Team Force of Infection spent our Saturday morning visiting all 50 state health department websites to bring you the latest on what’s going around.
Unfortunately, the federal government shutdown has interrupted the flow of surveillance data. Individual states and counties are still collecting and reporting public health data, but the CDC isn’t updating the dashboards that compile the national picture. As a workaround, we went state by state to check on influenza, Covid-19, and RSV.
One additional challenge is that flu season traditionally begins in calendar week 40, which is not until next week. Some states don’t publish data during the off-season, so not every location has information available yet. If you live in one of those states, I recommend checking neighboring states. Trends tend to be broadly similar by region.
Still, I wanted to ensure you have the information you need. This also gave me an opportunity to stress-test Plan B for future disruptions in data availability.
I’m keeping all reports free to everyone for the duration of the shutdown (here’s hoping it’s brief!) to ensure public health data remains accessible. Please share this post widely.
National
At the national level, test positivity for Covid-19 continues to fall, now at 6.7%, down from a recent high of 11.7%. Emergency department visits are falling rapidly as well, now at 0.7%, down from a recent high of 2%. Nearly all states are reporting improvements, so it’s safe to say we are on the far side of this summer’s small COVID wave.
Influenza and RSV activity both remain low across the country, but there are a few small stirrings as we head further into the autumn season. Florida is seeing an uptick in RSV activity, which may foreshadow broader trends.
Norovirus is increasing steadily and is now at moderate levels in the South, but remains low and stable in the rest of the country.
The full list of food recalls is at the bottom of this email, but important items to note include Hillshire brand corn dog and sausage, and Trader Joe’s Cajun Style Blackened Chicken Breast Fettucine Alfredo.
Caitlin Rivers, PhD, MPH is an epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health, where she directs the Center for Outbreak Response Innovation. In her free time, she writes Force of Infection, a bestselling newsletter about what’s going around. She is also the author of Crisis Averted, a book about the hidden science of fighting outbreaks and a proud mom of three.
States
Note: Including all 50 states uses a lot of email real estate. Click at the bottom of this email to expand to see the rest of the states, as well as the full Food Recalls section.
Alabama:
- Covid-19 activity in Alabama is declining rapidly, with the percentage of ED visits for COVID-19 falling from 1% to 0.6%.
- The proportion of ED visits that are for influenza remained stable at 0.2%.
- RSV activity also remained very low and stable.
Alaska:
- Activity for Covid-19, influenza, and RSV remains low and stable in Alaska. Covid-19 visits to the ED is 1.8%, also down from 2%.
- Influenza-like illness visits are 1.7% of visits to the emergency department, down from 2.0% last week.
- RSV activity remains near zero.
Arizona:
- Things look good in Arizona. Influenza activity remains very low in Arizona, with 1.4% of visits to the doctor for fever and cough or sore throat. The state’s threshold for the onset of flu season is 2.6%.
- Covid-19 activity is also low and falling. The two most affected age groups this year are people ages 19-44 and 65+.
- There is very little RSV activity.
Arkansas:
- I could not find any useful information. However, I did notice there are quite a few free flu clinics coming up, so do check it out if you are in Arkansas.
California:
Covid-19 activity continues to decline in California. Both test positivity and hospitalizations have fallen for three weeks in a row. Wastewater concentration is high across the state but is declining in all five regions.
The Bay Area is in the best shape with medium levels of wastewater concentration and a 51% decrease over the last three weeks. The other four areas are still seeing high levels of wastewater concentration, but all are registering significant 30 to 50% decreases.
The state has not begun reporting influenza or RSV activity yet.
A person in Kings County died due to the West Nile virus. It is the first such death in the county this year. Fresno County reported a death earlier this summer. West Nile virus is a mosquito-borne disease. There have been 1,324 West Nile cases reported across the United States so far this year.
Colorado:
- The percent of emergency departments that are for Covid-19 has fallen steadily since late August, now at 0.5%. Hospital admissions for Covid-19 and test positivity are declining as well. Wastewater concentration data is a little out of date, but activity looks fine.
- Influenza and RSV are even lower, each well below 0.1% of visits to the emergency department.
Connecticut
- Covid-19 activity remains moderate but stubborn in Connecticut, with 1.4% of visits to the emergency department for Covid-19, a level that has remained unchanged for the last three weeks. Of note, the latest data ends Sep 20 so it is one week out of date. Hospitalizations have also remained mostly stable through September. Wastewater concentration has been bouncing around but remains elevated compared to the offseason.
- Influenza activity remains very low in Connecticut, though like many places, the state did see a small increase aligning with the beginning of school season.
- RSV activity is very low.
Delaware
- Wastewater concentration of SARS-CoV-2 is moderate in Delaware and has declined since the peak of the summer wave. Influenza and RSV concentration remains very low. Most other metrics are not available yet for the state.
Florida:
- I was not able to find good data for Covid-19. The state reports cases and deaths by year, but that is not helpful for recent trends.
- Influenza activity is low and stable in all regions of the state, with emergency department visits falling following a small increase around the start of the school year. I see the same trends in outpatient influenza-like illness.
- RSV activity is low, but I do see signs of it increasing, particularly in children under the age of five. The central and southeastern regions are most affected.
Georgia:
- Influenza-like illness activity is low in Georgia. Just 2.1% of visits to the doctor were for fever and cough or sore throat. The state saw a bump at the beginning of the school year, but that is receding. However, I did notice that the 0-4 age group is increasing, which could foreshadow more general increases in the weeks ahead.
- I was not able to find information on Covid-19 activity.
Hawaii:
- Hawaii’s most recent data is from the week of September 7. As of last week, Covid-19 was steadily declining.
Idaho:
- Idaho is not currently publishing data.
Illinois:
- Covid-19 activity is declining in Illinois with 0.7% of ED visits, down from 1.0% the week prior. There is very little influenza and RSV circulating.
- Overall acute respiratory illness is also declining following a small spike at the beginning of the school year.
Indiana:
- Influenza-like illness was minimal in Indiana as of the week ending September 20th. 1.2% of visits to the emergency department and urgent care were for ILI.
- Covid-19 is also very low in Indiana, well below what is typical this time of year. Emergency department hospitalizations, emergency department visits, hospitalizations, and wastewater concentration are all low.
- Indiana recently reported a death from West Nile virus in Vanderburgh County. Surrounding areas have also identified cases of West Nile, which is a mosquito-borne disease. There have been 1,324 West Nile cases reported across the United States so far this year.
Iowa:
- Influenza activity remains very low in the state, with outpatient ILI at 0.46%.
- Covid-19 is low and declining in Iowa with ED visits for Covid-19 down to 0.9% of all trips to the ED, and 1% of hospitalizations due to Covid-19.
- Rhinovirus/enterovirus — a common cause of colds — is spreading widely in the state right now.
Kansas:
- RSV and influenza activity are very low.
- Covid-19 activity has fallen steadily since the state’s peak in early September. 0.5% of visits to the emergency department are for Covid-19, down from the summer high of 1.0%.
Kentucky:
- Covid-19 activity is holding stable in Kentucky, with around 1% of inpatient encounters associated with Covid-19.
- Influenza and RSV activity are very low in the state.
Louisiana:
- Covid-19 activity has come down notably in the past few weeks. Test positivity in the state has declined from 17% in late August to 3.9% this past week. ED visits are down threefold since late August, down to 1.3% of all trips to the ED.
- Influenza is low and stable in Louisiana, with no increases in test positivity, ED visits, or hospitalizations.
- RSV test positivity is picking up: it has risen in the past few weeks from 0.9% to 3.9%. However, trips to the ED for RSV remain flat at 0.0%.
Maine:
- For Covid-19, ED visit data has not been updated since July. However, the case count (calculated using test positivity) for Covid-19 in Maine, is just a couple weeks behind and shows elevated rates (though far below the peak over last winter). Hospitalizations are very low.
- I was not able to find recent flu or RSV data for the state.
Maryland:
- Pretty quiet situation in Maryland. For the week ending September 27, trips to the doctor for ILI accounted for 1.25% of all outpatient visits in the state.
- RSV hospitalizations remain very low. No other data on RSV is available.
- Covid-19 hospitalizations and test positivity are low in Maryland.
Massachusetts:
- Massachusetts is in great shape, with Covid-19, influenza, and RSV all coming in at very low.
- During the week ending September 27th, 0.9% of emergency department visits were for Covid-19, down from a recent high of 1.1%. Current activity remains below what we’ve seen in most previous seasons.
- Influenza and RSV activity is very low. With that being said, children under the age of five have seen a recent increase in visits to the emergency department for RSV, so that’s something to keep an eye on in the weeks ahead. An increase in RSV is expected, though unwelcome, this time of year.
Michigan:
- Trips to the ED for Covid-19 are declining, and are down to 0.6% of all ED visits. The youngest children — those 0 to 1 years old — are headed to the ED for Covid-19 at more than double the rate of all other age groups.
- Trips to the ED for both flu and RSV are minimal.
Minnesota:
- Covid-19 appears to be down significantly, with a large decrease in case rates and decreasing hospitalizations in the past couple weeks.
- Flu data for Minnesota is starting next week, so nothing to report quite yet, and there is similarly no RSV data available right now.
- Minnesota is currently experiencing a measles outbreak with 10 new cases reported since September 29th. The cases are in the Twin Cities metro area, and all are among unvaccinated people.
Mississippi:
- Mississippi provides some limited syndromic surveillance data for Covid-like illness and this shows a clear decline in the last few weeks, about in keeping with what we were seeing with other indicators last week.
- Very few people are headed to the doctor for ILI either.
Missouri:
- Influenza-like illness is low and stable in Missouri. I was not able to find data on Covid-19 in the state.
Montana:
- Both ED visits and case data (test positivity) suggests that Covid-19 is still increasing in the state, with case counts currently higher in the state than at any point since March of this year.
- Neither flu nor RSV surveillance reporting have started yet for the state this fall.
Nebraska:
- Quiet in Nebraska. ILI & RSV are very low and stable.
- Covid-19 emergency department visits have decreased to 1.4%; hospitalizations are also declining.
Nevada:
- Data on respiratory illnesses has not been updated on state websites since late August; this appears to be related to the cyberattack that occurred in late August against Nevada government websites.
New Hampshire:
- Weekly ILI surveillance has not yet started for the year, however, wastewater surveillance for the state shows very low levels of influenza circulating.
- There is decreasing wastewater activity for Covid-19, but no additional data are available to get a sense of more severe illness due to Covid-19.
- Wastewater surveillance shows very low RSV.
New Jersey:
- As of September 24, Covid-19 was continuing to rise in New Jersey, with increasing ED visits, hospitalizations, and wastewater activity.
- Influenza & RSV remain very low.
New Mexico:
- Covid-19 is improving: ED visits continue to decrease (down to .7% of all ED visits), and hospitalizations are very low.
- ILI activity remains very low, at 1.9%. Similarly, ED visits are very low for flu, as are hospitalizations.
- RSV is also quiet, with minimal trips to the emergency department.
New York:
- Covid-19 activity has declined in the state with the number of new hospitalizations declining since a peak in late September. Test positivity has also decreased.
- Covid-19 activity has also declined in New York City. The city also has a great lookup tool to find various vaccines, so if you still need your Covid-19 or influenza vaccines, take a look.
- An older adult in Madison County died from Eastern equine encephalitis in September. EEE is a rare mosquito-borne disease.
North Carolina:
- The percentage of visits to the emergency department for Covid-19 is 0.7%, down from a recent high of 1.1%. Current activity is in line with what we normally see this time of year. Wastewater concentration for SARS-CoV-2 has also declined markedly since a peak in early September. Wastewater concentration is now moderate.
- Influenza and RSV activity are low and stable.
- This note caught my eye, evidence of the impact of funding cuts on disease surveillance: “July 9, 2025: Starting the week of June 29, 2025, two hospital based public health epidemiologist network systems impacted by federal funding cuts are not reporting respiratory data.”
North Dakota:
- Influenza-like illness is low and stable at 0.5% of visits to the doctor for fever and cough or sore throat.
- Covid-19 data was a bit hard to interpret as the state reports counts instead of percentages, but activity appears to have declined steadily since a recent high in September.
Ohio:
Oklahoma:
- Covid-19 activity is looking good in Oklahoma. Wastewater concentration has decreased steadily since early to mid-September, as has test positivity. Hospitalizations have declined as well, though levels remain elevated compared to the off season.
- Influenza activity is low and stable. 0.9% of visits to the doctor’s office were for fever and cough or sore throat.
- Rhinovirus/enterovirus, a cause of the common cold, is very high but declining.
Oregon:
- Oregon relies on CDC to share most of its Covid-19 data, so there wasn’t much available, but I was able to confirm that test positivity for Covid-19 has declined steadily since mid-September.
- Oregon is not posting influenza data during the off season.
Pennsylvania:
- Covid-19 activity is drifting down in Pennsylvania. 0.5% of visits to the emergency department were for Covid-19, down from a recent high of 0.9%. Improvements are evident across all age groups.
- Influenza and RSV activity are both low and stable.
Rhode Island:
- Covid-19 activity is declining in Rhode Island, but improvements are slow compared to other regions of the country. 0.6% of visits to the emergency department were for Covid-19, down from a recent high of 0.9% in early September.
- Influenza and RSV activity are both low and stable.
South Carolina:
- Covid-19 activity is declining rapidly in South Carolina, but remains elevated compared to other states in the region. 1% of visits to the emergency department were for Covid-19, down from a recent high of 2.8%. Improvements are evident across all age groups, though the 18 to 49-year-old age group remains most affected as measured by emergency department visits.
- Influenza and RSV activity are low and stable. The 0 to 4 age group is seeing a slight uptick in RSV activity, but levels remain very low overall.
- South Carolina is reporting a measles outbreak in the upstate. Eight cases have been reported, five of which occurred in the past month.
South Dakota:
- Influenza activity is very low and stable. I was not able to find Covid-19 data.
Tennessee:
- Covid-19 activity has declined significantly in Tennessee. 0.4% of visits to the emergency department were from Covid-19, down from a recent high of 1.3%. Improvements have been seen across all age groups, with the most improvements evident in the 0 to 4-year-olds. Improvements are seen in all regions of the state.
- Influenza and RSV activity are very low and stable. The eastern regions of the state are seeing a little more influenza activity, with visits to the emergency department rising to 0.5%. Again, this is very low, but a little more than we’re seeing in other regions of the state.
Texas:
- Covid-19 activity has declined significantly in Texas. 0.5% of visits to the emergency department were for Covid-19, down from a recent high of 1.9%.
- Influenza activity is rising slowly but remains at very low levels. RSV activity remains very low and stable.
Utah:
- Covid-19 activity has declined markedly in Utah. Just 0.4% of visits to the ED were for Covid-19, down from a recent high of 1.9%. All age groups are seeing improvements.
- RSV and influenza activity remain very low in the state.
Vermont:
- Covid-19 activity remains elevated compared to the off season, but activity is low overall. Several outbreaks were reported in congregate settings: five in long-term care facilities and two in correctional facilities.
- Vermont is not publishing influenza data during the off season.
Virginia:
- Covid-19 activity is declining rapidly in Virginia. 0.7% of visits to the ED were for Covid-19, down from a recent high of 1.7%. All age groups are seeing improvements, though the 0-4 group remains most affected.
- Influenza and RSV activity remains very low, though the 0-4 age group is seeing an increase in visits to the ED for RSV.
Washington:
- Covid-19 activity is declining rapidly in Washington. 1.3% of visits to the ED were for Covid-19, down from a recent high of 1.9%. Activity is below what we typically see this time of year in the state.
- Influenza and RSV activity are very low.
West Virginia:
- Covid-19 activity remains elevated but is heading in the right direction. 1.6% of visits to the ED were for Covid-like illness, down from a recent high of 3%. Test positivity is declining as well.
- Influenza-like illness rose at the start of the school year, but is now declining. I don’t expect that to last too much longer, as we are headed into the flu season.
Wisconsin:
- Covid-19 activity has fallen, with 0.7% of visits to the ED, down from a recent high of 1.0%. Wastewater concentration is also declining
- Flu and RSV activity remains minimal. There has been a slight increase in test positivity for influenza, which is expected this time of year. Flu season is coming (but not here yet!).
- Two outbreaks of bird flu have been identified in chicken farms in Jefferson County. 3.5 million chickens will be depopulated to contain the virus.
Wyoming:
Outpatient ILI at 2.1%, well below the local threshold for the start of the season of 5.5%
Slight declines in Covid-19 activity following a peak in early September.
Food Recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
- Hillshire brands corn dog and sausage on a stick (more info)
- Trader Joe’s Cajun Style Blackened Chicken Breast Fettucine Alfredo (more info)
- Nature’s Own Pet Chews Bully Bites [for dogs]. These dog treats have the potential to be contaminated with Salmonella, which may sicken both pets who consume such products or humans who have handled such products or come into contact with contaminated surfaces that have touched such products without being washed thoroughly. (more info)
- Giant Eagle Smoked Mozzarella Pasta Salad (more info)
- Various store-made deli items containing bowtie pasta from a wide range of grocery stores across numerous states, including Albertsons, Andronico’s Community Markets, Carrs-Safeway, Eagle, Park ‘N Save, Market Street, Randalls, Safeway, and Tom Thumb (more info)
- Scott and Jon’s Shrimp Scampi with Linguini bowls (more info)
- Yet more shrimp have been recalled due to potential Cesium-137 contamination (see additional recalls below). Sea Port Products Corp Raw Frozen Easy Peel White Shrimp (more info)
- Signature Enoki mushrooms (more info)
- Tru Fru Freeze Dried strawberry products (more info)
- Fresh cut cantaloupe chunks as well as fruit trays and fruit salad products containing cantaloupe sold under the Harvest Cuts and Fresh and Finest labels (more info)
- Wise Wife brand ground cinnamon is being recalled due to potential lead contamination (more info).