Measles death, Covid hospitalizations, New vaccine law, Kratom

The CA Dose, September 12, 2025

Today’s edition contains two late breaking stories— a landmark vaccine law that’s likely being decided today in Sacramento, and a tragic death from measles in Los Angeles (so late breaking it didn’t make it into today’s video…). Plus you’ll find updates on our stubborn, ongoing Covid summer surge and an emerging substance use concern. Let’s dive in.

Covid-19 hospitalizations on the rise

Covid-19 hospital admissions in California are increasing, with an estimated 1,572 admissions statewide for the week ending August 30. This is up 60% from the week ending August 2, when around 950 people were admitted. These hospitalization rates are classified as Low.

In the last week of August (the most recent data), people age 65 or over in California were about 8 times more likely to be hospitalized for Covid than people under age 65.

It’s unwelcome but not surprising to see hospitalizations rising—we saw the usual precursors though late July and August. California Department of Public Health tracks five main Covid indicators. I look at these weekly, to summarize what’s most relevant for you. Here they are, in the order that they rise during a surge, from the earliest to the latest:

• Wastewater (sewage) surveillance for community virus levels

• Percent of tests that are positive for Covid-19

• Percent of Emergency Department visits that are due to Covid-19

• Number of patients admitted to the hospital for Covid-19

• Number of deaths due to Covid -19

When Covid levels are high for over a month, as we’ve experienced in California, all indicators are elevated at once (though mortality rates are very low relative to the height of the pandemic).

When Covid surges resolve, these drop in the same sequence, starting with declining wastewater levels. Currently California wastewater levels remain at a high plateau, so we’d expect hospitalizations to remain elevated.

What does this mean for us? Our Covid-19 summer surge remains active in California. With the confusion around vaccine access, it’s easy to forget that there’s consensus—even among federal leadership—that people over age 65 and people with risk factors for severe disease should get the vaccine. That’s important because those are the folks we’re seeing in hospitals today. Most California pharmacies are offering appointments for people in those groups. Kaiser has announced they’ll begin vaccinating members September 15th.

Getting the Covid vaccine now protects against ongoing risk of hospitalization, and will continue to protect you when cases rise again this winter.

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California’s new law to protect vaccine access

Today our elected leaders will be voting on a law that could protect Californians’ access to vaccines. If SB/AB 144 passes, it will be the first of its kind in the nation.

Why would CA law need to change? In California, laws that govern vaccine access have been anchored in the annual recommendations of the CDC’s Advisory Committee for Immunization Practices, or ACIP. Until a few months ago, ACIP was made up of experts whose guidance was trusted by health care providers and insurers, and taken as the national standard of practice.

On June 9, HHS Secretary RFK Jr. fired all 17 members of ACIP and replaced them with people who generally support his views on vaccines. Previously, members were selected by a panel after a lengthy review of their background, expertise, and potential conflicts of interest.

Our current dilemma: ACIP is no longer a trusted source for vaccine guidance, but remains on our law books as the standard for vaccine practices in California.

The proposed solution: The proposed legislation (SB/AB 144) removes all references to ACIP from state law, and replaces them with recommendations from professional organizations that rely on science, including the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP). These physician-led organizations have issued annual vaccine guidance for decades.

How does this relate to the new West Coast Health Alliance? Last week I described how California, Oregon, and Washington have come together to support vaccine access with unified guidance. Hawaii has now joined this group. This law would give teeth to their guidance, by requiring that clinicians and insurers offer shots based on the evidence-based guidance of professional organizations.

Which vaccine-related laws would change if SB/AB 144 passes?

• Insurance Codes: replace ACIP with AAP, ACOG, and AAFP as the organizations whose recommended vaccines must be covered by health insurance in California.

• Business and Professions Codes: replace ACIP with AAP, ACOG, and AAFP as approving organizations for professionals in healing arts to administer immunizations.

• Health & Safety Codes: replace ACIP with AAP, ACOG and AAFP as the organizations whose recommended vaccines can be administered by public health agencies.

• Offer a discretionary option for CDPH to modify or add to the recommended immunization list at any time.

The law does not include any new vaccine requirements.

What does this mean for us? This law is designed to restore California, as much as possible, to pre-RFK Jr era vaccine access. Ideally, we’ll be able to access vaccines as we have in the past, following our judgement and the guidance of our trusted healthcare providers.

My concerns for the long term: Current federal health agencies are proving to be scientifically unreliable, and more responsibility for public health is falling to states. While maybe necessary for the short term, a patchwork of state-by-state approaches moves us further from a coherent and unified national public health system. This may make the nation less well prepared to respond to the next public health crisis. But that’s a topic for another day…

For now, we’re fortunate to be in California, home to world-class scientific research, excellent healthcare providers, and courageous, science-driven policymakers.

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A measles death in California

Yesterday, Los Angeles County Department of Public Health reported the tragic death of a school-aged child from a complication of measles.

The child was infected with measles years ago, as an infant, before they were eligible to receive the vaccine. After recovering from the initial illness the child developed and ultimately died from a measles-related brain disease called subacute sclerosing panencephalitis (SSPE).

SSPE causes brain scarring and destruction of nerves, leading to progressive loss of neurologic function that can start two to ten years after a measles infection. Risk is higher when infection happens early in life-- about 1 in 600 people infected during infancy develop SSPE. Victims of SSPE usually die one to three years after symptoms begin. There is no cure or effective treatment.

Our hearts are with the family, friends and caregivers who carried, and then lost this child through a devastating and progressive brain disease.

What’s the lesson here?

• Measles is a serious and potentially deadly disease. This is the fourth measles death nationally this year.

• Measles carries short and long term risk. Like Covid, when we focus on acute infection we underestimate the long term burden of vaccine-preventable diseases.

• Measles is not just a respiratory illness— it also attacks the nervous system. Infection can also cause blindness or deafness by damaging nerves. California’s last measles death was a 37 year old man who died from meningitis— another brain complication— in 2019.

• Babies depend on us for protection. Infants can’t be vaccinated against measles before six months. Most measles cases occur when someone who’s unvaccinated spreads it to another unvaccinated person. Being vaccinated protects the most vulnerable in our homes and communities.

As the toll of measles increases, we share in the grief of families and communities. We can also share the message that measles is one of the most infectious and most preventable diseases in the world.

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Kratom and 7-OH: Emerging public health concerns

California communities are taking action to protect residents from kratom, an herbal supplement that’s sold mainly in gas stations and smoke shops.

What is kratom? Kratom comes from the leaves of a Southeast Asian tree and is commonly sold as powder or pills. People use it mainly for how it makes them feel—it’s a stimulant and can cause a feeling of euphoria. It’s also marketed as a remedy for pain and anxiety. The FDA has not approved kratom for any medical use.

Why the concern? Health officials are particularly worried about 7-OH, a natural chemical in kratom that acts like an opioid. 7-OH is being isolated, refined and sold separately as a “synthetic kratom product.” The relationship between kratom and 7-OH is like that between cannabis plants and THC, or coca leaves and cocaine—taking a plant’s most potent psychoactive component, synthesizing it in a lab, and selling it at potentially harmful levels.

The FDA has recommended placing 7-OH on the federal list of controlled substances. They’re particularly concerned about synthetic products marketed in vaping liquids, fruit-flavored gummies and “shots.”

Source: FDA

Because 7-OH activates the same parts of the brain as opioids, there is growing concern about overdose risk and addiction, especially for young people. During 2024, U.S. poison centers reported 165 cases involving 7-OH, including 6 children. About two-thirds required emergency medical treatment, with symptoms including:

• Nausea, vomiting, and agitation

• Rapid heart rate and high blood pressure

• Trouble breathing and loss of consciousness

• Signs of opioid overdose

Local action: Orange County recently banned synthetic kratom products (including 7-OH), joining Newport Beach, San Diego, and Oceanside. Other jurisdictions including Los Angeles County are reviewing similar measures, because residents might use synthetic kratom without a full understanding of its risks.

What does this mean for us? Kratom products are currently legal and on the market in most parts of the state. They vary widely in potency and safety, and some are marketed to appeal to adolescents. Marketing 7-OH that’s been made in a lab as “natural” or “plant-based” can mislead people into believing it is safe.

If you’re considering kratom or 7-OH for any health condition, consult with your health care provider about safer, tested alternatives.

For substance abuse resources, call the CA Addiction Treatment Helpline at 1-844-804-7500. If you think someone’s had an adverse reaction to kratom or 7-OH, call the Poison Help Line at 800-221-2222. If someone’s collapsed, has trouble breathing, or can’t be awakened, call 911.

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Bottom line

That’s it for this week. California continues to lead with science-based health policy, but taking personal action—getting vaccinated, and staying informed—remains your best protection.

Love,

Matt

Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and Public Health Officer for Marin County, where he guided the pandemic response. He lives in the Bay Area with his wife, children, and a dog named Teddy.