What to know about Bird Flu – Nick Landekic

By Nick Landekic, contributing writer

Bird flu has increasingly been in the news lately, including a report this week of it being found in a bird flock in South County, Rhode Island. Here are a few things you may want to know about it.

What is bird flu?

Bird flu is a form of influenza, called avian influenza and also by the scientific term, H5N1. It’s a viral infection that spreads in birds, cows, and other animals. It can sometimes also spread to people. Like the versions of the flu that people usually get, bird flu can make people severely ill.

As with other viruses, there are multiple subtypes or variants of bird flu circulating. The virus is also constantly evolving. Some types can cause especially severe disease in people. A greater than 50% death rate in people has been reported for infections with the A subtype. About half of all people who have ever gotten bird flu have died, which is why there is so much concern about this.

Can people catch bird flu?

Yes.

In the past, human cases of bird flu were rare and confined primarily to birds. However, in the past year the virus has mutated and made the jump to be able to infect and easily be spread in other animals, including cats, dogs, goats, seals, and most recently and of great concern, cows. People have caught bird flu without any contact with animals, raising the specter that human-to-human is already happening.

As of January 6 there have been 66 confirmed cases of bird flu in the U.S., with one death. Most cases to date are believed to be in farm workers exposed to infected cattle or poultry. So far, human-to-human spread of bird flu has happened, but has been rare.

However, the actual number of bird flu cases in people is believed to be much higher than formally reported. Testing for bird flu is rarely done, and the official counts are just a fraction of actual infections.

How much has bird flu spread?

Bird flu has now been found in all 50 states, including Rhode Island.

To date 623 commercial and 753 backyard bird flocks have become infected with bird flu and have had to be destroyed, a total of more than 140 million chickens and turkeys. This past week 100,000 infected ducks had to be destroyed on a farm on Long Island, New York. This is why the price of eggs has skyrocketed so much lately – there are far fewer chickens left to lay them.

The important news with bird flu is that it has recently mutated to become more easily spread among mammals – with a spike in human infections.

Tens of thousands of seals have died of bird flu, in Maine, Canada, and Argentina.

Of great concern, bird flu has made the evolutionary jump to cows. At least 925 cattle herds across 16 states have become infected.

Importantly, bird flu from infected cows is found in raw milk. It’s possible to become infected with bird flu from drinking raw milk, which is why health experts advise against doing this. Pasteurization kills the bird flu virus and makes pasteurized milk safe to drink. With increased recent discussions from some political types on drinking raw milk, you might want to keep this in mind and decide for yourself if it’s worth the risk.

Cooked beef and cooked eggs are considered safe, but raw meat and uncooked eggs carry the risk of infection.

Bird flu has also spread to pet cats. The infections were believed to be caused by feeding raw meat food to cats, and some have died of the infection.

What are the risks?

All viruses constantly mutate. That’s what they do. Evolutionary pressures dictate that viruses mutate and create new variants to reproduce and spread more efficiently. This means evolving to be both more contagious, and to evade immune system defenses. Contrary to some myths, viruses do not evolve to become “milder.” The mutations that give viruses the ability to spread more easily often also make them more virulent – which is what has been happening with COVID. 

However, the situation has dramatically and quickly changed with the mutation and jump of the virus to cows and other mammals. Studies suggest just a single additional mutation in the bird flu virus would enable to more easily spread from person to person. If this happens with the D.1.1 highly virulent variant of H5N1 bird flu we could be faced with a pandemic of a virus with a much higher death rate than COVID.

The greatest risk of a new and more contagious bird flu mutation happening would most likely occur in someone infected with conventional influenza and H5N1 bird flu at the same time. A key way viruses mutate and evolve to be more contagious is by a process called recombination, when a person or animal is infected with two viruses at the same time. The virions exchange and share information, giving rise to completely new and more fit mutations. This has happened many times with the SARS-CoV-2 COVID virus, resulting in the tens of thousands of COVID variants identified and dozens circulating at any one time. The more people or animals that are infected, the greater the number of new variants produced and the greater the risk of a more dangerous one emerging because of recombination.

Dr. Jeremey Faust, emergency medical physician at Brigham and Women’s Hospital and professor at Harvard Medical School, has estimated the risk of a person being simultaneously infected with conventional influenza and H5N1 bird flu resulting in creating a new, more easily transmissible mutation at 93%.

This is why there is so much concern in the scientific community about bird flu.

If – or more likely, when – this happens we could be facing a penta-demic, with a more contagious variant of bird flu circulating in addition to the high levels and quad-demic of COVID, RSV, flu, and norovirus we are already experiencing.

What are the symptoms of bird flu infection?

Symptoms of bird flu in humans are similar to conventional influenza (though depending on the variant may be more severe) and include:

• Fever: A temperature of 100°F (37.8°C) or greater, or feeling feverish

• Cough: A cough that may be accompanied by phlegm

• Sore throat: A sore throat that may be accompanied by a runny or stuffy nose

• Shortness of breath: Difficulty breathing or acute respiratory distress

• Eye irritation: Redness, tearing, or discharge from the eye

• Headache: A headache that may be accompanied by muscle aches

• Nausea: Nausea that may be accompanied by vomiting

• Diarrhea: Watery or green diarrhea

• Pneumonia: An infection of the lungs that may require hospitalization

• Neurologic changes: Altered mental status or seizures

Left untreated bird flu can often cause severe illness and complications including:

• Pneumonia

• Acute respiratory distress

• Bacterial infections

• Sepsis

• Brain swelling

• Respiratory failure

Bird flu is a very serious infection. If you experience any of these symptoms please seek medical care immediately.

Are there treatments or a vaccine?

If caught early there are a few anti-viral medicines that can be used to treat bird flu including Tamiflu (oseltamivir), Rapivab (peramivir), and Relenza (zanamivir).

Unfortunately, there is no commercially available vaccine yet to protect against bird flu. The regular annual flu vaccine does not protect you against bird flu, but is still important to get it to reduce the risk of co-infection with regular flu and bird flu.

In one of the last actions of the Biden administration the department of Health and Human Services announced $590 million in support to speed the development of mRNA vaccines against bird flu. It is unclear to what extent, if any, the new Presidential administration may support the development of new vaccines or treatments for bird flu.

What can I do to reduce risk of getting infected?

There are things you can do to protect yourself and reduce your risk of becoming infected with bird flu:

• Be thoughtful about being indoors in crowded settings during times of high transmission of respiratory viruses – like right now. Bird flu like other respiratory viruses comes from other people, and spreads in the air. Being in a crowded restaurant or bar, or unprotected on a plane, increases your risk of getting infected.

• Wear a mask. Masks work, and work very well. Masks can help protect you against any respiratory virus, COVID, flu, or RSV in addition to bird flu. The levels of all those respiratory infections remain high in the area. A great many studies have repeatedly shown that a N95 (or equivalent KN95, KF94, or FFP2 mask) worn properly can significantly reduce your risk of becoming infected, and even reduce the severity of illness if you do become infected (by reducing the number of virions inhaled). Consider wearing a mask in crowded indoor spaces or when traveling by plane, train, or bus.

• If you work with birds, wild animals, or livestock, wear protective clothing like gloves, a mask, and goggles.

• Wash your hands frequently when handling birds, wild animals and livestock, or after being in areas where they live. This includes visiting petting zoos, farms, or areas with water features where geese or ducks are found.

• Don’t handle animals who are sick or who’ve been exposed to bird flu.

• Take off your shoes before entering your home if you’ve been in areas where bird like waterfowl or chickens live. This reduces the risk of spreading bird droppings around your house.

• Don’t touch or drink unpasteurized (raw) milk.

• Get the seasonal flu shot. While it won’t directly protect you fro bird flu, it can reduce your risk of severe illness and of getting both avian influenza and seasonal influenza at the same time – a combination that could have a very bad outcome.

• Stay informed. The CDC recently started tracking H5N1 bird flu in wastewater. Like other viruses infected people excrete the bird flu virus in stool and it can be detected in wastewater. Detecting the virus is a sign infection is spreading among people. However, this past week the Trump administration has clamped down on the CDC, FDA, and other health agencies communications and the future of this reporting is uncertain. For the first time in 73 years, this past week the CDC was not allowed to print the widely used and useful Morbidity and Mortality Weekly Report because of a gag order from the Trump administration. Important updates on avian influenza were expected last week that were not allowed to be issued.

Rhode Island does not do any wastewater testing or reporting. Massachusetts has an extensive wastewater testing system. It’s likely if transmission is reported in Massachusetts, we probably have similar problems here.

The People’s CDC is an independent, non-partisan group of public health practitioners, scientists, healthcare workers, and others working to reduce the armful impacts of infections. Dr. Jeremey Faust, emergency medical physician at Brigham and Women’s Hospital and professor at Harvard Medical School, authors the Inside Medicine site with much useful information. Dr. Katelyn Jetelina and other scientists contribute to Your Local Epidemiologist with updates and news on infectious diseases.

With the likelihood of further reductions in federal public health support and attention to infectious diseases in the future, Rhode Island’s poor track record in managing public health aspects of respiratory infections, and the apparent lack of concern of the state medical director (the 5^th in 4 years) it’s going to increasingly be on us to stay aware of what is happening so we can take appropriate measures to protect ourselves and our families.

Robert F. Kennedy, candidate for Secretary of Health and Human Services, has announced his intention to ‘take a break from infectious diseases’ and stopping support for the development of new vaccines and treatments. Too bad infectious diseases like bird flu won’t be taking a break from us.

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Nick Landekic of Bristol is a retired C.E.O. and biotechnology entrepreneur who has spent more than 35 years working in the pharmaceutical industry.