Enjoying this newsletter? Why not share it with a friend? Covid-19, mosquitos, hand foot and mouth surging,kinder vaccination rates, Vaccine Injury program at riskand moreThe Dose (August 4) Reprinted with permission
Well, July just flew by. August is here—bringing peak mosquito season, back-to-school bustle with lower vaccination rates, and, unfortunately, Covid-19 and hand, foot, and mouth. Here’s what may impact your health, some communication tips in our recent NEJM article, and, as always, some good news to start your week! Let’s dive in. Disease “weather” reportCovid-19 The summer Covid-19 wave is growing—especially in the South and West—but national levels remain relatively low compared to this time last year. Infants under 6 months old are the most impacted right now, accounting for the highest rate of emergency room visits for Covid-19. How high will this wave get? No one knows for sure, but I wouldn’t be surprised if it passes last winter’s peak. That season was mild, and many people haven’t been infected in a while, leaving them more susceptible to infections.
Sources: CDC Covid Data Tracker (top), PopHIVE Respiratory Diseases (bottom), annotated by YLE If you squint, overall hospitalizations are starting to increase, which makes sense given they still lag the early indicators like wastewater. But each year we are getting fewer severe diseases in a step-like fashion. I expect this year to be no different.
Covid-19 hospitalizations, United States. Source: CDC; Annotated by Your Local Epidemiologist Hand, foot, and mouth disease Pediatricians and parents are anecdotally reporting more cases of hand, foot, and mouth disease than usual for this time of year. It’s hard to confirm in the data, as this disease isn’t a “nationally reportable disease” (i.e., clinician and public health department reporting not required). But among the few states that do track, like Maryland, New Jersey, and Virginia, reports are above normal. People are also searching for it on Google more than usual.
Google Trends data for “Hand, Foot, and Mouth” disease by Your Local Epidemiologist on August 3, 2025.
Peak mosquito season is here August marks the height of mosquito season—and with it, an uptick in local news about city/county spraying and human cases of West Nile virus.
West Nile Human Cases last year (2024), Source: CDC West Nile Virus Historic Data This is prime time for mosquito-borne diseases because mosquitos are cold-blooded and transmission is a bit like a chemistry experiment. If it’s too cold (below ~16°C, or ~60°F), the mosquito life cycle slows down too much to spread disease. Closer to the “magic temperature” of ~25°C (77°F), mosquitoes are happier—and diseases spread a little more easily mosquito to human. What’s being done: Public health departments around the country are randomly testing mosquitos by collecting them in traps to give a good view of risk. If there are consistent positives, vector control units will then go to these areas and spray mosquito repellent in mass. Is climate change making mosquito-borne illnesses worse? It depends. Diseases like Dengue are rising with climate change. But West Nile remains fairly stable. For more, check out our deep dive:
How to protect yourself: Risk of disease is low, but that doesn’t make mosquitos any less annoying. While mosquito spraying is safe for humans and pets, it can exacerbate symptoms of asthma or other respiratory conditions. It’s a good idea to try to stay inside during the spraying time. Also, in general, cover up with protective clothing (permethrin-treated is ideal), apply EPA-registered repellents (search tool here), and use screens on windows and doors. Turn on the AC, if you have it. Vaccine Injury Compensation Program at risk. Let’s remember why we have it in the first place.Last week, RFK Jr. announced his plans to “change” the Vaccine Injury Compensation Program (VICP). No medical intervention is without risk, and vaccines—while overwhelmingly safe—can rarely cause serious adverse reactions. If that happens, you can’t sue a pharmaceutical company directly. Instead, you must file a claim through the VICP, which was established by the National Childhood Vaccine Injury Act (NCVIA) of 1986. Since its creation, the program has paid over $5.4 billion in awards, which turns out to be ~1 individual compensated for every 1 million doses. The VICP has long been a target for vaccine skeptics, who argue that pharmaceutical companies should be held more accountable for alleged harms and that the program should compensate claims even when there’s no clear evidence that a vaccine caused the injury. So, what’s the problem? Eliminating this program could backfire. In the 1980s, a wave of lawsuits from parents who believed their children had been harmed by vaccines drove up legal costs and pushed many manufacturers to abandon vaccine production altogether because it didn’t make sense for their bottom line. To ensure vaccines remained available while still providing a path to compensation, Congress created this no-fault system funded by a small excise tax on each vaccine dose. The system isn’t perfect, but it strikes a delicate balance: compensating those who are harmed while ensuring continued access to lifesaving vaccines. Can it be improved? Absolutely. Bipartisan proposals over the years have included:
RFK Jr.’s proposals, however, remain vague, and based on his recent actions in the vaccine world, it’s likely he’s looking to dismantle the system altogether. What does this mean for you? Nothing yet. But if the VICP were eliminated, the future availability of vaccines could be at risk. We’re watching closely. Vaccination rates in the past year have decreased in 20 states.CDC just released kindergarten data from last year. There’s good and bad news. Good news: On a national level, the number of kindergartners vaccinated against diseases, like measles, is still very high: 92.5%. This is slightly lower than last year (92.7%), but I don’t think it warrants the dramatic headlines I’ve seen. Bad news: National vaccination rates don’t tell the whole story as outbreaks tend to occur at the hyperlocal level, where local vaccination coverage determines vulnerability. State-level trends show wide variation in coverage, with 20 states seeing declines in the past year. Idaho, for example—which has the lowest MMR rate in the country—has dropped to 78.5% (from 79.6%). (For context: the herd immunity threshold is 95% for measles and 80% for polio.)
Source: CDC; Annotated by Your Local Epidemiologist Multiple factors drive declining vaccination rates, but one is the rise in non-medical exemptions—parents opting out for religious or philosophical reasons. While still relatively low nationally (4.4%), in some states, these exemptions are increasing at an alarming pace with no signs of that trend slowing down. In Idaho, it’s up to 15.4% of parents opting out.
Share of kindergartners with a nonmedical vaccine exemption. Source: New York Times. What does this mean for you? Expect more outbreaks of vaccine-preventable diseases leading to school disruptions, and heightened concern for immunocompromised individuals and parents of children who are too young to be vaccinated. If you’re up to date on your vaccines, you’re well protected. But with public health infrastructure increasingly under strain, response efforts may be slower and less effective. Training health communicators: need for a new approachIn a not-so-shameless plug: Kristen Panthagani (YLE contributor), Katelyn Jetelina (YLE) and our co-authors Ted Melnick and Megan Ranney’s perspective piece on training the next generation of health communicators was published in the New England Journal of Medicine. The top-down model of health communication is broken—people increasingly turn to informal sources like social media and (ahem) newsletters for their health questions. Yet scientists, doctors, and public health professionals receive little to no training on how to communicate with the masses. We dove into this world at the beginning of the pandemic out of necessity, but largely had to figure it out on our own—with very little support (and zero training) from academic institutions. We need more credible voices in informal spaces and that means we need to train them in how to do it. (Katelyn is teaching a course at Yale in Spring 2025!) But in short, training needs to include:
Read the full piece here, and tune in tomorrow for a chat with lead author Kristen Panthagani on Substack Live. Good news!
TriviaIt’s peak summer, and we are all sweating. I just returned from Houston (who goes to Houston in August?) and it was… hot.
Scroll down for the answer. Bottom lineYou’re all set for this week! Have a healthy, beautiful summer day. Love, YLE Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife. YLE is a public health newsletter that reaches over 375,000 people in more than 132 countries, with one goal: to translate the ever-evolving public health science so that people are well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: |
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JULY 31—NEW! INTRODUCING MARISA DONNELLY –YOUR LOCAL EPIDEMIOLOGIST — A NEW UP CLOSE AND LOCAL REPORT ON NYC– GUN VIOLENCE IN NY, COVID INCREASING, LEGIONAIRE’S DISEASE LURKS
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It’s been a tough week in New York City. In this post, I break down the latest on gun violence, COVID trends across the state, and a new cluster of Legionnaires’ disease. Here’s what you need to know.
A mass shooting in NYC
Tragically, four New Yorkers lost their lives last Monday when a man opened fire in an office building in Midtown, New York City. My heart goes out to the families of those lost, and the NYPD, who lost an officer.
I was only 10 blocks away, getting ready to watch an outdoor movie, when alerts and frantic texts began. I became acutely aware of how crowded the plaza I was in was, heard helicopters overhead, and nervously checked my phone and scanned the crowd. I was fine, but scared the rest of the evening.
When I think about the context of last week’s tragedy, I’m left feeling profoundly confused, and frankly, angry.
In a state with some of the strictest gun laws and lowest firearm mortality rates, in a city with declining gun violence and increasing removal of firearms from the streets, in an office building with security guards and bulletproof saferooms, and with the rapid and heroic response of the NYPD, we still had a mass shooting. Guns were brought across state lines. Multiple people died.
This system is not working.
Gun violence in New York: the bigger picture
In 2023, the most recent year with complete data, the CDC showed that almost 47,000 people died of gun-related injuries in the U.S. In 2022, our state’s most recent data, there were 1,044 gun-related deaths in New York state.
The risk of gun violence depends heavily on which state you live in. Despite the recent NYC tragedy, data show that population-adjusted shootings are actually lower in New York compared to most other states.
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Data from CDC Wonder. Figure by YLE.
But even at ~5 deaths per 100,000 people, the state loses roughly three New Yorkers to gunfire every day—far too many. And, while our rates are low relative to most other states, gun violence in New York state has increased in recent years.
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Data from CDC Wonder. Figure by YLE.
While the New York state data reported to CDC is delayed, early NYC data for 2025 show that gun violence is down this year compared to last.
From January–May 2025, New York City recorded 264 shootings and 112 murders, while the NYPD removed more than 2,265 illegal guns off the streets. At this point, it’s hard to tell what the trend for New York state looks like over the past 2 years, but I’ll be back with updates when data is released.
What New York has done
Many attribute lower gun-related mortality in New York to our strict gun laws—some of the strictest in the country.
- Since 1993, universal background checks have been in place to obtain a firearm in New York.
- “Red flag” laws were instituted starting in 2019, which allow judges to temporarily suspend a person’s access to firearms with credible evidence that they might be dangerous to themselves or others. (Evidence can include information from family members, doctors, teachers, or other community members.)
- Permits are required in New York to carry a handgun, and the state prohibits magazines holding more than 10 rounds of ammunition.
While these policies likely affect firearm death and injury in New York, attributing causation for these lower death rates is complex.
Did CTE play a role in the shooting?
The short answer is that we don’t know. CTE (chronic traumatic encephalopathy) is a brain disease caused by repeated head trauma, seen most often in athletes and military veterans. It’s linked to impulsivity, depression, cognitive impairment, and suicidal thoughts. The gunman in the recent tragedy claimed he had CTE from football. Because CTE can only be diagnosed after death during a brain autopsy, it is notoriously hard to study. We need further scientific research, especially because it’s been connected to other violent incidents.
There are resources available for those with suspected CTE:
- CDC’s Heads Up Program and the Concussion Legacy Foundation HelpLine can provide resources to those at risk of or struggling with brain injury.
Aftermath and action
We talk about gun violence and mass shootings as public health issues because of their impact. Beyond immediate loss of life, they leave lasting and damaging effects on communities. Four years after the 2017 Las Vegas attack, 63 % of surveyed survivors still met the criteria for PTSD and half had major depression. Today, a third of American adults say that fear of mass shootings prevents them from going to certain places or events. In 2025 alone, there have already been 253 mass shootings across the country.
From a public health perspective, I think we need two things:
- Better science. We need clearer data on CTE’s causes, diagnosis, and treatment.
- Policy action. We need coordinated gun laws. As long as we have a patchwork of policies, guns will continue to move across state lines.
I’ll be calling my congressional reps this week to let them know how I feel. Find your local reps’ contact information here.
Also know that there are resources to support those who have experienced gun violence. The Sandy Hook Promise provides guidance and mental health resources for those coping with shootings.
COVID-19 is increasing in New York
Wastewater data is showing that COVID-19 is increasing in New York City and across the state, though on average levels remain low.
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Wastewater concentrations in New York state. Figure from the CDC National Wastewater Surveillance System. Annotations by YLE.
The most recent data show hotspots in Suffolk and Nassau counties, where wastewater activity levels are Very High and High, respectively.
COVID-19 hospitalizations also continue to increase, though they are still at pretty low levels.
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COVID-19 hospitalizations in New York State. Figure from NY Department of Health. Annotations by YLE.
Cluster of Legionnaires’ disease in Central Harlem
- Last week, health officials quickly identified a cluster of Legionnaires’ disease in Central Harlem. So far, 22 people have been diagnosed across five zip codes: 10027, 10030, 10035, 10037, and 10039.
The cluster was identified using a super cool surveillance software that scans NYC’s health data daily. It looks for unusual spikes or patterns and alerts public health officials of any signals. You can think of it like a smoke detector, signaling when something changes so officials can investigate further.
Legionnaires’ disease is a serious lung infection caused by the Legionella bacteria. It spreads when people breathe in mist or small droplets that contain the bacteria, not through person-to-person contact or by drinking water. Common sources include cooling towers (which we have a lot of in NYC), hot tubs, and showers. This is not an issue with any residential building’s plumbing system—it’s safe for you to drink water, bathe, shower, cook, and use your air conditioner.
Most people exposed to Legionella bacteria will not get sick. But some groups are at higher risk for severe illness, especially:
- Adults aged 50 or older
- People who smoke or who have chronic lung disease
- Those with weakened immune systems
- People taking medications that suppress the immune system
Symptoms can look like the flu: fever, cough, muscle aches, or shortness of breath. If you’ve spent time in the affected areas since late July and have any of these symptoms, seek medical care right away. Early treatment can prevent more serious complications.
The next steps for the city are to keep investigating the cluster and try to find the source. They have already started testing cooling water towers for Legionella in the area. If they find a positive hit, they’ll remediate by intensely cleaning it to remove the bacteria.
Bottom line
That’s it for this week. As always, stay safe, stay healthy, and take care of each other. I’ll see you next week.
Love,
Your NY Epi
Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.
JULY 31—-GOVERNOR HOCHUL TO FEMA: SO GO FUND ME
GOVERNOR HOCHUL’S LETTER TO SECRETARY OF HOMELAND SECURITY: RELEASE FEMA INTELLIGENCE FUNDING TO SECURE NEW YORK CITY METRO AREA
As New York City Remains A High-Level Target — Evidenced By Midtown Shooting — Department Of Homeland Security Fails To Release Essential Funding
Critical Resources Enable Increased Intelligence Analysis Capacity, Surge Capacity When New Threats Are Identified and Enhance Intelligence Collection
Governor Kathy Hochul issued a letter to U.S. Department of Homeland Security Secretary Kristi Noem demanding the release of funding for the Urban Area Security Initiative (UASI) through the Homeland Security Grant Program (HSGP) following Monday evening’s mass shooting in Midtown Manhattan.
UASI funding is critical to building intelligence analysis capacity within the NYPD, enabling surge capacity when new threats are identified, and allowing the NYPD to provide federal law enforcement partners with intelligence collection and analysis capacity during large National Special Security events. UASI also supports a wide array of security initiatives conducted by law enforcement and public safety agencies throughout Westchester, Nassau and Suffolk Counties
Eliminating this funding — which totaled more than $156.1 million for New York in 2024 — would make New Yorkers less safe at a time when New York City remains a high-level target for acts of targeted violence. New York City, the Port Authority of New York and New Jersey, City of Yonkers, and Nassau, Suffolk and Westchester Counties all received awards through this funding.
The full text of the letter is below:
Dear Secretary Noem:
As Governor, my top priority is keeping New Yorkers safe. For decades, New York has partnered with the federal government, your agency specifically, to resource homeland security and counter terrorism efforts in New York City and across New York State.
On Monday, it was once again apparent that New York City remains a high-level target for acts of targeted violence. Four New Yorkers lost their lives, including an NYPD officer, in Midtown Manhattan. The assailant responsible traveled from Nevada all the way to our nation’s largest metropolis to commit this heinous act.
Your Department has long recognized that densely populated urban areas constitute a specific and unique target for acts of terrorism and targeted violence, and that there are unique needs and challenges to securing them safely. However, under your watch the Department of Homeland Security has failed to release the funding for the Urban Area Security Initiative (UASI).
We know from public reporting that Acting FEMA Administrator David Richardson sent a memo to the White House that you approved recommending the elimination of UASI. In that memo, the Acting Administrator admitted that eliminating this funding would result in “a less secure nation, especially at the border and in some of the nation’s most targeted cities, including Miami, Washington DC, and Dallas…”. New York City is this nation’s most targeted city when it comes to terrorism threats.
Eliminating this funding — which totaled more than $553 million in 2024, $156.1 million of which went to New York — would make New Yorkers less safe, hamstring the NYPD’s efforts to confront terrorist threats, and reduce intelligence information sharing across local, state and federal law enforcement agencies.
This funding has been critical to building intelligence analysis capacity within the NYPD, enabling surge capacity when new threats are identified, and allowing the NYPD to provide federal law enforcement partners with intelligence collection and analysis capacity during large National Special Security events — all goals that until recently we were confident our federal partners shared with us.
On Monday, the same day as the latest targeted attack, your agency released several homeland security preparedness grants that we had expected to receive in May. However, you failed to also release UASI — the grant specifically designed to protect the nation’s highest urban terrorist targets.
Further delays in the release of UASI will degrade our nation’s ability to protect our urban centers including our ability to keep New Yorkers safe. I urge you to fulfill your duty to protect all Americans and to release UASI funding immediately.
Sincerely,
Governor Kathy Hochul