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Is the Bird Flu the Next Global Pandemic?

Just a few short years ago, the COVID-19 pandemic wreaked havoc across the globe, leaving economies in tatters, claiming millions of lives, and fundamentally altering the world as we knew it. 

Yet, scarcely after the dust settled from that crisis, virologists are now raising urgent concerns.

The specter of the bird flu looms large as it breaches the species barrier, with an alarming number of cows falling victim, and a recent human transmission case being confirmed.

With a nearly 50% mortality rate according to @Yale Medicine, the bird flu is making global headlines.

In the face of these developments, the question begs: how concerned should we be?

Tune in to the latest episode of @CareTalk, featuring discussions with @David E. Williams and @John Driscoll, alongside guest @Rick Bright, Former Head of the @Biomedical Advanced Research and Development Authority, as they delve into the escalating fears surrounding a potential new pandemic and the tangible threats posed by the bird flu.

Episode Transcript:

David Williams: Are you worried about bird flu? You probably should be. Today's guest, virologist Rick Bright, is alarmed by the latest human case because the patient is experiencing respiratory symptoms heralding possible human to human transmission.

Welcome to Care Talk, America's home for incisive debate about healthcare business and policy. I'm David Williams, president of Health Business Group. And 

John Driscoll: I'm John Driscoll, senior advisor at Walgreens. 

David Williams: Our guest, Dr. Rick Bright, is former head of the Biomedical Advanced Research and Development Authority within the U. S. Department of Health and Human Services, where he led the response to many man made and natural threats. Meanwhile, come join the fast growing Care Talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access Care Talk content, and interact. with the hosts and our guests.

And please be sure to leave us a rating on Apple or Spotify while you're at it. 

So welcome Rick. Maybe, maybe you could start by describing what BARDA is and how, what the critical role it plays in the federal government around the kinds of threats we're going to talk about. 

Rick Bright: Well, great. It's great to be here.

John and David. Good to see you all. You know, BARDA, the Biomedical Advanced Research and Development Authority was established by Congress to be able to support the private sector who are, that are developing drugs and vaccines and diagnostics to accelerate the development of those tools to be better prepared.

If we were to face a disaster, a public health disaster that could be a man made disaster, it could be a bioterrorism attack, or it could be something happening from nature, like a pandemic. And so we invested heavily in the private sector, primarily to support advanced development stage technologies that has already been through some of that early stage development at NIH or phase one clinical trials to bridge a valley of death to get them over that phase one clinical trial data set through the FDA approval and into the hands of people when they needed them. 

John Driscoll: And obviously you became quite famous when you were one of the early and accurate analysts of the danger of COVID. Do you want to just remind people of your brilliant moment of fame? 

Rick Bright: Thank you Well, infamy, or I'm not sure how you describe it, depending on who you talk to, probably.

But, you know, our role in BARDA, and my role as the head of BARDA, was to watch for those early signs and signals that something might be going wrong, and to make sure that we are geared up in government and our private sector partners are geared up to be able to respond quickly. Nothing that we do to protect people from a crisis happens quickly, and all of it's very expensive and takes time and a lot of innovation and collaboration with the public and private sector.

And so we've been trained in exercise in all of my career. When something looks bad, you should start at risk, preparing to respond. And when we saw the SARS CoV 2 virus, in China, you know, causing havoc and in those hospitals and they were building a hospital overnight basically. And those doctors, nurses were shaving their heads and, and sleeping in the lobby instead of going home because they could infect their families.

That's a pretty strong signal that something bad might be happening. And if it's virus in nature, we know viruses can spread around the planet so quickly. So, in early 2020, when I saw this happening, my job was to alert the Secretary of Health and Human Services and the White House and others that we believed something was happening and here are the things that we needed to do to get it done.

We need money. We need people. We need these viruses and data so we can gear up our machinery to do it. And that position was not popular, uh, in that administration. Um, people wanted to downplay it. People wanted to indicate there was no crisis. Um, no need to be concerned and no need to test because if you don't test, you don't have it.

And of course, America would be the strongest country in the, in the world. Um, all of those were wrong. Um, we needed to get a footing on this and unfortunately we failed to do that.

And every day that you wait, when you see those crisis signals, every day you wait to align your private sector and invest in those technologies is a day behind a virus that's spreading rapidly.

It means more cases, more hospitalizations, and more deaths. And that's why we saw over a million people die from SARS CoV 2 just in the United States. But, um, my Raising the alarm at that time, um, ruffle the feathers of the president. And, uh, unfortunately I was displaced and moved out of my position to lead our nation through that and move to a lower level position at the NIH.

Which I may do to make some diagnostics, actually, for the response. But, um,  basically, persona non grata in the government and in that emergency response. 

John Driscoll: Yeah, no, but thank you for your service and for raising the arm, because I do think that you were being, becoming a, a whistleblower was really, really, you were, you were the truth teller of the moment.

I think it's really hard for people, even, even, even open minded people, to understand the exponential nature of these, of how quickly viruses can spread. Once they, a flu, a flu like virus that's so easy to transmit. Maybe, David, maybe we could also, uh, have Rick talk a little bit about bird flu, because there's currently a, a potential of, uh, a crisis there, and you're sort of an expert on bird flu.

David Williams: Well, Rick, I think that would be great if you could talk about that. I mean, there's, uh, you know, I know the, the op ed writers are different from the headline writers, but, uh, at least from the headline standpoint, and if I've detected the content of your, of your piece, the recent piece in the New York Times, uh, we should be worried about bird flow.

Why? Why are we worried, should we be worried about [00:06:00] bird flu, and how do you relate it to some of these other things we've been through, so perhaps people could understand it a little bit better. 

Rick Bright: Well, great, yes, I've worked on H5N1, it's an avian influenza virus that we call bird flu, but there are many bird flus, actually, flu viruses that primarily infect birds.

And when they stay in that bird population, wild bird population, those birds can tolerate those, those viruses. But over the last several years, we've seen the bird flu viruses from wild animal wild birds start infecting poultry around the world and causing a lot of harm and havoc in the in the chickens and turkeys.

And we have to kill those. those birds to, um, actually manage the spread of that virus. Um, this started in 1997 when the first time we noticed one of these H5N1 bird flus jump from birds to people in Hong Kong and kill a large percent of those people. Um, that Infected. And that's when I started my grad school work on H5N1 influenza.

So my entire career for 27 years has been around building diagnostics and vaccines and antiviral drugs to address bird flu, H5N1. And I've worked at the CDC for 10 years in this space. And I've worked in the private sector and I've also worked back in government and in international organizations. This is a virus that Um, you don't want in a person, um, we see that probably since 1997, around 900 people have been confirmed to be infected with an H5N1 influenza virus.

And over 50 percent of those people died. In experimental animals, when we put this virus, like a ferret or a mouse model that we use experimentally, it rapidly kills those animals, and it infects every organ in their body, their heart, their lungs, their liver, their spleen, and concerningly, it goes to the brain.

And so it's definitely a virus you don't want in mammals, and it's one of these viruses that we've been managing quite well, I'd say, and keeping sort of in that bird population. And it was only in the last year, starting early this year, that we saw a big jump from, poultry population and wild birds perhaps into dairy cattle.

In the United States, dairy cattle are mammals. And once these bird viruses start adapting to mammals, then they can spread and, and become, uh, gain an ability to, to be transferred.

Admitted from person to person or animal to animal and that's what we're seeing now in the cow population And so it's really concerning if this virus were to continue circulating in cows and Mammals and adapting to be able to spread efficiently in mammals and jump into more people and then they can take off like wildfire.

You know, I'm going to go back to a real one quick model. Bill Gates funded an institution back in 2015 and 16 to model how fast an influenza virus such as the one that caused the 1918 pandemic, how fast in the 21st century could it spread through our populations and how much death could it cause? And it was really rapid and within six months of a spread of an influenza virus, like the 1918 virus in the 21st century, over 10 million people could die in the first six months.

So that tells you how fast it can be, how devastating it can be, and why an early signal, an early action is so important.

John Driscoll: Mean, that 1918 flu virus may have killed as many as 20 million people. We don't really know. even know. And it, but when people hear, I think, Rick about a bird flu or cows, there's sort of a little bit of a disconnect between well, but that's not like COVID, right?

I mean, it's that that is a animal. Or like, why should, what's the, what do you think the best way to inform, why should I care what the, should the average American care about animals getting sick would be, I think the way a lot of people might think about this. 

Rick Bright: Well, it's really important when this virus, cause it's a bird virus.

It's an avian influenza virus that really infects birds. And in domestic poultry, it can be quite lethal in domestic poultry. And when we see, uh, uh, uh, chicken flock, or turkey flock, or egg-laying flock. Um, we have to decimate and cull that entire flock and decontaminate the area because we want to keep this virus in the bird population.

When it starts appearing in more animals, more mammals, Um, now it's in over 40 different mammals. Um, it actually starts mutating. And right now, if it were to infect a person, and we've seen a few cases of it already, it doesn't really do well in people. It doesn't really replicate well. It doesn't really transmit to other people really well.

Because the virus has to undergo some mutations to really adapt to people. And our concern is, before, it was only in a few mammals, and those mammals were distant from people. So it might have been a polar bear, it might have been a fox somewhere, it might have been some seals or some sea lions or so, but very little interaction or interface between those animals and people.

So once we saw this virus, bird virus, taken off quite well in domestic dairy cattle, now we have over 12 states with over 90 different herds that have reported this virus replicating quite well in infecting dairy cattle. And we have a huge workforce of people that are working with those dairy cows every day.

Milking those cows sometimes twice a day is very close contact. And that milk is infected with very high levels of virus. Some of the highest levels of virus that we've seen in any substrate such as milk or, or anywhere in other labs even. And then you put that in the back of a truck, you transport it to a processing facility for pasteurization, so all of those people are exposed.

And then those cows, when they're sick and they can't recover, those cows are shipped to a slaughterhouse where they're processed as well. Sometimes they are processed and destroyed and sometimes they might actually go into the food chain. And so you have a lot of different close intimate interaction with infected mammals.

So it gives the virus a lot of time to mutate and adapt to mammals and people. And we have this interaction all along the food chain where people are really exposed to high levels of high levels of virus. So that gives the virus All the playground it needs to adapt to a new host and cause a lot of death and spread quickly.

David Williams: Rick, you pointed out that it's also, it's, there are a lot of people that have contact, uh, with the cattle as you've just described and high levels of, of virus. There's also something about the character, characteristics of those people different from that of the people that we've got on, on this call here in terms of their, their economic vulnerability, immigration status.

I think you had pointed out, uh, could actually make it, uh, more likely that they might be. infected, um, and not able to, uh, you know, kind of avoid this as well. 

Rick Bright: Well, there is this human toll and that's so important. And I think it gets overlooked and sometimes dismissed because the population that work in the dairy farm industry and other agricultural industries largely contains immigrants and undocumented immigrants.

And they don't have health care coverage, um, and they typically don't seek, um, health care when they're sick because they might have concerns of, uh, Being deported and they also don't have silk sick leave. So if they have to take some time away from work, I mean, they're paid on a cash basis, on a regular basis, and they need every bit of that money to support their family and sometimes even support their families back wherever, um, their family is, if it's not in the United States.

And so there's this culture that makes it really difficult to, um, support Infected workers and very difficult for them to seek health care because of this fear of Immigration status and immigration Processing that they might encounter that and there's also I would say at the farmer level and some of these farms are not Small dairy farmers.

Some of these are large industrial farms owned by some large industrial, um, companies, and they're really concerned about losing their workforce. And so, if there were to be, uh, oversight and maybe some investigation and, [00:15:00] uh, deportation, of their workforce, then these cows don't get milked and it really does hurt their income.

So, we have these opposing forces that are working against public health and the things that we need for an early warning and clear data that we need to track to understand how bad this outbreak is. And they're working against us, so it's leaving these huge, gaping, dark holes in our public health surveillance that is slowing our response for what could be a devastating pandemic.

John Driscoll: So Should we be surprised, Rick, that the virus is constantly evolving, if you would basically give the virus that, that is in, that starts in animals a lot of opportunity to be exposed to humans? Does the virus just keep evolving and, and, and, and search for more hosts? I mean, how should we think about that as a, as effectively the threat that just keeps on growing?

Rick Bright: What's the nature of influenza viruses? Do they just change? So by their genetic characterizations, they, when they make copies of themselves, it's not always a high fidelity copy. So they're always, um, changing and adapting and the, the versions that survive and do well, they go on and propagate and the ones that are mismatched or misread or didn't copy so well, they don't survive and they die.

So, but the virus is constantly. mutating. And another unique feature about influenza viruses is that in its genetic makeup, it's different segments of genetic genes that it has, the RNA.

And so these genes, when they infect a virus, can mix and match. You can get a weird reassortment, a mixture of a virus that has mutations.

And so if some of those viruses are adapting to a new host, of course, those new versions of the virus. that can survive in that host are going to do better, and the ones that are not as adapted to the host are not going to do so well. And so it's just the nature of the virus when it gets into a new host, a new environment, and the nature of it's sort of sloppy.

replication machinery and the fact that it can mix and match its genes, that there's this increased opportunity for the right combination to come out that's going to latch onto those receptors in its new host and infect and take off in that new host. It's not the same in every virus, but influenza viruses are made to be, um, especially promiscuous and versatile and, and adapted.

David Williams: Rick, some of the things that we're talking about are hard to change, like immigration policy and the structure of the farm economy. On the other hand, there are certain things that the federal government and maybe others can do. You had pointed out that USDA had been slow to share virus sequence information that's collected from infected cows, and it sounds like with what you're just describing, that kind of blindness is not going to be useful for the scientific community in terms of trying to make an impact here.

Rick Bright: Yeah, I mean, it's really important. So as a virologist, we have to be able to track this virus. It's constantly changing. So when it moves from cow to cow to cow, It's changing when it moves from cow back into the bird, bird population is changing when it moves from cow to person. So in one case, we have a gene sequence from the cow and then from the person who got infected.

And just that one generation of transfer from the cow to the person. We noticed in the virus sequence for the person, the virus had already made one of those critical mutations to adapt to people. It happens that quickly. And what we're seeing though, in this outbreak, every day, we see more herds that are infected.

We see more states reporting that have infected herds of dairy cattle, but the USDA. And the state agriculture departments haven't shared a sequence of those viruses from those infected animals in almost two months. So you can imagine this virus is just continually changing, continually adapting, continually mutating to be able to replicate better in mammals, in people, maybe even acquiring mutations that would make it resistant to our antiviral drugs.

And if we're not able to track that, and we only see that it's happened when it's too late, when it's really spreading quickly from person to person, and it might be drug-resistant , and it might be evasive to any vaccines we have, it's way too late to get in front of that virus. Every day, every time that virus jumps to another animal.

Last week we saw that it's in house mice as well. We saw it went to an alpaca as well. So this virus is changing. It is looking for a new host. Each of those animals is closer and closer to people in more and more interaction. We see it in cats. It's killing the cats, but we don't have the genetic makeup, those sequences, and it's the USDA that leads the state agriculture departments as well, that has a responsibility of collecting and reporting these data, so we can have an early look on how the virus is changing.

And for some reason, the USDA and the state agriculture departments are not sharing these critical data.  

John Driscoll: I mean, obviously their obligation is to support agriculture. Do you think the reason they're not sharing the sequencing is just government ineptitude? Because clearly we know that the speed of the transparency is going to lead to speed of response.

Rick Bright: That is absolutely correct. And the response we've heard so far from the USDA secretary, um, Bilsack, is that they believe they understand how this spreads in cows. They believe they have it under control and they believe it would just burn out. And it doesn't seem that there is a recognition of the spillover opportunity from cows to the dairy workers, and then the transition from, uh, avian virus to a human virus, and then the.

risk of transmitting human to human and the devastation it could cause. It's very expensive. I will say and admit that it's very expensive to have to kill a cow that might be infected with this virus. In some cases, they have to. It's very expensive to take these cows off the milking line for a period of time and have to destroy that milk.

There's a lot of money. Lost in that process. And we understand that in the USDA should come up with incentives to compensate the farmers for this loss. And we believe in that case, the farmers and the state agriculture departments will be more transparent. Right now, they're afraid of losing that revenue.

They're afraid of Having to kill a cow and, the revenue source, maybe for their family, if it's a small farm, could be devastating. Um, the governor of Iowa, just yesterday, Or over the weekend put out a report and a request to the USDA secretary saying that they need a compensation to cover about 90 percent of the loss of the farmers with experience from having to kill a cow or lost milk supply production.

And so far the USDA has not come up with that level of an incentive or compensation to cover those losses. I think these are the main reasons why we're not seeing transparency in the data, because farmers don't want the federal government on their property, uh, workers are afraid of their, of their immigration status, and no one quite understands how this can take off like a torch.

David Williams: So we talked early on also about testing as it related to COVID-19 . Uh, how does testing play in, uh, to this situation? It 

Rick Bright: was very critical. So there's the couple types of testing that are really important. One of them is testing that virus that is in every animal. As it jumps from cow to mouse to person and understanding the sequence of that virus and how it's evolving and how it's changing.

Another kind is um, what we call serology testing. So you take a sample of blood from people so you can look for antibodies in their blood to see if they've been infected with this virus. What we don't know right now is how many people might have already been infected with this virus. And perhaps they have a low level of infection with very minimal symptoms or no symptoms at all. And if we knew that this virus is spreading person to person and not causing a lot of symptoms, it could actually lower some of our risk concern about how bad the virus can be in people. But it can also inform us that this virus is in more people and the more people that is in, the more Chance it has to adapt to people and it would tell us that this virus could be spreading person to person and that would be really concerning as well.

And what we're not seeing right now is anyone allowing anyone, we'll say, to collect the blood samples from people. We don't get blood samples from people who are working on the farms in close contact with the cows. that are infected with the virus. When we have an infected case, human case, we're not getting the blood samples from other people on the farm or in their family or close contacts.

And we don't have a lot of blood samples even from cows to understand, um, which cows have been infected.

John Driscoll: So Rick, today, how worried should the average American be about this virus? Version of bird flu

Rick Bright: in terms of getting infected with this, the risk to the general population is pretty low unless they come in contact with an infected animal.

So if they see a dead bird or dead animal or sick animal, wherever they are in the country, they should leave it alone and not touch it and call for animal control to pick up that animal. If they work anywhere near a dairy farm, they should not be exposed to those dairy cows. If they work on the farm, they need to take every precaution the CDC has provided.

The risk is pretty high if you're working on a dairy farm. But the general public, unless you see a sick animal, or come in contact with some of those dairy products that could have high levels of virus, and I'm talking about raw milk. don't drink raw milk now because there's a very good chance it's loaded with this H501 virus.

So in general, the general public should be aware. They should know that there is something brewing in animals that could be devastating. I'm concerned that If this were to take off and spread efficiently person to person, there's going to be a lot of pushback on taking another vaccine, or wearing a mask, or social distancing, and all those things we know will be helpful in preventing severe infection from this virus.

But I think if we do a good job now of educating people of the risk, what we're doing to control it, what they can do to protect themselves now and hopefully if we need to move into those vaccination status then people will understand the importance of being vaccinated or getting an antiviral drug or getting tested so we can help manage the spread if it were to become out of hand.

David Williams: Well, that's it for yet another episode of Care Talk. We've been speaking about bird flu with urologist Rick Bright today. I'm David Williams, president of Health Business Group. And I'm John Driscoll, senior advisor 

John Driscoll: at Walgreens. If you like what you heard or you didn't, we really hope you subscribe on your favorite service.

And thank you, last month we hit nearly 50, 000 streams, so thank you listeners, watchers, and everyone in between.

Watch the full episode on YouTube:



CareTalk is the only healthcare podcast that tells it like it is. Join hosts John Driscoll (Senior Advisor, Walgreens Health) and David Williams (President, Health Business Group) as they provide an incisive, no B.S. view of the US healthcare industry.



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