I wanted to write about something fun but with the flurry of news about H5N1 yesterday, it is with a heavy heart that I have decided more people would want and might benefit from some notes about the bird flu.
Here's the TL;DR: H5N1 is not spreading human-to-human at this time. This is subject to change, and I really hope it doesn't. If it does change, it will become apparent pretty quickly. (This is an epidemiology thing, you can deduce how something is spreading from its patterns of spread. They make you do endless exercises on this in public health grad school; my takeaway from that is, never eat the mayonnaise-based salad at the cookout. It’s always the mayonnaise-based salad.)
There are outbreaks in many herds of dairy cattle across the US, some of which have caused human infections; these human infections have generally been mild, not the terrifying level of severity we usually associate with bird flu. The strain of H5N1 circulating in cattle herds is clade 2.3.4.4b, genotype B3.13. Another strain of H5N1 (2.3.4.4b genotype D1.1) is circulating in wild bird populations. This strain, not the cattle strain, is the one responsible for two severe human cases (that I am aware of), a teenager in British Columbia who remains in the hospital and an adult in Louisiana whose hospitalization was reported on yesterday.
What do you, as a member of the general public who does not work with potentially infected animals, do to protect yourself against H5N1 at this point? Two things: 1) do not drink raw milk, and 2) avoid contact with wild birds, especially dead ones; avoid contact with birds in general.
Easy enough, right?
This advice leaves out some populations of people that it is all too easy to overlook: poultry and dairy farm workers. These are people who have regular contact with potentially infected animals. Remember -- at this point, H5N1 can jump from other animals to human beings and cause infections that way, but it can't yet spread between human beings the way Covid or seasonal flu can.
Obviously, these H5N1 outbreaks are a hybrid public health/labor and workers’ rights issue, as so many are. Agricultural workers are not well-protected by what dogshit labor laws our country does have; many work in fiercely exploitative anti-union states, and many are undocumented. I’d be shocked if major industrial poultry farms, for example, are being proactive about supplying their workers with personal protective equipment for handling and being in close proximity to potentially infected birds. I could write a whole densely-researched post (or a book — Mike Davis wrote a whole book about this!) on this particular issue, but in the interest of time, and staying briskly on topic, I’m not gonna do that here.
What I will say is that I think an obvious opportunity for some public health organizing work presents itself here. Let’s get these workers PPE. If anybody who reads this newsletter knows anybody who works or organizes with people who work closely with birds or cattle (I’m not so delusional as to think that any of the low low number of subscribers to this newsletter are poultry farm workers, but if they are, hey! Hello!), hit me up — I’m happy to talk about this and advise in whatever capacity I can. (I’m also not so delusional, as I used to be, that I think I can sort of do it all or force it to happen just by applying myself really hard.) As is so often the case, occupational health and public health are one and the same; the better protected farm workers are from pathogens circulating in animals, the fewer opportunities for human infection and a dreaded “crossover” event.
One final note. Be careful who you trust. I don’t have all the information here, I don’t know everything, and anything I say in this newsletter or to any of you is always provisional — it could change at any time. Beware, especially, Covid influencers and news sources who have vested interest in presenting a frightening picture. Something is wrong when an individual’s or an oulet’s business model prevents them from just saying that Covid cases are low when Covid cases are low, as they have been for most of this fall. (Michael Hoerger is on about the “silent surge,” which is exactly the kind of thing someone with nothing to go on would invent. Apparently there’s some disagreement between him and another fake wastewater-to-cases modeler, JP Weiland, which I haven’t investigated but which I’m sure is funny.)
This extends to bird flu. The irresponsibility of Covid influencers and news sources, even serious ones, has been incredibly disappointing to me. Just yesterday in the caption of an Instagram post about the State of Emergency declared by Gov. Newsom in California, The Sick Times (which is a good and generally reliable outlet that I hold to a higher standard than random influencers) posted this:
Other experts recommend wearing a high-quality respirator, like an N-95, to protect yourself from the virus [H5N1], which, like SARS-CoV-2 (the virus that causes COVID-19) is airborne.
Are these experts in the room with us right now? This is, to put it gently, highly misleading. H5N1 is not “airborne” in a meaningful way right now; the only way to get it is by having contact with infected animals or surfaces that have come into contact with the piss/shit/blood of infected animals. But the implication in this post and others — that cases are spreading among people — is false. H5N1 is spreading among animals, and some of those infections in animals are infecting humans who are in contact with the animals. The difference matters a whole lot.
It seems clear to me that that these types of communications are well-intentioned and intended to push people towards masking for Covid. But this is dangerously short-sighted and Covid-centric in a way that does not serve anyone — and is not harmless. These types of little fibs about bird flu focus attention away from the obvious and pressing occupational health issues raised by the state of bird flu as it currently, actually exists. That is bad. Masking is not a bad idea, but as a general recommendation for the general public, masking only helps for things that actually are spreading person-to-person through infected aerosols and droplets in the air: Covid, seasonal influenza, RSV, the common cold. Not H5N1. Because H5N1 is not spreading person to person at this time. I cannot repeat this enough. Hopefully the time will not come. If it does, I will be honest with you about it, though.
It’s a basic axiom in Covid news-and-influencer-world that public health destroyed its credibility by downplaying Covid — aka by lying. Whatever the merits of their specific critiques (some have merit, some don’t), as a general truism, it cuts both ways. You destroy your credibility when you lie. Especially when the lie is in service of a narrative that you have a vested interest in.
To summarize: don’t drink raw milk, don’t touch wild birds live or dead, and don’t let your animals (dogs, cats) touch wild birds either.