Marco's Morning Report — Monday, August 17, 2026

Section A — Top Stories

COVID's seasonality has inverted: summer is now the bigger peak

What happened A Los Angeles Times piece published Friday (syndicated over the weekend, including the Star-Advertiser on 8/15) put numbers on something clinicians have been describing anecdotally for two years. Nationally, COVID-related ED visits peaked last summer in late August at 1.7% of all visits; the following winter peak was 1.0%. In California the split was starker — 2.1% in summer versus roughly 0.2% in winter. "It started in 2024. We started seeing a very large summer increase in cases and wastewater and hospitalizations, even dwarfing the winter," said Dr. Peter Chin-Hong, the UCSF infectious diseases physician. CDC currently has COVID growing or likely growing in 43 states per that reporting, with Florida among the states showing "high" or "very high" wastewater activity.

Why it matters to you The timing is the point. If the modern pattern holds, the peak arrives in late August — which is now. Chin-Hong's clinical observation maps directly onto your admit list: the COVID patients who actually need the hospital are older or immunocompromised and haven't been vaccinated in more than a year. Dr. Erica Pan, California's state health officer, is telling clinicians the same thing — that anyone who hasn't had a 2025–26 dose, or is due for the second dose six months out, should get it now rather than waiting for fall. Meanwhile everything institutional — respiratory season huddles, isolation-supply ordering, the annual vaccine push — is still calibrated to a November-through-February curve that may no longer be the dominant one.

Worth doing When you're admitting a 78-year-old with hypoxia and a viral prodrome this week, the base rate for COVID is higher than your November instincts suggest. Worth asking whoever runs your respiratory-season planning whether the surge playbook has a summer arm, or only a winter one.

The vaccine gap: the 2025–26 formula is disappearing before the 2026–27 one arrives

What happened In the same reporting, Kaiser Permanente confirmed it no longer offers the 2025–26 COVID vaccine and expects the 2026–27 version to be available by late September. That leaves a roughly six-week window — right now through late September — in which the current formula is being wound down at some systems while the replacement isn't shipping yet. Dr. Elizabeth Hudson, regional physician chief of infectious diseases at Kaiser Permanente Southern California, framed it as a live choice: get the older dose now "if your clinician still has them available," or wait, since the new one is close.

Why it matters to you This is an inventory question before it's a clinical one, and it lands precisely on the projected peak. If your pharmacy still has 2025–26 doses, discharge planning for a high-risk elderly patient this week has a real option in it. If it doesn't, "get vaccinated" is advice with no product behind it until late September — and you should know which of those two worlds you're in before you say it at a bedside. It also shapes what you tell families about a patient going back to a facility, where the exposure density is higher than at home.

Worth doing One message to inpatient pharmacy: do we still have 2025–26 doses, how many, and what's the expected arrival date for the 2026–27 formula? A two-line answer changes your discharge script for the next six weeks.

Section B — The Debate

Should a high-risk patient take the 2025–26 COVID shot now, or wait for the 2026–27 formula?

Why it's live right now: cases, test positivity, wastewater levels, and hospitalizations are all rising heading into what has been the year's biggest peak for two summers running — while the current-formula vaccine is being withdrawn at some systems and the updated one isn't expected until late September. Two infectious-disease physicians gave opposite practical advice in the same 8/14 piece.

Vaccinate now

Waiting five or six weeks means being unprotected through the part of the calendar that has produced the highest hospitalization counts in each of the last two years. The 2025–26 formula is still generating meaningful protection against severe disease, and severe COVID in an older or immunocompromised patient is, in Peter Chin-Hong's words, "preventable." His clinical read is that the people landing in hospital beds are precisely those more than a year out from a dose. Dr. Erica Pan at the California Department of Public Health has put the same position on the record institutionally: anyone who hasn't received a 2025–26 dose, or is due for a second dose six months after the first, "is encouraged to get vaccinated now, before the next COVID-19 surge." For the 65-and-up and immunocompromised groups, Chin-Hong is blunt — go get the shot now, "don't wait for the fall."

Wait for the updated formula

A dose taken in mid-August spends its best weeks on a wave that may already be cresting, and it may complicate or delay the updated shot that will be matched to circulating variants and timed to carry through the rest of the year. Elizabeth Hudson at Kaiser Permanente Southern California puts the threshold at availability and proximity: if you skipped last winter's dose and your clinician still has product, taking it now is defensible — "however, if you want to wait to get the newest one, given how soon it will be available, it's very reasonable to wait." The underlying argument is that this summer's rise is running below the last two summers on the measures that matter clinically — California is reporting 0.84 COVID hospitalizations per 100,000 residents against 1.92 a year ago and 8.12 the year before — so the downside of a short wait is smaller than it looks.

Where it might land Late September, when the 2026–27 formula ships, resolves the question by making it moot — which means the entire disagreement is about how to handle the next six weeks, and it will be settled patient by patient rather than by guidance.

Section C — On My Radar

Mets sweep Washington, 4–3. Luis Torrens hit a 407-foot shot to straightaway center off Jake Irvin in the fourth for the go-ahead run; Jorge Polanco added an RBI groundout and Jared Young a run-scoring double (ESPN recap). Third straight win over the Nationals.

Mets injury ledger, unchanged and thin. Juan Soto (left calf, IL 7/25) and Devin Williams (right shoulder strain, IL 8/10) are both tracking to September; Mark Vientos (fractured right hand) is the only one expected back in late August (MLB.com).

Tropics: 94L is the one to watch. Invest 94L holds roughly a 40% chance of development and could become a tropical depression late this week as it moves west, though shear and dry air ahead of it are real obstacles; Invest 92L fell apart and is down near 10%. No Florida impact anticipated in current guidance (WFTV).

Hormuz: talks continue, Lebanon does not quiet down. Al Jazeera's Sunday liveblog has Tehran and Oman still working route coordinates through the strait, alongside Israeli strikes that killed 11 in Lebanon (Al Jazeera, 8/16). Saturday's entry had Iran stating the strait remains under its control (8/15).

Cuba: sanctions, not strikes. Secretary of State Marco Rubio sanctioned five Cuban entities and eight individuals tied to Havana's military procurement (The Hill), as reporting continues to indicate the administration's Cuba strategy is tilting toward economic pressure and intelligence work rather than military options (Bloomberg via Energy Connects).

Movies: a 100% on Netflix. Don't Say Good Luck, a dramedy, hit Netflix Friday 8/14 with a perfect critics' score (Forbes). Also opening well in theaters: The Rivals of Amziah King (89%) and Union County (95%).

TV: Lanterns is out. The DC series premiered last night on HBO Max; first reviews landed 8/14 and were strong — graded as a grounded mystery rather than a superhero spectacle. Weekly release, eight episodes.

Golf tech: nothing new. No meaningful launch-monitor, swing-analyzer, or AI-coaching releases in the past 48 hours — 17th straight day. The pipeline is still year-end: Uneekor's AIMY prototype is slated for release later this year, and the sub-$800 radar-plus-dual-camera tier keeps filling in.

Section D — Trends to Watch

Respiratory-season infrastructure is now misaligned with respiratory season. Flu and RSV still behave like winter diseases; COVID increasingly does not. Every institutional rhythm built around a single November–February peak — vaccine campaigns, float-pool staffing, isolation-supply purchasing, quality-measure windows — was designed for a curve COVID has stopped following. The mismatch will show up first as understaffed late-August weekends, not as a headline.

The annual formula changeover is becoming a predictable coverage hole. Old formula withdrawn in August, new formula shipping in late September: that gap is structural, repeats yearly, and — now that the peak has moved — sits directly on top of the worst weeks. Expect this to become an access argument, not just a logistics one.

Cuba pressure is migrating from military to economic instruments. Sanctions on procurement chains plus intelligence activity, rather than strikes, means the pressure lands on fuel, the grid, and the pharmaceutical supply. For the diaspora here in Florida, that translates into a longer, quieter deterioration rather than a discrete event — and into more families asking about sending medicine.

Section E — Ideas & Opportunities

One message to inpatient pharmacy. Do we still stock 2025–26 COVID doses, and when does the 2026–27 formula arrive? The answer determines whether "get vaccinated before you go home" is real advice or a placeholder for six weeks.

Make vaccination interval part of the admission story for 65+. Not "vaccinated y/n" but "how long ago." Chin-Hong's observation — that the hospitalized are the more-than-a-year-out group — is the kind of thing that's easy to confirm or refute in your own unit over a month, and it's a clean five-minute item for a group meeting.

Post-nights watch. Don't Say Good Luck is on Netflix now at 100% with critics — a dramedy, not a two-and-a-half-hour commitment. Lanterns is weekly on HBO Max if you'd rather have something that parcels itself out.

Section H — Background / Already Covered

Older items and things already reported (no new developments)

Measles: still 2,566 confirmed US cases as of 8/13, 38 outbreaks, 94% outbreak-associated, 93% unvaccinated or unknown status, 7% hospitalized, no deaths. CDC updates midweek, so no change since Saturday's report. The elimination-status review is scheduled for November.
HCA Florida Cape Coral Hospital — the $300M, 322 SW Pine Island Road project announced 8/14; covered in full yesterday. No new filings over the weekend.
First mRNA flu vaccine approved. FDA approved Moderna's mFLUSIVA earlier this month for adults 50 and up — full approval for 50–64, accelerated approval for 65+ pending a confirmatory trial. Worth noting for your older patients: it was compared against standard-dose flu vaccines, not against the high-dose or adjuvanted formulations seniors have been getting for years. The 65+ mRNA flu question was Section B on 8/6.
Sepsis source and early mortality in the very old. Medscape, 8/12: among critically ill patients 90 and older, non-urinary sepsis was associated with higher early mortality than urinary-source sepsis — a reminder that source identification carries prognostic weight in the oldest cohort, not just therapeutic weight.
Puerto Rico water emergency — continuing. Roughly 72% of the island in drought, San Juan's driest July in more than 120 years, seven of the most populous municipalities on 48-hour-plus rotations, FEMA water trailers deployed for an initial 30 days. No material change reported over the weekend.
Cuba's grid — the island has had six nationwide blackouts this year, four of them within a month, with the government attributing them to fuel and spare-parts shortages under US restrictions. Early-August story; no new collapse reported this weekend.
Cuba's 176 economic measures — the package permitting private banks, freer foreign trade, and investment by Cubans abroad passed the National Assembly in June 2026, not this month. Flagging the date because it keeps recirculating in weekend aggregation as though it were new.
Golf tech pipeline — Uneekor AIMY due later this year; Shot Scope LM1 at $200 and the Par Breaker Swing Pulse X10 under $800 continue to define the entry tier. Nothing has shipped in 17 days.