\u201cIt\u2019s disheartening to see so many of the same failures that emerged during the covid-19 crisis reemerge,\u201d said Tom Bollyky, director of the Global Health Program at the Council on Foreign Relations.<\/p>\n
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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\u2019ve 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\u2019s milk production by about 20%.<\/p>\n
Worse, the outbreak poses the threat of a pandemic. More than 60 people in the U.S. 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<\/a> of a person critically ill in Louisiana with the bird flu shows that the virus can be dangerous.<\/p>\n Just a few mutations<\/a> 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.<\/p>\n \u201cEven if there\u2019s only a 5% chance of a bird flu pandemic happening, we\u2019re talking about a pandemic that probably looks like 2020 or worse,\u201d said Tom Peacock, a bird flu researcher at the Pirbright Institute in the United Kingdom, referring to covid. \u201cThe U.S. knows the risk but hasn\u2019t done anything to slow this down,\u201d he added.<\/p>\n Beyond the bird flu, the federal government\u2019s handling of the outbreak reveals cracks in the U.S. health security system that would allow other risky new pathogens to take root. \u201cThis virus may not be the one that takes off,\u201d said Maria Van Kerkhove, director of the emerging diseases group at the World Health Organization. \u201cBut this is a real fire exercise right now, and it demonstrates what needs to be improved.\u201d<\/p>\n A Slow Start<\/strong><\/p>\n It may have been a grackle, a goose, or some other wild bird that infected a cow in northern Texas. In February, the state\u2019s 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.<\/p>\n Long listed among pathogens with pandemic potential, the bird flu\u2019s unprecedented spread among cows marked a worrying shift. It had evolved to thrive in animals that are more like people biologically than birds.<\/p>\n 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.<\/p>\n 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.<\/p>\n Instead, Russo and other veterinarians said, they were dismayed by inaction. The USDA didn\u2019t respond to their urgent requests to support studies on dairy farms \u2014 and for money and confidentiality policies to protect farmers from financial loss if they agreed to test animals.<\/p>\n The USDA announced that it would conduct studies itself. But researchers grew anxious as weeks passed without results. \u201cProbably the biggest mistake from the USDA was not involving the boots-on-the-ground veterinarians,\u201d Russo said.<\/p>\n Will Clement, a USDA senior adviser for communications, said in an email: \u201cSince 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.\u201d The agency provided research funds to state and national animal health labs beginning in April, he added.<\/p>\n The USDA didn\u2019t 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\u2019s genes<\/a> implied that it spread between cows rather than repeatedly jumping from birds into herds.<\/p>\n 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.<\/p>\n \u201cThere is a fear within the dairy farmer community that if they become officially listed as an affected farm, they may lose their milk market,\u201d 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\u2019t happened.<\/p>\n 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 \u201cfloppy inflatable men you see outside of car dealerships\u201d to ward off the birds.<\/p>\n 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, \u201cThe response is adequate.\u201d<\/p>\n 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 \u201cOne Health\u201d approach. In reality, agriculture agencies took the lead.<\/p>\n This was explicit in an email from a local health department in Colorado to the county\u2019s commissioners. \u201cThe State is treating this primarily as an agriculture issue (rightly so) and the public health part is secondary,\u201d wrote Jason Chessher, public health director in Weld County, Colorado. The state\u2019s leading agriculture county, Weld\u2019s livestock and poultry industry produces about $1.9 billion in sales each year.<\/p>\n Patchy Surveillance<\/strong><\/p>\n In July, the bird flu spread from dairies in Colorado to poultry farms. To contain it, two poultry operations employed about 650 temporary workers<\/a> \u2014 Spanish-speaking immigrants as young as 15 \u2014 to cull flocks. Inside hot barns<\/a>, 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.<\/p>\n By the time Colorado\u2019s health department asked if workers felt sick, five women and four men had been infected. They all had red, swollen eyes \u2014 conjunctivitis \u2014 and several had such symptoms as fevers, body aches, and nausea.<\/p>\n State health departments posted online notices offering farms protective gear, but dairy workers in several states told KFF Health News<\/a> that they had none. They also hadn\u2019t heard about the bird flu, never mind tests for it.<\/p>\n Studies in Colorado, Michigan, and Texas<\/a> would later show that bird flu cases had gone under the radar. In one analysis<\/a>, eight dairy workers who hadn\u2019t been tested \u2014 7% of those studied \u2014 had antibodies against the virus, a sign that they had been infected.<\/p>\n Missed cases made it impossible to determine how the virus jumped into people and whether it was growing more infectious or dangerous. \u201cI have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,\u201d 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.<\/p>\n Citing \u201cinsufficient data,\u201d the British government raised its assessment<\/a> of the risk posed by the U.S. dairy outbreak in July from three to four on a six-tier scale.<\/p>\n Virologists around the world said they were flabbergasted by how poorly the United States was tracking the situation. \u201cYou are surrounded by highly pathogenic viruses in the wild and in farm animals,\u201d said Marion Koopmans, head of virology at Erasmus Medical Center in the Netherlands. \u201cIf three months from now we are at the start of the pandemic, it is nobody\u2019s surprise.\u201d<\/p>\n 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 \u2014 they weren\u2019t hospitalized. But that doesn\u2019t mean symptoms are a breeze, or that the virus can\u2019t cause worse.<\/p>\n \u201cIt does not look pleasant,\u201d wrote Sean Roberts, an emergency services specialist at the Tulare County, California, health department in an email to colleagues in May. He described photographs of an infected dairy worker in another state: \u201cApparently, the conjunctivitis that this is causing is not a mild one, but rather ruptured blood vessels and bleeding conjunctiva.\u201d<\/p>\n Over the past 30 years, half of around 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.<\/p>\n 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<\/a> saying, \u201cA sporadic case of severe H5N1 bird flu illness in a person is not unexpected.\u201d<\/p>\n \u2018The Cows Are More Valuable Than Us\u2019<\/strong><\/p>\n 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.<\/p>\n \u201cThe agriculture community has dictated the rules of engagement from the start,\u201d said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. \u201cThat was a big mistake.\u201d<\/p>\n 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. \u201cProducer refuses to send workers to Sunrise [clinic] to get tested since they\u2019re too busy. He has pinkeye, too,\u201d said an email from the Weld, Colorado, health department.<\/p>\n \u201cWe know of 386 persons exposed \u2014 but we know this is far from the total,\u201d said an email from a public health specialist to officials at Tulare\u2019s health department recounting a call with state health officials. \u201cEmployers do not want to run this through worker\u2019s compensation. Workers are hesitant to get tested due to cost,\u201d she wrote.<\/p>\n Jennifer Morse, medical director of the Mid-Michigan District Health Department, said local health officials have been hesitant to apply pressure after the backlash<\/a> many faced at the peak of covid. Describing the 19 rural counties she serves as \u201cvery minimal-government-minded,\u201d she said, \u201cif you try to work against them, it will not go well.\u201d<\/p>\n 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<\/a> to farmworkers and other historically marginalized groups led to a disproportionate toll<\/a> of the disease among people of color.<\/p>\n Kevin Griffis, director of communications at the CDC, said the agency worked with the National Center for Farmworker Health throughout the summer \u201cto reach every farmworker impacted by H5N1.\u201d But Bethany Boggess Alcauter, the center\u2019s director of public health programs, said it didn\u2019t 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. \u201cWe are certainly not reaching \u2018every farmworker,\u2019\u201d she added.<\/p>\n Farmworker advocates also pressed the CDC for money to offset workers\u2019 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<\/a>. \u201cOutreach is clearly not a huge priority,\u201d Boggess said. \u201cI hear over and over from workers, \u2018The cows are more valuable than us.\u2019\u201d<\/p>\n 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<\/a>, the CDC has advised against offering the ones on hand to farmworkers.<\/p>\n \u201cIf you want to keep this from becoming a human pandemic, you focus on protecting farmworkers, since that\u2019s the most likely way that this will enter the human population,\u201d said Peg Seminario, an occupational health researcher in Bethesda, Maryland. \u201cThe fact that this isn\u2019t happening drives me crazy.\u201d<\/p>\n Nirav Shah, principal deputy director of the CDC, said the agency aims to keep workers safe. \u201cWidespread awareness does take time,\u201d he said. \u201cAnd that\u2019s the work we\u2019re committed to doing.\u201d<\/p>\n As President-elect Donald Trump comes into office in January, farmworkers may be even less protected. Trump\u2019s 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.<\/p>\n Many dairy and poultry workers are living in the U.S. 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, \u201cMass deportation is an astronomical challenge for public health.\u201d<\/p>\n Not \u2018Immaculate Conception\u2019<\/strong><\/p>\n 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. \u201cEvidence points to this being a one-off case,\u201d Shah said at a briefing with journalists. About a month later, the agency revealed it was not.<\/p>\n Antibody tests found that a person who lived with the patient had been infected, too. The CDC didn\u2019t know how the two had gotten the virus, and the possibility of human transmission couldn\u2019t be ruled out.<\/p>\n Nonetheless, at an October briefing, Shah said the public risk remained low and the USDA\u2019s Deeble said he was optimistic that the dairy outbreak could be eliminated.<\/p>\n Experts were perturbed by such confident statements in the face of uncertainty, especially as California\u2019s outbreak spiked and a child<\/a> was mysteriously infected by the same strain of virus found on dairy farms.<\/p>\n \u201cThis wasn\u2019t just immaculate conception,\u201d said Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. \u201cIt came from somewhere and we don\u2019t know where, but that hasn\u2019t triggered any kind of reset in approach \u2014 just the same kind of complacency and low energy.\u201d<\/p>\n Sam Scarpino, a disease surveillance specialist in the Boston area, wondered how many other mysterious infections had gone undetected. Surveillance outside of farms was even patchier than on them, and bird flu tests have been hard to get.<\/p>\n Although pandemic experts had identified the CDC\u2019s 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\u00a0inquired 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.<\/p>\n 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.<\/p>\n 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\u2019t 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\u2019s possible.<\/p>\n Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. \u201cNot one and done,\u201d he added. If they detect the virus, they\u2019d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd \u2014 or at least to other farms. Cows can spread the bird flu before they\u2019re sick, he said, so speed is crucial.<\/p>\n 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 \u2014 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.<\/p>\n 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 \u2014 a common diagnostic that indicates human, swine, or bird flu \u2014 clinics should probe more deeply, Nuzzo said.<\/p>\n 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\u2019s 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.<\/p>\n Change may instead need to start from the bottom up \u2014 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: \u201cThey\u2019re starting to say, \u2018How do I save my dairy for the next generation?\u2019 They recognize how severe this is, and that it\u2019s not just going away.\u201d<\/p>\n Healthbeat is a nonprofit newsroom covering public health published by Civic News Company<\/a> and KFF Health News<\/a>. Sign up for its newsletters here<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n Subscribe<\/a> to KFF Health News’ free Morning Briefing.<\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons license.<\/p>\n <\/i> Description de l\u2019image : Micrographie \u00e9lectronique \u00e0 transmission coloris\u00e9e de trois particules du virus de la grippe aviaire (rose), sur fond bleu sarcelle. Photo : CDC et NIAID. L\u2019image est sous licence Creative Commons CC BY 2.0 DEED | Attribution 2.0 Licence g\u00e9n\u00e9rique<\/a>.<\/p>\n
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