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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 DiseasesInfluenzaThere were decreases this week in most states in the region, but many, many people are still ending up in the ED and hospitalized right now. It’s possible we’ve peaked, but last year we had an unusual double-peak, so I’m reluctant rest easy just yet. Outpatient influenza-like illness (%)
% of visits to the doctor that are for fever and cough or sore throat
 In New York state, outpatient influenza-like illness (ILI) decreased substantially, to 10.9%. Emergency department (ED) visits also decreased from over 9% to 6.3% in one week. Hospitalizations in the state decreased slightly, to a still-very-high 19.8 hospitalizations per 100,000 people. Decreases are also occurring in New York City, where visits to the ED have fallen by nearly half in the past two weeks, down to 5.0%, and hospitalizations are slowly coming down as well (to 3.5%). Northeast: ED visits for influenza (%)
% of visits to the emergency department that are for influenza
 Following a similar trajectory as New York, in Connecticut, ED visits dropped from around 12% to 8.4%, and hospitalizations decreased to a still-very-high 19.4. New Jersey, New Hampshire, and Massachusetts all reported decreases in ED visits to roughly 8.3%. Rhode Island dropped a bit further, down to 7.1%, and in Maine, outpatient ILI decreased slightly, to 7.6%, as did ED visits, to 6.7%. In Pennsylvania, outpatient ILI increased slightly to 5.1%, but ED visits decreased to 6.3%. Finally, in Vermont, ED visits held roughly stable at an elevated 5.5%. The Center for Forecasting and Outbreak Analytics is also estimating robust declines in all states in the region. COVID-19In the Northeast, Covid-19 activity is high and rising. The Northeast is the second-highest region in the country in terms of emergency department (ED) visits. Activity has already surpassed the levels seen in the small late summer wave, but has not reached those of last winter’s wave, which was also on the small side. Altogether, we’re in pretty good shape considering it’s peak season, but we’ll see what unfolds in the weeks ahead. Covid-19 Emergency Department Visits (%)
% of visits to the ED that are for Covid-19
 Nearly all states in the region are reporting very high or high wastewater concentration. Connecticut has the highest wastewater activity in the region, which is continuing to rise, as are visits to the ED (to 1.3%). Hospitalizations in the state have also increased again, to a moderate 4.6 hospitalizations per 100,000 people. Northeast: Covid-19 wastewater concentration
Wastewater concentration of SARS-CoV-2
 In Massachusetts, wastewater activity is very high, but dipped slightly this week — the peak may have passed. ED visits still increased, but just a little, which also suggests spread is slowing down (1.3%). Peak also appears to have passed in New Hampshire, where wastewater activity has declined to moderate levels. However, ED visits, a bit of a lagging indicator, are still rising — up to 1.5% this week. Activity is high and increasing in Pennsylvania, New York (incomplete data), Rhode Island, Vermont, and Maine. Most of these states are reporting ED visits that are increasing and between 1.2 and 1.6%. The exception is New York, which held roughly steady at 0.7% (and at a much lower 0.3% in New York City). New Jersey is the only state reporting low wastewater activity, though this is also on the rise, along with ED visits (0.85%). Northeast: ED visits for Covid-19 (%)
% of visits to the emergency department that are for Covid-19
 RSVTest positivity continues to rise, reaching 4.6% nationally this past week. ED visits held roughly steady this past week at 0.5% nationally, and hospitalizations are elevated at 1.8 hospitalizations per 100,000 people. RSV activity remains elevated, and ED visits held roughly steady this past week at about 0.4% for the region. New Jersey has the highest activity in the region, with ED visits at 0.6%, though this decreased a bit this past week. Activity increased notably in Rhode Island, pushing ED visits to 0.6%. ED visits also increased slightly in Connecticut (0.3%), and Maine (0.1%). ED visits held roughly steady at moderately elevated levels in Pennsylvania (0.5%), New Hampshire (0.4%), Massachusetts (0.4%), and New York (0.4%). Hospitalizations ticked up slightly in New York to 1.6 hospitalizations per 100,000 people. RSV activity decreased by more than half in Vermont, to 0.12%. Northeast: ED visits for RSV (%)
% of visits to the emergency department that are for RSV
 Other Bugs
Stomach BugsCDC norovirus data hasn’t updated since the week of December 20. My alternative source is finding high and fairly stable levels of wastewater activity nationally. In the Midwest, activity has decreased slightly over the past week, but remains quite high. In the South, activity is high, having rebounded after a slight decrease. In the Northeast, activity held roughly stable at high levels. Levels remain quite a bit lower in the West, where activity is moderate and held roughly steady this past week. 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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