Covid summer and confusion, measles, cucumber recall, maternal health declining, and a curious MAHA report
The Dose (June 2): This week in health
Happy June! We’re nearly halfway through the year. Phew.
This week’s edition of The Dose is a bit packed—partly because we took last week off, and partly because, well, a lot is happening. We’re covering everything from Covid-19 (variants, summer wave concerns, and vaccine eligibility confusion) to a Salmonella outbreak tied to cucumbers, the MAHA report, and more.
Covid-19: A summer wave brewing amid a ton of confusion
A lot is happening in the Covid-19 world. Here are 4 updates for you:
1. Transmission and a summer wave. Covid-19 levels in the U.S. remain low—but if history is any guide, that may not last. We’ve seen waves every summer, and cases are rising in parts of the Western Pacific, Southeast Asia, and Eastern Mediterranean.
Waves are started by a number of complex factors, including new variants. Last week, the WHO added a new strain, NB.1.8.1, to its variant monitoring watchlist. This variant is another descendant of Omicron. So far, it has a growth advantage of ~65% (compared to Omicron’s 500% advantage), which means it would cause a wave but not a tsunami.
This may be the one that helps jump-start a summer wave. But while this variant has been detected in the U.S., it’s still at low levels. Time will tell.
2. Covid vaccine formula for this fall.*** Last week, the FDA’s vaccine advisory committee (VRBPAC) recommended updating the Covid-19 vaccine strain for this fall to a strain called LP.8.1, which is new, though it cast the recommendation as a preferential one, which leaves room for Novavax to continue to use JN. If this will happen, though, is a big question with recent talks about the need for placebo trials. The WHO had a different recommendation: Use the same vaccine formula as last year.
3. Eligibility for Covid-19 vaccines is a confusing mess from the political ping-pong match. At first, the political appointee to FDA said one thing in an opinion piece on NEJM, then RFK Jr. said another on X, then the CDC overrode (or negotiated, it’s unclear) what the policy should be by publishing the vaccine schedule.
As of now:
65+ are eligible.
Under 65 with certain health conditions are eligible. (Although this is very unclear right now, and largely depends on how FDA changes the licenses.) BUT (and this is important): Recommendations are self-attestation at pharmacies. This means pharmacists are not permitted to ask for proof of underlying conditions.
Everyone else, including kids and pregnant women, may get the vaccine if they and their clinician agree it’s appropriate (called shared clinical decision-making). This was a really important change that the CDC overrode RFK Jr. on. While there is a legitimate debate around annual boosters, there is clear evidence on the importance of a primary vaccine series for kids and for immunity passed to babies from pregnant mothers.
Note: Insurance may not cover your vaccine under this category. Unfortunately, some payers have a long history of not covering shared clinical decision-making, so I would expect variability in coverage.
Later this month, the official meeting of external expert advisors (ACIP) should clarify things when they meet as scheduled. But this isn’t guaranteed; RFK Jr. could cancel or delay their ability to do this at any moment.
Out of all of this, my biggest concern remains: The damage is already done. A wave of confusion due to unilateral political decision-making instead of established evidence-based processes, resulting in whiplash headlines, likely hurts trust, sows immense confusion, and in turn, reduces vaccine uptake.
4. Some good news. FDA approved Moderna’s next-gen Covid-19 vaccine, with three improvements:
Sharper immune response. Instead of the whole spike protein, this vaccine only includes the pieces of the spike protein that change quickly and are the key targets for antibodies (the RBD and NTD). This workaround gets rid of the conserved parts so that the immune system has to pay attention to the parts of spike that change. In clinical trials, the updated vaccine gave better antibody responses and had higher effectiveness than Spikevax, particularly in older adults.
Smaller dose, more supply. The dose needed is much lower (10 vs. 50 micrograms), so we can vaccinate more people with the same amount of vaccine liquid in a vial. Note: The side effect profile for those who react badly to this vaccine (e.g., a fever for a few days) doesn’t change.
Easier storage. It can be stored in standard refrigerators—not ultracold freezers—making it far more accessible in clinics and pharmacies.
It’s unclear when this vaccine will become available because the CDC still needs to approve it.
Quick measles update
As of Friday, there are 1,132 confirmed measles cases in the U.S., compared to 1,856 in Mexico and 2,791 in Canada.
West Texas remains the main hotspot, though growth has slowed. Small but growing outbreaks have also been reported in Montana, North Dakota, and Colorado (all currently under 50 cases). Check with local health departments for exposure info.
Last week, CDC updated its travel warning, cautioning that “travelers can catch measles in many travel settings, including travel hubs such as airports and train stations, public transportation like airplanes and trains, tourist attractions, and large, crowded events.” If you’re fully vaccinated, you’re well protected.
Not-so-cool cucumbers recalled for Salmonella
Cucumbers across 18 states (see above in the map) were recalled due to Salmonella. Though this was listed on the FDA’s website, its usual alerts didn’t go out, which is unhelpful in empowering consumers to eat safe foods.
Bedner Growers Inc. distributed affected cucumbers between April 29 and May 19. Sixteen people were hospitalized, and 45 people have been known to be infected so far.
If you still have cucumbers in your fridge and don’t know their origin, toss them. The recalled cucumbers should now be off the shelves, so new ones are safe to buy.
Women’s health: a mixed bag
Mental health declining: New data show worsening mental health among women—especially mothers.
1 in 12 women now rate their mental health as “fair” or “poor.”
Fewer moms consider their mental health “excellent” compared to before the pandemic.
It’s past time we started better supporting parents. A recent YLE deep dive identified several places we can start.
A step forward in pain management: The American College of Obstetricians and Gynecologists announced its most recent consensus on pain management for in-office IUD procedures. Until now, patients were simply told to “take ibuprofen” for the often excruciating pain of cervical or uterine procedures like IUD insertions. Pain management has also been fraught with racist, misguided, and untrue assumptions that Black women feel less pain.
The new guidelines:
Local anesthetics, such as a paracervical block or lidocaine cream, are recommended as pain management options for IUD insertions and endometrial biopsies.
Clinicians should have upfront, transparent conversations about how pain might occur.
What does it mean to you? If you’re preparing for a procedure, bring these guidelines with you to discuss options with your clinician.
The MAHA report: what it got right—and missed
On May 22, the White House released the first Make America Healthy Again (MAHA) report—describing U.S. children as “the sickest generation in American history.” It focused on four main culprits: ultra-processed foods, environmental toxins, overuse of technology, and overmedicalization. This was a descriptive report. A strategy to tackle this is expected by August.
What the report got right:
Raised urgent concerns about children’s health.
Emphasized prevention through lifestyle: better nutrition, physical activity, sleep, and less screen time.
Called for systemic reform in programs, agriculture, and industry.
Some red flags:
The report lacked transparency—no authorship or methods were disclosed, despite calls for “radical transparency.”
Social determinants of health, like poverty, were not addressed or acknowledged.
Major contributions to the U.S. lagging life expectancy were left out—such as drug overdose, motor vehicle accidents, and firearms (the leading cause of death for children and teens).
Some sources were made up, and mainstream books and anecdotal quotes were used as evidence—unusual references in health publications and not strong indicators of scientific rigor.
Scientific consensus was consistently undermined, casting insidious broad strokes of doubt on vaccines, medicine, food safety, agricultural practices, and research integrity.
Two big unanswered questions:
How are they going to accomplish this? Funding for these initiatives has been slashed or is on the table to be (e.g., cuts to scientific research, food and health agencies, environmental protection, farm-to-school programs, and SNAP).
Will strategies be grounded in science—or ideology? We should know more in August.
If we truly want to support the health of American children, we need to align science, policy, and regulations by investing in health research, nutrition programs, and agriculture.
Bottom line
You’re now caught up. We hope you get outside and enjoy some summer sunshine—and maybe even a little vacation.
Love, the YLE team
***We originally got some of this wrong, so we edited to accurately reflect strain selection for vaccines for this fall.
Your Local Epidemiologist (YLE) is a public health newsletter with one goal: to “translate” the ever-evolving public health science so that people feel well-equipped to make evidence-based decisions. This newsletter is owned and operated by Dr. Katelyn Jetelina— an epidemiologist and mom. This 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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With regard to pain management for in-office IUD procedures, as a family doc I started putting in IUDs in the 1970s when they first were introduced. Any caring, attentive provider would soon observe that this procedure could be very painful, especially in nulliparous women, (if you attended to your patient ~ 30 minutes after insertion) and could somewhat commonly cause a vaso-vagal response with an injurious fall.
Glad to hear that it only took 50 years for the Academy to recognize this problem and recommend treatment.
I have a question (that you may not know the answer to) about self-attestation at the pharmacy. Will the pharmacist report the reason to insurance (I would think so), and will that affect insurance going forward? Will you now have a condition listed in your insurance record?