H5N1 is a strain of influenza (flu). It’s name comes from two of the eight genes in this virus Hemagglutinin (H) and Neuraminidase (N). When sequences within these two genes change enough, the H and N genes get new numbers. Flu viruses can change as a result of sequence changes within genes but also by recombining different gene variations. These different variations may have other designations such as “bird flu”. For example, the patient in Mexico who was recently reported to have died of “bird flu” in Mexico had been infected with H5N2, not H5N1. A patient who had been infected with H5N6 recently died in China. Terms like “bird flu”, “avian flu”, “pig flu” and “swine flu” can be misleading as they can encompass very different strains of flu and may infect species other than those for which they are named. The “human flus” that are also called “seasonal” flus include H3N2 and H1N1.
The H5N1 virus that we are concerned with today originated in China in 1996. It was originally reported in a goose. The virus spread to humans and started killing them shortly after, although Chinese authorities tried to cover this up with the help of their stooge in the World Health Organization, Margaret Chan. To this day, we do not know how many people in China have been infected and died due to the deliberate withholding of information by the Chinese government. Most of the infections and deaths due to H5N1 have occurred in Asia. In Vietnam, H5N1 is reported to have infected 129 people and killed 65 of them – a case fatality rate of 50%.
Many of the H5N1 cases in Asia have been reported in people who have been infected as a result of close contact with infected birds. However, family clusters have also been reported. A typical cluster might include a child who takes care of backyard birds who then infects other family members. The virus that spreads in these clusters can be quite lethal but thus far has not spread sustainably outside the clusters. In some cases, health care workers treating patients have also become ill with H5N1.
Flu viruses can change by mutation or recombination to create new strains with different properties, including the ability to spread sustainably in humans. This has happened many times. The odds that a rare event will occur that permits this depends in part on how many opportunities it has to do it. What are the odds that I will flip a coin and get 10 heads in row? Small, if I only flip it 10 times. But almost a certainty if I flip it 1,000,000 times. Right now, H5N1 is getting an almost infinite number of chances to adapt to humans and become a pandemic virus.
H5N1 has “spilled over” from birds to humans, cats a few other mammals in the past. More recently, it has “spilled over” to a wide variety of mammal species, including ones that have rarely been infected by any flu virus, previously. These include: domestic cats, mountain lions, bobcats, red foxes, coyotes, black bears, brown bears, polar bears, martens, minks, fishers, river otters, raccoons, skunks, opossums, mice, squirrels, harbor seals, grey seals, bottlenose dolphins and, of course, cows. The infections of farm workers by cows is significant as this represents mammal-to-human spread of H5N1 rather than avian-to-human spread. Since humans are mammals, this type of spread brings us much closer to a pandemic strain, one that can spread easily among humans.
There is evidence that H5N1 can spread efficiently among mammals. There have been multiple cases of spread among mink farmed for their fur. This mammal-to-mammal spread of H5N1 is associated with changes in sequence which has been linked to more efficient spread of flu viruses in humans. Tests in ferrets, considered to be a good model for how flu viruses will behave in humans, have shown that the H5N1 virus that infected mink can spread both through direct contact and, somewhat less efficiently, via airborne droplets. It is notable that this virus caused severe disease all the ferrets it infected. They either died directly from the virus or had to be euthanized because they were suffering too much and likely would have died. This is a strong indicator that H5N1 is getting close to becoming a pandemic virus in humans and that it may do so with its ability to kill intact.
Large numbers of farm workers are now being exposed to mammalian-adapted H5N1 due to inadequate personal protective equipment and absent vaccination. Large numbers of Americans are also being exposed to H5N1 by drinking raw milk (and perhaps even by drinking pasteurized milk). If this is true, why haven’t we heard of many cases of lethal H5N1 in people yet? I think there are several reasons. First, the farm workers that have been reported to be infected with H5N1 were treated with Tamiflu, which can be lifesaving in H5N1 infections. Second, there is little tracking of what happens to farm workers since many are in this country illegally. OSHA apparently is not interested in what happens to such people. Third, H5N1 causes unusual neurological symptoms which may not trigger testing for an influenza infection. Fourth, this is the most unfavorable season for influenza to spread. We often refer to “human flu” as “seasonal flu” because flu spreads best in humans in the winter. One possibility is that we won’t see large numbers of people infected with H5N1 until November or December when it may “bloom” all at once.
Suggestions that we have “learned our lesson” and should send kids back to school without masks or vaccination during an H5N1 pandemic seem insane, to me. Many of the deaths from H5N1 have been among children. They are definitely not immune to H5N1. No one is. We need continuous testing and sequencing so that we know where the virus is spreading and how it is changing. We need a massive increase in the supply of Tamiflu and other antivirals, and we need it right now. We have no choice but to use mRNA vaccines again as this is the only technology that can deliver a vaccine in time to do any good. I say we need all these things. Are they happening? No. Will they happen? Unlikely. The same stupid people who managed the SARS-CoV-2 pandemic will manage the H5N1 pandemic. All the editorials in the world saying we need to do X, Y and Z will not change this. The people in the CDC, FDA, etc. will wait until Americans are dying in large numbers before they start moving in their slow and inefficient manner. There will be confusing messaging. There will be blowhards on the radio and TV lying their teeth out. The travel industry lobbyists will swing into gear. You know what happens next – overwhelmed hospitals, lots of funerals, etc. This time we may face societal collapse, if the fatality rate is too high.
We face two threats – a virus that is now ubiquitous in the environment, surrounding us in almost every species of bird that flies in the air and mammal that creeps on the ground and in the very food we eat. The second threat we face is human. Human stupidity and human malice, in equal measures. The Great Sieve is coming. Prepare.
References
Avian Influenza A(H5N1) – Viet Nam
https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON511
2 April 2024
Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong. Bridges et al. 2009. Journal of Infectious Diseases.
https://pubmed.ncbi.nlm.nih.gov/10608786/
Detections of Highly Pathogenic Avian Influenza in Mammals. USDA.
https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/mammals
Highly pathogenic avian influenza A(H5N1) virus infection on multiple fur farms in the South and Central Ostrobothnia regions of Finland, July 2023. Lindh European Surveillance. 2023.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10401912/
‘Incredibly concerning’: Bird flu outbreak at Spanish mink farm triggers pandemic fears. January 24, 2023. Kai Kupferschmidt. Science.
https://www.science.org/content/article/incredibly-concerning-bird-flu-outbreak-spanish-mink-farm-triggers-pandemic-fears
Risk assessment of a highly pathogenic H5N1 influenza virus from mink. Restori et al. Nature. 2024
https://www.nature.com/articles/s41467-024-48475-y
Avian influenza virus type A (H5N1) in U.S. dairy cattle. American Veterinary Medical Association.
https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/avian-influenza/avian-influenza-virus-type-h5n1-us-dairy-cattle
Dairy Workers on Wisconsin’s Small Farms Are Dying. Many of Those Deaths Are Never Investigated. Maryam Jameel and Melissa Sanchez. Oct. 25, 2023. Pro Publica.
https://www.propublica.org/article/wisconsin-dairy-farms-osha-safety-death-investigation-immigrant-workers
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