I’m glad to be able to put good news in your inbox this week. Influenza-like illness (ILI) activity fell again this week, to 2% of outpatient visits for fever and cough or sore throat. We’ve seen continued declines week over week for about six weeks now. Even young children, whose ILI activity has remained stubbornly high the entire season, declined from 7.3% to 6.9% during the last reporting period.

There are now zero (!) jurisdictions with high ILI activity. New York City and Washington D.C. both dropped into the “moderate” category after many weeks in “high.” NYC is still seeing quite a bit of flu B, but it’s not driving much of a wave. I’m hoping it will be quiet until fall, when the next flu season begins again.

Covid-19 activity also continues to decline nationwide. Around 94,000 cases were reported in the last week, down from 101,000 the week before. Hospitalizations have also steadily declined. There are no regional hotspots, but there is a constellation of counties with increased activity, including parts of Southern California, southern Texas, Missouri and the Carolinas. Big picture though, Covid-19 trends look good.

First, the good news. Seasonal coronavirus activity has fallen dramatically, with the exception of CoVNL63 which continues to bounce around. Seasonal coronaviruses mostly cause the common cold. RSV activity is low, and its cousin metapneumovirus is also settling down. Both cause more severe respiratory illness, particularly in older adults and infants.

On the other hand, parainfluenza activity and adenovirus activity remain elevated. Parainfluenza causes flu-like symptoms, as the name suggests. Adenovirus infections cause a range of symptoms depending on the strain, from cold-like illness to lower respiratory infection to gastrointestinal distress. We don’t have great surveillance for either pathogen, but several sources indicate they remain active.

Norovirus must have heard me last week when I said it was finally fading. Activity is back up this week. The Southern region is looking good, but the other three big regions are still struggling to turn the corner.

For new readers, more on preventing norovirus: The biggest concern with norovirus is preventing dehydration. This is especially important in children and older adults, who dehydrate quickly. I keep Pedialyte powder packets in the pantry, because they take up less space and have a longer shelf life than bottles of liquid rehydration products. Water, broth, popsicles, diluted juice, sports drinks, etc. are also good options. Don’t fall behind by waiting until dehydration sets in. Encourage frequent sips from the onset of illness.

Norovirus spreads very easily between people through the “fecal-oral” route. To stop it from spreading, wash your hands thoroughly after using the bathroom and before eating or preparing food. I also use hand sanitizer while I’m in public like after I use self-checkout at the grocery store or when I use public transportation, but you should know that hand sanitizer is not as effective against norovirus as hand washing. Be sure to wash your hands properly when you get home. Most importantly, stay home if you have vomiting or diarrhea. 

Food recalls

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

New this week:

• Ground cumin from Lipari Foods (more info).
• Ready-to-eat salad products with chicken and ham (more info). This is in addition to the recalls that Fresh Express, Publix and Fresh from Meijer announced recently (more info, more info). See also the Revolution Farms salad recall (more info). I’m not feeling great about pre-packed salad products right now overall.

Reported in the last month:

• Raw flour (no brand identified yet). Unbaked flour is a common source of Salmonella food poisoning. Do not consume unbaked flour. (more info)
• Frozen organic strawberries and tropical fruit mix sold to Costco, Trader Joe’s, Aldi, KeHE, Vital Choice Seafood, and PCC Community Markets. (more info)
• If you have food allergies, you may wish to review these FDA safety alerts for foods with undeclared allergens.

In other news

• A spring bivalent booster is now available to people who are immunocompromised or over the age of 65. Federal officials approved the move last week. The authorization is an option for people who may benefit, not a blanket recommendation for anyone in those eligibility groups. There are also several new changes to the definition of what it means to be “up to date” on covid vaccinations. People who are getting vaccinated for the first time are considered up to date after one bivalent dose. The two-dose monovalent series that many of us got back in 2020 is no longer offered. Several additional changes were made to the children’s vaccine schedule. Your Local Epidemiologist has more on both updates.
• The Public Health Emergency is ending on May 11. Remember to order your at-home covid tests before then. Private insurance and Medicare will cover eight per person per month until the emergency ends. You can order them at pharmacies like CVS. While you’re there, pick up your preferred over the counter medicines to treat fevers, colds and dehydration. There was a big run on these products during the tripledemic and I heard of many families that had to go without during times of need. Might as well get some now, so you have it in stock for next time.
• Group A strep (GAS) activity may finally be dying down. The UK Health Security Agency reported that scarlet fever infections have returned to the normal levels for this time of year. The bacteria that causes scarlet fever also causes strep throat and, rarely, more invasive disease like necrotizing fasciitis. Invasive group A strep infections have also declined, but activity remains slightly elevated over normal levels. This winter was one of the worst on record, contributing to persistent shortages of common antibiotics. The U.S. does not have readily available data on GAS activity, but I expect we largely follow U.K. trends.
• In case you missed it, I am moving “This week in outbreaks” to a monthly schedule during the summer months. I’ll continue to keep an eye on Covid-19, which has flared in the summer in years past. Weekly updates will begin again when flu season resumes in October. In the meantime, you’ll still hear from me most weeks with other commentaries and analysis.
• My weekly Q&A in the New York Times is out, this time on H5N1. There is also an essay by author David Quammen.

This Op-Ed was submitted to a number of news organizations but never picked up. There is a deep need for this conversation and I am getting increasingly frustrated with the lack of action and/or community of practice. So, you’re the lucky audience that gets this in their inbox; a bit different format and tone than other YLE articles. Just pretend you’re reading the Washington Post.

A new bill introduced in Congress calls on the U.S government to focus on combating misinformation.

The “zero draft” of a proposed international pandemic treaty calls on member states to do the same.

The FDA is zeroing in on misinformation. Webinars galore are focusing on fighting misinformation to build trust. Even public libraries and schools are entering the fight against fake news.

These efforts are among the latest in a wave of initiatives—and for good reason.

Social media sites are flooded with inaccurate, misleading, and sometimes nefarious messaging about science and health. Too often, these falsehoods get traction.

Researchers have found that the modern information ecosystem allows false news to spread six times faster, more broadly, and by more people than the truth.

Public health has not kept up.

The field has stumbled in communicating effectively during times of crisis. During the pandemic, ineffective or absent risk communication left people scrambling for up-to-date and relevant information about their health and safety. (Hence YLE was born.) Concurrently, producers of disinformation were busy intentionally sowing doubt and confusion. Together, these obstacles created an impossible landscape for people to navigate when making decisions about everyday life, like whether and when to travel, wear a mask, see grandparents, or attend a party.

Meanwhile, researchers and policy experts are producing a steady stream of proposals to prevent the next pandemic. Too often, these plans do not even contain the word “communication.” What good is faster vaccine development if uptake is poor? If no one is proactively anticipating concerns, listening to people on the ground, and addressing their information needs from a place of empathy and authenticity, how will we influence evidence-based decision-making?

We are on the wrong path.

The wellspring of misinformation is effectively infinite compared to the scant resources of public health. It is unlikely that we will ever get ahead of the deluge. But there is another way forward: we must focus instead on getting our own house in order by improving core communications.

Communications should feature in every pandemic preparedness and response plan, with the same seriousness of purpose as vaccine development or diagnostic testing. Supporting people with readily available, relevant, detailed information will help to restore confidence in public health and address the systemic weaknesses that encouraged people to turn to misinformation in the first place.

The biggest gaps in public health information are timeliness and volume. Messaging is too slow and too scant to meet the need. Public health organizations and officials must get more comfortable communicating quickly, continuously, and with empathy.

For many organizations, this means expanding (or just creating) the scientific communication workforce. Officials must recognize that communicating with the public is an essential part of their mission, and energy and time allocations must reflect that. Also, the clearance processes for communication products must be dramatically thinned. Onerous clearance processes discourage frequent information sharing and can inadvertently erode key messages.

Once the systems and people are in place, the content of what is communicated is critical. Crisis communication should not serve the interests of the players, but of the people.

This means that messaging cannot hasten to reassure how much is being done by the responsible parties or how under control the situation is.

The proper goal of communication is to tell people honestly and clearly what the situation is, what risks they face, and what they should do to keep themselves and their families safe.

Missteps can be avoided by properly acknowledging uncertainty: What do we know? What do we not know? And how are we trying to find answers? 

Knowledge translation also must come from a place of empathy.

People do not turn to media companies for their news.

They turn to anchors and reporters whom they come to know and trust—warm bodies that they can relate to and who appear consistently over time.

We don’t give the public enough opportunities to see and trust warm bodies in public health. Messages must be delivered by real people, preferably the same people, in a style that feels human.

These challenges don’t just apply to a pandemic. Health emergencies happen all the time, from the mpox outbreak to the earthquake in Turkiye to the train derailment in East Palestine, Ohio.

Communities are starved for good information, leading to unnecessary anxiety, confusion, frustration. That void is often filled with misinformation. Going forward, the public health community should double down on bolstering frequent, reliable communications for these crises—instead of attempting to bat back the torrent of misinformation.

Bottom line

Public health is unlikely to “win” at combatting misinformation, at least in the near term. We win by earning the ear and the trust of the public, and we do that by communicating honestly, frequently and directly. We must not lose sight of that mission. I’m afraid it’s a lesson we haven’t yet learned.

Love, YLE and CR

Caitlin Rivers, PhD, MPH, is an assistant professor and epidemiologist at the Johns Hopkins Center for Health Security. She has her own newsletter called Force of Infection:

Subscribe to Force of Infections Here

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science 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.

This latest edition is published with permission.