It's summer, and RSV and flu have come and gone. But, as ever, COVID-19 is different. Even though the pandemic may be behind us, the virus is once again surging in the U.S.
Here's what to know about the current spike in COVID-19.
COVID-19 seems to be settling into a pattern of two peaks a year: one in the winter and one in the summer. According to the latest data from the end of June, rates of positive COVID-19 tests from labs (which represent only a small fraction of overall cases), increased by nearly 1% from June 23-29. Emergency room visits for COVID-19 jumped 23% during that same time period, and hospitalizations for the disease increased by 13% from June 9-15. Signs of the COVID-19 virus in wastewaterwhich provides among the most accurate, real-time snapshots of caseshave been increasing since May. Just before July 4, four statesFlorida, New Mexico, Nevada, and Utahreported very high levels of the virus in wastewater samples collected from sewage facilities.
The good news is that while the number of cases is climbing, deaths from COVID-19 continue to drop. In the last week of June, deaths from COVID-19 declined by 25%.
The rise in cases is due to a number of factors. First, peoples immunity to the virus is waning; only 22% of people in the U.S. received the most updated vaccine, which became available in the fall. Second, the newest variants are mutating to spread more easily between people. That means more people are likely to get infected.
Read More: The Vaccines You'll Need This Fall and Winter
But so far, the virus does not seem to be causing more severe disease. The latest data on COVID-19 show that it is now starting to settle in and have similar kinds of statistics to influenza, meaning hundreds of thousands of hospitalizations and tens of thousands of deaths every year, says Dr. Paul Offit, director of the vaccine education center at Childrens Hospital of Philadelphia and a member of the U.S. Food and Drug Administrations vaccine expert committee. And similar to flu, the people most severely affected are the elderly and those with weakened immune systems.
With a virus that mutates as quickly as SARS-CoV-2 does, keeping up with the alphabet-soup names of the newest variants is a daunting task. The latest strains are still from the Omicron family, and KP.2, and KP.3two examples of the circulating FLiRT variants, named for the locations of their particular mutations in the virus' spike proteinare dominating new infections in the U.S. right now. Since June, FLiRT variants have accounted for more than 60% of COVID-19 infections in the U.S. The newest data from WastewaterSCAN found that FLiRT variants account for 55% of the COVID-19 variants found in wastewater samples from across the country, and the concentration of the virus in samples is more than double what it was in June 2023.
For now, it doesnt appear that these mutations are making the virus more dangerous to human health or enabling the virus to cause more severe disease. But health experts are monitoring cases to learn more about these latest changes.
People who have been infected recently have experienced symptoms of fever, coughing, malaise, and even intestinal discomfort. But having more severe symptoms than you may be used to doesn't necessarily mean you've encountered a more virulent strain. Dr. Robert Murphy, professor of infectious diseases at Northwestern University Feinberg School of Medicine, says that worse-than-usual bouts with COVID-19 could be due to the fact that their immunity is much lower now than what it was in previous years when more people were more recently vaccinated. The low uptake of the newest vaccine means fewer people have the strongest possible protection against the latest variants. Vaccines gives you better immunity than getting the disease, says Murphy. "Vaccines provide a controlled exposure that gives you a stronger immunologic response than from an infection.
Offit says vaccines are critical for people who are at high risk of developing complications from COVID-19, and staying up to date can protect them from being hospitalized. But its important to set realistic expectations. The goal of the vaccine is to keep you out of the hospital, to keep you out of the intensive care unit, and to keep you out of the morgue, he says. Thats the goalits not to protect you against mild disease.
Read More: A Combined Flu and COVID-19 Shot May Be Coming
The CDCs expert vaccine committee recently recommended an updated COVID-19 vaccine for everyone six months and older for the coming fall and winter season. The shot will be revised to target the KP variant currently circulating, which should improve the shots ability to minimize symptoms and severe COVID-19 disease.
With a more transmissible virus circulating, some people should consider it. If I were in a high-risk group, such as being older or having a high-risk medical condition, and Im in a large group of people I didnt knowlike on an airplaneI think its reasonable to wear a mask, says Murphy. That consideration should also apply to people who are sick. I think anyone who has a respiratory illness should stay at home, says Offit. And if you cant stay at home, you should wear a mask. If youre in a high-risk group, get tested,and if you have COVID-19, take an antiviral [like Paxlovid].
The Centers for Disease Control and Prevention (CDC) suggests everyone six months and older should get one of the new 2024 versions of the COVID vaccines when they become available this fall.
The new vaccines went to manufacturing this month after receiving federal regulatory approval.
Its important for everyone to understand that this years COVID is different from last years COVID, said Dr. Zach Miller, an infectious disease expert with the Vashon Medical Reserve Corps. The COVID virus constantly mutates, so the vaccine has been adjusted annually to be more effective by targeting the new variants. We know from experience over the last four years that the mutations evolve to evade the immune defenses most of us have built up from previous vaccine doses and repeat COVID infections.
According to the CDC, two new variants, KP.3 and LB.1, account for more than half of new COVID cases nationwide. Those two variants did not exist last year. However, the new variants are descendants of Omicron and the more recent JN.1 variants. The new vaccine targets that variant family, as two CDC expert advisory panels recommended.
You might want to consider the timing of your next vaccination. If you want to get vaccinated now because of the summer surge or other risk factors, do it as soon as possible. Thats because theres some possibility the 2024 vaccine could be available as soon as late August or early September.
If that timing holds, you might need to delay getting the new vaccine because you might need to wait several months between vaccinations to optimize the vaccine benefit. The timing is still being worked out.
Last years updated vaccine had a good track record for preventing serious disease and hospitalization. In addition, the 2023 vaccine prevented just over 50% of symptomatic COVID during the winter respiratory disease season.
Over the next few months, VashonBePrepared will continue to provide information on the availability of the new versions of the COVID vaccines.
CDC: Summer COVID surge underway
The CDC reports that the number of COVID cases has been rising nationwide. COVID cases, according to the CDC, have been increasing in at least 44 of the 50 states.
Theres a lack of Vashon-specific COVID data since the pandemic emergency declaration ended last year. But we have some indicators from Public Health Seattle & King County (PHSKC) showing the expected annual summer surge has begun in our region.
Regional wastewater monitoring for the COVID virus shows sharp increases over the last several weeks, following a gradual rise that began in May. The wastewater data comes from three large King and Snohomish County mainland sewage treatment plants. No wastewater COVID monitoring takes place on Vashon.
Public Health Seattle & King County (PHSKC) tabulation of laboratory tests shows a surge in positive COVID test results that began in May. As with other COVID metrics, the total number of lab tests reported has declined with the end of the pandemic emergency declaration, but the uptick in positive test results shows a clear trend of increased COVID infections.
The percentage of emergency department visits with a COVID diagnosis has also been rising since May. In late June, 2.25% of visits to emergency departments yielded a COVID diagnosis. Thats still below the alert threshold of 3.0% set by PHSKC, but if the current trend continues, the alert threshold will soon be reached.
Protecting yourself and loved ones from COVID
The median age of Vashon residents is around 55, compared to around 35 for mainland King County. That means our island population is at greater risk than the mainland population.
We know from experience over the last four years that older people are at significantly greater risk of serious disease and even hospitalization if they get COVID. Given Vashons older population, it makes sense to continue the basic steps we all learned at the height of the pandemic.
Get vaccinated. The best protection is to get vaccinated. Stay current on COVID-19 vaccinations, especially if youre 50 and older or have a health condition.
Wear a mask in high-risk settings (such as crowded places) to protect yourself and others, especially people with medical conditions who are less able to fight the virus.
Test for COVID if you have symptoms or have been in close contact with someone who tests positive.
If you test positive for COVID, getting treatment early can help stave off severe illness and hospitalization. Thats especially important if you are at higher risk from the disease. Ask your healthcare provider to see if treatment such as Paxlovid is recommended for you.
Keep activities small and outdoors, especially if you suspect that unvaccinated people will be participating.
Good indoor airflow, ventilation, and air filters can reduce airborne virus particles at home or work.
Dont bring COVID home. Even though younger people are less likely to have serious consequences from COVID, they are probably not the only folks in your household. One major way that older people get COVID is from family members who bring the virus home from school, work, camp, or summer travels.
Stage 1 Burn Ban
With dry conditions and high temperatures moving in, a Stage 1 burn ban has been put in place for unincorporated (non-city) areas of King County, including Vashon.
The ban prohibits yard debris fires or fires to clear land. Still permitted: recreational fires and use of gas/propane appliances including grills, pellet smokers and charcoal grills.
Vashon Island Fire & Rescue Chief Matt Vinci urged islanders: It takes our entire community to protect our Island. Please do your part. Adhere to the burn ban and take precautions to prevent wildfires on Vashon.
The Chief added that VIFR firefighters are on the frontlines and ready to respond with enhanced equipment and staffing to protect our island.
In announcing the burn ban, King County Fire Marshal Eric Urban said: We are coming into the busy summer season. While its a time to celebrate and have fun with family and friends, its also a time when the risk of fire increases. Our first responders are always working hard to respond to any and all emergencies, but the community can do its part by obeying the Stage 1 Burn Ban to help prevent uncontrolled fires.
Urban also urged residents who smoke to use extreme caution with their ashes or when theyre extinguishing cigarettes.
The bird-flu virus H5N1 (purple; artificially coloured) infects a human cell.Credit: Steve Gschmeissner/Science Photo Library
As the H5N1 bird-flu virus spreads relentlessly in animals around the world, researchers seeking to understand how a human H5N1 pandemic might unfold have turned to a rich source of clues: data on the immune systems response to influenza.
Such information provides hints about who could be most vulnerable in an H5N1 pandemic. Previous research also suggests that, in a confrontation with the virus, our immune systems would not be starting from scratch thanks to previous infections with, and vaccinations against, other forms of flu. But this immunity is unlikely to prevent H5N1 from inflicting serious damage to global health, if a pandemic were to begin.
The H5N1 strain now running rampant began as a bird pathogen before branching out to mammals. Classified as a highly pathogenic virus for its lethality in birds, it has killed millions of domestic and wild birds around the world since it first emerged in 1996.1 It has also spread to a growing list of mammal species, including seals and foxes, and has caused more than 460 human deaths since 2003.
So far, the virus has not gained the ability to spread effectively between people, which has kept the potential for a pandemic at bay. But its repeated jumps from birds to mammals and evidence of transmission among mammals, such as elephant seals (Mirounga leonina)2, have alarmed researchers, who warn that the virus is gaining opportunities to become adept at spreading easily between people.
Bird flu in US cows: where will it end?
These worries were magnified when H5N1 was detected in March for the first time in US cattle animals that interact frequently with humans. As of 8 July, US health officials have confirmed bird-flu infections in nearly 140 dairy herds in 12 states and in 4 dairy farm workers.
All of the workers had mild symptoms, but scientists caution that the virus is still a threat. Its possible that the workers escaped severe illness because they might have caught H5N1 through exposure to milk from infected cows rather than the usual airborne particles, says Seema Lakdawala, an influenza virologist at Emory University School of Medicine in Atlanta, Georgia. Or perhaps its because the workers might have been infected through the eye rather than the typical route of the mouth or nose.
Malik Peiris, a virologist at the University of Hong Kong, says he is not surprised by these infections, nor reassured that mildness of these cases means that this virus is inherently mild.
The viruss inherent virulence isnt the only factor that would shape a pandemic, Peiris says. Another is the immune systems state of readiness.
Through a combination of past infection and immunization, by the time people reach adulthood, they have generally had considerable exposure to flu. Some estimates3 suggest that up to half of younger populations are infected annually with seasonal flu viruses, which cause regular waves of infections.
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But exposure to seasonal flu offers limited protection against the new flu strains that could cause pandemics. These strains are genetically distinct from circulating seasonal strains, meaning that they face less built-up immunity in humans and can thus be more dangerous.
For now, H5N1 does not spread easily between people. But scientists worry that if it gains that ability, it could spark a pandemic, given that it is genetically different from seasonal flu viruses now in circulation. Tests of people across the United States found that few have antibodies against todays strain of H5N1. This implies that most of the population would be susceptible to infection from this virus if it were to start infecting people easily, according to the US Centers for Disease Control and Prevention, which ran the tests.
That doesnt leave people completely unprotected, because exposure to an older pandemic flu strain can defend against a newer one, says Michael Worobey, an evolutionary biologist at the University of Arizona in Tucson. For example, in a 2009 pandemic caused by the swine-flu virus H1N1, 80% of deaths were in people younger than 654. Older generations were spared owing to immunity stemming from exposure to different H1N1 strains when they were younger.
Exposure to H1N1 during the 2009 pandemic and at other times might, in turn, provide some protection against the H5N1 strain on the rise today. Both the H5N1 and H1N1 viruses have a surface protein designated N1, and an immune system that responds to H1N1 might also respond to H5N1. Peiris and his colleagues found that the near-universal exposure to H1N1 in 2009 and subsequent years produces antibodies that respond to H5N1 in nearly 97% of the samples they collected5. He is now running animal experiments to determine whether this antibody response confers protection against infection and serious illness.
Theres yet another complicating factor to the immune response to H5N1: a persons first bout of flu might have an outsized effect on their future immunity. In a 2016 paper6, Worobey and his colleagues analysed almost two decades worth of severe infections caused by two subtypes of bird flu, H5N1 and H7N9. They found that people are generally unscathed by the flu strain that best matches the one that had caused their first childhood flu infection whereas they are more vulnerable to mismatched strains.
How COVID-19 is changing the cold and flu season
Thus, people born before 1968 have tended to escape H5N1s ravages, because they probably had their first flu infection at a time when the dominant flu virus in circulation matched H5N1. But people born after 1968 eluded the worst of H7N9, because their first encounter with flu was probably with a virus that matched it rather than H5N1. Immunity from a first infection provided 75% protection against severe disease and 80% protection against death with a matching bird-flu virus, the authors found.
If an H5N1 outbreak were to occur, this first-bout effect predicts that older people could once again be largely spared whereas younger people could be more vulnerable, Worobey says. We should have that somewhere between the back and front of our minds, he says.
Summary
What CDC knows
An outbreak of H5N1 bird flu among poultry and dairy cows continues to spread in the United States. Four human cases with exposures to sick cows have been reported.
What CDC is doing
CDC has issued updated guidance to help prevent the spread of flu, including from cattle to people, at livestock fairs or exhibitions across the country. CDC continues to respond to the public health challenge posed by the multistate outbreak of H5N1 bird flu in cows and other animals in the United States.
With agricultural and livestock fairs happening all around the country this summer and fall, the chances for people to be in close contact with pigs, poultry (e.g., chickens, turkeys, ducks, geese), and cattle increase. Livestock fairs and shows are an important learning opportunity for people of all ages interested in agriculture.
At the same time, animals exhibited at agricultural fairs and shows can carry and spread influenza A viruses that are different from the seasonal influenza A viruses that commonly spread among people.
As the multistate H5N1 bird flu outbreak in poultry, cows and other animals continues to spread, CDC is recommending that fair exhibitors take actions to help prevent the spread of influenza A viruses between animals and between animals and people.
Since the first report of H5N1 bird flu in U.S. dairy cows this March, four associated human cases have been detected. All four people had direct contact with sick cows before they got sick, had mild illness, and have recovered. These are the first reported instances of cow-to-human spread of H5N1 bird flu.
The number of dairy cow herds infected with H5N1 bird flu continues to grow. As of July 11, 146 dairy cow herds in 12 states have confirmed cases of A(H5N1) virus infections. CDC is working with the U.S. Department of Agriculture, the Food and Drug Administration, and state and local public health and animal health officials to respond to this public health challenge.
The risk of H5N1 bird flu to the general public is low at this time. People with close, prolonged, or unprotected exposures to infected birds or other animals (including livestock), or to environments contaminated by infected birds or other animals, are at greater risk of infection. Farm workers on affected farms, for instance, are at higher risk of infection than others in the population.
While rare, influenza A viruses can spread from animals (including pigs, poultry, and cattle) to people and also from people to animals. For example, swine influenza viruses spread commonly in pigs and avian influenza viruses spread commonly in wild birds and cause outbreaks in poultry and now cows. People can be infected by swine and avian influenza viruses and vice versa. People most often get infected with animal influenza A viruses after being in close contact with infected animals.
It is rare for people to get sick from these viruses, but when they do, the sickness has varied from mild to severe. In some cases, it has led to hospitalization or death.
Livestock exhibitors can take the following actions to help protect themselves, friends and family, other visitors, and livestock and prevent the spread of flu:
CDC has issued interim recommendations for preventing, monitoring and public health investigations of H5N1 bird flu in animals and people.
An appendix to CDCs interim H5N1 bird flu guidance categorizes the degree of risk by exposure.
In addition, USDA also has fair guidance that focuses on reducing the risk of influenza spread between animals.
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Several people have tested positive for bird flu in the U.S., raising questions about the availability of tests in the event of a potential outbreak.
As of July 11, the H5N1 virus has affected more than 99 million poultry (in all 50 states), more than 9,500 wild birds (in 48 states) and more than 145 dairy herds (in 12 states), according to data from the Centers for Disease Control and Prevention (CDC).
Five human cases have been reported since 2022, including a farm worker infected in Colorado and dairy workers ill in Texas and Michigan.
AMID BIRD FLU SPREAD, EXPERTS REVEAL IF IT'S SAFE TO DRINK MILK
As of June 28, only 53 people have been tested for the virus associated with the dairy cow outbreak, according to the CDC.
Here is more information.
Several humans have tested positive for bird flu in the U.S., raising questions about the availability of tests in the event of a potential outbreak. (REUTERS/Dado Ruvic/Illustration/File Photo)
At this point, only governmental health departments are providing H5N1 avian influenza testing, according to Edward Liu, M.D., chief of infectious diseases at Hackensack Meridian Jersey Shore University Medical Center.
"However, the CDC is taking steps to ramp up the nations capacity to test for the flu virus, asking private companies to develop and increase the number and types of tests that can effectively detect H5N1 infections in people," Liu told Fox News Digital via email.
COULD A BIRD FLU PANDEMIC SPREAD TO HUMANS? HERES WHAT YOU NEED TO KNOW
"A recent announcement from the CDC seemed to indicate that multiple private organizations are working on developing tests."
Private companies, however, will likely not ramp up production unless there is a clear demand for avian flu tests due to increasing numbers, Liu added.
As of July 11, the H5N1 virus has affected more than 99 million poultry, more than 9,500 wild birds and more than 145 dairy herds, according to the CDC. (iStock)
Neal Barnard, M.D., an adjunct professor of medicine at the George Washington University School of Medicine in Washington, D.C., and president of the Physicians Committee for Responsible Medicine, confirmed there are currently no consumer-level tests for bird flu.
"The home tests for flu (which can be bought on Amazon, for example) are not sensitive to bird flu," he told Fox News Digital in an email.
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"If a person has symptoms and an exposure history suggestive of bird flu, a doctor can send a swab sample to the state health department, which can arrange appropriate testing, but this is rarely done."
In a June 10 memo, the CDC issued a public statement warning of a lack of testing availability.
"The World Health Organization (WHO) has identified this virus as a major public health concern, as it has the potential to cause a global pandemic," the statement read.
"The home tests for flu are not sensitive to bird flu."
"The current testing capabilities for influenza A(H5) are limited, which could hinder efforts to contain and control the virus in the event of an outbreak."
Currently, only the CDC and certain jurisdictional public health laboratories are equipped to test for and diagnose bird flu, according to the agency.
In a June 10 memo, the CDC issued a public statement warning of lack of testing availability for the H5N1 virus. (Getty Images)
"This poses a significant problem, as these laboratories may not have the capacity to handle a large number of cases in the event of an H5 epidemic or pandemic," the statement said.
"This could result in delays in diagnosing and treating individuals, leading to the further spread of the virus."
It also noted, "The amount of testing required in the event of an emergency may quickly exceed the capacity to test at public health laboratories, both domestically and internationally."
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To address the situation, the CDC called for private companies to design a lab developed test (LDT) to gain regulatory approval from the U.S. Food and Drug Administration (FDA).
The tests currently available to individuals will alert that a person has the flu but may not be able to determine if it is avian flu (which is a flu A variant) versus other circulating strains of flu, the expert said.
"However, at the least, that broad detection will give enough information for a clinician to start the patient on antiviral medication, like Tamiflu, which currently will treat avian flu," Liu noted.
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A number of tests are available to detect flu viruses, the doctor said.
The most common are rapid influenza diagnostic tests (RIDTs), which detect parts of the virus that stimulate an immune response.
Advanced tests reverse transcription polymerase chain reaction (RT-PCR), viral culture and immunofluorescence assays will be able to differentiate avian flu from other strains of flu, a doctor said. (REUTERS/Dado Ruvic/Illustration/File Photo)
"These tests can provide results within approximately 10 to 15 minutes, but may not be as accurate as other flu tests," Liu said.
Other flu tests, called rapid molecular assays, detect the genetic material of the flu virus.
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"Rapid molecular assays produce results in 15 to 20 minutes and are more accurate than RIDTs," Liu said.
The CDC has recommended molecular tests due to their greater sensitivity.
There have been a total of five human cases reported since 2022, including the case of a farm worker in Colorado and that of dairy workers in Texas and Michigan. (iStock)
"There are several other, more accurate flu tests available that must be performed in specialized laboratories, such as hospitals and public health laboratories," Liu said.
These advanced tests reverse transcription polymerase chain reaction (RT-PCR), viral culture and immunofluorescence assays will be able to differentiate avian flu from other strains of flu, the doctor said.
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"These tests require a health care provider to swipe the inside of the nose or the back of the throat with a swab and then send it for testing," he said. "Results may take one to several hours."
Fox News Digital reached out to the CDC requesting comment.
This transcript has been edited for clarity.
We're now in the midst of a multistate outbreak of influenza A H5N1 bird flu in dairy cows and other animals. USDA has confirmed outbreaks in more than 130 dairy herds across 12 states, and also in a herd of alpacas. CDC has confirmed three human cases of bird flu in dairy farm workers.
The first case, on April 1, 2024, was the first-ever known case of cow-to-human transmission of bird flu viruses in the United States and globally, and it was the second-ever documented human case of bird flu in the United States. The first US case was in a poultry worker in Colorado in 2022. The chief complaint for the first two patients in that outbreak was conjunctivitis. The third patient had more typical flu symptoms, including a cough. All three of these patients had direct contact with infected cows. On July 3, 2024, a fourth human case of H5N1 bird flu, tied to the dairy cow outbreak, was identified in Colorado. This patient only reported eye symptoms.
Over the past 27 years, more than 900 sporadic bird flu cases in humans have been reported worldwide. Overall, 52% of them have been fatal. CDC says to avoid exposure to sick or dead animals. They also recommend wearing appropriate personal protective equipment for job-related exposure to infected or potentially infected animals.
Several questions come to mind. Is our milk supply safe? FDA says yes. PCR testing of milk samples did find genetic pieces of the virus, but they're not infectious. Pasteurization seems effective at killing this virus. This supports the safety of our commercial pasteurized milk supply, but not so for raw milk. So, people should avoid raw milk and any products made from it.
What about beef? USDA says our meat supply is safe. Even so, they've continued testing, and on Friday, May 24, bird flu was detected via PCR in beef muscle from a second condemned cow. However, results of a USDA ground beef cooking study are reassuring. In this study, high levels of virus were injected into large ground beef patties. The patties were then cooked to different temperatures 145 F (medium) and 160 F (well done). No virus was present in the burgers cooked to either temperature. The bottom line is that people should be careful handling raw meat and cook their meat to a safe internal temperature. No steak tartare.
Here's the good news. Currently available flu test kits can detect H5, but they can't distinguish bird flu from seasonal flu. Current flu antivirals seem to be effective against it, and if we do end up needing a new dedicated vaccine, we already have two candidate vaccine viruses that should provide good cross-reactivity.
CDC says that the risk to the general public, at least for now, is low. But CDC remains on high alert and is asking health partners to help raise awareness to physicians. Consider bird flu in patients with conjunctivitis and or other respiratory illness after relevant exposures. If this H5N1 virus starts to mix and mingle with the seasonal flu virus, we could really get into a mess. So please get your seasonal flu vaccine in the fall.
HUNT VALLEY, Md. (TND) It may not be the next pandemic, but scientists are warning its proof were not ready for when the next one comes: the bird flu.
Avian influenza a cousin of the seasonal influenza we deal with every year is not new. Its believed to have been around hundreds of years before the 1918 Spanish avian flu pandemic that killed an estimated 50 to 100 million people worldwide.
There have been numerous outbreaks of avian influenza in various countries among various animal species over the years, as its not just birds that get infected.
The latest outbreak surfaced in 2020 when a severe variant of the H5N1 avian influenza strain (referred to as H5) started spreading in animals around the world. In February 2022, the virus started causing sporadic outbreaks in backyard and commercial poultry flocks in the U.S.
As of May 2024, more than 90 million chickens and turkeys in 47 states have been killed since the outbreak began, according to the U.S. Department of Agriculture. The virus is typically fatal to birds within days of infection, and farmers have to euthanize flocks to stop the spread.
Its also infected alpacas, sea lions, house cats, skunks and more during this most recent outbreak.
But up until this year, it had never infected cows.
As of this week, there have been more than 135 dairy herds in a dozen states reported with H5 infections.
Cows are largely spared of the virus severity; the infection concentrates in the udders of lactating animals, meaning their raw milk is contaminated.
And thats where human H5 infections come in.
According to the Centers for Disease Control and Prevention, four human cases of the bird flu have been reported in the U.S. from exposure to dairy cattle since March 2024. Three of those four got conjunctivitis, otherwise known as pink eye, and the other had mild respiratory symptoms.
Experts say they were likely exposed when milking cows if milk happened to squirt in their eyes.
To date, there havent been any signs of human-to-human transmission.
These do appear, at this point, to be dead-end infections, which is reassuring, said Dr. Amesh Adalja, an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. But because of whats happened with other flu pandemics, were always on the lookout for bird flu viruses behaving differently: infecting more poultry; infecting mammalian species, because that gives these bird flu viruses the opportunity to evolve and become more efficient at infecting humans.
Adalja joins a chorus of scientists who are sounding the alarm that this could be another pandemic slowly unfolding.
On its website, the CDC says the current risk to the general public from bird flu viruses is low, and surveillance so far hasnt shown any unusual influenza activity in people. Dairy farmers and other animal workers are at the highest risk, but even when they contract the virus, they experience very mild symptoms. Some might not even notice.
Experts remind people to never drink unpasteurized milk, which can carry not just the bird flu, but a host of other pathogens and bacteria.
The Food and Drug Administration released a first-of-its-kind study last month further confirming pasteurization is effective at inactivating H5 in milk. The FDA did find traces of the virus in 20% of dairy products sampled from grocery shelves nationwide, but there were no signs of live infectious virus in those samples.
Not all countries have central pasteurization, so if the outbreak becomes more widespread globally, some experts say it could have concerning implications. Raw milk is legal in several European countries.
Because the bird flu is not new, the U.S. already has a strategic national stockpile of two different vaccines against it. The federal government also just paid drug manufacturer Moderna $176 million to develop another one, using the same mRNA technology Moderna used for the COVID-19 vaccine.
Shah says theres no recommendation for use of the H5-specific vaccine right now, and the regular flu season shot will not protect against the bird flu.
Still, he says the CDC is monitoring for any changes in the virus: increased severity; human-to-human transmission; infection in people not exposed to livestock, etc. Any of these would be turning points, and he anticipates, if we get to that point, the CDC would recommend vaccination for risk groups (likely farmworkers and their families), and then move out in concentric rings.
Testing for avian influenza is just like getting tested for regular influenza, meaning we have plenty of tests stockpiled just in case. Adalja says the U.S. has tests that can distinguish between different flu strains.
Adalja and federal agencies agree theres not a need right now for the general public to be tested.
According to Reuters, state health officials say 99 people have been tested for bird flu in Michigan, Texas, Idaho, Colorado and New Mexico. Several other states with bird flu outbreaks either didnt report their human testing data or said they hadnt tested anyone.
Meanwhile, the CDCs website says between March 2024 and now, there have been at least 1,390 people monitored for H5 (asymptomatic people who may have been exposed) and at least 61 people tested for H5 (symptomatic). Four positive cases have been identified.
Whats really of concern for Adalja and other scientists is the testing of cattle themselves, which is up to farmers. The federal government can only test herds before they cross state lines, and state testing efforts are currently inconsistent because, according to experts, some farmers arent quick to want to reveal that their herds might have an outbreak.
Many farm workers are reluctant to be tested and dont want the stigma of testing positive, Adalja said. Theres economic considerations that are constraining their ability. This is occurring in a commodity, and states dont want to have any kind of disruption to the economy.
Adalja points to the negative effects a stigma like this can have in April, Colombia became the first country to officially restrict imports of U.S. beef due to bird flu in cows. The U.S. Meat Export Federation called the restriction unworkable and misguided, arguing the rest of the United States trading partners are following the science, and havent restricted any imports.
But without accurate reporting to show the full scope of the virus spread, Adalja says this creates a lack of situational awareness about the bird flu in the country.
There are likely more dairy cattle herds that are infected across this country. We also expect that there have been more humans that have been infected, he said. Anecdotally, there have been reports of people with flu-like illness or eye infections that did not get tested. In the initial first case acquired from a cow in the U.S., the family members refused to be tested.
Shah says this is an issue public health officials have always dealt with, and when a virus changes or infects a new animal species, it takes time to build up trust among industry workers to agree to testing.
Still, as it stands, H5 does not cause severe illness in humans, which raises the question: if only four people have gotten it and had mild symptoms; if it doesnt impact our commercial milk supply; if sick cows generally recover; and if theres no human-to-human transmission, why risk the negative stigma and cause the economy to take a hit?
Scientists point to the H1N1 virus, often called the swine flu, which was declared a pandemic in 2009, and killed more than 280,000 people worldwide. It had previously spread among pigs and birds, but the different viruses combined to create a more severe strain that started infecting people.
Experts say more surveillance of that virus could have helped authorities prepare and possibly save more lives.
The same goes for the COVID-19 pandemic. Federal agencies have admitted their missteps: taking years to declare the virus as airborne; recommending measures to prevent the spread that werent backed by science; implying vaccines would stop transmission; and failing to prepare hospitals and nursing homes adequately.
A bipartisan group called the COVID Crisis Group published a report on the mistakes made during that pandemic. The primary author, Philip Zelikow, told USA Today, We went into a 21st-century pandemic with a 19th-century system. Weve come out of that pandemic essentially retaining the 19th century structure.
Adalja said many in the public health community agree they dont have a lot of confidence in our current system.
The point is that there will be avian flu viruses in the future that will cause pandemics, just like what happened in 1918, Adalja said. I think what we want to do is think of this bird flu outbreak in cows almost as a trial run and if we cant iron out the differences between agriculture and human health and commerce with a less forgiving virus, its not going to be a good situation."
Shah says the CDC has learned lessons from COVID-19, and state, county and local health officials are checking in with farmers across the country every day. Yet, theres only so much federal agencies can track and require, which is something Shah says his agency has discussed with the scientific community.
One of the challenges with outbreak response is, unfortunately, you never have all the data you want at the time that you need it in order to move forward. And thats the situation were in right now, he said. We absolutely wish that there was more testing happening. We wish we had better data and what is unfolding in real-time. Thats the goal that were moving to. Unfortunately, testing can be a challenge. Testing fundamentally takes trust.
By Amy Maxmen and Arthur Allen July 11, 2024
As bird flu spreads among dairy cattle in the U.S., veterinarians and researchers have taken note of Finlands move to vaccinate farmworkers at risk of infection. They wonder why their government doesnt do the same.
Farmworkers, veterinarians, and producers are handling large volumes of milk that can contain high levels of bird flu virus, said Kay Russo, a livestock and poultry veterinarian in Fort Collins, Colorado. If a vaccine seems to provide some immunity, I think it should be offered to them.
Among a dozen virology and outbreak experts interviewed by KFF Health News, most agree with Russo. They said people who work with dairy cows should be offered vaccination for a disease that has killed roughly half of the people known to have gotten it globally over the past two decades, has killed cats in the U.S. this year, and has pandemic potential.
However, some researchers sided with the Centers for Disease Control and Prevention in recommending against vaccination for now. Theres no evidence that this years bird flu virus spreads between people or causes serious disease in humans. And its unclear how well the available vaccine would prevent either scenario.
But the wait-and-see approach is a gamble, said Jennifer Nuzzo, director of the Pandemic Center at Brown University. By the time we see severe outcomes, it means a lot of people have been infected.
Now is the time to offer the vaccines to farmworkers in the United States, said Nahid Bhadelia, director of the Boston University Center on Emerging Infectious Diseases. Even more urgent measures are lagging in the U.S., she added. Testing of farmworkers and cows is sorely needed to detect the H5N1 bird flu virus, study it, and extinguish it before it becomes a fixture on farms posing an ever-present pandemic threat.
Demetre Daskalakis, director of the CDCs National Center for Immunization and Respiratory Diseases, said the agency takes bird flu seriously, and the U.S. is stockpiling 4.8 million doses of the vaccine. But, he said, theres no recommendation to launch a vaccine campaign.
Its all about risk-benefit ratios, Daskalakis said. The benefits are blurry because there hasnt been enough testing to understand how easily the virus jumps from cows into people, and how sick they become. Just four people in the United States have tested positive this year, with mild cases too few to draw conclusions.
Other farmworkers and veterinarians working on dairy farms with outbreaks have reported being sick, Russo said, but they havent been tested. Public health labs have tested only about 50 people for the bird flu since the outbreak was detected in March.
Still, Daskalakis said the CDC is not concerned that the agency is missing worrisome bird flu infections because of its influenza surveillance system. Hospitals report patients with severe cases of flu, and numbers are normal this year.
Another signal that puts the agency at ease is that the virus doesnt yet have mutations that allow it to spread rapidly between people as they sneeze and breathe. If we start to see changes in the virus, thats another factor that would be part of the decision to move from a planning phase into an operational one, Daskalakis said.
On July 8, researchers reported that the virus may be closer to spreading between people than previously thought. It still doesnt appear to do so, but experiments suggest it has the ability to infect human airways. It also spread between two laboratory ferrets through the air.
In considering vaccines, the agency takes a cue from a 1976 outbreak of the swine flu. Officials initially feared a repeat of the 1918 swine flu pandemic that killed roughly half a million people in the United States. So they rapidly vaccinated nearly 43 million people in the country within a year.
But swine flu cases turned out to be mild that year. This made the vaccine seem unnecessarily risky as several reports of a potentially deadly disorder, Guillain-Barr Syndrome, emerged. Roughly one of every million people who get influenza vaccines may acquire the disorder, according to the CDC. That risk is outweighed by the benefits of prevention. Since Oct. 1, as many as 830,000 people have been hospitalized for the seasonal flu and 25,000 to 75,000 people have died.
An after-action report on the 1976 swine flu situation called it a sobering, cautionary tale about responding prematurely to an uncertain public health threat. Its a story about what happens when you launch a vaccine program where you are accepting risk without any benefit, Daskalakis said.
Paul Offit, a virologist at the Childrens Hospital of Philadelphia, sides with the CDC. Id wait for more data, he said.
However, other researchers say this isnt comparable to 1976 because they arent suggesting that the U.S. vaccinate tens of millions of people. Rather theyre talking about a voluntary vaccine for thousands of people in close contact with livestock. This lessens the chance of rare adverse effects.
The bird flu vaccine on hand, made by the flu vaccine company CSL Seqirus, was authorized last year by the European equivalent of the FDA. An older variety has FDA approval, but the newer variety hasnt gotten the green light yet.
Although the vaccine targets a different bird flu strain than the H5N1 virus now circulating in cows, studies show it triggers an immune response against both varieties. Its considered safe because it uses the same egg-based vaccine technology deployed every year in seasonal flu vaccines.
For these reasons, the United States, the United Kingdom, the Netherlands, and about a dozen other countries are stockpiling millions of doses. Finland expects to offer them to people who work on fur farms this month as a precaution because its mink and fox farms were hit by the bird flu last year.
In contrast, mRNA vaccines being developed against the bird flu would be a first for influenza. On July 2, the U.S. government announced that it would pay Moderna $176 million for their development, and that the vaccines may enter clinical trials next year. Used widely against covid-19, this newer technology uses mRNA to teach the immune system how to recognize particular viruses.
In the meantime, Florian Krammer, a flu virologist at Mount Sinais Icahn School of Medicine, said people who work on dairy farms should have the option to get the egg-based vaccine. It elicits an immune response against a primary component of the H5N1 bird flu virus that should confer a degree of protection against infection and serious sickness, he said.
Still, its protection wouldnt be 100%. And no one knows how many cases and hospitalizations it would prevent since it hasnt been used to combat this years virus. Such data should be collected in studies that track the outcomes of people who opt to get one, he said.
Krammer isnt assuaged by the lack of severe bird flu cases spotted in clinics. If you see a signal in hospitals, the cat is out of the bag. Game over, we have a pandemic, he said. Thats what we want to avoid.
He and others stressed that the United States should be doing everything it can to curb infections before flu season starts in October. The vaccine could provide an additional layer of protection on top of testing, wearing gloves, and goggles, and disinfecting milking equipment. Scientists worry that if people get the bird flu and the seasonal flu simultaneously, bird flu viruses could snag adaptations from seasonal viruses that allow them to spread swiftly among humans.
They also note it could take months to distribute the vaccines after theyre recommended since it requires outreach. People who work beside dairy cows still lack information on the virus, four months into this outbreak, said Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health.
Health officials have talked with dairy farm owners, but Boggess interviews with farmworkers suggest those conversations havent trickled down to their staff. One farmworker in the Texas Panhandle told her he was directed to disinfect his hands and boots to protect cows from diseases that workers may carry. They never told us if the cow could infect us with some illness, the farmworker said in Spanish.
The slow pace of educational outreach is a reminder that everything takes time, including vaccine decisions. When deciding whether to recommend vaccines, the CDC typically seeks guidance from its Advisory Committee on Immunization Practices, or the ACIP. A consultant to the group, infectious disease researcher William Schaffner, has repeatedly asked the agency to present its thinking on Seqirus bird flu vaccine.
Rather than fret about the 1976 swine flu situation, Schaffner suggested the CDC consider the 2009-10 swine flu pandemic. It caused more than 274,000 hospitalizations and 12,000 deaths in the U.S. within a year. By the time vaccines were rolled out, he said, much of the damage had been done.
The time to discuss this with ACIP is now, said Schaffner, before the bird flu becomes a public health emergency. We dont want to discuss this until the cows come home in the middle of a crisis.
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Bird flu snapshot: This is the latest installment in a series of regular updates on H5N1 avian flu that STAT is publishing on Monday mornings. To read future updates, you can also subscribe to STATs Morning Rounds newsletter.
Last week, following an unusually udder pun-laden discussion, lawmakers in Delaware voted to become the latest state to legalize the sale of raw milk. Not part of the discussion was the fact that an ongoing outbreak of H5N1 bird flu in U.S. dairy cattle has scientists increasingly concerned that the virus could be transmitted to humans through raw milk.
While there have not yet been any confirmed human cases of bird flu transmission as a result of raw milk consumption, with the number of affected herds continuing to rise the figure hit 141 in 12 states at the end of last week public health officials worry its just a matter of time. (The USDAs count was 140 on Friday, which did not include the latest detection in Iowa.)
Results of a recently released study conducted by the Food and Drug Administration and U.S. Department of Agriculture show that commercial pasteurization techniques effectively reduce virus in milk to undetectable levels. But the study which was released as a preprint, meaning it has not yet been peer-reviewed also found an alarming amount of infectious virus is getting off of farms in contaminated milk.
Over two weeks in late April, officials from four states with infected herds collected 275 raw milk samples from bulk tanks large storage tanks used to cool and store milk until it can be picked up and pooled for processing. Scientists from the FDA and the USDA were able to grow live virus from 14% of raw milk samples.
Don Prater, the FDAs acting director of the Center for Food Safety and Applied Nutrition, told journalists Tuesday that the studys results provide broad assurance that pasteurized milk and dairy products made from pasteurized milk are safe.
But they also underline shortfalls in the dairy industrys ability to identify contaminated milk and divert it from the food supply. Those lapses are not necessarily due to negligence; researchers suspect that cows may be able to shed virus into milk before showing clinical signs of illness, and studies evaluating this possibility are currently underway.
Raw milk also remains a concern because people who are exposed to it on the job continue to fall ill.
In Colorado where one-quarter of the states dairy herds have been impacted by H5N1 state health authorities announced Wednesday the nations fourth human case of bird flu infection linked to the current outbreak. In a statement, health officials said the infected individual is an adult male farmworker who had mild symptoms, reporting only conjunctivitis, or pink eye, and has since recovered.
Three additional farmworkers, in Texas and Michigan, are known to have developed mild cases of H5N1, presumably from close contact with cows.
The Centers for Disease Control and Prevention said this latest infection doesnt change the agencys assessment that H5N1 bird flu is a low health risk for the general public. But the CDC announced last week that it is preparing for the possibility that the virus evolves to more easily spread to and between humans. As part of that effort, the agency is taking steps to ramp up the nations capacity to detect bird flu in people, including working with commercial labs to produce more H5-specific tests.
The move was hailed by many as a welcome development, given how the CDCs testing failures at the outset of the Covid-19 pandemic allowed the coronavirus to spread undetected. Others believe the agency is repeating many of the same mistakes. Rick Bright, the former head of the Rockefeller Foundations short-lived Pandemic Prevention Institute, and now a consultant in the pandemic preparedness sphere, said on X that there needs to be more emphasis on developing rapid, at-home tests for H5N1, which will be more useful in the event of an influenza pandemic.
On Tuesday, the Biomedical Advanced Research and Development Authority the federal agency Bright helmed from 2016 through 2020 announced plans to support the development of messenger RNA-based pandemic influenza vaccines. BARDA awarded a $176 million contract to Moderna, the company that produced one of the first Covid-19 vaccines.
In addition to the deal with Moderna, which is expected to begin a Phase 3 clinical trial of its pandemic influenza vaccine next year, the U.S. government already has vaccine contracts and stockpiles of H5 vaccines made using other platforms by other manufacturers, including CSL Seqirus and Sanofi.
Dawn OConnell, assistant secretary for preparedness and response at the Department for Health and Human Services, told reporters last week that nearly 5 million doses of H5 vaccine are being moved out of bulk storage and put into vials, with the first doses expected to roll off the finishing line in mid-July.
At this time, federal health officials are not recommending H5N1 vaccination for any segment of the U.S. population. In Finland, however, the government last week began offering shots to people at risk of exposure the first country to take such action. Although the Scandinavian nation has not recorded any H5N1 infections in humans, there have been outbreaks at fur farms among mink and foxes.
Finland has acquired 20,000 doses of an H5 vaccine manufactured by CSL Seqirus enough to vaccinate 10,000 people, with priority going to fur farm workers, poultry farmers, veterinarians, and scientists who study the virus. According to a public database, 15 shots have been administered so far, although Anniina Virkku, a medical specialist with the Finnish Institute for Health and Welfare, told STAT in an email that due to delays in data transmission, the actual number of doses administered might be higher.
The Biomedical Advanced Research and Development Authority (BARDA) has awarded a $749,999 contract to Cambridge, Massachusetts-based Tiba Biotech to develop a new RNAi-based therapeutic against bird flu.
In a July 11 press release, Tiba announced that BARDA had selected it for an EZ-BAA contract under the Flexible and Strategic Therapeutics, or FASTx, program. FASTx is focused on creating a robust arsenal of treatment platforms that can be adapted quickly in the case of public health emergencies like pandemics, according to the initiatives website.
Tibas technology is a synthetic, biodegradable nanoparticle platform for delivering RNA-based therapies. Its meant to be an upgrade from lipid nanoparticles (LNPs) like the ones used in Pfizer and Modernas mRNA vaccines for COVID-19. For Tiba, the rationale is that while LNPs are safe at low levels, dosing is limited by the possibility of toxicity and inflammation. They also have a low payload capacity that prevents them from being useful for treating certain kinds of diseases that would require larger, more complex molecules. Furthermore, ongoing patent wars and high licensing fees make new LNP applications too expensive to get off the ground.
In contrast, Tibas platform can handle a payload capacity that is an order of magnitude greater than traditional LNPs, the company claims. That provides room for new RNA designs that express more of a single protein as well as multiple antigens. The particles can perhaps handle other complex machinery, too, making them theoretically useful not just for vaccines but also CRISPR/Cas9 systems and smart RNA circuits for gene therapy, per Tibas website. The company plans to engineer therapies not only for infectious disease but also autoimmune conditions, allergies and oncology applications.
Tibas new work with BARDA will see the company develop an RNAi-based treatment for the bird flu strain H1N1. It will build upon existing work on a multi-antigen, mRNA-based H7N9 vaccine, the preclinical development of which is being funded by a National Institute of Allergy and Infectious Disease grant. The company also was recently accepted into a joint initiative between BARDA and Johnson & Johnson called Blue Knight, another project to boost pandemic and public health crisis preparedness.
Tibahas raised around $4 million in funding so far from organizations including the Gates Foundation on top of around $4 million in grants, with another $12 million in agreements for research support from both domestic and international government agencies.
Editor's note: This article was updated on July 11 to correct that Tiba is not making a vaccine for the bird flu, but an RNAi-based treatment. A previous version of this story mentioned that the company had worked on a treatment for the Zika virus; this research preceded the company's formation.
