12/ And with that, you're all caught up for the week!
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Love,
Matt
Your Local Epidemiologist in California
11/ A MarinHealth nurse changed that. In 2023, Duncan Sylvester launched a “Courtesy Tow” program with CHP and a local company so patients’ cars are moved to the hospital for free. It’s simple, humane, and powerful: in your hardest moments, people will show up. You are never a bother.
10/ Finally, when someone is rescued from the Golden Gate Bridge, they’re hospitalized for a few days. But for years, discharge came with a setback: their car had been ticketed and towed. After a crisis, they faced fines and logistics just to get it back, which is an exhausting first step.
9/ Suicidal crises are often brief, and most people who survive an attempt don’t go on to die by suicide. This means that If we can interrupt a crisis in the moment by creating time and distance between impulse and action, a life can often be saved for the long term.
8/ The impact has been striking. Before the net, the bridge averaged ~30 deaths per year. After the net, rates dropped ~80%. There were 8 deaths in 2024, and just 1 since mid-2025. The net illustrates a key principle in suicide prevention: restricting access to highly lethal methods saves lives.
7/ Now to San Francisco. In 2024, a suicide prevention net was completed along the Golden Gate Bridge. It sits 20 feet below the walkway, designed to interrupt attempts that would otherwise be fatal.
6/ What you can do: use flea control on pets year-round, secure trash, avoid contact with stray animals, and use repellent outdoors. If you have fever and rash after a possible flea bite, tell your provider this directly. This diagnosis is often missed.
5/ So why does this happen in Southern California? Warm, dry conditions support fleas and urban wildlife. 97% of California cases come from LA and Orange County. As rat and stray animal populations grow—and warming extends flea seasons—spillover into humans becomes more likely.
4/ Symptoms show up 1–2 weeks later: fever, headache, rash, nausea, and body aches. The good news is that it’s treatable with antibiotics like doxycycline. Unfortunately, it’s often missed, and delayed treatment can lead to severe illness.
3/ Flea-borne typhus is caused by Rickettsia typhi. Fleas pick it up from animals like rats, opossums, and stray cats. Humans get infected when flea feces enter the skin, often after a bite. We are a “dead-end” host: we get sick but don't pass the bacteria onward.
2/ Typhus cases are climbing in Los Angeles. 220 cases were reported in 2025, which is the highest on record, and nearly 90% required hospitalization. Early 2026 data shows 17 cases so far. It’s too soon to call a trend, but this is one we’re watching closely.
1/ All right California, we're discussing two tough topics this week: flea-borne typhus rising in LA, and a suicide prevention breakthrough on the Golden Gate Bridge. This thread will deal with heavy topics, so I want to put that warning out there. Let’s start with fleas. 🧵
10/ People aren’t having fewer children because they don’t care about family or the future of this country. They’re having fewer because the system makes it too hard, too risky, and too expensive. Build a society where families can thrive—and birth rates may follow.
9/ There's also the fact that while asking women to have more kids, we're dismantling support systems. The CDC’s Office of Women’s Health has been eliminated, and the long-running Women’s Health Study was shut down. We can’t boost birth rates while cutting vital programs.
8/ And in some states, that fear now includes criminalization. Women have been investigated after a miscarriage or pregnancy complication. Some states even propose tracking birth control use. This fear influences how people think about their health, autonomy, and safety when considering pregnancy.
7/ There is also so much (valid) fear around pregnancy. The U.S. has one of the highest maternal mortality rates in the developed world, with Black women nearly three times as likely to die. This isn’t just a statistic. It’s a fear many of us carry when considering pregnancy.
6/ Now we get to childcare. Childcare costs rival rent or a mortgage in many states, eating up to 19% of family income—far above the 7% affordability benchmark. Lack of access is another issue, forcing many parents, especially moms, to stop working. Expanding access to childcare boosts birth rates.
5/ Then there's the lack of support for parents. Paid maternity leave is rare in parts of the U.S., while other countries offer up to a year. And yes—paid leave increases birth rates. After the U.S. passed 12 weeks unpaid leave in 1993, first birth rates rose by 5% annually.
4/ Let's talk about affording care. Even with insurance, prenatal and postpartum care can be financially crushing. Infertility treatments in particular are prohibitively expensive, but states mandating coverage saw a 32% increase in birth rates.
3/ So people aren’t necessarily opting out of having kids, they’re delaying it. So why are people waiting longer? There’s no single answer, but the patterns are pretty consistent.
2/ The overall U.S. birth rate just hit another record low, and it’s been declining since about 2007. If we break the data down by age, a clearer picture starts to emerge. Yes, birth rates are dropping among teens and women in their early 20s, but they’re increasing among women in their 30s and 40s.
1/ 🧵 Last week, data on fertility and birth rates for 2025 was released. As news networks started reporting on it, this clip started making the rounds on socials. Now, I think most people will agree with me that a drop in teen pregnancy is a good thing. But when we zoom out, there is a bigger trend.
8/ For this city girl, spending time at the summit was both humbling and inspiring. This was a reminder to get out of my bubble, listen more, and keep this work grounded in real lives.
Read the full story here: yourlocalepidemiologistny.substack.com/p/the-opioid-crisis-rural-health-and
7/ And still, I saw so much hope. The people I met last week weren’t waiting for better systems or more political will before showing up. They were already there, at churches, knocking on doors, on county basketball courts, showing up with whatever they had.
6/ Many are navigating a health care system that looks almost nothing like it does for the coastal elite. There’s a massive gap between the public health guidance produced and what’s actually possible for the people receiving it.
5/ Public health priorities look very different depending on your community, resources, and what problems are most urgent.
Additionally, “prevention” assumes access that many Americans simply don’t have. Clinics are closing. Some people are driving hours for care or simply skip it entirely.
4/ It made me rethink a word we use all the time in public health: “prevention.” Where I work, prevention means vaccines, screenings, awareness campaigns. Where he works, prevention means showing up so a kid has one stable adult in their life.
3/ He told me more than 60% of kids in his county don’t live with a parent. Substance use, incarceration, and poverty have reshaped family structures in ways I hadn’t fully considered. I write about this work, but hearing it firsthand, my usual public health lens felt so…out of touch.
2/ One of the most eye-opening conversations was with a man from eastern Kentucky. He’s in recovery and now spends his time doing outreach with kids in his community. He shows up every week to play basketball as a trusted adult that a lot of them don’t have at home.
1/ Hey New York, Marisa here! Last week, I went to the largest addiction conference in the U.S.—and it completely shifted how I think about public health. I spend most of my time writing from cities like NYC. But this experience pushed me out of that bubble.
