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 DiseasesInfluenzaFlu is ratcheting up quickly, but unevenly, across the Northeast. It is now high in several states, but remains low (though growing) in others. New York and New Jersey are at the center of the wave. Outpatient ILI in the states have risen to 7.8% and 8.0%, respectively, which is really quite high. Emergency department (ED) visits have also increased sharply in both states, to 5.7% and 5.0%, respectively. Hospitalizations in New York have increased to 8.1 hospitalizations per 100,000 people. New York City is seeing a rapid escalation as well: ED visits have jumped from 4.2% to 6.7% in the last week, and hospitalizations have also jumped. Northeast: Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
 Outpatient ILI data is not available for Connecticut, but its ED visits are on par with those in New York at 5.7%. Similarly, hospitalizations have increased sharply, to 9.5 hospitalizations per 100,000 people. In Rhode Island, outpatient ILI is up to 6% and in Massachusetts, outpatient ILI activity is up to 4.2%. Both states reported notable increases in ED visits this past week, to 2.8% and 2.7%, respectively. Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
 Activity still remains fairly low in several states, however. In Pennsylvania, outpatient visits are at 2.2% and ED visits, while increasing, are still low at 1.8%. ED visits in New Hampshire are also low at 1.8%. In Maine, outpatient ILI increased slightly this past week to 1.9%, and in Vermont, outpatient ILI is at just 1.4%. Both states have ED visits for flu at 1.2%. *Please note: for a few states, outpatient ILI data was not in the centralized dataset used to create the graphics, but I was able to find the data directly from the state and have referenced it in-text here. COVID-19Covid-19 activity is increasing, with some states seeing much more activity than others. ED visits were stable or increasing in most states in the region, though they remain low overall, ranging from 0.4-0.8% of all ED visits. Wastewater activity dipped slightly this week, dropping from moderate to low wastewater activity. Nevertheless, activity remains more than double what it was back in November, and the overall trend still appears to be one of increasing activity. Connecticut has the highest rate of ED visits in the region, at 0.8%, and wastewater activity there is also high and increasing. Hospitalizations have also started to catch up, and increased notably this past week, to 3.1 hospitalizations per 100,000 people. In Maine, wastewater activity is also high and increasing, but ED visits dipped slightly this week, to 0.5%. Northeast: ED visits for Covid-19 (%)
% of visits to the emergency department that are for Covid-19
 In New Hampshire, ED visits have increased to 0.73, and wastewater activity is moderate. Massachusetts also has moderate wastewater activity, and stable ED visits (0.63%). In Rhode Island and Vermont, wastewater activity is low and decreasing, and ED visits declined in both states this past week. In Pennsylvania, ED visits increased slightly, and wastewater activity held roughly steady or declined slightly to low levels. Forming an inverse of what is happening with flu, things are very quiet in both New York and New Jersey — wastewater activity is very low, and ED visits are very low and stable (at 0.4 and 0.5%, respectively). This is also the case in New York City, where ED visits for Covid-19 are very low at just 0.2%. However, hospitalizations increased slightly in New York, to 3.1 (though they held steady in New York City). Northeast: Covid-19 wastewater concentration
Wastewater concentration of SARS-CoV-2
 RSVRSV remains unusually quiet for this time of year. Wastewater activity remains very low in most states in the region. Connecticut is the only state with low (rather than very low) wastewater activity. But ED visits remain very low and stable in the state (at 0.15) and hospitalizations are flat, at 0.8 hospitalizations per 100,000 people. ED visits remain <0.4% for all states in the region. There were slight increases in ED rates in Rhode Island, New York, and New Hampshire this last week. In New York, however, there has been an uptick in hospitalizations this past week, to 1.4 hospitalizations per 100,000 people. In New York City, RSV remains very low and stable, at 0.3% of all ED visits. Hospitalizations have decreased slightly over the past few weeks, to 0.2%. Northeast: ED visits for RSV (%)
% of visits to the emergency department that are for RSV
 Other Bugs
Stomach BugsNorovirus test positivity data was not updated this week. However, my back-up data source shows that norovirus wastewater activity is high, but decreasing slightly at the national level. In the Midwest, Northeast, and South wastewater activity is high and increasing. In the West, wastewater activity is also high, but has dipped slightly. 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:
In other news
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THE WORLD READS WHITE PLAINS CITIZENETREPORTER — 8,324,077 VISITS IN ONE YEAR
2,905,611 VISITORS VISIT 8,324,077 TIMES 3 TIMES EVERY DAY IN ONE YEAR. HIGHEST ACTIVITY IN WPCNR HISTORY.White PlainsCitizeNetReporter lifted its worldwide visits from unique visitors to wpcnr.com to 8,324,077,a 1,306,419 increase in visits in one year from 7,017,658 visits to the site last year which covers White Plains and Westchester County. The 8,324,077 visits were made by 2,005,611 unique visitors who visited wpcnr an average of 3 visits a day. ON JULY 20- -2026 visitors have accessed wpcnr and made 3,072 visits an average of 1.6 visits. In the last week 33,495 individual vistors made 54,458 visits, averaging 1.6 visits. In the last month, 152,940 visitors recorded 229,338 visits (1.5 visits)
