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Welcome to the Northeast edition of Outbreak Outlook! It is only available to paid subscribers. If you wish to become a paid subscriber and access region-specific information, please click the Subscribe now button below. Thanks for reading! -Caitlin Respiratory DiseasesNote: Data in this week’s report covers the period including the Thanksgiving holiday. Disease surveillance data is always wonky during the holidays for various reasons. I have accounted for the disruption in my analysis, but if some data points are missing or seem implausible or unexpected, that is why. InfluenzaFlu is low regionally, but is still picking up, particularly in New York. Most states continue to report very low and fairly stable wastewater activity. ED visits range from 0.4% to 2.6%, with most states reporting rates <1%. New York has the highest activity in the region. Wastewater activity is moderate and the trend is going up (though it did decrease slightly this week). Outpatient influenza-like illness (ILI) visits increased to 4.2%, nearing the threshold of 4.5% for the start of flu season and substantially above last week’s 2.3%. Emergency department (ED) visits more than doubled to 2.6%, but hospitalizations held steady at a low 0.1 per 100,000 population. Northeast: Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
 In New York City, flu continues its rapid rise. I encourage residents and visitors to take note. ED visits for flu increased 112% over the week prior, rising to 3.3% of all ED visits. Hospitalizations have also risen sharply, to 1.3%, more than double the week before. In Connecticut, wastewater activity is low, but nearly doubled this past week. ED visits in the state also jumped to 1.9%. Hospitalizations remain very low, but did increase a bit this past week, from 0.2 to 0.5 hospitalizations per 100,000 people. Wastewater activity is very low but increasing in New Jersey and Massachusetts. Similarly, ED visits in both states are low but increasing (to 1.8% and 1.0%, respectively). In Maine, flu remains very low but is increasing. Outpatient ILI increased to 1.2%, and ED visits increased to 0.5%. Similarly, ED visits are at just 0.4% in Vermont but are increasing. In Pennsylvania, wastewater activity is very low and stable, outpatient ILI visits held steady at 1.5%, and ED visits increased slightly to 0.8%. Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
 COVID-19Covid-19 activity remains low, but unfortunately there are signs of increases. We’ve got an unusual degree of conflicting data this week: wastewater activity is going one way, and ED visits are going the other. We typically see wastewater increasing first, followed by ED visits (a lagging indicator) second. However, right now we’re seeing the opposite: wastewater is decreasing and ED visits are increasing. My current hypothesis is that the increase in ED visits is not “real.” The Thanksgiving holiday may have disrupted care-seeking behavior (a fancy way of saying whether and how people decide to visit the doctor or emergency department vs toughing it out at home). However, it is wintertime, so a true rise in activity would not be shocking. I will use next week’s surveillance data to untangle what’s really going on. Wastewater activity is low and decreasing in Maine, Pennsylvania, and Connecticut, and remains very low and stable or declining in New Hampshire, Massachusetts, Rhode Island, New Jersey, and New York. Vermont is the outlier when it comes to wastewater activity: it is the only state in the region with high and increasing activity. Northeast: Covid-19 wastewater concentration
Wastewater concentration of SARS-CoV-2
 However, ED visits increased in every state except Vermont — the one state with high wastewater activity. In Vermont, ED visits decreased to 0.61%. ED visits range from 0.36% in New York to 0.66% in Connecticut. Northeast: ED visits for Covid-19 (%)
% of visits to the emergency department that are for Covid-19
 Severe illness is consistent, however: hospitalizations decreased in both Connecticut (to 1.6 per 100,000 people) and New York (to 1.2). RSVRSV remains quite low in the region. Wastewater activity is very low in all states in the region. Activity increased in Pennsylvania, decreased in New York, Connecticut, and Massachusetts, and held steady everywhere else. ED visits are very low, ranging from 0% in Maine to 0.25% in New Jersey. Rates went slightly up or held steady in New Jersey, Massachusetts, New York, Pennsylvania, Connecticut, Vermont and Maine. They decreased ever so slightly in Rhode Island and New Hampshire. Hospitalizations are very low, but increasing in New York (to 0.3 hospitalizations per 100,000 people) and Connecticut (to 0.2). Northeast: ED visits for RSV (%)
% of visits to the emergency department that are for RSV
 Other BugsTime to stock up on tissue boxes and your preferred over-the-counter meds. There are an assortment of infections circulating right now that cause cold- and flu-like illness.
Stomach BugsNorovirus is quite active. Test positivity nationally was at 11.6% this past week, roughly on par with the week before. This is the time of year when norovirus is expected to just keep rising. To avoid infection, wash your hands frequently with soap and water (hand sanitizer is not particularly effective at killing norovirus) and avoid touching your face. Test positivity is highest in the West: 13.5%. This is closely followed by the South, which reported a test positivity of 13.2%. However, I would take the results from the Southern region with a grain of salt this week: the total number of tests reported is about half that reported the week before, making it hard to directly compare this week’s results to the prior weeks’. I am guessing this is just a delay in reporting and by next week we should have a clearer picture. In the Midwest, test positivity is steadily rising and is now at 12.5%. In the Northeast, activity is middling at 5.9% but has been slowly and jaggedly rising over the past couple months. Food recallsThe following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items: New:
Previously Reported:
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