How Concerned Should We Be About Bird Flu?

Published May 16, 2023, 9:00 AM

Cases of avian flu in birds have hit record levels globally—but so far, there’s no evidence of human-to-human transmission. Bloomberg reporters Suzi Ring and Michelle Fay Cortez discuss how scientists are tracking the virus after lessons learned from Covid-19. Then, Dr. Richard Webby of the World Health Organization talks about how communities can respond to and prevent bird flu outbreaks.

Read more: Bird Flu's Surge Has Scientists Seeking Clues to Prevent the Next Pandemic

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In the animal populations around the world. There's a huge amount of different flu viruses of sort of all different shapes and flavors. It's only a very small percentage of those that actually make this leap from beings they are duck virus to being a human virus.

That's doctor Richard Webby. He studies how diseases move from animals to humans and then sometimes like coronavirus, from humans to humans.

These viruses typically are host specific, so they've got to change. If we're doing specifically now about this Bavian flu. That virus is everywhere out there at the moment, you know, throughout the Americas, throughout Europe, throughout Asia, so there's a lot of exposure of that virus to humans. But right now it's not really designed to replicate well in humans. It's designed to replicate better and birds. This virus has to change for that real threat to occur.

I'm west Kosova today on the Big Take. How concerns should we be about bird flu? The Biden administration has officially declared an end to emergency coronavirus measures in the US, saying the pandemic is more or less behind us.

White House is just now saying that the President has just signed a bill that will end the national emergency declared during the COVID pandemic.

So that's a relief. But the whole time COVID nineteen was racing around the world, scientists who monitor the spread of diseases, we're keeping an eye on other viruses, including avian flu. People like doctor Webby, and he has more to say later in the show about how these viruses learn and adapt and whether it's likely or not that bird flu may one day begin to spread from person to person. First, I want to to Bloomberg reporters Michelle Cortes and Susie Ring, who are covering this story. Michelle, why would it be so bad if bird flu does make that change.

Scientists and public health officials have been waiting for human to human transmission of avian influenza for decades now, and it continues to not happen. The fear is that once that actually does occur, they won't be able to get it under control. The mortality rates are so high with avian influenza that the fear is that once it starts transmitting easily between people, that there will be mass mortality among humans, and that we'll be on the back foot and won't be able to get in front of it. At this point, with such huge numbers of infections in wild and domesticated birds moving into mammals, that's the concern that that's what's going to be happening.

Now, Susie. Is that why even though, as Michelle says, scientists have been concerned about this for a long time, it's just the scale that there's so much more of this flu out there that it increases the chance that the flu can get smarter.

The scale that we've seen in terms of deaths among birds, we're seeing millions being cold because this has just become a complete epidemic among wild birds and then among poultry.

Are highly contagious.

Avian flu is infecting birds all over the globe.

The world is going through its largest ever recorded outbreak of bird flu.

More than two hundred million birds have died as a result of the current avian flu outbreak. And then also the concern is it's spreading to mammals as well, so we've seen Peruvian seals and bears also catching. This shows the virus is mutating, it is jumping between species, which then of course raises the question is it going to mutate further and then make its way into humans and then from there allow for human to human transmition if it's mutated in the right way.

Michelle, what is the risk of avian flu to humans? What does it actually do?

Avian influenza, in the end, is an influenza, and it works the same way as the seasonal flu that we're all very familiar you're with, causing anything from you a cough, a sore throat, runny nose. It can lead to difficulty breathing, high fevers, and of course the most feared outcome is a pneumonia, and that is what eventually kills people. The difference between avian influenza and seasonal flu is that avian influenza is incredibly virulent, killing more than half of all of the humans that it's infected. Of Course, the rub is is that only about a thousand humans have been infected, so the numbers are small, and we don't know as the mutations happen if that's going to make it more deadly or less deadly, as it makes it easier to transmit, if and when that happens. The issue is that you know, if you look at Spanish flu If you look at nineteen eighteen, the case mortality rate was under two percent. So the idea that avian influenza is killing half of people that it infects or more, that's a terrifying idea if you get something that's going to hit a similar number of people. We certainly saw that with COVID, where it transmitted so easily that mortality rates weren't anywhere near what we've seen with avian influenza, but it infected millions and millions and millions of people. If you start getting mortality rates that are even double digits, you will have a skyrocketing number of deaths, just absolutely overwhelming.

Avian influenza doesn't discriminate by age in the same way as we saw with the COVID dynamics, and that's very different. You know, we're seeing this girl in Cambodia died from it. She's eleven. So I think when you speak to epidemiologists and scientists, the ultimate concern is that an avian influenza pandemic could absolutely dwarf the six point eight million deaths we saw from COVID nineteen. COVID nineteen was an event that has traumatized the world was destructive economically, emotionally on every single scale globally, But Avian influenza would be something that would be so far beyond COVID nineteen it doesn't even bear thinking about.

Michelle Susie mentioned an eleven year old girl in Cambodia who died from bird flu. You went to Cambodia, where there is a very big effort to try to contain it spread. What did you find there.

Well, Cambodia has been dealing with bird flu for years. At this point, they haven't had any cases since twenty fourteen. The first sign that there was something amiss in Cambodia was when some chickens turned up dead on the side of the river, and the local villagers just put it down to the heat, which is unrelenting in Cambodia. In February when this all occurred. A few days after that, the eleven year old girl, a sixth grader, asked her teacher if she could go home because she wasn't feeling well. No one put those two pieces together, and of course they did send her home. Her family took care of her. Her grandmother and her aunt, who she lived with, tended to her and she continued to get worse, so they brought her to a local clinic who gave her some treatment, and she continued to not get better. At that point, the village doctor suggest that her family bring her to the main hospital in p Nom Pen. Her father brought her there the next morning, and they thought that she had seasonal influenza, which is something that is going around. They did give her tama flu to treat that infection, and they tested her to see what the infection was, but they didn't know about the chickens. No one put that piece together, so they didn't rush the test. She was there overnight. In the morning she had passed away. A few hours after that, they got the result that it was adian influenza. When they got that result, that's when the alarm bell started ringing, and the health authorities in that province rushed to the village to set up this makeshift testing and to reach out to everyone in the vicinity to find out exactly what the risk was.

And even though this girl and her father both contracted bird flu, they were able to determine that it wasn't a human to human transfer. The daughter didn't give it to the father or the other way around, right.

So the family actually lived in a house that was up on stilts. Now a lot of these homes are like that because they have hammocks and living space underneath the houses because of the shade, and they live very close to their animals. So many houses had dogs and cows in their yards, and chickens were ubiquitous. What happened with this family is that they did have four chickens, and two of them had died, and they slept right under the girl's room. The thought is that the girl actually contracted the virus from the chicken, either before it died or shortly after it died. Then her father actually took the chicken. And because they do live so closely with their poultry and with their animals, and because it is so unbelievably hot in Cambodia, sometimes animals do just die of heatstroke and they eat those animals. So the father did eat the chicken that died. Of course, they never did test it for bird flu, but at this point the speculation is is that it had been infected. Now, doctors point out that eating an infected animal is not a problem if you cook it properly. What was probably the issue for the father is that he had to pluck all of the feathers off of the bird, and by doing that he likely aerosolized the virus and contracted it that way. If this virus had been able to transmit from human to human, she had certainly been in contact with many other people during this period of time. So that's the piece that officials are still.

Going to have to be working on.

Within twenty four hours of doctors getting back the test result that she had avian influenza, they had an entire team, dozens of public health officials in her tiny village of less than two thousand people. They canvassed the village, they found her closest contacts, they did testings, they took the swabs, they got the results, and they found another infection in her father and ruled it out in about another dozen of her closest schoolmates, her grandmother, and her aunt. So they knew right away that they weren't dealing with a big outbreak. And then they continued to stay for another three weeks, testing dozens more people who developed flu symptoms, any kind of a sniffle, cold, cough, headache. They tested everybody. They didn't find anything else, so they were able to shut it down and knew that they weren't transmitting. But the idea that you can do something like that in Cambodia in a place where most people live in a pretty simple rural environment, and that they were able to get in there and use some of the most advanced medical technology that the world has in order to make sure that they didn't have a runaway outbreak was amazing. And the bottom line is that everywhere in the world knows that they do not want to be the next Wuhan, and health authorities worldwide are really focused on acting quickly.

When we come back, how countries around the globe are responding to these bird flu outbreaks Susie. In this case, we saw a rapid response from Cambodia, but what are other countries in Europe and the US other places around the world doing to prepare for the possibility that bird flu may one day start to spread from person to person.

So we've seen similar levels of alertness globally. In the UK, the government put together a panel around November of experts both in zoology but also in human pandemic preparedness epidemiologists. We had Neil Ferguson, the famous epidemiologists who advise the UK government on its COVID nineteen responses on that panel, and all of those experts have been meeting every week or so and in smaller groups to discuss developments.

A number of them are doing research.

I spoke to one who at the Perbright Institute, which is just outside London specifically focuses on animal diseases and they are doing a lot of testing to monitor if the virus is mutating and if the virus is able to jump to human cells, and then feeding that research.

Back into that panel to keep an eye on it.

Other things they have put in place include kind of risk based assessments, so they have alert levels for certain signs of the virus evolving or changing, because we have already seen mutations hence the jump from birds to mammalian species. Globally, when it comes to controlling the virus, we've seen a number of countries in the EU and the UK introducing housing measures that basically means that farmers are forced to keep their birds inside for the time being to make sure that they're kept away from contact as far as possible with wild birds that.

May be carrying the virus. In the UK.

That measure came in November and has actually just recently been lifted. Some countries are also now actually changing their stance around vaccination of birds as well.

The Buying Administration is considering vaccinations for chickens an option to address concerns about a bird flu pandemic.

To date, that has been something countries have been hesitant to do because of a fear of masking the virus and just allowing it to pervade with asymptomatic symptoms. But we've seen France has now asked a number of companies to create vaccines for its birds. Netherlands similarly because they've decided that it is actually going to be a better way to control the virus overall in the long term.

Yeah, this is absolutely an issue worldwide. Brazil, which is the largest exporter of chickens, hasn't had any Alian influenza cases yet, and they are now surrounded by them from their neighboring countries and they are really starting to worry about it. They're tracking birds, they're tracking wild birds, they're looking for the virus, trying to keep it out as best they can. Although as su As you said, earlier.

It's a very difficult thing to do.

Countries like the US, major manufacturers like Tyson's Food are really taking it very seriously, but it's very, very difficult to stop something that literally flies through the air and is carried by animals that are wild Asia. Avian influenza has been here for years at this point. Hundreds of people have gotten infected, hundreds have died from avian influenza. That's one of the reasons that Cambodia was able to respond so quickly when they did have a case. It wasn't something that was unfamiliar to them. But just as Cambodia is focusing in on this, everyone else in Asia is as well. The other thing, of course, is that influenzas do tend to pop up in Asia first and then circulate through the rest of the world. And because there is so much interaction between animals and people in this region, for whatever reason, we do seem to see a lot of spillover from animals to humans here happening first. A lot of the brand new novel viruses that are emerging come out of Asia. Of course, it's a significant issue for China, which is where COVID first was identified, and we have seen a case of avian influenza in China and a death this serial read, so it is something that is known and they are tracking it very closely.

I think the problem with this disease as well is that you can do a certain amount to protect farm animals and to protect poultry because they are in the control of humans who are operating those farms and who are producing eggs. So they can do what a number of countries have done, which is keep birds inside, make sure that they're not outside, to raise kind of levels of security coming in and out of farms, making sure people are having contact with the birds are doing so in a cleanly or sterile way. But what you can't control as wildbirds and the contact between wildbirds and domesticated birds. So it would just take one infected wild bird flying over a flock of domesticated poultry defecating and there you have the outbreak, and there's little that farmers can do about that.

And if that happens, it can decimate an entire flog.

Yes, that's right, because it's hugely transmissible. And also once the infection's been discovered, then a mass coll often has to happen because you need to make sure that that doesn't then get transferred over into humans. So to illustrate how difficult this virus is to control, we actually spoke to one duck farmer outside the city of Seattle, and she had, just before Christmas, decided to adopt some really strict biosecurity measures, no visitors, specific shoes, specific jackets, a guard dog, to make sure that wild birds were scared away from the farm, every measure she possibly could to protect her flock and ensure that avilamitwinsa didn't get in.

However, right before Christmas, she was forced to.

Call more than one hundred and seventy ducks and four geese, And that could have just been simply because one bird flew over her flock and defecated. And that's something that she just can't control, no matter how many biosecurity business she.

Puts in place.

Susie, the avian flu isn't just having this impact on birds and people in terms of becoming sick, but it's also having really big economic effects. How has this outbreak effected businesses and consumers?

So the economic impact of this has already been huge despite not being a pandemic in humans, despite still being limited to the animal population. The USSDA estimates the burfy outbreak has cost the US economy two billion dollars in twenty twenty two.

The average price for a dozen of eggs has more than a double.

Eggs has been skyrock The prices of eggs won't stop climbing.

Because we've had these mass coals.

That means you've got less birds producing eggs, but also it's a huge blow to the farming industry. By culling all these birds, you're significantly impacting those industries and their usual revenue generating means both selling and buying birds, but also the products.

The eggs, which has had a huge impact globally. That's not just limited to the US, of course.

We've seen huge coals in China, in the UK, in Europe.

And it goes beyond even the animals themselves. Many of the products that are made using these ingredients, right mayonnaise, think about it, there's been a shortage of eggs that you need to make mayonnaise in other places. In Japan, for example, some McDonald stopped making certain products because they needed to use ingredients that included eggs and they couldn't get enough of them to actually offer those products. So we did see a huge impact over the course of the early parts of this year from the mass calling and the lack of animal meat and eggs.

Susie, given everything we've been talking about today and the levels of preparation needed to combat what may be coming, what are you watching for as you're reporting this story? What do you think comes next?

I think the key things are that human to human transmission.

We have experts who are monitoring this constantly, and governments are clearly on high alert for this, and at the moment it's not seeming like scientists are overly concerned about that happening. However, you just can't say never with these diseases. But I think the bigger question that it also raises is while we have seen a good level of preparedness with avian influenza, it's also a disease that we know a lot about and scientists have been researching it for decades. We have influenza vaccines, albeit not bespoke ones to avian influenza of a strain that will transmit between humans at this point, but we have templates. What we don't have for a number of other invectious diseases is much for such at all. There's a whole list of infectious diseases that the WHO has that have very little known about them. And having spoken to scientists in recent months about this, there is a sense that governments have slightly kind of vacated this space. You know, we're living in a cost of living crisis, we have the a Russia Ukrainian War, there are so many other things that governments are having to contend with at this point, and also a certain amount of pandemic fatigue. People want to move on from COVID nineteen. They don't want it to be ever present in their lives, but there is a reality to which we will have another pandemic at point. It might not be tomorrow, but it will happen. So if we are not careful, we will find ourselves in a position that could be far far worse than COVID, with a.

Disease that we know very little about.

So I think it's just important at the moment that we keep that front of mine, and scientists are very much rallying governments to keep that front of mine right now.

Michelle Susie, thanks so much for speaking.

With me today.

Thanks guys, thank you so much.

After the break. How do these viruses work and how far are we from a bird flu vaccine? Now, let's hear from someone who studies exactly how bird flu and other viruses make that leap from animals to humans and then sometimes humans to humans. Doctor Richard Webbe is an infectious diseases expert at Saint Jude's Hospital in Memphis and director of the World Health Organization's Collaborating Center for Studies on the Ecology of Influenza in Animals and birds.

There's three sort of major categories of change the avian flu virus has to make to successfully make that next leap, so it goes.

Human to human, to human to human and then sort of it's all over.

One of those is the way in which this virus interacts with the host's cell. These viruses buying to sugars on the surface of a cell. Those sugars are different in avian hosts and now in human so as virus has got now change to recognize the human sugar a bit better, that allows it to get into the human cell. There's another category of change which stabilizes it makes it a little bit more stable in the environment. And the third category is the machinery that when this virus gets into a cell essentially tells that cell to make more copies of that virus. And the way it does it is slightly different in an avian cell to human cell, So it's got to make a few mutations in its own genes to allow that to happen as well.

Now that we've seen avian flu make the first leap from birds into humans, is it just a matter of time that it will learn to adapt and spread from human to humans? Is this just an inevitable thing or could it just never happen?

There is a possibility could never happen. If you think of all of the flu viruses that are in the wild bird wild duck populations, only three major groups. Some are very successfully actually made that leap from being a duck virus to being a human virus. This bird flu virus that we have circulating now, we have never seen it as a virus that successfully transmits in humans before, and some people interpret that as saying, well, it doesn't actually.

Have a threat.

Now I read the Telly's a little bit different. I read that as saying, you know, this is a virus that does have the capacity to transmit between humans, and there's some experimental data that suggests that's the case, but it just has a few more hurdles to get over to make that switch.

You and other scientists who are studying this problem are of something the alarmed to say, we need to have preparations in place for the day that it might happen.

Exactly how do you prepare for that? We really have to prepare for it. So and the question what can we do.

We can at least go down that pipeline of getting vaccines ready to go for some of these viruses.

You know, this virus will continue.

To evolve in birds and as it sort of jumps into different hosts, so it will change. But there's some things we can do now that if there is a response needed to this virus in terms of vaccine, you know, we're a little ways already down that path. We can make sure that our diagnostic cassays that we have to detect this virus are robust and they're widely distributed, make people aware of the fact that this is a virus that's out there in the environment.

So those are all things that can be done. What is being done? What are the World Health Organization and other government bodies doing to try to get ready.

In terms of the World Health Organization, there's a couple of things that they do do. One, follow the evolution of this particular virus, and if it looks like has changed a little bit, there will update some of what we call vaccine viruses, and these are the viruses that would go to manufacturers to make vaccine. Typically takes around about four to six weeks to make these, so if we make those in advance, then that takes that amount of time off a response. So this is a continual process. Quite a lot of risk assessment that's been done, sort of going over the data that's available on these viruses. There's anything changing in terms of risk to humans. From a more governmental national perspective, the US government has put a lot of resources into making some stockpoles against the H five, which is the avian flu that we're talking about now. Some of those are a little bit older now, so it's a little unclear as to how useful they'll be with the current strain. But as manufacturers get these viruses, they grow, then they put there in a facility. We do small clinical trials, we learn how to make manufacture, distribute these vaccines. So there is quite a bit of experience in terms of making at least small scale vaccines against this virus, and that's been a process that's been going on for a couple of decades.

Now.

Has it been difficult to communicate the sense of urgency to governments and even just citizens who may be kind of fatigued after COVID and not wanting to think about another pandemic.

I think we're all sick of hear hanging about viruses. This H five bird flu virus has been around in various forms for a lot of time. The alarm bells have been ringing on this one since really nineteen ninety seven when it first crossed over to humans in Hong Kong. So it's not just even the COVID pandemic with this, it's look out, this virus coming.

Look out, this virus is coming. And you know, so far it hasn't.

But yeah, it's really hard in that environment, and then with the COVID fatigue on top of it to get too many people sort of excited and interested and just to really understand the threat that this virus poses.

If it should come to pass, that it is able to transmit human to human. Are you optimistic that we're ready?

Unfortunately, we're not going to be ready in terms of if we're thinking, well, we're ready tomorrow, we're going to have vaccine in our arms. We're going to be able to stop the spread of this virus. That's not going to happen. Having said that, we're going to compare what our response to a flu pandemic might be to sort of what our response to the COVID nineteen pandemic was. There's are some advantages of flu one. We're preparing for it now. We've been preparing for a flu pandemic.

For a long time.

That wasn't necessarily the case for COVID. They came a little bit out of left field. We know how to make flu vaccines that work. We have a lot of experience with that. There's a lot of capacity to diagnose and fluenza out there. So rather than almost starting from zero to sixty, we had to go with the COVID response. You know, we're almost sort of cruising along at thirty mile an hour here, so I've just got to go thirty to sixty with a flu pandemic.

Doctor Richard Webby, thanks for speaking with me today.

It's a pleasure waste. Thank you so much.

Thanks for listening to us here at The Big Take. It's a daily podcast from Bloomberg and iHeartRadio. For more shows from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen. And we'd love to hear from you. Email us questions or comments to Big Take at Bloomberg dot net. The supervising producer of the Big Take is Vicky Bergolina. Our senior producer is Katherine Fink. Federica Romanello is our producer. Our associate producer is Zenobsidiki Raphael i'm seely is our engineer. Our original music was composed by Leo Sidrin i'm Weskasova. We'll be back tomorrow with another Big Take.

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