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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It is National Rural Health Day and experts are flagging research showing increasing health disparities between urban and rural places, including in South Dakota.

A new advisory from the American Heart Association shows between 2010 and 2022, cardiovascular death rates increased a whopping 21% among young adults in rural areas, especially after the onset of COVID-19. In urban areas, the rate increased only 3%.

Dr. Karen Joynt-Maddox, associate professor of medicine at Washington University, chairs the association's presidential advisory committee and said the change is due to a mixed bag of increased risk factors in rural areas.

"If you put that on top of a real problem with health care infrastructure and access in rural areas, you sort of have a perfect storm for worsening cardiovascular health."

Joynt-Maddox noted traditional risk factors include high blood pressure, diabetes and obesity, which have been increasing in rural areas over the last few decades. Other contributing factors, she said, include poverty, food insecurity, depression and substance use disorder.

Tim Nikolai, Midwest senior rural health director for the American Heart Association, said rural communities have less access to resources like health care and grocery stores with fresh produce. Even access to high speed internet contributes to health outcomes. Health care providers are stretched thin, Nikolai added.

"It stretched hospitals and health care providers to try to serve the needs of their community the best way they can," Nikolai observed. "And that's something we're trying to collaborate with them on, is how can they meet people where they are?"

Nikolai listed some work happening in South Dakota including offering blood pressure monitoring at local libraries, installing four new Public Health AmeriCorps members across the state and the town of Spearfish prioritizing public CPR training and AED access.

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More than 38 million Americans live with diabetes, including nearly 1 million Georgians.

The Georgia Department of Public Health estimates another 230,000 people in the state may have diabetes but don't know it.

During National Diabetes Month, Dr. Griffin Rodgers - director of the National Institute of Diabetes, Digestive, and Kidney Diseases at the National Institutes of Health - emphasized the importance of managing diabetes early to prevent serious health complications.

"Diabetes can damage blood vessels and nerves," said Rodgers, "so the patients that have it have a higher risk of developing conditions like a heart attack or a stroke, diseases of the kidneys and the eyes and the teeth, as well as the lower extremities."

Between 2014 and 2018, diabetes led to over 100,000 hospitalizations and 154,000 emergency-room visits in Georgia.

But Rodgers said diabetes is preventable and manageable. He added that regular wellness visits - where blood sugar, blood pressure, and cholesterol are checked - are key to staying healthy.

Rodgers said a healthy diet is a major part of managing or preventing diabetes.

He suggested eating plenty of fresh produce, whole grains, and lean proteins like fish - and cutting back on sugary drinks by choosing water instead.

Regular exercise and seven to eight hours of sleep each night are also important.

"On the physical activity side, 30 minutes a day, five days a week for most adults is what's
generally recommended," said Rodgers. "Just walking. And if you can't do the 30 minutes all at one time, breaking it into either two 15, or three 10-minute intervals is sufficient."

Early signals that diabetes could be a problem include frequent urination, constant thirst or hunger, fatigue, blurry vision, nausea, unexpected weight loss, or tingling in your hands and feet.

Rodgers said managing diabetes can be as simple as focusing on "the A-B-Cs of care" - checking your A1C, blood pressure and cholesterol levels, and quitting smoking.




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California could be in for some big cuts to health care for low-income families under a second Trump administration, according to health experts.

Policy specialists at the nonprofit KFF said they are bracing for Trump allies in Congress to make major reductions to Medicaid expansion under the Affordable Care Act, in order to pay for big tax cuts promised by the president-elect.

Larry Levitt, executive vice president of health policy at KFF, said it would force states to backfill or raise costs.

"For the ACA, simply letting enhanced financial aid expire after next year would result in big out-of-pocket premium increases, reduced enrollment and more people uninsured," Levitt projected.

Robert F. Kennedy Jr., President-elect Trump's choice for Health and Human Services Secretary, did not say much on the campaign trail about funding for Medicaid or the Affordable Care Act, so his positions are unclear. Kennedy has expressed skepticism about vaccines and has said the U.S. should stop putting fluoride in drinking water.

Jennifer Kates, senior vice president and director of the Global Health and HIV Policy Program for KFF, said the Centers for Disease Control and Prevention cannot require states to follow its recommendations on vaccines and fluoridation.

"That's up to states and local governments," Kates explained. "But CDC can recommend, and if those recommendations are not being made or being watered down or changed, that sends a message to states, to schools, to parents."

Health advocates are also raising concerns DACA recipients could lose access to health plans sold on the state marketplaces created under the Affordable Care Act. Changes to so-called "public charge" rules could make families with mixed immigration status hesitant to use Medicaid benefits.


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