When this version of H5N1 first landed in North America, borne on the wings of migratory birds blown off course from Europe in late 2021, Seema Lakdawala followed the developments closely, but she wasn’t overly worried about it leading to a pandemic in humans yet.

Here’s what Lakdawala, an influenza virologist and co-director of the Center for Transmission of Airborne Pathogens at Emory School of Medicine, told me in early 2023:

“We haven’t had any mammalian-to-human transmission events yet, so I think I’d be most concerned if we started to hear that,” Lakdawala said. And “until we hear about more human infections, I’m less concerned about human-to-human transmission—but that doesn’t mean that the risk is negligible.”

–When to Panic About Bird Flu, The New Republic

Back then, she was keeping a close eye on the outbreak, but there were still a few steps that bird flu needed to take before it rose the rungs of her worry scale: it would need to spread to new animals and then on to people; it would need to start mutating to become more transmissible or virulent among people; and it would need to start making more people pretty sick.

Now, all that has happened, she told me recently.

“I think we’re there. Now is when people should be concerned and take it seriously.”

–What we know about the U.S. bird flu outbreak and its chronic disease risk, The Sick Times

And she has a new concern: People might wait to take it seriously until there’s widespread transmission among humans.

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But by then, it would be too late to prevent a pandemic. Widespread human-to-human transmission would likely sweep the globe in a matter of weeks.

That’s why it’s so important to get the outbreak under control now. But:

“It really doesn’t seem like there’s any control over this,” said Thomas Peacock, a virologist at the Pirbright Institute in the United Kingdom.

In fact, what we’re doing is exactly what could lead to a new pandemic, he said.

“If you were trying to cause a pandemic with this virus, this is the sort of thing [you would do] – you would passage it through farm animals [to people].”

Acute illness from the flu is a serious concern. There is also the potential for developing long-term sequelae after influenza.

“My worry is that people will be like, ‘it’s just a flu, so it’s fine,’” said Jaime Seltzer, the scientific director at the myalgic encephalomyelitis (ME) advocacy organization, #MEAction.

Yet there is a “more than two-fold increased risk” of developing ME after infection with H1N1 flu compared to patients who got the flu vaccine, one study found in 2015.

I wrote about what you can do about all of this for The Sick Times today, and I hope you read the whole piece. But here’s one big takeaway that stuck with me:

“Contact your state,” Lakdawala said. “This is what I’ve realized: it’s really up to the states.”

Contact your governor and your state or local agriculture department, telling them why you’re concerned, noting any herds or flocks in the area that have tested positive, and talking about health conditions that might make illness more severe for you. Ask them what they’re doing to slow or stop the spread.

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Top photo: Liza