Outbreak Outlook - National - Jan 20

Early improvements in flu, Covid-19 and RSV. Not so with norovirus.

Respiratory Diseases

Influenza-like illness

It looks like we have turned the corner. Outpatient ILI activity has dropped for two weeks in a row. The timing is particularly convincing. While data around the holidays can be unreliable, we're now past that period of uncertainty. The trend we're seeing is more likely to reflect genuine improvement rather than reporting artifacts.

Around 5.4% of visits to the doctor were for fever and cough or sore throat during the week ending January 11th, down from 6.3% the week prior. However, we will remain in flu season for many weeks, so don't get too comfortable just yet.

Outpatient influenza like illness by season.

Children have seen major improvements in outpatient ILI, with visits in the 0-4 age group falling from a recent high of 16.5% to 13.4% at last report. The 5-24 age group has seen similar improvements, falling from 10.2% to 7.3%. The adult age groups are all now below 5% and are also seeing improvements.

All four regions of the country are enjoying similar declines. As of last report, the Northeast is in best shape (as measured by emergency department visits) though there are some hot spots including New York City and New Jersey. The Southern and Western regions are still recovering from the high rates of ED visits they weathered around the New Year. The consistent pattern across the country gives me further confidence that we are past peak.

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COVID-19

Covid-19 remains elevated, but I’m cautiously optimistic that it may be starting to ease up.

Wastewater activity is high, but it has come down a bit in the past week. Activity is highest in the Midwest, where SARS-CoV-2 wastewater concentration is about double what it is in the West, where rates are lowest.

Source: CDC

Severe illness continues to be a bit elevated. Trips to the emergency department for Covid-19 remained roughly steady this past week, at 1.3% of all trips to the ED. Hospitalizations have declined slightly in the past week to 4.3 per 100,000 but are still a bit elevated.

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RSV & Other Bugs

It is cold season, and as expected, two of the common causes of mild cold-like illness - human coronaviruses and human metapneumovirus are circulating widely.

As with influenza, RSV is beginning to recede with all four regions of the country registering declines in ED visits for the virus. I expect further improvements in the weeks to come.

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Norovirus

I really wish I had better news because norovirus is so deeply unpleasant, but rates have continued to rise. We are in the middle of very large wave, with 28% test positivity. Norovirus goes through annual waves in the winter months, but this year is a rough one. Current test positivity is now substantially higher than it has been at any point in more than 5 years. And by substantially, I mean nearly double. Yuck.

Source: CDC

Why is it so bad this year? It might be due to a new strain of norovirus that is circulating; lower population immunity to this strain may explain some of the high rates we are seeing. The good news is this strain does not appear to be worse in terms of how sick it makes you, and prevention measures remain the same: keep washing those hands (soap and water is most effective)!

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Food recalls

The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:

New:

• Casa Mamita frozen chicken and cheese taquitos (more info)

Previously reported:

• Wicklow Gold Cheddar Cheeses (more info)

• Blue Ridge Beef Kitten mix [for Cats] (more info). While not for human consumption, humans may be infected with Salmonella if they do not adequately wash their hands or contaminated surfaces after handling the product.

• Marketside Broccoli Florets (more info)

• Connie’s Thin Crust Cheese Frozen Pizzas (more info)

• If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.

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In other news

• Over 20 million egg-laying chickens in the U.S. died last quarter due to bird flu, marking the highest losses since the outbreak began, according to USDA data. The deaths, including birds culled to contain the virus, have driven egg prices to record highs. Unlike previous years, 2024 saw significant losses across all production systems, including conventional, cage-free, and organic. And 2025 is shaping up to be similar: Georgia, a leading poultry producer, recently detected highly pathogenic avian influenza in a commercial poultry operation.

• The CDC has issued a Health Advisory urging clinicians and laboratories to expedite subtyping of influenza A-positive specimens in hospitalized patients, especially those in ICUs, to identify potential human infections with H5N1. Testing should prioritize distinguishing seasonal influenza A viruses (H1 and H3) from novel strains like H5. Specimens testing positive for influenza A but negative for seasonal subtypes should be sent to public health or commercial laboratories within 24 hours for further analysis. Clinicians are encouraged to collect exposure histories, implement appropriate infection control measures, start antiviral treatments like oseltamivir promptly, and notify health departments of suspected H5 cases. Laboratories should avoid batching specimens to prevent delays in public health investigations.

• Government inspectors have documented unsanitary conditions at several Boar's Head deli meat plants, with issues such as meat residue, mold, insects, and dripping condensation reported over the past six years at facilities in Indiana, Arkansas, and Virginia. These findings echo violations found at the Jarratt, Virginia, plant, linked to a listeria outbreak in 2024 that sickened over 60 people and caused 10 deaths. The outbreak led to a recall of over 7 million pounds of deli meat and the plant's closure. Boar's Head acknowledged the violations, stating they do not align with company standards, while its other plants continue under USDA oversight.

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Photo by Arno Senoner on Unsplash