Outbreak Outlook - Sep 30

We are entering a period of relative quiet, with flu activity low and Covid-19 steadily falling.

Influenza-like illness + Other Respiratory

Influenza wastewater activity remains minimal, though it has picked up slightly to ‘low’ levels in several states, including California, Arizona, and North Carolina. Outpatient visits for ILI remained stable and very low at 1.9%.

RSV shows minimal activity in wastewater and very low test positivity.

Rhinovirus/non-polio enterovirus (one cause of the common cold) activity continues to increase nationally. Test positivity is up to 34%, which is higher than it has been at any point in the past five years.

Covid-19

Wastewater activity is still high but improving. Activity declined again this past week. Activity is roughly the same in the South, Midwest and West. The Northeast is in the best shape.

Source: CDC

Severe illness continues to decline as well. Visits to the emergency department for Covid-19 accounted for 1.4% of all ED visits last week, a substantial decrease from the week before. Hospitalizations declined again nationally, to 2.3 per 100,000 people.

Western region

Covid-19 conditions are improving in the region, with continued decreases in wastewater activity and severe illness.

About a month ago, nearly every state in the region had very high wastewater activity. This past week, only two still had very high activity: Washington and Colorado. Most states are in the ‘high’ category, including Montana and New Mexico.

Wastewater activity has decreased to moderate levels in Nevada, California, Arizona, Alaska, and low in Hawaii.

Severe illness remains stable or declined across the board - no states reported increases. ED visits declined substantially in California, Nevada, New Mexico, and Wyoming and moderately in Montana, Idaho, Colorado, and Alaska. They held steady in the rest of the region. Hospitalizations declined to relatively low levels in Oregon (2.9), California (2.8), Utah (2.3), Colorado (1.6), New Mexico (1.2).

Southern region

Wastewater concentration has fallen by about half compared to early August and is still falling. However, concentration remains high overall.

Several states have dropped to moderate levels in Florida, Louisiana, and Mississippi (though there is limited coverage in the state). Texas, Georgia, and Alabama are now reporting low levels.

Wastewater activity remains very high in Oklahoma, Arkansas, North Carolina and Virginia (though there is limited coverage for the state). It is high in Tennessee, South Carolina, Kentucky, Maryland, Washington, DC, and Delaware.

There was a substantial decline in ED visits in nearly every state in the South. (There was a moderate decline in Maryland and no data available for Oklahoma). Similarly, hospitalizations have dropped precipitously in Georgia (0.9) and Maryland (0.4), back down to the levels they were at before the late summer wave. Hospitalizations in Tennessee declined to 2.4, but remain well above the lows they were at in May of this year, meaning there is still room for further declines.

Northeastern region

Wastewater activity in the Northeast has declined almost by half since its peak earlier this summer, and is now down to moderate levels.

Wastewater activity continues to be very high in Maine, Vermont, Massachusetts, New Hampshire and high in Pennsylvania. However, wastewater activity is moderate in Connecticut and low in New Jersey.

No states reported increases in severe illness. ED visits were stable in Maine, New Hampshire, and New Jersey. In Connecticut, ED visits held steady, as did hospitalizations (at the elevated rate of 6.3). They decreased moderately in Massachusetts and Pennsylvania and substantially in Vermont.

Hospitalizations have also declined encouragingly in New York City. Wastewater concentration in the city is high but declining. (The data source for NYC is different, so the categories may not align.)

While wastewater activity is minimal in New York, and both ED visits and hospitalizations declined a bit, hospitalizations remain high at 7.0 per 100,000.

Midwestern region

The Midwest has (barely) edged out the South and West for the region with the highest wastewater activity. However, this does not mean that activity in the region is worsening. Rather, the South and West are improving a bit faster.

Wastewater activity in the region is declining, though most states continue to report to very high or high levels. The exception continues to be Michigan which had low activity again this past week.

Fewer people are getting severely ill from Covid-19 in the Midwest: ED visits declined in every state in the region, with substantial decreases in Iowa, Ohio, Indiana, Illinois, and South Dakota. (No data are available for Minnesota and Missouri). Hospitalizations finally decreased a bit in Michigan after several weeks of increases; however, they remain elevated at 4.5. Hospitalizations also decreased in Minnesota (to 2.0), Ohio (to 2.1).

Stomach Bugs

The data were hard to interpret again this week, because the overall number of tests reported was much lower than usual. I’ll check back again next week.

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Food recalls

New:

• 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)

Previously reported:

• 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

• Sneak peek for Outbreak Outlook readers — my publisher is giving away five copies of my new book, Crisis Averted. (It comes out October 8!) The sweepstakes technically opens tomorrow, but you can get in early using this link. The giveaway closes on October 7.

• The Federal program that sends 4 free Covid-19 tests through the mail is now accepting orders. Get yours here!

• A nationwide listeria outbreak linked to Boar's Head deli meat has claimed 10 lives, including one in New York, with 59 hospitalizations across 19 states since May. The outbreak, the largest since 2011, has been traced to liverwurst production at a Boar’s Head plant in Virginia, which has since closed. The plant had a history of safety violations, including rusted equipment and unsanitary conditions. Boar’s Head recalled over 70 products.

• A possible bird flu cluster in Missouri has expanded to eight people, raising concerns about potential human-to-human transmission of H5N1, which would be the first of its kind in the U.S. The Missouri Department of Health is investigating whether the virus spread from a hospitalized patient to a household member and six healthcare workers. While no cases (except the original) have been confirmed yet, this development is concerning. Missouri's initial patient had no known animal contact, and concerns have grown due to the slow release of information and potential gaps in public health response.