Imagine describing an unprecedented attack on and dismantling of public transit resources and a leftist telling you, “yeah, but what can we do? People can always buy a car.” That’s the situation we find ourselves in with COVID- not only are we not winning, we aren’t even fighting. Not only are we not protecting people, we aren’t even outraged. To engage with the reality of this crisis, we need to understand how adopting an individualist approach to public health is destroying decades of labor activism, human rights progress, and hard-won protections.

The history of public health in this country and around the world is the history of disease eradication, mitigation, suppression, and prevention. The name of the public health body currently pushing “you do you” as a strategy is the Center for Disease Control and Prevention, for God’s sake.

 It’s not the Center for Diseases Are Fine and Go About Your Day. It was initially founded in 1946 as the Communicable Disease Center with a mandate to eliminate malaria. Not ignore. Not “learn to live with.” Eliminate. A word that, four years into the disaster capitalist response that took neoliberal abandonment to new heights, cannot even be uttered aloud anymore.

For several years, when minimizers downplayed consistent findings of post-COVID immune damage, they stated that were we experiencing large-scale immune dysfunction, we’d expect to see  https://www.msn.com/en-us/health/other/invasive-fungal-infections-a-growing-risk-to-human-health-worldwide/ar-BB1h8Oag - spiking fungal infections ,  https://edmontonjournal.com/news/local-news/strep-surge-while-flu-has-peaked-out-alberta-health-care-workers-face-new-challenge-as-they-see-record-numbers-of-throat-illness - spiking bacterial infections ,  https://www.mprnews.org/story/2024/01/12/surging-into-2024-covid-flu-and-rsv-continue-to-climb-in-minnesota - worsening viral outbreaks ,  https://www.dailytelegraph.com.au/lifestyle/health/mycoplasma-pneumonia-deadly-infection-on-the-rise-in-children/news-story/2d373b67d19e512d31c798575d79e47b - pneumonias  and  https://kdvr.com/video/denver-health-tuberculosis-cases-spike-in-the-u-s/9232299/ - other opportunistic infections.  We are now seeing all of these effects internationally, yet minimizers continue to turn a blind eye and the press continues to push “your kid wore masks in 2020” as the explanation.

We are even beginning to see large resurgences of previously-eliminated-in-rich-countries viruses like measles. Lack of vaccination is a culprit; so is normalizing sending sick kids to schools, telling parents kids need to get sick to be healthy, denying people paid sick leave, and kicking kids’ immune systems in the teeth multiple times a year.

Unless we change course urgently- unless we fight back against the normalization of constant illness and the individualization of a critical public good- we are going to see a long, slow, across-the-board decline in health and life expectancy amid increasingly uncontrollable disease outbreaks and overwhelmed hospital systems. I haven’t even gotten into the damage COVID does to blood vessels, kidneys, livers, brains, and hearts, how it can trigger autoimmune diseases and reactivate latent pathogens; all of that information can be found elsewhere on this site. But the reality is that our kids will be continually reinfected with COVID while navigating the return of measles and other vaccine-controlled diseases, while being told there is zero technology that can protect them and zero reason to protect them, while contracting flu and RSV more frequently and with worse severity.

This is not 1824. It is 2024. We have the technology and knowledge to mitigate disease spread. Let’s fight for a future that is safer, better, and healthier than the world we grew up in, rather than sicker, crueler, and technologically regressed. If we don’t face reality and understand what we’re sacrificing right now, the next generation certainly will.

We now have the answer to at least 2 of our questions regarding the H5 virus infection in a teenager from British Columbia; according to a statement from the PHAC  https://flutrackers.com/forum/forum/canada/h5n1-tracking-ag/british-columbia-aa/1000092-canada-british-columbia-health-statement-first-presumptive-positive-human-case-of-h5-avian-influenza-detected-in-b-c-confirming-test-pending-november-9-2024 - (h/t FluTrackers)  the subtype has been confirmed to be H5N1 and the genotype is D1.1. 

Genotype D1.1 first showed up last month in Washington State, and is responsible for the  https://doh.wa.gov/you-and-your-family/illness-and-disease-z/avian-influenza - infection of 14 poultry workers  who were involved in culling.  A similar genotype - D1.2 - appeared last month in poultry, and 2 pigs in Oregon. 

These genotypes are genetically distinct from the B3.13 genotype which is found in cattle, and has turned up in some adjacent poultry infections.  It has been widely assumed that genotype D1.1 or D1.2 was behind the recent spike of poultry outbreaks in British Columbia, which this statement confirms.

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There have been no further cases identified at this time. The investigation has not yet determined how the individual became infected with avian influenza.

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Influenza's superpower is its ability to continually reinvent itself though reassortment, and that means that even if we mange to eradicate it in cattle, the problem won't have vanished. 

Which is why, nearly 3 decades after it first appeared in Hong Kong, HPAI H5 continues to pose a credible threat. 

The CDC updated their  https://www.cdc.gov/bird-flu/situation-summary/index.html - H5 case list  late this afternoon adding 6 more cases (5 from California & the 1st case reported by Oregon).  They cite 4 other cases that tested positively at the state level, that they were unable to confirm. 

From the Oregon Health Authority we get a press release describing their first case as linked to a large poultry outbreak in Clackamas county (see USDA listing below), which was reported on October 24th, but according to the  https://wahis.woah.org/#/in-review/4309?reportId=170013&fromPage=event-dashboard-url - WOAH report  began on Oct 21st. 

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The lack of details (such as symptoms, onset date, etc.) and the belated reporting are disappointing, but have become all too common during this outbreak.  

Earlier today we looked at a report from  https://afludiary.blogspot.com/2024/11/california-madera-county-public-health.html - Madera County Public Health  announcing 2 more California H5 cases (1 confirmed, 1 presumptive positive).  This afternoon the California Public DPH  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Bird-Flu.aspx - posted the above update , adding 5 new cases to their tally, which previously sat at 21 (+1 probable). 

Since none of the states are providing any date or location information (aka, an epidemiological line list), it is difficult to know if today's state announcement includes (one or both) of the Madera county cases. 

Since these numbers are continually increasing, and are unlikely to represent the true number of cases in the community, the point may be moot.  

Tuesday, November 19, 2024

While it hasn't appeared on the  https://www.cdph.ca.gov/Programs/OPA/Pages/News-Releases-2024.aspx - California PHD website yet , that agency emailed the following statement out shortly before noon EST today.  It described a presumed positive H5 case in a child in Alameda County with mild respiratory symptoms. 

Samples have been sent to the CDC for confirmation. Thus far the CDC has not offered a statement.

Note: The subtype is not mentioned in this statement, but I'm assuming it is H5. 

Family Members Tested Negative

No person-to-person spread of the virus has been detected or is suspected. Due to mild respiratory symptoms, all close family members of the child were tested – and all are negative for bird flu and not suspected of having the virus at all.

Blood is categorized into four main types—A, B, AB, or O—based on the types of antigens present on the surface of red blood cells. Antigens are proteins found on red blood cells that trigger an immune response when encountering unfamiliar substances, such as certain bacteria, Dr. Douglas Eric Guggenheim, a physician at the Abramson Cancer Center at the University of Pennsylvania Hospital,  https://www.pennmedicine.org/updates/blogs/health-and-wellness/2019/april/blood-types - explained  in a 2020 Penn Medicine article.

Increased Risk of Viral Infections

A  https://ashpublications.org/blood/article/142/8/742/496471/Blood-group-A-enhances-SARS-CoV-2-infection - 2023 study  from Harvard Medical School, published in the journal Blood, found that the SARS-CoV-2 virus, which causes COVID-19, preferentially targets type A blood cells.

“We show that the part of the SARS-CoV-2 spike protein that’s key to enabling the virus to invade cells displays affinity for blood group A cells, and the virus in turn also shows a preferential ability to infect blood group A cells,” Dr. Sean R. Stowell, of Harvard Medical School and Brigham and Women’s Hospital, said in a  https://www.hematology.org/newsroom/press-releases/2023/study-uncovers-direct-link-between-blood-group-a-and-a-higher-risk-for-covid-19-infection - press release .

Type A blood cells are more susceptible to SARS-CoV-2 infection than type O blood cells, Stowell noted. “Among a group of several thousand people, some studies suggest that those with blood group A may be 20 percent more likely to be infected after exposure to SARS-CoV-2 compared with those who have blood group O.” Subsequent experiments indicated that the Omicron variant demonstrated an even stronger preference for infecting type A blood cells than the original virus.

Other recent studies have explored the mechanisms linking blood type to susceptibility to SARS-CoV-2.   https://pubmed.ncbi.nlm.nih.gov/37425304/ - One study  showed that levels of ACE2 protein, the receptor that the virus binds to for cell entry, were significantly higher in people with type A blood compared to other blood types. The researchers also found that the binding rate of the spike protein to red blood cells was highest in people with type A blood and lowest in people with type O.

Despite these associations, when assessing a person’s risk of severe SARS-CoV-2 infection, factors such as age and pre-existing chronic conditions, like heart disease, tend to have more significant effects on the risk of severe SARS-CoV-2 infection than blood type.

Increased Risk of Cancer

Pancreatic cancer is one of the deadliest types of cancer because it tends to grow quickly, can rapidly invade surrounding organs, and is often difficult to detect early.  https://pmc.ncbi.nlm.nih.gov/articles/PMC2657095/ - One study  found a statistically significant association between ABO blood group and pancreatic cancer risk. Compared to people with type O blood, those with blood types A, AB, and B had a 32, 51, and 72 percent higher risk of developing pancreatic cancer, respectively.

Additionally, a  https://pmc.ncbi.nlm.nih.gov/articles/PMC5137991/ - comprehensive review  found that people with type A blood were more susceptible to Helicobacter pylori, a known risk factor for stomach cancer, thus increasing their likelihood of developing the disease. In contrast, type O blood was associated with a lower risk of several cancers, including colorectal, gastric, and breast cancer.

Higher Risk of Other Serious Conditions

Blood type has been found to be associated with an increased risk of other several serious health conditions.

Increased Risk of Heart Disease

Blood type may also be linked to the risk of developing heart disease. A  https://pubmed.ncbi.nlm.nih.gov/22895671/ - meta-analysis  from the Harvard T.H. Chan School of Public Health, analyzing health data from nearly 90,000 individuals over more than 20 years, found that people with type O blood had the lowest risk of developing coronary heart disease. After adjusting for cardiovascular risk factors, participants with blood types A, B, and AB had an increased risk of coronary heart disease by 6, 15, and 23 percent, respectively, when compared to people with type O blood.

Increased Risk of Allergic Diseases

There is also a clear association between blood type and allergic diseases.  https://bmjopen.bmj.com/content/10/2/e029559 - A review  found that people with type O blood were more prone to allergic rhinitis and asthma compared to those with non-O blood group. In contrast, people with non-O blood types had a higher likelihood of developing atopic dermatitis, with the highest prevalence among those with type B blood, followed by type A.

Although seasonal flu can occasionally cause neurological symptoms (see 2018's  https://afludiary.blogspot.com/2018/06/neuroinfluenza-review-of-recently.html - Neuroinfluenza: A Review Of Recently Published Studies ) it is relatively rare phenomenon, and usually only results in mild, and transient symptoms. 

The exact mechanisms behind these neurological manifestations are largely unknown, as seasonal flu viruses are generally regarded as being non-neurotropic.

Whenever we talk about long-term sequelae from influenza, the mysterious decade-long epidemic of Encephalitis Lethargica (EL) that followed the 1918 pandemic always comes to mind.

The cause remains a mystery.

Throughout history, there have been reports of similar outbreaks, including febris comatosa which sparked a severe epidemic in London between 1673 and 1675, and in the wake of the 1889–1890 influenza pandemic, a severe wave of somnolent illnesses (nicknamed the "Nona") appeared.

And more recently, we've seen evidence that SARS-CoV-2 infection can produce persistent neurological manifestations (see  https://afludiary.blogspot.com/2021/08/cmaj-even-mild-covid-19-may-have-long.html - CMAJ: Even Mild COVID-19 May Have Long-term Brain Impacts ).

While the mild presentation of H5N1 in the United States thus far is reassuring, these viruses continue to mutate and evolve, and what we say about them today may not hold true tomorrow. 

Because with influenza viruses, the only constant is change. 

On Monday,  https://afludiary.blogspot.com/2024/11/usda-california-reports-another-41-h5.html - California announced another 41 infected cow herds , bringing their total to 335. Today, just 3 days later, that number has jumped again by 63, bringing them to 398 infected herds and the nation to 612. 

At this point more than 1/3rd of California's (roughly 1,100) herds have tested positive. What we don't know is how many herds that have been tested, have come back negative.

Once again, most states are not aggressively testing bulk milk, or cattle, for the virus.  https://afludiary.blogspot.com/2024/11/pennsylvania-to-require-precautionary.html - Only 4 non-affected states  (Arkansas, Massachusetts, Oklahoma, and Pennsylvania) currently require precautionary bulk milk testing, and most states that have reported outbreaks do not have mandatory testing. 

As a result we continue to fly blind in regards to how many herds are affected, across how many states, and whether those numbers are increasing or declining. 

The USDA also updated the number of backyard and commercial poultry flocks that have been affected, with 13 outbreaks across 7 states (Alaska, California, Illinois, South Dakota, Minnesota, Washington, and Hawaii) added since Monday's update. 

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Since `bird flu season' generally begins in mid October, we've only just begun this year's battle. 

Friday, November 22, 2024

These detections via serological testing strongly suggest some additional cases have gone unidentified. How many, is unknowable.   

It takes more than a little luck for a community case  - one w ithout known contact with livestock or someone who is known to be infected - to be picked up by surveillance.  Most doctors and walk-in clinics only perform rapid flu tests (if they do a test at all), and that generally does not reveal the subtype, only if it is Influenza A positive or not. 

While there may be a heightened index of suspicion in community with outbreaks of H5N1 in cattle or poultry, in most communities mild or moderate cases can be difficult to detect.  https://afludiary.blogspot.com/2024/09/missouri-dhss-human-h5-bird-flu-case.html - The Missouri case  was only identified a week after the patient was released from the hospital.

Red Blood Cell Morphology Is Associated with Altered Hemorheological Properties and Fatigue in Patients with Long COVID

Simple Summary

H5N1 Mutations Detected in Canadian Case Favor Human Transmission

The  https://www.woah.org/ - World Organisation for Animal Health  (WOAH) has released their first update on HPAI H5 in cattle since  https://www.woah.org/en/high-pathogenicity-avian-influenza-in-cattle/ - their initial statement last May . Whereas the original statement said HPAI `is raising concerns within the international community', today's statement takes a more direct stance, saying:

The ongoing threat of high pathogenicity avian influenza (HPAI) demands urgent global attention as it transcends its avian origins to affect domestic and wild mammals with increasing frequency. 

Although the HPAI H5 virus still lacks the ability to spread efficiently between humans, nearly every week brings new revelations about its evolution, or new milestones in its spread.  

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WOAH calls on its Members to:

• Increase avian influenza surveillance in domestic and wild birds.
• Enhance surveillance for early detection in cattle population in countries where HPAI is known to be circulating.
• Include HPAI as a differential diagnosis in non-avian species, including cattle and other livestock populations, with high risk of exposure to HPAI viruses, in particular:
• Animals showing clinical signs compatible with avian influenza;
• Sick or dead domestic animals near HPAI affected premises;
• Suspected, including apparently healthy animals, that have been exposed to or epidemiologically linked to suspected or confirmed HPAI in birds or cattle (i.e. situated in HPAI high-risk areas or in areas where avian influenza has been confirmed).
• Notify cases of HPAI in all animal species, including cattle or other unusual hosts, to WOAH through its  https://wahis.woah.org/#/home - World Animal Health Information System (WAHIS)  . Genetic sequences of avian influenza viruses should be shared in publicly available databases.
• Implement preventive and early response measures to break the HPAI transmission cycle among animals. This includes applying movement restrictions of infected livestock holdings until infection has stopped and strict biosecurity measures in all holdings, in particular in milking parlours and employ good production and hygiene practices when handling animal products. Raw milk or raw milk products from HPAI infected cows or exposed to those infected with HPAI should not be used to feed animals or for human consumption.
• Protect humans in close contact with or handling sick cattle or other sick livestock and their products. Exposed humans should always take precautionary measures to avoid getting infected and minimise the risk to mechanically carrying the virus to livestock or companion animals. This should include wearing personal protective equipment, avoiding visiting other livestock premises after the exposure and implementing standard food safety measures when handling animal products from exposed livestock.
• Avoid implementing unjustified trade restrictions. Import risk management measures should be scientifically justified and in line with the WOAH International Standards.

Technical guidelines for the adaptation of diagnostic tests for Influenza A in animals including cattle and other species as well as different types of samples such as milk and nasal swabs are available in the OFFLU website and will be regularly updated.

WOAH is fully committed to supporting its Members to mitigate the risks associated with avian influenza. We will continue to engage with our networks of experts, OFFLU, as well as public and private partners, notably through the One Health Quadripartite and the Global Framework for Transboundary Animal Diseases (GF-TADs ) to provide technical updates as more information becomes available.

Late today, we got an announcement from  https://directorsblog.health.azdhs.gov/ - Arizona State Health Department  of 2 associated human infections (reportedly treated and recovered).

These cases are not currently reflected in the https://www.cdc.gov/bird-flu/situation-summary/index.html -  CDC's case count , and it is not clear whether they have been confirmed by that agency. 

Twenty-eight days, and 66 blog entries ago,  https://afludiary.blogspot.com/2024/11/a-review-of-significant-hpai-h5-related.html - we took a look back  at the previous 3 weeks of rapid-fire developments surrounding HPAI H5, and on several fronts the pace has only quickened since then. 

Admittedly, H5N1 isn't the only threat we are concerned with (see  https://afludiary.blogspot.com/2024/12/drc-reports-of-fatal-mystery-disease-in.html - DRC `Mystery Virus' investigation ), but it is the most pressing, and currently the closest to home. 

Over the past 4 weeks:

• The number of confirmed H5 human cases in the U.S. has increased by 12, to 58 (with several more announced by states, but not yet confirmed by the CDC.)  If you count serologically confirmed cases (the CDC doesn't) - and those in the pipeline - we are well over 70 cases. 

• The number of  https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock - known infected dairy herds  has grown from 473 to > 720 (a 65% increase), and a 16th State (Nevada) is now reporting cases. 

• Over the past 4 weeks more than  https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/commercial-backyard-flocks - 9 million birds from 78 flocks  across 8 states have been infected (and lost) due to H5N1 in the United States, and Canada has reported > 50 outbreaks in poultry.

• https://coronavirus.marinhhs.org/public-health-status-update-12062024 - According to the Marin County Health Dept.  they are investigating a second Bay Area child with suspected H5 infection, and currently no known risk exposure. If confirmed, this would become the 3rd `community' case, not linked to occupational exposure. 

• Hawaii reported  https://afludiary.blogspot.com/2024/11/hawaii-dept-of-health-statement-on.html - H5 in wastewater samples on Nov 13th , and at least  https://afludiary.blogspot.com/2024/11/hawaii-dept-of-agriculture-2nd.html - two outbreaks in captive and/or wild birds  the following week, marking the first known detections in that state. 

While the trends are ominous, we still don't know if H5N1 is capable of adapting well enough to humans to spark a pandemic. Of course, by the time we have proof positive, it will be too late to act. 

Hopefully we'll get lucky, and won't have to face another one for years. 

Although the 60+ H5N1 cases reported in the United States in 2024 have all been mild, in many other parts of the world different incarnations (subtypes, clades, or genotypes) of the HPAI H5 virus have not been so benign.

• In Cambodia, we've seen https://afludiary.blogspot.com/2024/09/who-update-on-cambodian-h5n1-cases.html -  18 human H5N1 infections  (clade 2.3.2.1c) reported since early 2023, with nearly a 40% fatality rate. And as we've seen previously with other incarnations of HPAI H5N1,  https://afludiary.blogspot.com/2024/07/cambodia-reports-7th-h5n1-case-of-2024.html - Children and adolescents have been the hardest hit .