Bird Flu Tests Are Hard To Get. So How Will We Know When To Sound the Pandemic Alarm?

Lambert here: We won’t. That’s what worries me. Robert Redfield:

There is no evidence yet that the virus is spreading between humans. Redfield said he knows exactly what has to happen for the virus to get to that point because he’s done lab research on it.

Scientists have found that five amino acids must change in the key receptor in order for bird flu to gain a propensity to bind to a human receptor “and then be able to go human to human” like COVID-19 did, Redfield said.

“Once the virus gains the ability to attach to the human receptor and then go human to human, that’s when you’re going to have the pandemic,” he said. “And as I said, I think it’s just a matter of time.”

All this is true. By nature, I am a worrier. But given the lack of tests, the failure to limit travel (of both cattle and humans), the failure to protect dairy workers with PPE, the stately pace of USDA/CDC investigations, the denigration of non-pharmaceutical interventions, inadequate vaccine manufacturing capacity (assuming them to be safe and effective), and the comprehensive moral and intellectual collapse of the public health establishment, I think it’s a rational apprension that we’d only discover an H5N1 breakout if demand for refrigerated trucks outruns supply (again). (There is also the multiplicity of transmission modes to consider, very different from SARS-CoV-2, including windborne dust from CAFOs to a distance of 15 miles, fomites –yes, this time — and even the food supply). But perhaps the bad thing won’t happen!

* * *

By Amy Maxmen and Arthur Allen. Originally published at KFF Health News.

Stanford University infectious disease doctor Abraar Karan has seen a lot of patients with runny noses, fevers, and irritated eyes lately. Such symptoms could signal allergies, covid, or a cold. This year, there’s another suspect, bird flu — but there’s no way for most doctors to know.

If the government doesn’t prepare to ramp up H5N1 bird flu testing, he and other researchers warn, the United States could be caught off guard again by a pandemic.

“We’re making the same mistakes today that we made with covid,” Deborah Birx, who served as former President Donald Trump’s coronavirus response coordinator, said June 4 on CNN.

To become a pandemic, the H5N1 bird flu virus would need to spread from person to person. The best way to keep tabs on that possibility is by testing people.

Scientifically speaking, many diagnostic laboratories could detect the virus. However, red tape, billing issues, and minimal investment are barriers to quickly ramping up widespread availability of testing. At the moment, the Food and Drug Administration has authorized only the Centers for Disease Control and Prevention’s bird flu test, which is used only for people who work closely with livestock.

State and federal authorities have detected bird flu in dairy cattle in 12 states. Three people who work on separate dairy farms tested positive, and it is presumed they caught the virus from cows. Yet researchers agree that number is an undercount given the CDC has tested only about 40 people for the disease.

“It’s important to know if this is contained on farms, but we have no information because we aren’t looking,” said Helen Chu, an infectious disease specialist at the University of Washington in Seattle who alerted the country to covid’s spread in 2020 by testing people more broadly.

Reports of untested sick farmworkers — as well as a maternity worker who had flu symptoms — in the areas with H5N1 outbreaks among cattle in Texas suggest the numbers are higher. And the mild symptoms of those who tested positive — a cough and eye inflammation, without a fever — are such that infected people might not bother seeking medical care and, therefore, wouldn’t be tested.

The CDC has asked farmworkers with flu symptoms to get tested, but researchers are concerned about a lack of outreach and incentives to encourage testing among people with limited job security and access to health care. Further, by testing only on dairy farms, the agency likely would miss evidence of wider spread.

“It’s hard to not compare this to covid, where early on we only tested people who had traveled,” said Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University. “That left us open to not immediately recognizing that it was transmitting among the community.”

In the early months of covid, the rollout of testing in the United States was catastrophically slow. Although the World Health Organization had validated a test and other groups had developed their own using basic molecular biology techniques, the CDC at first insisted on creating and relying on its own test. Adding to delays, the first version it shipped to state health labs didn’t work.

The FDA lagged, too. It didn’t authorize tests from diagnostic laboratories outside of the CDC until late February 2020.

On Feb. 27, 2020, Chu’s research lab detected covid in a teenager who didn’t meet the CDC’s narrow testing criteria. This case sounded an alarm that covid had spread below the radar. Scaling up to meet demand took time: Months passed before anyone who needed a covid test could get one.

Chu notes this isn’t 2020 — not by a long shot. Hospitals aren’t overflowing with bird flu patients. Also, the country has the tools to do much better this time around, she said, if there’s political will.

For starters, tests that detect the broad category of influenzas that H5N1 belongs to, called influenza A, are FDA-approved and ubiquitous. These are routinely run in the “flu season,” from November to February. An unusual number of positives from these garden-variety flu tests this spring and summer could alert researchers that something is awry.

Doctors, however, are unlikely to request influenza A tests for patients with respiratory symptoms outside of flu season, in part because health insurers may not cover them except in limited circumstances, said Alex Greninger, assistant director of the clinical virology laboratory at the University of Washington.

That’s a solvable problem, he added. At the peak of the covid pandemic, the government overcame billing issues by mandating that insurance companies cover tests, and set a lucrative price to make it worthwhile for manufacturers. “You ran into a testing booth on every other block in Manhattan because companies got $100 every time they stuck a swab in someone’s nose,” Greninger said.

Another obstacle is that the FDA has yet to allow companies to run their influenza A tests using eye swabs, although the CDC and public health labs are permitted to do so. Notably, the bird flu virus was detected only in an eye swab from one farmworker infected this year — and not in samples drawn from the nose or throat.

Overcoming such barriers is essential, Chu said, to ramp up influenza A testing in regions with livestock. “The biggest bang for the buck is making sure that these tests are routine at clinics that serve farmworker communities,” she said, and suggested pop-up testing at state fairs, too.

In the meantime, novel tests that detect the H5N1 virus, specifically, could be brought up to speed. The CDC’s current test isn’t very sensitive or simple to use, researchers said.

Stanford, the University of Washington, the Mayo Clinic, and other diagnostic laboratories that serve hospital systems have developed alternatives to detecting the virus circulating now. However, their reach is limited, and researchers stress a need to jump-start additional capacity for testing before a crisis is underway.

“How can we make sure that if this becomes a public health emergency we aren’t stuck in the early days of covid, where things couldn’t move quickly?” Pinsky said.

A recent rule that gives the FDA more oversight of lab-developed tests may bog down authorization. In a statement to KFF Health News, the FDA said that, for now, it may allow tests to proceed without a full approval process. The CDC did not respond to requests for comment.

But the American Clinical Laboratory Association has asked the FDA and the CDC for clarity on the new rule. “It’s slowing things down because it’s adding to the confusion about what is allowable,” said Susan Van Meter, president of the diagnostic laboratory trade group.

Labcorp, Quest Diagnostics, and other major testing companies are in the best position to manage a surge in testing demand because they can process hundreds per day, rather than dozens. But that would require adapting testing processes for their specialized equipment, a process that consumes time and money, said Matthew Binnicker, director of clinical virology at the Mayo Clinic.

“There’s only been a handful of H5N1 cases in humans the last few years,” he said, “so it’s hard for them to invest millions when we don’t know the future.”

The government could provide funding to underwrite its research, or commit to buying tests in bulk, much as Operation Warp Speed did to advance covid vaccine development.

“If we need to move to scale this, there would need to be an infusion of money,” said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. Like an insurance policy, the upfront expense would be slight compared with the economic blow of another pandemic.

Other means of tracking the H5N1 virus are critical, too. Detecting antibodies against the bird flu in farmworkers would help reveal whether more people have been infected and recovered. And analyzing wastewater for the virus could indicate an uptick in infections in people, birds, or cattle.

As with all pandemic preparedness efforts, the difficulty lies in stressing the need to act before a crisis strikes, Greninger said.

“We should absolutely get prepared,” he said, “but until the government insures some of the risk here, it’s hard to make a move in that direction.”

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. jefemt

    “We should absolutely get prepared,” he said, “but until the government insures some of the risk here, it’s hard to make a move in that direction.”

    If we learned anything from Covid-19, the government will do precisely all the wrong things. Really comes back to each of us to do the best we can to operate as wisely as we can each day as we navigate life in the 2020’s.

    Strong mind, strong body, eat well, get exercise, pursue positive actions and interactions, be as positive as is possible, recognize mortality. Here’s a breezy not-too-distant future dystopian summer read… the set-up is a global pandemic, story set in Colorado front-range and Rockies. Quite a read.

    Turn off the News ad Build a Garden. Lucas Nelson at the dining table. He is very talented. Great lyrics.
    Apple/ tree….

  2. JR

    I apologize for being a complete ding-dong here, but aren’t we (hah, what we…) incorporating H5N1 antibodies (or whatever it is that is done) into this year’s flu vaccine?

      1. polar donkey

        I ordered Tamil from India a few weeks ago. You can also get A/B flu tests for $2-$3. Bird flu is A.

  3. The Rev Kev

    My take is that the Biden White House will seek not to test for bird flu or take any precautionary measures at all. If there is one thing that they do not need between now and November is another Pandemic as it may be held against them with voters. Those voters may think that the first Pandemic can be put down to an accident but a second one is starting to look like carelessness.

    1. kareninca

      Yes, there is no political incentive at all for the Biden White House to deal with this. There is every political incentive for them to avoid acknowledging it. And so they are.

  4. Ron Singer

    Bird Flu Tests Are Hard To Get. So How Will We Know When To Sound the Pandemic Alarm?

    You won’t. Pandemics are extremely unpopular. To avoid generating conspiracy theories and getting their inboxes overloaded with threat messages officials tend to avoid talking about them. They’ve learned that they can get more votes (despite the loss of gaslighted voters) by pretending it will disappear by next Wednesday than by actively leading public health initiatives that limit the carnage. Covid killed a million Americans and fewer than half weren’t ideologically prevented from admitting it. The good news is that it’s nobody WE know.

    Besides, the USSC has ruled pandemics unconstitutional.

    Problem solved. Next!

  5. LawnDart

    Skynet won’t allow the link:

    HHS advances plan to produce 4.8 million H5N1 vaccine doses

    Dawn O’Connell, JD, said health officials have identified a manufacturing line at one of its manufacturing partners for fill-and-finish steps, without disrupting production of seasonal flu vaccine. Currently, the vaccine is in bulk form and will be produced in multidose vials.

    She said it takes a couple months to fill and finish the vaccine doses, which would save time in case a vaccine is needed. Federal health officials have said one of two H5N1 candidate vaccine viruses is well matched to the circulating strain…

    She also said discussions are still under way with mRNA vaccine makers Pfizer and Moderna, with an announcement expected soon on how the companies might be involved in vaccine development.

    [A copy-and-paste of the headline to your search-bar should take you to a link for the story.]

  6. Lambert Strether Post author

    Thanks! That is in fact the link that I just added. If there were one word that could describe my reaction to CDC’s thinking, that worrd would be “complacent.”

  7. Fritz

    This year, there’s another suspect, bird flu…

    “COVID-19 was not the Bubonic plague of the new millennium, but a financial coup enabled by the largest and most spectacular brainwashing operation ever experienced by humanity. It served to hide the fact that the system was infected by terminal sickness, not the global population. […]
    In retrospect, one could even appreciate the evil genius of a system that conceals its massive social, economic, and cultural implosion behind a tiny, invisible scapegoat.”
    — Fabio Vighi

  8. lb

    All this talk of not testing tickled a memory that’s apparently 20ish years old. When concerns about Bovine Spongiform Encephalopathy (BSE, aka “mad cow” disease) were all the rage, there was a ranch that wanted to prove their high-end cattle wasn’t full of relevant pathogens. They went to test their cattle to prove this, but the USDA had (and exercised) the authority to deny this testing:

    Per This NYT article:

    The Department of Agriculture refused yesterday to allow a Kansas beef producer to test all of its cattle for mad cow disease, saying such sweeping tests were not scientifically warranted.

    Under the Virus Serum Toxin Act of 1913, the department decides where cattle can be tested and for what.

    This sort of thing is on my bingo card for 2024 now.

  9. kareninca

    “To become a pandemic, the H5N1 bird flu virus would need to spread from person to person.”

    I keep reading that claim, but I don’t see why that should be. If it can be carried by birds and mice and spread by dust in the air, it seems we could have a pandemic without human to human spread. What about those marine mammals that died by the thousands? Were they getting it just from birds (and dust), or did they give it to one another?

    1. lambert strether

      Thank you. This says more crisply what I was trying to say with modes of transmission. I, and Redfield, were not considering vector transmission (rats, mosquitoes). That said, I envision superspreading from aerosols only, but can someone more familiar with the literature confirm or correct?

      1. Samuel Conner

        I am not an epidemiologist, but it seems to me that in order for there to be a pandemic without human-to-human spread, the pathogen would need to become environmentally pervasive, or else widely infect animal or insect vectors that so frequently interact with humans that infection from that source would be common.

        I don’t think that, without human/human spread, fomite transmission from contaminated point sources (CAFOs, dust from dried manure, etc) would do more than cause regional outbreaks in the vicinity of those point sources.

        That is not to minimize the danger of such non-pandemic forms of viral spread, since these will create opportunities for mutation and eventual acquisition of traits favorable to human/human spread and a true pandemic.


        Perhaps our public health authorities have taken inspiration from John Michael Greer and have decided to collapse now, before the rush.

      2. kareninca

        Do we actually know that it is spreading from cow to cow? My first google brought up:

        “The spread of the H5N1 virus within and among herds indicates that bovine-to-bovine spread occurs. Evidence also indicates that the virus can spread from dairy cattle premises to nearby poultry facilities.”

        But just because there is spread within and among herds, it doesn’t follow that it is bovine to bovine. Maybe it is all bird to cow (via dust). Each cow independently infected by bird-dust; not by another cow.

        Rick Bright keeps pointing out that relevant agencies are not providing the genetic sequences that they are finding. Maybe those sequences would show who is spreading to whom (or what, in the case of dust). Do we even know for sure that the barn cats got it from milk, rather than from bird dust?

        So far a grand total of 45 humans have been tested for this. What a joke. For all we know loads of them have had it due to bird dust.

        Then you could ask why cows are getting this now. Avian flu has been around for a while, but cows haven’t been getting it, even though they have bird flu receptors in their udders. Well, these cows have had covid; maybe that matters (ah, I just noticed that megrim has made that point below).

    2. megrim

      I’m starting to wonder if widespread covid immune damage in marine mammals and cows might be the reason that H5N1 started seriously infecting thousands of marine mammals and dairy cows en mass the last couple of years. And wondering if the widespread covid immune damage in the human population will allow H5N1 to spread among humans as well. I keep reading that they *haven’t* found a tell-tale mutation in the H5N1 that is enabling the current spread, and I also read a recent study linked here at NC about a woman in China who farmed dairy cattle and got H5N1 from her herd (IIRC she died), and the authors speculated that her recent covid infection could have damaged her immune system in such a way that it was easier for her to get infected with H5N1. I think that cows and even marine mammals could very well all have had covid, we gave it to all the deer here in the US. And I remember reading that seals brought TB from Africa to the Americas before 1492, and that is was took down the Cahokia civilization.

      1. kareninca

        Yes, exactly! The mice and cats, too. All of those barn mice and cats have had covid. Now they are sitting ducks for avian flu. I have read lots of people online saying that the forest that they are accustomed to wandering “feels empty.” Maybe that is just doomer blather, or maybe not; I don’t have a way to tell.

  10. antidlc

    Redfield interview on News Nation (about 5 and a half minutes):

    Around the 4:18 mark, he says he is more worried about bird flu coming out of the lab (gain of function research).

    There is a SHOW TRANSCRIPT button, but when I clicked on it, nothing happened.

    1. Spider Monkey

      this video below is pretty good. covers somebody who obtained a FOIA request for a gain-of-function grant on the same strain of bird flu going around about ~ 6 months prior to detection in the “wild”. Could already be a lab leak and there are at least 2 other bird flu lab leaks in the previous decades we know of.

  11. ChrisPacific

    The mortality rate is supposedly around 50%. I think the shortages will run well beyond refrigerator trucks and into other things, like shovels.

  12. Ann


    “A University of Maryland review of scientific literature suggests domestic cats can contract the rapidly evolving bird flu H5N1, potentially putting owners, veterinarians and others at risk if the virus continues to circulate unabated.

    The study, available in preliminary form on MedRxiv while awaiting peer review, examined the global distribution and spread of bird flu infections in feline species between 2004 and 2024, finding a drastic rise in reports starting in 2023, with a spike in infections reported among domestic cats, as opposed to wild or zoo-kept animals.

    This increase coincides with the rapid spread of the current strain of H5N1 among mammals, says the study’s first author, Assistant Professor Kristen Coleman, an airborne infectious disease researcher in the School of Public Health and an affiliate professor in the Department of Veterinary Medicine.

    Bird flu hasn’t been reported to be contagious between humans, and it is not certain to evolve in that direction, but the disease is clearly changing. The current strain of H5N1 has been spreading to animals that have never been affected before, and pets that can pass it to people could play a role in how it evolves.”

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