"[M]any people with chronic and debilitating conditions are more vulnerable than they were before the pandemic began. The policies that protected them during the pandemic’s height are gone—and yet SARS-CoV-2 is still here, adding to the dangers they face. The losses have been written off, Bortko told me: Cases of long COVID in Madison County have been dismissed as products of 'risk factors' that don’t apply to others; deaths, too, have been met with a shrug of 'Oh, they were old; they were unhealthy.' If, this winter, COVID sickens or kills more people who are older, more people who are immunocompromised, more people of color, more essential and low-income workers, more people in rural communities, 'there will be no press coverage,' Hlatshwayo Davis said. Americans already expect that members of these groups will die."
"COVID still kills roughly as many Americans every week as died on 9/11. It is on track to kill at least 100,000 a year—triple the typical toll of the flu. Despite gross undercounting, more than 50,000 infections are being recorded every day. The CDC estimates that 19 million adults have long COVID. Things have undoubtedly improved since the peak of the crisis, but calling the pandemic 'over' is like calling a fight 'finished' because your opponent is punching you in the ribs instead of the face."
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H5N1: What to know before fear spreads
What is H5N1?
H5N1 is a 1996 strain of the Spanish or Avian Flu first detected in Chinese birds before spreading globally across various avian species. H5N1 is similar to H1N1, but spreads slower and has a much higher mortality rate.
H5N1 may also be referred to as Influenza A. The American Association of Bovine Practitioners has seen fit to rename H5N1 to Bovine Influenza A Virus, or BIAV, and are encouraging others to use the same terminology.
I would not be surprised if the colloquial name among the public becomes Bovine Flu or American Flu in the coming months, and may be referred to as the Chinese Flu by the same folks who took the spark of the SARS-CoV-2 (COVID-19) pandemic as an excuse to be publicly racist to East Asian people without social repercussions.
BIAV is a virus, meaning that it is a (probably) non-living packet of self-replicating infectious material with a high rate of mutation. BIAV is structured similarly to SARS-CoV-2, having a packet of infectious material encased in a spherical shell with a corona, or crown, of proteins that can latch to living cells to inject RNA.
Image source with interactive model: ViralZone - H5N1 subtype
What is the history of BIAV?
In 1996 and 1997, an outbreak of BIAV occurred among poultry and infected 18 people in Hong Kong, 6 of which died. This seemingly isolated incident then infected ~860 people with a >50% death rate.
At the time, BIAV was known as Highly Pathogenic Avian Influenza, or HPAI, and killed nearly 100% of chickens within a 48 hour period.
From 2003 to 2005, continual outbreaks occurred in China and other East Asian countries, before spreading to Cambodia, the Netherlands, Thailand, and Vietnam.
From 2014 to 2016, it began being detected in American fowl, as well as mutating the H5N6 (lethal in birds, no human to human transmission) and H5N8 (largely spread through turkeys, ducks had immunity) viruses.
BIAV has since evolved into a clade known as 2.3.4.4b, and was first detected in 2021 in wild American birds. This then caused outbreaks in 2022 among wild and domesticated birds (such as chickens) alike, but was largely being overshadowed by the pressing SARS-CoV-2 pandemic at the time.
From 2022 to 2023, it was observed to be spreading among various mammals, including humans. Now, in 2024, we're having the most concerning rapid outbreak of BIAV since 2003.
BIAV is known to spread from mammal to mammal, particularly between cows and humans. BIAV may also be spread from cow to cow (highly likely, but not confirmed - this is likely the reason the virus has spread to Idaho from Texan cattle), and is known to be lethal to domestic cats and birds within 48 hours.
How does BIAV spread?
BIAV spreads through fomites - direct contact with infected animals or infected surfaces and then touching parts of your face or other orifices - as well as through airborne particulates, which may be inhaled and enter the sinuses and lungs.
BIAV is known to spread through:
Asymptomatic
Ducks, geese, swans, various shorebirds
Symptomatic, may be lethal
Foxes, bears, seals, sea lions, polar bears, domestic cats, dogs, minks, goats, cows, (potentially human to human, but unconfirmed - there have only been 8 potential human to human cases in 2024).
How can I protect against BIAV?
As BIAV is a type of Influenza A, existing protocols should do fine.
Current recommendations are to wash your hands vigorously after interacting with birds (I would also recommend doing this with mammals), avoid touching your face or other open orifices, and wear N95 masks.
Avoid sick or dead animals entirely - I would also recommend reporting them to your local Animal Control or veterinary centre and warning them about the infection risk. People who work with animals are recommended to also wear full PPE such as N95 masks, eye protection, gloves, and partake in vigorous hand washing.
If you suspect you've caught BIAV, seek medical attention immediately. Existing medications such as oseltamivir phosphate, zanamivir, peramivir, and baloxavir marboxil can reduce BIAV's ability to replicate.
Standard flu shots will not protect against BIAV. Remember - symptoms of BIAV may not manifest for between 2 to 8 days, and potentially infected people should be monitored for at least 10 days.
How far has BIAV spread?
BIAV is currently a global virus, though the current infection location of note is the United States.
Image Key:
Dark red - Countries with humans, poultry and wild birds killed by H5N1
Deep red - Countries with poultry or wild birds killed by H5N1 and has reported human cases of H5N1
Light red - Countries with poultry or wild birds killed by H5N1
Image source: Wikipedia - Influenza A virus subtype H5N1 - File: Global spread of H5N1 map
Image source: Metro.co.uk - Map shows where bird flu is spreading in US amid new warning - File: The Centers for Disease Control and Prevention’s H5N1 bird flu detections map across the United States
Should I be afraid?
You needn't be afraid, just prepared. BIAV has a concerningly high lethality, but this ironically culls its spread somewhat.
In the event human to human transmission of BIAV is confirmed, this will likely mainly affect marginalized communities, poor people, and homeless people, who are likely to have less access to medical care, and a higher likelihood of working in jobs that require frequent close human contact, such as fast food or retail jobs.
Given the response to SARS-CoV-2, corporations - and probably the government - may shove a proper response under the rug and refuse to participate in a full quarantine, which may leave people forced to go to work in dangerous conditions.
If this does spread into an epidemic or pandemic, given our extensive knowledge about Influenza, and the US having a backup vaccine for a prior strain of H5N1, a vaccine should be able to be developed relatively quickly and would hopefully be deployed freely without charge - we won't have to worry about a situation like The Stand.
Wash your hands, keep clean, avoid large social gatherings where possible, wear an N95 mask if you can afford them (Remember: Cloth masks are the least protective, but are better than nothing. If you can't afford N95 masks, I recommend wearing a well-fitted cloth mask with a disposable face mask over it to prevent pneumonia from moisture buildup in the disposable mask), support the disabled, poor, and homeless, and stay educated.
We can do better this time.
Further things to check out:
YouTube: MedCram - H5N1 Cattle Outbreak: Background and Currently Known Facts (ft. Roger Seheult, M.D.)
Wikipedia - Influenza A virus subtype H5N1
Maine.gov - Avian Influenza and People
CDC.gov - Technical Report: Highly Pathogenic Avian Influenza A(H5N1) Viruses
Wikipedia - H5N1 genetic structure
realagriculture - Influenza infection in cattle gets new name: Bovine Influenza A Virus (BIAV)
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