How Worried to Be About Bird Flu

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Over the past several months, bird-flu numbers have been steadily ticking up, especially among farmworkers who interact closely with cows. I spoke with my colleague Katherine J. Wu, who reports on science, about her level of concern right now, and the government’s response to the spread of the virus so far.

Lora Kelley: We last spoke in April, after a dairy worker became infected with bird flu. At the time, you described your level of concern about bird flu as “medium.” How would you describe your level of worry now?

Katherine J. Wu: At this point, I would upgrade it to “medium-plus.” I don’t think I will upgrade to “high” unless we start to see strong evidence of human-to-human transmission. I am not ruling out that possibility, but we aren’t there yet.

The situation has gotten quite a bit worse since last spring. We are seeing consistent infection of dairy workers, meaning an especially vulnerable population is exposed in their work environment. Each time the virus infects a new person, it’s an opportunity for it to evolve into something that could eventually become a pathogen that moves easily from person to person.

Lora: What could public-health officials have done differently in recent months to contain the outbreak?

Katherine: Part of the reason I feel concerned is the government’s lackluster response. The movement of the virus into cows was a huge red flag. Cows have never been a known source of this flu, so that was a complete surprise. That should have been a moment when officials said: We really need to contain this before it gets out of control. If some of the first afflicted herds had been kept from moving around, or even culled, it’s possible that the virus might have been contained before dairy workers got sick.

The USDA has ramped up its testing of milk, and the CDC is still working hard to do outreach to farmworkers, who are the population most at risk here. But there could still be more testing at the individual level—individual animals, individual people. There could be more frequent, aggressive sampling of where the virus is in the environment, as well as on farms.

Representatives at USDA and CDC have denied that their response has been inadequate—though independent experts I have spoken with dispute that. To be clear, officials can’t fully predict the future and stop an outbreak the second it starts to get bad, and critics aren’t demanding that. But right now, it’s still a very reactive approach: We see that the virus has been here; I guess we can keep checking if it’s there. But a more proactive approach with testing and better communication with the public would really help.

Lora: How has the government’s response to bird flu compared with its response to COVID?

Katherine: There’s no doubt that having COVID in the rearview affected the government’s response. I think they didn’t want to overreact and cause widespread panic when there wasn’t a need. That’s fair, but there’s a middle ground that I think they missed.

The response to COVID was by definition going to be haphazard, because we didn’t have a preexisting arsenal of tests, vaccines, and antivirals. We hadn’t dealt with a coronavirus like that in recent memory. Here, though, there is a slate of tools available. We’ve dealt with big flu outbreaks. We know what flu can do. We know that flu, in general, can move from animals into humans. We’ve seen this particular virus actually move into people in different contexts across the world.

Lora: Have we missed the opportunity to mitigate the spread of bird flu?

Katherine: Because there has not yet been evidence of sustained human-to-human transmission, there is still time to intervene. Did officials miss some opportunities to intervene more and earlier? Yes. But that doesn’t mean that from here the attitude should be I guess we should just let this roll.

Lora: We may have RFK Jr., a vaccine skeptic, leading the Department of Health and Human Services soon. How might his leadership affect the bird-flu response?

Katherine: I don’t think there is a need to roll out bird-flu vaccines to the general public yet. But I think there are likely to be major changes to public-health policy in this country. RFK Jr. has specifically said that the National Institutes of Health will be taking a break from focusing on infectious disease for the next few years, and that doesn’t bode terribly well. Infectious diseases are not going to take a break from us.

Lora: Are there lessons from the COVID era that the public should better absorb in order to deal with illness more broadly?

Katherine: To be fair, it’s hard to avoid getting sick in general, especially at this time of year. During the worst of the pandemic, when people were still masking more consistently and not going into public places, we did get sick a lot less often because we were avoiding each other.

That said, I think people did forget very, very quickly that the things that worked against COVID work well against a lot of other diseases, especially other respiratory viruses. I am not saying that we all need to go back to masking 24/7 and never going to school or work in person. But maybe don’t go to work when you’re sick—a practice that all employers should enable. Maybe don’t send your child to day care sick. Maybe don’t sneeze into your hand and then rub your hand all over the subway railing. Wash your hands a lot.

Unfortunately, there is this tendency for a really binary response of doing everything or nothing. Right now, people seem to be leaning toward doing nothing, because they are fatigued from what they felt like was an era of doing everything. But there’s a middle ground here too.

Bird flu is a national embarrassment.
America’s infectious-disease barometer is off. (From April)

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