Dr. Ruth Report, 5/17/26
Virus Summary
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)
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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.
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
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.
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
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
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
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:
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 **
Germany: WHN Germany **
Netherlands: WHN Netherlands **
Australia: Mike Honey
UK:
UKHSA Dashboard | UK BuDS | UK COVID PCR Test Positivity Map | Wastewater monitoring in Scotland | Bob Hawkins on UK and Europe
Thank you for the great research articles!
Always great info, thank you!
You've shared that COVID levels are the lowest they've been in 5 years. I'm wondering, in Santa Clara County, how many people out of 1,000 might be actively infected right now? (I'm wondering if I can skip the mask in crowds now.)