For months, fearing that the current version of bird flu had a much higher chance of spreading to humans than previous iterations, experts have pushed for a more aggressive response from U.S. health agencies to reduce human exposure and prevent a potential pandemic. The urgency of those requests is about to rise.
Late on Sunday, the Colorado Department of Public Health and Environment reported that five people have tested positive for bird flu among workers at an egg farm in Weld County, Colorado. Four of those cases have been confirmed by the federal Centers for Disease Control and Prevention(CDC), and one test is pending confirmation.
The cases emanated from a major flu outbreak at the farm, which affected nearly 1.8 million chickens. The workers were in the process of destroying those chickens, a process known as culling.
Colorado’s governor has declared a disaster emergency in response to the outbreak, and the announcement by state health officials of the positive cases represents a grim landmark. It denotes the first time a cluster of human infection has been reported on a single farm in the U.S., and it again raises the stakes on the seriousness of this virus.
A turning point
State health officials said the workers exhibited mild symptoms, including conjunctivitis (pink eye) and respiratory issues, and no one was hospitalized. But the incident marks the kind of turning point that experts have worried over for some time.
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“I am extremely concerned that we are on the brink of this being really already in humans—and once it’s in humans, it is going to be a real problem to control,” says Seema Lakdawala, a microbiologist and immunologist at Emory University who specializes in influenza. “I will tell you that what has been driving me the past few months is trying to prevent H5 from becoming a pandemic…I have never felt that we were as close as we are now.”
In its own way, the CDC echoes that concern, referencing in general terms the “pandemic potential” of H5N1 and other novel flu viruses once humans are in the mix. But the agency added that it hasn’t yet seen genetic changes in the virus that would make human transmission more likely, and it continues to judge the risk to the general public as low.
Farmworkers on the front lines
This basic concern—a virus that already has shown the ability to adapt to multiple animal species, now jumping to humans—is what prompted experts and researchers to begin clamoring for more testing of both animals and workers on farms, including blood tests, as well as for vaccinations and antivirals at the ready. They also want farmworkers to be educated about the importance of wearing personal protective equipment–and for the CDC, USDA, and other health agencies, especially those at the state level, to step up the urgency.
Farmworkers are considered to be on the front lines of risk because of their proximity to both chickens and dairy cattle, two species in which H5N1 has already been found in alarming numbers in the U.S.—and that is with limited testing of both animals and those who work near them. The key, experts say, is to broaden testing practices now, not later. Waiting for more clusters of infection to appear, they say, is an open invitation to mass spread.
“I’d like to see them swabbing from not just the symptomatic people that they’ve talked about, but also asymptomatic people on the same farm in the family circle unit and in the community,” says immunologist Rick Bright, a former federal health official. “And I’d like to see them taking blood samples for serology testing.”
Serologic testing could help to identify people who have been infected and had either mild or asymptomatic H5N1 disease that investigators may be missing. If the testing came back positive for a family member of an infected worker, for example, it could be indicative of human-to-human transmission. “And, that’s really important to see,” says Bright.
The CDC’s release on the events included the news that the agency was sending a team to assist Colorado’s investigation “at the state’s request.” The wording was noteworthy. Despite the national implications of a virus spreading from animal to human, and potentially from human to human (there is no evidence of that yet), the CDC still has to be invited to participate in any single state’s investigation of the problem.
Individual farms cannot be forced by the federal agency to test either animals or workers. Such authority resides with state and sometimes county or local agencies, and researchers say past experience suggests that many farms will be reluctant to a testing process that could lead to their shutdown or loss of their workforce.
But there are other issues that cry out for quick resolution. One of them, experts say, is a horrible lag time in reporting the results of testing by the U.S. Department of Agriculture, or USDA.
“We have not seen increased transparency from the USDA,” says Bright. “Last week they dumped about 80 viruses into the database, and when you look at those 80 viruses, they were a bunch of viruses collected from birds. The samples were collected throughout 2023 and into early 2024. It’s ridiculous…By not being transparent and timely with their data, the USDA is really forcing a lot of guesswork.”
Bright wants to see the most recent few weeks of virus sequences from cows, cats, mice, and humans, in order to understand if the virus is changing in ways that may make it easier to spread or cause more severe disease in people. “And we need them to be uncloaked to be able to determine where and when the blood samples were collected,” the immunologist says.
Even given the problems of coordinating federal, state, and local agencies, the lack of testing on humans in the U.S. is glaring. According to the CDC, barely more than 60 people have been tested for the novel bird flu virus since farm outbreaks began this spring. This testing often involves eye, nose or throat swabs to look for active infection, but does not include blood draws which would be needed for serosurveillance.
“There are barriers for our public health agencies to achieve this, but it would certainly be valuable to have more widespread testing,” says Emory virologist and influenza expert Anice Lowen. Lowen counts farm, dairy, and poultry workers with potential exposure among those in need of testing.
“We really do not have a good idea how much spillover is happening,” the virologist says. “The handful of cases that have been documented are potentially the tip of the iceberg, but we just don’t know because there’s not enough testing going on.”
Bright is among those calling for the CDC to make vaccines available now to farmworkers and others at high risk of contracting bird flu, arguing that it is unethical to do anything less. Though it’s clear that the U.S. lacks the stockpile to effectively vaccinate the full population in the case of a mass outbreak, there is more than enough to begin with those on the front lines.
“There’s no such thing as just a little conjunctivitis. or just a little respiratory (issue) when you’re dealing with a deadly virus,” Bright says. The virus, he adds, has already demonstrated the ability to mutate “very easily, very quickly, and it can cause severe illness and death. So let’s stop it in its tracks, not wait and see and let it get worse.”
Whether the CDC will follow the experts’ suggestions remains an open question. The agency’s response so far has been muted, with no change in official recommendation.
For those who’ve been closely tracking this bird flu, though, the signs are ominous, and they warrant a proactive response-including vaccination of frontline farmworkers. “That’s why we have these stockpiles,” Seema Lackdawala says. “It’s surprising to me that they haven’t been leveraged…We always expected this at some point in time.”
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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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