On Wednesday, May 8, the World Health Organization (WHO) confirmed an April outbreak of a coronavirus similar to SARS-CoV-2, which causes COVID-19. Four new infections of a coronavirus known as Middle East respiratory syndrome (MERS-CoV) have been reported in Saudi Arabia, according to health officials in that country. At least one of those cases resulted in death.
Because at least two of the MERS-CoV infections involved human-to-human transmission, some researchers are concerned that the outbreak could cause a new pandemic. Despite these fears, the WHO stillassesses the overall risk posed by MERS to be "moderate" both regionally and globally. That is in part because three of the four confirmed cases were all limited to a single hospital in the Saudi Arabian capital of Riyadh. The last infectionoccurred in the city of Taif and involved a patient who had contact with camels. That infection is not believed to be directly connected to the other three.
"The three cases are epidemiologically linked to exposures in a health-care facility in Riyadh, although investigations are ongoing to verify this and understand the route of transmission," the WHO said.
In the one case that became a fatality, the WHO reports that the patient was a 56-year-old male schoolteacher who reported a cough, runny nose, fever and body aches on March 29. He was admitted to an emergency room at a Riyadh hospital on April 4, and two days later was transferred to the Intensive Care Unit isolation and intubated. He had preexisting health conditions that may have contributed to his death, including high blood pressure andchronic renal failure requiring hemodialysis. It is unclear how he was initially exposed to MERS-CoV.
MERS first came to light in 2012, and since then has been responsible for about 940 deaths out of 2,500 cases, giving it a pretty high fatality rate of 36%. There is currently no vaccine for this virus.
Data trends show a new family of variants has arisen, but that hospitalizations and deaths have decreased.
CDC is reporting the KP2 variant is the dominant strain of COVID-19 in terms of cases being reported in the United States, with 25% of all current infections from it.1 This comes from the federal agencys latest reporting week, April 21-27, 2024.
KP2 is included in a newer family of variants, called FLiRTs, named after their mutations.2 According to CDC, another FLiRT variant, KP11, accounts for about 7.5% of cases. Together, they account for 32.5% of all reported cases in the country.1
Additionally, the JN1 strain, which was formerly the dominant strain in the United States is now shown to be 22% of all US cases.1
These newer FLiRT variants have been so named based on the technical names for their mutations, one of which includes the letters F and L, and another of which includes the letters R and T. 3
Table 1. Here is a summary of the variants, reporting the week of April 21-27, 2024.
Table credit: ChatGPT
Hospitalization and Mortality Rates CDCs data does show some positive news in that both hospitalizations and deaths have been trending down. For the reporting week of April 21-27, 2024, there was a total of 727 new hospital admissions of patients confirmed with COVID-19 in all age groups. This is down from the 819 hospitalizations the week before (April 14-April 20.)
In terms of mortality in the US, there were 184 provisional COVID-19 deaths for the week, ending April 27. This is a continuing downward trend from the previous 2 weeks where there was 347 deaths the week ending April 20, and the week before that (week ending April 13), there were 485 deaths.
Table 2. This summarizes the COVID-19 hospitalizations and mortality rates in recent weeks.
Table credit: CHATGPT
Changes in Data Reporting According to CDC, it is important to note that as of May 1, 2024, hospitals were no longer required to report COVID-19 hospital admissions, hospital capacity, or hospital occupancy data to Health and Human Services, through CDCs National Healthcare Safety Network (NHSN). Thus the data going forward could be limited, especially as medical institutions are not obligated to report data.
However, the CDC says it still encourages ongoing, voluntary reporting of hospitalization data. The data voluntarily reported to NHSN after May 1, will be available starting May 10.
References
1.COVID Data Tracker.CDC. Accessed May 6, 2024. https://covid.cdc.gov/covid-data-tracker/#variant-proportions
2. Novak S. New FLiRT Variants Spark Summer COVID Surge Warning. WebMD. April 30, 2024. Accessed May 6. 2024. https://www.webmd.com/covid/news/20240430/new-variant-sparks-summer-covid-surge-warning 3. Ducharme J. What to Know About the FLiRT Variants of COVID-19. Time. April 29, 2024. Accessed May 6. 2024. https://time.com/6972143/covid-19-flirt-variants-kp-2/
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US news
H5N1 has been found in commercially available milk but gaps in testing of cattle and humans are hampering effort to stop virus
Sun 12 May 2024 07.00 EDT
Serious gaps in testing animals and people could be obscuring the true rate of avian influenza cases in the US and make it difficult to understand how the H5N1 virus is spreading and how to stop it, experts say.
Facing reluctance from farms to test workers and animals, scientists are now turning to experimental studies to understand how H5N1, a highly pathogenic bird flu, is spreading through cows and on to other farms.
The bird flu count among dairy herds in the US continues rising, but infections are more widespread than previously realized, as testing in commercially available milk reveals.
While the risk to people is still low, that could change as the virus mutates, so its continued circulation remains a big concern.
This epizootic has caught people tremendously by surprise, said Gregory Gray, a professor of infectious diseases at the University of Texas Medical Branch. Scientists knew cows could be infected with all four different influenza types, but weve never seen this amount of infection, nor have we seen it move so fast.
Understanding how the virus moves is essential to stopping it but testing, which can reveal such transmission patterns, has been slow and inadequate.
A dairy worker in Texas, the only person confirmed to have H5N1 in this outbreak and the first documented case of mammal-to-human transmission of the virus, sought out a test at a local health department, a recent study shows. The worker reported a form of conjunctivitis that caused their eyes to hemorrhage and turn red.
Yet after the positive test, officials were not able to test any other workers or animals at the farm where the person worked. That makes it difficult for scientists to understand how the virus spread to the worker and whether it has affected other people.
The people that we need to get at most now are the other folks on these farms that are getting exposed to huge amounts of virus in these environments, said Richard Webby, a virologist at St Jude childrens research hospitals department of infectious diseases. Thats not easy, and its not happening at a scope that we probably need.
Only about two dozen people have been tested for H5N1 in this entire outbreak. The Centers for Disease Control and Prevention does not recommend testing unless symptoms develop after close contact with animals even if someone has milked a sick cow or lives with an infected person.
The lack of testing could be obscuring the true rate of transmission to people, if workers and their close contacts are not experiencing symptoms severe enough, or if they are unable or unwilling, to seek medical care.
Barb Petersen, the veterinarian who discovered the first case of H5N1 in Texas cows, said dairy workers were also sick some of them sick enough to miss work, which was very unusual, she said but they were not tested for the highly pathogenic avian influenza.
Other types of cows, including beef cattle and calves, seem to be going untested, despite evidence that the virus can be asymptomatic in cattle.
We dont know when this thing moves in the beef cattle, and no ones really talking about that, Gray said.
And it seems that pigs, which play a role in sparking human influenza epidemics, are not being monitored any more than usual, despite evidence that avian flu has spread from cows to chicken farms nearby and could spread in a similar fashion to swine farms.
Pigs are a concern because they can mix animal and human flu viruses, which could result in variants that are more transmissible or virulent among people.
Cows may have similar abilities, according to early research co-authored by Webby. Like pigs, cows have receptors for avian and human influenza, and might potentially make a hybrid virus that could affect humans more, Webby said.
But, he cautioned, the animals would have to be infected with both types of influenza at the same time, which is relatively rare especially at this time of year, when human influenza rates are low. Its theoretically possible, but perhaps unlikely but at the same time, if we have this virus continuing to circulate, it does increase the chances, even if those chances are really small.
Another challenge for scientists: the genomic sequences released thus far by US agencies were stripped of key data like when and where they were collected making it very difficult to track whats happening and how the virus is evolving, scientists say. This has global implications for understanding and tracking outbreaks among livestock.
The animal agriculture industry has largely resisted any attempts to test, with one Texas agriculture official telling the Biden administration to back off, in part because of mistrust of federal agencies among farmers.
Another problem is that cow farmers dont receive compensation for financial losses from lower milk yields or not being able to export cows to other markets, Gray said.
Theyre really concerned that if they wave the flag weve got the virus here, theyll be penalized either economically or through disruptions to their operating procedures, he said. We have to find a way to overcome that and protect the farms.
He points to poultry farms, which do have a federal compensation scheme for culling infected birds and which also monitor the poultry much more closely for infectious diseases, which allows them to take fast action to address outbreaks like these.
Scientists like Gray are also collaborating with farm veterinarians to test animals under nondisclosure agreements to avoid identifying farms.
And some of those veterinarians are conducting their own studies on the farms to understand transmission, Gray said. For instance, is the virus being moved through the milking procedure from cow to cow, is the virus aerosolized, is the virus moving from cow to cow through other means?
There are also questions about the extent to which people may be unwittingly spreading the virus, he said.
Some scientists, unable to track the transmission currently happening on farms, are turning to the experimental infection of healthy cows. The results of these experiments should come in the next few weeks, Webby said.
Is there anything actually different about this particular virus itself? Does it have properties that the other H5 circulating in wild birds doesnt? he asked. He is hoping that outbreaks like these are rare among cows, but understanding how they happen and then how they spread is critical to responding now and in the future.
Lets say we do eradicate this. Whats the chance of it happening again? Webby asked. If we can figure out how its moving, then I think we can absolutely think about eradicating this virus from cows.
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Even as it has become increasingly clear that the bird flu outbreak on the nations dairy farms began months earlier and is probably much more widespread than previously thought, federal authorities have emphasized that the virus poses little risk to humans.
Yet there is a group of people who are at high risk for infection: the estimated 100,000 men and women who work on those farms. There has been no widespread testing to see how many may be infected. None have been vaccinated against bird flu.
That leaves the workers and their families vulnerable to a poorly tracked pathogen. And it poses broader public health risks. If the virus were to find its way into the wider population, experts say, dairy workers would be a likely route.
We have no idea if this virus is going to evolve to become a pandemic strain, but we know today that farmworkers are being exposed, and we have good reasons to think that they are getting sick, said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.
A majority of dairy farmworkers are Spanish-speaking immigrants, often undocumented, who may not have paid sick leave or be protected by occupational safety laws. They may lack access to medical providers, and their employers can be intolerant of absences.
This sector of workers is not only at the very, very highest risk because theyre having that direct, intimate contact with discharge, raw milk, with infected animals, but theyre also at the very, very highest level of risk in terms of having no social safety net, said Elizabeth Strater, an organizer with United Farm Workers.
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Federal authorities on Friday pledged nearly $200 million in an attempt to control the spread of bird flu on dairy farms. Some of that money would go directly to farms to help them reduce the spread of the virus, cover veterinary costs and compensate farmers whove lost milk because of sick cows.
The money is also intended to encourage testing of both dairy cows and the people who work closely with them a key step, experts said, in understanding the true scope of bird flu, also known as H5N1, across the U.S.
Incentives work very well to get a better understanding of epidemiology, said Katelyn Jetelina, who tracks illnesses for a website called Your Local Epidemiologist.
Right now, there is no requirement for dairy cows to be tested unless theyre being moved across state lines, according to a recent federal order. Otherwise, the decision is left to farmers.
The U.S. Department of Agriculture said that since that federal order went into effect at the end of April, the National Animal Health Laboratory Network reported 905 tests for bird flu among cattle. Among those, 112 were positive.
(During a press briefing Friday, Agriculture Secretary Tom Vilsack said only around 80 cows had been tested since the order went into effect. A USDA spokesperson later clarified that since the order went into effect, an additional 80 tests have been conducted daily.)
As of Friday, 42 herds in nine states Colorado, Idaho, Kansas, Michigan, New Mexico, North Carolina, South Dakota, Ohio and Texas had been affected by the outbreak.
Those 42 family farm operations are suffering, and we want to make sure were there to provide help and assistance, Vilsack said.
The USDA will offer $98 million to affected farms over the next four months, which could equate to as much as $28,000 per farm, Vilsack said.
Jetelina called the program a fantastic step but way overdue. The outbreak among dairy cattle was first announced at the end of March.
The incentive program is a huge leap forward, especially for smaller farms, said Dr. Keith Poulsen, director of the Wisconsin Veterinary Diagnostic Laboratory. Its likely not enough, however, for larger farms that could lose upward of $3 million with a bird flu outbreak, he said.
This is not going to get fixed tomorrow, he said. But incentives like this lay the groundwork for it to be better, and it also gives us precedent if and when we deal with the next large outbreak.
The Department of Health and Human Services will put in an additional $101 million to ramp up monitoring of people who have been exposed to sick animals, contact tracing and genetic testing of the virus to watch for mutations.
Part of those funds will also go toward wastewater surveillance of the virus. The Centers for Disease Control and Prevention is expected to start posting that data publicly as early as Monday, a CDC spokesperson told NBC News.
A separate monitoring system called WastewaterSCAN, which tracks 191 sites in 41 states, is showing high levels of influenza A in the Midwest and Northeast. Thats unusual for mid-May, well past the typical flu season. The bird flu is a type of influenza A virus.
Those findings prompted the WastewaterSCAN researchers to look more closely at wastewater sites in Texas, where its believed the bird flu outbreak began.
Further testing indicated that, at the sites in Texas, what we were seeing was most likely attributable to an H5 influenza virus, said Marlene Wolfe, an assistant professor of environmental health at Emory University and program director forWastewaterSCAN.
While wastewater testing can detect influenza A, it cant distinguish whether the virus came from a human or an animal, according to the CDC.
The findings, coupled with recent announcements that fragments of the bird flu virus had been detected in 1 in 5 samples of pasteurized milk, indicate that bird flu may be spreading undetected. Further testing confirmed that the milk, along with other pasteurized dairy products including sour cream and cottage cheese, were safe to eat or drink.
Just one person, a dairy worker in Texas, has tested positive for the virus during the current outbreak. His illness was mild, and his only symptom was pinkeye.
But experts have suggested that other cases could be going undetected. Fridays incentives announcement included a $75 payment to any farm worker who agrees to give blood and nasal swab samples to the CDC.
Meanwhile, experts said the risk of bird flu spreading among the general public remains low.
Stay aware, but only let it take up a small part of your brain, Jetelina said. There is a good probability that this will fizzle away.
Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."
The age of extinction
Virus sent to high-security facility so that experts can examine the potential risks to people and livestock
Sat 11 May 2024 11.08 EDT
Avian flu typically spreads by infecting wild birds and moving along migration routes, but the virus currently running rampant in the US is about to be transported across the Atlantic by plane.
This category A pathogen, which is now spreading among cows in the US, is being sent to a high-security laboratory in the UK so that experts can better understand the potential risks to people and livestock.
Its due to be shipped any day now, said Dr Ashley Banyard, a virologist at the UKs Animal and Plant Health Agency (Apha) lab in Weybridge, Surrey, last week. I saw the packaging instructions in my email this morning. It is essential this virus does not escape into the wider environment: globally, H5N1 has killed millions of wild birds and thousands of mammals.
Although avian flu is widespread in the UK, the specific genome being imported for testing is the only one known to infect cattle, and the US is the only place where it has been recorded. We really want to know if theres something special about this particular genotype thats emerged, said Banyard.
It is being shipped in a small amount of liquid within three tubes, with dry ice between layers a bit like a Russian doll. A special courier costs hundreds of pounds to safely transport it door to door.
The virus made headlines in the US in March after it was detected in dairy cows in Texas and Kansas following widespread reports of a loss of milk production. Since then it has been reported across nine US states, with no sign of slowing. It has also been detected in cats and a human, and is likely to have been spreading for months before it was detected.
Were hoping that the American situation will be controlled and be limited further, and then we wont see this virus in cattle going forward, but you just never know with these things, said Banyard.
Everyone who works at the Weybridge lab is counter-terrorism checked, and there are multiple levels of locked doors and key cards. I know it sounds kind of James Bondesque but it absolutely isnt theyre just laboratories, he said.
From Spanish mink to polar bears in the Arctic and seals in the Antarctic, a range of mammals have been killed by the virus, generally through eating infected meat.
The US outbreak has sparked alarm because it is the first time bird flu has been detected in a cow, and it is not clear how it got there. The fact the virus can spread in dairy herds has led to enormous concern it could spread more easily in people, according to the World Health Organization (WHO). Its director general said last week the virus does not show signs of having adapted to spread human-to-human.
A pre-peer review paper published this month is the first to argue the virus came into dairy cows via a single introduction from a wild bird, and that it is transmitting cow to cow. It is currently believed that milk is the primary vector (perhaps via milking equipment) and symptoms are mild, including a drop in milk production and loss of appetite.
In the US, dairy cows being moved across states must now be tested for bird flu. Health officials say milk is fine to drink, provided it is pasteurised, a process which is designed to kill bacteria and viruses.
There are concerns cows may have been infected in other countries where testing is not being done, although Banyard is confident it hasnt already happened in the UK. Weve had more than 380 infected premises across the UK in the past two and a half to three years and have not seen any evidence of these symptoms in cattle, he said.
Very few livestock animals are brought in from the US, and it is rare for migratory birds to bring bird flu viruses from the US to Europe because it is not a common migration route. In the three years of this H5N1 outbreak, not a single north American strain has been found in Europe. And everyone in Europe has been looking, said Prof Ian Brown, a virologist from the Pirbright Institute in Surrey.
Brown said it was a surprise to see it crop up in dairy cows It shows us it can get into niches you wouldnt expect but this marks another chapter in the evolution of H5N1, which has continually surprised researchers with the number of animals it has been able to infect (at least 26 species of mammal have been infected). These are the early stages of an epidemiological investigation.
Scientists need to understand bird flus potential risks to humans. All international eyes are on this, said Brown. In order for the virus to start spreading between humans, it would have to make some genetic changes that mean it can replicate in human cells.
Brown said people who work in close contact with dairy cattle should be monitored, as they are the highest risk more than 200 people are being monitored in the US. We have to be watchful. We have to make sure we are on top of tracking this so that if the risk changes for humans we spot it early. Thats very important.
If bird flu did begin to spread between humans, it would be a cause for significant concern because the H5N1 virus has a high mortality rate. From 2003 to 2024, 889 cases were reported in 23 countries, and more than half of those people died, according to WHO. So pre-pandemic vaccines have already been stockpiled.
The virus is already circulating in ways it hasnt before. Prof Rowland Kao, an epidemiologist at the Roslin Institute at the University of Edinburgh, said: The fact that were throwing another animal into the mix could potentially shift it around it creates another layer of unpredictability.
It is the first time an influenza A virus has been found in cattle, which could create threats to wildlife, and livestock and potentially humans that we have not experienced before.
Monitoring and sharing data such as testing the US genome in UK labs is crucial to keeping on top of any potential outbreak. We are far away from a human pandemic, Kao said. But it does bring things a step closer.
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A cow drinks water from a trough at a dairy farm. At least one Colorado dairy farm was hit by highly pathogenic avian influenza, though the lack of testing means that no one knows how widespread the virus is.
The bird flu has arrived in Colorado, and while it doesnt represent anywhere near the threat that COVID-19 did at the beginning of the pandemic, people should take some precautions with animals that could carry it, experts say.
The Denver Post compiled the latest information on H5N1 highly pathogenic avian influenza, the bird flu virus that has jumped to cows in at least nine states including Colorado and has infected a small number of people.
While the virus at this point is only a threat to people who work with animals, scientists are concerned that it could mutate enough to spread between people, possibly sparking another pandemic.
If you want more in-depth information, the Colorado Department of Public Health and Environment and the Colorado Department of Agriculture will hold a virtual town hall on avian flu at 9:30 a.m. Wednesday at tiny.cc/birdfluwebinar.
The U.S. Department of Agriculture confirmed H5N1 highly pathogenic avian influenza had reached a dairy cow herd in northeast Colorado as of late April. The state also is investigating a second herd, but hasnt released any information while waiting for testing results.
Cows typically dont get influenza A viruses, the family that includes H5N1, so it was a shock to find they were infected, said Jenna Guthmiller, an assistant professor of immunology and microbiology at the University of Colorados Anschutz Medical Campus
At least 36 herds across nine states have tested positive, but without routine testing, the virus could be spreading undetected in others.
Over the last two years, some Colorado poultry operations have had to cull their birds (killing and properly disposing of all members of an infected flock to avoid spreading the virus to other farms), and the state health department has found infected wild birds or mammals in more than half of Colorados counties. You can reasonably assume that birds in your county also are carrying the virus, even if testing hasnt found it.
Right now, the country doesnt have a clear picture of how widely the virus has spread, particularly among cattle and people who work with them, Guthmiller said. Cows often have mild symptoms and may be able to spread the virus even if theyre asymptomatic, she said.
The major concern right now is still in dairy farm workers, she said.
The name refers to the high mortality rate among poultry. It doesnt appear to make cows severely ill, however, and we dont know how bad it could be for people.
A separate subgroup of H5 avian influenza, found in Asia in the 1990s, had an official human mortality rate of about 50%. The subgroup thats spreading now has caused 13 confirmed human cases worldwide and one death, though given the lack of testing, other cases may have flown under the radar, Guthmiller said.(Flu viruses are named based on two types of proteins on their surfaces. The current subgroup and the high-mortality one in Asia share one major protein H5 but have different forms of the second protein.)
So far, we only know of two human cases in the current U.S. outbreak: a poultry worker in Colorado in 2022 and a dairy worker in Texas this year. Both had mild symptoms and recovered.
So far, the current avian flu hasnt picked up mutations that would allow it to spread efficiently between humans in the way that the seasonal flu does. As it infects more mammals, however, it gets additional chances to adapt to bodies that are closer to our own. Scientists are watching for infections in pigs, in particular, because they can carry multiple types of flu viruses, which could swap genes and grant each other new abilities.
The concern is that if H5N1 spilled over to humans, it could cause a pandemic and stay with us as another seasonal flu virus, Guthmiller said.
Farmers are required to dispose of eggs and meat from infected birds. Since the virus is so severe in poultry, the odds of products slipping through because no one realized the birds were sick are extremely low.
Scientists found fragments of the bird flu virus in milk from grocery stores, but couldnt grow any live viruses, meaning the process of heating the milk to kill bacteria also killed the virus. Other products made with pasteurized milk also are safe to eat.
Raw milk might not be safe, however, because it hasnt undergone pasteurization to kill viruses and bacteria. (This made drinking it a risky decision even before the avian flu started to infect cows.) Cats in Texas died of neurological symptoms related to bird-flu infection after drinking raw milk, though researchers couldnt rule out that they could have caught the virus by eating wild birds.
Colorado doesnt allow sales of raw milk, though people in cowshare programs can receive it from the cow they partially own.
A sampling of ground beef from animals in states with avian influenza dairy outbreaks didnt find the virus in meat, according to the U.S. Department of Agriculture, though other studies are ongoing to find out if the virus could get into muscle tissue in cattle.
Veterinarians in Colorado have to report flu-like illnesses in cattle, and can request testing of herds.
The federal government also requires testing a sample of cows when moving a herd of lactating animals between states. It exempts calves and adult cows not involved in milk production. (The current leading theory is that the virus is spreading between cows during the milking process.)
On Monday, the Centers for Disease Control and Prevention asked state health departments to work on distributing personal protective equipment to dairy and poultry farms, as well as slaughterhouses. Workers arent required to wear masks and other protection, however.
States and the federal government could do a better job working with people whom farmers trust, such as local veterinarians, to increase testing, Guthmiller said. Right now, farmers dont see a reason to invite attention, because H5N1 isnt causing significant harm to their herds, she said.
Theres the presumption its controlled, she said.
The Colorado Department of Agriculture advises people who own domestic birds to keep them away from wild birds, and report any unusual illnesses or deaths.
The agency also said people and pets should avoid contact with sick or dead birds. If you have to remove a dead bird from your property, wear gloves and a mask, and place the bird in two bags. Then immediately throw out the bird, mask and gloves, and thoroughly wash your hands.
People who spend time around cattle or raw milk should monitor themselves for flu-like symptoms or eye inflammation, Guthmiller said. Most clinics dont have the ability to test for specific influenza subtypes, so people with risk factors need to tell them so they can send the sample to a lab that does, she said.
You should go to a clinic to be seen and report these risk factors, she said.
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Food and Drug Administration Commissioner Robert Califf warned lawmakers Wednesday that unless the United States initiates countermeasures to stem the spread of avian influenza, the government may be ill-prepared to respond if the virus mutates and spreads among humans.
While the risk to the general public remains low, he told Senate appropriators in charge of FDA funding that investment to clamp down on the spread of the virus among cattle and poultry would pay dividends. That includes providing protective equipment to dairy workers, conducting research to understand how the virus is evolving and maintaining funding for vaccine manufacturing to be able to ramp up production quickly if needed.
If we institute the countermeasures now and reduce the spread of the virus now, then were much less likely to see a mutation that jumps to humans for which we are ill-prepared, Califf said.
The FDA is seeking an additional $157 million in federal funding in its fiscal 2025 budget request compared with fiscal 2023. Combined with user fees, the agency seeks $7.2 billion.
Listen to the Episode
Today we have a timely bonus episode to bring you up to speed about something you might have seen in the news bird flu.
To explain whats going on we invited Brown University professor Jennifer Nuzzo to the show. Jennifer is a professor of epidemiology and the director of the Pandemic Center at Brown University.
Megan Hall 00:25
Jennifer Nuzzo Thank you so much for coming in today.
Jennifer Nuzzo 00:28
Thanks for having me.
Megan Hall 00:29
So let's just get to the basics. First, what is bird flu.
Jennifer Nuzzo 00:33
So bird flu is a type of influenza virus that has been mostly affecting birds and other wildlife, it's been on our radar for more than 20 years, there have been some human cases that have occurred over that time. But these, by and large, have occurred in people who have had contact with infected animals. So there are the sporadic infections, there have been almost 900 over this 20 year period. So not a small number, but not anything like we see with seasonal influenza.
Megan Hall 01:06
Okay, so why are we hearing about bird flu in the news right now?
Jennifer Nuzzo 01:10
Yeah, so it's been a virus that we've been watching and worrying about for 20 years. But it's kind of come back into the news in the last year or so in part, because in the last year, we've seen a really rapid expansion in terms of where on the globe, we're finding this virus, and also a rapid expansion in terms of the number of animal species that are affected by this virus. So as I said, it's largely been a virus that has affected birds. But over the last year, we have seen the virus be capable of infecting many more animal species, including mammals. And once we start seeing this virus show up in mammals that increases our worries that it might be getting better capable of infecting mammals and humans or a mammal, So that's one reason why we worry about it.
And recently, you've heard about this virus in the news, because we found the virus in cows, that was surprise number one, we hadn't previously seen this virus in cows before. And a dairy worker, someone who was exposed to a dairy cow also was determined to have been infected by the virus. And so seeing a human being who has close contact with an infected cow, that increased worries one because, you know, again, we don't want people getting this virus, but two it just raises concerns that if we let this virus continue to circulate around the world, it could get better capable of infecting humans.
Megan Hall 02:30
So can you help put this into perspective for me? Because there's always the struggle to balance keeping people informed with wanting to avoid alarming people. So, where would you say bird flu is right now on a scale of like, common flu to COVID, 19 in 2020? Like, where are we at?
Jennifer Nuzzo 02:47
Yeah, so we're nowhere near either of those. When you hear sort of experts worrying about this virus, what you're hearing is worrying about a future scenario that hasn't yet happened, and wanting to make sure that we take action to prevent that future scenario from happening. Now, this virus does present a threat today. But right now that threat is to the people who have exposure to infected animals. And I do very much worry about farm workers and people who are exposed to raw milk because we have found the virus and raw milk, I worry about needing to protect them. But I don't worry right now for the general public that isn't regularly in contact with animals that are likely to be infected.
Megan Hall 03:28
What do we know about bird flu in milk? Do people need to be worried about drinking milk?
Jennifer Nuzzo 03:32
So short answer no. About a week or so ago, there was a headline that they had found evidence of genetic material in milk that had been pasteurized. And that's not really surprising, because if you know that the virus is in raw milk, and it had been found in raw milk from the infected dairy cows, what pasteurization does is it basically heats the milk, it doesn't remove the genetic material of the virus, but it makes the virus inactive so that it can't infect us. So follow up testing of the pasteurized milk was not able to grow virus from it. So that gives us good confidence that pasteurized milk cannot hurt people. Public health experts have long advised against consuming raw milk. And this is just another reason not to consume raw milk.
Megan Hall 04:19
So if you think it's really trendy and you want to drink raw milk, this is not the time to start.
Jennifer Nuzzo 04:24
Correct.
Megan Hall 04:26
What do we know about how this is spread?
Jennifer Nuzzo 04:29
Yeah, so that's been a little bit of a mystery. And it's still a mystery. It is currently thought that there was probably one introduction to dairy cows, but there's a little bit of uncertainty around that. And then it has spread to cows in other states, don't fully understand how that happened, though there is some thought that the movement of cows has played a role. I would say, I'm not terribly satisfied with the answers that have been given, and, you know, I don't think the movement of cows fully explains it, or at least I haven't seen compelling evidence that that's it. So I basically think that there's a lot more to learn. And what has been challenging is that we know that surveillance for this virus in cows is just woefully inadequate. You know, there's deep disincentives to test these animals. And also the testing that's been done so far is really been oriented around protecting the industry rather than trying to protect the humans who may be exposed to the virus.
Megan Hall 05:27
We learned so much about how viruses are spread with COVID. And we eventually learned that you know, it's in the air. So the best way to protect yourself is through masks. But do we know if you know, a cow was next to a bird that was infected? I mean, how did it get from the bird to the cow, or we have no idea.
Jennifer Nuzzo 05:44
So we don't know, we don't know that. We don't know how it spread from cow to cow, though we do believe that there's been cow to cow transmission. We don't know if it's been through milking operations, that somehow there might be a contamination or an aerosolization of the virus. also, the movement of cows between states may have played a role. But really, I think it's not clear enough to understand. In the worker who was infected, the infection was mild, it was conjunctivitis so an eye infection. And some people have raised the possibility that that may have been, you know, maybe touched raw milk and touched eye, we don't fully know. But you know, there is the worry that, you know, more serious infections can occur, because of the nearly 900 people who have been infected with this virus so far, again, over the last 20 years, about half have died. So this is not an historically mild virus. And so while it's, you know, better that this case that we found recently was mild, we can't say that future cases will be.
Megan Hall 06:45
So what is the government doing to respond to this and prevent the spread?
Jennifer Nuzzo 06:50
So the biggest change that we've seen so far is that the USDA, the US Department of Agriculture has changed its policy for testing cows. They've implemented a policy that some people are calling Test To Move, meaning that they are now requiring that cows that are going to move between states have to be tested. So that's a new requirement. And there's also a requirement that the test results will be reported to the USDA. That is an improvement because before and still largely, testing is pretty much voluntary, and it's otherwise restricted to cows with symptoms.
We know from data from North Carolina, that cows without symptoms may also be infected, they can test positive. So there's a number of ways why this new policy while, somewhat of an improvement is not adequate to figure out where in the country the virus is and where it isn't. But also not adequate to protect farmworkers. Because if you're only testing a cow with symptoms right before it is going to move between states and you have to send that specimen out to a laboratory. It's going to be some time before you get that test results. And what that means is by the time you find out that that cows been infected, it's very likely that a worker has been exposed to it.
Megan Hall 08:03
So if you were in charge, how would you be responding?
Jennifer Nuzzo 08:07
Well, I think one of the things we need is tests that can be done on the farm. So we get test results more quickly, so that we can perform tests much more frequently. And that we can perform them for the purposes of making sure a cows not sick before someone has exposure to them, or to encourage those who are likely to be around these cows to make sure they have personal protective equipment on. The other thing is to think about protecting farm workers more directly. The US government has undertaken some effort to develop and stockpile H5N1 vaccines.
Megan Hall 08:39
And H5N1 is the technical term for this bird flu.
Jennifer Nuzzo 08:43
Yeah, so that's, that's the name that we are giving this virus. The government has vaccines for this, its not quite ready for human use. They are keeping these vaccines in case the virus does become capable of spreading between people more easily, and so that we could, you know, potentially start vaccinating earlier than, if you remember, back in COVID, it was about a year before vaccines became available. This effort that's gone on will make it faster to get vaccines out. But in my view, we should be thinking about using these vaccines now to protect farmworkers that we know have been exposed to what has been historically a deadly virus.
Megan Hall 09:20
The last time we spoke was in 2022. And you were just coming to Brown to set up this pandemic center. How does the mission of your center fit into responding to something like a bird flu? Like this seems like sort of your work in action?
Jennifer Nuzzo 09:36
Yes, it is. And I think when we talked, we talked about why COVID-19 was not going to be our last pandemic threat, why the conditions of the world were such that we're gonna keep seeing these new viruses emerge and potentially threaten us. And that the goal for preparing for them would be that we would have the tools and policies and practices that we need, so that when they do occur, we could respond quickly, we could respond effectively, such that we kind of take off the table, the ability of these pathogens to upend our lives in the way that COVID-19 was capable of doing. And so, you know, I think, with the ending of COVID-19 as a kind of global emergency, I think many people were tempted to think that we were sort of done. That the worst was behind us and we really didn't have to worry about these scenarios anymore.
Since I've gotten to Brown there have been a number of different things that have occurred since the pathogen so we had a historically significant epidemic of another virus, respiratory syncytial virus that really, you know, overwhelmed a number of hospitals around the country. We had a very rapid and vigorous flu season that happened. We had a pretty unprecedented global epidemic of M-pox, a virus formerly called Monkeypox. This H5N1 is also concerning and yet another one of these infectious disease threats that we have to think about and respond to. So, it's just part of the operating conditions of our lives. We live in an age of pandemic threats, we're going to keep seeing new events occur, that make us worried that another pandemic could happen, and we need to be ready to respond quickly, so that we don't allow the worst to happen.
Megan Hall 11:16
So instead of seeing these pathogens as sort of the specter of another COVID, we kind of have to see it as business as usual. Like they're just gonna keep coming.
Jennifer Nuzzo 11:25
Yeah, I mean, I think of them sort of as recurring hazards. Just like if you live in, you know, the southern coastal states, you'd be regularly thinking about getting ready for a hurricane. If you live in the western states, you worry about wildfires, you know, there are recurring hazards, that we get ready for, that we plan for so that when they happen, we don't let them just completely consume us, that we can work to protect ourselves and to prevent the worst from happening.
Megan Hall 11:53
Great. Well, we're gonna wrap up, but before we leave, I just want to get sort of a takeaway from you, for our listeners who are trying to kind of weigh how worried they should be. What's your kind of final message to people as they're learning about this latest version of bird flu?
Jennifer Nuzzo 12:08
Yeah, so what I tell people is if you're not someone who has exposure to animals that are likely to be infected, this is not something you have to put on your worry list. However, when you hear people talking about it publicly, they're talking about it publicly because we want the government and other partners to take action to prevent this from becoming a bigger threat. I have been worrying about this virus for 20 years, I have worried that this virus could cause a pandemic for 20 years. It hasn't happened yet. That doesn't mean it won't just because it hasn't happened doesn't mean it won't happen. But what it means is that we have to get ready so that we could take off the table worry about this virus for good.
Megan Hall 12:46
Great. Well, Jennifer Nuzzo. Thank you for coming in today.
Jennifer Nuzzo 12:49
Thanks so much for having me.
