This may be our last chance to halt bird flu in humans and we are blowing it

So far there is only one confirmed human case. Rick Bright, an expert on the H5N1 virus who served on President Joe Biden's coronavirus advisory board, said, 'there's a fine line between one person and 10 people with H5N1. By the time we've detected 10, it's probably too late'.
Last Updated : 24 April 2024, 21:27 IST
Last Updated : 24 April 2024, 21:27 IST

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The outbreak of H5N1 avian influenza among US dairy cows, first reported on March 25, has now spread to at least 33 herds in eight states. On Wednesday, genetic evidence of the virus turned up in commercially available milk. Federal authorities say the milk supply is safe, but this latest development raises troubling questions about how widespread the outbreak really is.

So far there is only one confirmed human case. Rick Bright, an expert on the H5N1 virus who served on President Joe Biden's coronavirus advisory board, told me this is the crucial moment. "There's a fine line between one person and 10 people with H5N1," he said. "By the time we've detected 10, it's probably too late" to contain.

That's when I told him what I'd heard from Sid Miller, the Texas commissioner for agriculture. He said he strongly suspected that the outbreak dated back to at least February. The commissioner speculated that back then, as much as 40% of the herds in the Texas panhandle may have been infected.

Bright fell silent, then asked a very reasonable question: "Doesn't anyone keep tabs on this?"

The H5N1 outbreak, already a devastating crisis for cattle farmers and their herds, has the potential to turn into an enormous tragedy for the rest of us. But having spent the past two weeks trying to get answers from our nation's public health authorities, I'm shocked by how little they seem to know about what's actually going on and how little of what they do know is being shared in a timely manner.

How exactly is the infection transmitted between herds? The US Department of Agriculture, the Food and Drug Administration and the Centers for Disease Control and Prevention all say they are working to figure it out.

According to many public health officials, the virus load in the infected cows' milk is especially high, raising the possibility that the disease is being spread through milking machines or from aerosolized spray when the milking room floors are power washed. Another possible route is the cows' feed, owing to the fairly revolting fact that the U.S. allows farmers to feed leftover poultry bedding material -- feathers, excrement, spilled seeds -- to dairy and beef cattle as a cheap source of additional protein.

Alarmingly, the USDA told me that they have evidence that the virus has also spread from dairy farms back to poultry farms "through an unknown route." Well, one thing that travels back and forth between cattle farms and chicken farms is human beings. They can also travel from cattle farms to pig farms, and pigs are the doomsday animals for human influenza pandemics. Because they are especially susceptible to both avian and human flu, they make for good petri dishes in which avian influenza can become an effective human virus. The damage could be vast.

The USDA also told me it doesn't know how many farmers have tested their cattle and doesn't know how many of those tests came up positive; whatever testing is being done takes place at the state level or in private labs. Just Wednesday, the agency made it mandatory to report all positive results, a long overdue step that is still -- without the negative results alongside them -- insufficient to give us a full picture. Also on Wednesday, the USDA made testing mandatory for dairy cattle that are being moved from one state to another. It says mandatory testing of other herds wouldn't be "practical, feasible or necessarily informative" because of "several reasons, ranging from laboratory capacity to testing turnaround times." The furthest the agency will go is to recommend voluntary testing for cattle that show symptoms of the illness -- which not all that are infected do. Bright compares this to the Trump administration's approach to COVID-19: If you don't test, it doesn't exist.

As for the FDA, it tells me it hasn't completed specific tests to confirm that pasteurization would make milk from infected cows safe, though the agency considers it "very likely" based on extensive testing for other pathogens. (It is not yet clear whether the elements of the H5N1 virus that recently turned up in milk had been fully neutralized.) That testing should have been completed by now. In any case, unpasteurized milk remains legal in many states. Bright told me that "this is a major concern, especially given recent infections and deaths in cats that have consumed infected milk."

Making matters worse, the USDA failed to share the genomes from infected animals in a timely manner, and then did so in an unwieldy format and without any geographic information, causing scientists to tear their hair out in frustration.

All this makes catching potential human cases so urgent. Bright says that given a situation like this, and the fact that undocumented farmworkers may not have access to health care, the government should be using every sophisticated surveillance technique, including wastewater testing, and reporting the results publicly. That is not happening. The CDC says it is monitoring data from emergency rooms for any signs of an outbreak. By the time enough people are sick enough to be noticed in emergency rooms, it is almost certainly too late to prevent one.

So far, the agency told me, it is aware of only 23 people who have been tested. That tiny number is deeply troubling. (Others may be getting tested through private providers, but if negative, the results do not have to be reported.)

On the ground, people are doing the best they can. Adeline Hambley, a public health officer in Ottawa, Michigan, told me of a farm whose herd had tested positive. The farm owner voluntarily handed over the workers' cellphone numbers, and the workers got texts asking them to report all potential symptoms. Lynn Sutfin, a public information officer in the Michigan Department of Health and Human Services, told me that response rates to those texts and other forms of outreach can be as high as 90%. That's heartening, but it's too much to expect that a poor farmworker -- afraid of stigma, legal troubles and economic loss -- will always report even mild symptoms and stay home from work as instructed.

It's entirely possible that we'll get lucky with H5N1 and it will never manage to spread among humans. Spillovers from animals to humans are common, yet pandemics are rare because they require a chain of unlucky events to happen one after the other. But pandemics are a numbers game, and a widespread animal outbreak like this raises the risks. When dangerous novel pathogens emerge among humans, there is only a small window of time in which to stop them before they spiral out of control. Neither our animal farming practices nor our public health tools seem up to the task.

There is some good news: David Boucher, at the federal government's Administration for Strategic Preparedness and Response, told me this virus strain is a close match for some vaccines that have already been formulated and that America has the capacity to manufacture and potentially distribute many millions of doses, and fairly quickly, if it takes off in humans. That ability is a little like fire insurance -- I'm glad it exists, but by the time it comes into play your house has already burned down.

I'm sure the employees of these agencies are working hard, but the message they are sending is, "Trust us -- we are on this." One troubling legacy of the coronavirus pandemic is that there was too much attention on telling the public how to feel -- to panic or not panic -- rather than sharing facts and inspiring confidence through transparency and competence. And four years later we have an added layer of polarization and distrust to work around.

In April 2020, the Trump administration ousted Bright from his position as the director of the Biomedical Advanced Research and Development Authority, the agency responsible for fighting emerging pandemics. In a whistleblower complaint, he alleged this happened after his early warnings against the coronavirus pandemic were ignored and as retaliation for his caution against unproven treatments favored by Donald Trump.

Bright told me that he would have expected things to be much different during the current administration, but "this is a live fire test," he said, "and right now we are failing it."

Published 24 April 2024, 21:27 IST

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