Who’s killing us all this week? It’s TikTok raw milk influencers! Plus Lessons not learned, Wastewater surveillance, and more
Bonus how kind, caring people became the bad guys
Welcome to the latest issue of the Covid-Is-Not-Over newsletter!
The mini-theme this week is pretty obvious: the looming threat of H5N1. I might do a few more of these H5N1 mini-themed issues over the course of the next month or two. The posts will feature maybe ⅔ H5N1 posts, ⅓ Covid. Which is more or less what we have this week. I’m thinking that next week I may get back to the Long Covid themed posts I was exploring a little while back. I’m intrigued by the recent Harvard Business Review Long Covid article, so that might be the jumping off point. We’ll see.
Looking a little further out into the future, I’m planning to take some time off from the newsletter from the end of June through to the beginning of August. I might line up a couple of scheduled posts that are basically link dumps with no excerpting or introductory material like I did during the recent winter break.
Disclaimer: I don’t agree with every word of every article that I highlight here. In particular with H5N1 articles, there’s a tendency to refer to Covid in the past tense. While these minimising aspects are problematic, these pieces also have other parts that can provide important ideas or information. Truly terrible takes are reserved for the What Are We Even Doing section.
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As most have probably noticed, there is no paid subscription option for this newsletter. However, Substack does have an option where subscribers can pledge to subscribe “just in case” and a few kind subscribers have made that pledge. I very much appreciated the vote of confidence in what I’m doing here. What I’ve decided to do on a trial basis is to set up a “tip jar” on the Ko-fi platform. I’m not anticipating a huge surge of income from using Ko-fi but whatever revenue I do end up with, I plan to spend on supporting artists on Bandcamp. Sadly, who knows how long that will seem like a good idea.
TikTok’s Raw Milk Influencers Are Going to Give Us All Bird Flu by Julia Métraux / Mother Jones
If you go on TikTok or Instagram, you’ll see legions of wellness influencers promoting the benefits of unpasteurized “raw” milk, which hasn’t been heated to kill off illness-causing microorganisms. Raw milk is risky business at the best of times, and despite what some influencers claim, there are no nutritional benefits to drinking it, according to the CDC. But it’s now also a vector for H5N1, the new bird flu spreading through cows.
On April 1, it was confirmed that H5N1 had spread to at least one person who worked with cattle—as of April 30, 36 dairy herds have been confirmed to have had cases of bird flu, although that’s a likely undercount based on limited testing. On April 25, the FDA announced its finding that one in five milk samples from grocery stores had trace amounts of H5N1. Colombia has restricted the import of beef from US states where the virus has been detected in cows, and the USDA is now testing ground beef for H5N1. The World Health Organization reported that between January 2003 and March 2024, 56 percent of bird flu cases detected in humans were fatal. Half the domestic cats on a Texas farm also recently died after drinking raw milk from cows infected with H5N1.
Pasteurization eliminates this risk. “Raw milk does not go through this process, so consuming [it] could unknowingly place you at risk of infection with H5N1,” said Brian Labus, a University of Nevada, Las Vegas public health professor and epidemiologist. There are still other ways that H5N1 can spread besides drinking raw milk, such as to dairy workers (human-to-human transmission hasn’t been detected in the US yet). But according to the Conversation, that’s not a common vector. And if other animals drink unpasteurized cow’s milk, they also risk contracting H5N1, just like any human would.
With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key by Mary Van Beusekom / CIDRAP
H5 wasn't detectable before mid-March but then quickly reached similar concentrations as IAV M genes—an indicator of influenza virus transmissibility—which were among the highest ever recorded in wastewater. At the same time, flu-related emergency department visits in the associated Texas public health regions were declining.
"These results suggest that wastewater monitoring is a viable method of monitoring certain animal pathogens, and can provide a leading edge of detection that is of particular importance for diseases with zoonotic potential like HPAI," the study authors wrote.
Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News, said testing wastewater systems that have no intake of animal-related sewage could serve as sentinels for human disease.
"There are those systems that have no animal input, so if they showed a spike, it could show evidence of human transmission," he said. He added that some systems like this may be testing for this now but that he hasn't seen the data yet.
From sewage to safety: Hospital wastewater surveillance as a beacon for defense against H5N1 bird flu by Denis Nash, John Dennehy, Monica Trujillo, and Leopolda Silvera / STAT
At this stage in the H5N1 situation, it is essential to rapidly detect spillover into the human population. Since community-based wastewater contains waste from both humans and animals, using community-based surveillance alone makes it impossible to rapidly detect and differentiate human outbreaks of H5N1 happening alongside animal outbreaks. Another limitation is that early in an outbreak, precisely when it is most important to detect, relatively few people are infected, and the concentration of the pathogen may be too low to detect.
To address these limitations, we initiated a pilot study of wastewater surveillance within New York City’s public health care system, a collaboration with NYC Health and Hospitals. As part of this work, we have been continuously monitoring wastewater at four H+H facilities for influenza and SARS-CoV-2, and have consistently found that we are able to detect surges in genome copies in hospital wastewater before surges in clinical cases are reported via traditional surveillance approaches. We have also monitored and detected mpox at different points when there were concerns about surges in cases of that infectious disease. (Technology developed by Sentinel Biotech, a company that two of us, J.D. and M.T., co-founded, is being used in this pilot.)
Wastewater from these facilities reflects activity from thousands of inpatients, outpatients, visitors, and employees. Routine testing of hospital-based wastewater may provide early detection and monitoring of potential infectious disease threats emergency rooms and hospitals are where very sick people show up first, and the wastewater samples are coming from fewer individuals. Also important, there is no animal waste present in hospital wastewater, meaning that the detection of any H5N1 and other zoonotic pathogens in hospital wastewater represents spillover activity in humans.
Worried About Bird Flu? Welcome to The Party, Pal. You're Late. by Jessica Wildfire / OK Doomer
I've noticed something about the way the news media covers these things. Whether it's bird flu or another unfolding disaster, they do the same thing. They design these stories now to simultaneously trigger a fear response, only to dismiss that fear and assure everyone that everything's okay "for now." They conveniently omit or downplay any proactive measure that anyone could take. So they work everyone up into a frenzy, then tell us not to worry, and then don't provide anyone with any useful framework for action, at all.
Covid lessons remain unlearned as avian flu infects cattle, hospitals say by Daniel Payne / Politico
Hospital leaders say the health system won’t be ready if the avian flu that’s infected American dairy cattle becomes widespread among humans.
In discussing a hypothetical scenario, the hospitals have struck a different tone than the Biden administration. It says the risk is currently low to most people and that agencies are closely monitoring for any sign of danger to Americans.
Still, hospital officials told POLITICO they’re dismayed that they don’t feel better prepared, just four years after Covid-19 caught them unawares. They’re not confident that the health care system — including the government agencies that have wound down Covid responses — can avoid the missteps around tests, bed space and communication that plagued the last public health emergency, should this strain of flu, H5N1, become more of a threat.
“I don’t think that we would do well if we were to be hit by a pandemic right now,” said Dr. Payal Patel, an infectious disease specialist at Intermountain Health in Utah. “What we’ve learned over the last few years is that it’s really hard to predict what turn things will take — and also that it’s important to learn from the past.”
4 years after COVID, we are still lacking an international prevention plan by Susan Lieberman, Chris Walzer, And Christine Franklin / The Hill
Governments, through the WHO, have given themselves until May 10 to reach a consensus on this international instrument, yet appear nowhere close to adopting text that will truly prevent consequential pathogen spillovers from wildlife that could bring us COVID-25, 26, or beyond. With only five negotiating days left on the calendar, governments must show leadership and converge on mutually acceptable text. Otherwise, we run the risk of a weak agreement or no agreement at all.
The WHO suggests that “zoonotic” spillovers of viral pathogens between wildlife and people have been responsible for up to 75 percent of new infectious diseases in the past decade. We know how to prevent such outbreaks, and scientists are clear that it’s not “if” but “when” the next pandemic will occur — unless strong actions are taken. But most scientists and other nongovernmental organization experts are sadly not allowed in the room where the WHO agreement text is being hashed out.
No one wants to think about pandemics. But bird flu doesn't care by Kelsey Piper / Vox
Crossing our fingers isn’t a policy response
H5N1 has never, as far as we know, had sustained human-to-human transmission. It may never mutate to be capable of that — many viruses don’t.
The CDC says “the current public health risk is low,” and while that gives me flashbacks to Covid, it’s accurate at this moment; unless you spend a lot of time with cows or poultry, or drink raw milk, you’re unlikely to be exposed unless the virus evolves new capabilities. H5N1 has been dancing along the line of human spillover for more than 25 years without making the full leap. Hoping really hard that it goes away might work out fine.
But if we are truly desperate to prevent the next pandemic — if we feel very viscerally that we can’t do this again, that our normalcy and our unmasked gatherings are among the most precious things we have these days — then that’s reason to prioritize preparedness more highly, not less so.
Bird flu in US cows: where will it end? by Sara Rearson / Nature
But Gray says that there have been anecdotal reports of many more human cases. Leibler suspects that exposure of farm workers is widespread. “When you see symptomatic patients, that’s the tip of the iceberg,” she says. In the worst-case scenario, she says, the virus would spread undetected in several species for a long time, accumulating mutations that prime it for causing a pandemic in the future. “We have an awareness now from the COVID pandemic of how devastating that could be,” she says.
Leibler hopes that public-health efforts will begin testing workers and their families so that any transmission in humans will quickly be detected. “H5N1 is with us,” she says. “It’s not a virus that’s going to disappear by any means.”
There's no question H5N1 bird flu has 'pandemic potential.' How likely is that worst-case scenario? by Lauren Pelley / CBC News
On Friday, federal officials said Canada is planning to expand its surveillance for avian flu amid the growing outbreak of H5N1 in U.S. dairy cattle, with monitoring efforts now set to include testing of milk being sold on store shelves.
But there's concern in both the U.S. and Canada that actual government efforts aren't going far enough.
"People working with cattle should have blood testing done, on a regular basis, to see if it's popping up among that group," said Sly. "Canada assumes the 49th parallel is a barrier against viruses, and it's not."
He says countries can't afford to look the other way, given the possibility of this virus eventually making its last few evolutionary leaps.
"It doesn't seem possible," Sly said, "until suddenly it is possible."
Should We Be Worried About Bird Flu? by Dhruv Khullar / The New Yorker
In the unlikely event of that emergency, we’re far better positioned than we were for covid. Influenza may be the world’s most familiar viral pathogen—its genome, virulence, and transmission patterns have been studied for decades. The U.S. has a large stockpile of Tamiflu, which should work against bird flu, as it does for other influenza strains, and which could be given to an infected person’s contacts to mitigate spread. Health officials have also indicated that they could rapidly scale up testing and, if needed, shift the nation’s annual flu-vaccine production to shots that are tailored for H5N1.
But the ability to respond is not the same as responding. The country’s initial approach has had an unsettling resonance with the first months of covid. Because there is no widespread program to screen farm animals for H5N1, we have little sense of how many have been tested or what proportion of tests have been positive. It took a month after bird flu was detected in cattle for the Department of Agriculture to require that lactating cows be tested before crossing state lines, and the agency has since clarified that only thirty animals in a group must be tested, irrespective of how large the group is. Last month, when the government released genetic sequences for scientists to study, it did not share information about where or when the samples were collected, making it difficult to track how the virus is spreading and evolving. Meanwhile, we haven’t conducted antibody studies of farmworkers that could determine the extent to which they are getting infected; we’ll know they’re sick if they show up in emergency rooms.
Scientists, clinicians across Canada preparing for future pandemic threats by Nicole Ireland / CTV News
Nearly $574 million will be doled out to researchers across the country for projects aimed at ramping up Canada’s preparedness for future health emergencies, including the next pandemic, the federal government announced on Monday.
One of the 19 projects is a national network of existing emergency departments and primary-care clinics, called Prepared, that will screen for any new viruses or pathogens that start to appear in patients.
“As a public health specialist and as a practising physician, I would very much anticipate there being another respiratory pandemic in the future. The challenge is we don’t know when it will be or what it will be,” said Dr. Andrew Pinto, Prepared project lead and a family physician at St. Michael’s Hospital in Toronto.
“We should think of this like a protective shield that’s helping detect things early. Far earlier than during COVID,” Pinto said in an interview.
How Good, Kind, Caring People Became The Bad Guys by Jessica Wildfire / OK Doomer
"Bad news messengers may be prime candidates in recipients' search for antagonists to cast in accounts of unwanted outcomes." Bad news also motivates people to come up with "fallacious" causal explanations "often generated effortlessly, seemingly automatically." They generate these fallacious explanations through poor reasoning "characterized by shallow, unconscious thought."
That's how we wind up with so many conspiracy theories. They're easier to swallow than the truth.
They gratify us.
To sum things up, people tend to attribute the bad news and negative events in their lives to those around them, often their friends and family. They don't do a good job of distinguishing between a threat and someone trying to warn them.
Does the public understand that "variant" means "vaccine resistant"? by Julia Doubleday / The Gauntlet
We will likely never see a wave as acutely deadly again, because the hundreds of thousands of people who could not survive their first contact with COVID-19 are already dead. …
Throughout the pandemic, the Biden and Trump administrations- and governments worldwide- have been prone to accepting the most optimistic science as the truth and promoting those optimistic predictions as solid facts. COVID isn’t the only arena where this is true; we certainly see it with climate change. We saw it with our premature declaration that COVID wasn’t airborne. We saw it with our claims that people would only get COVID once. We saw it with the claims that COVID would probably just randomly get milder. And in the case of the vaccines, we saw it with the idea that herd immunity to COVID would be possible, that the virus wouldn’t just quickly mutate around vaccine protection. Unfortunately, the virus mutated very, very quickly.
Has this been well communicated to the public? Or does most of the public believe we are as well protected as we were in the spring of 2021?
Hundreds of patients died after catching COVID in Victorian hospitals, new data shows by Hayley Gleeson / ABC News
Documents obtained by ABC News under Freedom of Information laws reveal at least 6,212 patients caught COVID in hospital in 24 months — 3,890 in 2022 and 2,322 in 2023. Of those, 586 died — almost six per week, on average — with men dying at a higher rate than women (11 per cent vs 8 per cent).
Though hospital-acquired infections and deaths declined in 2023 — in line with COVID mortality trends in the broader community — the proportion of patients who died after catching the virus in hospital hardly budged, dropping from about 10 per cent in 2022 to about 9 per cent in 2023.
It comes following the release of new research that shows screening hospital patients for COVID and staff wearing N95 masks can substantially reduce infections and deaths, saving the health system potentially hundreds of millions of dollars in the long term. Experts say the findings should spark a paradigm shift in the way hospitals approach COVID infection prevention — that's if the latest indicators of illness and death don't.
"The numbers indicate that there is a big problem here — these infections and deaths are potentially preventable," said Associate Professor Suman Majumdar, chief health officer for COVID and health emergencies at the Burnet Institute. "We're talking about a specific setting where people are sicker, more vulnerable and more at risk. We need to drastically reduce the risk of people catching COVID in hospital when they don't come in with it. I think we can all agree we can do better — that should be the starting point."
Covid staff absences in two hospitals cost nearly €400,000 in just nine months by Eilish O'Regan / Irish Independent
Absences of a group of health staff due to Covid-19 in two hospitals cost nearly €400,000 within just nine months, according to a new study.
The researchers surveyed 1,218 healthcare staff and 208 missed at least one day at work.
The snapshot of direct economic costs highlights the financial drain on hospitals as staff are absent due to Covid-19. …
Asked to comment on the survey, Dr Townsend said: “This study highlights the direct economic cost of healthcare worker work days missed due to Covid-19.
“The total cost over nine months of €397,000 is likely an underestimate, given that it only includes healthcare workers participating in the precise study.
What Are We Even Doing: Bad Takes on the Pandemic!
Covid changed how we spend: More YOLO splurging but less saving
Surveys spotlight pregnant women's drop in confidence over COVID vaccines | CIDRAP
Astor Piazzolla, Tanguedia III.
You may have to consider changing the name of this newsletter: "The Pandemic Is Not Over" or some such different title to include these other dangers that seem to be looming.
As a matter of fact, I kinda like: "Who's Killing Us All This Week?"