Lambert: No, that’s not going to happen. That’s what I’m worried about. Robert Redfield:
There is no evidence yet that the virus is spreading among humans, and Redfield said he knows exactly what needs to happen for it to get that far because he’s done studies in the lab.
Redfield said scientists found that for bird flu to acquire the propensity to bind to human receptors like COVID-19 does and “be able to transmit from person to person,” five amino acids in a key receptor must change.
“A pandemic occurs when the virus attaches to a human receptor and acquires the ability to spread from human to human,” he said. “And, as I said, I think it’s just a matter of time.”
All of this is true. I’m naturally worrisome. But given the lack of testing, the failure to restrict movement (of both cows and humans), the failure to protect dairy workers with PPE, the sluggish pace of USDA/CDC investigations, the neglect of non-pharmaceutical interventions, and the comprehensive moral and intellectual collapse of our public health agencies, I think there’s a reasonable concern that an H5N1 outbreak would only be discovered if demand for refrigerated trucks (again) exceeded supply. (There’s also a multiplicity of transmission modes to consider, entirely different from SARS-CoV-2, including wind-blown dust from a CAFO 15 miles away, fomites (yes, this time), and even the food supply.) But maybe nothing bad will happen.
By Amy Maxmen and Arthur Allen. Originally published in KFF Health News.
Abrar Karan, an infectious disease doctor at Stanford University, has seen many patients lately complaining of runny noses, fevers and itchy eyes — symptoms that could be signs of allergies, COVID-19 or the common cold. This year, bird flu is also a suspect, but most doctors have no way of knowing.
He and other researchers warn that unless the government prepares to ramp up testing for H5N1 avian flu, the United States could be hit by another pandemic.
“We’re making the same mistakes now that we made with COVID,” said Deborah Birx, former President Donald Trump’s coronavirus response coordinator. June 4th CNN.
For the H5N1 avian influenza virus to become a pandemic, Spreads from person to personThe best way to monitor that possibility is to test people.
Scientifically speaking, many diagnostic laboratories can detect the virus. But bureaucracy, billing issues, and minimal investment have prevented tests from being made available quickly and widely. Currently, the Food and Drug Administration has only authorized the Centers for Disease Control and Prevention’s avian flu test, which is for use only by people who work closely with livestock.
State and federal officials have detected avian influenza in dairy cows in 12 states. Three workers on separate dairy farms have tested positive and are presumed to have contracted the virus from the cows, though researchers agree that this figure is an underestimate given that the CDC has tested only about 40 people.
“It would be important to know if the infections are contained on the farms, but we don’t have that information because we’re not investigating,” said Helen Chu, an infectious disease expert at the University of Washington in Seattle, who expanded testing in 2020 and warned the country about the spread of COVID-19.
Reporting Untested Sick agricultural workers – Similarly Obstetric care workers In an area of Texas where the H5N1 virus is circulating among cattle, more than 1,000 cows have had flu-like symptoms, suggesting the number is much higher, and because the symptoms in cattle that test positive are mild — no fever, just a cough and eye irritation — infected people may not bother to go to the doctor or get tested.
The CDC is urging farmworkers with flu symptoms to get tested, but researchers Lack of outreach It would also create incentives to encourage testing among people with limited job security or access to health care, and by testing only on dairy farms, authorities would likely miss evidence of wider infections.
“It’s hard not to compare this to COVID-19 because initially they were only testing people who had traveled,” said Benjamin Pinsky, medical director of the Stanford University Clinical Virology Institute, “so they didn’t immediately realize that there was community spread.”
In the early stages of the COVID-19 pandemic, testing in the United States was slow. Catastrophically slowThe World Health Organization approved the test, and other groups were developing their own tests using basic molecular biology techniques, but the CDC initially Rely on your own testingAdding to the delays, the first version shipped to state health labs didn’t work.
The FDA also lagged behind, not authorizing testing by diagnostic laboratories other than the CDC until late February 2020.
February 27, 2020, Chu’s lab Detect coronavirus The case was discovered in a teenager who did not meet the strict CDC testing criteria. It was a wake-up call for COVID-19 to spread unnoticed. It took time to scale up testing to meet demand, and months passed before anyone who needed a COVID-19 test could get one.
Chu points out that this is not 2020. Far from it. Hospitals are not overrun with bird flu patients. And the country has the means to do better this time around, she says, if there is political will.
First, tests that detect a broad spectrum of influenza, the type of virus that H5N1 belongs to, called influenza A, are FDA-authorized and widely available. These tests are administered routinely during “flu season,” from November to February. If these routine flu tests produce an unusually high number of positive results this spring and summer, researchers might realize that something is wrong.
But Alex Greninger, associate director of the Clinical Virology Institute at the University of Washington, said doctors are unlikely to require influenza A testing for patients with respiratory symptoms outside of flu season because health insurance may not cover it except in limited circumstances.
It’s a solvable problem, he added. During the peak of the COVID-19 pandemic, the government overcame the billing issue by requiring insurers to cover the costs of testing and allowing manufacturers to set favorable prices to break even. “There were testing booths on every other block in Manhattan because companies would get $100 every time they stuck a swab up someone’s nose,” Greninger said.
Another hurdle is that the FDA has not yet allowed companies to use eye swabs to test for influenza A, although the CDC and public health labs have been allowed to do so. Notably, the avian flu virus was detected only in the eye swab of one infected farm worker this year, but not in samples taken from the nose or throat.
Chew said overcoming these barriers is essential to increasing influenza A testing in areas with livestock. “The most effective way to do this is to have these tests done routinely in clinics that serve agricultural worker communities,” she said, also suggesting pop-up testing at state fairs.
In the meantime, new tests specifically designed to detect the H5N1 virus may become available: The CDC’s current tests are not very sensitive or easy to use, the researchers say.
Diagnostic laboratories serving Stanford University, the University of Washington, the Mayo Clinic and other hospital systems have developed alternative ways to detect the virus now circulating, but their scope is limited, and researchers stress the need to ramp up testing capacity before the crisis progresses.
“If this becomes a public health emergency, how do we make sure we don’t end up like we were in the early days of COVID, when things didn’t move quickly enough?” Pinsky said.
a Recent rules Giving the FDA more authority to increase oversight of lab-developed tests could stall approval. In a statement to KFF Health News, the FDA said it may allow tests to move forward without the full approval process for now. The CDC did not respond to a request for comment.
But the American Association of Clinical Laboratories is asking the FDA and CDC for clarification of the new rules. “It’s creating confusion about what’s permissible and slowing things down,” said Susan Van Meter, president of the diagnostic testing industry group.
LabCorp, Quest Diagnostics and other large testing companies are in the best position to handle a surge in demand for tests because they can process hundreds rather than dozens per day, but that requires adapting the testing process to specialized equipment, which takes time and is expensive, said Matthew Binnicker, director of clinical virology at the Mayo Clinic.
“We’ve only seen a handful of human cases of H5N1 in recent years,” he says, “so it’s hard to invest millions of dollars in the unknown.”
Governments could provide funding to support research or commit to buying test kits in bulk, as Operation Warp Speed did to advance COVID-19 vaccine development.
“To scale this up, we’re going to need an infusion of funding,” said Kelly Wroblewski, infectious disease program director at the Association of Public Health Laboratories.As with insurance policies, the upfront costs are small compared with the economic hit of another pandemic.
Other ways to track the H5N1 virus are also important: detecting antibodies to avian flu in farmworkers could reveal whether more people are becoming infected and recovering, and analyzing wastewater for the virus could reveal increased infections in people, birds, and cattle.
Greninger said as with all pandemic preparedness efforts, it’s hard to emphasize the need to act before a crisis hits.
“We should absolutely be prepared,” he said, “but it’s hard to move in that direction unless the government underwrites some of the risks here.”
