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How to win the war of narratives in global public health

2026-03-19T11:00:00+00:00

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Hello from Nairobi.

This week we start with an incisive essay on how global public health might win back the narrative war around vaccines, trust, and misinformation. After that, well… let me just say that I really do try to take the “global” in global health seriously. I know that the United States is not the center of the world.

But several of the most important stories I’m tracking follow the health consequences of Trump administration policies playing out across Africa, the Caribbean, and Iran. So, buckle up for a red, white, and blue edition.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Global public health can win the narrative war

Measles is having a comeback. Vaccine skepticism is rising. And during the global pandemic, millions quickly turned against even basic public health protections. It’s pretty clear that somewhere along the way, public health started losing the narrative war.

The question is, how does the field fight back?

That’s the focus of a fascinating essay by Steve Hamill in Health Policy Watch, one which I haven’t been able to stop thinking about since I read it. Hamill is a senior marketing and comms executive at Vital Strategies, which is a nonprofit focused on global disease prevention.

Part of the problem, Hamill argues, is that for decades public health officials worldwide assumed that rational arguments, data, and scientific evidence would be enough to persuade the public. (And hey, for a time, it was!) But the era of institutional trust “dominated by elite opinion makers driving consensus” is over, he writes. And now, as we face a media landscape “driven by algorithms, influencers, and coordinated narrative warfare,” public health must take a new approach. And that includes borrowing several, highly effective tactics from public health’s worst detractors.

I reached out to Hamill about his essay, and we discussed what the field needs to do differently to win back trust and attention.

In our conversation, Hamill pointed to two realities about the modern media environment that ring especially true to me. One is that “we’re in an era of AI slop, where authenticity and trust in who the messenger is now matters even more than the message.” The other is that many persuadable people increasingly form their views about public health by “following culture, not evidence.”

Accepting those realities means recognizing that the battleground for public health is much less likely to be found in press conferences or government PSAs … and more likely to be found on TikTok, YouTube, or the broader “content creator sector.” And that, Hamill argues, is exactly where public health agencies need to start showing up.

Thankfully, Hamill says that engaging in this ecosystem is actually easier than ever. As advertisers have poured money into influencer marketing this decade, “the content creator sector has become much more formalized,” he says. Today, there are several platforms (like CreatorIQ, for example) that can connect public health agencies directly with a stable of appropriate influencers, at scale.

Now, you might ask: Will YouTubers deliver perfectly calibrated public health messages, the way officials might hope? Of course not. But Hamill argues that perfection isn’t the point. More important is that “we have to trust imperfect messengers who have social capital in the communities that we’re seeking to reach,” he says.

That gets to another of Hamill’s points: Public health organizations worldwide must begin staffing the experts and allocating the budgets needed to compete in this new media environment.

Specifically, that means staffing public health institutions worldwide with staff excelling in “public relations, community engagement, advertising and paid media, digital media production,” among other technical expertise, he says. For a field where “communications is rarely seen as a strategic competency,” that would be an enormous shift.

Hamill’s last point is that, offline, public health must stop broadcasting messages from the top down and start working through trusted voices inside communities. A major effort should be focused on “finding people in the communities that believe in the information that we are trying to propagate and working with them to give them the resources to bring that to scale within their community,” he says.

In many ways, this mirrors a key tactic of the MAHA movement: identifying communities that already share a concern and amplifying those voices until they dominate the conversation. The difference is that Hamill argues public health should use that same approach in service of accurate information and public good.

And crucially, he argues, these voices are in the majority. “There are more moms who are scared that their kids are going to go to school with unvaccinated people than there are moms who are scared that the vaccine is going to give their kid autism,” he says.

A battle over Cuban doctors

The Trump administration has been ratcheting up a pressure campaign on one of Cuba’s most valuable exports: doctors.

Guyana and Jamaica just announced that they will pull the Cuban doctors from their countries this year, the Miami Herald reports.

What’s the context here?

For decades, the Cuban government has sent hundreds of thousands of medical workers abroad through state-run medical missions. These programs have operated across the world but are particularly critical in parts of the neighboring Caribbean, where you can find Cuban clinicians staffing everything from hospitals to rural health clinics. Today, the program has more than 24,000 doctors working in 56 countries worldwide.

Why is the United States concerned about these doctors? Money.

Governments hosting Cuban medical missions typically pay Havana directly, with the Cuban state then passing along only a portion of the salary to the doctors. While the Trump administration is framing the issue partly about “labor exploitation” of the doctors, most observers see the campaign as an attempt to squeeze one of the (financially beleaguered) Cuban government’s most reliable sources of foreign currency.

Last year, the Trump administration began leaning hard on the foreign governments hosting Cuban doctors, threatening to cancel visas for anyone working with or supporting the Cuban programs, alongside other consequences. And the threats are working beyond just Jamaica and Guyana. Honduras also cancelled its program this year, and Guatemala has begun winding down its mission.

But the health care reality is brutal. As Al Jazeera reported last year:

“For many Caribbean nations, the short-term consequences could be devastating. Training local doctors takes years, and trained professionals often migrate to other countries, leaving behind a persistent shortage.”

That reality prompted unusually blunt pushback from Caribbean leaders. The prime minister of Barbados has called the U.S. pressure “unfair and unjustified,” and the prime minister of Saint Vincent and the Grenadines noted, “I will prefer to lose my visa than to have 60 poor and working people die.”

My takeaway?

The reporting suggests that this is a cold, geopolitical pressure campaign applied with little regard for the health care void it will create. (For example, the threats are not being paired with resources to replace those doctors.)

Two things can be true at once: Cuba’s medical missions may enrich a terrible government in Havana, while the Cuban doctors themselves provide lifesaving care to communities that will be worse off without them.

Black rain in Iran

New Scientist is reporting that recent strikes that set oil facilities ablaze near Iran’s capital, Tehran, have produced an unsettling phenomenon: black rain.

These “catastrophic scenes have raised concerns about threats to civilian health in Iran,” with “local people complain[ing] of their throats aching and their eyes burning.”

What exactly is black rain? It’s a byproduct of rain falling through heavily polluted air. Or, as Stanford University atmospheric scientist Mark Jacobson told me, it’s rain drops “filled with health-damaging, toxic air pollutants.” He says the drops themselves appear black because the concentration of “soot particles is so high in Tehran’s rain that no light penetrates” them, which is a sign of just how polluted the air above the city has become. (Keep in mind, this is a city with a population roughly equal to New York City’s.)

Ultimately, the toxic rain itself isn’t actually the biggest health worry for the city’s residents. As the article notes, “the biggest threat may be the smoke rather than the black rain.”

One researcher quoted in the article put it plainly: “If you get raindrops on your skin, yes, there will be some potentially carcinogenic compounds on your skin, but you can wash that off … but very fine smoke particles in the air can penetrate deep into the lungs and potentially get into the bloodstream.”

A flawed flu forecast

Two weeks ago, we talked about the strange annual ritual behind the flu shot. Which is how each year the World Health Organization tries to predict which flu strains will dominate in the upcoming winter, so that vaccine makers can aim for that educated guess.

Well, the Associated Press is reporting new data that shows that last year’s guess was … a bit of a flop.

U.S. health officials say the 2025 to 2026 flu vaccine was only about “25% to 30% effective” in preventing adults from getting sick enough that they needed to go see a doctor. All told, it was “one of its worst effectiveness rates in more than a decade.” For reference, “officials generally are pleased if a flu vaccine is 40% to 60% effective.”

What went wrong?

Oddly, this is actually a bit of good news. The culprit is exactly what we discussed two weeks ago: a fast-spreading branch of “the H3N2 flu strain,” which experts have already updated in next season’s vaccine. So, the problem has already been patched.

One final takeaway: It’s worth noting that even a mediocre flu shot still matters. In the United States, at least 101 children have died so far this flu season. Of the deaths where vaccination status was reported, about 85% weren’t vaccinated. That’s not a coincidence. As Vanderbilt University vaccine expert William Schaffner told the AP, that flu shot may not stop every infection, “but it can prevent people from becoming severely ill and dying.”

Health aid as a cudgel

Sorry folks, not ending on a happy note this week.

Two weeks ago, we covered the state of the Trump administration’ s new “America First” global health deals in Africa. I had spoken with Dr. Paul Spiegel, who directs Johns Hopkins’ Center for Humanitarian Health, who, as I wrote back then, “warned about turning health aid into what is openly described by Washington as a transactional exchange.”

Well, this week the New York Times published a staggering example of what that approach could look like in practice, in Zambia.

According to a draft State Department memo obtained by the paper, U.S. officials are considering withholding HIV assistance to Zambia unless the country expands access for American companies to its mineral sector. (For reference: Zambia is one of the countries most affected by HIV in Africa, with about 1.3 million people relying on daily treatment supported by the United States’ PEPFAR program.)

Here are two quotes from the memo (prepared for Secretary of State Marco Rubio) that really illuminate just how the officials view lifesaving HIV medicines as a raw, political cudgel.

“We will only secure our priorities by demonstrating willingness to publicly take support away from Zambia on a massive scale” … “sharp public cuts to American foreign assistance would significantly demonstrate to aid-receiving countries the seriousness of our interest in collaboration and our insistence on tangible benefits under our America First foreign policy.”

My takeaway? When we spoke with Spiegel, we talked about why transactional aid deals make for fragile and ineffective public health policy. That’s still true. But beyond the practical consequences for individual programs, he also made a broader point about what we lose when we treat lifesaving programs as bargaining chips: the trust and goodwill that once made global health “one of America’s most powerful forms of soft power,” he said.

I’ll see you next week.

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Georgia flu deaths highest in five years as RSV, other respiratory viruses rise

2026-03-13T21:28:43+00:00

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Deaths from flu in Georgia – 243 since the season started in October – are the highest they’ve been in five years, according to data released Friday from the Georgia Department of Public Health.

The deaths include five children. At this point in the season last year, 95 people had died, with 50 deaths at this point during the 2023-24 season.

Meanwhile, respiratory syncytial virus and human metapneumovirus, a lesser-known respiratory illness, have also been on the rise, said Dr. Andrew Thornton, a doctor with Wellstar in Cobb County. Those two conditions, while typically mild, can be more serious in children and the elderly. Covid rates remain low.

Here’s a look at what’s happening.

Flu rates, death toll still climbing

The death toll for flu since last fall hit 243 this week. Flu can be severe in any year, Thornton said, but the higher death toll could be related to the circulation of a new strain of flu this year.

“It’s possible that this became more severe in some patients and, sadly, led to unexpected death. Influenza can be a bit unpredictable, and it does depend on medical conditions and the immune system of the particular patient, and often the age of the patient,” Thornton said, adding that young children and older adults are often at higher risk.

“I don’t know that we know for sure why certain patients might die from the flu, but that is one of the reasons why we want to vaccinate for it, because it can be unpredictable, it can be severe,” Thornton said.

Nationally, 85% of the 101 reported influenza-associated pediatric deaths from this season were in unvaccinated patients, according to the Centers for Disease Control and Prevention.

Flu will continue to circulate through the spring, Thornton said, so it’s not too late to get a vaccine.

“We are still seeing plenty of flu cases, and we don’t know for sure that we’re not going to get any more spikes during the spring, so I would definitely still recommend it if a patient has not been vaccinated,” Thornton said.

Still, positivity rates are lower than earlier in winter. The positivity rate for tests conducted at select Georgia labs was 16.8% for the week ending March 7. While at the start of the season, most cases were Flu Type A, there has been a slight increase in the rate of Flu B cases, starting in late January, according to DPH data.

Covid rates have remained relatively low this winter, Thornton said. CDC data show low wastewater levels, and hospitalization and emergency room visit rates are lower this year than the same time last year in Georgia.

“We’ve seen less Covid this winter compared to last winter, as well as less hospitalizations, emergency room visits, and death compared to last year, which are obviously great trends for this disease,” he said.

RSV and HMPV rates higher than last year

Respiratory syncytial virus usually causes mild, cold-like symptoms but can be more serious in young children and older adults, according to the CDC.

“We are seeing a later rise in RSV this year compared to most recent years,” Thornton said. “RSV seems to be increasing right now, as opposed to last year, it was decreasing at this point in the year.”

At the same time last year, 1.6% of PCR tests for RSV were positive, while this year that rate is 8.3%, according to DPH data. Georgia wastewater data from the CDC also shows moderate levels of RSV. Hospitalization rates for RSV are also higher than at the same time last year, according to the CDC.

While RSV is typically mild, it can be serious in young people and older adults, especially those with risk factors like lung and heart diseases, a compromised immune system, or residence in a nursing home.

“We really, really pay attention to those younger kids with RSV, and that’s where we are still seeing elevated emergency room visits and hospitalizations in those younger patients.”

There aren’t anti-viral drugs to treat RSV for less severe cases, though there is a treatment that is used in hospitalized patients, Thornton said. Outpatient treatment focuses on managing symptoms. But there are steps parents and older adults can take to protect themselves.

Pregnant women can get an RSV vaccine that passes antibodies on to their infants. There’s also a vaccine for infants whose mothers did not get the shot during pregnancy.

The CDC also recommends that all adults over age 75 get a RSV vaccine and those with risk factors for serious illness who are over 50 get an RSV vaccine.

Another lesser-known virus is also on the rise, Thornton said: human metapneumovirus. The disease is also usually mild and causes cold-like symptoms like cough, fever, nasal congestion, and shortness of breath, according to the CDC.

HMPV tests from selected clinical laboratories in Georgia had a positive rate of 6.4% for the week ending March 7, while at the same time last year the positivity rate was 3%, according to DPH data.

Wastewater levels are also high, having climbed over the past three months, according to Georgia data from WastewaterSCAN.

Thornton said the virus belongs to the same family as RSV and is not related to pneumonia, but both viruses can cause pneumonia in more serious cases. There is no vaccine for it.

HMPV peaked in April nationally last year, Thornton said, and he expects this year’s pattern to be similar to last year.

“In general, a human metapneumovirus will often be more severe than the more mild viruses like rhinovirus,” Thornton said and will be more likely to cause a fever or a severe cough. “It also has a lot to do with the patient and their current medical conditions and immune status.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Flu rates remain high in Georgia but show signs of easing after holidays

2026-01-23T18:58:32+00:00

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Flu rates are still high in Georgia this month but appear to be dropping slightly as people resume regular schedules after the winter holidays.

That’s in line with national trends that show a drop in flu positivity rates from prior weeks, according to the latest data from the U.S. Centers for Disease Control and Prevention.

The percentage of flu tests that came back positive at selected labs in the metro Atlanta area dropped from a high of 40% for the week ending Dec. 20 to about 18% for the week ending Jan. 10, according to data from the Georgia Department of Public Health.

The CDC predicts a moderately severe flu season for adults 18-64 and those over age 65. However, it predicts a “high-severity” season for children 17 and under.

Why flu season will likely be worse this year and how to prepare

That doesn’t mean the threat is over. Six people died in Georgia in the week ending Jan. 10, bringing the death toll from the flu since the season started in October to 69. That includes two deaths of children between the ages of 5 and 17. The flu season usually runs through March.

Vaccination remains the best way to protect against the flu, said Dr. M.G. Finn, a professor of biochemistry at Georgia Tech and an expert in viruses and immunology.

Finn said there is a gap between this year’s vaccine and the variant of flu that is circulating widely, in part because scientists design the vaccine well in advance of the flu season. Still, the vaccine reduces the risk of hospitalization by about 40%, he said, making it a valuable tool for protecting health.

“You want to bias the odds in your favor of not getting seriously ill if you happen to come across somebody who has the flu, and you want to minimize the chances of you passing it along to people around you,” Finn said. “It’s completely and utterly safe, so there is no risk whatsoever for taking it.”

Other respiratory viruses also continue to circulate. The positivity rate for RSV at selected clinical laboratories was 10.6% for PCR tests, about the same rate it’s been since late November, according to DPH data

However, the CDC has identified low rates of Covid in wastewater for the week ending Jan. 10, with very low rates of Georgians visiting emergency rooms for Covid and lower rates of Covid-related hospitalizations than at the same time last year.

Meanwhile, Georgia reported its first measles case of the year, on Jan. 12, in a child who was too young to be vaccinated and who had a history of international travel. The case was reported in the Coastal Health District, which covers eight counties around Savannah.

The CDC and the American Academy of Pediatrics recommend that children get the first dose of the measles, mumps, rubella vaccine at ages 12 to 15 months and the second dose between 4 and 6 years of age.

That case was acquired during international travel, according to DPH, meaning it is not likely linked to the large outbreak in neighboring South Carolina.

There have been 700 cases reported since the outbreak in the region around Spartanburg began in October.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

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

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

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

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.

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

Flu is spreading across Georgia. Hospitals urge masking and vaccination.

2026-01-02T20:21:46+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As flu rates increase in Georgia, forcing families to replace trips to visit grandparents with trips to the doctor, local health systems are asking people to mask up and warning patients of longer wait times in the emergency room.

It’s hard to say exactly how many cases of flu there are in Atlanta, in part because of reporting delays due to the holidays. Many people now test for flu at home, said Dr. Andrew Thornton, a doctor who works in Wellstar urgent care clinics in Atlanta. That means official data sources are likely an undercount.

But health systems say they are being hit hard – and they expect the number of cases to increase in the coming weeks. Meanwhile, Georgia’s flu vaccination rates remain low, putting more people at risk of complications and even death.

Twenty-nine people died from flu in Georgia between the start of the season in October and Dec. 27, according to data from the Georgia Department of Public Health. That includes seven during Christmas week, Dec. 21-27. There were 1,580 hospitalizations for flu in an eight-county metro Atlanta area in the same period.

“We’re seeing a huge rise in flu these last couple of weeks,” Thornton said. And wastewater data from Wastewater Scan shows steady increases in flu in Atlanta over the course of December.

“It causes a major issue with volume, because not only does it fill our urgent cares, but it also can fill primary care practices and pediatric offices and also the emergency rooms and hospitals,” Thornton said.

Why flu season will likely be worse this year and how to prepare

Health care systems face an added strain when their workers get sick, he said. “Everyone gets affected by these spikes in flu cases.”

Georgia’s December surge is in line with national trends. Nationwide, the Centers for Disease Control and Prevention reported an increase of about 10,000 flu cases between Dec. 13 and 20.

There are several reasons for the increase, including a mismatch between the variant of flu covered by this season’s flu vaccine and the dominant type circulating (H3N2) relatively early in the season. That’s likely compounded by low vaccination rates.

Northeast Georgia Health System this week started requiring its staff to wear masks, and it strongly encourages patients to do so as well. On Friday, the system had 85 patients admitted for flu across its five hospitals, and 37.5% of the tests administered for flu came back positive for Influenza A this week, spokesperson Layne Saliba said. That’s about 10 percentage points higher than the same time last year.

“We are seeing an increase in very sick kids and teens this cold and flu season,” Children’s Healthcare of Atlanta’s website says, and the health system is requiring people over age 2 to wear masks in its facilities.

Emory Healthcare has created a dedicated 24/7 flu hotline where patients can speak to a nurse and be connected with the right kind of care. As of Tuesday, it is also asking people to wear masks while visiting its health care facilities.

‘I feel like I got hit by a train’

Thornton said telemedicine can be a good option for patients who want to stay home – and it can help relieve the pressure on local health systems. But people who are at higher risk for complications may want to see a doctor in person.

Rapid flu tests, whether self-administered at home or in a clinic, are about 70% accurate, Thornton said, but can sometimes result in false negatives. So health care providers also rely on other clues to diagnose and track flu.

Patients typically describe flu as having a very rapid onset of symptoms like body aches, fever, and respiratory ailments, which can help distinguish it from a cold or other illness, Thornton said.

“People tend to describe it very similarly. They say, ‘I feel like I got hit by a train’ or ‘I got hit by a bus’,” Thornton said. That telltale descriptor helps providers distinguish flu from a bad cold.

People at high risk for complications – such as the elderly, pregnant people, and those with certain chronic health conditions or who are immunocompromised – should check in with a medical provider, Thornton said. It’s also important to ensure that the flu does not progress to pneumonia or another complication.

Treatments like Tamiflu can reduce the severity of the flu if administered in time. Nationwide, the number of such prescriptions filled during December increased, another sign that flu cases are on the rise, according to data from GoodRx’s research team.

“We don’t want to see any deaths from the flu virus, and especially if we have a vaccine that can help protect people,” Thornton said.

Even though this year’s vaccine doesn’t perfectly match the current variant that is circulating widely (H3N2), it still provides good protection and reduces risk of serious complications and death from the disease.

Most Georgians have skipped the shot, with just 17.7% of adults and 12.6% of children age 6 months to 17 years vaccinated by the end of November, according to data from the CDC.

Cases could rise when metro school systems reopen next week, Thornton said.

“There’s a lot of factors involved. How many people picked up the virus over the holidays? How high are the vaccination rates in kids right now? We don’t quite have all that data yet, so it will remain to be seen,” Thornton said.

RSV, Covid are also on the rise

Thornton said he’s seen a “slight increase” in Covid cases over the past few weeks. He’s also noticed an uptick in RSV cases.

As of Dec. 20, CDC wastewater data showed Georgia with a moderate level of RSV and a very low level of Covid cases. The number of positive tests for RSV at selected clinical laboratories in Georgia increased during December as well, according to DPH data for the same period.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

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

Why flu season will likely be worse this year and how to prepare

2025-12-16T18:53:37+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In my clinic last week, I began to see the signs of what I have been fearing for months. Two patients came in on the same day with high fever, sore throat, and body aches. Both tested positive for influenza.

While there is nothing remarkable about people getting the flu in the winter, what worries me is the timing and spread. Across New York state, influenza activity is already far higher than it was at this point in recent years. During the week ending Dec. 6, there were more than 12,000 reported flu cases and nearly 1,400 hospitalizations. During the same week last year, there were fewer than 5,000 cases and about 300 hospitalizations. Two years ago, cases were similarly high, but hospitalizations were substantially lower.

This season, influenza is arriving earlier, spreading faster, and sending more people to the hospital. The United States is heading into a flu season that is likely to be worse than what we have experienced in recent winters.

Why this flu season is likely to be severe

Several factors are converging at the same time to increase the likelihood of a severe flu season.

The first factor is viral evolution. The dominant strain right now is influenza A H3N2, and it has accumulated mutations that allow it to partially evade prior immunity. This strain has already driven early and large flu surges in other parts of the northern hemisphere, including Japan, the United Kingdom, and parts of Europe. Some hospitals in those countries reported seeing January level flu activity as early as October.

The second factor is timing. Flu has arrived earlier than usual before health systems have fully prepared and before vaccination campaigns have reached their peak, so the pressure builds faster.

The third factor is behavioral. During the Covid pandemic, many people adopted habits that reduced flu transmission, including masking in crowded indoor spaces, staying home when sick, and improving indoor air quality and ventilation. Most of those practices have faded. At the same time, fewer Americans are getting their annual flu vaccine. Adult flu vaccination coverage has declined over the past several years, particularly among people under 65 who nonetheless have medical conditions that put them at higher risk of complications.

Finally, hospitals are entering this winter with little reserve. Emergency departments, inpatient wards, and intensive care units are operating close to capacity even before seasonal respiratory viruses peak. In that context, a severe flu season can make it much harder for people to get prompt and high-quality care in outpatient and inpatient facilities.

What we know about this year’s flu vaccine

Because of the way influenza viruses mutate and the waning of human immunity over time, the effectiveness of the seasonal flu vaccine varies each winter. Every spring, global experts analyze data and try to predict what influenza strains are likely to circulate in the coming winter. When circulating viruses mutate after those strains are selected, the match between vaccine and virus can be imperfect.

That is what has happened this year. Data from the United Kingdom show that the dominant H3N2 subclade circulating this winter is different from the strain used to produce the northern hemisphere vaccine. Laboratory studies confirm reduced reactivity between the vaccine strain and the circulating virus.

Early vaccine effectiveness data from the UK show that, despite this mismatch, vaccination does reduce severe illness, albeit not as much as we would like. The vaccine reduced emergency department visits and hospital admissions by 72%-75% among children and adolescents and 32%-39% among adults.

This aligns with how I have been counseling patients in my clinic. The flu vaccine does not guarantee that you will avoid infection. What it does is lower the odds that influenza turns into pneumonia, respiratory failure, or a hospital stay – turning a “wild” infection into a “mild” infection.

In a year when hospitals are stretched thin, that difference matters both for individuals and for the entire health system.

What public health agencies can do now

While the Centers for Disease Control and Prevention’s website still recommends annual seasonal flu vaccination for anyone ages 6 months or older, it is unlikely the CDC will be permitted to run advertising this year to promote that recommendation, as it has in years past. Last February, soon after taking office, the new Health and Human Services secretary cancelled the CDC’s 2024-25 flu vaccination campaign.

State and local health departments can fill that gap by promoting flu vaccine through all available channels and enlisting social media influencers to promote it as well. The priority is demographic groups and settings where flu spreads quickly and causes disproportionate harm. Nursing homes, assisted living facilities, long-term care facilities, shelters, jails, and prisons all require targeted vaccination efforts, rapid testing access, and clear infection control guidance.

Clinicians also need reminders about antiviral treatment. Medications like oseltamivir are only effective when started as soon as symptoms begin and primarily benefit populations at highest risk for severe complications, including young children, pregnant people, older adults, and those with chronic medical conditions. Too often, opportunities to reduce severity are missed because testing and treatment are delayed.

What health care facilities can do now

While flu season has begun, hospitals and clinics still have time to bolster their capacity to handle future surges. Bolstering capacity starts with ensuring their staff do not become severely ill from influenza.

Many patients arrive at a facility with one illness, but leave with influenza, because respiratory viruses spread easily inside health facilities. Facilities need to upgrade the completeness of screening patients for respiratory symptoms at initial intake, then isolating and testing patients for influenza and other respiratory viruses. Masking policies that include visitors, especially in patient care areas, remain a simple and effective tool during periods of high respiratory virus circulation. Assessing airflow, upgrading central air filtration, and using portable air purifiers in crowded spaces can reduce viral spread indoors. These improvements benefit patients and staff well beyond this flu season.

What employers can do now

Employers have more influence on flu spread in their offices and communities than they often realize. Providing paid time off for vaccination or offering on-site flu clinics removes a major barrier for many workers. Encouraging employees to stay home when sick and permitting remote work, rather than rewarding them for showing up despite illness, reduces outbreaks in the workplace.

Making high-quality masks available to employees that want to use them, improving ventilation, and offering home test kits are relatively low-cost interventions that can protect workforce health and continuity.

What individuals can do

This will be the first flu season since federal officials instituted severe cuts to infectious diseases and immunization programs across the country. For individuals, this means that it is more important than ever to take pro-active steps to protect your and your family’s health. Get vaccinated if you have not already. Keep high-quality masks and home test kits available in your home. If symptoms start, test early and contact a health care provider if you are at higher risk and may benefit from antiviral treatment.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

Flu and RSV climb in Georgia as winter virus season starts slowly

2025-12-05T22:06:33+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Georgia’s winter respiratory virus season is off to a slow start, with Covid numbers low. But local doctors say they are seeing an uptick in flu and RSV cases, and they expect numbers to rise over the coming months.

There are steps people can take to mitigate the spread of these viruses ahead of the holidays, Dr. Sara Turbow, a doctor at Grady Health and a professor of medicine at Emory University, and Dr. Andrew Thornton of Wellstar said, starting with vaccinations for all three illnesses.

“It’s never too late. Even if you get it five days before Christmas, I would say that that’s better than not getting it at all,” Turbow said. The vaccines are widely available at pharmacies and many doctor’s offices. The vaccines take about two weeks to provide full coverage.

Getting the vaccines is well worth it because the viral respiratory diseases can cause people to feel unwell, have to take time off work or school, and, in some cases, progress to bacterial pneumonia, the doctors said.

“I worry more about the complications that come from these illnesses, and pneumonia is a big one,” Thornton said. “We have already started to see an increase in pneumonia in the last month.”

While many patients can successfully be treated for pneumonia at home, others may require hospitalization, and it could lead to serious complications like sepsis, a systemic infection. He said people should also make sure they are up-to-date on pneumonia vaccines.

Much of the U.S. Centers for Disease Control and Prevention data collection about the three respiratory viruses was put on hold during the government shutdown. Since operations resumed Nov. 13, those surveillance systems have started to publish data again, though there is a lag of a few weeks.

The data mirror what the local doctors are reporting, with increases in RSV and flu rates and relatively low Covid rates.

“Usually, December, January, we start to see a lot of Covid cases, right along with an increase in flu, as well as RSV,” Thornton said. He reported an increase in flu and pneumonia among the patients of all ages that he sees at Wellstar urgent care clinics. Turbow said she’s seeing an increase in RSV among adult patients.

People can take other steps like masking in group settings, including airplanes and airports, and frequently washing their hands to help prevent the spread of these diseases, Turbow and Thornton said.

Turbow said she’s not as strict about masking as she was during the Covid pandemic but always tries to have a mask with her in case she’s in a crowded setting or next to someone who is coughing.

“It’s good to have that mask on hand if you find yourself near someone or sitting next to someone who’s visibly sick,” Turbow said. “You don’t want to be stuck on a multiple-hour flight next to somebody who’s coughing and sneezing.”

Drugs like Paxlovid, taken within five days of contracting of Covid, and Tamiflu, within about 48 hours of contracting flu, can help ward off more serious complications, especially for those at high risk, Thornton said.

“If you do it in the right patient and at the right time frame, it can reduce risk of complications like pneumonia,” Thornton said. Urgent care centers and retail clinics are able to test and treat the diseases, Turbow said, and people should consider going to those if they can’t get in to see their regular doctor instead of an emergency room.

Here’s what the data show:

Covid

Hospitalization rates per 100,000 are lower than last year for October and November in Georgia, with few emergency department visits (under 0.5%) for Covid in the same period.
While Covid rates are likely to grow or are already growing in many Midwestern and Northeastern states, as well as Alabama, the CDC does not predict a change in Covid rates in Georgia.

Flu

Nationally, seasonal activity is on the rise, according to the CDC, with an increase in positive tests over the past week.
That’s mirrored in a rise in positive flu tests in Georgia, according to state Department of Public Health data. More than 18% of flu tests at clinical laboratories tested positive for flu from Nov. 16 to 29, up over just 5.6% the week prior to Nov. 16. The vast majority of the positive flu tests were for Influenza A.

Visits to select outpatient health care facilities for illnesses like influenza have also increased since September, but at 3.4% are lower than in the past four flu seasons beginning in 2021, according to state data.
Flu hospitalization rates have ticked up since mid-November, with the latest data from Nov. 29 showing a rate of 1.2 hospitalizations per 100,000 people, according to data from the CDC’s Flu View. Last year, Georgia’s flu-related hospitalizations started to climb in early December and peaked in late January and early February at a rate of 13.4 per 100,000 people before falling.
In real terms, that means 194 hospitalizations in Georgia since early October, with four deaths. That’s higher than last year, when there were 75 hospitalizations in the same period.

RSV

RSV positivity rates are increasing in Georgia, from 2.8% in early October to 14.4% for the last week in November, according to DPH data. At the same time last year, about one-fifth of all RSV tests were positive.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

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

Louisiana took months to sound alarm after two babies died in whooping cough outbreak

2025-11-04T21:52:56+00:00

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When there’s an outbreak of a vaccine-preventable disease, state health officials typically take certain steps to alert residents and issue public updates about the growing threat. That’s standard practice, public health and infectious disease experts told KFF Health News and NPR. The goal is to keep as many other vulnerable people as possible from getting sick and to remind the public about the benefits of vaccinations.

But in Louisiana this year, public health officials appeared to have not followed that playbook during the state’s worst whooping cough outbreak in 35 years.

Whooping cough, also called pertussis, is a highly contagious, vaccine-preventable disease that’s particularly dangerous for the youngest infants. It can cause vomiting and trouble breathing, and serious infections can lead to pneumonia, seizures, and, rarely, death.

Madison Flake, a pediatric resident in Baton Rouge, cared for a baby who was hospitalized during this year’s outbreak. Less than 2 months old, he was sent to the intensive care unit.

“He would have these bouts of very dramatic coughing spells,” Flake said. “He would stop breathing for several seconds to almost a minute.”

Infants are not eligible for their first pertussis vaccine until they are 2 months old, but they can acquire immunity if the mother is immunized while pregnant.

By late January, two babies had died in Louisiana.

But the Louisiana Department of Health waited two months to send out a social media post suggesting people talk to their doctors about getting vaccinated. The department took even longer to issue a statewide health alert to physicians, send out a press release, or hold a news conference.

Doctors muffled as Florida moves to end decades of childhood vaccination mandates

That lag is not typical, according to Georges Benjamin, the executive director of the American Public Health Association.

“Particularly for these childhood diseases, we usually jump all over these,” said Benjamin, a physician who has led health departments in Maryland and Washington, D.C. “These are preventable diseases and preventable deaths.”

Because infectious diseases spread exponentially, if officials don’t alert the public quickly, they lose a key chance to prevent further infections, said Abraar Karan, an instructor at Stanford University who has worked on Covid and mpox outbreaks.

“Time is perhaps one of the most important currencies that you have,” he added.

General promotion of vaccines banned

Because pertussis vaccine immunity wanes over time, cases can ebb and flow. But in September 2024, Louisiana health officials started seeing a “substantial” increase in whooping cough cases, part of a national trend.

In late January, physicians at one Louisiana hospital warned their colleagues that two infants had died in the outbreak.

On Feb. 13, the state’s surgeon general, Ralph Abraham, sent a memo to staff ending the general promotion of vaccines and community vaccine events.

He sent that email a few hours after Robert F. Kennedy Jr., an anti-vaccine activist, won Senate confirmation as the new secretary of the U.S. Department of Health and Human Services.

Also that day, Abraham posted a public memo on the state health department’s website. In it, he said public health has overstepped with vaccine recommendations, driven by “a one-size-fits-all, collectivist mentality.” Abraham has called Covid vaccines “dangerous” and been a vocal supporter of Kennedy.

Four days later, in response to a request from WVUE Fox 8 News in New Orleans, the Louisiana Department of Health in an email confirmed the deaths of two infants from whooping cough for the first time. WVUE published the news on Feb. 20.

But Louisiana’s health department sent out no alerts, according to a review of external and internal communications by NPR and KFF Health News.

Over the next month, two more infants were hospitalized for whooping cough, according to internal health department emails obtained through a public records request.

In March, after inquiries from NPR and KFF Health News about the growing number of pertussis cases, the department put out its first social media communications about the outbreak and offered interviews to other journalists.

How measles, whooping cough, and worse could roar back on RFK Jr.’s watch

Then on May 1 — at least three months after the second infant death — the health department issued what appears to be its first and so far only official alert to physicians. It put out its first press release the next day and then held a news conference about pertussis on May 14.

By then, 42 people had been hospitalized for whooping cough since the outbreak began, three-quarters of whom were not up to date on their whooping cough immunizations, according to the Louisiana Department of Health.

More than two-thirds of those hospitalized were babies under the age of 1.

Throughout the summer, pertussis cases continued to climb in Louisiana. But there were no further public communications from the state health department.

NPR and KFF Health News contacted the department for comment on Sept. 25. Emma Herrock, a spokesperson, did not answer specific questions about the lack of communications but referred to a Sept. 30 post on X by the state surgeon general.

In the post, Abraham said the department “consistently reported cases of pertussis and provided guidance to help residents stay protected” in 2025. He called the pertussis vaccine “one of the least controversial” and said he recommends it to his patients.

The X post included a year-by-year graphic of pertussis cases that omitted 2024 and 2025. The post also provided a more specific timeframe for when the infant deaths occurred — one in late 2024 and the other in early 2025.

Louisiana sees ‘train wreck’ of cases

Louisiana should have started warning the public within days of the first infant’s death instead of waiting months, said Stanford’s Karan.

“At minimum,” he said, “it should be like heavy promotion of: ‘Hey, infants are at high risk. They get infected by people who have waning immunity. If you haven’t gotten vaccinated, get vaccinated. If you have these symptoms, get tested.’”

Deaths from a vaccine-preventable illness are tragic, but they can also serve as an opportunity to educate the public about the benefits of vaccines and try to save lives, said Joshua Sharfstein, a former Maryland health secretary and now a professor at the Johns Hopkins Bloomberg School of Public Health.

“The risk of pertussis is always there, but when you have two infant deaths it’s a really good opportunity to communicate that this is a real threat to the health of children,” Sharfstein said.

Karan said that by not acting more quickly, the Louisiana Department of Health may have set itself up for a worse outbreak.

“Because then what we see is this train wreck thereafter, of like an insanely large outbreak, a lot of hospitalizations,” he said.

The outbreak continued

As of Sept. 20, the most recent date for which data is available, Louisiana had counted 387 cases of whooping cough in 2025, according to the Centers for Disease Control and Prevention. In data going back to 1990, the previous high was 214 cases, in 2013.

Until the Sept. 30 post on X, the Louisiana Department of Health did not appear to put out any public communications about pertussis over the preceding four months, though hospitalizations continued, and case levels surpassed the 2013 levels.

The health department should be responding aggressively and consistently, said Joseph Bocchini, president of the Louisiana Chapter of the American Academy of Pediatrics.

Health officials should make sure “people are updated on a regular basis and reminded of what needs to be done,” he said. “Get your vaccines. Moms, if you’re pregnant, get vaccinated. And if you have a cough illness, see your doctor.”

Benjamin, with the American Public Health Association, said the ongoing goal of public health communication is to prevent the next hospitalization or death.

“The bottom line is, it’s not too late,” he said. “It’s not too late to be much more aggressive and proactive about dealing with pertussis.”

This article was produced by a partnership that includes WWNO, NPR, and KFF Health News, Healthbeat’s national reporting partner.

Cold and flu season is coming. Flu shots are widely available.

2025-09-26T16:15:43+00:00

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As Georgia heads into the fall respiratory virus season, public health officials say now is the time to get a flu shot.

“People forget how many people die every year in the U.S. and in Georgia of influenza,” Georgia Department of Public Health Commissioner Dr. Kathleen Toomey said during the Board of Health’s September meeting.

There have been 168 deaths, including five children, and over 5,000 hospitalizations from flu in Georgia since last October, according to DPH data. The number of deaths this year is much higher than the past two years – 61 deaths last year and 53 the year before.

Measles spreads from Georgia State student to three others

Last year’s flu season was particularly severe, with the 280 pediatric flu-associated deaths nationwide, a record high, according to the Centers for Disease Control and Prevention.

Wastewater surveillance data show very low rates of Influenza A and respiratory syncytial virus rates along with moderate rates of Covid in Georgia for the week of Sept. 7-13. Flu cases typically start to increase in the fall and peak between December and February.

State epidemiologist Dr. Cherie Drenzek, speaking at the meeting, urged people to get the flu shot in September or October.

Flu shots are widely available as usual at pharmacies and public health departments. So, too, are RSV vaccines, which are recommended by the CDC for everyone 75 and older and adults ages 50 to 74 who are at increased risk of a severe case.

DeKalb Public Health is hosting a drive-through event for flu shots Saturday at the Lou Walker Senior Center, 2538 Panola Rd. in Lithonia, from 9 a.m. until 1 p.m. Three types of flu shots will be available, along with FluMist, a nasal vaccine spray for children ages 6 to 18.

People with insurance can get the shots for no cost. For low-income people without insurance, there are programs to provide the shots at low or no cost, spokesperson Eric Nickens said. For others, the shots range $50-$94 out of pocket, depending on the shot, he said.

Covid declining after summer bump

Georgia’s summer uptick in Covid cases appears to be on the decline, according to the latest wastewater surveillance, after rising since July.

“What we see is this late summer little bump in Covid activity, and then we see another one that usually occurs after the holidays,” Drenzek said.

For the last week in August and the first two weeks in September, the Covid hospitalization rate ranged between 3 and 3.6 per 100,000, around the same rate as last February and March, according to CDC data. The hospitalization rate refers to how many people are hospitalized with a confirmed case of Covid within 14 days before or during the hospitalization per 100,000 people.

The increase was also reflected in emergency department visits, when rates were over 1% for each week from Aug. 3 to Sept. 6, according to CDC data.

Confusion around federal guidance has disrupted access to this fall’s updated Covid vaccine. The shots are on the market, but pharmacies are waiting to start distributing them without a prescription until the acting CDC director signs off on new guidance from the Advisory Committee on Immunization Practices.

The ACIP, meeting last week in Atlanta, recommended that all Americans over 6 months old be able to get a Covid shot after consultation with a health care provider, a category that includes pharmacists.

Once the CDC signs off on the recommendations, Georgians should be able to get the Covid shot in pharmacies without a prescription.

DPH has not started providing the new vaccines yet, spokesperson Nancy Nydam Shirek said. The agency will review the new ACIP guidance once the CDC signs off on it, she said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

It’s almost flu season. Should you still get a shot, and will insurance cover it?

2025-08-18T13:37:28+00:00

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For parents of school-aged children, the fall to-do list can seem ever-growing. Buy school supplies. Fill out endless school forms. Block off parent-teacher nights. Do the kids’ tennis shoes still fit?

Somewhere, at some point, you might remember flu shots. Get your flu shot. Get their flu shots. Or should you? Can you? Is that still a thing?

Amid political chatter about vaccines and the government entities that oversee them, it’s understandable to wonder where all this leaves the 2025-26 flu vaccine.

In short: Yes, the flu shot is still a thing. And four doctors we spoke to said they recommend you get your flu shot this year. (See the source list below this article.)

Here are some answers to common questions:

I heard the Trump administration could be changing vaccine recommendations. Does that apply to the flu vaccine?

There have been no substantial changes to the federal government’s flu vaccine recommendation: The Centers for Disease Control and Prevention still says that people 6 months old and up should get an annual flu vaccine.

That means most insurers will cover it, and it should soon be widely available.

Health and Human Services Secretary Robert F. Kennedy Jr., who has opposed vaccines, agreed that most people should get the flu vaccine. He followed a recommendation from the board that advises the federal government on vaccine policy; Kennedy replaced the members with his own.

The panel voted against recommending multidose flu shots that contained the preservative thimerosal, but the preservative had already been removed from most vaccines, including most flu shots.

Who should not get the flu shot?

Doctors acknowledged there are always exceptions to broad guidance. For example, people with severe allergies to flu vaccine components should not get vaccines that contain those components.

You should discuss your health situation with your physician for personalized guidance.

Is this season’s flu shot different from last season’s?

Yes. The flu shot was updated for the upcoming flu season, but the changes weren’t drastic. Like last year’s flu shot, this year’s vaccine is known as a three-component or trivalent vaccine that protects against three influenza viruses — two influenza A viruses and one influenza B virus.

This season’s vaccine was altered to target a specific strain of the influenza A/H3N2 virus expected to circulate this season, said Ryan Maves, a professor of medicine at Wake Forest University and a member of the Infectious Diseases Society of America. Those changes align with what the World Health Organization has recommended.

When is the best time to get vaccinated?

September, October, or early November. This allows your body time to build up its protective antibodies as flu season begins and ensures your protection doesn’t wane before it ends.

In the United States, influenza infection typically peaks in February, so you want to make sure you’re vaccinated and your protection is still strong through February and into March, said William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.

Is this season’s flu vaccine guaranteed to protect against the influenza strain that’s circulating?

Guarantee all protection? No.

Reduce risk of death? Yes.

Similar to the Covid-19 vaccine, flu vaccines are best at “protecting us from the most severe consequences of influenza,” Schaffner said. That means the flu vaccine is most effective at keeping people out of the hospital or the intensive care unit and keeping people from dying.

“A flu vaccine may not guarantee perfect protection against the flu, but skipping your flu shot simply guarantees you’ll have no protection at all,” said Benjamin Lee, a pediatric infectious diseases physician at the University of Vermont Children’s Hospital and an associate professor at the University of Vermont Larner College of Medicine.

Will the flu shot be readily available this year?

All signs point to yes.

The FDA passed its formula recommendations to vaccine manufacturers March 13 — early enough that the agency expected there would be “an adequate and diverse supply.” The people and places that administer flu shots should have them soon, typically beginning in September, said Flor Muñoz, a Baylor College of Medicine associate professor of pediatrics and infectious diseases.

I heard Kennedy canceled $500 million in funding for vaccine development. Could this affect future flu vaccines?

Kennedy announced the cancellation of funding for mRNA vaccine development. Some companies have been researching combined mRNA flu and Covid shots, but there are currently no approved mRNA flu vaccines.

Still, experts said the federal government’s changes — funding cuts, vaccine committee purges, deviations from existing procedures — are increasing uncertainty.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

SOURCES

Interview with Flor Muñoz, an associate professor of pediatrics and infectious diseases at Baylor College of Medicine, Aug. 4.

Interview with Ryan Maves, a professor of medicine at Wake Forest University and the medical director of the transplant Infectious Diseases Program at Wake Forest University, Aug. 4.

Interview with William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, Aug. 4.

Email interview with Benjamin Lee, a pediatric infectious diseases physician at the University of Vermont Children’s Hospital and an associate professor at the University of Vermont Larner College of Medicine, Aug. 3.

PolitiFact, “What Is the Vaccine Preservative Thimerosal? What To Know About It and Its Removal From Flu Vaccines,” June 26.

Pharmacy Times, “ACIP Recommends Adults Receive Seasonal, Single-Dose Influenza Vaccines Free of Thimerosal,” June 26.

CNN, “After Canceling Meeting of Independent Advisers, FDA Issues 2025-26 Flu Vaccine Recommendations,” March 13.

PolitiFact, “RFK Jr. Fired Everyone on a Key Vaccine Panel. Here’s Who He Replaced Them With,” June 18.

World Health Organization, “Recommended Composition of Influenza Virus Vaccines for Use in the 2025-2026 Northern Hemisphere Influenza Season,” Feb. 28.

Food and Drug Administration, “Influenza Vaccine Composition for the 2025-2026 U.S. Influenza Season,” March 13.

The Infectious Diseases Society of America, “Statement on Cancellation of FDA Vaccine Advisory Committee Meeting,” 2025.

Pharmacy Times, “Understand the 2025-2026 Flu Vaccine Composition Recommendations,” April 2.

CIDRAP, “FDA Announces Flu Strain Picks For Next Season’s Vaccines,” March 14.

U.S. Centers for Disease Control and Prevention, “Seasonal Flu Vaccine Basics,” Sept. 17.

U.S. Centers for Disease Control and Prevention, “Adult Immunization Schedule by Age (Addendum updated July 2, 2025),” July 2.

U.S. Centers for Disease Control and Prevention, “Child and Adolescent Immunization Schedule by Age (Addendum updated July 2, 2025),” July 2.

U.S. Centers for Disease Control and Prevention, “Trivalent Influenza Vaccines,” Sept. 10.

CNN, “Disrupted US Vaccine Meetings Could Threaten Timelines, Access and Transparency Around Shots,” Feb. 28.

The Associated Press, “RFK Jr. Cancels $500M in Funding for mRNA Vaccine Development,” Aug. 5.

NBC News, “CDC Ends Covid Vaccine Recommendation for Healthy Kids and Pregnant Women,” May 27.

NBC News, “Why Is the Flu So Bad This Year?” Feb. 28.

U.S. Centers for Disease Control and Prevention, “Weekly US Influenza Surveillance Report: Key Updates for Week 17, ending April 26, 2025,” May 2.

U.S. Centers for Disease Control and Prevention, “ACIP Recommendations,” Aug. 8.

MedPage Today, “RFK Jr. Quietly Endorses Flu Vaccine for Kids and Adults,” Aug. 7.

The Associated Press, “Moderna Study Shows Immune Response in Older Adults for a Combo Flu and COVID-19 Shot,” May 7.

U.S. Department of Health and Human Services, “HHS Winds Down mRNA Vaccine Development Under BARDA,” Aug. 5.

CBC, “Breaking Down How a Massive U.S. Funding Cut Could Impact Future mRNA Vaccines,” Aug. 8.

NBC News, “Could Flu Shot Supply Fall Short This Year? FDA’s Canceled Meeting Sparks Worries,” Feb. 27.

Louisiana Blue, “Flu Shot,” accessed Aug. 11.

Florida Blue, “Flu and Other Respiratory Viruses,” accessed Aug. 11.

Aetna, “Vaccines and Health Screenings,” accessed Aug. 11.

UnitedHealthcare, “Flu Shots: Frequently Asked Questions,” accessed Aug. 11.

U.S. Centers for Disease Control and Prevention, “Flu Prevention: Information for Travelers,” accessed Aug. 11.

U.S. Centers for Disease Control and Prevention, “Who Needs a Flu Vaccine,” accessed Aug. 11.

Cleveland Clinic, “When Is the Best Time To Get Your Flu Shot?” Aug. 5.

Trump team’s $500 million bet on old vaccine technology puzzles scientists

2025-05-05T13:57:10+00:00

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The Trump administration’s unprecedented $500 million grant for a broadly protective flu shot has confounded vaccine and pandemic preparedness experts, who said the project was in early stages, relied on old technology, and was just one of more than 200 such efforts.

Health and Human Services Secretary Robert F. Kennedy Jr. shifted the money from a pandemic preparedness fund to a vaccine development program led by two scientists whom the administration recently named to senior positions at the National Institutes of Health.

While some experts were pleased that Kennedy had supported any vaccine project, they said the Thursday announcement contravened sound scientific policy, appeared arbitrary, and raised the kinds of questions about conflicts of interest that have dogged many of President Donald Trump’s actions.

Focusing vast resources on a single vaccine candidate “is a little like going to the Kentucky Derby and putting all your money on one horse,” said William Schaffner, a Vanderbilt University professor and past president of the National Foundation for Infectious Diseases. “In science we normally put money on a number of different horses because we can’t be entirely sure who’s going to win.”

Others were mystified by the decision, since the candidate vaccine uses technology that was largely abandoned in the 1970s and eschews techniques developed in recent decades through funding from the Department of Health and Human Services and the Defense Department.

“This is not a next-generation vaccine,” said Rick Bright, who led HHS’s Biomedical Advanced Research and Development Authority in the first Trump administration. “It’s so last-generation, or first-generation, it’s mind-blowing.”

The vaccine is being developed at the National Institute for Allergy and Infectious Diseases by Jeffery Taubenberger, whom Trump named as acting chief of the institute in late April, and his colleague Matthew Memoli, a critic of U.S. Covid-19 policy whom Trump picked to lead the NIH until April 1, when Jay Bhattacharya took office. Bhattacharya named Memoli his principal deputy.

Taubenberger gained fame as an Armed Forces Institute of Pathology scientist in 1997 when his lab sequenced the genome of the 1918 pandemic influenza virus, using tissue samples from U.S. troops who died in that plague. He joined the NIH in 2006.

Broadly protective flu shot is not a new idea

In a Thursday news release, HHS called the Taubenberger-Memoli vaccine initiative “Generation Gold Standard,” saying it represented “a decisive shift toward transparency, effectiveness, and comprehensive preparedness.” Bhattacharya said it represented a “paradigm shift.”

But the NIH vaccine-makers’ goal of creating a shot that protects against multiple or all strains of influenza — currently vaccines must be given each year to account for shifts in the virus — is not new.

Then-NIAID Director Anthony Fauci launched a network of academic researchers in pursuit of a broadly protective flu vaccine in 2019. In addition to that NIH-led consortium, more than 200 flu vaccines are under development in the United States and other countries.

Many use newer technologies, and some are at more advanced stages of human testing than the Taubenberger vaccine, whose approach appears basically the same as the one used in flu vaccines starting in 1944, Bright said.

Public health labs are being defunded. Here’s what that means for disease surveillance.

In the news release, HHS described the vaccine as “in advanced trials” and said it would induce “robust” responses and “long-lasting protection.” But Taubenberger and his colleagues haven’t published a complete human study of the vaccine yet. A study showing the vaccine protected mice from the flu appeared in 2022.

For Operation Warp Speed, which led to the creation of the Covid vaccine during Trump’s first term, government scientists reviewed detailed plans and data from academic and commercial laboratories vying for federal money, said Greg Poland, a flu expert and president of the Atria Health Academy of Science and Medicine. “If that’s happening here, it’s opaque to me,” he said.

When asked what data beyond its press release supported the decision, HHS spokesperson Andrew Nixon pointed to the agency’s one-page statement. Asked whether the decision would curtail funding for the Fauci-created consortium or other universal vaccine approaches, Nixon did not specifically respond. “Generation Gold Standard is the most promising,” he said in an email.

Taubenberger did not respond to a request for comment. Nixon and NIH spokesperson Amanda Fine did not respond to requests for an interview with Taubenberger or Memoli.

The HHS statement stressed that by developing the vaccine in-house, the government “ensures radical transparency, public accountability, and freedom from commercial conflicts of interest.” While any vaccine would eventually have to be made commercially, NIH involvement through more stages of development could give the government greater influence on any vaccine’s eventual price, Schaffner said.

Inactivation method is a blast from the past

If the mRNA-based Covid shots produced by Moderna and Pfizer-BioNTech represented the cutting edge of vaccine technology, applying ultra-sophisticated approaches never before seen in an inoculation, the approach by Taubenberger and Memoli represents a blast from the past.

Their vaccine is made by inactivating influenza viruses with a carcinogenic chemical called beta-propiolactone. Scientists have used the chemical to neutralize viruses since at least the 1950s. This whole-virus inactivation method, mostly using other chemicals, was the standard way to make flu vaccines into the 1970s, when it was modified, partly because whole-virus vaccines caused high fevers or even seizures in children.

The limited published data from the Taubenberger vaccine, from an initial safety trial involving 45 patients, showed no major side effects. The scientists are testing the vaccine as a regular shot and as an intranasal spray with the idea of stopping the virus in the respiratory tract before it causes a broad infection.

“The notion of a universal influenza A pandemic vaccine is a good one,” said Poland, who called Taubenberger an excellent scientist. But he added: “I’m not so sure about the platform, and the dollar amount is a puzzler. This vaccine’s in very early development.”

Paul Friedrichs, a retired Air Force general who led the Office of Pandemic Preparedness and Response Policy in President Joe Biden’s White House, said that “giving $500 million upfront with very little data to support it is unlike anything I’ve ever seen.”

“The technology for developing vaccines has tremendously evolved over many decades,” Friedrichs said. “Why would we go back to an approach historically associated with greater or more frequent adverse events?”

The government appeared to be transferring the money for the Taubenberger vaccine development from an existing $1.3 billion vaccine fund at Project NextGen, a mostly Covid-focused program at BARDA, Friedrichs said. Most of that money was earmarked to support advanced research on Covid and other viral vaccines, including those protecting against emerging diseases.

It is “very concerning that we’re de-emphasizing Covid, which we may live to regret,” Poland said. “It assumes we won’t have a Covid variant that escapes the current moderately high levels of Covid immunity.”

Measles misinformation is on the rise — and Americans are hearing it, survey finds

Nixon said Project NextGen, for which some funds were earmarked for mRNA research, is under review. Kennedy is critical of mRNA vaccines, once claiming, falsely, that they are the deadliest vaccines in history.

Ted Ross, director of global vaccine development at the Cleveland Clinic, said he was “happy to see them investing in respiratory vaccines, including a universal flu vaccine, with all the programs they’ve been cutting.”

“But I don’t think this is the only approach,” Ross said. “Other universal flu vaccines are in progress, and their success and failure are not known yet.”

His team, part of the NIAID-funded flu vaccine consortium, is using artificial intelligence and computer modeling to design vaccines that produce the broadest immunity to influenza, including seasonal and pandemic strains.

As interim director, Memoli oversaw the start of the administration’s massive cuts at the NIH, with the elimination of some 800 agency grants worth over $2 billion. More than 1,200 NIH employees have been fired, and many researchers, including Ross, are in limbo.

His lab is close to testing a candidate vaccine on people, Ross said, while waiting to find out about its NIH funding. “I’m not sure whether my contract is on the chopping block,” he said.

This story was originally published at KFF Health News, Healthbeat’s national reporting partner.

Winter respiratory illnesses winding down in Georgia, but some Covid and flu still circulating

2025-04-18T20:08:46+00:00

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As spring temperatures rise along with pollen counts in Georgia, the state is seeing a decline in winter respiratory infections.

Data from the Centers for Disease Control and Prevention show the amount of respiratory illness causing people to seek health care is low nationwide and in Georgia. Flu, Covid, and RSV emergency department visits are all low and decreasing.

However, wastewater surveillance data still show moderate rates of Influenza A and high rates of Covid in Georgia.

Flu health care visits are down

The CDC collects data about ILI, or “influenza-like illness,” visits to over 3,400 health care providers nationwide. The data track patients who show up with flu-like symptoms, including fever, sore throat, and cough.

Those numbers in Georgia show a downward trend over the past weeks, at 2.3% for the week ending April 12, down from a high of 8.8% in late January.

The decline is mirrored in a drop in the number of positive flu tests at selected labs in Georgia. That was down to about 4.6% for the week ending April 12, from a high of 27% in late January, according to the latest available data from the CDC. A total of 1,367 specimens from Georgia were tested in the week ending April 12.

That system has eight sites in Georgia, from Alma to Columbus to Gainesville, including the state public health lab in Decatur, according to the CDC.

CDC wastewater surveillance data set Georgia’s level for influenza A at moderate for the week ending April 12, down from “very high” in January and February.

Since the season started in October, flu has killed 138 Georgians, according to data from the state Department of Public Health. Most of the fatal cases occurred in people over 50. Three children under 18 years old also died.

Covid and RSV levels declining

Wastewater viral activity level for Covid is high in Georgia for the week ending April 12, according to the CDC. That’s down from “very high” in August.

When it comes to positive Covid tests, rates are down from their highest rate this season but still up over the start of the season in the fall, according to DPH data from Georgia clinical labs.

For the week ending April 5, 5.5% of Covid tests were positive. That’s down from over 8%, the highest point in December 2024, and March, according to DPH data.

It’s important to note this data does not reflect all Covid tests performed in Georgia, just those performed at certain labs.

Rates for RSV, or respiratory syncytial virus, which often hits young children and the elderly the hardest, are down, with a positivity rate for the week ending April 5 of 0.3%. They hit a high of 26.9% in late fall, according to DPH.

The CDC’s wastewater RSV activity in Georgia for the week ending April 12 is very low.

Proliferation of pollen aggravates allergies

Meanwhile, people are sniffling, sneezing and even avoiding the beautiful Atlanta weather due to pollen rates, which have been high for several days over the past few weeks. The count, which tallies pollen from trees, grass, and weeds, ranged between 338 and 2128 this week.

Nurses who are certified pollen counters at Atlanta Allergy and Asthma count the pesky pollen spores daily. The clinic is the only National Allergy Bureau-certified pollen center in Georgia.

For Georgians, the pollen season appears to be lengthening, allergist Dr. Lily Hwang told Healthbeat recently.

“Our pollen is only going to get worse,” she said, adding that models predict an increase in severity and intensity until 2035. “They show that ragweed is moving more northward. We’re getting longer seasons. All these things are changing as we’re following them.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Reports of ‘Disease X’? Here’s how to think clearly when you hear about an outbreak

2025-04-09T15:24:46+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Social media feeds filled up in recent days with reports of an outbreak in Russia of people with severe respiratory symptoms, including coughing up blood. According to these reports, tests for common viruses were negative, and there was fear this was caused by a new virus. As one journalist aptly observed, “The speed with which viral rumors can trigger public concern is a growing challenge for health officials in Russia and globally.”

Indeed, in the past year, I have become concerned about an epidemic of epidemic reports, a tendency for social and mainstream media to write about illnesses or deaths in other countries and speculate that a “mystery” infectious disease has emerged. Notable examples include “disease X” in Congo from October to December 2024, human metapneumovirus in China in December 2024, a cluster of unexplained deaths in Congo in February 2025.

How can you interpret these reports better? When is concern justified, and when is it not?

When a new disease outbreak makes headlines, most people fixate on the wrong details. They often focus on gruesome symptoms, reported deaths, and stories involving particularly sympathetic groups, such as young children.

The past two decades of pandemics – from SARS to Ebola to Covid-19 – have taught epidemiologists that it is more important to think about a potential outbreak across three dimensions. Was there laboratory confirmation? How easily does it spread? How severe is it? What tools do we have to prevent or treat it?

Was there laboratory confirmation?

When I trained in the Centers for Disease Control and Prevention’s Epidemic Intelligence Service, the first lesson we learned about outbreak response is: Confirm it’s an outbreak. Part of that involves comparing the number of cases against what is expected, but the other important part is testing specimens from ill persons.

Early reports may simply reflect clinical symptoms — cough, diarrhea, fever — not the actual cause. These reports often lack important details about what tests, if any, have been performed.

If the report describes people with respiratory symptoms, how many people had specimens collected? Were they from the nose, throat, or lungs? What about specimens from the blood (which can be important for some viral infections and invasive bacterial infections) or even from the urine (for Legionella)?

Was testing done using polymerase chain reaction, a highly sensitive method of identifying genetic fragments of pathogens, or were they done using other techniques? Were those tests done in high-quality (also known as “reference”) laboratories?

In many low-income countries, clinics may lack the supplies to collect certain specimens, hospital laboratories lack the ability to perform many advanced tests, and, even if those labs have the appropriate equipment, the quality of testing may be inferior. Much of my work in Southeast Asia on tuberculosis and in China on foodborne and respiratory infections involved trying to address these weaknesses.

To determine whether a disease is caused by a known pathogen or something truly new, investigators must perform extensive testing. Without it, a cluster of reports about people with vomiting and diarrhea could just as easily be due to norovirus or Salmonella as it could be a new pathogens.

Consider, for example, the Disease X “outbreak” from Congo in late 2024 involving (as of Dec. 16) 891 ill people and 48 deaths. For weeks, news outlets speculated that a new disease had emerged and could spread to other countries. After a large international response, testing of 420 samples identified “malaria, [as well as] common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus).”

The presence — or absence — of laboratory confirmation helps separate signal from noise.

How easily does it spread?

The transmission patterns of a new disease provide crucial initial insights into its potential impact. The five most common routes of transmission are respiratory, vector-borne (e.g., mosquitos, ticks), direct contact, gastrointestinal, and body fluid (e.g., sexual, blood).

Of these, transmission by the respiratory tract is most worrisome. A person who expels a pathogen into the air by coughing or simply breathing (as happens with measles) can rapidly spread the infection to many people. When they do so in a public setting, they immediately extend the geographic spread of that pathogen beyond that person’s close contacts.

Think about how quickly the 2009 H1N1 influenza strain and Covid-19 spread around the world. This certainly explains why there was so much reporting about the increase in HMPV cases in China. But it’s important to put these infections in context. Unlike Covid-19, HMPV is a well-documented seasonal virus that has coexisted with human populations for decades. Understanding transmission requires looking beyond the simple fact of spread to examine whether a pathogen is following known patterns or exhibiting new behaviors.

Consider also the 2022 mpox outbreak. When it originally arose, there was concern that it might spread by the respiratory route similar to its sister virus, smallpox. But, to date, transmission appears limited to direct physical contact and the sexual route, which is why infections in the United States have largely been restricted to gay men and people in their sexual networks.

How severe is it?

Disease severity matters, but often not in the way that people think. Infections that kill a high percentage of people and that do so quickly can often be contained more easily than other infectious diseases. It is easy to identify and isolate the ill, and the ill have fewer opportunities to spread infections to other people.

Consider why Ebola never caused widespread outbreaks in the United States. People with Ebola are at highest risk of spreading infection when they are most severely ill – that is, they are not walking around, but rather confined to their bed or a hospital room.

Infections spread rapidly in settings in Africa, where infection control in health care facilities is inadequate, and where it is a common cultural practice for multiple people to bathe and touch a person after they have died – that is, at the moment of peak infectivity. Therefore, even though Ebola is a severe disease, those who are most severely ill in the United States are likely to be in a setting where they cannot readily spread the infection to others.

Consider also why SARS was contained, but Covid-19 has not been. With SARS, people did not readily spread the infection until they had symptoms. Even though those symptoms were severe (the “S” stands for severe), people could not readily spread it to other people because they were so ill.

Covid-19, in contrast, could infect people and not cause any symptoms. Many people cited this as a reason for why we should not be particularly worried about the virus. But, for infectious disease epidemiologists, this was one of its most worrisome features: People with minimal symptoms would walk around and spread it to lots of people without knowing it.

What tools exist?

Our capacity to respond to a disease threat represents the third crucial element in risk assessment. Do we have drugs that can reduce symptoms, reduce infectiousness, and/or cure disease? Do we have vaccines that can prevent severe illness and reduce infectiousness?

This is one reason Covid-19 was so problematic. When this pathogen emerged, we had no drugs or vaccines available and had to rely on masks and social distancing to reduce transmission. H5N1, bird flu, is particularly worrisome because existing influenza vaccines do not reliably prevent infection or reduce the severity of disease.

Thinking critically about outbreak news

In a world where information travels far faster than infections, it is more important than ever to think critically about reports of new diseases or outbreaks. While dramatic stories about individual cases may capture headlines, pay attention to both what these reports include and omit, particularly as it relates to laboratory testing, routes of transmission, disease severity, and existing treatments and vaccines. Evaluating the data behind the story is key to separating fear from fact.

As flu recedes in Georgia, health officials warn of measles, whooping cough threats

2025-03-28T18:23:42+00:00

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Even as one of the most severe Georgia flu seasons in recent years continues to recede, health workers in the metro Atlanta area continue to express caution about respiratory, vaccine-preventable diseases.

Throughout March, hospitalizations and health care visits for flu have continued to decline in the state, according to data from the Centers for Disease Control and Prevention. Although there were some signs that local Covid cases could be on the rise, this week’s CDC wastewater update indicates that the virus’ levels are beginning to drop.

These declines represent a shift from a flu season that has killed 130 Georgians since early October, according to the state’s Department of Public Health. The agency’s archives indicate it’s the highest number of seasonal Georgia deaths through the last week of March since 2018.

“Hopefully we won’t have any more flu activity,” Cobb and Douglas Public Health epidemiology director Rachel Franklin said at Thursday’s Cobb County Board of Health meeting. “Sometimes we see a little bump in the springtime with flu B. But so far, we’re looking pretty good.”

The CDC recently estimated that under 40% of adults in the state have been vaccinated against the flu this season. At the Cobb County meeting, local health director Dr. Janet Memark said under-vaccination against other preventable diseases could lead to a rise in a variety of sicknesses in the near future.

‘What should I look out for?’ Pediatrician shares insights on measles and its metro Atlanta impact

Memark and Franklin spoke about recent measles outbreaks throughout the United States, including along the Texas and New Mexico border that have infected at least 444 residents. They highlighted the Georgia cluster from earlier this winter, which Franklin said was contained to just three children, and a 2019 outbreak that was centered in Cobb County.

Memark said public health investigators like herself contacted over 3,000 people in the 2019 outbreak.

Janet Memark, the Cobb and Douglas Public Health director, speaks at the Cobb County Board of Health meeting in Marietta, GA, on March 27.

“We’ve already had multiple outbreaks in the metro area,” she told the board. “So please, get your kid vaccinated and make sure you follow the recommendations.”

She also brought up a rise in Georgia cases of pertussis, also known as whooping cough. In adults, the disease can cause coughing fits severe enough to induce vomiting or crack ribs. In babies, the bacteria can stop them from breathing.

As of Thursday, the Georgia DPH had identified 125 confirmed or probable cases of whooping cough this year, according to agency spokesperson Nancy Nydam. That puts on the state on pace for more cases than in 2024, when the health department warned about a rise in the disease.

The CDC recommends a series of whooping cough vaccines for children and a single shot for some adults, like people 65 or older and health care workers who are frequently exposed to the disease. Dr. Paula Greaves, a Cobb County Board of Health member and an OB-GYN at WellStar Health system, said at the Thursday meeting the case increase is a good reminder for expecting parents to get vaccinated

“If you’re seeing an uptick in pertussis, then that means that we have to uptick our campaign for prevention,” she told Memark.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Was the U.S. Covid pandemic response too much? Six questions to consider

2025-03-28T13:59:24+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In January 2020, countries around the world were forced to confront a brand new virus. We had no prior understanding of how it spreads or what it does to the body, and we lacked tests, drugs, and vaccines for it.

Five years later, it is abundantly clear that governments at all levels made missteps in how they managed what became the Covid pandemic, and, given the high likelihood of future pandemics from emerging infectious diseases, it is important to re-examine what we got right and wrong, so societies can respond more effectively the next time.

In recent months, a particular narrative has gained momentum. This narrative — often labeled Covid revisionism — suggests that the U.S. government’s response to the virus did more harm than good, that efforts to slow transmission through physical distancing, masks, and vaccines were misguided or excessive. Had we simply accepted the virus’ spread, society would have been better off, some argue.

The narrative that the United States should have had fewer or different virus control measures glosses over some important considerations. From April 2020 to May 2021, I served as the lead health adviser to the New York City mayor for the Covid response. Based on my experience, I offer six questions for everyone to consider.

1. How much power did public health experts actually have over elected leaders?

A common concern raised by those critical of Covid control measures is that a small number of scientists and public health officials exerted too much power. A recent New York Times podcast said one major problem with the U.S. pandemic response was “too much power was accorded to narrow experts in public health and epidemiology.”

In practice, however, virtually all significant policy decisions — particularly those affecting business closures, schools, and masks — were made by elected officials. Governors and mayors consulted with health experts within government and academia, but they were almost always the ones weighing the trade-offs, exerting their legal authority to restrict personal liberties, and taking responsibility for the choices that were made.

To suggest otherwise overlooks how democratic governance actually functioned during the pandemic. In the United States, public health officials at state and local levels report to a democratically elected executive or, in some situations, a board of public representatives. These health officials made recommendations, and elected leaders chose whether and how to implement them. If we want to improve our response to future infectious disease emergencies, it is important to scrutinize how these leaders used expert advice — not paint an inaccurate picture of technocratic overreach.

2. Were the social and economic costs ignored?

Another claim we often hear is that only a small group of dissenters were willing to talk about the mental health effects, economic damage, or social disruption caused by Covid control measures. These dissenters argue that public health officials were singularly focused on lives saved and failed to consider the loss of livelihoods.

In my experience, this was never the case. When I served in City Hall in New York, almost every major discussion I had with government officials involved me presenting multiple scenarios. I would start with the extreme scenario of us attempting to avert every illness and death, contrast that with the opposing extreme scenario of taking no action, and then discuss various policy options between these two.

How improving air quality in schools would minimize the threat of bird flu spread

Every policy option presented to the mayor was developed by a diverse team that included public health experts and people with backgrounds in law, policy, business, and community engagement. We spent countless hours debating how to protect vulnerable populations, support small businesses, and address acute and long-term mental health harms of these measures. Every decision involved excruciating trade-offs, and no one took them lightly.

Criticism is vital. Some measures seemed irrational — for example, liquor stores stayed open, while schools closed — and some measures lasted too long or were applied unevenly. These were the result of a messy democracy, reflecting a need for elected officials to balance competing centers of power in our society. To suggest that these consequences were ignored doesn’t reflect the reality I witnessed, where leaders agonized over these issues.

3. How should society think about acceptable loss of life?

Perhaps the most difficult — and least discussed — question is this: How many deaths are acceptable in a public health emergency? There is no simple or comfortable answer. Every pandemic policy requires balancing lives lost against the costs of prevention.

Those who supported strict control measures prioritized preventing illness and death. The rationale for this argument was straightforward: We have technologies to address poverty and depression from virus control measures; we do not have a technology to resuscitate the dead from the virus; and restrictions can be progressively lifted as vaccines and treatments become available.

Most important, as I have written elsewhere, how much a society should sacrifice to avert one death is not a question to be answered by scientists or epidemiologists. It should be answered by democratically elected leaders. These are decisions about values: How much is a life worth, and what responsibility do I have as an individual and does my government have overall for protecting a person’s life?

While it is ethically sound to argue that government should prioritize liberty over public health, I often hear Covid revisionists make an alternative argument. They try to impugn scientific understanding or epidemiologic statistics — questioning death estimates, vaccine effectiveness, or studies that show the risk of Covid to cardiovascular health — without wrestling with the more difficult question: If the scientific consensus is, in fact, accurate, do we still believe that fewer restrictions are acceptable?

To have an honest reckoning, we must be explicit about our values. Just as those advocating for strict measures made it explicitly clear that they prioritize averting deaths over personal liberty, the contrarians should be explicit in saying that they accept deaths as the cost of preserving liberty — and be willing to say exactly how many deaths are acceptable.

4. What was the alternative to stay-at-home orders when hospitals were overwhelmed?

One of the most sobering realities of spring 2020 was the strain placed on hospitals. In New York City, refrigerator trucks lined the streets to store bodies. Emergency departments were filled beyond capacity. Health care workers pleaded on social media with the public to stay home, because the system could not handle more patients. Many severely ill people, sadly, took this message to the extreme and died at home without seeking care.

Some critics argue that younger, healthier people should have been allowed to go about their lives during this time. But what would that have meant in practice when the health care system was already on the brink? Would we have told people that, if they got sick or injured, care might not be available? That their grandparents, neighbors, or co-workers might die unattended? That there may not be any space in the emergency department for young and healthy people if you are in a car accident or break your leg on the basketball court?

If we’re rethinking the response, it is worth asking what options we realistically had when we could not build more hospital beds or staff those beds safely, when the very infrastructure of care was at risk of collapse.

5. Should long-term health effects be part of the conversation?

The dominant focus in many debates about Covid policy is acute outcomes, such as hospitalizations and deaths. But, over time, we’ve learned that the virus can cause significant long-term health problems: heart attacks, strokes, clots, and a debilitating, poorly understood condition broadly referred to as “Long Covid.”

These conditions affect millions of Americans and have real consequences for people’s ability to work, care for families, and enjoy daily life. If we had known more about these long-term impacts in 2020, would that have changed how we weighed risks and benefits?

Any honest reassessment of the pandemic response should include these effects in the equation. Ignoring them presents an incomplete picture of the harm Covid can cause.

6. Do those who died from Covid get a voice in our reassessment of the past?

Finally, it is worth reflecting on who is not part of today’s debate: the millions who died. Survivor bias is powerful. It’s easy to criticize restrictions when you were lucky enough to come through the crisis without death or disability. I suspect many who died of Covid would have welcomed more efforts to protect their lives.

Keeping society functioning during a pandemic requires more than just protecting those fortunate to survive. A large percentage of the population had risk factors that put them at greater risk of Covid complications, and many of these still had to serve as “essential workers.”

Another group of advocates — some of whom have been diagnosed with Long Covid or who have medical conditions that put them at higher risk of Covid complications — argue that the United States did too little to contain the virus during the peak of the pandemic and continues to do too little to protect vulnerable populations.

There is no single right answer to how societies should handle pandemics. Every approach will involve trade-offs, regrets, and a need for humility. I used to tell colleagues and reporters that all options before us are bad and that we are trying to choose the least bad path forward. Each decision ideally starts with science, but turning science into policy requires a complex assessment of benefits, harms, feasibility, acceptability, affordability, legality, and ethics.

It is healthy in a democracy to challenge consensus, to debate what went wrong during the peak of the pandemic, and to listen to those who felt unheard or harmed by policy decisions. As we do so, we should also be wary of oversimplified narratives. The truth of the Covid response is more complex than either triumph or failure. As we reflect, we must hold space for different perspectives — while also insisting that those perspectives wrestle with the full scope of the crisis, not just the parts that fit our preferred narrative.

Covid cases in Georgia could soon see an uptick, CDC data show

2025-03-21T18:14:11+00:00

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While severe respiratory disease cases in Georgia have subsided significantly over the past few months, some early signs indicate the state could soon see a rise in Covid-19 infections.

Compared to the previous few winters, Georgia saw a relatively low number of hospitalizations and deaths related to the disease. But state wastewater data, which can help predict those two health outcomes, from the Centers for Disease Control and Prevention show an uptick in Covid-19 levels that is nearing the highest estimates of this year.

The virus more responsible for hospitalizing Georgians over the past few months has been the flu. Since October, it’s hospitalized more state residents than Covid and respiratory syncytial virus combined, according to data from the CDC.

But unlike Covid, flu and RSV measures from the Atlanta-based health agency indicate that new cases of the respiratory viruses continue to decrease as the winter turns to spring. As of the first week of March, new Georgia hospitalizations for the flu have dropped about 70% since the beginning of February.

Although it’s been responsible for less hospitalization this year, Covid-19 continues to be more deadly than flu. Since December, the virus has killed over 200 state residents, according to the CDC. In contrast, the Georgia Department of Public Health reports there’ve been 124 Georgia flu deaths since October.

The most recent surveys from the CDC estimate that between 13% and 18% of Georgia adults have received an updated Covid-19 vaccine for the 2024-25 respiratory virus season. That’s lower than the national average, which the agency puts at around 23%.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

How improving air quality in schools would minimize the threat of bird flu spread

2025-03-21T11:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Experts are growing increasingly worried that bird flu – avian influenza H5N1 – will evolve into a strain that causes widespread illness and death in humans and that the federal government is neither sufficiently containing the epidemic in animals, nor preparing sufficiently for widespread human illness.

While containment, preparedness, and overall response for national epidemics are inherently federal government responsibilities in the United States, there is one critical intervention that states and large cities should take now: Improve indoor air quality in schools and congregate settings.

State of bird flu epidemic: Threat is growing

The number of mammal species that can be infected is growing. While animal illness and deaths have been primarily in those in the wild or raised for food, infections are now spreading to household companions, such as cats, including two recent cases in New York City, and there is concern of infection spreading both human-to-pet and from pet-to-human.

Until now, most humans in the United States have been infected through close contact with an infected animal with only 70 cases (as of Tuesday). It is likely that many more infections have occurred but not been diagnosed and counted. Evolutionary changes in the virus suggest that it has a high likelihood of evolving into a strain that humans can spread to each other through the air.

To date, public concern has largely focused on food prices, food safety, and the health of pets. Experts have been focused on improving biosecurity on farms; improving surveillance in animals, humans, the environment, and food; and development of vaccines for chickens, cows, and humans. Across these discussions, the extreme impact that the Covid-19 pandemic had on all aspects of the country remains front and center.

Harms of virus vs. harms of virus-control measures

Central to the ongoing, intense debate about whether the U.S. Covid-19 response was too aggressive or not aggressive enough is the question: How does government balance the harms of the virus against the harms of virus-control measures? Between those that believe government did too much and those that believe government did too little, there are two areas of broad consensus:

Government should have done more to protect people living in nursing homes and assisted-living facilities from the harms of the virus.
Government should have done more to continue in-person schooling and protect children from the harms of the virus-control measures.

If H5N1 leads to a pandemic, governments will face an extreme challenge again protecting those most vulnerable to severe illness and death and ensuring that in-person schooling continues. Notable, there is one intervention that can substantially help with both: improving indoor air quality.

Why does indoor air quality matter for infectious diseases?

Infectious diseases that transmit through the air have the greatest potential to cause pandemics and impair health and wealth, because one human can readily infect multiple susceptible humans during a single interaction.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

Infectious disease control over the past 100 years has focused primarily on developing medical interventions (e.g., vaccines, antimicrobials), or stopping transmission through direct physical contact (e.g., handwashing, gloves, condoms), surfaces and materials (e.g., sterilizing equipment, cleaning surfaces), and consumables (e.g., water, food). Far less has been invested in ensuring that air — particularly indoor air — is made as safe and clean as surfaces, hands, water, and food.

How do we clean indoor air?

There are three general approaches to cleaning air. The first is ventilation: Ensuring that new air replaces old air. One reason infectious diseases do not transmit efficiently outdoors compared to indoors, is because there is a constant supply of new air (i.e., air free from infectious disease particles) to blow away old air (i.e., air that may contain infectious disease particles). In indoor settings, ventilation can be improved by opening windows and ensuring that central air systems pull old air out and push new air in frequently.

The second approach is through filtering air. Air can be blown by a fan through a filter that traps infectious disease particles, and the air that leaves the filter is considered fresh. These filters can either be installed in centralized air systems or in portable air purification devices.

The third approach is to disinfect the air by using ultraviolet energy (known as “germicidal UV”) to inactivate or kill infectious organisms in the air.

Studies performed in laboratories and real-world settings have conclusively demonstrated that all three of these approaches work on their own and synergistically to disinfect air and reduce human infections from airborne viruses (measles, influenza, Covid-19), bacteria (tuberculosis), and fungi.

The most recent comprehensive high-quality review of indoor air quality was conducted as part of The Lancet Commission on Covid-19, which concluded that indoor air-quality improvements can reduce transmission of Covid-19 and other respiratory infectious diseases in schools and congregate settings. In this review, they also highlighted additional benefits to overall health and cognition, beyond preventing respiratory infections, from these interventions.

Invest in indoor air in congregate settings and in schools

Covid-19 demonstrated the critical importance of improving indoor air in congregate settings and in schools. Covid-19 spread wildly through assisted-living facilities and skilled nursing homes and caused over 200,000 deaths. Many infections and deaths in these facilities could have been greatly reduced by improving indoor air-quality measures.

Much of the backlash against Covid-19 control measures focused on the closure of in-person schooling. Without in-person learning, children have impaired social, emotional, cognitive, and physical development, and many lose access to food and nutrition. Parents face difficulty working (either in-person or remotely), which directly impairs the economy.

The backlash against virus control measures in schools crossed the political spectrum and greatly eroded trust in government policies and institutions. Parents were angry at health and school officials; teachers were angry at parents and school officials; students became depressed; and elected officials fomented this anger to advance their political agendas.

Without question, the United States will struggle to implement and maintain an effective all-of-society response against a future H5N1 influenza epidemic unless schools are made as “pandemic proof” as possible. Keeping schools open and safe during a future emergency would greatly improve public trust in health experts and government.

What should states do now?

One of the most important pandemic preparedness initiatives after Covid-19 emerged was the White House Summit on Indoor Air Quality, which led to detailed guidance from the Centers for Disease Control and Prevention and the Environmental Protection Agency that never existed before. Industry, expert groups, and academic centers have also published detailed guidance on what governments and building operators can do. In most situations, states and cities will need to enact laws and regulations, and allocate funding for upgrading facilities and monitoring compliance.

The question most people ask is: Why make the investment in new regulations and building upgrades if we are not certain there will be a bird flu epidemic, particularly when there is a movement to shrink the size and budget of government?

The answer is that we know these investments will benefit health and productivity even if there is never a bird flu epidemic. They can help us reduce the spread of routine seasonal airborne flu and Covid-19, as well as outbreaks of measles. They will reduce the impact of allergies and pollution. They will protect people when there are wildfires.

The time to prepare our defenses is now.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

2025-03-20T11:00:00+00:00

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Following the bird flu-related deaths of two cats, the New York City Department of Health and Mental Hygiene is advising owners to avoid raw pet food.

Since 2022, the U.S. Department of Agriculture has reported more than 90 confirmed cases of bird flu in domestic cats. Those cats have typically lived on dairy farms or roamed outdoors. But cases have started to emerge of house cats being infected with bird flu, often from raw food or unpasteurized milk.

In New York City, bird flu was detected in two cats and a possible third cat in the recent months, in connection to raw poultry sold by Savage Cat Food, according to the Health Department. The company sells “prey-based” raw cat food, in flavors like chicken, rabbit and lamb, and duck, according to its website.

“We strongly encourage New Yorkers whose cats are experiencing illness after consuming Savage Cat Food products or other raw meat or dairy products to contact their veterinarian,” Dr. Michelle Morse, the acting health commissioner, said in a recent statement.

The highly pathogenic H5N1 bird flu, an influenza virus, has spread widely across the United States in recent years, primarily among birds and dairy cows. The Centers for Disease Control and Prevention has reported 70 human cases since the start of 2024, and one human death. There is no evidence of human-to-human transmission of the virus in the current outbreak.

In New York, bird flu has been occasionally detected in wild birds, backyard flocks and poultry across the state since 2022. Last month, the state temporarily shuttered all live bird markets in New York City after detecting the virus among poultry.

Cats appear to be especially vulnerable to bird flu. While there have been no confirmed cases of cat-to-human transmission during the current outbreak, it has happened before. In New York City in 2016, a veterinarian was infected with a different type of bird flu after interacting with a sick cat.

Here’s what to know about cats and bird flu.

How do cats get bird flu?

While bird flu has been detected in many animal species, cats are “very susceptible to this infection,” said Dr. Bruce Kornreich, the director of the Cornell Feline Health Center.

Cats can pick up the virus in a number of ways, including by eating raw meat and poultry products or drinking raw cow’s milk. They can also get infected by coming into contact with infected livestock, poultry, wild birds, or people and their clothing.

Last year, bird flu was detected in domestic cats in different households in Michigan. In both cases, according to a CDC report, the cats lived with people who worked on dairy farms, and the cats developed respiratory and neurologic illnesses. One cat owner worked transporting unpasteurized milk to farms, including those with cattle infected with bird flu, and their cat would often roll around in their work clothes.

What should pet owners know about raw food?

In New York City, the Health Department traced the two recent feline deaths back to raw food sold by Savage Cat Food. One of the cats became ill after eating a chicken product and was hospitalized with fever, loss of appetite and severe respiratory infection before dying.

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A second cat was diagnosed with bird flu and died following a fever and severe respiratory and liver disease. While that cat had not eaten Savage Cat Food, it had been exposed to a third cat, which became ill after eating Savage Cat Food, but survived. Testing on the second cat indicated that it had been infected with a bird flu strain found in the raw food.

In a letter to consumers, Savage Cat Food said that it issued a recall for the contaminated food and contacted retailers. The bird flu cases were connected to Savage Cat Food packets with lot number 11152026.

While some pet owners opt to feed their pets raw diets, the American Veterinary Medical Association and the CDC discourage the practice due to the risks to animal and human health.

Kornreich advised pet owners to provide their pets with cooked food and avoid raw diets.

“It’s just not worth the risk,” he said.

What are the symptoms of bird flu in cats?

Early symptoms of bird flu in cats include fever, loss of appetite and lethargy. As the illness progresses, cats might exhibit eye and nose discharge, respiratory issues, coughing, sneezing, and neurologic signs, including lack of coordination, seizures and blindness.

Any of those signs is a cause for concern, Kornreich said, especially if the cat has eaten raw food, been exposed to sick pets or people, preyed upon a dead bird, or been exposed to poultry or a dairy barn. If a pet owner notices those symptoms, the cat should be isolated from other pets and people, the owner should thoroughly wash their hands, and immediately contact a veterinarian, he said.

If infected with bird flu, cats have “very high morbidity and mortality,” Kornreich said.

There is no cure for bird flu in cats, and treatment is primarily supportive.

What about dogs?

The American Veterinary Medical Association notes that the likelihood of dogs being infected with bird flu is very low. Still, dogs could become sick from eating ill or dead infected birds, drinking unpasteurized milk, or eating undercooked, or raw meat.

The CDC advises pet owners to prevent their animals from interacting with wild birds, backyard poultry, cows, or indoor animals; to keep pets away from clothing, surfaces, and areas that could be contaminated with bird flu; and to avoid feeding pets raw food or milk.

Additionally, the Health Department advises New Yorkers to avoid dead or sick animals while walking their dogs.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Flu and RSV decline from respective winter peaks in Georgia

2025-03-14T20:06:35+00:00

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After months of rapid respiratory disease spread and sickness, Georgia and Atlanta cases of Covid-19, flu, or RSV appear to be declining from their respective winter peaks.

As of the first week in March, state hospitalizations for any of the three common viruses have continued to decrease dramatically since early February, according to data from the Centers for Disease Control and Prevention. The change is largely driven by lower in-patient stays for flu and RSV, which saw high spikes earlier in winter.

Additionally, the percentage of state heath care visits for flu-like sickness was lower than it has been since mid-November. Covid and RSV’s Georgia wastewater levels, which can help predict future hospital visits for infectious diseases, have also largely receded from measures taken earlier this winter.

In December, scientists with the federal health agency predicted that the upcoming health care burden of these three diseases would be similar to or lower than the previous winter’s numbers. So far, that forecast has largely come true

But there are some measures of this winter’s respiratory season that have surpassed last year’s severity. Since October, there have been 104 Georgia flu deaths, according to the state’s Department of Public Health.

That’s more than twice the Georgia death toll as there was in the same period last year, although CDC data indicates the number of fatal Georgia Covid cases this season is likely lower than any winter since 2020.

And Atlanta health professionals have warned residents that there could be another respiratory disease surge at a nontraditional time, such as the summer. That’s why many have continued to advocate for Georgians who have yet to get vaccinated for Covid-19 and flu to seek immunization against the diseases.

In an early March CDC survey, the agency estimated that about 37% of adults and 47% of children in Georgia had received flu shots this season, and only 9% of kids and 15% of adults in the state have been vaccinated against Covid-19. The same surveys estimated that the national averages are higher than Georgia’s except for pediatric flu vaccinations, which are similar.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Long Island measles case reported, possible public exposure at Queens hospital

2025-03-12T16:23:23+00:00

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The New York State Department of Health has reported a case of measles in a Long Island child, the state’s first case confirmed outside of New York City this year.

The Health Department announced the case on Tuesday, describing the patient as a Suffolk County resident under the age of 5. The child was unvaccinated, according to the Suffolk County Department of Health Services. The announcement follows two cases of measles confirmed in infants in New York City earlier this year, bringing the state’s total number of measles cases in 2025 to three.

Measles is a highly contagious respiratory disease that is preventable through the measles-mumps-rubella (MMR) vaccine. For those who are unvaccinated, particularly children, the disease can lead to serious complications or even death.

New York’s recent measles cases have emerged amid a rapidly growing outbreak on the Texas-New Mexico border, which has resulted in two deaths. Other measles outbreaks have been reported in a dozen jurisdictions across the country this year, including in Georgia and New Jersey.

Two measles cases have emerged in New York City. Here’s what to know and how to protect yourself.

The Long Island measles patient is being treated at Cohen Children’s Medical Center in Queens, which is part of Northwell Health, according to public health officials. The state and local health departments warned the public of at least two potential public measles exposures at the hospital from the case. Members of the public who visited the hospital’s pediatric emergency department from Mar. 3 to Mar. 4, or the Medicine 3 inpatient unit from Mar. 3 to Mar. 6, may be at risk of a measles exposure. Visitors who believe they may have been exposed should contact their local health department, or reach out to their doctor or pediatrician.

The child did not attend daycare or school while infectious, and other potential exposures are being assessed, according to the local health department.

“We are actively working with public health officials under established exposure protocols to ensure no further cases arise from this incident,” Northwell Health spokesperson Joseph Kemp said in a statement. “The situation underscores the critical importance of vaccinations, including the MMR vaccine, and the need for them to help prevent diseases like measles and minimize the risk of spreading these diseases.”

Public health officials urged residents to ensure that they are up-to-date on measles vaccinations.

“Measles can be very serious. It’s much more than just a rash as complications can include pneumonia and inflammation of the brain, and often results in hospitalization,” State Health Commissioner Dr. James McDonald said in a statement. “The most important thing people can do to protect themselves is to ensure they’ve been properly immunized against measles and immediately get a shot if they are not.”

Children should receive the first dose of the MMR vaccine at 12 months of age, followed by a second dose at 4 to 5 years of age, according to the childhood immunization schedule. Two doses of the MMR vaccine are 97% effective at preventing measles.

Public health experts stress that the MMR vaccine is safe and effective. But vaccination levels in some parts of New York state have fallen below the 95% threshold of immunization coverage needed to reach herd immunity, or widespread community protection.

In Suffolk County, only 82.6% of children had received one dose of the MMR vaccine by 2 years of age as of January 1, according to data from the state Health Department.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

MRNA vaccines, once a Trump boast, now face attacks from some in GOP

2025-03-11T11:00:00+00:00

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Researchers racing to develop bird flu vaccines for humans have turned to a cutting-edge technology that enabled the rapid development of lifesaving covid shots.

There’s a catch: The mRNA technology faces growing doubts among Republicans, including people around President Donald Trump.

Legislation aimed to ban or limit mRNA vaccines was introduced this year by GOP lawmakers in at least seven states. In some cases, the measures would hit doctors who give the injections with criminal penalties, fines, and possible revocation of their licenses.

Some congressional Republicans are also pressing regulators to revoke federal approval for mRNA-based covid shots, which President Donald Trump touted as one of the signature achievements of his first term.

The opposition comes at a critical juncture because vaccines using mRNA have applications well beyond avian flu and covid. They hold the promise of lifesaving breakthroughs to treat many diseases, from melanoma to HIV to Zika, according to clinical trials. The proposed bans could block access to these advances.

MRNA is found naturally in human cells. It is a molecule that carries genetic material and, in a vaccine, trains the body’s immune system to fight viruses, cancer cells, and other conditions. An advantage of mRNA technology is that it can be developed more quickly to target specific variants and is safer than developing a vaccine made from inactivated virus.

“Right now, if we had a bird flu pandemic, we would have a shortage of the vaccine we need,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “The one thing that could save us is mRNA vaccine. The challenge would be if mRNA is banned. This is truly dangerous policy.”

The pushback conflicts with innovations championed by Trump. He assembled tech tycoons at the White House just after his inauguration to announce Stargate, a $500 billion artificial intelligence initiative that could help transform cancer treatment by creating tumor-targeting mRNA vaccines. The fledging partnership between Oracle, SoftBank Corp., and OpenAI, co-founded by Elon Musk, envisions leveraging AI in part to improve health outcomes. Patients would undergo blood tests and AI would be used to find cancer.

Scientists would examine the DNA and RNA (RNA and mRNA serve different functions in a cell) of a specific patient’s tumor to create a vaccine to teach that person’s immune system to target and destroy cells driving cancer growth.

“Imagine early cancer detection, the development of a cancer vaccine for your particular cancer aimed at you, and have that vaccine available in 48 hours,” Oracle co-founder Larry Ellison said at the White House event.

Scores of mRNA clinical trials for cancer vaccines are underway and some have shown dramatic results, cutting the risk of death and recurrence roughly in half for certain patients. In research led by the Yale School of Medicine, for example, patients with advanced kidney cancer remained cancer-free about three years after an mRNA-based treatment in an early-phase trial.

But some politically conservative doctors, lawmakers, and researchers question the safety of mRNA vaccines, especially covid shots made with the technology. Robert F. Kennedy Jr. unsuccessfully petitioned the FDA in 2021 to rescind approval for covid shots and called them “the deadliest vaccine ever made” — a controversial statement that has been refuted.

Now that he’s newly confirmed as Health and Human Services secretary, Kennedy is poised to oversee federal approvals of vaccines, with the power to shape policy such as immunization schedules and appoint vaccine opponents to committees that advise on the approval of shots.

Bloomberg reported late last month that Trump administration health officials were reevaluating a $590 million contract for bird flu shots that the Biden administration awarded to Moderna as part of its push to examine spending on mRNA vaccines.

HHS and White House spokespeople didn’t return emails seeking comment.

Support for an mRNA ban is coming from other sources too. Florida Gov. Ron DeSantis on March 5 urged the Centers for Disease Control and Prevention to stop recommending the covid-19 vaccine for children and called for a state ban on mRNA vaccine mandates. In February, Rep. Thomas Massie (R-Ky.) said on X that the “FDA should immediately revoke approval of these shots,” and Sen. Ron Johnson (R-Wis.) is leading an investigation into the safety of the vaccines. Trump in February signed an order to strip federal funds from schools that require covid shots for attendance.

Vaccine skepticism has become pronounced among Republicans since the pandemic. Four in 10 Republicans who responded to a KFF poll published in January said it was “probably” or “definitely true” that “more people have died from covid-19 vaccines than from the virus itself.” Just a quarter of Republicans reported holding that view in 2023.

The effort is also finding traction at the local level. A district health departmentoutside Boise, Idaho, last year banned its health department from administering covid-19 vaccines, and local lawmakers in Franklin County, Washington, passed a resolution in February against mRNA vaccines.

The ABCs of mRNA

The CDC recommends covid vaccines for anyone 6 months and older, especially seniors and people who are immunocompromised. About 29 million doses had been administered to adults in the 2024-25 season in retail pharmacies and doctors’ offices through Feb. 8, based on federal data.

Given as a shot, mRNA enters muscle cells and teaches them to produce a spike protein found on the surface of a virus. The body’s immune system then targets the spike protein, priming it to identify and fight the virus — in this case, the coronavirus that causes covid. The body’s cells then break down the mRNA and remove it, according to federal health researchers.

More than 13 billion covid vaccines had been administered worldwide as of August 2024.

Researchers say the vaccinations saved countless lives — estimates for the first year alone go as high as 19.8 million — in the throes of a pandemic that had hospitals ordering refrigerated mobile morgues and deliberating over which patients to put on ventilators. Two University of Pennsylvania scientists credited with developing the mRNA technology behind the shots were awarded the Nobel Prize for medicine in 2023.

The FDA says the covid vaccines are safe, with fewer than 1 in 200,000 vaccinated individuals experiencing a severe allergic reaction or heart problems like myocarditis or pericarditis, and the agency notes that “inaccurate informationabout these vaccines, particularly the mRNA COVID-19 vaccines, continues to circulate.”

While many people hadn’t heard of the mRNA platform until the covid shots were rolled out, it was discovered in the 1960s. The first mRNA flu vaccines were tested in mice in the 1990s. A clinical trial involving direct injection of mRNA to fight cancer occurred in 2008. Clinical trials involving the covid mRNA vaccines involved tens of thousands of volunteers.

Reviews of mortality data showed “no unusual patterns of death were detected that might suggest a potential safety concern,” based on a September 2024 report by a technical working group that provided guidance to the CDC.

But those calling for a ban on all mRNA vaccines say there is a dearth of long-term safety data, and they say covid vaccines by Pfizer-BioNTech and Moderna were hastily approved without proper vetting. They assert without strong evidence that the vaccines cause serious injuries to the heart, nerves, and immune and reproductive systems, and can lead to cancer.

The vaccine has been linked to rare cases of heart inflammation and inflammation of the sac surrounding the heart, although the severity has varied and most patients fully recovered, the CDC says.

“The allegations are beyond reason,” said Anne Schuchat, a career scientist who worked on covid and who twice served stints as acting director of the CDC. “The mRNA covid vaccines were extensively studied after use and do not have those problems.”

“I’m concerned about the whole mRNA technology. I don’t trust anything that fools the body,” said Stephanie Seneff, a computer scientist and anti-vaccine activist at the Massachusetts Institute of Technology. “I’m really glad people are waking up and realizing it’s not the thing to do anymore.”

Vaccines generally work by tricking the body into producing antibodies to fight illnesses.

Pfizer spokespeople didn’t return an email seeking comment. A Moderna spokesperson, Chris Ridley, said legislative efforts to ban or restrict mRNA medicines are largely driven by misunderstandings about their safety profile and mechanism of action. While mRNA-based shots do not modify DNA, for example, that misconception is frequently cited in support of restrictions, Ridley said.

“If enacted, these measures could hinder important research and limit patient access to innovative treatments, potentially delaying life-changing medical advancements,” Ridley said in a written statement.

Networks of Opposition

Groups opposed to the mRNA technology have built a vast and well-funded legal, marketing, and social media network. Members hold conferences to discuss strategies, fund lawsuits against vaccine mandates, and produce reports on the covid vaccines.

As for state legislative efforts, measures introduced this year have varied and their progress has been mixed. Montana’s measure, for instance, was blocked. Idaho lawmakers in February held a hearing on its bill, which calls for a 10-year moratorium on mRNA vaccines. Idaho’s proposal, likely to be amended, as well as Iowa’s and Montana’s have featured criminal penalties for providers who administer all or certain mRNA vaccines. In addition, some state bills, such as legislation in Pennsylvania and Tennessee, focused on the use of the vaccine in livestock and food production.

Various bills are pending in the Texas Legislature to restrict mRNA vaccines in both livestock and humans. South Carolina’s pending bill would require anyone administering certain covid mRNA vaccines to inform patients that the shot is contaminated with fragments of “bacterial plasmid DNA.”

Covid mRNA shots may have minute amounts of residual DNA from production processes but they are heavily degraded and pose no risk, according to the Global Vaccine Data Network, which evaluates vaccine safety concerns.

Speakers at some legislative proceedings have included representatives from Children’s Health Defense, an activist, anti-vaccine group founded by Kennedy.

The Florida surgeon general in January 2024 called for a halt in the use of covid mRNA vaccines. And in Texas, Attorney General Ken Paxton in January moved to appeal a lawsuit he filed claiming Pfizer misrepresented the safety of its mRNA shot.

Efforts to restrict the shots have raised the profile of groups such as the Independent Medical Alliance, which advocates for mRNA-based covid vaccines to be withdrawn from the market.

“We should stop it and test it more before we move forward,” said pediatric cardiologist Kirk Milhoan, a senior fellow at the alliance.

Groups opposed to mRNA shots are pointing to a recent study to urge more caution. Yale University researchers reported in February that they found spike protein still circulating in a subset of individuals with a debilitating, post-vaccination condition. Some of the individuals who experienced chronic illness after getting the shots had detectable levels of spike protein more than 700 days after vaccination. This study was small — 42 participants — and not peer-reviewed.

Its findings also don’t show the spike protein is a health risk or a cause of vaccine injury.

“It’s an initial, provocative study in which you can’t draw conclusions,” said William Schaffner, past medical director of National Foundation for Infectious Diseases. “This is one of the most widely used vaccines around the globe. It’s the furthest thing from an experimental vaccine.”

But what this growing pushback shows, according to some researchers, is that distrust isn’t coming only from fringe groups anymore.

“There are truly amazing mRNA cancer vaccines out there,” said Kate Broderick, chief innovation officer at Maravai LifeSciences, which works on vaccine development. “My fear as a scientist is that it’s been tainted in the public.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

Flu levels in Georgia decline as whooping cough continues to circulate widely

2025-03-10T11:00:00+00:00

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Many of Georgia’s most deadly respiratory diseases have declined over the past few weeks, but others appear to still be broadly circulating as the state approaches spring.

Since a second viral surge in February, state hospitalizations for the flu, Covid-19, or respiratory syncytial virus have sharply decreased, according to data from the Centers for Disease Disease Control and Prevention. The drop has been highlighted by the decrease in the number of overnight hospital stays for flu, which has been the largest driver of illness among the three viruses this winter and so far has killed 95 Georgians since October.

These data match the trends reported from CDC viral wastewater sites, which help public health scientists predict if spikes in health care visits for illnesses are on the horizon. Georgia measurements from flu, Covid-19, and RSV wastewater sites all indicate that the viruses have all receded to more manageable levels than earlier this winter.

Still, other harmful airborne diseases continue to circulate throughout Georgia. In January and February, the state’s Department of Public Health detected 80 probable or confirmed cases of pertussis, according to agency spokesperson Nancy Nydam.

Nydam said last week that the health department accounted for 371 cases of pertussis, a respiratory disease also known as whooping cough, in 2024. While infections are often detected retrospectively and both time periods’ counts could change, that puts Georgia on pace to have more cases this year than in 2024.

State and national doctors have been concerned about a rise in whooping cough, which can prevent babies from breathing in extreme cases, over the past year. In December, Georgia’s health department put out a health advisory for parents and providers to be on the lookout for symptoms of the disease.

While the whooping cough vaccine is less effective at preventing the bacteria than other immunizations, it still offers a strong level of protection against the disease, according to the CDC. Last fall, the Atlanta-based health agency recommended whooping cough vaccinations for anyone who has never received it and periodic shots for kids six years old and under.

Dr. Mark Griffiths, an Emory University pediatric medicine associate professor and medical director of the Children’s Healthcare of Atlanta’s Hughes Spalding Emergency Department, told Healthbeat in February that pertussis is one of many vaccine-preventable diseases that could flourish if parents don’t take steps to protect their children.

“It is a concern that we might start to see some of these other things that we had hoped had been tamped down,” he said.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Two measles cases have emerged in New York City. Here’s what to know and how to protect yourself.

2025-03-07T22:46:50+00:00

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With measles cases on the rise in the United States, public health experts in New York are encouraging vaccination against the highly contagious virus.

Measles spreads easily and can lead to serious complications, or death, among those who are unvaccinated. New York City has confirmed two cases of measles so far this year, according to Chantal Gomez, a spokesperson for the Department of Health and Mental Hygiene. Both cases involved unvaccinated infants, who have since recovered. The cases were unrelated.

In nearby New Jersey, three connected measles cases have been confirmed this year. A significant measles outbreak has also emerged on the Texas-New Mexico border, with more than 200 cases reported as of Friday. Last week, an unvaccinated child in Texas died from measles — the first known measles fatality in a decade — and on Thursday, officials announced the death of an unvaccinated adult with measles in New Mexico.

Dr. Jennifer Duchon, the pediatric hospital epidemiologist and director of antimicrobial stewardship at the Mount Sinai Kravis Children’s Hospital, emphasized that measles is preventable through vaccination.

“We don’t need to have measles outbreaks,” she said. “We have a preventative strategy. People don’t need to get sick, and children don’t need to die from this disease.”

Here’s what to know about measles and how to protect yourself and your family.

How contagious is measles?

Measles is far more transmissible than the flu or Covid-19. The virus remains active and contagious in the air or on infected surfaces for up to two hours, according to the World Health Organization.

That means that if someone with measles enters a room of unvaccinated people, everyone would likely become infected, said Dr. Mark Jit, chair and professor of the Department of Global and Environmental Health at the NYU School of Global Public Health.

In the 1950s, before the development of vaccine, nearly all children had measles by the age of 15, according to the U.S. Centers for Disease Control and Prevention. Of the three million to four million Americans infected each year, about 400 to 500 people died.

The measles vaccine became available in the 1960s, followed by the combination measles-mumps-rubella (MMR) vaccine in 1971. In subsequent decades, as vaccination coverage increased, measles cases fell.

In 2000, measles was declared eliminated in the United States. Today, most measles cases that emerge in the United States are imported through travel to countries with high rates of the disease.

What do we know about measles cases in New York City?

In addition to New York City’s two confirmed measles cases, Montgomery County, Pennsylvania, reported a confirmed case of measles in an unvaccinated child who traveled by bus last week from John F. Kennedy International Airport in Queens to Philadelphia.

The Health Department is aware of that case, but New York City residents were not considered at risk, said Dr. Jennifer Rosen, the Health Department’s director of epidemiology and surveillance. She did not elaborate on how the agency made that determination.

Since New York City is a global travel hub, it’s not uncommon to see measles cases emerge through travel to other countries, she said. But outbreaks are rare.

“That’s really a testament to high vaccination coverage overall in New York City, and particularly among school-aged children,” she said.

Still, vaccination coverage is not equally distributed, and areas with low vaccination rates can increase the risk of local outbreaks.

That’s what happened in 2018, when an unvaccinated child returned to the city from a trip abroad, sparking a large outbreak among Orthodox Jewish communities in Brooklyn, with more than 600 cases by the following summer. The outbreak caused serious illness, particularly among unvaccinated children, but no deaths were reported.

For Rosen, that outbreak highlighted the importance of prompt vaccination and achieving herd immunity, which refers to the percentage of immunized people needed to ensure that a disease can’t spread widely in a community. For measles, herd immunity requires about 95% of the population to be vaccinated, according to the WHO.

“If most people in the community are protected, then even if one person gets measles, they can’t transmit it to anyone, because everyone around them is vaccinated,” Jit said.

How high are New York City vaccination rates?

Overall, MMR vaccination rates in New York City are very high. By kindergarten age, 98% of children have received two doses of the MMR vaccine, according to Health Department data.

But the rate of vaccination among younger children is lower, and has fallen in recent years. For children ages 24 to 36 months, the current coverage for one dose of the MMR vaccine is 81%, a decline from 88% in 2019, according to the Health Department.

The lower rate of vaccination for younger children indicates that “we have work to do,” Rosen said.

It’s a concern for the rest of the state as well. In a recent release, the state Health Department warned that current MMR vaccination rates among 2-year-olds have fallen below herd immunity levels in all counties outside of New York City. Only 81.2% of 2-year-olds statewide, excluding New York City, have received one dose of the MMR vaccine, and some counties have rates under 65%.

What are measles symptoms and how are they treated?

Measles symptoms typically appear a week or two after contact with the virus, and can include a high fever, cough, runny nose, red eyes, or a rash, according to the CDC.

Initially, symptoms can be quite general, making it hard for caregivers or health care providers to differentiate measles from other diseases, Duchon said.

But there are telltale signs. Children experiencing the initial stages of the disease are more “miserable” than they would be with a typical cold or cough, and often have a high fever, Duchon said. About three to five days after initial symptoms, a rash typically develops, which turns white when pressed. The rash tends to start in the face and spread across the body.

Not all measles symptoms look the same, and effects can vary as well, she added.

The disease can lead to encephalitis, an inflammation of the brain, which can be deadly. Measles can also weaken the immune system, making a patient vulnerable to secondary infections like pneumonia. A patient’s diminished immune system can persist for years.

There is no treatment for measles, Duchon said, and care for a patient tends to be supportive. On average, one to three in every 1,000 children infected with measles die.

How can you protect against measles?

Vaccination is the best way to avoid becoming sick with measles, according to doctors and public health experts.

The CDC recommends that children get two doses of the MMR vaccine, with a first dose at 12 months old and a second dose at 4 to 6 years old. Two doses of the MMR vaccine are 97% effective at preventing measles. Most people vaccinated against measles are protected for life.

“The vaccine is safe and efficacious,” Duchon said.

In the late 1990s, a now-debunked study by a British researcher connected an increase in autism diagnoses to the MMR vaccine. Overwhelming scientific evidence shows that the vaccine is not associated with an increased risk of autism.

An early dose of the MMR vaccine is also recommended for children ages 6 to 11 months who are traveling internationally or in the case of a local outbreak. Those children will still need to receive the full two-dose course of the vaccine at 12 months and at 4 to 6 years old.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Respiratory viruses continue to circulate throughout Georgia

2025-02-28T20:29:59+00:00

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As Atlanta and Georgia enter the end of the traditional winter respiratory illness season, there are still signs that airborne viruses are circulating widely.

Data from the Centers for Disease Control and Prevention related to flu, Covid-19, and respiratory syncytial virus indicate a wide range of trends. The number of flu hospitalizations, which have made up the vast majority of Georgia in-patient visits among the three diseases this year, continue to decrease from a second winter peak. But Covid hospital stays have risen throughout February to the highest numbers this winter.

Still, there continues to be significantly fewer state hospitalizations for Covid infections than for flu, which has killed 70 Georgia residents since early October. Georgia’s Covid hospitalization rate remains lower than any winter since U.S. cases were first detected in 2020.

These trends are reflected by the CDC’s wastewater data, which can help public health analysts predict future disease patterns. As of late February, Georgia’s Covid levels have elevated significantly compared to January, whereas flu wastewater sites have detected the opposite pattern.

Additionally, levels of RSV in Georgia have slightly ticked up after declining throughout January and February, indicating that hospitals could soon be seeing more patients with the virus. The rise has yet to approach the state’s December numbers, which were among the highest Georgia levels in years.

Georgia doctors have cautioned that while respiratory disease cases typically decline throughout March, there could be another surge in infections at untraditional times. That’s why many recommend that anyone who has yet to receive a Covid or flu shot over the past few months get one.

A different highly infectious virus, measles, appears to be contained in Georgia. Nancy Nydam, a spokesperson for the Georgia Department of Public Health, said there have been no additional cases related to the outbreak that infected three unvaccinated metro Atlanta residents earlier this winter. She added that potentially exposed residents, most of whom were in communication with local and state public health officials, are now out of the period where a new infection may emerge.

Georgia’s outbreak was relatively small compared to others across the United States. In Texas and New Mexico, 155 residents have contracted measles cases this winter. Earlier this week, Texas health officials announced a child had died of the disease — the first U.S. measles death since 2015.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

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

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.

Flu cases decline in Georgia and Atlanta as Covid rises slightly

2025-02-24T17:49:56+00:00

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Respiratory viruses are beginning to decrease from a second winter peak in Atlanta and across Georgia, data indicate.

Over the first two weeks of February, wastewater at sites throughout the state show a drop of about 40% in measured levels of the flu virus, according to the Centers for Disease Control and Prevention. Wastewater data can forecast other markers of the disease like health care visits and hospitalizations, and those points appear to be decreasing as well after alarming localm health care workers earlier this month.

In mid-February, metro Atlanta doctors said they were treating more flu cases than they had seen in years. Those observations are now reflected in the CDC’s health care data, which show a second winter peak in Georgia flu hospitalizations earlier this month. Similar trends can be seen at the national level, where high flu transmission has also begun to slow down.

The wastewater data signal a decline in flu sickness, but Dr. Mark Griffiths, an Emory University pediatric medicine associate professor and director of the Children’s Healthcare of Atlanta’s downtown emergency department, said it’s important for residents to stay vigilant against a respiratory illness that has killed at least 55 Georgians this season.

‘What should I look out for?’ Pediatrician shares insights on measles and its metro Atlanta impact

“Things are so unpredictable,” he said. “Who knows if there might be another flu surge at a non-traditional time period.”

If that happens, Americans could be more vulnerable to the worst effects of the disease, as the federal government has started taking steps to retire some of its flu prevention efforts.

Other infectious diseases are also continuing to spread throughout the state. While most of this winter’s Georgia respiratory virus hospitalizations have been related to the flu, Covid-19 wastewater levels rose slightly throughout the first two weeks of February. Dozens of Georgians died of causes related to the disease in January, but the count is lower than those over the same time the previous four winters.

The Georgia Department of Public Health has not reported any additional cases in the state’s measles outbreak, one of three the CDC has reported across the country this year. At three cases so far, Georgia’s outbreak is significantly smaller than one along the Western Texas-Eastern New Mexico border, which public health investigators believe has infected at least 99 people.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Texas measles outbreak nears 100 cases, raising concerns about undetected spread

2025-02-21T18:00:13+00:00

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Some private schools have shut down because of a rapidly escalating measles outbreak in West Texas. Local health departments are overstretched, pausing other important work as they race to limit the spread of this highly contagious virus.

Since the outbreak emerged three weeks ago, the Texas health department has confirmed 90 cases with at least 16 hospitalizations, as of Friday. Most of those infected are under age 18. Officials suspect that nine additional measles cases reported in New Mexico, across the border from the epicenter of the Texas outbreak in Gaines, are linked to the Texas outbreak. Ongoing investigations seek to confirm that connection.

Health officials worry they’re missing cases. Undetected infections bode poorly for communities because doctors and health officials can’t contain transmission if they can’t identify who is infected.

“This is the tip of the iceberg,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “I think this is going to get a lot worse before it gets better.”

An unknown number of parents may not be taking sick children to clinics where they could be tested, said Katherine Wells, the public health director in Lubbock, Texas. “If your kids are responding to fever reducers and you’re keeping hydrated, some people may keep them at home,” she said.

‘What should I look out for?’ Pediatrician shares insights on measles and its metro Atlanta impact

Most unvaccinated people will contract measles if they’re exposed to the airborne virus, which can linger for up to two hours indoors. Those infected can spread the disease before they have symptoms. Around 1 in 5 people with measles end up hospitalized, 1 in 10 children develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 children die from respiratory and neurological conditions.

Gaines has a large Mennonite population, which often shuns vaccinations. “We respect everyone’s right to vaccinate or not get vaccinated,” Albert Pilkington, CEO of the Seminole Hospital District, in the heart of the county, said in an interview with Texas Standard. “That’s just what it means to be an American, right?”

Local health officials have been trying to persuade the parents of unvaccinated children to protect their kids by bringing them to pop-up clinics offering measles vaccines.

“Some people who were on the fence, who thought measles wasn’t something their kids would see, are recalculating and coming forward for vaccination,” Wells said.

Schools close due to numerous sick children

Local health departments are also operating mobile testing units outside schools in an attempt to detect infections before they spread. They’re staffing clinics that can provide treatment prophylactically for infants exposed to the virus, who are too young for vaccination. Local health officials are advising day care centers on how to protect young children and babies, and educating school nurses on how to spot signs of the disease.

“I am putting 75% of my staff on this outbreak,” Wells said. Although Lubbock isn’t at the center of the outbreak, people infected have sought treatment there. “If someone infected was in the [emergency room], we need to identify everyone who was in that ER within two hours of that visit, notify them, and find out if they were vaccinated.”

Local health departments in rural areas are notoriously underfunded. Wells said the workload has meant pressing pause on other programs, such as one providing substance abuse education.

Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines, said health officials were following Centers for Disease Control and Prevention guidelines, as of last year, by advising schools to keep unvaccinated children home for 21 days if they shared a classroom or the cafeteria with someone infected. This means that many parents may need to stay home from work to care for their kids.

“A lot of private schools have closed down because of a high number of sick children,” Holbrooks said.

Georgia health agencies work to contain metro Atlanta measles outbreak

The burden of measles outbreaks multiplies as the disease spreads. Curbing a 2018 outbreak in Washington state with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantines, and caregiving.

Public health researchers expect such outbreaks to become larger and more common because of scores of laws around the United States — pending and recently passed — that ultimately lower vaccine rates by allowing parents to exempt their children from vaccine requirements at public schools and some private schools.

CDC immunization committee meeting postponed

Such policies are coupled with misinformation about childhood vaccination now platformed at the highest levels of government. The new director of the Department of Health and Human Services, Robert F. Kennedy Jr., has erroneously blamed vaccines for autism, pointing to discredited theories shown to be untrue by more than a dozen scientific studies.

In Kennedy’s first week on the job, HHS postponed an important meeting of the CDC’s Advisory Committee on Immunization Practices, without saying when it would resume. In addition, the CDC’s letter template to school principals, advising unvaccinated children to remain home from school for 21 days if they’ve been exposed to the measles virus, is no longer on the agency’s website. An old version remains posted on its archive.

As a rule, at least 95% of people need to be vaccinated against measles for a community to be well protected. That threshold is high enough to protect infants too young for the vaccine, people who can’t take the vaccine for medical reasons, and anyone who doesn’t mount a strong, lasting immune response to it. Last school year, the number of kindergartners exempted from a vaccine requirement was higher than ever reported before, according to the CDC.

In Gaines, exemptions were far higher than the national average, approaching 20% in 2023-24. Gaines has one of the lowest rates of childhood vaccination in Texas. At a local public school district in the community of Loop, only 46% of kindergarten students have gotten vaccines that protect against measles.

Amid an outbreak that displays the toll of measles in under-vaccinated pockets of America, Texas lawmakers have filed about 25 bills in this year’s legislative session that could limit vaccination further. Lakshaman said the public — the majority of whom believe in the benefits of measles vaccination — should contact their representatives about the danger of such decisions. Her group and others offer resources to get involved.

“We’ve got children winding up in the hospital, and yet lawmakers who’ve got their blinders on,” she said, referring to pending policies that will erode vaccination rates. “It’s just mind-blowing.”

Amy Maxmen is Healthbeat’s national reporter through its partnership with KFF Health News.

‘What should I look out for?’ Pediatrician shares insights on measles and its metro Atlanta impact

2025-02-20T12:23:50+00:00

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Weeks into 2025, measles cases have been reported in communities across the United States, from Georgia to Alaska to New York. As of Tuesday, a single Western Texas outbreak of the vaccine-preventable disease had infected 58 people — over 20% of the number of 2024 U.S. measles cases.

In Georgia, state and county public health officials have worked to respond to a measles outbreak among three unvaccinated metro Atlanta residents, who are all part of the same family. Last week, Gwinnett, Newton, and Rockdale Public Health Departments Epidemiologist Keisha Francis-Christian said her staff had worked with the state Department of Public Health and other local health agencies to contact over 300 people who may have been exposed to the virus.

Georgia health agencies work to contain metro Atlanta measles outbreak

Healthbeat recently spoke with Dr. Roy Benaroch, a Roswell pediatrician and an Emory University adjunct assistant professor of pediatrics, about how the outbreak has affected his practice. He explains how measles can spread, what short-term and long-term effects measles can have on children, and steps parents can take to keep their kids and communities healthy.

This conversation has been edited for length and clarity.

How has the measles outbreak impacted your practice?

Certainly, parents are hearing about it. Parents are raising some concerns — I’m glad they know about it. We have not seen a case of measles here, but we’ve been over with the staff how to handle phone calls, triage calls. If someone has symptoms that are suggestive of measles, we have a pathway in place to protect them, to get them evaluated, but also to protect our staff and other patients. Because it is so, so contagious.

The first patient to test positive had apparently gone to three different health care facilities. How does something like that happen?

The initial symptoms of measles may not seem very distinctive. It can begin with an ordinary runny nose and cough — sometimes with red eyes, sometimes with a fever. It’s only several days later, three to five days after that, that the very characteristic rash begins. So when the child is somewhat ill with these less specific symptoms, it may not occur to anyone that it could be measles. There are so many more common viruses out there. There’s plenty of flu out there now, plenty of ordinary common cold viruses. So it can seem very much like something of that nature.

You need to really have your antenna up to be very, very, extra careful with a child who, for some reason — perhaps wasn’t vaccinated or has been traveling outside the country — has big risk factors. You have to think about it, but it’s a needle in a haystack problem.

Fortunately, most Georgians are vaccinated, which provides - if you’ve received both doses - 97%-plus protection, preventing you from catching and preventing you from spreading it. But if you happen to be in a community that has a high proportion of people who are unvaccinated, that’s really asking for trouble once that genie is out of the bottle. If it’s in a community that’s not well-vaccinated, it’s going to spread very quickly.

Do you have concerns our community could be approaching that sometime in the future?

That’s what we’re worried about. Although overall vaccine rates are high, there are pockets, there are communities and neighborhoods where vaccine rates have fallen. And they’re much more vulnerable.

Metro Atlanta measles case spreads to two unvaccinated family members

What have some of the conversations with parents lately about measles been like?

Some parents are certainly frightened of it. They want to know what’s going on. They’re concerned that the health department may no longer have the resources they need to tackle this, to track it.

Now, I’m not so sure that’s true. On a national level, there’re concerns about the national leadership and the changes of leadership at the CDC [Centers for Disease Control and Prevention] and these sorts of things. Those are important, but most of the work being done is really boots on the ground, county health departments. And I’m confident they’re on this. They’ve got the people and the resources to track this and do a careful job.

What else are parents talking about?

Parents want to know, “What should I look out for?” That’s the most common. “How do I know if my child could have measles?” And the first question I’ll ask after that is, “Has your child been fully vaccinated?” If a child’s been fully vaccinated, the risk of contracting measles is just about zero. It’s not impossible. The vaccines are never absolutely 100% protective. But with two doses of MMR [measles, mumps, and rubella vaccine], which all children should have by about 15 to 18 months of age, they’re essentially 100% protected. You have a vaccinated child, you really don’t need to worry about your child catching measles.

Now, you may still worry about your neighbors and your family, but the most important single thing for parents to do it just make sure their kids are fully vaccinated.

Researchers estimate that in the United States, 25% of people who get measles are hospitalized. What is the toll of getting a measles case, and what is the experience of getting a measles case in the United States right now?

If you do get measles, you’re in for a pretty rough time. Very high fevers, terrible cough. About 1 in 4 will be hospitalized for respiratory support and fluids. There’s no specific medication that can be used to treat measles, so it’s just supportive care in the hospital. Unfortunately, even after a case of acute measles, there’s a generalized immune suppression that goes on for several years. So children who make it through measles for several years afterward are more susceptible to many other infections. It’s kind of frightening, but it’s a unique thing that the measles virus does to the immune system.

And then, unfortunately, there is a complication that occurs probably in something like 1 in 3,000 or 1 in 5,000 children who contract measles. Years later, six to 10 years later, [they] can develop an untreatable degenerative brain condition called SSPE [Subacute Sclerosing Panencephalitis], which will be fatal. That’s not so common, but boy it’s common enough that people should realize that measles is more than a high fever and a rash.

You talked about how effective two doses of the MMR is for kids. As more vaccine skepticism rhetoric has risen at a national level, especially since the Covid-19 pandemic, have you seen parents be more skeptical of vaccines like MMR?

In my practice, the vast majority of families are really relying on their physicians’ advice, and they want to make sure their kids are fully protected. But this does vary by neighborhood. There are neighborhoods and communities where there’s more vaccine distrust. We know nationally, there’s data showing families are looking into vaccine exemptions, for instance, so their kids can go to school without being fully vaccinated. There are state legislatures that are considering withdrawing school vaccine requirements. And it’s unfortunate because that’s really being driven by a lot of fear and misinformation. If families were getting the best information available, the vast majority would want their kids to be vaccinated. But there’s a lot of fear, and it’s a little bit hard to fight that.

You talked a little bit about talking to parents who may worry about getting their children vaccinated. What are those conversations like?

For the measles vaccine in particular, especially since it’s been on the news, you can share with them the numbers. You can say, “This is what happens.” Measles, we know, is one of the most infectious, contagious illnesses that we’ve ever experienced. If a child who has the measles has been in a room — even after they’ve left the room for two hours, the air in the room literally can still transmit measles. Measles is much more contagious than Covid or flu. And at the same time, it really can be a serious illness. It can put kids in the hospital. There are short-term and long-term complications.

Measles outbreak mounts among children in one of Texas’ least vaccinated counties

And then you can say this is the vaccine. It has been around for a very, very long time. The rate of [lasting] side effects is very, very low. You can get mild symptoms that will occur maybe even a week later. But then they go away, and your kiddo is protected. And the protection, having had two doses of the vaccine, lasts the rest of your life with no important common side effects. Rare side effects can happen, but they’re really rare. I can say in my career, which is getting close to 30 years, I’ve never seen a serious complication from any vaccine. What I have seen [are] children sick with illnesses that could have been prevented with vaccines.

Earlier in this conversation, you said you thought the state and local health departments had done a really good job investigating cases. But you also referenced uncertainty around federal public health funding.

Both the state and local health departments get a lot of their funds from the federal government. If funding changed so these local health departments and the state health department can’t carry out these types of investigations, what risk does that pose for the communities you serve?

People have gotten used to safe food. People have gotten used to knowing when there is illness in the community — how to prevent it, and how to avoid it. We’ve all gotten complacent about the role of public health. When the public health system is working, we don’t notice it very much. That means you have an effective public health system, it means you can just go about your life without a good deal of worry.

But if the funding dries up or if the funding is just unreliable — just not knowing if a grant is going to come through — that could really lead to problems with tracking, with employment, with having the right people in the right place being able to jump in to investigate outbreaks, and to educate the public about how to stay healthy. I think right now, there’s just a lot of uncertainty.

Public health affects all of us. This isn’t something that’s just for certain neighborhoods or underserved neighborhoods. It doesn’t matter how wealthy you may be, or how fancy your house is. You need clean air, you need a dependable food supply, clean water. These are very, very basic things that we’ve been able to take for granted for so many years. But the reason these are reliable is because of public health, and [workers] quietly doing their jobs.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

The Covid ‘contrarians’ are in power. We still haven’t hashed out whether they were right.

2025-02-19T12:25:56+00:00

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In October, Stanford University professor Jay Bhattacharya hosted a conference on the lessons of Covid-19 in order “to do better in the next pandemic.” He invited scholars, journalists, and policy wonks who, like him, have criticized the U.S. management of the crisis as overly draconian.

Bhattacharya also invited public health authorities who had considered his alternative approach reckless. None of them showed up.

Now, the “contrarians” are seizing the reins: President Donald Trump has nominated Bhattacharya to lead the National Institutes of Health and Johns Hopkins University surgeon Marty Makary to run the Food and Drug Administration. Yet the polarized disagreements about what worked and what didn’t in the fight against the biggest public health disaster in modern times have yet to be aired in a nonpartisan setting — and it seems unlikely they ever will be.

“The whole Covid discussion turned into culture war dialogue, with one side saying, ‘I believe in the economy and liberty,’ and the other saying, ‘I believe in science and saving people’s lives,’” said Philip Zelikow, a scholar and former diplomat based at Stanford’s Hoover Institution.

Frances Lee, a Princeton University political scientist, has a book coming out that calls for a national inquiry to determine the lockdown and mandate approaches that were most effective.

“This is an open question that needs to be confronted,” she said. “Why not look back?”

For now, even with the threat of an H5N1 bird flu pandemic on the horizon, and some other plague waiting in the wings of a bat or goose in a far-flung corner of the world, U.S. public health officials face ebbing public trust as well as a disruptive new health administration led by skeptics of established medicine. On Feb. 7, the Trump administration announced devastating National Institutes of Health budget cuts, although a judge put them on hold three days later.

Zelikow led the 34-member Covid Crisis Group, funded by four private foundations in 2021, whose work was intended to inform an independent inquiry along the lines of the 9/11 Commission, which Zelikow headed.

The Covid group published a book detailing its findings, after Congress and the Biden administration abandoned initiatives to create a commission.

That was a shame, said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, because “while there are some real ideological battles over Covid, there’s also lots of stuff that potentially could be fixed related to government efficiency and policy.”

Bhattacharya, Makary, and others in 2023 called for a larger study of the pandemic. It’s not known whether the Trump administration would support one, Lee said.

The new CIA director, John Ratcliffe, however, has reopened the Wuhan lab leak theory, an issue that Republicans have used to try to cast blame on Anthony Fauci, an infectious disease expert and a top Covid adviser to both the first Trump and Biden administrations. Sen. Ron Johnson, a Wisconsin Republican and the new head of the Senate’s Permanent Subcommittee on Investigations, says he’ll investigate what he described as a cover-up of Covid vaccine safety problems.

Bhattacharya declined to respond to questions for this article. Makary did not respond to requests for comment.

Stanford epidemiologist John Ioannidis said his colleague Bhattacharya has an opportunity to advance understanding of the pandemic.

“Until now it has been mostly a war on impressions and media, kind of mobilizing the troops. That’s not really how science should be done,” Ioannidis said. “We need to move forward with some calm reflection, with no retaliation.”

Mistakes were made

In October 2020, Bhattacharya co-authored the “Great Barrington Declaration” with Trump White House support. It called for people to ignore Covid and go about their business while protecting the old and vulnerable — without specifics about how.

Bhattacharya and Makary championed the policies of Sweden, which did not impose a harsh lockdown but emerged with a death rate far lower than that of the United States. The Swedes had advantages including lower poverty rates, greater access to health care, and high levels of social trust. For instance, by April 2022, 87% of Swedes ages 12 and over were vaccinated against Covid — without mandates. The U.S. figure, for adults over 18, was 76% at the time.

After Bhattacharya’s earlier research was rebuffed by most of the public health establishment, he “curdled into a theological position that the risk wasn’t that severe and the economic costs were so high that we had to roll the dice, or segregate the elderly — which you cannot do,” Zelikow said.

Ten experts interviewed for this article largely agreed that the health establishment lost public trust after bungling the initial handling of the pandemic. Existing pandemic plans were faulty or ignored. Shortages of protective gear and inadequate testing rendered containment of the virus impossible. As time wore on, government scientists failed to emphasize that their recommendations would change as new data came in.

“We totally blew it,” former NIH Director Francis Collins said, in a discussion sponsored by Braver Angels, a group that promotes dialogue among political opponents. Though he blamed disinformation about vaccines for many deaths, he also wished public health officials had said “we don’t know” more often.

Collins said he didn’t pay enough attention to the socioeconomic impact of lockdowns. “You attach infinite value to stopping the disease and saving a life,” he said. “You attach zero value to whether this actually totally disrupts people’s lives, ruins the economy, and has many kids kept out of school in a way that they never quite recover from.”

While Fauci and other public health officials did express worries about collateral damage from mandates, U.S. measures were stricter than in much of the world. That’s left unresolved issues, such as how long schools should have been shuttered, whether mask mandates worked, and whether the public was misled about the efficacy of vaccines.

At the same time, U.S. officials failed to communicate clearly that vaccines prevented most deaths and hospitalizations. An estimated 232,000 unvaccinated Americans died from Covid during the first 15 months in which shots were freely available.

Experiences with HIV control taught public health officials not to moralize about behavior, to focus on harm reduction, and to use the least restrictive methods possible, Nuzzo said. Yet politicization led to shaming of people who wouldn’t mask or refused vaccination.

Harm reduction was top of mind for infectious disease doctor Monica Gandhi when she defied lockdown orders by keeping open Ward 86, the clinic she runs for 2,600 HIV patients at Zuckerberg San Francisco General Hospital. Her patients — many poor or homeless — had to be treated in person to keep their HIV in check, she said.

In general, the lockdowns hurt low-income people most, she said. The wealthy “were happy to be shut down, and the poor struggled and struggled.” Gandhi’s two children attended a private school that quickly reopened, she said. Yet she recalled how a medical assistant burst into tears when asked how her family was doing.

“My 8-year-old is at home, on Zoom, all by himself,” the woman told Gandhi. “I have to work and he doesn’t know how to learn that way. There’s no one to give him food.”

Despite strictures, including school closures that were longer than in most European countries, the United States’ death rate from Covid was the highest in the world, except for Bulgaria, according to an Ioannidis study of countries with reliable data.

Part of the blame lies with the first Trump administration, which “more or less just said, ‘You states manage this crisis,’” Zelikow said. “They went through a lot of somersaults. They did a lot of feckless things and then they basically just gave up,” he said. Pandemic deaths peaked in the four months after the November 2020 election that Trump lost.

Ioannidis, a critic of lockdowns, said the United States was doomed to a bad outcome in any case because of vulnerabilities in the population including poverty, inequality, lack of health care access, poorly protected nursing homes, high rates of obesity, and low levels of trust.

But the disappearance of viral diseases such as respiratory syncytial virus and flu in late 2020 showed how much worse it could have been without lockdowns, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who has noted that, while children were the least vulnerable to Covid, it killed 1,700 of them by April 2023. More than a million American children had had long Covid as of 2022, according to a new Centers for Disease Control and Prevention study.

Consensus never arrived

After arising by accidental passage from bats and other animals to humans (or, alternatively, from a Chinese lab accident), the coronavirus was uncannily adept at frustrating containment efforts — and aggravating political tensions. Its ability to infect up to 50% of people asymptomatically, infection outcomes ranging from sniffles to death, waning immunity after infection and vaccination, and the shifting health impact of new variants meant “the deck was stacked against public health,” said biology professor Joshua Weitz of the University of Maryland.

In the end, teams formed along political lines. Conservatives attacked governors for depriving them of liberty, and Trump’s erroneous ramblings about curing the disease with bleach and ultraviolet light inspired intolerance on the left.

“If anyone else was president we would have had a better result,” Gandhi said. “But if Trump said the sky was blue, then goddamn it, the infection disease doctors disagreed.”

The right and left don’t even agree on the correct questions to ask about the pandemic, said Josh Sharfstein, a vice dean of the Bloomberg School of Public Health at Johns Hopkins University.

“Everyone knew that 9/11 was a terrorist attack,” he said. “But what the pandemic was and represents — there’s so much disagreement still.”

“We let children down, we let poor people down,” Ioannidis said in closing remarks at the Stanford conference. “We let our future down.”

The story originally published at KFF Health News, Healthbeat’s national reporting partner.

Georgia health workers handling flu surge, rare mpox case, measles outbreak

2025-02-14T19:45:43+00:00

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Influenza viruses have continued to steadily circulate within Atlanta and Georgia communities as the state contends with other concerning infectious diseases.

Health care visits for flu-like symptoms and community virus levels detected in wastewater sites remain near their highest marks of the winter, according to data released Friday from the Centers for Disease Control and Prevention. Close to 3,000 residents had overnight stays for the flu at metro Atlanta hospitals in January, according to the Georgia Department of Public Health.

None of these indicators have reached last year’s peak. But Dr. Mark Griffiths, an Emory University pediatric medicine associate professor and director of the Children’s Healthcare of Atlanta’s downtown emergency department, said his hospital is experiencing one of the largest flu surges he’s witnessed.

“We’re seeing higher levels of kids testing positive than probably seen the last decade or so,” he said. “And they are coming in of all ages.”

He attributes the spike in flu hospital visits to multiple factors. During the height of the Covid-19 pandemic, cases of other viruses fell to lower-than-normal rates. But now that some pandemic prevention steps have been relaxed, many airborne diseases have exceeded their baseline numbers.

Urgent CDC data and analyses on influenza and bird flu go missing as outbreaks escalate

Additionally, Griffiths said he’s seen fewer kids vaccinated against the flu compared to previous winters. The CDC estimates that as of early February, between 33% and 56% of children over 6 months old received this year’s shot.

He said the low vaccine uptake is concerning for the health of Georgia kids, as the shots add an extra layer of disease protection.

“Since Covid, we’ve seen the persistence of this vaccine hesitancy,” he said. “Now, we’re seeing it as these really high flu surges.”

Griffiths said it’s not too late for parents to have their children immunized this year, as traditional flu seasons last until March. Additionally, he highlighted new tools, like over-the-counter flu and Covid combination tests, and familiar protections, like wearing a mask when sick, as useful ways for people to prevent respiratory virus spread.

The state is also contending with a variety of other infectious diseases. Over the past few weeks, state and local public health officials have been responding to a small measles outbreak that has infected three members of the same family. None of the family members were vaccinated against measles. No other Georgia residents have tested positive, according to the state DPH.

A study published by the CDC on Thursday also found that public health officials detected a travel-associated Georgia case of Clade I mpox in January, the second case ever detected in the United States. The report says that Clade I cases lead to death more often than Clade II infections, which are still rare but more common domestically.

The Georgia patient’s case was not severe, according to the CDC study. Nancy Nydam, a DPH spokesperson, said the department monitored people who had been in contact with the patient for 21 days — the time in which symptoms usually appear — and none of them contracted the disease.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Urgent CDC data and analyses on influenza and bird flu go missing as outbreaks escalate

2025-02-14T18:32:51+00:00

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Sonya Stokes, an emergency room physician in the San Francisco Bay Area, braces herself for a daily deluge of patients sick with coughs, soreness, fevers, vomiting, and other flu-like symptoms.

She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, doctors and public health experts say.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Wednesday press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, Trump announced the United States would withdraw from the WHO.

Bird flu in house cats could pose a risk to public health

A critical analysis of the seasonal flu selected for distribution through the CDC’s Health Alert Network has stalled, according to people close to the CDC. They asked not to be identified because of fears of retaliation. The network, abbreviated as HAN, is the CDC’s main method of sharing urgent public health information with health officials, doctors, and, sometimes, the public.

A chart from that analysis, reviewed by KFF Health News, suggests that flu may be at a record high. About 7.7% of patients who visited clinics and hospitals without being admitted had flu-like symptoms in early February, a ratio higher than in four other flu seasons depicted in the graph. That includes 2003-04, when an atypical strain of flu fueled a particularly treacherous season that killed at least 153 children.

Without a complete analysis, however, it’s unclear whether this tidal wave of sickness foreshadows a spike in hospitalizations and deaths that hospitals, pharmacies, and schools must prepare for. Specifically, other data could relay how many of the flu-like illnesses are caused by flu viruses — or which flu strain is infecting people. A deeper report might also reveal whether the flu is more severe or contagious than usual.

“I need to know if we are dealing with a more virulent strain or a coinfection with another virus that is making my patients sicker, and what to look for so that I know if my patients are in danger,” Stokes said. “Delays in data create dangerous situations on the front line.”

Although the CDC’s flu dashboard shows a surge of influenza, it doesn’t include all data needed to interpret the situation. Nor does it offer the tailored advice found in HAN alerts that tells health care workers how to protect patients and the public. In 2023, for example, a report urged clinics to test patients with respiratory symptoms rather than assume cases are the flu, since other viruses were causing similar issues that year.

“This is incredibly disturbing,” said Rachel Hardeman, a member of the Advisory Committee to the Director of the CDC. On Monday, Hardeman and other committee members wrote to acting CDC Director Susan Monarez asking the agency to explain missing data, delayed studies, and potentially severe staff cuts. “The CDC is vital to our nation’s security,” the letter said.

Studies missing or delayed from Morbidity and Mortality Weekly Report

Several studies have also been delayed or remain missing from the CDC’s preeminent scientific publication, the Morbidity and Mortality Weekly Report. Anne Schuchat, a former principal deputy director at the CDC, said she would be concerned if there was political oversight of scientific material: “Suppressing information is potentially confusing, possibly dangerous, and it can backfire.”

CDC spokesperson Melissa Dibble declined to comment on delayed or missing analyses. “It is not unexpected to see flu activity elevated and increasing at this time of the year,” she said.

A draft of one unpublished study, reviewed by KFF Health News, that has been withheld from the MMWR for three weeks describes how a milk hauler and a dairy worker in Michigan may have spread bird flu to their pet cats. The indoor cats became severely sick and died. Although the workers weren’t tested, the study says that one of them had irritated eyes before the cat fell ill — a common bird flu symptom. That person told researchers that the pet “would roll in their work clothes.”

After one cat became sick, the investigation reports, an adolescent in the household developed a cough. But the report says this young person tested negative for the flu, and positive for a cold-causing virus.

Corresponding CDC documents summarizing the cat study and another as-yet unpublished bird flu analysis said the reports were scheduled to be published Jan. 23. These were reviewed by KFF Health News. The briefing on cats advises dairy farmworkers to “remove clothing and footwear, and rinse off any animal biproduct residue before entering the household to protect others in the household, including potentially indoor-only cats.”

The second summary refers to “the most comprehensive” analysis of bird flu virus detected in wastewater in the United States.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, said delays of bird flu reports are upsetting because they’re needed to inform the public about a worsening situation with many unknown elements. Citing “insufficient data” and “high uncertainty,” the United Kingdom raised its assessment of the risk posed by the U.S. outbreak on dairies.

“Missing and delayed data causes uncertainty,” Nuzzo said. “It also potentially makes us react in ways that are counterproductive.”

Study: Cattle veterinarians unknowingly infected with bird flu

Another bird flu study slated for January publication showed up in the MMWR on Thursday, three weeks after it was expected. It revealed that three cattle veterinarians had been unknowingly infected last year, based on the discovery of antibodies against the bird flu virus in their blood. One of the veterinarians worked in Georgia and South Carolina, states that haven’t reported outbreaks on dairy farms.

The study provides further evidence that the United States is not adequately detecting cases in cows and people. Nuzzo said it also highlights how data can supply reassuring news. Only three of 150 cattle veterinarians had signs of prior infections, suggesting that the virus doesn’t easily spread from the animals into people. More than 40 dairy workers have been infected, but they generally have had more sustained contact with sick cattle and their virus-laden milk than veterinarians.

Instead, recently released reports have been about wildfires in California and Hawaii.

“Interesting but not urgent,” Nuzzo said, considering the acute fire emergencies have ended. The bird flu outbreak, she said, is an ongoing “urgent health threat for which we need up-to-the-minute information to know how to protect people.”

“The American public is at greater risk when we don’t have information on a timely basis,” Schuchat said.

This week, a federal judge ordered the CDC and other health agencies to “restore” datasets and websites that the organization Doctors for America had identified in a lawsuit as having been altered. Further, the judge ordered the agencies to “identify any other resources that DFA members rely on to provide medical care” and restore them by Friday.

In their letter, CDC advisory committee members requested an investigation into missing data and delayed reports. Hardeman, an adviser who is a health policy expert at the University of Minnesota, said the group didn’t know why data and scientific findings were being withheld or removed. Still, she added, “I hold accountable the acting director of the CDC, the head of HHS, and the White House.”

Hardeman said the Trump administration has the power to disband the advisory committee. She said the group expects that to happen but proceeded with its demands regardless.

“We want to safeguard the rigor of the work at the CDC because we care deeply about public health,” she said. “We aren’t here to be silent.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

Measles outbreak mounts among children in one of Texas’ least vaccinated counties

2025-02-13T13:41:27+00:00

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A measles outbreak is growing in a Texas county with dangerously low vaccination rates.

In late January, two school-age children from Gaines County were hospitalized with measles. Since an estimated 1 in 5 people with the disease end up in the hospital, the two cases suggested a larger outbreak.

As of Wednesday, there were 24 cases, mainly children, with at least 14 hospitalizations, said Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines. A few cases are in surrounding counties. The department is investigating many other potential cases in hopes of treating people quickly and curbing the spread of the virus.

“There may be active cases out there and the individual has chosen not to seek medical attention,” Holbrooks said.

Public health practitioners warn such outbreaks will become more common because of scores of laws around the United States — pending and passed — that ultimately lower vaccine rates. Many of the measures allow parents to more easily exempt their children from school vaccine requirements, and a swell of vaccine misinformation has led to record rates of exemptions.

As Robert F. Kennedy Jr., one of the most influential purveyors of dangerous vaccine misinformation, prepares to take the helm of the Department of Health and Human Services, researchers say such bills have a higher chance of passing and that more parents will refuse vaccines because of false information spread at the highest levels of government.

Georgia reports measles case in unvaccinated metro Atlanta patient

“Mr. Kennedy has been an opponent of many health-protecting and life-saving vaccines, such as those that prevent measles and polio,” scores of Nobel Prize laureates wrote in a letter to the Senate. Having him head HHS, they wrote, “would put the public’s health in jeopardy.”

Most people who aren’t protected by vaccination will get measles if exposed. Gaines County has one of the lowest rates of childhood vaccination in Texas. At a local public school district in the community of Loop, only 46% of kindergarten students have gotten vaccines against measles, mumps, and rubella. Vaccination rates may be even lower at private schools and within homeschool groups, which don’t always report the information.

Holbrooks’ team is scrambling to track transmission, ensure that kids and babies seek prompt care, and offer measles vaccines to anyone who hasn’t yet gotten them.

“We are going to see more kids infected. We will see more families taking time off from work. More kids in the hospital,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “This is the tip of the iceberg.”

Measles is extremely contagious, so health workers preemptively treated infants too young to be vaccinated who had shared the emergency room with children later diagnosed with the virus, said Katherine Wells, public health director in Lubbock, Texas. Some children from Gaines were hospitalized in that county. The disease can cause severe complications, and about one of every thousand children with measles die.

An outbreak among a largely unvaccinated population in Samoa in 2019 and 2020 caused 83 deaths, mainly among children, and more than 5,700 cases. Kennedy, who peddles misinformation about measles vaccines, had visited the island earlier on a trip arranged by a Samoan anti-vaccine influencer, according to a 2021 blog post by Kennedy.

Without evidence, Kennedy cast doubt on the fact that measles caused the tragedy in Samoa. “We don’t know what was killing them,” he said at his first confirmation hearing. Samoa’s top health official denounced this evasion as “a complete lie,” in an interview with The Associated Press.

Last school year, the number of kindergartners exempted from a vaccine requirement — 3.3% — was higher than ever reported before, according to the Centers for Disease Control and Prevention. Numbers were far higher than that in Gaines County, where nearly 1 in 5 children in kindergarten had a vaccine exemption for philosophical or religious reasons in 2023-24.

4 ways vaccine skeptics mislead you on measles and more

Over the past couple of years, several states have allowed more parents to obtain exemptions. Already, about 25 bills have been filed in the 2025 Texas legislative session that could limit vaccination in various ways.

“We’re seeing a level of momentum this legislative session that we’ve never seen in the past,” Lakshaman said. Changes are afoot at the local level, too. For example, a school board in the Houston area voted to remove references to vaccines in its curriculum. “There is a top-down and bottom-up assault on these protections,” Lakshaman said.

About 80% of the public believes that the benefits of the measles, mumps, and rubella vaccines outweigh the risks, according to a 2025 KFF poll.

“Lawmakers who put forth dangerous policies need to know the people they hear from don’t represent the majority,” Lakshaman said. Her group offers resources on its website to help people influence decisions on vaccination policies.

This story was updated on Feb. 13 to reflect news developments.

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

Georgia health agencies work to contain metro Atlanta measles outbreak

2025-02-10T21:30:07+00:00

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Infectious disease specialists throughout Georgia have worked rapidly over the past few weeks to respond to a measles outbreak in the metro Atlanta area, according to the Gwinnett, Newton, and Rockdale Public Health Departments.

At the Gwinnett County Board of Health meeting Monday, epidemiology program manager Keisha Francis-Christian provided more information about how local health agencies have responded to the outbreak involving three members of the same family who were not vaccinated against measles. She told the board members that the first person to test positive, announced by the Georgia Department of Public Health in late January, sought health care at three locations before quarantining.

As a result of those visits, Francis-Christian and other epidemiologists have identified over 300 people who were exposed to the contagious person. She said residents in over 20 counties have been impacted by the disease investigation, including at least 114 in Gwinnett County. Francis-Christian said public health workers have tried to reach out to all these residents and have successfully made contact with most people.

Metro Atlanta measles case spreads to two unvaccinated family members

“We’re following them,” she said at the meeting. “For 21 days, they have to report their symptoms to us. If they don’t report, we’re calling them.”

GNR Public Health and other Georgia health departments have not found anyone with measles outside the initial family.

“It’s just a very labor-intensive kind of process just to, again, make sure that we’re not missing anyone,” Francis-Christian said.

In Gwinnett County, clinicians administered preventive measles, mumps and rubella vaccinations to nine people. If received within three days of exposure, the vaccine can help prevent infections in patients who were never immunized against the disease. Additionally, an infant and a pregnant woman in Gwinnett were treated with antibody medications designed to bolster the immune system against measles.

To try to contain the spread of the highly contagious disease, Francis-Christian said GNR Public Health and its partners have been helping exposed residents seven days a week. She said the agency’s epidemiology team alone worked about 100 hours the weekend after the state health department identified the first measles case.

“It’s a lot of work, but everyone’s all on board,” she said. “It’s a really, really great team.”

Francis-Christian also highlighted the first person to test positive had recently traveled domestically, but didn’t say where. She noted that in the United States, there was a nearly fivefold jump in identified measles infections between 2023 and 2024. This month, Texas health officials are responding to an outbreak of at least nine residents in one of the least vaccinated counties in the state.

“Overall, we’re seeing a lot less vaccination, a lot more travel, and ultimately that’s causing more disease,” Francis-Christian said.

Later in Monday’s meeting, she said GNR has detected rising levels of other infectious diseases. Just over a month into 2025, the agency has detected 10 pertussis cases and 6 varicella cases in Gwinnett. In all of 2024, there were just over 40 cases of each disease in the county.

Georgia and the United States as a whole have experienced more cases of pertussis, also known as whooping cough, since at least last summer. In December, the state’s DPH sent out a health advisory asking providers to test all patients with symptoms, report positive cases, and recommend vaccination for anyone who’s eligible to receive it.

“Over the last few years, we’re seeing these trending upward,” Francis-Christian told the board. “It’s a major concern.”

After her presentation, Dorian Freeman, GNR Public Health’s Director of Clinical Infectious Disease, told the board that her team was notified of an active case of pulmonary tuberculosis in a South Gwinnett High School student in December. To make sure the disease didn’t spread, the agency screened 159 staff and students at the school over the past two months and detected no other active cases. Freeman said GNR plans to conduct another round of screenings at Berkmar High School in late February.

Tuberculosis is the world’s deadliest infectious disease, killing around 1.3 million people each year. While effective medications for both latent and active cases are inaccessible in many parts of the world, they’re available in most parts of the United States. The bacteria spread is rare in school settings, said GNR Public Health Chief Clinical Officer Alana Sulka.

“When we do these screenings in the school, it’s out of an abundance of caution,” she told the board.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Bird flu in house cats could pose a risk to public health

2025-02-10T14:44:14+00:00

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More than 80 domestic cats, among many other types of mammals, have been confirmed to have had bird flu since 2022 — generally barn cats that lived on dairy farms, as well as feral cats and pets that spend time outdoors and likely caught it by hunting diseased rodents or wild birds.

Now, a small but growing number of house cats have gotten sick from H5N1, the bird flu strain driving the current U.S. outbreak, after eating raw food or drinking unpasteurized milk. Some of those cats died.

The strain of bird flu currently circulating has not adapted to efficiently spread among people. And there have been no known cases of cat-to-human transmission during the current outbreak of H5N1.

Still, there’s always been the risk that cats, which are arguably only semi-domesticated, could bring home a disease from a midnight prowl.

“Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said virologist Angela Rasmussen, who studies disease progression in emerging viruses at the University of Saskatchewan’s Vaccine and Infectious Disease Organization.

This is because we snuggle with and sleep in bed with our cats. When we’re not looking, cats drink from our water glasses and walk on kitchen counters. So, cat owners should be aware of the ongoing spread of bird flu. “By reducing the risk to your cats, you reduce the risk to yourself,” Rasmussen said.

NYC live bird markets shuttered for a week, following bird flu detections

Rasmussen doesn’t think pet owners should be afraid their cats will give them bird flu but said taking precautions is good for pets and for public health.

Signs of bird flu in cats include runny nose and discharge around the eyes, explained Michael Q. Bailey, president-elect of the American Veterinary Medical Association.

H5N1 also causes neurological problems like dizziness and seizures, which are symptoms of rabies, too. Rabies is almost always fatal, and it poses a threat to human health, so any animal suspected of having the viral disease must be euthanized. Bailey encourages people to ensure pets are up-to-date on their vaccinations.

Veterinarian Jane Sykes, who specializes in infectious diseases in cats and dogs at the University of California-Davis School of Veterinary Medicine, said people should not assume it’s bird flu if their cat is sick — even if their animal spends time outdoors or eats a raw diet. Upper-respiratory illnesses are common in cats, while H5N1 is “still pretty rare.”

Sykes gives her indoor cat, Freckles, regular kibble exclusively. She told NPR and KFF Health News she has no concerns about Freckles getting H5N1 because the heating process of making dry or canned pet food kills viruses.

More cases in cats, more risk to humans

Some people feed their pets raw meat or unpasteurized milk because they think it’s a more nutritious or natural diet. The American Veterinary Medical Association’s website discourages this due to foodborne pathogens like salmonella and listeria, and now the highly pathogenic H5N1.

By keeping pets healthy, veterinarians play an essential role in protecting humans from zoonotic diseases. The American Veterinary Medical Association says the risk of H5N1 spilling over from a pet to a person is “considered extremely low, but not zero.”

State and local public health agencies, including those in Los Angeles County and Washington state, have issued similar warnings against raw food diets for pets.

Concerns for human health are partly why the FDA announced last month it is now requiring cat and dog food companies to update their safety plans to protect against bird flu.

This came after the Oregon Department of Agriculture discovered a cat that was “strictly an indoor cat” had contracted H5N1 and died after consuming a frozen turkey product made by the raw pet food brand Northwest Naturals. It stated that “tests confirmed a genetic match between the virus in the raw and frozen pet food and the infected cat.”

How to reduce the risk of bird flu in backyard flocks

Northwest Naturals voluntarily recalled that batch of its frozen turkey-based product. The company told KFF Health News and NPR that the recall involved “a small product run” and that it has concerns about the accuracy of the Oregon Agriculture Department’s testing.

Los Angeles County’s public health department said five cats from two households tested positive for bird flu after drinking unpasteurized raw milk from the Raw Farm dairy in California’s Central Valley.

Raw Farm voluntarily recalled its milk and cream after retail products tested positive for H5N1, but it denies any food safety issues, calling the concern “a political issue.”

Veterinarians also warn pet owners not to allow cats unsupervised time outside as there’s the risk of them getting H5N1 by interacting with other animals that might carry the disease.

“This is a very scary virus, given that it can infect so many different host species,” said Bruce Kornreich, director of Cornell University’s Feline Health Center.

At least one instance of a cat infecting a person with bird flu occurred in 2016. As NPR reported, a veterinarian in New York City caught the virus after having close contact with infected cats. The vet experienced mild symptoms and quickly recovered.

In that case, the strain of bird flu was H7N2, not the H5N1 that is now circulating in the United States.

H7N2 is a very different type of virus, Sykes explained. But she said it shows that cat-to-human transmission of avian influenza is theoretically possible.

There isn’t a lot of research on transmission of bird flu from companion animals like cats or dogs to humans, though Rasmussen agreed it’s definitely a concern: The more infections you have in animals, “the more your luck is potentially going to run out.”

Most people who have caught H5N1 are agricultural workers who had direct contact with infected poultry or cattle. Of at least 67 confirmed human cases of H5N1 in the United States, there’s been one fatality in an immunocompromised person who had contact with birds.

In general, zoonotic disease researchers want more H5N1 surveillance in companion animals of all types. Even if the human death toll of H5N1 remains relatively low, it remains a public health risk.

Chances for mutation increase risk of spread

Part of the concern with this H5N1 outbreak is that bird flu viruses change. Just a few mutations could make this strain adept at spreading between people. And the more people who catch H5N1, the more likely it would adapt to be more efficient, said Suresh Kuchipudi, a virologist at the University of Pittsburgh School of Public Health, where he researches zoonotic diseases. Kuchipudi has studied H5N1 in cats.

Another concern is something called reassortment. If an animal or person is infected with two viruses at once, the viruses can trade genetic material, creating something new. This is common in influenza, so virologists are on the lookout for a case in which the bird flu reassorts to make a virus that’s far more contagious, and potentially more virulent.

Virologist Rasmussen is way more worried about this happening in pigs. Human respiratory physiology is more like that of swines than felines. So far, the current outbreak of H5N1 has not reached commercial hog operations. Rasmussen hopes it stays that way.

Kuchipudi said reassortments are relatively rare events, but the outcome is completely unpredictable. Sometimes the results are benign, though it was likely a reassortment that involved an avian virus that led to the 1918 flu pandemic, which killed an estimated 50 million people. In the century since, virologists have established a global surveillance network to monitor influenza viruses. Scientists say continued investment in this network is key to preparing for and hopefully preventing another pandemic.

Winter is “reassortment season” because of all the influenza viruses circulating, Rasmussen said. A reassortment in cats could technically be possible since these pets occasionally get seasonal flu, but it’s highly unlikely. Rather, Rasmussen said, it’s more likely that a cat would pass H5N1 to a human who already has seasonal flu, and then a reassortment happens in the sick person. While the risk isn’t zero, Rasmussen doubts this will happen. It would depend on how ill the human was, and how much virus they’re exposed to from their cat.

Trump administration’s halt of CDC’s weekly scientific report stalls bird flu studies

“Unless the cat is really shedding a ton of virus, and you’re kind of making out with the cat, I think it would be hard,” she said.

Rasmussen and Kuchipudi caution there isn’t enough research to know for sure how much virus cats shed, or even how they shed the virus.

The Centers for Disease Control and Prevention was poised to release a new study about H5N1 in cats, but that was delayed when the Trump administration paused the Morbidity and Mortality Weekly Report. That investigation, revealed through emails obtained by KFF Health News in a public records request, found that house cats likely got bird flu from dairy workers.

Scientists and public health agencies should question previously held assumptions about bird flu, Kuchipudi urged. He noted that 20 years ago nobody would have predicted that bird flu would infect dairy cattle the way it is now.

Cats’ behavior puts them at higher risk than dogs

The FDA says other domesticated animals, including dogs, can get bird flu infections. There are no confirmed cases of H5N1 among dogs in the United States, though in other countries they have died from the virus.

There’s some disagreement and an overall lack of research on whether cat biology makes them more susceptible to H5N1 than other mammals, including humans, pigs, or dogs.

But cat behaviors, such as their love of dairy and predation of wild birds, put them at higher risk, Kuchipudi said. Also, living in groups might play a role as there are more feral cat colonies in the United States than packs of stray dogs.

There’s very little people can do about the H5N1 circulating in wild birds. As Rasmussen explained, “It’s flying around in the skies. It’s migrating north and south with the seasons.”

But she said there’s a lot people can do to keep the virus out of their homes.

That includes limiting a pet’s exposure to H5N1 by not feeding them raw food or unpasteurized milk, and trying to keep them from interacting with animals like rodents and wild birds that could be infected with the virus.

This article is from a partnership that includes NPR and KFF Health News, Healthbeat’s national reporting partner.

NYC live bird markets shuttered for a week, following bird flu detections

2025-02-07T22:17:56+00:00

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New York state is shuttering all live bird markets in New York City, as well as in Westchester, Nassau and Suffolk counties, for the next week, following the recent detection of bird flu among some poultry in city markets.

During a virtual briefing on Friday morning, Gov. Kathy Hochul emphasized that while there is “no immediate public health threat” in New York, shutting down the markets would help guard against the further spread of disease.

“These are just simply measured, common sense steps that will curb the spread of bird flu and ultimately to keep New Yorkers safe, which is always my top priority,” she said.

No human cases of bird flu have been detected in New York state so far. For most residents — particularly those who do not have direct contact with infected birds — the risk of infection is low, according to health officials and experts.

But since 2022, cases have emerged in the state among wild birds, backyard and poultry flocks, including recently on a Long Island commercial farm, which culled 100,000 ducks. Nationwide, bird flu cases have mounted in the past year among cattle, poultry and other animals. Among humans, 67 cases of bird flu, and one death, have been reported across the country since the start of 2024, according to the U.S. Centers for Disease Control and Prevention.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

While there is no evidence that the current highly pathogenic H5N1 bird flu virus can be transmitted between humans, experts say that possibility hinges on how the virus mutates — which could have pandemic potential.

State officials and health experts recommend that New Yorkers get the seasonal flu vaccine, which while not protective against bird flu, can reduce the chance of having both viruses at the same time — which can create opportunities for the two viruses to interact and become more dangerous.

Anyone who keeps chickens, ducks or geese should contact a veterinarian or the state Department of Agriculture and Markets if multiple birds die suddenly, or if bird flu symptoms appear, said Dr. James McDonald, commissioner of the state Department of Health. Additionally, New Yorkers who work with livestock, including dairy or poultry, should wear personal protective equipment.

In New York City, seven cases of bird flu were detected in poultry during routine inspections at live bird markets in the Bronx, Brooklyn and Queens in the past week, officials said. The shutdown order for live bird markets is effective from Friday through Feb. 14, and will impact about 80 markets across the state.

During that period, no poultry can be delivered to those markets. Markets that test positive for bird flu must be depopulated, undergo cleaning and disinfection, remain closed for at least five days, and pass a state health inspection. All uninfected markets must sell down their stock in the next few days, also undergo cleaning and disinfection, remain closed for at least five days, and pass a state inspection.

“These cases in the live bird markets were detected on surveillance,” McDonald said. “In other words, we were looking for the problem. And this is what you do in public health. We work together and we look for problems.”

McDonald added that the state is prepared for “widespread testing” if needed, with sufficient testing capacity at the Wadsworth Center, the state’s public health laboratory, and “substantial additional surge capacity.”

The state is also in close contact with the New York City Department of Health and Mental Hygiene, which has instructed exposed individuals to monitor for signs of illness, will test in the case of symptoms, and will offer Tamiflu, an influenza medication, as a preventative measure, McDonald said.

“We are prepared to respond to any disease outbreak, including quickly ramping up testing and treatment, and working closely with providers and community partners to rapidly disseminate messaging,” Dr. Michelle Morse, the city’s health commissioner, said in a statement.

In New York, other preparations for bird flu have begun, including at Bellevue Hospital, which is a regional hub for special pathogen preparedness. Earlier this year, the outgoing Biden administration awarded the hospital $2 million for its bird flu preparedness efforts, which will likely go toward bolstering PPE stockpiles and training efforts, Dr. Vikramjit Mukherjee, the director of the Special Pathogens Program and of Critical Care Services at Bellevue, told Healthbeat last month.

The state has taken other preventative steps, according to Elizabeth Wolters, the deputy commissioner for the state agriculture and markets department. Those measures include testing samples of milk intended for pasteurization and instituting testing requirements for cattle imported into the state and those entering state fairs or exhibitions.

THE CITY visited five live poultry markets in Brooklyn on Friday afternoon, four of which were still open several hours after Hochul’s announcement.

“We’re closing,” said the owner of a poultry market in Bushwick, declining to answer multiple questions about how they planned to handle the governor’s mandates.

At one poultry shop in East Williamsburg, the store manager said “the store has no chickens” in plain view of dozens of live chickens crammed together in crates stacked to the ceiling, before ushering the reporter out.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Metro Atlanta measles case spreads to two unvaccinated family members

2025-02-07T19:40:09+00:00

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Two family members of the metro Atlanta resident who tested positive for measles last week have also acquired the virus, officially creating an outbreak.

None of the three patients had been vaccinated against measles, the Georgia Department of Public Health said Friday in a press release. The agency added that so far in its contact tracing efforts, it hasn’t found any cases outside the family. Last week, the department said the first patient had acquired measles while traveling domestically.

The Centers for Disease Control and Prevention defines a measles outbreak as three or more related cases. As of Thursday, the agency was aware of two U.S. measles outbreaks and 14 total cases so far in 2025, although it’s unclear whether the trio of Georgia cases were included in either count.

In western Texas, a measles outbreak has infected at least nine residents and hospitalized at least two school-age children. It’s spreading in a highly vulnerable community where vaccine uptake is low. At a local school district, only 46% of kindergartners had received the highly effective immunization that prevents measles.

Measles outbreak mounts among children in one of Texas’ least vaccinated counties

The outbreaks come as the U.S. Senate is considering whether to confirm Robert F. Kennedy Jr., a repeated skeptic of vaccines, as the nation’s Health and Human Services Secretary.

Georgia, unlike Texas, doesn’t allow parents to enroll unvaccinated children in schools based on personal beliefs. But both states’ laws permit religious exemptions to the shots.

Meanwhile, other infectious diseases continue to circulate in Georgia as residents make their way through the respiratory illness season. Preliminary CDC data indicate that the number of people in the state hospitalized for Covid-19, flu, and respiratory syncytial virus remains high but may be declining. The combination of overnight hospital stays for the viruses has yet to approach last winter’s peak. But wastewater data show that flu is still spreading freely in many Georgia communities.

Whooping cough also continues to circulate at high rates. As of Monday, the Georgia DPH had detected 28 probable or confirmed cases. The January count will likely go up as the department retrospectively identifies more cases, but even that total is in line with a transmission pace that concerned the DPH in December. In its end-of-the-year health alert, the agency asked providers and local health departments to test patients with severe coughing for the disease.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Public health data chaos: How New York is protected from federal communications freeze

2025-02-05T15:10:40+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.

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

Georgia respiratory disease hospitalizations decline, but flu and Covid could be rising

2025-01-31T20:46:24+00:00

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Georgia hospitalizations for the three most common U.S. respiratory diseases have continued to decline, but updates from Covid-19 and influenza data sources suggest that might change in the coming weeks.

In a Friday update, data from the Centers for Disease Control and Prevention continued to show the number of Georgia overnight hospital stays for flu, Covid-19, and respiratory syncytial virus has decreased from the first week of January through last Saturday. Flu hospitalizations continue to outnumber stays for either of the other two viruses, as they have since mid-December.

But other sources of data, ones that can be quicker to reveal disease trends in communities, indicate that flu and Covid infections are on the rise. State wastewater sites in the metro Atlanta area and eastern Georgia show rising virus levels for both diseases over the latter half of January, as does the percentage of emergency department visits for the illnesses.

Measles case reported in unvaccinated metro Atlanta patient

Still, most Georgia data indicate that this year’s respiratory disease season remains less severe than some recent winters. Covid and flu wastewater levels and hospitalization rates have yet to reach last year’s peaks. These data are in line with a December outlook from the CDC, which predicted national severe infection rates to be lower than last year but higher than before Covid’s emergence.

The state’s Department of Public Health has continued to update its seasonal flu death count, adding nine more to last week’s total. At the Board of Public Health’s January meeting, state epidemiologist Dr. Cherie Drenzek said these types of updates can reflect completed morbidity investigations from weeks earlier.

The state health department also announced this week that it had detected the first measles case of the year and emphasized the effectiveness of the disease’s vaccine.

The status of another concerning respiratory disease is less clear. Last month, Georgia’s DPH warned residents and state physicians to be on the lookout for pertussis, also known as whooping cough. As of the last week in December, the CDC had reported nearly three times as many cases as it did for 2023.

But the CDC hasn’t updated its counts of this or other nationally notifiable infectious diseases since then, making it unclear whether this trend has continued into 2025. The federal agency has stopped most external communications since President Donald Trump took office last week, and a CDC spokesperson said he couldn’t answer when the pertussis numbers would be updated.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

First Georgia measles case of the year detected in unvaccinated metro Atlanta patient

2025-01-28T21:59:05+00:00

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An unvaccinated metro Atlanta resident has tested positive for measles, the first case in Georgia this year of one of the most contagious vaccine-preventable diseases.

In a press release, the Georgia Department of Public Health announced Tuesday that the patient caught the airborne disease while traveling within the United States. The person was contagious between Jan. 19 and 24, and the agency is working to find residents who may have been exposed during that time.

The patient’s age and travel locations were not announced.

Last year, the department detected six measles cases in Georgia. It’s one of the highest recorded case totals over the past 10 years — second only to 2019, when a Cobb County outbreak contributed to 18 state cases. Most of those years, the agency detected no cases.

How measles, whooping cough, and worse could roar back on RFK Jr.’s watch

Researchers have repeatedly found that the disease’s vaccine — which protects against measles, mumps and rubella — is effective at preventing new infections. One dose prevents 93% of infections, and two doses prevent 97% of possible measles cases, according to the Centers for Disease Control and Prevention.

Childhood uptake of the MMR vaccine has declined in the United States and Georgia over the past few years. Some 88.4% of Georgia kindergartners had received the shot in the 2023-24 school year compared to 94% a decade earlier, according to the CDC. The state’s laws allow students in schools to receive religious and medical exemptions from their childhood vaccination requirements.

The first symptoms of measles — which include high fever and coughing — appear 7-14 days after catching the virus. A few days after these symptoms, people with the illness often develop small white dots in their mouths and red spots on their face. If Georgia residents notice symptoms for measles, the DPH asks that they call a health care provider before seeking treatment as measles is highly contagious.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Georgia reports first flu deaths of the season, but most data show declines in respiratory viruses

2025-01-24T16:51:00+00:00

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While the Georgia Department of Public Health recorded the first influenza deaths of the winter this month, many data indicate that flu and other respiratory illnesses are continuing to decline.

The agency’s most recent weekly respiratory disease report, which tracked the second week of January, noted that five people died of influenza throughout the state. The number of Georgia deaths since October, which had been at zero the week prior, was updated to 14 in the same report.

At last week’s Georgia Board of Public Health meeting, state epidemiologist Dr. Cherie Drenzek raised the possibility that there had already been deadly flu cases.

“These deaths can get delayed in reporting because they get investigated for other causes of death as well,” she told the board. She also highlighted that throughout this winter, influenza had caused the bulk of Georgia’s respiratory virus emergency department visits.

Warming centers fill up as metro Atlanta experiences its coldest week of winter yet

Respiratory virus death counts can lag behind other disease spread indicators, and many other Georgia flu data suggest cases are declining from January peaks. Preliminary numbers from the Centers for Disease Control and Prevention show state hospitalizations dropped the second week of this month, as did the percentage of health care visits for flu-like illnesses. Wastewater data, which provides some of the most up-to-date information about disease spread, also show a recent plateau and decline in state flu case levels.

Other respiratory diseases of concern also appear to be spreading slower than a few weeks ago in Georgia. Covid-19 hospitalization and wastewater data from the CDC show the lowest early January per-person numbers since the agency began tracking these measures. State respiratory syncytial virus detectors, which reached concerning levels in early December, also show signs of waning.

It’s unclear when the CDC will release its next data update. President Donald Trump’s administration instructed federal health agencies to pause most external communications this week.

This week, the CDC did not publish a Morbidity and Mortality Weekly Report, which updates the country on emerging health threats. It did, however, update its weekly lists of diseases that state health agencies track within their borders.

Meanwhile, H5N1 bird flu has been detected at two commercial poultry operations in Elbert County, Georgia. No human cases have been reported in the state. DPH and the state Department of Agriculture have said they’ll continue to monitor the situation closely.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

2025-01-24T10:00:00+00:00

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As more cases of bird flu emerge across the country, public health leaders in New York City are watching warily — and making preparations in case the virus becomes a more immediate threat.

There have been no confirmed cases of bird flu in humans in New York state. But cases have emerged recently among wild birds and poultry, including at a commercial farm on Long Island, which started euthanizing 100,000 ducks this week.

For New Yorkers who do not interact with infected animals, the risk of getting bird flu is low, public health experts and health officials say. While there is no evidence that the current highly pathogenic H5N1 bird flu virus can be transmitted between humans, that scenario remains a possibility — and one that, with certain mutations, could lead to a pandemic.

Since 2024, at least 67 people nationwide have been infected by the virus, according to data from the U.S. Centers for Disease Control and Prevention. Earlier this month, the CDC reported the first human death from bird flu, in Louisiana. Meanwhile, bird flu has appeared in animals across the country, from dairy herds to backyard chickens. This week, the poultry industry in Georgia — one of the nation’s largest — was working to contain an outbreak of the virus.

The United States has stumbled through its bird flu response, failing to stamp out the virus when it emerged on dairy farms in several states last year. Since then, slow federal interventions and depleted public health resources have created the conditions for what could become a pandemic.

How America lost control of the bird flu, setting the stage for another pandemic

The nationwide bird flu response is in limbo as President Donald Trump, who has vowed dramatic changes to federal health agencies, returned to the White House this week. Trump previously signaled that he would disband the Office of Pandemic Preparedness and Response Policy, which coordinated the bird flu response under the Biden administration. This week, the Trump administration instructed federal health agencies to pause all external communications.

Locally, some bird flu preparations are underway. Bellevue Hospital, part of the NYC Health + Hospitals system and a regional hub for special pathogen preparedness, is gearing up for the possibility that bird flu becomes a more serious public health threat. This month, the hospital announced that it would receive $2 million for bird flu preparedness efforts, part of a wave of federal funding released in the final weeks of the Biden administration.

“We’ve been tracking the avian influenza cases that have sprung up across the country,” said Dr. Vikramjit Mukherjee, the director of the Special Pathogens Program and of Critical Care Services at Bellevue. “We believe that it’s a matter of time before it becomes more significant.”

There’s low risk, but pandemic potential

In New York state, bird flu has been detected occasionally in wild birds, backyard flocks, and poultry since 2022. The state reported several cases in live poultry markets in Brooklyn and Queens in 2023. Last week, the Putnam County Health Department reported a bird flu case in a wild goose in Brewster, a village about an hour outside New York City.

This week, responding to the detection of bird flu on a Long Island farm, state officials said that individuals who may have had contact with infected birds were being monitored for symptoms, and that farmworkers were given personal protective equipment. The state Department of Agriculture and Markets is working with a division of the federal Department of Agriculture on surveillance and testing in the surrounding area, according to the state Department of Health.

“I urge everyone who has regular contact with livestock and wild birds to remain vigilant and take precautions by wearing personal protective equipment when you’re in contact with these animals,” Dr. James McDonald, the state health commissioner, said in a statement.

While the risk to the general public remains low, public health experts say that evidence of human-to-human transmission of bird flu would raise red flags, signaling a heightened threat — and pandemic potential. That possibility hinges on whether the virus is able to mutate enough to spread between people. In the recent death of a Louisiana resident from bird flu, CDC scientists found that the virus had started to mutate after infection.

“You have more and more spread now,” said Dr. Michael Merson, a clinical professor of global and environmental health at the NYU School of Global Public Health. “The question obviously is, is it going to be a mutation into humans, and we get person-to-person spread? That would be the most alarming situation.”

To public health experts, the emergence of bird flu cases during a worsening flu season is especially concerning, as it increases the risk of co-infection — having both viruses at the same time. Co-infection creates an opportunity for the two viruses to interact, exchange genetic material, and potentially become more dangerous to humans.

“That also is a way that we can have a pandemic situation, if a human virus mixes with the H5N1 virus,” said Dr. Denis Nash, an expert in infectious disease epidemiology and the executive director of the CUNY Institute for Implementation Science in Population Health. “During flu season, that is more likely to happen. That increases our risk a lot.”

As a protective measure, public health experts recommend that New Yorkers — and especially farmworkers — get the seasonal flu vaccine. While the flu shot won’t prevent a bird flu infection, it could help reduce the risk of co-infection.

Efforts have also ramped up to accelerate bird flu vaccine development. Last week, the federal Department of Health and Human Services announced it would provide about $590 million to Moderna to spur the development of an H5N1 mRNA influenza vaccine targeted at the current strain circulating in cows and birds.

In New York, Nash is part of a research team that has tested wastewater across the NYC Health + Hospitals system for infectious diseases including Covid, flu, and mpox. Researchers are in the process of setting up a wastewater test for H5N1, which could be an important tool for early detection in the city.

“The current outbreak in animals, and all of this spillover to humans, is of great concern and worrisome,” he said. “I don’t think we’re doing enough to mitigate the risk.”

NYC Health + Hospitals leads a training exercise testing the health care system’s ability to screen and isolate a “patient” with simulated symptoms of bird flu in October.

Bellevue would help lead regional response

If bird flu were to become more of a threat — or a pandemic — Bellevue Hospital would be at the center of New York’s response effort.

Bellevue serves as the regional hub for special pathogen preparedness and cases of highly infectious diseases for New York, New Jersey, Puerto Rico, and the U.S. Virgin Islands. The hospital is also a member of the National Emerging Special Pathogens Training and Education Center, a preparedness consortium.

Earlier this month, HHS announced $306 million in awards for bird flu preparedness and response, of which Bellevue will receive $2 million. Mukherjee, who leads the hospital’s Special Pathogens Program, said he expects the funds to go toward shoring up regional PPE stockpiles, as well as training and education programs.

Other preparedness measures have begun, he said. In October, health care workers donned PPE to simulate transporting an H5N1 patient from Kings County Hospital Center to Bellevue. Mukherjee said that Bellevue has conducted PPE training, reviewed its pandemic protocols, and offered its expertise to other regional facilities. The hospital is also assessing its surge capacity, including plans for expanding patient spaces, ramping up staffing, and ensuring adequate PPE, ventilators, and other supplies.

At the New York City Department of Health and Mental Hygiene, a spokesperson said in a statement that the agency is “prepared to respond to any disease outbreak, including quickly ramping up vaccination, testing, and treatment, as appropriate, and working closely with providers and community partners to rapidly disseminate messaging.”

A strong bird flu response hinges on federal partnership, public health experts say. Establishing an efficient testing system for bird flu is key, Mukherjee said, noting that the lack of such a system was a significant vulnerability during the early Covid response.

“We have some work to do in that sphere,” he said.

Nash emphasized that a good bird flu preparedness plan would look a lot like what the United States should have had when Covid hit: quick, scalable access to testing and masks, effective and widespread public health messaging, and swift vaccine production.

“We’re hopefully not going to be in a place like we were with Covid, where we couldn’t tell the extent of the outbreak, and how fast and where it was spreading until it was way too late,” he said. “If that happens with something like this virus, if it’s more pathogenic than Covid, we’ll be in a really bad place.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Bird flu found in second commercial chicken flock in Georgia, 200 yards from first location

2025-01-22T22:03:31+00:00

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Bird flu has been confirmed in a second commercial poultry flock in Elbert County, the Georgia Department of Agriculture said Wednesday.

The second contaminated site, listed as Elbert 02, is 210 yards away from the first location, Elbert 01, where bird flu was confirmed Friday. The farms, owned by the same family, are “just across a dirt road from each other,” said Matthew Agvent, Georgia Department of Agriculture spokesperson.

The owners were not identified. The second site housed 130,000 broilers. The first had about 45,500 broilers on site.

Agriculture Department employees completed the culling process within 48 hours of initial detection of the H5N1 virus, while cleaning and disinfecting were ongoing at both sites, the department said.

The clean-up process can pose a risk to workers, said Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health.

“There are documented cases of poultry workers getting infected with H5N1 during the cleanup of commercial poultry buildings,” he said.

No human cases have been reported in Georgia.

Agvent said employees involved in the response are being monitored daily for clinical symptoms and are using personal protective equipment and following biosecurity measures. Testing is also available if needed.

Some of the main symptoms in humans include fever, cough, sore throat, and pink eye (conjunctivitis).

The Georgia Department of Public Health has conducted a risk assessment for the family who owns the farms and “can make testing available if necessary,” Agvent said.

The agency’s law enforcement officers had set up a perimeter around the area. All commercial poultry operations within 6.2 miles have been under quarantine since Friday, and bird flu testing will be conducted for at least two weeks.

The state has also indefinitely suspended all poultry exhibitions, shows, swaps, meets, and sales.

Retail sales of eggs and chickens or other poultry products will not be affected, the agency said.

How to keep backyard flocks safe from bird flu

“The risk of H5N1 in the food supply is very low, partly because H5N1 kills poultry so quickly, and poultry rarely survive infection,” Pekosz told Healthbeat on Tuesday.

With a mortality rate of 100%, poultry or eggs “never make it off a commercial farm before the outbreak is detected.”

Georgia’s $7.75 billion commercial poultry industry is one of the largest in the nation.

Previously, some 30,580 birds had been culled in Georgia due to bird flu since the start of the current outbreak in February 2022, according to the U.S. Department of Agriculture. About 30,000 of those came from an infected flock at a commercial duck breeder in Sumter County in 2023.

Bird flu has also been detected in three backyard chicken flocks, including one in Clayton County earlier this month. Here’s how to protect backyard flocks.

The Centers for Disease Control and Prevention has confirmed 68 human cases in the United States since 2022. The first human death was reported this month in Louisiana, in an elderly person who had other underlying health conditions and was likely exposed via a backyard flock.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia works to contain spread of bird flu from commercial poultry farm

2025-01-21T17:33:00+00:00

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Georgia’s $7.75 billion commercial poultry industry – one of the largest in the nation – was working Tuesday to keep bird flu from spreading after a case was confirmed in an operation in Elbert County.

The Georgia Department of Agriculture said avian influenza breached the first commercial poultry operation in the state, confirming the diagnosis late Friday. About 45,000 broiler breeders were on the site and being destroyed.

Gilda Pedraza, executive director of the Latino Community Fund of Georgia, said Tuesday her organization sprang into action to help protect poultry workers.

The organization created materials to inform them about the new detection of bird flu, including safety information for those who keep backyard flocks.

“From our members, we have learned poultry plants continue to operate, and some have given masks to workers and have set up a nurse 24/7,” Pedraza said. “We have asked people that if they experience symptoms, to report them to their employers and to send us a message so we have some idea of what is going on at the ground level.”

How America lost control of the bird flu, setting the stage for another pandemic

State agriculture officials emphasized that the food supply is safe. Poultry operations near the contaminated farm were subjected to “additional surveillance” to find out whether the H5N1 virus has spread, Mike Giles, president of the Georgia Poultry Federation, said in a Friday press release.

The state did not name the company where bird flu was detected, but put all commercial poultry operations within 6.2 miles under quarantine and said they would be tested for at least two weeks.

The state also indefinitely suspended all poultry exhibitions, shows, swaps, meets, and sales.

“This is a serious threat to Georgia’s #1 industry and the livelihoods of thousands of Georgians who make their living in our state’s poultry industry. We are working around the clock to mitigate any further spread of the disease and ensure that normal poultry activities in Georgia can resume as quickly as possible,” Georgia Agriculture Commissioner Tyler Harper said Friday in a news release.

“The risk of an infected bird entering the food supply chain is low,” the state said.

How to keep backyard chickens safe from bird flu

Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health agreed.

“The risk of H5N1 in the food supply is very low, partly because H5N1 kills poultry so quickly, and poultry rarely survive infection.” With a mortality rate of 100%, poultry or eggs “never make it off a commercial farm before the outbreak is detected.”

The detection of bird flu in a small backyard chicken flock confirmed in Clayton County on Jan. 10 was the fourth instance in Georgia since the outbreak started.

Most human cases have come from dairy cattle

The Centers for Disease Control and Prevention has confirmed 68 human cases in the United States since 2022, as of earlier this month. The first human death was reported this month in Louisiana, in an elderly person who had other underlying health conditions and was likely exposed via a backyard flock.

Most infected people were likely exposed via contact with dairy cattle, according to the CDC, while others came from contact with poultry on farms.

No human cases have been reported in Georgia.

The state’s dairy operation is much smaller than the poultry industry. The Georgia Agriculture Department had tested 1,000 dairy cows by the end of December for bird flu and found no cases.

The state this month joined 27 others enrolled in a USDA program to test milk stored in silos at processing facilities for bird flu.

Commercial poultry producers test birds for avian influenza “at every stage of their life” as part of the state’s participation in the National Poultry Improvement Plan, Department of Agriculture spokesperson Liz Rivera-Brown told Healthbeat last week.

They have strong protocols in place to prevent bird flu because the industry is so important to the state, Giles said.

“The most important thing that we can do is prevent the virus from entering the poultry farms,” he said, adding that there is a focus on “consistent reinforcement” of existing protocols.

Poultry farms try to prevent infection by “drawing a line of separation” between the chicken houses and the outside world. That includes measures like foot pans to disinfect workers’ shoes, or changing footwear, Giles said.

Poultry workers need access to health care, sick leave

More than 37,000 people are directly employed in Georgia’s poultry industry, according to the U.S. Poultry and Egg Association. Many of them do not come into direct contact with birds, Giles said.

For those who do, it’s important for workers to know about bird flu and to have access to healthcare and financial support like sick leave, said Emory University epidemiology professor Jodie Guest, who helped with Covid testing efforts among poultry workers.

Guest said an on-site, mandatory bird flu testing system might not be a silver bullet solution, however.

“The best thing possible would be for there to be active surveillance [i.e. widespread testing at the facilities] but also paid sick leave,” Guest said. “If we’re going to require [testing], we need to support access to paid sick leave also.”

“Their access to health care has a tremendous number of barriers,” and workers could be reluctant to get tested because of concerns over losing wages or putting their immigration status at risk, Guest said.

Because many poultry workers, and others, may be reluctant or have a hard time accessing health care, and because bird flu often presents with only minor symptoms, human bird flu cases could fly under the radar, Guest said.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

There’s a higher risk for those workers who will have to deal with the dead birds after the culling process is complete, Pekosz said. “There are documented cases of poultry workers getting infected with H5N1 during the cleanup of commercial poultry buildings.”

“All workers involved will need to wear eye and respiratory protection, as well as disposable outer suits in order to prevent infection. Those items will then be decontaminated and destroyed after being used,” he said.

Some of the main symptoms in humans include fever, cough, sore throat, and pink eye (conjunctivitis).

The United States has a stockpile of 4.5 million H5N1 vaccines, but it’s unclear how well they would work because they are based on an older mutation formula, epidemiologist Dr. Katelyn Jetelina, a Healthbeat partner and supporter, wrote in a recent edition of her newsletter, Your Local Epidemiologist.

Finland last year started vaccinating at-risk farmworkers, and some experts have called on the CDC to do the same.

A federal program compensates commercial poultry owners if birds are infected and have to be destroyed.

Bird flu has also infected cats in some states, and Georgia is included in a recall of Northwest Naturals raw pet food.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Many schools used Covid aid on long-term needs like curriculum and buildings, new report says

2025-01-16T17:21:04+00:00

This story originally published at Chalkbeat, Healthbeat’s sister site. Sign up for Chalkbeat’s free weekly newsletter to keep up with how education is changing across the United States. Sign up for Healthbeat’s national newsletter here.

When schools were handed an unprecedented $129 billion in federal pandemic aid, it wasn’t surprising that Covid-related equipment topped the shopping list as schools rushed to snap up hotspots, laptops, desk dividers, and air filters.

But another widespread pattern is emerging as federal officials tally up the spending: Many districts also used their one-time funding to take care of longstanding needs, like replacing aging infrastructure and outdated textbooks, that schools previously wanted to tackle but could not afford.

Around 1 in 3 school districts and charter operators nationwide, or some 5,200, used Covid relief during the 2022-23 school year to adopt new curriculum or learning materials, a report released Wednesday by the U.S. Department of Education found. That made it the most common strategy to address learning loss, which schools spent $11 billion on that year.

Schools spent some $6 billion in federal pandemic aid that same year to upgrade and maintain their facilities. That meant 1 out of every 10 Covid relief dollars spent during the 2022-23 school year went toward a school building. It was six times more than states spent on tutoring.

And half of all Covid relief dollars schools spent that year, or just under $25 billion, were spent on staff salaries and benefits. A good chunk of that went toward paying new social workers and school nurses, which schools added to their ranks in droves with the aid.

Now that the Covid aid is mostly gone — schools have until the end of this month to spend it, unless they seek an extension — schools are confronting big questions about how they will cover curriculum overhauls and critical building repairs going forward, as well as how many of those additional staffers will lose their jobs. Many school districts, especially those with declining enrollments, are considering closing schools or cutting programs to balance their budgets.

The report looks at how the nation’s roughly 16,000 school districts and charter operators spent just over $49 billion in Covid relief dollars during the 2022-23 school year. Nearly all of the first two Covid relief packages had been exhausted, and schools were halfway through spending their last and largest aid package by the end of the 2022-23 school year. Schools had spent some $117 billion in pandemic aid by that point.

Investing in long-term projects encouraged

Investing in people and projects with the potential for long-term payoffs made sense, federal officials say, and the Biden administration encouraged this type of spending.

Federal officials also believe provisions in the Covid aid laws that required states to maintain their own school funding will help schools return to more usual levels of funding more easily than they did following the Great Recession. When stimulus packages enacted in the wake of that financial crisis expired, many states slashed education funding and schools cut hundreds of thousands of jobs, dramatically shrinking the size of the K-12 education workforce.

“There are certainly difficult decisions that are going to get made after $130 billion is fully invested,” said Adam Schott, the principal deputy assistant secretary in the Education Department’s Office of Elementary and Secondary Education. “We are just not seeing the type of fiscal cliff that we saw 10, 12, 15 years ago.”

Part of the reason for that, Schott said, is that the Biden administration urged schools to spend the pandemic aid on immediate needs, but also long-term academic goals.

To the administration, investing in school buildings — and getting rid of issues like asbestos, mold, and lead — was also crucial.

“For decades, we’ve known that a classroom that’s 90 degrees in May or in September is an impediment to in-person learning,” Schott said. “We saw this as really core to academic recovery.”

Pennsylvania's New Kensington-Arnold School District, like many across the U.S., used COVID aid to make long-term improvements to school buildings.

Many schools spent on curriculum amid worrying test scores

The new data about spending on curriculum and classroom materials comes as many states and districts overhaul their approach to teaching reading and math, opting for materials that better align with the science of how children learn.

That spending also coincides with several years of national and international test score data showing that American children are academically stagnant or falling behind their earlier counterparts. That was true even before the pandemic. But the trend is especially stark for kids who score the lowest on math and reading tests.

And while recent state test scores have shown some students are rebounding to pre-pandemic levels, “We are clearly not where we ought to be,” Schott said.

Federal COVID relief dollars improved student test scores, two new studies find

Now that the federal Covid aid is gone, “states have to be ready to grab the baton,” he added, whether that’s finding new ways to spend existing federal funding, or adding money to state education budgets. “We’re going to keep beating that drum with every minute we’ve got left.”

The new federal report also comes as President-elect Donald Trump prepares to start his second term in a few days. It’s unclear how or if top education officials in his administration will push schools to continue pandemic-era programs.

On the campaign trail, Trump and his supporters said they wanted to get rid of the federal education department or shrink its powers and give more responsibility to state officials — who already largely control what and how kids learn.

By the 2022-23 school year, most students were back to learning in person for a second school year. The Covid-19 global health emergency was declared officially over halfway through the school year. But many students were struggling to follow the routines of school. Student absenteeism rates were still abnormally high.

Expanded summer programming was a very common investment — though it’s unclear if some of these programs helped kids improve academically. About 2 in 5 school districts or charter school operators used Covid aid on summer programs that school year, reaching around 4.5 million students.

A smaller number of districts and charter operators — around 1 in 10 nationally, or around 2,100 — used pandemic money to add instructional time. Researchers were a fan of that strategy, but educators often found it was difficult to pull off.

Money went to tutoring and staffing

Meanwhile, states spent $1 billion on tutoring that school year, and districts ran intensive tutoring programs that reached some 3 million kids, or around 6% of public school students. Of those students, around half were from low-income families, while 13% were students with disabilities and 14% were learning English as a new language — suggesting that many students from historically disadvantaged backgrounds did not receive tutoring.

Earlier estimates have suggested less than 10% of students were getting tutoring thanks to Covid aid — a figure researchers have said was likely much smaller than the share of kids who needed extra academic help after the pandemic’s disruptions to learning.

The report points out that Covid aid helped to put “more people working in America’s schools than at any time in the last decade.” As of October 2024, the report notes, schools had added some 643,000 jobs since 2021, with a 43% increase in social workers and a 23% increase in school nurses.

Some school finance experts have criticized schools for adding many new staffers or programs that they couldn’t afford to keep after the Covid aid ran out. They’ve said the hiring and firing is destabilizing, especially for schools that had more staff turnover prior to the pandemic.

Still, Schott defended that use of the money. He pointed out that some of the added spending helped to raise low teacher pay or invest in gummed-up educator pipelines. Other spending got “more caring eyes on kids” at a chaotic time.

“You couldn’t maintain consistency for kids, you couldn’t deliver instruction, you couldn’t get core nutrition services flowing without people,” he said.

Kalyn Belsha is a senior national education reporter based in Chicago. Contact her at kbelsha@chalkbeat.org.

Most New Yorkers had Covid symptoms for more than a month, Health Dept. survey finds

2025-01-16T15:10:48+00:00

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Most New Yorkers infected with Covid experienced symptoms for a month or longer, the New York City Department of Health and Mental Hygiene found in a survey.

Of more than 2,000 adults infected with Covid who were surveyed by the Health Department in late 2022, 80% reported at least one post-acute symptom — a symptom lasting for a month or longer. The most commonly reported symptoms were fatigue and decreased exercise tolerance, according to the survey, which was released in late December.

The findings suggest that Covid symptoms frequently extend beyond one or two weeks, which is often referenced as the recovery period for mild or moderate cases. While 21% of surveyed adults reported no post-acute symptoms, 30% reported at least one mild symptom, 29% reported at least one moderate symptom, and 21% reported at least one severe symptom, according to the survey.

“It’s very common for people to experience some symptoms that last up to a month, and potentially longer than a month,” said Sam Packard, the senior project manager for Long Covid surveillance at the Health Department, who co-authored the report on the survey.

Some people with post-acute symptoms may go on to develop Long Covid, a chronic condition characterized by symptoms of more than three months, which can be severe or disabling. The Health Department survey did not assess the prevalence of Long Covid, but the agency has several ongoing data collection initiatives focused on the condition, Packard said.

It’s not unusual to have a “long tail” of recovery following a Covid infection, said David Putrino, the Nash Family Director of the Cohen Center for Recovery from Complex Chronic Illnesses at Mount Sinai Health System. The Health Department’s findings are consistent with larger epidemiological studies, as well as with his own clinical experience, he said.

“A majority of people do not quickly recover from an acute SARS-CoV-2 infection,” said Putrino, who is also a professor in the Department of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai.

In the Health Department survey, New Yorkers reported a wide range of post-acute symptoms, from anxiety and difficulty concentrating to coughs and muscle aches. Decreased exercise tolerance and fatigue were each reported by about half of all surveyed adults.

Of New Yorkers with at least one severe post-acute symptom, most reported activity limitations, and 1 in 3 had probable depression, according to the survey. People with at least one severe post-acute symptom also reported 10 days of reduced ability, or an inability, to complete typical activities or work, compared with six days for those with moderate symptoms and three days for those with mild symptoms.

Putrino, who treats Long Covid patients at the Cohen Center, noted that fatigue and post-exertional malaise — the worsening of symptoms after physical or mental activity — can be “quite disabling.” A Covid infection is a significant event, he emphasized.

“It’s not necessarily an easy and simple recovery from SARS-CoV-2, even if your acute illness is mild,” he said.

The Health Department’s survey found a similar prevalence of mild symptoms across socio-economic groups. But moderate symptoms were more prevalent among Latino and Asian/Pacific Islander adults than among white adults, and severe symptoms were more prevalent among Latino and Black adults than among white adults. Moderate and severe symptoms were also more prevalent in higher-poverty neighborhoods than in lower-poverty neighborhoods.

Packard noted that those findings reflect many of the structural determinants of health that produced unequal outcomes in Covid cases, hospitalizations, and deaths during the height of the pandemic.

“Those same structural determinants of health are at play when it comes to who’s experiencing severe illness, prolonged illness, post-acute symptoms, potentially even going on to develop Long Covid,” he said.

While the survey did not assess the prevalence of Long Covid, it found uncertainty among New Yorkers about the condition. Many people said they were unsure whether they had Long Covid. More than half of New Yorkers with post-acute symptoms said they had sought out a health care provider for their symptoms, and many reported receiving help. But the vast majority — even those with severe symptoms — said their provider had not talked to them about Long Covid.

Those findings highlight the need for better Long Covid education for the public, health care providers and policy makers, Packard said.

At the Cohen Center, which Putrino directs, the demand for Long Covid care has been overwhelming, he said. The clinic uses a precision medicine approach, performing comprehensive assessments on patients and treating specific deficits.

Long Covid remains a challenging condition to treat. Putrino said that for the majority of patients, the clinic can help improve symptom burden and the ability to function, but a small percentage of patients do not seem to recover.

“We can’t possibly manage the amount of Long Covid cases that are beating down our doors,” he said. “So we see the only way forward is to educate others on how to identify and then how to manage Long Covid and other infection-associated chronic conditions. That has largely become our mission.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Georgia state epidemiologist says flu season may have peaked

2025-01-14T22:37:35+00:00

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Officials with Georgia’s Department of Public Health reiterated Tuesday that while respiratory diseases are at seasonal heights, there are signs that this winter’s wave could be milder than recent years.

At the DPH board’s meeting, state epidemiologist Cherie Drenzek shared charts that showed stark winter increases in three major viruses — Covid-19, influenza, and respiratory syncytial virus. The graphs illustrated that so far, flu was the respiratory disease most responsible for driving up state and national hospital visits.

Drenzek said that infectious disease trends can change unpredictably, but that Georgia flu season has likely peaked and is expected to decline soon.

“Even though we have very high activity right now in regard to flu in Georgia, last year was even worse,” she told the board.

While more people with flu have sought hospital care than those with Covid, Drenzek said Covid continues to be more deadly. The DPH has yet to document a flu death this season, but that may be due to lags in reporting.

Covid appears to be on the rise. But cases and hospitalizations remain significantly lower than the previous four winters’ peaks, and deaths are at record lows.

Unlike the trend nationally, Georgia’s RSV cases have declined after reaching the state’s highest levels in recent history.

In a late December survey, the Centers for Disease Control and Prevention estimated that among Georgia adults this respiratory disease season, only 14% had received Covid vaccines, and 35% had been given a flu shot. Unlike previous years, the CDC recommends two Covid booster shots for adults 65 and older.

Drenzek said it’s not too late to seek immunizations for either disease.

“Even though we may be peaking or close to the peak, we often have declines and then spring waves,” she said.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Respiratory diseases reach new seasonal heights in Atlanta and Georgia

2025-01-10T12:00:00+00:00

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As the new year begins, Atlanta and Georgia respiratory disease spread has accelerated to some of the highest levels seen this winter.

Over the last week of 2024, flu cases hospitalized 220 residents in the metro Atlanta area, according to the latest report from the Georgia Department of Public Health. That week alone makes up over a third of the region’s count since October.

Statewide cases appear to be paralleling that trend. Preliminary data from the U.S. Centers for Disease Control and Prevention suggest that Georgia’s hospitalization rate for the virus also rose at the end of 2024 to its highest level in recent months. Additionally, the state percentage of health care visits for suspected flu cases has continued to increase and outpace the national average.

Respiratory syncytial virus, known as RSV, and Covid-19 are infecting many Georgians as well. Wastewater surveillance sites detect high levels of the viruses in communities across the state. RSV levels appear to have remained at the new heights they reached last month.

These state benchmarks show yearly rises in the three viruses, but many also indicate a less severe season so far relative to recent winters. In the last three months of 2023, metro Atlanta area health care centers hospitalized about 1,000 more people for the flu than they did at the end of 2024.

And while CDC numbers indicate that December’s final week was a recent peak for Georgia hospitalizations related to any of the three viruses, that rate is significantly lower than it was any of the past four years at the same time.

Still, there are other respiratory diseases that have outpaced recent Georgia recordings. One of them is pertussis, also known as whooping cough. The bacterial disease, most common in children, can compromise babies’ breathing and cause coughing strong enough to break ribs. For 2024, the CDC has recorded 280 Georgia cases — nearly three times the count of 2023.

The system used to detect whooping cough is updated frequently, and the 2023 and 2024 counts could continue to change. But in a health advisory last month, the state health department warned providers to be on the lookout for any patients presenting with severe coughs.

The CDC recommends five doses of vaccines throughout a child’s first six years that helps protect against whooping cough. The organization says besides some groups like pregnant people and seniors, most adults don’t need to seek additional immunizations.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Doctor who helped end smallpox reflects on Jimmy Carter, today’s politics, and restoring trust in science

2025-01-09T12:00:00+00:00

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When Jimmy Carter started his nongovernmental organization in Atlanta soon after leaving the White House, he reached out to his former CDC director to run it.

Dr. Bill Foege, who after leaving the Centers for Disease Control and Prevention launched what became The Task Force for Global Health, was known for his role in leading the eradication of smallpox in the 1970s. He wasn’t ready to give up his global public health work.

“‘Would it make a difference if I also became interested in global health?’” Carter asked Foege.

It made all the difference. In the ensuing decades, the Carter Center was credited with public health improvements around the world, fighting diseases like malaria, river blindness, and Guinea worm.

As Carter is laid to rest this week after his Dec. 29 death, Foege, 88, spoke with Healthbeat about his work on public health with Carter, his worries about the incoming Trump administration, and how to help win people’s trust in science.

The conversation has been edited for length and clarity.

What do you consider President Jimmy Carter’s public health legacy to be?

When he first approached me about being executive director at the Carter Center, I had real reservations. I told him I spent my life in global health. There aren’t enough people working in global health, and this was quite some time ago, and it was true, and I said it just didn’t seem right for me to leave it.

He came back a day or so later and said, “Would it make a difference if I also became interested in global health?” And of course, it’s incredible to have that sort of opportunity.

What he did was demonstrate to me what we should know, which is public health people and politicians have to work together because we’re totally dependent on appropriations that come from politicians making decisions on what they will fund. Sometimes you see public health people very distressed that politicians are involving themselves. Yet there’s no option; we have to get them involved, not just in appropriations, but to have them invested in a health outcome. And that’s what President Carter could do.

What Jimmy Carter taught us about public health: Peace, faith, science can work together

If I went to Africa, I could probably quite easily get an appointment with the minister of health. I could not get an appointment with the minister of finance, and they’re the crucial ones, and I certainly could not get an appointment with the head of state.

President Carter would go right to the head of state. Head of state would get a Cabinet meeting, including the minister of health and the minister of finance. When Carter would sell him on onchocerciasis [river blindness], or Guinea worm, or schistosomiasis, or other things, and the head of state would say, “This is something we want to do,” the minister of health and the minister of finance are going to just trip all over themselves to please the head of state. He showed what a politician could do working with public health.

What is the most effective thing public health leaders can do to build trust in their work and in science?

I often use the word trust because it’s the glue that holds together a coalition. It was certainly the glue that held together the coalition in India, as we were doing smallpox eradication.

With public health, there are three things that I often tell public health students that [they must do] in order to get trust.

Former CDC Director Bill Foege, right, walks with President Jimmy Carter at the CDC headquarters in Atlanta in 1985.

Number one, start with the best science. We’ll all make mistakes on science. No question about that. Admit them when you find them, go back and correct them and continue to do the best science possible. And [British biologist Thomas] Huxley once said that science is simply common sense at its best, that it’s not anything that people can’t understand. Nowadays, there are people who think they can’t understand science, and therefore they don’t trust it. No, it’s just common sense at its best. We have to become better at describing the science so that people do understand it.

Number two, add art. The first scientist that we know in history was an Egyptian by the name of Imhotep. He was a physician, but he was also an architect. He designed the step pyramid, and then he supervised the building of the step pyramid. The reason this is important is it brings creativity into the process. Instead of just common sense at its best, you have creative common sense at its best.

‘Protect our children’: Vaccine expert on why immunization remains crucial

And then, the third ingredient: I go back to Roger Bacon, who about 800 years ago, was asked to do a summary of science for the pope. And it’s been 50 years since I’ve read that, but I still remember so clearly that he said, “Science has no moral compass.” It means you have to provide scientists with a moral compass in order to bring all three of these together for moral, creative common sense at its best. That’s the way we regain trust — by keeping those things in mind.

What is your biggest worry about public health right now?

You hit it with the trust issue. The public health people have to take this very seriously, and this is part of why we have to reach out to politicians. We need them to fund our projects, and if they don’t fund the projects, then we can’t provide what we should to the public. I’m very concerned about this anti-science, anti-government movement, the anti-vaxxers, for instance.

The first vaccine that we have was developed by Edward Jenner in 1796. The first anti-vax group developed in 1796. This is an old, old problem. Because the smallpox vaccine was taken from cowpox, they would make cartoons of people who had the head of a cow growing out of their arm to warn people not to get vaccinated.

This 1980 photograph, taken at the Centers for Disease Control, depicted three former directors of the Global Smallpox Eradication Program, as they read the good news that smallpox had been eradicated on a global scale. From left to right: Dr. J. Donald Millar, who was director 1966–70, Dr. Bill Foege, who was director 1970-73, and Dr. J. Michael Lane, who was director 1973-81.

This anti-science, anti-government movement has to be countered with good information. Parents are not trying to hurt their children when they keep them from being vaccinated. They believe that the vaccines are harmful, and why shouldn’t they? Because now they don’t have the disease and the risk of the disease to compare to the risk of the vaccine. When I was young, you had no trouble convincing people to take the polio vaccine, because they saw what happened, the crippling of polio. You had no trouble in Africa getting people to take the measles vaccine, because 7% of all children were dying of measles in Africa.

Now you don’t have the disease, so people can’t make that comparison, and they only look at the risk of the vaccine, and they forget that the risk of the disease has gone down because of a social contract that we all have. The problems are gigantic, there’s no question about it. We have to be so careful about presenting the best information and figuring out how to get the grass roots to solve this on their own.

How do you expect public health to change under the new Trump administration? What do you tell colleagues who are worried about Trump’s policies or the officials he’s choosing?

I worry about what could happen over the next four years, and I worry about some of these ideas of stopping polio vaccines. Polio will come back.

We were at a very low point with measles. When I started working in Africa in the ’60s, 7% of children were dying of measles. The introduction of the measles vaccine was unbelievably important, and it went down from 3 million children a year dying of measles in the world to 2 million to 1 million to half a million, and we were down to about 100,000 – still far too many. But now measles is resurging in places because people are worried about giving the vaccine, or they’re competing with Covid and other things. There’s a real task for public health, and I worry about what will happen in this country.

We went through the ’90s and the early 2000s with almost no cases of the usual childhood diseases, but they’ve started coming back.

Why should Americans care about global public health?

Every place in the world is both local and global simultaneously, so no matter where you’re working on public health, you’re working on global public health.

You have one objective, which is global health equity. Those three words, you can’t take any of those three away and have it mean the same thing, and you can add 200 and not improve on it. Global health equity is the objective, and everyone working in public health is doing that.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Covid-19, influenza, and RSV increasing around the holidays in New York

2024-12-23T12:00:00+00:00

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Have questions, comments, or ideas for future topics? Just reply to this email. I would love to hear from you.

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 America lost control of the bird flu, setting the stage for another pandemic

2024-12-20T10:00:00+00:00

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Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A livestock veterinarian at the University of Wisconsin, Poulsen had seen sick cows before, with their noses dripping and udders slack.

But the scale of the farmers’ efforts to treat the sick cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy workers pumped gallons of electrolyte-rich fluids into ailing cows through metal tubes inserted into the esophagus.

“It was like watching a field hospital on an active battlefront treating hundreds of wounded soldiers,” he said.

Nearly a year into the first outbreak of the bird flu among cattle, the virus shows no sign of slowing. The U.S. government failed to eliminate the virus on dairy farms when it was confined to a handful of states, by quickly identifying infected cows and taking measures to keep their infections from spreading. Now at least 860 herds across 16 states have tested positive.

Experts say they have lost faith in the government’s ability to contain the outbreak.

“We are in a terrible situation and going into a worse situation,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “I don’t know if the bird flu will become a pandemic, but if it does, we are screwed.”

To understand how the bird flu got out of hand, KFF Health News interviewed nearly 70 government officials, farmers and farmworkers, and researchers with expertise in virology, pandemics, veterinary medicine, and more.

Together with emails obtained from local health departments through public records requests, this investigation revealed key problems, including a deference to the farm industry, eroded public health budgets, neglect for the safety of agriculture workers, and the sluggish pace of federal interventions.

Case in point: The U.S. Department of Agriculture this month announced a federal order to test milk nationwide. Researchers welcomed the news but said it should have happened months ago — before the virus was so entrenched.

“It’s disheartening to see so many of the same failures that emerged during the Covid-19 crisis re-emerge,” said Tom Bollyky, director of the Global Health Program at the Council on Foreign Relations.

Far more bird flu damage is inevitable, but the extent of it will be left to the Trump administration and Mother Nature. Already, the USDA has funneled more than $1.7 billion into tamping down the bird flu on poultry farms since 2022, which includes reimbursing farmers who’ve had to cull their flocks, and more than $430 million into combating the bird flu on dairy farms. In coming years, the bird flu may cost billions of dollars more in expenses and losses. Dairy industry experts say the virus kills roughly 2 to 5% of infected dairy cows and reduces a herd’s milk production by about 20%.

Worse, the outbreak poses the threat of a pandemic. More than 60 people in the United States have been infected, mainly by cows or poultry, but cases could skyrocket if the virus evolves to spread efficiently from person to person. And the recent news of a person critically ill in Louisiana with bird flu shows that the virus can be dangerous.

Just a few mutations could allow the bird flu to spread between people. Because viruses mutate within human and animal bodies, each infection is like a pull of a slot machine lever.

“Even if there’s only a 5% chance of a bird flu pandemic happening, we’re talking about a pandemic that probably looks like 2020 or worse,” said Tom Peacock, a bird flu researcher at the Pirbright Institute in the United Kingdom, referring to Covid-19. “The U.S. knows the risk but hasn’t done anything to slow this down,” he added.

Beyond the bird flu, the federal government’s handling of the outbreak reveals cracks in the U.S. health security system that would allow other risky new pathogens to take root, too. “This virus may not be the one that takes off,” said Maria Van Kerkhove, director of the emerging diseases group at the World Health Organization. “But this is a real fire exercise right now, and it demonstrates what needs to be improved.”

Farmers dismayed by inaction

It may have been a grackle, a goose, or some other wild bird that infected a cow in northern Texas. In February, the state’s dairy farmers took note when cows stopped making milk. They worked alongside veterinarians to figure out why. In less than two months, veterinary researchers identified the highly pathogenic H5N1 bird flu virus as the culprit.

Long listed among pathogens with pandemic potential, the bird flu’s unprecedented spread among cows marked a worrying shift. It had evolved to thrive in animals that are more like people biologically than birds.

After the USDA announced the dairy outbreak on March 25, control shifted from farmers, veterinarians, and local officials to state and federal agencies. Collaboration disintegrated almost immediately.

Farmers worried the government might block their milk sales or even demand sick cows be killed, as poultry are, said Kay Russo, a livestock veterinarian in Fort Collins, Colorado.

Instead, Russo and other veterinarians said, they were dismayed by inaction. The USDA didn’t respond to their urgent requests to support studies on dairy farms — and for money and confidentiality policies to protect farmers from financial loss if they agreed to test animals.

The runny nose of a dairy cow on a farm with a bird flu outbreak. This photo was taken by a livestock veterinarian who asked to remain anonymous because of employment concerns.

The USDA announced that it would conduct studies itself. But researchers grew anxious as weeks passed without results. “Probably the biggest mistake from the USDA was not involving the boots-on-the-ground veterinarians,” Russo said.

Will Clement, a USDA senior adviser for communications, said in an email: “Since first learning of H5N1 in dairy cattle in late March 2024, USDA has worked swiftly and diligently to assess the prevalence of the virus in U.S. dairy herds.” The agency provided research funds to state and national animal health labs beginning in April, he added.

The USDA didn’t require lactating cows to be tested before interstate travel until April 29. By then, the outbreak had spread to eight other states. Farmers often move cattle across great distances, for calving in one place, raising in warm, dry climates, and milking in cooler ones. Analyses of the virus’s genes implied that it spread between cows rather than repeatedly jumping from birds into herds.

Milking equipment was a likely source of infection, and there were hints of other possibilities, such as through the air as cows coughed or in droplets on objects, like work boots. But not enough data had been collected to know how exactly it was happening. Many farmers declined to test their herds, despite an announcement of funds to compensate them for lost milk production in May.

“There is a fear within the dairy farmer community that if they become officially listed as an affected farm, they may lose their milk market,” said Jamie Jonker, chief science officer at the National Milk Producers Federation, an organization that represents dairy farmers. To his knowledge, he added, this hasn’t happened.

Speculation filled knowledge gaps. Zach Riley, head of the Colorado Livestock Association, said he suspected that wild birds may be spreading the virus to herds across the country, despite scientific data suggesting otherwise. Riley said farmers were considering whether to install “floppy inflatable men you see outside of car dealerships” to ward off the birds.

Advisories from agriculture departments to farmers were somewhat speculative, too. Officials recommended biosecurity measures such as disinfecting equipment and limiting visitors. As the virus kept spreading throughout the summer, USDA senior official Eric Deeble said at a press briefing, “The response is adequate.”

The USDA, the Centers for Disease Control and Prevention, and the Food and Drug Administration presented a united front at these briefings, calling it a “One Health” approach. In reality, agriculture agencies took the lead.

This was explicit in an email from a local health department in Colorado to the county’s commissioners. “The State is treating this primarily as an agriculture issue (rightly so) and the public health part is secondary,” wrote Jason Chessher, public health director in Weld County, Colorado. The state’s leading agriculture county, Weld’s livestock and poultry industry produces about $1.9 billion in sales each year.

An email obtained through a Freedom of Information Act request to the public health department in Weld County, Colorado, illustrates that some workers on farms with bird flu outbreaks weren’t monitored for signs of infection.

Cases under the radar in three states

In July, the bird flu spread from dairies in Colorado to poultry farms. To contain it, two poultry operations employed about 650 temporary workers — Spanish-speaking immigrants as young as 15 — to cull flocks. Inside hot barns, they caught infected birds, gassed them with carbon dioxide, and disposed of the carcasses. Many did the hazardous job without goggles, face masks, and gloves.

By the time Colorado’s health department asked if workers felt sick, five women and four men had been infected. They all had red, swollen eyes — conjunctivitis — and several had such symptoms as fevers, body aches, and nausea.

State health departments posted online notices offering farms protective gear, but dairy workers in several states told KFF Health News that they had none. They also hadn’t heard about the bird flu, never mind tests for it.

Studies in Colorado, Michigan, and Texas would later show that bird flu cases had gone under the radar. In one analysis, eight dairy workers who hadn’t been tested — 7% of those studied — had antibodies against the virus, a sign that they had been infected.

Missed cases made it impossible to determine how the virus jumped into people and whether it was growing more infectious or dangerous. “I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, an executive director at the international organization the Coalition for Epidemic Preparedness Innovations, who served as assistant secretary for preparedness and response in the Obama administration.

A photograph of the eyes of an infected dairy worker in Texas, with ruptured blood vessels and bleeding conjunctiva.

Citing “insufficient data,” the British government raised its assessment of the risk posed by the U.S. dairy outbreak in July from three to four on a six-tier scale.

Virologists around the world said they were flabbergasted by how poorly the United States was tracking the situation. “You are surrounded by highly pathogenic viruses in the wild and in farm animals,” said Marion Koopmans, head of virology at Erasmus Medical Center in the Netherlands. “If three months from now we are at the start of the pandemic, it is nobody’s surprise.”

Although the bird flu is not yet spreading swiftly between people, a shift in that direction could cause immense suffering. The CDC has repeatedly described the cases among farmworkers this year as mild — they weren’t hospitalized. But that doesn’t mean symptoms are a breeze, or that the virus can’t cause worse.

“It does not look pleasant,” Sean Roberts, an emergency services specialist at the Tulare County, California, health department wrote in an email to colleagues in May. He described photographs of an infected dairy worker in another state: “Apparently, the conjunctivitis that this is causing is not a mild one, but rather ruptured blood vessels and bleeding conjunctiva.”

Over the past 30 years, half of about 900 people diagnosed with bird flu around the world have died. Even if the case fatality rate is much lower for this strain of the bird flu, Covid showed how devastating a 1% death rate can be when a virus spreads easily.

Like other cases around the world, the person now hospitalized with the bird flu in Louisiana appears to have gotten the virus directly from birds. After the case was announced, the CDC released a statement saying, “A sporadic case of severe H5N1 bird flu illness in a person is not unexpected.”

‘The cows are more valuable than us’

Local health officials were trying hard to track infections, according to hundreds of emails from county health departments in five states. But their efforts were stymied. Even if farmers reported infected herds to the USDA and agriculture agencies told health departments where the infected cows were, health officials had to rely on farm owners for access.

“The agriculture community has dictated the rules of engagement from the start,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That was a big mistake.”

Some farmers told health officials not to visit and declined to monitor their employees for signs of sickness. Sending workers to clinics for testing could leave them shorthanded when cattle needed care. “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too,” said an email from the Weld, Colorado, health department.

“We know of 386 persons exposed – but we know this is far from the total,” said an email from a public health specialist to officials at Tulare’s health department recounting a call with state health officials. “Employers do not want to run this through worker’s compensation. Workers are hesitant to get tested due to cost,” she wrote.

A photograph of a note found in a break room at a dairy farm saying “cows with flu in Pen 56” in Spanish. (Photo taken by livestock veterinarian who asked to remain anonymous because of concerns about reputational damage.)

Jennifer Morse, medical director of the Mid-Michigan District Health Department, said local health officials have been hesitant to apply pressure after the backlash many faced at the peak of Covid. Describing the 19 rural counties she serves as “very minimal-government-minded,” she said, “if you try to work against them, it will not go well.”

Rural health departments are also stretched thin. Organizations that specialize in outreach to farmworkers offered to assist health officials early in the outbreak, but months passed without contracts or funding. During the first years of Covid, lagging government funds for outreach to farmworkers and other historically marginalized groups led to a disproportionate toll of the disease among people of color.

Kevin Griffis, director of communications at the CDC, said the agency worked with the National Center for Farmworker Health throughout the summer “to reach every farmworker impacted by H5N1.” But Bethany Boggess Alcauter, the center’s director of public health programs, said it didn’t receive a CDC grant for bird flu outreach until October, to the tune of $4 million. Before then, she said, the group had very limited funds for the task. “We are certainly not reaching ‘every farmworker,’” she added.

Farmworker advocates also pressed the CDC for money to offset workers’ financial concerns about testing, including paying for medical care, sick leave, and the risk of being fired. This amounted to an offer of $75 each. “Outreach is clearly not a huge priority,” Boggess said. “I hear over and over from workers, ‘The cows are more valuable than us.’”

The USDA has so far put more than $2.1 billion into reimbursing poultry and dairy farmers for losses due to the bird flu and other measures to control the spread on farms. Federal agencies have also put $292 million into developing and stockpiling bird flu vaccines for animals and people. In a controversial decision, the CDC has advised against offering the ones on hand to farmworkers.

“If you want to keep this from becoming a human pandemic, you focus on protecting farmworkers, since that’s the most likely way that this will enter the human population,” said Peg Seminario, an occupational health researcher in Bethesda, Maryland. “The fact that this isn’t happening drives me crazy.”

Nirav Shah, principal deputy director of the CDC, said the agency aims to keep workers safe. “Widespread awareness does take time,” he said. “And that’s the work we’re committed to doing.”

As President-elect Donald Trump comes into office in January, farmworkers may be even less protected. Trump’s pledge of mass deportations will have repercussions whether they happen or not, said Tania Pacheco-Werner, director of the Central Valley Health Policy Institute in California.

Many dairy and poultry workers are living in the United States without authorization or on temporary visas linked to their employers. Such precarity made people less willing to see doctors about Covid symptoms or complain about unsafe working conditions in 2020. Pacheco-Werner said, “Mass deportation is an astronomical challenge for public health.”

Not ‘immaculate conception’: Missouri case a mystery

A switch flipped in September among experts who study pandemics as national security threats. A patient in Missouri had the bird flu, and no one knew why. “Evidence points to this being a one-off case,” Shah said at a briefing with journalists. About a month later, the agency revealed it was not.

Antibody tests found that a person who lived with the patient had been infected, too. The CDC didn’t know how the two had gotten the virus, and the possibility of human transmission couldn’t be ruled out.

Nonetheless, at an October briefing, Shah said the public risk remained low, and the USDA’s Deeble said he was optimistic that the dairy outbreak could be eliminated.

Experts were perturbed by such confident statements in the face of uncertainty, especially as California’s outbreak spiked and a child was mysteriously infected by the same strain of virus found on dairy farms.

“This wasn’t just immaculate conception,” said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “It came from somewhere, and we don’t know where, but that hasn’t triggered any kind of reset in approach — just the same kind of complacency and low energy.”

Sam Scarpino, a disease surveillance specialist in the Boston area, wondered how many other mysterious infections had gone undetected. Surveillance outside farms was even patchier than on them, and bird flu tests have been hard to get.

Although pandemic experts had identified the CDC’s singular hold on testing for new viruses as a key explanation for why America was hit so hard by Covid in 2020, the system remained the same. Bird flu tests could be run only by the CDC and public health labs until this month, even though commercial and academic diagnostic laboratories had inquired about running tests since April. The CDC and FDA should have tried to help them along months ago, said Ali Khan, a former top CDC official who now leads the University of Nebraska Medical Center College of Public Health.

As winter sets in, the bird flu becomes harder to spot because patient symptoms may be mistaken for the seasonal flu. Flu season also raises a risk that the two flu viruses could swap genes if they infect a person simultaneously. That could form a hybrid bird flu that spreads swiftly through coughs and sneezes.

A sluggish response to emerging outbreaks may simply be a new, unfortunate norm for America, said Bollyky, at the Council on Foreign Relations. If so, the nation has gotten lucky that the bird flu still can’t spread easily between people. Controlling the virus will be much harder and costlier than it would have been when the outbreak was small. But it’s possible.

Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. “Not one and done,” he added. If they detect the virus, they’d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd — or at least to other farms. Cows can spread the bird flu before they’re sick, he said, so speed is crucial.

Curtailing the virus on farms is the best way to prevent human infections, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, but human surveillance must be stepped up, too. Every clinic serving communities where farmworkers live should have easy access to bird flu tests — and be encouraged to use them. Funds for farmworker outreach must be boosted. And, she added, the CDC should change its position and offer farmworkers bird flu vaccines to protect them and ward off the chance of a hybrid bird flu that spreads quickly.

The rising number of cases not linked to farms signals a need for more testing in general. When patients are positive on a general flu test — a common diagnostic that indicates human, swine, or bird flu — clinics should probe more deeply, Nuzzo said.

The alternative is a wait-and-see approach in which the nation responds only after enormous damage to lives or businesses. This tack tends to rely on mass vaccination. But an effort analogous to Trump’s Operation Warp Speed is not assured, and neither is rollout like that for the first Covid shots, given a rise in vaccine skepticism among Republican lawmakers.

Change may instead need to start from the bottom up — on dairy farms, still the most common source of human infections, said Poulsen. He noticed a shift in attitudes among farmers at the Dairy Expo: “They’re starting to say, ‘How do I save my dairy for the next generation?’ They recognize how severe this is, and that it’s not just going away.”

Amy Maxmen is Healthbeat’s national reporter through its partnership with KFF Health News.

Georgia and Atlanta flu circulation rise as Covid cases remain limited

2024-12-13T17:35:56+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

While Georgia influenza and Covid-19 rates appear to be lower than last year at this time, flu circulation has reached a level that concerns some local health officials.

In data published by the Centers for Disease Control and Prevention, the percentage of state hospital visits for flu-like illnesses remains higher than the national average as of the first week of December.

In the metro Atlanta area, there were 12 hospitalizations for influenza throughout Thanksgiving week, according to the Georgia Department of Public Health. While that’s one of the largest weekly in-patient admission counts of this fall, it’s only about 15% of the rate experienced last year at that time. CDC emergency department data further indicate that Georgia respiratory virus visits, including for influenza, remain less common than last respiratory disease season.

At the Thursday Cobb County Board of Health meeting, Cobb and Douglas Public Health epidemiology and infectious disease director Rachel Franklin said Georgia flu transmission levels had switched from “moderate” to “high” earlier that week. She said that trend contrasts local and state Covid rates, which remain at relatively low levels.

“Right after Thanksgiving, right on time, it went up to high,” she told the Cobb County health board members. “Not too late for the flu vaccines, but remember that they do take about two weeks to actually give you some protection.”

A CDC survey from the last week of November estimates that in Georgia, about 30% of adults and 32% of kids have received a flu vaccine this season. Both of those approximations are lower than their national counterparts, but small Georgia sample sizes mean it’s difficult to determine how different the state and U.S. percentage of vaccinated residents actually is.

Incidents of respiratory syncytial virus, or RSV, grew to high levels throughout November. But recent wastewater and hospitalization data further indicate that the rate of new cases is plateauing, if not declining. Nationally, there appears to be less frequent but increasing circulation of the virus.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Georgia RSV reached peak levels last month, influenza appears to be rising

2024-12-06T19:29:10+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

While Georgia has had relatively few Covid and influenza cases this fall, data from the Centers for Disease Control and Prevention indicate that respiratory syncytial virus, also known as RSV, recently peaked at the state’s highest levels in years.

Numbers from late November indicate state hospitalization rates for the virus were the highest they’ve been since at least fall 2018, according to the CDC’s Respiratory Virus Hospitalization Surveillance Network. Wastewater sampling, which can be used to detect some infectious disease levels in localities, also reveals that there have been high amounts of RSV circulating in Fulton, Muscogee, and Chattahoochee County communities.

These trends are distinct from RSV levels in the rest of the country. For the United States as a whole, data suggest infection levels are rising but not yet approaching peaks in 2022 or 2023.

Georgia’s recent relative RSV increase is higher than previous markers, but visits for the virus haven’t surpassed 1% of hospital visits in a sample of eight CDC-monitored Georgia hospitals. In comparison, flu visits accounted for about 8% of visits at these sites last December.

Hospitalization counts can lag behind testing data, and the most recent preliminary CDC data show that in-patient RSV stays are decreasing in Georgia. Emory Director of Pulmonary and Critical Care Medicine Dr. Greg Martin said his system’s testing data also indicate cases have declined over the past two weeks. He said influenza cases appear to be on the rise after a more limited Georgia spread compared to the last two flu seasons.

This year’s flu vaccine, which is expected to provide an extra layer of protection from severe disease, appears to be embraced by most Georgia residents. A CDC survey from late November found that about 67% of adults in the state said they either have or intend to get a flu shot for this season. About 71% of Georgia parents said their kids are or probably will be vaccinated this season — about 6% higher than the national average.

That’s significantly lower than plans for the updated Covid-19 shot. The same survey noted that about half of Georgia adults plan to get or have gotten that vaccine, and only about 42% of parents are taking those steps for their children. Both responses are about 6% lower than the United States as a whole, respectively.

The CDC only recommends certain groups — seniors over 70, adults over 60 at high risk of severe symptoms, and infants under 8 months old — receive a vaccine that protects people from RSV. An October CDC survey showed that over 90% of U.S. infant parents said they had gotten or plan to get their babies immunized against RSV, and 76% American adults in recommended groups said they have received or intend to get the shot.

In contrast, 67% of adults in those high-risk categories living in a group of southeastern states, including Georgia, said they have done or plan to do the same.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

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

Parvovirus B19 on rise in Atlanta could be severe for kids with sickle cell disease

2024-12-03T15:31:40+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Amid doctors’ calls for protective measures against influenza and Covid this winter, some new Centers for Disease Control and Prevention reports highlight the need for Atlanta clinicians and residents to pay attention to another respiratory virus on the rise.

Three research articles published Thursday in the CDC’s Morbidity and Mortality Weekly Report found significant rises in infections of a virus called human parvovirus B19. While infections are common and often mild, kids and adults with compromised immune systems can be at risk of severe health problems.

One of those studies looked at infections detected among Children’s Healthcare of Atlanta patients with sickle cell disease, a genetic disorder that impacts how oxygen travels through blood. If people with the condition are infected by the B19 virus, they can develop severe anemia and their red blood cell production can be compromised.

The hospital system saw a stark increase in severe anemia cases among sickle cell patients from December 2023 to September 2024 — an annual case rate over three times as high as the rate it had detected over the previous 14 years. More than three-quarters of kids treated in that period were given red blood cell transfusions.

Dr. Marianne Yee is a pediatric hematologist with Children’s Healthcare of Atlanta.

Dr. Marianne Yee, a pediatric hematologist and the Atlanta study’s lead author, said the elevated risk of this medical condition among kids in the area was particularly noticeable after three years of very few cases — a trend that started around the time of the Covid-19 lockdowns. The other two recent CDC studies showed similar B19 infection trends in Minnesota and the United States broadly.

“We do continue to see cases of parvovirus B19,” she said. “There will eventually be a decline in this peak we’re going through. But I do not have a prediction when that will be.”

Yee emphasized that B19 infections in people with sickle cell disease are manageable with proper health care but can be life-threatening if untreated. She and her study co-authors wrote that last December, a 10-year-old child with sickle cell disease died of causes consistent with a B19 infection. Although doctors weren’t able to test the child before they died, the study noted the child’s 14-year-old sibling tested positive for a B19 infection soon after the death.

While the risk of developing a severe reaction to the virus remains low for most people, Georgia has one of the highest percentages of residents with sickle cell disease in the United States. In 2018, the CDC estimated that of the about 100,000 Americans who have the genetic health condition, 9,000 are Georgians. It’s a disease that primarily affects people with African ancestry, and Georgia has one of the largest Black populations of any state.

At an individual level, Yee said Atlantans with sickle cell disease can reduce their risk of being infected by the respiratory virus by taking some of the same steps doctors recommend to prevent Covid-19 spread — wearing masks in public indoor places, washing hands frequently, and avoiding large crowds.

At a clinical level, she hopes Atlanta providers think of testing for the B19 virus if a patient with sickle cell disease has signs of a respiratory sickness. For both groups, Yee said it’s important to be aware of the risk of this disease and the severe health consequences it can cause.

“Common symptoms, such as cough or runny nose or a fever, potentially can represent something really serious,” she said.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

Respiratory viruses creep up as we head into the holidays

2024-11-27T12:00:00+00:00

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Have questions, comments, or ideas for future topics? Just reply to this email. I would love to hear from you.

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

Emory researchers find clues to Covid severity in nasal swabs

2024-11-19T14:42:05+00:00

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Heading into the fifth U.S. winter of Covid-19, an Emory University lab has found the presence — or absence — of a particular antibody in the nose of patients can predict how severe their illness would be.

The presence of the antibody, called anti-interferon alpha, indicated the infection would likely be limited to mild symptoms like coughing or sore throats, according to a study published earlier this month in Science Translational Medicine. Those without the antibodies in their nostrils often experienced shortness of breath, indicative of a more severe case of Covid.

Emory and University of California San Francisco researchers developed diagnostic technology to test for the antibodies in nasal swabs for the disease, like those found in over-the-counter tests. Eliver Ghosn, an Emory Vaccine Center researcher and the study’s senior author, said if clinicians could use a commercialized version of this technology with the standard tubular tests, they may be able to determine which patients need more care.

“You have a lot of biological waste,” he said. “Because those tubes that we collect [and] the nasal swab, they go as biological waste. Our proposal is, why not collect that waste?”

Previous research suggested the presence of anti-interferon alpha antibodies could have the opposite effect, predicting that someone’s Covid infection symptoms would be severe or fatal. But those studies examined the biomarkers in blood samples — not mucus samples like Ghosn and his colleagues tested.

To Ghosn, the study results resolve a contradiction of what scientists know these antibodies can do and how they interact with Covid.

“We never looked at the nose,” he said. “And the nose was the key, right? That’s where the virus goes first.”

The antibodies keep the virus from flourishing in petri-dish tests, Ghosn said. But his team doesn’t claim the association between the nasal antibodies and quick infection recovery is causal, and he said more research is needed to better determine that relationship.

If in the next two to three months his lab finds a pharmaceutical company that could develop a commercial product using this technology, Ghosn said clinicians might be able to use such tests by this winter. But it has not yet signed an agreement to bring a product to market.

Georgia public health board: Respiratory viruses are low

Dr. Greg Martin, Emory’s director of pulmonary and critical care medicine, said the technology Ghosn’s lab developed and their research could bring clinicians insights beyond general risk factors as to what someone’s Covid-19 infection will be like. With that knowledge, health care workers can make better decisions as to who should be prescribed treatments like Paxlovid and how quickly they should be connected to care.

“This you could easily see as an important next step for particularly all these people in the gray zone, where you’re not sure the likelihood of them having a more severe course of disease,” he said.

Although the virus’ death rate has decreased significantly since 2020, it has contributed to the death of about 43,000 Americans and over 1,200 Georgians in 2024. That’s why Martin said innovations like those developed in Ghosn’s lab and new over-the-counter tests that can detect both flu and Covid-19 are important for keeping families healthy.

Last week at the Georgia Department of Public Health’s board meeting, the state’s epidemiologist said she expected the risk of Covid-19 death to be lower this winter than previous seasons. But that risk could be exacerbated if hundreds of thousands of uninsured Georgians don’t have access to updated vaccines.

Martin noted that recent seasonal data from the Southern Hemisphere can help scientists estimate what the U.S. flu season will be like. Because countries in South America and Oceania had mild respiratory disease winters, that may indicate Georgia could expect a similar situation.

But that could change if people let their guard down and forgo testing and vaccination, especially as families gather for the winter holidays.

“Which is why we still advocate for people to be attentive,” Martin said.

Allen Siegler is a reporter covering public health in Atlanta for Healthbeat. Contact Allen at asiegler@healthbeat.org.

As California taps pandemic stockpile for bird flu, officials keep close eye on spending

2024-11-14T16:21:57+00:00

California public health officials are dipping into state and federal stockpiles to equip up to 10,000 farmworkers with masks, gloves, goggles, and other safety gear as the state confirms at least 21 human cases of bird flu as of early November. It’s the latest reminder of the state’s struggle to remain prepared amid multibillion-dollar deficits.

Officials said they began distributing more than 2 million pieces of personal protective equipment in late May, four months before the first human case was confirmed in the state. They said they began ramping up coordination with local health officials in April after bird flu was first detected in cattle in the United States.

Bird flu has been confirmed at more than 270 dairies in central California, and traces were recently detected at a wastewater sampling site in Los Angeles County. Bird flu was also recently detected in a flock of commercial turkeys in Sacramento County.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

California is putting a number of lessons from the Covid-19 pandemic to use, such as coordinating emergency response with local health officials and tracking infectious diseases through wastewater surveillance, as the state tries to limit the spread of bird flu to humans. It’s striving to maintain an adequate emergency stockpile to withstand the first wave of any new public health disaster without hemorrhaging the state budget.

“We are far better prepared to respond to a pandemic than we were in 2020,” said Amy Palmer, a spokesperson for the Governor’s Office of Emergency Services.

For instance, before the coronavirus struck in 2020, the state’s emergency supplies stockpile was barely big enough to crowd two basketball courts.

By the time California ramped up its pandemic response, it had enough personal protective equipment and other disaster supplies to fill 52 football fields. California spent $15.6 billion on direct pandemic response during the Covid crisis years, much of it provided by the federal government.

Today, the stockpile fits into about 12½ football fields, though it can seesaw from month to month.

California has 88 million N95 face masks

According to the state, the current stockpile includes 101 million face masks, 26 million more than the 90-day supply recommended by the state’s pandemic preparedness guideline.

That includes 88 million N95 masks, more than the emergency services agency said was needed last year. The high-efficiency masks are considered crucial to protect against airborne viruses such as Covid-19.

Although the state is building up its stockpile, Palmer could not say if the additional masks are related to fears of bird flu, only that planners are always working “to keep pace with the current risk environment.”

The state’s goal, Palmer said, is to have “an initial supply during emergencies to allow us the time to secure resources,” whether through the federal government or by buying more.

There is no indication of spread between humans in the recent California bird flu cases, and health officials say public risk remains low. Human transmission of bird flu is among several worst-case scenarios for a new pandemic, alongside the possibility of a resurgent mutant coronavirus; wider international spread of mpox, Marburg virus, or Ebola; or an entirely new virus for which there initially is no immunity or vaccine.

Yet, health officials nationwide have struggled to track bird flu transmission. And California has a history of swinging back and forth on preparedness.

Republican Gov. Arnold Schwarzenegger ordered an increase in California’s pandemic preparedness in 2006 in response to an earlier threat from bird flu. That included three mobile hospitals that could immediately be deployed during disasters.

Gov. Jerry Brown, a Democrat, ended the program in 2011 as state finances went bust. By the time Covid struck, the state released 21 million N95 masks, some so old they were past their expiration date.

Hospitals required to have 3-month PPE supply

Now hospitals are required to maintain their own three-month supply of masks, gowns, and other personal protective equipment under a state law passed in 2020. California’s aerosol transmissible disease standard also uniquely requires hospitals and other high-risk workplaces to follow precautions such as using negative pressure isolation rooms and the highest level of protective equipment until more is known about a new pathogen.

“It is difficult to overstate the level of unpreparedness exhibited by hospitals both in and outside of California in dealing with the 2020 outbreak of Covid-19,” according to a legislative analysis. “Harrowing images of nurses walking the corridors of hospitals in makeshift masks and garbage bags became commonplace.”

California Hospital Association spokesperson Jan Emerson-Shea said hospitals “continuously prepare to respond to all types of disasters, including outbreaks of transmissible viruses.”

In addition, Palmer said California has five mobile hospitals acquired from the federal government, though they got little use during the pandemic. She said they have to be maintained, such as making sure pulse oximeters have working batteries.

But, once again, the current deficit has the state trying to strike a balance.

While lawmakers rejected most of Democratic Gov. Gavin Newsom’s $300 million proposed cut to public health funding, the state slashed funding for its stockpile of personal protective equipment by one-third a year ago after it determined that no additional Covid-related purchases were necessary, according to the Department of Finance. California eliminated funding this year for eight 53-foot-long trailers that would have moved stockpiled items between warehouses. It’s also cutting nearly $40 million over the next four years from its $175 million disaster stockpile budget.

The state’s preparedness wasn’t good enough for Californians Against Pandemics, which gathered more than 1 million signatures to put a ballot measure before voters in November. The measure would have increased taxes on people with incomes over $5 million and used that money for pandemic prevention and response.

But that effort collapsed after one of its key financial supporters, former cryptocurrency executive Sam Bankman-Fried, was convicted of defrauding customers and investors. In exchange for initiative backers dropping the measure, state officials agreed to broaden the scope of the California Initiative to Advance Precision Medicine, which was created in 2015 to focus on developing new medicines and therapies, to include technologies for preventing another pandemic.

“By harnessing the power of precision medicine, California is moving to the forefront of pandemic preparedness and prevention,” Newsom said at the time.

Rodger Butler, a spokesperson for the state Health and Human Services Agency, said it’s unclear if the precision medicine initiative will receive additional funding.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is Healthbeat’s national reporting partner.

Respiratory weather report for New York: Covid levels low as flu and RSV rise

2024-11-14T12:00:00+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.

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

Georgia public health board: Respiratory viruses are low; new infant screening detects threat to hearing

2024-11-13T01:12:01+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Georgia is expecting a “typical” respiratory virus season for Covid, flu, and RSV, and the state public health department has instituted a new testing protocol to catch a potentially harmful virus among infants.

Those updates came Tuesday during the first meeting since May of the Georgia Department of Public Health board. The meeting was online, as the board has not resumed in-person gatherings since the Covid-19 outbreak.

State epidemiologist Dr. Cherie Drenzek said Georgia is seeing a “much more typical picture for the seasonality” of respiratory viruses Covid, influenza, and RSV.

In the past few years, RSV — respiratory syncytial virus — hit high levels in the summer. It is now peaking in the fall, closer to a pre-Covid pattern, Drenzek said. The same is true for flu.

High simultaneous rates of all three viruses could impact health care capacity.

Respiratory viruses are lower overall right now, Drenzek said, suggesting that as the Centers for Disease Control and Prevention has predicted, the chances of a “tripledemic” – the three viruses hitting the population at once – will be lower.

“We’re starting to see just some slight increases,” but the levels are low overall, Drenzek said, especially compared to the prior few years.

While Georgia is seeing a “record low” level of Covid cases, Drenzek said most of the cases, including hospitalizations and deaths, are among people over age 65.

While the KP.3.1.1 Covid variant is still predominant, about 20% of cases appear to be caused by a new strain called XEC that is a hybrid of two variants. The XEC variant could be the primary driver of winter infections, Drenzek said, but vaccines are effective against it and there is no evidence it causes more severe infections.

Rockdale public health officials criticize poor communication, lack of EPA leadership in BioLab fire response

Flu levels are also low, Drenzek said, with few hospitalizations and the most outpatient visits among school-age children.

She expects flu to start peaking at the end of December and January, which is more typical of the virus’ pre-pandemic spread.

RSV is also following a more “traditional” pattern this year. Typically, RSV spread starts in October and is primarily concerning for infants.

Drenzek said there has been an increase in positive RSV tests in October, with about 16% of tests coming back positive. The positivity rate typically peaks at around 20%. Georgia is starting to see an increase in hospitalizations “but nowhere near where we were a year ago.”

Georgia seeing more kids with ‘walking pneumonia’

The state is seeing “large spikes” in “walking pneumonia,” or mycoplasma pneumoniae, in children. The infection typically affects older children but is now being found in children ages 2 to 4 or even younger. It is characterized by a fever, upper respiratory symptoms, and especially a lingering cough.

It’s called walking pneumonia because it’s “relatively mild,” Drenzek said, and children can end up returning to school or daycare while they are still infectious.

Children who do not have a fever for more than 24 hours without the use of fever-reducing drugs can return to school, Drenzek said.

In Georgia, the disease is not “notifiable” — health care providers do not have to report it to the state — and sometimes the diagnosis is based on symptoms, not testing.

That makes it hard to get exact numbers, Drenzek said, “but we have heard from many healthcare partners and pediatricians that they have seen more mycoplasma pneumonia in young kids than they really had ever seen before.”

Though there is no vaccine, it is treatable with antibiotics, if needed. Drenzek said “respiratory etiquette” and keeping kids home from school when they are sick can help stop the spread.

Respiratory illnesses are preventable, Drenzek said. New CDC guidance says seniors should get two doses of the latest Covid vaccine six months apart. There are immunizations for RSV for older adults and infants. And everyone over age 6 months is advised to get a flu shot.

Drenzek said Georgia has seen no cases of bird flu, which has affected almost 500 dairy herds in 15 states and 46 farmworkers in the United States.

“We have great plans in place in case we ever come across bird flu in our dairy birds or in our poultry,” Drenzek said.

Infant screening finds virus that can cause hearing loss

A new state screening regulation implemented last month has identified eight cases of congenital cytomegalovirus, Melanie Morris, child health deputy director at the department, told the board.

The new regulation requires all birthing facilities to screen newborns who fail hearing tests for cCMV before discharge or within 21 days of age, whichever comes first, Morris said.

The tests are designed to detect the congenital infection, which can cause hearing loss, that might not otherwise be caught among newborns. It’s not a universal screening protocol, Morris said, but only focuses on those infants who fail their hearing screenings.

Positive cases must be reported to the state health department so the agency can follow up with health care providers and parents or guardians.

The tests are typically performed via saliva or urine samples.

Since the new regulation was implemented on Oct. 10, eight cases have been found, Morris said.

The board’s next meeting is scheduled for Jan. 14, 2025.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

California dengue cases prompt swift response from public health officials

2024-11-12T16:32:34+00:00

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Jason Farned and his team at the San Gabriel Valley Mosquito and Vector Control District had spent years preparing for the likely arrival of dengue, a dangerous virus typically found in tropical climates outside the mainland United States.

They’d watched nervously as invasive Aedes mosquito species that can carry the virus appeared in Los Angeles about a decade ago and began to spread, likely introduced by international trade and enticed to stay by a warming climate that makes it easier for mosquitoes to thrive.

Then, in October 2023, an email came from the Pasadena Public Health Department: A person in the city had contracted California’s first-known case of dengue from a local mosquito.

“When it happens in real time, real life, you know, it is very different,” Farned said. “There’s no room for error here. We have to be quick and effective in identifying the most at-risk areas and responding.”

Across California, public health and pest control authorities are facing a new reality as the Aedes mosquitoes bring the threat of dengue and potentially other tropical diseases, such as chikungunya, Zika, and yellow fever, that were once of concern only to international travelers.

So far this year, authorities have identified at least 13 cases of locally acquired dengue, up from two in 2023, with 11 in Los Angeles County and two in the San Diego area. The Aedes mosquitoes spread the disease by biting an infected person and then biting a previously uninfected person.

Illness prevention centers on mosquito control

Mosquito-borne viral illnesses, chiefly malaria, have long been a scourge in many tropical regions, and preventive measures focus mainly on controlling the mosquitoes. The Aedes mosquitoes, known for their aggressive, daytime biting, are now present in at least 24 California counties. They breed in water, in as little as a capful.

“When these locally acquired cases occur, … we want to act on them pretty quickly so that it does not become an endemic infection in our region,” said Aiman Halai, director of the Los Angeles County Department of Public Health’s Vector-Borne Disease Unit.

California officials are hoping to beat back dengue by expanding mosquito surveillance, developing detailed response plans for mosquito outbreaks and human infections, and improving data sharing across agencies. They’re also going door to door in neighborhoods to remove standing water sources and apply pesticides. Residents are advised to wear bug repellent and long-sleeved clothing and control mosquitoes around their homes to prevent biting and infection.

Some vector control districts — local agencies charged with managing disease-bearing insects and other animals — are even growing their own sterile mosquitoes to release into the wild to reduce local Aedes populations.

What you need to know about mosquitoes and West Nile virus

Outside California, locally acquired dengue cases have occurred in Arizona, Florida, Hawaii, and Texas. In March, Puerto Rico declared a public health emergency after a spike in cases there, where dengue is endemic. Meanwhile, worldwide dengue cases are on track to more than double this year, with 12.3 million documented through August, up from 6.5 million in 2023, according to the World Health Organization.

Most people who get dengue have no symptoms, but about 1 in 4 become ill. A mild case can feel like the flu and usually dissipates within a week, but about 5% of those infected with dengue become very sick, with symptoms that can include internal bleeding, shock, and organ failure, and the most severe cases can be fatal. People infected a second time are at especially high risk.

There is no specific medication to treat dengue. Japanese pharmaceutical company Takeda developed a vaccine that has won approval in Europe and elsewhere, though it withdrew an application to the U.S. Food and Drug Administration last year, saying it could not provide data requested by the agency. A vaccine developed in Brazil could soon be approved for use in that country. But the only FDA-approved vaccine is authorized only for children in narrow circumstances and will soon go out of production.

At the San Gabriel Valley Mosquito and Vector Control District, one of five agencies tasked with mosquito control across Los Angeles County, public health workers have put together an Aedes and dengue response plan based on updated guidance from the state.

When they discover a case, they identify all the properties and public spaces within 150 meters — roughly the distance an Aedes mosquito can fly — and then go door to door, removing standing water, where mosquitoes can breed; applying pesticides from backpacks or trucks; and educating residents about the risk of dengue and how to protect themselves. District officials also set traps to catch mosquitoes so they can figure out their prevalence and test them for dengue.

West Nile virus shows up early in NYC; travelers bring dengue

Since local dengue cases began to appear, the district has gotten more efficient in implementing its response plan, district manager Farned said. All full-time and seasonal staff members — about 40 people — have been trained in a variety of tasks, such as door-to-door education and coming in during off-hours to answer phones, Farned said.

While vector control teams respond to cases, separate teams from the Los Angeles County Public Health Department go door to door in the affected neighborhood when they determine that a dengue case was locally acquired, surveying residents and offering free dengue testing to try to identify others who may be infected.

Additionally, the department has been sending alerts to local health providers, advising them to be on the lookout for possible dengue cases and test for it when suspected, even among patients who haven’t traveled to a place where dengue is endemic. This advice follows a national alert put out by the Centers for Disease Control and Prevention in June. Health authorities are also emphasizing that people who travel to locations with dengue should continue to wear mosquito repellent when they get home, to reduce the risk of spreading the disease to local mosquitoes.

As happened during the Covid-19 pandemic, mistrust of public health authorities can make outreach challenging for health and pest control teams in some neighborhoods, officials said.

Pest control officers can seek a warrant to enter and treat a property for mosquitoes if a homeowner refuses to give access, said Jeremy Wittie, a former president and the legislative committee chair for the Mosquito and Vector Control Association of California, which represents the more than 70 mosquito and vector control agencies in California. This is easier in districts such as his, the Coachella Valley Mosquito and Vector Control District, that have warrants giving officials standing permission to enter a property after 24 hours without needing to ask a judge.

Aerial spraying, mosquito sterilization combat threat

In counties such as Santa Clara, where Aedes mosquitoes first appeared in 2022 but have yet to establish themselves, officials hope to suppress the threat with stepped-up surveillance, speedy eradication efforts, and more public outreach. Santa Clara County Vector Control District Manager Nayer Zahiri said the aim was to eliminate Aedes but acknowledged the climate conditions that encourage the mosquitoes’ spread are “totally out of our control.”

In some counties with pervasive mosquito problems, including San Diego, San Joaquin, and Stanislaus, officials have sprayed pesticides from planes or helicopters to address spikes in local mosquito populations, Wittie said. These sprayings typically aim to control the larvae of a different type of mosquito, Culex, that can spread West Nile virus and which — unlike the Aedes species, which thrive in urban habitats — are found in harder-to-reach rural environments, Wittie said.

Aerial spraying hasn’t been deployed to address the recent dengue outbreaks, which are in more urban environments where spraying from trucks is a better option, Wittie said. Drones are another option that some vector control authorities are exploring.

Some districts are experimenting with the decades-old sterile insect technique, commonly used for other pests such as fruit and screwworm flies, in which males are sterilized with radiation and then released to mate, resulting in eggs that don’t hatch. (Female mosquitoes are separated from the males before sterilization and not released. Only the females bite).

Ultimately, the public will have to take the mosquito threat more seriously and contribute to prevention efforts, Wittie said. “This mosquito is going to be here to stay, unfortunately. I hope it kind of wakes people up and pushes them to be part of that solution.”

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

Bird flu: Emails reveal how health departments struggle to track human cases

2024-10-25T13:20:01+00:00

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Bird flu cases have more than doubled in the country within a few weeks, but researchers can’t determine why the spike is happening because surveillance for human infections has been patchy for seven months.

Just this week, California reported its 15th infection in dairy workers and Washington state reported seven probable cases in poultry workers.

Hundreds of emails from state and local health departments, obtained in records requests from KFF Health News, help reveal why. Despite health officials’ arduous efforts to track human infections, surveillance is marred by delays, inconsistencies, and blind spots.

Several documents reflect a breakdown in communication with a subset of farm owners who don’t want themselves or their employees monitored for signs of bird flu.

For instance, a terse July 29 email from the Weld County Department of Public Health and Environment in Colorado said, “Currently attempting to monitor 26 dairies. 9 have refused.”

The email tallied the people on farms in the state who were supposed to be monitored: “1250+ known workers plus an unknown amount exposed from dairies with whom we have not had contact or refused to provide information.”

Other emails hint that cases on dairy farms were missed. And an exchange between health officials in Michigan suggested that people connected to dairy farms had spread the bird flu virus to pet cats. But there hadn’t been enough testing to really know.

Researchers worldwide are increasingly concerned.

“I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, formerly the assistant secretary for preparedness and response in the Obama administration.

Bird flu viruses have long been on the short list of pathogens with pandemic potential. Although they have been around for nearly three decades in birds, the unprecedented spread among U.S. dairy cattle this year is alarming: The viruses have evolved to thrive within mammals. Maria Van Kerkhove, head of the emerging diseases unit at the World Health Organization, said, “We need to see more systemic, strategic testing of humans.”

Dairies refusing visits from health departments

A key reason for spotty surveillance is that public health decisions largely lie with farm owners who have reported outbreaks among their cattle or poultry, according to emails, slide decks, and videos obtained by KFF Health News, and interviews with health officials in five states with outbreaks.

In a video of a small meeting at Central District Health in Boise, Idaho, an official warned colleagues that some dairies don’t want their names or locations disclosed to health departments. “Our involvement becomes very sketchy in such places,” she said.

“I just finished speaking to the owner of the dairy farm,” wrote a public health nurse at the Mid-Michigan district health department in a May 10 email. “[REDACTED] feels that this may have started [REDACTED] weeks ago, that was the first time that they noticed a decrease in milk production,” she wrote. “[REDACTED] does not feel that they need MSU Extension to come out,” she added, referring to outreach to farmworkers provided by Michigan State University.

“We have had multiple dairies refuse a site visit,” wrote the communicable disease program manager in Weld, Colorado, in a July 2 email.

Many farmers cooperated with health officials, but delays between their visits and when outbreaks started meant cases might have been missed. “There were 4 people who discussed having symptoms,” a Weld health official wrote in another email describing her visit to a farm with a bird flu outbreak, “but unfortunately all of them had either already passed the testing window, or did not want to be tested.”

Jason Chessher, who leads Weld’s public health department, said farmers often tell them not to visit because of time constraints.

Dairy operations require labor throughout the day, especially when cows are sick. Pausing work so employees can learn about the bird flu virus or go get tested could cut milk production and potentially harm animals needing attention. And if a bird flu test is positive, the farm owner loses labor for additional days and a worker might not get paid. Such realities complicate public health efforts, several health officials said.

An email from Weld’s health department, about a dairy owner in Colorado, reflected this idea: “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too.” Pink eye, or conjunctivitis, is a symptom of various infections, including the bird flu.

Chessher and other health officials told KFF Health News that instead of visiting farms, they often ask owners or supervisors to let them know if anyone on-site is ill. Or they may ask farm owners for a list of employee phone numbers to prompt workers to text the health department about any symptoms.

Jennifer Morse, medical director at the Mid-Michigan District Health Department, conceded that relying on owners raises the risk cases will be missed, but that being too pushy could reignite a backlash against public health. Some of the fiercest resistance against Covid-19 measures, such as masking and vaccines, were in rural areas.

“It’s better to understand where they’re coming from and figure out the best way to work with them,” she said. “Because if you try to work against them, it will not go well.”

Domestic cat cases could offer clues

And then there were the pet cats. Unlike dozens of feral cats found dead on farms with outbreaks, these domestic cats didn’t roam around herds, lapping up milk that teemed with virus.

In emails, Mid-Michigan health officials hypothesized that the cats acquired the virus from droplets, known as fomites, on their owners’ hands or clothing. “If we only could have gotten testing on the [REDACTED] household members, their clothing if possible, and their workplaces, we may have been able to prove human->fomite->cat transmission,” said a July 22 email.

Her colleague suggested they publish a report on the cat cases “to inform others about the potential for indirect transmission to companion animals.”

Thijs Kuiken, a bird flu researcher in the Netherlands, at the Erasmus Medical Center in Rotterdam, said person-to-cat infections wouldn’t be surprising since felines are so susceptible to the virus. Fomites may have been the cause or, he suggested, an infected — but untested — owner might have passed it on.

Hints of missed cases add to mounting evidence of undetected bird flu infections. Health officials said they’re aware of the problem but that it’s not due only to farm owners’ objections.

Local health departments are chronically understaffed. For every 6,000 people in rural areas, there’s one public health nurse — who often works part-time, one analysis found.

“State and local public health departments are decimated resource-wise,” said Lurie, who is now an executive director at an international organization, the Coalition for Epidemic Preparedness Innovations. “You can’t expect them to do the job if you only resource them once there’s a crisis.”

Another explanation is a lack of urgency because the virus hasn’t severely harmed anyone in the country this year. “If hundreds of workers had died, we’d be more forceful about monitoring workers,” Chessher said. “But a handful of mild symptoms don’t warrant a heavy-handed response.”

All the bird flu cases among U.S. farmworkers have presented with conjunctivitis, a cough, a fever, and other flu-like symptoms that resolved without hospitalization. Yet infectious disease researchers note that numbers remain too low for conclusions — especially given the virus’s grim history.

About half of the 912 people diagnosed with the bird flu over three decades died. Viruses change over time, and many cases have probably gone undetected. But even if the true number of cases — the denominator — is five times as high, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, a mortality rate of 10% would be devastating if the bird flu virus evolved to spread swiftly between people. The case fatality rate for Covid was around 1%.

By missing cases, the public health system may be slow to notice if the virus becomes more contagious. Already, delays resulted in missing a potential instance of human-to-human transmission in early September. After a hospitalized patient tested positive for the bird flu virus in Missouri, public health officials learned that a person in the patient’s house had been sick — and recovered. It was too late to test for the virus, but on Thursday, the CDC announced that an analysis of the person’s blood found antibodies against the bird flu, signs of a prior infection.

CDC Principal Deputy Director Nirav Shah suggested the two people in Missouri had been separately infected, rather than passing the virus from one to the other. But without testing, it’s impossible to know for certain.

The possibility of a more contagious variant grows as flu season sets in. If someone contracts bird flu and seasonal flu at the same time, the two viruses could swap genes to form a hybrid that can spread swiftly. “We need to take steps today to prevent the worst-case scenario,” Nuzzo said.

The CDC can monitor farmworkers directly only at the request of state health officials. The agency is, however, tasked with providing a picture of what’s happening nationwide.

As of Thursday, the CDC’s dashboard states that more than 5,100 people have been monitored nationally after exposure to sick animals; more than 260 tested; and 30 bird flu cases detected. (The dashboard hasn’t yet been updated to include the most recent cases and five of Washington’s reports pending CDC confirmation.)

Van Kerkhove and other pandemic experts said they were disturbed by the amount of detail the agency’s updates lack. Its dashboard doesn’t separate numbers by state, or break down how many people were monitored through visits with health officials, daily updates via text, or from a single call with a busy farm owner distracted as cows fall sick. It doesn’t say how many workers in each state were tested or the number of workers on farms that refused contact.

“They don’t provide enough information and enough transparency about where these numbers are coming from,” said Samuel Scarpino, an epidemiologist who specializes in disease surveillance. The number of detected bird flu cases doesn’t mean much without knowing the fraction it represents — the rate at which workers are being infected.

This is what renders California’s increase mysterious. Without a baseline, the state’s rapid uptick could signal it’s testing more aggressively than elsewhere. Alternatively, its upsurge might indicate that the virus has become more infectious — a very concerning, albeit less likely, development.

The CDC declined to comment on concerns about monitoring. On Oct. 4, Shah briefed journalists on California’s outbreak. The state identified cases because it was actively tracking farmworkers, he said. “This is public health in action,” he added.

Salvador Sandoval, a doctor and county health officer in Merced, California, did not exude such confidence. “Monitoring isn’t being done on a consistent basis,” he said, as cases mounted in the region. “It’s a really worrisome situation.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News. KFF regional editor Nathan Payne contributed to this report.

Most infants with severe Covid had moms who didn’t get vaccine in pregnancy

2024-10-04T13:31:14+00:00

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Nearly 90% of babies who had to be hospitalized with Covid-19 had mothers who didn’t get the vaccine while they were pregnant, according to new data released by the Centers for Disease Control and Prevention. The findings appear in the agency’s Morbidity and Mortality Weekly Report.

Babies too young to be vaccinated had the highest Covid hospitalization rate of any age group except people over 75.

The study looked at infant medical data from October 2022 to April 2024 in 12 states and underscores the critical importance of vaccinating pregnant people. It also echoes what physicians have anecdotally reported for more than three years — that people are still skeptical of Covid vaccines due to persistent misinformation.

Of the 1,470 infants sick enough to be hospitalized due to Covid, severe outcomes occurred “frequently,” according to the report. Excluding newborns hospitalized at birth, about 1 in 5 infants hospitalized with Covid required intensive care, and nearly 1 in 20 required a ventilator.

“These aren’t necessarily high-risk, ill newborns. These are just regular, full-term, healthy newborn kids who happen to get Covid and wind up on a ventilator in the hospital,” said Neil Silverman, a professor of clinical obstetrics and gynecology and the director of the Infectious Diseases in Pregnancy Program at the David Geffen School of Medicine at UCLA.

Babies can’t get the Covid vaccination until they are at least 6 months old. That leaves a “huge window” when infants are most vulnerable, Silverman said. Vaccinating pregnant women so they pass the antibodies on to their newborns is an effective way of protecting babies during that time. Vaccination during pregnancy also protects pregnant people from severe disease.

But persistent vaccine misinformation online has led to skepticism among Silverman’s pregnant patients.

“The most frustrating response that I get from folks is that they need to do more research before they think about getting the Covid vaccine,” Silverman said. “We have dozens and dozens of studies showing the safety of the mRNA vaccine. I don’t know how much more research we can provide to skeptics.”

Among the 1,000-plus babies hospitalized with Covid, the median age was just 2 months old, according to the report. Nine of the infants died.

South Carolina pediatrician Deborah Greenhouse said she plans to share the study with families she cares for. “There absolutely is a proportion of the population who will look at this and say, ‘Hey, wow, I should get that vaccine. It could protect my baby,’” she said.

Greenhouse believes the new data could solidify the risk of skipping the vaccine when she speaks to families.

“I think that it might help to convince some parents when you can actually show them hospitalization numbers and you can show them intensive care numbers and you can show them mechanical ventilation numbers,” Greenhouse said. “Those things are a big deal.”

Often, Greenhouse waits to be informed that a person is pregnant before bringing up the updated Covid shot. Now she’s rethinking that strategy. “As pediatricians we do get moms in our office who are pregnant and we have an opportunity to intervene and to do some education and make them understand how important this is,” she said.

Physicians can encourage vaccination by making it as easy and simple as possible, Silverman said. He encouraged fellow doctors to offer the shots in their offices, rather than sending patients to pharmacies or other providers.

“We lose probably 30 to 40% of vaccination opportunities once someone has to leave the office to get a vaccine,” Silverman said.

But offering Covid shots in their clinics leaves some doctors with a difficult calculation. They are struggling to predict how many patients will be interested in the vaccine and may not be able to return all their excess doses. Many providers can’t afford to lose money on doses that won’t be used, but they still need to order enough to vaccinate vulnerable patients who want the shot.

Jackie Fortiér is a reporter for KFF Health News, Healthbeat’s national reporting partner.

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.

For uninsured Atlantans, conflicting information, fluctuating supplies complicate access to new Covid shot

2024-09-27T14:22:16+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

It’s been over a month since the FDA approved new Covid vaccines, but for uninsured and underinsured Atlantans who rely on the public health system to get the shots at low cost, the process is fraught with conflicting information and fluctuating supplies.

Some county health departments still don’t have the vaccine; others have a limited supply earmarked for the uninsured, which are free but carry service fees of about $21. (Paying out of pocket at a pharmacy chain will cost about $202, CVS says).

The vaccines will still be free for Marketplace and Medicare enrollees. Uninsured, underinsured and Medicaid-eligible kids should be able to get the vaccines for free under the Vaccines for Children program. And CVS said the shots should be free under most insurance plans at in-network pharmacies.

The Georgia Department of Public Health planned to purchase about 38,000 updated Covid vaccines for underinsured and uninsured adults, spokesperson Nancy Nydam told Healthbeat last month.

There are around 1 million uninsured Georgians under age 65.

In calling 20 public health clinics in metro Atlanta this week, Healthbeat found that some don’t have the vaccines and it’s unclear how uninsured people can get the shots at others.

After inquiries from Healthbeat, some county health departments said they would try to ensure their frontline workers provide accurate information about how to access the shots.

“Training will be provided to staff to ensure they have accurate and consistent information,” Fulton County Board of Health spokesperson Tia McCullough said after Healthbeat shared difficulties getting a vaccine appointment.

Spokesperson Eric Nickens of DeKalb Public Health said clinical leadership was working to ensure frontline staffers provide accurate information to callers after Healthbeat attempted to schedule vaccine appointments at four clinics and got inconsistent information.

That uninsured Georgians have to cover any of the costs out of pocket is a health equity problem, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit advocacy group.

“This imbalance unfairly leaves uninsured folks exposed to illnesses that others are protected from, putting their health and financial stability at risk,” she said.

Shots available for $21 service fee

Healthbeat attempted to contact 20 public health clinics in eight counties: Fulton, DeKalb, Clayton, Gwinnett, Newton, Rockdale, Cobb, and Douglas.

Many of the clinics said the vaccines would cost around $21.93 for an uninsured patient.

Representatives at a few clinics, including the College Park Health Center, part of the Fulton County Board of Health system, and the Norcross and Newton Health Centers, part of GNR (Gwinnett, Newton and Rockdale) Public Health, said a shot would cost more than $150.

Covid vaccines for kids may be harder to find after many went unused

Michele Kehler, a spokeswoman for the agency, said that was incorrect. Uninsured and underinsured patients would need to pay just the $21 administration fee.

Likewise, Fulton spokeswoman McCullough told Healthbeat the shots should cost only $21 for uninsured patients and the clinics will not turn away anyone who is unable to pay.

Colbert said even $21 is too much.

“For families already struggling to make ends meet, an administration fee for a vaccine may make the difference between getting protected or going without it,” Colbert said. “This means more Georgians will be at greater risk of getting sick, missing work, and losing wages they can’t afford to lose.”

Dr. Cecil Bennett, a family medicine doctor and fellow at Morehouse School of Medicine, told Healthbeat last month, “This season is going to be a very difficult Covid and flu season.”

Uptake has been low in Georgia for the flu and Covid vaccines.

Only about 17% of adult Georgians got last year’s Covid shot, according to the U.S. Centers for Disease Control and Prevention.

GNR Public Health chief clinical officer Alana Sulka said the agency’s clinics have not had to turn away any patients for lack of supply of Covid shots.

As of mid-September, Covid caused about 2.7% of all deaths in Georgia, according to the CDC.

The state’s Covid death rate should be close to zero, since deaths are largely preventable with vaccination, said Jodie Guest, senior vice chair of the Department of Epidemiology at Emory University’s Rollins School of Public Health.

“This is a vaccine preventable death for almost every case … At a minimum, we’d want to see it under 1%,” she said.

Shots not available in all counties

Some county health clinics don’t have the vaccine at all or only a limited supply for uninsured patients.

For example, a call center representative at the Clayton County Health District said Wednesday the vaccine wasn’t available for uninsured people and she didn’t know when it would be.

In the GNR district, supply “fluctuates daily.” People are urged to call the main line at 770-904-3717 to schedule an appointment, Kehler said.

Reached on Wednesday, representatives at two of four clinics, in Lawrenceville and Newton, said they did not have the vaccines.

Meanwhile, a representative at the Norcross clinic that is part of the same county system said the clinic has a limited supply for uninsured patients. The Rockdale clinic does have the shots and appointments were available.

It’s also a patchwork picture in the Cobb and Douglas Public Health system.

The Douglas and Kennesaw clinics do not have the shots in stock. The Marietta and Smyrna clinics are accepting appointments, as well as walk-ins, though the Smyrna clinic has a very limited supply for uninsured patients, a representative said.

Some clinics difficult to reach

Fulton County’s local health clinics can be difficult to access. The county website touts a main phone number, 770-520-7500, through which people can access local clinics to set up appointments.

But a Healthbeat reporter was only able to speak to a representative at two of those clinics, the Neighborhood Union and College Park Health Centers. At Neighborhood Union, a representative said the new Covid vaccines would cost $21.93 and appointments were available the next day.

It was difficult to reach other clinics in the Fulton health system, with some calls going to voicemail and other clinics not listed in the automatic phone directory system.

In DeKalb, Nickens said appointments are preferred, but walk-ins are accepted. But when contacted, three of the four clinics said the only way to get a vaccine is by walking in and not with an appointment.

Nickens said health department leaders are working to ensure staffers provide accurate information to callers.

Some local nonprofit clinics may also have free or low-cost Covid vaccines for uninsured people, Nydam said.

Here is the situation at five local public health agencies, plus the Grady Health System:

Fulton County Board of Health

Vaccine status: Appointment system unreliable; try walking in

The Fulton County Board of Health’s website lists seven clinics where people can get the Covid vaccines. The website states vaccine appointments and walk-ins are available at those centers.

However, a Healthbeat reporter faced difficulty reaching most of the clinics through the main phone number (770-520-7500) and received inconsistent information from phone representatives about the cost of the vaccines.

Spokesperson Tia McCullough said the agency would work to address those problems.

While uninsured and underinsured patients will not be charged a fee for the actual vaccine, they will need to pay a $21 administrative fee, McCullough said. However, no one will be turned away due to inability to pay.

Adamsville Health Center: 3700 MLK Jr Dr. SW, Atlanta. Monday-Friday: 9 a.m.–4 p.m.
College Park Health Center: 1920 John Wesley Ave., College Park. Monday–Friday: 8:30–11 a.m. and 1–3 p.m.
Neighborhood Union Health Center: 186 Sunset Ave. NW # 186, Atlanta. Monday & Tuesday, 8:30 a.m.– 5 p.m.

Healthbeat was unable to reach these clinics using the automated phone system (770-520-7500).

North Fulton Regional Health Center: 3155 Royal Dr., Alpharetta. Monday–Friday, 9 a.m.–4 p.m.
4700 North Point: 4700 North Point Pkwy., Alpharetta. Tuesday and Saturday: 9:30 a.m.–4:30 p.m.
Fulton County Government Center: 141 Pryor St. (near the Pryor Street entrance), Atlanta. Wednesday and Friday: 9:30 a.m. – 4:30 p.m.
Stonewall Tell: 5710 Stonewall Tell Rd., South Fulton. Monday & Tuesday, 9 a.m.– 5 p.m.

DeKalb Public Health

Vaccine status: Call for hours, appointments; walk-ins available

Spokesperson Eric Nickens said people should call 404-294-3700 and ask to schedule an appointment. Walk-ins are also available. DeKalb Public Health leadership is working to ensure phone representatives have accurate information, Nickens said.

For uninsured patients, the vaccines will cost $21.93. Call ahead.

Clifton Springs Health Center: 3110 Clifton Springs Rd., Decatur.
East DeKalb Health Center: 2277 S. Stone Mountain Lithonia Rd., Lithonia.
North DeKalb Health Center: 3807 Clairmont Rd., Chamblee.
T.O. Vinson Health Center: 440 Winn Way, Decatur.

Cobb and Douglas Public Health

Vaccine status: Marietta and Smyrna clinics have shots; call ahead

Two of the counties’ public health clinics have the shots for uninsured people in stock, while two do not. The Kennesaw and Douglasville clinics do not have the shots, representatives said, while the Marietta and Smyrna clinics do.

People are urged to call ahead to ensure the vaccines are still in stock. Uninsured people will be charged a $21 fee.

Call 770-514-2300 for an appointment or make an appointment online.

Marietta: 1650 County Services Pkwy.
Smyrna: 3001 South Cobb Dr.

Gwinnett, Newton, Rockdale Public Health

Vaccine status: Norcross, Rockdale clinics have shots; supply fluctuates so call ahead

GNR Public Health has a limited supply of Covid-19 vaccines, spokesperson Michele Kehler said. Call 770-904-3717 to inquire about availability.

On Wednesday, the vaccines were available at these locations:

Norcross Health Center: 5030 Georgia Belle Ct., Norcross.
Rockdale Health Center: 985 Taylor St. SW, Conyers.

Clayton County Health District

Vaccine status: None available

The Clayton County Health District does not have the vaccines in stock. A representative said she is unsure when they will be available.

Grady Health System

Vaccine status: Shots available

The new Covid vaccines are available at Grady Hospital in the primary care center and Grady’s neighborhood health clinics in the primary care center and Grady’s neighborhood health clinics, spokesperson Danielle Hackett said. For uninsured patients, the vaccine is still available at a nominal cost.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Florida’s new Covid booster guidance is straight-up misinformation

2024-09-23T13:16:07+00:00

In what has become a pattern of spreading vaccine misinformation, the Florida health department is telling older Floridians and others at highest risk from Covid-19 to avoid most booster shots, saying they are potentially dangerous.

Clinicians and scientists denounced the message as politically fueled scaremongering that also weakens efforts to protect against diseases like measles and whooping cough.

A prominent Florida doctor expressed dismay that medical leaders in the state, leery of angering Republican Gov. Ron DeSantis, have been slow to counter anti-vaccine messages from Surgeon General Joseph Ladapo, including the latest Covid bulletin. Ladapo is a DeSantis appointee and the top official at the state health department.

The bulletin makes a number of false or unproven claims about the efficacy and safety of mRNA-based Covid vaccines by Pfizer and Moderna, including that they could threaten “the integrity of the human genome.” Florida’s guidance generally regurgitates ideas from anti-vaccine websites, said John Moore, a professor of microbiology at Weill Cornell Medicine.

Ladapo did not respond to a request for comment. DeSantis referred questions to the health department, which said the surgeon general’s guidance and citations “speak for themselves” and pointed to a post he made on the social platform X accusing the Centers for Disease Control and Prevention and FDA of “gaslighting Americans.”

DeSantis has styled himself and his administration as a bulwark against vaccine mandates, lockdowns, and other restrictive public health protections adopted during the pandemic to curb infections and save lives. Covid vaccination has become a partisan issue, with surveys by KFF, the health information nonprofit that includes KFF Health News, finding that Republicans have far less confidence in the safety and efficacy of the shots than Democrats.

But vaccine historians consulted for this article could not recall any previous state health leader urging residents to shun an FDA-approved and CDC-recommended vaccination. “It’s unprecedented,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Florida medical leaders should speak out more forcefully against Ladapo’s attacks on public health, said Jeffrey Goldhagen, a pediatrician and professor at the University of Florida College of Medicine in Jacksonville. Ladapo urged people under 65 to avoid Covid shots last year and has rejected public health protocols for fighting measles outbreaks.

“What you see is a pattern of fear and neglect of professional responsibilities across the state, in part because of the fear of this governor and the vindictiveness of this governor,” said Goldhagen, a former health department director in Jacksonville.

He specifically criticized the Florida Medical Association, a trade group for physicians, noting that Ladapo is a nonvoting member of the group’s board of governors. The association did not respond to emails requesting comment.

Covid vaccines meet rigorous standards

The Florida Health Care Association, whose members run more than 600 long-term care facilities, declined to comment on Ladapo’s bulletin. One nursing home chain, LeadingAge Southeast, said it was aware of both federal and state recommendations on Covid boosters and encouraged providers to “engage with their residents, families, and healthcare professionals to make informed decisions.”

A spokesperson for the U.S. Food and Drug Administration, Cherie Duvall-Jones, said the agency “strongly disagrees with the State Surgeon General of Florida’s characterization of the safety and effectiveness of the updated mRNA Covid-19 vaccines.” The vaccines met the FDA’s “rigorous, scientific standards,” she said, and she urged people to get boosters since the population’s Covid immunity has waned.

Among its incorrect claims, the Florida bulletin says the new mRNA boosters wrongly target a viral variant, omicron, that is no longer circulating widely. This is false, since all major variants of Covid in the past two years evolved from omicron and subsequent mutations.

“You start off with that and then you go into head-exploding-emoji territory,” Moore said. “It’s a litany of lies out of the anti-vaxxer playbook.”

Other claims in Ladapo’s bulletin include:

Covid boosters don’t undergo clinical trials. It’s true that covid booster shots, whose mRNA sequences are changed slightly from previous shots, aren’t tested in large trials. Neither are annual influenza vaccines. By the time such tests would be completed, flu season would be over. But the original mRNA shots underwent clinical trials, and as with flu shots, “a lot of evidence has been collected in support of the ongoing use of the vaccines,” said Natalie Dean, a biostatistician at Emory University’s Rollins School of Public Health.
The shots pose a risk of infections, autoimmune disease, and other conditions. “I don’t know where these claims come from, but they aren’t accepted by the general medical community,” said William Schaffner, a Vanderbilt University School of Medicine infectious disease specialist. Serious side effects do occur, rarely, as with any medication. U.S. authorities were among the first to detect rare occurrences of myocarditis, an inflammation of the heart tissue, in young adults who got the covid vaccine. Most patients recovered quickly. Myocarditis is more commonly caused by covid infection itself.
The shots could cause elevated levels of spike protein and foreign genetic material in the blood. These concerns, which circulate on social media, have been disproved or have not panned out. For example, the billionths-of-a-gram quantities of bacterial DNA alleged to be contaminating covid shots are dwarfed by our other exposures, Offit said. “You encounter foreign DNA all the time, assuming you live on the planet and eat anything made from animals or vegetables,” he said. “I don’t know Dr. Ladapo, but I assume he does.”
Americans face “unknown risk” from too many booster shots. Scientists look at the possibility of “overvaccination” every time they study boosters. So far, no safety risks have been associated with multiple immunizations, Schaffner said.
Floridians should get exercise and eat vegetables and “healthy fats.” “These things will benefit your general health, but none of them will prevent Covid,” Schaffner said.

The bulletin urges all Floridians, including older residents, to avoid mRNA vaccines and find alternatives. But it comes off as “not in good faith” because it doesn’t specifically mention the only non-mRNA vaccine available, from Novavax, Dean said.

Florida statement aligns with Project 2025

Several critics of Ladapo’s bulletin said it read like a tryout for a job in a Trump administration advised by longtime anti-vaccine activist Robert F. Kennedy Jr., who has said Trump wants him to help vet senior health officials. Trump has said children receive too many vaccines and suggested that vaccines cause autism, a myth debunked by years of scientific research.

Ironically, although his administration oversaw the triumphantly rapid creation of the first Covid vaccines, Trump declined to receive his shots in public, as presidents have done during past epidemics.

Ladapo’s vaccine statement “aligns with Project 2025,” Offit said, referring to the conservative Heritage Foundation policy blueprint. While the plan’s authors include officials from Trump’s first term, he has said it doesn’t reflect his views.

The document calls the CDC “perhaps the most incompetent and arrogant agency in the federal government.”

Organized resistance to vaccines has existed as long as vaccination itself. Within six months of the release of the mRNA vaccines in December 2020, about 70% of American adults were vaccinated. Those who refused put themselves at greater risk of hospitalization or death if they contracted Covid, studies have shown.

Cheryl Holder, an internist who practices in Miami, said Ladapo’s statements had dampened interest in vaccination overall. People who are blasé about Covid “also don’t want to take the tetanus vaccine, and they don’t want to take the pneumococcal vaccine, or the flu vaccine,” she said.

“We’re in the disinformation age,” Offit said. “It’s certainly a lucrative business, more lucrative than the information business. But what really bothers me is when you have people who are credentialed stand up and say these ridiculous things.”

Ladapo, he noted, has medical and doctoral degrees from Harvard.

Arthur Allen, Daniel Chang and Sam Whitehead are reporters with KFF Health News, Healthbeat’s national reporting partner.

Don’t expect a new Covid policy for NYC schools, even as the virus surges

2024-09-04T15:44:42+00:00

This story was originally published by Chalkbeat. Sign up for Chalkbeat New York’s free daily newsletter to keep up with the city’s public schools.

More than 900,000 students will return to New York City schools on Thursday, after a summer that saw Covid cases surge across the nation and the five boroughs.

But don’t expect any changes to Covid guidance for the start of the 2024-25 school year.

Students will not be mandated to quarantine at home upon testing positive for the virus, under a policy adopted by city agencies in the spring that eliminated a prior five-day isolation requirement. Instead, officials ask individuals to remain at home until their symptoms improve as per the latest guidance from the U.S. Centers for Disease Control and Prevention.

“There is no real new guidance, because this is going to be our new normal,” said Anne Williams-Isom, the city’s deputy mayor for Health and Human Services, during a Tuesday press conference.

She urged New Yorkers to get their updated Covid vaccine and stay home if feeling ill.

“If you’re not feeling well, if you have sniffles, you should stay at home so we’re not spreading it,” she said. “We just have to make sure that we’re taking those precautions, and it’s the same thing for kids as they’re going back to school.”

New Covid vaccines are coming to New York; will they be accessible?

It may be difficult to track the city’s COVID rates as fewer people test for the virus. (The federal government discontinued its free at-home test program in March but plans to bring it back at the “end of September,” according to the CDC’s website.) A “very high” level of the virus was still being detected in New York state’s wastewater as of late August, according to CDC data.

Since March 1, the CDC has instructed people to stay home until their symptoms improve and they remain fever-free for at least 24 hours without using fever-reducing medication. The federal agency still advises people to take precautions over the following five days, including wearing a mask, social distancing, and testing. It’s part of a shift in health policy toward treating Covid like other common illnesses, including RSV and the flu.

Under current New York City Education Department policy, those who are experiencing Covid symptoms should isolate themselves from others and get tested. Like the CDC, the city advises students and staff to remain at home until symptoms have improved and they’re fever-free for 24 hours without medication.

The department also urges students and staff to wear a mask and take other precautions for five days after returning to school.

Those who test positive for Covid but do not exhibit symptoms do not need to stay home from school, according to the city’s policies. But upon returning to school, the city instructs individuals to take precautions to avoid getting others sick, such as wearing a mask and practicing good hygiene by covering coughs and sneezes, washing hands often, and using hand sanitizer.

The city’s Education Department did not immediately respond to a request for comment.

Julian Shen-Berro is a reporter covering New York City for Chalkbeat. Contact him at jshen-berro@chalkbeat.org.

Pediatricians scale back on Covid shot orders as families’ interest in vaccine wanes

2024-09-04T15:16:10+00:00

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When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

“This is where we usually store our Covid vaccines, but we don’t have any right now because they all expired at the end of last year and we had to dispose of them,” said Ball, who is part of a pediatric practice in Orange County, California.

“We thought demand would be way higher than it was.”

Pediatricians across the country are pre-ordering the updated and reformulated Covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said they’re struggling to predict whether parents will be interested. Providers like Ball don’t want to waste money ordering doses that won’t be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated Covid vaccination, but in the 2023-24 vaccination season only about 15% of eligible children in the United States got a shot.

A refrigerator contains tens of thousands of dollars’ worth of childhood vaccines. (Jackie Fortiér/KFF Health News)

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the Covid shot, which can have a very short shelf life compared with other vaccines.

“Watching it sitting on our shelves expiring every 30 days, that’s like throwing away $150 repeatedly every day, multiple times a month,” Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

“We took the number of flu vaccines that we order, and then we ordered 5% of that in Covid vaccines,” Ball said. “It’s a guess.”

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give Covid vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor’s office for inoculation.

It’s difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, Covid shots aren’t required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein’s, the upfront cost of the vaccine can be a gamble.

“The cost of vaccines, that’s far and away our biggest expense. But it’s also the most important thing we do, you could argue, is vaccinating kids,” Goldstein said.

Insurance doesn’t necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

“We’ve had things happen like a refrigerator gets unplugged. And then we’re all of a sudden out $80,000 overnight,” Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more Covid vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

Murals adorn the walls of the waiting room at Eric Ball’s pediatrics practice in Orange County, California. (Jackie Fortiér/KFF Health News)

“Pfizer is creating that situation. If you’re only going to let us return 30%, we’re not going to buy much,” she said. “We can’t.”

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused Covid shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, “The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients.”

Pfizer’s return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted Covid vaccines expiring on the shelves said flu shots cost them about $20 per dose, while Covid shots cost around $150 per dose.

“We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can’t absorb that kind of cost,” Greenhouse said.

Vaccine maker Moderna will accept Covid vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn’t specify the amount they’ll accept.

Greenhouse wants to vaccinate as many children as possible but said she can’t afford to stock shots with a short shelf life. Once she runs out of the doses she’s ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors’ offices.

“Frankly, it’s not an ideal situation, but it’s what we have to do to stay in business,” she said.

Ball, the California pediatrician, worries that parents’ limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest Covid shots difficult to find once they become available.

“I think there’s just a misperception that it’s less of a big deal to get Covid, but I’m still sending babies to the hospital with Covid,” Ball said. “We’re still seeing kids with long Covid. This is with us forever.”

Jackie Fortier is a reporter for KFF Health News, Healthbeat’s national reporting partner.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

2024-08-27T09:00:00+00:00

In early August, farmworkers gathered under a pavilion at a park here for a picnic to celebrate Farmworker Appreciation Day. One sign that this year was different from the others was the menu: Beef fajitas, tortillas, pico de gallo, chips, beans — but no chicken.

Farms in Colorado had culled millions of chickens in recent months to stem the transmission of bird flu. Organizers filled out the spread with hot dogs.

No matter the menu, some dairy workers at the event said they don’t exactly feel appreciated. They said they haven’t received any personal protective equipment beyond gloves to guard against the virus, even as they or colleagues have come down with conjunctivitis and flu-like symptoms that they fear to be bird flu.

“They should give us something more,” one dairy worker from Larimer County said in Spanish. He spoke on the condition of anonymity out of fear he’d lose his job for speaking out. “What if something happens to us? They act as if nothing is wrong.”

Agricultural health and safety experts have been trying to get the word out about how to protect against bird flu, including through bilingual videos on TikTok showing the proper way to gear up with respirators, eye protection, gloves, and coveralls. And Colorado’s health and agriculture departments have offered a free month’s supply of protective equipment to any producer who requests it.

But so far, many farms aren’t taking them up on it: According to numbers provided by the state health department in late August, fewer than 13% of the state’s dairies had requested and received such PPE.

The virus is known to infect mammals — from skunks, bears, and cows to people and house pets. It began showing up in dairy cattle in recent months, and Colorado has been in the thick of it. Ten of the 13 confirmed human cases in the United States this year have occurred in Colorado, where it continues to circulate among dairy cows. It isn’t a risk in cooked meat or pasteurized milk but is risky for those who come into contact with infected animals or raw milk.

Weld County, where the farmworker event was held, is one of the nation’s top milk producers, supplying enough milk each month this year to fill about 45 Olympic-size swimming pools, according to U.S. Department of Agriculture data. Neighboring counties are notable producers, too.

Concerns are growing about undiagnosed illness among farmworkers because of a lack of testing and safety precautions. One reason for concern: Bird flu and seasonal flu are capable of gene trading, so if they ended up in the same body at the same time, bird flu might end up with genes that boost its contagiousness. The virus doesn’t appear to be spreading easily between people yet. That could change, and if people aren’t being tested, then health officials may be slow to notice.

Strains of seasonal flu already kill some 47,000 people in the United States a year. Public health officials fear the havoc a new form of the flu could wreak if it spreads among people.

Some farmworkers face grueling conditions

The Centers for Disease Control and Prevention recommends that dairy workers don a respirator and goggles or a face shield, among other protections, whether they are working with sick animals or not.

A recent study found that not all infected cows show symptoms, so workers could be interacting with contagious animals without realizing it. Even when it is known that animals are infected, farmworkers often still have to get in close contact with them, sometimes under grueling conditions, such as during a recent heat wave when Colorado poultry workers collected hundreds of chickens by hand for culling because of the outbreak. At least six of the workers became infected with bird flu.

One dairy worker in Weld County, who spoke on the condition of anonymity for fear of losing his job, said his employer has not offered any protective equipment beyond gloves, even though he works with sick cows and raw milk.

His bosses asked the workers to separate sick cows from the others after some cows produced less milk, lost weight, and showed signs of weakness, he said. But the employer didn’t say anything about the bird flu, he said, or suggest they take any precautions for their own safety.

He said he bought protective goggles for himself at Walmart when his eyes became itchy and red earlier this summer. He recalled experiencing dizziness, headaches, and low appetite around the same time. But he self-medicated and pushed through, without missing work or going to a doctor.

“We need to protect ourselves because you never know,” he said in Spanish. “I tell my wife and son that the cows are sick, and she tells me to leave, but it will be the same wherever I go.”

He said he’d heard that his employers were unsympathetic when a colleague approached them about feeling ill. He’d even seen someone affiliated with management remove a flyer about how people can protect themselves from the bird flu and throw it in a bin.

The dairy worker in neighboring Larimer County said he, too, has had just gloves as protection, even when he has worked with sick animals — close enough for saliva to wipe off on him. He started working with them when a colleague missed work because of his flu-like symptoms: fever, headache, and red eyes.

“I only wear latex gloves,” he said. “And I see that those who work with the cows that are sick also only wear gloves.”

He said he doesn’t have time to wash his hands at work but puts on hand sanitizer before going home and takes a shower once he arrives. He has not had symptoms of infection.

Such accounts from dairy workers echo those from farmworkers in Texas, as reported by KFF Health News in July.

“Employers who are being proactive and providing PPE seem to be in the minority in most states,” said Bethany Boggess Alcauter with the National Center for Farmworker Health, a not-for-profit organization based in Texas that advocates for improving the health of farmworkers and their families. “Farmworkers are getting very little information.”

But Zach Riley, CEO of the Colorado Livestock Association, said he thinks such scenarios are the exception, not the rule.

“You would be hard-pressed to find a dairy operation that isn’t providing that PPE,” he said. Riley said dairies typically have a stockpile of PPE ready to go for situations like this and that, if they don’t, it’s easily accessed through the state. “All you have to do is ask.”

Producers are highly motivated to keep infections down, he said, because “milk is their life source.” He said he has heard from some producers that “their family members who work on the farm are doing 18-to 20-hour days just to try to stay ahead of it, so that they’re the first line between everything, to protect their employees.”

Safety messages aren’t reaching workers

Colorado’s health department is advertising a hotline that ill dairy workers can call for help getting a flu test and medicine.

Project Protect Food Systems Workers, an organization that emerged early in the Covid-19 pandemic to promote farmworker health across Colorado, is distributing PPE it received from the state so promotoras — health workers who are part of the community they serve — can distribute masks and other protections directly to workers if employers aren’t giving them out.

Promotora Tomasa Rodriguez said workers “see it as another virus, another Covid, but it is because they don’t have enough information.”

She has been passing out flyers about symptoms and protective measures, but she can’t access many dairies. “And in some instances,” she said, “a lot of these workers don’t know how to read, so the flyers are not reaching them, and then the employers are not doing any kind of talks or trainings.”

The CDC’s Nirav Shah said during an Aug. 13 call with journalists that awareness about bird flu among dairy workers isn’t as high as officials would like it to be, despite months of campaigns on social media and the radio.

“There’s a road ahead of us that we still need to go down to get awareness on par with, say, what it might be in the poultry world,” he said. “We’re using every single messenger that we can.”

KFF Health News correspondents Vanessa G. Sánchez and Amy Maxmen, Healthbeat’s national reporting partner, contributed to this report.

Bird flu cases are going undetected, new study suggests

Farmworkers face high-risk exposures to bird flu, but testing isn't reaching them

New Covid vaccines: Should you get shot now or wait for winter wave?

2024-08-26T09:00:00+00:00

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The FDA has approved an updated Covid shot for everyone 6 months old and up, which renews a now-annual quandary for Americans: Get the shot now, with the latest Covid outbreak sweeping the country, or hold it in reserve for the winter wave?

The new vaccine should provide some protection to everyone. But many healthy people who have already been vaccinated or have immunity because they’ve been exposed to Covid enough times may want to wait a few months.

Covid has become commonplace. For some, it’s a minor illness with few symptoms. Others are laid up with fever, cough, and fatigue for days or weeks. A much smaller group — mostly older or chronically ill people — suffer hospitalization or death.

It’s important for those in high-risk groups to get vaccinated, but vaccine protection wanes after a few months. Those who run to get the new vaccine may be more likely to fall ill this winter when the next wave hits, said William Schaffner, an infectious disease professor at Vanderbilt University School of Medicine and a spokesperson for the National Foundation for Infectious Diseases.

On the other hand, by late fall the major variants may have changed, rendering the vaccine less effective, Peter Marks, the FDA’s top vaccine official, said at a briefing Friday. He urged everyone eligible to get immunized, noting that the risk of long Covid is greater in the un- and undervaccinated.

Of course, if last year’s Covid vaccine rollout is any guide, few Americans will heed his advice, even though this summer’s surge has been unusually intense, with levels of the Covid virus in wastewater suggesting infections are as widespread as they were in the winter.

Covid hitting West and South hardest

The Centers for Disease Control and Prevention now looks to wastewater as fewer people are reporting test results to health authorities. The wastewater data shows the epidemic is worst in Western and Southern states. In New York, for example, levels are considered “high” — compared with “very high” in Georgia.

Hospitalizations and deaths due to Covid have trended up, too. But unlike infections, these rates are nowhere near those seen in winter surges, or in summers past. More than 2,000 people died of Covid in July — a high number but a small fraction of the at least 25,700 Covid deaths in July 2020.

Partial immunity built up through vaccines and prior infections deserves credit for this relief. A new study suggests that current variants may be less virulent — in the study, one of the recent variants did not kill mice exposed to it, unlike most earlier Covid variants.

Public health officials note that even with more cases this summer, people seem to be managing their sickness at home.

“We did see a little rise in the number of cases, but it didn’t have a significant impact in terms of hospitalizations and emergency room visits,” Manisha Juthani, public health commissioner of Connecticut, at said at a news briefing on Wednesday.

Unlike influenza or traditional cold viruses, Covid seems to thrive outside the cold months, when germy schoolkids, dry air, and indoor activities are thought to enable the spread of air- and saliva-borne viruses. No one is exactly sure why.

“Covid is still very transmissible, very new, and people congregate inside in air-conditioned rooms during the summer,” said John Moore, a virologist and professor at Cornell University’s Weill Cornell Medicine College.

Or “maybe Covid is more tolerant of humidity or other environmental conditions in the summer,” said Caitlin Rivers, an epidemiologist at Johns Hopkins University.

Covid vaccine uptake has waned

Because viruses evolve as they infect people, the CDC has recommended updated Covid vaccines each year. Last fall’s booster was designed to target the omicron variant circulating in 2023. This year, mRNA vaccines made by Moderna and Pfizer and the protein-based vaccine from Novavax — which has yet to be approved by the FDA — target a more recent omicron variant, JN.1.

The FDA determined that the mRNA vaccines strongly protected people from severe disease and death — and would do so even though earlier variants of JN.1 are now being overtaken by others.

Public interest in Covid vaccines has waned, with only 1 in 5 adults getting vaccinated since last September, compared with about 80% who got the first dose. New Yorkers have been slightly above the national vaccination rate, while in Georgia only about 17% got the latest shot.

Vaccine uptake is lower in states where the majority voted for Donald Trump in 2020 and among those who have less money and education, less health care access, or less time off from work. These groups are also more likely to be hospitalized or die of the disease, according to a 2023 study in The Lancet.

While the newly formulated vaccines are better targeted at the circulating Covid variants, uninsured and underinsured Americans may have to rush if they hope to get one for free. A CDC program that provided boosters to 1.5 million people over the last year ran out of money and is ending Aug. 31.

The agency drummed up $62 million in unspent funds to pay state and local health departments to provide the new shots to those not covered by insurance. But “that may not go very far” if the vaccine costs the agency around $86 a dose, as it did last year, said Kelly Moore, CEO of Immunize.org, which advocates for vaccination.

People who pay out-of-pocket at pharmacies face higher prices: CVS plans to sell the updated vaccine for $201.99, said Amy Thibault, a spokesperson for the company.

“Price can be a barrier, access can be a barrier” to vaccination, said David Scales, an assistant professor of medicine at Weill Cornell Medical College.

Without an access program that provides vaccines to uninsured adults, “we’ll see disparities in health outcomes and disproportionate outbreaks in the working poor, who can ill afford to take off work,” Kelly Moore said.

New York state has about $1 million to fill the gaps when the CDC’s program ends, said Danielle De Souza, a spokesperson for the New York State Department of Health. That will buy around 12,500 doses for uninsured and underinsured adults, she said. There are roughly 1 million uninsured people in the state.

What to do this fall

CDC and FDA experts last year decided to promote annual fall vaccination against Covid and influenza along with a one-time respiratory syncytial virus shot for some groups.

It would be impractical for the vaccine-makers to change the Covid vaccine’s recipe twice every year, and offering the three vaccines during one or two health care visits appears to be the best way to increase uptake of all of them, said Schaffner, who consults for the CDC’s policy-setting Advisory Committee on Immunization Practices.

At its next meeting, in October, the committee is likely to urge vulnerable people to get a second dose of the same Covid vaccine in the spring, for protection against the next summer wave, he said.

If you’re in a vulnerable population and waiting to get vaccinated until closer to the holiday season, Schaffner said, it makes sense to wear a mask and avoid big crowds, and to get a test if you think you have Covid. If positive, people in these groups should seek medical attention since the antiviral pill Paxlovid might ameliorate their symptoms and keep them out of the hospital.

As for conscientious others who feel they may be sick and don’t want to spread the Covid virus, the best advice is to get a single test and, if positive, try to isolate for a few days and then wear a mask for several days while avoiding crowded rooms. Repeat testing after a positive result is pointless, since viral particles in the nose may remain for days without signifying a risk of infecting others, Schaffner said.

The Health and Human Services Department is making four free Covid tests available to anyone who requests them starting in late September through covidtests.gov, Dawn O’Connell, assistant secretary for preparedness and response, said at Friday’s briefing.

The government is focusing its fall vaccine advocacy campaign, which it’s calling “Risk less, live more,” on older people and nursing home residents, said HHS spokesperson Jeff Nesbit.

Not everyone may really need a fall Covid booster, but “it’s not wrong to give people options,” John Moore said. “The 20-year-old athlete is less at risk than the 70-year-old overweight dude. It’s as simple as that.”

Arthur Allen is a reporter with KFF Health News, Healthbeat’s national reporting partner. Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Amy Maxmen, Healthbeat’s national reporter through KFF, contributed to this report.

New Covid vaccines coming to NY, but getting them may be challenge for uninsured

New Covid vaccines may be hard to come by for uninsured Georgians

New Covid-19 vaccines coming to New York, but getting shots may be a challenge for uninsured

2024-08-26T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Updated Covid-19 vaccines are expected to roll out as soon as this week in New York, following the Food and Drug Administration’s approval Thursday of the new shots. But accessing the vaccines may be challenging for some New Yorkers.

The new vaccines arrive at an uncertain time in the pandemic. Covid-19 infections spiked in New York City this summer. Once widely distributed for free by the federal government, Covid-19 vaccines are now sold commercially. And a program from the Centers for Disease Control and Prevention that covered the cost of Covid-19 shots for uninsured and underinsured Americans is ending prematurely — this month.

“As programs like this end, we’re going to see less availability of vaccines, we’re going to see more people have to pay out of pocket for vaccines,” said Dr. David Scales, an assistant professor of medicine at Weill Cornell Medical College. “We’re going to see the convenience of vaccination go down, and that means vaccination rates are going to go down. It’s a shame.”

Nationwide vaccination rates were low for last year’s updated vaccine. In New York, 23% of adult residents received the 2023-24 Covid-19 vaccine, according to CDC estimates.

The new shots will cost around $201.99 for uninsured patients paying out of pocket at CVS, spokesperson Amy Thibault told Healthbeat.

They will still be free for Marketplace and Medicare enrollees and for uninsured, underinsured and Medicaid-eligible kids under the Vaccines for Children program. CVS said the shots should be free under most insurance plans at in-network pharmacies.

To obtain the updated shot, the New York City Department of Health and Mental Hygiene recommends that New Yorkers reach out to their health care providers or use the city’s vaccine finder.

“Updated vaccines are another opportunity to protect against the latest variant,” Health Department spokesperson Patrick Gallahue said in a statement. “The COVID-19 vaccines are now distributed through the commercial market and manufacturers will work to fulfill orders placed by pharmacies and other providers.”

Will you get the new Covid shots? Tell us your thoughts.

Federal funding for Covid-19 vaccinations has long run dry. When Covid-19 vaccines hit the commercial market last year, the CDC’s Bridge Access Program offered a temporary solution for uninsured and underinsured adults, providing roughly 1.5 million free Covid-19 vaccines. The program was expected to run through December, but is ending months early.

Some state funding will help fill gaps when the Bridge Access Program — which the state and New York City participate in — ends this month, Danielle R. De Souza, a spokesperson for the New York State Department of Health, said in a statement.

The state’s Vaccines for Adults Program has roughly $1 million allocated this budget year for Covid-19 vaccines for uninsured and underinsured adults and plans to make up to 12,500 doses of the new vaccine available, De Souza said. That’s a tiny fraction of the roughly 1 million New Yorkers who are uninsured.

However, NYC Health + Hospitals, the city’s public health system, continues to offer Covid-19 vaccines at no cost to patients, said Dr. Jonathan Jimenez, a primary care doctor and the executive director of NYC Care, a health care access program that connects uninsured New Yorkers to services within the health system.

“The way we work at all of our facilities and clinics is to offer vaccines with no out-of-pocket costs to the patient, but also other preventive services,” Jimenez said. “Luckily, the end of the program doesn’t change how we’re operating.”

It’s smaller clinics and community health centers that may bear more of the brunt of the shift to commercial Covid-19 vaccines.

Callen-Lorde Community Health Center, a federally qualified health center in New York City that provides services to primarily LGBTQ+ patients, is poised to administer the updated vaccines. The health center uses a sliding scale payment system for uninsured and underinsured patients.

Immunization clinical director Elsbet Servay hopes that grants, patient assistance programs offered by vaccine manufacturers and state support might be able to help offset the cost of the new vaccines.

“Coverage has been an issue since commercialization rolled out last year and we unfortunately expect some challenges in maintaining access for un- and under-insured individuals,” Servay told Healthbeat in an email.

It’s difficult to know how many city residents are currently vaccinated against Covid-19. The Health Department stopped reporting new Covid-19 vaccination data last September. By that point, 91% of city residents had received at least one dose of a Covid-19 vaccine and 81% had completed the primary series, but only 16% had received the bivalent dose, introduced in 2022.

Jimenez urged New Yorkers to get flu and Covid-19 shots at the same time, particularly in anticipation of flu season this winter — and a likely rise in Covid-19 infections during that period.

“When you go into your fall visit, and you would typically get your flu shot, go ahead and ask for your Covid-19 shot as well,” he said.

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Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org. Healthbeat Atlanta reporter Rebecca Grapevine contributed to this report.

What to do if you test positive for Covid-19: Test and isolate

New Covid vaccines: Should you get now or wait for winter wave?

New Covid shots may be hard to come by for uninsured Georgians

2024-08-26T09:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Updated Covid vaccines, slated to hit shelves this week, could come with serious sticker shock for more than a million Georgians who don’t have health insurance.

The shots will cost around $201.99 for uninsured patients paying out of pocket at CVS, spokesperson Amy Thibault said.

The newly approved Covid vaccines should provide “great coverage” for current versions of the virus and will be effective in preventing serious hospitalizations and death, Emory University epidemiologist Jodie Guest said.

But doctors and public health practitioners are concerned about vaccine access and equity as Georgia is seeing “very high” rates of Covid and the federal Bridge Access Program, which provided vaccines to uninsured adults, ends this month.

With about 1 million uninsured adults under age 65, Georgia has one of the highest uninsured rates in the country. It also has a low vaccination rate, with only around 17% of adults having received last year’s Covid vaccine as of May this year, according to U.S. Centers for Disease Control and Prevention data.

“This season is going to be a very difficult Covid and flu season,” said Dr. Cecil Bennett, a family medicine doctor and fellow at Morehouse School of Medicine.

He warned that the ending of the federal vaccine access program could contribute to lost productivity and more deaths. Covid caused 2.4% of all deaths in Georgia in the week the week leading up to Aug. 10, according to the CDC.

“This is not the time that I would say the federal government should be penny wise and pound foolish,” Bennett said.

For comparison, New York state also has about 1 million uninsured people. But NYC Health + Hospitals, the city’s public health system, continues to offer Covid-19 vaccines at no cost to patients, said Dr. Jonathan Jimenez, a primary care doctor and executive director of NYC Care, which connects uninsured New Yorkers to services.

Nationwide, the vaccines will still be free for Marketplace and Medicare enrollees. Uninsured, underinsured and Medicaid-eligible kids should be able to get the vaccines for free under Vaccines for Children. And CVS said the shots should be free under most insurance plans at in-network pharmacies.

The CDC last week announced a tranche of $62 million that states across the country can use to buy vaccines for uninsured people as the Bridge Access Program ends.

Georgia already planned to purchase 4,600 updated Covid shots for underinsured and uninsured people, and last week applied to the CDC for funds to cover an additional 33,540 shots, Department of Public Health spokesperson Nancy Nydam said.

That would bring the state’s supply to 38,140 vaccines for uninsured and underinsured adults. Those would be distributed to county health departments and around 30 external providers through the state’s Adult Vaccine Program.

While that’s “still not enough to cover every uninsured and underinsured adult in Georgia,” Nydam said, “This still puts us in a better position to serve adults who seek service through our [Adult Vaccine Program] provider sites.”

Campaign to take on vaccine hesitancy

Beyond that program, the state health department plans to roll out its annual multi-platform campaign in the fall encouraging people to be vaccinated for COVID and flu, Nydam said. The campaign will include billboards, radio/TV, digital, web and social media.

Vaccine events are typically held at the district level. Events and clinic hours and appointments are listed on district websites and social media. DPH also works with the Community Organized Relief Effort to provide vaccines through local organizations and faith-based groups.

Will you get the new Covid shots? Tell us your thoughts.

Dr. Harry Heiman, a clinical professor at Georgia State University’s School of Public Health, said he would love to see how the state might work to boost federal efforts and fill any gaps.

“Those are the kinds of state level plans that even in the absence of guidance from the federal government you would hope are being put into place,” Heiman said.

For many local Georgia health departments, uptake remains a challenge.

For example, in DeKalb County, with a population of about 760,000, fewer than 200 people got Covid vaccines from the board of health between January and April, spokesperson Eric Nickens said.

In neighboring Fulton County, with a population just over 1 million, spokesperson Darryl Carver said the board of health has “actively continued promoting” vaccines as part of its #VaccineWorks campaign. But the agency has administered just 375 Covid vaccines so far this year.

Charity clinics lack funds for Covid shots

The end of the free federal vaccine program also means that nonprofit and charity clinics must now cobble together funds to provide vaccines, and some clinics are not able to provide them at all.

Georgia’s 35 federally funded nonprofit health centers will be able to continue providing vaccines, said Dr. Theresa Jacobs, medical director for the Georgia Primary Care Association, which represents the clinics.

The clinics serve around 650,000 patients a year, about a third of whom are uninsured. The clinics will rely on partnerships with public health departments and other groups as well as “small grants” to fill in the gaps for uninsured adults.

“They’re not going to miss a beat,” Jacobs said. “They’re going to still be able to offer them either free or at a very low discounted price for those that are uninsured.”

But some charity clinics are not able to offer Covid vaccines. For example, Clarkston Community Health Center, a free health clinic that serves uninsured people, including many refugees, is no longer able to provide any vaccines, said executive director Jeremy Cole, because of “funding shortages.”

“Funding for a charitable clinic is always a challenge, and we have not had grants or funding in the past few years that would allow us to relaunch a vaccine program,” Cole said. “But we are working on it.”

Many large metro Atlanta health systems like Wellstar, Emory and Children’s Healthcare of Atlanta do not offer the vaccine onsite, instead referring patients to other providers. Grady Health System provides Covid vaccines at its primary care clinic and neighborhood health centers, spokesperson Danielle Hackett said.

Representatives another large health system, Piedmont Healthcare, did not respond to questions about whether they provide the vaccine.

Uninsured left vulnerable to Covid risks

Some vaccine advocates say that given Georgia’s low uptake rates, health care providers and policymakers should focus on removing as many barriers to access as possible.

“The way that I think about this is that the second someone decides they’re ready to get a vaccine, there should be no additional barriers to that,” said Marquisha Johns, associate director for public health policy at the Center for American Progress, a left-leaning think tank.

“We should make it as easy as possible for them to take the very next step into actually getting the shot in their arm, because there are already so many barriers to getting the person to the first step,” Johns said.

The end of the program puts a burden on uninsured Georgians who need key preventive care like the Covid-19 vaccines, said Laura Colbert, executive director of Georgians for a Healthy Future, a health advocacy group in Atlanta.

Uninsured Georgians may have to cover their own vaccine costs, Colbert said, which “unfairly leaves them vulnerable to illnesses and health conditions that other Georgians are better protected from.”

Johns pointed out that Georgia policymakers could find a way to increase funding for vaccines in the state, especially since the state has a large uninsured population.

“If they wanted to make that a priority, they definitely, absolutely could say, like, ‘Us as the state of Georgia will guarantee that all of our uninsured people will have access to these. Every uninsured person will have access to these five vaccines,’” Johns said.

“The vaccine should be available for everyone,” said Christopher Pride, the director of clinical care at Positive Impact Health Centers, which provides comprehensive sexual health care in Atlanta. “Cost can make people, you know, determine whether they’re going to put food on their table or get a vaccine.”

Pride said he ensures the Positive Impact clinics always have vaccines available to patients. With the ending of the Bridge Access Program, the clinic has turned to other funding streams to ensure it can continue to offer the shots at low or no cost to patients.

“People who are hesitant are more likely to accept the vaccine from someone they trust, and that’s why the doctor’s office is key,” Pride said. “We will ensure that we always have it, regardless if you’re insured or uninsured.”

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Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org. New York Healthbeat reporter Eliza Fawcett contributed to this report.

The new Covid vaccine is out: Why you may not want to rush to get it

What to do if you test positive for Covid-19: Test and isolate

Covid cases surge in Georgia, FDA approves new vaccines

2024-08-22T18:41:19+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

As the United States heads toward a new summer record for Covid cases, rates in Georgia are “very high,” with related deaths and hospitalizations on the rise.

The surge comes as updated Covid vaccines were approved Thursday and granted emergency use authorization by the Food and Drug Administration.

The shots are expected to be available as soon as next week, said Jodie Guest, senior vice chair of the Department of Epidemiology at Emory University’s Rollins School of Public Health.

“It appears that we’re about to hit a new summer record for Covid [nationally], and so we are seeing currently the biggest summer wave since July of 2022,” Guest said.

While state-specific information about the rates of positive test results is not available, regionally, nearly 17% of tests reported in the Southeast are positive, more than three times the ideal of 5% or less, Guest said. “We want to be below 5% if we have some control over the outbreak.”

But those positivity rates don’t give the full picture, since many people are now testing for the virus at home and not reporting results, Guest said.

More reliable is wastewater surveillance data, which shows that Georgia’s Covid virus level is “very high,” with viral activity greater than 8, while less than 1.5 is considered “minimal,” according to the U.S. Centers for Disease Control and Prevention.

Georgia’s wastewater virus levels – measured against a baseline formula – were twice as high for the week of Aug. 10 as the same week last year, according to CDC data. It measured 9.18 as of Aug. 10, compared to 4.47 for the same week last year. Levels have been increasing over the summer.

A state government epidemiologist said the summer Covid bump was expected, given a seasonal increase in travel and people congregating indoors to escape the heat.

“This is a pretty typical pattern that we have been seeing each of the summers since Covid emerged,” said Dr. Cherie Drenzek of the Georgia Department of Public Health.

Death and hospitalization rates are also increasing, Drenzek said, though the increases are “not at a very high level.” Just over 2% of deaths in Georgia were caused by Covid in the week leading up to Aug. 10, according to the CDC.

What to do if you test positive for Covid

People who test positive for Covid should take a two-pronged approach to recover and avoid spreading the virus, starting with staying home while sick.

The CDC recommends resuming normal activities if symptoms are improving and you have been fever-free, without fever-reducing medications, for at least 24 hours.

After that, the CDC urges people to take preventative measures for the next five days, including physically distancing from others, masking, improving air purification, and testing when around other people indoors.

Other health experts recommend isolating until you test negative for Covid, which could be three to 15 days.

“Although many have fallen to Covid fatigue, it is important to remember to test if symptoms arise and speak with your provider about treatment options,” said Dr. Danny Branstetter, medical director of infection prevention for Wellstar Health System.

Guest said parents may need to test their children twice to accurately determine whether they have Covid.

A single at-home (antigen) test cannot rule out Covid, Guest said, but false negatives are less likely when a second test is given 48 hours later.

That’s a result of how the at-home tests work, since they’re more likely to give false negatives, and the timing of the testing, because testing early on can result in a negative even when someone is infected with Covid, Guest said.

No widespread guidelines encourage people to mask up in public places, Drenzek said, but it’s good “respiratory etiquette” for those who have symptoms.

“If you’ve been recently sick and had a positive Covid test, then you should really be masking for a period of at least five days after … your respiratory symptoms improve and you have no fever,” said Dr. Harry Heiman, a clinical professor at Georgia State University’s School of Public Health.

“That’s just really a respectful and appropriate way to behave, in terms of not giving it to other people around you,” he said.

Death rate ‘much higher than it should be’

The increase in Covid-related hospitalizations and deaths is frustrating to public health experts, who contend that severe outcomes are largely preventable through widespread Covid vaccination.

“The death rate is going up” in Georgia, Guest said. “It is lower than 2020 … but it is much higher than it should be.”

About 2.4% of all deaths in Georgia for the week leading up to Aug. 10 were caused by Covid, and that number was up over the previous week, according to CDC data.

Guest said Georgia’s Covid death rate should be close to zero, since deaths are largely preventable with vaccination. “This is a vaccine preventable death for almost every case … At a minimum, we’d want to see it under 1%.”

Vaccine uptake in Georgia has been low.

As of this spring, only about 10% or 11% of Georgians are fully boosted, Heiman said. That means about 9 in 10 Georgians “are not protected in the way they should be.”

“We continue to squander the tools that we have to prevent [serious outcomes] … I’m talking first and foremost about vaccination,” Heiman said.

He gave several reasons for the low vaccine uptake rate in Georgia, including a high rate of uninsured people — nearly 12% of the population, or about 1.2 million people, are uninsured, according to KFF’s State Health Facts — as well as “a failure of both our health care and our public health systems to do active outreach to patients and to communities” to ensure people understand the “critical importance” of vaccines.

Atlanta health systems seeing more cases

Metro Atlanta health systems said they are seeing more Covid cases among patients.

“The total number of inpatients with Covid-19 has increased, but the severity of cases has not worsened,” said Danielle Hackett, a spokesperson for Grady Health System. Many patients admitted to the hospital for non-Covid reasons are found to have Covid.

The number of children with Covid at a large local pediatric health system is also increasing.

“Children’s Healthcare of Atlanta has seen an increase in the number of children with Covid-19, especially over the past three weeks. Approximately one-quarter of our respiratory virus tests across our system have detected [Covid],” said Dr. Andi Shane, division chief of pediatric infectious diseases at Children’s Healthcare of Atlanta.

“Most of the children who test positive have mild illness, but we have cared for some children who have other medical conditions who have had more severe illness,” Shane said.

New vaccines on the way

The rising Covid rates come as new vaccinations are expected to be available as soon as next week.

“It will have great coverage for the vaccines or for the variants that we currently see circulating,” Guest said.

Epidemiologists and doctors recommend the new vaccines for everyone 6 months and older.

“Vaccination of children not only helps to protect them but also indirectly protects other people, including young babies under 6 months of age, who cannot be vaccinated, and grandparents, whose immune systems may not work as well,” Shane said.

People who have already been vaccinated need only wait four months between the last vaccine and this new one, Guest said. “Many people got theirs last fall, so most will be eligible right away.”

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

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What to do if you test positive for Covid-19

2024-08-09T12:31:33+00:00

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Covid-19 is on the rise in New York and across much of the United States this summer.

In recent years, the Centers for Disease Control and Prevention has significantly shifted its guidance for people who test positive for Covid-19. In 2021, the CDC shortened its recommended isolation period for people with Covid-19 to five days, down from 10 days, in most cases. The agency’s guidance became even less restrictive this year, though some public health experts urge stricter measures to stop the spread of disease.

Here’s what you need to know if you test positive.

How long should you isolate?

The CDC recommends a two-part approach if you test positive.

First, you should stay home when sick. You can resume normal activities if your symptoms are improving overall and you have not had a fever for 24 hours (without taking fever-reducing medications).

Second, when you end isolation, you should take preventative measures for the next five days, including physical distancing, air purification, masking, and testing when around other people indoors.

Some public health experts recommend taking stricter measures to ensure that you are not infecting others. Katelyn Jetelina, an epidemiologist, Healthbeat partner, and author of the “Your Local Epidemiologist” newsletter, says the best approach is to isolate until your at-home Covid-19 test is negative, which could range from three to 15 days. And if you must leave isolation beforehand, she urges wearing an N95 mask.

Dr. Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy, recommends erring on the side of caution, particularly to protect vulnerable people around you.

“The bottom line is, a lot of the original aspects of the virus still hold,” he said. “There are people that remain contagious after five days, or after two days, or three days, and that’s what should guide isolation. If you’re still contagious, you can still pass it on to someone else.”

How do you get tested?

Four years into the pandemic, much of the Covid-19 testing infrastructure in New York and across the country has faded away.

In New York, residents can find rapid and PCR testing at NYC Health + Hospitals facilities and community care clinics.

Pharmacies sell rapid test kits, typically for about $12 per test. But private insurers are no longer required to cover the cost of tests.

The federal government has resumed its Covid-19 test kit program, which mails free tests to Americans.

Should you take Paxlovid?

The antiviral medication Paxlovid is available for anyone ages 12 and older who is at high risk of developing severe Covid-19 — and particularly for people who are at least 65 years old.

Anyone who tests positive for Covid-19 should see if they are eligible for Paxlovid, said Dr. Sean T. Liu, the medical director of Mount Sinai’s COVID Clinical Trials Unit and an associate professor of medicine at the Icahn School of Medicine at Mount Sinai. Paxlovid is effective when taken within the first five days of developing symptoms.

“The faster you get the Paxlovid, the more effective it is,” Liu said. “It’s a timing thing.”

New Yorkers can call the city’s Covid-19 hotline (212-COVID19) to connect with a NYC Health + Hospitals clinician who can prescribe antiviral medication, according to Patrick Gallahue, a spokesperson for the Health Department.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

How the anti-vaccine movement pits parental rights against public health

2024-08-02T15:42:09+00:00

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Gayle Borne has fostered more than 300 children in Springfield, Tennessee. She’s cared for kids who have rarely seen a doctor — kids so neglected that they cannot speak. Such children are now even more vulnerable because of a law Tennessee passed last year that requires the direct consent of birth parents or legal guardians for every routine childhood vaccination. Foster parents, social workers, and other caregivers cannot provide permission.

In January, Borne took a foster baby, born extremely premature at just over 2 pounds, to her first doctor’s appointment. The health providers said that without the consent of the child’s mother, they couldn’t vaccinate her against diseases like pneumonia, hepatitis B, and polio. The mother hasn’t been located, so a social worker is now seeking a court order to permit immunizations. “We are just waiting,” Borne said. “Our hands are tied.”

Tennessee’s law has also stymied grandmothers and other caregivers who accompany children to routine appointments when parents are at work, in drug and alcohol rehabilitation clinics, or otherwise unavailable. The law claims to “give parents back the right to make medical decisions for their children.”

Framed in the rhetoric of choice and consent, it is one of more than a dozen recent and pending pieces of legislation nationwide that pit parental freedom against community and children’s health. In actuality, they create obstacles to vaccination, the foundation of pediatric care.

Such policies have another effect. They seed doubt about vaccine safety in a climate rife with medical misinformation. The trend has exploded as politicians and social media influencers make false claims about risks, despite studies showing otherwise.

Doctors traditionally give caregivers vaccine information and get their permission before delivering more than a dozen childhood immunizations that defend against measles, polio, and other debilitating diseases.

But now, Tennessee’s law demands that birth parents attend routine appointments and sign consent forms for every vaccine given over two or more years. “The forms could have a chilling effect,” said Jason Yaun, a Memphis pediatrician and past president of the Tennessee chapter of the American Academy of Pediatrics.

“People who promote parental rights on vaccines tend to downplay the rights of children,” said Dorit Reiss, a vaccine policy researcher at the University of California Law-San Francisco.

Vaccination rates are dropping

Misinformation coupled with a parental rights movement that shifts decision-making away from public health expertise has contributed to the lowest childhood vaccine rates in a decade.

This year, legislators in Arizona, Iowa, and West Virginia have introduced related consent bills. A “Parents’ Bill of Rights” amendment in Oklahoma seeks to ensure that parents know they can exempt their children from school vaccine mandates along with lessons on sex education and AIDS. In Florida, the medical skeptic leading the state’s health department recently defied guidance from the Centers for Disease Control and Prevention by telling parents they could send unvaccinated children to a school during a measles outbreak.

Last year, Mississippi began allowing exemptions from school vaccine requirements for religious reasons because of a lawsuit funded by the Informed Consent Action Network, which is listed as a leading source of anti-vaccine disinformation by the Center for Countering Digital Hate. A post on ICAN’s website said it “could not be more proud” in Mississippi to “restore the right of every parent in this country to have his or her convictions respected and not trampled by the government.”

Even if some bills fail, Reiss fears, the revived parental rights movement may eventually abolish policies that require routine immunizations to attend school. At a recent campaign rally, Republican presidential candidate Donald Trump said, “I will not give one penny to any school that has a vaccine mandate.”

The movement dates to the wake of the 1918 influenza pandemic, when some parents pushed back against progressive reforms that required school attendance and prohibited child labor. Since then, tensions between state measures and parental freedom have occasionally flared over a variety of issues. Vaccines became a prominent one in 2021, as the movement found common ground with people skeptical of Covid-19 vaccines.

“The parental rights movement didn’t start with vaccines,” Reiss said, “but the anti-vaccine movement has allied themselves with it and has expanded their reach by riding on its coattails.”

Lawmakers silence health experts

In Tennessee, anti-vaccine activists and libertarian-leaning organizations railed against the state’s health department in 2021 when it recommended Covid vaccines to minors, following CDC guidance. Gary Humble, executive director of the conservative group Tennessee Stands, asked legislators to blast the health department for advising masks and vaccination, suggesting the department “could be dissolved and reconstituted at your pleasure.”

Backlash also followed a notice sent to doctors from Michelle Fiscus, then the state’s immunization director. She reminded them that they didn’t need parental permission to vaccinate consenting adolescents 14 or older, according to a decades-old state rule called the Mature Minor Doctrine.

In the weeks that followed, state legislators threatened to defund the health department and pressured it into scaling back Covid vaccine promotion, as revealed by The Tennessean. Fiscus was abruptly fired. “Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic,” she wrote in a statement. “That’s nearly 40% of us.” Tennessee’s Covid death rate climbed to one of the nation’s highest by mid-2022.

By the time two state legislators introduced a bill to reverse the Mature Minor Doctrine, the health department was silent on the proposal. Despite obstacles for foster children who would require a court order for routine immunizations, Tennessee’s Department of Children’s Services was silent, too.

Notably, the legislator who introduced the bill, Republican Rep. John Ragan, was among those simultaneously overseeing a review of the agency that would determine its leadership and budget for the coming years. “Children belong to their families, not the state,” said Ragan as he presented the bill at a state hearing in April 2023.

Democratic Rep. Justin Pearson spoke out against the bill. It “doesn’t take into account people and children who are neglected,” he told Ragan. “We are legislating from a point of privilege and not recognizing the people who are not privileged in this way.”

Rather than address such concerns, Ragan referenced a Supreme Court ruling in favor of parental rights in 2000. Specifically, judges determined that a mother had legal authority to decide who could visit her daughters. Yet the Supreme Court has also done the opposite. For instance, it sided against a legal guardian who removed her child from school to proselytize for the Jehovah’s Witnesses.

Still, Ragan swiftly won the majority vote. Tennessee Gov. Bill Lee, a Republican, signed the bill in May, making it effective immediately. Deborah Lowen, then the deputy commissioner of child health at the Department of Children’s Services, was flooded with calls from doctors who now face jail time and fines for vaccinating minors without adequate consent. “I was and remain very disheartened,” she said.

Kindergartners are at risk

Yaun, the Memphis pediatrician, said he was shaken as he declined to administer a first series of vaccines to an infant accompanied by a social worker. “That child is going into a situation where they are around other children and adults,” he said, “where they could be exposed to something we failed to protect them from.”

“We have had numerous angry grandparents in our waiting room who take kids to appointments because the parents are at work or down on their luck,” said Hunter Butler, a pediatrician in Springfield, Tennessee. “I once called a rehabilitation facility to find a mom and get her on the phone to get verbal consent to vaccinate her baby,” he said. “And it’s unclear if that was OK.”

Childhood immunization rates have dropped for three consecutive years in Tennessee. Nationwide, downward trends in measles vaccination led the CDC to estimate that a quarter million kindergartners are at risk of the highly contagious disease.

Communities with low vaccination rates are vulnerable as measles surges internationally. Confirmed measles cases in 2023 were almost double those in 2022 — a year in which the World Health Organization estimates that more than 136,000 people died from the disease globally. When travelers infected abroad land in communities with low childhood vaccination rates, the highly contagious virus can spread swiftly among unvaccinated people, as well as babies too young to be vaccinated and people with weakened immune systems.

“There’s a freedom piece on the other side of this argument,” said Caitlin Gilmet, communications director at the vaccine advocacy group SAFE Communities Coalition and Action Fund. “You should have the right to protect your family from preventable diseases.”

In late January, Gilmet and other child health advocates gathered in a room at the Tennessee Statehouse in Nashville, offering a free breakfast of fried chicken biscuits. They handed out flyers as legislators and their aides drifted in to eat. One pamphlet described the toll of a 2018-19 measles outbreak in Washington state that sickened 72 people, most of whom were unvaccinated, costing $76,000 in medical care, $2.3 million for the public health response, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving.

Barb Dentz, an advocate with the grassroots group Tennessee Families for Vaccines, repeated that most of the state’s constituents support strong policies in favor of immunizations. Indeed, seven in 10 U.S. adults maintained that public schools should require vaccination against measles, mumps, and rubella, in a Pew Research Center poll last year. But numbers have been dropping.

“Protecting kids should be such a no-brainer,” Dentz told Republican Rep. Sam Whitson, later that morning in his office. Whitson agreed and reflected on an explosion of anti-vaccine misinformation. “Dr. Google and Facebook have been such a challenge,” he said. “Fighting ignorance has become a full-time job.”

Whitson was among a minority of Republicans who voted against Tennessee’s vaccine amendment last year. “The parental rights thing has really taken hold,” he said, “and it can be used for and against us.”

This story originally published on March 12, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Farmworkers face high-risk exposures to bird flu, but testing isn’t reaching them

2024-07-30T17:59:30+00:00

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Farmworkers face some of the most intense exposures to the bird flu virus, but advocates say many of them would lack resources to fall back on if they became ill.

As of May 30, only three people in the United States had tested positive after being exposed to a wave of bird flu spreading among cows. Those people, dairy farm workers in Texas and Michigan, experienced eye irritation. One of them also had a cough and sore throat.

Scientists warn the virus could mutate to spread from person to person like the seasonal flu, which could spark a pandemic. By keeping tabs on farmworkers, researchers could track infections, learn how dangerous they are, and be alerted if the virus becomes more infectious.

But people generally get tested when they seek treatment for illnesses. Farmworkers rarely do that, because many lack health insurance and paid sick leave, said Elizabeth Strater, director of strategic campaigns for the national group United Farm Workers. They are unlikely to go to a doctor unless they become very ill.

Strater said about 150,000 people work in U.S. dairies. She said many worker advocates believe the virus has spread to more people than tests are showing. “The method being used to surveil at-risk workers has been very passive,” she said.

Federal officials told reporters May 22 that just 40 people connected to U.S. dairy farms had been tested for the virus, although others are being “actively monitored” for symptoms.

Federal authorities recently announced they would pay farmworkers $75 each to be tested for the virus, as part of a new program that also offers incentives for farm owners to allow testing of their dairy herds.

Officials of the federal Centers for Disease Control and Prevention said they recognize the importance of gaining cooperation and trust from front-line dairy employees.

CDC spokesperson Rosa Norman said in an email that the incentive payment compensates workers for their time contributing to the monitoring of how many people are infected, how sick they become, and whether humans are spreading the virus to each other.

She noted the CDC believes the virus currently poses a low risk to public health.

Farmworkers can’t afford to miss work

But Strater is skeptical of the incentive for farmworkers to be checked for the virus. If a worker tests positive, they’d likely be instructed to go to a clinic then stay home from work. She said they couldn’t afford to do either.

“That starts to sound like a really bad deal for 75 bucks, because at the end of the week, they’re supposed to feed their families,” she said.

Katherine Wells, director of public health in Lubbock, Texas, said that in her state, health officials would provide short-term medical care, such as giving farmworkers the flu treatment Tamiflu. Those arrangements wouldn’t necessarily cover hospitalization if it were needed, she said.

She said the workers’ bigger concern appears to be that they would have to stay home from work or might even lose their jobs if they tested positive.

Many farmworkers are from other countries, and they often labor in grueling conditions for little pay.

They may fear attention to cases among them will inflame anti-immigrant fervor, said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Societies have a long history of blaming marginalized communities for the spread of contagious diseases. Latino immigrants were verbally attacked during the H1N1 “swine flu” pandemic in 2009, for example, and some media personalities used the outbreak to push for a crackdown on immigration.

Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health, said many workers on dairy farms have been told very little about this new disease spreading in the cows they handle. “Education needs to be a part of testing efforts, with time for workers to ask questions,” she said.

These conversations should be conducted in the farmworkers’ language, with people they are likely to trust, she said.

Georges Benjamin, executive director of the American Public Health Association, said public health officials must make clear that workers’ immigration status will not be reported as part of the investigation into the new flu virus. “We’re not going to be the police,” he said.

Vaccines are being prepared

Dawn O’Connell, an administrator at the Department of Health and Human Services, said in a press conference May 22 that nearly 5 million doses of a vaccine against H5N1, the bird flu virus circulating in cattle, are being prepared, but that officials have not decided whether the shots will be offered to farmworkers when they’re ready later this year.

The CDC asked states in early May to share personal protective equipment with farm owners, to help them shield workers from the bird flu virus. State health departments in California, Texas, and Wisconsin, which have large dairy industries, all said they have offered to distribute such equipment.

Chris Van Deusen, a Texas health department spokesperson, said four dairy farms had requested protective equipment from the state stockpile. He said other farms may already have had what they needed. Spokespeople for the California and Wisconsin health departments said they did not immediately receive requests from farm owners for the extra equipment.

Strater, the United Farm Workers official, said protective equipment offerings need to be practical.

Most dairy workers already wear waterproof aprons, boots, and gloves, she said. It wouldn’t be realistic to expect them to also wear N95 face masks in the wet, hot conditions of a milking operation, she said. Plastic face shields seem like a better option for that environment, especially to prevent milk from spraying into workers’ eyes, where it could cause infection, she said.

Other types of agricultural workers, including those who work with chickens, also face potential infection. But scientists say the version of the virus spreading in cows could be particularly dangerous, because it has adapted to live in mammals.

Strater said she’s most worried about dairy workers, who spend 10 to 12 hours a day in enclosed spaces with cows.

“Their faces are approximately 5 inches away from the milk and the udders all day long,” she said. “The intimacy of it, where their face is so very close to the infectious material, is different.”

This story originally published May 30, 2024 at KFF Health News, Healthbeat’s national reporting partner.

WHO overturns dogma on airborne disease spread. The CDC might not act on it.

2024-07-30T16:36:41+00:00

The World Health Organization has issued a report that transforms how the world understands respiratory infections like Covid-19, influenza, and measles.

Motivated by grave missteps in the pandemic, the WHO convened about 50 experts in virology, epidemiology, aerosol science, and bioengineering, among other specialties, who spent two years poring through the evidence on how airborne viruses and bacteria spread.

However, the WHO report stops short of prescribing actions that governments, hospitals, and the public should take in response. It remains to be seen how the Centers for Disease Control and Prevention will act on this information in its own guidance for infection control in health care settings.

The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others.

While it may seem obvious, and some researchers have pushed for this acknowledgment for more than a decade, an alternative dogma persisted — which kept health authorities from saying that Covid was airborne for many months into the pandemic.

Specifically, they relied on a traditional notion that respiratory viruses spread mainly through droplets spewed out of an infected person’s nose or mouth. These droplets infect others by landing directly in their mouth, nose, or eyes — or they get carried into these orifices on droplet-contaminated fingers. Although these routes of transmission still happen, particularly among young children, experts have concluded that many respiratory infections spread as people simply breathe in virus-laden air.

“This is a complete U-turn,” said Julian Tang, a clinical virologist at the University of Leicester in the United Kingdom, who advised the WHO on the report. He also helped the agency create an online tool to assess the risk of airborne transmission indoors.

Emphasis on improving ventilation

Peg Seminario, an occupational health and safety specialist in Bethesda, Maryland, welcomed the shift after years of resistance from health authorities. “The dogma that droplets are a major mode of transmission is the ‘flat Earth’ position now,” she said. “Hurray! We are finally recognizing that the world is round.”

The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals, it could evolve to more easily infect people and spread among them through the air.

Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. Such advice overwhelmed recommendations for N95 masks that filter out most virus-laden particles suspended in the air. Employers denied many health care workers access to N95s, insisting that only those routinely working within feet of Covid patients needed them. More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.

However, a committee advising the CDC appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities.

Lisa Brosseau, an aerosol expert and a consultant at the Center for Infectious Disease Research and Policy in Minnesota, warns of a repeat of 2020 if that happens.

“The rubber hits the road when you make decisions on how to protect people,” Brosseau said. “Aerosol scientists may see this report as a big win because they think everything will now follow from the science. But that’s not how this works and there are still major barriers.”

Money is one. If a respiratory disease spreads through inhalation, it means that people can lower their risk of infection indoors through sometimes costly methods to clean the air, such as mechanical ventilation and using air purifiers, and wearing an N95 mask. The CDC has so far been reluctant to press for such measures, as it updates foundational guidelines on curbing airborne infections in hospitals, nursing homes, prisons, and other facilities that provide health care. This year, a committee advising the CDC released a draft guidance that differs significantly from the WHO report.

Whereas the WHO report doesn’t characterize airborne viruses and bacteria as traveling short distances or long, the CDC draft maintains those traditional categories. It prescribes looser-fitting surgical masks rather than N95s for pathogens that “spread predominantly over short distances.” Surgical masks block far fewer airborne virus particles than N95s, which cost roughly 10 times as much.

Viruses travel like smoke

Researchers and health care workers have been outraged about the committee’s draft, filing letters and petitions to the CDC. They say it gets the science wrong and endangers health. “A separation between short- and long-range distance is totally artificial,” Tang said.

Airborne viruses travel much like cigarette smoke, he explained. The scent will be strongest beside a smoker, but those farther away will inhale more and more smoke if they remain in the room, especially when there’s no ventilation.

Likewise, people open windows when they burn toast so that smoke dissipates before filling the kitchen and setting off an alarm. “You think viruses stop after 3 feet and drop to the ground?” Tang said of the classical notion of distance. “That is absurd.”

The CDC’s advisory committee is comprised primarily of infection control researchers at large hospital systems, while the WHO consulted a diverse group of scientists looking at many different types of studies. For example, one analysis examined the puff clouds expelled by singers, and musicians playing clarinets, French horns, saxophones, and trumpets. Another reviewed 16 investigations into covid outbreaks at restaurants, a gym, a food processing factory, and other venues, finding that insufficient ventilation probably made them worse than they would otherwise be.

In response to the outcry, the CDC returned the draft to its committee for review, asking it to reconsider its advice. Meetings from an expanded working group have since been held privately. But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion. Another warned that “supply and compliance would be difficult.”

The nurses’ union, far from echoing such concerns, wrote on its website, “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.” Jane Thomason, the union’s lead industrial hygienist, said the meeting records suggest the CDC group is working backward, molding its definitions of airborne transmission to fit the outcome it prefers.

Tang expects resistance to the WHO report. “Infection control people who have built their careers on this will object,” he said. “It takes a long time to change people’s way of thinking.”

The CDC declined to comment on how the WHO’s shift might influence its final policies on infection control in health facilities, which might not be completed this year. Creating policies to protect people from inhaling airborne viruses is complicated by the number of factors that influence how they spread indoors, such as ventilation, temperature, and the size of the space.

Adding to the complexity, policymakers must weigh the toll of various ailments, ranging from Covid to colds to tuberculosis, against the burden of protection. And tolls often depend on context, such as whether an outbreak happens in a school or a cancer ward.

“What is the level of mortality that people will accept without precautions?” Tang said. “That’s another question.”

This story originally published on May 1, 2024 at KFF Health News, Healthbeat’s national reporting partner.

The CDC’s test for bird flu works, but it has issues

2024-07-30T12:42:32+00:00

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The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn’t harmed the agency’s outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.

The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.

At a congressional hearing July 23, Rep. Brett Guthrie, a Kentucky Republican, asked about the issue. “Boy, that rings of 2020,” he said, referring to when the nation was caught off guard by the Covid-19 pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.

“The tests are 100% usable,” he later told KFF Health News, adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, “We have made sure that we’re offering a high-quality product.”

CDC test only one available

Still, some researchers were unnerved by the news coming four months after the government declared a worrisome bird flu outbreak among cattle. The CDC’s test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.

The problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC officials detected the issue through a quality control system put in place after the Covid test catastrophe of 2020.

Daskalakis said the CDC’s original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.

The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be run again. With the FDA’s blessing, the CDC distributed the tests — with workaround instructions — to public health labs.

Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.

Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn’t yet signed off on their use. Daskalakis declined to name the manufacturers.

Labs working through red tape

Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don’t catch a person’s connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.

Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC’s tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.

But outside select circles, the news was largely overlooked. “I’m totally surprised by this,” Alex Greninger, assistant director of the University of Washington Clinical Virology Laboratory, told KFF Health News this week. Greninger’s lab is developing its own test and has been trying to obtain CDC test kits to evaluate.

“It’s not a red alarm,” he said, but he’s worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.

It’s not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn’t the agency’s first mishap. In 2016, well before the Covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.

The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.com, said diagnostic companies may be better suited to the task.

“It’s a reminder that CDC is not a robust manufacturer of tests” and lacks the resources that industry can marshal for their production, Mina said. “We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles.”

Labs need FDA clearance

The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.

Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.

Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.

The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky’s lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn’t have FDA authorization for its broad use.

The CDC’s test recipe is available in a published patent, Daskalakis said.

“We have made sure that tests are out there, and that they work,” he added.

As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: “It is not in the current budget and will go away without additional funding.”

This story originally published July 26, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Clues from bird flu’s ground zero on dairy farms in Texas Panhandle

2024-07-29T21:20:07+00:00

In early February, dairy farmers in the Texas Panhandle began to notice sick cattle. The buzz soon reached Darren Turley, executive director of the Texas Association of Dairymen: “They said there is something moving from herd to herd.”

Nearly 60 days passed before veterinarians identified the culprit: a highly pathogenic strain of the bird flu virus, H5N1. Had it been detected sooner, the outbreak might have been swiftly contained. Now it has spread to at least eight other states, and it will be hard to eliminate.

At the moment, the bird flu hasn’t adapted to spread from person to person through the air like the seasonal flu. That’s what it would take to give liftoff to another pandemic. This lucky fact could change, however, as the virus mutates within each cow it infects. Those mutations are random, but more cows provide more chances of stumbling on ones that pose a grave risk to humans.

Why did it take so long to recognize the virus on high-tech farms in the world’s richest country? Because even though H5N1 has circulated for nearly three decades, its arrival in dairy cattle was most unexpected. “People tend to think that an outbreak starts at Monday at 9 a.m. with a sign saying, ‘Outbreak has started,’” said Jeremy Farrar, chief scientist at the World Health Organization. “It’s rarely like that.”

By investigating the origins of outbreaks, researchers garner clues about how they start and spread. That information can curb the toll of an epidemic and, ideally, stop the next one. On-the-ground observations and genomic analyses point to Texas as ground zero for this outbreak in cattle. To backtrack events in Texas, KFF Health News spoke with more than a dozen people, including veterinarians, farmers, and state officials.

An early indication that something had gone awry on farms in northwestern Texas came from devices hitched to collars on dairy cows. Turley describes them as “an advanced fitness tracker.” They collect a stream of data, such as a cow’s temperature, its milk quality, and the progress of its digestion — or, rather, rumination — within its four-chambered stomach.

What farmers saw when they downloaded the data in February stopped them in their tracks. One moment a cow seemed perfectly fine, and then four hours later, rumination had halted. “Shortly after the stomach stops, you’d see a huge falloff in milk,” Turley said. “That is not normal.”

Tests for contagious diseases known to whip through herds came up negative. Some farmers wondered if the illness was related to ash from wildfires devastating land to the east.

In hindsight, Turley wished he had made more of the migrating geese that congregate in the panhandle each winter and spring. Geese and other waterfowl have carried H5N1 around the globe. They withstand enormous loads of the virus without getting sick, passing it on to local species, like blackbirds, cowbirds, and grackles, that mix with migrating flocks.

But with so many other issues facing dairy farmers, geese didn’t register. “One thing you learn in agriculture is that Mother Nature is unpredictable and can be devastating,” Turley said. “Just when you think you have figured it out, Mother Nature tells you you do not.”

Clues came from cats

One dairy tried to wall itself off, careful not to share equipment with or employ the same workers as other farms, Turley recalled. Its cattle still became ill. Turley noted that the farm was downwind of another with an outbreak, “so you almost think it has to have an airborne factor.”

On March 7, Turley called the Texas Animal Health Commission. They convened a One Health group with experts in animal health, human health, and agriculture to ponder what they called the “mystery syndrome.” State veterinarians probed cow tissue for parasites, examined the animals’ blood, and tested for viruses and bacteria. But nothing explained the sickness.

They didn’t probe for H5N1. While it has jumped into mammals dozens of times, it rarely has spread between species. Most cases have been in carnivores, which likely ate infected birds. Cows are mainly vegetarian.

“If someone told me about a milk drop in cows, I wouldn’t think to test for H5N1 because, no, cattle don’t get that,” said Thomas Peacock, a virologist at the Pirbright Institute of England who studies avian influenza.

Postmortem tests of grackles, blackbirds, and other birds found dead on dairy farms detected H5N1, but that didn’t turn the tide. “We didn’t think much of it since we have seen H5N1-positive birds everywhere in the country,” said Amy Swinford, director of the Texas A&M Veterinary Medical Diagnostic Laboratory.

In the meantime, rumors swirled about a rash of illness among workers at dairy farms in the panhandle. It was flu season, however, and hospitals weren’t reporting anything out of the ordinary.

Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health, has worked in the panhandle and suspected farmworkers were unlikely to see a doctor even if they needed one. Clinics are far from where they live, she said, and many don’t speak English or Spanish — for instance, they may speak Indigenous languages such as Mixtec, which is common in parts of Mexico. The cost of medical care is another deterrent, along with losing pay by missing work — or losing their jobs — if they don’t show up. “Even when medical care is there,” she said, “it’s a challenge.”

What finally tipped off veterinarians? A few farm cats died suddenly and tested positive for H5N1. Swinford’s group — collaborating with veterinary labs at Iowa State and Cornell universities — searched for the virus in samples drawn from sick cows.

“On a Friday night at 9 p.m., March 22, I got a call from Iowa State,” Swinford said. Researchers had discovered antibodies against H5N1 in a slice of a mammary gland. By Monday, her team and Cornell researchers identified genetic fragments of the virus. They alerted authorities. With that, the U.S. Department of Agriculture announced that H5N1 had hit dairy cattle.

Genomic sequences from H5N1 viruses suggest the current bird flu epidemic started with a spillover from birds into cows in Texas, and then spread to other states within cattle. Routes and timing remain uncertain because of limited data.

Recalling rumors of sick farmworkers, Texas health officials asked farmers, veterinarians, and local health departments to encourage testing. About 20 people with coughs, aches, irritated eyes, or other flu-like symptoms stepped forward to be swabbed. Those samples were shipped to the Centers for Disease Control and Prevention. All but one were negative for H5N1. On April 1, the CDC announced this year’s first case: a farmworker with an inflamed eye that cleared up within days.

Thirteen dairy farms in the panhandle had been affected, said Brian Bohl, director of field operations at the Texas Animal Health Commission. Farmers report that outbreaks among the herds last 30 to 45 days and most cows return to milking at their usual pace.

The observation hints that herds gain immunity, if temporarily. Indeed, early evidence shows that H5N1 triggers a protective antibody response in cattle, said Marie Culhane, a professor of veterinary population medicine at the University of Minnesota. Nonetheless, she and others remain uneasy because no one knows how the virus spreads, or what risk it poses to people working with cattle.

Although most cows recover, farmers said the outbreaks have disrupted their careful timing around when cattle milk, breed, and birth calves.

Farmers want answers that would come with further research, but the spirit of collaboration that existed in the first months of the Texas outbreak has fractured. Federal restrictions have triggered a backlash from farmers who find them unduly punishing, given that pasteurized milk and cooked beef from dairy cattle appear to pose no risk to consumers.

The rules, such as prohibiting infected cattle from interstate travel for 30 days, pose a problem for farmers who move pregnant cattle to farms that specialize in calving, to graze in states with gentler winters, and to return home for milking. “When the federal order came out, some producers said, ‘I’m going to quit testing,’” Bohl said.

In May, the USDA offered aid, such as up to $10,000 to test and treat infected cattle. “The financial incentives will help,” Turley said. But how much remains to be seen.

Federal authorities have pressed states to extract more intel from farms and farmworkers. Several veterinarians warn such pressure could fracture their relationships with farmers, stifling lines of communication.

Having fought epidemics around the world, Farrar cited examples of when strong-arm surveillance pushed outbreaks underground. During an early 2000s bird flu outbreak in Vietnam, farmers circumvented regulations by moving poultry at night, bribing inspection workers, and selling their goods through back channels. “Learning what drivers and fears exist among people is crucial,” Farrar said. “But we always seem to realize that at a later date.”

A powerful driver in the U.S.: Milk is a $60 billion industry. Public health is also bound to bump up against politics in Texas, a state so aggrieved by pandemic restrictions that lawmakers passed a bill last year barring health officials from recommending covid-19 vaccines.

Texas Agriculture Commissioner Sid Miller said that when he heard that federal agents with the CDC and USDA were considering visits to farms — including those where farmers reported the cattle had recovered — he advised against it. “Send federal agents to dairy that’s not sick?” he said. “That doesn’t pass the smell test.”

Analysis points to Texas as ground zero

Peacock said genomic analyses of H5N1 viruses point to Texas as ground zero for the cattle epidemic, emerging late last year.

“All of these little jigsaw puzzle pieces corroborate undetected circulation in Texas for some time,” said Peacock, an author on one report about the outbreak.

Evidence suggests that either a single cow was infected by viruses shed from birds — perhaps those geese, grackles, or blackbirds, he said. Or the virus spilled over from birds into cattle several times, with only a fraction of those moving from cow to cow.

Sometime in March, viruses appear to have hitched a ride to other states as cows were moved between farms. The limited genomic data available links the outbreak in Texas directly to others in New Mexico, Kansas, Ohio, North Carolina, and South Dakota. However, the routes are imprecise because the USDA hasn’t attached dates and locations to data it releases.

Researchers don’t want to be caught off guard again by the shape-shifting H5N1 virus, and that will require keeping tabs on humans. Most, if not all, of about 900 people diagnosed with H5N1 infections worldwide since 2003 acquired it from animals, rather than from humans, Farrar said. About half of those people died.

Occasional tests of sick farmworkers aren’t sufficient, he said. Ideally, a system is set up to encourage farmworkers, their communities, and health care workers to be tested whenever the virus hits farms nearby.

“Health care worker infections are always a sign of human-to-human transmission,” Farrar said. “That’s the approach you want to take — I am not saying it’s easy.”

This story originally published on May 23, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Summer Covid-19 cases rise in NYC as testing, vaccines wane

2024-07-29T20:48:00+00:00

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Covid-19 cases in New York City have trended upward this summer, as vaccine uptake remains low and testing and surveillance systems have been significantly scaled back.

Nationwide, Covid-19 test positivity rates have been rising since the spring, according to data from the Centers for Disease Control and Prevention. “FLiRT” variants — descendants of the JN.1 variant, which was dominant earlier this year — account for the vast majority of current Covid-19 cases across the country, according to CDC data.

The New York City Department of Health and Mental Hygiene reported an average of 888 Covid-19 cases per day in the week ending July 25. That’s a big jump from the weekly average of about 200 Covid-19 cases that the city recorded for much of the spring, though it’s still far lower than New York’s biggest Covid-19 surges. For the week ending July 25, the city reported an average of 36 hospitalizations per day and no deaths.

The NYS Wastewater Surveillance Network, which publishes wastewater data from participating counties statewide, showed “high” levels of Covid-19 detection in the sewage of the vast majority of New York City communities as of mid-July.

“We’re definitely seeing an uptick in the hospital at Mount Sinai,” Dr. Sean T. Liu, medical director of Mount Sinai’s COVID Clinical Trials Unit and an associate professor of medicine at the Icahn School of Medicine at Mount Sinai, said. “Personally, I know people who are getting it as well, so I do hear it in the community, and I see it in the hospital.”

What to do if you test positive

The Covid-19 cases Liu sees often include symptoms like a fever, a runny nose and a cough. Anyone who tests positive for Covid-19 should try to stay home from work, isolate from other people and mask, he said. The antiviral medication Paxlovid can also help, he said, noting that treatment is more effective the sooner it is started.

“Be mindful of others by taking care of yourself,” Liu said. “If you’re sick, try to isolate and try not to spread the virus, because it’s a very transmissible virus. Talk to your doctor — you might get Paxlovid. And get better soon.”

The CDC currently recommends resuming normal activities when, for at least 24 hours, you have not had a fever and your symptoms are improving overall. The CDC also encourages taking precautions for the next five days, including masking, physical distancing, air purification and testing.

“Cases are rising right now but we have the tools and experience to protect ourselves as well as one another,” Patrick Gallahue, a spokesperson for the Health Department, said in a statement.

He noted that New Yorkers can call the city’s Covid-19 hotline (212-COVID19) to connect with a NYC Health + Hospitals clinician who can prescribe antiviral medication.

Data has limitations

Even as Covid-19 continues to spread nationally and in New York, surveillance systems for tracking the virus have significantly diminished, said Dr. Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health & Health Policy and executive director of Public Health Informatics, Computational, and Operations Research.

“Previously, we were relying on testing, and of course a lot of testing is now done at home, with these kits,” Lee said. “When people are positive, they don’t really report it to anyone, most of the time.”

Much of the city’s Covid-19 testing infrastructure has also faded, making free tests harder to come by. New York offers rapid and PCR testing at NYC Health + Hospitals facilities and community care clinics. But the Health Department’s network of free express testing sites, which offer fast PCR results, has almost entirely disappeared.

Large-scale programs to distribute free rapid tests have also dwindled. The federal government’s free Covid-19 test kit program ended in March. Rapid test kits are available for purchase at pharmacies, but private insurers are no longer required to cover their cost.

“The strategies that have beaten back COVID time and again continue to be available to us, though now as part of our routine health care system,” Gallahue said in a statement. “At-home tests are sold at pharmacies and online, and testing is offered by many pharmacies and providers.”

Covid-19 test-tracking operations have scaled back, too. The CDC halted its community-level tracking of Covid-19 when the public health emergency expired last year, and turned its focus to wastewater surveillance.

Yet wastewater data has its own limitations, Lee said, noting that it is a “very blunt and broad measurement” of the prevalence of Covid-19 in a community. Meanwhile, data on Covid-19 hospitalizations, emergency room visits and deaths, while precise, are all “after the fact,” he said.

Virus protection reduced

More than four years into the Covid-19 pandemic, vaccination rates are low and many mitigation measures have fallen by the wayside, enabling the virus to continue to spread.

“You’re seeing a lot fewer people wearing masks, you’re not seeing as much attention to air quality, like filtration and ventilation, and social distancing,” Lee said. “It’s largely nonexistent.”

Vaccination remains a key weapon in the fight against Covid-19, but nationwide uptake of last year’s booster was low. As of May, 22.5% of adults in the U.S. reported having received an updated 2023-24 Covid-19 vaccine, according to the CDC.

Lee noted that the protection the Covid-19 vaccine offers generally wanes after four to six months, meaning that people who were vaccinated last fall became vulnerable to the virus again this past spring.

Updated Covid-19 vaccines are expected to become available this fall, and the CDC recommends that everyone older than 6 months receives the shot.

The NYC Health Department stopped reporting new Covid-19 vaccination data last September. By that point, more than 90% of city residents had received at least one Covid-19 vaccine dose, but only 16% had received a bivalent vaccine dose, which became available in late 2022 to fight new variants.

Liu, who runs studies at Mount Sinai about long Covid — a range of often debilitating symptoms that can occur after a Covid-19 infection — noted that recent data indicate that vaccination can lower the risk of long Covid.

“People’s lives are really devastated by long Covid,” he said. “Long Covid is a real, terrible illness that if you can avoid at all costs, please do.”

Colorado poultry workers battle bird flu in heat wave as US struggles to contain outbreak

2024-07-29T18:51:47+00:00

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Six people who work at a poultry farm in northeastern Colorado have tested positive for the bird flu, the Centers for Disease Control and Prevention reported Friday. This brings the known number of U.S. cases this year to 10.

The workers were likely infected by chickens, which they had been tasked with killing in response to a bird flu outbreak at the farm. The endeavor occurred amid a heat wave, as outside temperatures soared to 104 degrees Fahrenheit.

“The barns in which culling occurs were no doubt even hotter,” said CDC principal deputy director Nirav Shah at a July 16 press briefing. Wearing N95 respirators, goggles, and other protective gear was a challenge. Industrial fans whipped feathers around the facility that could have carried the virus, Shah added.

In this environment, the farmworkers collected hundreds of chickens by hand and placed them into carts where they could be killed by carbon dioxide gas within two minutes.

“If a farm worker gets severely ill or dies from an H5N1 infection, it will be a stain on U.S. public health that we didn’t do more with the tools we have,” Jennifer Nuzzo, director of the Pandemic Center at Brown University, posted on X. “You don’t send farm workers in to cull H5N1 infected birds without goggles and masks. Period. If it’s too hot to wear those protections, it’s too hot to cull. We need vaccines to be made available to farm workers. We have to stop gambling with peoples’ lives.”

More than 99 million chickens and turkeys have been infected with a highly pathogenic strain of the bird flu that emerged at U.S. poultry farms in early 2022. Since then, the federal government has compensated poultry farmers more than $1 billion for destroying infected flocks and eggs to keep outbreaks from spreading.

Virus shifts to dairy cattle

As summer temperatures rise across the country, Shah said, the agency is contending with how to offer farmworkers “safety from the virus, as well as safety from extreme heat.”

The H5N1 bird flu virus has spread among poultry farms around the world for nearly 30 years. An estimated 900 people have been infected by birds, and roughly half have died from the disease.

The virus made an unprecedented shift this year to dairy cattle in the U.S. This poses a higher threat because it means the virus has adapted to replicate within cows’ cells, which are more like human cells. The four other people diagnosed with bird flu this year in the U.S. worked on dairy farms with outbreaks.

Scientists have warned that the virus could mutate to spread from person to person, like the seasonal flu, and spark a pandemic. There’s no sign of that, yet.

So far, all 10 cases reported this year have been mild, consisting of eye irritation, a runny nose, and other respiratory symptoms. However, numbers remain too low to say anything certain about the disease because, in general, flu symptoms can vary among people with only a minority needing hospitalization.

The number of people who have gotten the virus from poultry or cattle may be higher than 10. The Centers for Disease Control and Prevention has tested only about 60 people over the past four months, and powerful diagnostic laboratories that typically detect diseases remain barred from testing for bird flu. Testing of farmworkers and animals is needed to detect the H5N1 bird flu virus, study it, and stop it before it becomes a fixture on farms.

Researchers have urged a more aggressive response from the CDC and other federal agencies to prevent future infections. Many people exposed regularly to livestock and poultry on farms still lack protective gear and education about the disease. And they don’t yet have permission to get a bird flu vaccine.

CDC decides against vaccination

Nearly a dozen virology and outbreak experts recently interviewed by KFF Health News disagree with the CDC’s decision against vaccination, which may help prevent bird flu infection and hospitalization.

“We should be doing everything we can to eliminate the chances of dairy and poultry workers contracting this virus,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “If this virus is given enough opportunities to jump from cows or poultry into people, it will eventually get better at infecting them.”

To understand whether cases are going undetected, researchers in Michigan have sent the CDC blood samples from workers on dairy farms. If they detect bird flu antibodies, it’s likely that people are more easily infected by cattle than previously believed.

“It’s possible that folks may have had symptoms that they didn’t feel comfortable reporting, or that their symptoms were so mild that they didn’t think they were worth mentioning,” said Natasha Bagdasarian, chief medical executive for the state of Michigan.

In hopes of thwarting a potential pandemic, the United States, United Kingdom, Netherlands, and about a dozen other countries are stockpiling millions of doses of a bird flu vaccine made by the vaccine company CSL Seqirus.

Seqirus’ most recent formulation was greenlighted last year by the European equivalent of the FDA, and an earlier version has the FDA’s approval. In June, Finland decided to offer vaccines to people who work on fur farms as a precaution because its mink and fox farms were hit by bird flu last year.

The CDC has controversially decided not to offer at-risk groups bird flu vaccines. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, told KFF Health News that the agency is not recommending a vaccine campaign at this point for several reasons, even though millions of doses are available. One is that cases still appear to be limited, and the virus isn’t spreading rapidly between people as they sneeze and breathe.

The agency continues to rate the public’s risk as low. In a statement posted in response to the new Colorado cases, the CDC said its bird flu recommendations remain the same: “An assessment of these cases will help inform whether this situation warrants a change to the human health risk assessment.”

This update published July 19, 2024 at KFF Health News, Healthbeat’s national reporting partner.

4 ways vaccine skeptics mislead you on measles and more

2024-07-29T15:58:50+00:00

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Measles is on the rise in the United States. In the first quarter of this year, the number of cases was about 17 times what it was, on average, during the same period in each of the four years before, according to the Centers for Disease Control and Prevention. Half of the people infected — mainly children — have been hospitalized.

It’s going to get worse, largely because a growing number of parents are deciding not to get their children vaccinated against measles as well as diseases like polio and pertussis. Unvaccinated people, or those whose immunization status is unknown, account for 80% of the measles cases this year. Many parents have been influenced by a flood of misinformation spouted by politicians, podcast hosts, and influential figures on television and social media. These personalities repeat decades-old notions that erode confidence in the established science backing routine childhood vaccines. KFF Health News examined the rhetoric and explains why it’s misguided:

The no-big-deal trope

A common distortion is that vaccines aren’t necessary because the diseases they prevent are not very dangerous, or too rare to be of concern. Cynics accuse public health officials and the media of fear-mongering about measles even as 19 states report cases.

For example, an article posted on the website of the National Vaccine Information Center — a regular source of vaccine misinformation — argued that a resurgence in concern about the disease “is ‘sky is falling’ hype.” It went on to call measles, mumps, chicken pox, and influenza “politically incorrect to get.”

Measles kills roughly 2 of every 1,000 children infected, according to the CDC. If that seems like a bearable risk, it’s worth pointing out that a far larger portion of children with measles will require hospitalization for pneumonia and other serious complications. For every 10 measles cases, one child with the disease develops an ear infection that can lead to permanent hearing loss. Another strange effect is that the measles virus can destroy a person’s existing immunity, meaning they’ll have a harder time recovering from influenza and other common ailments.

Measles vaccines have averted the deaths of about 94 million people, mainly children, over the past 50 years, according to an April analysis led by the World Health Organization. Together with immunizations against polio and other diseases, vaccines have saved an estimated 154 million lives globally.

Some skeptics argue that vaccine-preventable diseases are no longer a threat because they’ve become relatively rare in the U.S. (True — due to vaccination.) This reasoning led Florida’s surgeon general, Joseph Ladapo, to tell parents that they could send their unvaccinated children to school amid a measles outbreak in February. “You look at the headlines and you’d think the sky was falling,” Ladapo said on a News Nation newscast. “There’s a lot of immunity.”

As this lax attitude persuades parents to decline vaccination, the protective group immunity will drop, and outbreaks will grow larger and faster. A rapid measles outbreak hit an undervaccinated population in Samoa in 2019, killing 83 people within four months. A chronic lack of measles vaccination in the Democratic Republic of the Congo led to more than 5,600 people dying from the disease in massive outbreaks last year.

The ‘you never know’ trope

Since the earliest days of vaccines, a contingent of the public has considered them bad because they’re unnatural, as compared with nature’s bounty of infections and plagues. “Bad” has been redefined over the decades. In the 1800s, vaccine skeptics claimed that smallpox vaccines caused people to sprout horns and behave like beasts. More recently, they blame vaccines for ailments ranging from attention-deficit/hyperactivity disorder to autism to immune system disruption. Studies don’t back the assertions. However, skeptics argue that their claims remain valid because vaccines haven’t been adequately tested.

In fact, vaccines are among the most studied medical interventions. Over the past century, massive studies and clinical trials have tested vaccines during their development and after their widespread use. More than 12,000 people took part in clinical trials of the most recent vaccine approved to prevent measles, mumps, and rubella. Such large numbers allow researchers to detect rare risks, which are a major concern because vaccines are given to millions of healthy people.

To assess long-term risks, researchers sift through reams of data for signals of harm. For example, a Danish group analyzed a database of more than 657,000 children and found that those who had been vaccinated against measles as babies were no more likely to later be diagnosed with autism than those who were not vaccinated. In another study, researchers analyzed records from 805,000 children born from 1990 through 2001 and found no evidence to back a concern that multiple vaccinations might impair children’s immune systems.

Nonetheless, people who push vaccine misinformation, like presidential candidate Robert F. Kennedy Jr., dismiss massive, scientifically vetted studies. For example, Kennedy argues that clinical trials of new vaccines are unreliable because vaccinated kids aren’t compared with a placebo group that gets saline solution or another substance with no effect. Instead, many modern trials compare updated vaccines with older ones. That’s because it’s unethical to endanger children by giving them a sham vaccine when the protective effect of immunization is known. In a 1950s clinical trial of polio vaccines, 16 children in the placebo group died of polio and 34 were paralyzed, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and author of a book on the first polio vaccine.

The too-much-too-soon trope

Several bestselling vaccine books on Amazon promote the risky idea that parents should skip or delay their children’s vaccines. “All vaccines on the CDC’s schedule may not be right for all children at all times,” writes Paul Thomas in his bestselling book “The Vaccine-Friendly Plan.” He backs up this conviction by saying that children who have followed “my protocol are among the healthiest in the world.”

Since the book was published, Thomas’ medical license was temporarily suspended in Oregon and Washington. The Oregon Medical Board documented how Thomas persuaded parents to skip vaccines recommended by the CDC, and reported that he “reduced to tears” a mother who disagreed. Several children in his care came down with pertussis and rotavirus, diseases easily prevented by vaccines, wrote the board. Thomas recommended fish oil supplements and homeopathy to an unvaccinated child with a deep scalp laceration, rather than an emergency tetanus vaccine. The boy developed severe tetanus, landing in the hospital for nearly two months, where he required intubation, a tracheotomy, and a feeding tube to survive.

The vaccination schedule recommended by the CDC has been tailored to protect children at their most vulnerable points in life and minimize side effects. The combination measles, mumps, and rubella vaccine isn’t given for the first year of a baby’s life because antibodies temporarily passed on from their mother can interfere with the immune response. And because some babies don’t generate a strong response to that first dose, the CDC recommends a second one around the time a child enters kindergarten because measles and other viruses spread rapidly in group settings.

Delaying MMR doses much longer may be unwise because data suggests that children vaccinated at 10 or older have a higher chance of adverse reactions, such as a seizure or fatigue.

Around a dozen other vaccines have discrete timelines, with overlapping windows for the best response. Studies have shown that MMR vaccines may be given safely and effectively in combination with other vaccines.

‘They don’t want you to know’ trope

Kennedy compares the Florida surgeon general to Galileo in the introduction to Ladapo’s new book on transcending fear in public health. Just as the Roman Catholic inquisition punished the renowned astronomer for promoting theories about the universe, Kennedy suggests that scientific institutions oppress dissenting voices on vaccines for nefarious reasons.

“The persecution of scientists and doctors who dare to challenge contemporary orthodoxies is not a new phenomenon,” Kennedy writes. His running mate, lawyer Nicole Shanahan, has campaigned on the idea that conversations about vaccine harms are censored and the CDC and other federal agencies hide data due to corporate influence.

Claims like “they don’t want you to know” aren’t new among the anti-vaccine set, even though the movement has long had an outsize voice. The most listened-to podcast in the U.S., “The Joe Rogan Experience,” regularly features guests who cast doubt on scientific consensus. Last year on the show, Kennedy repeated the debunked claim that vaccines cause autism.

Far from ignoring that concern, epidemiologists have taken it seriously. They have conducted more than a dozen studies searching for a link between vaccines and autism, and repeatedly found none. “We have conclusively disproven the theory that vaccines are connected to autism,” said Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia. “So, the public health establishment tends to shut those conversations down quickly.”

Federal agencies are transparent about seizures, arm pain, and other reactions that vaccines can cause. And the government has a program to compensate individuals whose injuries are scientifically determined to result from them. Around 1 to 3.5 out of every million doses of the measles, mumps, and rubella vaccine can cause a life-threatening allergic reaction; a person’s lifetime risk of death by lightning is estimated to be as much as four times as high.

“The most convincing thing I can say is that my daughter has all her vaccines and that every pediatrician and public health person I know has vaccinated their kids,” Meyerowitz-Katz said. “No one would do that if they thought there were serious risks.”

This story originally published May 22, 2024 at KFF Health News, Healthbeat’s national reporting partner.

‘We’re flying blind’: CDC has 1M bird flu tests ready, but experts see repeat of Covid missteps

2024-07-29T15:36:55+00:00

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It’s been nearly three months since the U.S. government announced an outbreak of the bird flu virus on dairy farms. The World Health Organization considers the virus a public health concern because of its potential to cause a pandemic, yet the U.S. has tested only about 45 people across the country.

“We’re flying blind,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. With so few tests run, she said, it’s impossible to know how many farmworkers have been infected, or how serious the disease is. A lack of testing means the country might not notice if the virus begins to spread between people — the gateway to another pandemic.

“We’d like to be doing more testing. There’s no doubt about that,” said Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention. The CDC’s bird flu test is the only one the Food and Drug Administration has authorized for use right now. Shah said the agency has distributed these tests to about 100 public health labs in states. “We’ve got roughly a million available now,” he said, “and expect 1.2 million more in the next two months.”

But Nuzzo and other researchers are concerned because the CDC and public health labs aren’t generally where doctors order tests from. That job tends to be done by major clinical laboratories run by companies and universities, which lack authorization for bird flu testing.

As the outbreak grows — with at least 114 herds infected in 12 states as of June 18 — researchers said the CDC and FDA are not moving fast enough to remove barriers that block clinical labs from testing. In one case, the diagnostics company Neelyx Labs was on hold with a query for more than a month.

“Clinical labs are part of the nation’s public health system,” said Alex Greninger, assistant director of the University of Washington Medicine Clinical Virology Laboratory. “Pull us into the game. We’re stuck on the bench.”

The CDC recognized the need for clinical labs in a June 10 memo. It calls on industry to develop tests for the H5 strain of bird flu virus, the one circulating among dairy cattle. “The limited availability and accessibility of diagnostic tests for Influenza A(H5) poses several pain points,” the CDC wrote. The points include a shortage of tests if demand spikes.

Researchers, including former CDC director Tom Frieden and Anthony Fauci, who led the nation’s response to Covid, cite testing failures as a key reason the U.S. fared so poorly with Covid. Had Covid tests been widely available in early 2020, they say, the U.S. could have detected many cases before they turned into outbreaks that prompted business shutdowns and cost lives.

In an article published this month, Nuzzo and a group of colleagues noted that the problem wasn’t testing capability but a failure to deploy that capability swiftly. The U.S. reported excess mortality eight times as high as other countries with advanced labs and other technological advantages.

A Covid test vetted by the WHO was available by mid-January 2020. Rather than use it, the United States stuck to its own multistage process, which took several months. Namely, the CDC develops its own test then sends it to local public health labs. Eventually, the FDA authorizes tests from clinical diagnostic labs that serve hospital systems, which must then scale up their operations. That took time, and people died amid outbreaks at nursing homes and prisons, waiting on test results.

In contrast, South Korea immediately rolled out testing through private sector laboratories, allowing it to keep schools and businesses open. “They said, ‘Gear up, guys; we’re going to need a ton of tests,’” said Frieden, now president of the public health organization Resolve to Save Lives. “You need to get commercials in the game.”

U.S. weeks behind

Nuzzo and her colleagues describe a step-by-step strategy for rolling out testing in health emergencies, in response to mistakes made obvious by ovid. But in this bird flu outbreak, the U.S. is weeks behind that playbook.

Ample testing is critical for two reasons. First, people need to know if they’re infected so that they can be quickly treated, Nuzzo said. Over the past two decades, roughly half of about 900 people around the globe known to have gotten the bird flu died from it.

Although the three farmworkers diagnosed with the disease this year in the United States had only mild symptoms, like a runny nose and inflamed eyes, others may not be so lucky. The flu treatment Tamiflu works only when given soon after symptoms start.

The CDC and local health departments have tried to boost bird flu testing among farmworkers, asking them to be tested if they feel sick. Farmworker advocates list several reasons why their outreach efforts are failing. The outreach might not be in the languages the farmworkers speak, for example, or address such concerns as a loss of employment.

If people who live and work around farms simply see a doctor when they or their children fall ill, those cases could be missed if the doctors send samples to their usual clinical laboratories. The CDC has asked doctors to send samples from people with flu symptoms who have exposure to livestock or poultry to public health labs. “If you work on a farm with an outbreak and you’re worried about your welfare, you can get tested,” Shah said. But sending samples to public health departments requires knowledge, time, and effort.

“I really worry about a testing scheme in which busy clinicians need to figure this out,” Nuzzo said.

The other reason to involve clinical laboratories is so the nation can ramp up testing if the bird flu is suddenly detected among people who didn’t catch it from cattle. There’s no evidence the virus has started to spread among people, but that could change in coming months as it evolves.

The fastest way to get clinical labs involved, Greninger said, is to allow them to use a test the FDA has already authorized: the CDC’s bird flu test. On April 16 the CDC opened up that possibility by offering royalty-free licenses for components of its bird flu tests to accredited labs.

Several commercial labs asked for licenses. “We want to get prepared before things get crazy,” said Shyam Saladi, chief executive officer of the diagnostics company Neelyx Labs, which offered Covid and mpox tests during shortages in those outbreaks. His experience over the past two months reveals the types of barriers that prevent labs from moving swiftly.

Labs seek ‘right to reference’

In email exchanges with the CDC, shared with KFF Health News, Saladi specifies the labs’ desire for licenses relevant to the CDC’s test, as well as a “right to reference” the CDC’s data in its application for FDA authorization.

That “right to reference” makes it easier for one company to use a test developed by another. It allows the new group to skip certain analyses conducted by the original maker, by telling the FDA to look at data in the original FDA application. This was commonplace with Covid tests at the peak of the pandemic.

At first, the CDC appeared eager to cooperate. “A right of reference to the data should be available,” Jonathan Motley, a patent specialist at the CDC, wrote in an email to Saladi on April 24. Over the next few weeks, the CDC sent him information about transferring its licenses to the company, and about the test, which prompted Neelyx’s researchers to buy testing components and try out the CDC’s process on their equipment.

But Saladi grew increasingly anxious about the ability to reference the CDC’s data in the company’s FDA application. “Do you have an update with respect to the right of reference?” he asked the CDC on May 13. “If there are any potential sticking points with respect to this, would you mind letting us know please?”

He asked several more times in the following weeks, as the number of herds infected with the bird flu ticked upward and more cases among farmworkers were announced. “Given that it is May 24 and the outbreak has only expanded, can CDC provide a date by which it plans to respond?” Saladi wrote.

The CDC eventually signed a licensing agreement with Neelyx but informed Saladi that it would not, in fact, provide the reference. Without that, Saladi said, he could not move forward with the CDC’s test — at least not without more material from the agency. “It’s really frustrating,” he said. “We thought they really intended to support the development of these tests in case they are needed.”

Shah, from the CDC, said test manufacturers should generate their own data to prove that they’re using the CDC’s test correctly. “We don’t have a shortage such that we need to cut corners,” he said. “Quality reigns supreme.”

The CDC has given seven companies, including Neelyx, licenses for its tests — although none have been cleared to use them by the FDA. Only one of those companies asked for the right of reference, Shah said. The labs may be assisted by additional material that the agency is developing now, to allow them to complete the analyses — even without the reference.

“This should have happened sooner,” Saladi told KFF Health News when he was told about the CDC’s pending additional material. “There’s been no communication about this.”

Delays reminiscent of covid

Greninger said the delays and confusion are reminiscent of the early months of Covid, when federal agencies prioritized caution over speed. Test accuracy is important, he said, but excessive vetting can cause harm in a fast-moving outbreak like this one. “The CDC should be trying to open this up to labs with national reach and a good reputation,” he said. “I fall on the side of allowing labs to get ready — that’s a no-brainer.”

Clinical laboratories have also begun to develop their own tests from scratch. But researchers said they’re moving cautiously because of a recent FDA rule that gives the agency more oversight of lab-developed tests, lengthening the pathway to approval. In an email to KFF Health News, FDA press officer Janell Goodwin said the rule’s enforcement will occur gradually.

However, Susan Van Meter, president of the American Clinical Laboratory Association, a trade group whose members include the nation’s largest commercial diagnostic labs, said companies need more clarity: “It’s slowing things down because it’s adding to the confusion about what is allowable.”

Creating tests for the bird flu is already a risky bet, because demand is uncertain. It’s not clear whether this outbreak in cattle will trigger an epidemic or fizzle out. In addition to issues with the CDC and FDA, clinical laboratories are trying to figure out whether health insurers or the government will pay for bird flu tests.

These wrinkles will be smoothed eventually. Until then, the vanishingly slim numbers of people tested, along with the lack of testing in cattle, may draw criticism from other parts of the world.

“Think about our judgment of China’s transparency at the start of Covid,” Nuzzo said. “The current situation undermines America’s standing in the world.”

This story originally published June 20, 2024 at KFF Health News, Healthbeat’s national reporting partner.