Using Biobot and CDC data through June 6, Mike Hoerger estimated that about every 1 in 269 people was currently infected with COVID, with 182,000 new COVID cases each day in the United States.

This week, research shows autoantibodies in kids after COVID infection, decreased glucose metabolism in the brains of people with Long COVID, an ultrasound patch that can continuously monitor the fetus in pregnancy, inhaled insulin for kids with diabetes, and much more.

Pediatrics

Antibody repertoire associated with clinically diverse presentations of pediatric SARS-CoV-2 infection | Nature

• Rutgers and Stanford scientists analyzed antibody profiles in 139 children with COVID-19, ranging from mild infection to severe disease and MIS-C, plus 28 healthy controls. All COVID infected children, including those with asymptomatic COVID infections, showed increased autoantibodies, suggesting that pediatric SARS-CoV-2 infection may predispose to immune dysregulation. MIS-C patients had higher anti-Spike IgG than severe COVID-19 cases, though antibody function did not differ, pointing to possible antibody dysfunction in MIS-C.

Long-Term Outcomes of Multisystem Inflammatory Syndrome in Children (MIS-C) up to 4.5 Years After COVID-19 | Pediatrics (AAP)

• Montefiore Health System researchers tracked 14,363 children and adolescents and found that MIS-C was associated with elevated risks of cardiac, pulmonary, gastrointestinal, neurological, renal, and blood pressure disorders persisting as long as 4.5 years after COVID infection. These findings underscore that the health burden of MIS-C extends well beyond the acute phase of illness. “Structured long-term follow-up, including routine blood pressure monitoring, neurological and mental-health screening, and cardiovascular and renal surveillance, with coordinated multidisciplinary care is warranted.”

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Vaccines

Menstrual cycle phase and its association with COVID-19 vaccine outcomes among period tracking app users | npj Women’s Health

• London scientists, in collaboration with the Clue app, analyzed data from 1,474 women and found that receiving a COVID vaccine during the follicular (estrogen producing) phase of the menstrual cycle was associated with 35% greater odds of side effects as compared to the luteal (progesterone producing) phase, with longer lasting protection. “Median time to COVID infection was 35 days longer following follicular-phase vaccination (200 vs 165 days, p = 0.05), though infection numbers were limited,” and more studies are needed.

Sustained antigen-specific CD8+ T cell immunity post–mRNA booster requires notch pathway activation | Journal of Immunology

• Japanese researchers followed 141 people after a third Pfizer COVID-19 booster and tracked spike-specific CD8+ killer T cells for six months. People who maintained strong T cell responses showed higher activity of the Notch signaling pathway, while those whose responses waned did not. Blocking Notch signaling in the lab prevented CD8+ T cells from expanding after re-exposure to spike protein. These findings suggest that Notch signaling helps sustain long-term killer T cell immunity after mRNA vaccination and may be a target for improving future vaccines.

Long COVID

Persistent Cerebral 18-FDG PET Changes in Patients With Long COVID Presenting With Fatigue and Post Exertional Malaise | J of Primary Care & Community Health

• Scientists from Mayo Clinic examined 40 Long COVID patients experiencing fatigue and post-exertional malaise (PEM) and found measurably decreased cerebral glucose metabolism via 18F FDG PET imaging, concentrated in sensorimotor and visual brain regions. This pattern of reduced brain energy use persisted for at least two years after the initial COVID infection in patients with fatigue and PEM.

Figure 2. Representative ¹⁸F-FDG PET scan for a patient with Long COVID showing cerebral hypometabolism.

• The bottom panel shows “near global hypometabolism particularly pronounced in the occipital lobes, correlating with the participant’s symptoms of cognitive dysfunction and fatigue with post exertional malaise.”

From: https://journals.sagepub.com/doi/10.1177/21501319261458748

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Single-cell profiling of innate and adaptive immune dysregulation in Long COVID | BioRxiV

• Emory University researchers analyzed single-cell profiling on 156,478 peripheral blood mononuclear cells (PBMCs) from 20 Long COVID (LC) patients and 18 recovered controls (RC) and found that Long COVID patients show persistent immune cell activation consistent with ongoing viral antigen exposure. B cells remained in an activated state, T cells displayed markers of exhaustion, and NK cells lost normal function, collectively pointing to a system that cannot stand down from fighting an infection that may still be present in some form.

Beyond brain fog: viral proteins as convergent drivers of neuroinflammation and proteinopathy | Current Opinion in Virology

• A new review from the University of Veterinary Medicine Hannover proposes that viral proteins persist after viral infections. These viral protein fragments can act as neurotoxins and can activate TLR4 and TLR2 toll-like receptors on glial cells which triggers neuroinflammation even when live virus is absent from the nervous system. The inflammatory cytokines made by glia cells and astrocytes can also activate tau and alpha-synuclein proteins to accumulate in the brain. Tau protein is associated with Alzheimer’s disease and alpha-synuclein with Parkinson’s disease and Lewy body dementia. This offers a concrete molecular pathway connecting post-infectious illness, including Long COVID, to lasting cognitive (brain fog) and neurological symptoms.

From: https://www.sciencedirect.com/science/article/pii/S1879625726000519#fig0005

Intracellular microbial shifts during COVID-19 infection and longitudinal recovery revealed by single-cell RNA sequencing | iScience

• Scientists in India performed single-cell RNA sequencing of 191,417 peripheral blood mononuclear cells (PBMCs) from 57 individuals (9 healthy, 24 Omicron-infected, 16 recently recovered, 8 Long-recovered) and discovered that SARS-CoV-2 infection altered the microbial communities residing inside immune cells, with opportunistic bacteria accumulating specifically within T cells and platelets. Over the course of extended recovery, the intracellular microbial composition in these individuals gradually shifted back toward the patterns observed in healthy people.

Salivary microRNA Profiling of Long COVID Subjects Reveals Host-Encoded Regulators of Inflammation and Viral Persistence | BioRxiV

• Researchers from the University of Illinois Chicago studied 30 participants and found that Long COVID patients with periodontitis had widespread depletion of salivary microRNAs that ordinarily suppress NFκB driven inflammation and are capable of binding SARS-CoV-2 RNA. When those microRNAs were reintroduced in cell experiments, both inflammatory signaling and viral gene activity measurably declined.

COVID‐19 as a Potential Trigger for Tuberculosis: Insights From a Large‐Scale Japanese Insurance Database Analysis | J of Family and General Medicine

• A retrospective cohort study from Japan of over 6 million people shows that COVID infection is associated with a 4x risk of needing Tuberculosis treatment. In those who had prior tuberculosis, risk was 14.7x higher after COVID infection, showing that COVID infection may increase the risk of Tuberculosis reactivation.

A more than fourfold increased risk of active TB treatment initiation following COVID-19.

From: https://onlinelibrary.wiley.com/doi/10.1002/jgf2.70139

Immunothrombosis in hospitalized COVID-19 patients identified by multiomics profiling and linked to postacute complications | iScience

• A group from Latvia followed 81 hospitalized COVID patients and found that blood drawn three months after severe infection continued to show measurable abnormalities in platelets, the complement system, and vascular function in 46 people with Long COVID. These persistent immunothrombosis signatures suggest that clotting related disruptions in severe acute COVID infection can leave a lasting biological imprint in Long COVID.

Immunoadsorption Versus Sham Treatment for Post-COVID Syndrome: A Randomised Sham-Controlled Crossover Trial | Lancet Regional Europe

• Researchers from Mainz, Germany tested immunoadsorption in 40 Long COVID patients to determine whether removing GPCR autoantibodies from the bloodstream would relieve Long COVID symptoms, but outcomes did not improve compared to the sham procedure. Immunoadsorption also produced adverse events at a higher rate than the control condition.

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Measles

CDC Measles updates (on Wed.):

• As of June 11, 2026, 2,073 confirmed measles cases were reported in the United States in 2026.

John Hopkins US Measles Tracker

• There have been 86 new measles cases, mostly in Utah and Virginia.

Other news

Fetal monitoring for high-risk pregnancies using a wearable ultrasound patch | Nature Biotechnology

• This may be a game changer for obstetrics. UC San Diego researchers developed a wearable ultrasound patch (UPatch) for continuous fetal ultrasound monitoring. Tested on 62 pregnancies, the UPatch matched handheld clinical ultrasound readings and tracked fetal blood flow in real time autonomously without a sonographer. Continuous UPatch ultrasound monitoring in 52 pregnant women successfully stratified high risk obstetrical conditions including preeclampsia, gestational diabetes, and fetal growth abnormalities.

From: https://www.nature.com/articles/s41587-026-03140-1

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FDA Approves Inhaled Insulin for Children, Adolescents With Diabetes | AJMC

• The FDA approved Afrezza (inhaled insulin human) for children and adolescents ages 6 and older with type 1 or type 2 diabetes, making it the first needle-free mealtime insulin option for pediatric patients. The phase 3 INHALE-1 trial showed no significant pulmonary safety signals, and treatment satisfaction was higher in the inhaled insulin group for both patients and parents.

Microbiota-driven gut-brain signaling underlies antidepressant effects of a GLP-1 analog | Cell

• Chinese scientists showed that liraglutide reduced depressive behavior in mice through a pathway that bypasses its known GLP-1 receptor, instead operating through changes in gut bacteria. The drug selectively increased Lactobacillus delbrueckii populations in the gut, which in turn increased endocannabinoid 2-arachidonoylglycerol (2-AG), which then suppressed stress-related overactivation in brain circuits related to depression.

Gut microbiota-derived short-chain fatty acids (SCFAs): immunomodulatory effects and therapeutic potential in infections | Clinical Microbiology Reviews

• A new review examines how short-chain fatty acids (SFCAs), especially butyrate, propionate, and acetate, affect immune responses to bacterial, viral, and fungal infections. Gut bacteria produce SFCAs when they break down dietary fiber. SCFAs and SCFA-producing bacteria may support treatment of infections by strengthening the gut barrier, calming excess inflammation, and boosting pathogen clearance, but their effects vary depending on the microorganism and the SCFA concentration.

Fig 3 The regulatory effects of SCFAs on the intestinal barrier, host immunity, and distant organs.

From Fig 5: Interactions between SCFAs and viruses.

Made with Canva, based on https://journals.asm.org/doi/10.1128/cmr.00368-25

Interleukin-10 Autoantibodies and HLA-DRB1*01:03 in Inflammatory Bowel Disease | NEJM

• Interleukin-10 (IL-10) is an important anti-inflammatory cytokine. Researchers in England discovered anti-IL-10 autoantibodies in 3.5% of 4,909 Inflammatory Bowel Disease (IBD) patients studied. IL-10 autoantibodies were highly enriched in people with HLA-DRB1*01:03, with odds ratios of 24.7x - 50.0x found across two large cohorts. High anti-IL-10 titers were associated with exaggerated proinflammatory cytokine release. The findings reframe IBD as a group of mechanistically distinct diseases and open a path toward targeted anti-autoantibody therapy in a subset of patients.

Explainer article can be found here:

Autoantibodies against Cytokines — From Infection to Inflammation | NEJM

I’m a Tech Expert. Here’s How I Prep My Devices for an International Trip. | NY Times (Article can also can be found at https://archive.is/Jr0y5)

• Heading overseas this summer? A tech journalist’s pre-trip checklist: check your carrier’s international plan, grab an eSIM for cheap local data, download offline maps and translation tools, back up your itinerary and passport, and pack a universal travel adapter. He also recommends that before flying home, disable biometric unlock and consider hiding your social apps to protect your privacy at customs.

A former teacher reunited with students decades after inviting them to watch the 2024 solar eclipse together | Today

• Retired Rochester science teacher Patrick Moriarty reunited with over 100 former students for a solar eclipse watch party he had planned 46 years earlier. In 1978, he told his 9th graders to mark April 8, 2024 on their calendars. He also extended the invitation to students in subsequent years. Decades later, his former students came from across the country, some with gray hair like him, to watch the solar eclipse with their favorite teacher.

Mr. Moriarty and some of his former students

Photo: Caitlin Moriarty Hynick

Have a great week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Wastewater SCAN:

https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

COVID

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data in other countries: https://pmc19.com/data/index.php#internationa

https://www.cdc.gov/wastewater/respiratory-viruses/state.html?cove-tab=1

States through 6/6/26 per CDC wastewater. Mississippi 1 in 45 was infected with COVID as of June 6.

PMC19 using CDC data through June 6, 2026.

Wastewater SCAN- more up to date, but omits 12 states

CDC wastewater reporting: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International: See https://pmc19.com/data/index.php#internationa

UK: UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

Before you scroll past, please check out the Government News and Other News sections at the end of this issue of the newsletter. There is a Friday night executive order you may have missed, diabetes researchers removed by police at the ADA medical conference, a personalized melanoma vaccine with striking five-year results, and an Alzheimer’s case report that is surprising.

Weekly Virus Summary

COVID, RSV, Influenza A, and Influenza B remain low in wastewater across the country. In fact, COVID wastewater levels are their lowest in 5 years.

From: WastewaterSCAN

COVID

COVID data through 5/23/26 from Mike Hoerger:

• 1 in 277 Americans are currently infected with COVID which equals to about 177,000 new daily COVID infections in the U.S., and 1.2 Million new COVID infections per week.

• SARS-CoV-2 transmission remains at its lowest levels nationwide since mid-July 2021.

6/3/26 Newsweek: Worrying COVID ‘cicada’ variant spreads as US maps go dark https://buff.ly/Dq65XAn

• Newly proposed federal budget cuts would slash CDC wastewater surveillance funding from $125 million to $25 million annually, threatening the national early warning system experts say detects outbreaks weeks before clinical cases emerge.

Acute COVID infections, General COVID info

6/4/26 MedRxiV: Shared epigenetic regulation acting on neuroimmune pathways contributes to the comorbidity between generalized anxiety disorder and COVID-19

• Yale researchers analyzed genes from 893 participants and found that “generalized anxiety disorder (GAD) and COVID-19 share epigenetic and genetic architecture involving pathways related to vascular integrity, immune function, and cellular adaptation, highlighting a potential neuroimmune basis for their co-occurrence.” They found 60 overlapping genetic loci between GAD and COVID and brain-specific analyses flagged HLA and MICB genes.

6/2/26 Nature Sci Reports: A 19-layer convolutional neural network for accurate COVID-19 detection in chest X-ray images: comparative analysis with pretrained networks

• Using a new 19-layer convolutional neural network to evaluate 25,679 chest X-rays, Singaporean researchers found that the model was 98.4% and 97.5% accurate for diagnosing COVID infection. The model outperformed several established pretrained networks in image classification performance, but whether this translates to measurable improvements in real world patient outcomes would require clinical trials.

Pediatrics

6/3/26 Nature Scientific Reports: Retinal microvascular alterations consistent with endothelial dysregulation in paediatric post-COVID-19 syndrome: A prospective matched-cohort study

• German scientists examined the eyes of 74 pediatric patients with Long COVID and found measurable retinal microvascular abnormalities. These vascular changes, detectable through noninvasive eye imaging, point to disrupted endothelial cell function and abnormal blood flow patterns and may reflect microvascular issues in other organs in children with Long COVID.

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6/3/26 BioRxiV: SARS-CoV-2 BA.3.2.2 is more evasive of neutralization by sera from young children

• BA.3.2 is a fairly new COVID variant that appears to infect children more than adults. Columbia University researchers found that young children produced substantially weaker neutralizing antibody responses to the BA.3.2.2 variant compared to adults, while antibody responses to the XFG and NB.1.8.1 variants were broadly comparable across all age groups. Prior infection and vaccination histories, which differ considerably between children and adults, may be driving differences in immune protection against specific emerging variants.

Antiviral treatments

6/1/26 Shionogi Announces FDA Approval of XOCOVA® (ensitrelvir), the First and Only Oral Option to Help Prevent COVID-19 Following Exposure

• The FDA approved Ensitrelvir (XOCOVA) this week, making it the first oral medication indicated for preventing COVID following known exposure to the virus. In a Phase 3 clinical trial, the drug reduced the incidence of symptomatic COVID-19 by 67%, functioning by suppressing viral replication before symptoms have a chance to develop.

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Long COVID

Comment here by June 11:

https://www.federalregister.gov/documents/2026/05/12/2026-09366/drug-repurposing-for-unmet-medical-needs-request-for-information

PolyBio posted summaries of presentations and links to the talks from their recent PolyBio Spring 2026 Symposium

https://2026-spring-symposium-polybio.netlify.app/

• “Twenty-eight research presentations on Long COVID, ME/CFS, and related infection-associated chronic illness. Each card opens to a full technical summary.”

• PolyBio topics discussed:

6/2/26 Applied Psychopharmacology: The expanding potential of low-dose naltrexone in clinical practice with a focus on long COVID

• Researchers at the VA Northeast Ohio Healthcare System conducted a review of existing small-scale studies examining low-dose naltrexone (LDN) as a potential treatment for Long COVID. The findings suggested an association between LDN and reductions in fatigue, post-exertional malaise, disrupted sleep, and cognitive impairment, with researchers pointing to the suppression of neuroinflammation as a likely underlying mechanism. Evidence remains preliminary, however.

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5/31/26 Journal of Sleep Research: Association of Prodromal Parkinson’s Disease-Like Features in Long COVID With Dream-Enactment Behaviours

• Dream enactment behaviors (DEBs) are when someone physically acts out their dreams with movements or vocalizations during sleep. A large multinational study found that Long COVID patients show significantly elevated rates of prodromal Parkinson’s disease features including loss of smell, constipation, excessive daytime sleepiness, and cognitive difficulties. People with Long COVID who also developed or worsened DEBs had the highest risk. Because frequent DEBs can be an early marker of neurodegeneration including Parkinson’s and Lewy body dementia, the authors call for long term neurological monitoring of Long COVID patients.

Figure 2: Forest plot of adjusted odds ratios for potential prodromal PD-like features in participants with Long COVID (weighted sample).

From: https://onlinelibrary.wiley.com/doi/10.1111/jsr.70371

6/4/26 BioRxiV (UCSF): No objective evidence of neuropsychological deficits in people with subjective cognitive changes following COVID-19 infection

• UCSF scientists studied 86 people and found that individuals who reported brain fog following COVID infection did not have measurable cognitive deficits on standardized tests, yet they demonstrated elevated levels of the inflammation marker sCD14 along with greater rates of anxiety, depression, and the APOE ε4 genetic variant. These findings suggest that the subjective experience of post COVID cognitive impairment may reflect underlying neuroinflammatory and psychological processes that standard cognitive assessments are not designed to detect.

5/29/26 BMC Public Health: Bidirectional relationship between depression and long COVID symptoms: findings from the Sulcovid-19 longitudinal survey

• Researchers studying 2,919 Brazilian adults with prior COVID infection found that depression and Long COVID symptoms mutually amplify one another, creating a reinforcing cycle. A history of depression increased the likelihood of neurological Long COVID symptoms, and experiencing Long COVID raised the odds of a subsequent depression diagnosis by 65%.

5/30/26 Respiratory Medicine: Inspiratory Muscle Fatigue and Pulmonary Deposition–Perfusion Imaging Predict Sleep Dysfunction in Long COVID: Evidence From MTC Scintigraphy and FIT Performance Metrics

• Brazilian scientists studied 33 Long COVID patients and found that weakened inspiratory muscles corresponded with reduced aerosol deposition and abnormal perfusion patterns on scintigraphy, alongside disrupted sleep. Inspiratory muscle fatigue was a strong predictor of impaired lung ventilation, pointing to a mechanistic link between breathing muscle dysfunction and broader respiratory and sleep impairments in Long COVID.

Figure 4 Representative ventilation and perfusion scintigraphy images comparing symptomatic and asymptomatic post-COVID-19 individuals.

From: https://www.resmedjournal.com/article/S0954-6111(26)00288-X/fulltext

Here is a helpful explainer video from Tokyo on the basics of Long COVID:

6/3/26 Infectious Diseases and Therapy: Prior SGLT2 Inhibitor and Metformin Use and Risk of Long COVID in Type 2 Diabetes: A Nationwide Population-Based Cohort Study

• Researchers from Singapore analyzed 71,698 adults with Type 2 Diabetes and found that those who had previously taken SGLT2 inhibitors or metformin faced a meaningfully lower risk of developing Long COVID, with SGLT2 inhibitors showing a particularly notable association with reduced neurological complications. As this was an observational cohort study, it cannot establish that either medication directly protects against Long COVID, so more studies are needed.

6/4/26 Military Medicine: Lung Function in Young, Active Duty U.S. Marines After SARS-CoV-2 Infection

• The Naval Medical Research Command evaluated lung function in 889 Marines (mean age 19 years). Among those infected with COVID-19, nearly 25% reported Long COVID (PASC). Marines with PASC had reduced peak expiratory flow compared with recovered peers, suggesting subtle airway dysfunction that standard spirometry may miss, even in young, physically fit adults.

6/1/26 Wired by Alan Levinovitz: The Painful Truth About Long Covid https://buff.ly/bAYh0iE

• This week, Alan Levinovitz wrote an article in Wired magazine that received sharp criticism from the Long COVID community. He wrote about people recovering from Long COVID by doing “brain retraining”, but patients and researchers pointed out on Twitter and Instagram that the article was biased with cherry picked data that did not represent the experiences of most Long COVID patients.

MCAS

6/4/26 Diagnosis Journal: Progress in mast cell activation syndrome: the global consensus-2 diagnostic criteria at six years https://buff.ly/5DcTlYg

• Six years after consensus-2 diagnostic criteria were introduced for Mast Cell Activation Syndrome (MCAS), fears of overdiagnosis have not materialized, according to a new review. Appropriate treatment can dramatically improve quality of life for patients who often spent decades undiagnosed. MCAS frequently co-occurs with dysautonomia and EDS, with POTS as its most common comorbidity.

Measles

CDC Measles update (Wednesdays):

• As of June 4, 2026, 2,030 confirmed measles cases were reported in the United States in 2026 so far.

• South Carolina’s measles outbreak is over after 997 cases.

John Hopkins US Measles Tracker

In the past 2 weeks:

• Central Virginia has had 17 measles cases in the last 2 weeks.

• Utah has had 34 measles cases in the last 2 weeks.

New World Screwworm

6/4/26 CIDRAP: Texas reports New World screwworm in 3-week-old calf

• Texas reports New World screwworm in a 3-week-old calf. This is the first detection of larva of the parasitic fly in the U.S. in 60 years. The screwworm poses a significant threat to livestock and pets, but it rarely infects humans.

Ebola

6/1/26 NBC: As Ebola spreads, the institute Fauci once led (NIAID) stays on the sidelines without a leader https://buff.ly/QXMdlbQ

6/5/26 CIDRAP: WHO, Africa CDC announce joint Ebola response plan https://buff.ly/bfHwd4o

June 4 update from the government of DRC:

Government Health News

6/1/26 Melanie Matheu PhD (Lil Science): The President’s Friday Night Executive Order He Didn’t Want You To See: Elimination of Recommendations for 6 Childhood Vaccines

• On May 29, 2026, President Trump signed an executive order removing six childhood vaccines from the CDC recommended schedule, including Influenza, COVID-19, Rotavirus, Hepatitis A, Hepatitis B birth dose, and Meningococcal vaccines. A court previously blocked the RFK Jr. appointed ACIP committee from making these same changes. Many states are now following the guidance of the American Academy of Pediatrics (AAP) instead of the CDC.

6/1/26 NY Times: Trump Administration Announces Stricter Rules for Medicaid Work Requirement

• “A new rule by the Trump administration could make it even harder for millions of sick Americans to obtain or stay on Medicaid after work requirements start next year.” Adults on Medicaid will be required to work 80 hours per month. It is hard to work when you are sick with cancer or HIV.

6/2/26 NY Times: New Proposal Would Allow Administration to Block Grants if They Don’t Support Trump’s Agenda

• “A new proposal would allow the administration to block grants if they do not satisfy President Trump’s agenda or support what it calls “anti-American” values... The proposal was only the latest attempt by the Office of Management and Budget, led by Russell T. Vought, to exert power over federal funding.”

6/5/26 MedPage Today: Video: Police Tussle With Diabetes Experts at ADA Meeting

• At the American Diabetes Association‘s annual meeting in New Orleans, police escorted out senior researchers, including the Editor in Chief of the ADA’s journal Diabetes Care, for distributing copies of an editorial the journal had published criticizing Trump administration cuts to biomedical research. The editorial warned that NIH funding reductions threaten diabetes research and outcomes.

Here is the article that the doctors were passing out to their colleagues:

• 4/29/26 Diabetes Care:

Misguided Brushes of a Pen Continue to Dismantle and Destroy Biomedical Research in the United States: We Can No Longer Afford Complacency and Fear. We Must All Act Now!

From: Medpage Today

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6/4/26 Wash Po: House bill rolls back food aid for pregnant women, children

• “Millions of WIC recipients would have less money for fruits and vegetables under the legislation.”

6/2/26 Nature Medicine: Medically tailored meals receipt and healthcare utilization and costs in Massachusetts’ Medicaid demonstration

• A new study shows that if you give people healthy meals, they have fewer hospitalizations, fewer emergency department visits, and lower healthcare costs. Ironically, the House voted to remove funding for pregnant women and children to have fresh fruits and vegetables this week.

6/5/26 NPR: South Africa rolls out game-changing HIV shot amid funding shortfalls

• Lenacapavir is a new medication that can be given by injection once every 6 months to prevent HIV infections. South Africa is rolling out a program to provide Lenacapavir to reduce HIV infection rates, but cuts to USAID mean that access will be limited.

Other news

6/6/26 Journal of the American Heart Association: Glucagon‐Like Peptide‐1 Receptor Agonists and Cardiovascular Events in Adults With Obesity and Autoimmune Disease: A Target Trial Emulation

• In a propensity-matched analysis of more than 26,000 adults with both obesity and autoimmune disease, GLP-1 receptor agonists were linked to reduced mortality, stroke, pulmonary embolism, and emergency room visits.

5/27/26 Frontiers in Neuroscience: Transient multidomain functional improvement in advanced Alzheimer’s disease following high-dose psilocybin-containing mushroom administration: a case report

• A woman in her 80s with advanced Alzheimer’s disease could barely speak, had a flat affect, was incontinent, and could not walk. After taking a high dose of psilocybin mushrooms, she initially went into a sleep-like state and then woke up 19 hours later able to speak in full sentences, sharing detailed memories. Over the next few days, her family reported improved memory, ability to walk, emotional connection, and regained bladder control. This is a single case report, but the results are promising.

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6/1/26 Journal of Clinical Oncology: Intismeran Autogene Plus Pembrolizumab Versus Pembrolizumab Alone in High-Risk Resected Melanoma: 5-Year Update of the Randomized Phase 2b KEYNOTE-942 Study

• Wow! Five-year follow-up of a randomized trial finds that adding a personalized mRNA neoantigen vaccine called Intismeran autogene to Keytruda (pembrolizumab) cut metastatic melanoma recurrence and death by 49% compared to Keytruda alone. At five years, 69% of vaccine recipients were cancer-free versus 49% in the Keytruda-only group, with overall survival of 92% versus 71%. Distant metastasis of melanoma was also reduced by 59% with the addition of the personalized vaccine.

Figure 1. Kaplan-Meier estimates of Relapse-Free Survival (RFS). RFS was defined as time from first pembrolizumab dose to first recurrence (local, regional, or distant metastasis) by investigator assessment, new primary melanoma, or death from any cause.

From: https://ascopubs.org/doi/10.1200/JCO-26-00835

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6/4/26 Cell: Plasma signals of lung tumor promotion for molecular cancer prevention

• Researchers identified a 14-protein plasma signature that predicts lung cancer more than five years before diagnosis, validated across eight cohorts. The signature, discovered using machine learning, also identifies patients likely to benefit from anti-IL-1β preventive therapy, pointing toward a molecular early warning system for the disease.

Yesterday was D-Day, when the allied forces invaded Normandy. Historian Dr. Helen Fry shared the story of Gustav the carrier pigeon who flew 150 miles to Britain to relay news of D-Day success.

6/4/26 Space.com: Meteorite found in Sahara desert may be 1st evidence of lost solar system world

• A one pound meteorite found in the Sahara desert in 2019 may be the first physical evidence of a lost planet. Researchers at the University of Colorado Boulder identified it as an angrite, one of the oldest volcanic rock types in the solar system, with a chemical makeup distinct from Earth and Mars. Mineral crystals inside formed under pressures requiring a parent body at least the size of Earth’s moon, suggesting the rock originated from a now-destroyed protoplanet that existed 4.5 billion years ago.

John Kashuba, CU Boulder

6/21/26 NY Times: ‘La La Land’ Orchestral Performance Saved by Keyboardist in the Audience

• When the keyboardist fell ill mid-performance at a Sydney orchestral showing of La La Land, composer Justin Hurwitz asked the 2,000-person audience for a sight reader. 21-year-old University of Sydney student Sterling Nasa stepped up, delivered a solo on “Start a Fire,” and walked away considering music as his new career.

Photo: Lindsay Harapa, via Storyful

Have a good week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Wastewater SCAN: https://data.wastewaterscan.org/

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

COVID

Michael Hoerger modeling: http://pmc19.com, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

CDC: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

COVID, RSV, Flu A and Flu B in wastewater are all low or very low across the United States.

Acute COVID infections

5/27/26 Nature: Autoantibodies to IL-1Ra and PGRN in severe COVID-19 are associated with inflammation-induced hyperphosphorylated antigen isoforms https://buff.ly/AuIMMGT

• Germany’s NAPKON network analyzed blood from 280 COVID patients and found that severe COVID disease was associated with autoantibodies that neutralized two key regulators of inflammation, IL-1Ra and PGRN, effectively removing the natural brakes on the immune response. Although these autoantibodies declined over 12 months, affected cells retained abnormal sensitivity to inflammatory signals, suggesting lasting biological consequences beyond antibody clearance.

5/27/26 Nature Biotechnology: Scoring gene importance by interpreting single-cell foundation models - https://buff.ly/xYz6GJY

• Genentech researchers developed an AI tool called SIGnature that analyzed 22 million cells across 412 studies to identify gene activity patterns. The tool uncovered a shared immune cell program operating across Kawasaki disease, sepsis, and severe COVID infection. Serum from Kawasaki disease patients was also able to activate that same program in laboratory cells.

5/25/26 BMC Pulmonary Medicine: CT-adipose measures identify severe SARS-CoV-2 risk beyond traditional obesity metrics: a C4R cohort study https://buff.ly/StJJOX8

• A study of 8,412 American adults who had CT scans taken before the pandemic found that excess fat deposited around the heart and abdominal organs predicted higher odds of COVID hospitalization or death independently of BMI. These imaging based fat measurements captured risks that standard body weight classifications alone failed to detect.

5/23/26 Cell Discovery: Exosomal ORF3a mediates lung-liver axis to dysregulate hepatic lipid metabolism in mild COVID-19 https://buff.ly/6QU32Fz

• Researchers found that 53% of 196 patients with mild COVID infection had abnormal liver function tests. Follow-up mouse and laboratory studies identified the viral protein ORF3a as a likely cause, showing it can travel from the lungs to the liver inside exosomes, where it triggers fat accumulation and inflammation. These findings suggest that ORF3a can damage the liver even when the virus remains confined to the respiratory tract, making it a potential target for therapies aimed at preventing COVID-related liver injury.

Pediatrics

5/18/26 Journal of Allergy and Clinical Immunology: Circulating Extracellular Vesicles Drive Innate Immune Dysregulation in MIS-C https://buff.ly/Xmkz207

• Scientists from Turkey examined 98 pediatric patients and determined that small particles (extracellular vesicles) circulating in the blood, carrying remnants of the SARS-CoV-2 virus, triggered abnormal innate immune responses in children diagnosed with multisystem inflammatory syndrome (MIS-C). These extracellular vesicles activated specific inflammatory signaling pathways that researchers connected to potential vascular damage in affected children.

5/25/26 Brain, Behavior, and Immunity: Exposure to SARS-CoV-2 Spike protein during development induces astrogliosis, synapse loss and long-term cognitive dysfunction in mice https://buff.ly/94nQtYC

• “We found that a single neonatal injection of the Spike protein in mice [on day 1 after birth] increases seizure susceptibility, induces astrogliosis, and triggers a significant loss of excitatory and inhibitory synapses in the cortex and hippocampus within 10 days. Remarkably, 60 days post-Spike protein exposure, male mice exhibited persistent, sex-specific cognitive impairments” and memory deficits. The affected males also showed persistent neuroinflammation in the brain, suggesting that timing of viral protein exposure during development may have sex specific consequences for cognitive health.

From: https://www.sciencedirect.com/science/article/pii/S0889159126005477

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Long COVID

5/27/26 JAMA: Long COVID Persistence and Surveillance Gaps Across 58 US Hospitals https://buff.ly/zGt4uMR

• A cohort study of 457,950 hospitalized COVID patients across 58 US hospitals using AI found that 1 in 6 patients (16.3%) had Long COVID, with 89% of those cases progressing to chronic conditions. Standard diagnostic billing codes missed more than half of actual Long COVID cases, “obscuring a substantial chronic disease burden”. Long COVID prevalence continued to rise through 2024, showing an increasing and accumulating burden on the health care system.

5/28/26 Cell: Autoantibodies in long COVID: A mechanistic foothold in a heterogeneous disease https://buff.ly/GCwqjae

• English researchers Wall and Richter reviewed data from two independent groups- one from the Netherlands and the other from the United States- showing that giving purified IgG antibodies from people with Long COVID to mice causes similar Long COVID-like symptoms in the mice. They reviewed a paper from Chen et al. from the Netherlands that showed that transferring IgG antibodies from people with Long COVID (pwLC) and high GFAP levels caused pain-associated behaviors in recipient mice.

• They also discussed a new paper from the Iwasaki lab at Yale showing that people with Long COVID who had predominant neurocognitive symptoms had IgG autoantibodies targeting neural and endocrine tissues seen on immunofluorescence in mice and in human tissues. Transfer of IgG from these people to mice caused fatigue, pain sensitivity, and small fiber damage in the mice and immunofluorescence lit up in intraepidermal nerve fibers in murine tissue.

• They summarized: “Together, these studies provide compelling evidence that autoantibodies directly contribute to symptom generation in a subset of pwLC [people with Long COVID], particularly those with neurological symptoms, including pain and temperature sensitivity.”

4/21/26 Chen et al., Cell (Netherlands): Transfer of IgG from long COVID patients induces symptomology in mice https://buff.ly/Xqt2nUp

5//28/26 Cell (Iwasaki Lab): A causal link between autoantibodies and neurological symptoms in long COVID https://buff.ly/1nPeqLu

Graphical Abstract

From: https://www.cell.com/cell/fulltext/S0092-8674(26)00509-X

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5/27/26 Nature: Long-term cognitive outcomes after mild COVID-19, critical COVID-19, and non-COVID critical illness: a prospective cohort comparison https://buff.ly/MxGCS53

• Researchers from Germany evaluated 51 patients at a minimum of 12 weeks following illness and found that cognitive test performance was comparable between those who had mild COVID and those who had required intensive care. However, participants who developed Long COVID following a mild infection reported significantly greater burdens of fatigue, anxiety, and depression than their ICU counterparts despite that cognitive equivalence.

Made with ChatGPT and Canva

5/25/26 BMC Cardiovascular Disorders: Association of long-COVID with major adverse cardiovascular events and mortality: a real-world data cohort study https://buff.ly/ioBDTVL

• A matched cohort study of 86,122 patient pairs found that individuals with Long COVID have a 4.48 times greater risk of major adverse cardiovascular events (MACE), a 6.48x greater risk of coronary artery disease, and 3.46x greater risk of stroke. In addition, people with Long COVID also showed a 1.53x higher rate of death from any cause.

Made with Canva and ChatGPT

5/25/26 Annals of Allergy, Asthma & Immunology: Post-COVID-19 Onset of Allergic Conditions in a Propensity-Matched Cohort of Children and Adults https://buff.ly/reKTAFe

• In a propensity matched cohort of nearly 800,000 US military TRICARE beneficiaries ages 1 to 64, COVID infection was significantly associated with new onset allergic conditions across all six categories studied, with asthma showing the greatest risk increase (54% higher in the full cohort, 82% higher in children) in the 18 months after COVID infection. The findings suggest COVID drives persistent immune dysregulation toward type 2 inflammation.

5/13/26 Brain Communications (NIH): Central noradrenergic deficiency in post-infectious chronic fatigue: neurobehavioral correlates https://buff.ly/CLk76Gh

• Researchers at the NIH Clinical Center studied 122 individuals and found that both ME/CFS and Long COVID patients exhibit reduced activity in the brain’s norepinephrine signaling pathway. This neurochemical deficit was associated with greater fatigue severity, diminished grip endurance, post exertional malaise, and overall poorer health outcomes across the group.

5/17/26 Vascular Pharmacology: The role of the endothelium in long COVID https://buff.ly/hfs6bRS

• University of Miami investigators found that SARS-CoV-2 infection can impair the endothelial cells lining of blood vessels, compromising circulation and tissue oxygenation in Long COVID patients. Two small clinical trials observed that supplementation with vitamin C and L-arginine restored measurable improvements in vascular function, though researchers caution that large scale trials are needed before any conclusions can be drawn.

6/2026 (online 5/25/26) iScience: SARS-CoV-2 infects olfactory neurons and basal stem cells and induces axonal degeneration through TRPV1 activation https://buff.ly/s33iwpZ

• Scientists from the University of Hong Kong and Western University demonstrated in both human sensory cells and hamster models that SARS-CoV-2 directly infects the neurons responsible for smell as well as the basal stem cells that normally regenerate them, and also trigger axonal degeneration via the TRPV1 pathway. When TRPV1 was pharmacologically blocked with Capsazepine, this cellular damage was significantly reduced, pointing toward a concrete therapeutic target for the persistent smell loss seen in some Long COVID patients.

From: https://www.cell.com/iscience/fulltext/S2589-0042(26)01473-2

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Measles

CDC Measles Update

• As of May 28, 2026, 1,983 confirmed measles cases were reported in the United States in 2026.

John Hopkins US Measles Tracker

Vaccine Preventable Disease Tracker

10/29/25 Vaccine-Preventable Disease: A Global Tracker from Think Global Health https://buff.ly/6qBMq0w

Ebola in Democratic Republic of Congo (DRC)

5/29/26 NBC: Tracking the 2026 Ebola outbreak https://buff.ly/aQo5ggu

Other news

5/31/26 NEJM: Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer https://buff.ly/kw22hZ2

• In a randomized trial of 500 patients with previously treated metastatic pancreatic ductal adenocarcinoma (91.8% with RAS G12 mutations), the oral RAS(ON) multiselective inhibitor Daraxonrasib nearly doubled median overall survival compared to chemotherapy (13.2 vs. 6.7 months). Daraxonrasib also improved progression-free survival, marking a significant advance for a cancer with historically poor outcomes.

5/21/26 Nature Medicine: Resetting autoimmune disease with CAR cell therapies https://buff.ly/U6TAVT1

• Researchers from Germany and China reviewed the use of chimeric antigen receptor (CAR) cell therapies, originally developed to treat certain cancers, as a way to selectively eliminate B cells and “reset” the immune system in autoimmune diseases. They found that CAR therapies can achieve profound depletion of disease causing B cells throughout the body, potentially leading to long lasting remission from autoimmune diseases without the need for ongoing medication.

Fig. 1: Contribution of B cells in AutoImmune Diseases (AID)

From: https://www.nature.com/articles/s41591-026-04430-6/figures/1

5/27/26 Nature: Human haematopoietic stem cells remember inflammatory stress https://buff.ly/7DjnDT4

• A Canadian group shows that blood forming stem cells called Haematopoietic Stem Cells with inflammatory Memory (HSC-iM) retain a molecular memory of past inflammation. This phenomenon was confirmed in mouse xenograft models and in single cell genomic analysis of human samples. Inflammatory imprinting in HSC-iMs was observed in patients who experienced severe COVID infection, in aged individuals, and in those living with sickle cell disease.

5/30/26 CNN: After more than 66 years in the air, the industry’s longest-serving flight attendant prepares to retire https://buff.ly/D7LggrP

• Joan Prince Crandall, a Delta Air Lines flight attendant based in Seattle, retired May 30 after a record 66-year career. Crandall began working in 1959 at Pacific Airlines on a 24-passenger Douglas DC-3 plane. “There have been rapid advances in aviation during her career; the moon landing and the Boeing 747 came a decade after she started working as a stewardess.”

Joan Prince Crandall, center, with other Delta Air Lines flight attendants, pilots and crew members. (Delta Air Lines)

Have a great week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

• As of May 29, 2026, the amount of acute respiratory illness causing people to seek health care is very low.

• RSV activity started later than usual in most parts of the United States, but illnesses are not more severe than recent years. Activity has peaked in most regions of the country.

• COVID-19 activity is low in most areas of the country.

• Seasonal influenza activity is low.

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Updated last week, not yet for this week.

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

• San Jose wastewater has a small amount of Influenza B still, but otherwise, Santa Clara County wastewater is low for all 4 viruses.

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

COVID Variants

US Variant tracker | https://x.com/RajlabN | Mike Honey: https://bsky.app/profile/mikehoney.bsky.social

COVID levels continue to be low with only about 1 in 280 people currently infected with COVID in the United States. The CDC reported that Mississippi had MODERATE amounts of COVID in wastewater on 5/16/26, but that was calculated from limited data. The CDC reports that southern coastal states of Louisiana, Georgia, and Florida appear to have increasing levels of COVID, as does Hawaii.

RSV has peaked, and Flu A and Flu B are low in most areas.

From Wastewater SCAN

From: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

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Acute COVID infections, General COVID info

5/15/26 International Journal of General Medicine: BCG Vaccination Modulates Long-Term TNF-α and sCD40L in COVID-19: An Exploratory Longitudinal Study https://buff.ly/lwpzBJF

• In a small study, Brazilian researchers tracking 13 adults recovering from mild COVID infection found that BCG vaccination produced an initial rise in inflammatory markers TNF-α and sCD40L, followed by sustained reductions in both across a six month observation period. These findings point toward a trained immunity mechanism in which the BCG vaccine recalibrates the immune response to achieve better long term inflammatory control.

5/15/26 Nature: Tocilizumab versus Sarilumab among adults hospitalised with COVID-19: target trial emulation across England and Scotland https://buff.ly/W375Nml

• Actemra (Tocilizumab) and Kevzara (Sarilumab) are immunosuppressive biologic drugs that block interleukin-6 (IL-6) signaling to reduce inflammation. They are used to treat autoimmune and inflammatory diseases such as rheumatoid arthritis, with tocilizumab also approved for severe COVID and certain other inflammatory conditions.

• Using electronic health record data from England and Scotland, researchers analyzed outcomes among 10,487 adults hospitalized with COVID who received either tocilizumab or sarilumab. The study found no meaningful difference between the two treatments in survival or likelihood of hospital discharge, establishing both as clinically equivalent options for this patient population.

5/22/26 Nature Preprint (Russia and Germany): Mast cell–driven remodeling of pulmonary immune and stromal landscapes in COVID-19 https://buff.ly/BguKzpN

• Researchers from Russia and Germany analyzed 24 lung tissue samples and found that Mast Cells appear to activate immune signaling and fibrosis pathways during COVID infection which can lead to permanent fibrosis formation in the lungs.

Fig. 6 Interaction of Mast Cells (MCs) with collagen fibers in the lungs.

(C, D) Mast Cell (MC) colocalization with collagen fibers (double arrowed). Secretion of large tryptase-positive granules of mast cells (arrowed) to extracellular matrix targets

From: https://www.nature.com/articles/s41598-026-47864-1

Social and Advocacy

5/21/26 The Conversation: Long COVID will cost the US an estimated $8 billion over just 3 years due to healthcare burden, managing symptoms and loss to the workforce https://buff.ly/upjU0DV

• Scientists project that Long COVID will generate approximately $8 billion in costs across the United States over a three year period, driven by healthcare utilization, workforce absence, and persistent symptom management. The condition continues to affect significant numbers of Americans well beyond the acute phase of infection, and current US treatment capacity remains inadequate to meet the growing demand for care.

Pediatrics

5/19/26 BMC Public Health: Exploring post-Covid-19 condition in children and young people 3.5 years after infection: a mixed-methods analysis from the CLoCk study https://buff.ly/VXDh0ES

• University College London researchers tracked 50 children and young people (CYP) with Long COVID over 3.5 years following initial infection, finding that 84% continued to fulfill diagnostic criteria for Long COVID well into the study period. Participants frequently described profound fatigue, cognitive difficulties, and significant interference with schooling and everyday functioning.

Vaccines

5/22/26 Nature Immunology: A glycan-based adjuvant expands the breadth and duration of protection of mRNA-based vaccines https://buff.ly/owhEONA

• Boston Children’s Hospital researchers found that mannadjuvant, a formulation of fungal mannan and aluminum hydroxide, boosted antibody magnitude, durability, and breadth when combined with an ancestral-strain mRNA COVID vaccine in mice and non-human primates. Importantly, the combination produced neutralizing antibodies against highly immune-evasive Omicron variants including BA.5 and XBB.1.5, thus overcoming antigenic imprinting. Antibody-secreting cells also remained elevated in bone marrow for 500 days after vaccination eliminating the need for a booster.

Antiviral treatments

5/19/26 Journal of Infectious Diseases: Serum Virus-Neutralizing Antibody Titers in Clinical Trial Participants With and Without Immunocompromise Receiving Pemivibart, a Long-Acting Monoclonal Antibody for COVID-19 https://buff.ly/DdP2tPx

• Analyzing data from the phase 3 CANOPY trial, Invivyd researchers found that pre-dose neutralizing antibody titers against the then-circulating XBB.1.5 lineage were low in both immunocompromised and non-immunocompromised cohorts. A single 4500 mg pemivibart (Pemgarda) infusion raised those titers more than 55-fold by day 28 in both cohorts, and calculated titers were found to be similar to lab measured antibody titers.

5/18/26 BioRxiV: Orally Bioavailable SARS-CoV-2 Protease Inhibitors Bearing a Hydroxymethyl Ketone Warhead https://buff.ly/6GErC4J

• Scripps Research scientists developed a new oral COVID antiviral compound, mCMX110, that targets the SARS-CoV-2 main protease using a “hydroxymethyl ketone warhead” and demonstrated greater potency and substantially better oral bioavailability than earlier related compounds in animal studies. Unlike Paxlovid, mCMX110 does not require ritonavir boosting.

5/19/26 Nature: Cross-resistance patterns in SARS-CoV-2 against 3CL protease inhibitors https://buff.ly/Drp12Zp

• Researchers at Columbia University in New York found that SARS-CoV-2 can rapidly develop resistance to multiple leading antiviral drugs, including atilotrelvir, ibuzatrelvir, and simnotrelvir, which all target the viral 3CL protease. Critically, certain mutations confer simultaneous resistance to more than one of these drugs, identifying specific cross-resistance pathways that could significantly limit available treatment options as the virus continues to evolve.

5/15/26 JAMA Network Open: Early-Phase Oral Antiviral Use and Post–COVID-19 Condition in Outpatients https://buff.ly/PVexXnD

• In a prospective nationwide cohort study, Japanese researchers enrolled 7,699 outpatients and found that early oral antiviral use was associated with a 14% lower relative risk of Long COVID, translating to roughly 4 fewer cases per 100 patients treated. Ensitrelvir and molnupiravir both showed statistically significant benefits, while nirmatrelvir (Paxlovid) trended but did not reach significance due to small cohort size.

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Long COVID

5/21/26 MedRxiV (Yale): Analysis Of Salivary Herpes viruses Reveals Associations Between HHV-6 And Long COVID Severity https://buff.ly/M8lxlRP

• HHV-6 causes Roseola (sixth disease), a common childhood illness marked by sudden high fever followed by a faint pink rash. Typically benign, the virus lies dormant in the body for life.

• Researchers from Yale and Mount Sinai analyzed salivary hormone levels, SARS-CoV-2, and herpesviruses (EBV, HSV, HCMV, HHV-6) in 45 Long COVID patients and 45 controls. “Detection of salivary EBV and HHV-6 DNA was highest early in the morning. There were no significant differences in salivary cortisol, testosterone, or estradiol, or in EBV or HHV-6 shedding between the LC and control groups.” However, higher salivary HHV-6 DNA levels correlated with greater Long COVID symptom severity, and elevated anxiety and depression scores. HHV-6 may contribute to Long COVID, though the mechanisms are unknown.

4/23/26 Int J Medical Sciences (Taiwan): Association Between Post-COVID-19 Herpes Zoster Reactivation and Peripheral Nervous System Disorders: Multinational Real-World Evidence from TriNetX https://buff.ly/H1N73zd

• Another herpes virus, varicella zoster virus (VZV), causes chickenpox and can later reactivate as shingles (aka herpes zoster). Because shingles rates increase after COVID infection, researchers at Taipei Tzu Chi Hospital studied more than 110,000 people with post-COVID shingles and found that these patients also had increased risks of Bell’s palsy, Guillain-Barré syndrome, and Myasthenia Gravis for at least three years. The findings suggest shingles after COVID may signal long-term peripheral nervous system vulnerability.

From: https://www.medsci.org/v23p2006.htm

5/20/26 BMC Infectious Diseases (Oregon): A mixed-methods study comparing clinical and patient-reported perspectives on long COVID: insights from electronic health records and narrative journal entries https://buff.ly/BlvCb0f

• A study following 92 Long COVID patients found that electronic health records frequently failed to capture symptoms that participants documented in personal journals, including fatigue, cognitive difficulties, and anxiety. The gap between what clinicians recorded and what patients actually experienced related to how the illness interfered with work and everyday functioning.

5/20/26 BMJ Open Resp Research: Symptom-based rehabilitation in people with post-COVID-19 condition (RELOAD study): a randomised controlled trial https://buff.ly/Zg5UDuR

• Researchers in Germany enrolled 132 individuals living with Long COVID in a three week symptom focused rehabilitation program and found it produced meaningful gains in both physical and mental quality of life, as well as reductions in depression and anxiety compared to standard care. Several of these improvements were still measurable after three months.

5/3/26 Frontiers in Immunology: De novo COVID-19-associated insulin resistance drives dysregulated neutrophil extracellular trap formation (NETosis) four months after infection https://buff.ly/jZ30Ewd

• Scientists from Chile tracked 60 COVID patients and found that 24 out of 36 participants who had no prior metabolic conditions went on to develop insulin resistance several months after their COVID infection resolved. Four months after COVID infection, elevated insulin levels were associated with abnormal activation of neutrophil extracellular trap formation (NETosis), an immune process that can heighten clotting risk when dysregulated.

Graphical abstract

From: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1787799/full

5/16/26 Int. J. Mol. Sci (Bulgaria): Comprehensive Immunophenotyping of Monocytes and Dendritic Cells Suggests Distinct Pathophysiology in Chronic Fatigue Syndrome and Long COVID https://buff.ly/6R6OCwd

• Bulgarian researchers analyzed blood from 207 people (ME/CFS n = 103; Long COVID n = 63; healthy controls n = 41) and found that Long COVID and ME/CFS have distinct immune patterns. Peripheral blood mononuclear cells from Long COVID patients showed chronic immune overactivation, while those from ME/CFS patients demonstrated signs of immune suppression.

5/15/26 Nature: Integrated immune, apoptotic and mitochondrial gene dysregulation in Long COVID and their association with symptom burden at 10 months post-infection https://buff.ly/54kY916

• Researchers in Pakistan studied 100 people and found that Long COVID symptoms persisting 10 months after mild COVID infection were linked to changes in genes involved in immune function, antiviral defenses, mitochondrial activity, and cell death (apoptosis). People with more persistent Long COVID symptoms showed greater disruption in these gene expression patterns.

5/22/26 Association of Comorbid and Incident Depression and Other Mental Health Conditions With Long‐COVID: Results From the Johns Hopkins COVID Long Study https://buff.ly/wADtXk7

• Johns Hopkins researchers analyzing 9,637 U.S. adults found that preexisting mental health conditions raised the odds of Long COVID at roughly the same level as other preexisting health conditions. Adults who experienced more persistent Long COVID symptoms were more likely to develop new onset depression or anxiety following infection. They concluded, “Monitoring both physical and mental health outcomes is crucial for post-acute COVID-19 patients.”

5/16/26 Current Medicinal Chemistry (MIT): Melatonin in Health and Disease and its Metabolism by the Gut Microbes: Implications for Deuterium Homeostasis? https://buff.ly/8EaSTaM

• MIT scientists propose that COVID-related gut dysbiosis may reduce melatonin production in the gut, weakening antioxidant and anti-inflammatory defenses and potentially contributing to neurological and cognitive symptoms in Long COVID. They also hypothesize that disrupted microbial melatonin pathways could impair mitochondrial function and deuterium regulation.

From: https://www.eurekaselect.com/article/155753

5/22/26 Nature: A randomized controlled trial of adjunctive speleotherapy in asthma, COPD and long COVID https://buff.ly/2zcNN8y

• Speleotherapy, or underground cave therapy, is sometimes used for chronic respiratory diseases. Studies found it improved breathing comfort, fatigue, and quality of life in people with asthma, COPD, and Long COVID, although objective lung function measures showed minimal improvement.

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Measles

CDC: As of May 21, 2026, 1,952 confirmed measles cases were reported in the United States in 2026.

Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/

• In 2026, 474 people from Utah have been diagnosed with measles, with 30 cases in the last 3 weeks.

Bangladesh Measles Outbreak

5/22/26 JAMA: More Than 19 000 Measles Cases in a Month—What the Current Outbreak in Bangladesh Signals to the World https://buff.ly/G0qchwc

• The WHO has reported a sweeping measles outbreak in Bangladesh, with more than 19,000 suspected cases logged in just one month, and roughly 50,500 total suspected cases so far this year. Most cases (72%) have occurred in children 5 years or younger. Experts trace the surge to pandemic-era disruptions to routine immunization and a 2024 government-related vaccine shortage. They warn that with Canada and the UK having recently lost measles elimination status, lapsing vaccination coverage is now a global threat that mass gatherings like the FIFA World Cup could increase.

• “Although most people recover from measles within 2 to 3 weeks, the virus is highly contagious and can sometimes lead to complications such as pneumonia, diarrhea, hearing loss, and blindness. Postinfection encephalitis occurs in about 1 in every 1000 cases, and death occurs in 2 or 3 of every 1000 cases.”

5/23/26 Al Jazeera: More than 500 children die in measles outbreak in Bangladesh https://buff.ly/DEM81qH

• More than 500 children have died in the measles outbreak in Bangladesh, with most cases among children aged between six months and five years.

5/14/26 CTV News: Public health agency says World Cup poses high risk of measles spread https://buff.ly/w3WIiHJ

• The Public Health Agency of Canada warned that the FIFA World Cup poses a high risk of measles transmission within Canada, citing the country’s loss of measles elimination status last November following more than a year of sustained transmission. The warning arrives as Bangladesh records roughly 50,500 suspected measles cases this year, global vaccination rates slip, and millions of international travelers converge on Canadian host cities, creating conditions for the highly contagious virus to exploit gaps in population immunity.

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Ebola in Democratic Republic of Congo (DRC)

Update from the RDC Twitter Account:

5/22/26 YLE: Ebola: The disease of compassion, and the price of when “we” became “me” https://buff.ly/cO8bsZf

• Katelyn Jetelina and Emily Smith of YLE discuss that the current DRC Ebola outbreak is spreading not only through acts of caregiving (Ebola’s signature transmission route), but also because of the dismantling of global health infrastructure like USAID. Research shows that prioritizing the world’s poorest first produces better health and economic outcomes for everyone.

5/23/26 Gates Foundation Ebola Response Funding Announcement https://buff.ly/X5e7pRc

• Look for the helpers: The Gates Foundation is committing an initial $15 million in emergency funding for the Ebola outbreak in the DRC giving $5 million to Africa CDC, $5 million to WHO AFRO, and $5 million to WHO Headquarters.

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Other news

5/24/26 YLE: Garden Grove chemical plant situation https://buff.ly/A3yI6eR

• Excellent article by Katelyn Jetelina explaining why they needed to evacuate 50,000 people in Orange County, California for toxic chemical tanks that may explode.

5/21/26 Lilly PR: Lilly’s triple agonist, Retatrutide, delivered powerful weight loss in pivotal Phase 3 obesity trial https://buff.ly/PYXldkJ

• In the TRIUMPH-1 Phase 3 trial of 2,339 adults with obesity, participants taking 12 mg of Retatrutide lost an average of 70.3 pounds, or 28.3% of their body weight, over 80 weeks. Nearly half of participants, 45.3%, achieved at least 30% body weight reduction, a threshold historically linked to bariatric surgery.

5/21/26 NBC: GLP-1 drugs may reduce the risk of cancer progressing, study suggests https://buff.ly/VzZdGSf

• According to new research that will be presented next week at the American Society of Clinical Oncology’s annual meeting, GLP-1 drugs may be linked to a lower risk of cancer progression. GLP-1 drugs help with weight loss and with diabetes and have been shown to reduce risk of heart disease (Wegovy), to prevent worsening kidney disease (Ozempic) and to treat obstructive sleep apnea (Zepbound).

5/21/26 Nature Metabolism: The exercise hormone irisin has neuroprotective effects in a mouse model of multiple sclerosis https://buff.ly/vdBJE1O

• Harvard researchers demonstrated that Irisin, a hormone released during exercise, protected neurons and reduced Multiple Sclerosis symptoms in a mouse model. Mice lacking the irisin encoding gene Fndc5 had diminished exercise related neuroprotection, and direct administration of Irisin to these animals successfully replicated the protective effects that exercise would otherwise provide.

5/19/26 Nature: An AI system to help scientists write expert-level empirical software https://buff.ly/EyiBNHy

• Google Research and DeepMind have developed ERA, an AI system designed to autonomously generate and refine scientific code across research domains. In benchmark evaluations, ERA surpassed leading human developed methods in genomics tasks, bioinformatics, and COVID forecasting challenges.

From: https://www.nature.com/articles/s41586-026-10658-6

5/13/26 Science Alert: ‘Forever Chemicals’ Found in 98.8% of Human Blood Samples Tested https://buff.ly/p6yg8BT

• Toxicologists analyzed 10,566 serum and plasma samples and detected PFAS, the synthetic compounds known as “forever chemicals” for their resistance to environmental breakdown, in 98.8% of them, with only 0.18% of samples containing a single PFAS compound and most carrying a complex mixture of five or more PFAS. “Studies have linked PFAS to faster cellular aging, changes in the brain, and a higher risk of some types of cancer – though a direct cause-and-effect relationship hasn’t been established.”

As PFAS are produced and used, they can migrate into soil and water. (MI DEQ)

5/22/26 SF Gate: Santa Cruz is in the midst of a rare butterfly frenzy https://buff.ly/ku1tYRG

• Santa Cruz, California is experiencing a massive, rare butterfly frenzy right now. Wild lilac flowers have surged back after the 2020 CZU fires, creating the perfect habitat for California Tortoiseshells to visit and lay their eggs.

Photo by Shannon Robbins

Have a great week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Wastewater SCAN: https://data.wastewaterscan.org/

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

CDC wastewater maps: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

From: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

Wastewater

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

• Central Valley Area: WastewaterSCAN Central Valley

• Los Angeles Area: WastewaterSCAN Greater LA

• San Francisco Bay Area: WastewaterSCAN Greater SF Bay Area | WastewaterSCAN Marin County

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland |

Bob Hawkins on UK and Europe

• “This week, key Covid indicators across England, Scotland, Wales, and Northern Ireland remained very low, with several reaching record lows, showing that the risk level is still low.

• Flu activity is well below baseline levels across all home nations, following typical out-of-season patterns, confirming that this year’s flu season is over.”

Europe:

COVID levels are at their lowest in the last 5 years, and Influenza A and B wastewater levels are low in most parts of the country. There are still a few pockets of RSV, but RSV activity has peaked and is decreasing in most areas of the United States.

The Andes Hantavirus outbreak on the Dutch cruise ship appears to be contained.

The WHO has labeled an outbreak of the Bundibugyo strain of Ebola in the DRC and Uganda as a Public Health Emergency of International Concern. (see below)

___________________________________________________________________________

Regional wastewater levels for COVID, RSV, Flu A, Flu B from Wastewater SCAN:

Research on Acute COVID infection

5/15/26 BioRxiV (MIT and others): Expansion Revealing of Pathology Resolves Nanostructures Associated with Inflammatory Phenotypes in COVID-19 Decedent Human Brain Tissue https://buff.ly/ikYRPuI

“Expansion revealing of pathology” (ExRPath) is a new imaging technique that physically expands brain tissue about 20 times, allowing scientists to see structures as small as 20 nanometers and uncover details that are normally too crowded to detect. MIT researchers developed ExRPath, and a faster version of this technology called 15ExMPath, which expands tissue about 15 times in a single step instead of requiring multiple rounds.

Using ExRPath and 15ExMPath, MIT researchers examined brain tissue from 8 people who died of COVID infection and found SARS-CoV-2 spike proteins clustered with amyloid deposits in some of the brains, a hallmark of Alzheimer’s disease pathology. The same tissue samples also showed evidence of neuroinflammation operating through molecular pathways associated with Alzheimer’s disease.

Expansion revealing of pathology (ExRPath) Technique:

From: https://www.biorxiv.org/content/10.64898/2026.05.14.725177v1.full.pdf

5/9/26 Pathogens and Immunity: Impact of Sex on Viral Shedding and Symptom Severity During Acute COVID-19 https://buff.ly/Bez0ODy

Researchers at Brigham and Women’s Hospital tracked 668 COVID patients and found “In the first 3 days after symptom onset, female participants exhibited higher nasal SARS-CoV-2 RNA levels than males, but lower viral RNA levels thereafter… Female participants also tended to have higher symptom scores.”

Social and Advocacy

5/12/26 Bloomberg Law: Doctors Rebuffed by Courts in Long Covid and Disability Fights https://buff.ly/D7eH49L

A Bloomberg Law analysis of 130 Long Covid disability lawsuits filed in the United States found that judges frequently challenge the flawed conclusions of physicians hired by disability insurers to deny claimant benefits. The cases reveal how the private disability insurance system creates significant obstacles for Long COVID patients.

Seniors

5/8/26 PLOS One: Life lost due to the COVID-19 pandemic: A model-based cohort analysis of mortality displacement in the registered population of England https://buff.ly/8LYywNe

Analysis of 62 million registered residents of England found that a substantial portion of older adults who died of COVID had considerable remaining life expectancy prior to infection. Among individuals over age 65 who died, at least 28% were projected to survive five or more additional years had they not contracted the virus.

Pediatrics

5/11/26 BMJ Paediatrics Open: “It’s sad, and I want to go back to how things were before”: a qualitative study of young people’s experiences of living with long COVID https://buff.ly/2Zh0OM1

Swedish scientists conducted qualitative interviews with 7 young people under age 18 who are living with Long COVID. They found that “Long COVID negatively impacted the children and young people’s lives, affecting their relationships, education, leisure activities and sense of identity. Dismissive and sceptical attitudes from professionals and peers substantially increased the burden, whereas encountering acceptance and knowledgeable professionals facilitated coping with long COVID.”

Antiviral treatments

PEP for COVID

5/13/26 Nature: At last, a pill that can prevent COVID after exposure to infected people https://www.nature.com/articles/d41586-026-01546-0

5/13/26 NEJM: Ensitrelvir for Covid-19 Postexposure Prophylaxis in Household Contacts https://buff.ly/zWaGS6z

A clinical trial of 2,041 household contacts of COVID patients found that taking a 5 day course of the antiviral drug Ensitrelvir reduced the rate of symptomatic COVID infection from 9% down to 3% when taken after COVID exposure. This marks the first oral medication demonstrated to block COVID from developing in people who have been exposed but have not yet shown symptoms, offering particular promise for protecting vulnerable populations.

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Long COVID

May 2026 Lancet eClinical Medicine: The next phase in Long COVID research: addressing the ethical challenges in trials of disease-modifying treatments https://buff.ly/DGuTUI9

A team of bioethicists, doctors, and Long COVID patients argue in a new opinion piece that researchers should not wait for a complete mechanistic understanding of Long COVID before testing possible treatments. The authors say that the ethical hurdles created by Long COVID’s complexity, including the fact that it likely represents several distinct subtypes with different underlying causes, can be overcome with careful study design, thoughtful participant selection, and close attention to whether the benefits of any given trial outweigh the risks for all groups involved, including children. “Some treatment candidates are widely used to treat diseases other than Long COVID and are expected to be equally safe in people with Long COVID (PWLC), even if the evidence on the given agent’s potential clinical benefits for PWLC is still emerging (e.g., monoclonal antibodies, several immune modulators, GLP-1 agonists).”

5/9/26 Nature: Transcutaneous auricular vagus nerve stimulation improves dysautonomia, post-traumatic stress disorder and cognitive impairment in long covid patients: a pilot study https://buff.ly/LiwoDBT

Researchers at Paris Saclay conducted a pilot study of 17 Long COVID patients and found that noninvasive electrical stimulation of the vagus nerve through the outer ear reduced autonomic nervous system dysfunction by 56% over eight weeks of treatment. The same intervention also produced measurable improvements in both cognitive function and PTSD symptoms among participants.

5/13/26 Nature: Endothelial dysfunction and metabolic biomarkers in post-COVID-19 syndrome https://buff.ly/lSTbrI3

German scientists tracked 262 adults for nearly nine months following COVID infection and documented persistent markers of blood vessel dysfunction alongside measurable metabolic disruptions. Among participants reporting severe Long COVID fatigue, elevated circulating fatty acids associated with inflammatory processes (PUFA, LA, MUFAs, OA, PA) were a distinguishing biochemical feature and may have potential utility as biomarkers.

5/12/26 GeroScience: Tissue-specific autoantibody signatures reveal immune alterations undetected by routine serology in long COVID https://buff.ly/fzOXszO

Hungarian researchers compared 114 Long COVID patients to 36 pre-pandemic controls and found autoantibodies that standard ANA screening missed. “In the majority of Long COVID patients (83% vs. 53% in controls; p < 0.05), showing a dominant cardiovascular pattern…Vascular autoreactivity was markedly elevated in Long COVID (34% vs. 8% in controls; p < 0.05).” A significant portion of longitudinally studied autoantibodies were IgM, pointing to persistent immune system disruption.

4/29/26 International Journal of Molecular Sciences: Imbalance of Excitatory and Inhibitory Neurotransmitter Systems in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome https://buff.ly/byf9y1T

A new review from Charite in Berlin looked at “neurotransmitter systems implicated in ME/CFS and Long COVID, focusing on potential mechanisms of dysregulation and their roles in disease pathology and symptom generation, as well as implications for treatment.” They found an increase in excitatory neurotransmitters like Glutamate, Noradrenaline, Histamine and Dopamine, and a decrease in inhibitory neurotransmitters (GABA, Serotonin, and Glycine). This imbalance is proposed as a mechanism underlying characteristic symptoms including post exertional malaise, disordered sleep, chronic pain, and the paradoxical state of simultaneous exhaustion and heightened neurological arousal (aka “tired but wired” state).

Proposed multifactorial model:

From: https://www.mdpi.com/1422-0067/27/9/4041

5/12/26 Nature: Whole-protein screening and multi-modal profiling of antigen-specific CD4+ T cells at single-cell resolution https://buff.ly/HsiYmPq

Screening for antigen-specific CD8+ T cells is well established, but profiling CD4+ helper T cells has been too difficult to do until now. The Institute for Systems Biology researchers monitored a single Long COVID patient over three years and detected virus specific CD4+ helper T cells that remained active throughout the entire observation period. The ongoing immune response to the virus may help explain why Long COVID symptoms can continue long after the initial infection has ended.

7/2026 (5/11/26): Brain, Behavior, & Immunity - Health: White matter microstructural abnormalities in neurological poste-acute sequelae of coronavirus (PASC) disease: Imaging signatures consistent with persistent neuroinflammation https://buff.ly/lBAdVAP

Researchers at Stony Brook University studied 80 people, including 54 with Long COVID (PASC) and neurological symptoms such as brain fog and difficulty concentrating, 10 unexposed controls and 19 recovered COVID controls. They found that patients with neurological Long COVID (N-PASC) showed changes in white matter pathways involved in memory and attention. These structural brain abnormalities were still present approximately 2.7 years after the initial infection, suggesting that the neurological effects of COVID infection can persist far longer than previously thought.

Fig. 1. Correlational tractography shows tracts with increased (red) and decreased (blue) tractography when comparing Neuro-PASC (N-PASC) to controls.

From: https://www.sciencedirect.com/science/article/pii/S2666354626000839#fig1

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5/9/26 Nature: One-year longitudinal cohort study of chemosensory recovery and plasma biomarker dynamics in SARS-CoV-2 survivors https://buff.ly/4NSI77x

Hong Kong Polytechnic University researchers tracked 120 COVID survivors over 12 months and found that loss of smell recovered most within the first six months, while the loss of taste improved more rapidly. Elevated plasma alpha synuclein levels were associated with poorer recovery in the sense of smell.

5/11/26 Health and Quality of Life Outcomes: Impact of post-exertional malaise frequency and fatigue in Long COVID patients on health-related quality of life https://buff.ly/CGLgoFh

German researchers studied 161 Long COVID patients and found that both the frequency of post-exertional malaise (PEM) and the severity of fatigue were strongly associated with reduced health-related quality of life. Among all measured factors, experiencing post-exertional malaise (PEM) on a daily basis carried the greatest negative impact on participants’ overall health and functional capacity.

5/9/26 Nature: Interpreting hand grip strength in hospital employees with post-COVID syndrome compared to non-infected controls: a case-control study https://buff.ly/PthgUo1

In a small study, German researchers tested 19 hospital employees with Long COVID and 23 healthy controls, finding that those with post COVID syndrome demonstrated reduced hand grip strength (HGS) and diminished muscular recovery after repeat exertion compared to uninfected colleagues. These objective findings indicate that persistent fatigue commonly reported after COVID infection may have quantifiable physical markers detectable through standardized HGS testing.

5/8/26 J of Physical Medicine & Rehabilitation (PM&R): Factors associated with low anaerobic threshold and its impact on sleep quality and health‐related quality of life in individuals with long COVID https://buff.ly/OcIUPSj

Researchers in Taipei enrolled 219 Long COVID patients and found that reduced anaerobic threshold was associated with younger age and lower exercise capacity (peak VO2). Participants whose endurance testing revealed impaired aerobic limits also scored significantly worse on measures of sleep quality and quality of life.

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Hantavirus

5/15/26 Reuters: WHO revises hantavirus cases lower after US passenger tests negative https://buff.ly/4TCbQBQ

There have been a total of 10 confirmed Andes hantavirus cases and 3 deaths related to the Dutch cruise ship MV Hondius. “The Andes virus [is] a rare hantavirus strain and the only one known to be capable of ‌limited human-to-human transmission”. The risk to the general public is low.

5/15/26 YLE: Something deeper than hantavirus https://buff.ly/2Bplon5

Dr. Katelyn Jetelina from Your Local Epidemiologist discussed that public anxiety regarding the current Andes hantavirus cruise ship outbreak reveals something more concerning than the virus itself: a society operating on unprocessed COVID trauma and deeply eroded trust in the CDC and the US Government. In addition, mistrust is pervasive, and is often fueled by social media.

Measles

CDC Measles updates (on Wed.): https://www.cdc.gov/measles/data-research/index.html

• As of May 14, 2026, 1,893 confirmed measles cases have been reported in the United States in 2026.

At least 95% of people need to be vaccinated against measles, in order to prevent outbreaks.

MMR vaccine coverage for kindergarteners by school year:

From: https://www.cdc.gov/measles/data-research/index.html

South Carolina Department of Public Health (Measles):

• The South Carolina measles outbreak is over after 997 measles cases.

Utah Department of Public Health (Measles):

• Utah cases in 2025: 197

• Utah cases in 2026, so far: 466

• Utah cases in the last 3 weeks: 29

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NEW: Ebola (Bundibugyo) Outbreak in DRC and Uganda

5/17/26 WHO: Epidemic of Ebola Disease caused by Bundibugyo virus in the Democratic Republic of the Congo (DRC) and Uganda determined a public health emergency of international concern https://buff.ly/MSHn9aX

The WHO has now designated the Bundibugyo virus Ebola outbreak in the Democratic Republic of the Congo (DRC) and Uganda a Public Health Emergency of International Concern (PHEIC), but not a pandemic emergency. As of May 16, 246 suspected cases and 80 deaths have been reported in Ituri Province, with confirmed cases now reaching Kampala and Kinshasa. The outbreak is likely larger than what is being detected and reported. No approved vaccines or treatments exist for the Bundibugyo strain of Ebola. The WHO is calling for urgent international coordination.

UNICEF/Vincent Tremeau (2019)

U.S. Government Health News

5/13/26 Politico: White House cuts $1.3 billion in Medicaid payments to California https://buff.ly/53akP89

“The Trump administration is withholding $1.3 billion in Medicaid reimbursements to California for failing to “combat fraud”… Though the administration has repeatedly criticized California’s fraud oversight, this is the first time the Centers for Medicare and Medicaid Services has targeted payments to the state. In recent months it has withheld more than $300 million in Medicaid reimbursements to Minnesota for suspect claims.”

Other news

5/13/26 NY Times (gift link): Why U.S. Test Scores Are in a ‘Generation-Long Decline’ https://buff.ly/DfR2IFL

Stanford researchers looked at reading and math scores from 3rd grade through 8th grade across most U.S. school districts and found a troubling pattern: reading scores dropped in 83% of districts over the past decade, and math in 70% with rich districts, poor districts, urban, rural, and every racial group being affected. Experts point to the 2015 gutting of federal school accountability laws, the explosion of smartphones and social media, and the COVID pandemic. “Nearly half of American teenagers now say they are online “almost constantly,” compared with just under a quarter who said that a decade ago.”

From: NY Times https://buff.ly/DfR2IFL

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5/7/26 SciTech Daily: This Simple Movement Could Be Secretly Cleaning Your Brain https://buff.ly/aPi11ZB

4/27/26 Nature Neuroscience: Brain motion is driven by mechanical coupling with the abdomen https://buff.ly/GLzUdot

Penn State researchers have found that abdominal muscle contractions during everyday movement act like a hydraulic pump, pushing blood into the spinal canal and gently shifting the brain within the skull. Computer simulations indicate this motion boosts cerebrospinal fluid circulation, potentially clearing metabolic waste. Findings suggest routine physical activity may support brain health through a previously unrecognized daytime mechanism that drives interstitial fluid out of the brain, which is opposite to glymphatic flow during sleep.

5/15/26 Sutter Health and Santa Clara University to Launch the Mark & Mary Stevens School of Medicine https://buff.ly/dNgZRsx

A new Bay Area medical school called Mark & Mary Stevens School of Medicine is being created from a collaboration between Sutter Health and Santa Clara University. “It is being funded in part by a $175 million gift from Santa Clara 1984 alumna Mary (Mathews) Stevens and her husband, venture capitalist Mark Stevens, who, along with their children, are multi-decade Sutter Health patients.”

5/15/26 Nature: Even mild blows to the head disrupt the microbiome https://buff.ly/NpJdBYS

In a small study, Colgate University researchers found that mild, asymptomatic knocks to the head in American football players altered gut bacterial composition within just 3 days. Certain bacterial species declined in abundance as the season progressed, suggesting that repeated mild head hits may produce cumulative shifts in the gut microbiome over time. “Changes in bacterial populations have previously been seen after more severe traumatic brain injuries in mice and humans, and these variations might play a part in neurodegeneration caused by repeated injuries.”

Photo: Rich Barnes/Colgate Athletics

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5/8/26 Nature Metabolism: Metformin inhibits mitochondrial complex I in intestinal epithelium to promote glycaemic control https://buff.ly/uGlkm1k

Northwestern University scientists used transgenic mice and human metabolomic data to show that metformin works primarily by inhibiting mitochondrial complex I in intestinal epithelium, turning the gut into a glucose sink, and by increasing the conversion of glucose into lactate. They note that phenformin and berberine also block mitochondrial complex I in a similar fashion.

5/11/26 Nature Reviews Bioengineering: Organoids as platforms for infectious disease research https://buff.ly/J8fw9do

Organoids are miniature lab grown models of human organs that are emerging as powerful tools for studying how infectious diseases behave in human tissue. They mimic human biology better than animal models. A new review in nature explains how the use of organoids may accelerate the development of vaccines and antiviral treatments as well as strengthen global readiness for future pandemics.

Figure 2

From: https://www.nature.com/articles/s44222-026-00445-3/figures/2

5/15/26 Nature Cell Biology: Mechanisms and functions of large extracellular vesicle biogenesis https://buff.ly/32arCie

A new review published in Nature Cell Biology examines how cells produce large extracellular vesicles (EVs), bubble shaped particles that transport waste, signals, molecules, and even viruses between cells. While most research has been focused on smaller EVs (<200 nm), scientists are increasingly interested in larger EVs because of their roles in cell communication and waste removal. Researchers also believe these structures could become useful tools for disease diagnosis, laboratory testing, and targeted drug delivery.

I love these names: Blebbisome and Zombosome

From: https://www.nature.com/articles/s41556-026-01940-w/

5/4/26 SciTech Daily: First-of-Its-Kind Discovery: Homer’s Iliad Found Embedded in a 1,600-Year-Old Egyptian Mummy https://buff.ly/32BGAae

While excavating in Egypt, the University of Barcelona’s Oxyrhynchus Archaeological Mission discovered a Greek papyrus fragment placed on the abdomen of a Roman-era mummy during embalming. Analysis in early 2026 confirmed the text is from the Catalogue of Ships in Book II of Homer’s Iliad. It is the first instance in history of a Greek literary text deliberately incorporated into the mummification process rather than magical or ritual content.

The papyrus, placed in the mummy’s abdomen, contains a catalogue of ships.

Credit: Professor Ignasi-Xavier Adiego.

5/14/26 Guardian: How a kindergarten teacher became the accidental guardian of 200 king penguins https://buff.ly/Lsa5c6R

Former kindergarten teacher Cecilia Durán Gafo in Chile established the world’s only continental king penguin reserve after poachers, selfie seekers, and invasive mink nearly wiped out a colony that settled on her property in 2010. Her 12-person team now protects nearly 200 penguins, with a record 23 chicks surviving last year.

Photograph: Anastasia Austin/The Guardian

Have a good week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

• RSV activity started later than expected in most regions of the United States, though illness is not more severe compared with recent seasons. RSV activity has peaked in many regions of the country. This unusual timing means higher levels of RSV activity may continue into May for some regions.

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

COVID

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

5/15/26

Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDPH California SARS-CoV-2 in Wastewater:

• https://skylab.cdph.ca.gov/calwws/

• https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

• Central Valley Area: WastewaterSCAN Central Valley

• Los Angeles Area: WastewaterSCAN Greater LA

• San Francisco Bay Area: WastewaterSCAN Greater SF Bay Area | WastewaterSCAN Marin County

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

Palo Alto sewershed:

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

• RSV activity has peaked in most regions of the country and is decreasing.

• Flu activity continues to decrease. As of May 2, Influenza B is still high in many parts of the country per WastewaterSCAN. In Palo Alto, Influenza B is still moderately high.

• COVID activity is low in most parts of the United States.

The CDC reported that Nebraska had HIGH levels of SARS-CoV-2 in wastewater on 4/25/26, but there were only 2 sites reporting and they are right next to each other- one of which is VERY HIGH and the other of which is reported as VERY LOW.

As of 5/2/26, Omaha has LOW levels of SARS-CoV-2 in wastewater according to WastewaterSCAN.

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

Influenza B is still high in wastewater in many parts of the country.

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Acute COVID infections, General COVID info

4/29/26 Nature: Macrophage-derived MBL restrains coronavirus-induced pulmonary inflammation by modulating metabolic regulator PKM2-mediated NLRP3 activation https://buff.ly/IufGvv1

Southern Medical University (Guangzhou) researchers find that mannose-binding lectin (MBL), produced by macrophages, curbs coronavirus lung inflammation by binding directly to the metabolic enzyme PKM2. This blocks a structural shift in PKM2 that would otherwise drive NLRP3 inflammasome overactivation, reducing caspase-1 cleavage, IL-1β release, and lung tissue damage.

4/28/26 Nature: Widespread gene-environment interactions shape the immune response to SARS-CoV-2 infection in hospitalized COVID-19 patients https://buff.ly/UuvYd8h

Scientists used single-cell RNA sequencing to study immune responses in COVID patients, recovered patients, and healthy people. They found that genes and environmental factors interact to shape the body’s response to infection. About 17% of immune-related genetic regions changed activity during infection, especially in monocytes through interferon and metabolic pathways, helping explain why COVID may affect people differently.

Pediatrics

4/29/26 BMC Infectious Diseases: Association of race, ethnicity, and pediatric long COVID and MIS-C: a systematic review and meta-analysis https://buff.ly/mPAApD2

UTHealth Houston School of Public Health reviewed 31 studies and found non-Hispanic Black children faced 2.37 times higher odds of MIS-C and 89% higher odds of ICU admission than non-Hispanic White children. Hispanic children showed lower severe MIS-C risk but higher overall incidence, while Black children in UK cohorts faced more than 16 times the odds of PIMS-TS, underscoring structural healthcare inequities.

Vaccines

4/28/26 Nature Structural & Molecular Biology: TMPRSS2-mediated coronavirus spike activation and inhibition https://buff.ly/BXfvOZx

University of Washington (Veesler lab) researchers show that TMPRSS2 cleaves the SARS-CoV-2 spike only after ACE2 binding drives it into the early fusion intermediate conformation, exposing the S2 prime site at R815 and triggering membrane fusion. Antibodies targeting this site block TMPRSS2 access and SARS-CoV-2 viral infection. The team computationally designed a stabilized version of this as a vaccine candidate.

Antiviral treatments

4/27/26 Journal of Virology: SARS-CoV-2 3CLpro mutations T21I and E166A confer differential resistance to simnotrelvir, bofutrelvir, and ensitrelvir https://buff.ly/4JRQpyf

Just as bacteria can become resistant to antibiotics, viruses can become resistant tot antiviral medications. Researchers find that two mutations in the SARS-CoV-2 main protease (T21I and E166A), selected under simnotrelvir pressure, confer mild to moderate resistance against simnotrelvir, nirmatrelvir, and ensitrelvir. Bofutrelvir retains strong activity against these variants due to its aldehyde warhead chemistry, and both simnotrelvir and bofutrelvir remained effective in mouse studies.

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Long COVID

4/29/26 Nature: Current status and future perspectives on the mechanistic and pathophysiological understanding of long COVID https://buff.ly/ZASWfoq

This week, Nature had a review from an all-star team of Long COVID researchers looking at “current knowledge, gaps, and future directions for research, diagnosis, and treatment” of Long COVID. Faghy et al. reviewed Long COVID, which now affects over 400 million people and carries estimated annual economic costs exceeding $1 trillion. Symptoms spanning cognitive dysfunction, severe fatigue, and post-exertional malaise are likely driven by immune dysregulation, viral persistence, autonomic dysfunction, and microvascular damage, yet no validated diagnostic criteria or proven treatments currently exist.

From: https://www.nature.com/articles/s43856-025-01300-z/figures/1

Fig. 2: The role of viral persistence in Long COVID.

Mechanistic insight into the role of viral persistence across different systems and tissues in the context of Long COVID, image published by Chen et al.¹⁰⁸.

From: https://www.nature.com/articles/s43856-025-01300-z/figures/3

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5/1/26 Pilot and Feasibility Studies: An open-label, clinical feasibility study of the efficacy of Remdesivir for Long-COVID https://buff.ly/mLUFvK3

UK researchers will study a feasibility trial of “5-day intravenous treatment with Remdesivir for patients with Long COVID (LC). The treatment is already effective in the treatment of patients with acute severe cases of SARS-CoV-2. Remdesivir has an established safety profile.”

Of note, there are oral versions of Remdesivir like Obeldesivir (ODV) being developed. Obeldesivir is currently being tested in phase 3 trials for COVID treatment, but the drug may also be effective against filoviruses, including Marburg virus, Ebola virus, and Sudan virus (SUDV). If it is approved, I believe that it could be important to trial a longer course of Obeldesivir or another antiviral, in combination with either a monoclonal antibody or an immunomodulatory drug, to treat viral persistence, inflammation and immune system exhaustion in Long COVID.

4/10/26 Viruses: Integrative Insights into the Immunopathogenesis and Organ-Specific Immunological Mechanisms of Long COVID: A Narrative Review https://buff.ly/Bf1rVT4

In a lengthy review, Indian researchers looked at Long COVID mechanisms across organ systems and found that it may be driven by a multifactorial interplay of persistent viral reservoirs, chronic immune activation, autoimmunity, microvascular injury, and organ-specific inflammation. They noted that no single pathway dominates.

4/12/26 Frontiers in Immunology: Pathophysiological mechanisms of post-exertional malaise: an integrative analysis based on the metabolism-immune-neuro interaction model https://buff.ly/234D4ia

Chengdu University researchers reviewed how post-exertional malaise (PEM) may arise from a self-perpetuating loop of mitochondrial dysfunction, immune activation, and neuroinflammation. In people with underlying vulnerability from prior infection, physical or emotional exertion may act as a second hit that overwhelms adaptive repair, converting normal metabolic stress into escalating inflammatory injury and central fatigue seen in PEM.

Figure 1. The Two-Hit Model and Provocation Framework for Post-Exertional Malaise (PEM).

From: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1774310/full

4/27/26 Arthritis & Rheumatology: Differences in SARS‐CoV‐2 antigen persistence in individuals with systemic autoimmune rheumatic diseases compared to the general population: A RECOVER‐Adult Cohort Study https://buff.ly/cSmABMv

Mass General Brigham researchers compared 210 patients with systemic autoimmune rheumatic diseases to 348 controls and found nearly 3x higher odds of detectable viral antigens at three months and over 6x higher nucleocapsid antigen positivity at six months. Unlike controls, antigen levels in the rheumatic disease group did not decline between those timepoints, implicating immunosuppressive medications as the likely driver.

4/30/26 J of Extracellular Vesicles: When Viruses Talk through Extracellular Vesicles: a New Perspective on Sars‐Cov‐2‐Induced Neurodegeneration https://buff.ly/VuqtK6n

Dutch scientists propose that extracellular vesicles carrying SARS-CoV-2 proteins and dysregulated microRNAs can cross the blood-brain barrier and disrupt three pathways shared with Alzheimer’s and Parkinson’s disease: neurovascular integrity, metabolic homeostasis, and protein quality control. The authors position these vesicles as potential drivers of chronic neuroinflammation and neurodegeneration well after viral clearance.

4/27/26 Endocrine Reviews: Regulatory Cycles of Orexin and Glucagon-Like Peptide-1 in Post-Viral Syndromes https://buff.ly/fdOElIg

Philipps University Marburg (Germany) researchers review how disrupted orexin and GLP-1 signaling may connect the fatigue, sleep dysfunction, and metabolic abnormalities seen in Long COVID and ME/CFS. The review also examines GLP-1’s neuroprotective and anti-inflammatory roles and highlights GLP-1 receptor agonists and orexin-targeted drugs as promising treatment avenues for post-viral syndromes.

4/29/26 MedRxiV: Diagnostic Classification for Long Covid Patients identifying Persistent Virus and Hyperimmune Pathophysiologies https://buff.ly/0isHTah

University of Exeter researchers, using Attomarker‘s multiplex antibody platform in 159 Long COVID patients, identified that 62% of patients showed antibody patterns consistent with incomplete viral clearance and persistent infection, while about 12% displayed a hyperimmune profile. The findings support patient stratification toward targeted treatments.

4/29/26 NeuroImage: Decreased functional connectivity in post-COVID syndrome patients with high neuroinflammatory activity https://buff.ly/3GgGSxe

Amsterdam UMC researchers combined PET and MRI in 45 post-COVID patients finding that higher brain inflammation on PET was associated with weaker connectivity in brain networks governing attention and higher cognition (thinking). Thalamic and somatomotor network changes tracked with neurocognitive complaints, while brainstem connectivity changes tracked with neuroinflammatory activity.

4/29/26 Acta Neuropathologica: Pathogenic IgG from long COVID patients with neurological sequelae triggers sensitive but not cognitive impairments upon transfer into mice https://buff.ly/ULEZQQr

Belgian researchers purified IgG from 13 Long COVID patients with neurological symptoms and injected it into mice. The antibodies accumulated in dorsal root ganglia sensory neurons and produced transient mechanical and thermal pain hypersensitivity, with no effect on memory, anxiety, or depression, supporting autoantibody-mediated peripheral pain as one part of Long COVID.

1/26/26 Sensors & Diagnostics: Snapshot of long COVID in young adults: fast screening using electronic noses https://buff.ly/Jvk5KEB

A team from Mexico and Germany studied 78 university students with prior COVID infection and found 29.5% met WHO Delphi criteria for Long COVID despite normal lung function tests. They used an “electronic nose” to analyze exhaled breath volatile organic compounds (VOC) which distinguished Long COVID from controls with 97.4% accuracy, suggesting breath analysis as a rapid, noninvasive screening approach for Long COVID in younger populations.

4/16/26 Vaccines (Italy): Autoimmune Features of Post-COVID-19 Vaccination Syndrome and Their Impacts on the Renin–Angiotensin System https://buff.ly/VoTxgKZ

Verona and Milan researchers looked at post-COVID-19 vaccination syndrome (PACVS) and presented data from 17 patients showing autoantibodies to ACE2 and MAS1 receptors that may disrupt the renin-angiotensin system. Anti-ACE2 correlated significantly with skin symptoms and hypertension, while anti-MAS1 correlated with widespread burning pain, pointing to RAS dysregulation as a possible PACVS mechanism.

ME/CFS

4/28/26 Annals of Family Medicine (Mayo Clinic): Underuse of Pharmacologic Therapies for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Before Specialist Evaluation https://buff.ly/WTYUESX

Mayo Clinic researchers reviewed records of 571 ME/CFS patients referred to specialty care between 2018 and 2022 and found that medications used most often before consultation targeted pain, sleep, and mood, while specialist-favored options like low dose naltrexone, aripiprazole, and pyridostigmine were rarely prescribed. Meanwhile, 72.2% of patients were using supplements to manage symptoms.

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Measles

CDC Measles updates (on Wed.): https://www.cdc.gov/measles/data-research/index.html

As of April 30, 2026, 1,814 confirmed measles cases were reported in the United States in 2026.

“In the first 4 months of 2026, there have been 1,814 confirmed measles cases (& doubtless many more that were never confirmed). For context: That’s 79% of the total for the entirety of 2025 — but in 4 months, not 12.” -Helen Branswell

5/1/26 ABC: After nearly 1,000 cases, here’s how South Carolina officials beat back a measles outbreak https://buff.ly/5yMTC5w

The South Carolina measles outbreak that started in October 2025 has finally been declared over after a total of 997 confirmed measles cases, mostly in unvaccinated children. “Measles vaccinations [were] the most effective single containment tool,” Dr. James Harber… told ABC News. “And then to identify the index cases and their exposures and enforcing quarantine, and there’s that integrated public health and private sector collaboration. Those are the keys.”

Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/

In Utah, there have been 31 new measles cases reported to public health in the last 3 weeks, with 197 cases noted in 2025 and an additional 428 measles cases reported since the beginning of 2026.

4/30/26 NEJM Evidence: Detection of a Single Measles Infection Using Untargeted Ultra-Deep Metagenomic Sequencing of Wastewater in Cook County, Illinois https://buff.ly/JZuqfeI

Wastewater analysis can be powerful. Researchers at the University of Illinois at Chicago and the Illinois Department of Public Health detected a single measles infection in a Cook County wastewater system serving more than 1 million people, identifying just 43 matching reads out of nearly 1 billion sequenced. Genomic analysis confirmed the wastewater sequences matched a clinical isolate from an unvaccinated child, demonstrating the remarkable sensitivity of wastewater surveillance for infectious diseases.

John Hopkins US Measles Tracker: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker

• There were 64 cases of measles reported in the U.S. in the last 2 weeks.

Other news

5/1/26 Kristen Panthagani, MD, PhD: Did AI really beat ER doctors at ER triage? https://buff.ly/y0281DX

Great summary by Dr. Kristen Panthagani about the misleading new article from Science magazine (see below) that has the lay press saying that AI is better at diagnosing medical issues than ER doctors. The Science article had significant flaws including testing 2 internal medicine doctors and not ER doctors, making the goal of the study to find a final diagnosis and not to avoid emergencies, and the AI was fed all of the work of the ER team without gleaning this itself.

4/30/26 Science: Performance of a large language model on the reasoning tasks of a physician https://buff.ly/vMVL3UZ

4/27/26 J Clinical Oncology: Safety and Clinical Outcomes of Pooled Donor, Nonengrafting Expanded Progenitor Cells in Single-Unit Cord Blood Transplantation https://buff.ly/vvCJ55q

In a phase II trial, researchers at Fred Hutch Cancer Center treated 28 patients with leukemia or related blood cancers using a single umbilical cord blood transplant plus Dilanubicel, an expanded stem cell product from pooled cord blood donors. The treatment showed strong safety and effectiveness: 96% survived at least one year, with no severe graft-versus-host disease.

4/24/26 KFF Health News: A ‘Barbaric’ Problem in American Hospitals Is Only Getting Bigger https://buff.ly/lzNpqom

Emergency departments are so overwhelmed and hospitals are full that they “board” patients who are waiting to be admitted in the hallways of the ED for hours, days and even weeks. “In this limbo state, you’re technically admitted to the hospital, but still located in the physical domain of the ER. And the rules governing acceptable care and safety measures become much less clear.” This is subpar care and a public health catastrophe.

4/2/26 Cancer Immunology Research: Concurrent Pituitary and Thyroid Immune-Related Adverse Events after Immune Checkpoint Inhibitors Associated with HLA-DR15–Related Haplotypes https://buff.ly/1sXhkoG

Human leukocyte antigens (HLA) were analyzed in patients who developed pituitary and/or thyroid immune-related adverse events (irAE) after use of immune checkpoint inhibitor medications for cancer treatment. The frequency of the HLA-DRB1*15:01 and DRB1*15:02 haplotypes were found to be significantly higher in these patients. In the future, precision immunotherapy should include pretreatment testing of HLA haplotypes.

4/23/26 NY Times: New Gene Therapy Enables Children With a Rare Form of Deafness to Hear https://buff.ly/oikLsHF

“The Food and Drug Administration on Thursday approved a gene therapy that can cure a rare, inherited form of deafness. The treatment is the first to restore normal hearing in children who were born deaf…The maker of the therapy, Regeneron, plans to provide it free to any child who needs it.”

4/24/26 PBS: 988 hotline linked to thousands fewer youth suicide deaths since launch, study finds https://buff.ly/pkCS07V

Harvard Medical School researchers published in JAMA an analysis of national death certificate data from 1999 to 2024 and found suicide deaths among 15 to 34-year-olds ran 11% lower than projected in the first two and a half years after the 988 Suicide and Crisis Lifeline launched in July 2022, representing roughly 4,400 fewer deaths than expected. States with the largest increases in call volume saw the steepest declines.

4/19/26 CNN: Photographer Steve Parke’s new book on Prince https://buff.ly/9zvdP2N

Photo: Steve Parke

4/29/26 People: Baby Born on Board Delta Flight Pictured with Mom Moments After Birth as EMT Shares New Delivery Details (Exclusive) https://buff.ly/I3KrgMD

Mom Ashley Blair unexpectedly gave birth on a Delta flight from Atlanta to Portland this week with the assistance of 2 EMTs on board. Baby Brielle arrived safely shortly before landing and the whole plane cheered when the baby cried to announce her arrival.

EMTs Kaarin Powell and Tina Fritz, with Ashley Blair and her newborn baby Brielle.

I’ll be taking next week off from the newsletter.

Have a good week,

Ruth Ann Crystal MD

Respiratory Illnesses Summary

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

• RSV activity is decreasing and has peaked in most regions of the country.

• Flu activity continues to decrease. But, Influenza B is still high on May 2nd in many parts of the country per WastewaterSCAN.

• COVID activity is low in most parts of the country.

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

But, Influenza B is still high in many areas according to WastewaterSCAN (omits 12 states):

RSV

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

Nebraska is considered HIGH for COVID as of 4/25/26 by the CDC, but there are only 2 sites reporting and they are right next to each other. One is VERY HIGH levels of COVID in wastewater and the other site is VERY LOW.

However, as of 5/2/26, Omaha, NE has LOW levels of SARS-CoV-2 in wastewater per WastewaterSCAN.

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

California CDPH SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

• Central Valley Area: WastewaterSCAN Central Valley

• Los Angeles Area: WastewaterSCAN Greater LA

• San Francisco Bay Area: WastewaterSCAN Greater SF Bay Area | WastewaterSCAN Marin County

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

The Palo Alto watershed has high levels of Influenza B now. COVID is low and so is RSV.

San Jose’s watershed has more moderate Influenza B.

WastewaterSCAN:

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

Bob Hawkins on UK: This week, the main Covid indicators in England, Wales, and Northern Ireland remained very low, with several reaching record lows, suggesting the risk level is low.

Flu activity is at baseline levels across all home nations, following typical out-of-season patterns, confirming that this year’s flu season

Europe has record low levels of COVID in wastewater

• RSV activity is elevated but has peaked in most parts of the country.

• Seasonal influenza activity continues to decrease. Influenza A activity is low across all regions and influenza B activity continues to trend downward.

• COVID activity is low in most areas of the country.

COVID

According to JP Weiland, “we are at the lowest transmission levels in almost 5 years”. He expects this lull in COVID transmission to last at least 6 weeks and he estimates that there are currently only about 90,000 new COVID infections per day in the United States.

According to the CDC through 4/18/26, wastewater levels of SARS-CoV-2 were moderate in Wyoming and West Virginia, and high in Mississippi. This translates to about 1 in 58 people infected with COVID in Wyoming and West Virginia, and 1 in 36 people in Mississippi per Mike Hoerger.

From: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

Acute COVID infections, General COVID info

4/20/26 Medical Microbiology and Immunology: Acute COVID-19 is associated with altered CD8 T-cells indicative of impaired ability to control Epstein–Barr virus reactivation https://buff.ly/nkauvdc

German researchers studied moderate to critical hospitalized COVID patients and found that their T cells were no longer able to control latent viruses like EBV. In the 61 patients studied, 68% to 73% had EBV reactivation and this was associated with CD8 T cell exhaustion as seen by reduced CD28 and increased CD57 expression. These findings suggest that acute COVID infection causes impaired antiviral control of latent viruses by T cells.

4/20/26 BioRxiV: SARS-CoV-2 spike protein-associated sialoglycoconjugates induce nanoscale filipodia to facilitate micro-size platelet clotting https://buff.ly/FAKgJvu

Researchers at Griffith University, using platelets from 9 donors, found that sugar molecules attached to the SARS-CoV-2 spike protein trigger platelets to extend projections called filopodia and then aggregate into microclots. The clotting effect was driven by sialic acid on glycan chains rather than the spike protein itself. This carbohydrate-mediated mechanism may help to explain COVID coagulopathy and vascular injury seen in Long COVID.

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Pregnancy

4/20/26 Nature: Higher expression of SOX1, miR-155, and miR-21 in the colostrum of SARS-CoV-2-infected mothers https://buff.ly/wEa4iVZ

A Polish study of 19 people who had COVID during pregnancy vs. 21 healthy women who did not found that “SARS-CoV-2 infection during pregnancy induces changes in the molecular composition of early breast milk, promoting immunomodulatory (miR-155) and regenerative (miR-21, SOX1) molecules.” These immune signals modulate the newborn’s immune responses.

Pediatrics

4/22/26 Pediatric Research: Endovascular profiles linked to neutrophil activation in children and young adults with long COVID https://buff.ly/82qJh0y

Researchers at Massachusetts General Hospital studied 84 children and young adults and found that those with Long COVID had significantly elevated fibrin amyloid microclot burden and markers of endothelial injury compared to healthy controls. In vitro assays showed that SARS-CoV-2 spike immune complexes trigger neutrophils to release extracellular traps (NETs), directly damaging blood vessel lining. They noted intravascular NETosis from activated neutrophils as a key driver of ongoing endovascular pathology in pediatric Long COVID.

More Microclot Info

4/23/26 Preprint (Kell and Pretorius): On the Correspondence of Diseases Showing Microparticles, Fibrinaloid Microclots and Disorders of the Microcirculation https://buff.ly/miIxfrD

In a preprint, researchers Kell and Pretorius propose that numerous chronic diseases share a common pathological signature: circulating microparticles and amyloid rich fibrinaloid microclots that disrupt microvascular blood flow. Their analysis points to a shared pathway of persistent inflammation and vascular injury.

From: https://www.preprints.org/manuscript/202604.1728

Vaccines

4/23/26 CIDRAP: Moderna’s combo flu-COVID vaccine receives European authorization https://buff.ly/PbRoyWf

The European Commission granted marketing authorization to Moderna’s mCombriax, the world’s first combination mRNA influenza and COVID-19 vaccine. A phase 3 trial showed a single dose produced statistically higher immune responses against three flu strains and SARS-CoV-2 in adults 50 and older, with no major safety concerns identified. Approval by the U.S. FDA is pending, with a decision expected in August 2026.

4/19/26 Nature: Antibody profiling and plasma proteomics in SARS-CoV-2 infection: a pilot study https://buff.ly/FkAYCSn

Tokyo University scientists tracked plasma antibodies and proteomics in a single person over 310 days, finding minimal proteomic shifts after vaccination but distinct, coordinated immune and inflammation changes after SARS-CoV-2 infection.

Antiviral treatments

4/22/26 NEJM: Oral Nirmatrelvir–Ritonavir for Covid-19 in Higher-Risk Outpatients https://buff.ly/C81nxdP

In trials across the UK and Canada enrolling 4,232 predominantly vaccinated, high-risk adults, Paxlovid did not reduce hospitalization or death compared to placebo. The drug did shorten symptom duration and lower viral load, suggesting potential benefit for recovery even where it fails to prevent severe outcomes.

Long COVID

4/23/26 Physiological Reports: Impaired peripheral oxygen delivery during submaximal exercise in adults with long COVID https://buff.ly/J4umKr2

University of Derby researchers studied 56 adults with Long COVID using a 2-day submaximal CPET protocol combined with NIRS of the calf muscle and found reduced muscle oxygen delivery during mild exercise that worsened on day two of testing. Results suggest impaired peripheral oxygen extraction and delayed recovery, and not deconditioning, may be central drivers of post exertional malaise and fatigue in Long COVID.

Dr. Putrino announced this week that the Mount Sinai Long COVID trial of low dose Rapamycin will now be offering the medication to all study participants.

Phase I Open-Label Safety Trial of Pembrolizumab for Neurological Post- Acute Sequelae of SARS-CoV-2 (PD1-PASC I) https://buff.ly/Sge4Exd

The NIH has launched an open-label, Phase I trial of Keytruda (Pembrolizumab) for Neuro Long COVID. Keytruda is an immunotherapy that may help T cell exhaustion in Long COVID as it does in cancer therapy.

4/21/26 Journal of Translational Medicine: Identification of novel reproducible combinatorial genetic risk factors for myalgic encephalomyelitis in the DecodeME patient cohort and commonalities with long COVID https://buff.ly/jfpIDpq

Using the UK DecodeME cohort of 14,767 participants, researchers identified 22,411 reproducible genetic risk signatures for Myalgic Encephalomyelitis (ME) across three independent patient groups, with higher signature counts associated with 1.64 times greater odds of disease. Notably, 76 of 180 genes linked to Long COVID also mapped to ME, pointing to shared biological mechanisms and potential drug repurposing opportunities for both conditions.

H5N1

4/23/26 CIDRAP: More California marine mammals confirmed to have H5N1 avian flu, as USDA tracks poultry outbreaks in Midwest https://buff.ly/Kq0gJNQ

Eleven additional marine mammals tested positive for H5N1 in California, bringing the ongoing outbreak total to 58 animals across four counties, including 57 sea lions and one otter, mostly in San Mateo County. Separately, four new commercial poultry facilities in the Midwest and Southeast reported H5N1 outbreaks, though the overall pace of detections has slowed compared to March.

David Cook / Flickr cc

4/6/26 BioRxiV (T. Peacock lab): Bovine H5N1 influenza viruses have adapted to more efficiently use receptors abundant in cattle https://buff.ly/UEorl2r

Researchers at the Pirbright Institute found that two mutations now common in dairy cattle H5N1 strains allow the virus to bind NeuGc, a sugar molecule present on cattle mammary cells but absent in humans and birds. This increases viral replication in bovine tissue and may facilitate cow-to-cow transmission.

Measles

CDC Measles updates (on Wed.): https://buff.ly/zbA8Vtv

As of April 23rd, 1,792 confirmed measles cases were reported in the United States in 2026.

South Carolina Department of Public Health (Measles): https://buff.ly/w688rud

The South Carolina Department of Public Health (DPH) reports no new cases of measles with the exception of an isolated case in Saluda County for which 41 people are in quarantine. The number of measles cases in the Upstate, SC outbreak remains at 997.

Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/

The Utah measles outbreak saw 197 cases in 2025 and 410 measles cases so far in 2026. There have been 31 newly reported measles cases in Utah in the last 3 weeks.

John Hopkins US Measles Tracker: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker

Government Health News

4/21/26 NBC: Pete Hegseth says the U.S. military will no longer require flu shots https://buff.ly/4tUJZc7

4/23/26 Dr BK. Titanji: Why Militaries Vaccinate https://buff.ly/drXft6O

This week, Pete Hegseth announced that the U.S. military will no longer require flu shots. Infectious diseases like the flu can spread like wildfire through the military, as soldiers live and work in close quarters. If many soldiers get sick at the same time, it could become a national security threat.

4/22/26 NY Times: C.D.C. Cancels Publication of Study Showing Benefits of Covid Vaccines https://buff.ly/Oi4TlTW

CDC Director Jay Bhattacharya blocked publication of a completed CDC study in the agency’s flagship journal, the MMWR, after it had already cleared internal scientific review. The study found COVID vaccines cut emergency room visits and hospitalizations by roughly 50% last winter, using a methodology long accepted for flu and COVID vaccine effectiveness research and published without objection in a flu vaccine study just weeks earlier.

4/25/26 NY Times: Trump Fires Board Members of Group That Oversees U.S. Science Funding https://buff.ly/vq7AjfA

“The dismissals from an independent board that oversees the National Science Foundation marked the president’s latest assault on scientific research organizations.”

Other news

4/21/26 Nature Medicine: Epigenetic fingerprints link early-onset colon and rectal cancer to pesticide exposure https://buff.ly/EFEReKw

4/20/26 Nature Medicine: Microbiome signature of Parkinson’s disease in healthy and genetically at-risk individuals https://buff.ly/3mjyfQL

A UK and France research group found that a gut microbiome signature typical of Parkinson’s disease can occur in both genetically at-risk individuals and in healthy people without known risk. These microbiome patterns are linked to disease progression in Parkinson’s patients and to early, prodromal Parkinson’s symptoms in both genetically and non-genetically at-risk individuals in the general population.

4/18/26 NBC: Pancreatic cancer mRNA vaccine shows lasting results in an early trial https://t.co/13GBL8ujOV

This is great news! “Scientists caution that more research is needed, but nearly all of the [Pancreatic Cancer] patients who responded to the personalized vaccine are still alive six years later.”

4/25/26 NEJM: Pulsed Field Ablation as Initial Therapy for Persistent Atrial Fibrillation https://buff.ly/AM07xtp

In a randomized trial for preventing recurrent atrial arrhythmias, “Among patients with persistent atrial fibrillation, the risk of recurrence of atrial arrhythmia was significantly lower among those who received pulsed field ablation (PFA) as first-line treatment than among those who received antiarrhythmic-drug therapy.”

This week, I received a Health Advisory from the California Medical Board and CDPH regarding risking Silicosis cases in countertop workers who work with quartz countertops. Cutting engineered quartz releases silica dust causing an accelerated, incurable lung disease called Silicosis, which is now a reportable disease. As of April 23, 2026, 547 countertop workers in California have been diagnosed with Silicosis since 2019, 30 of whom died and 58 of whom required lung transplants.

4/20/26 Nature Reviews Cardiology: Beyond GLP1: modulating multiple nutrient-stimulated hormone pathways to reduce cardiovascular risk https://buff.ly/Beibd0W

A new review in Nature looks at GLP-1 receptor agonists combined with other hormone related medications and how they reduce cardiovascular risk. Tirzepatide is a GLP1 and GIP receptor co-agonist, while Retatrutide is a GLP1, GIP and glucagon agonist that has been shown to reduce body weight by 24% in obese individuals.

Fig. 1: Potential complementary actions of multi-NuSH agents and ongoing cardiovascular outcomes trials.

CNN: Hot air balloon makes emergency landing in backyard

A hot air balloon with 13 people in its basket made an unexpected emergency landing in a family’s backyard in Temecula, California this week. After refueling, the balloon company flew the 80 foot balloon over the houses to the street, where they were able to deflate it safely and remove it. No one was hurt.

Photos by Hunter Perrin

Have a great week,

Ruth Ann Crystal MD

References & Notes

Respiratory Illnesses Summary

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B and Norovirus.

WWSCAN Weekly Data:

Respiratory & Gastrointestinal Weekly Update:

• Influenza B, RSV, HMPV, Norovirus, and Rotavirus are in the high category.

• SARS-CoV-2, Influenza A, and EV-D68 are in the ‘Low’ category nationwide.

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

CDC Respiratory viruses (COVID, Flu, RSV) Hospitalizations (for those states reporting): https://www.cdc.gov/resp-net/dashboard/index.html

RSV

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

As of 4/18/26, the United States has the lowest SARS-CoV-2 transmission rates in almost 5 years.

Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

• Central Valley Area: WastewaterSCAN Central Valley

• Los Angeles Area: WastewaterSCAN Greater LA

• San Francisco Bay Area: WastewaterSCAN Greater SF Bay Area | WastewaterSCAN Marin County

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

Bob Hawkins:

UK Summary.

• Key Covid indicators across England, Scotland, Wales, and Northern Ireland stayed very low this week, with many hitting record lows, indicating a minimal level of risk.

• Flu activity has remained at baseline levels across all home nations, following typical out-of-season patterns, confirming that this year’s flu season is over.

COVID Variants

• US Variant tracker, Last updated 8/28/25

• https://x.com/RajlabN

• Weekly variant roundup by Mike Honey:

  • https://bsky.app/profile/mikehoney.bsky.social

  • https://mike-honey.github.io/covid-19-genomes/output/Coronavirus%20-%20Genomic%20Sequencing%20-%20report%20EUR-UK.pdf

BA.3.2 in Spain

As of Friday, April 17, 2026:

• RSV activity is elevated, but has peaked in most regions.

• Influenza A activity is low and Influenza B activity is medium, but is trending downward.

• COVID activity is low in most places in the United States with some pockets that are higher. Overall, COVID levels are the lowest that they have been in several years.

Regional wastewater levels for COVID, RSV, Flu A, Flu B:

From: https://data.wastewaterscan.org/

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COVID

Wastewater levels of SARS-CoV-2 are at their lowest in almost 3 years, but there are still about 200,000 new COVID infections daily across the states with 1 in 226 people currently infected.

From: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

COVID BA.3.2

As Ryan Hisner posted, “BA.3.2’s propensity for children is undeniable at this point.” JAMA had a new article this week on the BA.3.2 (Cicada) SARS-CoV-2 Variant.

Acute COVID

4/9/26 J of Physiology: SARS‐CoV‐2 targets mitochondria, exacerbating COVID‐19 pneumonia https://buff.ly/7g8fM0q

A review from the University of Cambridge looks at the biochemical processes in which SARS-CoV-2 disrupts mitochondrial function in lung cells, leading to impaired energy production and increased inflammatory responses that can worsen pneumonia severity. “Emerging studies suggest even after the active infection is resolved, residual viral proteins, particularly SARS-CoV-2 spike protein, may linger and continue to cause damage to the mitochondria by increasing oxidative stress and disrupting energy metabolism” in Long COVID.

From: https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/JP290297

4/10/26 BioRxiV (UC Irvine): Phagocytic Clearance of SARS-CoV-2 Nucleocapsid- and RNA-Containing Immune Complexes Drives Inflammatory Cytokine Production and Endothelial Dysfunction https://buff.ly/N7h6hCs

University of California Irvine scientists found that immune complexes (ICs) containing SARS-CoV-2 RNA + nucleocapsid (N) protein + human anti-N antibodies induce inflammatory cytokines and chemokines in monocytes which can lead to endothelial vascular dysfunction, severe COVID infection, and possibly Long COVID inflammatory and vascular complications.

4/10/26 Nature (Mt Sinai): Unveiling alternate pathways for SARS-CoV-2 infection via extracellular vesicle-mediated transfer of ACE2 and TMPRSS2 https://buff.ly/qaDZc2B

Icahn School of Medicine (Mount Sinai) scientists found that lung epithelial cells can transfer ACE2 and TMPRSS2 receptors via extracellular vesicles to macrophages, endothelial cells, and pericytes. These receptors enable SARS-CoV-2 to infect cells that would otherwise be resistant to the virus.

4/16/26 Journal of Virology: HuR enhances SARS-CoV-2 non-structural protein translation through the genomic 5′-UTR, by promoting polypyrimidine tract-binding protein binding https://buff.ly/vQGzTRQ

SARS-CoV-2 hijacks the host protein HuR which boosts early production of viral proteins and simultaneously suppresses structural protein translation. Blocking HuR reduced viral RNA levels, decreased growth of the virus, and made cells significantly more sensitive to Remdesivir. Therefore, HuR may be a potential antiviral target.

4/6/26 Mucosal Immunology: Differential effects of SARS-CoV-2-targeted infection of ATII, club cells, and macrophages on lung immunopathology and antiviral responses https://buff.ly/Alf6sr4

A mouse study showed that SARS-CoV-2 infection in different lung cell types leads to different immune responses. Infection of club cells triggered early antiviral defenses and caused only mild damage, while infection of ATII cells led to higher viral loads and moderate inflammation. When macrophages were infected along with ATII cells, the combined effect caused severe lung injury, increased viral burden, and prolonged tissue damage, suggesting that interactions between cell types play an important role in COVID severity.

3/30/26 Frontiers in Immunology: Thymidine phosphorylase promotes SARS-CoV-2 spike protein-driven lung tumor development https://buff.ly/OIOu8Td

Marshall University researchers analyzed 166,807 patients and found a statistically significant increase in lung cancer risk among COVID survivors, particularly in smokers, Mouse studies showed that the SARS-CoV-2 spike protein activates the enzyme TYMP, triggering fibrosis, and inflammation. TYMP may be a target for prevention.

Pregnancy

4/13/26 Nature: SARS-CoV-2 infection during the first trimester leads to profound immune dysregulation at the maternal-fetal interface despite limited virus detection in placental tissues https://buff.ly/Yc9Awdx

Chinese research teams studying 761 first trimester pregnancies found that SARS-CoV-2 was rarely detectable in placental tissues, but it triggered strong immune activation, including elevated cytokines and widespread interferon signaling at the maternal-fetal interface. The infection disrupted key signaling pathways and cell communication in trophoblasts, suggesting that immune dysregulation rather than direct viral invasion may drive adverse pregnancy sequelae.

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Long COVID

4/11/26 Journal of Translational Medicine: Immune dysregulation in prolonged Long-COVID: lymphocytes emerge as key mediators of persistent inflammation, exhaustion and cytotoxicity https://buff.ly/sFO33ry

Latvian researchers performed single cell immune profiling on 9 female patients who had been hospitalized with acute COVID October 2020 to January 2021 consisting of 3 Long COVID patients with cardiovascular symptoms, 3 Long COVID patients with pulmonary complications, and 3 patients who did not develop Long COVID. Long COVID patients had persistent alterations in T cells, natural killer cells, and B cell signaling up to 1.5 to 2 years after infection, with increased expression of exhaustion and cytotoxicity genes. The study also identified distinct early interferon responses in patients who later developed Long COVID, suggesting that lymphocyte dysfunction begins during acute infection and may predict long term disease risk.

4/15/26 PLOS One: Acute SARS-CoV-2 viral load and systemic inflammation are associated with neuropsychiatric and musculoskeletal symptoms in long COVID https://buff.ly/ebQ8GB6

Scientists from Dow University in Pakistan studied 300 COVID patients and found that 59% had persistent Long COVID symptoms at 10 months, with higher acute infection viral load and systemic inflammation strongly linked to ongoing neuropsychiatric and musculoskeletal symptoms.

4/11/26 BMC Medicine: Acute COVID-19 severity and impaired cognitive function up to 32 months after diagnosis: an observational study https://buff.ly/9sDg5wv

In a European study of 153,841 people, non-hospitalized patients with acute COVID infection who felt sick enough to stay in bed for 1-6 days or more than 7 days, had 2x to 3x higher prevalence of impaired cognitive function 18 to 32 months after COVID diagnosis.

4/16/26 (7/2026 issue) J of Neurological Sciences: The neuropsychiatric features of Long COVID in older adults and the potential association with neuroinflammation: Preliminary observations in a small cohort https://buff.ly/8fZwbQG

Stony Brook University in New York studied 24 older adults and found that those with Long COVID had significantly higher levels of depression and fatigue compared to controls, with a subset of 6 patients showing increased neuroinflammation on PET imaging. These preliminary findings suggest that persistent neuropsychiatric symptoms in older adults may be linked to ongoing brain inflammation, though the small sample size limits generalizability.

From: https://www.jns-journal.com/article/S0022-510X(26)00197-8/abstract

4/13/26 Nature Reviews Neurology: Understanding the long-term neurological effects of SARS-CoV-2 infection https://buff.ly/5glOL0I

A review from the UK “summarizes the spectrum of neurological and psychological symptoms that occur following acute SARS-CoV-2 infection,” looking at evidence for underlying mechanisms. In addition, they discuss ongoing and completed large-scale treatment trials. Long COVID’s most persistent effects center on the nervous system, including cognitive impairment, fatigue, sleep disturbances, anxiety, and depression, with growing evidence that neurological and psychiatric symptoms interact bidirectionally and may share underlying biological mechanisms.

4/13/26 Nature (Melbourne, Australia): Divergent inflammatory and neurology-related protein levels in long COVID following primary and breakthrough SARS-CoV-2 infections https://buff.ly/d6SdzTa

Scientists from Melbourne, Australia analyzed 182 plasma proteins in 57 participants and found that Long COVID was associated with a distinct and persistent inflammatory and neurologic protein signature months after infection. Booster vaccination or breakthrough infection did not reproduce or worsen this pattern, suggesting that the immune response to re-exposure differs from the initial infection and may not drive Long COVID.

4/13/26 Nature: Site-specific wastewater-based surveillance in early detection of COVID-19 new cases and prediction of mass testing outcomes in long-term care facilities https://buff.ly/6tWjcKU

A study from the University of Alberta of 9 long term care facilities found that wastewater surveillance detected new COVID cases approximately 3 days before clinical confirmation and correctly predicted 85% of negative mass testing outcomes. Wastewater testing may be a faster and less invasive approach to outbreak monitoring in vulnerable settings.

4/13/26 (June 2026) International Immunopharmacology: Aminopeptides ameliorate long COVID symptoms in immunocompromised rheumatic patients through immune reconstitution https://buff.ly/5JlRmZM

Researchers from Beijing, China studied 171 immunocompromised patients with rheumatic disease and found that oral aminopeptides from bovine spleen taken for 3 months was associated with improvement in Long COVID symptoms, particularly fatigue. In addition, they found increased T cell counts and markers of immune recovery.

4/12/26 JACC Advances: Post-COVID Postural Orthostatic Tachycardia Syndrome and Inappropriate Sinus Tachycardia: Prevalence, Overlap, and Clinical Characteristics https://buff.ly/08MnHhe

A study of 270 Long COVID patients referred for tachycardia showed that postural orthostatic tachycardia syndrome (POTS) or a combined dual diagnosis of POTS and inappropriate sinus tachycardia (IST) were more common diagnoses than IST alone in Long COVID. IST patients were more likely to have high blood pressure, while POTS patients showed higher rates of cognitive impairment, fainting, and nausea.

From: https://www.sciencedirect.com/science/article/pii/S2772963X26001201

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Measles

As of April 16, 2026, 1,748 confirmed measles cases were reported in the United States in 2026.

The South Carolina outbreak remains at 997 measles cases, with no new measles cases since March 17.

The Utah measles outbreak continues to spread with 75 new cases in the last 3 weeks and 602 cases since this outbreak started in 2025.

From: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker

Government Health News

4/1/26 CIDRAP: Trump nominates Dr. Erica Schwartz, former deputy surgeon general, to head CDC

From: Unbiased Science

Other news

4/16/26 NPR receives $113 million in charitable gifts https://buff.ly/p80D5df

NPR announced two of the largest donations in its history, totaling $113 million, following Congress’s elimination of all federal public media funding. Philanthropist Connie Ballmer contributed $80 million, the largest gift ever from a living donor to NPR, while another anonymous donor gave $33 million.

4/2026 Cleveland Clinic: Woman Undergoes First in World Transvaginal Robotic-Assisted Dual Kidney Transplant https://buff.ly/Ev5Uvi4

Cleveland Clinic surgeons performed the world’s first robotic transvaginal dual kidney transplant in June 2025, placing two donor kidneys through an incision in the posterior vaginal wall with minimal post operative pain and a faster recovery. The dual kidney technique allows transplant of two marginal donor kidneys placed on one side of the body, preserving the other side for any future need.

4/14/26 Nature Genetics (USC): Multi-ancestry genome-wide association study of severe pregnancy nausea and vomiting https://buff.ly/PaP3bNM

Hyperemesis Gravidarum (HG) is a severe form of pregnancy nausea and vomiting that causes dehydration requiring hospitalization and affects about 2% of pregnancies. Dr. Marlena Fejzo from the Keck School of Medicine of USC and colleagues analyzed DNA from 10,974 women with hyperemesis gravidarum and 461,461 controls across diverse ancestries. They identified 10 genetic loci, including 6 new ones, linking the condition to pathways in appetite regulation, insulin signaling, and brain plasticity. These findings build on GDF-15 biology as a cause for HG.

4/1/26 JACC: GLP-1 Receptor Agonist Exposure During Pregnancy: A Systematic Review and Meta-Analysis of Adverse Pregnancy Outcomes https://buff.ly/XA1CwQ6

A systematic review and meta-analysis shows that “GLP-1 RA exposure [during pregnancy] was associated with improved maternal and preterm birth outcomes, with no significant increase in congenital malformations or overall adverse fetal outcomes.”

4/9/26 NPR: 710,000 fewer babies were born last year in U.S. compared with two decades ago https://buff.ly/N7uACMg

The U.S. fertility rate has reached historic lows, with annual births dropping by 710,000 compared to figures from twenty years ago. Teen pregnancy rates have plunged to new lows and many women are delaying motherhood to their 30s and 40s. People are having fewer children, a shift that could permanently transform the global economy.

4/14/26 Cell Metabolism: The weight-loss-independent hepatoprotective benefits of semaglutide are orchestrated by intrahepatic sinusoidal endothelial GLP-1 receptors https://buff.ly/WyS7g1W

Scientists at the University of Toronto found that Semaglutide provides direct protection to the liver by activating specific GLP-1 receptors located on intrahepatic sinusoidal endothelial cells. This mouse study demonstrates that the medication successfully reduces hepatic fat accumulation, fibrosis, and inflammation through specialized pathways, showing that the drug has metabolic benefits independent of weight loss alone.

From: https://www.sciencedirect.com/science/article/abs/pii/S1550413126001051

4/14/26 Nature: Unexpected detection of Mycobacterium Tuberculosis DNA in US-born patients in putative association with clinical syndromes https://buff.ly/XDaMA8Z

Boston University researchers used a new ultrasensitive molecular test and unexpectedly detected Mycobacterium tuberculosis DNA in up to 16% of respiratory samples from predominantly U.S.-born patients hospitalized at two Boston hospitals, despite negative standard cultures. The findings suggest hidden TB burden in low-incidence urban settings. Notably, all three patients with sickle cell acute chest syndrome, a life-threatening complication, tested positive for TB DNA, pointing to a potential overlooked association.

4/1/26 JAMA Psychiatry: Patients Use AI—Clinicians Should Ask How https://buff.ly/q0JaY40

More than 5 million U.S. youth, including 13% overall and 22% of those aged 18 to 21, have used AI for mental health advice, with nearly half of adults with mental health conditions also turning to these tools. Patients are using AI for emotional support, psychoeducation, and processing experiences, sometimes outside or instead of care, highlighting the need for clinicians to routinely screen for AI use to ensure safe integration with treatment.

4/3/26 Guardian: Nuns who broke back into their Austrian convent ‘are step closer to being able to stay’ https://buff.ly/Epj37zP

Austrian nuns Sisters Bernadette, Regina, and Rita, all in their 80s, are getting closer to being able to stay in their convent after the Vatican signaled it supports the idea in principle. The sisters had a locksmith come to break back into their convent last September after being moved to a care facility against their wishes. Nothing is final yet, but the three have now been invited to Rome, for a possible meeting with Pope Leo.

Sister Rita, Bernadette and Regina back in their convent

Have a great week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses Summary https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

Wastewater SCAN:

https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B.

RSV

WastewaterSCAN 4/19/26:

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

WastewaterSCAN:

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

COVID in Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

CDC wastewater COVID: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

CDPH California viruses in wastewater: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

• Central Valley Area: WastewaterSCAN Central Valley

• Los Angeles Area: WastewaterSCAN Greater LA

• San Francisco Bay Area: WastewaterSCAN Greater SF Bay Area | WastewaterSCAN Marin County

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

Bob Hawkins UK and Europe https://substack.com/@bhawkins3

• Summary: Flu and COVID are very low in the UK

• Europe

Europe

https://arcgis.jrc.ec.europa.eu/portal/apps/dashboards/e296cdf0c0d042e6b60b07a351f2dc5c

COVID Variants

US Variant tracker,

https://x.com/RajlabN

Weekly variant roundup by Mike Honey: https://bsky.app/profile/mikehoney.bsky.social

BA.3.2

4/17/26 JAMA: What to Know About the Cicada SARS-CoV-2 Variant https://buff.ly/qgzGAOD

• RSV activity continues to be high into April in many U.S. regions.

• COVID is low in the West, moderate in some Midwestern and Southern locations, and is still high in a few spots through the Northeast. JP Weiland estimates that we are down to 118,000 new COVID infections per day in the United States, which is one of the lowest levels in years.

• Flu A is low overall, and Flu B varies by region, but is still high in some places like the Northeast.

From: WastewaterSCAN

Acute COVID Infections, General COVID Info

4/7/26 Cell: SARS-CoV-2 directly infects the inner ear and causes hearing dysfunction https://buff.ly/zU3Rl4P

A study from Huazhong University showed that SARS-CoV-2 can invade the cochlea directly in mice, killing the spiral ganglion neurons (SGNs) responsible for transmitting sound. Rather than causing damage through inflammation, the spike protein appears to trigger this cell death by disrupting the normal function of stress granules.

From: https://www.cell.com/cell-reports/fulltext/S2211-1247(26)00329-3

Pediatrics

4/2/26 Academic Pediatrics: School Difficulties and Long COVID in Children and Adolescents https://buff.ly/ssLaO9P

A RECOVER Pediatrics study of 1,976 children and teens found that those with Long COVID were more than twice as likely to experience falling grades, and also had greater difficulty with concentration and socializing with peers. Given how many children are affected, the authors call for urgent development of school-based support services.

Long COVID

2/2026 Journal of Advanced Research: SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations https://buff.ly/WjLO5BU

Electron microscopy shows that SARS-CoV-2 harms myofibrillar bundles in heart muscle and also severely damages mitochondria, the energy producers for the heart cells. This can lead to Long COVID/post-COVID cardiovascular symptoms and heart arrhythmias.

From: https://www.sciencedirect.com/science/article/pii/S2090123225003066?via%3Dihub

4/8/26 BioRxiV (Yale Iwasaki lab): Intranasal Anti-CD3 Antibody Treatment Attenuates Post-COVID Neuroinflammation and Enhances Hippocampal Neurogenesis and Cognitive Function in Mice https://buff.ly/qEpRMVu

A Yale University mouse study found that nasal administration of an anti-CD3 antibody controlled neuroinflammation after COVID, restored neuron growth in the hippocampus, and helped to improve memory. The findings suggest a potential noninvasive treatment for Long COVID cognitive dysfunction.

4/8/26 BMJ: Long covid’s £8bn bill: OECD report warns pandemic continues to cast a “long shadow” https://buff.ly/YZ4s987

A new OECD report projects that Long COVID will cost OECD countries $135 billion per year because of people leaving the workforce and having lower productivity from disability. In addition, Long COVID will generate an additional $11 billion per year in healthcare costs across member countries over the next decade.

4/9/26 BioRxiV Preprint: An imaging flow cytometry method to study platelet-monocyte aggregates (PMA) using Long COVID as a model https://buff.ly/xMjVdvo

Researchers at Stellenbosch University found that people with Long COVID had far higher levels of platelet-monocyte aggregates (PMA) than healthy controls, roughly 29% versus 5%. They suggest that PMA could act as a biomarker for thromboinflammatory burden in Long COVID.

3/28/26 European Archives of Oto-Rhino-Laryngology: Self-Reported Smell and Taste Disorders in the General Population: A Cross-Sectional Survey in Austria, Germany and Switzerland https://buff.ly/7FBxsi1

A survey of 2,340 people across Austria, Germany, and Switzerland found that roughly 40% reported significant loss of smell or taste, a striking prevalence that researchers have connected to COVID infections in the region.

4/9/26 Journal of Human Hypertension: COVID-19 and cardiovascular outcomes in patients with pre-existing hypertension https://buff.ly/Y7YgCeQ

A large study of 75,180 patients at Montefiore Health System found that COVID infection, irrespective of disease severity, raises long-term heart risks in people with hypertension. Hospitalized patients showed 65% higher rates of major cardiac events and 2.5x mortality, years after their infection.

4/6/26 JACC Case Reports: Atypical Presentations of Coronary Microvascular Dysfunction in Patients After COVID https://buff.ly/eCWD0Xw

University of Florida physicians describe 3 patients with persistent chest pain after COVID whose routine cardiac tests looked completely normal, but whose coronary flow reserve (CFR) was significantly impaired. They concluded, “Coronary microvascular dysfunction may be the etiology of post-COVID chest pain. An earlier CFR assessment may shorten diagnostic delays and improve quality of life.”

From: https://www.jacc.org/doi/10.1016/j.jaccas.2026.107508

3/24/26 Frontiers in Cellular and Infection Microbiology: Proteomic signatures of COVID-19 Post-Vaccination/Post-Infection Syndrome (PV/PIS) https://buff.ly/uwatuH2

In a small pilot study of 30 participants from Stellenbosch University, people with persistent symptoms following either COVID vaccination or infection showed signs of immune dysregulation and abnormal clotting patterns, with some differences from classic Long COVID. Larger studies are needed to confirm these findings.

3/27/26 Current Cardiology Reviews: Retrospective Analysis of Clinical Repurposing of Dipyridamole and L-Arginine for Treatment of Long COVID Endothelitis https://buff.ly/QzxljAj

In a retrospective study of 44 Long COVID endothelitis patients, “treatment with dipyridamole and L-arginine, particularly in combination, was associated with meaningful improvements in fatigue, dyspnea, ability to perform ADLs, and mental health symptoms in patients with Long COVID.” Larger controlled trials are needed before firm conclusions can be made.

4/8/26 CIDRAP: Eye symptoms may signal higher-severity long COVID https://buff.ly/kSk7OkY

A new study found that people who developed new eye symptoms such as blurred vision, dry eyes, or floaters after COVID were more likely to report worse overall health and greater financial and housing difficulties, suggesting that ocular symptoms may serve as a marker for more severe Long COVID.

4/6/26 Unilad: People with long Covid are turning to opera singing for a surprising reason https://buff.ly/SiQkz0O

A program rooted in opera based breathing techniques has now reached more than 5,000 Long COVID patients in England. Opera exercises teach people to breathe more slowly and deliberately can help with symptoms of shortness of breath, coughing, chest pain, and fast breathing. Organizers are now planning to extend the program to people living with asthma and COPD.

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SARS-CoV-2 envelope (E) protein

Three new studies about the SARS-CoV-2 envelope (E) protein show that it can 1) disrupt mitochondria, 2) can cause epithelial cells to dedifferentiate and then die, and 3) can increase iron within cells to help the virus replicate.

From: https://magazine.medlineplus.gov/article/sars-cov-2-up-close

4/1/26 J of Biological Chemistry: SARS-CoV-2 envelope protein mitochondrial localization reveals host metabolic disruption https://buff.ly/rHTTGj0

Purdue University researchers found that the SARS-CoV-2 envelope protein enters mitochondria, disrupts the cell’s energy and lipid balance, and causes a buildup of damaging reactive oxygen species (ROS) without killing the cell outright. This metabolic disruption may help the virus replicate more efficiently by shifting the cell toward aerobic glycolysis.

3/23/26 Cell Death & Disease: SARS-CoV-2 nonspike structural proteins hijack mucosa epithelial cell fate https://buff.ly/c3yeuex

Multinational researchers studying 64 COVID patients found that the SARS-CoV-2 envelope protein can push mucosal epithelial cells to dedifferentiate, stall tissue repair, and ultimately trigger cell death. A molecule called calponin 2 (CNN2) was identified as a potential new treatment target.

3/25/26 BioRxiV: Coronavirus envelope protein drives iron sensing disorder by hijacking the TAp73-FDXR axis https://buff.ly/0hQ5n6K

A preprint from Yangling, China reports that the coronavirus envelope protein disrupts iron sensing inside cells, causing iron to accumulate in ways that may help the virus replicate. The authors developed a new molecule called DPTP-FC that appears to reduce this iron buildup and limit tissue damage across several coronaviruses including SARS-CoV-2.

Measles

As of April 9, 2026, 1,714 confirmed measles cases have been reported in the United States in 2026. Actual hospitalization numbers are unclear because some states, including South Carolina, do not report all hospitalized cases.

By the end of March, the US reported 1,671 measles cases in the first 3 months of 2026. “That’s 73% of the total [measles cases] from 2025, the worst year for the virus in more than three decades.”

4/7/26 South Carolina Department of Public Health: No new measles cases have been reported in South Carolina since March 17, keeping the outbreak total at 997, which is larger than the 2025 Texas outbreak.

Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/

4/9/26 AP News: Too young for the MMR shot, babies become ‘sitting ducks’ in measles outbreaks https://buff.ly/2Ri8PSO

Babies under 6 months of age cannot receive the MMR vaccine and are especially vulnerable during outbreaks. “Babies depend entirely on herd immunity — at least 95% of a community must be vaccinated to prevent measles outbreaks.” National MMR vaccination rates among kindergartners have fallen to 92.5% in 2024-25, with some communities far below that. As Dr. Martha Edwards, president of South Carolina’s American Academy of Pediatrics chapter commented, “The choice not to vaccinate impacts other parents’ rights to keep their children safe.”

Government News

4/9/26 NBC: White House calls new ballroom a national security necessity that’s ‘vital’ to the Trump family’s safety https://buff.ly/xQpgcqw

The Trump administration described the proposed 90,000-square-foot White House ballroom as a “national security necessity” vital to the first family’s safety, and indicated it will seek Supreme Court review if a federal appeals court does not rule in its favor.

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Other News

4/8/26 Nature: Genetic predictors of GLP1 receptor agonist weight loss and side effects https://buff.ly/V0nKWDg

A genome-wide study of 27,885 people from 23andMe found specific variants in the GLP1R and GIPR genes that can predict both how much weight a person will lose on GLP-1 medications and whether they are likely to experience nausea or vomiting. The GIPR association for nausea was specific to people taking tirzepatide, and the findings may eventually help match patients to the right medication for them.

3/27/26 Gut Microbes: Circulatory dietary and gut-derived metabolites predict early cognitive decline https://buff.ly/yIb6nmB

University of East Anglia researchers analyzed blood and stool samples from 150 adults aged 50 and older and found that six metabolites produced by gut bacteria could classify people into healthy, mildly impaired, and cognitively declining groups with about 79% accuracy. The findings raise the possibility that a simple blood test based on gut-derived metabolites could one day help detect dementia risk before symptoms become obvious.

2/17/26 Fred Hutch Cancer Center: Scientists develop first-of-its-kind antibody to block Epstein-Barr virus https://buff.ly/11tV8e1

4/7/26 Signal Transduction and Targeted Therapy: Triggering multiple sclerosis: infection with Epstein-Barr virus activates multiple pre-existing autoreactive B and T cells https://buff.ly/t9381TQ

Munich researchers found that the Epstein-Barr virus (EBV) may trigger multiple sclerosis by waking up pre-existing immune cells that attack myelin, leading to brain inflammation and myelin loss years after the initial infection.

4/9/26 Nature: One woman, three autoimmune diseases: CAR-T therapy vanquishes ultra-rare disease trio https://buff.ly/506I4gq

A single course of CAR-T cell therapy made three simultaneous rare autoimmune diseases into remission in one patient. More than a year later, she remains free of symptoms without any ongoing medication.

4/3/26 Science: Copper supports regulatory T cell energetic state to sustain peripheral immune tolerance https://buff.ly/J9pEecr

A Chinese study of 122 people along with a separate mouse study found that adequate levels of copper are necessary for regulatory T cells to maintain the metabolic energy they need to keep the immune system calm. Disrupting copper transport caused T reg cells to lose their ability to prevent excessive inflammation, suggesting that copper metabolism could be a meaningful target in autoimmune disease.

4/11/26 AP News: Artemis II’s record-breaking journey around the moon ends with dramatic splashdown https://buff.ly/9BysiBi

The four Artemis II astronauts completed humanity’s first crewed lunar voyage in more than 50 years with a Pacific splashdown on Friday, breaking Apollo 13’s distance record at 252,756 miles from Earth. Data will be used to prepare for a new landing on the moon by another crew in approximately two years.

NASA photos of Artemis II: https://www.nasa.gov/artemis-ii-multimedia/#images

Zero gravity hug of pure joy

Lunar eclipse

“Echoing the iconic Earthrise photo captured by the Apollo 8 astronauts in 1968, during the lunar flyby, the Artemis II crew captured a shot of Earthset as they passed behind the Moon’s far side.”

Have a great week,

Ruth Ann Crystal MD

References & Notes

Respiratory Illnesses Summary

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B and Norovirus.

RSV

RSV in wastewater through 4/4/26 per CDC https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

California RSV: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

HMPV

HMPV causes cold symptoms in most people, but it can make young babies, the elderly and immunocompromised people more sick.

4/11/26 Wastewater levels of HMPV, EVD68, Norovirus, and Rotavirus:

COVID

CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: 4/10/26

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

COVID from WastewaterSCAN (up to date, but omits 12 states):

https://data.wastewaterscan.org/

COVID in wastewater per the CDC (all states, but older data from 4/4/26):

4/4/26 from https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

• No longer has COVID graph.

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

California CDPH: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

• Flu B is still up.

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada ** | Tara Moriarty Canadian COVID data | Canada national wastewater

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

• Australia: Mike Honey

UK:

UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe

UK COVID PCR Test Positivity Map

Bob Hawkins on UK and Europe

UK Summary:

“Once again, the key Covid indicators in England, Scotland, Wales, and Northern Ireland remained very low this week, indicating a low level of risk.

Flu activity has returned to baseline levels across all home nations, following typical out-of-season patterns, confirming that this year’s flu season has come to an end.

Europe:

Canada COVID, RSV, Flu A, and Flu B in wastewater through 3/28/26:

COVID Variants

BA.3.2 represents about 20% of all COVID cases now per JP Weiland.

4/10/26

https://www.cdc.gov/covid/php/variants/variants-and-genomic-surveillance.html

The Nature Conservatory: https://www.nature.org/en-us/get-involved/how-to-help/animals-we-protect/what-to-know-about-brood-x-cicadas/

Cicadas spend most of their life underground, but emerge every 13 to 17 years to reproduce.

https://x.com/RajlabN

Weekly variant roundup by Mike Honey:

• https://bsky.app/profile/mikehoney.bsky.social

• https://mike-honey.github.io/covid-19-genomes/output/Coronavirus%20-%20Genomic%20Sequencing%20-%20report%20EUR-UK.pdf

U.S. Respiratory Illness Summary:

COVID is low in most areas, RSV is having a late season and is high especially in the Northeast and Midwest, Flu A is low, and Flu B is still high in the northeastern United States.

From: https://data.wastewaterscan.org/

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COVID Variants

4/2/26 CNN: Kids may be more likely to get the new ‘Cicada’ variant of Covid-19, scientists say. Here’s what to know about BA.3.2 https://buff.ly/eBfzxj6

BA.3 was first seen briefly in 2022, but then went silent until November 2024, when it showed up in South Africa. It re-emerged after years and started to circulate again, kind of like what the cicada insect does. For this reason, BA.3.2 has been nicknamed “Cicada”.

BA.3.2 appears to infect children ages 5 to 15 about 5x more than adults. But so far, infections with BA.3.2 are not more severe than previous COVID variants. It has shown up in countries around the world, but has not caused large waves.

Acute COVID infections, General COVID info

3/22/26 Diagnostics: Serum Mammalian Target of Rapamycin (mTOR) Levels in Patients with Post-COVID-19 Fibrotic-like Lung Changes: A Cross-Sectional Study https://buff.ly/mOusdoN

Higher blood mTOR levels were linked to post-COVID lung scarring

Antivirals

4/1/26 BioRxiV: VYD2311 is a promising candidate for passive immunization against COVID-19 in immunocompromised individuals https://buff.ly/5JqkrMq

David Ho’s lab at Columbia tested new monoclonal antibody VYD2311 and found that it potently neutralized XFG, NB.1.8.1, and the newer, genetically distant BA.3.2.2 COVID variant, significantly more than pemivibart.

3/17/26 Reports: Successful Treatment of Persistent and Relapsing COVID-19 with Ensitrelvir in a Patient with Obinutuzumab-Induced Long-Term B-Cell Depletion: A Case Report https://buff.ly/XFpXJ5g

Adding Ensitrelvir to Remdesivir helped an immunocompromised person to get rid of a persistent COVID infection.

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Long COVID

4/1/26 eClinical Medicine (Lancet): Long COVID and risk of incident cardiovascular disease: a prospective cohort study using the Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) cohort https://buff.ly/DdD4bDt

A large prospective study of over 1.2 million people from Sweden shows that Long COVID is linked to heart issues including heart failure, coronary disease and arrhythmias, even after mild COVID infection, especially in women.

3/31/26 Annals of Internal Medicine: The Effect of Fluvoxamine and Metformin for Fatigue in Patients With Long COVID: An Adaptive Randomized Trial https://buff.ly/NOkPqBS

In a randomized, placebo-controlled, adaptive trial, “Fluvoxamine, but not Metformin, may be an effective treatment for reducing fatigue and improving quality of life in patients with long COVID.”

3/31/26 Nature: Long COVID disability burden in US adults https://buff.ly/7nZ44z0

“Long COVID YLDs [years lived with disability] approximate those of Alzheimer’s and Asthma”, yet NIH funding was only 14% of what this disability burden would suggest.

3/31/26 Lancet Infectious Diseases: Intravenous immunoglobulin treatment for long COVID: a case report of clinical and immunological findings https://buff.ly/OKIoCFj

In a case report, “ high-dose intravenous immunoglobulin was associated with sustained clinical recovery from long COVID over 1 year of follow-up, accompanied by immunological changes consistent with modulation of post-viral immune dysregulation, including a reduction in pathogenic T cell–monocyte synapses.”

3/31/26 J of Infectious Diseases: Comparison of Immune Activation and Gut Barrier Dysfunction between Long COVID and HIV infection https://buff.ly/ZOykHsI

“Long COVID is marked by lipid oxidation [oxidative stress] while HIV shows persistent monocyte activation” and worse vitamin K status.

3/27/26 American Heart Journal Plus: Cardiology Research and Practice: Elevated blood viscosity is associated with dysautonomia in long COVID symptoms https://buff.ly/qjp65Ew

In a Veteran’s Administration study in which only 32% of Long COVID patients were women, increased blood viscosity was linked to dysautonomia and POTS, but not to Long COVID symptoms.

3/30/26 June 2026 issue Clinical Immunology (Review): Post-acute sequelae of COVID-19: A disorder of impaired innate immune resolution – A narrative review https://buff.ly/2ShEj8y

A new review suggests that Long COVID is a disorder of failed innate immune resolution in which persistent stimuli (SARS-CoV-2, DAMPs, latent viruses, microbiota) drive chronic inflammation.

3/27/26 Study Results | NCT05965726 | RECOVER-VITAL: Effects of Paxlovid on Long COVID Symptoms https://buff.ly/xi2MM9F

Preliminary results from a study of 964 people showed that taking 15 days or 25 days of Paxlovid did not resolve Long COVID symptoms (brain fog, autonomic dysfunction or post exertional malaise).

3/28/26 RECOVER-AUTONOMIC clinical trial results shared at 2026 ACC Conference (Ivabradine) https://buff.ly/9w1YQk0

A NIH RECOVER trial shows that while Ivabradine lowered heart rate, it did not improve Long COVID POTS symptoms.

3/27/26 Preventive Medicine Reports: Exploring Long COVID diagnostic equity by sex, race and ethnicity, and insurance type https://buff.ly/cbn7vR0

Black, Hispanic and Medicaid patients are less likely to be diagnosed with Long COVID as compared to white patients and those with private insurance.

Measles

As of April 2, 2026, 1,671 confirmed measles cases were reported in the United States in 2026, with 5% (91 of 1,671 cases) reported hospitalized.

3/31/26 “The South Carolina Department of Public Health (DPH) is reporting no new cases of measles in the state since our last update Friday, keeping the total number of cases in South Carolina related to the Upstate outbreak at 997.”

Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/

362 people from Utah have been diagnosed with measles in 2026, with 142 cases reported in the last 3 weeks.

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Other News

4/3/26 CIDRAP: State public health labs step up as CDC pauses testing for various pathogens, including Rabies, Mpox https://buff.ly/lPQaC0K

4/2/26 CIDRAP: High-dose flu vaccine tied to lower Alzheimer’s risk in older adults https://buff.ly/jiBcmLm

4/2/26 CIDRAP: Similar costs associated with hospitalization in older adults for RSV and human metapneumovirus (HMPV) https://buff.ly/34zaLG3

4/1/26 Nature Microbiology: Chikungunya virus persists in joint-associated macrophages and promotes chronic disease in mice https://buff.ly/WunIy5M

The Chikungunya virus can persist in macrophages in joints, causing inflammation and arthritis.

3/30/26 Nature Immunology: Sex differences in immune responses to viruses, bacteria and vaccines https://buff.ly/kkP4u8i

There are sex-specific immune mechanisms related to gonadal hormones and to X chromosome gene activity in immune cells.

4/5/26 CBS: Big Bear bald eaglets hatch as Jackie and Shadow’s family grows by 2 https://buff.ly/ifZNb99

After losing their first 2 eggs of the season to ravens, eagles Jackie and Shadow welcomed two new baby eaglets late Saturday and early Easter Sunday.

Have a good week,

Ruth Ann Crystal MD

References & Notes

Respiratory Illnesses Summary

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

• As of April 3, 2026, the amount of acute respiratory illness causing people to seek health care is low.

• RSV activity started later than expected in most regions of the United States, though illness is not more severe compared with recent seasons. This unusual timing means higher levels of RSV activity may continue into April in many regions. Emergency department visits and hospitalizations for RSV are highest among infants and children less than 4 years old.

• COVID-19 activity is low in most areas of the country.

• Seasonal influenza activity continues to decrease in most areas of the country. Influenza A activity is low across all regions while trends in influenza B activity vary by region.

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for HMPV, EVD68, Norovirus, Rotavirus

Respiratory Illness Index | Walgreens https://buff.ly/u7MgH5P

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

Seasonal influenza activity continues to decrease in most areas of the country.

CDC Respiratory viruses (COVID, Flu, RSV) Hospitalizations (for those states reporting): https://www.cdc.gov/resp-net/dashboard/index.html

RSV

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

RSV in wastewater through 3/28/26 per CDC:

RSV in California: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

COVID

US CDC COVID data tracker: https://covid.cdc.gov/covid-data-tracker/index.html#datatracker-home

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

3/29/26

‪

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

From: https://pmc19.com/data/

COVID Wastewater

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

California: CDC California | WastewaterSCAN California

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada **

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

Canada

Tara Moriarty Canadian COVID data: https://bsky.app/profile/moriartylab.bsky.social

Canada wastewater https://health-infobase.canada.ca/wastewater/

UK

UKHSA Dashboard: https://ukhsa-dashboard.data.gov.uk/

UK BuDS: https://buds.org.uk/category/our-work/iag-covid-19/risk-assessments/

UK COVID PCR Test Positivity Map: https://jamestindall.info/skeuomorphology/ladb_covid/index.html

Wastewater monitoring in Scotland

Bob Hawkins UK and Europe https://substack.com/@bhawkins3

Europe

https://arcgis.jrc.ec.europa.eu/portal/apps/dashboards/e296cdf0c0d042e6b60b07a351f2dc5c

Australia https://bsky.app/profile/mikehoney.bsky.social

COVID levels continue to decrease, RSV is still high in some places, and Flu B is high in the Northeast, but overall influenza has now decreased across most of the country.

From: https://data.wastewaterscan.org/

The Durham County Department of Health had a good infographic this week regarding allergies vs. respiratory infections. If you have itchy eyes with that sneezing, it is probably allergies. But, if you have a fever or body aches with sneezing or a cough, it may be a viral infection.

RSV

“RSV activity started later than expected in most regions of the United States, though illness is not more severe compared with recent seasons. This unusual timing means that higher levels of RSV activity may continue into April in many regions. Emergency department visits and hospitalizations for RSV are highest among infants and children less than 4 years old.” Babies can receive monoclonal antibodies to help protect them from RSV.

COVID

COVID levels in wastewater are currently HIGH in the Northeastern states, moderate across the Midwest and South, and are low in the West.

COVID Variants

BA.3.2

Interest in the BA.3.2 variant has increased this week following the release of a new MMWR report on the worldwide surveillance of COVID variant BA.3.2. The BA.3.2 variant was first identified in South Africa at the end of 2024. It is an unusual variant because it has over 70 new mutations relative to JN.1, and its descendants, which have been circulating since 2023.

BA.3.2, also known as “Cicada”, has been reported in 23 countries on 4 continents in 2026. The concern is that if it gains more mutations, it could lead to a large COVID wave. But at this point, other COVID variants that are more immune evasive have been causing bigger increases in COVID than BA.3.2.

Ryan Hisner posted this week that BA.3.2 may infect children more often. He reviewed information from European countries that post age related data (Ireland, Spain, France, the Netherlands, and Luxembourg) in this thread which showed that BA.3.2 was responsible for more COVID infections in children. He posted, “Children are less likely to have been vaccinated or infected with pre-Omicron variants, so you would expect their immune response to vary from adults’, primarily by being more Omicron-specific. I don’t understand why that would translate to greater vulnerability to BA.3.2, but there it is.”

Hisner continued, “There’s not much BA.3.2 in the US yet, but the numbers are still pretty striking. Ages 0-18 are more than 5 times as common in BA.3.2 sequences as in non-BA.3.2 sequences.”

Acute COVID infections, General COVID info

Epithelial cells line organs such as the lungs and endothelial cells line blood vessels in the body. Australian researchers used a human lung barrier model of co-cultured human lung epithelial and endothelial cells and found that IL-1β and TNF are major drivers of the endothelial injury and clotting problems seen in acute COVID-19. This work adds to the idea that inflammation spilling over from infected airway cells, not direct viral invasion, may damage blood vessels in severe COVID infection.

A new preprint from India shows that the SARS-CoV-2 PLpro enzyme can directly weaken epithelial barriers in both Drosophila fly and mammalian models. PLpro-associated breakdown of epithelial barriers can trigger stress, inflammation, and cell death, suggesting PLpro is a key driver of COVID-related tissue injury beyond viral replication.

In Brazil and Mexico, a 64 patient study found that SARS-CoV-2 non-spike proteins, especially the SARS-CoV-2 envelope protein, may hijack mucosal epithelial cells pushing them into a less mature, damaged state before obvious pathology appears. Calponin 2 (CNN2) emerged as a possible driver of that process, pointing to a potential target for treatments.

A preprint from China suggests that the coronavirus envelope E protein (CoV-E) may disrupt iron sensing inside cells through the TAp73-FDXR axis, leading to iron buildup that could help coronaviruses to replicate. The authors developed a new molecule, DPTP-FC, which alleviates iron accumulation and tissue damage caused by several coronaviruses including SARS-CoV-2.

Pregnancy

Babies under 6 months cannot be vaccinated against COVID, but maternal mRNA vaccination during pregnancy offers early protection. In a large University of Oslo study of 146,031 infants in Norway (2020–2023), babies exposed to maternal COVID mRNA vaccination were about half as likely to be hospitalized for COVID in the first 2 months of life. Protection declined to 24% by months 3 to 5 and disappeared after 6 months, with no increased risk of other infections. COVID vaccination in pregnancy helps protect both mother and baby.

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Antiviral treatments

After a successful Phase 3 trial, the COVID antiviral medication Ensitrelvir has now been approved in Japan, not just for COVID treatment, but also for post-exposure prevention of COVID. If broader regulators agree, this could give exposed high-risk patients a new oral option beyond vaccination alone. “Ensitrelvir is currently under review by the U.S. Food and Drug Administration (FDA) for the prevention of COVID‑19 following exposure, with a Prescription Drug User Fee Act (PDUFA) target action date of June 16, 2026. Ensitrelvir is also under regulatory review with the European Medicines Agency for COVID-19 post-exposure prophylaxis and treatment.”

In a New England cohort of 19,413 adults with COVID infection, Paxlovid did not reduce overall Long COVID risk. However, Paxlovid use was associated with a 37% reduction in gastrointestinal PASC and a 17% reduction in Long COVID risk among non-hospitalized adults aged 65–75, but an increased risk of eye and ear-related symptoms. These findings suggest that Paxlovid’s impact on Long COVID varies by organ system and patient age rather than providing uniform protection.

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Long COVID

Dr. Elisa Perego, an archaeologist and research fellow at University College London, coined the term “Long COVID” in 2020. She has now written a narrative review on Long COVID synthesizing current definitions, epidemiology, and mechanisms of this complex, multisystem condition that affects approximately 400 million people worldwide. The review highlights overlapping drivers of Long COVID including viral persistence, immune dysregulation, microbiome dysbiosis, endothelial dysfunction, and autoimmunity, which together can impact multiple organs and lead to prolonged symptoms. The paper emphasizes that Long COVID is not a single disease, but a heterogeneous syndrome requiring multidisciplinary approaches to diagnosis and care.

Researchers in the Netherlands studied IgG from 34 patients with Long COVID and identified three subgroups based on GFAP, NFL, and interferon-β levels in their blood. When transferred into mice, these antibodies induced pain behaviors, showing a direct pathogenic effect. Autoantibody patterns were subgroup-specific and persisted for up to two years, with IgG retaining pain-inducing activity over time.

From: https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(26)00110-2

“Microtesla Magnetic Therapy (MMT) is a low-amplitude radiofrequency magnetic field intervention that has demonstrated anti-inflammatory and neuroprotective effects in preclinical models.” A small randomized trial of 30 people with Long COVID brain fog found that at-home microtesla magnetic therapy (MMT) was feasible, appeared safe, and showed sustained clinically meaningful improvements across multiple cognitive domains and mood at 8 weeks. This was a pilot study and larger randomized trials are needed to confirm that MMT can help people with Long COVID cognitive and mood issues.

Mount Sinai researchers and collaborators analyzed data from 4,244 Visible app users with complex illnesses like Long COVID and ME/CFS and found that higher morning heart rate and lower heart rate variability (HRV) predicted worse fatigue, brain fog, and crashes later that day. Smartphone and wearable data appear to show real-world utility for symptom prediction in complex chronic illnesses.

Researchers in Pavia, Italy studied autonomic function in 37 post-acute COVID patients (<120 days since infection), 36 long-term COVID patients (≥120 days), and 50 matched healthy controls. Both COVID groups showed signs of autonomic dysfunction, including lower heart rate variability and reduced baroreflex sensitivity, with slightly greater abnormalities earlier after infection, even in patients without orthostatic symptoms. The findings suggest that autonomic dysfunction can persist after SARS-CoV-2 infection even when typical orthostatic symptoms are not present.

UCSF and Yale researchers characterized autoantibody profiles in 111 post-COVID participants with neurological symptoms or cognitive impairment and found no single shared autoantibody signature across the group. Individual patients showed distinct and heterogeneous autoantibody patterns, indicating that neurological Long COVID and brain fog are unlikely to stem from a uniform antibody-mediated mechanism.

Researchers used a protein microarray to measure IgA antibodies in saliva in post-COVID patients with depression, healthy controls, and non-COVID depressed patients. 65 IgA autoantibodies targeting human proteins were identified exclusively in the post-COVID depression group, with several of the recognized antigens linked to neurological function. The results suggest that post-COVID depression may involve a distinct mucosal autoimmune response in each patient, with salivary IgA profiles as potential non-invasive biomarkers, though the study size is small and findings are preliminary.

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Measles

As of March 26, 2026, 1,575 confirmed measles cases were reported in the United States in 2026, with 5% (78 of 1,575 cases) noted to be hospitalized.

The South Carolina Department of Public Health reported no new cases of measles in the state since Tuesday, keeping the total number of measles cases in South Carolina at 997 since the outbreak started in October 2025.

In Utah, 486 people have been diagnosed with measles in this outbreak, with 107 new cases reported in the last 3 weeks.

Polio

The CDC has issued Level 2 precautions for polio in Germany, Poland, and the United Kingdom after recent cases there. Travelers should be up to date on polio vaccination, and adults who completed the polio routine vaccination series may receive a single lifetime polio booster before travel. These polio precautions also exist for many countries in Africa, Pakistan and Israel.

Polio has been detected in these countries over the last 13 months:

From:https://wwwnc.cdc.gov/travel/notices/level2/global-polio#xd_co_f=MDVmY2Q4YzItNWUxOC00NjQ1LWIxZDgtODg5NTA5YWFmNzU1~

Government Health News

A new article in the BMJ shows that international maternal mortality is linked to changes in United States presidential parties. Researchers analyzed World Bank data from 150 countries (1985–2023) and found that switches from Democratic to Republican U.S. administrations correlate with a 10.5% rise in maternal deaths in countries with above-average reliance on US family planning aid, equaling to about 45 additional maternal deaths per 100,000 live births. Family planning aid averages 48% higher under Democratic administrations, and the mortality gap narrows when the Global Gag Rule (GGR) is not in force.

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Other news

I am excited to announce that our new website is live at VivaBiome.com. We’d love for you to take a look and let us know what you think. If you happen to spot any bugs or have feedback on how we can improve your experience, please feel free to drop us a note at info@vivabiome.com.

From: https://vivabiome.com/

A group from the Arc Institute posted about their new article in Nature showing how “the gut can drive age-associated memory loss.” Aging is associated with lower gut microbial diversity which has been linked with frailty. The Thaiss and Levy labs found that certain bacteria in the gut microbiome of older mice, particularly P. goldsteinii, make medium-chain fatty acids (MCFAs) which negatively affect memory and are associated with cognitive decline. Lowering the MCFAs in the mice using bacteriophages improved memory. Vagus nerve stimulation with the gut hormone CCK or with GLP-1 receptor agonists also reversed age-related memory deficits.

From: https://arcinstitute.org/news/gut-drives-memory-loss

CNBC reports that the average price of menstrual products like tampons and sanitary pads has skyrocketed by almost 40% over the last several years due to inflation and tariffs.

An interesting article from October 2025 shows that an antibody called 04_A06 broadly neutralizes HIV and may be used in the future for treating and preventing HIV infection.

Project CETI researchers documented the first detailed video and audio recording of a sperm whale birth, publishing their findings about social behavior and whale communication in Science and in Nature magazines. Eleven female sperm whales from two different pods formed a protective circle and took turns lifting the newborn calf to the surface so that it could breathe. Onlookers included nearby pilot whales and Fraser’s dolphins. The event highlights a high level of social coordination, complex communication, and caregiving behaviors in sperm whale societies.

Photo from Project CETI

From: https://www.science.org/doi/10.1126/science.ady9280

Have a good week,

Ruth Ann Crystal MD

References & Notes

CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/data/index.html

Durham County Allergies vs Viral Infection post:

Wastewater SCAN: https://data.wastewaterscan.org/

Regional wastewater levels for COVID, RSV, Flu A, Flu B and Norovirus.

Flu

CDC Flu View: https://www.cdc.gov/fluview/index.html

Outpatient Visits for Influenza-like Illness (Flu):

RSV

CDC wastewater data from: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

RSV in wastewater per WastewaterSCAN: https://data.wastewaterscan.org/

RSV in California https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

COVID

CDC COVID data tracker:

https://www.cdc.gov/respiratory-viruses/data/activity-levels.html

JP Weiland: https://twitter.com/JPWeiland https://bsky.app/profile/jpweiland.bsky.social

Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger

• Find the complete PMC dashboard at http://pmc19.com/data

• US by State: https://pmc19.com/data/index.php#states

• Worldwide data: https://pmc19.com/data/index.php#internationa

Wastewater

CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html

CDC Wastewater STATE TRENDS: https://www.cdc.gov/nwss/rv/COVID19-statetrend.html

Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/

California statewide view https://buff.ly/3YObiul

CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx

• COVID is very low across California now

Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater

International Surveillance

Mike Hoerger https://pmc19.com/data/index.php#international

• Austria: Federal Government of Austria |

• Canada: C19 Resources Canada * | World Health Network (WHN) Canada **

• Finland: WHN Finland **

• France: Airborne Risk Reduction Association (ARRA) France

• Germany: WHN Germany **

• Netherlands: WHN Netherlands **

• U.K: Buckinghamshire Disability Service (BuDS) U.K.

Canada

Tara Moriarty Canadian COVID data: https://bsky.app/profile/moriartylab.bsky.social

Canada wastewater https://health-infobase.canada.ca/wastewater/

UK

UKHSA Dashboard: https://ukhsa-dashboard.data.gov.uk/

UK BuDS: https://buds.org.uk/category/our-work/iag-covid-19/risk-assessments/

UK COVID PCR Test Positivity Map: https://jamestindall.info/skeuomorphology/ladb_covid/index.html

Wastewater monitoring in Scotland

Bob Hawkins UK and Europe https://substack.com/@bhawkins3

UK Summary.

This week, the key Covid indicators in England, Scotland, Wales, and Northern Ireland remained very low, indicating a low level of risk.

Flu activity has returned to baseline levels across all home nations, following typical out-of-season patterns, confirming that this year’s flu season has come to an end.

European Countries: COVID is low

Europe

https://arcgis.jrc.ec.europa.eu/portal/apps/dashboards/e296cdf0c0d042e6b60b07a351f2dc5c

France https://associationarra.wordpress.com/suivi-regional-sumeau/

Australia https://bsky.app/profile/mikehoney.bsky.social

Variants

US Variant tracker, Last updated 8/28/25

https://x.com/RajlabN

Weekly variant roundup by Mike Honey:

• https://bsky.app/profile/mikehoney.bsky.social

• https://mike-honey.github.io/covid-19-genomes/output/Coronavirus%20-%20Genomic%20Sequencing%20-%20report%20EUR-UK.pdf

BA.3.2

Raj Rajnarayanan’s BA.3.2 tracker:

https://public.tableau.com/app/profile/raj.rajnarayanan/viz/TrackingSARSCoV2LineageBA_3_2-Globally/BA_3_2

Places where BA.3.2 has been detected: