The UK Health Security Agency has raised their pandemic threat level for H5N1 bird flu from a 3 to a 4 on a 6 point scale. 

My takeaway is that we have completely failed to stem the outbreak in cattle, there has been animal to human transmission which we are surely undercounting, but so far the virus has not mutated in a way to make it very adaptable to humans. 

The failure to stem the outbreak in cattle is concerning because it suggests we would not be able to stem a human outbreak. We can easily test, quarantine and cull cattle!

It is absolutely outrageous that dairy farmers are refusing to cooperate on testing:

To date dairy farmers have, in large measure, refused to cooperate with efforts to chart how deeply the virus has infiltrated U.S. herds, seeing the possible stigma of admitting they have H5N1-infected cows as a greater risk than the virus itself.

We should be testing at much higher rates and quarantining and culling. The dairy farmers should be and are being compensated but frankly the farmers should have no say in the matter of testing. Externalities! Preventing a pandemic is much cheaper both in resources and in restrictions on liberty than dealing with one.

And how about an Operation Warp Speed for a vaccine for cows? Vaccinate. Vacca! It’s right there in the name! If only we could come up with a clever acronym for an Operation Warp Speed for COWS.

Developing a vaccine for cows would also speed up a human vaccine if one were needed.

Here are some key points from the UK HSA:

There is ongoing transmission of influenza A(H5N1) in the US, primarily through dairy cattle but with multispecies involvement including poultry, wild birds, other mammals (cats, rodents, wild mammals) and humans (1, 2). There is high uncertainty regarding the trajectory of the outbreak and there is no apparent reduction in transmission in response to the biosecurity measures that have been introduced to date. There is ongoing debate about whether the current outbreak should be described as sustained transmission given that transmission is likely to be facilitated by animal farming activities (3). However, given that this is a permanent context, the majority of the group considered this outbreak as sustained transmission with the associated risks.

…There is evidence of zoonotic transmission (human cases acquired from animals). There is likely to be under-ascertainment of mild zoonotic cases.

..Overall, there is no evidence of change in HA which is suggestive of human adaptation through these acquired mutations. Although genomic surveillance data are likely to lag behind infections, the lack of evidence of viral adaptation to α2,6SA receptors after thousands of dairy cattle infected may suggest that transmission within cows does not strongly predispose to human receptor adaptation. Evidence of which sialic acid receptors are present in cows, which is needed to support this hypothesis, is still preliminary and requires confirmation.

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