Title: Bird Flu, Public Health and Milk Testing

[MUSIC]

Brian Lehrer: Brian Lehrer on WNYC. Now we'll talk about the current bird flu situation. Recent outbreaks of the H5N1 strain have affected not only wild birds and poultry, but have also made jumps to dairy cattle and humans, and with the United States grappling with containment issues and new testing strategies emerging, we'll get some insight now on what the experts are doing to prevent a pandemic scenario. Joining me is Amy Maxmen, a PhD and public health correspondent and editor at KFF Health News. Hi, Amy. Welcome back to WNYC.

Amy Maxmen: Hi, Brian.

Brian Lehrer: Let's start with the basics. How many cases of bird flu have there been in the US to this point in any species?

Amy Maxmen: It's too hard to say in any species, but in humans, we know that there's been 58 cases. We also know there's probably been many more cases in farm workers who've gotten them directly from livestock or poultry. We know that there are cows in 15 states at least, that have it.

Brian Lehrer: The birds are giving it to those workers and the birds are giving it to cows. It's mostly poultry, chickens?

Amy Maxmen: Wild birds have had the bird flu, which often kills them for the past almost 30 years now. It spilled over into cows one time in Texas, maybe late last year or early this year. Since then it's been traveling within from cow to cow. That's what's really remarkable and unprecedented. The virus has evolved the ability to spread between mammals and spreading between cows. That's the worry.

Brian Lehrer: This gets us to the milk testing program. That's one of the concerns for people, if it's spreading to cows. Then I'll ask you about human-to-human transmission later. The USDA, the Agriculture Department, has announced a new milk testing program. Can you walk us through this strategy and how it might help control the spread of bird flu in the dairy sector, the dairy products that humans consume?

Amy Maxmen: I should say starting off, every study we've done so far shows that pasteurized milk, which is all the milk that you buy in grocery stores, the virus has been killed. It's broken apart. Our milk supply is safe, unless you drink raw milk, which you just shouldn't for multiple reasons. That's as far as the safety of that goes. The new program, what this is meant to do is when you have an outbreak, you want to know where it is, what are the cows that have this? Then you can try and do things like say isolate those cows so that you stop the spread.

What the USDA talked about is they're going to start rolling out a program so that nationally, they'll be able to look at bulk milk from different states and be able to say, "These states that say there's no outbreaks, are there really no outbreaks, or how long do outbreaks last in a state?" It'll give us a sense of what's happening in the country. What everyone's saying, though, is why are we doing this almost a year into the outbreak when the outbreak had started out as really small, now it's across the country. It's good that we're doing it. The big question is why are we only doing it now?

Brian Lehrer: Listeners, we can take your questions about bird flu and how concerned you should be, and what, if anything, you should be doing to prevent the likelihood of you or someone you know getting it. 212-433-WNYC for Amy Maxmen, an editor at KFF Health News, public health correspondent and editor there. Amy Maxmen, a PhD as well. 212-433-WNYC. If you have questions about bird flu, 212-433-9692, call or text. You mentioned raw milk and you gave your opinion that nobody should drink raw milk.

I guess you're not going to be named President-Elect Trump's Health and Human Services secretary because people who have been following this know that RFK Jr is a proponent of raw milk, a critic, I guess, of routine pasteurization. Has he said anything, to your knowledge, reevaluating his take on the risks and benefits of raw milk given the recent bird flu news?

Amy Maxmen: No, he's not. I should say it's not just me with my opinion about the raw-- The CDC, the FDA, even a lot of farm-- I've talked to a lot of dairy farm industry associations who are also very strong proponents of pasteurization that kills salmonella, E. Coli, all sorts of stuff that can be in milk. It's safer to avoid those risks. No, I haven't heard that RFK has changed his mind. I should say, today the news is that there's a possible case of the bird flu in a child in California who was given raw milk from their parents.

It has to be confirmed. The case might turn out to be the regular flu, but right now, Marin in the Bay Area put out a statement saying this might be happening.

Brian Lehrer: I don't know if you want to get into it on this sociology level as opposed to medicine level, but raw milk, which had been an alternative health food in more left-of-center alternative communities, if we can call them that, is now growing in popularity among MAGA world types suspicious of public health and food safety regulations generally. I wonder if you have any comment on who's attracted to raw milk today compared to in the past and why?

Amy Maxmen: Yes, it's a deep question. I think overall, what worries me is the mistrust that's being promoted at a high level. If the overall message is scientists are lying to you about salmonella and E. Coli being dangerous or the bird flu being dangerous, what else are you not going to believe and why do you believe that information? Why is it growing in popularity? I guess because those sentiments are growing in popularity. I think we've seen a lot of various politicians, especially on the right, promoting ideas that are not backed by evidence.

Brian Lehrer: Now, the United States has faced criticism for its failure to contain bird flu outbreaks this year. What factors have contributed to that criticism? You've talked about what some of the transmission patterns have been and some of the things that are being done. Why is the United States getting criticized, and how do US efforts compare to containment efforts in other countries?

Amy Maxmen: To start with, this outbreak that's so worrisome, which is that the bird flu is spreading within dairy cows, this is only in the US. It happened here. This is our problem for now, and then it might travel to other countries. I've spent a lot of time researching why have we been so poor at containing this or even getting a handle on it. There's a number of reasons. One of them is that we work on a voluntary basis. USDA, CDC, other federal agencies involved with this really haven't been pushing for more testing of cattle, and they haven't been pushing for more testing of people.

We've really fallen behind. The biggest concern is actually an uncertain concern. The fact that we have very little data about where this is, even how it spreads, and we see the number of human cases ticking up. These are mainly almost all from animals like dairy cows or poultry into the people who work with them. We know that's an undercount. Why are we not doing this? There's a few reasons.

We leave it up to farmers to decide if they want to test their herds and if they want to say if there's anybody on their farms that are sick and they feel that they could be punished in some ways like their milk supplies are cut off. Like I said, pasteurization kills this, but they're still really afraid, "Well, what is the government going to do that might punish us?" It took time for the USDA to say, "We'll reimburse you for milk losses." It's taken time to give them promises that, "We're not going to cut off their sales."

All of that took a lot of time. There was a lack of cooperation. I think a lot of public health officials are afraid to push too hard after all the backlash after COVID. Then also there's a general lack of concern for the health and safety of farm workers in this country. Programs to really reach out to them and tell farm workers who are most at risk. That's also if we have a mutant virus that becomes a pandemic, it's likely going to happen in a person. We should try and prevent human infection.

We're afraid about raw milk, but the truth is, most people who've been infected are farm workers, and there's been very little done to reach out to them and to make sure that they're safe.

Brian Lehrer: Has there been any human-to-human transmission as far as you know?

Amy Maxmen: It's possible. We know that there was somebody in Missouri who was mysteriously infected, and it turned out that somebody in their households also had the bird flu. Now the CDC thinks they must have just gotten it from the same mysterious source. We can't rule it out. The fact is we're not doing a ton of surveillance, so you can't really rule out that this hasn't happened. What I can say, what the important thing is, is not that it happens one time, but that it becomes efficient so that we start spreading the bird flu like we do the seasonal flu or COVID.

That's really the key that would be the difference, and that is absolutely not happening. If that happened, we'd be seeing a big surge in cases at hospitals, and we're not seeing that.

Brian Lehrer: What are the symptoms of bird flu in a person?

Amy Maxmen: They've varied. The most common one we've seen in farmworkers is conjunctivitis, which has actually sometimes been quite bad, but there's also been people who have soreness, have fevers. The person in Missouri had gastrointestinal symptoms. There's been some respiratory systems like a cough and a sore throat, but really I think the main thing here is if you think you have the flu, get tested. There's a very simple regular flu test. That's the most likely case, like I said.

Unless you or your family is working on a dairy farm or a poultry farm or unless you're regularly drinking raw milk, chances are you don't have this.

Brian Lehrer: Conjunctivitis, just for people who don't know the word, sometimes colloquially called pink eye. Let's take a phone call.

Amy Maxmen: Yes. Red eyes.

Brian Lehrer: Elizabeth in Washington Heights, you're on WNYC. Hi, Elizabeth.

Elizabeth: Hi, Brian. My question has to do with preexisting immunity. I've seen from some epidemiologists that there might-- The studies aren't peer-reviewed yet, but that older folks might have some preexisting immunity from past flu infections and then also the existing vaccine, because it does contain that H1 component, may help mitigate symptoms. Maybe not infection, but make it milder. I don't know if you've heard anything about that or have any commentary and wanted to see.

Brian Lehrer: Thanks, Elizabeth. Amy?

Amy Maxmen: It's a great question. There are some reasons and lab studies to hope that maybe the regular flu-- H1, not H5, which stands for one of the proteins in this virus. There's some hope that maybe there'll be some cross-immunity, but that's very far from confirmed. I can say in the past, bird flu infections killed half of some 900 people. They all probably got it from poultry or the vast majority from poultry. In the past, we know that it has killed people. You don't want to make too much of that rate for various reasons.

There's also reasons to be concerned. I've talked to influenza experts who warn that if this becomes a pandemic, it could be as bad as 2020 with COVID or even worse. Hopefully there's some immunity, but we really don't know. I think big picture is why are we gambling with this?

Brian Lehrer: What do the experts who you report on say they think the risk is of a pandemic-level spread of bird flu?

Amy Maxmen: The closest I got to a number, it's a ballpark. There's a bird flu expert I spoke with named Tom Peacock who said-- he's saying maybe there's just a 5% chance of this becoming a pandemic. You need to have mutations for that and you also need to have the right conditions. If it becomes a pandemic, maybe it's just a 5% chance, but like I said, it could be on the order of COVID or worse. That's why you don't even want to gamble with that possibility.

Brian Lehrer: You did say there's a bird flu expert named Peacock, didn't you?

Amy Maxmen: Isn't that great? It's amazing.

Brian Lehrer: It's like a piano player named Keys.

Amy Maxmen: I love it.

Brian Lehrer: Text message from a listener, "Does your guest have any take on unpasteurized cheese?" You were talking about the science that suggests nobody should be drinking raw milk, unpasteurized milk. Listener asks if you have any take on unpasteurized cheese and its relatively safety and adds that you can buy it in New York State if it was made here.

Amy Maxmen: I would personally stay away from it. Especially right now, I would stay away from it because we don't have studies showing that raw cheese is going to give you the bird flu, but that said, raw milk is really-- it's such a high concentration of virus in it, it's killed dozens of cats that have drunken raw milk. We're not cats, but I might as well be cautious for now and stay away from raw cheese.

Brian Lehrer: Another text, "Is there a vaccine to prevent spread from cattle to cattle?"

Amy Maxmen: No, there is not. The USDA has put money into the development of that vaccine. That's something we hope for.

Brian Lehrer: A related question. It says, "It would be very interesting if they could create a bird flu vaccine that could be given to farm workers to protect them since you've told us that those are the humans who are most at risk."

Amy Maxmen: Yes, I would say the majority of the researchers I spoke with, there already is a bird flu vaccine. Now it's not perfect in efficacy, but neither is our seasonal flu vaccine. It's good enough that the US has actually stockpiled a bunch of it. Finland has already said they're going to offer it to their own farm workers even though they don't have an ongoing outbreak now. It's a big controversy. The CDC said they don't want to do this, to offer this to farm workers who are at highest risk. Most of the researchers I talk to think that's a bad idea.

Brian Lehrer: By the way, a listener writes, "I had H1N1." That's not bird flu, right?

Amy Maxmen: No.

Brian Lehrer: Then they go on to post how scary the symptoms were of that. Bird flu is what? H5N1. If people are confused, what's the difference?

Amy Maxmen: Basically, there's different-- We're talking about the flu virus, and there's a protein called the-- I'm going to mispronounce it if I say it. Hemagglutinin. I'm sorry. Basically there's different forms of it. H5 is the one that's an avian influenza bird flu, and then the avian influenza we have here right now is H5N1.

Brian Lehrer: We're going to leave it there, listeners, all we probably know at this point about H5N1, also known as bird flu, where it's spreading and the risks, and the critiques of US efforts to control it. We thank Amy Maxmen, PhD and public health correspondent and editor at KF Health News. Listeners, thanks for your calls and texts. Amy, Thanks a lot.

Amy Maxmen: Thank you so much.

[music]

Brian Lehrer: That's the Brian Lehrer Show for today, produced by Mary Croke, Lisa Allison, Amina Srna, Carl Boisrand, and Esperanza Rosenbaum. Zach Gottehrer-Cohen edits our daily politics podcast. Our interns this term are Andrés Pacheco-Girón and Olivia Greene. Megan Ryan is the head of live radio, and we had Shayna Sengstock at the audio controls. I'm Brian Lehrer. Thanks for listening. Stay tuned for Allison.

[music]

Copyright © 2024 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.