US repeats Covid mistakes with bird flu, spread raises alarm, experts say

The US is making the same mistakes with the H5N1 bird flu virus as it did with Covid, as the highly pathogenic bird flu continues to spread on American farms and alarms are raised that the virus could mutate into a pandemic, public health experts say. to argue in the New England Journal of Medicine.

“We are turning a blind eye to both the COVID pandemic and to a potential avian flu (pandemic) on the horizon,” said Gregg Gonsalves, an associate professor of epidemiology at the Yale School of Public Health and a co-author of the paper. “Our ability to respond quickly and decisively is the big problem.”

Beyond outbreaks—of Covid, bird flu, mpox, measles and other dangerous pathogens—the failure or refusal to learn lessons from each crisis is the most pressing public health problem facing America, he said. “The social epidemic of forgetting is likely to be the most troubling public health event of 2024.”

A lack of testing, opaque data, political divisions, poor access to health care and a sense of arrogance – all of these have plagued the response to Covid, and now these failures are playing a role in the response to bird flu, Gonsalves said.

“We haven’t really done anything to address the continued spread of bird flu in the U.S. — we’re back to square one, the same old mistakes,” he said. “Right now, the imminent risk is low and we haven’t seen human-to-human transmission. But the point is, we’re not waiting for that to happen. Right?”

Officials worldwide have feared an H5N1 pandemic since the first case was identified in humans in 1997.

Highly pathogenic influenza viruses have been closely watched for decades for their pandemic potential. It is partly due to the monitoring of such pathogens that may have pandemic potential that the US ranks #1 for pandemic preparedness in 2019.

Yet the U.S. fared far worse than other countries in the Global North when it was hit by a new respiratory virus, SARS-CoV-2, killing at least 1.2 million people and sickening and disabling millions more.

Experts are still trying to figure out the reasons for this and draw attention to these failures before the next avoidable crisis occurs.

A lack of testing and monitoring of the virus plagued the Covid response, from the limited and flawed testing in the early days to the lack of testing that has persisted. Similarly, scientists now know that H5N1 circulated in livestock for months before it was detected, and reporting indicates that infections among farm workers may also be underreported. Some farm employers are reluctant to cooperate with health officials — just as the meatpacking industry did with Covid, Gonsalves said.

The confusing and byzantine structure of federal, state and local agency accountability also creates significant challenges. While there have been calls to give the U.S. Centers for Disease Control and Prevention more authority to lead federal responses to Covid pandemics, no such changes have been made.

Agencies are still grappling with jurisdiction and collaboration, and there are also significant differences between federal, state and local approaches. With Covid, “we had a patchwork of state responses, some more robust than others, and we paid for it,” Gonsalves said.

The restrictions on public health authorities have only been exacerbated by Covid. At least 26 states have introduced new laws restricting the powers of public health authorities during the pandemic.

For example, in Iowa and Tennessee, face masks are no longer required in schools, and in Wisconsin, health officials cannot close schools.

That’s deeply troubling because the next pandemic could hit schoolchildren hard, as has historically been the case for influenza, Gonsalves said. “We’re fixated on what just happened, and we don’t have any imagination about what a new pandemic could bring.”

The next pandemic virus could spread even faster and be even more deadly — and that’s true even if the virus itself isn’t more virulent — because of the public health system’s lack of funding, trust and authority, he said.

Recent U.S. Supreme Court decisions, including invoking the “big questions” doctrine and overturning the Chevron precedent, mean that federal agencies will likely need explicit authorization from a divided and slow-moving Congress to take swift action to contain new outbreaks.

“We are basically being told, ‘Ignore what has happened over the last four years, ignore what is happening now with bird flu, And “Let’s tie your hands behind your back when it comes to being able to respond when the time comes,” Gonsalves said.

Political divisions have only widened during the Covid pandemic, threatening efforts to contain infectious disease outbreaks.

Growing anti-vaccine sentiment could block the development and distribution of new and existing pharmaceutical products, such as vaccines, once they have gone through the complicated and expensive development process. Operation Warp Speed, a large and successful project to rapidly produce Covid vaccines, was wound down instead of becoming a permanent part of the pandemic response.

Inequalities are still hampering vaccine distribution even now. “We have a fragmented health system, which means if you can’t get a vaccine because you don’t have insurance right now, you’re out of luck,” Gonsalves said.

Those who can afford it can access quality health care in the U.S., but serious gaps remain for those who are uninsured or underinsured. The U.S. health care system has “the most luxurious tertiary care in the world,” he said, but it stumbles in primary care, preventive medicine and public health. “We’re not good at the basics.”

Vast inequalities meant that some patients had access to the world’s most advanced care, while others struggled to find enough masks, ventilators and treatments. While other countries cushioned the pandemic’s worst blows with social safety nets, many Americans were left to fend for themselves, Gonsalves said. And the focus on individual health ignores the role of public health, which is by definition collective.

Despite these fatal missteps, the US never had a Covid commission to analyse what went wrong, as countries like the UK did. There was a bipartisan attempt to set up an inquiry similar to the 9/11 commission, but it failed.

It was America’s sense of misplaced and persistent confidence that it was handling the pandemic as best it could that was perhaps most damaging to its response, Gonsalves said. “We have a vastly exaggerated view of our skills, capabilities and willingness to do the right thing.”

For example, officials have reiterated that “we have the tools” — but treatments and vaccines are quickly becoming outdated as the virus evolves, while access problems and misinformation persist, and other precautions, such as isolation for the duration of the illness, are no longer recommended.

There is still time to correct these mistakes, experts say.

“Everyone is extremely grateful that we’re not stuck in a loop of 2020, where our hospitals were overcrowded, morgues were overcrowded, and we had no recourse against the virus,” Gonsalves said. But “we can do much more,” from updating respiratory virus guidelines with the latest evidence on transmission to improving indoor air quality.

The COVID pandemic is “one of the most important historical events in the United States in the last 100 years, in terms of public health. We have all suffered from it,” Gonsalves said. “The best way to avoid the pain that we have felt over the last four years is to be prepared.”