Avian Flu Spreading In California Raises Pandemic Threat To Humans

SACRAMENTO, California — Health officials across the U. S. as avian flu rips through one of the country’s largest milk-producing regions during the height of flu season, efforts are being made to prevent a potentially dangerous combination virus.

Avian flu is a serious pandemic threat to humans, as public health experts have long warned, and the number of cases among California’s dairy workers is still rising. The timing of the outbreak coincides with the seasonal flu, which will make tracking bird flu more difficult and increase the possibility that the two viruses could combine to create a virulent combination that could infect not just dairy workers but the general public as well.

Public health experts outside of California argue that not enough is being done to track and contain the avian flu outbreak, which has spread to 105 dairy farms since the virus was discovered here in August, despite claims made by California officials that their proactive approach is working. The World Health Organization estimates that roughly 50% of human cases of H5N1 avian flu in the previous 20 years have resulted in death.

Chief scientific officer of the digital health company eMed Michael Mina stated, “As soon as it gains any foot in the door for human-to-human transmission, it will mutate to become increasingly optimal in humans.”. Right now, it’s nearly impossible to predict how far that goes or how quickly the virus begins to spread. “.

This year, there have been a few cases of avian flu in humans in other states, including one in Texas and ten in Colorado. However, with over 11.7 million cows, California is the nation’s largest dairy producer, so its response could be used as a model for handling large numbers of sick people or cows.

As of October 10, the California Department of Public Health revealed the first presumed infection in the state. According to the state, 3, 11 human infections have been confirmed. The workers, who are employed by nine distinct farms, have all come into close contact with dairy cattle that are infected.

Notably, there has been no proof of bird flu spreading from person to person in the United States. S. “In an email, a CDPH representative stated.

However, from March 31 through October. CDPH reports that as of 14, just 25 people in the state have received avian flu testing. Prior to further testing specific to bird flu, workers who exhibit symptoms are first tested for the flu. More than 17,500 dairy workers work in California, the majority of them are located in the Central Valley.

In anticipation of the 12 states experiencing outbreaks, the CDC reserved over 100,000 doses of the seasonal flu vaccine. Only in October did counties with large herds have the option to order the 5,000 doses intended for California’s dairy workers. 14.

The goal of regularly administering flu shots to dairy workers is to improve their ability to identify avian flu. Health professionals should be better able to identify cases of avian flu as fewer people will be displaying typical flu symptoms. The effort also aims to reduce the likelihood that the avian flu undergoes reassortment, a process that could produce a virus that can spread from person to person.

According to Mina of eMed, “that alone, without taking into account high pathogenicity, equates to huge numbers of increased hospitalizations and deaths nationally and globally.”.

It’s not something that has never been witnessed by anyone. The 2009 swine flu pandemic was caused by a “quadruple-reassortant virus,” which combined human, avian, and swine flu genes. Between April 2009 and April 2010, over 60 million individuals became ill, and nearly 12,500 of them passed away.

The prompt identification of human avian flu infections in farmworkers exposed to infected dairy cows, according to state officials, is the result of proactive preparation. These initiatives, which are focused in the Central Valley of California, are utilizing lessons learned by public health officials from Covid outbreaks that occurred even earlier this summer as well as from an avian flu tabletop simulation earlier this summer.

In reference to the initial infections in dairy herds that authorities linked to the Texas panhandle, California State Epidemiologist Dr. Erica Pan said in an interview, “Once we first heard about what’s happening in Texas and dairy herds in other states, and knowing we’re a large dairy state, we activated sort of an instant management team early.”.

All individuals who test positive are recommended to take antivirals, and those who are in close contact with them are instructed to keep an eye out for symptoms for ten days. The CDPH advises getting tested for bird flu if any show symptoms. All of the cases thus far have been mild, with the majority exhibiting pink eye, or conjunctivitis.

The state has issued repeated warnings that more cases are likely to be found among those who handle infected dairy cattle.

“We are playing a huge risk and game of chicken with this virus,” Mina stated, arguing in favor of widespread testing at the onset of the Covid-19 pandemic. “[The cases] represent the tip of an iceberg.”. The fact that we are probably going to lose is the only issue. We still don’t know how often it spreads to or among humans because we haven’t done nearly enough surveillance and diagnostic testing. “.

Additionally, Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health and professor of epidemiology, contended that insufficient data is being released regarding human avian flu infections.

The lack of important information, such as the date of symptom onset and the date they were actually tested, has greatly frustrated Nuzzo. It would be extremely difficult to comprehend the situation without these data, which are standard outbreak data that should be reported but aren’t. “.

According to interviews with four public health departments in the Central Valley, the California response has been split between human and animal health. Agriculture departments have taken the lead in testing milk to identify infected herds, then flagging those farms to public health officials who search for infected individuals.

An epidemiologist at the Johns Hopkins Center for Health Security and a former founding associate director of the CDC’s Center for Forecasting and Outbreak Analytics, Caitlin Rivers stated, “I think they’re identifying a lot of herds through aggressive disease surveillance, and I think identifying infected herds is allowing them to better identify human cases.” “California is doing bulk testing,” she added.

Dairy-producing counties are currently pushing vaccinations as part of their regularly scheduled seasonal flu outreach, setting up walk-up clinics at the Kern County swap meet, or hiring mobile health clinics in Tulare to visit farms in the interim until the additional doses of the vaccine arrive.

“We wanted to get farm workers vaccinated for Covid-19, so we did outreach of Covid vaccines with the local dairy cooperatives in Tulare County because we had relationships established with our dairy industry partners because of Covid-19,” stated Carrie Monteiro, a representative for the Tulare County Health and Human Services Agency. Thus, we were able to establish those relationships, which worked out well for us. “.

The counties do not maintain employment information on who is receiving vaccinations, so there are currently no statistics on how effective this outreach is. According to CDPH spokesperson Brian Micek, the overall vaccination rate for the flu in California is the same as it was the previous year.

Some farmers have stated that they are reluctant to let public health officials into their farms to perform testing and surveillance ever since the dairy cattle outbreak first started. Farmers who cross state lines with lactating dairy cattle must test them first, and the USDA provides financial assistance to those who lose milk production due to sick animals. However, farmers might be less likely to test due to the dairy industry’s narrow profit margins and the government’s limited ability to assist affected farms.

However, only 64 herds have enrolled, with only three in California, under the voluntary bulk milk testing program offered by the USDA. Despite this, the program has allowed some states and farmers to comply with federal testing regulations and to conduct additional surveillance.

USDA spokesman Will Clement stated in a statement that “the Department does not believe mandatory bulk milk testing is necessary at this time.”. “Since the start of this outbreak, the USDA has maintained tight ties with the states and has assisted them in putting testing programs into place when asked. “.

In an effort to determine the extent of the virus’s spread, the Food and Drug Administration intends to increase milk testing later this month and conduct a different study in each of the participating states.

According to Steve Lyle, a representative for the California Department of Food and Agriculture, the state’s bulk milk testing program, which is mandated “where there is elevated risk of the disease,” has expanded the state’s testing program and contributed to the high caseload in the state. Currently, the state is testing over 350 dairies that together house over a million cattle.

“We’re introducing a testing scale that hasn’t been used in any other state before, and California is the largest dairy state in the country,” Lyle stated in a statement.

Regarding human health, the state has attempted to be proactive by drawing on knowledge gained and innovations in technology from COVID-19.

Antiviral doses totaling about 700,000 have been accumulated by the state and distributed to 18 local health departments in advance of the outbreak. In order to prevent them from becoming ill as well, some of those doses will be given to the workers’ close contacts who are infected.

CalCONNECT is an IT system designed for Covid-19 that is used by local health departments to aggregate data from other systems, such as vaccine registries and disease surveillance, for their use. Although it’s complicated by the presence of infected wild birds, some counties are using wastewater surveillance, another Covid-era technology, to monitor where the virus is showing up.

In order for counties to promptly request additional PPE to be distributed to farms, the state has also reopened a mass procurement system. Providing PPE, especially gloves, goggles, and face shields, to dairy farms ahead of outbreaks has been a major component of California’s response. For example, Tulare County officials claim that prior to their first confirmed case, they provided a million PPE pieces to farms.

However, experts argue that more needs to be done to support workers, such as offering monetary compensation for time missed from work.

Dr. Meghan Davis, an associate professor at the Johns Hopkins Bloomberg School of Public Health and a veterinarian, stated, “We probably need to be thinking about ways of supporting our workforce, more than just recommending PPE.”. It’s possible that there are additional measures we should consider taking to lessen their exposure. “.

The dairy-producing counties in the Central Valley have been attempting to adopt a unified strategy due to the fact that dairy workers are required to travel between counties and dairy owners operate in multiple jurisdictions.

A joint advisory from the six counties was sent to medical professionals in August, outlining best practices for treating patients who are dairy workers and reminding them to notify local health departments of any cases as soon as possible. Doctors are supposed to act as a sort of backup if patients or their employers fail to report cases to the health department.

According to Amy Liebman, chief program officer for workers, environment, and climate with the Migrant Clinicians Network, it’s critical that this information be shared because doctors might not be aware of what they’re dealing with and it might be endangering farm workers.

She stated, “The bottom line is we…think that the symptoms are mild, and as a result, we don’t really have the documentation that we need,” adding that employees might not seek medical attention for minor ailments. It’s not like we’re testing everyone, or testing everyone when they exhibit these symptoms, so I don’t think we truly know how bad it is. “.

Dairy farms are being gently coaxed into participating and complying by public health. “There’s a lot of competing priorities as these farms are dealing with their sick cattle,” observed Dr. Erica Pan, the state epidemiologist. “.

In order to inform employees and to check in with them, officials are attempting to use more social media and texting. The practice of “contact tracing,” which is laden with remnants of the Covid era, is no longer in use.

In essence, Pan stated, “We’re framing this as ‘these are health checks for your employees’ and to the workers themselves.”. We’re kind of moving away from words like monitoring, in my opinion. These are health checks, this is what we can do to help your workers stay healthy. “.

There is a limited time frame in which to administer medication that may save lives because flu antivirals must be given within days of symptom onset.

The cases have fortunately been minor, but assuming that the remainder will be the same is a real risk, according to Nuzzo.