CLEVELAND, Ohio — In a city that has not yet forgotten the wounds of the pandemic, Cleveland's wastewater signals a warning: the level of COVID-19 virus has risen by more than 250%, warning of an approaching wave of infections bearing down on the community. On Friday, June 13, 2025, the Cleveland Department of Health announced a public health emergency, urging residents to get vaccinated, wear masks, and remain vigilant to contain the unseen threat already gaining momentum.
"These are not just numbers; they are a harbinger of what awaits us in a week or two," — stated Department of Health Director David Margolius at an urgent press conference. Data collected at the Easterly wastewater treatment plant, serving the northeastern part of the city, showed a sharp spike in the concentration of SARS-CoV-2 virus, exceeding thresholds set by the Ohio Department of Health. According to Margolius, this increase is the highest since early 2024, when a similar surge preceded the fall hospitalization wave.
Wastewater as a mirror of the epidemic
Monitoring wastewater, which has become the gold standard of epidemiological surveillance since the 2020 pandemic, allows detection of the virus even among those who do not test or show symptoms. In Cleveland, this system, implemented in collaboration with the Northeast Regional Sewer District of Ohio, has been operational since 2021 and has repeatedly helped forecast outbreaks. However, current indicators, which include not only COVID-19 but also rising influenza and respiratory syncytial virus (RSV), paint a grim picture: the city is on the verge of a "triple threat" of respiratory infections.
"It's like a radar that sees a storm before it hits," explains Dr. Amy Edwards, an infectious disease specialist at MetroHealth Medical Center. According to her, rising viral loads in wastewater usually precede increases in hospitalizations by 7–14 days, giving authorities valuable time to respond. But this time, the scale of the spike is especially concerning: in some Cleveland neighborhoods, such as West Side, virus concentrations have tripled over two weeks.
The city on the brink
The declaration of a public health emergency is accompanied by several recommendations: updating COVID-19 and flu vaccinations, wearing masks in public places for those with symptoms, and self-isolation at the first signs of illness. The city is also expanding access to free testing and vaccines by opening additional sites in community centers and libraries. "We are not returning to lockdowns, but we are asking everyone to do their part," — emphasized Margolius, acknowledging community fatigue from pandemic restrictions.
Cleveland, where the COVID-19 vaccination rate stands at 62% among adults (below the national average of 68%), faces additional challenges. Insiders from the Department of Health report that vaccination campaigns are hampered by misinformation on social media and skepticism, especially in underserved neighborhoods such as Hough and Collinwood. In 2023, a similar wastewater spike led to hospital overloads, including at Cleveland Clinic, where 20% of ICU beds were occupied by COVID-19 patients.
The broader context
The situation in Cleveland reflects a troubling national trend. According to the Centers for Disease Control and Prevention (CDC), COVID-19 levels in wastewater are rising in 22 states, including Ohio, Illinois, and Michigan. The new Omicron subvariant, known as XEC, which evades immunity from previous vaccines, is believed to be a primary driver of this surge. Cleveland also reports an increase in influenza A (H3N2), posing a double burden on the healthcare system ahead of the winter season.
Local hospitals are already preparing for the worst. University Hospitals reported a 15% increase in COVID-19 hospitalizations in the past week, and MetroHealth has implemented mandatory masking for staff in high-risk zones. "We cannot afford another winter like 2021," — says Dr. Edwards, recalling the collapse of the healthcare system during the Delta wave.
Community voices
For Cleveland residents who have endured lockdowns, lost loved ones, and economic shocks, the news of a public health emergency elicits mixed feelings. "I'm tired of this, but I understand we need to act," — says Leila Thompson, a café owner in the Tremont neighborhood, who plans to reintroduce masks for staff. Others, like 72-year-old John Carter from Glenville, are skeptical: "They panic every time, but I’ve been vaccinated three times already. What more can I do?"
Mayor Justin Bibb, who faced criticism for slow responses to previous outbreaks, promised a "transparent and coordinated" response. On Friday, he announced the creation of a hotline for vaccine and testing information, and called on employers to reinstate flexible schedules for symptomatic workers.
A look to the future
As Cleveland prepares for a possible wave, the Department of Health promises weekly updates on wastewater and hospitalization data. But success depends on the community: can residents be persuaded to return to vaccination and vigilance? For a city proud of its resilience, this is yet another test. "We cannot control the virus, but we can control our response," — summarized Margolius.
While Cleveland’s wastewater signals alarm, one thing remains clear: in the fight against the unseen enemy, vigilance and solidarity are the only weapons that can protect the city from yet another storm.
