Dr. Ruth Report, 3/8/26
We are finally seeing COVID levels decrease in the Midwest and Northeast. RSV season is very late this year and is expected to continue to cause disease in babies and in the elderly until April. Flu A is low, but Flu B is high especially in the Midwest and Northeast. Other common winter viruses are mentioned below.
Wastewater levels for COVID, RSV, Flu A, Flu B:
From: https://data.wastewaterscan.org/
Flu
Although Influenza A has declined, Influenza B is increasing and is HIGH in many places in the United States. Influenza activity is VERY HIGH in Oregon, Idaho, New Mexico, and Missouri.
Ninety children have died of the flu this year so far. Vaccination can provide protection against severe disease and there are effective antiviral medicines against influenza that are especially effective if taken early.
RSV
We are having an unusually late RSV season this year as reflected by high RSV in wastewater and significant emergency department visits and hospitalizations for RSV in infants and children 4 years and younger. “This atypical season indicates that higher levels of RSV activity may continue into April in many regions”, according to the CDC. RSV vaccines are available and are important for pregnant women and older adults. Babies may receive monoclonal antibodies like Beyfortus to protect against RSV which can cause very severe disease in infants.
HMPV, Norovirus and Rotavirus are HIGH in wastewater now:
From: https://data.wastewaterscan.org/
Human Metapneumovirus (HMPV)
HMPV causes cold symptoms in most people, but it can make young babies, the elderly and immunocompromised people more sick. It is HIGH in wastewater now across many parts of the United States.
Norovirus
Norovirus, sometimes referred to as the “stomach flu”, causes nausea, vomiting, and diarrhea. It is the top cause of foodborne illness in the United States. Norovirus has caused outbreaks on cruise ships and is very contagious. Wastewater levels of Norovirus are HIGH right now, especially in the Midwest and Northeast.
Rotavirus
Rotavirus causes diarrheal illness mostly in babies and young children under age 5. Adults are rarely affected due to immunity to the virus. We are seeing HIGH levels of Rotavirus across the nation presently.
COVID
Nationwide, SARS-CoV-2 is MEDIUM in wastewater according to WastewaterSCAN, with higher levels in the Midwest and Northeast. WastewaterSCAN is more up to date than the CDC, but it omits 12 states. Levels of COVID in wastewater have finally been decreasing over the last several weeks.
COVID Variants
According to WastewaterSCAN, variant XFG was causing most cases of COVID as of 2/22/26. Sequencing data has a lag of 1-2 weeks after collection for WastewaterSCAN. I am glad that they are reporting on COVID variants, since the CDC stopped reporting them back in August 2025. Our current COVID vaccines should protect against XFG, but vaccine efficiency against infection declines over 2 to 3 months and against severe disease declines by 6 months.
Acute COVID infections, General COVID info
The National Clinical Cohort Collaborative “conducted an emulated target trial in a retrospective cohort of [3,553] patients with moderate-to-severe rheumatoid arthritis who were prescribed IL-6 receptor antagonists (sarilumab or tocilizumab, pooled treatment) or other biologic agents (anakinra or baricitinib, pooled comparator) in 2022.” They found that those prescribed IL-6 receptor antagonists had a 60% lower mortality, and about 58% lower risk of being diagnosed with Long COVID compared to other biologic agents in this patient group. Protection was strongest when the IL-6 receptor antagonist medication was started before COVID infection.
A group from Hong Kong University found persistence of SARS-CoV-2 viral fragments in nasal tissue of hamsters for 120 days after COVID infection. This led to ongoing inflammation, dysregulation of tissue repair and remodeling, and increased the animals’ vulnerability to secondary respiratory infections.
🧠 DNA methylation is an epigenetic switch that controls how certain genes are turned on or off. Researchers from the Van Andel Institute in Michigan looked at whole-genome DNA methylation sequencing (WGMS) in the blood of 101 people with COVID infections ranging from asymptomatic to severe versus 105 SARS-CoV-2 negative individuals. They found widespread gene hypomethylation in infected individuals, which was more pronounced in severe COVID cases and varied depending on the severity of infection. The DNA hypomethylation turned on genes related to immune function and to neurodegenerative pathways linked to Alzheimer’s, Parkinson’s, and neuropsychiatric conditions. These findings show how epigenetic changes in gene methylation from COVID infection may connect to long-term neurological sequelae.
Social and Advocacy
International Long COVID Awareness Day is on March 15, and in honor of this occasion, landmarks across the globe will be lit up teal and gray. COVID Safer San Francisco Bay Area (CSSFBA) has posted a list of landmarks around the world that will be marking Long COVID awareness including San Francisco City Hall which will be lit teal and gray on March 15.
Pediatrics
“Chronic orthostatic intolerance (COI) refers to a group of conditions in which upright posture triggers a wide range of symptoms, including dizziness, fatigue, cognitive fog, and palpitations, among others, persisting for at least three months. Postural Orthostatic Tachycardia Syndrome (POTS) represents a specific subset of COI, distinguished by an exaggerated heart rate response, defined in adolescents as an increase of ≥40 beats per minute (bpm) or an upright HR exceeding 120 bpm.” Researchers from the University of Utah studied 92 adolescents with COI and found that the teens had similar disability scores whether they met POTS heart rate criteria or not.
Long COVID
Good news! PhysicsGirl Dianna Cowern just posted her first teaching video in 3 years. “After three years away from creating videos due to severe Long COVID, Dianna returned in 2026, continuing her mission to share curiosity, resilience, and the wonder of science.”
🧠 Researchers at NYU Langone Health followed 260 adults and found Long COVID patients had a much higher rate of mild cognitive impairment (MCI) over 4.4 years. About 27% of Long COVID patients developed MCI, compared with 5% of recovered COVID patients and 1% of uninfected participants. The findings suggest persistent post-COVID neurological effects may increase long-term Alzheimer’s dementia risk.
🧠 A new article shows how the gut microbiome-brain axis affects cognitive dysfunction (brain fog) in Long COVID. Researchers from the Université de Montréal performed several different experiments in mice and in vitro showing that certain gut bacteria in people with Long COVID release tiny signaling particles called gut microbiota-derived extracellular vesicles (GMEVs) that weaken the intestinal barrier and trigger inflammation in immune cells and in brain glial cells. First, germ-free mice were given gut microbes from women with Neuro-Long COVID and this caused brain inflammation and behavior changes in the mice. Next, GMEVs from Long COVID patients were found to induce intestinal epithelial inflammation, impair gut barrier function and activate macrophages in vitro. A third experiment showed that GMEVs from Long COVID patients induced a pro-inflammatory response in iPSC-derived microglia (brain immune cells). Finally, when wild-type mice were given GMEVs from Long COVID patients orally, their gut microbiome changed, and they developed intestinal inflammation, behavioral changes, and brain inflammation.
This study provides strong evidence that GMEVs from gut bacteria in Long COVID may contribute to cognitive dysfunction, or brain fog. The findings suggest a gut–brain inflammatory pathway that drives neurological symptoms in Long COVID and may represent a potential target for microbiome-based therapies such as synbiotics that help restore gut microbial balance.
🧠 Scientists from the Karolinska Institutet in Sweden studied 22 people with Long COVID after mild infection using resting-state functional magnetic resonance imaging (rs-fMRI) brain imaging to analyze neural connectivity. They found higher default mode brain network connectivity that correlated with reduced cognitive performance at 32 months after infection in Long COVID patients with cognitive symptoms and fatigue.
A study from Yale of 43,067 US adults found that the risk of Long COVID decreased from 20% in 2022 to 14% in 2024. Over the same time period, recovery from Long COVID increased from 51% to 60%, with less recovery seen in women and lower income groups. Although the prevalence of Long COVID has decreased over time and some people recover, there are still millions of Americans and people worldwide who continue to suffer from this debilitating disease.
A group from Zurich compared 24 Long COVID patients (LC) who reported fatigue, neurocognitive symptoms, and exercise intolerance to 40 post-severe COVID patients (PC) who most often showed pulmonary impairment. Using a 3 protein blood signature (LAMP3, CKAP4, KRT19), they were able to distinguish between the LC and the PC group with 89% accuracy.
Researchers in the United States and Sweden studied 28 adults with persistent taste complaints more than 12 months after SARS-CoV-2 infection and performed detailed taste testing and tongue biopsies in 20 participants. Eleven participants had selective loss of sweet, umami, or bitter taste, which was linked to reduced expression of key taste-signaling genes such as PLCβ2 and TAS1R3 in taste receptor cells. The overall structure of taste buds was largely preserved and viral RNA was not detected, suggesting that Long COVID taste dysfunction may reflect lingering molecular changes in taste signaling rather than permanent structural damage.
In a South Korean study of 396 people with PASC (Long COVID), a 2 week course of metformin or ursodeoxycholic acid (UDCA) did not significantly improve recovery from PASC (Long COVID) as measured by the PASC index score at 8 weeks.
ME/CFS
Researchers in Norway studied blood proteins in 50 ME/CFS patients and 29 healthy controls using large-scale proteomics. They found reduced intracellular proteins in skeletal muscle in ME/CFS and immune reprogramming, including a distinct reduction in proteins secreted by activated neutrophils. “Focused secretome analysis supports intensified regulatory interactions related to immune activity, inflammation, vasculature, and metabolism” in ME/CFS.
Proteomics in ME/CFS from: https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(26)00064-9
Measles
As of March 5, 2026, 1,281 measles cases have been confirmed so far in the United States in 2026 with 5% (62 of 1281 cases) hospitalized.
As of March 6, 2026, the South Carolina Department of Public Health reports 991 cases of measles in an outbreak that started in October 2025.
The Utah Department of Public Health states that 358 Utahns have been diagnosed with measles in this outbreak, with 78 new cases reported to public health in the last 3 weeks.
U.S. health officials have postponed a meeting with the regional World Health Organization until after the November midterm elections that will probably confirm that the United States has lost its measles elimination status. Delaying the meeting will not make U.S. measles cases disappear, but it could affect the elections.
ICE confirms a measles outbreak in the nation’s largest ICE detention center in Texas. There are 14 confirmed measles cases in the camp and 112 other individuals have been isolated in connection to the outbreak, according to Rep. Veronica Escobar, D-Texas. On average, every person who has the measles will infect 12 to 18 other people in an unvaccinated population. Congresswoman Escobar added, “There has been nothing but crisis after crisis inside the walls of this tent city.”
Camp East Montana is an immigration detention facility on Fort Bliss along the Texas-Mexico border.
Photo by Paul Ratje / The New York Times / Redux file
This week it was reported that an unvaccinated adult who traveled from Europe to the United States while infectious with measles last year spread the virus to 17 other people on the airplane and at the airport, according to the CDC. The case-patient had a fever, persistent cough, cold-like symptoms, and conjunctivitis (“pink eye”) during travel, and his rash occurred one day after his domestic flight. People are most contagious with measles for 4 days prior to the rash and 4 days after the rash appears.
Measles and other infectious diseases are not just a health problem, they are also an economic problem. A policy analysis from the Common Health Coalition examines how declining childhood vaccination rates lead to more outbreaks of vaccine-preventable diseases and to significantly higher medical spending due to hospitalizations, treatment, and public health responses needed.
From: https://commonhealthcoalition.org/wp-content/uploads/2026/02/SpotlightBrief_ChildImms.pdf
Measles cases in the last 2 weeks from the John Hopkins US Measles Tracker:
Global Vaccine Preventable Disease Tracker
From: https://www.thinkglobalhealth.org/article/vaccine-preventable-disease-a-global-tracker
Tuberculosis
As of February 20, 2026, 3 cases of active tuberculosis (TB) have been confirmed at Archbishop Riordan High School in San Francisco. Among 1,261 students and staff tested, 219 (17%) had positive TB tests, including 204 confirmed latent TB infections. Additional chest X-rays are underway to rule out active disease in the remaining cases. Health officials emphasize that latent TB is not contagious, but testing and treatment are important because it can later progress to active TB.
Other news
In 507 adults with obesity, combining bimagrumab with semaglutide led to larger weight loss and reduced body fat by 34% while preserving lean mass compared to either drug alone, highlighting a potentially more effective therapy for improving body composition.
Researchers at the US Department of Veterans Affairs analyzed data from 606,434 veterans with type 2 diabetes to study whether GLP-1 receptor agonists affect substance use risk. Veterans starting GLP-1 drugs had lower risks of developing alcohol, nicotine, opioid, cannabis, and cocaine use disorders compared with those starting SGLT-2 inhibitors. Among people with existing substance use disorders, GLP-1 treatment was also linked to fewer overdoses and fewer substance use disorder related hospitalizations.
A common anti-seizure drug called levetiracetam (Keppra) has been found to prevent the production of toxic amyloid-beta 42 peptides and amyloid plaques which can ultimately lead to Alzheimer’s disease.
In the 2026 Milano Paralympics, 25 competitors are expected to use the prosthetics that Paralympian Mike Schultz had initially invented for himself. Mike said, “I personally assemble all the legs that go out and being able to see the best athletes in the world, choose our equipment is awesome.”
Photo from: https://www.monstermikeschultz.com/
Giant tortoises have returned to Floreana Island in the Galápagos for the first time in nearly 200 years. Conservationists released 158 young giant tortoises descended from the extinct Floreana lineage, helping restore the island’s ecosystem and seed dispersal.
Have a good week,
Ruth Ann Crystal MD
References & Notes
CDC Respiratory Illnesses Summary 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.
HMPV, Norovirus and Rotavirus are HIGH in wastewater.
3/3/26 YLE: Hep B vaccine rates declining, RSV is having a late surge, more disease=more economic cost, AI and triage, and the U.S. surgeon general https://buff.ly/6owZRDS
Source: NREVSS
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 in California from https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx
COVID
Michael Hoerger modeling: http://pmc19.com/data/, https://twitter.com/michael_hoerger
Using data through 2/21/26. Will update tomorrow.
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 Wastewater
CDC COVID data tracker: https://www.cdc.gov/respiratory-viruses/data/activity-levels.html
CDC wastewater reporting: https://www.cdc.gov/nwss/rv/COVID19-nationaltrend.html
CDC wastewater map: https://www.cdc.gov/nwss/rv/COVID19-currentlevels.html
COVID Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/
Nationwide, SARS-CoV-2 is MEDIUM in wastewater according to WastewaterSCAN. WastewaterSCAN is more up to date than the CDC, but it omits 12 states.
California statewide view https://buff.ly/3YObiul
CDPH California SARS-CoV-2 in Wastewater: https://skylab.cdph.ca.gov/calwws/
Resp viruses in California: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx
COVID levels in California continue to be VERY LOW.
Santa Clara County wastewater: https://publichealth.santaclaracounty.gov/health-information/health-data/disease-data/covid-19/covid-19-wastewater
International Surveillance https://pmc19.com/data/index.php#international
Austria: Federal Government of Austria |
Canada: C19 Resources Canada * | World Health Network (WHN) Canada **
Finland: WHN Finland **
Germany: WHN Germany **
Netherlands: WHN Netherlands **
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.
“Once again, the main Covid indicators in England, Scotland, Wales, and Northern Ireland stayed low, indicating a low level of risk.
“Flu activity is now at baseline levels across all home nations, confirming that this year’s Flu season is over.”
Europe
https://arcgis.jrc.ec.europa.eu/portal/apps/dashboards/e296cdf0c0d042e6b60b07a351f2dc5c
Australia https://bsky.app/profile/mikehoney.bsky.social
COVID Variants
US Variant tracker, Last updated 8/28/25
See WastewaterSCAN above
Weekly variant roundup by Mike Honey: https://bsky.app/profile/mikehoney.bsky.social
Acute COVID infections, General COVID info
3/2/26 MedRxiV: IL-6 Receptor Antagonists and Severe Post-COVID-19 Outcomes: An Emulated Target Trial https://buff.ly/CgW9Ti7
3/2/26 npj Viruses: Prolonged dysregulation and pathological changes in the upper respiratory tract of SARS-CoV-2 infected hamsters https://buff.ly/Jd0amDv
🧠 2/27/26 Clinical Epigenetics: Genome-wide DNA methylation profiling in COVID-19 positive patients reveals alterations in pathways linked to neurological dysfunction https://buff.ly/DSNxeMW
Social and Advocacy
International Long COVID Awareness Day is on March 15.
COVID Safer San Francisco Bay Area (CSSFBA) list of landmarks to be lit.
Pediatrics
2/17/26 J of Pediatrics: Impact of Excessive Postural Tachycardia on Disability in Youth with Orthostatic Intolerance https://buff.ly/UWCYODe
Long COVID
🧠 3/2/26 Alzheimer’s & Dementia Journal (NYU): Increased incidence of mild cognitive impairment in long COVID patients https://buff.ly/Elojwma
3/3/26 Annals of Internal Medicine: Neither Metformin nor Ursodeoxycholic Acid Effectively Treats Postacute Sequelae of COVID-19: A Randomized Clinical Trial https://buff.ly/j1DaoA9
🧠 3/2/26 MedRxiV (Montreal): Microbiota-derived extracellular vesicles link intestinal dysbiosis to neuroimmune activation in long COVID https://buff.ly/HmMw59R
3/3/26 Nature: Brain connectivity and its relation to cognitive function in patients with post-COVID 19 condition after mild infection https://buff.ly/dfgT1jX
3/2/26 JAMA (Yale): Long COVID and Recovery Among US Adults https://buff.ly/tAW2ZxZ
2/27/26 PLOS One: Distinguishing post-COVID from long-COVID in adults: Development and validation of a biomarker signature using targeted proteomics and machine learning in a cross-sectional observational study https://buff.ly/XXJ17k0
1/29/26 Chemical Senses: Taste dysfunction in long COVID https://buff.ly/GYLL4Lg
Good news! PhysicsGirl Dianna Cowern just posted her first teaching video in 3 years.
ME/CFS
3/4/26 Cell Reports Medicine: Charting the circulating proteome in ME/CFS using cross-system profiling to uncover mechanistic insights https://buff.ly/rH2c9iZ
Measles
CDC Measles updates (on Wed.): https://www.cdc.gov/measles/data-research/index.html
South Carolina Department of Public Health (Measles):
https://dph.sc.gov/diseases-conditions/infectious-diseases/measles-rubeola/2025-measles-outbreak
Utah Department of Public Health (Measles): https://epi.utah.gov/measles-response/
3/2/26 NY Times: Meeting on U.S. Measles Status Is Delayed Until November https://buff.ly/quohVUR
3/4/26 NBC: ICE confirms a measles outbreak in the nation’s largest detention facility in Texas https://buff.ly/ItQHivY
3/2/26 CIDRAP: CDC: Unvaccinated international traveler spread measles to 17 other travelers to, within US https://buff.ly/El0n89P
3/3/2026 Common Health Coalition: More Illness, Greater Cost Spotlight Brief: Childhood Immunizations https://buff.ly/3wyJUqA
John Hopkins US Measles Tracker: https://publichealth.jhu.edu/ivac/resources/us-measles-tracker
Vaccine Preventable Disease Tracker
10/29/25 Vaccine-Preventable Disease: A Global Tracker from Think Global Health https://buff.ly/6qBMq0w
Tuberculosis
2/20/26 San Francisco Department of Public Health Update on Tuberculosis Cases at Archbishop Riordan High School | SF.gov https://buff.ly/Ta0t5my
Other news
3/2/26 Nature Medicine: Bimagrumab plus semaglutide alone or in combination for the treatment of obesity: a randomized phase 2 trial https://buff.ly/O13z2ga
3/4/26 BMJ (Al Aly lab): Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study https://buff.ly/cXjiqlV
3/4/26 The Conversation by Dr. Z. Al-Aly: GLP-1 drugs may fight addiction across every major substance, according to a study of 600,000 people https://buff.ly/qMYcfI4
2/12/26 Northwestern: Common Anti-Seizure Drug Prevents Alzheimer’s Plaques from Forming https://buff.ly/t0dgGBx
2/21/26 BBC: Giant tortoises return to Galápagos island after nearly 200 years https://buff.ly/beWx2o3
Milano Cortina 2026: Mike Schultz on Para snowboard prosthetics and equipment https://buff.ly/PWsyipz
Thanks for the comprehensive update. Long covid studies were very interesting.