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Force of Infection
5 min read Paid Subscriber Report: Northeast

Outbreak Outlook - Northeast - Dec 31

2025 closes out with lots of flu and rising Covid

Welcome to the Northeastern edition of Outbreak Outlook! It is only available to paid subscribers. If you wish to become a paid subscriber and access region-specific information, please click the Subscribe now button below. Thanks for reading! -Caitlin

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Respiratory Diseases

Influenza

Overall

Flu is hitting hard. Activity is higher in the Northeast than any other region of the country. Emergency department visits for flu for the region are at ~5.8% and outpatient visits for fever and cough or sore throat (known as ILI) are around 6.7%. For context, last year was especially bad, and outpatient ILI topped out at 9.4%. And hospitalization rates for flu are the currently highest in the country by quite a bit, as shown below.

We are at levels where avoiding large crowds and masking up makes a lot of sense. If you haven’t had your flu shot it is not too late, but do keep in mind that it takes about two weeks to be fully protective. Metrics of serious illness are also rising, with nearly all states in the region reporting an increase in emergency department (ED) visits this past week, along with increases in hospitalizations.

What’s ahead

Personally, I am not really seeing signs of peaking yet, but the Center for Forecasting and Outbreak Analytics estimates that growth has nearly stopped in New York, Massachusetts and New Jersey. That would suggest we are at or near peak in those states, with the remaining states in the region likely not far behind.

And going by the calendar, peak week could happen any time now. We typically hit peak week either during or soon after the holidays. Last year we had an uncommon double peak, which prolonged the season by quite a bit, which just goes to show that flu loves to surprise.

State details

Flu is very high in New York. About 13.5% of outpatient visits this past week were for ILI in the state. ED visits increased a couple points, to 8.3%. Hospitalizations have spiked and are very high in New York: 14.8. Last year, hospitalizations peaked at 17.5. In New York City, ED visits for flu increased again to 8.8%, and hospitalizations increased to 4.9%.

Similarly, in New Jersey, outpatient ILI is at 11% (roughly equal to last season’s peak) and still rising. To give a sense of rapid growth, ED visits for flu in the state have increased more than 10-fold since end of November, from 0.8% to 8.5%.

Flu is also very high in Connecticut, Massachusetts, Rhode Island and New Hampshire. All these states reported substantial increases in ED visits, with Connecticut winning highest rate at 9.9%. In Massachusetts, hospitalizations doubled this past week to 4.8% of all hospitalizations.

In Pennsylvania and Maine, outpatient ILI and ED visits remain a bit lower, but are increasing quickly. Only in Vermont is flu still quite low, with ED visits at 1.8%.

COVID-19

Covid-19 activity is on the rise. Wastewater activity has increased to moderate levels in the region. ED visits are low, ranging from ~0.5-1%, but increased in most states this past week.

Connecticut has the highest ED visits in the region as well, at just under 1% and wastewater concentration is high. and Massachusetts is not far behind, at 0.9%. Hospitalizations held roughly steady in Connecticut at a low-to-moderate 3.1.

Wastewater activity is moderate and rising in Rhode Island, Pennsylvania, and New Hampshire, and all three states also reported increases in ED visits.

In Maine, wastewater activity has fallen down from high levels to moderate. We need a couple more data points to see if this was a relatively small wave (even under the small late summer wave), or if it will rise again. ED visits continue to rise in the state, to 0.9%.

In Vermont, wastewater activity is low and ED visits held steady at 0.76%. In New York and New Jersey, wastewater activity remains very low and the states have the two lowest ED rates in the region, at 0.5% and 0.6%, respectively. In New York, hospitalizations are low and decreased slightly this past week, to 2.9 hospitalizations per 100,000 people. Activity is stable in New York City.

RSV

RSV is now classified at moderate activity nationally and is growing in nearly all states. ED visits have increased to 0.4% for all age groups, and to 3.6% for children aged 0 to 4 years. For children 0-4, hospitalizations are elevated at 8 hospitalizations per 100,000 people.

ED visits for RSV increased in most states in the Northeast this past week, including Connecticut, Pennsylvania, and New Hampshire. In New Jersey, ED visits increased to 0.5%, the highest rate in the region. Rates held steady in New York (0.3%) and Maine at less than 0.1%.

Hospitalizations increased slightly in Connecticut (to 1.0) and decreased slightly in New York (to 1.3).

Other Bugs

Stomach Bugs

Norovirus is high nationally, at 12.1% test positivity. Test positivity rebounded in the South up to 15%. In the West and Midwest, test positivity is high and increasing at 11.2% and 12.2%, respectively. In the Northeast, test positivity increased to 8.8%. Norovirus loves the type of close contact and shared food plates that occur over the holidays, so I expect these rates to be even higher by next 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:

Previously Reported:

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