Important programming note: During summer months, this weekly respiratory illness report is available to paid subscribers. Beginning in October with the onset of flu season, everyone receives the national overview for free, while paid subscribers receive bonus regional reports with state-by-state details to help you understand what's happening locally.

Respiratory Diseases

Influenza-like illness

Influenza-like illness (ILI) held steady this week, so the small increase I noted last week did not intensify. Outpatient visits for influenza-like illness have increased to 1.8%, up from 1.0% six weeks ago. This remains well below the 3% threshold that marks the start of flu season.

Outpatient ILI by age group ranges from a low of 0.7% for those 65+ to 5.2% for kids aged 0-4. School age kids (5-24) saw a slight decline, from 2.8% to 2.7%.

Activity in the Southern region as a whole declined slightly from 2.3% to 2.0%. It was offset by small increases in the Midwest, from 0.9% to 1.2%.

Hospitalizations held steady at a very low 0.3 per 100,000 people.

COVID-19

Wastewater activity for Covid-19 is high and continuing to rise nationally. However, both emergency department visits and hospitalizations declined in the South and West, so I continue to assess that we are past the peak in those regions—though please note, there are exceptions at the state level.

CDC’s reproduction number estimates (a measure of epidemic trends) also finds Covid-19 activity to be declining in the South and West.

Activity is still rising in the Midwest and Northeast, but is lower overall compared to other regions of the country.

South

Wastewater activity in the South is very high and increased again this past week. It remains a bit below its peak from last summer. However, both emergency department visits and hospitalizations are declining in the southern-most states. The more northern part of the region has not yet turned the corner.

The peak appears to have passed in Florida, Texas, and Louisiana, though activity remains high in all three states. In Alabama, activity has declined to high levels, down from a peak a few weeks ago. ED visits remain elevated but decreased in all of these states in the past week. Hospitalizations also decreased slightly in Florida and Texas.

In Tennessee, wastewater activity surged this past week, tripling to very high levels. Hospitalizations are also increasing in the state, though ED visits are quite low. Similarly, wastewater activity is very high and still rising, in Washington, DC, North Carolina, Maryland, and Delaware. ED visits also increased in these states, as did hospitalizations in North Carolina and Delaware.

Despite very high and rising wastewater activity and increasing hospitalizations in South Carolina and Kentucky, ED visits decreased in both states.

In Arkansas and Virginia, activity is high and rising and ED visits have been an on increasing trend. The lowest activity in the region can be found in West Virginia and Georgia, where activity remains moderate.

West

Some mixed signals: wastewater activity in the West is high and increasing, but ED visits declined in most states in the region this past week, as did hospitalizations.

In California, wastewater activity is very high and surging higher, and both hospitalizations and ED visits are moderately elevated and declined during the last week.

Activity is very high and appears to be peaking in Nevada, with wastewater activity slowing its rise and ED visits decreasing slightly this past week. Hospitalizations in the state have remained fairly low throughout this wave.

In Alaska, activity has spiked back up again, though a bit lower than the peak it reached in late July. Activity remains very high in Utah, and in Washington, Oregon, and Montana activity is high and steadily increasing. Trips to the ED increased in both Oregon and Montana, and held steady in Washington.

The peak appears to have passed in both Idaho and Hawaii, though activity remains very high in both states. In Hawaii, hospitalizations are declining and ED visits in both states decreased this past week.

Northeast

Wastewater activity in the Northeast held steady this past week at a moderate level. Trips to the emergency department remain low but are increasing in every state except Vermont. Hospitalizations also ticked up slightly.

Connecticut remains the central point of Covid spread in the region: wastewater activity in the state is very high and looks near-peak. ED visits increased notably there this past week as well, though the hospitalization rate remains low (at 1.4 per 100,000). In neighboring Massachusetts and Rhode Island, activity has increased to high levels.

In Pennsylvania and New Jersey, activity remains moderate but increased notably this past week, as did ED visits. Activity is moderate and decreased slightly in Maine, and remains low in New York, New Hampshire, and Vermont.

Midwest

Activity in the Midwest remains moderate but is picking up steam. More severe illness, i.e., emergency department or hospitalization, remains low but is increasing in most states in the region.

In Indiana and in South Dakota, wastewater activity is very high and increasing. In Nebraska, activity looks to be peaking at very high levels. Nevertheless, hospitalizations in all three states remain low.

Iowa leads the region for ED visits due to Covid-19, though wastewater activity in the state remains moderate. Activity is moderate and increasing, and ED visits are rising, in Minnesota, Illinois, Kansas, and Ohio.

RSV & Other Bugs

RSV: Activity is still very low, but it does look to be increasing. Wastewater activity remains very low in every state, as do rates of ED visits and hospitalizations. Nevertheless, there are tiny increases in ED visits in a handful of states in each region, including Minnesota, Alaska, Delaware, Kentucky, and Massachusetts. Nothing to worry about yet, but it does suggest the season is starting.

Other Bugs: Cold season is upon us. One common cause of colds, rhinoviruses/enteroviruses, are high and appear to have peaked. Two other causes of cold- and flu-like illness (adenovirus and parainfluenza) are fairly low but are picking up.

Norovirus

CDC data has not been updated in over a month. I will inquire about the source of the delay. My backup data source shows an increase to moderate spread in the South, increasing but still low spread in the Northeast, and low spread in the Midwest and West.

Food recalls

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

New:

• Frozen vegetables and fruits sold under the Deep brand name (more info)
• Multiple cheeses sold under the Middlefield Original Cheese Co-Op label, including cheddar and Monterey Jack (more info)
• Ready-to-eat, home delivery meals from Metabolic Meals (more info)

Previously reported:

• Endico frozen peas and carrots, and mixed vegetables (more info)
• Various cocktail shrimp, including those sold under brand names Kroger, Great Value and Aqua Star (more info) and frozen and cooked shrimp under multiple brand names (Sand Bar, Arctic Shores, Best Yet, Great American, First Street) due to possible Cesium-137 (radionuclide) contamination (more info)
• Country Eggs, large brown sunshine yolks (more info)
• Viva ground beef for dogs and ground chicken for dogs and cats (more info)
• Pepper Jack cheese and Horseradish-flavored cheese sold under Middlefield, Copia Collective, and Farmers Cheese labels (more info)
• If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.

In other news

• Measles update. Public health officials have confirmed 36 measles cases (2 hospitalizations) in Oconto County, Wisconsin. All cases have been among unvaccinated individuals.

  • In Los Angeles County, a school-aged child died of subacute sclerosing panencephalitis (SSPE), a late complication of measles infection in infancy. SSPE is nearly always fatal.

  • Nationally, new measles cases have slowed over the past few months, but clusters continue to appear in multiple states. 1,454 cases of measles have been confirmed by the CDC in 2025.

• Salmonella outbreak linked to home delivery meals from Metabolic Meals. There have been 16 cases across 10 states linked to specific lots of ready-to-eat meals from the food delivery service, including 7 hospitalizations (see Food Recalls, above). Since most people who get food poisoning recover on their own without seeking medical care (and those that who receive care often do not receive diagnostic testing that would link them to a given outbreak), the true number of affected individuals is likely substantially higher.

• ACIP meets this week. CDC’s Advisory Committee on Immunization Practices, which advises on vaccine matters, will meet this week. All previous committee members were removed over the summer and replaced by allies of RFK Jr. There are votes scheduled on vaccines for Covid-19, measles, mumps, rubella, varicella and hepatitis B. Recommendations that reduce vaccine access seem likely.

Get detailed, state-specific public health updates with regional editions—available to paid subscribers. Stay informed where it matters most to you!