Healthbeat

Polio can still be eliminated – it just may take longer with $1.7B shortfall

2025-10-30T11:00:00+00:00

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Hello from Nairobi.

Winter may be coming elsewhere ... but certainly not here! I’m nursing a sunburn from a warm weekend getaway and a long swim in a spring-fed river with my toddler. (She’s fine; I dipped her in sunscreen like a SPF-50 Achilles.)

This week’s report brings a few stories that buck the fear that, as the tide of global health financing recedes, we’re headed for the worst possible outcomes. Still, if you think I’m missing the takeaway, or just spotted a story I should have, let me know: wherkewitz@healthbeat.org.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Polio vs. the clock

There’s big news in the decades-long fight to wipe polio from the planet. First the bad: the Global Polio Eradication Initiative’s budget is shrinking by 30% starting next year, purely due to global health budgets tightening. All told, that’s a $1.7 billion shortfall through 2029.

The good news? Officials say the cuts aren’t a death knell. Global elimination remains in sight, even if it will take longer to reach, Reuters reports.

Disease breakdown: Polio, or poliomyelitis, is a gut virus that spreads largely through feces. While most infections pass without symptoms, the worst cases can wither limbs or invade the spinal cord to cause paralysis or death. Importantly, the disease can’t hide in animals, and vaccines stop it cold. That’s why although polio is ancient enough to have been carved into Egyptian hieroglyphs, today we are on the verge of its eradication. In fact, two strains of the virus were eliminated in 1999 and 2020, and only two more remain.

I reached out to Steven Lauwerier, director of UNICEF’s polio eradication team (note: UNICEF works under the World Health Organization on the global effort) to understand how to digest this news.

First, while “the cuts are serious,” Lauwerier says, he makes it clear that the new game plan isn’t just kicking the deadline down the road. The Global Polio Eradication Initiative is taking a genuine effort to do more with less: to squeeze out inefficiencies in existing programs, stretch out vaccine supplies with smaller doses, merge vaccination drives with other programs like Gavi, and refocus on the few places where the virus still hides. (My take, not Lauwerier’s: Anyone who’s worked with the bureaucratic shoggoth that is the WHO knows that there are efficiencies out there to be claimed, so it’s excellent that the polio campaign is taking the challenge so seriously.)

As for timing, the last wild strain of the virus (still hanging on in Afghanistan and Pakistan) is now expected to be stopped by 2027, a year later than planned. Meanwhile a strain of the virus that bubbled up from earlier vaccine drives, and which is largely pocketed across the African continent, now has a new 2029 target.

Lauwerier notes that one of the biggest challenges is the “wild polio virus in Afghanistan, where we are not allowed to do house-to-house campaigns,” he says. That’s because of a ban under Taliban rule, which is a lingering consequence of the CIA’s 2011 fake polio vaccine plot to find Osama bin Laden in neighboring Pakistan.

Still, Lauwerier reminds me that the initiative has “had bigger challenges in the past and [has] shown that we can overcome them.” He notes incredible progress fighting polio in the Democratic Republic of the Congo, Madagascar, and hard to reach communities across south eastern Africa. “If we can do it there, we can do it everywhere.”

The heartening takeaway? “Eradication is still fully achievable,” he says. “We will go full speed until we reach interruption everywhere.”

Bird flu, big in Europe

Bird flu is sweeping across Europe. Outbreaks have hit 10 European Union countries plus Britain since August, including major poultry producers Poland, Spain, and Germany. It’s the widest early spread of this disease in a decade.

Disease breakdown: Bird flu is a cousin of human influenza, also known as H5N1. (The H and N numbers refer to the shape of two important proteins on the outside of the virus.) Bird flu spreads largely through bird droppings and is usually fatal in poultry. It usually peaks in autumn and winter in the Northern Hemisphere because that’s when migratory birds carrying the virus arrive along ancient flyways from the Arctic to Africa. The virus mostly stays bird-bound, with crowded poultry farms especially vulnerable. (They are proverbially, and sometimes literally, sitting ducks.) The virus will also occasionally jump to mammals, including humans.

Nowhere is the alarm louder than in Germany. Daily Finland reports that bird flu has been confirmed in wild birds across all but one of 16 German states. According to the article, “more than 200,000 chickens, geese, ducks, and turkeys have been culled … in order to contain the spread of the disease.” While this is still just a 10th of the culling that happened during the worst-ever 2020 outbreak, German Agriculture Minister Alois Rainer noted, “This is not unusual for this time of year.”

And the outbreaks are not just in Europe. Healthbeat Atlanta reports the state of Georgia has confirmed its fifth outbreak this year. And the New York Times reports elsewhere across the United States — where “the virus has affected more than 180 million farmed birds” since 2022 — cases are likewise surging. Worse still, so far “three states … have identified outbreaks in dairy cows.”

What’s the takeaway? Bird flu used to largely be a winter problem. Now it’s showing up earlier each year and in more species, slowly blurring the line between outbreaks from wild flocks and commercial farms. And while the virus hasn’t yet evolved to spread between humans, that leap remains one of the biggest worries for the next pandemic.

A 20/20 future for Fiji

The World Health Organization has officially declared Fiji free of trachoma, which is the leading infectious cause of blindness, Fiji’s Islands Business reports. It’s a victory decades in the making that relied on a long chain of partnerships, including between local nongovernmental organizations like Project Heaven and international efforts such as the former U.S. Agency for International Development-funded Global Trachoma Mapping Project.

Disease breakdown: Trachoma is an infection caused by the chlamydia trachomatis bacteria. It spreads through direct contact with eye and nose discharge, and largely in places with poor water and sanitation. It’s found in 31 countries and is responsible for blindness or visual impairment in about 1.9 million people. That’s because repeated infections scar the eyelid until lashes turn inward and scrape the eye.

Why does eliminating one disease on one tiny island country make the cut this week? (... Other than my desperate attempt to sneak in some good news in a field that, let’s face it, can often be a bit of a bummer.)

Fiji’s trachoma victory, like the progress on polio, is a reminder that international funding and global commitments can be rolling back even as dedicated heroes refuse to let that stop them. Both stories are long-tail wins born of decades of patient coordination and community work. They’re also proof that the systems built by the old global health order are still out there, saving lives.

Following Senegal’s Rift Valley Fever fight

We’ve been following Senegal’s worst outbreak in decades of Rift Valley Fever. Since my last update on Oct. 16, reported cases have more than doubled, and the government has rolled out a nationwide campaign, SciDev.net reports. (A reminder: Rift Valley Fever is largely a mosquito-borne livestock disease, which occasionally spills over into humans, as it’s doing now.) This outbreak is slowly building to what we expected it might become, as I wrote, “a test of how well these national and regional health systems can respond during the global health funding crunch.”

Senegal is taking this extremely seriously. The nationwide campaign has brought “together ministries of health, agriculture, environment, and water resources,” to conduct disease surveillance, mosquito control, livestock vaccination, and a public advisory campaign in various local languages. (Senegal is home to more than 30 languages and dialects.)

I have lots of questions: I’m curious about funding, about the efficacy of this coordinated push, and about what happens beyond Senegal’s borders. Remember, the outbreak cuts through a livestock corridor shared with Mauritania and Mali, which are behind Senegal in development and their outbreak response capacity. Will those countries match Senegal’s urgency, and will international organizations step in to help?

We’ll follow up once there’s concrete evidence on how this all plays out.

The high cost of cutting malaria aid

Last week we covered a bit of political drama on fundraising for The Global Fund, which is the massive organization that collects donations from wealthy governments and funnels them into programs that fight AIDS, tuberculosis, and malaria. Over the weekend, a new analysis put hard numbers on what those shortfalls might actually mean, The Guardian reports.

According to researchers from the inter-governmental body the African Leaders Malaria Alliance and the nonprofit Malaria No More, a 20% funding cut to the Global Fund could lead to 33 million extra malaria cases, 82,000 malaria deaths, and roughly $5 billion in lost GDP across sub-Saharan Africa by 2030. This effect is particularly severe because The Global Fund “provides nearly 60% of all international financing for malaria controls, such as mosquito nets and preventive drugs.”

The researchers also modeled a total funding collapse scenario, and the toll would be staggering:

“The report estimates there would be 525 million more cases, 990,000 more deaths, and $83 billion in lost GDP. About 750,000 of those deaths would be of children under 5, representing ‘the loss of a generation to malaria’, the report’s authors warned.”

To be clear, there is zero reporting that an apocalyptic collapse in malaria funding is coming. Heck, I’m going on record: It’s not coming. But as countries start to turn down their pledges (the UK is rumored to be considering a 20% cut) this report makes clear the stakes. We’ll follow up at the end of November, when The Global Fund’s public pledging conference wraps up to see where we’ve landed.

See you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Georgia confirms 5th bird flu outbreak this year. 140,000 chickens culled at commercial farm.

2025-10-27T20:06:37+00:00

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Georgia agricultural officials have confirmed a fifth bird flu outbreak this year in a commercial poultry operation, this time in Gordon County in North Georgia, resulting in the killing of about 140,000 broiler chickens over the weekend.

This is the third confirmed detection of bird flu in a commercial poultry operation this year. The two prior commercial outbreaks were in neighboring flocks owned by the same family in Elbert County. Bird flu was also found in backyard poultry flocks in Clayton County in January and in Henry County in September.

Since the surveillance and cleanup operations for the Gordon County case have been handled by state agencies, the federal government shutdown has had a limited impact, said Georgia Department of Agriculture spokesperson Matthew Agvent.

The chicken farm operators suspected bird flu last Wednesday, and samples were sent to the Georgia Poultry Laboratory Network for testing the next day. Bird flu was confirmed by the lab on Thursday, with additional confirmation by the U.S. Department of Agriculture’s laboratory on Friday, according to a press release from GDA.

The disease can be transferred from infected birds to workers involved in the cleanup, Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, told Healthbeat earlier this year.

Georgia Department of Public Health officials will monitor involved workers for symptoms for 10 days after the cleanup and containment operations end to ensure they are not affected, Agvent said.

Bird flu in Georgia: How to lower risk in backyard chicken flocks

While the impacts of the federal shutdown are limited, it may affect the farmer’s ability to get an indemnity payment from the federal government, as well as the GDA’s ability to get reimbursed for cleanup expenses, Agvent said.

Georgia’s $7.75 billion commercial poultry industry is one of the largest in the nation, so bird flu “poses a serious threat,” Georgia Agriculture Commissioner Tyler Harper said.

The 51 commercial poultry operations within 6.2 miles of the infected flock have been under quarantine since Friday. Bird flu testing will be conducted for at least two weeks.

About 345,530 birds in Georgia have been affected since the current outbreak began in the United States in February 2022, according to the USDA.

Bird flu cases are higher in the spring and fall because that’s when wild birds migrate, the USDA says.

In the past week, bird flu has been detected in wild birds in Colorado, Florida, Illinois, Michigan, Missouri, New York, South Dakota, and Wisconsin, according to the USDA.

Visitors to a petting zoo in Alberta, Canada were recently advised to get tested for bird flu after birds at the farm were found to be infected.

Some of the main symptoms of bird flu in humans include fever, cough, sore throat, and pink eye (conjunctivitis). If a health care provider identifies a human case, it must be reported to the state within seven days.

The Centers for Disease Control and Prevention has confirmed 70 human cases in the United States since April 2024; none in Georgia. There has been one death: an elderly person in Louisiana who had underlying health conditions and was likely exposed via a backyard flock.

Researchers could not trace a source of exposure in a San Francisco child who came down with bird flu earlier this year and found no evidence of human-to-human transmission, according to a September report from the CDC.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Bird flu in Georgia: How to lower risk in backyard chicken flocks

2025-09-08T15:45:37+00:00

This story has been updated with a new case of bird flu in a backyard flock.

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Chicken enthusiasts with backyard flocks are believed to number in the thousands in Georgia. With bird flu confirmed in a Henry County flock last week, people keeping fowl as a hobby are urged to take some precautions.

“Chickens are everywhere in Atlanta,” said Heath Ward, who owns CityChick, a local backyard farm supply company. His business increased during the Covid pandemic in 2020 as people looked for at-home hobbies. Now he makes his living delivering chicken supplies to families all over the metro area.

Matthew Agvent, spokesperson for the state Department of Agriculture, said his agency doesn’t have the exact number of backyard flocks, but “It would be safe to say that number is well into the thousands.”

H5N1 has been detected in two backyard flocks this year, one in Henry and one in Clayton County. The disease was also found at two commercial poultry farms in Elbert County in January.

The Centers for Disease Control and Prevention has confirmed 70 human cases in the United States since 2024 – none in Georgia. The first human death was reported in January in Louisiana, in an elderly person who had other underlying health conditions and was likely exposed via a backyard flock.

A report from the U.S. Centers for Disease Control and Prevention published Thursday said no source of exposure could be identified despite extensive contact tracing in a San Francisco child who came down with bird flu earlier this year. There was no evidence of human-to-human transmission.

Ward said he would still encourage people to get backyard chickens if they are considering it – but emphasized that new owners should read up and be prepared to implement biosecurity practices like using separate shoes for the chicken coop area.

“Too many people just ‘wing it’ and try to figure it out as they go,” Ward said.

Other experts advised waiting. Backyard flocks can be exposed to bird flu via droppings from wild birds.

“Biosecurity … takes a lot of effort to do it well, and especially if you’re new to this,” said Meghan Davis, a professor at Johns Hopkins Bloomberg School of Public Health.

“If all you have is just a screen, you can still sometimes get exposure that way, so you sometimes need to have a little bit more infrastructure to be able to manage that,” Davis said.

Ward’s business is entirely online, in part to minimize the risks of chicken flock owners from spreading diseases at a store.

“It’s a good idea to wear a separate pair of boots to the feed store,” he said.

Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health, advises waiting to bring home chickens.

“It might be prudent to wait a few weeks, as the outbreaks of H5N1 seem to be stemming from migratory birds moving south in particular parts of the country,” he said. Backyard chicken flocks typically do not live in completely enclosed areas, putting them at risk of contact with wild birds.

To keep bird flu from spreading to humans, people are urged to keep from touching dead birds with their bare hands. Use gloves and dispose of the dead birds in double plastic bags, Agvent said.

The Georgia Poultry Laboratory Network is helpful for all kinds of poultry owners, Ward said. He encourages bird owners to use the lab’s necropsy service if they have dead birds. The service is free to private owners.

“They do amazing work,” he said. The lab has a bird flu hotline that can be accessed online or by calling 770-766-6850.

Tips for reducing threat in home flocks

Dr. Katelyn Jetelina of Your Local Epidemiologist, a Healthbeat partner and supporter, offers these tips for backyard chicken owners to reduce the risk of bird flu spread.

Keep your flock contained: Isolate your birds from visitors and other birds.
Prevent germs from spreading by cleaning shoes, tools, and equipment.
Reduce the risk of transmission by avoiding sharing tools and equipment with neighbors.
Know the warning signs of infectious bird diseases among the flock, including fatigue, abnormal drop in egg production, swelling or discoloration of the eyelids/comb/wattles/shanks, stumbling or falling down, diarrhea, or unexplained death.

If one of your birds is sick or dies unexpectedly:

Avoid contact with the sick or dead bird. Assume other birds in the flock and their enclosures, droppings, feeders, and water sources are also infectious. (If you can’t avoid contact completely, take steps to protect yourself.)
If possible, isolate the bird from other animals and pets. (Don’t let your dog near it.)
Immediately report sick or dead birds to the Georgia Department of Natural Resources at 1-800-366-2661 or the U.S. Department of Agriculture at 1-866-536-7593.

What about bird feeders?

Birds that gather at feeders (like cardinals, sparrows, and bluebirds) do not typically carry H5N1. The USDA does not recommend removing backyard bird feeders for H5N1 prevention unless you also care for poultry. The less contact between wild birds and poultry (by removing sources of food, water, and shelter), the better.

Rebecca Grapevine is a Healthbeat reporter in Atlanta. Contact Rebecca at rgrapevine@healthbeat.org.

In axing mRNA contracts, Trump delivers another blow to U.S. biosecurity, former officials say

2025-06-06T14:00:00+00:00

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The Trump administration’s cancellation of $766 million in contracts to develop mRNA vaccines against potential pandemic flu viruses is the latest blow to national defense, former health security officials said. They warned that the United States could be at the mercy of other countries in the next pandemic.

“The administration’s actions are gutting our deterrence from biological threats,” said Beth Cameron, a senior adviser to the Brown University Pandemic Center and a former director at the White House National Security Council. “Canceling this investment is a signal that we are changing our posture on pandemic preparedness,” she added, “and that is not good for the American people.”

Flu pandemics killed up to 103 million people worldwide last century, researchers estimate.

In anticipation of the next big one, the U.S. government began bolstering the nation’s pandemic flu defenses during the George W. Bush administration. These strategies were designed by the security council and the Biomedical Advanced Research and Development Authority at the Department of Health and Human Services, among other agencies. The plans rely on rolling out vaccines rapidly in a pandemic. Moving fast hinges on producing vaccines domestically, ensuring their safety, and getting them into arms across the nation through the public health system.

The Trump administration is undermining each of these steps as it guts health agencies, cuts research and health budgets, and issues perplexing policy changes, health security experts said.

Since President Donald Trump took office, at least half of the security council’s staff have been laid off or left, and the future of BARDA is murky. The nation’s top vaccine adviser, Peter Marks, resigned under pressure in March, citing “the unprecedented assault on scientific truth.”

Trump administration is ending multiple HIV vaccine studies, scientists and officials say

Most recently, Trump’s clawback of funds for mRNA vaccine development put Americans on shakier ground in the next pandemic. “When the need hits and we aren’t ready, no other country will come to our rescue and we will suffer greatly,” said Rick Bright, an immunologist and a former BARDA director.

Countries that produced their own vaccines in the Covid-19 pandemic had first dibs on the shots. While the United States, home to Moderna and Pfizer, rolled out second doses of mRNA vaccines in 2021, hundreds of thousands of people in countries that didn’t manufacture vaccines died waiting for them.

Moderna deal on bird flu vaccines no longer stands

The most pertinent pandemic threat today is the bird flu virus H5N1. Researchers around the world were alarmed when it began spreading among cattle in the United States last year. Cows are closer to humans biologically than birds, indicating that the virus had evolved to thrive in cells like our own.

As hundreds of herds and dozens of people were infected in the United States, the Biden administration funded Moderna to develop bird flu vaccines using mRNA technology. As part of the agreement, the U.S. government stipulated it could purchase doses in advance of a pandemic. That no longer stands.

Researchers can make bird flu vaccines in other ways, but mRNA vaccines are developed much more quickly because they don’t rely on finicky biological processes, such as growing elements of vaccines in chicken eggs or cells kept alive in laboratory tanks.

Time matters because flu viruses mutate constantly, and vaccines work better when they match whatever variant is circulating.

Developing vaccines within eggs or cells can take 10 months after the genetic sequence of a variant is known, Bright said. And relying on eggs presents an additional risk when it comes to bird flu because a pandemic could wipe out billions of chickens, crashing egg supplies.

Decades-old methods that rely on inactivated flu viruses are riskier for researchers and time-consuming. Still the Trump administration invested $500 million into this approach, which was largely abandoned by the 1980s after it caused seizures in children.

“This politicized regression is baffling,” Bright said.

A bird flu pandemic may begin quietly in the United States if the virus evolves to spread between people but no one is tested at first. Indeed, the Centers for Disease Control and Prevention’s dashboard suggests that only 10 farmworkers have been tested for the bird flu since March. Because of their close contact with cattle and poultry, farmworkers are at highest risk of infection.

Hospitalizations would be first sign of spread

As with many diseases, only a fraction of people with the bird flu become severely sick. So the first sign that the virus is widespread might be a surge in hospital cases.

“We’d need to immediately make vaccines,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada.

The U.S. government could scale up production of existing bird flu vaccines developed in eggs or cells. However, these vaccines target an older strain of H5N1 and their efficacy against the virus circulating now is unknown.

In addition to the months it takes to develop an updated version within eggs or cells, Rasmussen questioned the ability of the government to rapidly test and license updated shots, with a quarter of HHS staff gone. If the Senate approves Trump’s proposed budget, the agency faces about $32 billion in cuts.

Trump’s team cited safety in limiting Covid shots. Patients, health advocates see more risk.

Further, the Trump administration’s cuts to biomedical research and its push to slash grant money for overhead costs could undermine academic hospitals, rendering them unable to conduct large clinical trials. And its cuts to the CDC and to public health funds to states mean that fewer health officials will be available in an emergency.

“You can’t just turn this all back on,” Rasmussen said. “The longer it takes to respond, the more people die.”

Researchers suggest other countries would produce bird flu vaccines first. “The U.S. may be on the receiving end like India was, where everyone — rich people, too — got vaccines late,” said Achal Prabhala, a public health researcher in India at medicines access group AccessIBSA.

He sits on the board of a World Health Organization initiative to improve access to mRNA vaccines in the next pandemic. A member of the initiative, the company Sinergium Biotech in Argentina, is testing an mRNA vaccine against the bird flu. If it works, Sinergium will share the intellectual property behind the vaccine with about a dozen other groups in the program from middle-income countries so they can produce it.

The Coalition for Epidemic Preparedness Innovations, an international partnership headquartered in Norway, is providing funds to research groups developing rapid-response vaccine technology, including mRNA, in South Korea, Singapore, and France. And CEPI committed up to $20 million to efforts to prepare for a bird flu pandemic. This year, the Indian government issued a call for grant applications to develop mRNA vaccines for the bird flu, warning it “poses a grave public health risk.”

Pharmaceutical companies are investing in mRNA vaccines for the bird flu as well. However, Prabhala says private capital isn’t sufficient to bring early-stage vaccines through clinical trials and large-scale manufacturing. That’s because there’s no market for bird flu vaccines until a pandemic hits.

Studies find mRNA Covid vaccines are safe

Limited supplies means the United States would have to wait in line for mRNA vaccines made abroad. States and cities may compete against one another for deals with outside governments and companies, like they did for medical equipment at the peak of the Covid pandemic.

“I fear we will once again see the kind of hunger games we saw in 2020,” Cameron said.

In an email response to queries, HHS communications director Andrew Nixon said, “We concluded that continued investment in Moderna’s H5N1 mRNA vaccine was not scientifically or ethically justifiable.” He added, “The decision reflects broader concerns about the use of mRNA platforms — particularly in light of mounting evidence of adverse events associated with Covid-19 mRNA vaccines.”

Nixon did not back up the claim by citing analyses published in scientific journals.

In dozens of published studies, researchers have found that mRNA vaccines against Covid are safe. For example, a placebo-controlled trial of more than 30,000 people in the United States found that adverse effects of Moderna’s vaccine were rare and transient, whereas 30 participants in the placebo group suffered severe cases of Covid and one died.

Trump team’s $500 million bet on old vaccine technology puzzles scientists

More recently, a study revealed that three of nearly 20,000 people who got Moderna’s vaccines and booster had significant adverse effects related to the vaccine, which resolved within a few months. Covid, on the other hand, killed four people during the course of the study.

As for concerns about the heart issue, myocarditis, a study of 2.5 million people who got at least one dose of Pfizer’s mRNA vaccine revealed about 2 cases per 100,000 people. Covid causes 10 to 105 myocarditis cases per 100,000.

Nonetheless, HHS Secretary Robert F. Kennedy Jr., who founded an anti-vaccine organization, has falsely called Covid shots “the deadliest vaccine ever made.” And without providing evidence, he said the 1918 flu pandemic “came from vaccine research.”

Politicized mistrust in vaccines has grown. Far more Republicans said they trust Kennedy to provide reliable information on vaccines than their local health department or the CDC in a recent KFF poll: 73% versus about half.

Should the bird flu become a pandemic in the next few years, Rasmussen said, “we will be screwed on multiple levels.”

Amy Maxmen is Healthbeat’s national reporter through its partnership with KFF Health News.

Trump’s immigration tactics obstruct efforts to avert bird flu pandemic, researchers say

2025-04-10T12:35:01+00:00

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Aggressive deportation tactics have terrorized farmworkers at the center of the nation’s bird flu strategy, public health workers say.

Dairy and poultry workers have accounted for most cases of the bird flu in the United States — and preventing and detecting cases among them is key to averting a pandemic. But public health specialists say they’re struggling to reach farmworkers because many are terrified to talk with strangers or to leave home.

“People are very scared to go out, even to get groceries,” said Rosa Yanez, an outreach worker at Strangers No Longer, a Detroit-based Catholic organization that supports immigrants and refugees in Michigan with legal and health problems, including the bird flu. “People are worried about losing their kids, or about their kids losing their parents.”

“I used to tell people about the bird flu, and workers were happy to have that information,” Yanez said. “But now people just want to know their rights.”

Outreach workers who teach farmworkers about the bird flu, provide protective gear, and connect them with tests say they noticed a dramatic shift — first in California, the state hit hardest by the bird flu — after immigration raids beginning on Jan. 7, the day after Congress certified President Donald Trump’s election victory. That’s when Border Patrol agents indiscriminately stopped about 200 Latino farmworkers and day laborers in California’s Central Valley, according to local reports cited in a lawsuit subsequently filed by the American Civil Liberties Union on behalf of the United Farm Workers union and several people who were stopped and detained.

“Border Patrol agents went on a fishing expedition” in a three-day raid called “Operation Return to Sender” that “tore families apart and terrorized the community,” the lawsuit alleges.

How ripple effects of ICE raids affect community health

Among those stopped was Yolanda Aguilera Martinez, a farmworker and grandmother who lives legally in the United States and has no criminal record. She was driving at the speed limit on her way to a doctor’s appointment when plainclothes agents in unmarked vehicles pulled her over, ordered her out of the car, pushed her to the ground, and handcuffed her, the lawsuit says. Agents eventually released Aguilera Martinez, but the lawsuit says others who faced deportation were detained for days in “cold, windowless cells” before they were transported to Mexico and abandoned.

They weren’t told why they had been arrested, given an opportunity to defend themselves, or allowed to call a lawyer or their families, the lawsuit alleges. It says that the four children of one deported father, who had no criminal record, “have become quiet and scared” and that his epileptic son’s “seizures have worsened.”

News of the raid spread quickly in California, where an estimated 880,000 mainly Latino farmworkers live. Dairies that employ immigrant labor produce nearly 80% of the U.S. milk supply, according to a 2014 survey.

“After Operation Return to Sender, dairy workers became even less willing to speak about the lack of protection on dairy farms and the lack of sick pay when they’re infected — even anonymously,” said Antonio De Loera-Brust, a spokesperson for the United Farm Workers.

Outreach workers in other states report a similar chilling effect from raids and immigration policies passed after Trump took office. He repeatedly degraded immigrants and pledged mass deportations on the campaign trail. “They’re not humans, they’re animals,” he said of immigrants illegally in the United States last April.

Trump’s first legislative action was to sign the Laken Riley Act into law, mandating federal detention for immigrants accused of any crime, regardless of whether they’re convicted. On Jan. 21, the Department of Homeland Security rescinded the “protected areas” policy, allowing agents to arrest people who don’t have legal status while they’re in schools, churches, or hospitals. Last month, the Trump administration deported more than 100 Venezuelans and others without a hearing, ignoring a court order to turn around planes flying the men to El Salvador.

The public health ramifications of farmworkers shrinking from view are potentially massive: Infectious disease scientists say that preventing people from getting bird flu and detecting cases are critical to warding off a bird flu pandemic. That’s why the government has funded efforts to protect farmworkers and monitor them for signs of bird flu, like red eyes or flu-like symptoms.

“Every time a worker gets sick, you’re rolling the die, so it’s in everyone’s interest to protect them,” De Loera-Brust said. “The virus doesn’t care what your immigration papers say.”

Fear hampering bird flu outreach to farmworkers

About 65 dairy and poultry workers have tested positive for the bird flu since March 2024, but the true number of infections is higher. A KFF Health News investigation found that patchy surveillance resulted in cases going undetected on farms last year, and studies have revealed signs of prior infections in farmworkers who hadn’t been tested.

State and local health departments were beginning to overcome last year’s barriers to bird flu testing, said Salvador Sandoval, a doctor who retired recently from the Merced County health department in California. Now, he said, “people see a mobile testing unit and think it’s Border Patrol.”

Last year, outreach organizations connected with farmworkers at places where they gathered, like at food distribution events, but those are no longer well attended, Sandoval and others said.

“Regardless of immigration status, people who look like immigrants are feeling a lot of fear right now,” said Hunter Knapp, the development director at Project Protect Food Systems Workers, a farmworker advocacy organization in Colorado that does bird flu outreach. He said some Latino community health workers have scaled back their outreach efforts because they worry about being harassed by the authorities or members of the public.

A Latina outreach worker in Michigan, speaking on the condition of anonymity because she’s worried about retaliation against her family, said, “Many people don’t go to the doctor right now, because of the immigration situation.”

“They prefer to stay at home and let the pain or redness in the eye or whatever it is go away,” she said. “Things have really intensified this year, and people are very, very scared.”

The Centers for Disease Control and Prevention has reported far fewer human cases since Trump took office. During the three months before Jan. 20, the agency confirmed two dozen cases. Since then, it’s detected only three, including two people with cases severe enough to be hospitalized.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

The CDC has said it continues to track the bird flu, but Jennifer Nuzzo, director of the Pandemic Center at Brown University, said the slowdown in cases might be due to a lack of testing. “I am concerned that we are seeing a contraction in surveillance and not necessarily a contraction in the spread of the virus.”

Undetected infections pose a threat to farmworkers and to the public at large. Because viruses evolve by mutating within bodies, each infection is like a pull of a slot machine lever. A person who died of the bird flu in Louisiana in December illustrates that point: Scientific evidence suggests that bird flu viruses evolved inside the patient, gaining mutations that may make the viruses more capable of spreading between humans. However, because the patient was isolated in a hospital, the more dangerous viruses didn’t transmit to others.

That might not happen if sick farmworkers don’t receive treatment and live in crowded households or windowless detention centers where they might infect others, said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. Although the bird flu doesn’t yet have the ability to spread easily between people through the air, like the seasonal flu, it might occasionally spread when people are in close quarters — and evolve to do so more efficiently.

“I worry that we might not figure out that this is happening until some people get severely sick,” Rasmussen said. “At that point, the numbers would be so large it could go off the rails.”

The virus might never evolve to spread easily, but it could. Rasmussen said that outcome would be “catastrophic.” Based on what’s known about human infections, she and her colleagues predict in a new report that an H5N1 bird flu pandemic “would overwhelm health care systems” and “cause millions more deaths” than the Covid-19 pandemic.

Flu vaccinations drop off

Late last year, the CDC rolled out a seasonal flu vaccine campaign targeted at more than 200,000 livestock workers. The hope was that flu vaccinations would lessen the chance of a farmworker being infected by seasonal flu and bird flu viruses simultaneously. Co-infection gives the two flu viruses a chance to swap genes, potentially creating a bird flu virus that spreads as easily as the seasonal variety.

Yet Sandoval said flu vaccine uptake dropped immediately after the January operation in California.

U.S. Customs and Border Protection officials said in a statement that they arrested 78 immigrants “unlawfully present in the U.S.” during the three-day operation. They included a convicted sex offender and others with criminal histories including vandalism and petty theft, the statement said. The agency did not name allegations against each person and did not say whether all had been charged.

Former officials with the Biden administration, which was in its waning days as the arrests occurred, distanced itself from the operation in interviews with the Los Angeles Times.

Mayra Joachin, an attorney at the ACLU of Southern California, said the operation was unlike others under the Biden administration in that these were indiscriminate arrests by Border Patrol in the interior of the country. “It fits with the Trump administration’s broader campaign of instilling fear in immigrant communities,” she said, “as seen in the election campaign and in subsequent actions attacking anyone perceived to be a noncitizen in the country.”

In March, an assistant chief in the Border Patrol unit that conducted the operation, David Kim, called the operation a “proof of concept.”

“We know we can push beyond that limit now as far as distance goes,” he told the Southern California news outlet Inewsource.

The Department of Homeland Security did not respond to requests for comment. In an email, White House spokesperson Kush Desai wrote, “Despite what the ‘experts’ believe, combatting the avian flu epidemic and enforcing our immigration laws are not mutually exclusive.”

Anna Hill Galendez, a managing attorney at the Michigan Immigrant Rights Center, which is involved in bird flu outreach, said unusually aggressive tactics by Immigration and Customs Enforcement agents deterred sick dairy workers in Michigan’s Upper Peninsula from leaving their homes for care in late January. They contacted the center for help.

“They wanted medical care. They wanted flu vaccines. They wanted [personal protective equipment]. They wanted to get tested,” Hill Galendez said. “But they were afraid to go anywhere because of immigration enforcement.”

Lynn Sutfin, a public information officer at the Michigan Department of Health and Human Services, responded to queries about the situation in the peninsula in an email to KFF Health News, saying, “The farmworkers did not take the local health department and MDHHS up on the testing offer.”

The CDC declined to comment on the impact of immigration actions on farmworker outreach.

To adapt to the new reality, Yanez now draws attention to her advice on the bird flu in Michigan by pairing it with information on immigrant rights. Knapp, in Colorado, said his organization is shifting its approach away from bird flu outreach at events where farmworkers congregate, because that could be perceived as a setup — and could inadvertently become one if ICE agents targeted such an event.

Outreach workers who live among farmworkers are withdrawing a little, too. “Being Latinos, we are always identified,” said the outreach worker who spoke on the condition of anonymity. “I have a visa that protects me, but things are changing very quickly under the Trump administration, and the truth is, nothing is certain.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

FDA monitoring bird flu in raw milk cheese, and two NYC cats test positive for disease. Here’s what to know.

2025-03-26T11:00:00+00:00

Sign up for Your Local Epidemiologist New York and get Dr. Marisa Donnelly’s community public health forecast in your inbox a day early.

I’m back on the public health beat in New York after taking a vacation in Hawaii. (Take me back to snorkeling 🐠 and mai tais🍹please!)

A lot happened in New York public health this week. From bird flu in cats to rabies in raccoons, here’s what you need to know.

Bird flu in two New York City cats

Earlier this month, two cats from separate households in New York City tested positive for bird flu. Both died. The likely source of infection? Raw pet food.

The Food and Drug Administration has said uncooked and unpasteurized pet food from cattle or poultry — think raw meat, eggs, or unpasteurized milk — can make pets sick with bird flu. Both New York City cats that died ate raw, canned chicken from Savage Cat Food.

Since 2022, more than 100 domestic cats nationwide have been infected with bird flu, and their infections have been particularly bad. Most have died. (Though they may have been more likely to be tested because of serious illness). The risk of cat-to-human transmission is low but possible — in 2016, a veterinarian was infected with a different type of bird flu (H7N2) after treating a sick cat.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

For dog lovers, it’s worth noting bird flu doesn’t seem to be as common or severe in dogs. One study found signs of infection in hunting dogs with a lot of contact with waterfowl, but the dogs did not have serious symptoms.

What pet owners need to know

Avoid feeding pets, especially cats, raw meat, raw milk, or uncooked eggs.
Avoid letting pets roam where they are exposed to wild animals. Cats can get infected by exposure to wild birds, animals, or animal droppings.
Contact your veterinarian if your pet becomes ill after eating raw meat or dairy products. Call ahead so that the veterinarian can be prepared when you arrive.

New York and FDA monitoring for bird flu in raw milk cheese

New research from Cornell University and the FDA found bird flu survived the 60-day aging process in raw milk cheese. While no bird flu has been found in cheeses sold in retail markets, and no human cases have been linked to eating raw cheese, this raises questions about food safety.

Raw milk cheese is made with unpasteurized milk. In the United States, cheese from raw milk must be aged for at least 60 days to reduce pathogen risk. The aging process creates a more difficult environment for bacteria to grow (higher acidity, salty environment, less moisture). This study suggests that it’s not enough to rid cheese of active bird flu virus.

Monitoring will be key to ensuring that our cheese supply remains safe:

FDA will continue sampling at least 300 cheese products nationwide, including aged raw milk cheeses, as part of its ongoing surveillance system.
New York participates in the National Milk Testing Strategy led by the USDA. We’re one of 28 states testing raw milk for H5N1.

What you need to know

Most cheeses in our markets are made from pasteurized milk and are safe to consume. Raw milk products are higher risk, not just for bird flu but also for other bacteria that can make you sick.
Check labels to know if the cheese has been made with raw milk. There is no federal requirement to label whether raw or pasteurized milk was used, but many cheeses label it in the ingredients. Restaurants should also know, too, if you ask.

Rabies in Suffolk County

Rabies, nearly 100% fatal for humans, circulates in the wild animals around us. For the first time since 2009, rabies has been detected in Suffolk County raccoons: Two have tested positive since January.

In 2024, Westchester and Erie counties had the highest rabies detections of New York counties.

However, this shouldn’t be too worrisome for a few reasons:

1-Rabies is common in New York wild animals. New York state frequently leads the nation in the number of rabid animals. (A raccoon rabies outbreak hit New York in the ‘90s, spreading rabies in wild animals across the state.) Infections are most common in raccoons, bats, skunks, and foxes. Among domestic animals, cats are most frequently diagnosed in New York.

2-We have tools to help.

a. Wildlife: We reduce wild animal rabies by vaccinating wildlife. Many communities, including in New York, distribute baits containing oral rabies vaccine across parks and wooded areas (sometimes using helicopters). When raccoons and other animals eat the baits (which smell like fish), they become immunized, protecting them against rabies.

b. Pets that come into contact with wild animals are at greatest risk of rabies. All cats, dogs, and ferrets should be vaccinated for rabies—in New York, state law requires it. Unvaccinated dogs or cats that are exposed are required to be euthanized or isolated for up to 6 months under observation.

c. Humans: People who work directly with animals have occupational risk, and should be vaccinated for rabies. People who may have been exposed to rabies (through an animal bite or scratch) will need post-exposure prophylaxis of the vaccine (getting vaccinated after exposure).

Vaccination and post-exposure prophylaxis have made human rabies rare: We see just 1 to 3 cases in the United States annually. Still, animal bites are common. About 60,000 Americans need post-exposure prophylaxis following an animal bite annually. Thanks to vaccination, New York City hasn’t seen a single human rabies case since 1947.

What you can do

Ensure that your pets are vaccinated for rabies. All New York counties offer free rabies vaccination clinics. For more information, contact your local health department.
Do not touch or get close to wild animals, including feral cats. If you are bitten, immediately wash the wound with soap and water and contact your medical provider. Advise children to immediately tell an adult if they are bitten or scratched by an animal.
If you see a wild animal that doesn’t look well or encounter a dead animal, contact your local health department or 311 if you are in New York City. Rabies symptoms in animals include tiredness, confusion, difficulty moving, aggression, drooling, and chewing objects like wood, soil, or stones.

Getting vaccinated is crucial if a wild animal bites you. I learned that firsthand in college when a monkey bit me while I was traveling — and I’m thankful I got the shots.

Bottom line

The health of our furry friends plays a big role in our community health, even in urban centers like New York City. Consuming raw animal products (milk, meat, eggs, etc.) is risky for people and animals alike. And rabies remains a deadly threat to us and our pets. But keeping pets vaccinated, practicing good food safety, and talking to a provider if you’re exposed or bitten can protect you, your family, and your pets.

Love,

Your Local Epidemiologist

Dr. Marisa Donnelly, a senior epidemiologist with wastewater monitoring company Biobot Analytics, has worked in applied public health for over a decade, specializing in infectious diseases and emerging public health threats. She holds a PhD in epidemiology and has led multiple outbreak investigations, including at the California Department of Public Health and as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Marisa has conducted research in Peru, focusing on dengue and Zika viruses and the mosquitoes that spread them. She is Healthbeat’s contributing epidemiologist for New York in partnership with Your Local Epidemiologist, a Healthbeat supporter. She lives in New York City. Marisa can be reached at mdonnelly@healthbeat.org.

How improving air quality in schools would minimize the threat of bird flu spread

2025-03-21T11:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Experts are growing increasingly worried that bird flu – avian influenza H5N1 – will evolve into a strain that causes widespread illness and death in humans and that the federal government is neither sufficiently containing the epidemic in animals, nor preparing sufficiently for widespread human illness.

While containment, preparedness, and overall response for national epidemics are inherently federal government responsibilities in the United States, there is one critical intervention that states and large cities should take now: Improve indoor air quality in schools and congregate settings.

State of bird flu epidemic: Threat is growing

The number of mammal species that can be infected is growing. While animal illness and deaths have been primarily in those in the wild or raised for food, infections are now spreading to household companions, such as cats, including two recent cases in New York City, and there is concern of infection spreading both human-to-pet and from pet-to-human.

Until now, most humans in the United States have been infected through close contact with an infected animal with only 70 cases (as of Tuesday). It is likely that many more infections have occurred but not been diagnosed and counted. Evolutionary changes in the virus suggest that it has a high likelihood of evolving into a strain that humans can spread to each other through the air.

To date, public concern has largely focused on food prices, food safety, and the health of pets. Experts have been focused on improving biosecurity on farms; improving surveillance in animals, humans, the environment, and food; and development of vaccines for chickens, cows, and humans. Across these discussions, the extreme impact that the Covid-19 pandemic had on all aspects of the country remains front and center.

Harms of virus vs. harms of virus-control measures

Central to the ongoing, intense debate about whether the U.S. Covid-19 response was too aggressive or not aggressive enough is the question: How does government balance the harms of the virus against the harms of virus-control measures? Between those that believe government did too much and those that believe government did too little, there are two areas of broad consensus:

Government should have done more to protect people living in nursing homes and assisted-living facilities from the harms of the virus.
Government should have done more to continue in-person schooling and protect children from the harms of the virus-control measures.

If H5N1 leads to a pandemic, governments will face an extreme challenge again protecting those most vulnerable to severe illness and death and ensuring that in-person schooling continues. Notable, there is one intervention that can substantially help with both: improving indoor air quality.

Why does indoor air quality matter for infectious diseases?

Infectious diseases that transmit through the air have the greatest potential to cause pandemics and impair health and wealth, because one human can readily infect multiple susceptible humans during a single interaction.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

Infectious disease control over the past 100 years has focused primarily on developing medical interventions (e.g., vaccines, antimicrobials), or stopping transmission through direct physical contact (e.g., handwashing, gloves, condoms), surfaces and materials (e.g., sterilizing equipment, cleaning surfaces), and consumables (e.g., water, food). Far less has been invested in ensuring that air — particularly indoor air — is made as safe and clean as surfaces, hands, water, and food.

How do we clean indoor air?

There are three general approaches to cleaning air. The first is ventilation: Ensuring that new air replaces old air. One reason infectious diseases do not transmit efficiently outdoors compared to indoors, is because there is a constant supply of new air (i.e., air free from infectious disease particles) to blow away old air (i.e., air that may contain infectious disease particles). In indoor settings, ventilation can be improved by opening windows and ensuring that central air systems pull old air out and push new air in frequently.

The second approach is through filtering air. Air can be blown by a fan through a filter that traps infectious disease particles, and the air that leaves the filter is considered fresh. These filters can either be installed in centralized air systems or in portable air purification devices.

The third approach is to disinfect the air by using ultraviolet energy (known as “germicidal UV”) to inactivate or kill infectious organisms in the air.

Studies performed in laboratories and real-world settings have conclusively demonstrated that all three of these approaches work on their own and synergistically to disinfect air and reduce human infections from airborne viruses (measles, influenza, Covid-19), bacteria (tuberculosis), and fungi.

The most recent comprehensive high-quality review of indoor air quality was conducted as part of The Lancet Commission on Covid-19, which concluded that indoor air-quality improvements can reduce transmission of Covid-19 and other respiratory infectious diseases in schools and congregate settings. In this review, they also highlighted additional benefits to overall health and cognition, beyond preventing respiratory infections, from these interventions.

Invest in indoor air in congregate settings and in schools

Covid-19 demonstrated the critical importance of improving indoor air in congregate settings and in schools. Covid-19 spread wildly through assisted-living facilities and skilled nursing homes and caused over 200,000 deaths. Many infections and deaths in these facilities could have been greatly reduced by improving indoor air-quality measures.

Much of the backlash against Covid-19 control measures focused on the closure of in-person schooling. Without in-person learning, children have impaired social, emotional, cognitive, and physical development, and many lose access to food and nutrition. Parents face difficulty working (either in-person or remotely), which directly impairs the economy.

The backlash against virus control measures in schools crossed the political spectrum and greatly eroded trust in government policies and institutions. Parents were angry at health and school officials; teachers were angry at parents and school officials; students became depressed; and elected officials fomented this anger to advance their political agendas.

Without question, the United States will struggle to implement and maintain an effective all-of-society response against a future H5N1 influenza epidemic unless schools are made as “pandemic proof” as possible. Keeping schools open and safe during a future emergency would greatly improve public trust in health experts and government.

What should states do now?

One of the most important pandemic preparedness initiatives after Covid-19 emerged was the White House Summit on Indoor Air Quality, which led to detailed guidance from the Centers for Disease Control and Prevention and the Environmental Protection Agency that never existed before. Industry, expert groups, and academic centers have also published detailed guidance on what governments and building operators can do. In most situations, states and cities will need to enact laws and regulations, and allocate funding for upgrading facilities and monitoring compliance.

The question most people ask is: Why make the investment in new regulations and building upgrades if we are not certain there will be a bird flu epidemic, particularly when there is a movement to shrink the size and budget of government?

The answer is that we know these investments will benefit health and productivity even if there is never a bird flu epidemic. They can help us reduce the spread of routine seasonal airborne flu and Covid-19, as well as outbreaks of measles. They will reduce the impact of allergies and pollution. They will protect people when there are wildfires.

The time to prepare our defenses is now.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

NYC Health Dept. warns against raw food after two cats die from bird flu. Here’s how to protect your pet.

2025-03-20T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

Following the bird flu-related deaths of two cats, the New York City Department of Health and Mental Hygiene is advising owners to avoid raw pet food.

Since 2022, the U.S. Department of Agriculture has reported more than 90 confirmed cases of bird flu in domestic cats. Those cats have typically lived on dairy farms or roamed outdoors. But cases have started to emerge of house cats being infected with bird flu, often from raw food or unpasteurized milk.

In New York City, bird flu was detected in two cats and a possible third cat in the recent months, in connection to raw poultry sold by Savage Cat Food, according to the Health Department. The company sells “prey-based” raw cat food, in flavors like chicken, rabbit and lamb, and duck, according to its website.

“We strongly encourage New Yorkers whose cats are experiencing illness after consuming Savage Cat Food products or other raw meat or dairy products to contact their veterinarian,” Dr. Michelle Morse, the acting health commissioner, said in a recent statement.

The highly pathogenic H5N1 bird flu, an influenza virus, has spread widely across the United States in recent years, primarily among birds and dairy cows. The Centers for Disease Control and Prevention has reported 70 human cases since the start of 2024, and one human death. There is no evidence of human-to-human transmission of the virus in the current outbreak.

In New York, bird flu has been occasionally detected in wild birds, backyard flocks and poultry across the state since 2022. Last month, the state temporarily shuttered all live bird markets in New York City after detecting the virus among poultry.

Cats appear to be especially vulnerable to bird flu. While there have been no confirmed cases of cat-to-human transmission during the current outbreak, it has happened before. In New York City in 2016, a veterinarian was infected with a different type of bird flu after interacting with a sick cat.

Here’s what to know about cats and bird flu.

How do cats get bird flu?

While bird flu has been detected in many animal species, cats are “very susceptible to this infection,” said Dr. Bruce Kornreich, the director of the Cornell Feline Health Center.

Cats can pick up the virus in a number of ways, including by eating raw meat and poultry products or drinking raw cow’s milk. They can also get infected by coming into contact with infected livestock, poultry, wild birds, or people and their clothing.

Last year, bird flu was detected in domestic cats in different households in Michigan. In both cases, according to a CDC report, the cats lived with people who worked on dairy farms, and the cats developed respiratory and neurologic illnesses. One cat owner worked transporting unpasteurized milk to farms, including those with cattle infected with bird flu, and their cat would often roll around in their work clothes.

What should pet owners know about raw food?

In New York City, the Health Department traced the two recent feline deaths back to raw food sold by Savage Cat Food. One of the cats became ill after eating a chicken product and was hospitalized with fever, loss of appetite and severe respiratory infection before dying.

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A second cat was diagnosed with bird flu and died following a fever and severe respiratory and liver disease. While that cat had not eaten Savage Cat Food, it had been exposed to a third cat, which became ill after eating Savage Cat Food, but survived. Testing on the second cat indicated that it had been infected with a bird flu strain found in the raw food.

In a letter to consumers, Savage Cat Food said that it issued a recall for the contaminated food and contacted retailers. The bird flu cases were connected to Savage Cat Food packets with lot number 11152026.

While some pet owners opt to feed their pets raw diets, the American Veterinary Medical Association and the CDC discourage the practice due to the risks to animal and human health.

Kornreich advised pet owners to provide their pets with cooked food and avoid raw diets.

“It’s just not worth the risk,” he said.

What are the symptoms of bird flu in cats?

Early symptoms of bird flu in cats include fever, loss of appetite and lethargy. As the illness progresses, cats might exhibit eye and nose discharge, respiratory issues, coughing, sneezing, and neurologic signs, including lack of coordination, seizures and blindness.

Any of those signs is a cause for concern, Kornreich said, especially if the cat has eaten raw food, been exposed to sick pets or people, preyed upon a dead bird, or been exposed to poultry or a dairy barn. If a pet owner notices those symptoms, the cat should be isolated from other pets and people, the owner should thoroughly wash their hands, and immediately contact a veterinarian, he said.

If infected with bird flu, cats have “very high morbidity and mortality,” Kornreich said.

There is no cure for bird flu in cats, and treatment is primarily supportive.

What about dogs?

The American Veterinary Medical Association notes that the likelihood of dogs being infected with bird flu is very low. Still, dogs could become sick from eating ill or dead infected birds, drinking unpasteurized milk, or eating undercooked, or raw meat.

The CDC advises pet owners to prevent their animals from interacting with wild birds, backyard poultry, cows, or indoor animals; to keep pets away from clothing, surfaces, and areas that could be contaminated with bird flu; and to avoid feeding pets raw food or milk.

Additionally, the Health Department advises New Yorkers to avoid dead or sick animals while walking their dogs.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

New York public health update: Fentanyl overdoses, bird flu on Long Island, changes to mental health laws

2025-03-12T21:00:00+00:00

Sign up for Your Local Epidemiologist New York and get Dr. Marisa Donnelly’s community public health forecast in your inbox a day early.

A lot going on in the world of public health — here’s some news New Yorkers can use.

Bird flu confirmed on Long Island

Last week, dozens of dead ducks, geese, and seagulls infected with bird flu washed up on Long Island beaches.

Bird flu has now been detected in birds in 44 of New York’s 62 counties. No cases of humans or cattle in New York have been reported.

Why it matters:

Bird flu spreads easily among wild birds and poultry, disrupting ecosystems and farms and posing risk to those who work with animals. It’s also making our eggs very expensive.

It’s particularly deadly for birds, reaching close to a 100% fatality rate. In January, a Long Island farm outbreak led to 100,000 ducks being culled. (This is a biosecurity measure to mass-kill animals so it doesn’t continue spreading on the farm.) While human risk remains low, awareness and precautions are key.

What you should do:

Do not touch dead or sick birds. If you see dead birds anywhere, assume they have bird flu. Several Americans outside of New York have been directly infected by sick birds. If you must dispose of dead birds, wear gloves, a N95 mask, and eye protection.
- Use a shovel or a garbage bag to pick up the bird, avoid direct contact with the carcass or carcass fluids.
Report sightings of dead birds to the Department of Environmental Conservation using this form.
If you have flu-like symptoms after exposure, call your doctor.

Fentanyl continues to drive the overdose epidemic in New York City

Last week, a 4-year-old child died from possibly ingesting fentanyl in a Brooklyn shelter.

This is a tragic reminder that fentanyl remains the leading cause of preventable overdose deaths in New York. In 2023, 2,444 New Yorkers died from a fentanyl-involved overdose — that’s one overdose death in NYC every four hours.

Quarterly overdose rates in New York City.

Though rates remain high, there are glimmers of hope. Our most recent data, from the first quarter of 2024 (overdose data is notoriously delayed), shows the fewest overdose deaths in New York City since 2020. This followed a downward trend that started in 2023.

The latest report, explained by Healthbeat, found 3,046 deaths in 2023 compared to 3,070 deaths in 2022, representing a 1% decrease. There were also fewer deaths in the first quarter of 2024 compared to the same time the previous year.

Overdoses remain particularly high in some New York communities hit hardest by the opioid crisis.

Overdose deaths are highest in the dark blue communities.

What you can do:

Carry Narcan (naloxone), a life-saving medication that reverses opioid overdoses.

All New Yorkers can receive free naloxone and training from registered Opioid Overdose Prevention Programs (OOPPs) on how to recognize the signs of an overdose and administer naloxone.
Health Department vending machines: Locations can be found on this page.
Over-the-counter naloxone at pharmacies: Available without a prescription at most major chains (map here).
- Most insurance providers will cover all or part of the cost of naloxone, and New York State will cover copayments of up to $40.

There is also a hotline for individuals seeking support or treatment for substance use for themselves or their loved ones. Call or text 988, or visit the 988 website for 24/7, confidential support.

Mental health crisis care in New York: New proposals and their complexities

Involuntary treatment for mental illness is being actively debated in New York. Governor Kathy Hochul recently proposed expanding New York’s Mental Hygiene Law to help get people with mental illness access to treatment before they potentially become dangerous to themselves or others. Some advocacy groups say these changes undermine patients’ rights and could widen inequities in our mental health system.

This debate isn’t new. Every state allows short-term involuntary hospitalization for people experiencing severe mental health crisis, such as those at risk of suicide, often holding them for up to 72 hours to stabilize and arrange care.

The question New York is facing is where to draw the line between protecting individuals and preserving their autonomy while their mental state puts them or others at risk.

What would the proposals change?

The proposed updates focus on expanding intervention options and adjusting hospital procedures. Key provisions include:

Broadened commitment criteria: The rationale is to allow earlier intervention for those unable to meet basic needs due to mental illness before self-harm or harm to others occurs.
Hospital rules: Requiring hospitals to consider patients’ long-term history and the frequency and outcomes of past crises — not just their current state — for involuntary admission or discharge decisions.
Provider expansion: Authorizing psychiatric nurse practitioners, not just psychiatrists, to approve involuntary holds.
Strengthened outpatient oversight: Simplifying the renewal process for court orders under Kendra’s Law, which mandates continued outpatient treatment, including taking medication, after discharge.

The debate and pushback

Supporters argue these changes could prevent crises and get people the care they need sooner. However, critics, including some committees and civil rights groups, have raised several concerns:

Stripping individuals of freedom or bodily autonomy.
Lack of investment in street-level mental health workers.
Racial biases. Black and Hispanic populations have been disproportionately enrolled more than white people since the inception of Kendra’s Law.
Lack of evidence. Critics say it’s unclear whether involuntary treatment is better than peer support or peer-led mental health crisis response teams.

According to a report by the New York Lawyers for the Public Interest, as of Feb. 25, 3,674 people were under an active involuntary outpatient commitment order statewide, including 1,684 in New York City.

Moving forward

New York’s mental health problem is deeply intertwined with housing instability, economic hardship, and racial disparities. While these proposals attempt to address real and urgent issues, there is no one-size-fits-all solution. Regardless of the outcome of these changes, there is a clear need to improve mental health services for our most vulnerable New Yorkers.

If you see someone in crisis:

Don’t hesitate to seek assistance from a trained professional.
If there is no imminent risk of danger, call or text 988.
If someone appears to be an immediate danger to themselves or others, find a safe location and promptly call 911.

Bottom line

It may seem like the issues surrounding bird flu, the fentanyl overdose crisis, and mental health support have little in common. However, they are connected by our ability to take action to mitigate these concerns and improve community safety. We can contribute by reporting dead birds, carrying naloxone, or seeking help for someone in a mental health crisis.

Love,

Your Local Epidemiologist

MRNA vaccines, once a Trump boast, now face attacks from some in GOP

2025-03-11T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Researchers racing to develop bird flu vaccines for humans have turned to a cutting-edge technology that enabled the rapid development of lifesaving covid shots.

There’s a catch: The mRNA technology faces growing doubts among Republicans, including people around President Donald Trump.

Legislation aimed to ban or limit mRNA vaccines was introduced this year by GOP lawmakers in at least seven states. In some cases, the measures would hit doctors who give the injections with criminal penalties, fines, and possible revocation of their licenses.

Some congressional Republicans are also pressing regulators to revoke federal approval for mRNA-based covid shots, which President Donald Trump touted as one of the signature achievements of his first term.

The opposition comes at a critical juncture because vaccines using mRNA have applications well beyond avian flu and covid. They hold the promise of lifesaving breakthroughs to treat many diseases, from melanoma to HIV to Zika, according to clinical trials. The proposed bans could block access to these advances.

MRNA is found naturally in human cells. It is a molecule that carries genetic material and, in a vaccine, trains the body’s immune system to fight viruses, cancer cells, and other conditions. An advantage of mRNA technology is that it can be developed more quickly to target specific variants and is safer than developing a vaccine made from inactivated virus.

“Right now, if we had a bird flu pandemic, we would have a shortage of the vaccine we need,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “The one thing that could save us is mRNA vaccine. The challenge would be if mRNA is banned. This is truly dangerous policy.”

The pushback conflicts with innovations championed by Trump. He assembled tech tycoons at the White House just after his inauguration to announce Stargate, a $500 billion artificial intelligence initiative that could help transform cancer treatment by creating tumor-targeting mRNA vaccines. The fledging partnership between Oracle, SoftBank Corp., and OpenAI, co-founded by Elon Musk, envisions leveraging AI in part to improve health outcomes. Patients would undergo blood tests and AI would be used to find cancer.

Scientists would examine the DNA and RNA (RNA and mRNA serve different functions in a cell) of a specific patient’s tumor to create a vaccine to teach that person’s immune system to target and destroy cells driving cancer growth.

“Imagine early cancer detection, the development of a cancer vaccine for your particular cancer aimed at you, and have that vaccine available in 48 hours,” Oracle co-founder Larry Ellison said at the White House event.

Scores of mRNA clinical trials for cancer vaccines are underway and some have shown dramatic results, cutting the risk of death and recurrence roughly in half for certain patients. In research led by the Yale School of Medicine, for example, patients with advanced kidney cancer remained cancer-free about three years after an mRNA-based treatment in an early-phase trial.

But some politically conservative doctors, lawmakers, and researchers question the safety of mRNA vaccines, especially covid shots made with the technology. Robert F. Kennedy Jr. unsuccessfully petitioned the FDA in 2021 to rescind approval for covid shots and called them “the deadliest vaccine ever made” — a controversial statement that has been refuted.

Now that he’s newly confirmed as Health and Human Services secretary, Kennedy is poised to oversee federal approvals of vaccines, with the power to shape policy such as immunization schedules and appoint vaccine opponents to committees that advise on the approval of shots.

Bloomberg reported late last month that Trump administration health officials were reevaluating a $590 million contract for bird flu shots that the Biden administration awarded to Moderna as part of its push to examine spending on mRNA vaccines.

HHS and White House spokespeople didn’t return emails seeking comment.

Support for an mRNA ban is coming from other sources too. Florida Gov. Ron DeSantis on March 5 urged the Centers for Disease Control and Prevention to stop recommending the covid-19 vaccine for children and called for a state ban on mRNA vaccine mandates. In February, Rep. Thomas Massie (R-Ky.) said on X that the “FDA should immediately revoke approval of these shots,” and Sen. Ron Johnson (R-Wis.) is leading an investigation into the safety of the vaccines. Trump in February signed an order to strip federal funds from schools that require covid shots for attendance.

Vaccine skepticism has become pronounced among Republicans since the pandemic. Four in 10 Republicans who responded to a KFF poll published in January said it was “probably” or “definitely true” that “more people have died from covid-19 vaccines than from the virus itself.” Just a quarter of Republicans reported holding that view in 2023.

The effort is also finding traction at the local level. A district health departmentoutside Boise, Idaho, last year banned its health department from administering covid-19 vaccines, and local lawmakers in Franklin County, Washington, passed a resolution in February against mRNA vaccines.

The ABCs of mRNA

The CDC recommends covid vaccines for anyone 6 months and older, especially seniors and people who are immunocompromised. About 29 million doses had been administered to adults in the 2024-25 season in retail pharmacies and doctors’ offices through Feb. 8, based on federal data.

Given as a shot, mRNA enters muscle cells and teaches them to produce a spike protein found on the surface of a virus. The body’s immune system then targets the spike protein, priming it to identify and fight the virus — in this case, the coronavirus that causes covid. The body’s cells then break down the mRNA and remove it, according to federal health researchers.

More than 13 billion covid vaccines had been administered worldwide as of August 2024.

Researchers say the vaccinations saved countless lives — estimates for the first year alone go as high as 19.8 million — in the throes of a pandemic that had hospitals ordering refrigerated mobile morgues and deliberating over which patients to put on ventilators. Two University of Pennsylvania scientists credited with developing the mRNA technology behind the shots were awarded the Nobel Prize for medicine in 2023.

The FDA says the covid vaccines are safe, with fewer than 1 in 200,000 vaccinated individuals experiencing a severe allergic reaction or heart problems like myocarditis or pericarditis, and the agency notes that “inaccurate informationabout these vaccines, particularly the mRNA COVID-19 vaccines, continues to circulate.”

While many people hadn’t heard of the mRNA platform until the covid shots were rolled out, it was discovered in the 1960s. The first mRNA flu vaccines were tested in mice in the 1990s. A clinical trial involving direct injection of mRNA to fight cancer occurred in 2008. Clinical trials involving the covid mRNA vaccines involved tens of thousands of volunteers.

Reviews of mortality data showed “no unusual patterns of death were detected that might suggest a potential safety concern,” based on a September 2024 report by a technical working group that provided guidance to the CDC.

But those calling for a ban on all mRNA vaccines say there is a dearth of long-term safety data, and they say covid vaccines by Pfizer-BioNTech and Moderna were hastily approved without proper vetting. They assert without strong evidence that the vaccines cause serious injuries to the heart, nerves, and immune and reproductive systems, and can lead to cancer.

The vaccine has been linked to rare cases of heart inflammation and inflammation of the sac surrounding the heart, although the severity has varied and most patients fully recovered, the CDC says.

“The allegations are beyond reason,” said Anne Schuchat, a career scientist who worked on covid and who twice served stints as acting director of the CDC. “The mRNA covid vaccines were extensively studied after use and do not have those problems.”

“I’m concerned about the whole mRNA technology. I don’t trust anything that fools the body,” said Stephanie Seneff, a computer scientist and anti-vaccine activist at the Massachusetts Institute of Technology. “I’m really glad people are waking up and realizing it’s not the thing to do anymore.”

Vaccines generally work by tricking the body into producing antibodies to fight illnesses.

Pfizer spokespeople didn’t return an email seeking comment. A Moderna spokesperson, Chris Ridley, said legislative efforts to ban or restrict mRNA medicines are largely driven by misunderstandings about their safety profile and mechanism of action. While mRNA-based shots do not modify DNA, for example, that misconception is frequently cited in support of restrictions, Ridley said.

“If enacted, these measures could hinder important research and limit patient access to innovative treatments, potentially delaying life-changing medical advancements,” Ridley said in a written statement.

Networks of Opposition

Groups opposed to the mRNA technology have built a vast and well-funded legal, marketing, and social media network. Members hold conferences to discuss strategies, fund lawsuits against vaccine mandates, and produce reports on the covid vaccines.

As for state legislative efforts, measures introduced this year have varied and their progress has been mixed. Montana’s measure, for instance, was blocked. Idaho lawmakers in February held a hearing on its bill, which calls for a 10-year moratorium on mRNA vaccines. Idaho’s proposal, likely to be amended, as well as Iowa’s and Montana’s have featured criminal penalties for providers who administer all or certain mRNA vaccines. In addition, some state bills, such as legislation in Pennsylvania and Tennessee, focused on the use of the vaccine in livestock and food production.

Various bills are pending in the Texas Legislature to restrict mRNA vaccines in both livestock and humans. South Carolina’s pending bill would require anyone administering certain covid mRNA vaccines to inform patients that the shot is contaminated with fragments of “bacterial plasmid DNA.”

Covid mRNA shots may have minute amounts of residual DNA from production processes but they are heavily degraded and pose no risk, according to the Global Vaccine Data Network, which evaluates vaccine safety concerns.

Speakers at some legislative proceedings have included representatives from Children’s Health Defense, an activist, anti-vaccine group founded by Kennedy.

The Florida surgeon general in January 2024 called for a halt in the use of covid mRNA vaccines. And in Texas, Attorney General Ken Paxton in January moved to appeal a lawsuit he filed claiming Pfizer misrepresented the safety of its mRNA shot.

Efforts to restrict the shots have raised the profile of groups such as the Independent Medical Alliance, which advocates for mRNA-based covid vaccines to be withdrawn from the market.

“We should stop it and test it more before we move forward,” said pediatric cardiologist Kirk Milhoan, a senior fellow at the alliance.

Groups opposed to mRNA shots are pointing to a recent study to urge more caution. Yale University researchers reported in February that they found spike protein still circulating in a subset of individuals with a debilitating, post-vaccination condition. Some of the individuals who experienced chronic illness after getting the shots had detectable levels of spike protein more than 700 days after vaccination. This study was small — 42 participants — and not peer-reviewed.

Its findings also don’t show the spike protein is a health risk or a cause of vaccine injury.

“It’s an initial, provocative study in which you can’t draw conclusions,” said William Schaffner, past medical director of National Foundation for Infectious Diseases. “This is one of the most widely used vaccines around the globe. It’s the furthest thing from an experimental vaccine.”

But what this growing pushback shows, according to some researchers, is that distrust isn’t coming only from fringe groups anymore.

“There are truly amazing mRNA cancer vaccines out there,” said Kate Broderick, chief innovation officer at Maravai LifeSciences, which works on vaccine development. “My fear as a scientist is that it’s been tainted in the public.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

Urgent CDC data and analyses on influenza and bird flu go missing as outbreaks escalate

2025-02-14T18:32:51+00:00

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Sonya Stokes, an emergency room physician in the San Francisco Bay Area, braces herself for a daily deluge of patients sick with coughs, soreness, fevers, vomiting, and other flu-like symptoms.

She’s desperate for information, but the Centers for Disease Control and Prevention, a critical source of urgent analyses of the flu and other public health threats, has gone quiet in the weeks since President Donald Trump took office.

“Without more information, we are blind,” she said.

Flu has been brutal this season. The CDC estimates at least 24 million illnesses, 310,000 hospitalizations, and 13,000 deaths from the flu since the start of October. At the same time, the bird flu outbreak continues to infect cattle and farmworkers. But CDC analyses that would inform people about these situations are delayed, and the CDC has cut off communication with doctors, researchers, and the World Health Organization, doctors and public health experts say.

“CDC right now is not reporting influenza data through the WHO global platforms, FluNet [and] FluID, that they’ve been providing information [on] for many, many years,” Maria Van Kerkhove, interim director of epidemic and pandemic preparedness at the WHO, said at a Wednesday press briefing.

“We are communicating with them,” she added, “but we haven’t heard anything back.”

On his first day in office, Trump announced the United States would withdraw from the WHO.

Bird flu in house cats could pose a risk to public health

A critical analysis of the seasonal flu selected for distribution through the CDC’s Health Alert Network has stalled, according to people close to the CDC. They asked not to be identified because of fears of retaliation. The network, abbreviated as HAN, is the CDC’s main method of sharing urgent public health information with health officials, doctors, and, sometimes, the public.

A chart from that analysis, reviewed by KFF Health News, suggests that flu may be at a record high. About 7.7% of patients who visited clinics and hospitals without being admitted had flu-like symptoms in early February, a ratio higher than in four other flu seasons depicted in the graph. That includes 2003-04, when an atypical strain of flu fueled a particularly treacherous season that killed at least 153 children.

Without a complete analysis, however, it’s unclear whether this tidal wave of sickness foreshadows a spike in hospitalizations and deaths that hospitals, pharmacies, and schools must prepare for. Specifically, other data could relay how many of the flu-like illnesses are caused by flu viruses — or which flu strain is infecting people. A deeper report might also reveal whether the flu is more severe or contagious than usual.

“I need to know if we are dealing with a more virulent strain or a coinfection with another virus that is making my patients sicker, and what to look for so that I know if my patients are in danger,” Stokes said. “Delays in data create dangerous situations on the front line.”

Although the CDC’s flu dashboard shows a surge of influenza, it doesn’t include all data needed to interpret the situation. Nor does it offer the tailored advice found in HAN alerts that tells health care workers how to protect patients and the public. In 2023, for example, a report urged clinics to test patients with respiratory symptoms rather than assume cases are the flu, since other viruses were causing similar issues that year.

“This is incredibly disturbing,” said Rachel Hardeman, a member of the Advisory Committee to the Director of the CDC. On Monday, Hardeman and other committee members wrote to acting CDC Director Susan Monarez asking the agency to explain missing data, delayed studies, and potentially severe staff cuts. “The CDC is vital to our nation’s security,” the letter said.

Studies missing or delayed from Morbidity and Mortality Weekly Report

Several studies have also been delayed or remain missing from the CDC’s preeminent scientific publication, the Morbidity and Mortality Weekly Report. Anne Schuchat, a former principal deputy director at the CDC, said she would be concerned if there was political oversight of scientific material: “Suppressing information is potentially confusing, possibly dangerous, and it can backfire.”

CDC spokesperson Melissa Dibble declined to comment on delayed or missing analyses. “It is not unexpected to see flu activity elevated and increasing at this time of the year,” she said.

A draft of one unpublished study, reviewed by KFF Health News, that has been withheld from the MMWR for three weeks describes how a milk hauler and a dairy worker in Michigan may have spread bird flu to their pet cats. The indoor cats became severely sick and died. Although the workers weren’t tested, the study says that one of them had irritated eyes before the cat fell ill — a common bird flu symptom. That person told researchers that the pet “would roll in their work clothes.”

After one cat became sick, the investigation reports, an adolescent in the household developed a cough. But the report says this young person tested negative for the flu, and positive for a cold-causing virus.

Corresponding CDC documents summarizing the cat study and another as-yet unpublished bird flu analysis said the reports were scheduled to be published Jan. 23. These were reviewed by KFF Health News. The briefing on cats advises dairy farmworkers to “remove clothing and footwear, and rinse off any animal biproduct residue before entering the household to protect others in the household, including potentially indoor-only cats.”

The second summary refers to “the most comprehensive” analysis of bird flu virus detected in wastewater in the United States.

Jennifer Nuzzo, director of the Pandemic Center at Brown University, said delays of bird flu reports are upsetting because they’re needed to inform the public about a worsening situation with many unknown elements. Citing “insufficient data” and “high uncertainty,” the United Kingdom raised its assessment of the risk posed by the U.S. outbreak on dairies.

“Missing and delayed data causes uncertainty,” Nuzzo said. “It also potentially makes us react in ways that are counterproductive.”

Study: Cattle veterinarians unknowingly infected with bird flu

Another bird flu study slated for January publication showed up in the MMWR on Thursday, three weeks after it was expected. It revealed that three cattle veterinarians had been unknowingly infected last year, based on the discovery of antibodies against the bird flu virus in their blood. One of the veterinarians worked in Georgia and South Carolina, states that haven’t reported outbreaks on dairy farms.

The study provides further evidence that the United States is not adequately detecting cases in cows and people. Nuzzo said it also highlights how data can supply reassuring news. Only three of 150 cattle veterinarians had signs of prior infections, suggesting that the virus doesn’t easily spread from the animals into people. More than 40 dairy workers have been infected, but they generally have had more sustained contact with sick cattle and their virus-laden milk than veterinarians.

Instead, recently released reports have been about wildfires in California and Hawaii.

“Interesting but not urgent,” Nuzzo said, considering the acute fire emergencies have ended. The bird flu outbreak, she said, is an ongoing “urgent health threat for which we need up-to-the-minute information to know how to protect people.”

“The American public is at greater risk when we don’t have information on a timely basis,” Schuchat said.

This week, a federal judge ordered the CDC and other health agencies to “restore” datasets and websites that the organization Doctors for America had identified in a lawsuit as having been altered. Further, the judge ordered the agencies to “identify any other resources that DFA members rely on to provide medical care” and restore them by Friday.

In their letter, CDC advisory committee members requested an investigation into missing data and delayed reports. Hardeman, an adviser who is a health policy expert at the University of Minnesota, said the group didn’t know why data and scientific findings were being withheld or removed. Still, she added, “I hold accountable the acting director of the CDC, the head of HHS, and the White House.”

Hardeman said the Trump administration has the power to disband the advisory committee. She said the group expects that to happen but proceeded with its demands regardless.

“We want to safeguard the rigor of the work at the CDC because we care deeply about public health,” she said. “We aren’t here to be silent.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

Bird flu in house cats could pose a risk to public health

2025-02-10T14:44:14+00:00

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More than 80 domestic cats, among many other types of mammals, have been confirmed to have had bird flu since 2022 — generally barn cats that lived on dairy farms, as well as feral cats and pets that spend time outdoors and likely caught it by hunting diseased rodents or wild birds.

Now, a small but growing number of house cats have gotten sick from H5N1, the bird flu strain driving the current U.S. outbreak, after eating raw food or drinking unpasteurized milk. Some of those cats died.

The strain of bird flu currently circulating has not adapted to efficiently spread among people. And there have been no known cases of cat-to-human transmission during the current outbreak of H5N1.

Still, there’s always been the risk that cats, which are arguably only semi-domesticated, could bring home a disease from a midnight prowl.

“Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said virologist Angela Rasmussen, who studies disease progression in emerging viruses at the University of Saskatchewan’s Vaccine and Infectious Disease Organization.

This is because we snuggle with and sleep in bed with our cats. When we’re not looking, cats drink from our water glasses and walk on kitchen counters. So, cat owners should be aware of the ongoing spread of bird flu. “By reducing the risk to your cats, you reduce the risk to yourself,” Rasmussen said.

NYC live bird markets shuttered for a week, following bird flu detections

Rasmussen doesn’t think pet owners should be afraid their cats will give them bird flu but said taking precautions is good for pets and for public health.

Signs of bird flu in cats include runny nose and discharge around the eyes, explained Michael Q. Bailey, president-elect of the American Veterinary Medical Association.

H5N1 also causes neurological problems like dizziness and seizures, which are symptoms of rabies, too. Rabies is almost always fatal, and it poses a threat to human health, so any animal suspected of having the viral disease must be euthanized. Bailey encourages people to ensure pets are up-to-date on their vaccinations.

Veterinarian Jane Sykes, who specializes in infectious diseases in cats and dogs at the University of California-Davis School of Veterinary Medicine, said people should not assume it’s bird flu if their cat is sick — even if their animal spends time outdoors or eats a raw diet. Upper-respiratory illnesses are common in cats, while H5N1 is “still pretty rare.”

Sykes gives her indoor cat, Freckles, regular kibble exclusively. She told NPR and KFF Health News she has no concerns about Freckles getting H5N1 because the heating process of making dry or canned pet food kills viruses.

More cases in cats, more risk to humans

Some people feed their pets raw meat or unpasteurized milk because they think it’s a more nutritious or natural diet. The American Veterinary Medical Association’s website discourages this due to foodborne pathogens like salmonella and listeria, and now the highly pathogenic H5N1.

By keeping pets healthy, veterinarians play an essential role in protecting humans from zoonotic diseases. The American Veterinary Medical Association says the risk of H5N1 spilling over from a pet to a person is “considered extremely low, but not zero.”

State and local public health agencies, including those in Los Angeles County and Washington state, have issued similar warnings against raw food diets for pets.

Concerns for human health are partly why the FDA announced last month it is now requiring cat and dog food companies to update their safety plans to protect against bird flu.

This came after the Oregon Department of Agriculture discovered a cat that was “strictly an indoor cat” had contracted H5N1 and died after consuming a frozen turkey product made by the raw pet food brand Northwest Naturals. It stated that “tests confirmed a genetic match between the virus in the raw and frozen pet food and the infected cat.”

How to reduce the risk of bird flu in backyard flocks

Northwest Naturals voluntarily recalled that batch of its frozen turkey-based product. The company told KFF Health News and NPR that the recall involved “a small product run” and that it has concerns about the accuracy of the Oregon Agriculture Department’s testing.

Los Angeles County’s public health department said five cats from two households tested positive for bird flu after drinking unpasteurized raw milk from the Raw Farm dairy in California’s Central Valley.

Raw Farm voluntarily recalled its milk and cream after retail products tested positive for H5N1, but it denies any food safety issues, calling the concern “a political issue.”

Veterinarians also warn pet owners not to allow cats unsupervised time outside as there’s the risk of them getting H5N1 by interacting with other animals that might carry the disease.

“This is a very scary virus, given that it can infect so many different host species,” said Bruce Kornreich, director of Cornell University’s Feline Health Center.

At least one instance of a cat infecting a person with bird flu occurred in 2016. As NPR reported, a veterinarian in New York City caught the virus after having close contact with infected cats. The vet experienced mild symptoms and quickly recovered.

In that case, the strain of bird flu was H7N2, not the H5N1 that is now circulating in the United States.

H7N2 is a very different type of virus, Sykes explained. But she said it shows that cat-to-human transmission of avian influenza is theoretically possible.

There isn’t a lot of research on transmission of bird flu from companion animals like cats or dogs to humans, though Rasmussen agreed it’s definitely a concern: The more infections you have in animals, “the more your luck is potentially going to run out.”

Most people who have caught H5N1 are agricultural workers who had direct contact with infected poultry or cattle. Of at least 67 confirmed human cases of H5N1 in the United States, there’s been one fatality in an immunocompromised person who had contact with birds.

In general, zoonotic disease researchers want more H5N1 surveillance in companion animals of all types. Even if the human death toll of H5N1 remains relatively low, it remains a public health risk.

Chances for mutation increase risk of spread

Part of the concern with this H5N1 outbreak is that bird flu viruses change. Just a few mutations could make this strain adept at spreading between people. And the more people who catch H5N1, the more likely it would adapt to be more efficient, said Suresh Kuchipudi, a virologist at the University of Pittsburgh School of Public Health, where he researches zoonotic diseases. Kuchipudi has studied H5N1 in cats.

Another concern is something called reassortment. If an animal or person is infected with two viruses at once, the viruses can trade genetic material, creating something new. This is common in influenza, so virologists are on the lookout for a case in which the bird flu reassorts to make a virus that’s far more contagious, and potentially more virulent.

Virologist Rasmussen is way more worried about this happening in pigs. Human respiratory physiology is more like that of swines than felines. So far, the current outbreak of H5N1 has not reached commercial hog operations. Rasmussen hopes it stays that way.

Kuchipudi said reassortments are relatively rare events, but the outcome is completely unpredictable. Sometimes the results are benign, though it was likely a reassortment that involved an avian virus that led to the 1918 flu pandemic, which killed an estimated 50 million people. In the century since, virologists have established a global surveillance network to monitor influenza viruses. Scientists say continued investment in this network is key to preparing for and hopefully preventing another pandemic.

Winter is “reassortment season” because of all the influenza viruses circulating, Rasmussen said. A reassortment in cats could technically be possible since these pets occasionally get seasonal flu, but it’s highly unlikely. Rather, Rasmussen said, it’s more likely that a cat would pass H5N1 to a human who already has seasonal flu, and then a reassortment happens in the sick person. While the risk isn’t zero, Rasmussen doubts this will happen. It would depend on how ill the human was, and how much virus they’re exposed to from their cat.

Trump administration’s halt of CDC’s weekly scientific report stalls bird flu studies

“Unless the cat is really shedding a ton of virus, and you’re kind of making out with the cat, I think it would be hard,” she said.

Rasmussen and Kuchipudi caution there isn’t enough research to know for sure how much virus cats shed, or even how they shed the virus.

The Centers for Disease Control and Prevention was poised to release a new study about H5N1 in cats, but that was delayed when the Trump administration paused the Morbidity and Mortality Weekly Report. That investigation, revealed through emails obtained by KFF Health News in a public records request, found that house cats likely got bird flu from dairy workers.

Scientists and public health agencies should question previously held assumptions about bird flu, Kuchipudi urged. He noted that 20 years ago nobody would have predicted that bird flu would infect dairy cattle the way it is now.

Cats’ behavior puts them at higher risk than dogs

The FDA says other domesticated animals, including dogs, can get bird flu infections. There are no confirmed cases of H5N1 among dogs in the United States, though in other countries they have died from the virus.

There’s some disagreement and an overall lack of research on whether cat biology makes them more susceptible to H5N1 than other mammals, including humans, pigs, or dogs.

But cat behaviors, such as their love of dairy and predation of wild birds, put them at higher risk, Kuchipudi said. Also, living in groups might play a role as there are more feral cat colonies in the United States than packs of stray dogs.

There’s very little people can do about the H5N1 circulating in wild birds. As Rasmussen explained, “It’s flying around in the skies. It’s migrating north and south with the seasons.”

But she said there’s a lot people can do to keep the virus out of their homes.

That includes limiting a pet’s exposure to H5N1 by not feeding them raw food or unpasteurized milk, and trying to keep them from interacting with animals like rodents and wild birds that could be infected with the virus.

This article is from a partnership that includes NPR and KFF Health News, Healthbeat’s national reporting partner.

NYC live bird markets shuttered for a week, following bird flu detections

2025-02-07T22:17:56+00:00

Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here. This article is a collaboration with THE CITY.

New York state is shuttering all live bird markets in New York City, as well as in Westchester, Nassau and Suffolk counties, for the next week, following the recent detection of bird flu among some poultry in city markets.

During a virtual briefing on Friday morning, Gov. Kathy Hochul emphasized that while there is “no immediate public health threat” in New York, shutting down the markets would help guard against the further spread of disease.

“These are just simply measured, common sense steps that will curb the spread of bird flu and ultimately to keep New Yorkers safe, which is always my top priority,” she said.

No human cases of bird flu have been detected in New York state so far. For most residents — particularly those who do not have direct contact with infected birds — the risk of infection is low, according to health officials and experts.

But since 2022, cases have emerged in the state among wild birds, backyard and poultry flocks, including recently on a Long Island commercial farm, which culled 100,000 ducks. Nationwide, bird flu cases have mounted in the past year among cattle, poultry and other animals. Among humans, 67 cases of bird flu, and one death, have been reported across the country since the start of 2024, according to the U.S. Centers for Disease Control and Prevention.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

While there is no evidence that the current highly pathogenic H5N1 bird flu virus can be transmitted between humans, experts say that possibility hinges on how the virus mutates — which could have pandemic potential.

State officials and health experts recommend that New Yorkers get the seasonal flu vaccine, which while not protective against bird flu, can reduce the chance of having both viruses at the same time — which can create opportunities for the two viruses to interact and become more dangerous.

Anyone who keeps chickens, ducks or geese should contact a veterinarian or the state Department of Agriculture and Markets if multiple birds die suddenly, or if bird flu symptoms appear, said Dr. James McDonald, commissioner of the state Department of Health. Additionally, New Yorkers who work with livestock, including dairy or poultry, should wear personal protective equipment.

In New York City, seven cases of bird flu were detected in poultry during routine inspections at live bird markets in the Bronx, Brooklyn and Queens in the past week, officials said. The shutdown order for live bird markets is effective from Friday through Feb. 14, and will impact about 80 markets across the state.

During that period, no poultry can be delivered to those markets. Markets that test positive for bird flu must be depopulated, undergo cleaning and disinfection, remain closed for at least five days, and pass a state health inspection. All uninfected markets must sell down their stock in the next few days, also undergo cleaning and disinfection, remain closed for at least five days, and pass a state inspection.

“These cases in the live bird markets were detected on surveillance,” McDonald said. “In other words, we were looking for the problem. And this is what you do in public health. We work together and we look for problems.”

McDonald added that the state is prepared for “widespread testing” if needed, with sufficient testing capacity at the Wadsworth Center, the state’s public health laboratory, and “substantial additional surge capacity.”

The state is also in close contact with the New York City Department of Health and Mental Hygiene, which has instructed exposed individuals to monitor for signs of illness, will test in the case of symptoms, and will offer Tamiflu, an influenza medication, as a preventative measure, McDonald said.

“We are prepared to respond to any disease outbreak, including quickly ramping up testing and treatment, and working closely with providers and community partners to rapidly disseminate messaging,” Dr. Michelle Morse, the city’s health commissioner, said in a statement.

In New York, other preparations for bird flu have begun, including at Bellevue Hospital, which is a regional hub for special pathogen preparedness. Earlier this year, the outgoing Biden administration awarded the hospital $2 million for its bird flu preparedness efforts, which will likely go toward bolstering PPE stockpiles and training efforts, Dr. Vikramjit Mukherjee, the director of the Special Pathogens Program and of Critical Care Services at Bellevue, told Healthbeat last month.

The state has taken other preventative steps, according to Elizabeth Wolters, the deputy commissioner for the state agriculture and markets department. Those measures include testing samples of milk intended for pasteurization and instituting testing requirements for cattle imported into the state and those entering state fairs or exhibitions.

THE CITY visited five live poultry markets in Brooklyn on Friday afternoon, four of which were still open several hours after Hochul’s announcement.

“We’re closing,” said the owner of a poultry market in Bushwick, declining to answer multiple questions about how they planned to handle the governor’s mandates.

At one poultry shop in East Williamsburg, the store manager said “the store has no chickens” in plain view of dozens of live chickens crammed together in crates stacked to the ceiling, before ushering the reporter out.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Trump administration’s halt of CDC’s weekly scientific report stalls bird flu studies

2025-01-30T12:30:00+00:00

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The Trump administration has intervened in the release of important studies on the bird flu, as an outbreak escalates across the United States.

One of the studies would reveal whether veterinarians who treat cattle have been unknowingly infected by the bird flu virus. Another report documents cases in which people carrying the virus might have infected their pet cats.

The studies were slated to appear in the official journal of the Centers for Disease Control and Prevention, the Morbidity and Mortality Weekly Report. The distinguished journal has been published without interruption since 1952.

Its scientific reports have been swept up in an “immediate pause” on communications by federal health agencies ordered by Dorothy Fink, the acting secretary of the Department of Health and Human Services. Fink’s memo covers “any document intended for publication,” she wrote, “until it has been reviewed and approved by a presidential appointee.” It was sent on President Donald Trump’s first full day in office.

That’s concerning, said former CDC officials, because a firewall has long existed between the agency’s scientific reports and political appointees.

“MMWR is the voice of science,” said Tom Frieden, a former CDC director and the CEO of the nonprofit organization Resolve to Save Lives.

“This idea that science cannot continue until there’s a political lens over it is unprecedented,” said Anne Schuchat, a former principal deputy director at the CDC. “I hope it’s going to be very short-lived, but if it’s not short-lived, it’s censorship.”

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

White House officials meddled with scientific studies on Covid-19 during the first Trump administration, according to interviews and emails collected in a 2022 report from congressional investigators. Still, the MMWR came out as scheduled.

“What’s happening now is quite different than what we experienced in Covid, because there wasn’t a stop in the MMWR and other scientific manuscripts,” Schuchat said.

Neither the White House nor HHS officials responded to requests for comment. CDC spokesperson Melissa Dibble said, “This is a short pause to allow the new team to set up a process for review and prioritization.”

Webinar planned to reveal bird flu study results

News of the interruption hit suddenly last week, just as Fred Gingrich, executive director of the American Association of Bovine Practitioners, a group for veterinarians specializing in cattle medicine, was preparing to hold a webinar with members. He planned to disclose the results of a study he helped lead, slated for publication in the MMWR later that week. Back in September, about 150 members had answered questions and donated blood for the study. Researchers at the CDC analyzed the samples for antibodies against the bird flu virus, to learn whether the veterinarians had been unknowingly infected earlier last year.

Although it would be too late to treat prior cases, the study promised to help scientists understand how the virus spreads from cows to people, what symptoms it causes, and how to prevent infection. “Our members were very excited to hear the results,” Gingrich said.

Like farmworkers, livestock veterinarians are at risk of bird flu infections. The study results could help protect them. And having fewer infections would lessen the chance of the H5N1 bird flu virus evolving within a person to spread efficiently between people — the gateway to a bird flu pandemic.

At least 67 people have tested positive for the bird flu in the United States, with the majority getting the virus from cows or poultry. But studies and reporting suggest many cases have gone undetected, because testing has been patchy.

Just before the webinar, Gingrich said, the CDC informed him that because of an HHS order, the agency was unable to publish the report last week or communicate its findings. “We had to cancel,” he said.

Bird flu found in second commercial chicken flock in Georgia

Another bird flu study slated to be published in the MMWR last week concerns the possibility that people working in Michigan’s dairy industry infected their pet cats. These cases were partly revealed last year in emails obtained by KFF Health News. In one email from July 22, an epidemiologist pushed to publish the group’s investigation to “inform others about the potential for indirect transmission to companion animals.”

Jennifer Morse, medical director at the Mid-Michigan District Health Department and a scientist on the pending study, said she got a note from a colleague last week saying that “there are delays in our publication — outside of our control.”

A person close to the CDC, speaking on the condition of anonymity because of concerns about reprisal, expected the MMWR to be on hold at least until Feb. 6. The journal typically posts on Thursdays, and the HHS memo says the pause will last through Feb. 1.

“It’s startling,” Frieden said. He added that it would become dangerous if the reports aren’t restored. “It would be the equivalent of finding out that your local fire department has been told not to sound any fire alarms,” he said.

MMWR info used to detect health threats

In addition to publishing studies, the MMWR keeps the country updated on outbreaks, poisonings, and maternal mortality, and provides surveillance data on cancer, heart disease, HIV, and other maladies. Delaying or manipulating the reports could harm Americans by stunting the ability of the U.S. government to detect and curb health threats, Frieden said.

The freeze is also a reminder of how the first Trump administration interfered with the CDC’s reports on Covid, revealed in emails detailed in 2022 by congressional investigators with the House Select Subcommittee on the Coronavirus Crisis. That investigation found that political appointees at HHS altered or delayed the release of five reports and attempted to control several others in 2020.

In one instance, Paul Alexander, then a scientific adviser to HHS, criticized a July 2020 report on a coronavirus outbreak at a Georgia summer camp in an email to MMWR editors, which was disclosed in the congressional investigation. “It just sends the wrong message as written and actually reads as if to send a message of NOT to re-open,” he wrote. Although the report’s data remained the same, the CDC removed remarks on the implications of the findings for schools.

Later that year, Alexander sent an email to then-HHS spokesperson Michael Caputo citing this and another example of his sway over the reports: “Small victory but a victory nonetheless and yippee!!!”

Schuchat, who was at the CDC at the time, said she had never experienced such attempts to spin or influence the agency’s scientific reports in more than three decades with the agency. She hopes it won’t happen again. “The MMWR cannot become a political instrument,” she said.

Gingrich remains hopeful that the veterinary study will come out soon. “We’re an apolitical organization,” he said. “Maintaining open lines of communication and continuing research with our federal partners is critical as we fight this outbreak.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News.

Bird flu isn’t an immediate health threat in New York. But preparations have begun.

2025-01-24T10:00:00+00:00

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As more cases of bird flu emerge across the country, public health leaders in New York City are watching warily — and making preparations in case the virus becomes a more immediate threat.

There have been no confirmed cases of bird flu in humans in New York state. But cases have emerged recently among wild birds and poultry, including at a commercial farm on Long Island, which started euthanizing 100,000 ducks this week.

For New Yorkers who do not interact with infected animals, the risk of getting bird flu is low, public health experts and health officials say. While there is no evidence that the current highly pathogenic H5N1 bird flu virus can be transmitted between humans, that scenario remains a possibility — and one that, with certain mutations, could lead to a pandemic.

Since 2024, at least 67 people nationwide have been infected by the virus, according to data from the U.S. Centers for Disease Control and Prevention. Earlier this month, the CDC reported the first human death from bird flu, in Louisiana. Meanwhile, bird flu has appeared in animals across the country, from dairy herds to backyard chickens. This week, the poultry industry in Georgia — one of the nation’s largest — was working to contain an outbreak of the virus.

The United States has stumbled through its bird flu response, failing to stamp out the virus when it emerged on dairy farms in several states last year. Since then, slow federal interventions and depleted public health resources have created the conditions for what could become a pandemic.

How America lost control of the bird flu, setting the stage for another pandemic

The nationwide bird flu response is in limbo as President Donald Trump, who has vowed dramatic changes to federal health agencies, returned to the White House this week. Trump previously signaled that he would disband the Office of Pandemic Preparedness and Response Policy, which coordinated the bird flu response under the Biden administration. This week, the Trump administration instructed federal health agencies to pause all external communications.

Locally, some bird flu preparations are underway. Bellevue Hospital, part of the NYC Health + Hospitals system and a regional hub for special pathogen preparedness, is gearing up for the possibility that bird flu becomes a more serious public health threat. This month, the hospital announced that it would receive $2 million for bird flu preparedness efforts, part of a wave of federal funding released in the final weeks of the Biden administration.

“We’ve been tracking the avian influenza cases that have sprung up across the country,” said Dr. Vikramjit Mukherjee, the director of the Special Pathogens Program and of Critical Care Services at Bellevue. “We believe that it’s a matter of time before it becomes more significant.”

There’s low risk, but pandemic potential

In New York state, bird flu has been detected occasionally in wild birds, backyard flocks, and poultry since 2022. The state reported several cases in live poultry markets in Brooklyn and Queens in 2023. Last week, the Putnam County Health Department reported a bird flu case in a wild goose in Brewster, a village about an hour outside New York City.

This week, responding to the detection of bird flu on a Long Island farm, state officials said that individuals who may have had contact with infected birds were being monitored for symptoms, and that farmworkers were given personal protective equipment. The state Department of Agriculture and Markets is working with a division of the federal Department of Agriculture on surveillance and testing in the surrounding area, according to the state Department of Health.

“I urge everyone who has regular contact with livestock and wild birds to remain vigilant and take precautions by wearing personal protective equipment when you’re in contact with these animals,” Dr. James McDonald, the state health commissioner, said in a statement.

While the risk to the general public remains low, public health experts say that evidence of human-to-human transmission of bird flu would raise red flags, signaling a heightened threat — and pandemic potential. That possibility hinges on whether the virus is able to mutate enough to spread between people. In the recent death of a Louisiana resident from bird flu, CDC scientists found that the virus had started to mutate after infection.

“You have more and more spread now,” said Dr. Michael Merson, a clinical professor of global and environmental health at the NYU School of Global Public Health. “The question obviously is, is it going to be a mutation into humans, and we get person-to-person spread? That would be the most alarming situation.”

To public health experts, the emergence of bird flu cases during a worsening flu season is especially concerning, as it increases the risk of co-infection — having both viruses at the same time. Co-infection creates an opportunity for the two viruses to interact, exchange genetic material, and potentially become more dangerous to humans.

“That also is a way that we can have a pandemic situation, if a human virus mixes with the H5N1 virus,” said Dr. Denis Nash, an expert in infectious disease epidemiology and the executive director of the CUNY Institute for Implementation Science in Population Health. “During flu season, that is more likely to happen. That increases our risk a lot.”

As a protective measure, public health experts recommend that New Yorkers — and especially farmworkers — get the seasonal flu vaccine. While the flu shot won’t prevent a bird flu infection, it could help reduce the risk of co-infection.

Efforts have also ramped up to accelerate bird flu vaccine development. Last week, the federal Department of Health and Human Services announced it would provide about $590 million to Moderna to spur the development of an H5N1 mRNA influenza vaccine targeted at the current strain circulating in cows and birds.

In New York, Nash is part of a research team that has tested wastewater across the NYC Health + Hospitals system for infectious diseases including Covid, flu, and mpox. Researchers are in the process of setting up a wastewater test for H5N1, which could be an important tool for early detection in the city.

“The current outbreak in animals, and all of this spillover to humans, is of great concern and worrisome,” he said. “I don’t think we’re doing enough to mitigate the risk.”

NYC Health + Hospitals leads a training exercise testing the health care system’s ability to screen and isolate a “patient” with simulated symptoms of bird flu in October.

Bellevue would help lead regional response

If bird flu were to become more of a threat — or a pandemic — Bellevue Hospital would be at the center of New York’s response effort.

Bellevue serves as the regional hub for special pathogen preparedness and cases of highly infectious diseases for New York, New Jersey, Puerto Rico, and the U.S. Virgin Islands. The hospital is also a member of the National Emerging Special Pathogens Training and Education Center, a preparedness consortium.

Earlier this month, HHS announced $306 million in awards for bird flu preparedness and response, of which Bellevue will receive $2 million. Mukherjee, who leads the hospital’s Special Pathogens Program, said he expects the funds to go toward shoring up regional PPE stockpiles, as well as training and education programs.

Other preparedness measures have begun, he said. In October, health care workers donned PPE to simulate transporting an H5N1 patient from Kings County Hospital Center to Bellevue. Mukherjee said that Bellevue has conducted PPE training, reviewed its pandemic protocols, and offered its expertise to other regional facilities. The hospital is also assessing its surge capacity, including plans for expanding patient spaces, ramping up staffing, and ensuring adequate PPE, ventilators, and other supplies.

At the New York City Department of Health and Mental Hygiene, a spokesperson said in a statement that the agency is “prepared to respond to any disease outbreak, including quickly ramping up vaccination, testing, and treatment, as appropriate, and working closely with providers and community partners to rapidly disseminate messaging.”

A strong bird flu response hinges on federal partnership, public health experts say. Establishing an efficient testing system for bird flu is key, Mukherjee said, noting that the lack of such a system was a significant vulnerability during the early Covid response.

“We have some work to do in that sphere,” he said.

Nash emphasized that a good bird flu preparedness plan would look a lot like what the United States should have had when Covid hit: quick, scalable access to testing and masks, effective and widespread public health messaging, and swift vaccine production.

“We’re hopefully not going to be in a place like we were with Covid, where we couldn’t tell the extent of the outbreak, and how fast and where it was spreading until it was way too late,” he said. “If that happens with something like this virus, if it’s more pathogenic than Covid, we’ll be in a really bad place.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Bird flu found in second commercial chicken flock in Georgia, 200 yards from first location

2025-01-22T22:03:31+00:00

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Bird flu has been confirmed in a second commercial poultry flock in Elbert County, the Georgia Department of Agriculture said Wednesday.

The second contaminated site, listed as Elbert 02, is 210 yards away from the first location, Elbert 01, where bird flu was confirmed Friday. The farms, owned by the same family, are “just across a dirt road from each other,” said Matthew Agvent, Georgia Department of Agriculture spokesperson.

The owners were not identified. The second site housed 130,000 broilers. The first had about 45,500 broilers on site.

Agriculture Department employees completed the culling process within 48 hours of initial detection of the H5N1 virus, while cleaning and disinfecting were ongoing at both sites, the department said.

The clean-up process can pose a risk to workers, said Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health.

“There are documented cases of poultry workers getting infected with H5N1 during the cleanup of commercial poultry buildings,” he said.

No human cases have been reported in Georgia.

Agvent said employees involved in the response are being monitored daily for clinical symptoms and are using personal protective equipment and following biosecurity measures. Testing is also available if needed.

Some of the main symptoms in humans include fever, cough, sore throat, and pink eye (conjunctivitis).

The Georgia Department of Public Health has conducted a risk assessment for the family who owns the farms and “can make testing available if necessary,” Agvent said.

The agency’s law enforcement officers had set up a perimeter around the area. All commercial poultry operations within 6.2 miles have been under quarantine since Friday, and bird flu testing will be conducted for at least two weeks.

The state has also indefinitely suspended all poultry exhibitions, shows, swaps, meets, and sales.

Retail sales of eggs and chickens or other poultry products will not be affected, the agency said.

How to keep backyard flocks safe from bird flu

“The risk of H5N1 in the food supply is very low, partly because H5N1 kills poultry so quickly, and poultry rarely survive infection,” Pekosz told Healthbeat on Tuesday.

With a mortality rate of 100%, poultry or eggs “never make it off a commercial farm before the outbreak is detected.”

Georgia’s $7.75 billion commercial poultry industry is one of the largest in the nation.

Previously, some 30,580 birds had been culled in Georgia due to bird flu since the start of the current outbreak in February 2022, according to the U.S. Department of Agriculture. About 30,000 of those came from an infected flock at a commercial duck breeder in Sumter County in 2023.

Bird flu has also been detected in three backyard chicken flocks, including one in Clayton County earlier this month. Here’s how to protect backyard flocks.

The Centers for Disease Control and Prevention has confirmed 68 human cases in the United States since 2022. The first human death was reported this month in Louisiana, in an elderly person who had other underlying health conditions and was likely exposed via a backyard flock.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Georgia works to contain spread of bird flu from commercial poultry farm

2025-01-21T17:33:00+00:00

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Georgia’s $7.75 billion commercial poultry industry – one of the largest in the nation – was working Tuesday to keep bird flu from spreading after a case was confirmed in an operation in Elbert County.

The Georgia Department of Agriculture said avian influenza breached the first commercial poultry operation in the state, confirming the diagnosis late Friday. About 45,000 broiler breeders were on the site and being destroyed.

Gilda Pedraza, executive director of the Latino Community Fund of Georgia, said Tuesday her organization sprang into action to help protect poultry workers.

The organization created materials to inform them about the new detection of bird flu, including safety information for those who keep backyard flocks.

“From our members, we have learned poultry plants continue to operate, and some have given masks to workers and have set up a nurse 24/7,” Pedraza said. “We have asked people that if they experience symptoms, to report them to their employers and to send us a message so we have some idea of what is going on at the ground level.”

How America lost control of the bird flu, setting the stage for another pandemic

State agriculture officials emphasized that the food supply is safe. Poultry operations near the contaminated farm were subjected to “additional surveillance” to find out whether the H5N1 virus has spread, Mike Giles, president of the Georgia Poultry Federation, said in a Friday press release.

The state did not name the company where bird flu was detected, but put all commercial poultry operations within 6.2 miles under quarantine and said they would be tested for at least two weeks.

The state also indefinitely suspended all poultry exhibitions, shows, swaps, meets, and sales.

“This is a serious threat to Georgia’s #1 industry and the livelihoods of thousands of Georgians who make their living in our state’s poultry industry. We are working around the clock to mitigate any further spread of the disease and ensure that normal poultry activities in Georgia can resume as quickly as possible,” Georgia Agriculture Commissioner Tyler Harper said Friday in a news release.

“The risk of an infected bird entering the food supply chain is low,” the state said.

How to keep backyard chickens safe from bird flu

Andrew Pekosz, a professor of microbiology and immunology at Johns Hopkins Bloomberg School of Public Health agreed.

“The risk of H5N1 in the food supply is very low, partly because H5N1 kills poultry so quickly, and poultry rarely survive infection.” With a mortality rate of 100%, poultry or eggs “never make it off a commercial farm before the outbreak is detected.”

The detection of bird flu in a small backyard chicken flock confirmed in Clayton County on Jan. 10 was the fourth instance in Georgia since the outbreak started.

Most human cases have come from dairy cattle

The Centers for Disease Control and Prevention has confirmed 68 human cases in the United States since 2022, as of earlier this month. The first human death was reported this month in Louisiana, in an elderly person who had other underlying health conditions and was likely exposed via a backyard flock.

Most infected people were likely exposed via contact with dairy cattle, according to the CDC, while others came from contact with poultry on farms.

No human cases have been reported in Georgia.

The state’s dairy operation is much smaller than the poultry industry. The Georgia Agriculture Department had tested 1,000 dairy cows by the end of December for bird flu and found no cases.

The state this month joined 27 others enrolled in a USDA program to test milk stored in silos at processing facilities for bird flu.

Commercial poultry producers test birds for avian influenza “at every stage of their life” as part of the state’s participation in the National Poultry Improvement Plan, Department of Agriculture spokesperson Liz Rivera-Brown told Healthbeat last week.

They have strong protocols in place to prevent bird flu because the industry is so important to the state, Giles said.

“The most important thing that we can do is prevent the virus from entering the poultry farms,” he said, adding that there is a focus on “consistent reinforcement” of existing protocols.

Poultry farms try to prevent infection by “drawing a line of separation” between the chicken houses and the outside world. That includes measures like foot pans to disinfect workers’ shoes, or changing footwear, Giles said.

Poultry workers need access to health care, sick leave

More than 37,000 people are directly employed in Georgia’s poultry industry, according to the U.S. Poultry and Egg Association. Many of them do not come into direct contact with birds, Giles said.

For those who do, it’s important for workers to know about bird flu and to have access to healthcare and financial support like sick leave, said Emory University epidemiology professor Jodie Guest, who helped with Covid testing efforts among poultry workers.

Guest said an on-site, mandatory bird flu testing system might not be a silver bullet solution, however.

“The best thing possible would be for there to be active surveillance [i.e. widespread testing at the facilities] but also paid sick leave,” Guest said. “If we’re going to require [testing], we need to support access to paid sick leave also.”

“Their access to health care has a tremendous number of barriers,” and workers could be reluctant to get tested because of concerns over losing wages or putting their immigration status at risk, Guest said.

Because many poultry workers, and others, may be reluctant or have a hard time accessing health care, and because bird flu often presents with only minor symptoms, human bird flu cases could fly under the radar, Guest said.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

There’s a higher risk for those workers who will have to deal with the dead birds after the culling process is complete, Pekosz said. “There are documented cases of poultry workers getting infected with H5N1 during the cleanup of commercial poultry buildings.”

“All workers involved will need to wear eye and respiratory protection, as well as disposable outer suits in order to prevent infection. Those items will then be decontaminated and destroyed after being used,” he said.

Some of the main symptoms in humans include fever, cough, sore throat, and pink eye (conjunctivitis).

The United States has a stockpile of 4.5 million H5N1 vaccines, but it’s unclear how well they would work because they are based on an older mutation formula, epidemiologist Dr. Katelyn Jetelina, a Healthbeat partner and supporter, wrote in a recent edition of her newsletter, Your Local Epidemiologist.

Finland last year started vaccinating at-risk farmworkers, and some experts have called on the CDC to do the same.

A federal program compensates commercial poultry owners if birds are infected and have to be destroyed.

Bird flu has also infected cats in some states, and Georgia is included in a recall of Northwest Naturals raw pet food.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

New York winter virus report: Norovirus, flu, and Covid-19 on the rise

2025-01-15T12:00:00+00:00

Sign up for Your Local Epidemiologist New York and get Dr. Marisa Donnelly’s community public health forecast in your inbox a day early.

Have questions, comments, or ideas for future topics? Email YLE NY at mdonnelly@healthbeat.org. I would love to hear from you.

Does it feel like everyone around you is sick right now? Yeah, me too. It seems like half my friends and family have the sniffles, and I’m still recovering from a respiratory infection. Our New York communities are in peak respiratory season. Let’s dive into the most recent respiratory data following the holidays, plus a bit on norovirus. Here’s your State of Affairs.

The flu: High and increasing

The number of people with flu in New York is high — hospitalizations in the state increased by 44% during the week ending Jan. 4, compared to the prior week. Increases are widespread across all regions of the state.

Influenza hospitalizations from the New York State Influenza Surveillance Report.

In an earlier post, I mentioned that flu activity started later this year compared to last year and shared some guesses as to what that could mean for flu intensity this year.

At this point, the flu season is shaping up to be similar to pre-pandemic times. Flu activity hasn’t peaked yet (unlike last year when it peaked the last week of December). The question is, will the number of severe infections be similar to last year, or worse?

Flu hospitalizations in New York. During the 2020-21 season, there were very few flu cases in the state.

Only time will tell, but in the meantime, it’s a good idea to take protective measures against the flu, like wearing a mask in crowded spaces (while traveling, on the subway, in supermarkets, etc.) and avoiding social interactions if you aren’t feeling well. Flu usually has a second peak later in winter due to flu B circulation (right now, most flu cases are from flu A), and infections can go into March or April, so it’s not too late to get your flu vaccine at a local pharmacy or clinic.

Covid-19: Minimal and increasing

Covid-19 activity in New York this season has been surprisingly low, with levels inching up more slowly compared to last season. This is our mildest winter for Covid-19 since the start of the pandemic. This is likely because we had such a big Covid-19 wave late last summer, resulting in a lot of immunity. I expect Covid-19 activity to continue increasing in New York, as national and regional Covid-19 levels are high and continue to increase.

SARS-CoV-2 concentrations in New York state (yellow line) are minimal, while national concentrations (black) are high and increasing.

Covid-19 continues to increase in New York City, where wastewater levels are increasing.

New York City average SARS-CoV-2 wastewater concentrations.

RSV: High but decreasing

RSV has peaked and is now declining in New York. This season’s peak happened about two weeks later than last year, but it was largely a middle-of-the-road season (so far there have been a similar number of cases compared to last year).

New York City RSV testing data from the Influenza and RSV Surveillance Report.

RSV infections in kids, who are usually hit hardest, have been similar this season to pre-pandemic levels. We hoped that RSV vaccines would have a stronger effect this year in keeping kids out of hospitals. I’ll be looking for more data on how RSV vaccines affected hospitalizations after the season ends.

National RSV hospitalization rates for people 4 years of age and younger.

We still expect there to be several weeks of high RSV activity, so we aren’t out of the woods yet.

Norovirus: Surging, and you don’t want it

Norovirus cases are surging in New York City and many other parts of the United States. Norovirus is a highly contagious group of viruses responsible for gastrointestinal issues like vomiting and diarrhea. It’s the most common cause of the stomach “flu” or “bug,” causing 19 million-20 million cases in the United States annually. In New York City, there were about 1,300 cases in December — almost triple the number during the same time in 2023 (488 cases).

Norovirus outbreaks in the United States reported by NoroSTAT-participating states.

Norovirus is spread through contact with infected people, contaminated surfaces, and food. It’s notoriously infectious. While infected with norovirus, people shed billions of virus particles, but it only takes a couple of particles to infect someone. Unfortunately, hand sanitizer doesn’t kill the virus because it has no outer membrane.

To prevent norovirus spread:

Wash hands frequently with soap and warm or hot water for at least 20 seconds.
Use detergents with bleach to clean and disinfect surfaces.
- To make your own, mix 1 teaspoon of bleach in 1 gallon of cool water.
Any material handled by people infected with norovirus — linens, towels, dishware, utensils, doorknobs, and especially surfaces in the bathroom — should be cleaned well to prevent spread.

Most people should recover from norovirus on their own in 2-3 days.

Emerging diseases: Avian flu

Last week, news broke of the first avian flu (H5N1) death in the United States, a tragic reminder that this virus is dangerous and that we as a country need to be on alert. Thankfully, we still haven’t seen any person-to-person transmission, and only two of the 74 cases identified in the United States have had severe illness. (See this recent YLE post for more details.)

We haven’t had any known cases of avian flu in dairy herds or humans in New York, so the current risk to New Yorkers is low. However, we may be missing cases, given testing cattle is voluntary. Starting this month, though, we should have more visibility. New York is part of a national milk testing program led by the USDA and is one of 28 states testing milk for H5N1 in bulk raw milk (both milk that will be pasteurized and remain raw). I’ll be back with a deeper dive when we have more information.

Bottom line

Winter virus transmission is high right now. Stay healthy: Mask up, wash your hands, and bleach surfaces.

Love,

Your Local Epidemiologist

How America lost control of the bird flu, setting the stage for another pandemic

2024-12-20T10:00:00+00:00

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Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A livestock veterinarian at the University of Wisconsin, Poulsen had seen sick cows before, with their noses dripping and udders slack.

But the scale of the farmers’ efforts to treat the sick cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy workers pumped gallons of electrolyte-rich fluids into ailing cows through metal tubes inserted into the esophagus.

“It was like watching a field hospital on an active battlefront treating hundreds of wounded soldiers,” he said.

Nearly a year into the first outbreak of the bird flu among cattle, the virus shows no sign of slowing. The U.S. government failed to eliminate the virus on dairy farms when it was confined to a handful of states, by quickly identifying infected cows and taking measures to keep their infections from spreading. Now at least 860 herds across 16 states have tested positive.

Experts say they have lost faith in the government’s ability to contain the outbreak.

“We are in a terrible situation and going into a worse situation,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “I don’t know if the bird flu will become a pandemic, but if it does, we are screwed.”

To understand how the bird flu got out of hand, KFF Health News interviewed nearly 70 government officials, farmers and farmworkers, and researchers with expertise in virology, pandemics, veterinary medicine, and more.

Together with emails obtained from local health departments through public records requests, this investigation revealed key problems, including a deference to the farm industry, eroded public health budgets, neglect for the safety of agriculture workers, and the sluggish pace of federal interventions.

Case in point: The U.S. Department of Agriculture this month announced a federal order to test milk nationwide. Researchers welcomed the news but said it should have happened months ago — before the virus was so entrenched.

“It’s disheartening to see so many of the same failures that emerged during the Covid-19 crisis re-emerge,” said Tom Bollyky, director of the Global Health Program at the Council on Foreign Relations.

Far more bird flu damage is inevitable, but the extent of it will be left to the Trump administration and Mother Nature. Already, the USDA has funneled more than $1.7 billion into tamping down the bird flu on poultry farms since 2022, which includes reimbursing farmers who’ve had to cull their flocks, and more than $430 million into combating the bird flu on dairy farms. In coming years, the bird flu may cost billions of dollars more in expenses and losses. Dairy industry experts say the virus kills roughly 2 to 5% of infected dairy cows and reduces a herd’s milk production by about 20%.

Worse, the outbreak poses the threat of a pandemic. More than 60 people in the United States have been infected, mainly by cows or poultry, but cases could skyrocket if the virus evolves to spread efficiently from person to person. And the recent news of a person critically ill in Louisiana with bird flu shows that the virus can be dangerous.

Just a few mutations could allow the bird flu to spread between people. Because viruses mutate within human and animal bodies, each infection is like a pull of a slot machine lever.

“Even if there’s only a 5% chance of a bird flu pandemic happening, we’re talking about a pandemic that probably looks like 2020 or worse,” said Tom Peacock, a bird flu researcher at the Pirbright Institute in the United Kingdom, referring to Covid-19. “The U.S. knows the risk but hasn’t done anything to slow this down,” he added.

Beyond the bird flu, the federal government’s handling of the outbreak reveals cracks in the U.S. health security system that would allow other risky new pathogens to take root, too. “This virus may not be the one that takes off,” said Maria Van Kerkhove, director of the emerging diseases group at the World Health Organization. “But this is a real fire exercise right now, and it demonstrates what needs to be improved.”

Farmers dismayed by inaction

It may have been a grackle, a goose, or some other wild bird that infected a cow in northern Texas. In February, the state’s dairy farmers took note when cows stopped making milk. They worked alongside veterinarians to figure out why. In less than two months, veterinary researchers identified the highly pathogenic H5N1 bird flu virus as the culprit.

Long listed among pathogens with pandemic potential, the bird flu’s unprecedented spread among cows marked a worrying shift. It had evolved to thrive in animals that are more like people biologically than birds.

After the USDA announced the dairy outbreak on March 25, control shifted from farmers, veterinarians, and local officials to state and federal agencies. Collaboration disintegrated almost immediately.

Farmers worried the government might block their milk sales or even demand sick cows be killed, as poultry are, said Kay Russo, a livestock veterinarian in Fort Collins, Colorado.

Instead, Russo and other veterinarians said, they were dismayed by inaction. The USDA didn’t respond to their urgent requests to support studies on dairy farms — and for money and confidentiality policies to protect farmers from financial loss if they agreed to test animals.

The runny nose of a dairy cow on a farm with a bird flu outbreak. This photo was taken by a livestock veterinarian who asked to remain anonymous because of employment concerns.

The USDA announced that it would conduct studies itself. But researchers grew anxious as weeks passed without results. “Probably the biggest mistake from the USDA was not involving the boots-on-the-ground veterinarians,” Russo said.

Will Clement, a USDA senior adviser for communications, said in an email: “Since first learning of H5N1 in dairy cattle in late March 2024, USDA has worked swiftly and diligently to assess the prevalence of the virus in U.S. dairy herds.” The agency provided research funds to state and national animal health labs beginning in April, he added.

The USDA didn’t require lactating cows to be tested before interstate travel until April 29. By then, the outbreak had spread to eight other states. Farmers often move cattle across great distances, for calving in one place, raising in warm, dry climates, and milking in cooler ones. Analyses of the virus’s genes implied that it spread between cows rather than repeatedly jumping from birds into herds.

Milking equipment was a likely source of infection, and there were hints of other possibilities, such as through the air as cows coughed or in droplets on objects, like work boots. But not enough data had been collected to know how exactly it was happening. Many farmers declined to test their herds, despite an announcement of funds to compensate them for lost milk production in May.

“There is a fear within the dairy farmer community that if they become officially listed as an affected farm, they may lose their milk market,” said Jamie Jonker, chief science officer at the National Milk Producers Federation, an organization that represents dairy farmers. To his knowledge, he added, this hasn’t happened.

Speculation filled knowledge gaps. Zach Riley, head of the Colorado Livestock Association, said he suspected that wild birds may be spreading the virus to herds across the country, despite scientific data suggesting otherwise. Riley said farmers were considering whether to install “floppy inflatable men you see outside of car dealerships” to ward off the birds.

Advisories from agriculture departments to farmers were somewhat speculative, too. Officials recommended biosecurity measures such as disinfecting equipment and limiting visitors. As the virus kept spreading throughout the summer, USDA senior official Eric Deeble said at a press briefing, “The response is adequate.”

The USDA, the Centers for Disease Control and Prevention, and the Food and Drug Administration presented a united front at these briefings, calling it a “One Health” approach. In reality, agriculture agencies took the lead.

This was explicit in an email from a local health department in Colorado to the county’s commissioners. “The State is treating this primarily as an agriculture issue (rightly so) and the public health part is secondary,” wrote Jason Chessher, public health director in Weld County, Colorado. The state’s leading agriculture county, Weld’s livestock and poultry industry produces about $1.9 billion in sales each year.

An email obtained through a Freedom of Information Act request to the public health department in Weld County, Colorado, illustrates that some workers on farms with bird flu outbreaks weren’t monitored for signs of infection.

Cases under the radar in three states

In July, the bird flu spread from dairies in Colorado to poultry farms. To contain it, two poultry operations employed about 650 temporary workers — Spanish-speaking immigrants as young as 15 — to cull flocks. Inside hot barns, they caught infected birds, gassed them with carbon dioxide, and disposed of the carcasses. Many did the hazardous job without goggles, face masks, and gloves.

By the time Colorado’s health department asked if workers felt sick, five women and four men had been infected. They all had red, swollen eyes — conjunctivitis — and several had such symptoms as fevers, body aches, and nausea.

State health departments posted online notices offering farms protective gear, but dairy workers in several states told KFF Health News that they had none. They also hadn’t heard about the bird flu, never mind tests for it.

Studies in Colorado, Michigan, and Texas would later show that bird flu cases had gone under the radar. In one analysis, eight dairy workers who hadn’t been tested — 7% of those studied — had antibodies against the virus, a sign that they had been infected.

Missed cases made it impossible to determine how the virus jumped into people and whether it was growing more infectious or dangerous. “I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, an executive director at the international organization the Coalition for Epidemic Preparedness Innovations, who served as assistant secretary for preparedness and response in the Obama administration.

A photograph of the eyes of an infected dairy worker in Texas, with ruptured blood vessels and bleeding conjunctiva.

Citing “insufficient data,” the British government raised its assessment of the risk posed by the U.S. dairy outbreak in July from three to four on a six-tier scale.

Virologists around the world said they were flabbergasted by how poorly the United States was tracking the situation. “You are surrounded by highly pathogenic viruses in the wild and in farm animals,” said Marion Koopmans, head of virology at Erasmus Medical Center in the Netherlands. “If three months from now we are at the start of the pandemic, it is nobody’s surprise.”

Although the bird flu is not yet spreading swiftly between people, a shift in that direction could cause immense suffering. The CDC has repeatedly described the cases among farmworkers this year as mild — they weren’t hospitalized. But that doesn’t mean symptoms are a breeze, or that the virus can’t cause worse.

“It does not look pleasant,” Sean Roberts, an emergency services specialist at the Tulare County, California, health department wrote in an email to colleagues in May. He described photographs of an infected dairy worker in another state: “Apparently, the conjunctivitis that this is causing is not a mild one, but rather ruptured blood vessels and bleeding conjunctiva.”

Over the past 30 years, half of about 900 people diagnosed with bird flu around the world have died. Even if the case fatality rate is much lower for this strain of the bird flu, Covid showed how devastating a 1% death rate can be when a virus spreads easily.

Like other cases around the world, the person now hospitalized with the bird flu in Louisiana appears to have gotten the virus directly from birds. After the case was announced, the CDC released a statement saying, “A sporadic case of severe H5N1 bird flu illness in a person is not unexpected.”

‘The cows are more valuable than us’

Local health officials were trying hard to track infections, according to hundreds of emails from county health departments in five states. But their efforts were stymied. Even if farmers reported infected herds to the USDA and agriculture agencies told health departments where the infected cows were, health officials had to rely on farm owners for access.

“The agriculture community has dictated the rules of engagement from the start,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That was a big mistake.”

Some farmers told health officials not to visit and declined to monitor their employees for signs of sickness. Sending workers to clinics for testing could leave them shorthanded when cattle needed care. “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too,” said an email from the Weld, Colorado, health department.

“We know of 386 persons exposed – but we know this is far from the total,” said an email from a public health specialist to officials at Tulare’s health department recounting a call with state health officials. “Employers do not want to run this through worker’s compensation. Workers are hesitant to get tested due to cost,” she wrote.

A photograph of a note found in a break room at a dairy farm saying “cows with flu in Pen 56” in Spanish. (Photo taken by livestock veterinarian who asked to remain anonymous because of concerns about reputational damage.)

Jennifer Morse, medical director of the Mid-Michigan District Health Department, said local health officials have been hesitant to apply pressure after the backlash many faced at the peak of Covid. Describing the 19 rural counties she serves as “very minimal-government-minded,” she said, “if you try to work against them, it will not go well.”

Rural health departments are also stretched thin. Organizations that specialize in outreach to farmworkers offered to assist health officials early in the outbreak, but months passed without contracts or funding. During the first years of Covid, lagging government funds for outreach to farmworkers and other historically marginalized groups led to a disproportionate toll of the disease among people of color.

Kevin Griffis, director of communications at the CDC, said the agency worked with the National Center for Farmworker Health throughout the summer “to reach every farmworker impacted by H5N1.” But Bethany Boggess Alcauter, the center’s director of public health programs, said it didn’t receive a CDC grant for bird flu outreach until October, to the tune of $4 million. Before then, she said, the group had very limited funds for the task. “We are certainly not reaching ‘every farmworker,’” she added.

Farmworker advocates also pressed the CDC for money to offset workers’ financial concerns about testing, including paying for medical care, sick leave, and the risk of being fired. This amounted to an offer of $75 each. “Outreach is clearly not a huge priority,” Boggess said. “I hear over and over from workers, ‘The cows are more valuable than us.’”

The USDA has so far put more than $2.1 billion into reimbursing poultry and dairy farmers for losses due to the bird flu and other measures to control the spread on farms. Federal agencies have also put $292 million into developing and stockpiling bird flu vaccines for animals and people. In a controversial decision, the CDC has advised against offering the ones on hand to farmworkers.

“If you want to keep this from becoming a human pandemic, you focus on protecting farmworkers, since that’s the most likely way that this will enter the human population,” said Peg Seminario, an occupational health researcher in Bethesda, Maryland. “The fact that this isn’t happening drives me crazy.”

Nirav Shah, principal deputy director of the CDC, said the agency aims to keep workers safe. “Widespread awareness does take time,” he said. “And that’s the work we’re committed to doing.”

As President-elect Donald Trump comes into office in January, farmworkers may be even less protected. Trump’s pledge of mass deportations will have repercussions whether they happen or not, said Tania Pacheco-Werner, director of the Central Valley Health Policy Institute in California.

Many dairy and poultry workers are living in the United States without authorization or on temporary visas linked to their employers. Such precarity made people less willing to see doctors about Covid symptoms or complain about unsafe working conditions in 2020. Pacheco-Werner said, “Mass deportation is an astronomical challenge for public health.”

Not ‘immaculate conception’: Missouri case a mystery

A switch flipped in September among experts who study pandemics as national security threats. A patient in Missouri had the bird flu, and no one knew why. “Evidence points to this being a one-off case,” Shah said at a briefing with journalists. About a month later, the agency revealed it was not.

Antibody tests found that a person who lived with the patient had been infected, too. The CDC didn’t know how the two had gotten the virus, and the possibility of human transmission couldn’t be ruled out.

Nonetheless, at an October briefing, Shah said the public risk remained low, and the USDA’s Deeble said he was optimistic that the dairy outbreak could be eliminated.

Experts were perturbed by such confident statements in the face of uncertainty, especially as California’s outbreak spiked and a child was mysteriously infected by the same strain of virus found on dairy farms.

“This wasn’t just immaculate conception,” said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “It came from somewhere, and we don’t know where, but that hasn’t triggered any kind of reset in approach — just the same kind of complacency and low energy.”

Sam Scarpino, a disease surveillance specialist in the Boston area, wondered how many other mysterious infections had gone undetected. Surveillance outside farms was even patchier than on them, and bird flu tests have been hard to get.

Although pandemic experts had identified the CDC’s singular hold on testing for new viruses as a key explanation for why America was hit so hard by Covid in 2020, the system remained the same. Bird flu tests could be run only by the CDC and public health labs until this month, even though commercial and academic diagnostic laboratories had inquired about running tests since April. The CDC and FDA should have tried to help them along months ago, said Ali Khan, a former top CDC official who now leads the University of Nebraska Medical Center College of Public Health.

As winter sets in, the bird flu becomes harder to spot because patient symptoms may be mistaken for the seasonal flu. Flu season also raises a risk that the two flu viruses could swap genes if they infect a person simultaneously. That could form a hybrid bird flu that spreads swiftly through coughs and sneezes.

A sluggish response to emerging outbreaks may simply be a new, unfortunate norm for America, said Bollyky, at the Council on Foreign Relations. If so, the nation has gotten lucky that the bird flu still can’t spread easily between people. Controlling the virus will be much harder and costlier than it would have been when the outbreak was small. But it’s possible.

Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. “Not one and done,” he added. If they detect the virus, they’d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd — or at least to other farms. Cows can spread the bird flu before they’re sick, he said, so speed is crucial.

Curtailing the virus on farms is the best way to prevent human infections, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, but human surveillance must be stepped up, too. Every clinic serving communities where farmworkers live should have easy access to bird flu tests — and be encouraged to use them. Funds for farmworker outreach must be boosted. And, she added, the CDC should change its position and offer farmworkers bird flu vaccines to protect them and ward off the chance of a hybrid bird flu that spreads quickly.

The rising number of cases not linked to farms signals a need for more testing in general. When patients are positive on a general flu test — a common diagnostic that indicates human, swine, or bird flu — clinics should probe more deeply, Nuzzo said.

The alternative is a wait-and-see approach in which the nation responds only after enormous damage to lives or businesses. This tack tends to rely on mass vaccination. But an effort analogous to Trump’s Operation Warp Speed is not assured, and neither is rollout like that for the first Covid shots, given a rise in vaccine skepticism among Republican lawmakers.

Change may instead need to start from the bottom up — on dairy farms, still the most common source of human infections, said Poulsen. He noticed a shift in attitudes among farmers at the Dairy Expo: “They’re starting to say, ‘How do I save my dairy for the next generation?’ They recognize how severe this is, and that it’s not just going away.”

Amy Maxmen is Healthbeat’s national reporter through its partnership with KFF Health News.

As California taps pandemic stockpile for bird flu, officials keep close eye on spending

2024-11-14T16:21:57+00:00

California public health officials are dipping into state and federal stockpiles to equip up to 10,000 farmworkers with masks, gloves, goggles, and other safety gear as the state confirms at least 21 human cases of bird flu as of early November. It’s the latest reminder of the state’s struggle to remain prepared amid multibillion-dollar deficits.

Officials said they began distributing more than 2 million pieces of personal protective equipment in late May, four months before the first human case was confirmed in the state. They said they began ramping up coordination with local health officials in April after bird flu was first detected in cattle in the United States.

Bird flu has been confirmed at more than 270 dairies in central California, and traces were recently detected at a wastewater sampling site in Los Angeles County. Bird flu was also recently detected in a flock of commercial turkeys in Sacramento County.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

California is putting a number of lessons from the Covid-19 pandemic to use, such as coordinating emergency response with local health officials and tracking infectious diseases through wastewater surveillance, as the state tries to limit the spread of bird flu to humans. It’s striving to maintain an adequate emergency stockpile to withstand the first wave of any new public health disaster without hemorrhaging the state budget.

“We are far better prepared to respond to a pandemic than we were in 2020,” said Amy Palmer, a spokesperson for the Governor’s Office of Emergency Services.

For instance, before the coronavirus struck in 2020, the state’s emergency supplies stockpile was barely big enough to crowd two basketball courts.

By the time California ramped up its pandemic response, it had enough personal protective equipment and other disaster supplies to fill 52 football fields. California spent $15.6 billion on direct pandemic response during the Covid crisis years, much of it provided by the federal government.

Today, the stockpile fits into about 12½ football fields, though it can seesaw from month to month.

California has 88 million N95 face masks

According to the state, the current stockpile includes 101 million face masks, 26 million more than the 90-day supply recommended by the state’s pandemic preparedness guideline.

That includes 88 million N95 masks, more than the emergency services agency said was needed last year. The high-efficiency masks are considered crucial to protect against airborne viruses such as Covid-19.

Although the state is building up its stockpile, Palmer could not say if the additional masks are related to fears of bird flu, only that planners are always working “to keep pace with the current risk environment.”

The state’s goal, Palmer said, is to have “an initial supply during emergencies to allow us the time to secure resources,” whether through the federal government or by buying more.

There is no indication of spread between humans in the recent California bird flu cases, and health officials say public risk remains low. Human transmission of bird flu is among several worst-case scenarios for a new pandemic, alongside the possibility of a resurgent mutant coronavirus; wider international spread of mpox, Marburg virus, or Ebola; or an entirely new virus for which there initially is no immunity or vaccine.

Yet, health officials nationwide have struggled to track bird flu transmission. And California has a history of swinging back and forth on preparedness.

Republican Gov. Arnold Schwarzenegger ordered an increase in California’s pandemic preparedness in 2006 in response to an earlier threat from bird flu. That included three mobile hospitals that could immediately be deployed during disasters.

Gov. Jerry Brown, a Democrat, ended the program in 2011 as state finances went bust. By the time Covid struck, the state released 21 million N95 masks, some so old they were past their expiration date.

Hospitals required to have 3-month PPE supply

Now hospitals are required to maintain their own three-month supply of masks, gowns, and other personal protective equipment under a state law passed in 2020. California’s aerosol transmissible disease standard also uniquely requires hospitals and other high-risk workplaces to follow precautions such as using negative pressure isolation rooms and the highest level of protective equipment until more is known about a new pathogen.

“It is difficult to overstate the level of unpreparedness exhibited by hospitals both in and outside of California in dealing with the 2020 outbreak of Covid-19,” according to a legislative analysis. “Harrowing images of nurses walking the corridors of hospitals in makeshift masks and garbage bags became commonplace.”

California Hospital Association spokesperson Jan Emerson-Shea said hospitals “continuously prepare to respond to all types of disasters, including outbreaks of transmissible viruses.”

In addition, Palmer said California has five mobile hospitals acquired from the federal government, though they got little use during the pandemic. She said they have to be maintained, such as making sure pulse oximeters have working batteries.

But, once again, the current deficit has the state trying to strike a balance.

While lawmakers rejected most of Democratic Gov. Gavin Newsom’s $300 million proposed cut to public health funding, the state slashed funding for its stockpile of personal protective equipment by one-third a year ago after it determined that no additional Covid-related purchases were necessary, according to the Department of Finance. California eliminated funding this year for eight 53-foot-long trailers that would have moved stockpiled items between warehouses. It’s also cutting nearly $40 million over the next four years from its $175 million disaster stockpile budget.

The state’s preparedness wasn’t good enough for Californians Against Pandemics, which gathered more than 1 million signatures to put a ballot measure before voters in November. The measure would have increased taxes on people with incomes over $5 million and used that money for pandemic prevention and response.

But that effort collapsed after one of its key financial supporters, former cryptocurrency executive Sam Bankman-Fried, was convicted of defrauding customers and investors. In exchange for initiative backers dropping the measure, state officials agreed to broaden the scope of the California Initiative to Advance Precision Medicine, which was created in 2015 to focus on developing new medicines and therapies, to include technologies for preventing another pandemic.

“By harnessing the power of precision medicine, California is moving to the forefront of pandemic preparedness and prevention,” Newsom said at the time.

Rodger Butler, a spokesperson for the state Health and Human Services Agency, said it’s unclear if the precision medicine initiative will receive additional funding.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is Healthbeat’s national reporting partner.

Bird flu: Emails reveal how health departments struggle to track human cases

2024-10-25T13:20:01+00:00

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Bird flu cases have more than doubled in the country within a few weeks, but researchers can’t determine why the spike is happening because surveillance for human infections has been patchy for seven months.

Just this week, California reported its 15th infection in dairy workers and Washington state reported seven probable cases in poultry workers.

Hundreds of emails from state and local health departments, obtained in records requests from KFF Health News, help reveal why. Despite health officials’ arduous efforts to track human infections, surveillance is marred by delays, inconsistencies, and blind spots.

Several documents reflect a breakdown in communication with a subset of farm owners who don’t want themselves or their employees monitored for signs of bird flu.

For instance, a terse July 29 email from the Weld County Department of Public Health and Environment in Colorado said, “Currently attempting to monitor 26 dairies. 9 have refused.”

The email tallied the people on farms in the state who were supposed to be monitored: “1250+ known workers plus an unknown amount exposed from dairies with whom we have not had contact or refused to provide information.”

Other emails hint that cases on dairy farms were missed. And an exchange between health officials in Michigan suggested that people connected to dairy farms had spread the bird flu virus to pet cats. But there hadn’t been enough testing to really know.

Researchers worldwide are increasingly concerned.

“I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, formerly the assistant secretary for preparedness and response in the Obama administration.

Bird flu viruses have long been on the short list of pathogens with pandemic potential. Although they have been around for nearly three decades in birds, the unprecedented spread among U.S. dairy cattle this year is alarming: The viruses have evolved to thrive within mammals. Maria Van Kerkhove, head of the emerging diseases unit at the World Health Organization, said, “We need to see more systemic, strategic testing of humans.”

Dairies refusing visits from health departments

A key reason for spotty surveillance is that public health decisions largely lie with farm owners who have reported outbreaks among their cattle or poultry, according to emails, slide decks, and videos obtained by KFF Health News, and interviews with health officials in five states with outbreaks.

In a video of a small meeting at Central District Health in Boise, Idaho, an official warned colleagues that some dairies don’t want their names or locations disclosed to health departments. “Our involvement becomes very sketchy in such places,” she said.

“I just finished speaking to the owner of the dairy farm,” wrote a public health nurse at the Mid-Michigan district health department in a May 10 email. “[REDACTED] feels that this may have started [REDACTED] weeks ago, that was the first time that they noticed a decrease in milk production,” she wrote. “[REDACTED] does not feel that they need MSU Extension to come out,” she added, referring to outreach to farmworkers provided by Michigan State University.

“We have had multiple dairies refuse a site visit,” wrote the communicable disease program manager in Weld, Colorado, in a July 2 email.

Many farmers cooperated with health officials, but delays between their visits and when outbreaks started meant cases might have been missed. “There were 4 people who discussed having symptoms,” a Weld health official wrote in another email describing her visit to a farm with a bird flu outbreak, “but unfortunately all of them had either already passed the testing window, or did not want to be tested.”

Jason Chessher, who leads Weld’s public health department, said farmers often tell them not to visit because of time constraints.

Dairy operations require labor throughout the day, especially when cows are sick. Pausing work so employees can learn about the bird flu virus or go get tested could cut milk production and potentially harm animals needing attention. And if a bird flu test is positive, the farm owner loses labor for additional days and a worker might not get paid. Such realities complicate public health efforts, several health officials said.

An email from Weld’s health department, about a dairy owner in Colorado, reflected this idea: “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too.” Pink eye, or conjunctivitis, is a symptom of various infections, including the bird flu.

Chessher and other health officials told KFF Health News that instead of visiting farms, they often ask owners or supervisors to let them know if anyone on-site is ill. Or they may ask farm owners for a list of employee phone numbers to prompt workers to text the health department about any symptoms.

Jennifer Morse, medical director at the Mid-Michigan District Health Department, conceded that relying on owners raises the risk cases will be missed, but that being too pushy could reignite a backlash against public health. Some of the fiercest resistance against Covid-19 measures, such as masking and vaccines, were in rural areas.

“It’s better to understand where they’re coming from and figure out the best way to work with them,” she said. “Because if you try to work against them, it will not go well.”

Domestic cat cases could offer clues

And then there were the pet cats. Unlike dozens of feral cats found dead on farms with outbreaks, these domestic cats didn’t roam around herds, lapping up milk that teemed with virus.

In emails, Mid-Michigan health officials hypothesized that the cats acquired the virus from droplets, known as fomites, on their owners’ hands or clothing. “If we only could have gotten testing on the [REDACTED] household members, their clothing if possible, and their workplaces, we may have been able to prove human->fomite->cat transmission,” said a July 22 email.

Her colleague suggested they publish a report on the cat cases “to inform others about the potential for indirect transmission to companion animals.”

Thijs Kuiken, a bird flu researcher in the Netherlands, at the Erasmus Medical Center in Rotterdam, said person-to-cat infections wouldn’t be surprising since felines are so susceptible to the virus. Fomites may have been the cause or, he suggested, an infected — but untested — owner might have passed it on.

Hints of missed cases add to mounting evidence of undetected bird flu infections. Health officials said they’re aware of the problem but that it’s not due only to farm owners’ objections.

Local health departments are chronically understaffed. For every 6,000 people in rural areas, there’s one public health nurse — who often works part-time, one analysis found.

“State and local public health departments are decimated resource-wise,” said Lurie, who is now an executive director at an international organization, the Coalition for Epidemic Preparedness Innovations. “You can’t expect them to do the job if you only resource them once there’s a crisis.”

Another explanation is a lack of urgency because the virus hasn’t severely harmed anyone in the country this year. “If hundreds of workers had died, we’d be more forceful about monitoring workers,” Chessher said. “But a handful of mild symptoms don’t warrant a heavy-handed response.”

All the bird flu cases among U.S. farmworkers have presented with conjunctivitis, a cough, a fever, and other flu-like symptoms that resolved without hospitalization. Yet infectious disease researchers note that numbers remain too low for conclusions — especially given the virus’s grim history.

About half of the 912 people diagnosed with the bird flu over three decades died. Viruses change over time, and many cases have probably gone undetected. But even if the true number of cases — the denominator — is five times as high, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, a mortality rate of 10% would be devastating if the bird flu virus evolved to spread swiftly between people. The case fatality rate for Covid was around 1%.

By missing cases, the public health system may be slow to notice if the virus becomes more contagious. Already, delays resulted in missing a potential instance of human-to-human transmission in early September. After a hospitalized patient tested positive for the bird flu virus in Missouri, public health officials learned that a person in the patient’s house had been sick — and recovered. It was too late to test for the virus, but on Thursday, the CDC announced that an analysis of the person’s blood found antibodies against the bird flu, signs of a prior infection.

CDC Principal Deputy Director Nirav Shah suggested the two people in Missouri had been separately infected, rather than passing the virus from one to the other. But without testing, it’s impossible to know for certain.

The possibility of a more contagious variant grows as flu season sets in. If someone contracts bird flu and seasonal flu at the same time, the two viruses could swap genes to form a hybrid that can spread swiftly. “We need to take steps today to prevent the worst-case scenario,” Nuzzo said.

The CDC can monitor farmworkers directly only at the request of state health officials. The agency is, however, tasked with providing a picture of what’s happening nationwide.

As of Thursday, the CDC’s dashboard states that more than 5,100 people have been monitored nationally after exposure to sick animals; more than 260 tested; and 30 bird flu cases detected. (The dashboard hasn’t yet been updated to include the most recent cases and five of Washington’s reports pending CDC confirmation.)

Van Kerkhove and other pandemic experts said they were disturbed by the amount of detail the agency’s updates lack. Its dashboard doesn’t separate numbers by state, or break down how many people were monitored through visits with health officials, daily updates via text, or from a single call with a busy farm owner distracted as cows fall sick. It doesn’t say how many workers in each state were tested or the number of workers on farms that refused contact.

“They don’t provide enough information and enough transparency about where these numbers are coming from,” said Samuel Scarpino, an epidemiologist who specializes in disease surveillance. The number of detected bird flu cases doesn’t mean much without knowing the fraction it represents — the rate at which workers are being infected.

This is what renders California’s increase mysterious. Without a baseline, the state’s rapid uptick could signal it’s testing more aggressively than elsewhere. Alternatively, its upsurge might indicate that the virus has become more infectious — a very concerning, albeit less likely, development.

The CDC declined to comment on concerns about monitoring. On Oct. 4, Shah briefed journalists on California’s outbreak. The state identified cases because it was actively tracking farmworkers, he said. “This is public health in action,” he added.

Salvador Sandoval, a doctor and county health officer in Merced, California, did not exude such confidence. “Monitoring isn’t being done on a consistent basis,” he said, as cases mounted in the region. “It’s a really worrisome situation.”

Amy Maxmen is Healthbeat’s national reporter through a partnership with KFF Health News. KFF regional editor Nathan Payne contributed to this report.

Amid bird flu, farmworkers tending sick cows with only gloves to protect them

2024-08-27T09:00:00+00:00

In early August, farmworkers gathered under a pavilion at a park here for a picnic to celebrate Farmworker Appreciation Day. One sign that this year was different from the others was the menu: Beef fajitas, tortillas, pico de gallo, chips, beans — but no chicken.

Farms in Colorado had culled millions of chickens in recent months to stem the transmission of bird flu. Organizers filled out the spread with hot dogs.

No matter the menu, some dairy workers at the event said they don’t exactly feel appreciated. They said they haven’t received any personal protective equipment beyond gloves to guard against the virus, even as they or colleagues have come down with conjunctivitis and flu-like symptoms that they fear to be bird flu.

“They should give us something more,” one dairy worker from Larimer County said in Spanish. He spoke on the condition of anonymity out of fear he’d lose his job for speaking out. “What if something happens to us? They act as if nothing is wrong.”

Agricultural health and safety experts have been trying to get the word out about how to protect against bird flu, including through bilingual videos on TikTok showing the proper way to gear up with respirators, eye protection, gloves, and coveralls. And Colorado’s health and agriculture departments have offered a free month’s supply of protective equipment to any producer who requests it.

But so far, many farms aren’t taking them up on it: According to numbers provided by the state health department in late August, fewer than 13% of the state’s dairies had requested and received such PPE.

The virus is known to infect mammals — from skunks, bears, and cows to people and house pets. It began showing up in dairy cattle in recent months, and Colorado has been in the thick of it. Ten of the 13 confirmed human cases in the United States this year have occurred in Colorado, where it continues to circulate among dairy cows. It isn’t a risk in cooked meat or pasteurized milk but is risky for those who come into contact with infected animals or raw milk.

Weld County, where the farmworker event was held, is one of the nation’s top milk producers, supplying enough milk each month this year to fill about 45 Olympic-size swimming pools, according to U.S. Department of Agriculture data. Neighboring counties are notable producers, too.

Concerns are growing about undiagnosed illness among farmworkers because of a lack of testing and safety precautions. One reason for concern: Bird flu and seasonal flu are capable of gene trading, so if they ended up in the same body at the same time, bird flu might end up with genes that boost its contagiousness. The virus doesn’t appear to be spreading easily between people yet. That could change, and if people aren’t being tested, then health officials may be slow to notice.

Strains of seasonal flu already kill some 47,000 people in the United States a year. Public health officials fear the havoc a new form of the flu could wreak if it spreads among people.

Some farmworkers face grueling conditions

The Centers for Disease Control and Prevention recommends that dairy workers don a respirator and goggles or a face shield, among other protections, whether they are working with sick animals or not.

A recent study found that not all infected cows show symptoms, so workers could be interacting with contagious animals without realizing it. Even when it is known that animals are infected, farmworkers often still have to get in close contact with them, sometimes under grueling conditions, such as during a recent heat wave when Colorado poultry workers collected hundreds of chickens by hand for culling because of the outbreak. At least six of the workers became infected with bird flu.

One dairy worker in Weld County, who spoke on the condition of anonymity for fear of losing his job, said his employer has not offered any protective equipment beyond gloves, even though he works with sick cows and raw milk.

His bosses asked the workers to separate sick cows from the others after some cows produced less milk, lost weight, and showed signs of weakness, he said. But the employer didn’t say anything about the bird flu, he said, or suggest they take any precautions for their own safety.

He said he bought protective goggles for himself at Walmart when his eyes became itchy and red earlier this summer. He recalled experiencing dizziness, headaches, and low appetite around the same time. But he self-medicated and pushed through, without missing work or going to a doctor.

“We need to protect ourselves because you never know,” he said in Spanish. “I tell my wife and son that the cows are sick, and she tells me to leave, but it will be the same wherever I go.”

He said he’d heard that his employers were unsympathetic when a colleague approached them about feeling ill. He’d even seen someone affiliated with management remove a flyer about how people can protect themselves from the bird flu and throw it in a bin.

The dairy worker in neighboring Larimer County said he, too, has had just gloves as protection, even when he has worked with sick animals — close enough for saliva to wipe off on him. He started working with them when a colleague missed work because of his flu-like symptoms: fever, headache, and red eyes.

“I only wear latex gloves,” he said. “And I see that those who work with the cows that are sick also only wear gloves.”

He said he doesn’t have time to wash his hands at work but puts on hand sanitizer before going home and takes a shower once he arrives. He has not had symptoms of infection.

Such accounts from dairy workers echo those from farmworkers in Texas, as reported by KFF Health News in July.

“Employers who are being proactive and providing PPE seem to be in the minority in most states,” said Bethany Boggess Alcauter with the National Center for Farmworker Health, a not-for-profit organization based in Texas that advocates for improving the health of farmworkers and their families. “Farmworkers are getting very little information.”

But Zach Riley, CEO of the Colorado Livestock Association, said he thinks such scenarios are the exception, not the rule.

“You would be hard-pressed to find a dairy operation that isn’t providing that PPE,” he said. Riley said dairies typically have a stockpile of PPE ready to go for situations like this and that, if they don’t, it’s easily accessed through the state. “All you have to do is ask.”

Producers are highly motivated to keep infections down, he said, because “milk is their life source.” He said he has heard from some producers that “their family members who work on the farm are doing 18-to 20-hour days just to try to stay ahead of it, so that they’re the first line between everything, to protect their employees.”

Safety messages aren’t reaching workers

Colorado’s health department is advertising a hotline that ill dairy workers can call for help getting a flu test and medicine.

Project Protect Food Systems Workers, an organization that emerged early in the Covid-19 pandemic to promote farmworker health across Colorado, is distributing PPE it received from the state so promotoras — health workers who are part of the community they serve — can distribute masks and other protections directly to workers if employers aren’t giving them out.

Promotora Tomasa Rodriguez said workers “see it as another virus, another Covid, but it is because they don’t have enough information.”

She has been passing out flyers about symptoms and protective measures, but she can’t access many dairies. “And in some instances,” she said, “a lot of these workers don’t know how to read, so the flyers are not reaching them, and then the employers are not doing any kind of talks or trainings.”

The CDC’s Nirav Shah said during an Aug. 13 call with journalists that awareness about bird flu among dairy workers isn’t as high as officials would like it to be, despite months of campaigns on social media and the radio.

“There’s a road ahead of us that we still need to go down to get awareness on par with, say, what it might be in the poultry world,” he said. “We’re using every single messenger that we can.”

KFF Health News correspondents Vanessa G. Sánchez and Amy Maxmen, Healthbeat’s national reporting partner, contributed to this report.

Bird flu cases are going undetected, new study suggests

Farmworkers face high-risk exposures to bird flu, but testing isn't reaching them

Bird flu cases are going undetected, new study suggests. It’s a problem for all of us.

2024-08-01T15:49:13+00:00

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A new study lends weight to fears that more livestock workers have gotten the bird flu than has been reported.

“I am very confident there are more people being infected than we know about,” said Gregory Gray, the infectious disease researcher at the University of Texas Medical Branch who led the study, posted online Wednesday and under review to be published in a leading infectious disease journal. “Largely, that’s because our surveillance has been so poor.”

As bird flu cases go underreported, health officials risk being slow to notice if the virus were to become more contagious. A large surge of infections outside of farmworker communities would trigger the government’s flu surveillance system, but by then it might be too late to contain.

“We need to figure out what we can do to stop this thing,” Gray said. “It is not just going away.”

The Centers for Disease Control and Prevention bases decisions on its surveillance. For example, the agency has bird flu vaccines on hand but has decided against offering them to farmworkers, citing a low number of cases.

But testing for bird flu among farmworkers remains rare, which is why Gray’s research stands out as the first to look for signs of prior, undiagnosed infections in people who had been exposed to sick dairy cattle — and who had become ill and recovered.

Gray’s team detected signs of prior bird flu infections in workers from two dairy farms that had outbreaks in Texas earlier this year. They analyzed blood samples from 14 farmworkers who had not been tested for the virus and found antibodies against it in two. This is a nearly 15% hit rate from only two dairy farms out of more than 170 with bird flu outbreaks in 13 states this year.

One of the workers with antibodies had been taking medicine for a lingering cough when he agreed to allow researchers to analyze his blood in April. The other had recently recovered from a respiratory illness. She didn’t know what had caused it but told researchers that untested farmworkers around her had been sick too.

Richard Webby, director of the World Health Organization Collaborating Center for Influenza at St. Jude Children’s Research Hospital in Memphis, Tennessee, said the results confirmed his suspicions that the 13 human bird flu cases reported this year by the CDC were an undercount.

“Maybe what we see isn’t exactly the tip of the iceberg, but it’s certainly not the whole story,” Webby said.

There’s little testing of farmworkers

Although small, the study gives fresh urgency to reports of undiagnosed ailments among farmworkers and veterinarians. The CDC has warned that if people are infected by the seasonal flu and the bird flu simultaneously, the two types of viruses could swap genes in a way that allows the bird flu to spread between people as easily as seasonal varieties.

No evidence suggests that’s happening now. And asymptomatic cases of the bird flu appear to be rare, according to a Michigan antibody study described by the CDC on July 19. Researchers analyzed blood samples from 35 workers from dairy farms that had outbreaks in Michigan, and none showed signs of missed infections. Unlike the study in Texas, these workers hadn’t fallen sick.

“It’s a small study, but a first step,” said Natasha Bagdasarian, Michigan’s chief medical executive. She said that the state was boosting outreach to test farmworkers but its efforts were complicated by systemic issues like precarious employment that renders them vulnerable to getting fired for calling out sick.

Without more assistance for farmworkers, and cooperation between the government and the livestock industry, Gray said, the U.S. risks remaining in the dark about this virus.

“There’s a lot of genomic studies and laboratory work, but farms are where the real action is,” Gray said, “and we’re not watching.”

Communication breaks down

A dairy worker in Colorado told KFF Health News that he sought medical care about a month ago for eye irritation — a common symptom of the bird flu. The doctor conducted a usual checkup, complete with a urine analysis. But the farmworker hadn’t heard of the bird flu, and the clinician didn’t mention it or test for the virus. “They told me I had nothing,” he said in Spanish, speaking on the condition of anonymity because he feared retaliation from employers.

This dairy worker and two in Texas said their employers have not provided goggles, N95 masks, or aprons to protect them from milk and other fluids that could be contaminated with the virus. Buying their own gear is a tall order because money is tight.

As is going to the doctor. One worker in Texas said he didn’t seek care for piercing headaches and a sore throat because he doesn’t have health insurance and can’t afford the cost. He guessed the symptoms were from laboring long hours in sweltering barns with limited water. “They don’t give you water or anything,” he said. “You bring your own bottles.” But there’s no way to know the cause of symptoms — whether bird flu or something else — without testing.

About a fifth of workers on livestock farms are uninsured, according to a KFF analysis, and a similar share have household incomes of less than $40,000 a year.

The three farmworkers hadn’t heard of the bird flu from their employers or state health officials, never mind offers of tests. The CDC boasted in a recent update that, through its partnership with Meta, the company that owns Facebook and Instagram, bird flu posts have flickered across computer and smartphone screens more than 10 million times.

Such outreach is lost on farmworkers who aren’t scrolling, don’t speak English or Spanish, or are without smartphones and internet access, said Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health. She and others said that offers of protective gear from health officials weren’t reaching farms.

“We’ve heard that employers have been reticent to take them up on the offer,” said Christine Sauvé, policy and engagement manager at the Michigan Immigrant Rights Center. “If this starts to transmit more easily person to person, we’re in trouble,” she said, “because farmworker housing units are so crowded and have poor ventilation.”

Clinics might alert health officials if sick farmworkers seek medical care. But many farmworkers don’t because they lack health insurance and could be fired for missing work.

“The biggest fear we hear about is retaliation from employers, or that someone might be blacklisted from other jobs,” Sauvé said.

Flu surveillance hasn’t triggered alert

The CDC assesses the current bird flu situation as a low public health risk because the country’s flu surveillance system hasn’t flagged troubling alerts.

The system scans for abnormal increases in hospital visits. Nothing odd has turned up there. It also analyzes a subset of patient samples for unusual types of flu viruses. Since late February, the agency has assessed about 36,000 samples. No bird flu.

However, Samuel Scarpino, an epidemiologist who specializes in disease surveillance, said this system would miss many emerging health threats because, by definition, they start with a relatively small number of infections. Roughly 200,000 people work on farms with livestock in the United States, according to the CDC. That’s a mere 0.1% of the country’s population.

Scarpino said the CDC’s surveillance would be triggered if people started dying from the bird flu. The 13 known cases have been mild. And the system will probably pick up surges if the virus spreads beyond farmworkers and their closest contacts — but by then it may be too late to contain.

“We don’t want to find ourselves in another Covid situation,” Scarpino said, recalling how schools, restaurants, and businesses needed to close because the coronavirus was too widespread to control through testing and targeted, individual isolation. “By the time we were catching cases,” he said, “there were so many that we were only left with bad options.”

Troubling signs emerging

Researchers warn that the H5N1 bird flu virus has evolved to be more infectious to mammals, including humans, in the past couple of years. This drives home the need to keep an eye on what’s happening as the outbreak spreads to dairy farms across the country.

The bird flu virus appears be spreading mainly through milk and milking equipment. But for the first time, researchers reported in May and July that it spread inefficiently through the air between a few laboratory ferrets kept inches apart. And in cattle experiments, some cows were infected by breathing in virus-laden microscopic droplets — the sort of thing that could happen if an infected cow was coughing in close proximity to another.

Cows do, in fact, cough. The new study from Texas notes that cattle coughed during outbreaks on the farms and showed other signs of respiratory illness.

Other observations were ominous: About half of some 40 cats on one farm died suddenly at the peak of its outbreak, probably from lapping up raw milk suffused with bird flu virus.

Most people diagnosed with the bird flu have been infected from animals. In his new study, Gray saw a hint that the virus may occasionally spread from person to person, but he added that this remains conjecture. One of the two people who had antibodies worked in the farm’s cafeteria adjacent to the milking parlor — alongside farmworkers but not cattle.

“We need to find ways to have better surveillance,” he said, “so we can make informed decisions rather than decisions based on guesswork.”

Farmworkers face high-risk exposures to bird flu, but testing isn’t reaching them

2024-07-30T17:59:30+00:00

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Farmworkers face some of the most intense exposures to the bird flu virus, but advocates say many of them would lack resources to fall back on if they became ill.

As of May 30, only three people in the United States had tested positive after being exposed to a wave of bird flu spreading among cows. Those people, dairy farm workers in Texas and Michigan, experienced eye irritation. One of them also had a cough and sore throat.

Scientists warn the virus could mutate to spread from person to person like the seasonal flu, which could spark a pandemic. By keeping tabs on farmworkers, researchers could track infections, learn how dangerous they are, and be alerted if the virus becomes more infectious.

But people generally get tested when they seek treatment for illnesses. Farmworkers rarely do that, because many lack health insurance and paid sick leave, said Elizabeth Strater, director of strategic campaigns for the national group United Farm Workers. They are unlikely to go to a doctor unless they become very ill.

Strater said about 150,000 people work in U.S. dairies. She said many worker advocates believe the virus has spread to more people than tests are showing. “The method being used to surveil at-risk workers has been very passive,” she said.

Federal officials told reporters May 22 that just 40 people connected to U.S. dairy farms had been tested for the virus, although others are being “actively monitored” for symptoms.

Federal authorities recently announced they would pay farmworkers $75 each to be tested for the virus, as part of a new program that also offers incentives for farm owners to allow testing of their dairy herds.

Officials of the federal Centers for Disease Control and Prevention said they recognize the importance of gaining cooperation and trust from front-line dairy employees.

CDC spokesperson Rosa Norman said in an email that the incentive payment compensates workers for their time contributing to the monitoring of how many people are infected, how sick they become, and whether humans are spreading the virus to each other.

She noted the CDC believes the virus currently poses a low risk to public health.

Farmworkers can’t afford to miss work

But Strater is skeptical of the incentive for farmworkers to be checked for the virus. If a worker tests positive, they’d likely be instructed to go to a clinic then stay home from work. She said they couldn’t afford to do either.

“That starts to sound like a really bad deal for 75 bucks, because at the end of the week, they’re supposed to feed their families,” she said.

Katherine Wells, director of public health in Lubbock, Texas, said that in her state, health officials would provide short-term medical care, such as giving farmworkers the flu treatment Tamiflu. Those arrangements wouldn’t necessarily cover hospitalization if it were needed, she said.

She said the workers’ bigger concern appears to be that they would have to stay home from work or might even lose their jobs if they tested positive.

Many farmworkers are from other countries, and they often labor in grueling conditions for little pay.

They may fear attention to cases among them will inflame anti-immigrant fervor, said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Societies have a long history of blaming marginalized communities for the spread of contagious diseases. Latino immigrants were verbally attacked during the H1N1 “swine flu” pandemic in 2009, for example, and some media personalities used the outbreak to push for a crackdown on immigration.

Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health, said many workers on dairy farms have been told very little about this new disease spreading in the cows they handle. “Education needs to be a part of testing efforts, with time for workers to ask questions,” she said.

These conversations should be conducted in the farmworkers’ language, with people they are likely to trust, she said.

Georges Benjamin, executive director of the American Public Health Association, said public health officials must make clear that workers’ immigration status will not be reported as part of the investigation into the new flu virus. “We’re not going to be the police,” he said.

Vaccines are being prepared

Dawn O’Connell, an administrator at the Department of Health and Human Services, said in a press conference May 22 that nearly 5 million doses of a vaccine against H5N1, the bird flu virus circulating in cattle, are being prepared, but that officials have not decided whether the shots will be offered to farmworkers when they’re ready later this year.

The CDC asked states in early May to share personal protective equipment with farm owners, to help them shield workers from the bird flu virus. State health departments in California, Texas, and Wisconsin, which have large dairy industries, all said they have offered to distribute such equipment.

Chris Van Deusen, a Texas health department spokesperson, said four dairy farms had requested protective equipment from the state stockpile. He said other farms may already have had what they needed. Spokespeople for the California and Wisconsin health departments said they did not immediately receive requests from farm owners for the extra equipment.

Strater, the United Farm Workers official, said protective equipment offerings need to be practical.

Most dairy workers already wear waterproof aprons, boots, and gloves, she said. It wouldn’t be realistic to expect them to also wear N95 face masks in the wet, hot conditions of a milking operation, she said. Plastic face shields seem like a better option for that environment, especially to prevent milk from spraying into workers’ eyes, where it could cause infection, she said.

Other types of agricultural workers, including those who work with chickens, also face potential infection. But scientists say the version of the virus spreading in cows could be particularly dangerous, because it has adapted to live in mammals.

Strater said she’s most worried about dairy workers, who spend 10 to 12 hours a day in enclosed spaces with cows.

“Their faces are approximately 5 inches away from the milk and the udders all day long,” she said. “The intimacy of it, where their face is so very close to the infectious material, is different.”

This story originally published May 30, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Finland is offering farmworkers bird flu shots. Some experts say the U.S. should too.

2024-07-30T15:03:40+00:00

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As bird flu spreads among dairy cattle in the U.S., veterinarians and researchers have taken note of Finland’s move to vaccinate farmworkers at risk of infection. They wonder why their government doesn’t do the same.

“Farmworkers, veterinarians, and producers are handling large volumes of milk that can contain high levels of bird flu virus,” said Kay Russo, a livestock and poultry veterinarian in Fort Collins, Colorado. “If a vaccine seems to provide some immunity, I think it should be offered to them.”

Among a dozen virology and outbreak experts interviewed by KFF Health News, most agree with Russo. They said people who work with dairy cows should be offered vaccination for a disease that has killed roughly half of the people known to have gotten it globally over the past two decades, has killed cats in the U.S. this year, and has pandemic potential.

However, some researchers sided with the Centers for Disease Control and Prevention in recommending against vaccination for now. There’s no evidence that this year’s bird flu virus spreads between people or causes serious disease in humans. And it’s unclear how well the available vaccine would prevent either scenario.

But the wait-and-see approach “is a gamble,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University. “By the time we see severe outcomes, it means a lot of people have been infected.”

“Now is the time to offer the vaccines to farmworkers in the United States,” said Nahid Bhadelia, director of the Boston University Center on Emerging Infectious Diseases. Even more urgent measures are lagging in the U.S., she added. Testing of farmworkers and cows is sorely needed to detect the H5N1 bird flu virus, study it, and extinguish it before it becomes a fixture on farms — posing an ever-present pandemic threat.

U.S. stockpiling vaccines

Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, said the agency takes bird flu seriously, and the U.S. is stockpiling 4.8 million doses of the vaccine. But, he said, “there’s no recommendation to launch a vaccine campaign.”

“It’s all about risk-benefit ratios,” Daskalakis said. The benefits are blurry because there hasn’t been enough testing to understand how easily the virus jumps from cows into people, and how sick they become. Just four people in the United States have tested positive this year, with mild cases — too few to draw conclusions.

Other farmworkers and veterinarians working on dairy farms with outbreaks have reported being sick, Russo said, but they haven’t been tested. Public health labs have tested only about 50 people for the bird flu since the outbreak was detected in March.

Still, Daskalakis said the CDC is not concerned that the agency is missing worrisome bird flu infections because of its influenza surveillance system. Hospitals report patients with severe cases of flu, and numbers are normal this year.

Another signal that puts the agency at ease is that the virus doesn’t yet have mutations that allow it to spread rapidly between people as they sneeze and breathe. “If we start to see changes in the virus, that’s another factor that would be part of the decision to move from a planning phase into an operational one,” Daskalakis said.

On July 8, researchers reported that the virus may be closer to spreading between people than previously thought. It still doesn’t appear to do so, but experiments suggest it has the ability to infect human airways. It also spread between two laboratory ferrets through the air.

In considering vaccines, the agency takes a cue from a 1976 outbreak of the swine flu. Officials initially feared a repeat of the 1918 swine flu pandemic that killed roughly half a million people in the United States. So they rapidly vaccinated nearly 43 million people in the country within a year.

But swine flu cases turned out to be mild that year. This made the vaccine seem unnecessarily risky as several reports of a potentially deadly disorder, Guillain-Barré Syndrome, emerged. Roughly one of every million people who get influenza vaccines may acquire the disorder, according to the CDC. That risk is outweighed by the benefits of prevention. Since Oct. 1, as many as 830,000 people have been hospitalized for the seasonal flu and 25,000 to 75,000 people have died.

An after-action report on the 1976 swine flu situation called it a “sobering, cautionary tale” about responding prematurely to an uncertain public health threat. “It’s a story about what happens when you launch a vaccine program where you are accepting risk without any benefit,” Daskalakis said.

Paul Offit, a virologist at the Children’s Hospital of Philadelphia, sides with the CDC. “I’d wait for more data,” he said.

However, other researchers say this isn’t comparable to 1976 because they aren’t suggesting that the U.S. vaccinate tens of millions of people. Rather they’re talking about a voluntary vaccine for thousands of people in close contact with livestock. This lessens the chance of rare adverse effects.

FDA hasn’t approved new version

The bird flu vaccine on hand, made by the flu vaccine company CSL Seqirus, was authorized last year by the European equivalent of the FDA. An older variety has FDA approval, but the newer variety hasn’t gotten the green light yet.

Although the vaccine targets a different bird flu strain than the H5N1 virus now circulating in cows, studies show it triggers an immune response against both varieties. It’s considered safe because it uses the same egg-based vaccine technology deployed every year in seasonal flu vaccines.

For these reasons, the United States, the United Kingdom, the Netherlands, and about a dozen other countries are stockpiling millions of doses. Finland expects to offer them to people who work on fur farms this month as a precaution because its mink and fox farms were hit by the bird flu last year.

In contrast, mRNA vaccines being developed against the bird flu would be a first for influenza. On July 2, the U.S. government announced that it would pay Moderna $176 million for their development, and that the vaccines may enter clinical trials next year. Used widely against COVID-19, this newer technology uses mRNA to teach the immune system how to recognize particular viruses.

In the meantime, Florian Krammer, a flu virologist at Mount Sinai’s Icahn School of Medicine, said people who work on dairy farms should have the option to get the egg-based vaccine. It elicits an immune response against a primary component of the H5N1 bird flu virus that should confer a degree of protection against infection and serious sickness, he said.

Still, its protection wouldn’t be 100%. And no one knows how many cases and hospitalizations it would prevent since it hasn’t been used to combat this year’s virus. Such data should be collected in studies that track the outcomes of people who opt to get one, he said.

Krammer isn’t assuaged by the lack of severe bird flu cases spotted in clinics. “If you see a signal in hospitals, the cat is out of the bag. Game over, we have a pandemic,” he said. “That’s what we want to avoid.”

Action urged before flu season

He and others stressed that the United States should be doing everything it can to curb infections before flu season starts in October. The vaccine could provide an additional layer of protection on top of testing, wearing gloves, and goggles, and disinfecting milking equipment. Scientists worry that if people get the bird flu and the seasonal flu simultaneously, bird flu viruses could snag adaptations from seasonal viruses that allow them to spread swiftly among humans.

They also note it could take months to distribute the vaccines after they’re recommended since it requires outreach. People who work beside dairy cows still lack information on the virus, four months into this outbreak, said Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health.

Health officials have talked with dairy farm owners, but Boggess’ interviews with farmworkers suggest those conversations haven’t trickled down to their staff. One farmworker in the Texas Panhandle told her he was directed to disinfect his hands and boots to protect cows from diseases that workers may carry. “They never told us if the cow could infect us with some illness,” the farmworker said in Spanish.

The slow pace of educational outreach is a reminder that everything takes time, including vaccine decisions. When deciding whether to recommend vaccines, the CDC typically seeks guidance from its Advisory Committee on Immunization Practices, or the ACIP. A consultant to the group, infectious disease researcher William Schaffner, has repeatedly asked the agency to present its thinking on Seqirus’ bird flu vaccine.

Rather than fret about the 1976 swine flu situation, Schaffner suggested the CDC consider the 2009-10 swine flu pandemic. It caused more than 274,000 hospitalizations and 12,000 deaths in the U.S. within a year. By the time vaccines were rolled out, he said, much of the damage had been done.

“The time to discuss this with ACIP is now,” said Schaffner, before the bird flu becomes a public health emergency. “We don’t want to discuss this until the cows come home in the middle of a crisis.”

This story originally published July 11, 2024 at KFF Health News, Healthbeat’s national reporting partner.

The CDC’s test for bird flu works, but it has issues

2024-07-30T12:42:32+00:00

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The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn’t harmed the agency’s outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.

The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.

At a congressional hearing July 23, Rep. Brett Guthrie, a Kentucky Republican, asked about the issue. “Boy, that rings of 2020,” he said, referring to when the nation was caught off guard by the Covid-19 pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.

“The tests are 100% usable,” he later told KFF Health News, adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, “We have made sure that we’re offering a high-quality product.”

CDC test only one available

Still, some researchers were unnerved by the news coming four months after the government declared a worrisome bird flu outbreak among cattle. The CDC’s test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.

The problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC officials detected the issue through a quality control system put in place after the Covid test catastrophe of 2020.

Daskalakis said the CDC’s original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.

The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be run again. With the FDA’s blessing, the CDC distributed the tests — with workaround instructions — to public health labs.

Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.

Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn’t yet signed off on their use. Daskalakis declined to name the manufacturers.

Labs working through red tape

Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don’t catch a person’s connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.

Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC’s tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.

But outside select circles, the news was largely overlooked. “I’m totally surprised by this,” Alex Greninger, assistant director of the University of Washington Clinical Virology Laboratory, told KFF Health News this week. Greninger’s lab is developing its own test and has been trying to obtain CDC test kits to evaluate.

“It’s not a red alarm,” he said, but he’s worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.

It’s not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn’t the agency’s first mishap. In 2016, well before the Covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.

The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.com, said diagnostic companies may be better suited to the task.

“It’s a reminder that CDC is not a robust manufacturer of tests” and lacks the resources that industry can marshal for their production, Mina said. “We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles.”

Labs need FDA clearance

The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.

Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.

Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.

The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky’s lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn’t have FDA authorization for its broad use.

The CDC’s test recipe is available in a published patent, Daskalakis said.

“We have made sure that tests are out there, and that they work,” he added.

As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: “It is not in the current budget and will go away without additional funding.”

This story originally published July 26, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Clues from bird flu’s ground zero on dairy farms in Texas Panhandle

2024-07-29T21:20:07+00:00

In early February, dairy farmers in the Texas Panhandle began to notice sick cattle. The buzz soon reached Darren Turley, executive director of the Texas Association of Dairymen: “They said there is something moving from herd to herd.”

Nearly 60 days passed before veterinarians identified the culprit: a highly pathogenic strain of the bird flu virus, H5N1. Had it been detected sooner, the outbreak might have been swiftly contained. Now it has spread to at least eight other states, and it will be hard to eliminate.

At the moment, the bird flu hasn’t adapted to spread from person to person through the air like the seasonal flu. That’s what it would take to give liftoff to another pandemic. This lucky fact could change, however, as the virus mutates within each cow it infects. Those mutations are random, but more cows provide more chances of stumbling on ones that pose a grave risk to humans.

Why did it take so long to recognize the virus on high-tech farms in the world’s richest country? Because even though H5N1 has circulated for nearly three decades, its arrival in dairy cattle was most unexpected. “People tend to think that an outbreak starts at Monday at 9 a.m. with a sign saying, ‘Outbreak has started,’” said Jeremy Farrar, chief scientist at the World Health Organization. “It’s rarely like that.”

By investigating the origins of outbreaks, researchers garner clues about how they start and spread. That information can curb the toll of an epidemic and, ideally, stop the next one. On-the-ground observations and genomic analyses point to Texas as ground zero for this outbreak in cattle. To backtrack events in Texas, KFF Health News spoke with more than a dozen people, including veterinarians, farmers, and state officials.

An early indication that something had gone awry on farms in northwestern Texas came from devices hitched to collars on dairy cows. Turley describes them as “an advanced fitness tracker.” They collect a stream of data, such as a cow’s temperature, its milk quality, and the progress of its digestion — or, rather, rumination — within its four-chambered stomach.

What farmers saw when they downloaded the data in February stopped them in their tracks. One moment a cow seemed perfectly fine, and then four hours later, rumination had halted. “Shortly after the stomach stops, you’d see a huge falloff in milk,” Turley said. “That is not normal.”

Tests for contagious diseases known to whip through herds came up negative. Some farmers wondered if the illness was related to ash from wildfires devastating land to the east.

In hindsight, Turley wished he had made more of the migrating geese that congregate in the panhandle each winter and spring. Geese and other waterfowl have carried H5N1 around the globe. They withstand enormous loads of the virus without getting sick, passing it on to local species, like blackbirds, cowbirds, and grackles, that mix with migrating flocks.

But with so many other issues facing dairy farmers, geese didn’t register. “One thing you learn in agriculture is that Mother Nature is unpredictable and can be devastating,” Turley said. “Just when you think you have figured it out, Mother Nature tells you you do not.”

Clues came from cats

One dairy tried to wall itself off, careful not to share equipment with or employ the same workers as other farms, Turley recalled. Its cattle still became ill. Turley noted that the farm was downwind of another with an outbreak, “so you almost think it has to have an airborne factor.”

On March 7, Turley called the Texas Animal Health Commission. They convened a One Health group with experts in animal health, human health, and agriculture to ponder what they called the “mystery syndrome.” State veterinarians probed cow tissue for parasites, examined the animals’ blood, and tested for viruses and bacteria. But nothing explained the sickness.

They didn’t probe for H5N1. While it has jumped into mammals dozens of times, it rarely has spread between species. Most cases have been in carnivores, which likely ate infected birds. Cows are mainly vegetarian.

“If someone told me about a milk drop in cows, I wouldn’t think to test for H5N1 because, no, cattle don’t get that,” said Thomas Peacock, a virologist at the Pirbright Institute of England who studies avian influenza.

Postmortem tests of grackles, blackbirds, and other birds found dead on dairy farms detected H5N1, but that didn’t turn the tide. “We didn’t think much of it since we have seen H5N1-positive birds everywhere in the country,” said Amy Swinford, director of the Texas A&M Veterinary Medical Diagnostic Laboratory.

In the meantime, rumors swirled about a rash of illness among workers at dairy farms in the panhandle. It was flu season, however, and hospitals weren’t reporting anything out of the ordinary.

Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health, has worked in the panhandle and suspected farmworkers were unlikely to see a doctor even if they needed one. Clinics are far from where they live, she said, and many don’t speak English or Spanish — for instance, they may speak Indigenous languages such as Mixtec, which is common in parts of Mexico. The cost of medical care is another deterrent, along with losing pay by missing work — or losing their jobs — if they don’t show up. “Even when medical care is there,” she said, “it’s a challenge.”

What finally tipped off veterinarians? A few farm cats died suddenly and tested positive for H5N1. Swinford’s group — collaborating with veterinary labs at Iowa State and Cornell universities — searched for the virus in samples drawn from sick cows.

“On a Friday night at 9 p.m., March 22, I got a call from Iowa State,” Swinford said. Researchers had discovered antibodies against H5N1 in a slice of a mammary gland. By Monday, her team and Cornell researchers identified genetic fragments of the virus. They alerted authorities. With that, the U.S. Department of Agriculture announced that H5N1 had hit dairy cattle.

Genomic sequences from H5N1 viruses suggest the current bird flu epidemic started with a spillover from birds into cows in Texas, and then spread to other states within cattle. Routes and timing remain uncertain because of limited data.

Recalling rumors of sick farmworkers, Texas health officials asked farmers, veterinarians, and local health departments to encourage testing. About 20 people with coughs, aches, irritated eyes, or other flu-like symptoms stepped forward to be swabbed. Those samples were shipped to the Centers for Disease Control and Prevention. All but one were negative for H5N1. On April 1, the CDC announced this year’s first case: a farmworker with an inflamed eye that cleared up within days.

Thirteen dairy farms in the panhandle had been affected, said Brian Bohl, director of field operations at the Texas Animal Health Commission. Farmers report that outbreaks among the herds last 30 to 45 days and most cows return to milking at their usual pace.

The observation hints that herds gain immunity, if temporarily. Indeed, early evidence shows that H5N1 triggers a protective antibody response in cattle, said Marie Culhane, a professor of veterinary population medicine at the University of Minnesota. Nonetheless, she and others remain uneasy because no one knows how the virus spreads, or what risk it poses to people working with cattle.

Although most cows recover, farmers said the outbreaks have disrupted their careful timing around when cattle milk, breed, and birth calves.

Farmers want answers that would come with further research, but the spirit of collaboration that existed in the first months of the Texas outbreak has fractured. Federal restrictions have triggered a backlash from farmers who find them unduly punishing, given that pasteurized milk and cooked beef from dairy cattle appear to pose no risk to consumers.

The rules, such as prohibiting infected cattle from interstate travel for 30 days, pose a problem for farmers who move pregnant cattle to farms that specialize in calving, to graze in states with gentler winters, and to return home for milking. “When the federal order came out, some producers said, ‘I’m going to quit testing,’” Bohl said.

In May, the USDA offered aid, such as up to $10,000 to test and treat infected cattle. “The financial incentives will help,” Turley said. But how much remains to be seen.

Federal authorities have pressed states to extract more intel from farms and farmworkers. Several veterinarians warn such pressure could fracture their relationships with farmers, stifling lines of communication.

Having fought epidemics around the world, Farrar cited examples of when strong-arm surveillance pushed outbreaks underground. During an early 2000s bird flu outbreak in Vietnam, farmers circumvented regulations by moving poultry at night, bribing inspection workers, and selling their goods through back channels. “Learning what drivers and fears exist among people is crucial,” Farrar said. “But we always seem to realize that at a later date.”

A powerful driver in the U.S.: Milk is a $60 billion industry. Public health is also bound to bump up against politics in Texas, a state so aggrieved by pandemic restrictions that lawmakers passed a bill last year barring health officials from recommending covid-19 vaccines.

Texas Agriculture Commissioner Sid Miller said that when he heard that federal agents with the CDC and USDA were considering visits to farms — including those where farmers reported the cattle had recovered — he advised against it. “Send federal agents to dairy that’s not sick?” he said. “That doesn’t pass the smell test.”

Analysis points to Texas as ground zero

Peacock said genomic analyses of H5N1 viruses point to Texas as ground zero for the cattle epidemic, emerging late last year.

“All of these little jigsaw puzzle pieces corroborate undetected circulation in Texas for some time,” said Peacock, an author on one report about the outbreak.

Evidence suggests that either a single cow was infected by viruses shed from birds — perhaps those geese, grackles, or blackbirds, he said. Or the virus spilled over from birds into cattle several times, with only a fraction of those moving from cow to cow.

Sometime in March, viruses appear to have hitched a ride to other states as cows were moved between farms. The limited genomic data available links the outbreak in Texas directly to others in New Mexico, Kansas, Ohio, North Carolina, and South Dakota. However, the routes are imprecise because the USDA hasn’t attached dates and locations to data it releases.

Researchers don’t want to be caught off guard again by the shape-shifting H5N1 virus, and that will require keeping tabs on humans. Most, if not all, of about 900 people diagnosed with H5N1 infections worldwide since 2003 acquired it from animals, rather than from humans, Farrar said. About half of those people died.

Occasional tests of sick farmworkers aren’t sufficient, he said. Ideally, a system is set up to encourage farmworkers, their communities, and health care workers to be tested whenever the virus hits farms nearby.

“Health care worker infections are always a sign of human-to-human transmission,” Farrar said. “That’s the approach you want to take — I am not saying it’s easy.”

This story originally published on May 23, 2024 at KFF Health News, Healthbeat’s national reporting partner.

Colorado poultry workers battle bird flu in heat wave as US struggles to contain outbreak

2024-07-29T18:51:47+00:00

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Six people who work at a poultry farm in northeastern Colorado have tested positive for the bird flu, the Centers for Disease Control and Prevention reported Friday. This brings the known number of U.S. cases this year to 10.

The workers were likely infected by chickens, which they had been tasked with killing in response to a bird flu outbreak at the farm. The endeavor occurred amid a heat wave, as outside temperatures soared to 104 degrees Fahrenheit.

“The barns in which culling occurs were no doubt even hotter,” said CDC principal deputy director Nirav Shah at a July 16 press briefing. Wearing N95 respirators, goggles, and other protective gear was a challenge. Industrial fans whipped feathers around the facility that could have carried the virus, Shah added.

In this environment, the farmworkers collected hundreds of chickens by hand and placed them into carts where they could be killed by carbon dioxide gas within two minutes.

“If a farm worker gets severely ill or dies from an H5N1 infection, it will be a stain on U.S. public health that we didn’t do more with the tools we have,” Jennifer Nuzzo, director of the Pandemic Center at Brown University, posted on X. “You don’t send farm workers in to cull H5N1 infected birds without goggles and masks. Period. If it’s too hot to wear those protections, it’s too hot to cull. We need vaccines to be made available to farm workers. We have to stop gambling with peoples’ lives.”

More than 99 million chickens and turkeys have been infected with a highly pathogenic strain of the bird flu that emerged at U.S. poultry farms in early 2022. Since then, the federal government has compensated poultry farmers more than $1 billion for destroying infected flocks and eggs to keep outbreaks from spreading.

Virus shifts to dairy cattle

As summer temperatures rise across the country, Shah said, the agency is contending with how to offer farmworkers “safety from the virus, as well as safety from extreme heat.”

The H5N1 bird flu virus has spread among poultry farms around the world for nearly 30 years. An estimated 900 people have been infected by birds, and roughly half have died from the disease.

The virus made an unprecedented shift this year to dairy cattle in the U.S. This poses a higher threat because it means the virus has adapted to replicate within cows’ cells, which are more like human cells. The four other people diagnosed with bird flu this year in the U.S. worked on dairy farms with outbreaks.

Scientists have warned that the virus could mutate to spread from person to person, like the seasonal flu, and spark a pandemic. There’s no sign of that, yet.

So far, all 10 cases reported this year have been mild, consisting of eye irritation, a runny nose, and other respiratory symptoms. However, numbers remain too low to say anything certain about the disease because, in general, flu symptoms can vary among people with only a minority needing hospitalization.

The number of people who have gotten the virus from poultry or cattle may be higher than 10. The Centers for Disease Control and Prevention has tested only about 60 people over the past four months, and powerful diagnostic laboratories that typically detect diseases remain barred from testing for bird flu. Testing of farmworkers and animals is needed to detect the H5N1 bird flu virus, study it, and stop it before it becomes a fixture on farms.

Researchers have urged a more aggressive response from the CDC and other federal agencies to prevent future infections. Many people exposed regularly to livestock and poultry on farms still lack protective gear and education about the disease. And they don’t yet have permission to get a bird flu vaccine.

CDC decides against vaccination

Nearly a dozen virology and outbreak experts recently interviewed by KFF Health News disagree with the CDC’s decision against vaccination, which may help prevent bird flu infection and hospitalization.

“We should be doing everything we can to eliminate the chances of dairy and poultry workers contracting this virus,” said Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “If this virus is given enough opportunities to jump from cows or poultry into people, it will eventually get better at infecting them.”

To understand whether cases are going undetected, researchers in Michigan have sent the CDC blood samples from workers on dairy farms. If they detect bird flu antibodies, it’s likely that people are more easily infected by cattle than previously believed.

“It’s possible that folks may have had symptoms that they didn’t feel comfortable reporting, or that their symptoms were so mild that they didn’t think they were worth mentioning,” said Natasha Bagdasarian, chief medical executive for the state of Michigan.

In hopes of thwarting a potential pandemic, the United States, United Kingdom, Netherlands, and about a dozen other countries are stockpiling millions of doses of a bird flu vaccine made by the vaccine company CSL Seqirus.

Seqirus’ most recent formulation was greenlighted last year by the European equivalent of the FDA, and an earlier version has the FDA’s approval. In June, Finland decided to offer vaccines to people who work on fur farms as a precaution because its mink and fox farms were hit by bird flu last year.

The CDC has controversially decided not to offer at-risk groups bird flu vaccines. Demetre Daskalakis, director of the CDC’s National Center for Immunization and Respiratory Diseases, told KFF Health News that the agency is not recommending a vaccine campaign at this point for several reasons, even though millions of doses are available. One is that cases still appear to be limited, and the virus isn’t spreading rapidly between people as they sneeze and breathe.

The agency continues to rate the public’s risk as low. In a statement posted in response to the new Colorado cases, the CDC said its bird flu recommendations remain the same: “An assessment of these cases will help inform whether this situation warrants a change to the human health risk assessment.”

This update published July 19, 2024 at KFF Health News, Healthbeat’s national reporting partner.

‘We’re flying blind’: CDC has 1M bird flu tests ready, but experts see repeat of Covid missteps

2024-07-29T15:36:55+00:00

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It’s been nearly three months since the U.S. government announced an outbreak of the bird flu virus on dairy farms. The World Health Organization considers the virus a public health concern because of its potential to cause a pandemic, yet the U.S. has tested only about 45 people across the country.

“We’re flying blind,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. With so few tests run, she said, it’s impossible to know how many farmworkers have been infected, or how serious the disease is. A lack of testing means the country might not notice if the virus begins to spread between people — the gateway to another pandemic.

“We’d like to be doing more testing. There’s no doubt about that,” said Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention. The CDC’s bird flu test is the only one the Food and Drug Administration has authorized for use right now. Shah said the agency has distributed these tests to about 100 public health labs in states. “We’ve got roughly a million available now,” he said, “and expect 1.2 million more in the next two months.”

But Nuzzo and other researchers are concerned because the CDC and public health labs aren’t generally where doctors order tests from. That job tends to be done by major clinical laboratories run by companies and universities, which lack authorization for bird flu testing.

As the outbreak grows — with at least 114 herds infected in 12 states as of June 18 — researchers said the CDC and FDA are not moving fast enough to remove barriers that block clinical labs from testing. In one case, the diagnostics company Neelyx Labs was on hold with a query for more than a month.

“Clinical labs are part of the nation’s public health system,” said Alex Greninger, assistant director of the University of Washington Medicine Clinical Virology Laboratory. “Pull us into the game. We’re stuck on the bench.”

The CDC recognized the need for clinical labs in a June 10 memo. It calls on industry to develop tests for the H5 strain of bird flu virus, the one circulating among dairy cattle. “The limited availability and accessibility of diagnostic tests for Influenza A(H5) poses several pain points,” the CDC wrote. The points include a shortage of tests if demand spikes.

Researchers, including former CDC director Tom Frieden and Anthony Fauci, who led the nation’s response to Covid, cite testing failures as a key reason the U.S. fared so poorly with Covid. Had Covid tests been widely available in early 2020, they say, the U.S. could have detected many cases before they turned into outbreaks that prompted business shutdowns and cost lives.

In an article published this month, Nuzzo and a group of colleagues noted that the problem wasn’t testing capability but a failure to deploy that capability swiftly. The U.S. reported excess mortality eight times as high as other countries with advanced labs and other technological advantages.

A Covid test vetted by the WHO was available by mid-January 2020. Rather than use it, the United States stuck to its own multistage process, which took several months. Namely, the CDC develops its own test then sends it to local public health labs. Eventually, the FDA authorizes tests from clinical diagnostic labs that serve hospital systems, which must then scale up their operations. That took time, and people died amid outbreaks at nursing homes and prisons, waiting on test results.

In contrast, South Korea immediately rolled out testing through private sector laboratories, allowing it to keep schools and businesses open. “They said, ‘Gear up, guys; we’re going to need a ton of tests,’” said Frieden, now president of the public health organization Resolve to Save Lives. “You need to get commercials in the game.”

U.S. weeks behind

Nuzzo and her colleagues describe a step-by-step strategy for rolling out testing in health emergencies, in response to mistakes made obvious by ovid. But in this bird flu outbreak, the U.S. is weeks behind that playbook.

Ample testing is critical for two reasons. First, people need to know if they’re infected so that they can be quickly treated, Nuzzo said. Over the past two decades, roughly half of about 900 people around the globe known to have gotten the bird flu died from it.

Although the three farmworkers diagnosed with the disease this year in the United States had only mild symptoms, like a runny nose and inflamed eyes, others may not be so lucky. The flu treatment Tamiflu works only when given soon after symptoms start.

The CDC and local health departments have tried to boost bird flu testing among farmworkers, asking them to be tested if they feel sick. Farmworker advocates list several reasons why their outreach efforts are failing. The outreach might not be in the languages the farmworkers speak, for example, or address such concerns as a loss of employment.

If people who live and work around farms simply see a doctor when they or their children fall ill, those cases could be missed if the doctors send samples to their usual clinical laboratories. The CDC has asked doctors to send samples from people with flu symptoms who have exposure to livestock or poultry to public health labs. “If you work on a farm with an outbreak and you’re worried about your welfare, you can get tested,” Shah said. But sending samples to public health departments requires knowledge, time, and effort.

“I really worry about a testing scheme in which busy clinicians need to figure this out,” Nuzzo said.

The other reason to involve clinical laboratories is so the nation can ramp up testing if the bird flu is suddenly detected among people who didn’t catch it from cattle. There’s no evidence the virus has started to spread among people, but that could change in coming months as it evolves.

The fastest way to get clinical labs involved, Greninger said, is to allow them to use a test the FDA has already authorized: the CDC’s bird flu test. On April 16 the CDC opened up that possibility by offering royalty-free licenses for components of its bird flu tests to accredited labs.

Several commercial labs asked for licenses. “We want to get prepared before things get crazy,” said Shyam Saladi, chief executive officer of the diagnostics company Neelyx Labs, which offered Covid and mpox tests during shortages in those outbreaks. His experience over the past two months reveals the types of barriers that prevent labs from moving swiftly.

Labs seek ‘right to reference’

In email exchanges with the CDC, shared with KFF Health News, Saladi specifies the labs’ desire for licenses relevant to the CDC’s test, as well as a “right to reference” the CDC’s data in its application for FDA authorization.

That “right to reference” makes it easier for one company to use a test developed by another. It allows the new group to skip certain analyses conducted by the original maker, by telling the FDA to look at data in the original FDA application. This was commonplace with Covid tests at the peak of the pandemic.

At first, the CDC appeared eager to cooperate. “A right of reference to the data should be available,” Jonathan Motley, a patent specialist at the CDC, wrote in an email to Saladi on April 24. Over the next few weeks, the CDC sent him information about transferring its licenses to the company, and about the test, which prompted Neelyx’s researchers to buy testing components and try out the CDC’s process on their equipment.

But Saladi grew increasingly anxious about the ability to reference the CDC’s data in the company’s FDA application. “Do you have an update with respect to the right of reference?” he asked the CDC on May 13. “If there are any potential sticking points with respect to this, would you mind letting us know please?”

He asked several more times in the following weeks, as the number of herds infected with the bird flu ticked upward and more cases among farmworkers were announced. “Given that it is May 24 and the outbreak has only expanded, can CDC provide a date by which it plans to respond?” Saladi wrote.

The CDC eventually signed a licensing agreement with Neelyx but informed Saladi that it would not, in fact, provide the reference. Without that, Saladi said, he could not move forward with the CDC’s test — at least not without more material from the agency. “It’s really frustrating,” he said. “We thought they really intended to support the development of these tests in case they are needed.”

Shah, from the CDC, said test manufacturers should generate their own data to prove that they’re using the CDC’s test correctly. “We don’t have a shortage such that we need to cut corners,” he said. “Quality reigns supreme.”

The CDC has given seven companies, including Neelyx, licenses for its tests — although none have been cleared to use them by the FDA. Only one of those companies asked for the right of reference, Shah said. The labs may be assisted by additional material that the agency is developing now, to allow them to complete the analyses — even without the reference.

“This should have happened sooner,” Saladi told KFF Health News when he was told about the CDC’s pending additional material. “There’s been no communication about this.”

Delays reminiscent of covid

Greninger said the delays and confusion are reminiscent of the early months of Covid, when federal agencies prioritized caution over speed. Test accuracy is important, he said, but excessive vetting can cause harm in a fast-moving outbreak like this one. “The CDC should be trying to open this up to labs with national reach and a good reputation,” he said. “I fall on the side of allowing labs to get ready — that’s a no-brainer.”

Clinical laboratories have also begun to develop their own tests from scratch. But researchers said they’re moving cautiously because of a recent FDA rule that gives the agency more oversight of lab-developed tests, lengthening the pathway to approval. In an email to KFF Health News, FDA press officer Janell Goodwin said the rule’s enforcement will occur gradually.

However, Susan Van Meter, president of the American Clinical Laboratory Association, a trade group whose members include the nation’s largest commercial diagnostic labs, said companies need more clarity: “It’s slowing things down because it’s adding to the confusion about what is allowable.”

Creating tests for the bird flu is already a risky bet, because demand is uncertain. It’s not clear whether this outbreak in cattle will trigger an epidemic or fizzle out. In addition to issues with the CDC and FDA, clinical laboratories are trying to figure out whether health insurers or the government will pay for bird flu tests.

These wrinkles will be smoothed eventually. Until then, the vanishingly slim numbers of people tested, along with the lack of testing in cattle, may draw criticism from other parts of the world.

“Think about our judgment of China’s transparency at the start of Covid,” Nuzzo said. “The current situation undermines America’s standing in the world.”

This story originally published June 20, 2024 at KFF Health News, Healthbeat’s national reporting partner.

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Poultry workers need access to health care, sick leave

New York winter virus report: Norovirus, flu, and Covid-19 on the rise

The flu: High and increasing

Covid-19: Minimal and increasing

RSV: High but decreasing

Norovirus: Surging, and you don’t want it

Emerging diseases: Avian flu

Bottom line

How America lost control of the bird flu, setting the stage for another pandemic

Farmers dismayed by inaction

Cases under the radar in three states

‘The cows are more valuable than us’

Not ‘immaculate conception’: Missouri case a mystery

As California taps pandemic stockpile for bird flu, officials keep close eye on spending

California has 88 million N95 face masks

Bird flu: Emails reveal how health departments struggle to track human cases

Dairies refusing visits from health departments

New York public health update: Fentanyl overdoses, bird flu on Long Island, changes to mental health laws