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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
Most of the region is reporting low levels of influenza-like illness, with a few exceptions. There’s a general pattern of decreasing activity as you move north, with the lowest levels in northern New England.
New Jersey and New York City stand out from the rest of the Northeast, with both reporting over 4% of visits due to flu-like illness (4.2% and 4.5% respectively).
Connecticut is the next highest at 2.4% of visits, while New York State (excluding NYC) is reporting about 2% of visits for ILI.
A cluster of states including Massachusetts, Maine, Rhode Island, and Pennsylvania are all reporting similar moderate levels between 1.5-1.8% of visits.
New Hampshire and Vermont have the region’s lowest activity, at 1.3% and 1.0% respectively.
COVID-19
Covid-19 wastewater activity is minimal and decreasing in the Northeast. It is lower now than at any point in the last year. Severe illness is also low and declining in most states in the region.
Activity was moderate in Vermont and Pennsylvania (limited data). It was low or minimal in New York, New Jersey, Rhode Island, Massachusetts, and Connecticut. The exception to this rosy picture is Maine, where wastewater activity spiked this past week, from moderate to high activity.
Trips to the ED for Covid-19 are minimal (<1.5% of all ED visits) in every state in the region. The rate decreased across much of the region this past week, including in Massachusetts, New Hampshire, and Vermont. In New York, both ED visits and hospitalizations are down. Hospitalizations in the state decreased for the fourth week in a row, to 3.6 hospitalizations per 100,000 people. This is still a bit elevated but much better than where it was a month ago. In Connecticut, ED visits declined, but hospitalizations crept up a bit, to 3.6. ED visits held steady in Pennsylvania and New Jersey. No states reported an increase in ED visits.
RSV
Minimal activity, according to both hospitalizations and wastewater. Enjoy the lull!
Other Bugs
Some common causes of respiratory illness, with cold and flu-like symptoms, continue to rise nationally.
Parainfluenza viruses in particular has increased rapidly, and is up to about 5% test positivity. Parainfluenza viruses have had two waves in the past year, and right now test positivity is higher than its peak last fall, but remains lower than its peak in May of this year (which was 8%).
After decreasing slightly a couple weeks ago, rhinoviruses/enteroviruses have also increased again in the past week, and remain quite elevated at 28% test positivity.
Adenovirus has been slowly increasing for the past few weeks, as have human coronaviruses, though neither are at particularly high levels at the moment.
Stomach Bugs
Norovirus rates are low in the Northeast – around 2% – in contrast to the rest of the country. Norovirus tends to pick up starting around November – and other regions are already seeing increases, so I’m enjoying the quiet while it lasts!
Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
Enoki mushrooms sold by HH Fresh Trading Corp (more info)
Gourmet Cafe Chicken Caesar Salad Bowls sold by Fresh Express (more info)
Previously reported:
Waffles and pancakes – many flavors and styles – sold under a very large variety of brand names, including numerous store brands, including 365 Organic, Best Choice, Good & Gather, Harris Teeter, H-E-B, Nature’s Promise, Publix, Trader Joe’s and Wegmans.
Given the size of this recall, if you have any variety of frozen/toaster waffles, Belgian waffles or pancakes in your freezer that you bought in the US or Canada, check this list. (more info)
Prepackaged Chicken Street Taco Meal Kit produced by Sprouts Farmers Market (more info)
Ready to eat meals and store-made deli items including chicken from a variety of grocery chains, including Albertsons, Safeway, Star Market, and others. (more info)
Green onions sold under Church Brothers, Trader Joe’s and Imperial Fresh brand names (more info)
Prepackaged sandwiches – Pepperjack Cheeseburger, Bacon Cheeseburger and The Gambler sold under the Dakota Tom’s brand name (more info)
Large variety of ready-to-eat meat and poultry products under different brand names, including Rao’s chicken alfredo and Michael Angelo’s grilled chicken piccata with penne pasta (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
Greely High School in Cumberland, Maine is under investigation by the Maine CDC for a whooping cough outbreak following multiple reported cases, including a recent one this week. Pertussis, or whooping cough, spreads through respiratory droplets and starts with cold-like symptoms that progress to a severe cough. School officials are notifying students and staff of potential exposure.
Vaccines that protect against pertussis include the DTaP vaccine for infants and young children and the Tdap booster for older children, teens, and adults. The CDC recommends DTaP doses at 2, 4, 6, and 15-18 months, with a final dose at 4-6 years. Tdap is recommended at 11-12 years, with adults advised to get a Tdap booster every 10 years to maintain immunity.
It’s November! (How is it November?) Here is a dose of public health that may help you forget the stress of the elections. Including a Halloween poll at the end.
Your “weather” report for the week
The “big three” (RSV, Covid, and flu) are at low levels.
If you or your kid has a cough that has lingered for weeks, it may be mycoplasma pneumonia or “walking pneumonia.” Cases are typically mild, but because bacteria causes the disease, antibiotics can help. The U.S. usually gets a surge every 3-7 years, and thus far, cases have been about 10 times higher this year than last year.
Opportunity to Get At-Home Tests for Multiple Respiratory Viruses This Fall!
Once the respiratory season starts heating up again, you may be interested in knowing which virus you have if you get sick. Some brilliant City University of New York scientists are working on cutting-edge, multi-pathogen rapid tests for Covid-19, RSV, and influenza (with flu a and b subtyping). They are recruiting study participants and shipping testing kits right now!
Participation in the study involves completing surveys about your health. You will also have free at-home testing for Covid-19, RSV, and flu.
They are particularly looking for people ages 50 and older or those living with chronic health conditions, but anyone over 18 in the United States is eligible to join.
If you want to participate, email recruitprotects@sph.cuny.edu with “Interested in CUNY Project PROTECTS – YLE” in the subject line.
Note: I don’t get anything from this other than cheering on my colleagues who are doing good science.
Feeling stressed from elections? You’re not alone.
The world feels very heavy a week before the election, at least to me. I’m not alone. A recent American Psychology Association report found that 3 in 4 Americans are stressed about the 2024 election.
Elections can have a pretty dramatic impact on health right before and right after, especially among those who are predisposed to heart problems. Studies have shown a dramatic increase in heart attacks, strokes, and heart failure:
One study found cardiovascular events increased nearly 2 times in the 2 days immediately following the 2016 election.
Another study found rates were 17% higher in the 5 days after the 2020 election than in the same 5 days in the period 2 weeks before the election.
I spent some time in Boston this week, speaking at several events. (Here is the Harvard recording, if you’re interested.) While I enjoyed them immensely, I found taking (a million) photos of the changing leaves and hugging friends was exactly what my soul needed to reduce stress. All this to say: Please take care of yourself in this stressful time.
Pneumococcal vaccine eligibility is lowered to 50+, and… you may need a booster.
Last week, CDC lowered the recommended pneumococcal vaccine age to 50. This seems like a straightforward policy, but… it’s complicated in real life.
Here’s the deal.
Pneumococcal disease is caused by bacteria, which can result in pneumonia, meningitis, joint space infections, and sometimes sepsis. There are around 15-25 cases per 100,000 people every year.
Since 2013, anyone over age 65 has been recommended for pneumococcal vaccination. (And children.) It was also recommended for people aged 50-64 with certain risk factors; however, uptake is incredibly low, especially for Black Americans.
Last week, CDC simplified recommendations for all people aged 50 and older. The upside: clearer eligibility. The downside: the likelihood of serious illness is low, and the vaccines are expensive.
But there’s an even bigger complication, regardless of your age. The bacterium has many different strains— about 100. So, over time, manufacturers and scientists have tried to figure out how many strains vaccines should cover, for whom they offer most benefit, and when. This has generated a variety of options:
PCV21 (Capvaxive) covers 21 strains, which is ~85% of strains that are known to affect adults
PCV20 (Prevnar 20) covers ~55% of the strains impacting adults but also includes serotype 4, which PCV21 does not include and can be important in some parts of the U.S. (This is especially important if you are in Alaska).
PCV15 (Vaxneuvance) covers 15 strains.
PCV13 (Prevnar 13) was one of the earlier vaccines available, and the one infants receive.
Because we keep adding strains, you may not be up-to-date on your pneumococcal vaccine. Here is an updated chart that may help.
(Source: CDC)
Not great news coming from a pig
Earlier this week, a pig in a small backyard farm tested positive for H5N1, known as bird flu. Viruses spread, so it’s unsurprising that a virus jumped from poultry to pigs.
Then why is a pig a big deal? Pigs are dangerous hosts for bird flu because they have avian and human receptors. This makes them “mixing vessels”—if a pig is infected with a human and bird flu strains, the virus can switch genes. When this happens, the virus could become more adaptable to human spread and become a pandemic. This is how the 2009 H1N1 pandemic started.
The risk to you today is still very low. But this virus is making public health very uncomfortable.
Poll
POLL
Happy Halloween to those of you in the States! Which of the following costumes is most spooky to you?
PROFESSOR ROLANDI OF PACE UNIVERSITY AND JOHN JAY SCHOOL OF JUSTICE, IS AN EXPERT IN NEW YORK STATE LAW AND THE STATE POSITION AND STRATEGIES IN WHAT IT CAN AND CANNOT DO UNDER DIRECTIONS AND POLICIES SET BY WASHINGTON. TONIGHT HE REVIEWS HOW A TRUMP ADMINISTRATION AND A HARRIS ADMINISTRATION HAVE AS THEIR OPTIONS IN VARIOUS CONGRESS AND PRESIDENCY POLICIES AND NEW YORK STATE OPTIONS IN THE SITUATIONS.
(This “People To Be Heard” election special is being aired on www.whiteplainscommunitymedia.org at special repeat times along with other programs commenting on the election. Check the website for days and times.)
Crowd gathering on Wall Street after the 1929 crash
The Wall Street Crash of 1929, also known as the Great Crash, Crash of ’29, or Black Tuesday,[1] was a major American stock market crash that occurred in late 1929. It began in September with a sharp decline in share prices on the New York Stock Exchange (NYSE), and ended in mid-November. The pivotal role of the 1920s’ high-flying bull market and the subsequent catastrophic collapse of the NYSE in late 1929 is often highlighted in explanations of the causes of the worldwide Great Depression.
It was the most devastating stock market crash in the history of the United States when taking into consideration the full extent and duration of its aftereffects.[2] The Great Crash is mostly associated with October 24, 1929, called Black Thursday, the day of the largest sell-off of shares in U.S. history,[3][4] and October 29, 1929, called Black Tuesday, when investors traded some 16 million shares on the New York Stock Exchange in a single day.[5] The crash, which followed the London Stock Exchange‘s crash of September, signaled the beginning of the Great Depression.
The “Roaring Twenties“, the decade following World War I that led to the crash,[6] was a time of wealth and excess. Building on post-war optimism, rural Americans migrated to the cities in vast numbers throughout the decade with hopes of finding a more prosperous life in the ever-growing expansion of America’s industrial sector.[7]
Scholars believe that declines in the money supply caused by Federal Reserve decisions had a severely contractionary effect on output.[8] Despite the inherent risk of speculation, it was widely believed that the stock market would continue to rise forever. On March 25, 1929, after the Federal Reserve warned of excessive speculation, a small crash occurred as investors started to sell stocks at a rapid pace, exposing the market’s shaky foundation.[9] Two days later, banker Charles E. Mitchell announced that his company, the National City Bank, would provide $25 million in credit to stop the market’s slide.[9] Mitchell’s move brought a temporary halt to the financial crisis, and call money declined from 20 to 8 percent.[9] However, the American economy showed ominous signs of trouble.[9] Steel production declined, construction was sluggish, automobile sales went down, and consumers were building up large debts because of easy credit.[9]
Despite all the economic warning signs and the market breaks in March and May 1929, stocks resumed their advance in June, and the gains continued almost unabated until early September 1929 (the Dow Jones average gained more than 20% between June and September).
The market had been on a nine-year run that saw the Dow Jones Industrial Average increase in value tenfold, peaking at 381.17 on September 3, 1929.[9] Shortly before the crash, economist Irving Fisher famously proclaimed “Stock prices have reached what looks like a permanently high plateau”.[10]
The optimism and the financial gains of the great bull market were shaken after a well-publicized September 8 prediction from financial expert Roger Babson that “a crash is coming, and it may be terrific”.[11][12] The initial September decline was thus called the “Babson Break” in the press. That was the start of the Great Crash, but until the severe phase of the crash in October, many investors regarded the September “Babson Break” as a “healthy correction” and buying opportunity.[13]
On September 20, 1929, top British investor Clarence Hatry and many of his associates were jailed for fraud and forgery, leading to the suspension of his companies. This may have weakened the confidence of Americans in their own companies,[14] although it had minimal impact on the London Stock Exchange. In the days leading up to the crash, the market was severely unstable. Periods of selling and high volumes were interspersed with brief periods of rising prices and recovery.[citation needed]
Overall Price Index[clarification needed] on Wall Street from just before the crash in 1929 to 1932 when the price bottomed out
Selling intensified in mid-October. On October 24, “Black Thursday“, the market lost 11% of its value at the opening bell on very heavy trading.[citation needed] The huge volume meant that the report of prices on the ticker tape in brokerage offices around the nation was hours late, and so investors had no idea what most stocks were trading for.[15]
With the bankers’ financial resources behind him, Whitney placed a bid to purchase 25,000 shares of U.S. Steel at $205 per share, a price well above the current market.[18] As traders watched, Whitney then placed similar bids on other “blue chip” stocks. The tactic was similar to one that had ended the Panic of 1907 and succeeded in halting the slide. The Dow Jones Industrial Average recovered, closing down only 6.38 points (2.09%) for the day.[citation needed]
On October 28, “Black Monday“,[19] more investors facing margin calls decided to get out of the market, and the slide continued with a record loss in the Dow for the day of 38.33 points, or 12.82%.[20]
On October 29, 1929, “Black Tuesday” hit Wall Street as investors traded some 16 million shares on the New York Stock Exchange in a single day. Around $14 billion of stock value was lost, wiping out thousands of investors.
The panic selling reached its peak with some stocks having no buyers at any price.[21] The Dow lost an additional 30.57 points, or 11.73%, for a total drop of 68.90 points, or 23.05% in two days.[22][23][24][25]
On October 29, William C. Durant joined with members of the Rockefeller family and other financial giants to buy large quantities of stocks to demonstrate to the public their confidence in the market, but their efforts failed to stop the large decline in prices. The massive volume of stocks traded that day made the ticker continue to run until about 7:45 p.m.[citation needed]
Dow Jones Industrial Average on Black Monday and Black Tuesday[26]
Date
Change
% Change
Close
October 28, 1929
−38.33
−12.82
260.64
October 29, 1929
−30.57
−11.73
230.07
After a one-day recovery on October 30, when the Dow regained 28.40 points, or 12.34%, to close at 258.47, the market continued to fall, arriving at an interim bottom on November 13, 1929, with the Dow closing at 198.60.
The market then recovered for several months, starting on November 14, with the Dow gaining 18.59 points to close at 217.28, and reaching a secondary closing peak (bear market rally) of 294.07 on April 17, 1930.
The Dow then embarked on another, much longer, steady slide from April 1930 to July 8, 1932, when it closed at 41.22, its lowest level of the 20th century, concluding an 89.2%loss forthe index in less than three years.[27][28]
Beginning on March 15, 1933, and continuing through the rest of the 1930s, the Dow began to slowly regain the ground it had lost. The largest percentage increases of the Dow Jones occurred during the early and mid-1930s. In late 1937, there was a sharp dip in the stock market, but prices held well above the 1932 lows. The Dow Jones did not return to its peak close of September 3, 1929, for 25 years, until November 23, 1954.[29][30][31]
Afterwards, stock markets around the world instituted measures to suspend trading in the event of rapid declines, claiming that the measures would prevent such panic sales.
However, the one-day crash of Black Monday, October 19, 1987, when the Dow Jones Industrial Average fell 22.6%, as well as Black Monday of March 16, 2020 (−12.9%), were worse in percentage terms than any single day of the 1929 crash (although the combined 25% decline of October 28–29, 1929, was larger than that of October 19, 1987, and remains the worst two-day decline as of October 7, 2024).[34]
The crash followed a speculative boom that had taken hold in the late 1920s. During the latter half of the 1920s, steel production, building construction, retail turnover, automobiles registered, and even railway receipts advanced from record to record. The combined net profits of 536 manufacturing and trading companies showed an increase, in the first six months of 1929, of 36.6% over 1928, itself a record half-year. Iron and steel led the way with doubled gains.[35]
Such figures set up a crescendo of stock-exchange speculation that led hundreds of thousands of Americans to invest heavily in the stock market. Many people were borrowing money to buy more stocks. By August 1929, brokers were routinely lending small investors more than two-thirds of the face value of the stocks that they were buying. Over $8.5 billion was out on loan,[36] more than the entire amount of currency circulating in the United States at the time.[37][38]
The rising share prices encouraged more people to invest on the hope that share prices would rise further. Speculation thus fueled further rises and created an economic bubble. Because of margin buying, investors stood to lose large sums of money if the market turned down or even if it failed to advance quickly enough. The average price to earnings ratio of S&P Composite stocks was 32.6 in September 1929,[39] clearly above historical norms.[40] According to the economist John Kenneth Galbraith, the exuberance also resulted in a large number of people placing their savings and money in leverage investment products like Goldman Sachs‘s “Blue Ridge trust” and “Shenandoah Trust”, which crashed in 1929 as well, resulting in losses to banks of $475 billion in 2010 dollars ($663.68 billion in 2023).[41]
Good harvests had built up a mass of 250 million bushels of wheat to be “carried over” when 1929 opened. By May there was also a winter wheat crop of 560 million bushels ready for harvest in the Mississippi Valley. The oversupply caused such a drop in wheat prices that the net incomes of farmers from wheat were threatened with extinction.
Stock markets are always sensitive to the future state of commodity markets,[citation needed] and the slump in Wall Street that had been predicted for May by Sir George Paish arrived on time. In June 1929, the position was saved by a severe drought in the Dakotas and the Canadian West, as well as unfavorable seed times in Argentina and eastern Australia. The oversupply was now wanted to fill the gaps in the 1929 world wheat production. From 97¢ per bushel in May, the price of wheat rose to $1.49 in July. When it was seen that figure would make American farmers get more for their crop that year than in 1928, stocks went up again.[42]
In August, the wheat price fell when France and Italy were bragging about a magnificent harvest, and the situation in Australia improved. That sent a shiver through Wall Street and stock prices quickly dropped, but word of cheap stocks brought a fresh rush of “stags” (amateur speculators) and investors. Congress voted for a $100 million relief package for the farmers on the hope of stabilizing wheat prices, but by October, the price had fallen to $1.31 per bushel.[43]
Other important economic barometers were also slowing or even falling by mid-1929, including car sales, house sales, and steel production. The falling commodity and industrial production may have dented even American self-confidence, and the stock market peaked on September 3 at 381.17 just after Labor Day, and it started to falter after Roger Babson issued his prescient “market crash” forecast.
By the end of September, the market had dropped 10% from the peak (the “Babson Break”). Selling intensified in early and mid-October, with sharp down days punctuated by a few up days. Panic selling of massive proportion started the week of October 21 and intensified and culminated on October 24, October 28, and especially October 29 (“Black Tuesday”).[44]
The president of the Chase National Bank, Albert H. Wiggin, said at the time:
We are reaping the natural fruit of the orgy of speculation in which millions of people have indulged. It was inevitable, because of the tremendous increase in the number of stockholders in recent years, that the number of sellers would be greater than ever when the boom ended and selling took the place of buying.[45][46]
Crowd at New York’s American Union Bank during a bank run early in the Great Depression
Together, the 1929 stock market crash and the Great Depression formed the largest financial crisis of the 20th century.[47] The panic of October 1929 has come to serve as a symbol of the economic contraction that gripped the world during the next decade.[48] The falls in share prices on October 24 and 29, 1929 were practically instantaneous in all financial markets, except Japan.[49]
The Wall Street Crash had a major impact on the U.S. and world economy, and it has been the source of intense academic historical, economic, and political debate from its aftermath until the present day. Some people believed that abuses by utility holding companies contributed to the Wall Street Crash of 1929 and the Great Depression that followed.[50]Many people blamed the crash on commercial banks that were too eager to put deposits at risk on the stock market.[51]
In 1930, 1,352 banks held more than $853 million in deposits; in 1931, one year later, 2,294 banks failed with nearly $1.7 billion in deposits. Many businesses failed (28,285 failures and a daily rate of 133 in 1931).[citation needed]
As tentatively expressed by economic historian Charles P. Kindleberger, in 1929, there was no lender of last resort effectively present, which, if it had existed and been properly exercised, would have been key in shortening the business slowdown that normally follows financial crises.[49]
The crash instigated widespread and long-lasting consequences for the United States.
Historians still debate whether the 1929 crash sparked the Great Depression[53] or if it merely coincided with bursting a loose credit-inspired economic bubble. Only 16% of American households were invested in the stock market within the United States during the period leading up to this depression, suggesting that the crash carried somewhat less weight in causing it.[citation needed]
However, the psychological effects of the crash reverberated across the nation as businesses became aware of the difficulties in securing capital market investments for new projects and expansions. Business uncertainty naturally affects job security for employees, and as the American worker (the consumer) faced uncertainty with regard to income, naturally the propensity to consume declined. The decline in stock prices caused bankruptcies and severe macroeconomic difficulties, including contraction of credit, business closures, firing of workers, bank failures, decline of the money supply, and other economically depressing events.[54]
The resultant rise of mass unemployment is seen as a result of the crash, although the crash is by no means the sole event that contributed to the depression. The Wall Street Crash is usually seen as having the greatest impact on the events that followed and therefore is widely regarded as signaling the downward economic slide that initiated the Great Depression. True or not, the consequences were dire for almost everybody. Most academic experts agree on one aspect of the crash: It wiped out billions of dollars of wealth in one day, and this immediately depressed consumer buying.[53]
The failure set off a worldwide run on US gold deposits (i.e., the dollar) and forced the Federal Reserve to raise interest rates into the slump. Some 4,000 banks and other lenders ultimately failed. Also, the uptick rule,[55] which allowed short selling only when the last tick in a stock’s price was positive, was implemented after the 1929 market crash to prevent short sellers from driving the price of a stock down in a bear raid.[56]
The stock market crash of October 1929 led directly to the Great Depression in Europe. When stocks plummeted on the New York Stock Exchange, the world noticed immediately. Although financial leaders in the United Kingdom, as in the United States, vastly underestimated the extent of the crisis that ensued, it soon became clear that the world’s economies were more interconnected than ever. The effects of the disruption to the global system of financing, trade, and production and the subsequent meltdown of the American economy were soon felt throughout Europe.[57]
In 1930 and 1931, in particular, unemployed workers went on strike, demonstrated in public, and otherwise took direct action to call public attention to their plight. Within the UK, protests often focused on the so-called means test, which the government had instituted in 1931 to limit the amount of unemployment payments made to individuals and families. For working people, the means test seemed an intrusive and insensitive way to deal with the chronic and relentless deprivation caused by the economic crisis. The strikes were met forcefully, with police breaking up protests, arresting demonstrators, and charging them with crimes related to the violation of public order.[57]
There is a debate among economists and historians as to what role the crash played in subsequent economic, social, and political events.
The Economist argued in a 1998 article that the Depression did not start with the stock market crash,[58] nor was it clear at the time of the crash that a depression was starting. They asked, “Can a very serious Stock Exchange collapse produce a serious setback to industry when industrial production is for the most part in a healthy and balanced condition?” They argued that there must be some setback, but there was not yet sufficient evidence to prove that it would be long or would necessarily produce a general industrial depression.[59]
However, The Economist also cautioned that some bank failures were also to be expected and some banks may not have had any reserves left for financing commercial and industrial enterprises. It concluded that the position of the banks was the key to the situation, but what was going to happen could not have been foreseen.[59]
This is the link to the live stream of Greenburgh Town Hall early voting site. Lines were very long on Saturday and Sunday (close to two hours). We provided a live stream four years ago of early voting. It helped voters decide when lines were shortest. The live stream will be up till the end of early voting on Sunday. We want the voting process to be as convenient as possible.
As Caitlin Rivers reports in this morning’s “Outbreak Outlook:Northeast Whooping Cough has doubled since last year in New Jersey. What is Whooping Cough? Here is the Mayo Clinic on the symptoms:
Overview
Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it’s marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like “whoop.”
Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.
Deaths associated with whooping cough are rare but most commonly occur in infants. That’s why it’s so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.
Symptoms
Once you become infected with whooping cough, it takes about seven to 10 days for signs and symptoms to appear, though it can sometimes take longer. They’re usually mild at first and resemble those of a common cold:
Runny nose
Nasal congestion
Red, watery eyes
Fever
Cough
After a week or two, signs and symptoms worsen. Thick mucus accumulates inside your airways, causing uncontrollable coughing. Severe and prolonged coughing attacks may:
Provoke vomiting
Result in a red or blue face
Cause extreme fatigue
End with a high-pitched “whoop” sound during the next breath of air
However, many people don’t develop the characteristic whoop. Sometimes, a persistent hacking cough is the only sign that an adolescent or adult has whooping cough.
Infants may not cough at all. Instead, they may struggle to breathe, or they may even temporarily stop breathing.
When to see a doctor
Call your doctor if prolonged coughing spells cause you or your child to:
Vomit
Turn red or blue
Seem to be struggling to breathe or have noticeable pauses in breathing
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
Influenza-like illness is minimal across most of the Northeast. The bottom line is that very little influenza is circulating, but if you want the details:
Connecticut and New Jersey report outpatient activity at a “low” level, but wastewater concentration remains minimal in these states, so not much is happening.
Similarly, Pennsylvania and Massachusetts have low wastewater concentration but show minimal outpatient illness.
Rhode Island has moderate levels of wastewater concentration but minimal outpatient visits.
Activity in New York City is minimal.
P.S. New to the regional editions? This information will get more detailed when activity picks up later in the season.
COVID-19
Things are quiet with Covid-19. Covid-19 wastewater activity is minimal across the region. That increase I reported last week appears to have been a blip; rates are now lower than they were before that transient increase. Severe illness is low and declining, with minimal visits to the emergency department for Covid-19.
Only one state in the region is reporting high wastewater activity: New Hampshire (limited coverage), but it appears to be declining there. In addition, wastewater activity has declined from high to moderate in Maine and Vermont.
These states have similarly seen a drop-off in ED visits over the past month. In Maine, ED visits declined substantially this past week to 0.9%, down from 2.6% of all ED visits a month ago. And in Vermont, rates have fallen from 3% a month ago to 1% this past week.
Wastewater activity is low in Pennsylvania (limited coverage), and minimal in Rhode Island and New Jersey.
The exceptions to these improving trends are Connecticut and Massachusetts where wastewater activity is moderate and increasing. However, in both of these states, ED visits declined (in the case of Massachusetts) or held steady (Connecticut) at minimal levels this past week, and hospitalizations decreased in Connecticut. (Massachusetts did not report Covid-19 hospitalizations).
Last week I reported that it looked like there might be a notable increase in wastewater activity in New York, but that there were lags in reporting, so this increase was based on data from <5% of the state’s population. The data caught up and fortunately that increase was just sampling error: activity remains minimal for the state. Further supporting that rates are low, ED visits in the state were minimal (0.5% all ED visits were for Covid-19) and hospitalizations decreased (to 4.0 per 100,000).
In New York City, the number of Covid-19 hospitalizations has declined steadily, now averaging less than 20 city-wide. Still, the City reports an average of one death per day.
RSV
As noted last week, test positivity is increasing, but continues to be very low. One curious data point is that wastewater concentration in Connecticut is coming in as “very high,” but again test positivity in the state is very low so I am not too concerned right now.
Other Bugs
Common causes of cold- and flu-like symptoms are picking up steam. Parainfluenza has increased rapidly the past few weeks, and is now at a moderately high level. Adenovirus activity has also increased moderately. Human coronaviruses have started increasing as well, but remain at low levels.
Stomach Bugs
No updates this week; there were reporting delays.
Food recalls
The following foods are being recalled because they are contaminated. Please check your cupboards and throw out any of these items:
New:
Waffles and pancakes – many flavors and styles – sold under a very large variety of brand names, including numerous store brands, including 365 Organic, Best Choice, Good & Gather, Harris Teeter, H-E-B, Nature’s Promise, Publix, Trader Joe’s and Wegmans.
Given the size of this recall, if you have any variety of frozen/toaster waffles, Belgian waffles or pancakes in your freezer that you bought in the US or Canada, check this list. (more info)
Prepackaged Chicken Street Taco Meal Kit produced by Sprouts Farmers Market (more info)
Ready to eat meals and store-made deli items including chicken from a variety of grocery chains, including Albertsons, Safeway, Star Market, and others. (more info)
Green onions sold under Church Brothers, Trader Joe’s and Imperial Fresh brand names (more info)
Prepackaged sandwiches – Pepperjack Cheeseburger, Bacon Cheeseburger and The Gambler sold under the Dakota Tom’s brand name (more info)
Previously reported:
Large variety of ready-to-eat meat and poultry products under different brand names, including Rao’s chicken alfredo and Michael Angelo’s grilled chicken piccata with penne pasta (more info)
Eggs under labels “Milo’s Poultry Farms” and “Tony’s Fresh Market” (more info)
Don’t forget to throw out Boar’s Head deli meats (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
Whooping cough cases in New Jersey have surged, reaching 423 confirmed cases by mid-October 2024, more than double last year’s count. This uptick coincides with a relatively mild start to flu and COVID season, unlike the intense start seen in 2022. Nationally, whooping cough cases also rose significantly, with nearby states like Pennsylvania seeing particularly sharp increases. New Jersey health officials urge vaccinations to curb the spread, especially in schools where outbreaks have occurred.