Emails reveal how health departments struggle to track human cases of bird flu

Within weeks, the number of bird flu cases in the nation more than doubled, but because human infection surveillance has been inconsistent for seven months, researchers are unable to identify the cause of the spike.

Just this week, Washington state reported seven likely cases in poultry workers, and California reported its fifteenth infection in dairy workers.

This is explained in part by hundreds of emails from state and local health departments that KFF Health News was able to obtain through records requests. Even with the diligent efforts of health officials to monitor human infections, blind spots, delays, and inconsistencies plague surveillance.

There is a communication breakdown with some farm owners who do not want their employees or themselves to be watched for bird flu symptoms, according to a number of documents.

For example, the Weld County Department of Public Health and Environment in Colorado sent a brief email on July 29 that stated, “We are currently trying to monitor 26 dairies.”. Nine have rejected. “”.

“1250+ known workers plus an unknown amount exposed from dairies with whom we have not had contact or refused to provide information,” the email said, listing all of the state’s farm workers who were to be monitored. “.”.

It appears from other emails that dairy farm cases were overlooked. Additionally, a Michigan health officials’ exchange revealed that individuals associated with dairy farms may have infected pet cats with the bird flu virus. But not enough tests had been conducted to be certain.

There is growing concern among researchers around the world.

Nicole Lurie, the former assistant secretary for preparedness and response in the Obama administration, stated, “The lack of surveillance and epidemiologic data has troubled and depressed me.”.

Viruses that cause bird flu have long been considered to be among the few pathogens that have the potential to spread like wildfire. In birds, they have existed for almost thirty years, but the extraordinary spread among U. S. . This year’s dairy cattle is concerning because the viruses have adapted to flourish in mammals. More systematic, strategic testing of humans is required, according to Maria Van Kerkhove, head of the World Health Organization’s emerging diseases unit. “.”.

Delayed and refused.

According to emails, slide decks, and videos that KFF Health News was able to obtain, as well as interviews with health officials in five states where outbreaks have occurred, a major contributing factor to spotty surveillance is that farm owners who have reported outbreaks among their cattle or poultry make the majority of the public health decisions.

During a brief meeting at Central District Health in Boise, Idaho, an official was seen on camera cautioning colleagues that certain dairy companies do not want their locations or names to be shared with health departments. In these situations, “our involvement becomes very sketchy,” she stated.

A public health nurse at the Mid-Michigan district health department sent an email on May 10th, saying, “I just finished speaking to the owner of the dairy farm.”. The first time they noticed a drop in milk production was weeks ago, so [REDACTED] believes this may have begun then,” she wrote. She continued, referring to Michigan State University’s outreach to farmworkers, by saying, “[REDACTED] does not feel that they need MSU Extension to come out.”.

“We have had several dairies decline a site visit,” the Weld, Colorado, communicable disease program manager wrote in an email on July 2.

Although many farmers complied with health officials, cases may have gone unnoticed because of the time lag between their visits and the outbreaks’ onset. “Unfortunately, all of them had either already passed the testing window or did not want to be tested,” a Weld health official wrote in another email detailing her visit to a farm with a bird flu outbreak. “There were four people who discussed having symptoms.”. “.”.

According to Jason Chessher, head of Weld’s public health division, farmers frequently advise them not to come due to time constraints.

Work is necessary for dairy operations all day long, particularly when cows are ill. Stopping work to allow staff members to get tested or learn more about the bird flu virus could reduce milk production and possibly injure sick animals. Additionally, a worker may not receive payment if a bird flu test comes back positive, and the farm owner will lose labor for more days. Public health initiatives are complicated by these realities, according to a number of health officials.

This concept was echoed in an email from Weld’s health department regarding a Colorado dairy owner: “The producer says they’re too busy to send workers to Sunrise [clinic] for testing. He also has pinkeye. A number of infections, including the bird flu, can cause pink eye, also known as conjunctivitis.

Instead of going to farms, Chessher and other health officials told KFF Health News that they frequently ask owners or supervisors to notify them if anyone is sick on the property. Alternatively, they might request a list of employee phone numbers from farm owners so that workers can text the health department with any symptoms.

Although Jennifer Morse, medical director of the Mid-Michigan District Health Department, acknowledged that depending on owners increases the likelihood that cases will be overlooked, she also warned that being overly assertive could rekindle anti-public health sentiment. Rural communities exhibited some of the strongest opposition to COVID-19 measures, including masks and vaccinations.

“It’s better to figure out how to work with them and understand where they’re coming from,” she said. “Because it will not go well if you try to work against them.”. “.”.

Cat hints.

Next were the cats that were kept as pets. These domestic cats did not wander among herds, consuming milk teeming with viruses, in contrast to the dozens of feral cats discovered dead on farms where outbreaks occurred.

Mid-Michigan health officials speculated in emails that the cats contracted the virus from fomites, or droplets, on their owners’ hands or clothes. A July 22 email stated, “We might have been able to prove human->fomite->cat transmission if we could have gotten testing on the [REDACTED] household members, their clothing if possible, and their workplaces.”.

In order “to inform others about the potential for indirect transmission to companion animals,” her colleague proposed that a report on the cat cases be published. “”.

According to Thijs Kuiken, a bird flu researcher at the Erasmus Medical Center in Rotterdam, the Netherlands, person-to-cat infections would not be unexpected because cats are particularly vulnerable to the virus. Fomites could have been the source, or he proposed that an untested but infected owner might have transmitted it.

Evidence of undetected bird flu infections is growing, and there are hints of missed cases. Health officials acknowledged the issue but stated that it is not solely the result of farm owners’ protests.

The number of employees in local health departments is consistently insufficient. According to one analysis, there is one public health nurse for every 6,000 residents in rural areas; these nurses typically work part-time.

Lurie, an executive director at the Coalition for Epidemic Preparedness Innovations, an international organization, stated that state and local public health departments are severely lacking in resources. “If you only provide them with resources during a crisis, you can’t expect them to perform the job. “”.

Since the virus hasn’t seriously injured anyone in the nation this year, there is also a lack of urgency. Chessher stated, “We would have been more aggressive in our worker monitoring if hundreds of workers had perished.”. However, a few minor symptoms do not call for a harsh reaction. “.”.

every case of bird flu in the United States. S. Farmworkers have reported conjunctivitis, fever, coughing, and other flu-like symptoms, but these have all gone away without the need for hospitalization. However, given the virus’s somber past, researchers studying infectious diseases point out that the numbers are still too low to draw any firm conclusions.

Over the course of three decades, 912 people were diagnosed with bird flu, and about half of them died. Since viruses evolve over time, many cases have most likely gone unnoticed. But if the bird flu virus developed to spread quickly between people, a 10 percent mortality rate would be disastrous, according to Jennifer Nuzzo, director of Brown University’s Pandemic Center, even if the true number of cases—the denominator—is five times as high. Approximately 1% of people died from COVID-19.

The public health system might not be quick to recognize if the virus spreads more if cases are missed. In early September, delays already caused the loss of a possible case of human-to-human transmission. Public health officials in Missouri discovered that someone in the patient’s home had been ill — and recovered — after a hospitalized patient tested positive for the bird flu virus. As of October, it was too late to test for the virus. 24 The CDC reported that antibodies against the bird flu, which are indicators of a previous infection, were discovered in the individual’s blood after an analysis.

According to CDC Principal Deputy Director Nirav Shah, the two individuals in Missouri may not have contracted the virus from one another, but rather contracted it independently. However, it’s impossible to know for sure without testing.

As flu season approaches, the likelihood of a more contagious variant increases. The two viruses may exchange genes to create a hybrid that can spread quickly if a person gets both seasonal flu and bird flu at the same time. “We must act now to avoid the worst-case situation,” Nuzzo stated.

Only when state health officials request it can the CDC conduct direct monitoring of farmworkers. Nonetheless, the agency’s job is to paint a picture of the situation across the country.

In October… 24 According to the CDC’s dashboard, 30 cases of bird flu have been identified, over 260 people have been tested, and over 5,100 people have been monitored nationwide following exposure to sick animals. (The most recent cases and five of Washington’s reports are still awaiting CDC confirmation; the dashboard has not yet been updated to reflect this. ).

The lack of specificity in the agency’s updates, according to Van Kerkhove and other pandemic experts, disturbed them. The number of people who were tracked through visits with health officials, daily text updates, or a single call with a busy farm owner preoccupied with cows getting sick is not broken down by state on its dashboard. It doesn’t specify the number of workers on farms that declined contact or the number of workers tested in each state.

According to Samuel Scarpino, an epidemiologist with expertise in disease surveillance, “they don’t provide enough information and enough transparency about where these numbers are coming from.”. Without knowing what percentage of workers are infected, the number of bird flu cases that have been reported is meaningless.

This makes the rise in California enigmatic. The state’s sharp increase without a baseline might indicate that it is testing more vigorously than other states. On the other hand, its increase may suggest that the virus has become more contagious, which is a very worrying but unlikely development.

Concerns regarding monitoring were not addressed by the CDC. Oct. 4. Shah gave reporters an update on the outbreak in California. He claimed that because the state was actively monitoring farmworkers, it was able to identify cases. “This demonstrates public health in action,” he continued.

The same was not true of Salvador Sandoval, a physician and county health officer in Merced, California. As the number of cases increased in the area, he claimed that monitoring wasn’t being done consistently. The situation is extremely concerning. “”.

Nathan Payne, regional editor at KFF Health News, helped write this article.