As questions arise about the spread of bird flu among livestock and people, one US state – Michigan – has taken the lead in monitoring and studying the outbreak.
Other states seem cautious about tracking animal and human cases, but Michigan has taken a proactive approach, sending daily texts and phone calls to check on farm workers who handle cows who have tested positive for H5N1. They have also offered free testing if symptoms develop.
Officials weren’t surprised when a third person tested positive for the highly pathogenic bird flu, and they weren’t surprised it happened in Michigan. Nearly two-thirds of the people being monitored for H5N1 symptoms are in Michigan, Nirav Shah, deputy director of the U.S. Centers for Disease Control and Prevention (CDC), said recently.
By May 22, 35 of the 40 tests had been conducted among humans executed in Michigan. That leaves only five other bird flu tests conducted in other states, including Texas, the only other state to report a human case in the outbreak.
Michigan is the state with the highest concentration of influenza A in its wastewater, according to to WastewaterScan. H5N1 belongs to the influenza A family, and relatively high levels of influenza A indicate possible outbreaks of H5N1 – most likely among animals.
But that’s not the only reason bird flu keeps making headlines in Michigan.
“I don’t think we’re the only state that has cases. I think we’re the only state that’s detecting our cases,” aside from Texas, said Dr. Natasha Bagdasarian, chief medical executive for the state of Michigan. “It gives me hope that the system is working here.”
It’s not just testing and monitoring. Michigan also invited epidemiologists from the U.S. Department of Agriculture (USDA) to study the transmission of the virus. The authors of a recent USDA report thanked Michigan dairy producers for their openness and transparency. “This report could not have been completed without them,” the researchers wrote.
Officials in Michigan have announced new biosafety rules for farms after the first detection of bird flu in cows, and quickly began promoting seasonal flu vaccines among dairy and poultry workers to prevent the possibility of flu strains mixing and causing more severe illness.
Michigan too announced additional funding for flu-affected farms, in addition to available federal assistance. Up to 20 farms affected by H5N1 could receive up to $28,000 for participating in studies and working with health officials.
“Michigan has done a lot of work to really understand what’s going on with H5N1,” said Marisa Eisenberg, associate professor of epidemiology and co-director of the Michigan Public Health Integrated Center for Outbreak Analytics and Modeling at the University of Michigan.
“Part of what we see is that if you look for something, you will find it.”
It’s important that state and local officials work closely with the agricultural sector — including cows, chickens, pigs and other potentially affected animals — to understand how transmission occurs and how to stop it, experts said.
“It’s in everyone’s best interest to try to be as proactive as possible,” Eisenberg said. “Because if you bury your head in the sand, ostrich-style, it’s going to continue to spread and it’s going to continue to cause a broader range of problems — from a public health perspective, from a milk production perspective, from an economic perspective.”
In Michigan, that approach involved regularly contacting farmworkers for symptoms and working closely with officials from state and local agriculture and health departments.
“We see how human and animal health are inextricably linked and we make sure we address these issues together,” Bagdasarian said.
Farm owners and workers who come into contact with sick cows receive daily text messages or phone calls to check for even mild or unusual symptoms.
Those reporting symptoms are being tested for H5N1 and, in the case of two people who tested positive, offered antiviral drugs.
That program, Eisenberg said, “has been really helpful in terms of finding the two cases that we’ve seen so far, and also encouraging testing at farms and at dairies in particular.”
A Michigan worker who tested positive developed conjunctivitis, or pinkeye, after milk from a sick cow splashed into the person’s eyes.
The other worker developed more typical flu symptoms, including coughing, nasal congestion, sore throat and watery eyes, after working in close quarters with a sick cow.
The risk of bird flu is still low for most people, but anyone who comes into close contact with potentially sick animals should take precautions, officials say.
“It really highlights how useful personal protective equipment can be for people who have prolonged contact with sick animals,” Bagdasarian said.
But such protective gear can be difficult to wear while working on a farm, in conditions such as summer heat and splashing water and milk.
“One of the biggest concerns was visibility,” Bagdasarian said. “If you are working with a large animal and there is a risk of injury, anything blocking your view can also be difficult to use.”
Michigan officials are taking care not to release details that could identify affected farms or individuals as they announce new cases.
“Michigan as a state has been quite good at dealing with privacy concerns and not wanting to specifically identify farms, but sharing data in a transparent way,” Eisenberg said.
During this bird flu outbreak, officials have stressed the importance of trust.
“One of the things we’ve learned from Covid is that you have to build relationships before any kind of public health emergency arises,” Bagdasarian said.
“We have a lot of health clinics and outreach staff who work directly with farmworkers, and the local health departments know the farms in their jurisdiction.”
If an H5N1 vaccine becomes available to people, it could fall prey to the same politicization and misinformation around vaccines that have increased during the pandemic, she said — including lower uptake of the seasonal flu vaccine.
“We are still working to restore that public trust,” Bagdasarian said.
The bird flu outbreak is “concerning, but we cannot yet say whether it will really become a major problem that the general public should be concerned about,” Eisenberg said.
“It’s worrying enough that we certainly need to do everything we can to make sure it doesn’t become a bigger problem.”