| |  | | Opinions columnist | | For months, the threat of the H5N1 avian flu becoming the next pandemic has been keeping me up at the night. Three recent developments have increased my level of concern. Here is why, and what I will be tracking in the weeks ahead. | | 1. Many human cases are not being diagnosed. | | The Centers for Disease Control and Prevention published a study that found 7 percent of dairy workers at farms with active outbreaks had evidence of recent infection. None of these individuals were diagnosed while actively infected. Their infections were noted after the fact and only because they were taking part in this study. Half remembered having symptoms; the others did not. | | Public health experts have long speculated that because testing is so limited, many human cases were probably undetected. This study suggests that the extent of bird flu might be far greater than we know. | | The CDC, to its credit, altered its guidance based on the new research. They now recommend offering tests to asymptomatic workers with high-risk exposures as well as antivirals to decrease their chances of developing and spreading H5N1. | | This is an important step. We shouldn’t be surprised to see the number of bird flu diagnoses increase as enhanced testing picks up more cases. The CDC should further expand testing to family members of exposed workers to see whether human-to-human transmission might be occurring. | | 2. Some new cases do not involve exposure to farm animals. | | I wrote recently about a patient in Missouri who was found to have avian flu while hospitalized for other reasons, even though the patient had no known exposure to farm animals. Another person in their household also had evidence of infection, but given the timing of symptoms, the CDC concluded the two probably contracted the virus from another source rather than from one another. | | But what was the original source of infection? No one knows. | | Worryingly, a teen in Canada — the first recorded human case in that country — has also contracted H5N1 and is reported to be critically ill. This person also had no known exposure to farm animals, and the source of infection is unclear. Genetic sequencing of the teen’s viral strain revealed mutations that render the virus more capable of infecting humans. | | There are two possibilities that might explain the origin of the Missouri and Canada cases: One is that they contracted the virus from a person with whom they came into contact. Another is that they got it from a non-farm animal, such as a domestic cat or a rodent. | | Both possibilities would be alarming, especially because the Canadian patient — unlike others thus far — is very ill. | | 3. There will soon be a change in administration. | | I have argued that the Biden administration should have moved faster in responding to H5N1, especially regarding testing. Still, I had confidence the administration understood the gravity of the situation and would implement a sound plan if widespread distribution of vaccines and treatments were needed. | | On Jan. 20, we will have a new administration that has, at best, a spotty record when it comes to pandemic response. Decisions could soon be made by Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead the Department of Health and Human Services, who has a long history of anti-vaccine advocacy. In addition to closely tracking Kennedy, I will also be following who Trump nominates to head key agencies such as the CDC and the Food and Drug Administration. | | I will also be following what the Biden team does in its final days. The administration has funded vaccine makers to ensure millions of vaccine doses for H5N1 are manufactured and ready to deploy. But it has not sought FDA authorization for the vaccines. | | That’s a step Biden officials can take before the January handover. The CDC can then start vaccinating at-risk populations. It can also make rapid tests readily available. | | These steps empower state and local governments to take matters into their own hands if the incoming federal team falters — or worse, deliberately scuppers existing efforts. The outgoing administration should institute as many protections as possible now to prepare for the bird flu situation worsening — which almost certainly will happen. | | “In a recent column, you responded to Anita from Maryland, an 82-year-old woman who had never had covid, that if she got covid, she was likely to have a mild case since she was current with her vaccinations. What constitutes ‘mild’? I’m a 69-year-old woman who had not had covid and got all the vaccinations and took all precautions possible for more than 4½ years. Then I got covid. I had even gotten my last vaccination just six weeks before. My case began with a fever of 102.8, severe sinus congestion and pain, a hard dry cough and extreme fatigue. Fortunately, I started Paxlovid on the first day and the symptoms started to ease the second day, though my fever stayed higher than 101 for another day. Did what I had constitute a mild case?” — Amy from Kansas | | The studies on the effectiveness on coronavirus vaccines have generally differentiated between those who required inpatient hospitalization and those who recovered at home. By that distinction, you would be in the latter category — you were not so severely ill that you were hospitalized. | | That said, I can certainly understand why the symptoms you described did not feel “mild” to you! You had a high fever and other symptoms that significantly impacted your quality of life. You followed exactly the right steps to take the antiviral Paxlovid, which, in addition to you being up-to-date on vaccines, helped reduce your chances of requiring in-hospital treatment. | | “I am a very healthy athletic woman in my 50s who rarely gets sick. I got the most recent covid vaccine on Oct. 8 along with my annual flu shot. I have gotten every covid vaccine available to me since they began. I have been lucky enough to avoid covid — until Oct. 25, when I tested positive and was symptomatic with fever, muscle aches, congestion, coughing and fatigue, all of which lasted a little over a week. While I understand the vaccine is to prevent severe illness, it’s still hard for me to understand how I would have gotten sick within three weeks of the latest vaccine.” — Beth from Missouri | | Beth, I appreciate your sharing your experience and asking this question, which illustrates the complexity around vaccine messaging. | | You are right: The primary reason to keep up to date with coronavirus vaccines is to reduce the chance of severe illness. This is especially important for older individuals and those with chronic underlying medical conditions that increase their risk of hospitalization and death. | | The coronavirus vaccines do reduce the risk of illness, and though they provide maximal protection two weeks to two months after being administered, it’s still possible to be infected during this period. A CDC analysis published earlier this year found that those who received an updated vaccine experienced a 51 percent effectiveness against covid-associated urgent care or emergency department visits in the first 7 to 59 days. This declined to 39 percent between 60 and 119 days. | | This means the updated vaccine cut your risk of getting covid severe enough to result in urgent or emergency care in half following vaccination. That’s a notable reduction, but it does not eliminate the risk. | | It’s always hard to know the counterfactual. What would have happened if you did not get the vaccine? Clearly, it did not prevent you from contracting covid, but perhaps it kept you from having a more severe case. Still, I think it’s important to raise your experience because people need to understand the benefits and limitations of the coronavirus vaccine. When it fails to protect people against infection, it’s not evidence that it doesn’t work, but rather as a data point to help people weigh additional steps to protect themselves. | | “I was sick last November but tested negative several times for covid. I’d been vaccinated against flu and covid three weeks previously, and a nurse practitioner told me that I did not have strep. I think it’s likely that I had the respiratory syncytial virus (RSV). Should I get vaccinated against RSV this fall? I’m in my mid-70s. I don’t know how long my immunity would last after having RSV.” — Wendy from Canada | | It’s not clear what you had last year was RSV. Plus, past RSV exposure does not convey durable immunity; one could be re-infected a few months after recovering. | | Those 75 or older are recommended to receive the RSV vaccine. Those 60 to 74 with underlying conditions should consider it, as well. | | Children and young adults with elevated body mass index are more likely to have long covid, a study published in JAMA Network Open found. Researchers examined the incidence of post-covid conditions in children and adolescents. They found that those with obesity had a 25 percent increased risk of developing long covid compared to those with normal BMI. Those with severe obesity had a 42 percent increased risk. | | New CDC data indicates that the proportion of American adults experiencing anxiety or depression rose substantially between 2019 and 2022, from 15.6 to 18.2 percent for anxiety and 18.5 to 21.4 percent for depression. The highest rates were among 18- to 29-year-olds, though increases were seen across age and other demographic groups. | | More good news on Paxlovid: A real-world study conducted in the United Arab Emirates and published in Nature’s Scientific Report concluded that the covid antiviral medication reduced hospitalizations by 61 percent. Use of the antiviral also lowered the rate of long covid by 58 percent. The authors speculate that the treatment might reduce viral loads, which could decrease the possibility of developing persistent symptoms. | | By Charles Lane, Leana S. Wen and Robert Gebelhoff | | | | By Jamie Friedlander Serrano | | | | Advertisers and sponsors play no role in the content or production of the newsletter. | | | |
Email
