Dr. Ruth Report, 6/29/26
First, I wanted to highlight an important article that affects us all.
How The OMB Rule Could Hurt You And Your Town | Dr. Judy Stone, Forbes 6/24/26
A proposed OMB rule (2 CFR Part 200) would extend Trump administration grant cuts beyond scientific research to all federal grants to states, cities, and nonprofits nationwide. Political appointees would replace peer review panels, DEI research would be effectively banned, agencies could terminate grants at any time for any reason, and all grant programs would have to “align with the President’s policy priorities” or be denied if an organization’s affiliations or views are deemed “un-American”.
What can you do? Please write a comment on the Federal website here before July 13. Here is a guide giving examples of how to write your comment regarding the OMB proposed rule change to 2 CFR Part 200.
COVID
COVID levels are very low across most of the United States now. Even the hotspots are not anywhere as high as they were in the past. For example, the highest level on WastewaterSCAN is in Pascagoula Moss Point, Mississippi at 160 PMMoV. While this is high, it is nowhere near what past COVID levels have been.
On June 23, 2026, the CDC estimated that COVID infections were growing in Louisiana, Mississippi, and parts of Texas. COVID infections were declining in 34 states, and were unchanged in 12 states according to the CDC.
According to JP Weiland, COVID wastewater levels are 5 to 8x lower than prior lulls, with roughly 40,000 new U.S. infections daily, though a small late summer wave is possible in the West and South. Mike Hoerger estimates are somewhat higher, putting active infections at about 1 in 310 Americans, with hot spots like Mississippi closer to 1 in every 40 people currently infected.
Acute COVID infections, General COVID info
Large-scale genomic surveillance reveals immunosuppression drives mutation dynamics in persistent SARS-CoV-2 infections | Nature 6/19/26
University of Copenhagen researchers screened 738,944 SARS-CoV-2 genomes from Denmark’s national surveillance system and identified 303 cases of persistent infection. Immunosuppressed patients faced nearly 6x the odds of prolonged COVID infection compared to others. These persistent infections also accumulated more nonsynonymous mutations, including variants associated with antiviral drug resistance, underscoring immunocompromised populations as a critical site of viral evolution.
Coevolving Mutations in Chronic SARS-CoV-2 Infections | BioRxiV 6/25/26
Researchers analyzed 3,332 SARS-CoV-2 sequences from chronic COVID infections and identified 14 recurring mutation patterns, including signatures associated with deep lung tissue and evasion of T cell immunity. These co-evolving mutations may help explain how prolonged viral persistence inside individual hosts shapes the evolution of the virus and potentially contributes to Long COVID pathology.
Plasma proteomics reveal SERPINA1 and CD59 as candidate biomarkers for COVID-19 severity stratification and prognosis prediction | Annals of Medicine 6/21/26
Chinese scientists found that plasma levels of proteins SERPINA1 and CD59 increased with acute COVID severity, reflecting disruptions in both complement activation and coagulation pathways. When evaluated together, the two proteins outperformed D-dimer in predicting mortality at 12 months, though the findings require validation in larger cohorts.
Type I unconventional protein secretion of the SARS-CoV-2 nucleocapsid protein promotes inflammatory cytokine release | Cell 6/26/26 “July 2026”
A new study shows that the SARS-CoV-2 nucleocapsid protein (NP) can exit infected cells independently through an unconventional secretion pathway, releasing NP into the bloodstream, even in the absence of detectable viral RNA. The secreted NP was found to activate granulocytes which make inflammatory cytokines IL-6 and TNF-α.
COVID and Immunology
Persistent CD4+ T cell hyporesponsiveness during recovery from prolonged symptomatic SARS-CoV-2 infection | Cellular Immunology 6/21/26 (August issue)
Researchers from the Oklahoma Medical Research Foundation studied 17 COVID patients and found that 5 individuals with prolonged symptoms showed CD4 T cells that responded weakly to stimulation, producing more than 50% fewer gene activations and reduced interferon signaling compared to normal immune responses. Encouragingly, 4 of those 5 patients eventually showed improvement over time, suggesting the immune dysfunction was not necessarily permanent.
This is similar to the Columbia University preprint from last week that showed that dysfunctional T cells paradoxically suppressed antiviral interferon responses, permitting chronic viral persistence and recapitulating features of Long COVID.
Pediatrics
A parent’s story of Long COVID by Cartoonist Summer Pierre 6/24/26
SSRI/SNRI and long COVID in children and adolescents with neuropsychiatric conditions: a cohort study from the RECOVER Initiative | Nature Mental Health 6/29/26
University of Pennsylvania scientists examined data from 110,955 children and adolescents with neuropsychiatric conditions to evaluate whether antidepressant use affected Long COVID outcomes. SSRI and SNRI use showed no association with reduced Long COVID risk overall, but was linked to elevated rates of POTS, brain fog, and fatigue in this population.
Antiviral treatments
Dual engagement of Spike and ACE2 by annexin A5 contributes to pleiotropic SARS-CoV-2 inhibition | Nature preprint 6/20/26
Annexin A5 (or annexin V) is a cellular protein that can bind to phosphatidylserine, a marker of apoptosis. The function of the protein is unknown, but it has been shown to inhibit blood coagulation in vitro. Antibodies to annexin A5 are found in patients with antiphospholipid syndrome (APS), which is a thrombophilic disease.
A new preprint shows that Annexin A5 (Anx5) can simultaneously bind both the SARS-CoV-2 Spike protein and the ACE2 receptor. This dual binding action reduced SARS-CoV-2 viral burden and increased survival rates of infected cells, suggesting that annexin A5 may work as a COVID antiviral.
Long COVID
How to Apply For—and Receive—Your SSDI by Dr. Zeest Khan
Long COVID physician Dr. Zeest Khan, herself disabled by the condition, breaks down the SSDI application process with disability attorney Barbara Comerford. Only 32% of initial claims are approved, and Long COVID rarely qualifies for fast-track approval, but expert documentation of PEM, dysautonomia, and cognitive dysfunction can make the difference.
Blinded 2-Year Longitudinal Evaluation of SARS-CoV-2 Antigenemia in Long COVID | Clinical Microbiology and Infection 6/20/26
Spanish researchers studied 425 adults (167 with Long COVID, 148 COVID recovered, and 110 uninfected controls) and found that 31% of Long COVID patients, 20% of recovered individuals, and 5% of never infected controls had detectable SARS-CoV-2 antigens in the blood using the ultra-sensitive Simoa® assay at 6-12 months post infection. COVID antigen levels had largely disappeared by the two year mark. They concluded “SARS-CoV-2 antigens circulate in plasma up to one year after infection in a minority of individuals, regardless of whether they develop Long COVID or not, and become rarely detectable later on. Therefore, current evidence does not support its use to guide clinical monitoring or treatment decisions in Long COVID.”
A) Proportion of participants with detectable antigenemia on Simoa assay
Increased Mannosylation of Extracellular Vesicles in Long COVID Plasma as a Binding Target for Galanthus nivalis Agglutinin (GNA) Affinity Resin | Int J of Molecular Sciences 6/25/26
Researchers from UCSF and Aethlon Medical analyzed plasma samples from 45 individuals and found that Long COVID patients had 2x higher levels of extracellular vesicles coated with mannose, a sugar molecule that tags these microscopic cargo carriers. This pattern of mannose enrichment on the surface of extracellular vesicles may help explain aberrant immune signaling in Long COVID.
Aethlon Medical Announces Publication Demonstrating Novel Long COVID Biomarker and Potential Therapeutic Target for the Hemopurifier® | Aethlon Press Release 6/26/26
Mannose positive extracellular vesicles can be removed from the blood using GNA resin in the Hemopurifier from Aethlon. These vesicles may act as a measurable biomarker for Long COVID and are a potential therapeutic target for filtration based treatments like the Hemopurifier.
MicroRNAs (miRNAs) can also be removed with the GNA resin Hemopurifier.
Circulating micro RNAs in post-COVID-19 patients and its association with cognitive impairment | Nature 6/24/26
MicroRNAs (miRNAs) are tiny RNA molecules that regulate gene activity by binding to messenger RNAs (mRNAs), preventing those mRNAs from being translated into proteins. Spanish researchers studied 64 long COVID patients and identified a specific blood microRNA signature associated with measurable cognitive deficits. Reduced levels of miR-448 and miR-450a in the blood were linked to worse performance across memory, processing speed, and executive function assessments.
Integrated miRNAome-transcriptome analyses identify an immuno-hematopoietic
subcluster in patients with long COVID | J of Allergy and Clinical Immunology 5/31/26
University of Helsinki scientists analyzed blood microRNA and messenger RNA (miRNA and mRNA) from 107 adults (50 Long COVID, 57 recovered controls) following COVID infection and identified two distinct Long COVID subgroups. Subgroup LC1 was distinguishable by 9 miRNAs and LRRFIP2 with an AUROC of 0.91 and showed elevated D-dimer levels, activated platelet pathways, and immune and blood cell signaling patterns which was linked to worse symptoms, disability and reduced quality of life.
From: https://www.jacionline.org/article/S0091-6749(26)00439-2/pdf
Increased anti-nucleocapsid secretory IgA and consumption of complement component 3 in post-COVID syndrome patients | Frontiers in Immunology 5/13/26
Researchers from Madrid compared 104 post-COVID syndrome (PCS or Long COVID) patients to 34 COVID-recovered controls and found significantly elevated salivary anti-nucleocapsid secretory IgA and reduced serum C3 levels in Long COVID patients, with 17.3% of Long COVID samples falling below the normal C3 range compared to none among controls. A combined biomarker model using salivary anti-nucleocapsid IgA and C3 achieved an AUC of 0.93, suggesting these paired mucosal and systemic immune markers may offer clinically useful discrimination of Long COVID.
Cellular Metabolic Signatures of Long COVID-19 | Infectious Disease Reports 5/26/26
Clemson University researchers generated Lymphoblastoid cell lines (LCLs) from 10 Long COVID patients, 10 COVID-recovered controls, and 50 pre-pandemic healthy controls, finding distinct metabolic signatures in each group. Long COVID cells showed depleted energy production across glycolytic, TCA cycle, and mitochondrial pathways. They also responded poorly to hormones and cellular signaling molecules, with greater metabolic dysfunction seen in those Long COVID patients with higher symptom burden, providing a potential biological explanation for hallmark Long COVID symptoms including fatigue and muscle weakness.
Donepezil ameliorates fatigue and depression in PASC patients with HHV-6B SITH-1-induced acetylcholine deficiency | Frontiers in Pharmacology 6/3/26
Donepezil (Aricept) treats memory loss and confusion in people with Alzheimer’s disease. It works by boosting acetylcholine in the brain to help improve attention, memory, and daily functioning. Japanese researchers found that nearly 63% of 156 Long COVID patients carried antibodies to the HHV-6B protein SITH-1, which animal models suggest suppresses acetylcholine production in the brain. Among 73 trial participants, the Alzheimer’s drug donepezil (Aricept) reduced fatigue and depression exclusively in those Long COVID patients who tested positive for the antibody.
Functional and structural olfactory changes in post-COVID-19 patients detected by 7 Tesla MRI | Nature 6/26/26
In 30 adults with persistent COVID related smell loss, researchers from the University of São Paulo used 7 Tesla MRI brain scans and found thinning of the orbitofrontal cortex, and disrupted activity in the insula, thalamus, and memory-linked smell circuits of the brain. These findings show a distinct brain signature for long-term impaired smell function (dysosmia) after COVID infection.
Transcranial direct current stimulation in affecting neuropsychiatric symptoms of post-COVID syndrome: No change in microstates and functional connectivity | PLOS One 6/26/26
A Czech study of transcranial direct current stimulation (tDCS) in 35 people with Long COVID showed that this tDCS protocol did not improve neurocognitive symptoms nor EEG measures of brain network activity.
Algorithm dependence of patient phenotypes in Long COVID: a patient-led, multi-method clustering of 6031 patients using 162 self-reported symptoms | Oxford Open Immunology 6/13/26
The Patient-Led Research Collaborative analyzed 162 self-reported symptoms from 6,031 Long COVID adults and found that subgroup clusters shifted substantially depending on the algorithm used, with no clear natural boundaries in the symptoms. All methods used identified a high-burden group enriched for post-exertional malaise. Patient “types” may be gradients, and not fixed categories.
Pilot longitudinal integrated transcriptomic–metabolomic study reveals immune and metabolic signatures in non-hospitalized healthcare workers with long COVID | Frontiers Cellular and Infection Microbiology 6/3/26
In a small study, University of British Columbia scientists studied transcriptomics and metabolomics in 47 healthcare workers (12 with Long COVID and 35 recovered controls) and found that Long COVID was associated with neutrophil driven inflammation alongside elevated levels of oxoglutarate, an energy related metabolite that signals metabolic disruption. The authors postulate that there may be “potential links between persistent innate immune activation, metabolic reprogramming, and neurocognitive or systemic symptoms in Long COVID.”
Risk of new-onset obstructive sleep apnea up to 4.5 years after COVID-19 in the urban population | Nature 6/23/26
Researchers from Einstein Med and Montefiore analyzed more than 910,000 adults and found that COVID infection was associated with a significantly elevated risk of developing obstructive sleep apnea for up to 4.5 years afterward, even after mild infection. The authors caution that this large observational study establishes a statistical association rather than a confirmed cause.
Viruses and Neurodegeneration
Viral Infections and Neurodegenerative Diseases: Reinterpreting the Crosstalk Through a Dual-Role Lens | Current Microbiology 6/24/26
A review from Golestan University, Iran shows that viral infections can accelerate neurodegenerative diseases through at least four overlapping biological mechanisms: persistent brain inflammation, abnormal protein folding, mitochondrial dysfunction, and breakdown of the blood brain barrier. Engineered viruses may paradoxically be used as targeted therapeutic delivery systems.
Measles
As of June 25, 2026, 2,134 confirmed measles cases have been reported in the United States in 2026.
CIDRAP Op-Ed: Call it what it is—the US has lost its hold on measles elimination | CIDRAP 6/24/26
Public health scientist Jess Steier, DrPH (Unbiased Science) states that the US has already lost measles elimination status by any objective measure. With 2,104 cases by June 18, 2026, 48 outbreaks in 2025, and genomic sequencing tracing continuous transmission across multiple states since January 2025, only 6% of current cases are imported. PAHO’s review is now delayed until November after the midterm elections.
Utah tops 500 cases for the year | CIDRAP 6/26/26
Active measles outbreaks now in Utah (507 for the year, 9 new cases this week), Virginia (129 cases), Pennsylvania (83 measles cases). South Carolina’s measles outbreak was 670 cases. Texas has had 182 measles cases, and Florida 155 measles cases through June 20.
Ebola in DR Congo (DRC)
As Ebola deaths top 300, African officials meet to boost regional readiness | CIDRAP 6/26/26
“The Ebola outbreak, which is now the second largest in DRC [history], shows no signs of slowing and currently stands at 1,155 confirmed cases and 304 deaths. Neighboring Uganda has 20 confirmed cases and two deaths. In a press conference yesterday, Africa CDC Director-General Jean Kaseya, MD, MPH, warned that if contact tracing efforts don’t pick up, “for sure it will be the largest Ebola outbreak ever.”
Government News
How The OMB Rule Could Hurt You And Your Town | Dr. Judy Stone, Forbes 6/24/26
Flu cases at Texas base hit 275 as services again require recruits to get shots | The Hill 6/25/26
At least 275 military training recruits at Lackland Air Force Base in Texas have contracted the flu, up from 160 last week. Four trainees have been hospitalized with influenza, and one recruit’s death is under investigation. Defense Secretary Hegseth’s April 2026 decision to make flu vaccination optional for all U.S. troops led to 60% of trainees being unvaccinated. The Army, Navy and Air Force are reportedly now requiring flu shots once again for basic trainees.
A look at the science that’s been lost on long COVID | NPR 6/22/26
The Trump administration has dismissed hundreds of scientific advisory committee members since taking office, including a dedicated Long COVID panel. Clinicians managing Long COVID patients are now without formal federal guidance on the underlying mechanisms, diagnostic criteria, and treatments for Long COVID.
A Terrible Thing Happened to My Family | Pete Buttigieg 6/26/26
Former Transportation Secretary Pete Buttigieg revealed that his 4-year-old twins were temporarily removed from their home after an anonymous caller made a false CPS report accusing him of violent crimes. Michigan State Police confirmed the report was fabricated. Buttigieg called it a politically motivated hoax and said he is exploring civil and criminal legal options.
Other news
An ECG biomarker for sudden cardiac death discovered with deep learning | Nature 6/24/26
Wow! Researchers from the University of Gothenburg applied deep learning to a dataset linking all ECGs recorded in Sweden, identifying a new biomarker on ECG for sudden cardiac death risk. The marker in lead aVL was validated in 3 different cohorts and was linked to the benefit of using a defibrillator.
An explainer article can be found here.
WHO warns Europe is world’s fastest-warming continent as heat heave shatters records | CBC News 6/28/26
France reported an extra 1,000 deaths in 3 days from a severe heat wave this week. WHO Director Dr. Tedros warns that Europe is the world’s fastest warming continent now and European workplaces, hospitals, and homes were not built for these high temps.
Hospitals in England declare critical incidents as machines and IT fail in heat | Guardian 6/25/26
At least three NHS England hospital trusts declared critical incidents as record June heat exceeding 36°C (96.8°F) knocked out chiller units, MRI scanners, operating theatres, cancer radiotherapy machines, and IT servers. Norfolk and Norwich University Hospitals had no working MRI scanners; Portsmouth and Southampton also suspended planned surgeries and appointments. A prior report found 90% of NHS buildings ill-equipped for prolonged extreme heat.
Imperial Valley data center developer files lawsuit seeking access to Colorado River water | KPBS 6/15/26
“For months, Sebastian Rucci said his massive data center project would not take water from the drought-stricken Colorado River.” He is now suing for 260 million gallons of Colorado River water annually to cool a proposed AI data center. The Colorado River supplies water to roughly 40 million people across seven states, and Imperial Valley farmers hold some of the river’s oldest and largest water rights.
Phase 3 Trial of Oral Infigratinib in Children with Achondroplasia | NEJM 6/28/26
Achondroplasia is a genetic disorder that is the most common cause of dwarfism. A new study shows that “In children with achondroplasia, treatment with once-daily oral infigratinib for 52 weeks resulted in a significantly greater increase from baseline in the annualized height velocity than placebo.”
Global competition on Influenza and COVID-19 prevention and control | WHO
Students and young professionals ages 18 to 35 are invited by the WHO to submit short videos (90 seconds maximum) addressing Influenza and COVID prevention, myths, and protection strategies. Submissions open August 3 and close September 13, 2026.
Ending respiratory infections | Intercept 6/24/26
Intercept is a new $500 million philanthropic initiative aimed at catalyzing the development and deployment of technologies to drastically reduce the burden of respiratory infections, with an eventual goal of eliminating them altogether.
Kate, Princess of Wales, climbs Britain’s three highest peaks in 24 hours to raise money for cancer hospital | CNN 6/29/26
“ Catherine, Princess of Wales, completed Britain’s arduous Three Peaks Challenge over the weekend to support the hospital where she underwent cancer treatment two years ago.”
AI helps read papyrus scroll burnt to crisp during Vesuvius eruption | Guardian 6/24/26
Using AI trained to detect ink from X-ray scans, researchers virtually unwrapped a carbonized scroll charred in the 79 AD Vesuvius volcano eruption, revealing 20 columns of previously hidden text. The content, discussing stoic ethics and impulse regulation, may be an unpublished work by Greek philosopher Chrysippus.
I will be taking off next week for the holiday. Have a wonderful 4th of July!
Ruth Ann Crystal MD
References & Notes
Wastewater SCAN: https://data.wastewaterscan.org/
Regional wastewater levels for COVID, RSV, Flu A, Flu B.
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
CDC data through 6/13/26 (2 weeks ago). Newer data from 6/20/26 exists, but has not yet been posted on PMC19.com.
Wastewater
Wastewater SCAN (omits 12 states): https://data.wastewaterscan.org/
As of 6/27/26:
Pascagoula Moss Point, MS 160 PMMoV
Gautier, MS 122 PMMoV
Snohomish, WA 112 PMMoV
Anchorage, AK 93 PMMoV
Tallahassee, FL 90 PMMoV
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/
California https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/RespiratoryVirusReport.aspx
Flu, RSV, and COVID are low to very low in California per CDPH.
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 **
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
Bob Hawkins: This week, key Covid indicators across England, Scotland, and Wales stayed very low, indicating that the risk level is still low. There was no update for Northern Ireland this week.
Europe
https://arcgis.jrc.ec.europa.eu/portal/apps/dashboards/e296cdf0c0d042e6b60b07a351f2dc5c
Enjoy the holiday and will try to send that message on the Fed website.