Marco's Morning Report — Monday, August 10, 2026

Morning, Marco. Monday, so the journals wake back up tomorrow — today's news is mostly weekend accumulation. Three things moved: Puerto Rico is now several days into scheduled water shutoffs and the mood has turned, the Pentagon is quietly looking for a way out of the Iran fight, and the VA is about to run the biggest test yet of semaglutide for alcohol use disorder. Nothing here needs a decision from you. Coffee, seven minutes, then sleep.

ATop Stories

Update: Puerto Rico's rationing is no longer a plan on a website — it's people waking up with dry taps

The 48-hours-on / 48-hours-off schedule that started Friday is now in its second full cycle, covering more than 180,000 AAA customers across San Juan plus Carolina, Juncos, Gurabo, Trujillo Alto, Canóvanas and Loíza. The driver is stark: July was the driest month San Juan has recorded in more than 120 years and its fourth hottest; roughly a quarter of the island is in severe drought and another 36% in moderate. AAA is trucking water with priority to hospitals and long-term care facilities, and telling residents to boil for three full minutes once service returns, because pressure loss in old distribution lines invites contamination. Rationing runs at least through the end of August, and officials have floated stretching the cycle to 72 hours if Carraízo keeps dropping. The NPR piece from Sunday is the one to read — the anger is now the story, not the drought.

Why it matters — Two reasons. Family first: if you're calling the island this week, the schedule matters more than the weather. Clinically, this is the setup for a predictable downstream pattern — boil advisories after pressure loss produce GI illness clusters, and elderly people ration their own intake when they're rationing storage, which shows up in an ED three days later as an AKI with a bland sediment.

Talking point — Worth knowing that a U.S. jurisdiction is prioritizing hospital water delivery by truck in 2026. If your group ever revisits its own utility-failure contingency, this is the live case study.

Update: The chairman of the Joint Chiefs is privately pushing for an off-ramp on Iran — while the Houthis hit a Saudi refinery

Sources told CNN on Sunday that the chairman of the Joint Chiefs has made clear internally that the U.S. needs a way out, because the remaining escalation options could backfire. Meanwhile Houthi forces claimed a strike on Saudi Aramco's Jazan refinery on the Red Sea coast, and the Pentagon sent a memo to defense contractors — the war's industrial tail is lengthening. On the diplomatic track, Vice President Vance told Fox News the U.S. goal is to "maximize" oil and gas moving through Hormuz, but the IRGC said Friday that reopening the strait is not governed by the Oman deal at all — Tehran's list now includes ending the naval blockade of Iranian ports, withdrawing forces, and permanently ending the war.

Why it matters — The route through the strait was agreed more than a week ago and the strait is still shut. That gap is the whole story: the technical negotiation and the political one have come apart, which is why "close to a deal" has now been true for eight days running.

Watch for — A joint statement out of Muscat. Until there's a signed document, treat the reopening headlines as forecasts.

The VA is about to run the largest trial yet of semaglutide for alcohol use disorder

Recruitment opens this month for CRAVE (Cessation or Reduction of Alcohol Consumption in Veterans), a phase 3, double-blind, placebo-controlled trial across 18 VA sites, enrolling more than 600 veterans aged 18–80 with moderate or severe AUD, on weekly injectable semaglutide for 24 weeks. It follows two smaller signals: a CU Anschutz phase 2 of oral semaglutide that missed its primary endpoint (lab-induced craving at six weeks) but significantly cut heavy drinking days, naturalistic craving and alcohol-related consequences; and a Lancet RCT in patients with AUD and comorbid obesity. Medscape's write-up is the efficient version.

Why it matters to you — Alcohol-related admissions are a standing fraction of your census, and GLP-1s are already on a lot of your med lists. Within a year or two the answer to "why is this patient on semaglutide?" may be AUD rather than diabetes or weight — which changes what you assume about their diet history, their gastric emptying before a procedure, and how you read a withdrawal trajectory in someone who has been quietly drinking less for months.

Suggested action — Nothing to change today. But it's a clean five-minute agenda item for the next group meeting: does our admission med-rec capture the indication for a GLP-1, or just the drug and dose? Right now, for most shops, it's just the drug.

BThe Debate

Has the United States lost its measles elimination status — and is that the right thing to be arguing about?

The U.S. National Verification Committee meets this month to review the CDC's annual measles report and forward its opinion to PAHO, which announces a decision in November. As of Aug. 6 the CDC counted 2,465 confirmed cases in 2026 — past all of 2025 (2,289), the highest since 1991 — across 38 outbreaks, 94% of them outbreak-associated. Canada lost its status in November 2025.

The case for calling it lost

Paul Offit, Children's Hospital of Philadelphia, on CNN; Noel Brewer, UNC, in STAT.

The criterion is twelve months of continuous domestic transmission, and the public data clear it without much argument. Asked directly whether the U.S. can still claim elimination, Offit's answer was one word: "No." Brewer, who chairs the committee doing the review and can't disclose the report, nonetheless laid out publicly what anyone can see — the country has had measles cases every week since January 2025, roughly 20 months, and Utah's outbreak alone has run past a year, "the main criterion for loss of elimination." A CIDRAP editorial in June put the position bluntly: call it what it is. The deeper argument is about honesty as a public-health tool. A designation that survives 2,465 cases and 38 outbreaks stops describing reality and starts insulating the systems that failed.

The case against — or against the fight

William Moss, Johns Hopkins IVAC, on Public Health On Call; Jennifer Nuzzo, Brown, quoted in CNN.

Continuous transmission and repeated importation produce identical case curves, and until recently the tools couldn't tell them apart. Global immunization has narrowed circulating measles to two genotypes, so the 450-base-pair sequencing that historically decided these questions gives almost no resolution — which is precisely why PAHO pushed the review to November while roughly a thousand whole genomes get sequenced. Moss notes this is the first time whole-genome sequencing has been used in an elimination verification, and that CDC is leaning on the Broad Institute and Utah's health department to do it, given its own lab's staffing. Nuzzo goes further: "This is the wrong thing to pay attention to. Our attention has to be on stopping the outbreaks." The label changes no child's risk; the vaccination rate does.

Where it might land: committee review mid-August, PAHO announcement in November — and Mexico and Bolivia are being assessed in the same cycle, which is part of why the calendars were merged.

COn My Radar

Cyclosporiasis, still the biggest open outbreak — 10,468 lab-confirmed domestically acquired cases since May 1 across 47 states, with at least 6,358 tied to Taylor Farms de México iceberg lettuce (recalled July 17) in 15 states. Two deaths, both in Michigan, both with serious underlying illness. Michigan — the hardest-hit state — reports cases slowing. CDC is publishing weekly rather than monthly for the rest of the year.

The DOJ memo that touches your discharge planning — the Office of Legal Counsel's June 18 opinion reinterprets the ADA and Section 504 to say states are not required to provide services in community settings, only barred from unjustified institutionalization. It doesn't change the law or bind courts, but it puts two decades of Olmstead consent decrees in play. Medscape's summary is the clinician-facing version; the ABA response has the legal detail. If it holds, the pressure on states to fund community-based alternatives eases — which shows up on your end as fewer discharge destinations that aren't a facility.

Hospitalists and AI, by the numbers — SHM's 2026 Workforce Experience Report has 64% of hospitalists using AI and 73% of those reporting benefit, but only about a third saying they've been adequately trained. Same report: 50.2% feel they control their clinical workflow, 53% their non-clinical workload. The August issue of The Hospitalist is out, still built around the specialty's 30th anniversary.

Mets — took two of three in Pittsburgh, closing with an 11-1 rout on Sunday after Saturday's 9-0 shutout loss. Xzavion Curry optioned to Syracuse, Jack Weisenburger selected. Carson Benge back in the lineup Sunday — imaging on the jammed left wrist was negative.

TV — Reacher season 4 lands on Prime Video Wednesday, Aug. 12. Nothing new opened this weekend with reviews worth clearing an evening for.

Golf tech — no new launches, analyzers or training devices announced in the past 48 hours. Eleventh straight day of nothing; the 2026 field is still Shot Scope LM1, Rapsodo MLM2PRO, Garmin R10 and Mevo+.

Cuba — no new nationwide grid collapse since power was restored on Aug. 3 after the sixth of 2026. Nothing new in mainstream reporting in the past 48 hours; daily life in Havana still organized around long outages.

DTrends to Watch

Disease elimination is becoming a genomics question, not an epidemiology question. The U.S. review is the first time whole-genome sequencing has been used to adjudicate an elimination status, because two circulating genotypes no longer give enough resolution to separate sustained transmission from re-importation. That's a permanent change in how these calls get made — and it now depends on sequencing capacity that CDC is partly outsourcing.

GLP-1s are migrating out of metabolic medicine and into psychiatry and addiction. A 600-patient VA phase 3 in alcohol use disorder is a serious commitment of federal trial infrastructure. The practical consequence for inpatient work is that the drug on the list will stop telling you the diagnosis.

Physician AI adoption keeps outrunning physician consent. The AMA's 2026 survey has 81% of physicians using AI professionally — more than double three years ago — while 85% say they want a real voice in how it's adopted. SHM's numbers show the same gap in hospital medicine: 64% using, roughly a third trained. And the FDA's January narrowing of what counts as a regulated clinical decision support device means less federal scrutiny of the tool paired with more liability for whoever clicks accept.

Caribbean resource failure has shifted from emergency to schedule. Puerto Rico now publishes a rationing calendar; Cuba's grid collapses are numbered events. Two very different political systems converging on the same operating mode — planned scarcity instead of episodic crisis.

EIdeas & Opportunities

One question for pharmacy: does admission med-rec capture the indication for a GLP-1, or only the agent and dose? Cheap to ask now, awkward to retrofit once AUD and other non-metabolic indications are common.

One question for ED triage: does check-in prompt airborne isolation on febrile rash, and does the adult admission workflow ask about measles immunity? Florida's counts are climbing with the national ones, and 93% of 2026 patients were unvaccinated or unknown.

One thing to queue: Reacher S4, Wednesday on Prime. Zero cognitive load, which is the correct specification for a post-nights Wednesday.

That's the lot. The only thing with a clock on it this week is the CY2027 OPPS comment window, and that's three Mondays out. Sleep well, Marco.