traveling, on the subway, in supermarkets, etc.).
Avoiding social interactions if you aren’t feeling well.
Getting vaccinated.
- Flu usually has a second peak later in winter due to flu B circulation (right now, most flu cases are from flu A), and infections can go into March or April, so it’s not too late to get your flu vaccine at a local pharmacy or clinic.
People who are at increased risk of serious flu complications (pregnant people, people over age 65, people with asthma and chronic lung disease, diabetes, or heart disease) should contact their doctor for possible treatment within two days of symptom onset.

Covid-19: Minimal and holding steady

Covid-19 activity in New York has remained surprisingly low — this is our mildest Covid-19 winter to date.

It’s striking that Covid-19 levels are so low in New York compared to national and Northeast regional averages. High community immunity from vaccinations and past infections — especially following a big summer wave — likely plays a role, but I don’t think it tells the whole story. Milder infections may be leading to less viral shedding, and behavioral changes like isolating when sick or masking could also be reducing spread. Given the high flu activity in New York, I also wonder if interactions or competition between respiratory viruses are slowing Covid-19 transmission.

SARS-CoV-2 concentrations in New York state (yellow line) are minimal, while national concentrations (black) are high and increasing, according to data from the CDC National Wastewater Surveillance System.

RSV: Moderate and decreasing

RSV has peaked and continues to decline in New York. This season looks like a middle-of-the-road RSV season, like last year’s. The shape of the RSV seasonal curve in New York is similar to the past three years.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

We still expect there to be several weeks of RSV activity, so we aren’t entirely out of the woods yet.

Emerging diseases: Avian flu

Two weeks ago, avian flu (bird flu, H5N1) was detected on a Long Island duck farm. This is important because, up to now, New York has been relatively spared the impacts of H5N1 compared to other states. We’ve had no reported cases among humans or cattle. The duck farm outbreak is only our second in a commercial flock statewide and our first in three years (United States Department of Agriculture Avian Influenza Tracker). Thankfully, New York agriculture and public health authorities are taking steps to prevent further spread.

All 100,000 ducks at the Crescent Duck Farm in Aquebogue on Long Island had to be culled (euthanized). Culling birds after an avian flu detection happens for two main reasons:

To contain the spread by preventing transmission to other birds or animals, including humans. The goal is to keep this an isolated event.
To protect public health by reducing opportunities for mutation. Every infection is a chance for the virus to pick up mutations that could make it more transmissible to humans and potentially spark a pandemic.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

These efforts don’t come without risks. The workers tasked with culling animals are at high risk for exposure to the virus. Of the human avian influenza infections in the United States, 23 of 67 had exposure at poultry farms. Proper personal protective equipment and handling of animals are essential.

The risk of avian flu to the general public remains low, with no human cases reported in New York. But there are some precautions we can take, especially for those who spend time around birds or keep backyard flocks. In the past three years, 27 backyard flocks have tested positive for avian flu in New York.

Report sick or dead birds immediately.
- For poultry, call the New York State Department of Agriculture and Markets at 518-457-3502.
- For wild birds, call the New York State Department of Environmental Conservation at 718-482-4922 or 518-478-2203.
- For other animal-related concerns, call 311.
Avoid contact with birds that appear sick or have died, and avoid contact with surfaces that have bird feces.
- If you must touch sick or dead birds:
- - Wear gloves and a facemask (preferably N95 or better).
  - Place dead birds in a double-bagged garbage bag.
  - Throw away your gloves and facemask after use.
  - Wash your hands well with soap and warm water.

Avian flu has also been affecting cattle nationally. Thankfully, New York, which ranks fifth in dairy-producing states, has not detected avian flu in cattle. To bolster public health surveillance, New York joined a national USDA program to test bulk raw milk (both milk that will be pasteurized and remain raw) for avian flu. We are still being onboarded, and milk testing has not yet started.

Bottom line

These are uncertain times for federal public health agencies. I’m grateful we can rely on strong local and state public health systems in New York to keep us informed. For now, winter virus transmission, especially the flu, is still high. Stay healthy: Mask up, avoid social interactions when you’re sick, and get vaccinated.

Love,

Your Local Epidemiologist

Ripple effects of ICE raids create health challenges for New York City

2025-01-29T12:00:00+00:00

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Immigration, one area experiencing significant policy change, is inextricably linked to public health. News of ICE raids has been all over the media, but what does that mean, and how do they affect New Yorkers?

Regardless of one’s political stance on immigration, understanding the health consequences and downstream effects of changing policies is crucial for protecting community health. It’s important to understand the data and look at the bigger picture—that’s what I’m here to do.

Let’s dig in.

What are ICE raids?

What changed last week?

Since 2011, ICE has not been allowed to arrest people in “sensitive locations,” including hospitals, schools, daycare centers, and places of worship. This policy was established to maintain people’s access to essential services, like medical care and school, regardless of immigration status.

Last week, the policy protecting sensitive locations from ICE raids was revoked. This means officers can now arrest people at places like hospitals and schools. But, under protections from the 4th Amendment, ICE cannot enter the private spaces of hospitals (like patient areas) or schools without a judicial warrant.

Who does this affect in New York?

Immigration status is not a simple yes-no but rather exists on a spectrum.

Documentation status continuum from undocumented immigrants (left) to U.S.-born citizens (right).

As this graphic shows, many U.S. residents are not citizens and live here under work visas, green cards, or are somewhere in the process of gaining citizenship. Reports of raids and deportations can instill fear in all of these groups and lead to avoidance of essential services.

Among the 3.1 million immigrants in New York City (about 1 in 3 New Yorkers), around 400,000 are undocumented with around 50,000 of those children. Pew has estimated that 650,000 are undocumented across the state (1 in 4). New York is one of the most diverse parts of the country, as shown in the map below.

ICE raids have profound health effects on individuals and communities

In 2023, after Florida passed a law to require hospitals to ask for immigration status, 66% of noncitizens reported increased hesitation to go to the hospital (compared to just 27% of citizens).
After a similar law was passed in Alabama, visits to county public health clinics among Latino adults decreased by 25%.

But this doesn’t just impact the health of individuals who are undocumented, it affects the health of the communities as well.

Infections have the chance to spread more widely. In Los Angeles, research shows that patients who fear immigration authorities are about three times more likely to delay seeking care for tuberculosis. Without treatment, TB is contagious and can lead to severe illness or death.
Mental health impacts, like toxic stress, are not limited to undocumented immigrants; it can affect the community at large. A 2008 raid at an Iowa factory resulted in the detention of 400 people, spreading news throughout the state. A study found that in the 37 weeks following the raid, there were more Hispanic babies born with low birth weight due to stress in mothers across the community, while birth weights in babies born to white mothers remained stable.
Delayed care among extended families and communities who step up and offer support. In one study, a clinician described an example: “(My patient)…from Uganda with HIV/AIDS and end-stage renal disease was unable to consistently keep appointments for dialysis because she needed to work to support her sister’s two children after (her) sister was arrested by immigration."

Children are especially vulnerable

There are many “mixed” status families. But families tend to behave according to the person with the least documentation—and they may forgo services that children who are U.S. citizens are eligible for.

From Chalkbeat: Deportation fears keep immigrant students home from NYC schools

Toxic stress is the prolonged stress response in the brain and body (e.g., increases in heart rate, blood pressure, and stress hormones like cortisol). It has long-lasting effects because it prevents normal development of neural connections in the brain.

We are hearing of families who are afraid to take their kids to school out of fear of deportation. Missing school can deprive students of more than just learning—for many, schools are one of the primary ways kids access nutritious meals, mental health services, and other essential support.

How can we support children?

Create a safe and supportive environment: Speak calmly, reassure children, and provide comforting actions like hugging (with permission) or reading.
Address emotional and behavioral needs: Children may exhibit behaviors like irritability, clinginess, or withdrawal. These could be signs of trauma, not “bad behavior.” Encourage calming or enjoyable activities like drawing, games, or music.
Foster family and cultural connections: Support contact with family members when possible (e.g., visits, calls, or video chats). Avoid speaking negatively about family. Try to celebrate and honor cultural traditions and foods.
Provide trauma-informed care: To help manage stress, teach calming exercises like slow breathing or muscle relaxing. Limit exposure to distressing media while providing accurate, age-appropriate information about their situation.

What can educators do?

Protecting student information
- The Family Educational Rights and Privacy Act prohibits disclosing personally identifiable information without parental consent (except in some legal circumstances). Student information should only be released to federal or local law enforcement when legally compelled (e.g., judicial warrant or subpoena).
- Avoid collecting immigration or citizenship status information, and anonymize such data when collected for specific programs.
- Do not collect (or ask for) Social Security numbers.
Responding to law enforcement requests
- ICE or law enforcement officers should only be allowed on school property when there is a judicial warrant, and the school district attorney should always be consulted.
Supporting families affected by immigration enforcement
- Encourage families to update emergency contact information, including secondary contacts.
- Schools may recommend legal and advocacy organizations to help plan and establish standby guardianship.

What can clinicians do?

Ensure confidentiality and reassure patients that their immigration status is confidential and protected under HIPAA (Health Insurance Portability and Accountability Act).
- Avoid collecting or documenting any non-required immigration-related information, especially within patients’ medical records. (This is required in Texas and Florida, but not in New York.)
- Stop asking for Social Security numbers.
Know the legal landscape and understand patients’ rights, such as their right to health care regardless of immigration status, and communicate these rights to patients.
- Stay informed about policy, like New York’s Executive Order 170, which prohibits inquiring about or disclosing immigration status unless legally required.
Train staff to respond to ICE or law enforcement inquiries. If ICE does show up:
- Obtain the officer’s information (name, badge number, etc.).
- Ask for any supporting documents (e.g., judicial warrant or subpoena). Make copies or take photos of these.
- Immediately call the hospital’s Risk Management Office or immigration liaison. They can contact proper legal channels and advise on the next steps.
- If officers take action before immigration liaisons can be contacted, take videos and photos of any enforcement actions.
- Do not try to actively help a person hide from ICE.

Providing compassionate, trauma-informed care is always critical, especially for patients who may have experienced fear or discrimination due to their status.

Bottom line

Immigration raids have big impacts on the public’s health—both individually and for communities. As a community, we can take action to lessen health impacts. When we protect the health of our most vulnerable community members, we protect everyone’s health.

Love,

Your Local Epidemiologist

Long Covid in New York City data findings: Symptoms, treatments and risk factors

2025-01-23T12:00:00+00:00

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Covid-19 is here to stay, and with it come persistent and potentially life-altering symptoms from Covid-19 infections, also known as Long Covid. This is where most concerns lie for the majority of us when encountering Covid-19.

A new report found just how much it has impacted New York City—80% of New York respondents suffered symptoms for more than one month after infection. HowNew does this figure hold up? And what can we do about it?

Let’s dig in.

What is Long Covid, exactly?

Early in the pandemic, clinicians quickly found that patients with severe infections had lasting and sometimes debilitating symptoms, from brain fog to headaches to being bedridden. Long Covid has since been documented after mild or moderate disease, too. The long-term effects cause a wide range of physical, mental, emotional, and psychological symptoms.

We still don’t fully know the physiological pathways, but hypotheses include continued viral replication, overactive immune response, micro-blood clots, inflammation of blood vessels, or organ damage from initial infection. Tightly controlled studies put the prevalence of Long Covid around 3%-6%.

In 2022, long-term Covid symptoms were common among New Yorkers

Last month, the New York City Department of Health published survey results from 2022 to understand the burden of Long Covid on New Yorkers.

Most New Yorkers had Covid symptoms for more than a month, Health Dept. survey finds

Before we jump into the data, keep this in mind: Measuring Long Covid is really hard. While New York tracks Covid-19 hospitalizations and deaths, Long Covid cases aren’t reportable, and there’s no diagnostic test. Many of the symptoms are common, like fatigue and headache. These results are also coming from a subset of people who chose to respond to a voluntary survey about enduring symptoms, so the findings may not represent the experience of New York City residents overall.

The Covid-19 Experiences Survey asked 2,081 New York City residents about longer-term symptoms following Covid-19 infection. These are the results:

80% reported at least one symptom lasting one month or longer.
- Half of respondents reported at least one moderate or severe symptom lasting at least one month.
Fatigue and decreased exercise tolerance were the most common long-lasting symptoms—about half of adults reported these.
Black and Latino communities, women, transgender people, and those living in low-income neighborhoods were more likely to have symptoms lasting more than one month. These communities were hit hardest during the pandemic, and inequities have persisted for Long Covid.

Black and Latino communities, women, transgender people, and those living in low-income neighborhoods were more likely to report severe symptoms lasting more than one month following Covid-19 infection.

Severe symptoms had big impacts on mental health and activity

Among adults reporting at least one severe long-term symptom, 1 in 3 (33%) had probable depression, much higher than those with mild symptoms (6%) or no symptoms (2%).

People with severe Covid symptoms were more likely to report activity limitations and depression.

These numbers highlight the impact of long-term Covid-19 symptoms in limiting daily activities, which can result in social, economic, and mental health difficulties.

Take this with a grain of salt

While reports like this one are important, and highlight patterns in symptoms and risk factors for those most affected (like fatigue and lower exercise tolerance in New Yorkers), take the 80% metric with a grain of salt:

2022 is very different from 2025 for Covid-19, thanks to immunity from vaccines, infections, or both. As we’ve seen in the United Kingdom, the risk of developing Long Covid is declining over time. Other studies show staying up to date on vaccines lowers risk of Long Covid. (The jury is still out on whether taking Paxlovid—a Covid antiviral—reduces Long Covid.)
The survey focused on symptoms lasting one month or more after a Covid-19 infection—an outdated definition of Long Covid. Today, the official definition of Long Covid is symptoms lasting more than three months.
People with lingering symptoms may have been more likely to participate in a survey like this, so the findings may not represent the wider population.
There is no control group or comparison group among people who weren’t infected. This is especially critical when assessing a broad range of symptoms, like headaches, for which there are other causes.

Regardless of the exact number of cases, some people are still suffering from Long Covid with debilitating symptoms, and the condition should be taken seriously.

New York researchers are enrolling people in studies

Answers and treatments are not coming fast enough for Long Covid patients. But research is ongoing, and many studies are happening in New York:

NYU Langone is enrolling adult patients with Long Covid symptoms in a National Institutes of Health-funded post-Covid registry.
Mount Sinai is enrolling adult patients with fatigue-related Long Covid symptoms in an NIH-funded study to determine the effect of vagus nerve stimulation on Long Covid recovery.
- Some research shows that dysregulation of the vagus nerve could be responsible for fatigue and worsening symptoms after exercise.
Last year, the New York City Department of Health and Mental Hygiene launched a multi-year research study following 10,000 New Yorkers experiencing Long Covid to better inform support services and policy using New York-specific data.

Treatment for Long Covid is getting better in New York

Navigating and getting care for Long Covid can be overwhelming. However, many New York clinics and hospitals are on the leading edge of understanding and treating Long Covid. Here are some resources for getting treatment for Long Covid in New York:

Call New York City’s Long Covid hotline. New Yorkers recovering from Covid-19 or Long Covid can be connected to care by calling 212-COVID19 (212-268-4319).
Find a Long Covid clinic that specializes in treatment:
1. NYC Health + Hospitals has three Covid-19 centers in the Bronx, Queens, and Brooklyn, offering care for Long Covid. The AfterCare program provides excellent resources for getting support.
2. NYU Langone Health runs the Post-Covid Care Program, which provides treatment for adults with Long Covid.
3. Mount Sinai at the Cohen Center for Recovery from Complex Chronic Illness (CoRE) and Center for Post-COVID Care. Reach out to CORE@mountsinai.org to obtain more information.
4. 1. An Upper East Side location of Mount Sinai is providing targeted Long Covid care for South Bronx and East Harlem residents, neighborhoods that were particularly hard hit during the pandemic.

I also found the Centers for Disease Control and Prevention appointment checklist for Long Covid helpful for patients and providers to get the most out of appointments.

Bottom line

While our understanding of the causes and treatments for Long Covid is slowly evolving, some still struggle with its long-lasting impact. Many New York hospitals are at the forefront of developing better treatments, offering relief and hope to those affected in our city.

Love,

Your Local Epidemiologist

New York winter virus report: Norovirus, flu, and Covid-19 on the rise

2025-01-15T12:00:00+00:00

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Does it feel like everyone around you is sick right now? Yeah, me too. It seems like half my friends and family have the sniffles, and I’m still recovering from a respiratory infection. Our New York communities are in peak respiratory season. Let’s dive into the most recent respiratory data following the holidays, plus a bit on norovirus. Here’s your State of Affairs.

The flu: High and increasing

The number of people with flu in New York is high — hospitalizations in the state increased by 44% during the week ending Jan. 4, compared to the prior week. Increases are widespread across all regions of the state.

Influenza hospitalizations from the New York State Influenza Surveillance Report.

In an earlier post, I mentioned that flu activity started later this year compared to last year and shared some guesses as to what that could mean for flu intensity this year.

At this point, the flu season is shaping up to be similar to pre-pandemic times. Flu activity hasn’t peaked yet (unlike last year when it peaked the last week of December). The question is, will the number of severe infections be similar to last year, or worse?

Flu hospitalizations in New York. During the 2020-21 season, there were very few flu cases in the state.

Only time will tell, but in the meantime, it’s a good idea to take protective measures against the flu, like wearing a mask in crowded spaces (while traveling, on the subway, in supermarkets, etc.) and avoiding social interactions if you aren’t feeling well. Flu usually has a second peak later in winter due to flu B circulation (right now, most flu cases are from flu A), and infections can go into March or April, so it’s not too late to get your flu vaccine at a local pharmacy or clinic.

Covid-19: Minimal and increasing

Covid-19 activity in New York this season has been surprisingly low, with levels inching up more slowly compared to last season. This is our mildest winter for Covid-19 since the start of the pandemic. This is likely because we had such a big Covid-19 wave late last summer, resulting in a lot of immunity. I expect Covid-19 activity to continue increasing in New York, as national and regional Covid-19 levels are high and continue to increase.

SARS-CoV-2 concentrations in New York state (yellow line) are minimal, while national concentrations (black) are high and increasing.

Covid-19 continues to increase in New York City, where wastewater levels are increasing.

New York City average SARS-CoV-2 wastewater concentrations.

RSV: High but decreasing

RSV has peaked and is now declining in New York. This season’s peak happened about two weeks later than last year, but it was largely a middle-of-the-road season (so far there have been a similar number of cases compared to last year).

New York City RSV testing data from the Influenza and RSV Surveillance Report.

RSV infections in kids, who are usually hit hardest, have been similar this season to pre-pandemic levels. We hoped that RSV vaccines would have a stronger effect this year in keeping kids out of hospitals. I’ll be looking for more data on how RSV vaccines affected hospitalizations after the season ends.

National RSV hospitalization rates for people 4 years of age and younger.

We still expect there to be several weeks of high RSV activity, so we aren’t out of the woods yet.

Norovirus: Surging, and you don’t want it

Norovirus cases are surging in New York City and many other parts of the United States. Norovirus is a highly contagious group of viruses responsible for gastrointestinal issues like vomiting and diarrhea. It’s the most common cause of the stomach “flu” or “bug,” causing 19 million-20 million cases in the United States annually. In New York City, there were about 1,300 cases in December — almost triple the number during the same time in 2023 (488 cases).

Norovirus outbreaks in the United States reported by NoroSTAT-participating states.

Norovirus is spread through contact with infected people, contaminated surfaces, and food. It’s notoriously infectious. While infected with norovirus, people shed billions of virus particles, but it only takes a couple of particles to infect someone. Unfortunately, hand sanitizer doesn’t kill the virus because it has no outer membrane.

To prevent norovirus spread:

Wash hands frequently with soap and warm or hot water for at least 20 seconds.
Use detergents with bleach to clean and disinfect surfaces.
- To make your own, mix 1 teaspoon of bleach in 1 gallon of cool water.
Any material handled by people infected with norovirus — linens, towels, dishware, utensils, doorknobs, and especially surfaces in the bathroom — should be cleaned well to prevent spread.

Most people should recover from norovirus on their own in 2-3 days.

Emerging diseases: Avian flu

Last week, news broke of the first avian flu (H5N1) death in the United States, a tragic reminder that this virus is dangerous and that we as a country need to be on alert. Thankfully, we still haven’t seen any person-to-person transmission, and only two of the 74 cases identified in the United States have had severe illness. (See this recent YLE post for more details.)

We haven’t had any known cases of avian flu in dairy herds or humans in New York, so the current risk to New Yorkers is low. However, we may be missing cases, given testing cattle is voluntary. Starting this month, though, we should have more visibility. New York is part of a national milk testing program led by the USDA and is one of 28 states testing milk for H5N1 in bulk raw milk (both milk that will be pasteurized and remain raw). I’ll be back with a deeper dive when we have more information.

Bottom line

Winter virus transmission is high right now. Stay healthy: Mask up, wash your hands, and bleach surfaces.

Love,

Your Local Epidemiologist

New York public health successes: overdose death decline, paid prenatal leave, air quality in schools

2025-01-08T12:02:46+00:00

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Happy New Year, New York! Before we take on the (numerous) health challenges of 2025, I’d like to reflect on the many health successes in our state over the past year. Together, we are making big strides to build a healthier and safer community.

Public health is often only brought into the limelight when something scary happens, like Covid-19 or foodborne illness outbreaks. Its successes and what this field prevents are often invisible.

So I combed through a year’s worth of press releases, articles, and data to highlight public health accomplishments and achievements in New York this past year. Let’s share and celebrate the wins.

(Disclaimers: These are in no particular order, and I’m sure I missed some. Some of these accomplishments also happened in 2022 or 2023, but we learned about them in 2024 — I’m counting those as 2024 wins.)

Turning the tide

1-The steepest decline in overdose deaths in New York in a decade, thanks to education, access to treatment, and harm reduction. Naloxone can now be ordered online here, and more than 2 million fentanyl and xylazine test strips were distributed to New Yorkers.

Overdose deaths in New York, 2015-24.

2-New Yorkers' life expectancy increased from 78 years in 2020 to 81.5 years in 2022 (above the national life expectancy of 77.5 years). This follows a decrease caused by the Covid-19 pandemic. The HealthyNYC program, a campaign to raise New York City life expectancy to 83 years by 2030, is celebrating its one-year anniversary, which sets priorities for reducing the primary causes of death in New York City and tracks our progress.

New York City life expectancy.

3-COVID-19 deaths are way down, thanks to increasing immunity. More than 15.7 million residents of the Empire State have been vaccinated against Covid-19.

New York Covid-19 deaths.

4-Deaths from screenable cancers are declining in New York City, including breast, cervix, prostate, lung/bronchus/trachea, and colon/rectum/anus.

Deaths from screenable cancers in New York City.

Maternal and child health support

5-New Yorkers now have the right to paid prenatal leave, with an additional 20 hours of paid leave for prenatal care, on top of existing leave like from employer leave policies or sick leave. More information on the program is available here.

6-All pregnant New Yorkers on Medicaid can now access doula (birthing coach) services at no cost, including support up to 12 months postpartum, regardless of pregnancy outcome. The provider’s recommendation requirement to get Medicaid coverage for doula services is met by the Commissioner of Health’s standing order, which universally recommends doula services for all pregnant, birthing, or postpartum New Yorkers.

7-Childhood vaccination rates remained the third-highest in the country, with 97.7% of kindergartners receiving the MMR vaccine during the 2023-24 school year.

Measles, mumps, and rubella (MMR) vaccination rates among kindergartners for the 2023-24 school year.

Investing in health infrastructure

8-Greater access to public restrooms in New York City through the “Ur In Luck” (🚽😅) initiative, which will add 46 new public restrooms and renovate 36 across all five boroughs in New York City, with restroom locations mapped in Google Maps. (Here’s a video showing how to access it on phone map layers.)

9-Improved air quality in schools with $5 million in funding to provide education and technical assistance to implement improvements.

Advances in health care access and equity

10-Medicaid was expanded to cover undocumented immigrants 65 and older who meet income and other eligibility requirements. Additionally, a new law will ensure that kids on Medicaid under age 6 don’t have breaks in their health care coverage when their family circumstances change.

11-Health insurers are now required to cover EpiPens, and patient out-of-pocket costs are capped at $100. This makes the life-saving treatment for severe allergic reactions more affordable for New Yorkers who need it.

Cutting-edge innovation

12-New York’s first cell and gene therapy hub was opened at the Roswell Park Comprehensive Cancer Center in Buffalo.

13-Wastewater surveillance was expanded to track additional diseases (including influenza, RSV, hepatitis A, and norovirus) when the New York State Wastewater Surveillance Network was named a CDC Center of Excellence.

14-Biomonitoring efforts will increase to identify harmful chemicals (like PFAS, lead, and mercury) in New Yorkers through $2.5 million in Centers for Disease Control and Prevention funding. One goal for this funding is to improve participation among minority and low-income New Yorkers who are more likely to be exposed to harmful contaminants.

YLE New York successes

Launched YLE New York. Cheers to our first couple of months!
Published 14 newsletters sent to thousands of readers across New York.
Co-hosted a community listening session to understand community health information needs better.
Represented the New York YLE community at the White House to discuss how to continue building trust and support public health communication.

Bottom line

We continue to make life healthier for millions of New Yorkers through teamwork, partnership, investment, and advocacy. I can’t believe how much this New York YLE community has grown in just a few months! The comments and questions I receive from you give me so much energy and inspiration to keep sharing trustworthy and unbiased public health information.

Here’s to 2025!

Love,

Your Local Epidemiologist

Covid-19, influenza, and RSV increasing around the holidays in New York

2024-12-23T12:00:00+00:00

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We’ll be taking a break for the next two weeks to recharge (and recuperate after getting sick myself 🤧), but we wanted to share the latest data on respiratory viruses in time for holiday travels. Here’s the State of Affairs.

RSV: high and increasing

RSV continues to increase in New York and nationally. In New York City, there was a 30% increase in positive RSV tests during the week ending Dec. 7, compared to the prior week. We’re seeing a serious RSV surge, and it seems to be happening later than usual. During the past two seasons, RSV rates peaked in November and declined in December. (Looks like we are back to pre-pandemic trends.) This year, rates continue to rise, and it’s too early to tell when they might peak.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

RSV continues to have the largest effect on children, but older adults are also at increased risk for severe RSV and hospitalization. The Centers for Disease Control and Prevention estimates that, nationally, there are 100,000–150,000 hospitalizations among adults age 60+ years due to RSV. While I’m not aware of public data for New York, we’ve seen recent increases in hospitalizations for people age 65+ years across the United States.

National hospitalization rates for people 65 years of age and older.

Because older adults are also at increased risk of severe RSV, it’s recommended that anyone age 75+ years get an RSV vaccine.

The RSV vaccine is also recommended for those who are 60+ years and who have heart or lung disease, are immunocompromised, or who live in a nursing home.
The RSV vaccine for adults is a single dose, given once — it’s not an annual vaccine.

In one of our recent posts, we discussed the importance of also vaccinating pregnant women and giving monoclonal antibodies to protect babies against RSV. (See the post here.)

The RSV vaccine works for older adults

A recent study published in JAMA Network Open showed that the RSV vaccine for adults age 60+ years was highly effective at preventing severe disease.

In fact, the study estimated that the RSV vaccine had 90-91% efficacy at protecting against hospitalizations and emergency department visits for adults age 60+ years — that’s great vaccine efficacy.

With that kind of efficacy, high RSV vaccine coverage could cut the number for folks hospitalized annually from 100,000 to closer to 10,000.

The flu: moderate and increasing

Seasonal flu transmission is also ramping up in New York — the number of cases in the state increased by 53% during the week ending Dec. 7, compared to the prior week. Flu hospitalizations are increasing in every region of the state.

Influenza hospitalizations from the New York State Influenza Surveillance Report.

Like RSV, this year’s flu season in New York is off to a slower start compared to the last two years, with fewer positive tests and hospitalizations so far. I see two possible scenarios for this year’s flu season:

A flu season with a similar number of hospitalizations compared to last year’s, but with a later peak. Last year, seasonal flu peaked in the last week of December. This year is shaping up to be more like pre-pandemic flu seasons. (In the 2018-19 and 2019-20 seasons, flu hospitalizations peaked in March and February, respectively.)
We could also have a milder flu season overall, with fewer hospitalizations compared to last year. In the 2021-22 season, flu hospitalizations were much lower overall. But we were masking up a lot more that winter. We don’t know yet if the slow start is just pushing everything back, or if it’s a sign that we’ll have a milder year. Either way, it’s a good time to get vaccinated, since flu is rising.

Flu hospitalizations in New York.

You may also have seen national headlines about H5N1 (bird flu). This is a type of flu, but not like the seasonal strain. It hasn’t spread from human to human yet; those at risk are people with direct contact with sick animals (dairy, wild birds, and poultry). New York hasn’t detected H5N1 yet in humans or dairy herds, but I predict it’s only a matter of time given that more and more states are finding it. If/when that happens, I’ll be back with a deeper dive.

Covid-19: minimal but increasing

Covid-19 levels in New York state are minimal, but expect an increase soon. Nationally, Covid-19 levels have risen from minimal to low, and this trend is likely to carry over to New York in the near future.

SARS-CoV-2 concentrations in New York state (yellow line) are minimal while national concentrations (black) are low and increasing, according to data from the CDC National Wastewater Surveillance System.

Covid-19 continues to pick up in New York City, where wastewater shows that levels are increasing.

New York City average SARS-CoV-2 wastewater concentrations.

Reduce your chances of infection while traveling

These tips to stay healthy while traveling generally apply, regardless of what is circulating.

Mask up while traveling. This includes on the subway, at airports, train stations, and when boarding or deboarding for a flight.
- Planes typically have good air filtration when moving. However, air filters are not usually run at full strength when the plane is stationary or during taxiing. This means that during boarding and deboarding, when everyone is close together waiting, air circulation is minimal, and the risk of being exposed to a respiratory pathogen is higher. This is a good time to mask up, as I plan to do.
- Well-fitting filtration masks like N95s are the best, but a KN95 or a surgical mask are still good options.
Ventilate and filter air to help reduce transmission. When you’re indoors together, turn on an air purifier, use a fan, or open a window.
Stay home if you feel sick. I know it’s really hard around the holidays, but this is the most important way to protect vulnerable friends or relatives who may be over age 65, pregnant, or immunocompromised from getting sick.

Bottom line

Though they came late, RSV and flu are here and on the move in our communities. Respiratory virus transmission will likely increase over the holidays as many of us travel and expand our social networks. However, we still have several tools to stay healthy. I hope you all have a happy and restful holiday!

Love,

Your Local Epidemiologist

How New York is addressing health disparities in pregnancy-associated deaths

2024-12-18T12:00:00+00:00

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Last month, the March of Dimes released its annual report on maternal and infant health in the United States. New York did not score well — a C+ in preterm births, with almost 1 in 10 babies in New York born preterm.

And it’s not just the health of the babies scoring low. Maternal mortality is a huge problem. Two to three women die of pregnancy-associated factors each week in New York, on average. The majority of these deaths are preventable.

Let’s dig into the data to understand how New York is addressing this crisis.

How do we know these stats? All pregnancy-associated deaths are reviewed in New York.

In 2019, New York passed a law requiring all pregnancy-associated deaths to be thoroughly reviewed. Two maternal mortality review boards were formed — one for New York City and one for the rest of the state.

For each pregnancy-associated death, the boards assess preventability, underlying causes, and contributing factors, and then submit a report every other year to identify where and how we must make changes. The most recent reports were released earlier in 2024 using data from 2018-20 (our most recent data).

Maternal mortality in New York state is lower than the national average but still high.

The United States has the highest maternal mortality of all other high-income countries and is one of the only countries where it has risen since 2000. There are also tremendous disparities as to who is most at risk — Black women in the United States die at more than double the rate of white women. Maternal mortality is a public health crisis.

In 2010, New York ranked 46th of 50 states for maternal mortality — meaning New York had some of the highest maternal deaths. In the most recent report, New York is down to 15th.

The reports show that from 2018 to 2020, there were 386 pregnancy-associated deaths in New York. While maternal mortality in New York state has remained relatively stable, significant progress has been made in New York City. Still, we have a long way to go to reach the Healthy People 2030 goal of getting down to 15.7 deaths per 100,000 live births. (For comparison, the U.S. maternal mortality ratio is more than 1.5 times higher than in the United Kingdom — 20.4 vs 13.4 per 100,000 live births.)

Three-year rolling average maternal mortality for New York state (including New York City; red), New York City (green), the rest of the state (excluding New York City; purple), and nationwide (blue).

In New York, the risk is not uniform.

Black women in New York are five times more likely to die when pregnant (or soon after delivery) compared with white women.

Pregnancy-related mortality ratios by race and ethnicity in New York.

Disparities are also seen in infant health. The infant mortality rate for babies born to Black mothers is 2.4 times the average New York state rate.

Infant mortality rates by race and ethnicity in New York.

There has been little improvement in these gaps over the past two decades. Mortality for Black pregnant women in New York has consistently remained higher than the national average for Black pregnant women.

Annual maternal mortality for Black and white women. Colors correspond to Black women in New York (orange), white women in New York (purple), Black women in the U.S. (red), and white women in the U.S. (blue).

There are also stark disparities based on where pregnant women live in New York. Maternal vulnerability (a mom’s risk of poor health outcomes during pregnancy) is highest in the Bronx, Orleans, Cattaraugus, and Chautauqua counties.

Maternal vulnerability by county in New York.

What is causing these high mortality rates, and why are there such substantial disparities?

Bleeding, strokes (embolism), and mental health conditions (including overdoses) are the leading medical causes.

Overdose has recently emerged as a leading cause of pregnancy-associated death. From 2016 to 2020, 14% of pregnancy-associated deaths in New York City were due to overdose, with the vast majority involving an opioid. For context, around 4% of deaths in New York state are due to overdose.

Chronic health conditions are also significant risk factors for poor maternal health outcomes and preterm delivery. Nationally, women with diabetes had a preterm birth rate of 28.8%, and women who had high blood pressure had a similar rate (23.3%).

Discrimination was a probable or definite circumstance for 47.1% of pregnancy-related deaths in New York. This includes the following:

Structural and systemic discrimination, like how care and services are harder to access for people living in low-income communities
Individual discrimination, like not taking patient complaints seriously or dismissing them as normal discomfort due to race, gender, education status, income status, etc.

What is being done to address the maternal mortality crisis in New York?

Public health efforts have to be hyper-focused and evidence-based:

Ensure access to doulas. Doulas are professional perinatal coaches who support pregnant people one-on-one and have been shown to improve pregnancy outcomes. Anyone enrolled in New York State Medicaid can receive doula services at no cost during pregnancy and up to 12 months after, regardless of pregnancy outcome. More information and a doula directory are available here.
Plans of Safe Care to support moms, babies, and families affected by substance use. After screening for substance use and mental health conditions, federal law requires that providers develop personalized plans to identify how a provider, family, and community can support the safety and well-being of the baby and mom. These plans address basic needs, identify support systems, and connect moms to their needed resources. More information on safe care plans is available here.

Gov. Kathy Hochul recently signed legislation to expand coverage and make care more affordable in New York state during and after pregnancy. The new laws include the following:

Permit pregnant women to enroll in health insurance policies at any time without any extra charges or fees. (Before, companies could charge fees for enrolling due to pregnancy.) Resources are available here.
Require commercial health insurers in New York to cover prenatal vitamins when a health care provider prescribes them.
Offer paid prenatal care leave starting Jan. 1, 2025, in New York. More information is available here.

Are these initiatives working?

It’s hard to tell. The data give mixed signals. On one hand, New York has improved its maternal mortality rankings in recent years. On the other hand, the Centers for Disease Control and Prevention estimated that maternal deaths in New York increased by 33% during the pandemic. Many initiatives are just beginning, so time will tell how effective they are.

Bottom line

The health of a health system can be measured by how well it cares for expecting moms. Maternal deaths have profound ripple effects on families and communities and provide an important window into broader health disparities. The loss of any expecting or new mother is a tragedy. We have a lot of work to do to keep our New York mothers and babies safe.

Love,

Your Local Epidemiologist

RSV, Covid, flu cases are on the rise in New York

2024-12-11T12:00:00+00:00

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The respiratory season has continued to pick up in New York and nationally. We now have data from the week of Thanksgiving, so it’s time for another State of Affairs to kick this week off. But first…

Your Local Epidemiologist visited the White House!

Last week, I had the privilege of attending a White House convening of public health communication and advocacy experts. A special shoutout to Your Local Epidemiologist founder Dr. Katelyn Jetelina for her incredible insights on the panel!

Hearing stories from people across the country — healthcare workers, teachers, community leaders, pastors, caregivers, and many others — was profoundly inspiring. These individuals tirelessly share health information and advocate for their communities. Here are a few takeaways I wanted to share:

Health communication is a team effort. We need to stick together and support each other.
Science isn’t finished until it’s communicated.
Science communication needs to be rooted in truth — opinions without facts can’t stand.
Trust is mutual and earned — you must give it to get it.
Lead with empathy. Everyone makes decisions for themselves and their loved ones based on the information they have. We need to meet people where they are, without judgment, to build trust and connection.

I left the event energized, hopeful, and motivated to keep sharing actionable health information with you all, and I look forward to continuing this work together.

Now, back to the data.

RSV and flu: increasing

Respiratory Syncytial Virus is on the rise and is affecting a lot of young children. Recent data from laboratories across New York show that positive RSV tests are increasing. In New York City, RSV cases are significantly rising — there was a 22% increase in positive RSV tests during the week ending Nov. 30, compared to the week prior.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

We are seeing the effects of increasing RSV activity in hospitals — national RSV hospitalization rates in children have shot up in the past couple of weeks.

Hospitalization rates for RSV (green), Covid-19 (red), and influenza (blue) among children aged 4 or under.

Children are being hit hardest by respiratory viruses, especially RSV. National Centers for Disease Control and Prevention data show that children aged 4 and under currently account for 8% of emergency department visits for COVID-19, flu, or RSV, while adults aged 65 and older account for just 1.4%.

The good news is that there are now two key ways to protect babies against RSV:

An RSV vaccine that pregnant women can get. The timing of this vaccine is very important. Time is needed for antibodies to develop, cross the placenta, and protect the infant during the RSV season over the winter. That is why it’s given between weeks 32 and 36 of pregnancy, from September through January. With this timing, the protection passed to the baby will last for their first RSV season.
Monoclonal antibodies for infants. For pregnant women who miss the RSV vaccination window, infants can receive RSV monoclonal antibodies (named nirsevimab) just before or at the start of the RSV season. This is an effective option — research has shown that nirsevimab is 90% effective against RSV-associated hospitalization in infants during their first RSV season.

RSV vaccines are also recommended for all adults ages 75 and older and adults ages 60–74 who are at increased risk for severe RSV.

RSV vaccine and immunization recommendations from the CDC.

The flu is also increasing in New York — the number of cases in the state increased by 47% during the week ending Nov. 30, compared to the week prior. The biggest increases are happening in New York City and the surrounding metro area, but hospitalizations are increasing across the state.

Influenza regional incidence from the New York State Influenza Surveillance Report.

Covid-19: minimal but increasing

Covid-19 levels are minimal in New York, but we are starting to see some signals that transmission is increasing.

SARS-CoV-2 concentrations in New York (yellow line) are minimal and declining, according to data from the CDC National Wastewater Surveillance System.

Covid-19 is picking up in New York City, where wastewater shows that levels are increasing.

New York City average SARS-CoV-2 wastewater concentrations.

Fortunately, hospitalizations for Covid-19 among New Yorkers are low, especially among those over the age of 65, who have the highest risk.

This year’s Covid-19 season is looking a bit different from last year’s. In 2023, Covid-19 hospitalizations in New York started to rise as early as mid-November. However, this year Covid-19 activity is beginning later. One key factor may be the large summer wave that occurred this past July and August. With so many people infected over the summer, community immunity has likely remained higher into the fall, delaying the start of this winter’s Covid-19 season. It’s been a welcome reprieve.

It’s easy to find a place to get vaccinated

I was able to make a same-day appointment at my local pharmacy for Covid-19 and flu vaccines. If you haven’t had a chance to get your vaccines (I get it — the holidays are crazy), the time is now.

We shared a lot of information on how to get vaccines in New York City and the rest of the state in our holiday respiratory virus post, available here.

Bottom line

Respiratory viruses (especially RSV) are picking up, it’s not too late to get vaccinated, and there are many people out there working hard to keep us healthy!

Love,

Your Local Epidemiologist

Whooping cough and food insecurity levels are on the rise in New York

2024-12-04T13:41:52+00:00

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I hope everyone had a great Thanksgiving! Here’s what you need to know about New York public health this week.

Whooping cough is spreading in New York and nationally

Whooping cough (pertussis) cases have surged in New York and nationally, returning to pre-pandemic levels. New York has reported 2,337 cases this year, compared to 687 last year. Nationally, there has been almost a fivefold increase in infections this year compared to last.

This bacterial infection causes runny/stuffy nose, sneezing, fever, and intense and sometimes uncontrollable coughing fits. Newborns are especially at high risk — the name “whooping” cough comes from the sound babies make between coughing fits. Among infants under 2 months who contract whooping cough, about half require hospitalization, and 1 out of 100 die. This is why vaccination of pregnant women and close contacts is critical to protecting newborns before they can receive their own vaccines.

One reason whooping cough may resurge is that vaccine protection wanes over time. New vaccines are being developed to provide more durable protection, but they aren’t yet on the market. Currently, there are two types of combination vaccines (meaning they protect against multiple things) available:

DTap
Tdap

These vaccines protect against whooping cough, tetanus (the “T” in the name), and diphtheria (the “D/d” in the name). Children younger than 7 years receive DTaP, while older children and adults receive Tdap.

Whooping cough vaccine guidelines from the Centers for Disease Control and Prevention

The CDC recommends that everyone be vaccinated against whooping cough.

For people who are pregnant, getting a shot of Tdap during the 27th-36th week of pregnancy is crucial to boost the baby’s immunity, helping protect them from whooping cough when they are most vulnerable to it. Tdap vaccination during pregnancy protects 9 in 10 babies from being hospitalized with whooping cough.
Babies, young children, preteens, and teens can follow vaccination schedules for their initial DTap and Tdap shots and boosters.
It’s a good idea for adults who have never received Tdap to get it — it can be given anytime.

When we see whooping cough increase, our response as a community is mainly aimed at protecting babies through vaccination and ensuring those around babies are vaccinated.

Hunger and food insecurity are on the rise in New York

Last week, while most gathered to share Thanksgiving meals, many faced a very different reality. Food insecurity, meaning someone doesn’t have enough to eat at least some of the time, affects 1.9 million New Yorkers. This is up 76% since 2021, with 1 in 6 households with children lacking enough to eat, and is higher than the 55% increase seen nationwide.

Food insufficiency in New York state and New York City metropolitan area, 2021 vs 2024.

During 2021-23, 1.2 million people in New York City (14% of the population) lived in food-insecure households. New York City’s rates are highest in the Bronx, where 1 in 5 residents and 1 in 3 children experience food insecurity.

To combat food insecurity, food assistance programs provide free or reduced-cost food. There are three main ways to access food assistance in New York:

From THE CITY: How to get help paying for food and groceries in NYC

SNAP (Supplemental Nutrition Assistance Program): A federal program that issues EBT cards for purchasing food.
- About 35% of New Yorkers qualify for SNAP, but only 75% of eligible New York City residents are enrolled. There’s a lot of room for improvement.
- See the New York SNAP website for eligibility criteria.
Free or reduced-price meals for children in school.
- New York City public schools offer free meals to all students during the school year. Learn more here.
- Many schools outside New York City also offer free or reduced-price meals — eligibility details are available here.
Food banks, pantries, and soup kitchens. These organizations offer free or low-cost food across New York.
- Use the Food Help NYC tool or call 311 to find nearby locations, or view a list of food assistance providers across the state here.

If you’re not food-insecure and want to help:

Donate food: Drop off items at supermarket collection points, send them via online shops, or donate money to food banks.
Volunteer: Help sort, pack, cook, serve meals, or assist with home deliveries.

To find ways to get involved, reach out to your local food bank or soup kitchen.

New York is still in a drought while fires die down

While recent rain in New York helped wildfire suppression and improved air quality, much of the state is still under drought warning. New York City’s reservoir is still below 20% of historical standards.

Data and figure from the New York Department of Environmental Conservation

During the drought, New Yorkers are urged to conserve water:

Shorten showers: Save 5–7 gallons a minute.
Turn off faucets: While shaving, brushing teeth, or doing dishes (faucets use 2–3 gallons a minute).
Fix leaks: A slow drip wastes 15–20 gallons daily.
Report fire hydrant leaks: Call 311.

More tips are available here.

Dry conditions have increased wildfire risks in New York. The Jennings fire, which burned 5,304 acres along the New York-New Jersey border in November, is fully contained. Thank you to all the firefighting professionals and volunteers who responded.

Freezing temperatures in New York City trigger Code Blue warnings

A Code Blue Weather Emergency notice is issued when the temperature drops below freezing (32 degrees Fahrenheit or less) between 4 p.m. and 8 a.m. No one will be denied shelter in New York City during a Code Blue. Should you see a vulnerable person out in the cold, call 311, and an outreach team will be dispatched to offer assistance. We expect more frequent Code Blue warnings to be issued now that temperatures have dropped this season.

Bottom line

You’re all caught up on this week’s New York public health news. See you next week!

Love,

Your Local Epidemiologist

Respiratory viruses creep up as we head into the holidays

2024-11-27T12:00:00+00:00

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Happy (early) Thanksgiving! As many of us get ready to travel and spend time with loved ones this week, it’s a good idea to check in on the state of respiratory viruses and share tips to stay healthy this Thanksgiving. I’m personally looking forward to indulging in some pumpkin pie, guilt- and respiratory virus-free. 🥧

Covid-19: minimal

Covid-19 transmission has continued to decrease across New York. Levels are “minimal.”

SARS-CoV-2 concentrations in New York (yellow line) are minimal and declining, according to data from the CDC National Wastewater Surveillance System.

It’s the same story in the city — transmission of Covid-19 is low. Good news for travelers: Covid-19 transmission is also low in the Midwest and West, and minimal in the South and Northeast.

Influenza and RSV: low but increasing

Influenza (flu) is increasing in New York; the number of cases in the state increased by 12% compared to the previous week. The biggest increases are happening in New York City and the metro area.

Laboratories report that positive RSV tests are also increasing in New York state and New York City. Younger kids, especially infants, older adults, and people with weakened immune systems are at greatest risk for severe RSV. If this is you, consider taking extra precautions this week.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

Other viruses: circulating

Even though we are seeing low levels of Covid-19, influenza, and RSV, the percent of clinic visits for general fever, cough, or runny nose is similar to last year — people are still showing up sick to clinics.

Percent of influenza-like illness among patients from New York State Influenza Surveillance Report.

Two viruses are the likely culprits: enteroviruses or rhinoviruses, which cause the common cold. It turns out the common cold is, well, common in New York right now.

New York City respiratory virus testing data from the Influenza and RSV Surveillance Report.

Walking pneumonia: increasing

Nationally and in parts of New York, clinics are seeing more children with walking pneumonia, a respiratory illness often caused by the bacteria Mycoplasma pneumoniae (and other pathogens). Symptoms include fever, sore throat, and persistent cough, but in severe cases, lungs can fill with fluid, causing difficulty breathing.

Walking pneumonia is harder to track because healthcare providers aren’t required to report cases. This year, the Centers for Disease Control and Prevention put together a national surveillance system of hospitalizations to track walking pneumonia — and it’s much higher right now than previous years (it flares every 3-5 years.) There’s no reason to think it’s any different in New York. The largest rise in cases is among children ages 1 to 4.

National percentage of pneumonia-associated emergency department visits with Mycoplasma pneumoniae infection.

Because it’s caused by a bacteria, severe Mycoplasma pneumonia cases can be treated with antibiotics, but most people fully recover without them. The CDC has helpful information about walking pneumonia here.

Avoid getting sick leading up to the holidays

Regardless of what is circulating, things you can do to stay healthy generally apply across all viruses and bacteria.

It’s not too late to get vaccinated. Immunity helps prevent infection for Covid-19, flu, and RSV. It’s also a great time to ask family members if they are vaccinated.
- Find locations using the NYC Vaccine Finder, including sites offering free vaccines for people without insurance.
- Vaccination locations throughout the rest of New York state can be found at Vaccines.gov.
- RSV vaccines and monoclonal antibodies are also available for a subset of people (pregnant people, older adults, and babies).
Mask up in the days leading up to the holidays to prevent bringing a virus to the celebration. Well-fit filtration masks like N95s are the best, but I find I’m less likely to wear these for long periods of time, so I’ve settled for a surgical mask or KN95. I’ll be wearing a mask at the airport and on the plane, and I have started to use one when I remember in the subway.

Reduce spreading infection during holiday events

Stay home if you feel sick. This is the most important way to avoid spreading illness, especially to vulnerable friends or relatives who may be over age 65, pregnant, or immunocompromised.
Ventilate and filter air to help reduce transmission. When you’re together indoors, open a window, use a fan, or turn on an air purifier.
Test at home for Covid-19 and flu. Tests are more accurate if taken when symptoms are present (in which case, stay home to reduce spread regardless). Rapid tests can catch about 40% of asymptomatic infections if two tests are taken 48 hours apart. This is a good way to take extra precaution before visiting someone who’s immunocompromised.
- Four free rapid tests from the U.S. Department of Health and Human Services can be ordered here and mailed to you.
- There is now an Food and Drug Administration-approved combined Covid-19 and flu rapid test. It is helpful to test for both because the earlier you find out if you have flu or Covid-19, the earlier you can call your doctor and get started on antiviral treatments.

Get treatment if you do get sick

If you have symptoms or test positive, assume you are contagious and stay home.
At-home rapid tests. If you test positive, you are infectious. Stay in isolation and wear a mask (preferably an N95) around others for at least 5 days or until you test negative.
Antivirals can help reduce severe illness, especially if you are over age 65.
- Paxlovid helps treat Covid-19 but should be taken within 5 days of symptom onset.
- Tamiflu helps treat influenza and should be taken within 48 hours of symptom onset.

Bottom line

Respiratory season is starting to pick up, and it will likely be intensified this Thanksgiving and thereafter because we are increasing our social networks. But there are tons of ways we can stay healthy and still celebrate with loved ones. Happy Thanksgiving, all. I’m very grateful for this community :)

Love,

Your Local Epidemiologist

New York’s fire season: Drought conditions and dry winds increase wildfire risk

2024-11-20T11:48:34+00:00

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I didn’t expect to write this post for our New York community when I moved here from California, where wildfires are common and worsening. Yet wildfires are burning across New York, New Jersey, and Connecticut, making it important to understand their impact on our health and how to stay safe.

Over the past couple of weeks, multiple fires have ignited across New York, New Jersey, and Connecticut.

The Jennings Creek fire along the New York-New Jersey border has burned more than 5,000 acres, making it the largest wildfire in New York since 2008. (Healthbeat reported on this recently.)
Over the weekend, strong winds led to the voluntary evacuation of 165 houses in Warwick, New York.
Last week, an 18-year-old New York State Parks employee died while responding.
Between Oct. 29 and Nov. 12, the Fire Department of New York City responded to 229 brush fires — the most in a two-week period in city history.
- Brush fires have occurred in Brooklyn’s Prospect Park, Manhattan’s Inwood Park, and Queen’s Alley Pond Park.

With dry and windy conditions expected to continue for the next few weeks, fires may take longer to put out, and additional fires may start.

Tips to prevent wildfires

This fall has been abnormally dry in New York state, making it easier for wildfires to ignite and spread quickly. Because it has been so dry, much of New York state is under a drought warning.

To reduce the risk of new wildfires, Gov. Kathy Hochul recently issued a statewide fire ban until Nov. 30. The FDNY also issued a public service announcement sharing these tips for how to reduce brush fires:

Do not use fire pits, bonfires, campfires, or open cooking fires at least until Nov. 30.
Do not grill outside in New York City. Outdoor grilling is banned in city parks until the end of the drought watch.
- If you are elsewhere in the state and you must grill, be very careful and stay away from dry grassy areas. Keep a bucket of water and fire extinguisher within easy reach.
Dispose of cigarette butts and ashes properly.
If you see a fire, call 911.

Breathing in any kind of smoke isn’t healthy

Poor air quality from wildfire smoke poses health risks to everyone, but some groups are especially sensitive:

Older adults
Pregnant people
Children
People with pre-existing respiratory and heart conditions

Why? Wildfire smoke contains various gasses and particles, but the most concerning are fine particles known as PM2.5. These particles measure less than 2.5 micrometers in diameter (smaller than a human hair), and can penetrate deep into the lungs and enter the bloodstream, causing both immediate and long-term health effects.

Symptoms can range from mild (e.g., eye irritation) to serious health impacts (e.g., asthma exacerbation or heart issues). Recent studies have shown increases in hospitalizations, heart attacks, and strokes during periods of elevated PM2.5 exposure from wildfire smoke. Health risks increase the longer you’re exposed to smoke and the more dense the smoke is.

Monitor the air quality in your neighborhood

Air quality is measured by sensors that detect the concentration of pollutants in the air. Results are reported as the Air Quality Index, which is a number between 0 and 500. The higher the AQI, the more polluted the air is, and the higher the health risk. There are six AQI levels to describe levels of health concern, and what activities should be avoided at each level. When the AQI reaches 50 (the yellow category), people who are more sensitive to poor air quality should reduce strenuous activity outdoors (like working out). Once the AQI hits 100 (the orange category), everyone should reduce strenuous activity outdoors.

Air Quality Index levels of health concern.

The New York Department of Health issued a health advisory last week when the AQI reached over 100. You can easily check the air quality of your local area on some weather apps, AirNow, or download the EPA’s AirNow mobile app.

At a recent glance, air quality is good or moderate in most of New York, but it’s good to check this frequently if there are wildfires around — air quality can change rapidly over the course of a day.

New York Air Quality Index data from Monday.

What can I do to avoid health effects of smoke?

The Centers for Disease Control and Prevention suggests multiple ways to reduce your risk. These include:

Stay indoors, if possible.
Keep your indoor air as clean as possible. Run an air conditioner if you have one, but keep the fresh-air intake closed.
Use an air filter/purifier. Use a freestanding indoor air filter with particle removal.
Do not add to indoor pollution. Do not use candles, fireplaces, or smoke tobacco. Do not vacuum because it stirs up particles inside your home.
Wear an N95 mask outside. Recent research found that N95s reduced hospitalizations from wildfire smoke by 30%. In other words, it offers some protection, at least in the short term, for example while running to the grocery store. Cloth or paper masks and tissues will not filter out the smoke.

It seems like we are getting more wildfires. Why?

We know that changing climate trends, like warmer temperatures and less rain, are associated with a longer fire season, more frequent fires, and more intense fires that spread farther. The New York City Department of Environmental Protection commissioner reported that this October was the driest in New York City in over 150 years. Higher temperatures and drought conditions have made our region more fire-prone, even into the fall.

Bottom line

With drought conditions and dry winds in New York, wildfire risk is very high. Report any fires and avoid wildfire smoke as much as possible. Stay safe!

Love,

Your Local Epidemiologist

Respiratory weather report for New York: Covid levels low as flu and RSV rise

2024-11-14T12:00:00+00:00

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I want to start this week’s YLE New York by acknowledging the uncertainties and anxieties around what the election results mean for public health in the United States, and by recommitting to our YLE mission. Regardless of politics, we will continue sharing accurate, honest, and reliable public health information. We are still here to empower you all to make evidence-based decisions to keep yourselves and your loved ones healthy. That won’t change.

Now, let’s get back to this week’s public health updates.

New Yorkers voted to protect abortion rights

In last week’s election, New Yorkers passed Proposition 1, a ballot measure that makes abortion rights part of the New York state constitution.

Proposition 1 was also known as the Equal Rights Act because it prevents discrimination based on pregnancy, pregnancy outcomes, and reproductive health care, as well as age, gender identity, and sexual orientation. New York joined six other states that voted to protect abortion rights last week.

In New York, abortion has been legal since 1970 (three years before Roe vs. Wade). People of all ages have the right to abortions in New York:

Through the 24th week of pregnancy, or
After that, if a medical provider decides the fetus is not viable, or if the mother’s life or health are at risk.

Minors do not need parental permission to receive an abortion or birth control in New York.

In 2021, there were 59,616 abortions in New York state, including 37,813 in New York City. While the data are not finalized, we have more recent estimates of between 9,000 and 11,000 abortions per month in the state.

Estimated monthly abortions in New York state.

Covid-19 remains minimal across New York

Covid-19 is minimal and continues to decline in New York. SARS-CoV-2 wastewater concentrations (a good proxy for Covid-19 infections) continue to be minimal. The hospitalization rate in New York state is only 0.47 per 100,000 persons, which is down from the summer peak of 1.12 in August.

New York state Covid-19 wastewater activity levels from CDC NWSS. There are now 105 New York sites reporting data to CDC NWSS.

Influenza and RSV increasing in New York

The respiratory season has “officially” begun in New York. The state and city health departments are sharing weekly updates on influenza and RSV transmission for the respiratory season.

The number of flu cases in New York state is still low but starting to increase quickly. It’s increased by 12% since last week. These increases are happening in all New York regions except the West. It’s not clear why, but I expect increases there soon, too.

Influenza regional incidence from the New York State Influenza Surveillance Report.

RSV is also starting to increase. Testing data for New York City show that positive RSV tests increased by 34% last week.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

Severe influenza and RSV remain low in New York state: influenza has 0.1 hospitalizations per 100,000 people, and RSV has 0.6.

Now is a great time to get vaccinated before the respiratory season

Influenza and updated Covid-19 vaccines are available throughout New York City; find locations using the NYC Vaccine Finder, including sites offering free vaccines for people without insurance.
Vaccination locations throughout the rest of New York state can be found at Vaccines.gov.
- The New York State Vaccines for Adults Program provides vaccines at no cost to underinsured, eligible adults throughout the state. More info here.
RSV vaccines and monoclonal antibodies are available for a subset of people (pregnant people, older adults, and babies). YLE National had a great post on how effective these treatments were in preventing severe disease last year.

Adults aged 65+ or immunocompromised: Expect a Covid-19 shot this spring

The Centers for Disease Control and Prevention and the New York State Department of Health recommend that those aged 65 and over or who are immunocompromised get two doses per year, six months apart. This is because protection wanes. Last fall, there was zero additional protection against hospitalization six months after vaccination. (Note: This is additional protection compared to all the immunity already out there.)

Vaccine effectiveness against Covid-19 hospitalization.

Bottom line

You’re all caught up on this week’s New York public health news. See you next week with more!

Love,

Your Local Epidemiologist

Respiratory season begins in New York: Flu and RSV levels low but rising

2024-11-06T12:12:26+00:00

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It’s officially the respiratory season. The New York state and New York City health departments have begun releasing data. Time for a State of Affairs to kick us off.

Covid-19: minimal

Covid-19 transmission has continued to decrease in New York. Levels are considered “minimal.”

SARS-CoV-2 concentrations in New York (yellow line) are minimal and declining.

It’s the same story in the city — transmission of Covid-19 is low.

New York City average SARS-CoV-2 wastewater concentrations.

To continue the good news (there is a lot of it this week!), hospitalizations for Covid-19 have gone down among New Yorkers, especially those over 65 years old, who have the highest risk.

New York City daily hospitalizations by age.

Influenza and RSV: low but increasing

Influenza is increasing in New York — the number of cases in the state increased by 42% last week. These increases are widespread across the state; influenza cases and hospitalizations are going up in all regions except for the Western region (but I expect things will begin picking up there soon).

Influenza regional incidence from the New York State Influenza Surveillance Report. Annotations by YLE.

RSV data are harder to analyze because cases are not required to be reported to public health departments in New York. However, six New York labs (Liverpool, Albany, Syracuse, and three from New York City) participate in an optional Centers for Disease Control and Prevention surveillance program. Data for the most recent week show that positive tests for RSV remain low.

Testing data for RSV, influenza, and Covid-19 for New York state labs participating in the Centers for Disease Control and Prevention National Respiratory and Enteric Virus Surveillance System NREVSS.

Data for the city show that positive RSV tests increased by 12% last week, but we’re still at very low levels.

New York City RSV testing data from the Influenza and RSV Surveillance Report.

Severe influenza and RSV remain very low in New York state: Both are less than 0.1 hospitalizations per 100,000 people.

Other viruses: circulating

If you’re feeling sick, it’s most likely due to enteroviruses or rhinoviruses, which cause the common cold, or parainfluenza viruses, which also cause cold or flu-like illness. Those are testing very high, which is normal once kids go back to school.

New York City respiratory virus testing data from the Influenza and RSV Surveillance Report.

Typically, these infections are milder, but they can still be annoying. If you are feeling ill, wearing a mask and limiting social gatherings are ways to slow down disease transmission.

It’s still a great time to get your vaccines

Ideally, we want to get these before respiratory waves start, as they are a prevention tool. The time is now!

Influenza and updated Covid-19 vaccines are available throughout New York City; find locations using the NYC Vaccine Finder, including sites offering free vaccines for people without insurance.
Vaccination locations throughout the rest of New York state can be found at Vaccines.gov.
- The New York State Vaccines for Adults Program provides vaccines at no cost to underinsured, eligible adults throughout the state; find more info here.
RSV vaccines and monoclonal antibodies are available for a subset of people (pregnant people, older adults, and babies). YLE National has a great post on how effective these treatments were in preventing severe disease last year.

Bottom line

Respiratory diseases are still low, but influenza and RSV are starting to heat up, marking the start of the respiratory season. Now is a great time to consider getting your fall vaccines!

Love,

Your Local Epidemiologist

The Dose: Respiratory viruses, listeria recall, and more public health news

2024-10-30T11:00:00+00:00

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Have questions, comments, or ideas for future topics? Email me at mdonnelly@healthbeat.org. I would love to hear from you.

Time for something a little different. This week’s top 4 public health nuggets in New York — whether or not they made headlines — explained.

Respiratory viruses are low: Enjoy the lull

Covid-19 is minimal and continues to decline in New York. SARS-CoV-2 wastewater concentrations (a good proxy for Covid-19 infections) in New York are minimal, and most individual sites show some of the lowest wastewater levels they’ve experienced all year. Severe Covid-19 disease continues to decline in New York state — 2.92 hospitalizations per 100,000 persons. This is down from the summer peak of 6.5 in August.

New York state Covid-19 wastewater activity levels from Centers for Disease Control and Prevention National Wastewater Surveillance System. There are now 107 New York sites reporting data to CDC NWSS.

While the state has not yet started its weekly flu and RSV reports for this respiratory season (we expect that to happen in the next week or two), the available data, like wastewater, indicate that influenza and RSV are low in New York.

Flu and RSV hospitalizations reported to the Centers for Disease Control and Prevention are also very low for New York state (0.1 hospitalizations per 100,000 persons). Your Local Epidemiologist National had a great explanation of why RSV is so low right now; head on over there for more info (spoiler: It’s returning to pre-pandemic patterns).

New York Covid-19, influenza, and RSV hospitalizations reported as part of the CDC Resp-NET system.

Now is a great time to get your fall vaccines. Updated Covid-19 vaccines are free throughout New York City; find locations here. Vaccination locations throughout the rest of New York state can be found here.

Rapid tests for multiple respiratory illnesses studied

Once the respiratory season starts heating up, you may be interested in knowing what virus you have if you get sick. Some brilliant City University of New York scientists are working on cutting-edge, multi-pathogen rapid tests for Covid-19, RSV, and influenza (with flu a and b subtyping). They are recruiting study participants:

Participation in the study involves completing surveys about your health. You will also have access to free at-home testing for Covid-19, RSV, and flu.
Here is a video about what you can expect from the study. If you would like to participate, send an email to recruitprotects@sph.cuny.edu with “Interested in CUNY Project PROTECTS - YLE” in the subject line for more info.
They are particularly looking for people ages 50 and older or those living with chronic health conditions, but anyone over 18 in the United States is eligible to join.

Overdose deaths decline in New York City

After four consecutive years of increases, overdose deaths in New York City decreased slightly in 2023. The latest report, explained by Healthbeat, found 3,046 deaths in 2023 compared to 3,070 deaths in 2022, representing a 1% decrease.

Number of annual New York City overdose deaths from 2000 to 2023.

Fentanyl remains a leading cause (80%) of overdose deaths in New York City. Xylazine, a non-opioid sedative often used in veterinary medicine, is also very common (31%).

What is driving this decrease? We don’t really know, but have a hunch it’s harm reduction. In nearly two years, New York City has distributed 440,000 naloxone kits and 63,000 fentanyl test kits. The city has also launched four public health vending machines to dispense free naloxone and fentanyl test strips.

Locations for those vending machines are found on this page.
There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit nyc.gov/988 for 24/7, confidential support.

Listeria food recall: for your radar

Several schools in New York and New Jersey are among the sites that received ready-to-eat meat products that have since been recalled after listeria was detected at a processing plant in Oklahoma. The complete list of schools impacted is available here from USDA.

If your school is on here, don’t panic – USDA is in contact with them to pull the ready-to-eat meat. And, thus far, there have been no human cases of illness. This recall was done out of precaution in response to routine testing that detected listeria.

Listeria is a potentially dangerous bacteria known to cause food-borne outbreaks. This detection prompted the USDA to recall more than 11.7 million pounds of products. Currently, the recommendation is for commerce and businesses to remove the products from circulation.

Bottom line

You’re now caught up with public health in our state. See you next week.

Love,

Your Local Epidemiologist

Your waste isn’t wasted: How New York’s wastewater network keeps you healthy

2024-10-23T11:00:00+00:00

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Disclosure: At my day job, I am an epidemiologist at Biobot Analytics, a wastewater company. While we don’t have wastewater sites in New York City, we work with several New York counties.

Ever wonder what is streaming in the sewers below the New York streets? Our wastewater system provides more than just sanitation. It can also act as an unbiased surveillance system (an epidemiologist’s dream).

This approach grew in popularity during the COVID-19 emergency and delivers an insightful, near-real-time view of our community’s health. Turns out, the best way to understand what’s going around — and what we can do to keep healthy — is by watching what’s going down — literally.

We New Yorkers don’t just have any old system, though. We have one of the strongest state-level systems in the United States. In August, the New York State Wastewater Surveillance Network was named a CDC Center of Excellence.

What is the NY state wastewater system?

Wastewater surveillance began only three years ago in New York during the Covid-19 emergency. Wastewater detected increases in virus activity before other data sources, like hospitalization records, making it an incredibly useful tool for early warning. Everyone uses the toilet, so wastewater can give a picture of the entire community (when connected to sewers) instead of relying on individuals getting swabbed and tested.

How it works: Sewage samples are collected from multiple sites and sent to labs for testing. The data is then analyzed to detect the spread of pathogens within communities. This process is the same across the United States.

One big difference between states, though, is coverage. Our state has over 200 wastewater surveillance sites, covering more than 75% of the New York population — one of the highest coverages in the United States.

For Covid-19 alone, New York can track levels across 60 counties, including all five counties in New York City.

One big reason the New York wastewater network is so strong is funding from the state and Centers for Disease Control and Prevention. Last year, Gov. Kathy Hochul added it to the fiscal budget: $5 million per year for three years (starting in 2023), totaling $15 million. New York is one of the only states with a state-line budget item for wastewater surveillance.

You have two places to see data (and thus take action)

Checking wastewater trends can help with personal decision-making, like wearing a mask when Covid-19 levels are high.

First, you can go to the state website. Covid-19 data, for example, is available on this public dashboard. I’ll also keep you updated once fall respiratory season kicks off.

Wastewater monitoring sites in the New York State Wastewater Surveillance Network

There is also the CDC National Wastewater Surveillance System dashboard, where average wastewater activity levels for New York state and individual sites are available.

There may be differences between the two dashboards, though. This can happen for three main reasons:

Local differences. Some communities have more or less Covid-19 activity than the statewide average, leading to differences between local levels and state averages.
Levels are defined differently. New York’s wastewater levels are based on early pandemic data (2020-21), while the CDC recalibrates its levels every six months, making them more adaptive to current trends, such as increased viral shedding from new variants.
Delays in reporting. Averages will fluctuate depending on how many sites are contributing data and if there are delays in reporting.

For example, the most recent New York data on CDC NWSS shows an apparent increase from recent minimal levels to moderate this week. However, the New York data sent to NWSS is delayed this week, with only two sites reporting. In other words, the most recent data displayed is not representative of the entire state. I expect the New York wastewater level on NWSS to go back down once the data is updated.

New York state Covid-19 wastewater activity levels from Centers for Disease Control and Prevention National Wastewater Surveillance System. Note, the New York data on CDC NWSS is delayed this week and the most recent uptick on this figure represents only two New York sites.

I like to use the New York dashboard for site-specific trends and the CDC NWSS dashboard for state-level averages and activity. Not every community in New York state has wastewater monitoring, but following the average state levels can often be good enough.

Wastewater system is also useful for polio

In July 2022, after 25 years, the first case of paralytic poliovirus in the state was confirmed in Rockland County, New York. The state public health system quickly adapted its Covid-19 wastewater program to begin tracking polio — after all, the process is the same; the test in the lab is just different.

After taking many samples across the state, wastewater showed that polio was present elsewhere: Sullivan, Orange, and Nassau counties, and New York City. When they tested historical wastewater samples, polio was present in wastewater as early as April 2022, three months before the case was identified. Public health departments prioritized resources — like education and vaccine campaigns — to communities where wastewater showed that polio was circulating.

Center of Excellence Award will allow even more

The quick move to scale the program to track polio likely played a significant role in the program being recognized as a CDC Center of Excellence. This places the New York wastewater system alongside five other CDC Centers of Excellence to continue expanding wastewater monitoring for public health.

This award:

Recognizes the excellent work thus far, and
Provides an additional $1 million in funding to support program expansion. New York plans to expand to test for more diseases, including influenza, RSV, hepatitis A, and norovirus, as well as the presence of antimicrobial-resistance genes.

Wastewater must have limitations, right?

Yes, like anything in this world, it’s not perfect:

It doesn’t cover everyone. Sampling is very difficult in communities that rely on septic systems. The >200 sites in the New York wastewater monitoring program cover about 75% of the state’s population (representing 95% of those connected to sewer systems.) However, the remaining 25% — not currently monitored — are in non-sewered areas, making it difficult to get a hyperlocal perspective on diseases in these areas. (If you’re in these areas, follow the wastewater site closest to you for rough estimates of disease activity.)
Ethical and privacy concerns. Although wastewater data is anonymized (sampled at pipes that several houses/blocks feed into), concerns could still arise about monitoring. Acknowledging these concerns is important, but a recent national survey found that nearly 75% of adults support wastewater monitoring for infectious diseases.
Interpretation for epidemiologists is … tough. Wastewater data is great for showing increases or decreases in disease levels. However, it can’t provide the number of people who are sick. When people get sick, the amount of virus they shed is quite variable.
Non-standardized methods. In New York state (and across the United States), different lab methods are used across counties, making comparisons difficult. In other words, we don’t know if “high” Covid-19 levels in one county are the same as “high” levels in another. New York City uses consistent methods across all sites, allowing for easier comparison within the city.

Bottom line

The wastewater pipelines below our streets provide pivotal information about diseases in New York and how (and when) to protect ourselves. However, this information is not a standalone solution and should be combined with other data sources to provide a holistic view of public health trends.

Love,

Your Local Epidemiologist

P.S. Ever wonder how much waste actually goes into the sewer? On average, individuals will flush the toilet five to seven times daily. With about 8.4 million people, that’s an average of 42 million to 58.8 million toilet flushes daily in New York City. 💩

Childhood vaccine coverage remains high, but we can't let our guard down

2024-10-16T11:00:00+00:00

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New data on childhood vaccinations shows many states are sweating because coverage continues to decline after taking a big hit during the pandemic.

However, New Yorkers have a different story: We continue to be one of the state leaders in vaccine coverage. It’s something to celebrate, but importantly, we can’t let our guard down.

New York has very high vaccination rates.

Recent data on kindergartners during the 2023-24 school year show that New York’s MMR (Measles, Mumps, and Rubella) vaccine coverage is 97.7%, making it the third-highest state in vaccine coverage.

Importantly, 97% is above the threshold needed to reach herd immunity for measles (95% must be vaccinated to prevent outbreaks). Measles is one of the most contagious viruses, so we need a very high vaccination rate to prevent outbreaks.

Measles, mumps, and rubella (MMR) vaccination rates among kindergarteners for the 2023-24 school year.

Why does New York have high rates?

One big reason is the elimination of non-medical vaccine exemptions. There was a major measles outbreak in New York City in 2019: 605 cases in a community with low vaccination coverage (79.5%), leading to 20 kiddos going to the intensive-care unit. Outbreaks like these not only harm the health of individuals and communities but are very expensive — it’s estimated that the 2019 outbreak cost the city $8.4 million.

Shortly after, New York passed a law that made us the fifth U.S. state to address increasing pediatric undervaccination by eliminating non-medical exemptions (like for religious reasons). This directly increased vaccination coverage in public and private schools.

Vaccination coverage increased at public and private schools after New York eliminated non-medical exemptions.

All states, including New York, still allow medical exemptions, such as when someone is allergic to a vaccine component.

Does this mean we are in the clear?

Not really. While the state average is high, there are still counties with very low rates. These unvaccinated pockets — like Rockland, Yates, and Orange — have vaccination rates between 54% and 58%. All these counties need is a spark — an infected person traveling — to spread measles like wildfire.

Receipt of 1 MMR dose by 2 years of age. Rates shown here are lower than the New York state average because they are for individuals up to 2 years of age, while the state average MMR coverage rate is for kindergarteners. Vaccination is required to start kindergarten which explains the higher rate.

And there are sparks out there. This year there have been 13 measles cases in New York City and at least one in New York outside the city.

Polio and whooping cough are out there, too.

In 2022, a young, unvaccinated man was paralyzed by polio in Rockland County, an area with historically low vaccination rates. Wastewater monitoring showed polio was circulating in other New York counties as well. (This isn’t a surprise because, for every one case of paralysis from polio, about 100 people are infected.) Any detection of polio in the United States is considered a public health emergency.

We are also seeing an exponential rise in whooping cough — called pertussis — that can be prevented with a Tdap or DTaP vaccine.

New York City: Cases in 2024 are up 169% compared to 2023, with 427 cases reported so far.
New York state: Cases are up over 300% in 2024.

Ensure your kids, grandkids, neighbors, and friends are vaccinated.

Childhood vaccinations are safer than getting the disease itself. Over the past 30 years, childhood vaccinations prevented 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths.

In New York, children must have the following vaccinations to enroll in New York schools:

All students (child care and prekindergarten through 12th grade):

Diphtheria and tetanus toxoid-containing vaccine and pertussis vaccine (DTaP or Tdap)
Hepatitis B vaccine
Measles, Mumps and Rubella vaccine (MMR)
Polio vaccine
Varicella (chickenpox) vaccine

Children under 5 in child care or pre-K:

Haemophilus influenzae Type B conjugate vaccine (HiB)
Pneumococcal Conjugate Vaccine (PCV)

Middle school and high school:

Tdap vaccine for Grades 6-12
Meningococcal conjugate vaccine (MenACWY) for Grades 7-12
- Students in Grade 12 need an additional booster dose of MenACWY on or after their 16th birthday.

How can I persuade hesitant people?

It takes listening, time, and hearing the right things from a trusted source. Research shows health care providers are among the most influential factors in whether parents vaccinate their children.

Local health departments in New York state provide annual training to clinicians about evidence-based strategies to increase vaccination among populations with low or lagging rates, considering vaccine hesitancy.
Training can also be targeted to areas of the state identified as hotspots for vaccine hesitancy.

Talk to your local health department for their next training date.

Bottom line

New York has some of the highest vaccination rates in the country. And we should be proud of that. But we can’t let our guard down, as pockets of under-vaccination still pose a serious risk for outbreaks.

Love,

Your Local Epidemiologist

Mosquitoes linger as fall arrives

2024-10-09T11:00:00+00:00

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As the leaves change, we say goodbye to summer, but at least one thing remains for a couple more weeks — mosquitoes.

Yes, mosquitoes are annoying, but they can also pose serious health risks for New Yorkers. It’s worth grabbing mosquito spray for a couple more weeks.

Here’s what’s going on with mosquitoes in New York (state and city) and especially the two diseases making the news.

New York state reports human case of EEE

This is the first case in the state since 2015. The case was identified in Ulster County and the patient died.

Eastern Equine Encephalitis is a virus transmitted by the bite of a certain species of mosquito. Thankfully, most people infected with EEE won’t have any symptoms. But for those who develop symptoms, the illness can be severe and involve inflammation of the brain (encephalitis) and spinal cord (meningitis).

About one-third of people who develop severe illness die.
There is no specific treatment available.
People over the age 50 or younger than 15 are at greatest risk.

EEE rare in New York, but may be more active this year

Since 1971, only 12 human cases have been identified in the state, including the most recent one. Of these patients, seven died. A human case of EEE is a significant event.

There are some signs that this year might be worse than recent years. Typically, two or three New York counties detect EEE annually by testing mosquitoes, horses, and birds. This year, though, 14 counties have detected it all across the state. And this isn’t because there is more testing this year; the level of testing is similar to last year.

Counties in solid blue have detected EEE mosquitoes, with Ulster County detecting positive mosquitoes and a human case. Striped blue counties are testing mosquitoes for EEE but have not detected it. Data from the New York state mosquito activity report

West Nile virus is circulating in New York City and state

West Nile virus is also a disease spread by some mosquitoes and is more common than EEE.

So far, 42 human cases have been detected in New York state (excluding New York City) and 35 cases in New York City. Compared to the past few years, this has been a normal year.

West Nile virus cases in New York state, excluding New York City.

WNV has been detected in most of the New York counties that are testing for it. On the map below, solid light or dark orange and brown counties have had WNV detections in humans, mosquitoes, horses, or birds.

Counties where humans, mosquitoes, horses, or birds have tested positive for West Nile virus (solid light or dark orange and brown).

If we zoom in on New York City, we are also in the average range of WNV human cases. Over the past 10 years, the total number of annual cases has ranged from 6 to 46.

West Nile virus cases in New York City.

WNV-positive mosquitoes are almost everywhere in the city. Below, regions in blue are where West Nile virus has been detected in the past two weeks (light blue) and earlier this season (dark blue).

The number of WNV cases in the city is similar to the rest of the state (35 vs. 42) for two reasons:

The high population density in the city — more people are there to get bitten.
There is a lot of WNV activity. When adjusting for population size, Richmond (Staten Island) and Queens counties have some of the highest WNV case rates in the state.

Most people infected with WNV will not have symptoms or will have very mild illness. However, those over 60 years old or with immunocompromising conditions are at higher risk for severe illness, which can include inflammation of the brain (encephalitis) and spinal cord (meningitis), or muscle weakness or paralysis (acute flaccid paralysis).

What is being done to prevent more human cases?

A lot!

First, public health departments randomly test mosquitoes. Mosquitoes are collected in traps, identified in the lab, and tested in groups (for efficiency). We’ve been doing this for decades, and although imperfect, it gives us a good view of risk.

With consistent positives (in mosquitoes or humans), vector control units will then go to these areas and spray mosquito repellent in mass. Several factors go into the decision to spray:

Mosquito density and species
Persistence of the virus
Time of year
Proximity to human populations

While mosquito spraying is safe for humans and pets, if spraying is happening in your neighborhood and you have asthma or other respiratory conditions, it’s a good idea to try and stay inside during the spraying time.

There are no mosquito spraying events scheduled for New York City in the near future. You can check for schedule updates here. For spraying events in other areas of New York state, check with your local public health or mosquito control departments.

On top of ongoing mosquito control, New York state health commissioners issued a Declaration of Imminent Threat to Public Health in response to the Ulster County EEE case. This move:

Frees up additional state resources to go toward reducing mosquito-borne diseases, including more public outreach and strengthening public health surveillance to detect human cases and positive mosquitoes
Increases mosquito spraying throughout the state to reduce the adult mosquito population
Provides free insect repellent to visitors at New York state parks and campgrounds

When will the mosquitoes leave?

Mosquitoes can only transmit these diseases when it’s warm. Once average temperatures drop to around 60°F, mosquito biology makes transmission much more difficult. It likely won’t be that cool consistently in New York until late October or early November, so until that happens, we should all be diligent about protecting ourselves from mosquitoes.

To avoid contracting WNV or EEE, the best thing you can do is avoid mosquito bites:

Wear EPA approved mosquito repellent when outside and especially during peak-mosquito activity time: dawn and dusk.
Avoid being outside when mosquitoes are most active (the morning and evening) — but this can be really hard.
Dump standing water (think flower/plant saucers, buckets, fountains, toys that have been sitting outside, etc.) to eliminate mosquito habitats.

Bottom line

We are still in mosquito season. Because mosquitoes can carry some nasty diseases, keep that mosquito spray close for a few more weeks!.

Love,

Your Local Epidemiologist

Covid-19 declines in NYC, and other diseases stay at bay

2024-10-02T11:00:00+00:00

Sign up for Your Local Epidemiologist New York and get Dr. Marisa Donnelly’s community public health forecast in your inbox a day early.

Welcome to the first edition of Your Local Epidemiologist New York.

These reports will provide essential information about public health issues in New York every week and tips on keeping yourself and your loved ones healthy — directly from me, an epidemiologist.

I’m Dr. Marisa Donnelly, Your Local Epidemiologist in New York. I have a PhD in epidemiology and have spent the past 10 years as a disease detective on the front lines — doing everything from investigating Covid-19 and mpox, to searching for the source of food poisoning (i.e., E. coli) outbreaks and researching mosquitoes that transmit viruses. When I’m not writing these reports or analyzing wastewater data (my day job), you can find me jogging or doting on my two cats 🐈🐈‍⬛.

Let’s kick things off with the State of Affairs — an infectious disease “weather report” for New Yorkers.

Covid-19: minimal

SARS-CoV-2 levels in wastewater, one of our best proxies for Covid-19 infections and spread throughout New York state, are “minimal.”

SARS-CoV-2 concentrations in New York (yellow line) are minimal and declining.

In more good news, severe Covid-19 disease remains low in New York City (2.0 per 100,000 people) and continues to decline. Hospitalizations in New York City are lower than the national average (2.3 per 100,000). These rates are so low because most New Yorkers have some sort of immunity, either through vaccination or prior infections.

New York City daily hospitalization counts continue to decline.

Most New Yorkers getting hospitalized for Covid-19 are those over 65 years old.

New York City daily hospitalizations by age.

Influenza and RSV: minimal (we assume), but increasing

New York typically begins releasing influenza and RSV data in October, marking the “official” start of the respiratory season. Although they haven’t posted any updates for this season yet, I expect the data to be available later this month.

Right now, we assume levels are low for three reasons:

Wastewater data can also detect flu and RSV, and activity for New York is low.
Testing data for New York shows that the percent of tests positive for influenza, RSV, rhinovirus, or enteroviruses are low, but starting to show some increases.
Influenza-like illness (ILI) — a physician tally of coughs, sore throats, and fevers — is minimal. (You’ll notice that New York and other states in the east and south are starting to change colors other than dark green. This indicates that seasonal flu activity is just beginning.)

This may be a great time to get your fall vaccines. Ideally, we want to get these before respiratory waves start, as they are a prevention tool.

Updated Covid-19 vaccines are now available for free throughout New York City; find locations here. Vaccination locations throughout the rest of New York state can be found here.
For those without insurance or whose insurance does not cover the Covid-19 vaccine, the New York State Vaccines for Adults Program provides vaccines at no cost to eligible adults throughout the state; find more info here.

Mpox (monkeypox): Clade II present in NYC

Mpox — formally known as monkeypox—is an infectious disease spread through very close contact, like sex. New York City has one of the highest case counts this year, with more than 350 cases. In the past month, 38 cases have been detected in the city. As shown in the graph below, this year has been worse than last.

Daily mpox cases diagnosed in New York City.

You may also be hearing about mpox in Africa in the news. But, keep in mind there are two types of mpox:

Clade I is causing an emergency in Central Africa and seems to be causing more severe disease. However, it has yet to be detected in the United States (or New York).
Clade II caused a massive outbreak in 2022 and has stuck around at endemic levels since. Severe disease is rare, but regardless, infection can be painful. In New York, we only have Clade II cases at this time.

Fortunately, the JYNNEOS vaccine provides protection, but be sure to get both doses. Who is eligible?

Men who have sex with men
People who identify as trans, nonbinary, genderqueer, or gender non-conforming.

Find mpox vaccination locations here.

Bottom line

Respiratory diseases are low, giving us a bit of a break before picking up again due to social networks changing (students going to school, holiday gatherings) and the weather cooling.

Mpox is still lingering around New York. There’s a lot we can do to stay healthy though: Stay up to date on your vaccines!

Love,

Your Local Epidemiologist

Dr. Marisa Donnelly, a senior epidemiologist with wastewater surveillance firm Biobot Analytics, has worked in applied public health for over a decade, specializing in infectious diseases and emerging public health threats. She holds a PhD in epidemiology, and has led multiple outbreak investigations, including at the California Department of Public Health and as an epidemic intelligence service officer at the Centers for Disease Control and Prevention. Marisa has conducted research in Peru, focusing on dengue and Zika viruses, as well as the mosquitoes that spread them. She is Healthbeat’s contributing epidemiologist for New York in partnership with Your Local Epidemiologist, a Healthbeat supporter.

New Yorkers, meet Your Local Epidemiologist

2024-09-30T10:00:00+00:00

We have some exciting news for Healthbeat’s New York readers.

This week, we are welcoming a new contributor and the formal launch of our partnership with Your Local Epidemiologist.

Meet Dr. Marisa Donnelly, a research epidemiologist with a decade of experience in public health. She’ll be providing New Yorkers with reports every week on what’s happening, from infectious disease threats to the latest intelligence on vaccines and other important information. Think of her reporting as a community health forecast.

Marisa, who holds a PhD in epidemiology and works at wastewater monitoring firm Biobot Analytics, has more than 10 years experience in public health. She has specialized in infectious diseases and emerging threats, serving at the California Department of Public Health and the Centers for Disease Control and Prevention.

She joins the Healthbeat team to translate public health science so people have the information they need to make evidence-based decisions about their health — and the well-being of the people around them.

We’re excited to add Marisa’s reports to Healthbeat as we bring the story of public health to our communities, grounded in data and science.

Your Local Epidemiologist was founded by Dr. Katelyn Jetelina, a Healthbeat supporter who has grown her popular national newsletter into a must-read for 268,000 subscribers. Marisa will use her expertise to localize the YLE approach for New York readers.

You can find Marisa’s reports on Healthbeat New York starting Wednesday. Sign up here to get them direct to your inbox a day early. You can sign up here for YLE’s national newsletter.

We’d also love to hear from you about what public health topics Marisa and our New York public health reporter Eliza Fawcett should be pursuing. Fill out this form to send us your thoughts.

We’re listening.

Charlene Pacenti, Editor in Chief