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Public Health SITREP: H5N1 By Evan Anderson Why Read: Due to the lack of effective response to the ongoing pandemic of H5N1 "bird flu" in wild animals and livestock, the danger of a human pandemic has increased dramatically. This week, we cover where we are now, what can be done, and how you can be better prepared for the possibility of a human-to-human H5N1 outbreak. ________ It's not a question of if; it's more a question of when. [. . .] Once the virus gains the ability to attach to the human receptor and then go human to human, that's when you're going to have the pandemic. - Former CDC Director Robert Redfield (6/15/24) Whoever wins the election is going to have to deal with a bird flu outbreak that shows no signs of letting up, and now seems destined to become the next pandemic [. . .] at a time when neither administration seems willing or able to focus on fighting infectious disease. - Former US Surgeon General Jerome Adams, in an X post (11/4/24)
In our issue "The Next Pandemic: H5N1 and Why You Should Be Paying Attention" (6/3/24), we covered the rapidly spreading H5N1 pandemic in animals, noting insufficient public-health response and the resulting high likelihood of an eventual human pandemic. We promised then to keep members apprised of important updates. Unfortunately - in large part due to the exact issues we described - the situation has since become much more grave. First, last spring's move to allow the USDA to run the response to the outbreak spreading across the United States in cattle has not proven wise. The organization has many connections with industrial farming, creating a complex and politicized situation on the ground for the veterinarians it normally employs to ensure the health of America's herds. As Katherine Eban noted in an excellent Vanity Fair piece on the nature of the response: At that existential moment back in March, when the virus was first detected in cows, veterinarians involved in the response had every expectation that a well-honed network of experts, led by USDA scientists, would immediately rev to life. But it didn't. "Nobody came," says one veterinarian in a Western state. "When the diagnosis came in, the government stood still. They didn't know what to do, so they did nothing." Now, H5N1 has spread to more than 324 dairy herds in 14 states and has sickened at least 26 farm workers exposed to infected cows and poultry. Those numbers are widely assumed to be vast undercounts, as there is no formal nationwide surveillance program, many dairy farmers oppose testing, and few farm workers are being screened. Second, the number of animals H5N1 has been confirmed to have infected has grown - including in pigs - dramatically increasing the threat that rampant spread and a genetic mutation or recombination event that leads to human transmission could occur. Third, in a situation that feels akin to the early days of the COVID pandemic, it now appears that health authorities who claimed the virus was not spreadable by respiratory routes were likely wrong. Multiple studies have shown droplet spread in animal models that indicate the possibility of spread without contact (albeit, less so than seasonal flu). While surfaces and direct contact with animals are clearly also a way the virus can spread, this potential respiratory-droplet factor is concerning. All of this adds up to a situation in which a human pandemic of H5N1 is increasingly, imminently, likely. With spread occurring in many disparate regions, and with more human cases every day, human-to-human transmission is just a mutation away. Small wonder, then, that out of 115 farmworkers examined in a recent serology study, 7% of them tested positive for a recent H5N1 infection; or that LA and San Francisco recently found H5 in their wastewater samples. We are interacting far too much with this virus at present to avoid an eventual pandemic. Unfortunate news, in multiple categories. But as we mentioned back in June, our purpose is not to alarm you, but to inform and arm you against potential problems. With that in mind, let's begin with the current situation regarding animal outbreaks.
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