As the Trump administration struggles to find its footing on the outbreak, state collaboration will be key

Two people, a woman from Wyoming and a man in Ohio, have been hospitalized with H5N1, the CDC said in a routine flu update on Friday.

The woman is still in hospital, while the man has been released to recover at home. Both patients experienced “respiratory and non-respiratory symptoms”, the report said, without detailing those symptoms.

I wrote an article for the Guardian this week about what it means:

“This shows that H5N1 can be very severe and we should not assume that it will always be mild,” said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.

The news comes amid one of the worst seasonal flu outbreaks in 15 years – raising the potential for the emergence of a more dangerous virus that combines bird flu and seasonal flu in a process called reassortment.

“I am very worried about H5N1 in patients that are being treated in hospitals where there are also many seasonal flu patients because this creates opportunities for reassortment, which could potentially produce a pandemic-capable H5N1,” Rasmussen said.

–Two people in US hospitalized with bird flu, CDC reports, The Guardian US

Two new studies on ferrets indicate that prior infection with H1N1 — one of the seasonal flu variants driving our current surge — may provide some cross-protection against H5N1.

But people aren’t ferrets. And it’s not clear how much cross-protection would help against a novel (and mutating) virus.

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Endemic in cows

Meanwhile, a newer variant of H5N1, called D1.1, has spilled over into dairy cows separately in Nevada and Arizona.

This is changing our understanding of how the virus is spread — and it’s not great news for containing it, I reported for the Guardian last week.

“It’s endemic in cows now. There is no way this is going to get contained” on its own, said Seema Lakdawala, an influenza virologist and co-director of the Center for Transmission of Airborne Pathogens at Emory School of Medicine.

–Alarm as bird flu now ‘endemic in cows’ while Trump cuts staff and funding, The Guardian US

That means the Trump administration needs to change its tack for trying to contain this outbreak, and quickly — but there are several worrying signs there.

Robert F. Kennedy Jr., the new health secretary, halted a seasonal flu vaccination campaign, and a meeting of independent vaccine advisers was postponed.

The US has also halted communication with the World Health Organization on influenza data, while U.S. officials signal a possible move away from culling poultry — a cornerstone in global efforts for containing bird flu.

Meanwhile, the new administration has been firing employees who monitor and respond to outbreaks like this, which is… not a great sign:

“The possibility of new outbreaks or public health events is certain given the recent concerning spread of bird flu, which is still hampered by a slow response,” one employee at the CDC told me.

–Musk’s takeover of US health agencies raises pandemic threat, experts warn, The Guardian US

State cooperation

As the federal government falters, states will need to take up the slack — and, as I reported last month for the Guardian, many of them already have strong existing relationships.

(Finally, some good news! Sort of.)

As soon as the first infection was detected in wild birds, Delaware and Maryland formed a command center to track the outbreak and conduct follow-up sampling across the affected area in both states.

“During an active response, we do not consider any state lines,” said Stacey Hofmann, a spokesperson for the Delaware-Maryland Avian Influenza Joint Information Center. “At the first suspect case in a commercial poultry farm or a backyard flock, our multi-state response team is already communicating, and it is all hands on deck.”

–‘All hands on deck’: Bird flu in US poultry puts state cooperation to the test, The Guardian US

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Top image: Photo of chickens by Aimee Rivers.