On Monday, the Louisiana Department of Health reported that a patient with a severe case of bird flu, caused by the H5N1 virus, had died from their infection, a first for the United States. The deceased was over age 65 and was reported to have underlying medical conditions. Even before the patient died, their case made headlines for several reasons: bird flu is raging across North America, swamping dairy and poultry farms and causing at least 66 human infections. But most of these cases, with the exception of three, have not been severe i.e. they haven’t warranted hospitalization or caused death.
Historically, bird flu has been a nasty bug to catch. Since it was first documented in the ‘90s, it has generally had a 50% mortality rate — far higher than something like COVID-19, with a death rate of around 2% to 3% at its peak or seasonal influenza, which has an average death rate of about 0.1% for most adults. But despite H5N1’s reputation as a killer in other countries, no patients in the U.S. have died, until now.
Public health experts have long warned that H5N1 has extreme pandemic potential, but so far, the risk to the general public remains low, according to the Centers for Disease Control and Prevention.
While the egg and chicken industry has been straining under bird flu outbreaks for several years, last April, bird flu made the jump from wild birds to dairy cows. Since then, it has jumped to farmworkers several dozen times, while also infecting people from poultry farms and, in rare cases, wild birds. The Louisiana patient reportedly contracted H5N1 after exposure to a combination of a backyard flock and wild birds.
Public health experts have long warned that H5N1 has extreme pandemic potential.
While so far there has been no hard evidence of human-to-human transmission — a key factor in these outbreaks turning into a pandemic — each infection in humans gives the virus more opportunity to mutate and evolve genetics that make it easier for it to spread. Indeed, testing revealed that the Louisiana patient possessed “concerning” viral mutations that are associated with being more infectious, according to a CDC report released in December.
Similarly, a teenager in British Columbia, Canada who contracted bird flu was hospitalized and put on life support after coming into contact with wild birds. According to a recent analysis in the New England Journal of Medicine, the teen’s virus also had mutations that would allow H5N1 to more easily infect and reproduce in the respiratory system. Such infections can be more easily spread by coughing or breathing, which is pure pandemic fuel.
Every infection, especially severe cases, is a reminder that “H5N1 influenza has been and continues to be a dangerous virus,” Dr. James Lawler, a director of the University of Nebraska’s Global Center for Health Security, told the New York Times, adding, “The more widely the virus circulates, particularly infections in humans and other mammals, the higher the risk that the virus will acquire mutations that adapt the virus for human disease and transmission.”
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And the virus shows no signs of slowing down. Also on Monday, the U.S. Department of Agriculture, specifically their Animal and Plant Health Inspection Service, confirmed more H5N1 avian flu outbreaks in poultry in five states, three involving commercial farms. APHIS also reported 10 more infections in domestic cats, which follows other cat infections reported after they consumed raw pet food. Many of the cats did not survive.
Last week, the U.S. Department of Health and Human Services announced $306 million in funding to continue surveilling the virus as it spreads. For example, the funds will increase the number of tests and provide outreach to high-risk populations, such as livestock workers.
“While the risk to humans remains low, we are always preparing for any possible scenario that could arise. These investments are critical to continuing our disease surveillance, laboratory testing, and monitoring efforts alongside our partners at USDA,” HHS Secretary Xavier Becerra said in a statement. “Preparedness is the key to keeping Americans healthy and our country safe. We will continue to ensure our response is strong, well equipped, and ready for whatever is needed.”
While some bird flu vaccines have been developed, they aren't currently approved for use in humans in the U.S. Multiple pharmaceutical companies, including Pfizer, Moderna and GlaxoSmithKline are racing to develop new H5N1 vaccines. With only a few weeks before Trump becomes president again, many are worried how this crisis will be handled — or if it will be a mangled public health response like the COVID pandemic.
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