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WPCNR THE LETTER TICKER. February 21, 2024:

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Force of Infection

NORTHEAST
Outbreak Outlook – Northeast – February 19
FEB 19, 2024

BY DR. CAITLIN RIVERS

(REPRINTED WITH PERMISSION)

Welcome to the Northeastern 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

Subscribed

Respiratory Diseases

ILI

Flu season is not over quite yet for the Northeast. Outpatient visits for influenza-like illnesses held roughly steady, instead of declining as hoped, and influenza hospitalization rates are on an upward climb in about half the states in the region.

The rate of both new hospitalizations for influenza and proportion of outpatient visits for ILI held roughly steady in Pennsylvania, New Jersey, New York and New Jersey.

Spotlight on New York: In New York City, the percentage of visits to the doctor for fever and cough or sore throat is still very high at 8%. It is declining, but very slowly. It’s been a very long flu season in NYC. Other parts of the New York State are struggling more. Confirmed influenza cases have increased in recent weeks in the Central, Capital, and Western parts of the state, and hospitalizations are rising too. The season is not over yet, so continued caution is warranted.

Massachusetts held roughly steady for outpatient visits, and saw a decrease of 0.6 points to 5.5 per 100,000 population for influenza-related hospitalizations.

Rhode Island and Vermont are mixed: they had moderate decreases in the proportion of outpatient visits for ILI but also saw moderate increases in new hospital admissions for influenza.

Maine saw a slight increase of 0.4 points to 3.2% of all outpatient visits for ILI, and continued the upward trajectory in hospital admissions that it has been on for a few weeks, increasing by 0.9 points to 5.7 admissions per 100,000 population.

New Hampshire (+0.5 to 3.2), and Connecticut (+0.9 to 4.0) also reported moderate increases in new hospital admissions for influenza.

COVID-19

The number of new weekly hospitalizations for Covid-19 has improved steadily since the holiday season, though current levels remain elevated. Wastewater concentration of SARS-CoV-2 has dropped considerably in the Northeast, too.

More recently, in the past week wastewater concentrations remained relatively stable in the region, though the Northeast continues to have the highest wastewater concentration in the country.

At the state level, Vermont stands out in a good way this week: it had a 31% drop in new hospitalizations in the past week, and now has the lowest regional rate of hospitalizations as well: at 4.7 per 100,000. (Caveat: States with smaller population appear to have larger fluctuations due to the smaller number of individuals involved.)

New Jersey (-13% to 7.5 per 100,000) and Connecticut (-5% to 7.0) also logged notable improvements in hospitalization rates in the past week.

Rates remained roughly stable over the past week in New York (8.6 per 100,000 population), Massachusetts (7.8), and Pennsylvania (6.3).

RSV

PCR test positivity for RSV continues to improve. After a peak in December, positivity has now decreased to below 4%.

Stomach Bugs

Norovirus activity remains elevated, with test positivity over 15%. The Northeast has the highest test positivity in the country. The next month or two is peak norovirus season, so be cautious. Norovirus spreads very easily from person to person, causing vomiting and diarrhea. Wash your hands frequently with soap and water to prevent transmission.

Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:

New

Raw Cheddar Cheese (more info)

Multiple other product recalls associated with the queso fresco and Cotija cheese recall from last week, including taco kids. See the full list here.

Ready to eat meat products from Don Novo, including chorizo and smoked pork ribs (more info)

Previously reported:

A big recall of Queso Fresco and Cotija Cheese is affecting numerous consumer products: (more info)

Trader Joe’s Chicken Enchiladas Verde, Cilantro Salad Dressing, Elote Chopped Salad Kit, Trader Joe’s Southwest Salad (more info)

Cilantro Lime Crema, Everything Sauce Fiesta, Cilantro Cotija dressing, Poblano Caesar dressing, Cilantro Dressing, Street Taco Express Meal Kit sold at Trader Joes, Don Pancho and HEB (more info)

Rojo’s Black Bean 6 Layer Dip (more info)

Cheese, Yogurt, Sour cream by Rizo Brothers California Creamery (more info)

Robitussin Honey CF Max cough syrup products (more info)

Charcuterie meats sold by Fratelli Beretta and, newly, Busseto (more info)

Tons of different granola and oatmeal products from Quaker (more info).

If you have food allergies, you may wish to review these FDA safety alerts and USDA alerts for foods with undeclared allergens.

In other news
A measles case was reported in a child with a recent history of international travel in Toronto, Canada. While not technically in the Northeastern census region, I couldn’t find much else to share this week.

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“Plus ça change, plus c’est la même chose.” Marcel Proust

WPCNR CAMPAIGN 2024 ROUNDUP. By John F. Bailey February 17, 2023:

The New York State Independent Redistricting Commission has sent its redrawn congressional maps characterized as having been arrived at by a genuine effort of compromise to the state legislature for legislature approval.

All 26 District maps are on the NYIRC website: https://nyirc.gov/storage/plans/20240215/congressional_plan.pdf

(Simply scroll Down to District 16 and District 17.)

Leaks of how districts changed  found their way into the hands of some media outlets in time for stories to be published in major media as of Wednesday morning, when no maps were available. There were no explanations from the NYIRC  as to the effects of the redrawn maps and how many districts had changed, after the Commission voted 9 to 1 Abstention Tuesday afternoon to approve maps and then a second 9-1 vote to send the new maps on to Albany legislature for approval or denial.

The legislature in on vacation now and as of today Saturday State Senator Andrea Stewart-Cousins has not called the legislators back to Albany to consider a timely approval or more time to make changes before petition signature collections are scheduled to start.

The Congressional Districts of interest in the Westchester area are District 16 and 17. The District 16 map below shows no change from the previous district. The 17th district remains the same and incumbent Congressman Mike Lawler is very pleased at that.

NEW REDRAWN DISTRICT 16 IN GREENOVERLAY SHOWING NO CHANGE. (AND A CLOSER VIEW BELOW 🙂

THE NEW CONGRESSIONAL DISTRICT 16 HAS  519,751 REGISTERED VOTERS, 255,074 WHITE, 119,751 BLACK, 112,155 HISPANIC AND 30,355 ASIANS.

DISTRICT 17 NEWLY REDRAWN IS SHOWN BELOW IT TOO IS VIRTUALLY UNCHANGED

DISTRICT 17 HAS 533,808 REGISTERED VOTERS, 45,236 BLACK, 390,729 WHITE, 69,538 HISPANIC AND 26,093 ASIAN.

Voting organizations across the state were not enthusiastic about the proposed redrawn districts.

The NY League of Women Voters rounded up statements from a number organizations on the execution of the new proposed redrawn maps:

In what feels like the never-ending story, we bring you more news on redistricting. On Thursday, the Independent Redistricting Commission met and announced a new set of Congressional maps. You can take a look at the maps here and compare them with the 2022 version. NYC and Long Island will remain mainly unchanged, aside from a few small sections in Brooklyn and Queens. Upstate NY (yes, I’m unfortunately referring to anything above the city as Upstate) will see more drastic changes if these maps pass in the Legislature. Legislators are in their home districts on break next week so we won’t see them re-convene until February 26th. 

In response, the following groups released these statements:

“The reconvened Independent Redistricting Commission (IRC) owes New Yorkers an apology. From the start, thiscommission met behind closed doors, locking New Yorkers out of a process that directly impacts them. We have no idea how these maps were drawn, who influenced them, and why the districts are the way they are. Now, the Legislature must hold at least one public hearing – and allow written testimony – so New Yorkers can weigh in on the process before lawmakers vote on these maps. It’s the least they can do,” 

Susan Lerner, Executive Director
of Common Cause/NY.

“New Yorkers deserve a better redistricting process. The IRC should have held deliberations in public, and sought public input. Before voting on the maps, the legislature must hold at least one public hearing, and allow New Yorkersto comment on these lines. Going forward, we need a more independent process that reduces partisanship and outside influence over the commission, brings more diverse voices to the table, minimizes the potential for deadlock, and eliminates the Legislature’s authority to veto the final maps,”

Betsy Gotbaum, Executive Director of
Citizens Union.

“New York’s redistricting process has been plagued with multiple changes and convoluted decision making, ” said Cesar Ruiz, Associate Counsel at LatinoJustice PRLDEF.

“It’s essential that the legislature hold a public hearing.We cannot allow the will of the voters to be undermined. A redistricting process only works where there is a processin place that is fair, transparent, and equitable.”

“The League of Women Voters of NYS is dismayed that the Independent Redistricting Commission (IRC) held no hearings during their consideration of new congressional maps. Public input is critical to ensuring that the voters are choosing their elected officials and not the reverse. Even though it was not required by the court decision, the IRCshould have realized the importance to all to solicit this public input in this redrawing of the maps. The League has advocated for public input throughout this multi-year redistricting process and will continue to support all efforts now and in the future to ensure the public’s voice is heard in determining district lines,”

said Laura Ladd Bierman,
Executive Director, League of Women Voters of NYS.

“Public input is essential to give legitimacy to the redistricting process. Eyes are on New York. Don’t shut the public out of the process for a second time.

We ask the legislature to prioritize democracy over expediency and hold a
public hearing before any map is finalized,”

said Elizabeth R. OuYang, Coordinator, APA VOICE Redistricting
Task Force.

“New Yorkers deserve a transparent, fair and inclusive process when it comes to redistricting.

Instead, constituents were handed a set of congressional maps developed by the Independent Redistricting Commission without community input and shrouded in secrecy until their release today. Now it’s up to the Legislature to correct this wrong, by seeking and incorporating public input from New Yorkers before voting on these new maps.

This is the only way to increase trust in the system and ensure that every New Yorker has a say in the process that will impact their lives foryears to come. Building a more open process is vital for fostering an inclusive democracy that represents and upliftsthe voices of immigrants and all New Yorkers,”

said Murad Awawdeh, Executive Director of the New York
Immigration Coalition.

On Tuesday, these groups will host a virtual hearing on New York’s redistricting process. Attendees will hear from
members of the public and voting and civil rights groups about the current state of New York’s redistricting, why

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Changing Covid-19 isolation?

My thoughts.

BY DR. KATELYN JETELINA FEB 16 (REPRINTED WITH PERMISSION)

READ IN APP

In true Covid-19 fashion, news broke at an inconvenient time. Greetings from Mt. Fuji.

What happened? The Washington Post leaked that CDC is considering replacing the Covid 5-day isolation guidance with “staying home until 24 hours fever free and improving symptoms.”

This is what we know and don’t know, and what this all means in the larger context.

First, what we do know

• Contagiousness has not changed. If infected, you still spread Covid-19 to others for 5-12 days.
• Spreading Covid-19 is less consequential these days, though. Hospitalizations and deaths continue to decouple from infections. (This means ~300 deaths per day—which is still a lot—compared to the peak of 3,500.) Long Covid-19 prevalence is decreasing slowly, but millions still suffer.
• Testing is expensive. Innovation has not kept up. Antigen tests are not positive until days 3, 4, or 5 now.
• The number of paid sick days for Americans is abysmal—23% of Americans have zero (!) paid sick leave. Among those who do have it, the average American has 10 days.
• We are no longer in an emergency. The majority of Americans have put Covid-19 in the rearview mirror. Only 1 in 5 adults are vaccinated.

What we do not know

The actual proposed policy from the actual agency. This was a leak, which means it lacks justification, context, and details. We don’t have the full picture, like whether they will recommend masks, a cautionary period, or what to do for those at high risk.

A leak automatically puts CDC on the defense, which is disappointing as stakeholder engagement, gathering data, and conducting models takes time. Let’s give them time to line up their ducks.

One of the worst things CDC did throughout the emergency was change guidance without clear communication. I’m optimistic this will change.

What would be nice to know

We are always working off incomplete data, but some rough answers would certainly help me, at least, craft an opinion:

• How many people follow the current isolation guidelines? In other words, will this impact community transmission? Data from the U.K., California, and Oregon can help answer this, as they have already implemented similar guidance. Oregon, for example, shared that dropping isolation did not impact community transmission.
• How many people get a fever with Covid-19 infection? Is a fever or improving symptoms correlated with contagiousness for Covid-19? How well does this align with the flu and RSV? Do people know what “symptoms improving” means?
• Is there a risk difference between a symptomatic person on Day X vs. asymptomatic case walking around (which is about 40% of Covid-19 cases)?

Even if we get answers to the science, health policy is also based on psychology, politics, economy, culture, and values:

• What is acceptable to the majority of Americans? 100% protection x 0% adherence = 0% benefit.
• How many sick days are people willing to cash in for Covid-19? How many missed school days is “worth it”?
• Does a 5-day isolation period disincentivize people from testing in the first place?
• How will institutions react? If someone needs to stay home longer, will their employer let them? What will happen at hospitals?
• What do key high-risk stakeholder organizations (i.e., nursing homes, AARP, immunocompromised, health departments, healthcare workers) think?

What is the purpose of public health?

Whether we get answers or not, all of this centers around one core question: What is the purpose of public health? Do we meet people where they are (e.g., people aren’t isolating anyways, so let’s drop), or provide a north star (e.g., this is ideal, although we know most people won’t follow it)?

Ideally, it’s a balance with a clear goal in mind. This has resulted in a tug-of-war throughout the pandemic.

This isn’t abnormal in public health, though. Take car safety. In the 1980s there was incredible pushback on seatbelt laws. But that didn’t stop guidance, and wearing a seatbelt was eventually normalized. Seatbelts had minimal (if any) tradeoffs, though. We don’t tell people not to drive, even though it’s the most dangerous thing people do daily. Instead, public health put in place interventions and recommendations to mitigate harm.

When recommending an intervention to a huge fraction of society, we’d better have strong justification of the benefits and risks, even if acting on the precautionary principle and limited data.

Ideally, guidance comes in tandem with background systematic change after an emergency—ventilation, free vaccines, paid sick leave, normalizing mask usage. I see it in Japan, but it is a fleeting pipedream in the U.S. Of course, a lot of this isn’t in the purview of CDC.

Air quality monitor in a Japanese taxi

Bottom line

Health policy is messy and complex, involving weighing tradeoffs that change over time for very diverse 330 million people. We ultimately need guidance that is protective and actionable and feasible. I’m optimistic CDC will provide answers and clarity soon.

Love, YLE

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“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, M.P.H. Ph.D.—an epidemiologist, wife. During the day, she is a senior scientific consultant to several organizations, including CDC. At night, she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

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JOHN BAILEY INTERVIEWS THE NEW REPUBLICAN STEERING COMMITTEE AND THEIR PLANS FOR BUILDING BACK THE REPUBLICAN PARTY IN WHITE PLAINS NY  USA

PLANS FOR REGISTERING MORE VOTERS

THE STATE OF WHITE PLAINS

ISSUES NOT BEING ADDRESSED

THE MOOD OF THE CITY AND HOW TO CHANGE iT

MEET LEFT TO RIGHT:

ANTHONY PILLA, ENRIQUE JENETE, CHARLES LEDERMAN AND BRIAN PERONI

REACHING OUT TO MR.AND MRS. WHITE PLAINS