H5N1 Bird Flu Concerns Grow. Are COVID-19 Mistakes Being Repeated?

There’s a saying that those who do not learn from history are doomed to repeat it. Will that be the case with the H5N1 avian influenza virus that’s been spreading amongst birds for years, jumped to dairy cattle earlier this year and recently made a pig appearance over the past month? Is hindsight not 2020, and are we seeing with the H5N1 bird flu repeats of the same mistakes made before and during the COVID-19 pandemic? Or is this H5N1 virus situation right now different enough from the severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 situation that we don’t have to worry about the “p” word?

Well, the Centers for Disease Control and Prevention currently lists the public health risk of bird flu as low. But there’s no guarantee that it will stay that way forever. Here’s what we know at the moment about H5N1:

The H5N1 Bird Flu Has Been A Problem Among Birds for Years

It’s been called the bird flu because it is a type of influenza virus first noticed as spreading among birds. While I’ve been covering its progression through different bird populations around the world since 2021, the H5N1 virus has been around for much longer than that. For example, a 1997 outbreak in Hong Kong did consist of 18 animal-to-human infections and six deaths. There were also two human deaths soon after H5N1 surfaced among wild birds in Asia in 2003. The virus has garnered more attention over the past several years mainly because it has been giving the U.S. poultry industry the bird—make that a lot of infected birds—with at least 45 commercial poultry flocks and 30 backyard flocks, for a total of at least 22.37 million birds infected since April 2024 alone, based on reports from the U.S. Department of Agriculture. This H5N1 going around birds received the designation highly pathogenic avian influenza because it’s been causing sickness and death among birds. Such deaths along with the culling of flocks in attempts to curtail the spread of the virus have already affected humans by causing shortages and pushing up the prices of poultry and eggs.

The H5N1 Bird Flu Has Been Spreading Among Cattle At Least Since Spring 2024

Earlier this year, there was a holy cow moment, when dairy cattle began getting infected. That showed the virus’s ability to mutate to the point that it could jump to another set of animals. Since this bird flu was first detected among cattle in March 2024, the virus has spread to at least 440 dairy herds in 15 U.S. states, according to the U.S. Department of Agriculture. The virus has been detected in cow’s milk, although this wasn’t something to have a cow about. At present, you don’t have to really worry about catching the virus through drinking properly pasteurized milk or properly prepared beef like hamburgers. This doesn’t necessarily make the spread of the virus among cows a nothing burger, though.

The Recent Pig Appearance of H5N1 Bird Flu Does Raise Reassortment Concerns

Then there was the pig event on October 30, 2024. This was when the USDA reported for the first time a case of H5N1 in a U.S. pig. This was in a pig on a backyard farm in Oregon. Such an announcement sowed even bigger concerns. That’s not because the thought of a coughing pig is any more disturbing than that of a coughing cow. It’s because the influenza viruses tend to swap their genetic material with each other more readily and faster in pigs than in birds.

Such swapping is called genetic reassortment and can result in viruses with completely new combinations of genetic material. New combinations of genetic materials can result in the viruses having more capabilities, sort of like how some of the members of the fictional X-Men series got their powers. This could at some point result in a virus that can spread to and among even more species like humans, which presumably is your species. The higher reassortment rates in pigs can be sort of a significant problem.

Pig Reassortments Were What Led to the 2009 H1N1 Pandemic

If you are indeed human, it’s important to remember that a series of reassortment events in pigs is what led to the 2009 influenza A(H1N1) pandemic. These pig events resulted in a version of the H1N1 influenza virus that could jump to and spread among humans back in 2009. That pandemic led to an estimated 60.8 million cases, 274,304 hospitalizations and 12,469 deaths in the U.S. and an estimated 284,400 deaths worldwide. That wasn’t nearly as bad as what COVID-19 has done, resulting in over 1.2 million deaths in the U.S. and over 7 million deaths worldwide, along with a long, long, long list of long Covid cases and counting.

Don’t assume, though, that any new novel influenza virus would be an exact repeat of 2009 if it were to jump to and spread among humans. The world did get lucky in 2009 because the H1N1 virus did resemble a strain that older people had been exposed to in a previous pandemic. That meant that many older folks already had some degree of protection against the H1N1 flu virus and thus were less susceptible to badness. Contrast the 2009 pandemic with the 1918 flu pandemic, which resulted in an estimated 50 million deaths. That was roughly one-fifth of the world’s population back then, which was not too far from the level of the Thanos snap in the movie Avengers: Infinity War.

The key here is the word novel. When a novel virus infects your body, your immune system can behave like a virgin on a first date. It doesn’t quite know how to act and can end up firing in different random directions, causing more damage to your body than protecting it. Therefore, you never quite know what may happen when a virus reaches a human for the first time. So, not only is the potential for the “p” word there with H5N1, there is always the potential for a bad “p.”

There Have Been 55 Confirmed Human Cases of H5N1 Bird Flu In The U.S.

So far, there have been 55 confirmed H5N1 cases in humans in the U.S. The vast majority have had clear direct contact with infected animals. such as the dairy worker that I wrote about for Forbes. There hasn’t been any clear evidence of infected humans transmitting the virus to other humans. Of course, seeing such human-to-human transmission would be a big deal. That would mean that humans could then pass a novel virus to each other.

Most of the human cases of H5N1 to date have been mild, as well. An 11-year old girl in Cambodia did die in 2023, and one teenager in British Columbia is currently critically ill after getting infected. Keep in mind that mutations could turn a not-so-nasty virus into a nasty one, especially if those mutations allow the virus to more effectively attack human’s lower respiratory tracts. Therefore, it will be important to closely follow what happens with each person getting infected.

With the H5N1 Bird Flu, The U.S. Is Repeating Many COVID-19 Mistakes

While it’s still unclear what will happen with the H5N1 virus and how much of a threat it will be to humans in the coming years, one thing is fairly clear: the U.S. is not doing all that it can to prevent and prepare for another possible pandemic. In fact, in many ways, the U.S. appears to be winging it with the bird flu and repeating many of the same mistakes as it did in the years leading up to the COVID-19 pandemic.

Many of the problems that existed in 2019 still exist today. The U.S. continues to lack comprehensive respiratory virus surveillance and reporting systems that would allow everyone to see where different pathogens may be spreading. For example, good luck finding out how many COVID-19 cases have occurred in your area over the past week. Moreover, the COVID-19 pandemic exposed major longstanding deficiencies in the U.S. healthcare and public health systems that haven’t been fixed since. For example, physician and nurse burnout have been persistent problems, and Suhauna Hussain just reported for the Los Angeles Times about how personnel at the California Animal Health and Food Safety Laboratory have been complaining about being overworked and understaffed.

There remain big holes in the U.S. armamentarium against H5N1. For example, the U.S. is at the moment without commercially available monoclonal antibodies against the virus. Existing antiviral medications like oseltamivir (Tamiflu) and baloxavir marboxil may have limited effectiveness against H5N1 due to mutations. Additionally, the time to invest into H5N1 research is now. Waiting until it’s already caused a human epidemic or pandemic would be like waiting until your house is on fire before purchasing fire extinguishers and figuring out what fire can do.

Meanwhile, the misinformation and disinformation that hindered the response to the COVID-19 pandemic continues to spread without much of an organized plan to counter anti-science messages and thinking. People have been able to successfully politicize the heck out of evidence-based infectious disease counter-measures like face mask use. Imagine how politicized things could get the next time a pandemic hits.

Finally, the bird flu seems to be getting relatively little attention from political leaders. How much talk of H5N1 preparedness have you heard from the current Presidential administration, the incoming one or members of Congress besides one party trying to criticize the other? The concern is that once again political leaders are repeating the cycle of panic during pandemics and neglect in between them that has continuously plagued pandemic preparedness as I described for Forbes back in 2020.

This is not to say that political leaders should be running, waving their arms and yelling, “Panic, panic.” That p-word should never be used, and it’s still way to early to use the other p-word—meaning pandemic—when it comes to what H5N1 bird flu will do. However, it’s certainly not too early to use another p-word—namely preparedness—much more.