H5N1-2023 – The Big One Is Coming (And Why We Won’t Be Ready)

June 24, 2023

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Over the last several years, we’ve gone through a lot when it comes to dealing with transmissable diseases. We’ve witnessed our entire world shut down which is pretty significant. As of late, there’s understandably been exhaustion over the discussion on viruses and other human infectious diseases in regards to what role they play in deciding how we live our lives. I suppose there’s 2 camps that have formed after we all had to deal with Covid in how we perceive such illnesses: either this is an overblown concern or we need to be very concerned. I think like most things, the truth lies somewhere in the middle. Recently in the media there’s been a lot of attention drawn to the H5N1 Bird Flu, aka Avian Influenza. In this video, we’re going to take a deeper look at the Avian Flu and discuss what you should be watching for, try to answer the question: “at what point you should we be concerned?”, and discuss what you should be doing to prepare for the potential spread of this virus if it does indeed make the jump to humans. We’ll finish the video by trying to address the issue of whether we will be ready if it does indeed become a zoonotic disease. There’s a lot to discuss here, so let’s jump in.

EXPERTS ARE WARNING

Alright, so let’s just rip the bandaid off and start off by discussing the bad news first. Experts are warning that the bird flu virus is changing rapidly in the largest outbreak ever. Already tens of millions of poultry birds have been culled, wild birds are experiencing a massive die off, and an estimated 9,000 sea lions, penguins, otters, porpoises, and dolphins have all died from it along the Chilean coastline. Worldwide, experts say the potential for a “spillover” of the virus to humans is of “critical concern.” Their concern is justifiable. For some reason, the virus is mutating more rapidly than ever, and there have been a record number of cases in not just birds but mammals. This current outbreak is alarming, too, because H5N1 doesn’t seem to be contained to mostly seasonal outbreaks. It’s occurring year-round now. Rapid mutation, outbreaks in mammals, and is no longer contained seasonally are all significant red flags that a leap of this lethal strain of the zoonotic flu virus to humans may be about to happen.

I say this “strain” of the virus because it isn’t new. I graduated with a degree in microbiology, so I have followed it with some interest since it first emerged in 1996 in southern China and Hong Kong. It is considered highly pathogenic because it kills a high proportion of the poultry it infects. This avian virus is an influenza-type virus. There are other strains of it, like the H7N9, considered a low pathogenic avian influenza A virus, but it’s H5N1 that is the real cause for concern right now. At this time, it remains poorly adapted to humans. Transmission from birds to humans is infrequent, but it has occurred, usually in instances where extensive human and bird interaction has occurred– like poultry workers.

The leap to mammals like sea lions, otters, and dolphins is believed to be from the consumption of infected birds and not airborne transmission. There is some concern over how it spread through a Spanish mink farm and with the sea lions off the coast of South America. The rate of spread in these locations has scientists and epidemiologists studying whether mammal-to-mammal spread has occurred.

To date, no sustained human-to-human transmission has been notably observed. For that to happen, some viral adaption has to occur. Avian viruses and human viruses utilize distinct receptors on host cells for binding. To acquire greater adaptability to humans, avian viruses would typically require only two or three slight modifications in a specific viral protein. The virus process is to attach, enter into host cells, replicate, and evade the host’s immune system. The current strain has a hard time attaching to human cells. It’s not impossible for it to do so, but it’s harder to do so in humans than it is in birds.

That’s also why the scientists are so concerned with the spread in sea lions and the minks. They are trying to determine if this viral adaptation has occurred and whether we are facing a possible zoonotic spillover. Whereas the avian flu has, in years past, been primarily contained in the commercial poultry industries, this more extensive spread in the wild bird population provides more instances of the virus in more unregulated hosts. Therefore, there are also more opportunities for the viruses to mutate. When mammals are infected, the virus has the most significant chance of viral adaptation in mammalian hosts. We may be seeing that now. In one recent study, some of the viruses from mammals have markers in the PB2 protein associated with increased virulence and replication in mammals—very rarely seen before 2020. In layman’s terms, that’s scientist-speak for “buckle up. This could get bad quickly.”

ARE WE ON THE CUSP OF ANOTHER PANDEMIC?

OK, so let’s talk about the good news, at least good news for the moment. Even with the increased possibility of a spillover of the zoonotic virus in humans, it’s essential to put that into perspective and not panic. That is hopefully good news to many since we just made it through the COVID pandemic. Unlike the virus that caused that, SARS-CoV-2, H5N1 is a strain of influenza-type virus. Although there is no universal consensus regarding where the influenza virus originated, it spread worldwide during 1918-1919. Even before COVID, we did a whole video on that, which I will link to in the comments below.

What we do know is that we humans have over 100 years of experience and built up immunity to the influenza virus. Because of this, most humans, even newborns, have some antibodies against the virus. That alone makes it significantly different from the coronavirus. When a person is infected with the influenza virus, their immune system can recognize the viral antigens as foreign. Our bodies start producing antibodies that can bind to and neutralize the virus. These antibodies help to eliminate the virus from the body and provide immunity against that specific strain of influenza. Even lacking the exact ability to identify a particular antigen, our immune systems can recognize other proteins in the virus.

When humans do catch H5N1, when it does spill over and spread human-to-human, it likely won’t have the same lethality as a never before seen virus-like SARS-CoV-2. It will likely manifest as a nasty flu requiring the same attention as any other flu. Also, because we have some general immune defense against it, the rate of spread is reduced. This means that the chances of it becoming a wildfire-spreading pandemic are less probable, as the direct transmission line is broken by each person who can fight off the infection and contain and eradicate the viral load they received.

So, are we on the cusp of another pandemic? Not really, at least not at the time of recording this video. So much would have to happen to the virus. First, it would have to mutate to adapt to human proteins. That would allow it to spread between humans via respiratory droplets. Second, it would have to mutate into a more virulent strain than it currently is to have the chance of sustaining its spread and pumping up its lethality. It would have to leapfrog over a century of our working immune systems. Can it leap to humans? Absolutely. Can it kill humans? Sure. Nature is tricky and clever, and everything, including viruses, wants to survive and thrive. There’s just so much that has to happen, though, that I’m not overly concerned at this point, and I don’t think you should be either.

SICK PEOPLE

As of April 2023, there was only one potential case of H5N1 infection in the United States. However, it’s uncertain whether this was an actual infection or a misdiagnosis, as the individual had been involved in culling birds. It’s possible that highly sensitive tests detected the presence of the virus without an actual infection. A 53-year-old woman from Jiangsu province in eastern China tested positive for H5N1 after exposure to poultry. Her symptoms developed on January 31, and she tested positive sometime in February. Although she was last reported in serious condition, there have been no reports of human-to-human transmission in this case or any other H5N1 cases.

Furthermore, the first recorded case of H5N1 in South America occurred in January, involving a 9-year-old girl from Ecuador. While she was initially hospitalized in critical condition, she has since recovered. Similarly to the previous cases, the girl had close contact with poultry, their feces, or their fluids.

Although these cases raise concerns, the absence of human-to-human transmission suggests that the necessary genetic changes in the virus to bind with human protein receptors effectively have not yet taken place. That’s not to say that it won’t ever make this leap, nor that human-to-human transmission isn’t possible in the near future. It’s just not happening now or in our immediate foreseeable future based on the evidence we do have.

WHAT YOU SHOULD BE DOING

The key to protect yourself is by minimizing your exposure risk. This can be a challenge as some of us in the preparedness community raise chickens. If you have a backyard flock of chickens, ducks, geese, turkeys, or Guinea Fowl, isolate them away from wild birds. Ensure your coop and its run are secure from wild animals and rodents. Use fencing or netting to create a physical barrier. Clean the coop, equipment, and surrounding areas on a regular basis. Monitor your flock for any signs of illness and isolate birds exhibiting symptoms. Practice a routine of good hygiene during and after interacting with them. Additionally, stay informed about avian flu outbreaks in your area through local veterinary services or agricultural agencies. A few years ago we couldn’t get chickens in our area for nearly a year as an illness was spreading through the chicken community.

When it comes to wild birds, avoid handling them along with exposure to their droppings. If you do encounter a grounded wild bird that may be in distress, either keep your distance and let nature take its course or wear a mask and gloves and practice good sanitation when dealing with it. Keep your pets away from any possibly infected birds, and watch them for signs of illness if they interact with wild birds, especially birds expressing symptoms.

The hardest-hitting impact, at least for now, will still be the poultry industry. Over 40 million egg-laying hens have been culled in the U.S. alone, making it the worst outbreak on record. Expect the price of poultry and eggs to continue to rise for more than just inflationary reasons. Higher prices and fluctuating supply will put pressure on all other meat industries.

WILL WE BE READY FOR THE NEXT ONE?

Here’s the rub. The potential for biological threats, whether natural or man-made are increasing on a daily basis. Since the early 1900’s, there’s been 11 outbreaks. Of those 11, 5 of them had a lethality equal to or greater than Covid. And as you can probably easily imagine, there’s been other new, more pathogenic viruses that emerged in the last several decades.

I think there’s 4 current primary areas of concern:

When I graduated in 1999, one of the biggest concerns within the Microbiology community was the inevitable outbreak of an illness that could not be contained or treated. The medicine of that time was being outpaced by pathogens that were mutating fasterer than they could be stopped and the issue is still overshadowing the medial community to this day.
New infectious diseases have been showing up at a faster pace due to growing zoonotic transmission from animals. Add to that, we’re now able to travel quickly and increase our risk of spreading those diseases faster.
Laboratories around the world are testing and experimenting with increasingly dangerous pathogens. It’s not exactly a regulated industry and one simple slip up somewhere could lead to it quickly spreading. The origins of Covid are still uncertain and the potential for it having started in a Wuhan lab have not been ruled out.
What’s even more concerning are the unknown malicious actors around the world who could purposefully release a biological weapon, a highly contagious one at that.

All of these previous points are not conspiracy theories, but instead are very real possibilities that even our current administration has pointed out that we have to consider and factor in to how we prepare.

So to try and answer the question of whether or not we’ll be prepared for the next virus, I guess I would only say, not really. Let’s be honest, most people got extremely upset and aggravated with the restrictions and lockdowns we all faced during Covid. You really think if another pathogen were to show up that people would go along with mandates? I don’t see that happening, at least not probably in many parts of the U.S. This is not my attempt to say that we shouldn’t take the next major outbreak as serious, but I really have a hard time believing people wouldn’t just throw up their hands and go on with their life regardless of the potential health implications. This is not a statement of judgement, but merely an observation. Maybe I’m a bit jaded, but I think if we see a run-away illness sweep through, I can’t imagine most will take it seriously, but hey, what do I know?

It’s clear that H5N1 has numerous genetic hurdles to overcome before it can rise to a pandemic level in humans. It is picking up speed and lethality in animals worldwide, and that’s reason enough for us to keep a close eye on it and proceed with caution. Now would be a good time to review the video we did several years ago discussing practical steps you can take to prepare for pandemic.

Let me finish by saying this.