Marco's Morning Report — Tuesday, July 7, 2026

2026 Surviving Sepsis Campaign guidelines are out — and older adults get a lower MAP target

The SCCM/ESICM 2026 update landed: 129 statements, 46 of them brand new, building on the 2021 edition. The headline for your patient population — in septic shock adults aged 65 and older, an initial MAP target of 60–65 mm Hg is now suggested over higher targets, backed by a meta-analysis showing lower mortality (RR 0.89, high certainty). Other new ground: antibiotic optimization, fluid removal after resuscitation, and — notably — post-discharge continuity including physical and psychological rehab.

Why it matters: most of your inpatients are exactly the 65+ cohort this recommendation carves out. If your order sets and nursing titration protocols default everyone to ≥65 mm Hg, that's now out of step with the evidence for your typical admit.

Talking point / action: flag the ≥65-year MAP target for your next sepsis order-set review, and mention the post-discharge rehab language to case management — it dovetails with transitions-of-care work. SCCM guideline · summary

Cuba

Cuba hits its third nationwide blackout of the year

The island's grid collapsed again Monday — the third total blackout since January — as fuel reserves dwindle. State grid operator UNE said it could serve barely 1% of Havana's demand by late afternoon, protecting only hospitals and food-production centers. Officials tie it to the fuel squeeze that deepened after Venezuelan oil deliveries were cut off in January; Díaz-Canel accused Washington of trying to "incite social unrest."

Why it matters: family-relevant, and the humanitarian angle keeps sharpening — hospitals running on protected-but-thin power is the kind of detail that lands at the dinner table.

Reported here via Al Jazeera (mainstream, your preferred source for the region). Al Jazeera

The Debate

One live argument, both sides steelmanned. No verdict.

Should Florida sharply cut homestead property taxes?

Why it's live: HJR 1F cleared a June special session and now heads to voters on the Nov. 3 ballot (needs 60%). It would raise the homestead exemption to $150K in 2027 and $250K in 2028 — but not for school levies. A new poll shows 64% support with a sharp partisan split, and DeSantis pointedly said Monday he'll vote yes but "what the Legislature did wasn't my proposal."

For

Homeowners have watched assessments and bills climb for years while incomes haven't kept pace; a bigger homestead exemption is overdue, direct relief that lets families keep more of their own money. Backers — Gov. DeSantis and the Republican legislative majority that passed it — note the measure was written to shield funding for law enforcement, fire, and other essential services, and argue Florida's budget surpluses can absorb it.

DeSantis on the ballot measure (CBS Miami)

Against

It's a cost shift, not a savings. Sadaf Knight, CEO of the Florida Policy Institute, argues the lost revenue — pegged near $5B in year one, growing to ~$11.9B by 2031-32 — forces local governments to cut services families rely on or raise other taxes and fees to backfill. Critics add it tilts power toward Tallahassee and away from local budget control.

Florida Policy Institute analysis

Where it might land: voters decide Nov. 3, 2026; 60% threshold is the bar to clear.

On My Radar

Noteworthy, not urgent.

Mets — deadline sellers, and Bichette's the puzzle. At 37-53 (16 back in the East), Stearns is selling before Aug. 3. Rentals Peralta (ERA up to 4.81), Holmes, Raley, Minter draw interest; Lindor and Soto untouchable. Bo Bichette's an "only if he signals an opt-out" case. amNewYork · MLBTR outlook

Hospitalist AI adoption is outrunning training. SHM's 2026 Workforce Experience Report: 64% of hospitalists now use AI and 73% of those report benefits — but only about a third say they've had adequate training. SHM

Puerto Rico — FY2027 budget begins, growth flatlines. The new fiscal year started July 1; the Planning Board is holding its slowdown forecast (~0% GNP for 2026), and proposed LUMA/PREPA rate hikes would raise the cost of doing business. El Nuevo Día

Iran — Khamenei funeral winds down; successor still unseen. The multi-day state funeral concluded, but new supreme leader Mojtaba Khamenei still hasn't appeared publicly, reportedly recovering from injuries. No fresh escalation today. TIME

Golf tech — the mid-2026 launch-monitor field. Worth a look if you're upgrading: FlightScope Mevo Gen2 (no subscription, sim-ready), Rapsodo MLM2Pro (radar + dual camera, 15 metrics), Garmin Approach G82 (GPS + launch monitor crossover), and Voice Caddie SC4 Pro (reads numbers aloud so you watch ball flight, not your phone). Golf Monthly roundup

Trends to Watch

Signals, not headlines.

"Less is more" hemodynamics in the elderly. The lower MAP target for 65+ septic shock, plus the new emphasis on de-resuscitation (fluid removal) and post-discharge rehab, all point the same direction: gentler, more individualized targets for older patients rather than one-size-fits-all resuscitation.

AI in the wards is now mainstream — governance isn't. With two-thirds of hospitalists using AI but only a third trained, the gap between adoption and oversight is the story to watch; expect institutional policies and documentation-tool credentialing to catch up.

A full Mets reset. If the rentals move, the roster that comes out of Aug. 3 looks meaningfully different — worth tracking which prospects come back, not just who leaves.

Ideas & Opportunities

Small, actionable.

Queue up the sepsis order-set review. Bring the 2026 SSC ≥65-year MAP target to your group — it's a concrete, low-friction change with a mortality signal behind it.

For the couch: The Pitt Season 2 is back and critics are calling it a near-perfect medical procedural (you'll either love or hate how close to home it hits); The Vampire Lestat is the buzzy prestige swing; and Man on the Run, the Paul McCartney doc, is a warm one-nighter. RT best new TV

Golf demo idea: if you want home-practice numbers without a subscription, the FlightScope Mevo Gen2 is the value pick this year — worth a demo before you spend on a driver.

Background / Already Covered

Older items & things covered earlier this week

Cuba's fuel-blockade health crisis — the deeper backstory to today's blackout (hospitals, harvests, health system under strain) has been building for weeks; today's item is the newest data point.
ACA enhanced premium tax credits — the expiration debate (premiums up ~114% on average, enrollment projected to fall) was this week's debate on July 5; no new congressional action to report today.
Iran war aftermath — the ceasefire/Doha-talks thread and the succession question have run all week; today is a continuation, not a new development.
Medicaid work requirements & frailty exemption — covered July 6; multi-state litigation ongoing.