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H5N1 Update: How concerned should you be?

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But first, Covid-19. Last week, hospitals were no longer required to share data on Covid-19 hospitalizations. However, Health and Human Services proposed a new rule requiring hospitals to continue reporting Covid-19 hospitalizations during non-emergency times. Public comment is now open. Please go HERE to provide your opinion. (My humble opinion: This is an essential system needed to protect our communities’ health and safety.)


Now, onto H5N1. A State of Affairs and your top questions answered.

H5N1 State of Affairs

There are 36 known infected herds across 9 states. The last identified herd was on April 25. Is this fizzling out? Could be. Or, more likely, it’s continuing to spread without us knowing. Testing animals and humans is still voluntary, and asymptomatic testing is not happening.

We are flying blind.

This is nicely demonstrated in wastewater. There are quite a few areas where Flu A is “high” or “medium” in wastewater—indicating H5N1 since we are out of flu season— but where herds have not been identified. This is most likely from animals (like milk dumping), but we certainly could use more clarity on what is exactly causing the increase.

Flu A levels in wastewater sheds across the United States. Figure source: WastewaterSCAN; Annotated by YLE

There is still just one confirmed human case. I would not be surprised if there were more undetected, though. Some veterinarians have reported that workers have symptoms on farms with sick cows but didn’t test. The good news is that we’re not seeing huge clusters of sick people in emergency departments. So, if there are more human cases, I’m pretty confident they’re mild, from direct contact with sick animals.

1. How concerned should you be?

H5N1 is taking up a lot of brain space for epidemiologists, virologists, and veterinarians alike. Alarm bells are going off, many questions are thrown around, and frustration is brewing.

Concern has percolated to the public. I tell my family and friends: H5N1 is something to watch, but for the general public, should only take up about 2-7% of your headspace.

Three reasons:

  1. Spillovers happen all the time, but very few become pandemics because many unlucky things must occur in sequence. The probability of a pandemic in any given year is 2%; this outbreak has increased it a little (I would wager 7%).

  2. The risk to the general public today remains low. According to a risk assessment report from Dr. Caitlin Rivers’ team at John Hopkins, we are currently between risk scenarios 2 and 3 below. This isn’t March 2020—not even January 2020. H5N1 is not spreading among humans, and this virus isn’t novel; we have been studying it for years. Risk will ramp up if we see human clusters (Scenario 4) or sustained human spread (Scenario 5).

Table Source: Johns Hopkins University; Annotated by YLE
  1. There’s not much you can do. Don’t drink unpasteurized milk. (It isn’t sold in grocery store chains, but you can find it at farmers markets, etc.) Don’t touch wild birds. And if livestock animals look sick, stay away. Call your Congressman and urge pandemic preparedness and/or biosecurity support.

We are coming off an exhausting and hugely traumatic Covid-19 emergency. Many of us aren’t psychologically or physically ready for another, but our survival sensors remain on high alert. Watching that we haven’t learned lessons from Covid-19 after all we went through is equally frustrating.

But right now, H5N1 remains a low-chance, high-consequence situation.

2. What are the symptoms of H5N1 infection?

Unless you work closely with livestock, have had contact with dead birds, or drink raw milk, it’s very unlikely that H5N1 is causing your symptoms.

Symptoms can range from asymptomatic to severe. Textbook symptoms for H5N1 are like the flu: fever, chills, cough, runny nose, etc. Some people also get red eyes because our eyes have bird flu receptors. The only symptom the Texas farmer had was red eyes (see his eyes in the picture below).

3. Can this affect my pets?

Domestic animals—cats, dogs, and backyard flocks—can get H5N1 if they contact (usually eat) a dead or sick bird or even its droppings. The current cow outbreak revealed another infection pathway: unpasteurized milk.

Cats on farms in Texas with infected cows got very sick; 50% died (presumably) from drinking raw milk.

Cat's Sweet Friendship With Cows Is So Pure and Beautiful

4. How do we know that our food is safe?

FDA found dead viral fragments in milk. It sounds scary, but we have over 100 years of data on the effectiveness of pasteurization. To confirm, the FDA tried to grow an active virus from pasteurized milk samples at our grocery stores. These experiments failed, which means virus fragments detected in milk were broken pieces that could not replicate and thus could not harm humans.

They also tested other milk products, such as cottage cheese, sour cream, and beef, in grocery store products. All are safe to consume.

Don’t drink unpasteurized milk. It can make you very sick.

5. How dangerous is H5N1 to humans?

You will see a 50% fatality rate cited. Technically, this is correct because it’s listed on WHO’s website.

However, the “true” fatality rate is likely lower for three reasons:

  1. This is among the cases detected. Past antibody studies of H5 suggest we are missing many infections.

  2. When viruses mutate for human-to-human spread, they have to make trade-offs. Usually, this is trading disease severity for transmissibility.

  3. We may have some cross-protection with regular flu strains. We’ve all seen N1 (the second part of H5N1) a bunch of times through flu vaccines and/or infection.

Of course, as we learned during the pandemic, even a small percentage of a large number of people is a large number. It could be devastating. So, regardless of the exact number, we need the government to prevent this from jumping to humans.

Bottom line

The H5N1 puzzle marches on. The risk to humans is not uniform. Unless you work on a farm or drink unpasteurized milk, keep H5N1 as a small nugget in your headspace. If risk changes (which it can and can quickly), at the very least, I will let you know.

In the meantime, local, state, and federal governments and key partners really need to get a handle on this so a pandemic can be prevented. The time to stop H5N1 is now.

Love, YLE

P.S. Keep those questions coming!


“Your Local Epidemiologist (YLE)” is founded and written by Dr. Katelyn Jetelina, M.P.H. Ph.D.—an epidemiologist, wife, and mom of two little girls. During the day, she is a senior scientific consultant for several organizations, including CDC. At night, she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

Subscribe now

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sarcozona
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Don’t just keep it as a nugget in your headspace! Advocate for labor protections and healthcare for the undocumented farm workers!
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The WHO Ensured They Had Clean Air and Ventilation While Telling the World Covid was Not Airborne

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Like most of us - I’m feeling hurt & betrayed by the knowledge that the WHO quietly upgraded their ventilation & air quality while pushing droplet dogma to the masses. They knew it was airborne & only protected themselves. 

Let’s face it - we’ve known for a long time that many governments and people in positions of power have been taking more Covid precautions than they publicly admit. They downplayed the risks to the average Joe while using as many layers of protection as possible for themselves .

The World Economic Forum in Davos was perhaps the best example of this - where attendees had access to PCR tests and state of the art ventilation and filtration to lower their risk of Covid. Clean air for me but not for thee. 

Despite this not being new information - the WHO news hits extra hard. These are the people who are supposed to be overseeing the literal health of the world. Keeping us safe, advising us of risks, educating us on prevention. 

Yet they pushed droplet dogma for FOUR years - and people died or were left permanently disabled. They allowed bad science like cloth masks & 6 foot distancing requirements to proliferate while taking actual airborne precautions for themselves.  

They quietly walked things back a few weeks ago and finally (albeit unenthusiastically) acknowledged that Covid is indeed airborne (while changing the definition of airborne). The problem is … who’s going to listen to them now? The guidelines have made no sense for 4 years and their credibility is severely damaged. 

So I’m mourning. I’m mourning the thought of what could have been. If the WHO had admitted it was airborne & advised governments to take the same precautions they were taking for themselves … how many lives could have been saved? How many people could have avoided disability? 

I’m also mourning the loss of trust in our public institutions and science. It’s having a downstream impact on health the likes of which we’ve never seen - and I fear it’ll only get worse. And it’s all too easy to understand how we got here. 

If the “experts” tell you that a cloth mask, sanitizing groceries, washing hands & standing 6 feet apart will prevent spread of COVID …. And you get Covid anyways … you’re going to distrust them. 

If you followed all their rules only to find out they took far more precautions for themselves? You will distrust them. 

If you rushed out to get the vaccine and happily went vaxx and relax only to become seriously ill and disabled? You will distrust them. If you’re independently following the science and know that a respirator and clean air is necessary for prevention? You will distrust them. 

The guidance we’ve received since the beginning of the pandemic has almost always been wrong. And no one has stood up and admitted that. No one has said sorry. So we see more and more people distrusting public health, ignoring the science & endangering their health. 

I don’t know where we go from here but I know that it’s going to take a lot for people to get over the betrayal they’re feeling right now. Just like it’ll take a lot to undo the damage done and squash the rising anti-science, anti-vaxx movements that are growing the world over. 

But we have to try. Literal lives are at stake. People are still dying and becoming disabled every day - and we know that risk goes up with cumulative infections. In 5-10 years there could be very few people left who aren’t experiencing long term health consequences. 

I wish people in postions of power like the WHO would publicly say “we’re sorry - we got it wrong.” I genuinely think it would go a long way. People need to hear them say the actual words…. And apologies can do wonders for healing trauma. There’s much healing to be done. 

Until that day - I hope and plead with people to continue following the science and advocating for clean air, better vaccines & treatments, respirators and a layered approach to Covid. It’s unfortunate so many of us are doing the job of public health - but it’s necessary. 

Days like today it might feel impossible - the pain & anguish too much to bear. But never lose sight of the fact that there are people out there who see and appreciate what you’re doing. Who wouldn’t know how to clean the air or choose a respirator if it weren’t for YOUR advocacy.

Regular people on social media may not be changing policy at the public health or government level (yet)… but that doesn’t mean we aren’t saving lives. Even if you only reach one person… that’s one person who might avoid death or disability because of what you shared. 

So keep up the fight. Call out injustices when you see them - but then refocus on the message at hand. Covid is airborne. It’s not over. It causes devastating Long Covid. The best way to prevent it is a layered strategy that includes clean air & respirators. We can do this.

Thank you for reading The Disabled Ginger. This post is public so feel free to share it.

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If you want to learn more about the Covid pandemic and agree that some of the best information comes from people donating their time and energy and sharing on social media - there are a few excellent SubStacks I want to recommend. All of whom have inspired me to write more on the subject of public health and Covid - but who’ve also been integral to helping me keep myself safe throughout the pandemic.

writes some of the best Covid journalism I’ve found. Her pieces are always timely, accurate and tackle issues that mainstream media seem unwilling to discuss. She recently wrote about the WHO changing the definition of airborne (and the lives lost due to their refusal to call Covid airborne in the first place).

first landed on my radar via twitter/X - and writes about the pandemic, public health and issues of social justice. Recently he wrote one of the best pieces I’ve seen on Paul Alexander’s passing - the last man in the iron lung. 

writes about the pandemic, climate change and being a prepper/doomer. Her posts are always insightful and challenge me to look at things in a different way.

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rocketo
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seattle, wa
sarcozona
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Experts blast CDC over refusal to test sewage for signs of H5N1 bird flu virus - Los Angeles Times

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It emerged as a powerful tool for public health officers during the COVID-19 pandemic, when it was used to gauge the prevalence of coronavirus in communities across the nation.

But wastewater surveillance — the testing of sewage for signs of pathogens such as SARS-CoV-2, poliovirus and mpox virus — has yet to be employed in the tracking of H5N1 bird flu virus.

Now, as officials attempt to determine the extent of bird flu outbreaks among dairy herds, some experts are urging that wastewater surveillance begin immediately. Others are faulting the U.S. Centers for Disease Control and Prevention for reportedly discouraging its use.

“It has been consistently demonstrated that wastewater surveillance only enhances traditional surveillance, and often outperforms it when it comes to early/timely outbreak or surge detection,” said Denis Nash, distinguished professor of epidemiology and executive director of City University of New York’s Institute for Implementation Science in Population Health.

“In this case, since traditional surveillance is not really systematically occurring, and wastewater surveillance is relatively low-cost and easy to implement, it makes a lot of sense to me to go ahead and deploy it strategically,” said Nash, whose lab developed New York City’s community-based wastewater surveillance for SARS-CoV-2.

That has not been the view of the CDC, however.

Recently, Marc Johnson, a professor of molecular microbiology and immunology at the University of Missouri, said he was told by the agency not to use a virus assay he’d created for the purpose of tracking H5N1 outbreaks. The reason? Johnson said officials told him it would just add to the confusion.

Johnson said that if the assay had been in widespread use earlier this year, the spread of bird flu through the nation’s dairy herds could conceivably have been stopped, or at least slowed down.

“I always think the more information we have, the better,” he said.

However, he said he did understand the government’s rationale.

“Public health does not like ambiguous information,” he said. “You get a positive, you don’t know if that’s from a cow or a bird. Or maybe from milk poured down the drain.”

The CDC did not respond to questions from The Times.

Concern over the virus escalated in March, when federal officials announced the discovery of avian flu in a Texas dairy herd. Over the next few weeks, reports of the virus in other states began to pop up. It also showed up in barn cats that drank raw milk, and in one dairy worker.

H5N1 bird flu has now been detected in 36 herds across nine states, and health and U.S. Department of Agriculture officials are scrambling to determine its reach. They believe the virus was introduced by a wild bird — either via contact or feed — at a Texas farm in December, giving the virus months to travel to other herds and animals.

The virus was also found in one of five grocery-shelf milk samples tested by federal researchers. Those samples showed the virus had been inactivated by pasteurization, reducing the health threat to people.

In California, where the virus has yet to be detected in dairy cows, wildlife officials are keeping a wary eye on migrating wild bird populations as well as domestic poultry and farm animals.

Eric Topol, a professor of molecular medicine at Scripps Research Institute in La Jolla, said the CDC is “off base” to say wastewater surveillance would cause confusion.

“If anything, we need to track the spread of the virus and its evolution, which isn’t getting done well by USDA and CDC,” he said.

Michael Payne, a dairy educator and researcher at the University of California’s School of Veterinary Medicine, agreed with that sentiment. Although he was not familiar with the assay Johnson devised, he said an accurate test would be valuable.

“Such a wastewater assay could be a useful tool, even given the uncertainty of exactly where the virus was coming from,” he said. “There is a growing body of literature that is using PCR testing in wastewater to measure pathogens of public health interest.”

Nash, of CUNY, said he’d advocate for a “strategic deployment of community-based and facility-based wastewater surveillance.”

He said testing wastewater at hospitals and health clinics would provide clear signals if an outbreak were to occur. Starting testing now, when a baseline for other “confusing” elements such as contaminated milk and bird droppings could be established, would help quell that noise.

He said that in the current situation, “we need reliable early warning because if community spread did happen, every additional day of notice would matter a great deal in terms of potential lives saved.”

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sarcozona
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Head in the sand, geez
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World’s top climate scientists expect global heating to blast past 1.5C target | Climate crisis | The Guardian

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Hundreds of the world’s leading climate scientists expect global temperatures to rise to at least 2.5C (4.5F) above preindustrial levels this century, blasting past internationally agreed targets and causing catastrophic consequences for humanity and the planet, an exclusive Guardian survey has revealed.

Almost 80% of the respondents, all from the authoritative Intergovernmental Panel on Climate Change (IPCC), foresee at least 2.5C of global heating, while almost half anticipate at least 3C (5.4F). Only 6% thought the internationally agreed 1.5C (2.7F) limit would be met.

Many of the scientists envisage a “semi-dystopian” future, with famines, conflicts and mass migration, driven by heatwaves, wildfires, floods and storms of an intensity and frequency far beyond those that have already struck.

Numerous experts said they had been left feeling hopeless, infuriated and scared by the failure of governments to act despite the clear scientific evidence provided.

“I think we are headed for major societal disruption within the next five years,” said Gretta Pecl, at the University of Tasmania. “[Authorities] will be overwhelmed by extreme event after extreme event, food production will be disrupted. I could not feel greater despair over the future.”

But many said the climate fight must continue, however high global temperature rose, because every fraction of a degree avoided would reduce human suffering.

Peter Cox, at the University of Exeter, UK, said: “Climate change will not suddenly become dangerous at 1.5C – it already is. And it will not be ‘game over’ if we pass 2C, which we might well do.”

The Guardian approached every contactable lead author or review editor of IPCC reports since 2018. Almost half replied, 380 of 843. The IPCC’s reports are the gold standard assessments of climate change, approved by all governments and produced by experts in physical and social sciences. The results show that many of the most knowledgeable people on the planet expect climate havoc to unfold in the coming decades.

The climate crisis is already causing profound damage to lives and livelihoods across the world, with only 1.2C (2.16F) of global heating on average over the past four years. Jesse Keenan, at Tulane University in the US, said: “This is just the beginning: buckle up.”

Nathalie Hilmi, at the Monaco Scientific Centre, who expects a rise of 3C, agreed: “We cannot stay below 1.5C.”

The experts said massive preparations to protect people from the worst of the coming climate disasters were now critical. Leticia Cotrim da Cunha, at the State University of Rio de Janeiro, said: “I am extremely worried about the costs in human lives.”

The 1.5C target was chosen to prevent the worst of the climate crisis and has been seen as an important guiding star for international negotiations. Current climate policies mean the world is on track for about 2.7C, and the Guardian survey shows few IPCC experts expect the world to deliver the huge action required to reduce that.

Younger scientists were more pessimistic, with 52% of respondents under 50 expecting a rise of at least 3C, compared with 38% of those over 50. Female scientists were also more downbeat than male scientists, with 49% thinking global temperature would rise at least 3C, compared with 38%. There was little difference between scientists from different continents.

Dipak Dasgupta, at the Energy and Resources Institute in New Delhi, said: “If the world, unbelievably wealthy as it is, stands by and does little to address the plight of the poor, we will all lose eventually.”

The experts were clear on why the world is failing to tackle the climate crisis. A lack of political will was cited by almost three-quarters of the respondents, while 60% also blamed vested corporate interests, such as the fossil fuel industry.

Many also mentioned inequality and a failure of the rich world to help the poor, who suffer most from climate impacts. “I expect a semi-dystopian future with substantial pain and suffering for the people of the global south,” said a South African scientist, who chose not to be named. “The world’s response to date is reprehensible – we live in an age of fools.”

About a quarter of the IPCC experts who responded thought global temperature rise would be kept to 2C or below but even they tempered their hopes.

“I am convinced that we have all the solutions needed for a 1.5C path and that we will implement them in the coming 20 years,” said Henry Neufeldt, at the UN’s Copenhagen Climate Centre. “But I fear that our actions might come too late and we cross one or several tipping points.”

Lisa Schipper, at University of Bonn in Germany, said: “My only source of hope is the fact that, as an educator, I can see the next generation being so smart and understanding the politics.”

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sarcozona
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Israel-Gaza war live: Israeli whistleblowers claim abuse of Palestinians at detention centre

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An official for the UN’s Office for the Coordination of Humanitarian Affairs working in Rafah says all crossings into southern Gaza remain closed, cutting off supplies and preventing medical evacuations and the movement of humanitarian staff.

Around 1.3 million Palestinians — over half Gaza’s population — had sought refuge in Rafah.

Israeli prime minister Benjamin Netanyahu said on Thursday that a US threat to withhold some weapons would not deter Israel from expanding its offensive in Gaza.

A limited Israeli operation earlier this week captured the Gaza side of Rafah’s border crossing with Egypt, throwing humanitarian operations into crisis, Reuters reported.

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sarcozona
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Can-crisociality 🦀〰️🥫 (@inquiline@union.place)

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sarcozona
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