Respiratory Diseases

Influenza-like illness

Flu remains very high, but it appears to be declining in most states in the country. Outpatient influenza-like illness (ILI) decreased from 8.3% to 7.2%, and emergency department (ED) visits for flu dropped decreased from 8.5% to 6.3%. Test positivity has also decreased in the past week. Precautionary measures (such as masks and frequent handwashing) are still a good idea with rates this high.

Rates are highest in the Northeast, and lowest in the West. However, all four regions reported declines in both outpatient ILI and ED visits for flu this past week.

Children, always the most affected by influenza-like illness, are also seeing the biggest improvements. School age kids (ages 5-25) saw a sizable drop in activity, which could be the result of being out of school over winter break. I’ll be keeping a close eye on activity in the next 1-2 weeks. Last year, we had an unusual double peak, so I am reluctant to say we have passed the worst of it yet.

The CDC estimates that there have been at least 15 million cases, 180,000 hospitalizations and 7,400 deaths in the US so far this flu season. And it is far from over, as we have another few months of elevated activity still ahead of us.

COVID-19

Covid-19 activity is going up. Wastewater activity has bounced up to high levels nationally. ED visits remain fairly low, at 0.9% nationally, but are increasing. Hospitalizations have also increased, to 2.7 hospitalizations per 100,000 people (more than double where they were for much of the fall).

The Midwest is getting hit hardest. Wastewater activity is very high there, surpassing levels reached in the summer wave and approaching those during last season’s winter wave. ED visits are also substantially higher there than elsewhere in the country, at about 1.6%.

Similarly, while levels remain a bit lower (high instead of very high) in the Northeast, activity has already surpassed levels reached during the summer wave. ED visits are at about 1.2%.

In the South, wastewater activity is moderate and rising steadily, and ED visits have risen to a little under 1%. Activity remains really quiet in the West, holding steady at very low levels, with ED visits at just 0.5%.

RSV & Other Bugs

RSV: Test positivity continues to rise, reaching 4.6% this past week. ED visits held roughly steady this past week at 0.5%, and hospitalizations are elevated at 1.8 hospitalizations per 100,000 people. There is a patchwork of activity right now. Many states in the Midwest and West continue to have activity that is likely growing or growing, but many in the South and Northeast are not changing or are declining.

Other Bugs:

• Adenovirus has decreased notably over the past several weeks and is back down into moderate territory.
• Both human metapneumovirus and human coronaviruses continue to steadily rise and are now at moderate levels.
• Parainfluenza and rhinoviruses/enteroviruses are low.

Norovirus

CDC norovirus data hasn’t updated since the week of December 20. My alternative source is finding high and fairly stable levels of wastewater activity nationally.

In the Midwest, activity has decreased slightly over the past week, but remains quite high. In the South, activity is high, having rebounded after a slight decrease. In the Northeast, activity held roughly stable at high levels.

Levels remain quite a bit lower in the West, where activity is moderate and held roughly steady this past week.

Food recalls

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

New:

• Klong Kone Shrimp Paste, sold exclusively at Golden Land in Des Moines, Iowa and Terri Lee Oriental Groceries in Maywood, New Jersey (more info)

Previously Reported:

• Primavera Nuevo tamales, various flavors (more info)
• There is a big recall of hundreds of products — from Airhead candies to meat to Splenda packets — that passed through a single distributor and were sold to over 50 stores, primarily in Minnesota and Indiana. I strongly urge you to check out the list of stores (here) and if you’ve shopped at one of them recently, check out the much longer list of items that are being recalled (here)
• Country Vet Biscuits & Heartland Harvest Dog Biscuits [for dogs] are being recalled for potential contamination with Salmonella. Salmonella can sicken both pets who consume the treats, and humans who handle the products (or who touch surfaces the items touched). (more info)
• Forward Farms Grass-Fed Ground Beef (more info)
• Frozen raw shrimp sold under the Market 32 and Waterfront Bistro brand names, due to possible cesium-137 contamination (more info)
• Lucky Foods cinnamon powder, due to potential lead contamination (more info)
• ByHeart Infant Formula due to potential botulism contamination (more info)

In other news

• RSV prevention for infants reduce hospitalizations — and are now at risk. In the past few years, new options to reduce the risk of severe RSV infection in infants have become available. I have written about how both monoclonal antibodies (sometimes called passive vaccination) and maternal vaccination are highly safe and effective ways to reduce the risk that infants will develop serious complications due to RSV infection. Now that the medications have been in use for several seasons, two new studies have evaluated their performance in ‘real world’ conditions. The first, a case-control study involving over 5,000 children under the age of 2, found that nirsevimab was 81% effective at preventing RSV-associated hospitalizations for newborns (compared to 70% for maternal vaccination). The second study was a cohort study that followed over 42,000 infants in France. It similarly found that nirsevimab was associated with fewer hospitalizations than maternal vaccination. Importantly, both nirsevimab and maternal vaccination significantly reduce the risk of hospitalization due to RSV compared to no preventive intervention.

  • Unfortunately, alongside vaccines, monoclonal preventive treatments for RSV are now being reevaluated by FDA officials due to unsubstantiated concerns about the products. The evidence strongly supports the safety and efficacy of these treatments, and there has been no new evidence provided that would support such a reevaluation.

• Crisis Averted, my narrative nonfiction book, is on super sale at Amazon for $5.39 for hardcover or $4.99 for Kindle. It’s also available at other retailers, like Bookshop.

  • In related news, I am participating in a film premiere and panel discussion for the brand-new documentary, Forgetting to Remember: Lessons from A Vaccine Lost. The documentary tells the story of the loss of the adenovirus vaccine, and the tragic deaths that followed—an event which also appears in my book. The premiere is Jan. 13, 2026, at 1 p.m. ET. It’s free and on Zoom, but you must register.

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