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SITREP: H5N1
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Public Health
SITREP: H5N1
By Evan Anderson
Why Read: Due to the lack of effective response to the ongoing pandemic of H5N1 “bird flu” in wild animals and livestock, the danger of a human pandemic has increased dramatically. This week, we cover where we are now, what can be done, and how you can be better prepared for the possibility of a human-to-human H5N1 outbreak.
________
It’s not a question of if; it’s more a question of when. [. . .] Once the virus gains the ability to attach to the human receptor and then go human to human, that’s when you’re going to have the pandemic.
– Former CDC Director Robert Redfield (6/15/24)
Whoever wins the election is going to have to deal with a bird flu outbreak that shows no signs of letting up, and now seems destined to become the next pandemic [. . .] at a time when neither administration seems willing or able to focus on fighting infectious disease.
– Former US Surgeon General Jerome Adams, in an X post (11/4/24)
In our issue “The Next Pandemic: H5N1 and Why You Should Be Paying Attention” (6/3/24), we covered the rapidly spreading H5N1 pandemic in animals, noting insufficient public-health response and the resulting high likelihood of an eventual human pandemic. We promised then to keep members apprised of important updates. Unfortunately – in large part due to the exact issues we described – the situation has since become much more grave.
First, last spring’s move to allow the USDA to run the response to the outbreak spreading across the United States in cattle has not proven wise. The organization has many connections with industrial farming, creating a complex and politicized situation on the ground for the veterinarians it normally employs to ensure the health of America’s herds. As Katherine Eban noted in an excellent Vanity Fair piece on the nature of the response:
At that existential moment back in March, when the virus was first detected in cows, veterinarians involved in the response had every expectation that a well-honed network of experts, led by USDA scientists, would immediately rev to life.
But it didn’t. “Nobody came,” says one veterinarian in a Western state. “When the diagnosis came in, the government stood still. They didn’t know what to do, so they did nothing.”
Now, H5N1 has spread to more than 324 dairy herds in 14 states and has sickened at least 26 farm workers exposed to infected cows and poultry. Those numbers are widely assumed to be vast undercounts, as there is no formal nationwide surveillance program, many dairy farmers oppose testing, and few farm workers are being screened.
Second, the number of animals H5N1 has been confirmed to have infected has grown – including in pigs – dramatically increasing the threat that rampant spread and a genetic mutation or recombination event that leads to human transmission could occur.
Third, in a situation that feels akin to the early days of the COVID pandemic, it now appears that health authorities who claimed the virus was not spreadable by respiratory routes were likely wrong. Multiple studies have shown droplet spread in animal models that indicate the possibility of spread without contact (albeit, less so than seasonal flu). While surfaces and direct contact with animals are clearly also a way the virus can spread, this potential respiratory-droplet factor is concerning.
All of this adds up to a situation in which a human pandemic of H5N1 is increasingly, imminently, likely. With spread occurring in many disparate regions, and with more human cases every day, human-to-human transmission is just a mutation away. Small wonder, then, that out of 115 farmworkers examined in a recent serology study, 7% of them tested positive for a recent H5N1 infection; or that LA and San Francisco recently found H5 in their wastewater samples.
We are interacting far too much with this virus at present to avoid an eventual pandemic.
Unfortunate news, in multiple categories. But as we mentioned back in June, our purpose is not to alarm you, but to inform and arm you against potential problems. With that in mind, let’s begin with the current situation regarding animal outbreaks.
The discovery that an avian influenza A virus has infected a new mammal species is always concerning, especially when the virus is detected in pigs, which are susceptible to influenza viruses circulating in pigs, humans, birds, and other species. These viruses can swap genes through a process called genetic reassortment, which can occur when two (or more) influenza viruses infect a single host. Reassortment can result in the emergence of new influenza A viruses with new or different properties, such as the ability to spread more easily among animals or people. Reassortment events have happened in pigs in the past. A series of reassortment events in pigs is believed to have caused the 2009 influenza A(H1N1) pandemic. Based on available information, the risk to the general public remains low; however, CDC is continuing to gather information.
– US Centers for Disease Control (11/4/24)
One of the larger underlying problems with the current outbreak of H5N1 is that, unlike past outbreaks, it is being found in many species and in many places.
Briefly, let’s recap where we are.
Detections of H5N1 have now been found in a variety of animals. At this point, it is safe to assume that most regions likely have ongoing outbreaks in animals, given that initial spread from birds to animals has been found on multiple continents over years. That being said, the most concerning outbreaks (and the one about which we have the most data) are those found in domestic animals in the United States at the moment, which are also repeatedly crossing over into human infections. Currently, H5N1 has been identified in:
Wild birds, including ducks, geese, swans, gulls, terns, storks, plovers, sandpipers, and others:
Counties Affected
Counties in which bird flu has been detected in wild birds are marked in purple.
Domestic birds, including chickens, turkeys, pheasants, quail, ducks, and geese:
Counties Affected
Counties that have reported bird flu outbreaks are marked in purple.
Mammals: Aquatic mammals, such as seals, dolphins, otters, and sea lions; wild predators, such as big cats, bears, coyotes, foxes, minks, possums, and martins; and species that more commonly interface with humans, such as mice, raccoons, pigs, and house cats:
Of course, cattle are on the list – and the number of herds across the country that are infected has increased dramatically over the last few months. Numbers of infected herds have increased across all of the states that were known to have infections in June, with even more states joining now. Total infections are currently at 446 herds in 15 states.
The recent rapid spread and increased mortality in cattle across California in particular has been very concerning. Herds in that state were seeing mortality rates as high as 15%-20% – much higher than that reported elsewhere. This has also led to overwhelmed infrastructure when it comes to disposing of dead animals – meaning, infected deceased cattle are lying in piles outdoors and increasing the risk of spread. Biocontainment in these cases can be critical, as old carcasses are far harder to clean up; and further transmission occurs when scavengers enter the scene.
Source: USDA
October also saw the first report of an infected pig, in Oregon. This is particularly concerning in that pigs share many characteristics with humans and are an ideal candidate for incubation of viruses that go on to spread in human populations.
Finally, and most concerning, the number of human beings contracting H5N1 is on the rise. What originally appeared over the summer to be just a few farmworkers with the virus has burgeoned into 46 confirmed cases in 6 states as of Wednesday of this week.
Inherently, this raises the chances that genetic mutations that are better adapted to human physiology may occur. As we head into the normal flu season, it also increases the chance of a recombination or reassortment event between normally circulating and more transmissible strains of flu and H5N1 – which, in the worst case, would lead to high transmissibility between human beings and high mortality.
Traditionally, direct contact and surface contamination by influenza viruses has been a key concern. This remains the case, with those farmworkers now infected likely having been in heavy contact (and with many “known unknowns” about personal protective equipment and use) with infected animals in myriad ways. Last month also saw the publication of two studies with troubling implications. Both sampled virus from a known cattle outbreak and replicated it in lab animals. Using a strain from Texas, the work confirmed spread by direct contact, fomites, and airborne droplets in ferrets (used for such experiments because their lung tissue is similar to that of humans). According to an NIH brief on the research:
The scientists found that the virus infected and replicated efficiently in cultured human lung cells. It could also infect cultured cells from the human cornea, albeit less efficiently than in lung cells.
The virus caused lethal infections in all infected mice and ferrets. This is not unusual for an H5N1 virus. However, the cow virus studied before killed only 1 in 4 infected ferrets and required a much higher dose to kill mice. Virus was found not just in the respiratory tract, but in many tissues throughout the body, including blood, spleen, and liver.
Thus, the changes observed here are for the worse. If the virus is allowed to circulate indefinitely, and to continue to infect humans, the possibility of a transmissible human strain will increase.
When it comes to pandemics, the options for addressing the risk to public health fall into two categories: either prevent it or address it after it’s in full swing. The easier, by far, is prevention. Even at the last proverbial minute (picture the spread of SARS-1 and the containment efforts that stopped it), an ounce of prevention can stop a global disaster and save millions of lives.
Most of the prevention work that can be done requires strong and well-resourced governmental response. Look for the following to occur if we are to improve the prospective situation:
- Large increases in animal and human disease surveillance (testing)
- Improved biocontainment, through training of workers and new required standards for those working with infected or potentially infected animals
- Moves to improve methods for preventing outbreaks on farms via better cleaning, culling, infected animal quarantine, and other standards
- Employment of new avenues for the treatment or prevention of disease in animals
All of these approaches may still not be enough, but they are currently deeply lacking. The risk level is simply too high to justify a lackluster approach to public health.
Meanwhile, after years of pandemic already, the world’s public-health infrastructure is badly in need of reinforcements. A letter from a team at the Johns Hopkins Bloomberg School of Public health put it succinctly, noting:
The COVID-19 pandemic has led to depleted and weakened health systems. An estimated 180,000 healthcare workers lost their lives during the pandemic, and some estimates show that at least one in five have left the field and about 31% intend to leave the health workforce within the next 2-3 years as a result of the pandemic. Public health has seen an unprecedented attrition of national, state and local public health officers and epidemiologists. In addition, century-long legal precedents and once-well-established powers that enable leaders and agencies to implement control measures have been rolled back by legislators or limited by courts. The ongoing COVID-19 pandemic has paradoxically left the world probably even less prepared for stopping the next outbreak from becoming a pandemic. The world is in a precarious public health position that warrants weighing potential pandemic risks more seriously. The next pandemic may not be influenza, but the risk calculus for such a pandemic must be prepared now.
Governments should recognize the strain that has been put on public-health systems and move to address it. Without an increase in staff, resources, and research, we can be sure that the next pandemic will find us off-balance.
The hard way to address pandemics, of course, is to fight them once they’re already well under way. We have just been through exactly this kind of scenario with COVID, but a potential and untraced H5N1 pandemic in humans would be even more disruptive. The main thing to keep an eye out for is evidence of human-to-human transmission.
For anyone from investors to businesses to the common citizen, the emergence of human-to-human transmission should trigger a re-evaluation of the level of risk. With the risk of such an event being on the rise, it is wise to think about contingency plans. An easy way to do so is to consider the biggest problems you, your family, your workplace, and/or your portfolio had in 2020. In the event of an H5N1 pandemic, many of the same problems would occur, only magnified.
Contingency planning for what you, your company, or your country will need to do in the case of another pandemic could save countless lives, and dollars. The ability of governments the world over to respond (in funding, in public-health resources, and in public will) is much more limited than it was in 2020.
In many ways, the point of doing so is in the planning itself. In the case of a new pandemic, much will be unknowable – so exercising mental flexibility in how we think about our operations ahead of time is key to resilience if disaster strikes. Building strong, iterative contingency planning skills (in both your personal and your work life) is far better than building specific plans and inflexibly trying to stick to them.
With risks on the rise, this is the time to think about continuity in the face of disruption. If there were to be a crisis, ask yourself if you, your family, and/or your business would be:
- financially prepared
- able to adjust to supply-chain disruptions
- able to shift your personal and work lives to digital platforms if need be
- vulnerable to sudden cessations of in-person interactions
What might you do now to prepare for a crisis?
It is this habit, this method of clear-eyed gaming-out of possible circumstances, that allows us to be resilient in the face of potential catastrophe. In a Harvard Business Review piece on resilience (both in business and in life), Diane Coute noted:
A common belief about resilience is that it stems from an optimistic nature. That’s true but only as long as such optimism doesn’t distort your sense of reality. In extremely adverse situations, rose-colored thinking can actually spell disaster. This point was made poignantly to me by management researcher and writer Jim Collins, who happened upon this concept while researching Good to Great, his book on how companies transform themselves out of mediocrity. Collins had a hunch (an exactly wrong hunch) that resilient companies were filled with optimistic people. He tried out that idea on Admiral Jim Stockdale, who was held prisoner and tortured by the Vietcong for eight years.
Collins recalls: “I asked Stockdale: ‘Who didn’t make it out of the camps?’ And he said, ‘Oh, that’s easy. It was the optimists. They were the ones who said we were going to be out by Christmas. And then they said we’d be out by Easter and then out by Fourth of July and out by Thanksgiving, and then it was Christmas again.’ Then Stockdale turned to me and said, ‘You know, I think they all died of broken hearts.'”
It is not unbridled optimism that makes us resilient. It is training ourselves: to adapt to change as habit; to think about ripple effects and what can proactively be done to address them, ahead of time. To prepare for many contingencies calmly without being overwhelmed and blindly reactionary if they occur.
In the face of a burgeoning pandemic, we should actively work to encourage our governments, our companies, our families, and ourselves to get deeply into the habit of resilience.
Understanding that we are all capable of adapting is the first step.
Mastering it is what we will need moving forward.
As always, your comments are welcome.
Sincerely,
Evan Anderson
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Subject: Chinese hacking coup
Evan,
Ken Kreutz-Delgado
Senior Technical Fellow
Mathematics & Machine Learning
Pattern Inc.
Redmond, WA
Ken,
Thanks, Ken. A very troubling failure.
Evan Anderson
Subject: “SNS: The US Food Economy’s Rule of Fours”
Berit,
Where to start? Masterfully-written and -condensed, as usual, Berit. And as you allude to, this concentration is not unique to food, it permeates most major industries (FFANG, for example). I don’t think I can add any value re: market concentration, but maybe I can from another angle – the climate, soil, and health (CSH) costs of this concentration.
The quick history of how we got here can be tracked through three key moments – 1) coming out of WW2, the production of chemicals we killed Nazis with “had to” be repurposed, so what do we do? Created pesticides, herbicides, and fertilizers to spread on human food. If that sounds bizarre, believe me, I had to look it up a half dozen times to believe what I was being told when I started this gig in 2022; 2) Earl Butz, the Sec’y of Agriculture about 50 years ago, said it’s all about farms getting BIG (or go home); and 3) what followed was a complex web of USDA subsidies of tens of billions of $$$ that incentivize the industry and behavior we have today. All the beef packers et al. did was exploit the rules of the game (and manipulate them as well). You said it well: “the downstream effects on US agriculture is to weaken its resilience and shift to monoculture crops to attract the benefits of federal subsidies.”
The CSH costs that resulted are rapidly degrading and disappearing topsoils (there is an end game on that one), loss of massive carbon sequestration potential in our soils, and the acceleration of highly-processed (sugar, artificial everything, etc.) food that has had massive public health costs. None of those consequences is a political statement by the way, they are just facts. One other result has been Concentrated Animal Feeding Operations or “CAFO’s,” those massive feed and slaughter lots run by Tyson, JMS, et al. I promise if consumers saw what goes on in those places one time, many wouldn’t buy another hamburger for the rest of their lives. Like much of this complex story, meat is not bad, it’s the way we treat and process animals that is. It can be done in a better way.
Which brings me to regenerative / organic agriculture. There is an “answer” to all of this and it has an underlying economic engine and it’s currently about 1%-2% of ag but there is a strong and growing movement of producers, financers, and consumers that give some hope. There are many definitions, don’t get hung up on details, this is a pretty good overview:
https://www.nrdc.org/stories/regenerative-agriculture-101#principles
If there is one core idea I’ve learned it’s this – what happens below the ground is more important, over the long term, than what happens above ground. I could go on for paragraphs more so I can tell you more over a beer who these actors are. We are one of them at www.carnationfarms.org, 15 minutes from SpaceX and 30 minutes from MSFT. All SNS members are welcome to come visit anytime.
As you note a few times, Berit, one of the most fundamental and brutal outcomes of all this is farmers / producers are screwed. They have no market power or leverage. When those beef packers restrict their production, I can promise you (just like any other crop or livestock) they are shoving that down the throats of every farm that supplies them and those farms have no choice. We all know the “Walmart story” about gutting small-town downtowns, I am positive the hollowing-out effects on rural America is greater from your food rule-of-four than it is even from Walmart.
If you want a quick, evocative synopsis of all this, listen to Will Harris on Joe Rogan two years ago:
https://open.spotify.com/episode/0qf7CYEhxSFPAcdSw1JJMY
And if you prefer to eat some processed popcorn while watching instead of listening, try out Kiss The Ground and its sequel, Common Ground. There is hope but it’s gonna be a hell of a good fight.
P.S. One argument you will often hear is about how these monoculture crops and CAFO livestock are needed to scale enough food to feed the world. If we had aligned the economic incentives differently, there would have been enough money to grow enough food the right way and regardless, if the scaling solution being used will ultimately kill those same people it’s meant to feed, at some point that fits, I believe, the definition of insanity or worse.
Paul Shoemaker
Executive Director, Carnation Farms
Consultant & Author, Can’t Not Do & Taking Charge of Change
Founding President, Social Venture Partners Int’l
www.paulshoemaker.org
Seattle, WA
Paul,
Thank you for all that you’re doing to support regenerative agriculture. So much here to discuss, which I look forward to doing on our podcast on this topic next week. It sounds like we should follow that conversation up with an in-person visit for SNS members in the Seattle area.
I believe there are quite a few people who would be interested to see more of what you’re doing at Carnation Farms.
Food. It’s what’s for dinner. And breakfast. And lunch.
Berit Anderson
Subject: Essay I wrote just out on arrhythmias as heart malady and as metaphor
Hi Amazing Andersons,
Hope you are all well. Wanted to share this with you as the election approaches.
The arrhythmia of our current age
The rhythms of life seem off. Can we restore a steady beat?
Missed FiRe! Hope we can convene soon.
Best,
David Ewing Duncan
Journalist & Author
Creative Director for Cure
Co-Founder & CEO, ARC Fusion
Boston, MA, and New York, NY
David,
Thank you for sharing this. It’s always a delight to read a master wordsmith, like yourself.
I think you’ve captured the current gestalt accurately.
Looking forward to seeing you again at our next FiRe.
Best,
Scott Schramke
CTO
Strategic News Service
Seattle, WA
David,
A very nice piece, David. Arrhythmia indeed these days.
Evan Anderson
David,
What a fright! And what a thought-provoking circle, drawn from the dot of a simple summer’s day, looping around ancient arts and anxieties, nature, emotions, science and medicine, modern travails and near-miracles, closing with a single finger on a pulse – where all human stories begin and (arguably) end. And even more timely today than when published, one week before election results set many of us navigating our own arrhythmias of anxiety.
Well-done, and thank you. We’re so glad you’re still in the circle.
Sally Anderson
Editor-in-Chief, SNS & Future in Review
Managing Director, FiReFilms & FiReBooks
Seattle, WA
Subject: From the Economist “The War Room” newsletter (by Shashank Joshi, Defence editor)
https://www.economist.com/international/2024/09/22/a-new-quartet-of-chaos-threatens-america
“Western officials see a growing alignment between Russia, China, Iran and North Korea – ‘adversary alignment’ is the phrase used in Britain; the “Evil Quad” is the more colourful phrase I’ve also heard.”
Whither “CRINK” (the term I like best)? Get your PR team working on the Economist! 🙂
All the best,
Marc Prensky
Founder and Executive Director
The Global Future Education Foundation and Institute
Author & Keynote Speaker
marcprensky.com, marcprenskysblog.com, betterthieirworld.org,
global-future-education.org, globalempoweredkids.org
Palo Alto, CA
Marc,
Everyone is using the same descriptions now, with [The Week . . .] even attributing CRINK’s first use to the Halifax Forum (in 2023 to boot, long after we coined it*). I for one am mostly just happy to see the world waking up to the alliance, although we will have to do a lot more than “wake up” to stop them…
*Ed. Note: Members will recognize “CRINK” as an SNS term, coined here in 2017.
Evan Anderson
* On December 11 and 12, Mark will be attending the Fortune Brainstorm AI Conference in San Francisco, where he will yet again be trying to break through the walls of Valley bull***t and move toward trust and transparency in AI.
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