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  • COVID Nimbus Variant Now Leads the U.S. as Cases Grow in 27 States and Emergency Visits Rise

    COVID Nimbus Variant Now Leads the U.S. as Cases Grow in 27 States and Emergency Visits Rise

    A Summer Wave Is Taking Shape

    COVID-19 has not gone away. A new subvariant has taken over as the dominant circulating strain in the United States, emergency department visits are rising across all age groups, and federal epidemic models now show infections growing or likely growing in at least 27 states as of mid-July 2026.

    The variant, known as NB.1.8.1 and informally called “Nimbus,” accounted for an estimated 43% of sequenced COVID cases in the U.S. during the two-week period ending late June 2026, according to CDC genomic surveillance data, surpassing all other circulating strains to become the dominant U.S. lineage. It is a descendant of the JN.1 Omicron lineage, first detected globally in early 2025 and identified in the United States through airport screening programs in March 2026.

    This variant drove earlier surges in China, Singapore, and parts of Southeast Asia before establishing itself in the U.S. — a pattern that health officials have been watching as a leading indicator of domestic wave dynamics.

    Why This Matters

    For most healthy, vaccinated adults, the Nimbus variant appears to cause illness consistent with other recent Omicron descendants: upper respiratory symptoms, sore throat, fatigue, and fever. WHO and CDC have not found evidence of vaccine escape sufficient to cause widespread serious illness in vaccinated populations. It does not appear to cause a higher rate of severe illness, hospitalization, or death compared to LP.8.1 and other recent Omicron strains.

    But transmissibility — not just severity — drives surge dynamics. In Singapore, NB.1.8.1 spread at approximately 60% weekly growth rates before becoming dominant, and a variant capable of infecting large numbers of people simultaneously always poses an elevated risk to those who are most vulnerable: older adults, immunocompromised people, and those who have not updated their COVID vaccination.

    Rising emergency department visits are now visible across all age groups — a pattern that appeared before national clinical case counts reflected the underlying trend, consistent with how COVID summer waves have developed in prior years.

    What We Know So Far

    CDC forecasting models as of July 15, 2026 estimate that COVID infections are currently growing or likely growing in at least 27 states, based on the most recent epidemiological trend modeling.

    As of July 12, 2026, COVID test positivity nationally stood at 4.8%, up 1.1% from the previous week. Emergency department visits are also rising across all age groups, according to the CDC’s respiratory illness surveillance data.

    Nine states are currently reporting moderate to very high COVID viral levels in wastewater: California, Florida, Hawaii, Idaho, Louisiana, Nevada, Oregon, South Carolina, and Texas. Wastewater surveillance detects COVID viral particles in sewage before those infections show up in clinical test counts or hospital admissions — typically providing one to two weeks of early warning of rising community transmission.

    WastewaterSCAN, which independently monitors diseases through municipal wastewater systems, reported national COVID levels in the “high” category as of its most recent available data — a more aggressive characterization than the CDC’s current “low” national wastewater reading, reflecting different measurement methodologies.

    Where the Risk Is Highest

    The geographic pattern of elevated wastewater activity — concentrated in the South and West — is consistent with the CDC’s 2026 Summer Outlook, which identified these regions as most likely to see early COVID activity this summer, citing lower recent immunity in populations that had limited COVID exposure last winter.

    Among the states with current high or very high wastewater activity, the most populous are California, Florida, and Texas — states whose combined populations exceed 90 million people. Louisiana and South Carolina, also on the elevated list, have historically had higher rates of chronic conditions that increase COVID severity risk.

    Nimbus has been detected in sequences across multiple U.S. states, with a wide geographic spread already established. The CDC has not published a detailed regional breakdown of variant proportions due to current limitations in sequencing coverage, but the 27-state growth model reflects national-level epidemiological trends.

    What Experts Say

    The Nimbus variant first demonstrated its capacity for rapid spread in Asia, where it drove surges in China, Singapore, and parts of Southeast Asia before being identified in the U.S. through airport monitoring. The pattern from those earlier waves — high transmissibility, widespread community spread, manageable severity in vaccinated populations, but significant risk for the immunocompromised and unvaccinated — is what U.S. health officials are using to calibrate their summer expectations.

    The CDC’s 2026 Summer Outlook identified the South and West as the most likely regions for early summer COVID activity. The current wastewater data is confirming that pattern. Health officials are urging high-risk individuals to verify their vaccination status before exposure opportunities increase with summer travel and large indoor gatherings.

    The current 2025–2026 updated COVID vaccines target the LP.8.1 variant. Health authorities are monitoring whether an NB.1.8.1-specific update to the vaccine formulation will be needed for the fall 2026 vaccine cycle, though no announcement on that question has been made as of mid-July 2026.

    What the Evidence Shows and What It Does Not

    MedicalDaily Evidence Check

    • Variant proportion data: 43% of sequenced cases attributed to NB.1.8.1 as of late June 2026. The CDC notes that its precision in variant proportion reporting is currently “low” due to limited sequencing data; the exact proportion may shift as more samples are processed. The dominant status of the variant is well-established.
    • Severity: Available data from WHO, ECDC, and U.S. surveillance do not show increased severe disease, hospitalization rates, or case fatality compared to recent prior variants. This may change as the wave develops and more clinical data accumulates.
    • Vaccine protection: Current vaccines are expected to retain meaningful protection against severe illness and hospitalization, though their effectiveness against infection with NB.1.8.1 specifically is still being assessed.
    • What is not yet known: U.S.-specific clinical severity data for NB.1.8.1 is still accumulating. The peak of the current wave has not yet been reached in most affected states.

    Who Faces the Greatest Risk?

    COVID continues to cause serious illness and death primarily in specific vulnerable populations:

    • Adults 65 and older, who account for a disproportionate share of COVID hospitalizations and deaths in every recent wave
    • People who are immunocompromised — including those receiving cancer chemotherapy, organ transplant recipients, people with HIV, and those on biologics or corticosteroids
    • People who have not received an updated COVID vaccine in the past year
    • Individuals with multiple chronic conditions — particularly heart disease, diabetes, chronic kidney disease, and obesity
    • Pregnant people, who face elevated risk from respiratory infections
    • People in high-density settings — nursing facilities, group homes, correctional facilities — where transmission risk is amplified

    For younger, healthy, vaccinated adults, the current evidence suggests the Nimbus variant causes illness that is unpleasant but rarely severe.

    Symptoms and Warning Signs to Watch For

    Nimbus appears to cause symptoms consistent with other recent Omicron subvariants. Some patients have reported a more pronounced sore throat — described in some accounts as a “razor blade” sensation — as a notable early symptom. Other common presentations include:

    • Sore throat and upper respiratory congestion
    • Fatigue and body aches
    • Fever or chills
    • Headache
    • Runny nose or cough

    Symptoms that warrant prompt medical attention, particularly in high-risk individuals:

    • Shortness of breath or difficulty breathing
    • Persistent chest pain or pressure
    • Confusion or inability to stay awake
    • Bluish lips or face
    • Oxygen saturation below 94% if monitored at home

    What You Can Do Now

    • Check whether you are up to date on your COVID vaccination. The 2025–2026 updated vaccine is available at most pharmacies and health department clinics, many at no cost. Use vaccines.gov to find a location near you.
    • If you are immunocompromised or in a high-risk category, ask your provider whether you qualify for COVID pre-exposure prophylaxis or treatment options like Paxlovid, should you test positive.
    • Use a high-quality mask — N95 or KN95 — in crowded indoor settings if you are at high risk, particularly in airports, public transit, or large indoor gatherings.
    • If you test positive, isolate to protect others and contact your provider immediately if you are in a high-risk category to discuss whether antiviral treatment is appropriate. Paxlovid is most effective when started within five days of symptom onset.
    • Monitor CDC COVID Data Tracker and your state health department for updated local wastewater and clinical trend data.

    Cost and Access: What Patients Should Know

    Updated COVID vaccines are available at no cost at most pharmacy chains — including CVS, Walgreens, Rite Aid, and Walmart pharmacy — for people with Medicare, Medicaid, or private insurance. For uninsured patients, the CDC’s Bridge Access Program and state vaccination programs provide vaccines at no out-of-pocket cost at participating locations.

    Paxlovid, the antiviral treatment for COVID-19, requires a prescription. It is covered under most insurance plans for eligible patients with COVID-19 who are at high risk of severe illness. Patients without insurance can ask their provider or pharmacist about the Pfizer patient assistance program.

    At-home COVID tests remain available at pharmacies and continue to detect the Nimbus variant, though their sensitivity may be lower early in infection than at 48 to 72 hours after symptom onset.

    What Happens Next

    The summer COVID wave is expected to develop through July and into August in the states currently showing elevated wastewater signals. The CDC updates its COVID epidemic trend forecasts weekly; MedicalDaily will report on significant changes in wave dynamics, vaccination guidance, or variant severity data as they emerge.

    The WHO and FDA are monitoring whether the fall 2026 COVID vaccine formulation should target NB.1.8.1 or a newer variant; decisions on the fall vaccine strain typically come in late summer.

    The Bottom Line

    The Nimbus variant has made COVID the dominant public health story of midsummer 2026, with infections growing in 27 states and ER visits rising nationally. For most vaccinated, healthy adults, this wave is likely to produce an uncomfortable but manageable illness. For older adults, immunocompromised people, and those without updated vaccinations, this summer presents a genuine and preventable risk. Get vaccinated, monitor your local wastewater data, and know how to access antiviral treatment quickly if you are in a high-risk group.

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  • States Have Until October 2027 to Fix SNAP Error Rates, with Reviews That Could Trigger Penalties Already Underway

    States Have Until October 2027 to Fix SNAP Error Rates, with Reviews That Could Trigger Penalties Already Underway

    For the first time in the more than 50-year history of the Supplemental Nutrition Assistance Program, states are now financially on the hook for how accurately they manage food benefit payments, and the data being collected right now will determine how much they owe.

    The USDA released its annual SNAP payment error rate report on June 24, 2026, revealing a national average error rate of 10.62 percent for fiscal year 2025 — far above the 6 percent threshold that the One Big Beautiful Bill Act (OBBBA) set as the trigger for financial penalties. Beginning October 1, 2027, states with error rates at or above that threshold will be required to cover a portion of their own SNAP benefit costs — from 5 percent for states with rates between 6 and 8 percent, to 15 percent for states above 10 percent.

    Only nine states had payment error rates below 6 percent in fiscal year 2025, allowing them to avoid the new cost-sharing requirement. The remaining 41 states and the District of Columbia face financial consequences unless they reduce their error rates before the penalty calculation is finalized.

    Critically, states can choose to use either their fiscal year 2025 or fiscal year 2026 error rate — whichever is lower — to calculate what they owe. That means the data being generated right now, through the end of fiscal year 2026 in September 2026, still matters. States that act aggressively in the next several months to reduce errors may be able to lower their financial exposure.

    Why This Matters

    SNAP — the Supplemental Nutrition Assistance Program — provides grocery assistance to approximately 42 million Americans, including children, elderly adults, people with disabilities, and low-income working families. For the entirety of its history, SNAP benefits have been paid entirely by the federal government. The OBBBA ended that guarantee.

    The practical consequences are large. Using fiscal year 2025 error rates, the Center on Budget and Policy Priorities estimates states collectively could owe roughly $9 billion in SNAP cost-sharing. For individual states with already-strained budgets — many of which are also absorbing Medicaid cost shifts from the same legislation — the new SNAP obligations arrive at a particularly difficult fiscal moment.

    The accountability logic behind the policy is straightforward: states that miscalculate eligibility or benefit amounts generate either overpayments (giving recipients more than they should receive) or underpayments (giving them less). SNAP payment error rates measure how often and by how much those miscalculations occur. But advocacy groups and many state officials note that error rates are not a measure of fraud — they reflect administrative and systems errors, many of which occur when complex federal and state rules interact with limited state administrative capacity.

    What We Know So Far

    The USDA’s June 24 release established the FY 2025 error rate as the first benchmark that will be used to calculate potential cost-sharing obligations. Under the law, states may elect to use either the FY 2025 or FY 2026 error rate — whichever produces a lower obligation.

    The penalty structure, as described by Grocery Dive and confirmed by the USDA press release:

    • States with error rates between 6% and 8%: responsible for 5% of their SNAP benefit costs
    • States with error rates between 8% and 10%: responsible for 10%
    • States with error rates above 10%: responsible for 15%

    One important carve-out: states with error rates above 13.32 percent in FY 2025 qualify for a two-year delay in the cost-sharing requirement. Alaska (23.15%), Oregon (14.14%), Illinois (14.67%), Georgia (15.21%), Delaware (16%), and New Mexico (16.81%), as well as the District of Columbia (18.66%), qualify for this delay— meaning they will not face penalties until fiscal year 2030.

    Perversely, this created an incentive problem. Maryland dropped its error rate from 13.64 to 13.08 percent — an improvement — but in doing so, fell just below the 13.33 percent threshold that would have qualified it for the two-year delay. The states that made less progress are being shielded from near-term consequences, while Maryland faces an earlier and larger financial burden for having improved.

    Where the Impact Is Highest

    Maryland’s situation is among the most closely watched. State analysts project Maryland could be on the hook for at least $240 million just for the new cost-sharing requirements in fiscal year 2027, with more exposure expected in subsequent years from other OBBBA provisions. The state’s current error rate of 13.08 percent places it in the 15 percent cost-sharing tier — the maximum penalty level.

    Maryland’s Acting Secretary for Human Services Stacy L. Rodgers told Maryland Matters that the agency is “laser-focused” on bringing the error rate down and that the notion of qualifying for a delay by maintaining a high error rate has not been the agenda. But she acknowledged that FY 2026 data will not be released until June 2027 — months after the Maryland General Assembly finalizes the state budget — creating a structural planning problem.

    Oklahoma’s situation illustrates the scale in other states: with an error rate of 11.04 percent, Oklahoma projects it could owe approximately $250 million in SNAP benefit costs. California, at a lower 5 percent bracket, is projected to face over $627 million in additional spending.

    Some states are acting quickly. Arkansas is investing in AI tools to improve eligibility systems and has allocated $5 million in its FY 2027 budget to the state inspector general’s office to detect vulnerabilities. Minnesota allocated $90 million to replace 35-year-old county software used for SNAP processing. These technology investments may reduce error rates before the penalty-determining data closes.

    What Officials and Experts Say

    Agriculture Secretary Brooke Rollins, in announcing the FY 2025 data, said the payment error rates are further proof that state accountability is severely lacking in SNAP, and urged other states to prioritize needy families and the American taxpayer over politics.

    Maryland’s Stacy Rodgers offered a sharply different framing. She told WYPR that Maryland has led the nation in reducing its error rate over the past three years — from 35.56 percent in fiscal year 2022 to 13.08 percent today — but is still being penalized for a rate that remains above the threshold. She said there was simply no runway for states to drive the error rate down to 6 percent given the structural complexity of SNAP administration.

    Carolyn Vega, associate director of policy analysis for No Kid Hungry, told Maryland Matters the penalty structure creates a “really perverse incentive” — a state has almost an incentive to do worse, since dropping below 13.33 percent removes the protection of the two-year delay.

    Brookings Institution researchers warned that the combination of SNAP benefit cost-shifting, Medicaid reductions, and other OBBBA provisions could lead some states to drop out of the SNAP program entirely — an outcome that would eliminate food assistance for all participants in those states. Analysts across the political spectrum have described this as the single most significant structural change to SNAP in the program’s history.

    What the Evidence Shows and What It Does Not

    MedicalDaily Policy Check

    • Policy source: One Big Beautiful Bill Act (OBBBA), signed July 4, 2025
    • USDA data release: FY 2025 SNAP payment error rates, June 24, 2026
    • National average FY 2025 error rate: 10.62%
    • Total FY 2025 improper payments: $10.1 billion (per USDA)
    • Cost-sharing effective date: October 1, 2027 (federal fiscal year 2028)
    • States below 6% (exempt): 9 states
    • States with delay (above 13.32%): Alaska, Oregon, Illinois, Georgia, Delaware, New Mexico, DC — delay until FY 2030
    • Key option: States may choose FY 2025 or FY 2026 error rate, whichever produces a lower obligation — FY 2026 data collection is ongoing through September 2026
    • What this policy does not constitute: A measure of SNAP fraud — error rates measure administrative accuracy, including both overpayments and underpayments, often caused by eligibility or calculation mistakes

    Who Is Most Affected?

    The financial impact of the new SNAP cost-sharing rules will fall on several groups:

    • State SNAP administrators and human services agencies, who must reduce error rates under extreme time pressure with limited resources
    • State legislators and budget directors, who must now plan for large new obligations that were not anticipated in recent state budgets
    • Advocacy organizations that serve SNAP recipients, who are concerned that states facing financial pressure may tighten eligibility or create bureaucratic barriers to enrollment
    • SNAP recipients themselves — particularly in states where budget pressure from SNAP cost-sharing leads to service reductions, staffing cuts, or changes to how applications and renewals are processed
    • Residents of states with the highest error rates: Maryland (13.08%), Hawaii (10.92%), Oklahoma (11.04%), and many others where the cost-sharing obligation will be highest

    What You Can Do Now

    • If you receive SNAP benefits, respond promptly to any renewal requests, verification requests, or correspondence from your state’s human services agency. Delayed or incomplete responses are a common source of administrative errors that inflate error rates and may affect your own benefit accuracy.
    • If you are a state resident concerned about SNAP funding in your state, contact your state legislators — particularly those on budget and human services committees — to ask how the state is planning to manage new cost-sharing obligations.
    • Advocacy organizations tracking this issue include the Food Research and Action Center, the Center on Budget and Policy Priorities, and No Kid Hungry. All publish state-specific data and advocacy resources.
    • If your state has announced changes to SNAP administration or access in response to budget pressure, contact the USDA’s Food and Nutrition Service or a legal aid organization if you believe your SNAP benefits have been incorrectly reduced or terminated.

    Cost and Access: What Families Should Know

    SNAP error rates measure administrative accuracy — not whether eligible families are being helped. But the financial consequences of this policy will inevitably affect how states administer the program. States may respond by hiring more caseworkers, investing in technology, tightening verification processes, or — advocates fear — creating administrative barriers that make it harder for eligible families to receive benefits.

    If you believe you are eligible for SNAP and have been denied or had benefits reduced, you have the right to request a fair hearing through your state’s human services agency. The USDA’s Food and Nutrition Service maintains state-level contact information and complaint procedures. For families in financial crisis, local food banks remain a parallel resource — find one near you at feedingamerica.org.

    What Happens Next

    FY 2026 error rate data — the second data point states can use to calculate their obligation — will not be released until June 2027. That timing creates a difficult planning window: states will not know their final FY 2026 number until after most state legislatures have finalized their fiscal year 2027 budgets.

    Maryland’s Stacy Rodgers is banking on the National Governors Association successfully lobbying Congress to delay the penalty deadline. That lobbying effort is ongoing. Some states are filing Corrective Action Plans with USDA as required for states above the 6 percent threshold. The outcome of those plans and any Congressional action on the deadline will significantly shape how this policy ultimately affects both state budgets and SNAP recipients.

    MedicalDaily will continue tracking state error rate developments, Congressional responses, and the downstream effects on SNAP access as the October 2027 implementation date approaches.

    The Bottom Line

    The USDA’s FY 2025 SNAP error rate data revealed that 41 states and the District of Columbia exceed the threshold that will trigger financial penalties starting October 2027 — a deadline that is 15 months away. For Maryland, the potential liability exceeds $240 million. For California, it exceeds $627 million. For Oklahoma, it approaches $250 million. The data being collected right now — through September 2026 — will shape those final numbers. States that invest in better eligibility systems, caseworker capacity, and technology in the next several months may reduce their exposure. Those that do not may find themselves choosing between cutting other services, raising taxes, or creating barriers that effectively push eligible families off SNAP assistance.

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  • Lyme Disease Is Spreading into States That Rarely Saw It Before — Is Your County at Risk?

    Lyme Disease Is Spreading into States That Rarely Saw It Before — Is Your County at Risk?

    Lyme disease was once thought of as a problem concentrated in the Northeast and a few Midwest states. That geographic assumption is no longer accurate. Deer ticks — the primary carrier of the Lyme disease bacterium — are now establishing themselves in Ohio, Indiana, Illinois, and Michigan, areas where they were rarely found just a generation ago.

    Emergency department visits for tick bites were up more than 25 percent in April 2026 compared to April 2025, according to CDC data cited at a Johns Hopkins Bloomberg School of Public Health media briefing on May 5, 2026. Researchers called it an early signal of what could be a challenging year ahead.

    Why This Matters

    Lyme disease is the most common vector-borne illness in the United States, and it is underreported by a wide margin. State health departments reported more than 89,000 confirmed cases to the CDC in 2023 — the most recent year for which national data were published, but researchers estimate the true number is closer to half a million annually, largely because of misdiagnosis and underreporting in areas where the disease is newly arriving.

    For residents of expanding-risk states, this matters in a very practical way: your doctor, your local emergency room, and even the diagnostic tests used to confirm Lyme disease may not be calibrated to a disease that was once considered rare in your area. Early Lyme disease is treatable with antibiotics, but a delayed diagnosis can lead to more serious complications, including neurological and cardiac involvement.

    What We Know So Far

    The Companion Animal Parasite Council’s 2026 annual forecast — which tracks tick populations and disease risk — identifies Ohio, Kentucky, West Virginia, Tennessee, North Carolina, Indiana, Illinois, and Michigan as projected areas of significant Lyme disease expansion. The forecasts have historically been 94 percent accurate when compared to actual diagnostic results.

    The Upper Midwest and Northeast remain the highest-risk regions overall, with Minnesota, Wisconsin, Pennsylvania, New York, New Jersey, and Connecticut continuing to account for the largest share of confirmed cases. But the expansion is moving steadily south and west.

    According to Contagion Live, Dr. Elitza Theel, a Mayo Clinic infectious disease microbiologist, noted that “these cases have progressively spread into more Midwest states, such as Ohio, Pennsylvania, Indiana, and Illinois,” and attributed the spread to both tick range expansion and the proliferation of environmental reservoirs — particularly white-footed mice and deer.

    Where the Risk Is Highest

    Pennsylvania remains among the highest-burden states in the nation for both Lyme disease and related tick-borne conditions. The state is also now formally tracking cases of alpha-gal syndrome — a rare red meat allergy triggered by tick bites from the lone star tick — adding another dimension to tick-related health risk.

    Within the broader risk map, the CAPC forecast projects that some of the greatest expansions in Lyme disease risk in 2026 will occur in Ohio, Kentucky, West Virginia, and parts of Tennessee and North Carolina — states that until recently saw very few cases. Iowa is also identified as a higher-than-normal risk area, particularly in the southeastern part of the state, due to forested river corridors along the Mississippi and Iowa rivers.

    In Indiana, blacklegged ticks have now been found in almost every county, according to Purdue University’s Medical Entomology program. The tick was first discovered in the state of northwestern Indiana in 1987 and has since expanded rapidly.

    What Doctors and Experts Say

    Dr. Thomas Hart, an infectious disease microbiologist at the Johns Hopkins Bloomberg School of Public Health’s Lyme and Tick-Borne Diseases Research and Education Institute, explained the environmental drivers at the May 2026 briefing: “This increase in tick populations is going to be caused primarily by climate change. Warmer, milder winters are great for ticks to survive to the next year without freezing. And it also helps the animals that the ticks feed on — deer and mice — survive at greater populations.”

    Dr. Nicole Baumgarth, a Bloomberg Distinguished Professor at Johns Hopkins, noted that suburban expansion into wooded areas is another key contributor: human activity is increasingly bringing people into contact with tick habitat that was previously less accessible.

    What the Evidence Shows — and What It Does Not

    Researchers at Johns Hopkins have noted a well-documented challenge that comes with geographic expansion: diagnostic gaps. Lyme disease is confirmed using a blood test that detects antibodies, but antibodies may take several weeks to develop after infection. A test done too early can come back negative even in an infected patient.

    This limitation matters more in newly expanding regions, where physicians are less accustomed to suspecting Lyme as a diagnosis, and patients are less likely to report a tick bite as a relevant medical history item.

    Established science shows that early Lyme disease, caught within days to a few weeks of a tick bite, responds well to oral antibiotics. Later-stage disease — which can involve the joints, heart, and nervous system — requires more intensive treatment and may have lingering symptoms even after treatment is complete.

    Who Faces the Greatest Risk?

    People most at risk for Lyme disease in 2026 include:

    • Outdoor workers in landscaping, forestry, agriculture, and construction in the Northeast and expanding Midwest
    • Hikers, campers, hunters, and people who spend time in wooded or grassy areas
    • Children between 5 and 15 years old, who show consistently higher case rates in national surveillance
    • Adults between 45 and 55, the other age group with elevated case rates
    • Residents of newly endemic counties in Ohio, Indiana, Illinois, and Michigan who may not recognize tick exposure as a health concern
    • Pet owners whose dogs spend time outdoors and can carry ticks into the home

    Symptoms and Warning Signs to Watch For

    Early Lyme disease — within the first three to 30 days after a tick bite — may cause:

    • A bull’s-eye rash (erythema migrans) at the bite site, though this rash does not appear in all cases
    • Fever, chills, and fatigue
    • Muscle and joint aches
    • Headache
    • Swollen lymph nodes

    Later symptoms, if the infection goes untreated, may include severe joint pain and swelling, neurological problems such as facial palsy or numbness, heart rhythm irregularities, and cognitive difficulties.

    Contact a health care provider promptly if you find an attached tick, develop a rash near a bite site, or experience fever and fatigue following outdoor activity in a tick-prone area.

    What You Can Do Now

    • Use EPA-registered insect repellents with DEET (20–30 percent), picaridin, or IR3535 on exposed skin when outdoors in wooded or grassy areas.
    • Wear long sleeves and pants, and tuck pants into socks when hiking in tick habitat.
    • Perform a full-body tick check — including scalp, behind the ears, under the arms, and between the legs — after any outdoor activity.
    • Remove attached ticks promptly using fine-tipped tweezers, pulling upward with steady pressure. Do not twist or crush the tick.
    • Shower within two hours of coming indoors after outdoor activity.
    • Talk to your veterinarian about tick prevention for dogs, which can also bring ticks into your home.
    • If you find an attached tick or develop symptoms after potential exposure, contact a clinician. Do not wait for the rash — not everyone with Lyme disease develops the classic bull’s-eye pattern.

    Cost and Access: What Patients Should Know

    Standard Lyme disease testing is typically covered by health insurance, though the two-step testing protocol may require a laboratory order and follow-up confirmatory testing. Patients in newly expanding areas who suspect tick exposure should be specific with their health care provider about their outdoor activities and location.

    In areas with limited primary care access, telehealth can be a practical option for initial evaluation and a discussion of whether testing and empiric treatment are warranted. Oral antibiotics such as doxycycline, amoxicillin, and cefuroxime are effective for early Lyme disease and are widely available and relatively low-cost in generic form.

    What Happens Next

    The 2026 tick season is expected to remain active through October in most of the affected region. Researchers at Johns Hopkins are continuing work on Lyme disease diagnostics and are monitoring a pipeline of Lyme vaccines, though none is currently approved for human use in the United States. Updated CDC case data for 2024 are expected to be published later in 2026 and may confirm the geographic expansion already visible in tick surveillance data.

    The Bottom Line

    Lyme disease is no longer confined to the Northeast. If you live in Ohio, Indiana, Illinois, Michigan, or other expanding-risk areas, the risk of tick exposure in 2026 is meaningfully higher than it was just a few years ago. The best protection is simple and well-established: repellent, protective clothing, prompt tick checks, and early medical attention if you develop symptoms after possible tick exposure. Do not wait for the classic bull’s-eye rash, which is absent in a meaningful share of cases.

    References

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