Quick Take
COVID-19 is no longer the public threat it was in 2020, writes retired Santa Cruz physician Jeoffry Gordon, but our public officials have not learned from the tragedy. Bird flu, known as H5N1, is on the rise in the nation and in California, which had its first animal-to-human transmission in the Central Valley four weeks ago. Here, Gordon explains the sort of testing we are not doing and asks citizens to contact the governor and other officials to ask them to be more proactive to prevent another possible pandemic.
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The threat, confusion and disruptions of the COVID-19 pandemic vibrate deep in our memory, even now, almost five years later. Whether you think our national response was too little, or too much, the pandemic was a personal, family, community and national crisis. There is no avoiding that on the whole, the United States did a poor job – in 2020 our whole medical system was overwhelmed, schools and businesses were shut down, over 1.2 million Americans died and many more are left with long-term, COVID-related illnesses.
Speedy development of an effective vaccine was a medical miracle, but it – inappropriately – left us with the impression that vaccination was going to be a cure for the whole problem.
It wasn’t.
One would think we would have learned from this challenge of biblical proportions and we would be doing our utmost to avoid another pandemic or infectious threat. Sadly, this is not so.
Another pandemic threat is on the horizon – the threat of the H5N1 influenza A virus, colloquially known as “bird flu.” The influenza virus caused significant worldwide epidemics in 1918-20, 1957-58, 1968-69, 1977-78 and 2009-10.
Last week, two Central Valley dairy workers came down with H5N1. It was the first case of human transmission from dairy cows in our state and among 16 human cases of bird flu in the nation this year.
As a retired physician who is actively following this trend, I am worried. If this virus can, indeed, transfer from animals, I fear we are setting ourselves up for another pandemic.
This virus first spread to U.S. wild birds in 2016, then to poultry farms, then, just in spring of this year, to dairy cows. It has infected at least 25 mammal species, including domestic and farm cats and house mice. Even with limited surveillance, by mid-August the Centers for Disease Control and Prevention (CDC) had reported 9,831 infected wild birds in 48 states, over 100 million infected poultry in 48 states, and 255 infected dairy herds in 14 states.
Sporadic human H5N1 infections have been reported in 23 countries over 20 years, with a cumulative case fatality rate of more than 50%. In April 2022, the first (mild) U.S. human case of highly pathogenic avian influenza H5N1 virus was reported.
Now, in the past year, we have had 16 human cases from exposure to infected farm animals. In the past month, a person with no known contact with infected animals contracted bird flu. He was hospitalized and is said to have eight contacts who have become ill with as yet-unidentified illnesses.
Here’s the biggest problem. The current general H5N1 status of U.S. dairy cows, beef cattle, swine or humans is unknown because no valid national testing surveillance has occurred.
The U.S. Department of Agriculture (USDA) and the CDC are set up to find infections when they cause illness – not to do a broad sweep to catch and identify the less dramatic extent of mild, asymptomatic or hidden penetration of the virus throughout the country.
As an example, with 1.7 million cows, California is the largest dairy farming state in the country. In August, there were no known H5N1-infected herds. The California Departments of Food and Agriculture (CDFA) and Public Health (CDPH) had protocols for H5N1 screening, but they were voluntary and little used. At the end of August, the first three infected herds were identified.
Now there are 79 infected herds and two infected dairy farm workers. The CDFA has instituted bulk milk testing within 10 miles of each infected herd, but there is no routine testing in other herds or for human cases.
Testing has turned up large amounts of infectious virus in raw milk and rarely in beef from dairy cows. Raw milk is popular in Santa Cruz. Less than half of people who drink raw milk understand that it can contain infectious germs. Pasteurization and cooking to well-done probably eliminates any risk to the general public.
Concerned citizens should write or call the governor, local legislators or the California Department of Public Health to ask them to be more proactive in assessing and monitoring the spread of the H5N1 virus.
Influenza viruses, as we all know from our yearly experience with influenza B seasonal flu, have the capacity to nimbly evolve genetically, thus evading immune protection.
The ongoing and expanding infection of poultry, dairy cows, housecats, mice and now people has created a perfect opportunity for the H5N1 to evolve.
Recently the number of known human cases has almost doubled. Every human infection presents increased risk for the H5N1 virus to mutate and adapt to humans. If it adapts to infect humans – which might have already happened – and/or develops the capacity for human-to-human spread, we could have another pandemic.
The CDC has repeatedly, and correctly, reported that influenza A H5N1, bird flu, is low-risk. This is true currently, but the possibility of a high-risk variant genetically evolved to infect and multiply in humans is no longer small and is increasing by the week.
Anticipatory public health, preventive intervention has a unique calculus. When it is most successful, it is outside our attention. Nationally, without thinking about it or taking any action, we enjoy a clean and safe water supply due to universal public-health- guided infrastructure. We no longer have polio, smallpox and measles epidemics, afflicting thousands, because of evidence-based vaccinations.
Public health interventions can appear excessive, expensive, intrusive and have uncertainty. Effective public health initiatives might not fit into the usual political and civic considerations of practicality and acceptance. If the expected epidemic does not occur, there will be debate about whether the intervention was successful – or unnecessary.
This should not prevent proactive preventive assessment and intervention when the risk is substantial, as it is now with H5N1.
Here in Santa Cruz we often enjoy an idyllic isolation. But COVID-19 taught us that this is an illusion. The adverse evolution of bird flu influenza has the potential to impact us all.
Attentive, concerned citizens should write or call the governor, local legislators or the CDPH and CDFA. Let’s get them to wake up and be more proactive in assessing and monitoring the spread of the H5N1 virus.
Jeoffry B. Gordon had a family medicine practice in Santa Cruz for 35 years until his retirement 17 years ago. He spent four years in a federally qualified health center treating the unhoused. He is currently a member of the California Citizens Review Panel for Critical Incidents (fatalities due to child abuse). He served as a medical bioethics consultant at Sharp Memorial Hospital in San Diego for 10 years. He spent eight years on the Medical Board of California, which licenses and disciplines physicians. Gordon lives in Santa Cruz and is a widower with two daughters and four grandchildren.