For public health news this week, I’m covering a measles exposure at Newark Airport and a local pediatric emergency room, the importance of closing doors for fire safety, and peptides being sold at local NYC medspas. With the seasonal change, I’m taking a break from reporting on respiratory viruses, but you’ll know I’ll be back if anything important comes up. Okay, let’s get to it.

Measles exposure at Newark Airport

New Jersey has reported a possible measles exposure at Newark Airport last week. Anyone who visited these locations during these dates and times may have been exposed:

• Newark Liberty International Airport, Terminal B. April 14, 5:30 AM – 9:00 AM. Monitor for symptoms until May 11th.

• Pediatric Emergency Department, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ, 07601. April 17, 11:15 PM through April 18, 3:15 AM. Monitor for symptoms until May 11th.

Potentially exposed people should contact their health care practitioner if they develop measles symptoms, which usually start like a cold and progress to a rash.

So far, no cases have been identified following these two exposure events. If you do develop symptoms, it’s important to call your doctor or clinic before you visit in person so special precautions can be taken to prevent further spread.

What this means for you:

• The best thing to do is to make sure you and your children are vaccinated.

  • Kids under 6 months old. Not yet eligible for MMR vaccine. If mom was vaccinated, then babies under 6 months should have some protection from immunity passed from mother to baby. This immunity wanes within the first 6 months.

  • Kids 6 months to 1 year. Early vaccination can be considered, especially if there’s upcoming travel planned. However, since this is an isolated case in New Jersey and not an outbreak (which is defined as 3 or more cases), health officials aren’t specifically recommending early vaccination.

  • Kids 1 year and older. Follow the standard MMR vaccine schedule, typically administered at 1 year and again between ages 4 and 6.

  • Adults. If you have not been vaccinated or are unsure of your vaccination status, it’s a good idea to discuss getting a shot with your doctor.

I’ve seen a lot of people asking about titer tests to confirm immunity. While titers measure antibodies in the blood, they do not account for T cell and B cell immunity, which also offer protection. The main reason to get titers would be as a matter of insurance coverage for a booster, as some plans won’t cover the cost unless titers to one of the MMR viruses come back negative. We can’t give medical advice but if you’re concerned about whether or not you are still immune, ask your doctor about getting your titers checked or getting a booster.

To dive deeper, YLE National has a great measles FAQ post.

Building fire codes and violations can mean life or death—here’s how to check yours

Tragically, two people died in a five-alarm fire in the Bronx last week. This week, FDNY investigators said that the outcome could have been different if doors weren’t left open during the fire, allowing it to spread and the stairwell to fill up with smoke, where the two victims were found.

This is not the first time NYC has seen this scenario play out. The January 2022 Twin Parks fire in the Bronx—the deadliest NYC fire in decades, which killed 17 people—was also linked to doors that failed to close, allowing smoke to fill the stairwell of a 19-story building.

I probably learned these lessons when I was in elementary school during fire drills, but nothing sticks like seeing the tragic outcomes play out in real time. The lesson is stark, yet simple: a closed door is a fire barrier. It buys time and saves lives.

What to do:

• Heaven forbid there’s a fire in your building, close every door behind you when evacuating—don’t prop building entrances or stairwell doors. And remember: if your apartment door feels hot, do not open it—seal gaps with towels, go to a window firescape, and signal for help if you need it.

• This week, walk your building’s fire escape route so you know it before you need it.

• If self-closing doors in your building are broken, report it to your super or call 311. (You can also look up previous building violations and complaints here.) Self-closing doors on stairwells are a legal requirement. Doing this prompted me to talk to our super about a stairwell door that wasn’t fully closing.

• Now is also a great time to check your smoke detectors and make sure the batteries still have juice.

This is the kind of risk where preparation genuinely changes outcomes.

NYC Medspas are offering clients experimental peptides that have not been FDA-approved

Peptides are getting a ton of attention right now.

I’ve seen them all over my social media, often promoted by wellness influencers for faster recovery, better skin, and reduced inflammation. But it’s no longer just online. They’re showing up in NYC medspas now, too.

A recent Gothamist report found that Apollo House, a medspa in NYC near Union Square, offers a “peptide stack membership” that includes injections of BPC-157, TB-500, and GHK-Cu. These are marketed for healing, recovery, and anti-aging. But they have never been FDA-approved for these uses, and the human evidence for their injection is limited. Several other medspas offer similar packages.

I’m not going to do a full peptide deep dive here, as YLE National just covered that last week. If you want to understand what peptides are and where they stand with FDA, I recommend starting there.

For New Yorkers, there are a couple of issues at play.

New York has already raised concerns about medspas. A recent investigation found unlicensed medical procedures, sanitation violations, expired or unlabeled products, and other safety issues in medspas across the city. (I covered that here.) When you add on this peptide layer, it gets even murkier. Gothamist reported that the New York state department that oversees compounding pharmacies (special pharmacies that custom-make drugs for patients and often market peptides) has not issued guidance on peptides or where the FDA stands on them. This is concerning when these peptides are being used in medspas in ways that aren’t FDA-approved. This means that New Yorkers are being left to sort through the noise on their own, trying to sort fact from fiction about the safety of peptides.

We’re also hearing of people self-sourcing and injecting peptides from overseas wholesalers or online vendors, marketing them for “research purposes, not for human consumption.” This can be even more concerning because it may happen without clinical oversight or a reliable way to determine what is actually in the purchased vial.

I want to be clear that I don’t mean to fearmonger. Not all peptides are dangerous. Insulin and GLP-1 medications like semaglutide (Ozempic) are peptides with clinical trial data and FDA-approvals for specific use cases. The concern is the growing grey market for unapproved injectable peptides, which leaves purity, dosing, clinical oversight, and potential long-term effects to chance.

What this means for you:

• Do not self-inject peptides sourced online or from overseas vendors. There is no way to verify the purity, dosing, or potential for harmful effects.

• If you are curious about peptides, discuss them with your primary care clinician. It’s better to talk to a clinician who knows your history than someone at a wellness spa who doesn’t have that context. And if you’re already using peptides, it’s a good idea to tell your doctor.

• Watch for updates. I’ll be keeping an eye on the FDA advisory committee meeting in July 2026 and sharing anything I learn.

Bottom line

You’re caught up on New York’s public health news. If there are other topics you’d like to see covered here, please drop me a comment. 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.

And congratulations to everyone else who left it all on the course this weekend. The videos of runners helping other runners over the finish line, people giving everything they had, and the volunteers, medics, and coordinators making sure everyone stayed safe and cared for—wow. Man, I love runners.

Okay, back to this week’s New York Dose. I’m covering new data on childhood MMR vaccination, what New York is doing to reduce Black maternal mortality, an environmental win for people fishing the Lower Hudson, and a few spring health updates, including what I’m doing to get ready for warm weather.

NYC childhood MMR coverage is down

New York has long had some of the highest vaccination rates in the country. But even here, cracks in that strong foundation are starting to show. In New York City, new data suggest routine childhood vaccination is being delayed. In March, the city reported that about one in three 2-year-olds had not received all doses of the seven recommended vaccines, prompting officials to launch a new campaign in response.

This is the kind of shift that can seem small on paper, but it’s exactly how vulnerability builds quietly over time.

One of the clearest warning signs is measles, mumps, rubella (MMR) coverage. In 2024, 93% of NYC children ages 24 to 35 months had received at least one MMR dose by their second birthday. In 2025, that dropped to 89%.

That matters, especially right now. As of this month, New York state has confirmed 8 measles cases this year. Nationally, we’ve already seen how quickly measles can spread in communities with lower vaccination rates (YLE national has covered that here). And in 2019, NYC experienced a major outbreak with 649 cases in a largely unvaccinated community in Williamsburg.

Even small percentage-point drops matter. In a city as large as New York, they translate to thousands more children vulnerable to measles if the virus is introduced.

This is one of those issues that can feel abstract until it isn’t. Delayed vaccination leaves young children vulnerable during the exact years when some vaccine-preventable diseases can hit hardest. Measles is extraordinarily contagious, and community protection depends on keeping coverage high.

Black mothers in New York state die from pregnancy-related causes at 4x the rate of white mothers

Black Maternal Health Week (April 11–17) just wrapped up across the state, and unfortunately the numbers underlying it are striking. The week exists in part to address some of the most persistent and devastating disparities in American medicine: Black women are substantially more likely to die from pregnancy than mothers of other races. State data estimates that Black women died of pregnancy-associated causes about four times more often than White women in New York. In NYC, it’s about five times higher.

That gap is shocking, and frankly, unacceptable. But New York is taking steps to reduce Black maternal mortality by putting several policies in place to help.

Here are some programs in New York aimed at reducing maternal deaths:

• Postpartum coverage now lasts a full year. New York Medicaid and Child Health Plus extended postpartum coverage from 60 days to 12 months, helping more families stay connected to care during a period when serious complications can still happen.

• Doula care is covered by Medicaid. New York Medicaid covers doula services during pregnancy and up to 12 months postpartum, including prenatal visits, labor and delivery support, and postpartum care. Eligible New Yorkers can find participating doulas in the Medicaid program here.

• New York became the first state in the country to offer paid prenatal leave. Since January 1, 2025, New York has required private-sector employers to provide pregnant workers with 20 additional hours of paid prenatal leave for pregnancy-related medical care. This is the first law of its kind in the country, and it is separate from other leave options.

The paid prenatal leave policy is especially important. It gives workers paid time off for things like OB visits, testing, monitoring, and other pregnancy-related appointments. And that matters, because barriers to prenatal care are often not about willingness, but can be about whether someone can afford to miss work. It may mean choosing between a clinic visit and food for dinner, a copay and prenatal vitamins, an ultrasound and keeping the air conditioning on. Policies that reduce the financial cost of getting care are one of the clearest ways to reduce barriers to care.

What you can do to access benefits:

• If you’re pregnant or recently postpartum and on Medicaid, confirm that your coverage extends for a full year after pregnancy.

• If you want labor or postpartum support, check whether you’re eligible for a state-covered doula through New York’s Medicaid doula directory.

• And if you work in the private sector, ask your HR department about your paid prenatal leave rights.

For the first time in 50 years, you can eat striped bass you catch from the lower Hudson River

New York State recently updated its fish consumption advice and says you can now eat some fish from the Lower Hudson River for the first time in 50 years. The updated advisory reflects decades of cleanup on the Hudson to lower polychlorinated biphenyls (PCBs—a toxic synthetic chemical) contamination enough to meet health guidelines.

The biggest update is for striped bass: pregnant women and children under 15 can now eat one meal per month, and the general population can eat up to four meals per month from the Lower Hudson. But some fish, including carp and smallmouth bass, are still off-limits because of PCBs, so it’s still important to check the specific guidance before eating what’s caught.

For example, there are new advisories on forever chemicals known as PFOS, which apply to Lake Ontario, Lake Erie, Lake George, Lake Champlain’s Cumberland Bay, Seneca Lake, and others. So, if you fish or your family fishes, check the local updated guidance before eating your catch.

This change is a good reminder that public health wins can be slow, and often unglamorous (no offense to the fish). But the fact that we have cleaner water, better environmental regulation, and long-term monitoring for these chemicals—and can see our progress firsthand—is worth celebrating.

Pollen and tick updates

Some quick notes on spring health.

Tree pollen is ramping up, with some parts of the state now experiencing high levels. For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen makes it worse.

Reducing pollen exposure comes down to a couple key behaviors:

• Avoid pollen outside. Check local pollen counts (like on pollen.com) and limit outdoor activity during early morning and on high-wind, dry days. The best time to go outside is after it rains, which helps clear pollen from the air.

• Avoid pollen inside. Remove shoes before entering your home, wipe down pets, change after being outside, shower especially before bed to rinse off pollen, keep windows and doors closed, and run a HEPA filter.

For a deeper dive, check out my recent post on pollen.

We’re also in the thick of tick season. From now until about October, ticks will be active across New York, including in NYC. If you’re heading to parks, wooded areas, or anywhere with brush and tall grass, use repellent, and do tick checks on yourself, kids, and pets.

Here’s what I’m doing to get ready for warm weather

Last quick segment. I know the weather has been all over the place, from gorgeous 88° afternoons, back to the icy rain we have this week, but I wanted to get a couple things on your radar as we get closer to more warm days.

First, the program that provides FREE air conditioners is now accepting applications across New York state. This is important because extreme heat is NY’s most deadly weather.

To see if you qualify to get a free air conditioner through the Essential Plan Cooling Program, check out the qualifying conditions and application here.

Second, now is a good time to check the expiration date of your sunscreen. The active ingredients that block UV rays in sunscreen degrade over time, reducing effectiveness, increasing sunburn risk, and potentially causing skin irritation or rashes. It’s a good idea to make sure what you have on hand isn’t expired, and replace it if needed.

Bottom line

You’re all caught up on New York public health news. Have a great weekend, and 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.

There’s a ton going on in the world of New York health, so let’s jump right into it.

Pollen is here. Ugh.

Is anyone else starting to notice the little tree buds and green sprouts starting to pop up? And despite the confusing false spring/second winter chaos weather we’ve been experiencing in New York, daily temperatures have been warming. That means we can expect local pollen counts and allergies to increase over the next several weeks, along with those cute little sprouts.

Most U.S. communities see three pollen waves—trees, grass, weeds. NY is currently in the tree pollen season. This is relevant because individual allergy sensitivity can vary by pollen type.

If you feel like allergies have been starting earlier or lasting longer, you aren’t imagining it. Over the past few decades, allergy seasons in New York have gotten worse, partly due to climate change and warming temperatures. Earlier this month, the 80℉ day we had in NYC was record breaking—the earliest 80-degree day we’ve had on record.

The length of the average allergy season has now grown by over three weeks since 1970, with higher pollen counts.

Longer and more intense pollen seasons can exacerbate allergies and respiratory conditions for New Yorkers. While simply annoying for many of us, seasonal allergies can actually be dangerous for many with asthma—every spring, emergency department visits for asthma spike.

For those with asthma or more intense allergies, it’s a good idea to speak with a health care practitioner about controlling symptoms before pollen season really takes off. There are also many actions we can take to reduce pollen exposure and prevent it from entering your home:

• Check local pollen counts.

• Leave shoes at the door and change clothes after outdoor activities.

• Wipe furry animals off after they’ve been outside.

• Shower before bed.

• Keep windows closed during peak pollen times (midday).

• Run air conditioning or HEPA filters.

• Dust and vacuum regularly.

Dr. Zach Rubin, an allergy doctor, joined YLE on the America Dissected podcast last year and gave great tips on managing allergies:

• To relieve sinus symptoms, it can help to rinse your nose with saline water (like with a neti pot), but only using distilled or sterilized water. I’ve found neti pots to really help.

• For medications, second-generation antihistamines like cetirizine (ZyrtecⓇ) tend to have fewer side effects than diphenhydramine (BenadrylⓇ). As always, talk with your doctor or pharmacist for more information on medications.

Alpha-gal, aka meat-allergy, from ticks is increasing in NY

Alpha-gal syndrome, the red meat allergy caused by lone star tick bites, is rising in New York, and Long Island is a hotspot. The CDC estimates that 96,000 to 450,000 people in the U.S. may have been affected since 2010, and cases have been increasing. Suffolk County stands out: CDC data suggest it accounts for about 4% of suspected cases nationwide.

Symptoms can include:

• Hives

• Stomach pain

• Vomiting or diarrhea

• In more severe cases, anaphylaxis, which is life-threatening

Reactions can begin 2–6 hours after eating red meat or other mammal-derived products, which can make it harder to link consuming meat with the reaction.

It used to be that alpha-gal syndrome was mostly found in people who spent a lot of time outdoors or in the woods (like hikers, hunters, farmers, and outdoor workers). But now, many communities are reporting it to be more common, even in people who don’t spend much time in rural outdoor spaces.

So how does a tick bite turn into a meat allergy? After feeding on mammal blood, the lone star tick carries a sugar molecule called alpha-gal in its gut. When it bites a person, trace amounts of that sugar slip into the body through its saliva. Because humans don’t naturally carry alpha-gal, our immune system may treat it as foreign and start making antibodies against it (i.e. have an immune response to the sugar molecule). Later, when that same person eats red meat or other mammal products, the immune system recognizes alpha-gal again—and can trigger an allergic reaction, often several hours after a meal.

What else to know:

• How long does it last? It’s considered a chronic disease, persisting indefinitely. For some, sensitivity fades after 1–5 years without new tick bites.

• Is there a blood test? Yes. A specific blood test can measure IgE antibodies to alpha-gal. It’s the most reliable diagnostic tool available today.

• Why is it hard to track? Cases are not nationally notifiable, so public health officials don’t get complete real-time data.

The best protection against alpha-gal syndrome is the same as with Lyme disease: prevent tick bites in the first place.

Health policy updates

Changes to the Essential Plan and what it means for insurance coverage

But first, where are my Pitt fans at?

Remember how earlier this season there was a construction worker (Orlando) who came in with diabetic ketoacidosis after rationing his insulin because he couldn’t afford it? While the acid built up in his blood was life-threatening, he was terrified of what the hospital bill would be. He worked multiple part-time jobs, none of which provided insurance, and he made just above Medicaid’s income cutoff. He was fully employed, but still couldn’t afford health insurance.

This story hit close to home for New York.

New York’s Essential Plan was built for people in this exact situation: those who don’t get insurance through work but earn just over the limit to qualify for Medicaid. It now covers 1.7 million New Yorkers, up from 380,000 when it launched in 2016.

But the program is now shrinking. After budget cuts from the “Big Beautiful Bill Act” (HR.1), New York asked CMS for permission to switch the current Essential Plan to an older structure. (I wrote about it last month.) CMS just approved that request last week (which to be honest, was a pleasant surprise). This means that income-based eligibility for the Essential Plan will now drop from 250% of the federal poverty level (FPL), to 200% on July 1, 2026. This change preserves Essential Plan coverage for about 1.3 million New Yorkers statewide, but about 500,000 are expected to lose it.

For single adults, this means that the income cutoff falls from ~$40,000/year to ~$32,000/year. For a family of four, that threshold drops from ~$83,000 to ~$66,000. People making just above the new thresholds will now likely be pushed to the marketplace to pay for insurance, where coverage can cost far more ($10,000-$12,000 per year out of pocket) with higher deductibles that many families simply can’t afford.

While this is bad news, it could have been a whole lot worse. If CMS didn’t approve New York’s workaround, the entire Essential Plan could have shut down. This move doesn’t save everyone’s coverage, but it did prevent a total collapse.

Here’s what to do:

• Check your pay stubs: if your income is between $32,000–$40,000 as a single adult or ~$66,000–83,000 for a family of four, watch your mail closely.

• New York has started notifying affected New Yorkers, and coverage changes will begin July 1st.

• Visit NY State of Health to explore your options, or call the helpline at 1-855-355-5777.

Something to watch: New vaccine bills in NY

Governor Hochul and New York lawmakers are moving forward with two bills that would further protect vaccines in New York, as federal vaccine policy has become unstable.

The first bill focuses on insurance coverage for vaccines. It would require state-regulated insurers to fully cover the costs of vaccines recommended by the Advisory Committee on Immunization (ACIP) or recommended by the state’s health commissioner. The goal is to make sure that insurance coverage continues even if federal ACIP recommendations change.

This bill would require private insurers and state-sponsored insurance to cover the cost of these vaccines. So far, it does not make any changes to vaccines covered by Medicaid or the Vaccines for Children program, both of which are still linked only to ACIP recommendations.

The second bill is about broader immunization guidance. It would remove references to ACIP in multiple state laws, like school immunization requirements, the recommended schedule for newborns, and pharmacist vaccine administration rules. Like the first bill, it shifts guidances towards the New York state health commissioner. This could be good, but it could also be risky in the future—politics change, and there’s no guarantee that future commissioners will be as evidence-forward as ours is right now.

The proposed bills build on the executive order Governor Hochul put forward in the fall to preserve vaccine access, and would put those actions into state law. It’s a good step. These bills are also an example of how vaccine access is increasingly becoming a hyperlocal issue. But the bills still need to pass through the state legislature, so they aren’t set in stone yet.

Bottom line

You’re all caught up on New York public health news! Enjoy this weather, and consider stocking up on tissues and bug repellent. :)

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.

There’s a lot going on this week in New York health news, including a city campaign trying to encourage conversations about vaccines, a win for vaccine access at the federal level, and a new program for PFAS testing in private wells. I also quickly cover the mpox clade I case in NYC in the video, and why we don’t need to worry. Let’s jump in.

NYC launched a new vaccine campaign. Here’s what it gets right, and where it misses.

This week, the NYC Health Department launched a new $1 million, four-week vaccine campaign: “Ask Questions, Get Answers, Vaccinate.”

When a friend first shared it with me, I was genuinely stoked. A campaign trying to create a feedback loop between institutions and local communities?! Yes, please! That’s exactly what we need right now—more health departments meeting people where they are, addressing real confusion, and empowering New Yorkers to make evidence-based decisions. Something that closes the distance between officials and the communities they serve.

But after looking into it further, and seeing the price tag, I was honestly pretty bummed.

The campaign will run across TV, radio, print, LinkNYC kiosks, and on transportation hubs, with a focus on neighborhoods with lower vaccination rates. Medical practitioners participating in the Vaccines for Children program will also receive posters and handouts to share with families. The city also launched a webpage that answers common vaccine questions and links to additional resources (which are pretty good FAQs).

The intent was there. And, it’s really important to acknowledge that people have questions about vaccines. That is a good thing.

But if you dig deeper, the campaign falls short in a couple of important areas:

• The cost. A four-week ad campaign is not the same as long-term trust-building, and it’s expensive ($1M!), especially for its length, at a time when public health departments are scraping for pennies.

• Telling people to “talk to your doctor” assumes they have a doctor they trust and can access. One in three Americans don’t have a primary care physician. It also assumes that clinicians themselves feel equipped and empowered to respond to these questions in a short 12 minute visit. What we’re hearing at YLE is that many clinicians need more support in this area.

• This also doesn’t move us toward the affordability that the new health commissioner is prioritizing. Telling someone to see a doctor is, for many people, telling them to take time off work, find childcare, and potentially take on debt.

• There doesn’t appear to be much of a feedback loop. Good communication is not just sharing information; it also means listening and asking for feedback.

• It misses some of the places where many families are actually getting health information now, especially social media.

If I had $1 million to spend, it wouldn’t be on a short-term advertising campaign. What is needed is something far more structural: direct public access to the health department and supporting trusted community messengers with the tools, staff, knowledge, and partnerships to reach families where they’re at, sustainably. I would also like to see greater investment in open communication channels for families to share their questions, concerns, and experiences back to the health department, instead of information flowing only top-down.

This could look like:

• Hosting listening session in neighborhoods with lower vaccination rates.

• Partnerships with community-based organizations, schools, and faith leaders.

• Regular surveys and summaries of questions and concerns from New Yorkers.

• Clinician training and tools for talking about hot-button topics.

• Online and social media monitoring to know what is circulating in real time.

Being trustworthy happens over time, through a set of actions taken over and over and over again. Some of those actions include repeated conversations in communities, schools, clinics, and neighborhood spaces, through relationships.

What this means for you: If you have questions about vaccines, drop them in the comments below, and we will get back to you! And maybe we can send them to the health department as well.

New York is offering free PFAS testing and money to fix contaminated wells.

If you own or rent a home with a private well in Westchester, Suffolk, Dutchess, Putnam, Orange, or Ulster County, this is for you.

New York State launched a new program on March 9 that offers free private well testing for PFAS, often called “forever chemicals.” If contamination is found above the state threshold, the state will also help pay to address it.

PFAS (per- and polyfluoroalkyl substances) are a group of manmade chemicals that persist in the environment and in the body. They’ve been used for decades in products like nonstick cookware, firefighting foam, and food packaging. They’re also linked to some health issues, including kidney and testicular cancer, thyroid disease, immune suppression, and pregnancy complications.

This matters especially for people with private wells because private well water does not get the same routine oversight as public drinking water systems. Private household wells are not regulated under the federal Safe Drinking Water Act, and government agencies usually do not monitor or treat private well water—that’s the responsibility of the owner. Sources of PFAS in well water can come from runoff from manufacturing, landfills, wastewater, contaminated soils, or fertilizers.

Here are the details for the new program:

• Testing is free for eligible households in six counties.

• If PFOA or PFOS (specific types of PFAS) levels are at or above 10 parts per trillion, New York’s drinking water standard, residents may qualify for financial help.

• Eligible households can receive up to $5,000 for a PFAS treatment system, or up to $10,000 to connect to public water.

• Renters are eligible too, not just homeowners.

• Funding is first-come, first-served, with $1.5 million available per county.

Dutchess and Putnam County applications are open now. Orange, Suffolk, Ulster, and Westchester are expected to open in the coming months.

What this means for you: If you live in one of these counties and use a private well, this is a concrete opportunity to check for contamination and get financial help if a problem is found. Apply or learn more here.

A judge blocked RFK Jr.’s ACIP overhaul—what it means for New York.

A judge blocked RFK Jr.’s overhaul of ACIP and the related changes to the childhood vaccine schedule. While this is a win for Americans, it likely doesn’t change much day to day for New Yorkers. That’s because New York had already moved to preserve prior vaccine recommendations, protect access, and require insurance coverage, creating a buffer against much of the federal disruption. (I’ve covered this previously.)

In practical terms, the ruling mostly restores nationally what New York had already protected locally.

The bigger issue here is continued confusion: back-and-forth changes to vaccine guidance are hard for families, clinicians, and schools to follow, even when access is protected. For a deeper dive into the ruling and what it means nationally, read Katelyn’s YLE National piece from Tuesday.

Bottom line

The bottom line this week is that the city’s new campaign to improve communications around vaccines has a lot of room for improvement, the state PFAS well-testing program is a clear example of environmental health in action, and the court decision on ACIP was a win for federal vaccine policy but doesn’t practically affect New Yorkers. You’re all caught up—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.

Spring is basically here, people! This dreamy weather has my winter blues melting away. I walked to the gym in a t-shirt the other day, thinking is this real life?!

This was one of the roughest winters we’ve had in years. We endured NYC’s longest below-freezing streak since 2018 and a major February blizzard that buried Central Park under nearly 20 inches of snow. But these were more than just inconveniences. They caused real harm. At least 29 New Yorkers tragically died from cold-related causes in NYC this year. So yes, I’m grateful to feel the warm air, and to see some easing of the health risks that come with extreme cold, at least for a while.

And while I’m physically and emotionally ready for the spring, my epi brain is already turning to the health topics that warmer temps bring. In the coming weeks, I’ll be covering allergies, how to avoid mosquito and tick bites (and the pathogens they can carry), heat exposure, and environmental health threats like wildfire smoke. And as always, I’m keeping a close eye on infectious diseases circulating around New York.

This week, I’m covering bird flu in New York, food recalls, homelessness, and circulating respiratory viruses and infectious diseases. Let’s get into it!

Dead birds in NY parks could be bird flu-positive. Here’s what to do if you see one.

Bird flu season is not over—and if you’ve been to a park near water lately, you may have walked past it.

Bird flu is widespread in wild birds in New York, with several birds recently testing positive. Infections have also been found in some wild mammals, like raccoons. Human risk remains low, and most U.S. cases have involved close contact with infected birds or cows (no human-to-human transmission has been documented). As more birds fly through New York on their migration back north, it’s good to be aware.

What to do:

• Don’t touch sick or dead birds or mammals, and keep kids and pets away.

• If you spot dead wildlife, report it using the NYSDEC Avian Influenza Reporting Form.

• Backyard chicken owners should review best health practices with the NYS Department of Agriculture and Markets.

• If you must handle a dead bird, use gloves, a mask, eye protection, and triple-bag the carcass.

Food recalls worth checking your kitchen for

A handful of recalls, both national and local, with New York relevance have popped up over the past couple of weeks, so this is a good time for a quick pantry and freezer check. If you have any of the following products with the affected best-by dates, toss them.

1. Frozen meatballs sold at Aldi

Rosina Food Products recalled almost 10,000 pounds of ready-to-eat frozen meatballs sold at Aldi because of possible metal fragments. The affected meatballs include 32-oz. bag packages of frozen “Bremer Family Size Italian Style Meatballs” containing about 64 meatballs per package with a best by date of 10/30/26.

2. Trader Joe’s Chicken Fried Rice

Trader Joe’s Chicken Fried Rice was recalled because of possible glass fragments in the product. The affected packages have best-by dates between 9/08/26–11/17/26.

3. Some oysters and clams distributed in New York due to norovirus

The FDA is advising restaurants, retailers, and consumers not to sell, serve, or eat oysters harvested by Drayton Harbor Oyster Company or Manila clams harvested by Lummi Indian Business Council. Affected clams and oysters have harvest dates from February 13 to March 3, 2026.

4. Rosabella moringa capsules

FDA and CDC are investigating an outbreak of drug-resistant Salmonella linked to Rosabella-brand moringa capsules. In addition to throwing these out or returning them, clean any surfaces that might have come into contact with the capsules to kill any potential Salmonella.

If any of these are in your home, don’t eat them. Toss or return them. And pay attention to any symptoms that develop, like diarrhea, vomiting, and stomach cramps. Listeria, norovirus, and Salmonella can be especially dangerous for those who are pregnant, newborns, older adults, and those with immunocompromising conditions.

Project HOPE and data for homelessness resources

The Homeless Outreach Population Estimate, or HOPE, is NYC’s annual survey to estimate the number of people experiencing unsheltered homelessness. On one night each year, trained volunteers canvass across the city to estimate how many people are sleeping in public places including streets, parks, and subways. This year’s count happened Tuesday night.

The survey offers one of the city’s clearest snapshots of unsheltered homelessness and provides data to inform outreach, shelter, and supportive services. While HOPE is only a one-night estimate and likely doesn’t capture everyone experiencing homelessness, it’s an important tool for understanding broad trends over time.

Last year, HOPE estimated 4,504 people were experiencing unsheltered homelessness on the night of the survey, an increase of 9% compared to 2024.

If you want to help with next year’s count, you can sign up to volunteer for next year’s HOPE survey here.

Infectious disease “weather report”—and why that lingering cold is likely not one single thing

I’ve been hearing from so many friends that they tested negative for Covid and flu but still feel crummy, and that it’s lasting for weeks. Super annoying, I know. Let’s talk about what could be going on.

A lot of respiratory viruses look super similar at first. They bring sore throat, runny nose, cough, fatigue, and maybe even fever—there’s a lot of overlap. And some of these viruses are known to leave people with symptoms that drag on. Here’s what I’m watching in New York:

• Enterovirus and rhinovirus. These are a common cause of colds and those milder respiratory symptoms. These viruses are known to linger, and unfortunately, can be common triggers for asthma flare-ups.

• Adenovirus. This can look like a cold, but can also lead to bronchitis, pneumonia, pink eye, or cause stomach symptoms.

• Human metapneumovirus, or HMPV. This virus tends to circulate a little later in the winter and is actually picking up now. It’s usually milder than the flu or Covid, but can progress to bronchitis or pneumonia, especially in young children, older adults, and those who are immunocompromised. YLE National dug into it earlier this week.

• Parainfluenza viruses. These usually cause mild illness but can be worse in kids and other higher-risk groups (older, immunocompromised, etc.).

• Human coronaviruses (HCoV). These are common seasonal respiratory viruses that usually cause mild illness like colds. They are different from the virus that causes Covid (SARS-CoV-2), but like other respiratory viruses, they can occasionally cause more severe illness in infants, older adults, and immunocompromised people.

What this means for you: That mystery cold you may have is not imaginary—all of these viruses are circulating in the New York area right now. And the practical guidance is the same for other respiratory viruses:

• Stay home if you feel sick, especially if you have a fever.

• Mask if you need to be around others while sick, and especially if you are going to be with those at higher risk for severe illness (infants, older adults, pregnant people, and those who are immunocompromised).

• Wash hands often and try to increase indoor air circulation.

Measles: No new updates on the three cases in Rockland county that were international visitors. The best thing to do still is make sure that you and your family are fully vaccinated for measles.

Free MMR vaccines are available by calling the Rockland County Department of Health at 845-364-2497. Immunizations are given at Spring Valley and Pomona clinics. In addition, MMR vaccines are available at local health care providers or by calling a local federally qualified health center, such as Refuah or Sun River Health Care.

RSV: RSV is finally decreasing in New York. It’s still elevated, so those at risk for severe disease (older adults, infants, and those with immunocompromising conditions) should still take precautions. But I think the worst of the season is behind us.

Flu: Flu is decreasing in New York, and low, signaling it’s close to the end of the season.

Covid: Also decreasing. Overall, Covid remains low compared to previous winters.

Bottom line

You’re all caught up on NY health news! I hope you can get outside during this amazing weather!

Love,

Your NY Epi

P.S. Evidence that spring is here in NY: Mister Softee has woken up from winter hibernation.

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.

A lot is changing in U.S. health policy, and New York is feeling the ripple effects. Changes are showing up in New Yorkers’ appointments, prescriptions, and prevention tools. This week’s Dose covers disruptions to youth gender-affirming care in NYC, a vaccine access package moving through the state legislature, and an update on measles cases in Rockland County.

Gender-affirming care disrupted at NYC’s major hospitals: what the whole community should know

NYU Langone has closed its gender-affirming care program for trans youth, and Mount Sinai has reduced or cut some services, leaving families scrambling for alternatives.

For a lot of families, gender-affirming care isn’t an abstract policy, it’s part of daily life. It’s a standing appointment. A prescription refill that keeps things steady. A clinician who knows their child, their history, what’s worked, what hasn’t.

So when that care changes suddenly, it can be destabilizing, with families describing abrupt changes and referrals to private clinics.

And this isn’t a small slice of NYC. While we don’t have data available on the number of trans youth in NYC, we do have an estimate for adults. Based on NYC survey data, about 0.6% of NYC adults identify as transgender—roughly 50,000 people. If kids make up about 20% of NYC’s population, the back-of-the-envelope math suggests there may be at least 10,000 transgender youth in NYC, too.

Why are there disruptions?

These stories are unfolding because federal funding cuts and regulatory pressure are disrupting gender-affirming care for minors across the country, including in New York. The Trump administration has threatened to pull funding from hospitals and practices associated with hospitals that provide these services. They are also trying to end Medicaid coverage for gender-affirming care, which would mean that even if a family can find non-hospital-based care, they wouldn’t be able to access it if their insurance is through Medicaid.

I also want to call out some of the fear-based language in these federal documents. Phrases like “sex-rejecting procedures” and “chemical and surgical mutilation” are meant to alarm and make people think of non-reversible treatments or “removing body parts.” But that’s not what most families are facing right now. Most of the access being cut off is for puberty blockers—medication which pauses puberty and is reversible (when stopped, puberty resumes). Puberty blockers actually give families, children, and their clinical teams more time to make longer-term decisions. For a more detailed explanation, Those Nerdy Girls has a helpful post on puberty blockers.

It’s also worth putting surgery in context: a 2024 analysis of insurance data found that among minors aged 15–17, gender-affirming surgeries were rare—for every 100,000 minors, there were only ~2.1 surgeries.

The ray of light is that New York is pushing back. The attorney general’s office told NYU Langone to resume care, noting the federal funding threats they cited aren’t currently in effect, and raising concerns the pause could violate state anti-discrimination law. There is also a bill going through NY state legislature that would ensure that Medicaid covers gender affirming care in the absence of federal funding.

What this means: continuity of care is a health issue

For many families, “just go somewhere else” isn’t a real option—it’s waitlists, insurance challenges, travel across the city (or out of state), and clinical disruption piled onto a situation that can be stressful and sensitive. And when care gets interrupted, the ripple effects aren’t just medical, they also affect mental health, school, stability, and trust.

What to do: practical steps for families and caregivers

If your child is currently receiving care:

• Ask for a written transition plan that includes a timeline, prescription guidance, referral list, a record transfer process, and any important points of contact.

• Request copies of records now (visit notes, medication history, labs, etc.) and keep them for your records and for finding new care.

• Ask for prescriptions with plenty of refills if they are at a stable point in their care.

• Read this amazing piece by my friend MK that describes how to help kids feel emotionally safe during these uncertain times.

• Know these resources are available:

  • Trevor Project hotline for LGBTQ+ young people

  • Trevor Project’s Finding Support & Building Community Amid Political Uncertainty guide

  • Trans Lifeline

  • LGBT National Help Center

  • Organizations hosting in-person support spaces, including HMI, The Center, and The Black Trans Liberation Kitchen, among others

• Encourage hope. Here are some success stories you can share:

  • Society for Research on Adolescence: Trans Stories

  • Human Rights Campaign: Trans Stories are Everyone’s Stories: Daniel

  • The Trevor Project: Stories of Pride: Sophia

If you’re searching for care:

• The NYCHealthMap lists clinicians offering gender-affirming care for adults and youth (select LGBTQ Health Services > Gender Affirming Care >Youth).

• Connect with trusted local advocacy groups that often keep updated provider lists. Community Support Resources are listed on this NYC DOH Transgender Health page.

• When you call practices, ask directly: Are you accepting new adolescent/minor patients? What’s the wait? Do you take my insurance? What documentation do you need?

If you’re a clinician or educator:

• This is a moment to tighten safety nets: proactive check-ins, mental health supports, and warm handoffs are important.

• Don’t assume families have a backup plan. Encourage or help them set one up if possible.

At the end of the day, the most important things for kids affected right now are making them feel safe and maintaining access and continuity of care. This means steady and coordinated, not abrupt and fragmented.

Something to watch: a vaccine package going through the NY Senate

In response to the rapidly shifting federal vaccine landscape, New York State Senate Democrats are moving a package of vaccine-access bills through the state legislature this week.

Together, these seven bills would protect insurance coverage for vaccines regardless of changes in federal recommendations, expand who can vaccinate (like pharmacy techs, nursing students, and medical assistants), and ensure clinicians are reimbursed for the full cost of vaccination.

These bills still need to pass through the state assembly and be signed by Governor Hochul to become law, and the package could reach the Assembly as early as next week.

This isn’t about changing the science, it’s about protecting the infrastructure that helps maintain vaccine access in New York—insurance coverage, staffing, reimbursement—when federal guidance is actively damaging those systems.

Infectious disease “weather report”

Measles: Three measles cases were just reported in Rockland County, all international tourists visiting the county. Residents who were exposed to these measles cases have been notified and are being closely monitored.

Rockland County has had large outbreaks of measles previously—last year there were more than 20 cases, and in 2019 there were more than 300. The county has some pockets vulnerable to measles—in some zip codes, fewer than 50% of eligible infants are vaccinated, far below the 95% needed for community protection.

The best thing to do right now is check the vaccination status of everyone in your family, and get up to date if needed. If you’re unsure whether you or your child is immune, talk to your healthcare provider.

RSV: For the tenth week in a row, RSV remains quite high.

Who should pay extra attention right now because of RSV risks:

• Older adults

• People with chronic conditions

• Pregnant people (to protect newborns)

• Families with young infants

What to do:

• Same as last week—if you’re eligible and haven’t gotten protected yet this season, it’s still worth doing because we have weeks ahead of us of elevated activity.

• Layer in protections when you can: avoid visiting newborns or older people when sick, mask in crowded indoor spaces, and keep an eye on breathing symptoms in little kids (fast breathing, retractions—when the skin sucks in around the ribs, collarbone, or stomach with each breath—or dehydration).

Flu: Across New York state and in NYC, flu cases have increased slightly. Flu is still relatively low compared to the season so far, but it’s something to keep an eye on.

Covid: Covid cases are holding steady, while ED visits are going down. Overall, Covid remains low compared to previous winters.

Bottom line

If you or your loved ones are affected by disruptions to gender affirming care, prioritize continuity (records, refills, and a written transition plan) and supporting mental health. For other community members, now’s the time to support the kids and families navigating these disruptions.

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.

If you want to know how a city really functions, watch it in a blizzard. NYC, I’m impressed. This storm came out of nowhere, and the city moved fast—increasing plows, recruiting temporary shovelers, and providing clearer info on warming centers and buses. I’m still watching the aftermath (big storms will have health tolls after), but overall this felt better than the last storm.

And even as the snow melts, I’m covering why snow and ice still matter for health, plus new data on police responding to mental health 911 calls and the latest on infectious diseases.

And if you’re in your 20s or 30s and this newsletter helps you make decisions—at work, for your family, or just for you—I really want your input. We’re running a quick reader survey, and I’m trying to avoid the problem that “only people with extra time respond.” If you’re so busy that you usually skip a survey, I ESPECIALLY want to hear from you. Your voice helps shape what I cover and how I cover it.

Survey Here

The blizzard’s hidden health toll

Not so fun fact: hundreds of people end up in the hospital after shoveling snow each year, and injuries like wrist and ankle fractures spike.

1. Heart attacks can spike after storms (especially from shoveling).
Heavy snow with cold air is a rough combo for your cardiovascular system. Snow shoveling is essentially short-burst, high-intensity exercise, often done by people who haven’t done that kind of exertion in months. Freezing temperatures can constrict blood vessels, increasing blood pressure. Studies have linked heavy snowfall to increased risk of heart attack, with snow shoveling as a key trigger.

What to do:

• If you have heart disease, high blood pressure, chest pain with exertion, or you haven’t exerted yourself in a while: avoid shoveling if you can (ask a neighbor, hire help, or wait for plows).

• If you must shovel: go slow, take frequent breaks, push snow when possible, and lift small loads.

• Know the red flags: chest pressure, shortness of breath, dizziness, nausea, pain radiating to arm/jaw. If any of these show up and persist, stop and seek emergency care.

2. Slips on ice lead to a wave of fractures.
After storms, the most dangerous part is often what you can’t see: ice under snow. When people fall, they instinctively throw out a hand, which is why forearm and wrist fractures jump during icy periods (classic “FOOSH” injuries: fall on outstretched hand). The risk of more serious injuries also increases, including head, spinal, and hip injuries.

What to do:

• Wear traction-focused footwear (or add ice cleats/spikes for errands).

• Walk like a penguin: shorter steps, feet slightly outward, hands out of pockets for balance.

• Assume shaded sidewalks, corners, and curbs are icy even if they look “just wet.”

• Use salt/sand if you can, and give yourself permission to delay non-urgent trips until ice is cleared.

Storms create a second wave of harm including overexertion and falls. But slowing down, adding traction, and treating shoveling like the workout it is can reduce risk.

Mental health crises and 911: Police still respond most of the time, even in B-HEARD areas

On January 26, 2026, 22-year-old Jabez Chakraborty was in a mental health crisis in Queens. His family did what we tell people to do: they asked for help. They asked for clinicians. They asked for medical support and an ambulance. Instead, NYPD was dispatched. And during that response, Chakraborty was shot by police.

This isn’t just one story. When you call 911 for a mental health crisis in NYC, even in neighborhoods with the B-HEARD program (which aims to respond to 911 mental health calls with trained medical and mental health teams), police still show up 86% of the time instead. And that trend has been going up year over year.

I don’t read this as a failure of B-HEARD, but an example of how B-HEARD is constrained by upstream functions of 911.

Between 2022 and 2024, there were more than 96,000 mental health-related 911 calls. A city comptroller audit last year found that about 40% were eligible for B-HEARD (I covered it here). Of the calls that were ineligible, some were excluded because of safety concerns, and others because there weren’t enough EMS resources available to help screen for medical needs. Even among calls that were eligible, 35% never received a B-HEARD response for reasons that aren’t clear. Add in the fact that B-HEARD only operates in about 40% of NYC, and you can see how narrow the funnel is.

These are what I see as the system-level constraints:

1. 911 operators have to make high-stakes decisions with limited information.
These calls are often chaotic and time-pressured. Dispatchers rarely have access to someone’s mental health history, and they’re being asked to rapidly assess safety, medical need, and violence risk. These are all genuinely hard to predict over the phone.

2. EMS can’t always arrive as quickly as police.
In NYC, EMS response times have been getting slower, averaging about 11 minutes in 2025. That’s driven largely by staffing shortages, and traffic to a smaller degree. When the system is strained, “who can arrive fastest” becomes the default safety plan, even if it’s not the best medical plan.

3. B-HEARD eligibility criteria screen out a lot of calls, and the screening process itself is fragile.
911 dispatchers can route a call to B-HEARD only if it’s clearly nonviolent and there’s no imminent risk. But when that’s not clear, NYPD gets sent. On top of that, if a 911 dispatcher needs a second opinion, EMS is not always available to help screen, increasing the likelihood that the call gets the default NYPD response.

What would actually improve B-HEARD expansion and access

Expanding B-HEARD was one of the actions Mayor Mamdani campaigned on. But if 911 mental health calls continue to be triaged through NYPD protocols, then even if B-HEARD expands to more neighborhoods, it may not change the mechanism that keeps routing police to the scene instead of health professionals.

I think that greater impact will come from changing the front end in two key areas:

1. Better decision support for 911 dispatchers. Can we get to a point that for mental health related calls, sending the police is the exception, not the default (e.g. only if there is a weapon, active violence, or a credible threat)? Are there risk assessment tools that could be implemented, or could we have more clinical backup to help evaluate more ambiguous calls?

2. Faster clinical response times and greater capacity. We need to increase EMS staff to improve response times.

If NYC expands B-HEARD precinct-by-precinct without changing the routing logic, we should expect to see the same results: police will continue to respond to most calls.

What to do: know your options before a crisis

• When there isn’t a threat to others, NYC’s 988 Suicide & Crisis Lifeline connects you to trained counselors and can dispatch mobile crisis teams without going through 911. Call or text 988.

• If you are in crisis and need to call 911, absolutely call, and try to be as specific as possible about what you’re seeing and what you’re requesting, to increase the chance of the most appropriate routing.

• If you have a family member with mental illness, work with their treatment team to create a psychiatric advance directive or crisis plan that specifies preferred interventions (what helps, what escalates, medications, de-escalation strategies).

This isn’t about what type of responder is “good” or “bad.” The most important thing is designing a system where the tools to triage and send help actually match the need. For many mental health crises, that need is medical emergency response, not law enforcement.

Infectious disease weather report

RSV: RSV is the main story right now. This is the ninth week in a row that hospitalizations have held steady at a high level.

Who should pay extra attention right now because of RSV risks:

• Older adults

• People with chronic conditions

• Pregnant people (to protect newborns)

• Families with young infants

What to do:

• If you’re eligible and haven’t gotten protected yet this season, it’s still worth doing because we have weeks ahead of us of elevated activity.

• Layer in protections when you can: avoid visiting newborns or older people when sick, mask in crowded indoor spaces, and keep an eye on breathing symptoms in little kids (fast breathing, retractions—when the skin sucks in around the ribs, collarbone, or stomach with each breath—or dehydration).

Flu: Across New York state, including NYC, flu cases increased slightly, but for the most part, activity has dropped down to lower levels.

Covid: Covid cases slightly increased, while ED visits and hospitalizations didn’t change. Overall, Covid remains low compared to previous winters.

Bottom line

Stay warm and 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.

The cuts keep coming: New York health insurance coverage

For 1.7 million New Yorkers, the Essential Plan is the safety net that makes health coverage possible when Medicaid, Medicare, or employer insurance isn’t an option. But new federal policy changes could make that coverage harder to keep.

The “Big Beautiful Bill” includes a major provision that restricts how federal dollars can be used to cover non-citizens. This change is expected to reduce federal funding for New York’s Essential Plan by about $7.5 billion each year.

The rollout has already begun and will continue in a phased approach. Starting in October 2026, federal Medicaid matching funds will no longer cover many legally present non-citizens, including green card holders in the U.S. less than 5 years, refugees, asylees, and trafficking victims (with limited state options remaining for lawfully residing children and pregnant people in states with those options).

This comes just weeks after another hit: the loss of enhanced ACA subsidies—extra financial help that lowered monthly marketplace premiums for many middle- and low-income enrollees. This loss made marketplace coverage more expensive for about 140,000 New Yorkers. (See more about that here in a previous YLE post in January.)

What is the Essential Plan?

To understand what’s at stake, it helps to understand the several ways New Yorkers are covered by health insurance:

1. Employers: they cover about half of New Yorkers.

2. Medicare/Medicaid: funded by both the state and federal government.

3. Health coverage from the marketplace: paid out of pocket and/or subsidized by the federal government.

4. Essential Plan: a New York-specific program that is funded through the federal government.

The Essential Plan (#4 above) is important because it’s designed to fill a gap for people who earn too much for Medicaid but not enough to afford marketplace plans (and who don’t have employer-based coverage). It also includes many lawfully present non-citizen immigrants (about 750,000 in New York), such as permanent residents with green cards and DACA recipients, who may face eligibility barriers in other programs. The $7.5 billion cut puts all of the Essential Plan coverage at risk.

Is there a workaround? Maybe!

To lessen the blow and keep as many people insured as possible, the governor’s office seems to be trying by moving people around in a pretty creative way.

Some of those in the Essential Plan qualify for Medicaid, so the state will cover them (which will cost $3 billion).

But that doesn’t cover everyone.

For those who can’t move to Medicaid, because of income limits or immigration status, the governor is proposing to shift the Essential Plan back to an older funding model, one that isn’t bound by the new federal immigration restrictions. The trade-off? The old model only allows eligibility up to 200% of the federal poverty level (FPL).

The governor’s Essential Plan change proposal (note: it hasn’t passed yet) tightens eligibility. As a result, ~460,000 New Yorkers would lose insurance coverage.

This is a balancing act—one that aims to preserve health care coverage for the greatest number of New Yorkers, despite federal cuts. The move would maintain coverage for about 1.3 million New Yorkers, but leave 460,000 without the Essential Plan.

Here is the problem: The governor’s Essential Plan change proposal requires approval from the federal government (Centers for Medicare & Medicaid Services to be exact). If CMS says no (which I think is likely—I don’t think the same administration that cut funding in the first place would approve a workaround), the entire Essential Plan may be cut. If that’s the case, it would likely result in 1.7 million New Yorkers without coverage.

What you can do

• Get help with applying for insurance coverage if you need it: https://communityhealthadvocates.org/

• Check in on neighbors who may be on Medicaid or need help with renewal forms. The New York State Medicaid Help Line is (800) 541-2831.

• Call your senators and congressional representatives to advocate for the issues that matter to you. (Find their contact information here.) Some apps provide representative info as well as scripts for specific topics.

FYI—Free HIV tests available to New Yorkers

New York State just launched a free HIV self-test giveaway campaign with nearly 2,000 kits available statewide.

• If you live in New York outside NYC, you can take the eligibility survey to see if you can get a free at-home kit mailed to you.

• If you live in NYC, request a free kit through an agency listed on the NYC Health Map and (click “HIV Testing”).

Free testing helps people get care earlier and prevents transmission:

• Antiretroviral therapy treatment (ART) can make HIV undetectable—meaning it can’t be passed through sex (undetectable = untransmittable).

• Pre-exposure prophylaxis (PrEP), medication that can be taken before sex, injection drug use, or other potential HIV exposures, can prevent HIV.

• Post-exposure prophylaxis (PEP) can reduce risk if started within 72 hours of potential exposure. (Visit the New York State PrEP website for more info.)

These treatments and medications are truly remarkable for HIV prevention and treatment, but early testing, diagnosis, and access to care are essential.

Good news: An eye fungus outbreak stopped in its tracks

This week, disease detectives at the NYC Department of Health published an investigation that underscores the critical importance of infection prevention in health care settings. In December 2024, three people developed serious fungal eye infections after elective laser eye surgery at a single NYC ophthalmology clinic. All three had vision loss, and one required a corneal transplant.

The clinic reported the trend after noticing that three of 11 patients (27%) who underwent surgery over a two-week period developed eye infections. After testing, Purpureocillium lilacinum, an environmental mold that rarely infects healthy people but can be dangerous to the eyes, was found to be the culprit.

After an investigation, there were many things that went wrong at this clinic:

• Incomplete sterilization logs.

• No EPA-registered disinfectants for work surfaces.

• Expired eye medications.

• Notably, cool-mist humidifiers in the procedure room. (CDC specifically warns against cool-mist humidifiers in health care settings because they can aerosolize mold spores.)

A single definitive “smoking gun” source wasn’t confirmed, but fungal DNA was detected in the tubing of one surgical device.

The good news was that after the clinic paused surgeries, fixed infection control problems, and resumed operations in January 2025, no new cases occurred. This is a solid example of how fast action and cooperation can stop an outbreak.

What this means for you: If you’re considering LASIK or similar procedures, ask your clinic about infection prevention practices: how they sterilize instruments, whether they use EPA-registered disinfectants, whether they check medication expiration dates, and if cool-mist humidifiers are used near procedure rooms. If you’ve had recent eye surgery and develop pain, vision changes, or discharge, seek care immediately—eye infections require fast treatment to prevent permanent damage or vision loss.

Infectious disease “weather report”

Measles: NYC reported the first measles case of the year—an unvaccinated infant with a history of international travel. Contact tracing by the health department is underway, and people who may have been exposed are being notified.

Measles is of increasing concern in the U.S., including in New York. (See YLE National’s updates.) Last year there were 48 cases in New York, including 20 in NYC.

The most important thing to do is check the MMR status for everyone in your household, and get vaccinated if eligible and not fully vaccinated, especially if you will be traveling internationally or to any U.S. region with a measles outbreak. Two doses are about 97% effective at preventing measles.

Flu: Cases increased slightly in NYC, but ED visits and hospitalizations continue to fall. With severe indicators continuing to decline, this small increase in cases isn’t a big concern.

RSV: RSV cases went up while ED visits slightly decreased, a sign that activity is still elevated but that severe infections are going down. If you’re an older adult or have small children, it’s still worth continuing to take precautions like masking in indoor crowded spaces.

Covid: ED visits and hospitalizations for Covid slightly increased, but overall remain low compared to previous winters.

Bottom line

Health coverage for up to 1.7 million New Yorkers is on the line, and the state’s workaround would still leave hundreds of thousands uninsured. If you or someone you know is affected, now is the time to plan: get enrollment help, watch for renewal paperwork, and talk to your representatives about your concerns.

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.

I know this isn’t public health, but it’s deeply New York. NYC is home to the second-largest Puerto Rican population outside the Island. Puerto Ricans helped build this city—and continue to keep it thriving.

When I was training for the marathon last summer, local run clubs would line routes with speakers and support. More than half of them were blasting, and I mean blasting, Bad Bunny. Every time I hear NUEVAYoL, I’m transported to summer parties, sidewalk drinks, humidity and fireflies, and the heartbeat of the city.

So, I hope you enjoyed the Benito Bowl as much as I did. 🙂

Okay, back to health news. Today I have an update on the Legionnaires’ investigation in Harlem, harms of the cold snap, a look at why NYC and New York state joined a global early warning system for disease threats, and an infectious disease weather report.

Legionella found in Harlem building’s water system

Legionella in one of NYC’s largest residential buildings (333 Broadway) is making thousands of New Yorkers forgo one of the basic hallmarks of modern infrastructure: safe hot water in their homes. And the city has provided little support to address the challenges.

This follows two confirmed cases of Legionnaires’ disease in the past year, triggering the investigation and testing. The building is now undergoing remediation, but that process could take months. These cases are not linked to the 2025 Harlem outbreak, which involved cooling towers. (We covered that here.)

The risk is real. Legionnaires’ disease kills about 10% of people who get it, and NYC sees 200-700 cases annually. The risk comes from inhaling mist containing the bacteria—that’s why showers are the problem, not drinking water. The good news is that it’s easily treated with antibiotics if caught early.

The city is asking residents to take precautions against exposure, mainly recommending that they avoid creating water mist by:

• Filling baths slowly at any temperature instead of showering. (It has been clarified by the health department that baths can be filled with warm water as long as they are filled slowly). If you don’t have a bathtub, use a shower hose with the head removed or buckets.

• Letting faucets flow slowly when washing hands.

• Drinking cold tap water, which is safe. But, when heating water for cooking, start with cold water.

• Watching for symptoms (cough, fever, muscle aches, shortness of breath) and seeking care immediately. It presents like pneumonia and is treatable with antibiotics.

The city requires the building to test, remediate, and then retest, but most of the burden to reduce exposure right now falls on residents. While the city did pass a law after the 2025 outbreak requiring cooling towers to be inspected every 60 days instead of 90 (going into affect in May), because the bacteria is in the residential plumbing system, not a cooling tower, that law doesn’t actually apply here.

This situation is incredibly frustrating. Thousands of people can’t safely take a shower in their own homes, in the middle of one of the coldest winters in decades. Filling up a tub slowly is not a practical solution for families, older adults, or people with disabilities. How slow is “slow enough”? What about the anxiety of doing it wrong and risking exposure?

The mental and physical toll of managing risk in one’s own home is real. Are there really no better options? No partnerships with local gyms for safe showers? No temporary shower trailers?

When this many people are affected, the burden shouldn’t fall on residents to find workarounds. We need stronger accountability for large residential buildings—and stronger public health infrastructure to support residents.

NYC and New York state have secured early warning capacity for disease outbreaks by joining WHO disease network

New York City became the first U.S. city to join the World Health Organization’s Global Outbreak Alert and Response Network (GOARN) on Thursday and New York state joined shortly after—a direct response to the U.S. withdrawal from WHO last month.

GOARN is the global early warning system for disease threats. When outbreaks emerge, the network rapidly shares information—think urgent alerts, lab data, and technical guidance—and deploys epidemiologists and scientists to investigate and respond.

In other words, New York’s decision to join is saying: we aren’t waiting for the federal government. We’re going to step up and build our own public health firewall against international outbreaks.

Here’s what you need to know:

• NYC and New York state join more than 360 public health institutions worldwide in GOARN.

• This means faster access to outbreak alerts and coordination.

• The timing matters: The FIFA World Cup final is being hosted by MetLife Stadium in July, and is expected to bring more than 1 million visitors to the greater New York area.

• California and Illinois also joined at the state level.

• Even with NYC and some states joining the WHO, the U.S. leaving has still caused lasting damage to international outbreak response. The U.S. was WHO’s largest donor—we donated $1.2 billion in 2022—before the January withdrawal.

What this means for you: New York just helped secure some early warning capacity that the federal government walked away from. With three major international airports, millions of annual visitors, and a major event being hosted this summer, any early warning is critical for preparing our city to respond. Infectious diseases don’t care about borders or politics.

22 people in NYC have died due to the cold snap

As of Monday morning, 18 people have died outdoors during this week’s extreme cold in New York City and four died indoors due to hypothermia, showing just how dangerous freezing temperatures are for the city’s most at-risk residents.

While 1,400 people were placed in shelters and warming centers, 22 deaths are a tremendous amount. For context, NYC typically sees 10-20 cold-related deaths in the entire winter season. Reaching 22 during a single cold spell signals a serious public health emergency.

With more than 550 outreach workers deployed and the extra warming shelters and heated buses stationed around the city, I’m left wondering how this could happen.

I’ve learned that there are many reasons someone may not go to a shelter, even in the freezing cold. Reasons include:

• Safety concerns: Many individuals report feeling unsafe in shelters due to past experiences of violence, theft, or harassment. While women, LGBTQ+ individuals, and people with disabilities are especially vulnerable, men also report violence against them in shelters. Security may be a challenge for some shelters due to under-resourcing and understaffing.

• Mental health conditions: Some people experiencing homelessness live with untreated psychiatric disorders, including schizophrenia or severe depression, which may cause distrust, fear, or confusion around outreach or institutional settings. For some, it may be scarier to go to a shelter than try to weather the storm.

• Substance use: Fear of being denied entry due to intoxication or drug use can keep people away.

• Shelter rules and restrictions: Many facilities prohibit pets, separate couples, or enforce curfews. These can be dealbreakers for people who can’t separate from pets or loved ones. Though shelters in New York pause these rules during weather emergencies, it may not be common knowledge.

This isn’t to place blame, but to help explain the realities of why “just go to a shelter” doesn’t always work—or reflect the complexity of the crisis.

Some things to keep in mind:

• If you see someone outside who appears to be in distress or suffering from the cold, call 311 immediately or 911 if it’s an emergency. Don’t assume that someone has already called.

• Know that warming centers aren’t just for people who are unhoused. They can be literal lifesavers if the heat is out in your home.

• Neighbors who are elderly or who have health conditions are at increased risk during cold snaps. Check in on them, especially during power outages.

Infectious disease “weather report”

RSV: Although RSV cases declined slightly last week, ER visits in NYC and hospitalizations across the state went up. If you’re an older adult or have small children, it’s worth continuing to take precautions like masking in indoor crowded spaces.

Flu: Flu cases and hospitalizations are steadily declining in NYC and the state at large. But sadly, NYC just reported the first pediatric deaths of the season—four kids died of flu recently. As of the end of January, nine kids have died of flu statewide. This is a stark reminder of how dangerous flu infections can be. My heart goes out to the families of these kids.

Covid: Covid decreased in NYC and statewide. Overall, Covid remains low.

Bottom line

New Yorkers are navigating real challenges—from Legionella concerns in Harlem to deadly cold—but our city is also stepping up where it can. Joining a global outbreak alert system will help protect us from future outbreaks, especially with big upcoming events like the World Cup. I’m looking forward to seeing how the city continues to respond to these challenges.

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.

This is a packed week for New York health news. From an urgent call for blood donations and Legionnaires’ disease cases in Harlem, to a Code Blue warning for freezing temperatures and the ongoing virus season. Here’s your New York Dose.

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New York is facing a blood supply shortage—your donation matters

The American Red Cross and regional partners, including the New York Blood Center, are raising the flag that the local blood supply is critically low, with donations down to nearly 40% below hospital demand in parts of the state. Types O (the universal donor type), A‑, and B‑ are especially needed.

Why this matters

Hospital care—including emergency trauma response, childbirth, surgeries, cancer treatment, and chronic disease management like for sickle cell anemia—depends on a steady blood supply. National data show someone in the U.S. needs blood every two seconds, and nearly 29,000 pints are required daily. If hospitals don’t have enough blood on hand, clinicians may need to make hard decisions about who gets blood transfusions and who has to wait.

The challenge with having enough blood on hand is that it’s perishable—red blood cells last 42 days and platelets only five days. Winter holidays, bad weather, and a more severe flu season this year are resulting in fewer blood donations and cancelled blood drives. Even without these seasonal challenges, only about 3% of age‑eligible Americans donate blood each year.

How can we improve this system?

Addressing blood shortages requires innovation as well as better infrastructure. Strategies being explored to be less reliant on the limited donor supply include:

• Blood substitutes designed to temporarily carry oxygen when donated blood isn’t available. But these substitutes can’t replace blood entirely—they don’t clot, lack immune functions, and aren’t widely available.

• Lab-grown red blood cells show promise, especially for rare blood types. They are in the early stages of trials, but scaling the technology and science to meet hospital demand will be a big challenge.

• Advances in medical procedures that require less blood, and better inventory systems that reduce waste and expiration, will reduce the amount of blood needed.

Despite innovations and improvements, community blood donations remain the backbone of the blood supply and are essential to hospitals.

What you can do now

• Schedule a donation appointment through the Red Cross, New York Blood Center, or other local blood centers.

• Encourage family and friends to donate—one donation can help up to three people.

• Regular, year‑round donations help prevent seasonal shortages.

You can make a huge difference—donating blood literally saves lives.

Legionnaires’ disease under investigation in Harlem residential complex

City health officials are investigating two cases of Legionnaires’ disease at 3333 Broadway in Harlem, one of NYC’s largest residential buildings, home to about 10,000 people. Both cases occurred in the past year and were not fatal. Clusters like this raise concerns about water system exposure—especially following last summer’s Harlem outbreak that sickened more than 100 and killed seven (which I covered here).

While tests are being run, the building’s management and public health agencies have advised residents who are at higher risk for Legionnaires’ disease—those who are 50 and older, people with compromised immune systems or chronic diseases like diabetes or asthma, or who smoke—to do the following:

• Use cold water for drinking and bathing.

• Take baths or sponge baths instead of showers to avoid breathing in mist.

• Boil water if hot water is needed.

If you live or work in the affected building and develop flu-like symptoms, contact a healthcare provider and mention this exposure. Early antibiotic treatment greatly improves outcomes.

What this means and why it matters

Even with only two cases, this situation raises several big issues:

1. It’s not surprising the residents are scared and upset. Seven community members were lost in last year’s Harlem outbreak. Asking residents to take cold baths and avoid showers during a January cold snap is not realistic, especially in a building where many are older or have chronic illnesses. The communication and assistance for affected residents are lacking.

2. This is a health equity issue. Harlem has some of the highest rates of asthma, diabetes, and poverty in NYC, all of which increase Legionnaires’ risk. Communities here deserve rapid, culturally responsive public health action, not lagging testing and unattainable guidance. The city should prioritize better and faster Legionella inspections in Harlem and the surrounding areas, in particular.

3. There are policy gaps. While NYC requires regular Legionella testing for cooling towers, there is no law requiring routine testing of building plumbing systems (e.g., hot-water plumbing and domestic taps), even in large residential buildings like this one. Building water systems can be a source of Legionella, and in NYC, buildings aren’t tested for the bacteria until after two cases occur in the same building within a year. It’s important to note, though, that most big outbreaks in NYC have been linked to cooling towers.

A bill in NYC Council (Intro. 434) would require large residential buildings to implement Legionella testing and water management plans for domestic water systems, but it has stalled in City Council. I’ll be paying attention to see if it picks up momentum again—I think that increased testing of large residential buildings has the potential to reduce the risk of these Legionnaires’ clusters.

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Cold temps this weekend and a Code Blue

A strong cold snap is on the forecast this weekend, bringing “feels like” temperatures close to 0°F across New York and in NYC this weekend. Extreme cold can cause real health risks—from hypothermia and frostbite to worsening of chronic heart and lung disease, especially among older adults and people experiencing homelessness.

Tips to stay safe

• Keep children and pets inside when temperatures drop.

• Check in on older neighbors and people with chronic health conditions.

• If you use a space heater, make sure to follow the manufacturer’s guidance to avoid fire hazards.

Code Blue

A Code Blue Weather Emergency notice is issued in NYC when the temperature drops below freezing (32°F or less) between 4 p.m. and 8 a.m.—which will be the case this weekend. No one will be denied shelter in NYC during a Code Blue. Should you see a vulnerable person out in the cold, call 311, and an outreach team will be dispatched to offer assistance.

The ripple effects of ICE in communities

It’s heart-wrenching to watch communities live in fear—families unsure if they’ll be able to safely pick up their kids from school, loved ones waiting anxiously for family members to come home.

Immigration and Customs Enforcement (ICE) raids and activity have increased across the U.S., including here in New York. A new ICE processing and detention facility is slated to open just 50 miles north of NYC, a large facility opened last year in Newark, and ICE continues to hold contracts with several upstate county jails.

I wrote about the ripple effects of ICE enforcement on communities’ health and wellbeing last year, and it’s just as relevant today. The impacts go far beyond immigration policy. They reach deep into the health, safety, and stability of families and neighborhoods. But there are ways we can support each other—neighbors, educators, and clinicians play a huge role in mitigating harmful health effects. I cover ways we can support families and communities carrying the burden in the piece here.

Infectious disease weather report

Flu: The good news is that flu has decreased for the past couple of weeks in New York. The bad news is that this has still been a really bad flu year. In the first week of January, we saw the highest number of flu hospitalizations in a single week ever recorded in New York. In New Jersey, a young child tragically died of a flu infection last week.

I’ve been hearing a lot of chatter about the flu vaccine this year and questions about whether it was a good match. Although the circulating flu strain (subclade K) emerged after the vaccine formula was selected, effectiveness data from Europe in the fall showed that the vaccine still offered meaningful protection against hospitalization even with the circulation of subclade k, with estimates of 70–75% effectiveness in children and 30–40% in adults.

RSV: RSV cases in New York are holding steady, but the good news is that emergency department visits are declining, which means less pressure on clinics and hospitals. This has been a milder RSV season in New York.

Covid: Covid slightly increased in New York the past week, but overall the burden remains low. In NYC, only a very small percentage of hospitalizations are due to Covid—it isn’t a major driver of severe illness right now.

No change to child vaccine schedule in New York

In case you missed it, the Northeast Public Health Collaborative announced that it is continuing to recommend the American Academy of Pediatrics’ (AAP) Recommended Child and Adolescent Immunization Schedule, despite changes to the federal vaccine schedule (Katelyn covered those changes here).

We also put together one-pagers in English and in Spanish to use and distribute:

Vaccination Schedule Change YLE

66.8KB ∙ PDF file

Download

Download

Vaccination Schedule Change YLE Spanish

68.3KB ∙ PDF file

Download

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Bottom line

You’re all caught up on NY health news. Stay warm, and 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.

There’s a lot happening in New York health right now—from universal childcare plans and the NYC nurses’ strike to rising healthcare premiums and continued flu. Let’s jump right in.

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Gov. Hochul and Mayor Mamdani announce a plan for universal childcare in New York

Last week, Mayor Mamdani and Gov. Hochul announced a joint plan to bring truly universal childcare to New York City and extend it across the state.

Why this matters

Access to high quality childcare has been shown to benefit children’s and parents’ health and wellbeing:

• High quality early care and education programs are associated with positive developmental outcomes for children, including early learning, cognitive and language development, stronger school readiness, and emotional skills.

• Childcare has been associated with improved maternal mental health, including protection against symptoms of depression, by reducing stress and caregiving burden on parents.

• Expanded access has also been shown to increase maternal employment and economic stability—important components of health equity. One assessment found that mothers’ labor force participation in NYC increased by 7.5% after universal pre-K for four-year-olds was implemented.

It’s important to note that the quality of the care is what’s most important, not necessarily where the care takes place. High quality care and education can take place at childcare centers or inside the home, and with community-based caretakers or family members.

What’s the plan?

The joint plan to expand childcare in NYC and the rest of the state is mostly driven by funding additional childcare facilities and increasing staffing levels.

In NYC, the additional funding would help make 3k (childcare for 3-year-olds) access truly universal. Right now, many families qualify for 3k but don’t have spots available in their neighborhoods, requiring them to commute unfeasible distances or find/pay for other childcare. The funding would increase facilities and staffing in NYC.

The proposal would also launch a new “2-Care” program in the city, providing free childcare for 2,000 2-year-olds in high-need areas beginning this year. The program would then be expanded citywide over four years, with the state fully funding it for the first two.

The state’s goals are to expand childcare to all 4-year olds (also called pre-k) statewide by fall 2028, and help counties build pilot programs to offer affordable childcare. Hochul said the broader statewide plan would increase affordable childcare to nearly 100,000 additional children through a mix of universal pre-K expansion, new community-based care programs, and broader eligibility for childcare subsidies.

The plan also includes:

• Increasing state funding for pre-k seats to at least $10,000 per child

• Expanding childcare subsidies, with most eligible families paying no more than $15 per week

• Raising income eligibility to about $114,000 for a family of four

How will it be funded?

The governor has committed a $1.7 billion investment to expand childcare across the state. If the legislature approves the budget, total childcare and pre-k funding will be $4.5 billion for fiscal year 2027. The current proposal uses funds that already exist and would not currently require increased taxes. However, a plan for long-term funding of the expansion has not been proposed.

What happens next?

To accomplish the goals of universal childcare in New York, there are a couple of big milestones ahead:

1. The state legislature still needs to approve Gov. Hochul’s funding requests, although the strategy of using existing state funds rather than raising taxes makes it more likely to go through.

2. The childcare workforce will then need rapid growth, including hiring and training teachers, and improving the infrastructure of the current fragmented system of schools, day care centers, and private home caregivers.

3. The plan will also need long-term funding. If the program is successful, will taxpayers and lawmakers be willing to sustain its funding? Additionally, how will changes in federal funding affect New York programs? ($10 billion in federal funding for childcare subsidies is currently frozen, including in New York, and being debated in the courts.)

Making childcare truly universal in New York has great potential to improve the health of children and parents. I’ll be watching its progress closely and reporting back.

~140,000 New Yorkers now face higher healthcare costs

Remember the 43-day government shutdown in the fall? (Feels like years ago already, I know…) One of the issues at the center of the debate was whether to extend health insurance subsidies under the Affordable Care Act (ACA). While the government eventually reopened, Congress never reached an agreement, so the enhanced subsidies expired on December 31, 2025.

Now, 140,000 New Yorkers, and millions of Americans across the country, are seeing their health insurance costs substantially increase.

I did a deep dive on ACA subsidies in November, but here’s a quick refresher:

Under the ACA, coverage in New York is tiered based on income, anchored to the Federal Poverty Level (FPL). Before 2021, anyone making just $1 over 400% of the FPL—roughly $60,000 for an individual or $124,000 for a family of four—got zero financial help through the ACA. This was called the “subsidy cliff.” It disproportionately affected those who don’t get insurance from an employer and don’t qualify for Medicaid or Medicare. This includes many self-employed or freelance workers, small business owners, farmers, and early retirees, among others.

In 2021, the pandemic relief package removed the subsidy cliff, allowing anyone to get financial help if their premiums were greater than 8.5% of their income. But when the ACA subsidies expired at the end of last year, the cliff came back.

Gov. Hochul’s office estimates the average healthcare cost for a New York couple who previously qualified for ACA subsidies is now up 38%, meaning an additional $238 per month. That’s nearly $3,000 more per year for couples. It also varies across New York; Mohawk Valley has seen the steepest increase at 49%.

Despite the increases, there are some signals that Congress may be moving towards getting these subsidies back up. Earlier this month, the House passed a bill to reinstate and extend the ACA subsidies another three years; this moved to the Senate for consideration, where negotiations are ongoing. (A similar bill was voted down just last month.)

If you have questions about your New York coverage options, premiums, or eligibility, call 1-855-355-5777 or visit nystateofhealth.ny.gov. The deadline to enroll in a Qualified Health Plan (i.e., if you aren’t eligible for Medicaid, Medicare, the Essential Plan, or Child Health Plus) is January 31st.

I’ll also keep watching this and share updates as they come.

NYC nurses strike: what’s happening and what it means for you

This week, nearly 15,000 nurses across some of NYC’s major hospitals—Montefiore Medical Center, Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, and New York-Presbyterian—went on strike. This is the largest healthcare strike in NYC’s history.

Why are they striking?

The union is calling for:

• Legally enforceable nurse-to-patient staffing ratios, so that nurses aren’t overwhelmed with too many patients, increasing safe patient care.

• Higher wages to keep pace with inflation and retain staff amid worsening nursing shortages.

• Increased hospital security to reduce workplace violence, which has risen in NYC healthcare settings.

The hospitals have pushed back on the demands, stating they would cost billions of dollars over the next three years and that they can’t afford the increases in light of healthcare funding cuts from the One Big Beautiful Bill Act. They also say these funding issues will be exacerbated as more New Yorkers lose health insurance, resulting in more uncompensated medical care.

What this means for patients

The New York State Nurses Union is encouraging patients to continue seeking care at the hospitals. In preparation, hospitals have brought in travel nurses and temporary staff, and Governor Hochul issued an executive order to temporarily suspend certain licensing and practice restrictions so that clinicians who are licensed and in good standing elsewhere can work in New York without penalties, allowing hospitals more flexibility to keep adequate staffing. Still, hospitals may resort to transferring patients to other hospitals if capacity is strained.

How long will it last?

The last major NYC nurse strike in 2022 lasted three days. This one is much larger with the potential to cause more disruption to hospital systems—the longer it continues, the more pressure hospitals may face to delay non-emergency procedures and divert incoming patients.

Why it matters

Staffing ratios are a public safety and health equity issue. Studies show that safe nurse staffing is linked to lower patient mortality, shorter hospital stays, and better health outcomes. A 2002 JAMA study showed that:

• Hospitals that staff 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than a 1:4 nurse-to-patient ratio.

• The odds of patient death increase by 7% for each additional patient the nurse must take on at one time.

Ensuring nurses have the time and bandwidth to adequately care for their patients is vital.

I’ll keep you updated if anything changes.

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Infectious disease “weather report”

Flu: It looks like flu may have peaked in New York, but levels remain very high across both the state and NYC. Even with recent declines over the past two weeks, we’re still at levels close to the peak of the 2023-24 season. In short: flu is still widespread in New York.

I wouldn’t be surprised if we saw flu pick up again—that happens in some seasons. Because flu will still circulate into February and March, it’s not too late to get your flu shot.

RSV: Remains high but may have plateaued. (I know I said that last week, but the data is holding.) The good news is that RSV this season is lower than in the past two years.

Covid: In good news, Covid is still low across the state. State case data show that it may have peaked, and at a lower level than the late-summer surge we saw earlier this year.

Bottom line

There’s a lot going on in the New York health policy world, with many evolving situations that I’ll keep a close eye on.

From an infectious disease standpoint, flu is still the biggest concern right now. Staying cautious, especially in crowded indoor settings, is still a smart move, particularly for those at higher risk (older adults, people who are immunocompromised, pregnant, etc.).

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.

We’re heading into peak travel season during the holidays, and respiratory viruses are along for the ride (especially the flu). So before we dive into your infectious disease “weather report” (plus a measles outbreak update in Rockland County), I want to emphasize that it’s not too late to get your flu, Covid, or RSV shots. We’ve got a couple more months of higher virus activity ahead of us. Getting vaccinated now can still reduce your risk of infection and serious illness.

And quick heads up, I’ll be taking a break to recharge over the holidays, but I’ll be back in the new year with more updates, data, and public health guidance to help you navigate what’s ahead in New York. Okay, let’s get into it.

Infectious disease “weather report”

Flu: Continuing to increase sharply, and much faster than Covid or RSV. The most recent data show that cases and hospitalizations in the state have increased by 83% and 61%, respectively. Emergency department visits and hospitalizations for the flu in NYC are also rising, especially for kids.

The flu shot is most important for young kids and infants, older adults, those who are pregnant, and people with conditions that put them at higher risk. (See specific guidance here.) During last year’s flu season, 26 kids, only one of whom was vaccinated, tragically died of the flu.

Unfortunately, flu vaccination coverage is lower this year compared with the same time last year, especially for kids:

• Coverage for children 0–18 years is down by 7.5%.

• Coverage for adults 19 and up is down by 1.4%.

The best thing to do right now is make sure the kids in your life, and you, are vaccinated. Anyone 6 months or older can get vaccinated for the flu.

RSV: Also increasing across the state, mostly in kids under age 4. Statewide, hospitalizations increased by 32%.

RSV vaccination has a little bit more nuance to it because there are different immunizations based on one’s age:

For older adults:

• One RSV shot is recommended for everyone 75 and older.

• People 50–74 with risk factors for severe disease should also get vaccinated.

• Only one dose is needed—this is not a yearly vaccine.

For infants:

• All infants should be protected, either by:

  • Vaccinating the pregnant parent between 32–36 weeks, or

  • Giving monoclonal antibodies (like nirsevimab or clesrovimab) to the baby after birth.

• Most infants only need one of these options.

• If the pregnant parent got the RSV shot during a past pregnancy, the baby should get monoclonal antibodies.

For young children (8 to 19 months):

• It’s recommended that kids with risk factors for severe disease also get monoclonal antibodies going into their second RSV season.

• Nirsevimab is the only recommended option for this age group.

Covid: Continuing to increase in New York slowly. Statewide, Covid hospitalizations increased by 23%.

Measles is back in Rockland County

Rockland County is experiencing a measles outbreak. Twenty cases have occurred since October, bringing the total to 21 in 2025. All cases are in unvaccinated people, and mostly kids under 5.

Measles is one of the most contagious viruses we know: if one person has it, up to 9 out of 10 unvaccinated people around them will catch it too. It can also linger in the air for up to two hours after an infected person has left a room.

And it’s more than just a rash. At least four children in the Rockland County outbreak have been hospitalized, including one who was critically ill. Thankfully, all have since recovered. But it’s a reminder that measles is a serious illness. It can lead to pneumonia, brain swelling, and death, especially in children under 5, pregnant people, and those who are immunocompromised.

This is the county’s first outbreak since the large one in 2018–2019 (which saw more than 300 cases). Then, like now, measles took hold in communities with low MMR vaccination coverage. In some Rockland zip codes, less than 50% of eligible infants are vaccinated, far below the 95% needed for community protection.

The best thing to do right now is check the vaccination status of everyone in your family, and get up to date if needed. If you’re unsure whether you or your child is immune, talk to your healthcare provider. Immunity is confirmed with either two documented doses of the MMR vaccine or a blood test (titer) showing protection from past infection or vaccination.

Free MMR vaccines are available by calling the Rockland County Department of Health at 845-364-2497. The Spring Valley and Pomona clinics are also providing immunizations, as are local health care providers and local federally qualified health centers, such as Refuah Health or Sun River Health Care.

Bottom line

Flu is surging, RSV is rising, Covid is creeping up, and measles is back in Rockland. The good news? The best protection against all these is the same: vaccination. It’s not too late to get your flu, Covid, or RSV shots for this season, and to make sure that MMR vaccines are up to date.

Wishing you and your loved ones a relaxing, healthy, and joyful holiday season and New Year!

Love,

Your NY Epi

P.S. Some of you have asked about including Your Local Epidemiologist in your year-end charitable giving. I would be honored to have your support. YLE is a fiscally sponsored project of Social Good Fund, a California nonprofit corporation and registered 501(c)(3) organization, Tax ID (EIN) 46-1323531. You can make a tax-deductible donation online here.

If you need to send a paper check instead, the following is important: make the check out to Social Good Fund and write Your Local Epidemiologist in the memo. You can mail the check to: Social Good Fund, PO Box 5473, Richmond, CA 94805-4021.

And of course, you can always join us as a paid subscriber to support this work.

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.

How beautiful was New York this weekend with the snow?! I hope you all enjoyed it, stayed warm, and didn’t have any slips (I had to catch myself a couple times on ice.)

As we head into the holidays and many of us travel to be with loved ones, there’s some health news to keep in mind. This week, I’m covering a recall of mixed nuts, measles in Connecticut, health violations at medspas, and circulating respiratory viruses. Next week I’ll check in with a quick infectious disease update before YLE slows down for a holiday break. As always, drop us any comments on what you’re interested in hearing more about.

Let’s jump in.

Salmonella and Wegmans mixed nuts recall

Time for a pantry check: Wegmans grocery store is recalling two mixed nuts products for potential Salmonella contamination, sold in New York and eight other states and Washington, D.C. Products were sold between Nov. 3 and Dec. 1. No illnesses have been reported so far.

Products recalled:

• Wegmans Deluxe Unsalted Mixed Nuts 34 oz. tub, Family Pack

  • UPC 077890421314

  • Lot 58041

  • Best by Jul. 28, 2026

• Wegmans Deluxe Unsalted Mixed Nuts 11.5 oz. bag

  • UPC 077890421352

  • Lot 58171

  • Best by Aug. 10, 2026

Routine testing by the supplier found one lot of raw pistachios to be positive for salmonella. The company then initiated a recall after determining these pistachios had been further used in the production of the Deluxe Mixed Nuts products.

What to do:

• Don’t eat them. Return for a refund or discard them.

• If you ate them and get fever, diarrhea, vomiting, or belly pain, most people can recover at home. But call your clinician sooner if you’re pregnant, over age 65, immunocompromised, or if your symptoms are severe/dehydrating.

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Medspas are everywhere—here’s how to check if yours is legit

Medical spas (or “medspas”)—those day spa-like clinics offering beauty services—are popping up everywhere. While they might feel like day spas, offering services like manicures or facials, many of their other procedures—Botox, fillers, IV drips, etc.— require providers to have a medical license. So before you visit one for a holiday-season facial or a new treatment, it’s a good idea to make sure you know what you’re getting into.

A recent investigation into 15 NYC medpas (all of which had been flagged by consumers or agency staff as potentially problematic) found several health and safety violations, many of which could put customers and employees at risk.

If you plan to visit a medspa, there are a couple of steps you can take to make sure standards are being met:

1. If you are getting something that qualifies as a medical procedure (a rule of thumb is anything that breaks the skin or goes inside your body), check that your provider has a valid license. You can verify it through NY’s official database. Medical procedures must be performed by a licensed medical professional—like an MD, DO, PA, or RN—and in a licensed medical setting. It’s the law. All 15 of the investigated medspas were offering medical procedures without proper licensing.

2. Check the business’s license. An “Appearance Enhancement Business” license covers cosmetology-type services (like facials, manicures, and hair salon services), but it does not cover injectables or other more invasive medical services, such as Botox, IV drips, or liposuction.

3. Look for medical “green flags”:

• A real medical intake (history, meds, allergies), informed consent, and a plan for complications.

• Clear labeling and unopened product (especially for injectables).

• Clean room setup (hand hygiene, sharps container, sterile supplies).

Over half of the investigated medspas had serious sanitation and hygiene issues; some offered foreign or unregulated medications, and others used expired or potentially fraudulent products.

4. Report concerns. To file a complaint against a medical practitioner in New York, you can contact the NYS Department of Health’s Office of Professional Medical Conduct (OPMC) for doctors/PAs or the NYS Education Department’s Office of Professional Discipline (OPD) for other professionals (licensed or unlicensed).

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Measles in Connecticut (and what it means for New York)

Connecticut just confirmed its first measles case in more than four years in an unvaccinated child under 10 in Fairfield County. The child had recently traveled internationally with family. Contact tracing by the health department is underway, and people who may have been exposed are being notified. The health department said unvaccinated or under-vaccinated (with fewer than two doses of MMR) children and adults, including those with vaccination exemptions, will need to be out of school for 21 days.

Measles is one of the most contagious viruses—it can linger in the air for up to two hours after an infected person leaves a room, and nine out of 10 unvaccinated people exposed will get infected. It also isn’t “just a rash” and can cause severe illness: in children under 5 years old, one in five cases are hospitalized. In severe cases, measles can cause pneumonia and brain swelling.

What to do (in Connecticut, New York, and anywhere else really):

• Check MMR status for everyone in your household. Two doses are about 97% effective at preventing measles.

• If you think you or your child were exposed and develop symptoms, call your doctor/urgent care. Make sure to call before showing up in person so that proper precautions can be taken to avoid exposing others.

• Watch for symptoms: fever/cough/runny nose/red eyes, then rash that often starts at the hairline and moves downward.

It’s not too late to get vaccinated, especially if you will be traveling internationally or to any U.S. region with a measles outbreak.

The recommendation is:

• Being fully vaccinated with the MMR vaccine at least two weeks before departure.

• If the trip is less than two weeks away and the traveler is not immunized, getting one dose of MMR is advised.

As always, consult with your medical provider to discuss what’s right for you and your family.

Infectious disease “weather report”

Flu: Increasing sharply. The most recent data show that cases and hospitalizations in the state have increased by 29% and 75%, respectively. Emergency department visits and hospitalizations for the flu in NYC are also rising, with the largest increases among kids under 18.

RSV: Also increasing across the state, mostly in kids under age 4. Statewide, hospitalizations increased by 18%.

Covid: Slowly increasing in New York.

As we head into the holidays, when many of us will be traveling to see loved ones, flu is top of mind. To reduce the spread of illness, consider masking in indoor crowded spaces—I’ve been wearing mine on the train, in the airport, and at grocery stores—and reducing contact with others if you’re feeling sick.

Bottom line

You’re all caught up on New York public health news! I hope the holidays bring you peace, joy, rest, and all the cookies.

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.

There’s a lot to cover and celebrate this week in New York public health. From improving NYC’s life expectancy to a new state law ensuring inhaler coverage, public health and policy are quietly working behind the scenes. But there’s still plenty of work ahead. Let’s jump in.

Insurance has to pay for inhalers in NY

No one should struggle to breathe because they can’t afford it, but that’s been the reality for many New Yorkers with asthma. The cost of inhalers varies widely, from $35 with insurance to over $500 if uninsured, and depending on the type (e.g. daily preventative vs. emergency relief inhaler). Starting in 2027, though, that reality will shift for many. Last week, Gov. Kathy Hochul signed into law a bill that will require state-regulated health plans—including those on the Affordable Care Act marketplace—to cover the cost of asthma inhalers fully.

Why this matters

Nearly 2 million New Yorkers (about 10% of the state) live with asthma. In New York City, the problem is even greater, especially in neighborhoods with higher pollution levels due to heavy traffic and industrial zoning. In the Bronx, for example, the neighborhood of Mott Haven has become known as “Asthma Alley” because of its concerningly high rates of childhood asthma. Mott Haven has nearly double the rate of asthma-related emergency room visits for kids 5-17 years old (266.2 per 10,000) compared to city averages (143.7 per 10,000). And these are some of the highest asthma-related emergency room visit rates in the country. (For comparison, the national average asthma-related emergency room visit rate is 36.6 per 10,000 for kids aged 0-18.)

Access to free inhalers is more than a convenience—it’s a lifeline. This is especially true for low-income families living in neighborhoods with high air pollution, who are least likely to afford consistent care. Mott Haven is one of these neighborhoods: a community with many families earning low incomes, surrounded by three major highways and industrial warehouses, resulting in higher air pollution.

While this new law is a major step forward for health equity, it’s still a band-aid: it doesn’t address why asthma rates are so high in the first place. Until we tackle the upstream causes, like air pollution, housing quality, and environmental justice, New Yorkers will continue to need more inhalers.

The state has taken similar steps to make treatments accessible for other chronic conditions, such as capping insulin costs under state-regulated plans. Though this piecemeal approach raises a bigger question: is the best solution to pass drug-by-drug legislation? Do we need individual bills for every lifesaving medication New Yorkers depend on, and that many families struggle to pay for? This approach is reactive, and many experts argue that broader reforms may be more effective at addressing the underlying root drivers of high drug pricing.

New York City just beat its own health goal, 5 years early

In 2023, the city launched HealthyNYC following a dramatic drop in life-expectancy—from 82.6 years in 2019 to 78 years in 2020, mainly due to the Covid-19 pandemic. The initiative aims to raise life expectancy to 83 years by 2030. But according to new data released last week, we’ve already passed that goal: life expectancy in NYC is now 83.2 years—the highest in our city’s history since we began tracking.

What drove this change?

Covid-19 deaths dropped by over 90% from 2021 to last year. This alone added years back to New Yorkers’ lives. Other leading causes of death, like heart disease, diabetes, suicide, and homicide, also declined.

But not every number went in the right direction. Deaths from screenable cancers (think breast, colorectal, cervical) rose slightly—up 0.7%. These are cancers we can often catch early or prevent through routine screening, yet outcomes worsened last year in the city.

Additionally, major health inequities persist:

• Screenable cancer deaths are still highest among non-Hispanic Black New Yorkers, and especially men.

• Heart and diabetes-related deaths are most common in non-Hispanic Black communities.

• Homicide and overdose rates disproportionately affect Black and Hispanic communities.

What’s working?

Some of the programs helping to improve life expectancy include:

• The Public Health Corps, connecting high-risk communities to care.

• Citywide media campaigns and vaccine outreach.

• Distribution of 300,000+ naloxone kits and harm reduction services.

• New investments in opioid treatment programs like Relay.

• Doula and nurse home visiting programs for 20,000+ families.

• Action centers focusing on neighborhoods with the highest premature death rates.

With the HealthyNYC initiative codified into law, these efforts won’t disappear with a new mayor or budget cycle—the city will keep working on improving these metrics. But these successes aren’t the finish line. There’s still a big question: how do we not just live longer, but live better? Some city leaders say the next chapter should focus on healthspan—the years of life spent in good health—not just lifespan. It’s also crucial that we continue to double down on closing health inequities across neighborhoods and populations.

Infectious disease “weather report”

Flu: Flu continues to increase quickly. The most recent data show that cases and hospitalizations in the state have increased by 117% and 99%, respectively. In NYC, emergency department visits for the flu rose by 142%.

RSV: Also increasing across the state and in NYC, mostly in kids under 4. Statewide, hospitalizations increased by 21%, while emergency department visits in NYC went up by 71%.

Covid-19: Cases and hospitalizations are holding steady at low levels in both NYC and across the state.

The New York state wastewater program recently launched a helpful update to its dashboard. They now color-code sites by whether they are increasing, decreasing, or stable for Covid-19.

Right now, most sites across the state have either stable or decreasing Covid-19 wastewater values. Sixteen sites, though, are reporting increases, with the largest spikes seen in Seneca and Tioga.

HIV diagnoses have gone up in NYC

A new report shows that last year, 1,791 people were diagnosed with HIV in NYC, up 5.4% compared with 2023. And huge inequities remain: 86% of people newly diagnosed with HIV were Black or Latino/a, and 91% of newly diagnosed women were Black or Latina. Among people newly diagnosed with known transmission category, 65% were men who have sex with men, 82% of whom were Black or Latino.

Upstate updates

If you are looking forward to ice fishing this winter, make sure to check the conditions of the ice before you go out. A minimum of three to four inches of solid ice is the general rule for safety. For more information and to learn about specific fish species in ice fishing, check out the New York Department of Environmental Conservation page.

A raccoon tested positive for rabies in Deansboro. This is a reminder to avoid touching wildlife. If you see any acting strangely (acting mad, shy, getting unusually close, or drooling or foaming at the mouth), stay away and call your local animal control officer for help. (Find contact information on your city’s website).

Monroe County launched MonroeAlert, an emergency notifications system for residents to get alerts about critical situations in their community. Residents can sign up to receive alerts via text message, email, phone call, or mobile app about emerging issues like severe weather, public safety incidents, travel restrictions, and shelter information.

Bottom line

New York is making real progress, from adding years to our lives to making breathing a little easier for those with asthma. But equity and prevention must stay front and center. Our communities should strive to live better, in addition to living longer.

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.

There’s a lot to cover before the holiday next week, so let’s jump right in.

Infectious disease “weather report”

Flu: Flu is increasing quickly. The most recent data show that cases and hospitalizations in the state have increased by 78% and 53%, respectively. In NYC, emergency department visits for the flu rose by 104%.

Earlier this week, YLE National reported on a new flu virus mutation that could potentially lead to a bad flu year in the U.S. We don’t know exactly how things will play out, but the bottom line is that flu vaccination remains our best protection.

RSV: Also increasing across the state and in NYC, mostly in kids under 4. Statewide, hospitalizations increased by 70%, while emergency department visits in NYC went up by 40%.

Covid-19: Cases and hospitalizations are decreasing in both NYC and across the state.

As we head into Thanksgiving, when many of us will be traveling to see loved ones, flu and RSV are top of mind. To reduce the spread of illness, consider masking in indoor crowded spaces—I’ll be wearing mine on the train and in the airport—and reducing contact with others if ill.

Good news: Overdose deaths are declining in NYC—but progress is uneven

For the first time in years, NYC saw a significant drop in overdose deaths—a 28% decrease last year from 2023—but that still totals 2,192 deaths: far too high.

Last year, 78% of overdose deaths in NYC involved an opioid, a reduction from 83% in 2023. Fentanyl remains the leading driver, involved in 73% of deaths, but that’s also down from 80% in 2023.

One success story is Staten Island, which saw the steepest drop in overdose deaths. A possible reason: the implementation of a hot-spotting strategy. Officials analyzed emergency medical services (EMS) and hospital data to identify where overdoses were happening most. Then they deployed peer counselors to those areas with the life-saving opioid overdose-reversing medication naloxone (also known as Narcan), support services, and treatment referrals.

Over the summer a hot-spotting program based off of Staten Island’s was launched in the Bronx as well. This is greatly needed as the Bronx still has the highest overdose death rate compared to other boroughs. I’ll be keeping an eye on the program’s progress and any outcomes reported.

Despite the encouraging drop, overdose is still a leading cause of premature death in NYC. And huge inequities still exist. Overdose deaths in black and Latino New Yorkers remain about twice as high as the rate among white New Yorkers.

There are still actions we can take to continue to reduce the risk of overdose death amongst our fellow New Yorkers:

Carry naloxone (Narcan).

• All New Yorkers can receive free naloxone and training from registered Opioid Overdose Prevention Programs (OOPPs) on how to recognize the signs of an overdose and administer the medication.

• Health Department vending machines: Locations can be found on this page.

• Over-the-counter naloxone at pharmacies: Available without a prescription at most major chains (map here).

  • Most insurance providers will cover all or part of the cost of naloxone, and New York State will cover copayments of up to $40.

There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit the 988 website for 24/7, confidential support.

Changes to the B‑HEARD program

Last week, Mayor Eric Adams announced a shift to B-HEARD—the Behavioral Health Emergency Assistance Response Division, a pilot program launched in 2021 to respond to 911 mental health emergency calls with trained medical and mental health teams. Under the new model, teams will move from two emergency medical technicians (EMT) and a social worker to one nurse, a social worker, and an ambulance driver—all employed by NYC Health + Hospitals.

These teams are dispatched in cases of nonviolent but urgent behavioral health crises: suicidal ideation, substance misuse, acute mental health episodes, and similar situations.

In the triage process, 911 operators route mental health‑related calls based on criteria around safety and risk. If a situation is assessed as nonviolent and primarily behavioral health driven, it may be routed to B‑HEARD instead of the traditional law enforcement/emergency medical services (EMS) response. The program operates in Northern Manhattan, the Bronx, Central and South Brooklyn, and Western Queens, from 9 a.m. to 1 a.m.

Let’s give it a closer look.

Why does this program exist?

Historically, almost all mental health 911 calls in NYC were routed to the New York City Police Department (NYPD), sometimes alongside basic EMS responders. Some experts argue that this approach often lacks the de‑escalation skillset, therapeutic lens, and follow‑up needed for mental health emergencies.

There is evidence that when police are first responders in a mental health crisis, outcomes can be worse: individuals in crisis may feel criminalized, unsafe, reluctant to seek help, and in worst cases may face use of force. For example, in the U.S. people with untreated serious mental illness are estimated to be up to 16 times more likely to be killed by law‑enforcement during an encounter.

By deploying mental or behavioral-centered teams, B‑HEARD tries to reduce unnecessary police involvement, deliver more appropriate care at the scene, and connect people to community‑based follow‑up.

Has B‑HEARD been effective so far?

A city comptroller audit earlier this year found the program is promising in concept but hard to evaluate due to limited data and implementation gaps.

Key findings:

• Between fiscal years 2022-2024, B-HEARD covered 96,291 mental health-related 911 calls during operating hours.

• Only about 25% (just over 24,000 calls) resulted in a B-HEARD response.

• Around 60% were deemed ineligible (some due to safety concerns, others because no EMS operators were available to screen).

• Even among eligible calls, 35% never received a response for unknown reasons.

• Critical process steps (assessments, follow-up referrals) were often incomplete or not documented.

On the positive side, among clients surveyed, the results were strong:

• 99 % said they were treated with respect.

• 96 % said the team helped them.

In short, the idea is promising, but the current program lacks data to properly evaluate its effectiveness at meeting its goals.

Why the change?

New York faces a shortage of EMTs and paramedics and has long ambulance response times. By freeing up EMS workers for broader medical emergencies, the city hopes to improve ambulance response times across the city.

Importantly, during a behavioral health crisis, if additional medical backup is needed (e.g., someone becomes medically unstable), the driver/nurse team can summon an ambulance. The nurse offers stronger clinical capacity on‑scene than EMTs alone, potentially improving care and triage.

Looking ahead and my thoughts

With longer ambulance wait times, it’s a logical step to free up EMTs to shorten response times. And if there are enough nurses at NYC Health + Hospitals to redirect some to B-HEARD teams without disrupting hospital operations, having advanced medical support on the response teams could be beneficial. But the bigger question remains how effective this program has been at responding to mental health issues, while maintaining safety for those experiencing mental health crises and for first responders.

The other question at hand is the timing of this change. Mayor Adams has one more month on the job before Mayor‑elect Zohran Mamdani takes the helm on January 1st. Mamdani has signaled plans to expand B‑HEARD city‑wide beyond the pilot, and fold it into a new Department of Community Safety. Will these changes hold in Mamdani’s new administration? If not, will shoring up EMTs in NYC for one month make any real difference in ambulance wait times? Will the program go through another overhaul, potentially further limiting our ability to assess its effectiveness? These are the things I’ll be looking out for over the coming months, and I will report back with any updates.

Bottom line

As we head into the holiday, I’m feeling especially grateful for New York’s public health champions—the heroes and systems working behind the scenes to keep us safe. The encouraging decline in opioid deaths, expanded mental health outreach, and strong infectious disease surveillance systems are testaments to that.

To everyone working towards a healthier state: thank you for all you do. Your work makes New York better, every single day.

I’m wishing everyone a restful Thanksgiving—indulge in that pie, wear those stretchy pants, and I’ll see you after our break 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.

For those who are older, it could be even higher. Let’s break down what that means (and give an update on respiratory viruses at the end).

The longest government shutdown in U.S. history is over. Last night, the president signed a bill that narrowly passed the House. The government is officially reopened.

But even as Washington moves to turn the lights back on after more than 40 days, another major fight over health policy looms. Republicans have promised to bring a separate vote in December on whether to extend the expanded Affordable Care Act (ACA) subsidies, which are set to expire at the end of the year. These subsidies, introduced during the pandemic through the 2021 American Rescue Plan and extended by the 2022 Inflation Reduction Act, made health insurance more affordable for millions of Americans.

If they expire at the end of the year, health care will become more expensive for millions. But first, some background.

What’s “the marketplace”?

The Marketplace (also called the Exchange) is the online platform set up under the ACA where individuals can shop for, compare, and enroll in health insurance plans that meet specific government standards. It’s especially important for those who don’t get insurance through their jobs.

• In New York, the marketplace is called the New York State of Health.

• The ACA Marketplace open enrollment period for 2026 coverage started on November 1 and runs through January 15. Some states have different deadlines.

New York’s coverage framework: Who’s covered

Under the ACA, there are four tiers of coverage in New York based on income, using the percent of the Federal Poverty Level (FPL). These income thresholds are adjusted each year to reflect inflation. Here’s how it breaks down for 2025:

Return of the “subsidy cliff” and what the 400% FPL line really means

Before 2021, people who earned even just $1 over the 400% FPL got zero help, regardless of how expensive their insurance costs were. This was called the “subsidy cliff.” During the pandemic, the subsidy cliff was removed, letting anyone get help if premiums were unaffordable (greater than 8.5% of one’s income).

Now, with the new federal budget, the subsidy cliff is set to return next year. Those making just above 400% of the FPL—roughly $60,000 for an individual or $124,000 for a family of four—will be hit hardest if the expanded ACA subsidies expire. These middle-income families could see the steepest increases in their insurance costs.

A real-world example: a single adult in NYC

Take a hypothetical single adult living in New York City, making $63,000 per year—just over 400% of the FPL. Their employer doesn’t offer insurance. Today, with ACA subsidies, they would pay $446/month for a basic, silver plan from the Marketplace ($5,335 annually). This is 8.5% of their income, capped by the federal limit.

Next year, without the subsidies, they would pay the full cost, around $867 per month ($10,404 annually). It almost doubles the price. This, compounded by the high cost of living in New York (with the average monthly rent for a studio apartment in NYC running about $2,500), could have serious consequences.

You can estimate your own insurance costs here through KFF.

For older adults, the costs hit even harder

Insurance premiums rise with age. Older adults tend to use more health care, more often, for more complex or chronic health issues, and insurers use age to price risk. A couple in NYC making $85,000 per year (402% of the FPL limit) would currently expect to pay about $602 per month ($7,224 annually) for a silver plan. Without the ACA subsidies, that would go up to about $1,734 ($20,808 annually)—almost triple the cost, and about a quarter of their total income. When accounting for rising premium costs, especially for older adults, it would likely be higher.

This couple could see annual insurance costs jump by more than $13,000—a cost that would have significant implications for someone’s budget and any emergency cushion.

The takeaways

• New Yorkers with the lowest incomes, who qualify for Medicaid or the New York Essential Plan (<250% FPL), will be insulated from these changes—this safety net is holding.

• Many New Yorkers, especially older adults who don’t yet qualify for Medicaid (<65) and middle-income individuals without employer-sponsored health insurance, will face steep increases in insurance costs.

• The “subsidy cliff” will return, causing those with incomes just above the threshold to face the highest cost increases.

If you’re unsure what you or your loved ones qualify for, visit nystateofhealth.ny.gov.

This debate isn’t over yet, so now’s a good time to understand what’s at stake. We’ll be watching closely.

Infectious disease “weather report”

Covid-19: Cases and hospitalizations are decreasing in both NYC and across the state. However, wastewater data (via Biobot and WastewaterSCAN) are showing signs of an increase in the Northeast and South. This could mean that we start seeing more cases and hospitalizations for Covid in the next few weeks.

Flu: Flu is increasing quickly. The most recent data show that cases and hospitalizations in New York have increased by 49% and 71%, respectively. In NYC, emergency department visits for the flu rose by 83%.

RSV: Also increasing across the state and in NYC, mostly in kids under 4. Statewide, cases increased by 19%, while emergency department visits in NYC went up by 67%.

Covid vaccinations are down in New York

Data from the New York Department of Health shows that Covid vaccinations in the state are down by 30% compared to this time last year. Doses for those over 65, the group most vulnerable to severe illness, are down ~25%. With fewer New Yorkers getting vaccinated, our collective defenses are weaker.

As we head into the holidays, where many of us will pass through crowded airports and spend time with young and old family members, vaccination remains our best bet to protect ourselves and our loved ones.

It’s still a great time to get vaccinated. In New York, anyone over three years old can be vaccinated at a pharmacy. Kids under three need to get their Covid vaccines from a pediatric provider, like their pediatrician. Make sure to call ahead to ensure that the provider has pediatric doses of the Covid vaccine.

Bottom line

If Congress lets the expanded ACA subsidies expire, many middle-income New Yorkers, especially those just above the 400% federal poverty limit, could see their health insurance costs substantially increase. For older adults, this could hit even harder. Now’s a good time to stay informed about what’s being discussed in Washington.

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.

To each and every runner, volunteer, spectator, and crew member who participated in the NYC Marathon this past weekend, you are incredible. The sheer scale of coordination and determination to pull off this event shows us what New York is all about—grit, community, and dreams.

And it’s not just the runners. The marathon couldn’t exist without public investment—in parks, clean air, and safe roadways, as well as the labor it takes to keep the city moving. I want to give a special shoutout to the city sanitation department as well, as they did some heavy lifting to get the streets back in good shape for Monday.

Thank you to everyone who made this possible, and to those who lined the streets to cheer on Sunday. I’ll never forget the roar of the crowds. And how sore I was after. 😅

Now let’s get into this week’s Dose. We’ll cover updates to SNAP funding in New York, new data on declining tobacco use among teens, and respiratory viruses.

SNAP state of emergency in NY

Due to the ongoing federal government shutdown, a timeline for food aid for nearly 3 million New Yorkers is still unclear. Last week, Gov. Kathy Hochul declared a state of emergency to free up an additional $65 million in state funding for food pantries and hunger relief—enough to cover 40 million meals. The state also began mobilizing SUNY and Empire Corps teams to help food banks and expand the Supplemental Nutrition Assistance Program (SNAP) outreach on college campuses.

Then came a wave of legal pressure. Last Friday, two federal judges ruled that the SNAP freeze was unlawful. In response, the US Department of Agriculture (USDA) announced it would issue half of November’s SNAP benefits using contingency funds. But then, on Tuesday, President Donald Trump, in defiance of the two court orders, threatened to deny the assistance for the 42 million low-income Americans until the end of the shutdown. Hours after that, White House press secretary Karoline Leavitt told reporters the administration would fully comply with the court and provide the partial food stamp payments. The back and forth on this has been exhausting, and only compounds the uncertainty many families are experiencing as they think about food for the next month.

Hochul’s emergency funds—$40 million for the Hunger Prevention and Nutrition Assistance Program and $25 million for Nourish NY—are filling some gaps. And these new emergency funds are on top of the $41 million in state funds for food assistance issued earlier last week, bringing the total state emergency funds to $106 million. But as Gov. Hochul emphasized, “No state can replace SNAP.” The federal program provides $650 million per month to New York residents. If half gets paid out with USDA contingency funds (~$325 million), and the state has committed $106 million, New York will have ~$431 million for SNAP in November—$219 million short of the need.

This isn’t only an economic issue. Nutrition insecurity worsens chronic disease, disrupts childhood development, and places enormous stress on mental health. Ensuring consistent food access is foundational to public health.

What you can do

• If you’re a SNAP recipient: Monitor your EBT card closely and check otda.ny.gov

  for updates.

• If you’re not: Volunteer or donate to your local food pantry. They need it now more than ever.

• If you want to make your voice heard: Call your reps. Tell them hunger shouldn’t be a political tactic.

I’ll keep watching this story.

Tobacco use in New York hits a record low

Great news: last month, a New York State Department of Health (NYSDOH) report revealed that youth tobacco use in the state has declined to its lowest level since the agency started measuring it 25 years ago. The agency found that fewer high school students reported using cigarettes, e‑cigarettes, or other tobacco products last year.

Why it matters

• If fewer young people pick up tobacco, fewer will carry nicotine dependence, lung disease, or cardiovascular risk into adulthood.

• Lower youth uptake often predicts lower adult usage in the years ahead.

• It shows that there is potential to move the dial.

The key here, though, is understanding what actually caused the reduction. I think the decline is likely due to a combination of new policies, outreach efforts, and educational initiatives. Over the past six years, several state policies have been implemented, including bans on flavored e-cigarettes, an increase in the minimum purchasing age, and restrictions on tobacco price discounts. The New York State Quitline also developed a program to help teens quit smoking called “Drop the Vape.” While we won’t be able to determine the exact impact each of these changes had on reducing tobacco use among teens, gathering more data would help us better direct resources in the future.

Infectious disease “weather report”

New York state and New York City have rolled out updated, more user-friendly reports and dashboards to track viruses this season. The standout feature for both is the summary boxes at the top of each report showing which viruses are ramping up and causing the most disease.

Covid-19: Decreasing in both NYC and across the state. We are in a Covid lull, but likely not for long. Wastewater data (via Biobot and WastewaterSCAN) are showing early signs of a small uptick in the Midwest, a sign Covid might begin increasing elsewhere, too.

Influenza: Rising steadily across the state and city.

RSV: Also increasing across many counties statewide and in NYC, mostly in the youngest children.

Who’s most affected?

• Infants and toddlers (ages 0-4) are currently seeing the highest rates of flu and RSV.

• Covid is hitting both the youngest children and adults over 75 the hardest.

What you can do right now

1. Get vaccinated. It’s not too late. Flu, updated Covid, and RSV vaccines (for eligible groups—see this YLE National post) are all available. I’m getting my flu shot this week.

2. Layer protections. If you’ll be around young kids, older adults, or those who are immunocompromised, consider masking in crowded indoor spaces like the grocery store, airports, or on the train/subway.

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Bottom line

From marathons to sanitation crews and food banks to virus tracking, there’s a web of systems and people keeping New York running. It’s a reminder that public health is public infrastructure. And we need to keep investing in it and ensuring it has what it needs to keep serving New Yorkers.

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.

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