Trying to figure out how to message about the risk posed by #H5N1 #birdflu at this point is devilishly hard. https://t.co/P4Mf4pyGDw
— Helen Branswell 🇨🇦 (@HelenBranswell) October 16, 2024
Because the important stories are inevitably posted immediately after my weekly pandemic updates… Helen Branswell, at Statnews, “The answer is not as straightforward as one might like”:
If you’re aware of the H5N1 bird flu outbreak in U.S. dairy cattle — you may have seen some headlines or read something on social media — perhaps you are wondering what the fuss is about. Yes, there have been nearly a couple dozen human cases, but all have had mild symptoms. The virus does not decimate herds in the way it does poultry flocks; most — though not all — of the infected cows come through the illness OK.
If, however, you are more familiar with the history of this form of bird flu, you might be getting anxious. You might be worried that no one has figured out how one of the infected individuals, who lives in Missouri, contracted H5N1. Or you might recall that the virus has killed half of the 900-plus people known to have been infected with it over the past 27 years. Above all, you might fret that the virus is now circulating in thousands of cows in the U.S., exposing itself to some unknowable portion of the more than 100,000 dairy farmworkers in this country — the consequences of which could be, well, disastrous.
Ongoing transmission in cattle means that every day in this country, a virus that is genetically suited to infecting wild birds is being given the opportunity to morph into one that can easily infect mammals. One of these spins of the genetic roulette wheel could result in a version of H5N1 that has a skill that is very much not in our interest to have it gain — the capacity to spread from person to person like seasonal flu viruses do.
So is this freak-out time? Or is the fact that this virus still hasn’t cracked the code for easy access to human respiratory systems a sign that it may not have what it takes to do so?
The answer, I’m afraid, is not comforting. Science currently has no way of knowing all the changes H5N1 would need to undergo to trigger a pandemic, or whether it is capable of making that leap. (This important article lays out what has been learned so far about some of the mutations H5N1 would have to acquire.)
The truth is, when it comes to this virus, we’re in scientific limbo…
Since the outbreak was first detected in late March, the Centers for Disease Control and Prevention has declared, over and over again, that it deems the risk to people who aren’t working with cows to be low. The troika of United Nations agencies that monitor H5N1 closely — the World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization — shares that opinion.
Between the lines of both assessments, though, are words public health authorities rarely volunteer but will acknowledge if pushed. As best they can tell, the risk now is low. But things could change, and if they do, the time it takes to transition from low risk to high risk may be dizzyingly brief…
One of the fundamental reasons it’s difficult to clearly communicate the risks posed by a flu virus is that it is impossible to predict what influenza will do. There’s a line that flu scientists use to describe the dilemma; I first heard it from Nancy Cox, the former head of the CDC’s influenza division, who retired in 2014. “If you’ve seen one flu season, you’ve seen one flu season.”
To be fair, there are a few basic truisms of flu. There will be a surge of flu activity most years; the first winter of the Covid pandemic was a rare exception. People will get sick — some mildly, some miserably. Some will die. The virus will evolve to evade our immunity and force the regular updating of flu vaccines. Because the viruses don’t give us roadmaps of where they’re heading, some years vaccines will work reasonably well, others not so much. And finally, there will be more flu pandemics.
But when? No one knows. Will they be deadly? The 1918 Spanish flu was far worse than the Covid pandemic, but some bad flu seasons claim more lives than the 2009 H1N1 pandemic did. Will H5N1 become a pandemic virus? Anyone who insists it is inevitable is guessing. Anyone who opines that it will never happen is guessing, too…
So how should one talk about the risk H5N1 in cows poses? Nowak, who is on a National Academy of Sciences, Engineering and Medicine committee reviewing the CDC’s Covid-19 vaccine safety research and communications, said it depends on who you’re communicating to, and what you expect them to do with the information.
“You always want to know: Who are the priority audiences? Who really needs to have information about what we need to be doing to prepare for this?” he said, suggesting that right now the answer is probably policymakers facing decisions about how to prepare for the possibility of wider spread, farmworkers who need to be protected against the virus, and local public health officials on the lookout for human cases. It’s probably not people in general, Nowak said…
Baud
It’s never time to freak out IMHO.
Ksmiami
Hmm. Part of me is hoping for a mass denial in red states
WaterGirl
@Baud:
As I started reading your comment, I thought it was going to say:
edit: Fucking N key!
different-church-lady
No.
Might be time to take it more seriously, though.
different-church-lady
@Baud: In the eyes of the media, it’s always time to freak out.
Your refusal to freak out really pisses them off.
Chet Murthy
I have to say, I don’t see what the fuss is all about. I got my flu shot, and I wear my mask anyplace it isn’t worth going unmasked (so sure, in restaurants and in friends’ houses, I go unmasked, but otherwise, I’m masked in foreign buildings and public transit). Sure, if there’s a massive outbreak, I’ll go back into isolation. But otherwise, I kinda feel like I’m already pretty safe?
What’s the rumpus?
P.S. Yes, I know what the rumpus is: all those people who go about unmasked, routinely huddling in close quarters with other unmasked people for no good reason at all. Sure, I get it.
hrprogressive
Prior to COVID, this was always prophesied to be “the next big pandemic”, one with a semi-existentially high death toll, if mortality rates ranging from 30 to 50% are to be believed.
That, in and of itself, is potentially apocalyptically bad.
But after watching how miserably almost every country on earth save maybe New Zealand treated the COVID pandemic, I am much more worried that this particular subset of the human species won’t take it seriously, because “it’s just a flu, and I ain’t never doing lockdowns or masks again after covid, fuck y’all pussy liberals” or whatever.
So even if, tomorrow, the health experts came out and said “no, really, this could be hyper bad, better prepare now”, I worry not only will far too few people heed such a warning, but after people got violent and stupid over a comparatively much safer virus…
Yeah.
That truly is potential “end of days” sort of stuff, if it really were to get as bad as it possibly could.
hrprogressive
@Chet Murthy:
The rumpus is that this particular strain of flu has an astonishingly high mortality rate.
It’s nothing like the other strains of flu that others get.
Could make COVID19 look like a walk in the park if it were to ever go pandemic.
Ruckus
@Baud:
Really this is true.
But.
There is a time to think about it a bit, about one’s personal routine and exposure, especially when you get old (often takes less to inflect most olds) or are particularly easily susceptible to these kinds of infections/diseases, or if you work among a lot of people or are easily infected.
Chet Murthy
@hrprogressive: Sure, I get it. Nobody is taking any precautions, even though a very contagious respiratory disease is still spreading like wildfire, said disease causing with some decent probability long-term damage to victims’ brains and other organs. So it’s likely that if a new disease comes along that’s somewhat like this current disease, only much more deadly, nobody will do jack-shit.
I guess I could/should be concerned, but really, I can’t be bothered. Unless there’s an actual large outbreak, my behaviour won’t change, b/c I’m already doing more than most so-called diligent people ever did during the COVID pandemic’s height. About the only change I might make before going into isolation again, would be to stop swimming at my gym. And sure, stopping eating in restaurants, but I hardly ever do that anyway.
Sure Lurkalot
My freak out is confined to the knowledge that probably half of our population will do little to nothing even if it were highly contagious and more deadly than the plague.
Chet Murthy
@Sure Lurkalot: I fear you’re wrong about that: there’s a level of deadliness above which that half the population will switch from “STOP OPPRESSING ME!” to “HERD THEM ALL INTO CAMPS AND THROW AWAY THE KEY!” *grin* [all-caps being necessary to properly convey their level of outrage]
Princess
Decimate means reduce by one tenth. When she says bird flu decimates poultry flocks, does she mean they are wiped out completely or that they’re reduced by roughly a tenth? Either could be true but I thought it was the former.
Anyway I can’t panic about bird flu because I’m too busy panicking about the election. After the election I’m sure media will be quick to tell me that it’s either a product of unbridled immigration, or a nothing burger we should pay no attention to, depending on who is elected. Or maybe they’ll wait until the inauguration.
Baud
I’m looking forward to staying home all day with my dog again.
glc
The only useful time to freak out is before you need to, in this type of situation.
It’s called asymmetrical risk.
2liberal
you have been big-footed
Bill Arnold
A reminder that seasonal influenza was basically wiped out for a while (both Northern and Southern hemisphere) due to public health measures against SARS-CoV-2, which, even the initial wild strain, was much more infectious than seasonal influenza strains, so SARS-CoV-2 continued to spread even with public health measures (a bit slower) but influenza did not.
Estimates vary, but (from memory here) seasonal influenza strains have an R (number of people an infected person infects with no precautions or population immunity) of about 1.2 to maybe 1.4, and novel influenza strains (like this bird flu would be) an R of more like 1.6/1.8.
Initial SARS-CoV-2 was R like 2.5+, and current SAR-CoV-2 strains have a much higher R.
Good masks(respirators), like N95 or equivalent or better, would totally block it (hand hygiene assumed as well).
Sister Inspired Revolver of Freedom
Thanks for all your updates. They are invaluable.
Chet Murthy
@Bill Arnold: Bill, thank you for this quantitative information. More reason to continue masking (and yeah, hand washing).
Another Scott
@Chet Murthy: I think it really, really depends on what the mass media does if/when the next pandemic comes in the next 20 years or so. (COVID-19 will be lost to the sands of time by then.)
My recollection is that a switch flipped when the RWNJs decided that COVID-19 was mostly killing Democrats in cities. They pumped up that story, and sensible public health efforts became much, much more difficult as a result.
But I also remember the RWNJ freakout about Ebola, how they wanted everyone who came within 5 miles of an infected person locked away to keep the virus at bay.
The media can play either side, for good or ill.
The vast majority of the public will watch to see what their favorite media does. If the media is on-board with the pandemic being serious and needing a sensible strong federal response, then the vast majority of the public will be too.
How do we get there? Beats me.
:-(
Cheers,
Scott.
Chet Murthy
@Another Scott: You’re more optimistic than I am. I’m convinced that the reason the MAGAts decided COVID was no biggie, was that it evidently didn’t have a really high mortality rate, and that was enough for them. Everything else was pretext. And the reason they decided that Ebola was enough to set up concentration camps, was …. well, b/c it had a high mortality rate. I believe that the media has little to do with it: it’s about whether these people fear dying of the bug. And if a bug comes along that makes them actually fear dying, they’ll rapidly switch to “lock up anybody who shows any symptoms, ESPECIALLY THE BROWN ONES!!?!?!!!”
It’s Wilhoit’s Law, Pandemic Corollary.
hoppie
@2liberal: She knew the job was dangerous when she took it, Fred.
Sister Golden Bear
@Baud: Panic now and avoid the rush.
Another Scott
@Chet Murthy: Yeah, fear of death is a powerful motivator.
But something flipped the switch from treating COVID as a serious public health challenge to a cudgel to bash Democrats.
Wikipedia:
3 opposing is pretty much unanimous, especially these days.
Of course, there were always going to be people griping (or legitimate and not so legitimate reasons) about lockdowns and schools and bars and sporting events being closed for months. But there was huge unanimity early on and there’s every reason to expect that that can happen again if people are convinced it serious.
(Recall the “if you stay, you will die” admonitions about the hurricanes and flooding recently.)
We have to assume that doing public health correctly still matters and not give up. No matter how difficult the RWNJs and the anti-vaxers and all the rest make it.
My $0.02.
Cheers,
Scott.
Gvg
1. Long term we need to figure out how to defeat the anti vaxers, before the next crisis.
2. When they say decimate poultry flocks, I presume that means chicken and turkey prices will go back up, so maybe we can emphasize that fighting it is an economic and business measure, that may also impact human health, but also might not. It definitely will impact people’s pocketbook though so be sure and get that message out too. Normally the human health angle would work better, but right now after Covid and with the oppositional defiant disorder motivating too many supposed adults, it’s not the best message. IMO of course.
Jay
@Princess:
Protocol here is when a poultry farm has an outbreak of Bird Flu, all of the flock is killed and the bodies buried. (offsite).
So “decimate” does not mean the Roman Legionnaire Punishment of “killing 1:10”.
The reason the entire flock is killed is it rapidly spreads amongst birds and fowl, spreads to wild birds, who spread it further, and it cannot be contained amongst flocks.
So the entire flock is killed, buried (offsite), and then a lengthy program of cleaning, sterilization of the buildings, cages and grounds is undertaken.
For the Farmer, that basically means no crop of eggs or meat for at least a year.
cain
These fucking anti-vax people … whopping cough is a thing. All the diseases are coming back because of these assholes.
I just.. I just can’t with this crap. There needs to be some serious policies towards mis-information. It’s becoming a health hazard. People are going to die. This stuff isn’t entertainment. It is dangerous.
cain
@Another Scott: What does Rand Paul do, exactly? He just seems to vote against everything. Even when it makes sense.
I can’t name anything positive he has done.
Chet Murthy
@cain: Ditto that anal fistula Thomas Massie.
Quantum man
Perfect storm. H5N1 pandemic and a second orange asshole presidency. Next Steven King novel.
Ksmiami
@cain: I want the us government to eminent domain all of Musk’s businesses and then burn x to the ground.
Dan B
My father got the Spanish Flu and had an open drain in one mastoid sinus for forty years. My brother and I always get our flu shots. We also believe that there are people who cannot comprehend science or medicine.
Redshift
@cain:
He styles himself a libertarian, so for his people, stopping government from doing things is the only accomplishment that matters.
Carlo Graziani
The disappointing thing to me is that the promise of the mRNA vaccines has not been extended to flu vaccines. I don’t really know why, although I suspect that the answer is “not worth the money to any pharma company”.
Flu vaccines have a latency of 6-7 months between the canvas of circulating strains (which closes in February or so, as I recall) and the appearance of mass-market vaccines (typically September). It takes that long to grow enough of the vaccine by the classical process. The problem is that occasionally, variants of concern uncloak in the meantime, and a whole flu season is lost to ineffective vaccines.
In principle, the mRNA vaccine manufacturing process is vastly simplified by comparison—almost at the level of “type in the genetic sequence of the virus at one end, emit the vaccine at the other a few weeks later.” It’s more complicated, of course, but as recently as 2022, experts in virology and infectious diseases were claiming that this process was the future of flu vaccination. It hasn’t panned out so far, though, and I wish I knew why.
dc
@cain:
He got beat up by a neighbor.
YY_Sima Qian
@Chet Murthy: I think the point here isn’t what individuals can or should do (not much beyond the standard precautions w/ COVID-19 already prevalent everywhere all the time), but what we can & should push the policymakers at different levels to do.
Kudos to the state & federal governments the US for being transparent w/ what information they have, but thumbs down on the very limited efforts at surveillance to monitor the spread between herds & the crossovers into humans, & the non-existent effort to slow the spread between herds or reduce cross-overs to humans. Should one of the human Petri dishes finally evolve a strain that is good at human to human transmission, I don’t see how the US will be able to slow let alone contain the spread, or how anyone will know it is spreading in the human population until after the virus is already all over the world.
& this is w/ the Dems in charge of the federal government, it will be much worse if Trump is elected.
YY_Sima Qian
Missed the weekly COVID thread, but the PRC National Bureau of Statistics has finally published the excess mortality data for 2020 – 2023. Dali L. Yang, who has perhaps written the definitive account of the early COVID spread in Wuhan, summarized the data below on Twitter (chart through the link):
While the 158K excess deaths in 2021, presumably largely attributable to the impact of Dynamic Zero COVID restrictions, is horrific, it needs to be weighed against the 1.13M excess deaths due to the exit tsunami in the beginning of 2023 (& a large part of the 426K excess deaths in 2022 probably also occurred in Dec. during the exit tsunami). The Chinese population, particularly the most vulnerable cohorts, were not nearly as well vaccinated in 2021, & the most vulnerable cohorts were still very poorly vaccinated even in H1 2022 (vaccination rates among the elderly remained poor at the end of 2022, but still much better than in the 1st half of the year).
A minor point is that, given the PRC’s aging population, the number of deaths has been trending higher annually as a baseline, so the number of excess deaths attributable to Dynamic Zero COVID & COVID-19 from 2020 – 2023 is probably a bit lower than Yang’s rough estimate, at the margins.
steve g
For comparisons, SARS (the first one, virus name SARS-COV-1), had 8000 cases with 9.6% fatality. MERS, the middle east one, has had 2000 cases and 35% fatality. COVID 19 is at about 7 million cases and 1% to 5% fatality, depending on how you count excess deaths.
It sort of seems like the more fatal a virus is, the fewer the cases. So bird flu would be more like the other SARS viruses, not like COVID. But not necessarily.