Trying to spot human cases of #H5N1 #birdflu in the US this summer has been a challenge. The coming cold-and-flu season is going to make it way harder. Thoughts from @MarionKoopmans, @PeacockFlu, @florian_krammer & others. https://t.co/MN7lntguYU
— Helen Branswell ???? (@HelenBranswell) October 28, 2024
This article was published at the end of October, when it looked like we might be lucky enough to be living under an administration that understood science, not to mention law. Conditions which, of course, no longer hold… Helen Branswell, at STATNews — “Health systems will likely struggle to differentiate the virus from flu-like illnesses”:
If one can point to anything good about the H5N1 bird flu outbreak in dairy cattle — to be honest, there’s nothing good about this situation — it’s the timing. Transmission of the virus through U.S. dairy herds took off when last winter’s flu season was effectively over, making the job of looking for people infected with H5N1 an easier task in theory, though there have been plenty of human hurdles impeding those efforts.
But in the months since the outbreak was first detected, the spread of the virus in cows has not been contained, with infections reported in 380 herds in 14 states so far. Now, with cold and flu season looming, it is likely to become significantly more difficult for the country’s public health departments to track the virus.
In the weeks and months to come, when dairy farmworkers or others culling infected poultry flocks develop influenza-like symptoms, what ails them could be a common cold, Covid-19, regular influenza, or a bird flu virus. Spotting a new flu virus before it starts to transmit more easily among humans and stopping that spread — if it’s possible — could make the difference between a close call and something no one wants, another pandemic.
Trying to do this surveillance at any point in the year is devilishly tough. Doing it in flu season will be next-level hard, experts warn.
“It’s going to be more challenging. You’re going to have more viruses that are in circulation, more cases coming forward. The labs are going to have much more to do,” said Maria Van Kerkhove, the World Health Organization’s acting director of epidemic and pandemic preparedness and prevention…
You may be wondering: Can wastewater testing help in what’s going to be a more challenging situation? Long used elsewhere to detect transmission of polio viruses, it is proving to be a useful tool to detect levels of a number of pathogens such as SARS-CoV-2, the cause of Covid-19. And it can detect H5N1, differentiating it from seasonal flu viruses, said Marlene Wolfe, an assistant professor of environmental health at Emory University and program director for WastewaterSCAN. But if wastewater testing turns up H5N1 virus in a community’s sewage system, it cannot say if the virus came from a person, a cow, or discarded contaminated milk.
Here are three ways in which H5N1 surveillance is about to get more difficult.
The risk of more infections and maybe worse, co-infections…
Reassortment is something flu virologist Florian Krammer worries about. “By reassorting with seasonal influenza viruses, [H5N1] could get a replication machinery that just does much better in human cells,’’ said Krammer, who teaches at Mount Sinai’s Icahn School of Medicine in New York. “That could get hairy.”…In an effort to lower the risk of a reassortment event, the CDC is calling for farmworkers who might be exposed to H5N1 to be vaccinated against seasonal flu. Knowing that many do not have health care coverage — and may be unlikely to prioritize getting a flu shot they have to pay for — the CDC is providing 100,000 doses for farmworkers in 12 of the states where H5N1 has been seen to circulate in cows. (Wyoming and Oklahoma, where the virus has also been detected in cows, declined to take part in the program, a CDC spokesperson said.)
The approach, however, is far from perfect. For starters, 100,000 doses divided by 12 states isn’t a lot of vaccine. California, for instance, is the country’s largest milk producer, with over 1,100 dairy herds in the state, and an estimated dairy farm workforce of between 17,000 and 18,000 workers. It is getting 5,000 doses of flu vaccine through the CDC program — in effect 4.5 doses per farm…
Getting exposed people to get tested
Mild H5N1 cases — virtually all of the 34 cases reported in the United States this year have been mild — could be especially hard to find in winter, given that there is no culture of widespread flu testing in this country.People rarely seek medical care when they have what seems like a garden variety influenza-like illness, known among health care providers as an ILI. Doctors typically only test for flu when someone is severely ill, at high risk of becoming seriously ill from flu because of age or underlying health conditions, or has been admitted to hospital…
Dairy farms in some states rely heavily on undocumented workers who may well be nervous about their immigration standing, especially in these turbulent political times. Take Wisconsin, for example. In the nation’s second biggest dairy-producing state, more than 10,000 undocumented workers hold down 70% of the dairy jobs, according to a survey released in April 2023 by the School for Workers at the University of Wisconsin-Madison. State law bars them from driving legally, which can limit what they can do outside of work, a ProPublica report from August 2023 explained.
How realistic is it to expect workers in this situation, people who would be docked wages if they were told not to work, to seek and potentially have to pay for a test if they develop conjunctivitis or cold-like symptoms? Even if the testing is offered for free — near the farm gate, by local public health workers — what is the upside for farmworkers? For their bosses?…
The workload on labs
Frontline tests typically will tell you if a person is infected with flu, and if so, whether the virus is influenza A or B. (It is believed that only influenza A viruses can trigger flu pandemics.) H5N1 is an influenza A virus, as are the H3N2 and H1N1 viruses that circulate every winter. To spot H5N1 cases — or in fact any novel flu virus that could cause a pandemic — additional testing needs to be done to tease out which flu A virus was responsible for the positive test result.Only a portion of positive flu A tests are subtyped in this way. The CDC’s Reed said that after the 2009 H1N1 pandemic, a lot of work went into determining what percentage of tests should undergo subtyping, in order to be able to detect spread of a new flu virus before it becomes a significant public health problem. The CDC called the effort “right sizing” testing. In partnership with public health laboratories, state and local health departments, and statisticians, guidance for individual jurisdictions was developed and published in 2013. It’s been updated since then, Reed said…
Don’t panic, but *do* stay vigilant. Update your vaccinations, consider your masking strategies (might want to order more of your preferred style before the incoming administration gets cute ideas about spot tariffs), and maybe dig out those bottles of hand sanitizer.
In the Street of the Blind, the One Eyed Man Is the Guiding Light*
J. Arthur Crank
That is one way of putting it…
trollhattan
I, for one, can’t wait for HHS Secretary RFK Jr to launch “Friends of Bird Flu” as an early White House initiative.
Barbara
@trollhattan:
Wait until the price of milk doubles.
Old School
Not panicking, but I didn’t really need something to add to the list of things to be concerned about.
Sigh.
The Audacity of Krope
I plan on aggressively spreading any respiratory illness I obtain this winter, as is my right as an American, primarily to places where lots of Trumpers congregate.
trollhattan
@Barbara:
La-la-la I can’t hear you!
Also: did you see what Biden did?
p.a.
Can’t wait for the 100,000 doses to be framed by the pukefunnel as “a giveaway to illegals…”🤬
Mai Naem mobile ¹
@Barbara: the price of eggs not milk. Get with the program here!
Anne Laurie
Oh, the price of milk is probably gonna skyrocket, too. (I’ve got articles about this, but there’s only so much bad news you guys need in a single post.) Milk, right now, is cheap — too cheap — because legacy producers are being squeezed dry, plus at least 70% of the dairy workforce is (you guessed!) non-documented. Cows are already dying from this new H5N1 variant, and it takes a minimum of two to three years to replace a milking cow.
lollipopguild
So, Trumpflu will be fought with masks? NO It will be fought with vaccines? NO! It will be fought with mountains of Gibberish! “there’s nothing to see here, go away you are bothering me”
Barbara
@Mai Naem mobile ¹: Well lucky for me I consume probably less than 1/4 of those commodities than I did even 10 years ago. But my nephew’s wife told me that she buys 3 dozen eggs every week.
Steve LaBonne
@Anne Laurie: But if enough consumers die when a virulent strain that spreads rapidly among humans develops, that will reduce demand enough to bring prices back in line. See, there’s always a bright spot!
Sister Machine Gun of Quiet Harmony
@Barbara: Tell her to buy a couple of chickens and keep them away from other birds.
Steve LaBonne
@Barbara: Jesus. My wife and I have trouble using up a dozen long-shelf-life organic eggs before they go bad.
trollhattan
[note to self: hoard toilet paper.]
Steve LaBonne
@trollhattan: Time for a trip to Costco!
OId Man Shadow
I’m sure the faith healers and crystals and memory water that Bobby Jr. substitutes for medicine and vaccines will be twice as effective at protecting us.
Ohio Mom
To add to all this gloom, I remember reading that this year’s flu vaccine may not be all that effective. Every year’s recipe is an educated guess about what the genetics of the prevalent virus will be. Some years the vaccine makers have better guesses than others.
mali muso
@trollhattan: We bought and installed bidets in all our bathrooms after the Covid-times, so at least we are prepared for a TP shortage if absolutely necessary.
I transitioned to a more plant-based diet this year but haven’t gone full vegan. Time to start phasing out the dairy and eggs in my diet, I guess.
trollhattan
@Ohio Mom: This year’s is trivalent; hopefully, the prevalent flu(s) will be among the three.
Leto
Didn’t think I’d live long enough for Atwood’s Oryx and Crake to materialize, but here we are. Just missing the pigoons, but I’m sure they’re right around the corner.
Mai Naem mobile ¹
@Anne Laurie: i know avian flu is currently primarily affecting farm workers, but there’s been a hike in people in Phoenix(by Phoenix I mean central Phoenix,not just exurbs) keeping chickens at home for eggs. I wonder how that would affect the spread of avian flu.
Gin & Tonic
We’re all gonna die.
Geo Wilcox
@Leto: Yes there was some traces in swine but not enough to make them sick. 491 dairy herds as of this morning. I have seen videos of dead cattle, aborted calves, and dozens of workers without PPE around them. The rendering trucks are running weeks behind so all the dead cattle and their viral load is just sitting there waiting for the fomites like flies to help spread it even more. Also it is fatal in cats.
Gravenstone
@lollipopguild: Don’t neglect the bleach and internalized sunlight approaches.
Peale
Just so you know, while I doubt the cost of TP is going to be impacted so much, remember that tariffs will drive up prices or make us produce less soft and absorbent tissues. So you might want to pick up a pallet if “soft and absorbent” is important to you. Or pick up one of them there Japanese Bidet’s before they get hit with tariffs on electronics.
M
One of the large worries I have of RFK Jr. or others of his ilk in the FDA is not the response to bird flu but creating the conditions that an outbreak is bound to happen, which is most likely through industrialization of raw milk. Pasteurization effectively kills bird flu in milk, but if RFK Jr. gets raw milk to be able to be sold to consumers, it vastly increases the likelihood of people catching the disease and thus allowing it to mutate to start human to human transmission.
Leto
@Geo Wilcox: the pigoons in the novel were basically human equivalent intelligent animals that ruled a lot of the post apocalyptic land. They hunted in packs, could use deception and subterfuge to lure prey out, and basically hated humanity. It’s not a comment on viral load/cross species migration, as much a comment that we’re just proceeding along the same lines. But so far, no roving bands of killer pigs.
So far…
Barbara
@Steve LaBonne: Yep. Same here. We struggle to eat a dozen eggs over the course of two months, except for when we have holiday baking projects.
Baud
Fewer Americans should help bring down housing prices.
CaseyL
Anyone worried about TP supply – *and* who doesn’t mind spending a fair bit more for TP – should check out Cloud Paper. I’ve been getting my TP and paper towels from them since lockdown. They make their products from bamboo, I *think* locally-supplied bamboo.
There may be other soruces for bamboo paper products. Cloud Paper is just the one I happen to use/support.
Baud
If there’s a TP shortage, I’ll subscribe to the NYT.
artem1s
@Geo Wilcox:
Welcome to the middle ages. Eradication of cats followed by infestations of rats and mice followed by Black Death and who knows what other plagues.
Maybe FOAF Jeebus is pissed at his followers for worshiping manon and false orange idols.
xephyr
@Baud: My first good laugh of the day. Much obliged!
artem1s
Bamboo grows everywhere. It’s impossible to get rid of once it’s taken root. I’ve plenty in my back yard that’s grown over from the neglected lot next door I’ll let them have for free if they come out an harvest it regularly.
I wish they had non-bleached products.
Suzanne
The thing we have been debating is whether or not to buy a new refrigerator. The existing one was left behind by the previous owner, and it’s not in great shape. We’ve been thinking about the best time to replace it. Usually, I wait until things break before replacing them, but if there’s gonna be a big tariff, might be better to do it now.
artem1s
@Suzanne: Black Friday or monday after xmas. go for it.
Ksmiami
@The Audacity of Krope: me too. Time to destroy them.
hrprogressive
@Gin & Tonic:
The difference is that if H5N1 takes off as it’s own pandemic, the level of destruction it could wreak will be orders of magnitude worse than COVID.
So much so, that all these anti-science fashwads won’t be able to wave it away.
Ohio Mom
@artem1s: Thanks, now I have a set of target dates for purchasing my new washer and dryer.
Like Suzanne and her refrigerator, I was waiting until they finished dying (so what if not every setting works, there’s enough settings that do) but now I realize I’d better beat the tariffs and inflation.
Mart
@Barbara: Daughter told Mrs. Mart she bought two gallons of raw milk and is feeding it to her one year old. This after I warned her about bird flu in dairy cattle, and children’s immune systems. Yeesh.
Ksmiami
@hrprogressive: 30-40 percent mortality rates….
hrprogressive
@Ksmiami: Exactly. At this point in time, I’m much more worried about H5N1 than COVID, and I say that as someone who spent almost 2.5 years functionally never leaving the house to avoid COVID.
The only consolation I feel is that people have been warning about a possible Bird Flu Pandemic for 25+ years if not longer and, thankfully, it hasn’t materialized.
Of course, a new incoming Fascist government that won’t give a shit about trying to stop it is brand new, so, you know.
Definitely considering maybe grabbing extra N95’s now.
Barbara
@Sister Machine Gun of Quiet Harmony: I am pretty sure their HOA would not allow them to keep chickens, but it’s a good idea. Their total family size is five, which means they go through seven eggs per day plus eight on Sunday!
Barbara
@Suzanne: Yes, some people are recommending that you make big purchases like that sooner rather than later. The tariffs that Trump placed on appliances early in the first term were limited to washing machines, and they were supposed to expire. Of course, they didn’t have the intended result, but prices for all appliances seem to have risen a lot over the last 6-8 years. I am sure the supply chain issues have exacerbated this, and the higher end makers are the ones that seemed to have the most acute supply chain problems.
No Nym
@Leto: We’ve already got The Handmaid’s Tale in progress, so why not Oryx and Crake, too?
Peke Daddy
@Anne Laurie: This will spur the adoption of precision fermentation/cellular agriculture milk fractions. Dairy is already having to compete with the above in casein and whey.
https://www.rethinkx.com/food-and-agriculture/in-depth/precision-fermentation/dairy
mellowjohn
But if the CDC doesn’t develop a test for it, we won’t have any cases. Right?
artem1s
@CaseyL:
Note from Cloud Paper – they import their products. only the packaging is locally made.
Our products are made overseas, and our bamboo is grown on local farms in Asia (where most bamboo is grown!), which are FSC certified, and we have sustainability-focused manufacturing partners who create the paper itself in China. We then 2x offset all carbon generated during the transportation of our product overseas. As we grow, we’ll continue to evaluate the best manufacturing partners across the supply chain!
wu ming
this thread on bluesky by angie rasmussen is sobering, esp. towards the end when she considers the potential effects of deportation camps on an emerging flu pandemic.
Kayla Rudbek
@wu ming: will have to read this. I was surprised when reading recent books about the 1918 influenza pandemic that it apparently originated in the USA at some of the Army bases, then went over to Europe with the US troops. But Spain had no censorship in their newspapers because they were neutral, so everyone back then thought it originated in Spain