By Seth Millstein for Sentient.
Broadcast version by Kathleen Shannon for Texas News Service reporting for the Sentient-Public News Service Collaboration

Bird flu has been making a comeback, with multiple strains detected in multiple people across multiple continents over the last few months. As of this writing, three people in the U.S. have contracted the H5N1 strain, one person in Mexico has died from the H5N2 strain, and H5N1 has been detected in 118 U.S. dairy herds across 12 states. Thankfully, the disease is not easily transmissible between humans - but some epidemiologists fear that eventually, it will be.

Here's what you need to know about bird flu and human health.

What Is Bird Flu?

Bird flu, also known as avian influenza, is shorthand for influenza type A viruses and the illness they cause. Although avian influenza is common in birds, non-avian species can contract it as well.

There are many, many different strains of bird flu. However, most strains are what's called low pathogenic, meaning they're either asymptomatic or only cause mild symptoms in birds. For instance, low pathogenic strains of avian influenza, or LPAI, might cause a chicken to have ruffled feathers, or produce fewer eggs than normal. But high pathogenic strains of avian influenza, or HPAI, cause severe and often deadly symptoms in birds.

It's important to note, though, that this distinction between LPAI and HPAI strains only applies when avian species contract it. A cow who gets an LPAI strain of bird flu might experience severe symptoms, for instance, while a horse who gets an HPAI strain might be asymptomatic. In humans, both LPAI and HPAI strains of bird flu can cause both mild and severe symptoms.

Can Humans Get Bird Flu?

We sure can.

Bird flu strains are categorized on two different spectrums based on two different proteins on their surface. The protein hemagglutinin (HA) has 18 different subtypes, labeled H1-H18, while the protein neuraminidase has 11 subtypes, labeled N1-11. The two proteins combine with one another to create unique strains of bird flu, which is why strains have names like H1N1, H5N2, and so on.

Most of these strains don't affect humans, but a handful of them do. Several strains have been particularly concerning to epidemiologists:

• H7N9


• H5N1


• H5N6


• H5N2

The current strain of bird flu that's been detected in humans is H5N1.


How Do Humans Get Bird Flu?


In very rare cases, it's possible for bird flu to pass from human to human. Most of the time, though, humans get bird flu by coming into contact with infected animals or their byproducts. This could mean touching the carcass, saliva or feces of an infected bird; however, bird flu is also transmissible by air, so merely breathing while in the vicinity of an animal with the virus can also be enough to contract it.


There are no documented cases of humans contracting bird flu by drinking raw milk, but some recent cases suggest that it may be a possibility. The current strain has been detected in cow's milk, and in March, several cats died after drinking raw milk from a cow who'd been infected with the virus.


What Are the Symptoms of Bird Flu?


At the risk of stating the obvious, the symptoms of bird flu in humans are generally what one would describe as "flu-like," including:

• Fever


• Sore throat


• Runny or stuffy nose


• Nausea and vomiting


• Coughing


• Fatigue


• Muscle aches


• Diarrhea


• Shortness of breath


• Pink eye

Birds who've contracted avian flu, on the other hand, might display slightly different symptoms, including:

• Decreased appetite


• Purple discoloration of body parts


• Lethargy


• Reduced egg production


• Soft-shelled or misshapen eggs


• General respiratory issues, such as nasal discharge, coughing and sneezing


• Lack of coordination


• Sudden, inexplicable death

Can Humans Die of Bird Flu?


Yes. In the three decades since bird flu was first detected, 860 humans have contracted it, and 463 of them died. This means the virus has a staggering 52 percent mortality rate, though there have been no deaths in the U.S. attributed to the most recent spread of the disease here.


Who Is Most At Risk of Contracting Bird Flu?


Because the disease is primarily transmitted to humans through animals and their byproducts, people who spend time around animals are at the highest risk of contracting bird flu. Wild and farmed animals pose the greatest risk, but even dogs can get bird flu if, for instance, they come across the infected carcass of an animal who had it. Domestic pet owners whose animals don't go outside are not at risk.


Occupationally-speaking, the people most susceptible to getting bird flu are those who work in the poultry industry, as they spend a significant amount of time around birds, their byproducts and their carcasses. But livestock workers of all sorts are at a high risk; the first person to test positive for this most recent strain works in the dairy industry, and is believed to have caught it from a cow.


Other people who face elevated risks of bird flu include hunters, butchers, certain conservationists, and anybody else whose line of work involves touching potentially infected animals or their carcasses.


What's Going on With the Current Strains of Bird Flu?


The H5N1 strain has been slowly spreading across the globe since 2020, but it wasn't until March that it was detected in the unpasteurized milk of U.S. dairy cows. This was significant for two reasons: it was the first known instance of that strain infecting cows, and it was discovered in multiple states. By April, it had spread to 13 herds across six different states.


Also around that time, humans began contracting H5N1. The first two people only experienced mild symptoms - pinkeye, to be specific - and quickly recovered, but the third patient experienced coughing and watery eyes as well.


That may sound like a minor distinction, but because a virus is much more likely to be spread through coughing than an eye infection, that third case has virologists on edge. All three were farmworkers who'd had contact with dairy cows.


By May, H5N1 had been detected in the muscle tissue of a dairy cow - though the meat didn't enter the supply chain and had already been marked as tainted, as the cow was sick beforehand - and by June, cows infected with the virus had died in five states.


Meanwhile, a man in Mexico died after contracting H5N2, a different strain of bird flu that had never before been detected in humans. It's unclear how he contracted it.


To be sure, there's no reason to believe that a widespread outbreak among humans is imminent, or even possible (yet). But the fact that there have been so many bird flu "firsts" in such a short time has many experts concerned, as it raises the possibility that a strain could mutate and become more easily transmissible to humans.


While much of the coverage of H5N1 has focused on cows, the current outbreak has wrought havoc on chickens, too: As of June 20, more than 97 million poultry have been affected by H5N1, according to the CDC.


Is Drinking Raw Milk An Effective Deterrent Against Bird Flu?


Absolutely not. If anything, coming into contact with raw milk increases your exposure to bird flu, not to mention your risk of contracting other potentially serious illnesses.


In April, the Food and Drug Administration announced that 1 in 5 milk samples from grocery stores were found to contain traces of H5N1. That's not quite as alarming as it sounds; these milk samples were pasteurized, and preliminary studies show that pasteurization neutralizes, or "inactivates," influenza type A viruses.


What's especially worrisome is sales of raw milk have been increasing since the latest bird flu outbreak, spurred in part by viral misinformation spread by health influencers touting raw milk.


Could Bird Flu Become a Human Pandemic?


Though it's difficult to say for certain, the general consensus in the scientific community is that the extant strains of bird flu are, in their current forms, unlikely to reach pandemic levels. The reason for this is that they almost never pass from one human to another, and are instead contracted from animals.


But viruses mutate and change over time, and the long-gestating fear among epidemiologists is that a strain of bird flu will mutate, or undergo a genetic reassortment, in such a way that allows it to be easily transmitted from human to human. If this were to happen, it could very plausibly become a global pandemic for humans.


How Is Bird Flu Diagnosed?


In humans, bird flu is detected via a simple throat or nasal swab, but infectious disease experts warn that much like the early days of the Covid pandemic, we aren't testing most of the population or measuring disease spread in wastewater. In other words, we don't know for sure whether the disease is circulating. Physicians don't routinely test for bird flu, so you'll have to specifically request a test if you're concerned that you might have it.


Do Standard Flu Shots Protect Against Bird Flu?


No. The current annual flu shot that we're all encouraged to get protects against the common flu, including swine flu, but not avian influenza.


The Bottom Line


Development is underway for a new bird flu vaccine, and the CDC says that despite all of these recent developments, the public health risk of bird flu is still low. But there's no assurance that this will always be the case; as a highly fatal virus with multiple, mutating strains, bird flu is a constant looming threat for humans and animals alike.




Seth Millstein wrote this article for Sentient.


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Groups advocating for better access to health care have introduced what they call "Care4All California," a package of 13 bills designed to shore up the health system as the state braces for the possibility of huge cuts in federal funding for Medi-Cal.

The bills aim to get more people insured, connect them to care and make health care more affordable.

Chris Noble, organizing director for the nonprofit Health Access California, explained the group's priorities.

"It's crucial that our State Legislature shows their commitment to advancing a universal, affordable and equitable health care system," Noble emphasized. "This year's package of legislative and budget priorities requires no interventions by the federal government and should be adopted to safeguard our health care system in case there are federal attacks."

One bill would make sure people with Medicare supplemental insurance cannot be penalized for having preexisting conditions. Another would require hospitals to prescreen all patients to see if they are eligible for discounted or charity care programs. A third bill would allow undocumented people access to health plans on the CoveredCA exchange. Opponents cited cost concerns.

Noble emphasized the bills build on the progress California has made to lower its uninsured rate.

"These priorities will continue to cover gaps within our health care system, ensure that when people are denied or delayed care, there's certain accountability, or ensure that folks are getting access to accurate and up-to-date provider directories," Noble outlined.

Advocates have also made a number of budget requests, including one to give kids who qualify for Medi-Cal continuous coverage from birth to age 5, rather than making their parents reapply every year.

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As Republican lawmakers in Washington, D.C., consider cuts to Medicaid, a new report has found thousands of veterans in Virginia could be affected.

Virginia passed Medicaid expansion in 2018, which broadened who qualified for the program, including people under 65 and without children who make 138% or less of the federal poverty level. The report by The Commonwealth Institute showed more than 47,000 Virginia veterans receive health coverage through Medicaid.

Freddy Mejia, policy director at the institute, said work requirements or cuts to the Medicaid expansion would increase barriers to Virginians' access to health care.

"We just kind of want to raise the profile of how federal cuts to Medicaid could impact not only hundreds of thousands of Virginians, nearly 629,000 Virginians that have health coverage through Medicaid expansion, but also to veterans in particular here in Virginia," Mejia outlined.

Rep. Mike Johnson, R-La., the Speaker of the House, has said the Medicaid expansion under the Affordable Care Act allowed people who did not truly need the benefit to enroll. Republicans have called for major cuts in spending across the federal government but are split on which entitlement programs should be trimmed, and by how much.

Virginia is one of eight states with what is known as an automatic trigger law in place, where states would immediately end their expansion if the federal government lowers its funding of the Medicaid expansion below 90%.

Mejia argued veterans in the Commonwealth would get caught up in the cuts.

"If the federal government decides to reduce funding for Medicaid expansion by even 1%, our state law means that it would automatically end Medicaid expansion," Mejia pointed out. "That would immediately throw potentially thousands of veterans off of coverage."

More than 20% of Virginians access health care through Medicaid.


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By Brett Kelman for KFF Health News.
Broadcast version by Freda Ross for Arkansas News Service reporting for the KFF Health News-Public News Service Collaboration

In the wooded highlands of northern Arkansas, where small towns have few dentists, water officials who serve more than 20,000 people have for more than a decade openly defied state law by refusing to add fluoride to the drinking water.

For its refusal, the Ozark Mountain Regional Public Water Authority has received hundreds of state fines amounting to about $130,000, which are stuffed in a cardboard box and left unpaid, said Andy Anderson, who is opposed to fluoridation and has led the water system for nearly two decades.

This Ozark region is among hundreds of rural American communities that face a one-two punch to oral health: a dire shortage of dentists and a lack of fluoridated drinking water, which is widely viewed among dentists as one of the most effective tools to prevent tooth decay. But as the anti-fluoride movement builds unprecedented momentum, it may turn out that the Ozarks were not behind the times after all.

"We will eventually win," Anderson said. "We will be vindicated."

Fluoride, a naturally occurring mineral, keeps teeth strong when added to drinking water, according to the Centers for Disease Control and Prevention and the American Dental Association. But the anti-fluoride movement has been energized since a government report last summer found a possible link between lower IQ in children and consuming amounts of fluoride that are higher than what is recommended in American drinking water. Dozens of communities have decided to stop fluoridating in recent months, and state officials in Florida and Texas have urged their water systems to do the same. Utah is poised to become the first state to ban it in tap water.

Health and Human Services Secretary Robert F. Kennedy Jr., who has long espoused fringe health theories, has called fluoride an "industrial waste" and "dangerous neurotoxin" and said the Trump administration will recommend it be removed from all public drinking water.

Separately, Republican efforts to extend tax cuts and shrink federal spending may squeeze Medicaid, which could deepen existing shortages of dentists in rural areas where many residents depend on the federal insurance program for whatever dental care they can find.

Dental experts warn that the simultaneous erosion of Medicaid and fluoridation could exacerbate a crisis of rural oral health and reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist.

"If you have folks with little access to professional care and no access to water fluoridation," said Steven Levy, a dentist and leading fluoride researcher at the University of Iowa, "then they are missing two of the big pillars of how to keep healthy for a lifetime."

Many already are.

Overlapping 'Dental Deserts' and Fluoride-Free Zones

Nearly 25 million Americans live in areas without enough dentists - more than twice as many as prior estimates by the federal government - according to a recent study from Harvard University that measured U.S. "dental deserts" with more depth and precision than before.

Hawazin Elani, a Harvard dentist and epidemiologist who co-authored the study, found that many shortage areas are rural and poor, and depend heavily on Medicaid. But many dentists do not accept Medicaid because payments can be low, Elani said.

The ADA has estimated that only a third of dentists treat patients on Medicaid.

"I suspect this situation is much worse for Medicaid beneficiaries," Elani said. "If you have Medicaid and your nearest dentists do not accept it, then you will likely have to go to the third, or fourth, or the fifth."

The Harvard study identified over 780 counties where more than half of the residents live in a shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water, according to a KFF analysis of fluoride data published by the CDC. That means people in these areas who can't find a dentist also do not get protection for their teeth from their tap water.

The KFF Health News analysis does not cover the entire nation because it does not include private wells and 13 states do not submit fluoride data to the CDC. But among those that do, most counties with a shortage of dentists and unfluoridated water are in the south-central U.S., in a cluster that stretches from Texas to the Florida Panhandle and up into Kansas, Missouri, and Oklahoma.

In the center of that cluster is the Ozark Mountain Regional Public Water Authority, which serves the Arkansas counties of Boone, Marion, Newton, and Searcy. It has refused to add fluoride ever since Arkansas enacted a statewide mandate in 2011. After weekly fines began in 2016, the water system unsuccessfully challenged the fluoride mandate in state court, then lost again on appeal.

Anderson, who has chaired the water system's board since 2007, said he would like to challenge the fluoride mandate in court again and would argue the case himself if necessary. In a phone interview, Anderson said he believes that fluoride can hamper the brain and body to the point of making people "get fat and lazy."

"So if you go out in the streets these days, walk down the streets, you'll see lots of fat people wearing their pajamas out in public," he said.

Nearby in the tiny, no-stoplight community of Leslie, Arkansas, which gets water from the Ozark system, the only dentist in town operates out of a one-man clinic tucked in the back of an antique store. Hand-painted lettering on the store window advertises a "pretty good dentist."

James Flanagin, a third-generation dentist who opened this clinic three years ago, said he was drawn to Leslie by the quaint charms and friendly smiles of small-town life. But those same smiles also reveal the unmistakable consequences of refusing to fluoridate, he said.

"There is no doubt that there is more dental decay here than there would otherwise be," he said. "You are going to have more decay if your water is not fluoridated. That's just a fact."

Fluoride Seen as a Great Public Health Achievement

Fluoride was first added to public water in an American city in 1945 and spread to half of the U.S. population by 1980, according to the CDC. Because of "the dramatic decline" in cavities that followed, in 1999 the CDC dubbed fluoridation as one of 10 great public health achievements of the 20th century.

Currently more than 70% of the U.S. population on public water systems get fluoridated water, with a recommended concentration of 0.7 milligrams per liter, or about three drops in a 55-gallon barrel, according to the CDC.

Fluoride is also present in modern toothpaste, mouthwash, dental varnish, and some food and drinks - like raisins, potatoes, oatmeal, coffee, and black tea. But several dental experts said these products do not reliably reach as many low-income families as drinking water, which has an additional benefit over toothpaste of strengthening children's teeth from within as they grow.

Two recent polls have found that the largest share of Americans support fluoridation, but a sizable minority does not. Polls from Axios/Ipsos and AP-NORC found that 48% and 40% of respondents wanted to keep fluoride in public water supplies, while 29% and 26% supported its removal.

Chelsea Fosse, an expert on oral health policy at the American Academy of Pediatric Dentistry, said she worried that misguided fears of fluoride would cause many people to stop using fluoridated toothpaste and varnish just as Medicaid cuts made it harder to see a dentist.

The combination, she said, could be "devastating."

"It will be visibly apparent what this does to the prevalence of tooth decay," Fosse said. "If we get rid of water fluoridation, if we make Medicaid cuts, and if we don't support providers in locating and serving the highest-need populations, I truly don't know what we will do."

Multiple peer-reviewed studies have shown what ending water fluoridation could look like. In the past few years, studies of cities in Alaska and Canada have shown that communities that stopped fluoridation saw significant increases in children's cavities when compared with similar cities that did not. A 2024 study from Israel reported a "two-fold increase" in dental treatments for kids within five years after the country stopped fluoridating in 2014.

Despite the benefits of fluoridation, it has been fiercely opposed by some since its inception, said Catherine Hayes, a Harvard dental expert who advises the American Dental Association on fluoride and has studied its use for three decades.

Fluoridation was initially smeared as a communist plot against America, Hayes said, and then later fears arose of possible links to cancer, which were refuted through extensive scientific research. In the '80s, hysteria fueled fears of fluoride causing AIDS, which was "ludicrous," Hayes said.

More recently, the anti-fluoride movement seized on international research that suggests high levels of fluoride can hinder children's brain development and has been boosted by high-profile legal and political victories.

Last August, a hotly debated report from the National Institutes of Health's National Toxicology Program found "with moderate confidence" that exposure to levels of fluoride that are higher than what is present in American drinking water is associated with lower IQ in children. The report was based on an analysis of 74 studies conducted in other countries, most of which were considered "low quality" and involved exposure of at least 1.5 milligrams of fluoride per liter of water - or more than twice the U.S. recommendation - according to the program.

The following month, in a long-simmering lawsuit filed by fluoride opponents, a federal judge in California said the possible link between fluoride and lowered IQ was too risky to ignore, then ordered the federal Environmental Protection Agency to take nonspecified steps to lower that risk. The EPA started to appeal this ruling in the final days of the Biden administration, but the Trump administration could reverse course.

The EPA and Department of Justice declined to comment. The White House and Department of Health and Human Services did not respond to questions about fluoride.

Despite the National Toxicology Program's report, Hayes said, no association has been shown to date between lowered IQ and the amount of fluoride actually present in most Americans' water. The court ruling may prompt additional research conducted in the U.S., Hayes said, which she hoped would finally put the campaign against fluoride to rest.

"It's one of the great mysteries of my career, what sustains it," Hayes said. "What concerns me is that there's some belief amongst some members of the public - and some of our policymakers - that there is some truth to this."

Not all experts were so dismissive of the toxicology program's report. Bruce Lanphear, a children's health researcher at Simon Fraser University in British Columbia, published an editorial in January that said the findings should prompt health organizations "to reassess the risks and benefits of fluoride, particularly for pregnant women and infants."

"The people who are proposing fluoridation need to now prove it's safe," Lanphear told NPR in January. "That's what this study does. It shifts the burden of proof - or it should."

Cities and States Rethink Fluoride

At least 14 states so far this year have considered or are considering bills that would lift fluoride mandates or prohibit fluoride in drinking water altogether. In February, Utah lawmakers passed the nation's first ban, which Republican Gov. Spencer Cox told ABC4 Utah he intends to sign. And both Florida Surgeon General Joseph Ladapo and Texas Agriculture Commissioner Sid Miller have called for their respective states to end fluoridation.

"I don't want Big Brother telling me what to do," Miller told The Dallas Morning News in February. "Government has forced this on us for too long."

Additionally, dozens of cities and counties have decided to stop fluoridation in the past six months - including at least 16 communities in Florida with a combined population of more than 1.6 million - according to news reports and the Fluoride Action Network, an anti-fluoride group.

Stuart Cooper, executive director of that group, said the movement's unprecedented momentum would be further supercharged if Kennedy and the Trump administration follow through on a recommendation against fluoride.

Cooper predicted that most U.S. communities will have stopped fluoridating within years.

"I think what you are seeing in Florida, where every community is falling like dominoes, is going to now happen in the United States," he said. "I think we're seeing the absolute end of it."

If Cooper's prediction is right, Hayes said, widespread decay would be visible within years. Kids' teeth will rot in their mouths, she said, even though "we know how to completely prevent it."

"It's unnecessary pain and suffering," Hayes said. "If you go into any children's hospital across this country, you'll see a waiting list of kids to get into the operating room to get their teeth fixed because they have severe decay because they haven't had access to either fluoridated water or other types of fluoride. Unfortunately, that's just going to get worse."


Brett Kelman wrote this story for KFF Health News.


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