Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. We'll talk now about bird flu. Very few human cases, but could it become a serious epidemic? We'll talk about COVID, with the biggest summer spike in years taking place right now. Since March, bird flu has been causing outbreaks in dairy and poultry farms across the country, with several recent human cases in farmworkers. There have been 13 human cases of bird flu documented in the US this year. All were from exposure to sick dairy cows or virus infected poultry. The CDC says the current public health risk is low, but some health officials are beginning to think about what another pandemic could look like.

Joining us now to talk more about bird flu, also known as H5N1, and also what to know and what to do about the latest COVID wave, is Amy Maxmen, a PhD and public health correspondent and editor at KFF Health News.

Hi, Amy. Welcome to WNYC.

Amy Maxmen: Hi, Brian. It's a pleasure to be here.

Brian Lehrer: Listeners, we can open up the phones right away. How concerned are you about bird flu, or about COVID, or the upcoming flu season this fall, for that matter? Or if you have any questions for our guest, 212-433-WNYC. 212-433-9692. Call or text.

What more can you tell us about how widespread bird flu is, and why some scientists are wondering if it could become much more widespread than people with direct exposure to sick dairy cows or virus infected poultry?

Amy Maxmen: It's a big concern, actually, for a few reasons. One is, we're not doing a ton of testing, not of cows and not of people. Although there's 13 people who are all dairy workers who we know have been infected. I covered a study suggesting the number is a little bit higher. Then also we're not doing a lot of testing, so it could be more. It doesn't seem like the bird flu is spreading between people, and that would be the thing that could lead us to a pandemic. That's the fear. Viruses evolve over time. Flu viruses evolve pretty quickly. They also do this interesting thing, in a biologically interesting sense. They swap genes with each other. If a person gets infected, say, by a seasonal flu virus and a bird flu virus, the two viruses can swap genes in this process called reassortment. Then you might be able to get, say, a bird flu virus that's as contagious as the seasonal flu. This is a fear that we want to prevent. The way to prevent it is by making sure this isn't spreading across the country permanently in dairy cattle, and then also jumping into a lot of farmworkers.

Brian Lehrer: I guess there's the risk, if I understand you correctly, if, let's say, some of these farmworkers with bird flu also get the regular flu, then they can mingle, swap genes, as you call them, and then it could start to spread person to person, theoretically?

Amy Maxmen: Yes. That's a thing that can happen. That actually happened within pigs for the swine flu. There was a mix and match of viruses that led to something really contagious. It can happen also in pigs, it could happen in dairy cows. This is why evolution's like rolling the dice every time these things replicate, and we just want to stop rolling the dice.

Brian Lehrer: We might have some farmworkers in our listening area. I don't know if anybody wants to call in and discuss how you protect yourself from bird flu or anything else before we get to COVID. 212-433-WNYC. 212-433-9692. What do they do in the at risk populations to protect themselves from bird flu?

Amy Maxmen: What should be happening is that, first of all, people who work with dairy cows should be learning a lot. First and foremost, there should be people who are going and speaking with farmworkers about what the bird flu is, why it's scary, and how to best protect yourself. It seems like a lot of the cases so far have had conjunctivitis. It could be that, say when you're milking a cow, you either get some liquid on your fingers and touch your eyes or it sprays into your eyes. Goggles and face coverings are supposed to be a big deal. You might need good masks.

There was a situation at a poultry farm in Colorado where farm workers were having to work in 105-degree days inside of a hot poultry barn that was infected by the bird flu, and they had to cull a lot of chickens. They were working in these conditions without masks, understandably, because it was so hot. The first thing is education, and then also the protective gear and why you would want to use it.

Brian Lehrer: Let's take a phone call that is relevant. Sariah in Brooklyn, you're on WNYC. Hi, Sariah.

Sariah: Hi. Longtime listener. I'm sure you've heard this before. First time caller. Thank you. You are fantastic. The reason why I'm calling is because I don't see on the political side, the USDA, whether it's through the presidency, whether it's local leaders addressing the fact that factory farms produce, number one, 70% of the meat within the United States and how it spreads, and it is a petri dish for zoonotic diseases. Why is that never addressed from the media and or our political leaders? Thank you.

Brian Lehrer: Sariah, thank you very much. There are many reasons that people are opposed to factory farming. Should creating conditions for bird flu be one of them, as far as you can tell, Amy?

Amy Maxmen: Yes. I think there's definitely a lot of industry interest here. The tricky thing is, I always think about what's kind of a realistic move in the near term. I think in the near term, what needs to happen is that there needs to be more collaboration between the government, between public health people, especially in the government, and farms. I think shutting down all of these farms is just simply not an option. This is US food security. A lot of people rely on this meat [unintelligible 00:06:33] as farmers. I think in the near term, there needs to be collaboration between the groups so that farmers who actually are concerned about this because it's lowering their milk production. If nothing, they're probably concerned about their animals, too, but also just their bottom line.

What we need is collaboration between farmers, between the industry, and the government, so that we can study what's happening here and come to some sort of solutions, whether that's figuring out how to make sure that these outbreaks are contained on farms, which is really in everybody's best interest.

Brian Lehrer: By the way, how serious is bird flu and the humans who've contracted it?

Amy Maxmen: In the 13 cases we know about so far, it's been relatively mild. Some people had respiratory symptoms, some people had conjunctivitis, and they were given Tamiflu, and they seem to have recovered. Those are the 13 cases. That's great news. I think myself and a lot of researchers who I interview aren't resting on our laurels because a lot of diseases have different effects in different people. 13 isn't that many. If we had 13 cases of COVID, that's not enough to say the disease isn't severe.

Brian Lehrer: There is a third infectious disease story that I didn't mention in the intro in the last day. We're talking about bird flu, and we're going to talk about COVID. The World Health Organization put out a warning about monkeypox spreading yet again. Not so much in this country, but we have a caller about that, and I want to take him next. Mark in Long Valley in Jersey, you're on WNYC.

Hi, Mark. Mark, you there?

Mark: Hello?

Brian Lehrer: Hello. Can you hear me? I think we have a bad connection.

Mark: Hello?

Brian Lehrer: Hello? I can hear you. Can you hear me? I guess not. Do you know anything about this? This is just breaking within the last day.

Amy Maxmen: Yes. The breaking part of the news is that, monkeypox, which is now termed Mpox, it's spread to 13 countries. That prompted the World Health Organization to declare it their, pandemic isn't actually a declaration. The declaration is Public Health Emergency of International Concern, or PHEIC. They declared the PHEIC. That can be a prompt for various things. It might be a prompt for countries to give money so that African countries can better control Mpox within their countries. There's an urgent need for vaccines and tests. Although we have vaccines and we have tests here in the US, a lot of African countries are really without them. That's a prompt to do those measures. Again, not only is it good to help countries control their own outbreaks, but that's the best protection to protect people here, too, because we're a global, interconnected world.

Brian Lehrer: Right. Looking at the World Health Organization site just now, I see they're most concerned about Congo at the moment.

Let's go on to COVID. The current COVID wave, the number of reported cases seems to be climbing both in the US and abroad, according to the Centers for Disease Control. The wastewater activity for COVID, that's one of the ways they monitor general population levels, is 'currently very high' in New York City. The hospitalization rate for COVID is around 4 per 100,000 people, and 0.1 deaths per 100,000 people, which is similar to nationwide trends. Those numbers are abstract to most listeners. What's going on with COVID this summer that maybe wasn't going on last summer?

Amy Maxmen: I think the difference, what's unusual right now, is that the COVID surge, which we're definitely in a COVID surge, it's as high right now as during the holiday season. Normally what we've been seeing is that the holiday, it's called the holiday season, winter season, flu season, usually that's when, right around late December, early January, we see this big surge in cases of COVID. We've seen that ever since 2020. Right now, what's weird is this summer, we're seeing a surge that seems to be as big as that. That's in terms of maybe number of cases. It's a little bit tricky because not as much testing, but we did see it in wastewater.

What's different from other years is that hospitalizations and deaths from COVID are also up, but they are definitely not to the levels we've seen in past years or in past summers. Deaths right now are high. I think I just looked around the country, something like 550 a week. It means COVID is still serious, but that's a quarter of what it was in 2021.

Brian Lehrer: If people are getting it in the summer this year at the same rate that they've been getting it around the holidays, after people gather, people do more indoor things in the colder weather months, that's when we think of these spikes as generally coming, December, January, February, why is that? Because generally people think of any of those seasonal viruses, the flu, or just other viruses that we tend to get, as winter season things that don't occur so much in the summer. Why would COVID be different?

Amy Maxmen: This is showing doesn't need to be that way. Virus has always evolved, but it doesn't seem like there's anything strikingly different about the variants that are around right now. I think there's probably a mix of factors at play. I know for myself, I got my first case of COVID in June. A lot of people are taking even fewer precautions than they have been in years past. It could be a lot of behavioral stuff. A lot of people aren't testing anymore. That means people might have COVID and just continue doing what they usually do, and therefore they're spreading it. People go on vacation a lot, get together a lot in the summer. Maybe people are inside because it's so hot and ventilation is a huge factor, and AC is not the same as ventilation. Yes, I think a lot of this could be behavioral.

Brian Lehrer: Listener texts, "I'm less worried about getting COVID, I've had it twice so far, but more worried about long COVID. What's the latest info on that?" You have anything in relation to, let's say, these more recent variants of COVID and whether they are any more or less likely to produce long COVID than the original?

Amy Maxmen: I don't think we've seen anything about the variant's long COVID. I will say there's some strong data showing that getting a vaccine or getting the boosters decreases your risk of getting long COVID. I read into this a little bit. If you do get COVID, I've heard that if you're symptomatic and you have things like a migraine and brain fog, take it easy. Make sure you get a lot of sleep. This isn't a perfect anecdote, but that might lower your risk of getting long COVID. Of course, the best protection against long COVID is not getting COVID. I'd say it's a good time to wear a mask and a good mask, like an N95 mask, if you can stand it. If you're in public transportation, or on a flight, or in an airport, or in a train, you might as well just try and reduce your risk of getting COVID, and that's the best protection against long COVID.

Brian Lehrer: Listener writes, "Are current COVID deaths unvaccinated?" Do you happen to know the data on that, the comparative death rate among those who are dying from COVID between those who are vaccinated and those who are not, or how recently?

Amy Maxmen: I don't have the current data on that, and it's always a little bit tricky to parse. Still, we know the vaccines, really what they're best at is protecting against severe disease and death. It gets tricky because of numbers of people who are vaccinated. The vaccines still work well protecting against severe disease and death?

Brian Lehrer: It seems to me, and I don't have the latest numbers on this, but when the current COVID wave started in the spring and early summer, that there were a lot of cases being reported in the New York area, but almost zero deaths. I wonder if you've been looking into that, whether people who get COVID are much less likely to die from it than they were earlier in the pandemic.

Amy Maxmen: I think that's definitely without a doubt true. I think that's a mix of the vaccines and also natural infections that people have gotten at this point. That's what's the good news right now. It's a surge. Cases are remarkably high, but we're not seeing the hospitalizations and deaths that would have gone with this in 2020. I looked and it's something like, the death rates this July from COVID are about 15 times less than in 2020.

Brian Lehrer: Wow. What about boosters, if that's even the right word for them, or the next generation of vaccines? Once we get to the fall, there'll be, I think, an increased focus on recommending that all people, or certainly people who are considered vulnerable because of age or medical condition, get a latest version of the vaccine. Do you know if that's being tweaked again for whatever the current variance is called, or would it be the same vaccine that people may have gotten last fall?

Amy Maxmen: It's not going to be the same vaccine as last fall. I'm not sure about that, actually, but right, I think the recommendation right now from the CDC is that for people who are older than age 65 or who have weakened immune system, get the updated 2024 booster as soon as it's available this year. For other people, I think they are going to do what they always do.

Brian Lehrer: That recommendation has been in effect for a few months. Really, they were recommending that people over 65 or with compromised immune systems get vaccinated twice in the last year, right?

Amy Maxmen: Yes. I think the reason why this is a more clear cut decision is because the risk of death is much greater in this group, the risk of death and hospitalization. There are the benefits of the vaccine. Even if the vaccine's not perfect, it's still decent and decent at protecting against hospitalization and death. Therefore, with this group, it's a clear benefit. For everyone else, I think they're going to do the thing that they do every year where there's meetings about what is the benefit of the most updated vaccine versus the strain that's circulating and decide what to do for other age groups.

Brian Lehrer: Let's take another call. This is going to go back to bird flu, I think. Carol in [unintelligible 00:17:55], you're on WNYC. Hi, Carol.

Carol: Hi. My point was just that regarding the factory farm issue with the chickens and the workers couldn't put on their masks, it was too warm in the barns. Doesn't that mean that it's too warm for the chickens to live in those barns? That was just a question about factory farm, or maybe a point about factory farming that I think we too often ignore.

Brian Lehrer: All right. An animal cruelty point. I guess theoretically, and I don't know anything about this, but I guess theoretically, different species could have different levels of heat tolerance. It's a compassionate question that Carol raises. Right, Amy? If it's too hot for the humans, why isn't it too hot for the chickens?

Amy Maxmen: I would say two things. One, if it's 105 degrees, I don't know where the chickens would go anyway. I think it's 105 degrees, period. Yes, your point's taken. In that particular case, also all the chickens were being culled. There's been millions of chickens killed because they have the bird flu in order to contain it. That's also what's happening on these farms.

A question I had was, why are farm workers being asked to work in these conditions? Forget even saying they have to wear masks. What about, is it too hot to work? We have pending rules at the Occupational Safety and Health Agency about doing work in extremely hot conditions. That's something that I'm watching as well.

Brian Lehrer: Justina in Queens, you're on WNYC with Amy Maxmen from KFF Health News. Hi, Justina.

Justina: Hi, Brian and Amy. How are you, guys? I'm actually currently recovering from COVID, and to Amy's point, it is totally behavioral. I happened to be at a show and somebody was coughing like crazy. My mistake was not putting on a mask, but that's not the point that I'm calling about. It is hard to get vaccinated. I was told by my doctor, after I had COVID for the first time, to wait six months. Then when I reached out to my hospital, because I have the NYC Care insurance, which is the city insurance, I was told that they don't do walk-ins anymore. The earliest appointment was within two or three months.

Brian Lehrer: Whoa.

Justina: They don't make it easy. They do not make it easy. I am very much for vaccines, and obviously I wanted to get one, but it's hard to schedule something ahead of time for two or three months.

Brian Lehrer: Do you know anything about that, Amy?

Amy Maxmen: I'm sympathetic.

Brian Lehrer: There certainly have been different waves of different times where they're either begging people to come in, "COVID vaccines available here. Walk in," and other times where you can't get an appointment.

Amy Maxmen: Yes. Us healthcare system, problematic. I'm sorry. I know when I was trying to get a vaccine, I was just constantly updating the CVS and Walgreens website, and eventually an appointment popped up. It's a pain, I agree.

Brian Lehrer: Originally, 2021, right?

Amy Maxmen: Yes, similar but different. Now it's the whole thing private insurers are covering it, so you have to deal with that part of it. Yes, it's a problem. I also wish that we still had, the government was offering free COVID tests that could be mailed to your house. It's a shame that that program's over.

Brian Lehrer: Yes. I was actually just trying to sign up for a vaccine for October, which is when I want to get my next one, and they wouldn't take an appointment at my local drugstore, where I've gotten it in the past, that far in advance. You get squeezed between what I just said and what Justina just said, where you can't even get an appointment for a foreign advance.

I wonder if potentially making that worse in the future, is that the House Republicans recently proposed massive cuts to the Centers for Disease Control, $1.8 billion, or over 20% of their budget. Would you be able to talk about the potential effect on public health programs generally if those cuts were to actually pass?

Amy Maxmen: Yes, it's depressing because that's the opposite direction we need to be going in. I'm tough on the CDC when I report on the CDC because I hold our government agencies to account, but certainly getting rid of them is not the answer. There's a lot of reasons why I think we as a country, our government agencies should be acting faster to make sure that we contain the bird flu, first of all, because it just gets harder the bigger it gets. We want to do it before flu season. There's lots of reasons, but. right, if this gets worse and worse, and then we're in a situation where the CDC is defunded, or if it gets worse and worse and we want the public health, the CDC wants to pass rules that actually do things, which I should make clear they're not doing this, but let's say their public health wanted to have rules about testing cattle and things like that, things like that can be overturned now through the Chevron decisions.

There's a real reason why we want to contain this before we need to really take out these big, drastic measures.

Brian Lehrer: All right, we've talked about bird flu, we've talked about Mpox, we've talked about COVID, and we thank Amy Maxmen, PhD and public health correspondent and editor at KFF Health News, for coming on and talking about the various infectious diseases on her beat. Thanks for joining us. We really appreciate it.

Amy Maxmen: Thank you so much.

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.