Dr. Ruth Report, 5/24/26

U.S. Respiratory Virus Summary

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

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.

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.

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.

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.

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: