Outbreak Outlook - October 7

Influenza-like illness is still quiet, and Covid-19 continues to recede.

Influenza-like Illness + RSV

This is the final reporting week of the 2023-2024 flu season, and we're ending on a positive note. Only 1.9% of doctor visits were for fever and cough or sore throat. As always, children aged 0-4 have the highest rate of influenza-like illness (ILI) at 6.3%. All states are reporting low or minimal levels of ILI, both for outpatient visits and wastewater.

Source: CDC

RSV activity remains very low, though it has increased slightly. This season is starting later than in recent years, which is fine by me!

Covid-19

Covid-19 continues to calm down. For the first time since July, wastewater activity is moderate nationally.

Source: CDC

The West continues to have high activity, but both the Midwest and South have dropped to moderate activity. The Northeast has low activity - about half the national average.

ED visits for Covid-19 have declined again, down to 1.1% of all emergency departments last week. Similarly, hospitalizations declined for the 7th week in a row, to 1.9 hospitalizations per 100,000 people. This is starting to approach the low of 1.1 we were at in early May of this year.

Western Region

Wastewater activity for the region as a whole stayed roughly level this past week at high levels, after sharp declines the past couple weeks.

Although activity remains very high in Washington, activity is decreasing. Similarly, it remains high but is on a downward trend in Colorado, Idaho, Utah, and Wyoming.

Activity remains very high and increased a bit last week in Oregon after steep declines the prior two weeks.

Wastewater activity is down to low levels in California, Arizona, and Alaska, and to minimal levels in Nevada and Hawaii.

Severe illness is down across the region. Nearly all states reported moderate or substantial declines in ED visits last week. The sole exception is Arizona where ED visits held steady (at 1.1%). Hospitalizations decreased in all reporting states: California (2.7 per 100,000), Oregon (2.6), Utah (1.9), Colorado (1.8), and New Mexico (1.7).

Midwestern Region

Wastewater activity in the Midwest has declined to moderate levels. Things are looking quite good in Michigan and Illinois, where wastewater activity is low. Wastewater activity is moderate in Indiana and Kansas. 

Although activity remains very high in Minnesota, there was a steep decline this past week. Similarly, activity is high but declining in Wisconsin, Iowa, Missouri, Nebraska, and Ohio. In South Dakota activity appears to be high and increasing, though there is limited coverage in the state, so take this with a grain of salt.

Severe illness universally declined this week. There were substantial declines in ED visits in every state but Iowa (which had a more moderate decline). (Minnesota and Missouri do not report ED data). In addition, hospitalizations finally decreased a bit in Michigan—dropping nearly 3 points in just one week, to 3.2 per 100,000. Similarly, the hospitalization rate was cut nearly in half in the past week in Minnesota, to 2.2. Hospitalizations also decreased in Ohio, to 2.1.

Southern Region

Wastewater activity in the region has dropped to moderate levels and severe illness is on the decline. Wastewater activity has dropped to minimal levels in Washington, DC and low levels in Florida, Texas, Georgia, Tennessee, Mississippi (limited coverage), and Maryland. Activity is moderate in Louisiana, Alabama, and West Virginia.

For the most part, even in the places where wastewater activity remains high, it is on the decline, including in Arkansas, Oklahoma, North Carolina, Virginia, and Kentucky. The exception to this is South Carolina, where activity rebounded this week and remains high.

ED visits and hospitalizations are down. Most states reported substantial declines in ED visits; more moderate declines were reported by Arkansas and Georgia (no data are available for Oklahoma). Hospitalizations decreased down to low levels in Maryland (0.4 per 100,000) and Georgia (0.8). In Tennessee, hospitalizations also decreased substantially (to 1.4), but there is still room for further declines.

Northeastern Region

Wastewater activity for the region is low - and ED visits and hospitalizations decreased. Wastewater activity is minimal in New York and Rhode Island and is low in New Jersey. Activity is moderate in Connecticut and Pennsylvania (limited coverage). Activity remains very high in Maine, New Hampshire, and Vermont, though there were decreases in all these states this past week. Activity is high and decreasing in Massachusetts and New York City.

ED visits for Covid decreased in every state in the Northeast this past week. Substantial declines were reported in Maine, Massachusetts, Connecticut, New Jersey, New York City and Pennsylvania. More moderate decreases occurred in New York, Vermont, and New Hampshire. Hospitalizations decreased in Connecticut by over 3 points, to 3.5. Although hospitalizations have declined substantially in New York to 5.1, this is still quite elevated.

Norovirus

Norovirus test positivity is 8.6% and rising, up from about 5% in August. Activity is highest in the Southern region, where test positivity has risen to around 17%. Wastewater concentration of norovirus has also increased in the South in recent weeks.

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Food recalls

New:

• Alfalfa sprouts from Jack & the Green Sprouts (more info)

Previously reported:

• Dynacare Baby Power has been recalled due to the potential to be contaminated with asbestos (more info)

• ANSWERS beef and chicken dog food (more info)

• Whole Cantaloupe (more info)

• Eggs under labels “Milo’s Poultry Farms” and “Tony’s Fresh Market” (more info)

• Don’t forget to throw out Boar’s Head deli meats (more info)

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In Other News

• Tomorrow is publication day for my debut book, CRISIS AVERTED. I would love for you to check it out.

• In August, I noted a rise in EVD-68 activity, which is linked to Acute Flaccid Myelitis (AFM), a polio-like paralysis. I'm happy to report that AFM cases have not increased.

• Rwanda has confirmed its first Marburg virus disease (MVD) cases, with 49 cases and 12 deaths reported across at least seven districts. A majority of cases are healthcare workers, and contact tracing is underway. MVD, similar to Ebola, is spread through contact with infected bodily fluids. Symptoms include fever, severe headache, and diarrhea. No treatment or vaccine is available, though some are in development.

• California has announced three human cases of H5N1. All three are dairy workers who developed mild symptoms. California has been working hard to identify infected dairy herds, so I am not surprised that they have also uncovered a few human cases.

  • In Missouri, tests to determine whether there was human to human transmission are still pending. The tests may not be complete until the second half of the month.

Crisis Averted’s birthday is TOMORROW!