We hope everyone is staying warm; the weather is certainly turning now!

After our updated disease “weather” report, we’ll call out a few midterm results that we didn’t cover on October 29 that can shape birth control access, gun laws, and the health care workforce. We’ll also talk about rhabdomyolysis and problem gambling in New York. Connecticut has a new overdose dashboard and has declared a One Health Day!

Disease “weather” report

The respiratory season “big three”

1. The flu continues to increase in activity, surpassing Covid levels. Test positivity in the Northeast is now around 8%, just trailing the national percentage (about 9%) but will continue to increase as we get into the winter.
2. Covid test positivity in HHS Regions 1 and 2 is sitting at around 2 to 3%. Wastewater levels for the Northeast region are moderate and decreasing. Historically, there is an increase in Covid activity in the Northeast around the holiday season, though the size of this increase has varied and severe outcomes like hospitalization have declined over time.
3. RSV is low (<1% of tests come back positive), but it is starting to stir.

Election results: what the midterms mean for public health in the Northeast

There are three important health care impacts in New Hampshire, Massachusetts, and Rhode Island. Now that the votes are in, here’s what they mean:

• New Hampshire: A new Executive Council could revisit family planning contracts. New Hampshire’s Executive Council, a five-member board that approves state contracts, has rejected five family planning contracts with three clinics that covered birth control, STI testing, and cancer screenings since 2021. Democrats won all five seats for the first time ever, and returning councilor Karen Liot Hill is asking the state health department when the contracts will come back after the new council is sworn in in January.
• Massachusetts: The state’s 2024 gun law stays in place. Voters kept the state’s 2024 gun law, with about 67% voting yes on Question 9. The law:
  • Requires nearly every gun to be entered into the state registration system
  • Adds oversight of ghost guns, the untraceable homemade firearms
  • Strengthens the state’s red flag law, which lets courts temporarily remove guns from people at risk of hurting themselves or others
  • Tightens firearms licensing
  • Updates the assault weapons ban
  • Expands data collection and reporting on gun violence

• Rhode Island: Voters fund training for future health care workers: Voters approved Question 1, a $275 million higher-education bond, with about 60% of the vote. The largest piece is $165 million for a new integrated health building at the University of Rhode Island. It will modernize teaching and clinical training space for the nursing, pharmacy, and health sciences programs. Construction spending is expected to run through fiscal year 2031.

New York City: What is rhabdomyolysis?

In the last two weeks, there have been two rhabdomyolysis cases, also known as rhabdo, in the Northeast. Rhabdo took the life of 24-year-old Rachel Apa, who collapsed after the New York Marathon. Four-year-old Ali Modica from New Jersey could not walk or talk after rhabdo.

This is heartbreaking, and our thoughts are with Apa and Modica’s families.

What is rhabdo? Rhabdo happens when damaged muscle breaks down quickly, releasing into the bloodstream a protein called myoglobin that can injure the kidneys. Kidney injury occurs in an estimated 10% to 40% of severe cases.

Who gets it? In adults, overexertion is a major cause, especially when people push harder than usual or exercise in the heat. In children, viruses are the most common cause, with flu behind about a third of those cases.

What are the signs? Look for muscle pain, weakness, and dark, tea-colored urine, though many people don’t have all three. Fewer than 5% of children with rhabdo have dark urine. Fever and flu-like symptoms are more common in kids.

New York state curbs problem gambling

October through March is full of events people love to predict—elections, red carpets, the Super Bowl, March Madness, and more. Now, those predictions often come with money attached.

New York launched online sports betting in January 2022, making apps like DraftKings and FanDuel available to anyone over 21. Since then, online sports betting has become the top reason New Yorkers call the state’s gambling helpline. Nationally, gambling disorder diagnoses rose about 61% in states with legal sports betting.

Gambling disorder is a recognized addiction. Like alcohol and other drugs, it triggers the brain’s reward system, which can drive people to keep doing it.

At-risk groups include:

• Young adults under 25
• People earning under $30,000 a year
• Men ages 18 to 49 (a national poll found half have a sportsbook account)

Gambling disorder is also a public health issue because health impacts go beyond money. For example, one in five people with a gambling problem have attempted or died by suicide.

What New York is doing: In October, the NYS Gaming Commission proposed new rules on online sports betting to address these trends:

• Apps must watch for warning signs, like large deposits or repeated visits to the self-exclusion page, where users can ban themselves.
• Flagged bettors get escalating outreach and can be suspended or closed.
• Apps also can’t use AI or personal data to tailor promotions or suggest bets.

After the rules are published in the State Register, the Gaming Commission can finalize and enforce them.

What’s missing:

As we’ve seen in the opioid crisis, some people “doctor shop,” or visit multiple doctors to get more prescriptions. New York closed that gap for opioids with a shared prescription database.

Similarly, someone flagged on one betting app can move to another. The Gaming Commission chair has told licensed apps to share data, or the state will require it.

Connecticut proclaims Nov. 3 One Health Day, and the new overdose dashboard

I (Tamara) think about ticks when I’m outside with my dogs, Booberry and Frankenberry. It’s a reminder that our health is tied to them and our surroundings.

That’s the idea behind One Health Day in Connecticut, which Gov. Ned Lamont proclaimed for Nov. 3. The day celebrates how the state’s public health, agriculture, and environmental agencies work together to track threats like bird flu, rabies, mosquito-borne and drug-resistant infections, along with extreme heat, wildfire, and smoke. When it comes to food safety, they bring together inspections, animal health monitoring, and education.

Another Connecticut update is the recent launch of DPH’s interactive overdose death dashboard on October 21. Updated monthly, you can use it to see how unintentional overdose deaths have changed in your town, your region, or across the state, and which groups are most affected.

The city of Meriden offers a great example of what communities can do with local data. Public health officials looked at gaps in prevention, treatment, and recovery services and developed the Meriden Opioid Referral for Recovery program, which helps first responders connect people with follow-up care after an overdose. Meriden also uses a separate, near-real-time overdose mapping system to spot spikes and bring services like pop-up naloxone (Narcan) training to affected neighborhoods.

Bottom line

Public health shows up in nearly every part of life, from sports betting to exercise to our pets. The measures we vote on and the agencies that run our programs shape how it plays out in our communities.

Love,

YLE Northeast

Julia Tellerman, MPH, is an epidemiologist in Rochester, NY. Asuka Koda is a health journalist in New Haven, CT. Tamara Rissman, MPH, is an epidemiologist and professor in New Haven, CT.