A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

A viral hurricane is making landfall on health care systems battered by three pandemic years. With the official start of winter still weeks away, pediatric hospitals are facing crushing caseloads of children sick with RSV and other viral illnesses. Schools that promised a “return to normal” now report widespread absences and even closures from RSV and flu in many parts of the country, contributing to parents missing work in record numbers. With this year’s flu season beginning some six weeks early, the CDC has already declared a flu epidemic as hospitalizations for influenza soared to the highest point in more than a decade.

A storm of these proportions should demand not only crisis clinical measures, but also community prevention efforts. Yet instead of deploying public health strategies to weather the storm, the U.S. is abandoning them.

Even before the arrival of the so-called tripledemic, U.S. health systems were on the brink. But as the fall surge of illness threatens to capsize teetering hospitals, the will to deploy public health measures has also collapsed. Pediatricians are declaring “This is our March 2020” and issuing pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as inevitable, or billed as the predictable outcome of an “immunity debt,” despite considerable uncertainty surrounding the scientific underpinnings and practical utility of this concept.

The Covid-19 pandemic should have left us better prepared for this moment. It helped the public to understand that respiratory viruses primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving activities outdoors, and limiting large gatherings during surges — were incorporated into the daily routines of many Americans. RSV and flu are also much less transmissible than Covid-19, making them easier to control with common-sense public health practices.

Instead of dialing up those first-line practices as pediatric ICUs overflow and classrooms close, though, the U.S. is relying on its precious and fragile last lines of defense to combat the tripledemic: health care professionals and medical facilities.

Warnings and advisories recently issued by U.S. public health leadersclinical leaderspoliticians, and the media have consistently neglected to mention masking as a powerful short-term public health strategy that can blunt the surge of viral illness. Instead, recent guidance has exclusively promoted handwashing and cough etiquette. These recommendations run counter to recent calls to build on improved understanding of the transmission of respiratory viruses.

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

The tripledemic has already claimed its first child deaths in the U.S., adding to a large ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many more preventable deaths among pediatric and other vulnerable patients who can’t access the care they need.

By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the tripledemic is a crisis that leaders, health agencies, and institutions have, in a sense, chosen. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to stand down on public health measures, with the President even stating in September that “the pandemic is over.” By moving real risks out of view and failing to push for more robust measures to mitigate Covid, these messages have put the country on a path to its present circumstances, in which pediatric RSV patients are transferred to hospitals hundreds of miles away because there is no capacity to treat them in their own communities.

Living with viruses should mean embracing simple public health measures rather than learning to live with staggering levels of illness and death. Leaders in public health and medicine should issue timely and appropriate guidance that reflects the latest science instead of second-guessing the prevailing winds in public opinion. Instead of self-censoring their recommendations out of fear of political consequences, they should continue to promote the full range of public health strategies, including masking in crowded indoor public places during surges.

The tripledemic should bring renewed urgency to policies that will reduce the toll of seasonal illness on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can limit the spread of diseases and have many demonstrated health and economic benefits, yet the U.S. continues to lack standards to guide infrastructure or workplace safety standards. Paid leave enabling workers to stay home when they are ill can reduce the transmission of disease as well as loss of income, yet the U.S. is one of the only high-income countries without universal paid sick leave or family medical leave.

Greater effort must also be made to increase vaccination coverage for flu and Covid and bring an RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 received a flu shot last year, a gap that can be closed with more energetic vaccination campaigns. Reducing annual flu deaths using a broader range of strategies enabled by the pandemic — rather than pegging Covid deaths to them — should be the goal.

Amid the many sobering stories of the tripledemic, there is some good news. As the experience of Covid-19 has shown, it is possible to limit the toll of respiratory viruses like flu and RSV. However, this work requires resources, appropriate policies, and political will. Americans don’t need to accept winter disease surges and overrun health systems as an inevitable new normal. Instead, the country should see the tripledemic as a call to reinvigorate public health strategies in response to these threats to the health of our communities.

China’s COVID storm

https://www.axios.com/2022/11/26/china-covid-outbreak-lockdown-economy

A new COVID calamity is hammering China, with a surge in infections prompting a return of lockdowns, including in some manufacturing areas that supply the West.

  • China reported a record number of infections this week, amid lockdowns and mass testing that are fueling unrest and darkening the country’s economic outlook. Schools in Beijing returned to online teaching.

Why it matters: In addition to the human misery for the world’s most populous country, the effects will be felt around the globe, Axios China author Bethany Allen-Ebrahimian reports from Taipei.

  • Supply chains are likely to be disrupted, causing prices to rise in an already rocky global economy.

Rare protests broke out today in China’s far western Xinjiang region. Crowds shouted at hazmat-suited guards after a deadly fire triggered anger by prolonged COVID lockdowns, Reuters reports.

  • “End the lockdown!” shouted protesters in the Xinjiang capital Urumqi, where an apartment fire killed 10.

What’s happening: The moment of truth for China’s zero-COVID policy has finally come.

  • Either party leaders will need to plunge much of the country into draconian lockdowns, as we saw at the beginning of the pandemic — or they’ll decide it’s time to learn to live with COVID.

Reality check: China’s doctors have warned Xi Jinping that the healthcare system isn’t prepared for the huge outbreak likely to follow the easing of strict anti-COVID measures, the Financial Times reports.

  • Chinese-made vaccines, which don’t use the mRNA technology employed by many produced by the West, aren’t as effective compared to those made in the U.S. And China has worrisomely low vaccination rates among older people.
  • But the number of cases in China is actually still very low for anywhere but China.

The big picture: “Zero COVID” restrictions have damaged the economy and undermined people’s trust in government.

  • That’s a stark about-face from the height of the pandemic. Then, many Chinese people felt the tight central control had protected them better than any other governance model in the world.
  • But it’s that very model that has plunged China into its current predicament. Xi tied his reputation, and the party’s legitimacy, to the success of “zero COVID.”

Between the lines: Chinese leaders made a huge, politically motivated mistake. They resisted the import of Western-made mRNA vaccines (including Pfizer and Moderna) for its citizens. These vaccines were only recently made available to foreigners.

  • That’s likely because of Beijing’s big vaccine diplomacy push: Chinese officials touted their own vaccines as the best and safest.
  • It was politically unpalatable to admit “defeat,” and allow Chinese people to get more effective — but Western-made — jabs.

China faces dilemma in unwinding zero-COVID

https://www.axios.com/2022/11/28/china-dilemma-unwinding-covid-zero

China is facing an increasingly precarious situation as new COVID cases soar and the population seems to be hitting a breaking point with the government’s stringent zero-tolerance policies.

Why it matters: The world’s most populous nation has massive vulnerabilities heading into this winter, starting with the fact the vast majority of its population has yet to be exposed to the virus and has little ‘natural immunity.’

  • China’s vaccines didn’t work well compared to those distributed in the West, and the government refused to approve foreign vaccines and doesn’t have a version to combat Omicron.
  • Vaccine uptake was particularly low among the elderly.
  • And now, public outrage over new COVID lockdown restrictions has fueled rare protests, Axios’ Herb Scribner writes, with residents demanding the government to lift restrictions quickly and some calling for President Xi Jinping’s resignation.

State of play: Overall, China’s number of reported COVID cases and COVID deaths are far lower than other nations, but there have been recent reported spikes in overall numbers of cases and some new deaths.

  • It came after the Chinese government announced some easing of its zero-COVID policy, such as reducing mass testing and quarantine requirements, earlier this month.

Reality check: China’s doctors have warned that the health care system isn’t prepared for the huge outbreak likely to follow any easing of public health measures, Axios’ Bethany Allen-Ebrahimian writes.

  • That includes worries the nation doesn’t have enough ICU bed capacity to handle such outbreaks, according to the Financial Times.

Between the lines: Another concern is the potential evolution of a new, more dangerous variant if there’s a huge surge of infections, Christian Drosten, Germany’s most prominent virologist, told Bloomberg.

  • “Xi Jinping knows very well that he can’t simply let the virus loose,” Drosten said. “The Chinese population first needs to be as well vaccinated as we are.”

Be smart: China’s officials are scrambling to address the vaccine problem.

  • For instance, they are launching more aggressive vaccine drives and limiting movement among at-risk groups, including the elderly, the Washington Post reports.
  • They’ve also approved the use of the first inhaled COVID-19 vaccine in dozens of cities earlier this month in a bid to boost uptake, WSJ reported. Experts have said the vaccine, which was found to stimulate a mucosal response, may create more durable protection against the virus, although more data is needed.
  • But they have yet to open up the availability of mRNA vaccines from Pfizer-BioNTech and Moderna, opting to focus on their own, per the Post.

The bottom line: China’s zero-COVID policy has kept cases in China relatively low compared to the rest of the world.

  • But even as the societal and economic consequences of shutdowns become apparent, it faces a very difficult path ahead in unwinding strict public health policies.

Can updated boosters prevent another Covid-19 surge? Why some experts are skeptical.

Most experts agree that updated bivalent Covid-19 boosters provide additional protection against serious illness and death among vulnerable populations—but evidence suggests that increased booster uptake may not prevent a “wave of Covid” infections this winter, Apoorva Mandavilli writes for the New York Times.

Can bivalent boosters prevent another surge of infections?

While the Biden administration’s plan to prevent another surge of Covid-19 infections relies on increasing Americans’ uptake of the updated booster doses of the PfizerBioNTech and Moderna vaccines, some experts doubt the strategy.

According to John Moore, a virologist at Weill Cornell Medicine, boosters provide additional protection to vulnerable populations—including older adults, immunocompromised individuals, and pregnant people—who should get boosted to prevent severe illness and death.

However, the benefit is not as clear for healthy, younger Americans who “are rarely at risk of severe illness or death from Covid, and at this point most have built immunity through multiple vaccine doses, infections or both,” Mandavilli writes.

“If you’re at medical risk, you should get boosted, or if you’re at psychological risk and worrying yourself to death, go and get boosted,” Moore said. “But don’t believe that will give you some kind of amazing protection against infection, and then go out and party like there’s no tomorrow.”

Separately, Peter Marks, FDA‘s top vaccine regulator, noted the limited data available data for the updated boosters.

“It’s true, we’re not sure how well these vaccines will do yet against preventing symptomatic disease,” he said, especially as the newer variants spread.

However, Marks added, “even modest improvements in vaccine response to the bivalent boosters could have important positive consequences on public health. Given the downside is pretty low here, I think the answer is we really advocate people going out and consider getting that booster.”

How much additional protection do updated shots provide?

While Pfizer-BioNTech and Moderna recently reported that their bivalent boosters produced antibody levels that were four to six times higher than the original vaccine, their results were based on BA.4 and BA.5 antibodies, instead of the more prevalent BQ.1 and BQ.1.1 variants.

According to Mandavilli, “[a] spate of preliminary research suggests that the updated boosters, introduced in September, are only marginally better than the original vaccines at protecting against the newer variants — if at all.”

These small studies have not been reviewed for publication in a journal—but they all came to similar conclusions.

“It’s not likely that any of the vaccines or boosters, no matter how many you get, will provide substantial and sustained protection against acquisition of infection,” said Dan Barouch, head of Beth Israel Deaconess Center for Virology and Vaccine Research, who helped develop Johnson & Johnson‘s vaccine.

Notably, Barouch’s team recently discovered that BQ.1.1 is around seven times more resistant to the body’s immune defenses than BA.5, and 175 times more resistant than the original strain of the coronavirus. “It has the most striking immune escape, and it’s also growing the most rapidly,” he said. BQ.1 will likely follow a similar pattern.

“By now, most Americans have some degree of immunity to the coronavirus, and it does not surprise scientists that the variant that best evades the body’s immune response is likely to outrun its rivals,” Mandavilli writes.

The new vaccine increases antibodies, but the fact it is bivalent may not be significant. In August, a study by Australian immunologists suggested that any kind of booster would offer extra protection. In addition, the study noted that a variant-specific booster would likely not be more effective than the original vaccine.

“The bulk of the benefit is from the provision of a booster dose, irrespective of whether it is a monovalent or bivalent vaccine,” according to the World Health Organization.

Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai, noted that despite recent research, which evaluated immune response soon after vaccination, immune response may improve over time.

“We will see with larger studies and studies at a later time point if there is a good or a significant benefit, but I think it’s certainly not worse,” he added. “I don’t see much risk when you get the vaccine, so you might as well get the benefit.”

“What we need to do right now to get us through the next few months when I think we are in yet another wave of incipient wave of Covid,” Marks added. “And then we need to look forward, and lean into how we’re going to do things differently moving forward.”

Will we see an increase in vaccine uptake?

Currently, FDA allows the booster dose at least two months after a Covid-19 infection or previous does. However, some studies suggest boosting too early could have negative consequences. “Lengthening the interval between boosts to five or six months may be more effective, giving the immune system more time to refine its response,” Mandavilli writes.

Still, “adding yet another shot to the regimen seems unlikely to motivate Americans to opt for the immunization,” no matter the schedule, she adds.

“Each new booster we roll out is going to have a lower and lower uptake, and we’re already pretty close to the floor,” said Gretchen Chapman, an expert in health behavior at Carnegie Mellon University.

Ultimately, “[w]e should not spend a lot of political capital trying to get people to get this bivalent booster, because the benefits are limited,” Chapman added. “It’s more important to get folks who never got the initial vaccine series vaccinated than to get people like me to get their fifth shot.” 

COVID public health emergency (PHE) likely to extend past January

https://mailchi.mp/4b683d764cf3/the-weekly-gist-november-18-2022?e=d1e747d2d8

The Department of Health and Human Services (HHS) appears set to extend the federal COVID PHE past its current expiration date of January 11, 2023, as HHS had promised to give stakeholders at least 60 days’ notice before ending it, and that deadline came and went on November 11th. Days later the Senate voted to end the PHE, a bill which Biden has promised to veto should it reach his desk. Measures set to expire with the PHE, or on a several month delay after it ends, include Medicare telehealth flexibilities, continuous enrollment guarantees in Medicaid, and boosted payments to hospitals treating COVID patients. 

The Gist: Despite growing calls to end the PHE declaration, and even as White House COVID coordinator Dr. Ashish Jha has said another severe COVID surge this winter is unlikely, the White House is likely trying to buy time to resolve the complicated issues tied to the PHE, some of which must be dealt with legislatively. 

And with a divided Congress ahead, it remains to be seen how these issues, especially Medicare telehealth flexibilities—a topic of bipartisan agreement—are sorted out. Meanwhile the continuation of the PHE prevents states from beginning Medicaid re-determinations, allowing millions of Americans to avoid being disenrolled.

Who is still dying of COVID?

https://mailchi.mp/46ca38d3d25e/the-weekly-gist-november-4-2022?e=d1e747d2d8

While we have mercifully moved beyond the crisis phase of the pandemic, COVID remains a leading cause of US deaths, taking the lives of hundreds of Americans each day.

In the graphic above, we analyzed COVID mortality data, finding the defining characteristic of Americans still dying of COVID is age. As death rates have dropped, the percentage of COVID deaths accounted for by individuals 65 years or older has risen to an all-time high of 88 percent. 

Notably, a majority of people dying of COVID today are vaccinated, due to the high rate of vaccination in the 65+ population. While the near-universal vaccination of seniors, including the fact that one in five have received the most recent bivalent booster, is not sufficient to save all of their lives, unvaccinated seniors are still dying at higher rates than vaccinated ones.

In August 2022, vaccinated individuals over age 80, who represent about four percent of the total US population, made up 31 percent of COVID deaths, while unvaccinated individuals in the same age group, who represent less than one percent of the total population, made up 19 percent of COVID deaths. 

We entered 2020 with about 55M Americans ages 65 and older, and have since lost 790K, or nearly 1.5 percent of the senior population, to COVID. Meanwhile, reports of the new, immune-evasive BQ variant sweeping New York and California remind us that COVID’s not done with us yet, even if we think we’re done with it. 

RSV: A pediatric disease expert answers 5 questions about the surging outbreak of respiratory syncytial virus

Respiratory syncytial virus, more commonly known as RSV, sends thousands of children to the hospital every year in the U.S. But during September and October 2022, health professionals across the country have watched an unprecedented spike in the number of cases of this usually mild, but occasionally dangerous, respiratory infection in children. Jennifer Girotto is a pharmacist who studies pediatric infectious diseases. She explains how RSV infects the human body, who is most at risk and what might be causing this year’s outbreak to be worse than normal.

1. What is respiratory syncytial virus?

RSV is a common, RNA respiratory virus that affects about 2 million children under 5 years old annually nationwide. Researchers think that most children have been infected by age 2. Like the flu, in most areas of the U.S., RSV usually circulates from November through March and then mostly disappears during the summer months, with only sporadic cases being seen.

2. Who is most at risk?

A microscope image of thin blue lines among cells.
Respiratory syncytial virus – highlighted in blue – infects cells in a person’s lungs, throat and nose and can lead to anything from a mild cold to pneumonia and croup in more severe cases. National Institute of Allergy and Infectious Diseases/Wikimedia CommonsCC BY

For most people, especially those who have had an RSV infection in the past, the virus only causes mild symptoms like cough, runny nose and fever, with instances of wheezing and decreased appetite more common in young children.

But young infants, especially those under 6 months old, born prematurely or with congenital heart, lung or other health issues are at increased risk for more severe symptoms. The U.S. Centers for Disease Control and Prevention estimates that 1% to 2% of infants younger than 6 months who get infected with RSV require hospitalization. In an average year, around 250 children die from the disease.

In recent years, researchers have found that RSV can also cause severe disease in high-risk adults and people older than 65..

3. How does RSV make people sick?

The main reason RSV sends babies and young children to the hospital is because the virus infects and kills surface cells within small sacs of the lungs. The body responds by increasing the production of mucus and fluid in these areas. But the extra mucus can plug up and obstruct these parts of the lung and make it so that an infant doesn’t get enough oxygen.

A second common cause for hospitalization due to RSV is pneumonia, where a person’s lungs fill up with fluid. The pneumonia can either be triggered by the virus itself or by a secondary, bacterial infection. Finally, some infants get so sick that they struggle to eat and are unable to take in sufficient nutrients, eventually landing them in the hospital.

4. How concerning is this year’s outbreak?

On average, RSV sends about 60,000 young children to the hospital each year in the U.S. In 2022, however, the virus has hit early and hard. According to the CDC, doctors have found more cases in each week of October than any week in the prior two years.

Health officials aren’t yet sure why the outbreak is so bad this year, but the COVID-19 pandemic may have something to do with it. Some research has shown that seasonality of RSV has shifted. In 2021, RSV infections started much earlier than normal, and over the summer of 2022, they never quite went away. One theory as to why RSV season is starting earlier and hitting harder is that, due to social distancing measures since 2020, an unusually high number of infants and children are experiencing their first exposures and infections at once.

5. How can you protect against catching RSV?

Like colds and the flu, RSV infections spread when people touch dirty surfaces or from respiratory droplets, when an infected person coughs or sneezes.

Health professionals recommend that premature infants and infants with certain medical conditions take a monthly monoclonal antibody medication, called Palivizumab, during the RSV season to help keep them out of the hospital. There are a few RSV vaccines under development, but none are yet approved. For now, preventative measures are the best way to avoid an infection.

If someone is sick with symptoms that look like a cold, it may be best to avoid close contact until they feel better, especially if you have young children or high-risk people around.

Covid-19 is surging in Europe. Is America next?

https://www.advisory.com/daily-briefing/2022/10/10/covid-resurgence

While infections, hospitalizations, and deaths from Covid-19 have been steadily declining in the United States in recent months, experts warn that rising cases in Europe may be “a harbinger for what’s about to happen in the United States,” Rob Stein writes for NPR’s “Shots.”

Will the US see a ‘winter resurgence’ of Covid-19?

Currently, several models project that U.S. Covid-19 infections will continue to decline at least until the end of 2022. However, researchers caution that there are multiple variables that could change current projections, including whether more infectious strains start circulating around the nation.

According to Stein, “[t]he first hint of what could be in store is what’s happening in Europe.” Recently, many European countries, including the U.K., France, and Italy, have seen an increase in Covid-19 infections.

“In the past, what’s happened in Europe often has been a harbinger for what’s about to happen in the United States,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “So I think the bottom line message for us in this country is: We have to be prepared for what they are beginning to see in Europe.”

“We look around the world and see countries such as Germany and France are seeing increases as we speak,” said Lauren Ancel Meyers, director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin. “That gives me pause. It adds uncertainty about what we can expect in the coming weeks and the coming months.”

However, Justin Lessler, an epidemiologist at the University of North Carolina who helps run the COVID-19 Scenario Modeling Hub, noted that the United States may not have the same experience as Europe, largely because it is unclear whether Europe’s increase is related to individuals’ vulnerability to new strains.

“If it is mostly just behavioral changes and climate, we might be able to avoid similar upticks if there is broad uptake of the bivalent vaccine,” Lessler added. “If it is immune escape across several variants with convergent evolution, the outlook for the U.S. may be more concerning.”

Some researchers believe the United States is already experiencing early signs of this. “For example, the levels of virus being detected in wastewater is up in some parts of the country, such in Pennsylvania, Connecticut, Vermont and other parts of Northeast,” Stein writes. “That could an early-warning sign of what’s coming, though overall the virus is declining nationally.”

It’s really too early to say something big is happening, but it’s something that we’re keeping an eye on,” said Amy Kirby, national wastewater surveillance program lead at CDC.

According to David Rubin, the director of the PolicyLab at Children’s Hospital of Philadelphia, which tracks the pandemic, Covid-19 infections and hospitalizations are already rising in some parts of New England, and other northern regions, including the Pacific Northwest.

“We’re seeing the northern rim of the country beginning to show some evidence of increasing transmission,” Rubin said. “The winter resurgence is beginning.”

How likely is a severe Covid-19 surge?

Unless a “dramatically different new variant emerges,” it is “highly unlikely this year’s surge would get as severe as the last two years in terms of severe disease and deaths,” Stein writes.

“We have a lot more immunity in the population than we did last winter,” said Jennifer Nuzzo, who leads the Pandemic Center at the Brown University School of Public Health.

“Not only have people gotten vaccinated, but a lot of people have now gotten this virus. In fact, some people have gotten it multiple times. And that does build up [immunity] in the population and reduce overall over risk of severe illness,” Nuzzo said.

Another factor that could affect the severity of the impact of rising infections is the number of people who receive updated Covid-19 vaccines, which help boost waning immunity from previous infections or shots.

However, the United States’ booster uptake has been slow. “Nearly 50% of people who are eligible for a booster have not gotten one,” said William Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health. “It’s wild. It’s really crazy.”

Since updated boosters became available in September, less than 8 million of the over 200 million people who are eligible have received one.

According to Nuzzo, it is critical for people to stay up to date on their vaccines, especially with the high likelihood of another Covid-19 surge. “The most important thing that we could do is to take off the table that this virus can cause severe illness and death,” Nuzzo said.

“There are a lot of people who could really benefit from getting boosted but have not done so,” she added.

Houston Methodist reports flu levels not usually seen until December

Houston Methodist is reporting an early increase in flu cases, with numbers hitting levels not usually seen until the end of the year.

The hospital recorded 100 cases of influenza A and B in the week ending Sept. 21. A week prior, this figure hit 226. 

“We experienced an early uptick in mid-September, which relaxed some last week, but still these are the sorts of numbers we usually see in December, not now,” Wesley Long, MD, PhD, a pathologist and medical director of diagnostic microbiology at Houston Methodist, tweeted Sept. 26.

Texas is the only state in the U.S. — outside of Washington, D.C. — that already has a moderately high rate of flu cases, according to the CDC’s latest weekly flu report published Sept. 23.

The early rise in cases comes amid warnings that this season’s flu season may be severe.

New York declares polio a state emergency

New York Gov. Kathy Hochul on Sept. 9 declared a state of emergency amid evidence that polio is spreading in communities around the state. The move unlocks federal resources to help the state respond and boost vaccination rates. 

Under the declaration, pharmacists, emergency medical personnel and midwives can now administer polio vaccines. The executive order also requires providers to send polio vaccination data to the state’s health department. 

“On polio, we simply cannot roll the dice,” said Mary Bassett, MD, health commissioner at the state’s health department. “If you or your child are unvaccinated or not up to date with vaccinations, the risk of paralytic disease is real. I urge New Yorkers to not accept any risk at all.”

The declaration came the same day state health officials reported that the virus had been detected in wastewater samples from Nassau County. Officials have also found the virus in sewage samples from New York City, Orange County, Sullivan County and Rockland County, where the nation’s first polio case in nearly a decade was confirmed July 21 in an unvaccinated man. Health officials have suggested the Rockland County case may just be the “tip of the iceberg” with hundreds of other cases potentially going undetected in the state. 

The threat of polio’s resurgence is magnified by the many pockets of unvaccinated residents throughout the state. New York’s polio vaccination rate is 78.96 percent. That figure is lower in many of the counties where the virus has been detected in wastewater. In Rockland County, for example, the polio vaccination rate is 60.3 percent, state data shows. Nationwide, polio vaccination coverage sits at about 93 percent, according to the CDC.