(Bloomberg) — It’s spreading rapidly among cows. It’s also infecting skunks, mountain lions and red foxes.
Yet as the highly contagious avian flu affects mammals across the US, just one human case has been reported so far.
But that’s probably only because there is extremely limited testing of people underway to detect it. State governments and farm owners have kept Centers for Disease Control and Prevention teams from conducting on-the-ground investigations that would offer a fuller picture of the prevalence of the virus in humans.
That threatens to impair federal officials’ response to an outbreak that many experts view as the biggest test for pandemic readiness systems since Covid-19. The recent patient is recovering after experiencing eye redness as their sole symptom. However, avian flu typically kills half the people known to have been infected, hinting at the danger it poses if it were to spread widely.
The CDC does not have authorization to carry out on-the-ground investigations without an invitation, and the states that have confirmed infected cattle say they have not made such an overture to the agency.
Private dairy farms would also have to welcome the CDC investigators, a fraught proposition in an industry heavily reliant on immigrant workers who are often leery of interacting with government officials and worried about losing income if they test positive. Farms may also be reluctant to scour for infected cows, out of concern that might have downsides for their low-profit margin businesses.
“The CDC is not able to go in and do the type of testing and investigative work they need to do,” Abraar Karan, an infectious disease researcher at Stanford University, said. “That’s a huge problem and it’s a blatant issue.”
The CDC says the current risk to the general public from bird flu is low, because it’s not known to transmit efficiently from person to person. But each infection in a cow or human provides an opportunity for the virus to mutate and become better adapted to mammalian respiratory cells.
Key to understanding that risk – and preventing the emergence of a deadly pandemic – is the ability to detect the infection and track molecular changes in the virus.
“We’re playing with fire,” said Sam Scarpino, a professor at Northeastern University, who helped lead pathogen surveillance at the Rockefeller Foundation during the coronavirus pandemic. “We’re really not doing the surveillance to say that it’s not here.”
On-The-Ground Testing
CDC Director Mandy Cohen said her agency is prepared to conduct on-the-ground bird flu testing and other forms of surveillance.
“We are ready to deploy,” Cohen said in an interview Monday. “We have been for weeks.” Those on standby at the CDC include multilingual and multidisciplinary epidemiological teams.
Yet the nine states with infected cattle — Texas, New Mexico, Michigan, Kansas, Idaho, Colorado, North Carolina, Ohio and South Dakota — said in statements they have not invited the CDC.
In New Mexico and Texas, the only two states that have reported conducting testing of their own, the scope of that work has been limited. New Mexico tested three people for avian flu, a spokesperson said in an email.
The Texas Department of State Health Services tested about 20 people, with one positive case in a dairy farm worker. The worker showed signs of conjunctivitis with red, swollen eyes and returned to work the day after testing. A spokesperson for the department said it hasn’t invited the CDC “because we have not found any dairy farms interested in participating in an epidemiological field study.”
Since March, more than 30 people have been tested for novel influenza A, the broad category of flu that includes H5N1, and over 220 have been monitored for symptoms, many of whom are being asked to self-report signs of disease, according to the CDC.
The CDC is monitoring multiple flu indicators, and Cohen notes that data from emergency rooms and commercial laboratories across the US isn’t currently showing concerning patterns.
“The good news is we’re not seeing anything unusual,” Cohen said, such as a spike in doctors ordering flu tests.
Yet she also stressed the need to continue to work with agriculture partners – especially given the novel nature of how this strain of bird flu is spreading.
“There is a very robust way in which we’ve worked with our poultry farmers, but this is new in cattle,” Cohen said.
‘Huge Problem’
The FDA found traces of the H5N1 virus in 1 in 5 retail milk samples. Although pasteurization has been shown to render the pathogen harmless, that incidence shows it has spread widely among cows. In the US, some 36 dairy herds are known to have been affected.
The people most likely to be infected – dairy farm workers who have their hands on cows regularly – aren’t necessarily going to doctors for treatment, community health workers say.
Wastewater testing in Texas found H5N1 traces, which could be attributed to humans or animals with the virus. In a study of wastewater from hundreds of plants in the US, samples from three of them were found to have genetic markers of H5N1.
“We’ve almost certainly missed human cases,” Scarpino said, referencing the Texas wastewater findings. “The real question we need to answer is: Are there thousands of flu cases we missed, or a handful?”
Worker Reluctance
Even if the CDC were to gain authorization from states and farms to perform onsite testing, it would face additional challenge: Workers would have to agree to participate, and many of them would likely be hesitant to do so.
Fear of job loss, language barriers, transportation costs and distrust in public health systems are all factors that might deter migrants from consenting to test, said Bethany Alcauter, director of research at the National Center for Farmworker Health. She said the situation reminds her of the early days of the coronavirus pandemic, when workers were reluctant to test and the illness wasn’t well understood.
Lus Chavez, rural outreach director at Family Support Services in Amarillo, Texas, said she spoke with dairy workers in late February with flu-like symptoms including congestion, but they tested negative for flu and Covid. The farm workers, she said, were convinced it was a new strain of Covid that wasn’t showing up on tests.
Chavez said she has been contacted by the Texas health department to advertise that it can provide voluntary tests, but workers are reluctant to do so out of fear of retaliation for raising concerns or worries about losing pay.
Even if workers elect to test, there is no requirement to reveal where they work, another challenge for authorities trying to track and contain the virus.
The CDC is engaged in discussions with multiple states about setting up field investigations to answer questions about the ongoing outbreak, including by examining flu antibodies in blood samples from farm workers in order to see if any of them had been previously infected. The CDC would help establish protocols for studies that would allow data to be standardized across states. Such an effort could similarly face hesitation from farms and staff.
It’s not just a dearth of bird-flu testing that concerns public health experts. A lack of funding and research, some say, has also left the US flatfooted if a wider outbreak of bird flu – or any other deadly virus – takes hold.
“We’re not going to be ready,” Katrine Wallace, epidemiologist at the University of Illinois, said. “We’re not even dealing with what’s right in front of us.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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.
