One exception: this is the first week in months that Biobot is observing an increase in COVID-19 activity in the Midwest. All other regions remain low and steady. It’s too early to know whether this is the start of a surge or just a small fluctuation, but it’s a signal worth watching.

The Bottom Line: We’re still in a low-risk period for respiratory disease, nationally and across most regions. The main thing to watch is COVID-19 in the Midwest, where activity is starting to increase slightly after months of decline. This doesn’t change the overall picture for now, but it’s an early signal worth watching. We’ll keep an eye on this and share updates as data come in.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is holding steady at very low levels.

Influenza

Nationally, influenza A is holding steady at very low levels while influenza B is decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are holding steady at very low levels in the South.

RSV: RSV is decreasing in the South.

HMPV: HMPV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is slightly increasing in the Midwest.

Influenza: Influenza A is holding steady at very low levels in the Midwest, while influenza B is decreasing.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is holding steady in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is holding steady at very low levels in the Northeast.

Influenza: Influenza A is holding steady at very low levels in the Northeast, while influenza B is decreasing.

RSV: RSV is decreasing in the Northeast.

HMPV: HMPV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is holding steady at very low levels in the West.

Influenza: Influenza A is holding steady at very low levels in the West, while influenza B is decreasing.

RSV: RSV is decreasing in the West.

HMPV: HMPV is decreasing in the West.

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Wastewater data from Biobot Analytics for RSV, influenza, HMPV, and SARS-CoV-2 are through May 23, 2026 (MMWR week 20).

The Bottom Line: We’re continuing to move into a lower-risk period. But, RSV, HMPV, and influenza B are still circulating in some places at lower levels. If you’re at higher risk, or spending time with someone who is, it still makes sense to use extra layers when needed, especially in crowded indoor spaces or around anyone who is sick.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is holding steady at very low levels.

Influenza

Nationally, influenza A is holding steady at very low levels while influenza B is decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are holding steady at very low levels in the South.

RSV: RSV is decreasing in the South.

HMPV: HMPV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is holding steady at very low levels in the Midwest.

Influenza: Influenza A is holding steady at very low levels in the Midwest, while influenza B is decreasing.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is holding steady at very low levels in the Northeast.

Influenza: Influenza A is holding steady at very low levels in the Northeast, while influenza B is decreasing.

RSV: RSV is decreasing in the Northeast.

HMPV: HMPV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is holding steady at very low levels in the West.

Influenza: Influenza A is holding steady at very low levels in the West, while influenza B is decreasing.

RSV: RSV is decreasing in the West.

HMPV: HMPV is decreasing in the West.

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Wastewater data from Biobot Analytics for RSV, influenza, HMPV, and SARS-CoV-2 are through May 16, 2026 (MMWR week 19).

The Bottom Line: It’s great news that we continue to move into a lower-risk period. Still, respiratory viruses have not disappeared—RSV, HMPV, and influenza B are still circulating at low levels in some places. People at higher risk may want to continue using layered protection when needed, especially in crowded indoor spaces or around someone who is sick.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

HMPV: HMPV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is decreasing in the Northeast.

HMPV: HMPV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

HMPV: HMPV is decreasing in the West.

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Wastewater data from Biobot Analytics for RSV, influenza, HMPV, and SARS-CoV-2 are through May 9, 2026 (MMWR week 18).

We can’t rewrite the early 2000s, when opioids were taking hold. But we can learn from them and build faster and stronger detection and treatment strategies. In the early days of Rx opioid’s and fentanyl’s spread, national surveillance tools weren’t built for rapid detection and response. Today, we’re in a different position. Wastewater monitoring gives us a faster, more complete way to see changes in substance use, so we can act quickly before problems escalate.

Traditional surveillance data: necessary but lagging

Traditional substance use epidemiology and data are important and help us understand the bigger picture.

But, these data have real limitations, especially their lack of timeliness. Large national surveys take years to collect, analyze, and report results. CDC’s final national overdose data for 2024, for example, was just released in April, 2026. Survey data are subject to under-reporting and recall bias (where people don’t remember exactly what they were exposed to, or may not be honest). These approaches also assume people know what they’ve consumed, and with emerging drugs and polysubstance use (the use or dependence on multiple substances), this assumption becomes increasingly difficult.

Healthcare data like emergency department visits, 911 or poison control calls, or hospitalizations can characterize burden, but these are often more reflective access to care, insurance coverage, and local policies, like Good Samaritan laws. They only capture those who interact with the system. Individuals who are silently struggling with substance use disorder but never interact with EMS, hospital systems, or community surveys are not included in the data, and thus excluded from the overall picture of community substance use.

Traditional data remain an important piece of the system. But they are often too delayed, too incomplete, or too dependent on health care access to keep pace with today’s rapidly changing drug supply.

The drug supply is changing: it’s no longer just fentanyl

It’s true that fentanyl is still a huge issue—in 2024, an estimated 60% of overdose deaths in the U.S. were due to synthetic opioids, mostly fentanyl. But newer drugs are increasingly apparent in the drug supply: nitazines and orphines (new opioids), xylazine and medetomidine (non-opioid sedatives), semi-synthetic cannabinoids (THC products), kratom-derived compounds (7-hydroxymitragynine), and combinations people may not even know they were exposed to, including other adulterants and stimulants like cocaine or methamphetamine. This is incredibly concerning.

Because the more complex the supply becomes, the harder overdose response becomes too.

Naloxone (also known as Narcan) is still a critical, life-saving tool and it should still be the first response when someone is overdosing. It’s also now widely available over the counter and through free public health programs. One of its benefits is that it won’t harm someone if opioids aren’t involved, but it could save their life if they are.

But, naloxone isn’t effective for everything—it won’t reverse non-opioids like medetomidine or xylazine, and with more potent opioids you may need multiple doses. And when people are exposed to multiple substances at once, treatment and recovery becomes much more complicated—you may end up needing to address dependence on multiple substances at once, each with its own treatment strategy.

We need better systems that keep up with the changing substance use landscape: faster tools to identify what’s circulating in the drug supply, warning systems to alert people who may be exposed, and more responsive strategies for poly-substance use and what communities are actually seeing on the ground, or in the case of wastewater, below the ground ;).

Right now, there are still huge gaps in what we can see and respond to in time.

The case for wastewater—and downstream public health action

This is where wastewater can help.

Wastewater data can fill in some of the most important gaps: speed, geographic coverage, anonymity, and visibility into the rapidly changing drug supply.

Because of our infrastructure, Biobot’s wastewater monitoring network is uniquely positioned to help communities understand what substances relevant to overdose risk are circulating, where trends are changing, and when new drugs may be emerging—all while protecting individual privacy. Wastewater samples provide aggregated, community-level signals across communities.

Biobot’s focus is on community-level indicators of the evolving drug supply and overdose risk (i.e. not individual medication use). We’re currently working in partnership with the White House Office of National Drug Control Policy (ONDCP) on a national wastewater monitoring effort focused on supporting overdose prevention, community health response, and emerging drug supply risks. Our data visualizations are helping identify where overdose-prevention resources may be needed most, and where emerging drug supply changes may require faster action and outreach. For example, because wastewater data can be generated much faster than traditional public health data, our data and insights showed that fentanyl consumption was decreasing more than a year before the CDC reported similar findings in their overdose data.

There are key features that make wastewater especially useful for getting ahead of community health issues:

Near-real-time reporting: Biobot’s Wastewater data can be processed and made available within days of substance use. It’s one of the fastest ways to identify community-level changes in the drug supply and overdose risk.

Community-wide population coverage: Wastewater captures a community-wide signal—not just people who appear in surveys, hospitals, or toxicology reports. A single wastewater sample represents an aggregated community signal from a sewer catchment area. It does not tell us who used a substance, who is taking medication, or what happened in any individual or household.

Privacy and anonymity: Data from wastewater is naturally anonymized because it’s aggregated and contains no identifying data. The wastewater samples Biobot typically works with are from thousands to millions of people and contain no personal identifiers. We report community-level patterns to guide public health action, and don’t collect any individual data, behaviors, or treatment status. Our goal is to help communities respond faster to overdose risk, not to identify or penalize people.

Breadth of detection: Biobot can test for and quantify more than 30 substances. We can also use non-targeted methods to detect unexpected or emerging compounds in the drug supply, like novel opioids or adulterants. This capability is intended to help public health teams identify new overdose risks (not monitor individual medication use). This matters because emerging substances can spread quietly before they appear in traditional data systems.

Cost effectiveness: Wastewater monitoring offers broad visibility at a very low cost. A single wastewater sample represents an entire community, often translating to literal cents per person per year. That is substantially cheaper than trying to understand local trends only through individual urine tests, toxicology screens, or clinical encounters, which are far more expensive and only represent those accessing the system.

The next generation of substance use intervention

We are seeing the drug landscape change rapidly, with new substances, different combinations, and spread into new regions.

And we need community health infrastructure that can keep up.

At Biobot, we see wastewater as part of the next generation of substance use intervention, taking what we’ve learned from the opioid crisis to prevent it from ever happening again.

Communities need faster ways to understand what’s changing in the drug supply, where trends are shifting, and how to respond. Implementing wastewater monitoring to track these trends buys community stakeholders critical time to act faster than they ever could before.

That added time could translate to issuing alerts before someone unknowingly consumes something dangerously potent, distributing naloxone to the neighborhoods most in need, or preparing clinicians and outreach teams to effectively treat what’s showing up in their clinics.

By building wastewater monitoring into community health infrastructure now, we have a chance to identify shifts early, and respond faster.

To learn more about how wastewater monitoring can support substance use monitoring and public health response in your community, reach out to us at hello@biobot.io.

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That is great news. But we’re not all the way back to low-season levels yet. A few viruses are still hanging on and remain slightly elevated including flu B, RSV, and especially HMPV.

The Bottom Line: Overall respiratory risk is coming down, which is great. But, there’s still some viral activity worth paying attention to. RSV, flu B, and HMPV are still circulating higher than others, and can cause illness, especially in young children, older adults, immunocompromised people, and others at higher risk. The usual precautions still matter around higher-risk loved ones: stay home when sick, consider masking in crowded indoor spaces if you have symptoms or recent exposure, and keep up with vaccines when recommended.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

HMPV: HMPV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is decreasing in the Northeast.

HMPV: HMPV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

HMPV: HMPV is holding steady in the West.

Wastewater data from Biobot Analytics for RSV, influenza, HMPV, and SARS-CoV-2 are through April 25, 2026 (MMWR week 16).

The Bottom Line: This is the most encouraging respiratory virus update we’ve had in a while—everything is moving in the right direction. RSV, influenza B, and HMPV are still worth paying attention to because they’re higher than other viruses and, especially for RSV, continue to affect the youngest kids most, but the trends are improving. For the public, this means respiratory virus risk is coming down overall, while the usual precautions still matter around infants, older adults, and others at higher risk.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

HMPV: HMPV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is decreasing in the Northeast.

HMPV: HMPV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

HMPV: HMPV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through April 18, 2026 (MMWR week 15).

The Bottom Line: While the major respiratory viruses are declining, the virus season is not over. Flu B, RSV, and HMPV are all circulating at high levels and for people at higher risk of severe illness—older adults, young children, and those who are pregnant or with underlying health conditions—it’s still a good time to consider added protections, especially in crowded indoor settings or before seeing vulnerable family members.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

HMPV

Nationally, HMPV is increasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is slightly increasing in the South.

HMPV: HMPV is increasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

HMPV: HMPV is increasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is increasing in the Northeast.

HMPV: HMPV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

HMPV: HMPV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through April 11, 2026 (MMWR week 14).

The Bottom Line: All major respiratory viruses are declining, but flu B and RSV are still circulating at meaningful levels. For high-risk individuals—older adults, young children, and those with underlying health conditions—layered protections still matter: masking in crowded indoor spaces, improving ventilation when possible, and using a rapid test if symptoms start (which are available over the counter at pharmacies).

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is holding steady in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through April 4, 2026 (MMWR week 13).

The Bottom Line: Most respiratory viruses are in decline, but influenza B signals continue to increase, particularly in the Northeast and West. High-risk individuals—older adults, young children, and those with underlying health conditions—should consider continuing to layer protections including masking in crowded indoor spaces, improving ventilation, and using rapid tests when symptomatic (which are available over the counter at pharmacies).

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A is decreasing while influenza B is increasing again.

RSV

Nationally, RSV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is holding steady in the South.

Influenza: Influenza A is decreasing in the South, while influenza B is mostly holding steady.

RSV: RSV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A is decreasing in the Midwest, while influenza B is increasing.

RSV: RSV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is holding steady in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing.

RSV: RSV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is decreasing in the West, while influenza B is increasing.

RSV: RSV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through March 28, 2026 (MMWR week 12).

Biobot’s national wastewater network shows that RSV is still hanging on later into the season than many expected, having real-world implications for treatment and prevention guidance. Our most recent data shows that while RSV levels are finally trending downward, overall RSV activity is still elevated nationally, with the highest levels in the Northeast and Midwest regions.

These signals and trends matter because RSV prevention timing has been built around a set time period coinciding with the classic RSV season. For infants, protection against severe RSV can come from maternal vaccination during pregnancy or from a monoclonal antibody after birth. CDC guidance says RSV antibodies for infants (nirsevimab or clesrovimab) should be administered from October through the end of March, to protect infants when risk is traditionally highest. But CDC also explicitly allows public health departments to revise that window based on local RSV epidemiology, including continuing beyond March when local activity supports it.

In other words: the calendar is a guide, but the virus actually decides the season.

Wastewater shows the long tail, earlier

Wastewater is particularly useful for RSV because traditional surveillance can miss part of the picture. Testing varies by clinic, milder infections often go undetected, and hospitalizations tend to reflect severe disease only after transmission is already underway. Wastewater can provide a population level read on whether transmission is truly fading or whether it’s still simmering. Especially with less hospitalizations, clinical data can lag for RSV, fluctuate with testing practices throughout the season, and miss milder infections that never make it into a doctor’s office. Wastewater helps fill in that gap by showing what’s circulating in communities in near real time.

This year, RSV rose later than usual in many places, and instead of dropping off quickly, as it often does following the peak, levels have stayed elevated deeper into early spring. Biobot’s latest national report described RSV as “declining but still at high levels,” with regional data showing that most parts of the country are still very much in season.

Hospitalization data also show that RSV is still contributing to severe illness, especially among the youngest children. CDC’s RSV hospitalization surveillance shows that RSV hospitalizations are highest among infants and children ages 4 and younger.

What this means for infant protection

How does this translate to real-world impacts? A prolonged season can translate into a longer period of risk for families with infants who are young and vulnerable. For infant monoclonal antibody programs, seasonal dynamics create a practical challenge: babies born after the traditional cutoff may still face significant RSV exposure if transmission remains elevated locally. That makes timely, local surveillance especially important.

Without changes to the March cutoff for the RSV antibody schedule this season, babies born in April, when RSV will still be elevated, could be left unprotected while RSV continues to circulate. Thankfully, some states, like California, are stepping up to cover the gaps.

How California adapted: extending antibody recommendations for a longer season

Earlier in March, California issued a Health Alert notifying healthcare practitioners that the Department of Public Health recommended continuing RSV immunization of eligible infants and young children with RSV monoclonal antibodies through April 30, 2026:

• All infants aged 0 through 7 months, within 1 week of birth, ideally during the birth hospitalization or as soon as possible after discharge (unless prenatal RSV immunization occurred between 32 through 36 weeks of gestation and at least 14 days before delivery)

  • Nirsevimab or clesrovimab are recommended

• Children aged 8 through 19 months at high risk of severe RSV

  • Only nirsevimab is recommended

California’s wastewater data, as well as other sources, showed that the RSV season started later and remained elevated for longer. Because of these elevated levels, the Department of Public Health determined that RSV transmission would last into April.

Babies born later in the RSV season in California are now more likely to be given these monoclonal antibodies, and therefore, protected against RSV. When states, or other entities, consider extending RSV immunization windows, Biobot’s wastewater can provide an additional, community-level signal to support those decisions.

The takeaway

The timing and intensity of the RSV season is not fixed. It shifts by year and by community. That is why wastewater is so valuable: it helps us see when the season is really ending, not when we assume it should end.

For manufacturers of RSV prevention products, tracking the dynamics of the season is not just interesting data. It affects when protection is most needed, where risk remains elevated, and how quickly medical, policy, communications, and commercial teams may need to adapt.

For families, clinicians, and policymakers, the takeaway is that if RSV is still elevated in wastewater, we should respond like the season is still here.

And this year, it is.

The Bottom Line: Respiratory virus activity for the major viruses is broadly declining heading into spring, but RSV is a notable exception—it’s increasing across some parts of the country. People at higher risk, including older adults, young children, and those who are immunocompromised, should continue taking precautions such as wearing masks in crowded indoor settings, ensuring good ventilation, and using rapid tests when symptomatic.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is increasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A is decreasing in the South, while influenza B is holding steady.

RSV: RSV is increasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is increasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing slightly.

RSV: RSV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is holding steady in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through March 21, 2026 (MMWR week 11).

The Bottom Line: We are on the downward slope of the respiratory virus season, but we’re not quite done yet. Flu B and RSV will likely stay elevated for a few more weeks. For older adults, pregnant women, infants, and people with weakened immune systems, who remain at higher risk of severe illness, this is still a good time to layer protections. This could look like wearing a mask at the grocery store or on the train this week, or improving indoor ventilation with fans or air purifiers. Rapid flu and COVID-19 tests are now available at many pharmacies, so testing early can help people get treatment sooner.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A and B are decreasing.

RSV

Nationally, RSV is decreasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A and B are decreasing in the Midwest.

RSV: RSV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A and B are decreasing in the Northeast.

RSV: RSV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A and B are decreasing in the West.

RSV: RSV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through March 14, 2026 (MMWR week 10).

The Bottom Line: We are still in the respiratory season. While Covid and flu A are declining, RSV and flu B remain high enough to matter—especially for older adults, pregnant women, infants, and people with weakened immune systems, who are all at higher risk of severe illness. For those groups, layering protections is still a good idea, whether that’s wearing a mask at the grocery store or on the train this week, or improving indoor ventilation with fans or air purifiers. Rapid flu and COVID tests are now available at many pharmacies, so testing early can help people get treatment sooner.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A is decreasing while influenza B continues to increase.

RSV

Nationally, RSV is increasing but likely at or near its peak.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A is decreasing in the South while influenza B is increasing.

RSV: RSV is increasing again in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A is holding steady in the Midwest, while influenza B is increasing.

RSV: RSV is slightly increasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is holding steady.

RSV: RSV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is decreasing in the West, while influenza B is holding steady.

RSV: RSV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through March 7, 2026 (MMWR week 9).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

The Bottom Line: The respiratory season is hanging on. Flu B and RSV are still increasing, both of which can cause significant illness, especially for older people, those who are immunocompromised, young infants, and those who are pregnant. While the season lingers, it’s still a good time to layer protections (like masking in indoor crowded spaces or increasing ventilation), and test early if symptoms start (there are now rapid tests for the flu you can buy at your local pharmacy).

National Outlook

COVID-19

Nationally, SARS-CoV-2 is fluctuating—it increased slightly, but is generally going down.

Influenza

Nationally, influenza A is decreasing while influenza B continues to increase.

RSV

Nationally, RSV is increasing again.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A and B are decreasing in the South.

RSV: RSV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is increasing in the Midwest.

Influenza: Influenza A is decreasing in the Midwest, while influenza B is increasing.

RSV: RSV is increasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is slightly increasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing.

RSV: RSV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is decreasing in the West, while influenza B is increasing.

RSV: RSV is increasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through February 28, 2026 (MMWR week 8).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

The Bottom Line: Flu B continues to grow while RSV is holding on, showing that we are still very much in the respiratory season. For those at higher risk for severe illness (young children, older adults, immunocompromised, etc.), it’s still a good time to continue layering protections (like masking in indoor crowded spaces or increasing ventilation), and test early if symptoms start (there are now rapid tests for the flu you can buy at your local pharmacy).

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing again.

Influenza

Nationally, influenza A is decreasing while influenza B continues to increase substantially.

RSV

Nationally, RSV is holding steady at elevated levels.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A is decreasing in the South, while influenza B is increasing substantially.

RSV: RSV is decreasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A is decreasing in the Midwest, while influenza B is increasing substantially.

RSV: RSV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing substantially.

RSV: RSV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is decreasing in the West, while influenza B is increasing.

RSV: RSV is decreasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through February 21, 2026 (MMWR week 7).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

As outbreaks spread like wildfire, health departments and clinicians across the country are rushing to rapidly identify cases, increase vaccinations, and put out the sparks that could ignite outbreaks.

With developments from Biobot and our partners last year, health practitioners have a new tool in their kits to rapidly detect and reduce the spread: wastewater monitoring for measles. Biobot searched for signals of measles across our national network of wastewater treatment plants in 2025. Here’s what we found and how our data was used to slow the spread of measles.

What We’re Seeing across Biobot’s Network

During our investigation period—August through November, 2025—we detected measles in 12 counties, representing over 5.5 million people. Detections were spread across 11 states, including locations in both urban metros and rural communities.

Our investigation found that:

• Measles was found in states with no reported cases. Not all states had known measles cases when wastewater detected the virus—highlighting gaps in case detection. In Hawaii, Biobot’s signal led the health department to issue public notices alerting clinicians and the public, as no recent measles cases had been identified.

• Detections were brief and isolated. In Biobot Network communities, measles signals were short-lived, suggesting they came from one or two community cases, rather than sustained transmission or an outbreak.

• Measles was not detected between spikes. Outside of these brief detections, measles was not found in wastewater—consistent with how rare it is in the general population.

This investigation illustrates a key point: despite measles’ low-level, sporadic presence in wastewater compared to endemic viruses like influenza or Covid-19, wastewater can pick up real signals when a rare or emerging virus is circulating.

Why Wastewater for Measles?

Measles is a highly contagious virus that typically spreads through respiratory droplets. Clinical surveillance (counting reported cases from clinics and labs) remains a key component of outbreak tracking. But clinical data only captures infections that get tested and reported, representing only the tip of the iceberg. Infections can be missed due to access barriers or healthcare seeking habits, mild illness, or delays in reporting.

Wastewater surveillance offers a complementary view, revealing more of the iceberg. Infected individuals shed virus in bodily fluids, including feces and urine. These viral signals, even for pathogens primarily transmitted via air and respiratory droplets (like measles), can accumulate in the sewer system and be measured.

Unlike something like bird flu (H5N1), measles does not have an animal reservoir, which means that wastewater detections are coming from humans. Additionally, Biobot’s assay is specific to the measles virus, and will not pick up the vaccine, so we can be sure that detections are from infections.

This makes wastewater a non‑invasive, community‑wide indicator, especially useful for detecting rare pathogens and early signals of spread, before clinical case counts climb.

Translating Signals Into Action

What do these wastewater detections mean?

1. Early warning signal: Wastewater detections can precede clinical trends, offering an early and independent signal that measles is present locally. This early information allows local communities to respond faster to get ahead of outbreaks.

2. Population‑level insight: Because wastewater represents contributions from thousands to millions of people, it’s a more efficient and cost-effective detection system than relying solely on individuals to present to clinics. Wastewater aggregates information from anyone using the bathroom, allowing for the detection of measles infections from people who may not ever visit a clinic or get tested.

3. Complementary to clinical data: Clinical reporting remains important for case counts and individual diagnosis and treatment. But wastewater becomes especially valuable when clinical testing lags, is limited by access or healthcare seeking behavior, or undercounts infections.

Looking Ahead

These community measles detections show that wastewater monitoring is a powerful complement to traditional health data systems—one that casts a wider net across populations and can help signal earlier when a virus reemerges or resurges.

By combining wastewater data with health campaigns, clinical testing, and community outreach, we can respond more quickly and efficiently to measles and other rising health threats.

Want to learn how wastewater monitoring can help protect your community?

Reach out to us today at hello@biobot.io or visit www.biobot.io to get started.

The Bottom Line: We are still in the respiratory virus season, and flu B is of biggest concern right now. If you’re at higher risk for severe illness (young children, older adults, immunocompromised, etc.) now is a good time to continue layering protections (like masking in indoor crowded spaces or increasing ventilation), and test early if symptoms start (there are now rapid tests for the flu you can buy at your local pharmacy).

National Outlook

COVID-19

Nationally, SARS-CoV-2 is increasing, mostly driven by increases in the Midwest.

Influenza

Nationally, influenza A is holding steady while influenza B is increasing substantially.

RSV

Nationally, RSV is increasing.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is slightly increasing in the South.

Influenza: Influenza A is decreasing in the South while influenza B is increasing substantially.

RSV: RSV is increasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is increasing in the Midwest.

Influenza: Influenza A is slightly increasing in the Midwest, while influenza B is increasing substantially.

RSV: RSV is increasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is holding steady in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing substantially.

RSV: RSV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is slightly increasing in the West, while influenza B is increasing substantially.

RSV: RSV is increasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through February 14, 2026 (MMWR week 6).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

Biobot’s national wastewater data show a mixed bag: COVID-19 is decreasing again nationwide and across all regions, and influenza A is also declining nationally. But influenza B is climbing substantially, while RSV has leveled off and is holding steady.

The Bottom Line: The respiratory virus season isn’t over. Keep an eye on your local trends, and consider layering protections (like masking in indoor crowded spaces or improving ventilation), especially if you’re at higher risk or spending time with someone who is.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is decreasing.

Influenza

Nationally, influenza A is decreasing while influenza B is increasing.

RSV

Nationally, RSV is holding steady.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is decreasing in the South.

Influenza: Influenza A is holding steady in the South while influenza B is increasing.

RSV: RSV is increasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is decreasing in the Midwest.

Influenza: Influenza A is decreasing in the Midwest, while influenza B is increasing.

RSV: RSV is decreasing in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing.

RSV: RSV is increasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is decreasing in the West, while influenza B is increasing.

RSV: RSV is increasing in the West.

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through February 7, 2026 (MMWR week 5).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

The Bottom Line: We’re still in the respiratory virus season. Keep an eye on your local trends and continue layering protections, especially if you’re at higher risk.

National Outlook

COVID-19

Nationally, SARS-CoV-2 is increasing.

Influenza

Nationally, influenza A is decreasing while influenza B is increasing.

RSV

Nationally, RSV is holding steady.

Regional Outlook

The South

COVID-19: SARS-CoV-2 is increasing in the South.

Influenza: Influenza A is holding steady in the South while influenza B is increasing.

RSV: RSV is increasing in the South.

The Midwest

COVID-19: SARS-CoV-2 is increasing in the Midwest.

Influenza: Influenza A is holding steady in the Midwest, while influenza B is increasing.

RSV: RSV is holding steady in the Midwest.

The Northeast

COVID-19: SARS-CoV-2 is decreasing in the Northeast.

Influenza: Influenza A is decreasing in the Northeast, while influenza B is increasing.

RSV: RSV is decreasing in the Northeast.

The West

COVID-19: SARS-CoV-2 is decreasing in the West.

Influenza: Influenza A is holding steady in the West, while influenza B is decreasing.

RSV: RSV is decreasing in the West.

Footnotes:

Wastewater data from Biobot Analytics for RSV, influenza, and SARS-CoV-2 are through January 31, 2026 (MMWR week 4).

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io

The Direct-To-Consumer (DTC) marketing team at a pharmaceutical company is seeking to optimize regional resource allocation in support of a national DTC advertising campaign for a product indicated to treat SARS-CoV-2

Respiratory viruses have a seasonal growth pattern when viewed at a national level but often exhibit asymmetry at the regional level.

The challenge:

The DTC Marketing team seeks to leverage wastewater data to deploy resources in areas where the respiratory virus will surge and engage more consumers seeking treatment information.

Business benefit:

By effectively allocating marketing funds to regions where the respiratory virus was indicated to surge in the near term, the team would optimize their advertising budget and increase effectiveness

Increase campaign effectiveness KPIs:

• Cost/click

• Click rate

• Number of consumers navigating to the product website

• Time spent on the product website

How was wastewater data used to achieve these goals?

First, the DTC Marketing team compared the wastewater data with known respiratory virus claims data and product prescription data at the national and regional levels. There was a high correlation between these data sources, with the wastewater data indicating increased claims and prescriptions.

Next, the team began using the wastewater data to effectively deploy drivers to the DTC campaign website in regions where virus levels were known to be surging. Various display advertisements, banner ads, and targeted e-mails were included in their marketing mix. The frequency of using these existing assets was increased or decreased throughout the US based on the indicated surge in certain regions (vs. non-surge areas).

Impact and Outcomes:

Wastewater data indicated regions of the country experiencing a surge in respiratory virus 2-4 weeks before spikes in diagnoses and hospitalizations. As outlined above, the DTC Marketing team allocated the budget to regions where the virus was predicted to increase.

As a result, the DTC Marketing team was able to reduce the cost/click by ~50% by increasing click rates by nearly ~100% vs prior months, meaning that they could either:

Reduce spend and still reach the desired numbers of their target audience (approximately $100K/month if the original ad spend was $200K/month)

-OR-

Redeploy the budget to regions with emerging respiratory viruses and increase the effectiveness of their DTC campaign.

The increase in the number of clicks to the DTC Marketing product website meant that more targeted consumers were navigating to it. These new consumers spent more time on the website, which represented a doubling in the amount of time spent on that product website compared to prior months.

To learn more about turning wastewater data into health action, contact us at hello@biobot.io or visit www.biobot.io