Agriculture officials could start testing every silo of bulk milk, in every state, monthly, said Poulsen, the livestock veterinarian. “Not one and done,” he added. If they detect the virus, they’d need to determine the affected farm in time to stop sick cows from spreading infections to the rest of the herd — or at least to other farms. Cows can spread the bird flu before they’re sick, he said, so speed is crucial.
Cows from a non-suspect herd are milked at the Cornell Teaching
Dairy Barn at Cornell University on December 11, 2024, in Ithaca,
New York. Michael M. Santiago / Getty Images
Keith Poulsen’s jaw dropped when farmers showed him images on their
cellphones at the World Dairy Expo in Wisconsin in October. A
livestock veterinarian at the University of Wisconsin, Poulsen had
seen sick cows before, with their noses dripping and udders slack.
But the scale of the farmers’ efforts to treat the sick cows stunned
him. They showed videos of systems they built to hydrate hundreds of
cattle at once. In 14-hour shifts, dairy workers pumped gallons of
electrolyte-rich fluids into ailing cows through metal tubes
inserted into the esophagus.
“It was like watching a field hospital on an active battlefront
treating hundreds of wounded soldiers,” he said.
Nearly a year into the first outbreak of the bird flu among cattle,
the virus shows no sign of slowing. The U.S. government failed to
eliminate the virus on dairy farms when it was confined to a handful
of states, by quickly identifying infected cows and taking measures
to keep their infections from spreading. Now at least 845 herds
across 16 states have tested positive.
Experts say they have lost faith in the government’s ability to
contain the outbreak.
“We are in a terrible situation and going into a worse situation,”
said Angela Rasmussen, a virologist at the University of
Saskatchewan in Canada. “I don’t know if the bird flu will become a
pandemic, but if it does, we are screwed.”
To understand how the bird flu got out of hand, KFF Health News
interviewed nearly 70 government officials, farmers and farmworkers,
and researchers with expertise in virology, pandemics, veterinary
medicine, and more.
Together with emails obtained from local health departments through
public records requests, this investigation revealed key problems,
including a deference to the farm industry, eroded public health
budgets, neglect for the safety of agriculture workers, and the
sluggish pace of federal interventions.
Case in point: The U.S. Department of Agriculture this month
announced a federal order to test milk nationwide. Researchers
welcomed the news but said it should have happened months ago —
before the virus was so entrenched. [USDA
Announces New Federal Order, Begins National Milk Testing Strategy
to Address H5N1 in Dairy Herds]
“It’s disheartening to see so many of the same failures that emerged
during the covid-19 crisis reemerge,” said Tom Bollyky, director of
the Global Health Program at the Council on Foreign Relations.
Far more bird flu damage is inevitable, but the extent of it will be
left to the Trump administration and Mother Nature. Already, the
USDA has funneled more than $1.7 billion into tamping down the bird
flu on poultry farms since 2022, which includes reimbursing farmers
who’ve had to cull their flocks, and more than $430 million into
combating the bird flu on dairy farms. In coming years, the bird flu
may cost billions of dollars more in expenses and losses. Dairy
industry experts say the virus kills roughly 2 to 5% of infected
dairy cows and reduces a herd’s milk production by about 20%.
Worse, the outbreak poses the threat of a pandemic. More than 60
people in the U.S. have been infected, mainly by cows or poultry,
but cases could skyrocket if the virus evolves to spread efficiently
from person to person. And the recent news [CDC
Confirms First Severe Case of H5N1 Bird Flu in the United States] of a person critically
ill in Louisiana with the bird flu shows that the virus can be
dangerous.
Just a few mutations [A
single mutation in bovine influenza H5N1 hemagglutinin switches
specificity to human receptors] could allow the bird flu to spread between
people. Because viruses mutate within human and animal bodies, each
infection is like a pull of a slot machine lever.
“Even if there’s only a 5% chance of a bird flu pandemic happening,
we’re talking about a pandemic that probably looks like 2020 or
worse,” said Tom Peacock, a bird flu researcher at the Pirbright
Institute in the United Kingdom, referring to covid-19. “The U.S.
knows the risk but hasn’t done anything to slow this down,” he
added.
Beyond the bird flu, the federal government’s handling of the
outbreak reveals cracks in the U.S. health security system that
would allow other risky new pathogens to take root, too. “This virus
may not be the one that takes off,” said Maria Van Kerkhove,
director of the emerging diseases group at the World Health
Organization. “But this is a real fire exercise right now, and it
demonstrates what needs to be improved.”
A Slow Start
It may have been a grackle, a goose, or some other wild bird that
infected a cow in northern Texas. In February, the state’s dairy
farmers took note when cows stopped making milk. They worked
alongside veterinarians to figure out why. In less than two months,
veterinary researchers identified the highly pathogenic H5N1 bird
flu virus as the culprit.
Long listed among pathogens with pandemic potential, the bird flu’s
unprecedented spread among cows marked a worrying shift. It had
evolved to thrive in animals that are more like people biologically
than birds.
After the USDA announced the dairy outbreak on March 25, control
shifted from farmers, veterinarians, and local officials to state
and federal agencies. Collaboration disintegrated almost
immediately.
Farmers worried the government might block their milk sales or even
demand sick cows be killed, like poultry are, said Kay Russo, a
livestock veterinarian in Fort Collins, Colorado.
Instead, Russo and other veterinarians said, they were dismayed by
inaction. The USDA didn’t respond to their urgent requests to
support studies on dairy farms — and for money and confidentiality
policies to protect farmers from financial loss if they agreed to
test animals.
The USDA announced that it would conduct studies itself. But
researchers grew anxious as weeks passed without results. “Probably
the biggest mistake from the USDA was not involving the
boots-on-the-ground veterinarians,” Russo said.
Will Clement, a USDA senior adviser for communications, said in an
email: “Since first learning of H5N1 in dairy cattle in late March
2024, USDA has worked swiftly and diligently to assess the
prevalence of the virus in U.S. dairy herds.” The agency provided
research funds to state and national animal health labs beginning in
April, he added.
The USDA didn’t require lactating cows to be tested before
interstate travel until April 29. By then, the outbreak had spread
to eight other states. Farmers often move cattle across great
distances, for calving in one place, raising in warm, dry climates,
and milking in cooler ones. Analyses of the virus’s genes. [The
global H5N1 influenza panzootic in mammals]
Milking equipment was a likely source of infection, and there were
hints of other possibilities, such as through the air as cows
coughed or in droplets on objects, like work boots. But not enough
data had been collected to know how exactly it was happening. Many
farmers declined to test their herds, despite an announcement of
funds to compensate them for lost milk production.
“There is a fear within the dairy farmer community that if they
become officially listed as an affected farm, they may lose their
milk market,” said Jamie Jonker, chief science officer at the
National Milk Producers Federation, an organization that represents
dairy farmers. To his knowledge, he added, this hasn’t happened.
Speculation filled knowledge gaps. Zach Riley, head of the Colorado
Livestock Association, said wild birds may be spreading the virus to
herds across the country, despite scientific data suggesting
otherwise. Riley said farmers were considering whether to install
“floppy inflatable men you see outside of car dealerships” to ward
off the birds.
Advisories from agriculture departments to farmers were somewhat
speculative, too. Officials recommended biosecurity measures such as
disinfecting equipment and limiting visitors. As the virus kept
spreading throughout the summer, USDA senior official Eric Deeble
said at a press briefing, “The response is adequate.”
The USDA, the Centers for Disease Control and Prevention, and the
Food and Drug Administration presented a united front at these
briefings, calling it a “One Health” approach. In reality,
agriculture agencies took the lead.
This was explicit in an email from a local health department in
Colorado to the county’s commissioners. “The State is treating this
primarily as an agriculture issue (rightly so) and the public health
part is secondary,” wrote Jason Chessher, public health director in
Weld County, Colorado. The state’s leading agriculture county,
Weld’s livestock and poultry industry produces about $1.9 billion in
sales each year.
Patchy Surveillance
In July, the bird flu spread from dairies in Colorado to poultry
farms. To contain it, two poultry operations employed about 650
temporary workers[Cluster
of Influenza A(H5) Cases Associated with Poultry Exposure at Two
Facilities — Colorado, July 2024]— Spanish-speaking immigrants as young as 15 — to
cull flocks. Inside hot barns [Colorado
Poultry Workers Battle Bird Flu in Heat Wave as US Struggles to
Contain Outbreak], they caught infected birds, gassed
them with carbon dioxide, and disposed of the carcasses. Many did
the hazardous job without goggles, face masks, and gloves.
By the time Colorado’s health department asked if workers felt sick,
five women and four men had been infected. They all had red, swollen
eyes — conjunctivitis — and several had such symptoms as fevers,
body aches, and nausea.
State health departments posted online notices offering farms
protective gear, but dairy workers in several states told KFF Health
News [Bird
Flu Cases Are Going Undetected, New Study Suggests. It’s a Problem
for All of Us.] that they had none. They also said they hadn’t been asked to
get tested.
Studies in Colorado, Michigan, and Texas would later show that bird
flu cases had gone under the radar. In one analysis [Serologic
Evidence of Recent Infection with Highly Pathogenic Avian Influenza
A(H5) Virus Among Dairy Workers — Michigan and Colorado, June–August
2024], eight dairy
workers who hadn’t been tested — 7% of those studied — had
antibodies against the virus, a sign that they had been infected.
Missed cases made it impossible to determine how the virus jumped
into people and whether it was growing more infectious or dangerous.
“I have been distressed and depressed by the lack of epidemiologic
data and the lack of surveillance,” said Nicole Lurie, an executive
director at the international organization the Coalition for
Epidemic Preparedness Innovations, who served as assistant secretary
for preparedness and response in the Obama administration.
Citing “insufficient data,” the British government raised its
assessment
[Influenza A(H5N1) 2.3.4.4b B3.13: US cattle outbreak update] of the risk posed by the U.S. dairy outbreak in July from
three to four on a six-tier scale.
Virologists around the world said they were flabbergasted by how
poorly the United States was tracking the situation. “You are
surrounded by highly pathogenic viruses in the wild and in farm
animals,” said Marion Koopmans, head of virology at Erasmus Medical
Center in the Netherlands. “If three months from now we are at the
start of the pandemic, it is nobody’s surprise.”
Although the bird flu is not yet spreading swiftly between people, a
shift in that direction could cause immense suffering. The CDC has
repeatedly described the cases among farmworkers this year as mild —
they weren’t hospitalized. But that doesn’t mean symptoms are a
breeze, or that the virus can’t cause worse.
“It does not look pleasant,” wrote Sean Roberts, an emergency
services specialist at the Tulare County, California, health
department in an email to colleagues in May. He described
photographs of an infected dairy worker in another state:
“Apparently, the conjunctivitis that this is causing is not a mild
one, but rather ruptured blood vessels and bleeding conjunctiva.”
Over the past 30 years, half of around 900 people diagnosed with
bird flu around the world have died. Even if the case fatality rate
is much lower for this strain of the bird flu, covid showed how
devastating a 1% death rate can be when a virus spreads easily.
Like other cases around the world, the person now hospitalized with
the bird flu in Louisiana appears to have gotten the virus directly
from birds. After the case was announced, the CDC released a
statement [CDC
Confirms First Severe Case of H5N1 Bird Flu in the United States] saying, “A sporadic case of severe H5N1 bird flu illness
in a person is not unexpected.”
‘The Cows Are More Valuable Than Us’
Local health officials were trying hard to track infections,
according to hundreds of emails from county health departments in
five states. But their efforts were stymied. Even if farmers
reported infected herds to the USDA and agriculture agencies told
health departments where the infected cows were, health officials
had to rely on farm owners for access.
“The agriculture community has dictated the rules of engagement from
the start,” said Michael Osterholm, director of the Center for
Infectious Disease Research and Policy at the University of
Minnesota. “That was a big mistake.”
Some farmers told health officials not to visit and declined to
monitor their employees for signs of sickness. Sending workers to
clinics for testing could leave them shorthanded when cattle needed
care. “Producer refuses to send workers to Sunrise [clinic] to get
tested since they’re too busy. He has pinkeye, too,” said an email
from the Weld, Colorado, health department.
“We know of 386 persons exposed – but we know this is far from the
total,” said an email from a public health specialist to officials
at Tulare’s health department recounting a call with state health
officials. “Employers do not want to run this through worker’s
compensation. Workers are hesitant to get tested due to cost,” she
wrote.
Jennifer Morse, medical director of the Mid-Michigan District Health
Department, said local health officials have been hesitant to apply
pressure after the backlash [‘We’re
Coming for You’: For Public Health Officials, a Year of Threats and
Menace] many faced at the peak of covid.
Describing the 19 rural counties she serves as “very
minimal-government-minded,” she said, “if you try to work against
them, it will not go well.”
Rural health departments are also stretched thin. Organizations that
specialize in outreach to farmworkers offered to assist health
officials early in the outbreak, but months passed without contracts
or funding. During the first years of covid, lagging government
funds for outreach [Ten
Americas: a systematic analysis of life expectancy disparities in
the USA] to farmworkers and other historically
marginalized groups led to a disproportionate toll [Inequality’s
deadly toll] of the disease
among people of color.
Kevin Griffis, director of communications at the CDC, said the
agency worked with the National Center for Farmworker Health
throughout the summer “to reach every farmworker impacted by H5N1.”
But Bethany Boggess Alcauter, the center’s director of public health
programs, said it didn’t receive a CDC grant for bird flu outreach
until October, to the tune of $4 million. Before then, she said, the
group had very limited funds for the task. “We are certainly not
reaching ‘every farmworker,’” she added.
Farmworker advocates also pressed the CDC for money to offset
workers’ financial concerns about testing, including paying for
medical care, sick leave, and the risk of being fired. This amounted
to an offer of $75 [Farmworkers
Face High-Risk Exposures to Bird Flu, but Testing Isn’t Reaching
Them] each. “Outreach is clearly not a huge priority,”
Boggess said. “I hear over and over from workers, ‘The cows are more
valuable than us.’”
The USDA has so far put more than $2.1 billion into reimbursing
poultry and dairy farmers for losses due to the bird flu and other
measures to control the spread on farms. Federal agencies have also
put $292 million into developing and stockpiling bird flu vaccines
for animals and people. In a controversial decision [Finland
Is Offering Farmworkers Bird Flu Shots. Some Experts Say the US
Should, Too.], the CDC has
advised against offering the ones on hand to farmworkers.
“If you want to keep this from becoming a human pandemic, you focus
on protecting farmworkers, since that’s the most likely way that
this will enter the human population,” said Peg Seminario, an
occupational health researcher in Bethesda, Maryland. “The fact that
this isn’t happening drives me crazy.”
Nirav Shah, principal deputy director of the CDC, said the agency
aims to keep workers safe. “Widespread awareness does take time,” he
said. “And that’s the work we’re committed to doing.”
As Trump comes into office in January, farmworkers may be even less
protected. Trump’s pledge of mass deportations will have
repercussions, said Tania Pacheco-Werner, director of the Central
Valley Health Policy Institute in California, whether they happen or
not.
Many dairy and poultry workers are living in the U.S. without
authorization or on temporary visas linked to their employers. Such
precarity made people less willing to see doctors about covid
symptoms or complain about unsafe working conditions in 2020.
Pacheco-Werner said, “Mass deportation is an astronomical challenge
for public health.”
Not ‘Immaculate Conception’
A switch flipped in September among experts who study pandemics as
national security threats. A patient in Missouri had the bird flu,
and no one knew why. “Evidence points to this being a one-off case,”
Shah said at a briefing with journalists. About a month later, the
agency revealed it was not.
Antibody tests found that a person who lived with the patient had
been infected, too. The CDC didn’t know how the two had gotten the
virus, and the possibility of human transmission couldn’t be ruled
out.
Nonetheless, at an October briefing, Shah said the public risk
remained low and the USDA’s Deeble said he was optimistic that the
dairy outbreak could be eliminated.
Experts were perturbed by such confident statements in the face of
uncertainty, especially as California’s outbreak spiked and a child
[Technical
Update: Summary Analysis of the Genetic Sequence of a Highly
Pathogenic Avian Influenza A(H5N1) Virus Identified in a Child in
California]
“This wasn’t just immaculate conception,” said Stephen Morrison,
director of the Global Health Policy Center at the Center for
Strategic and International Studies. “It came from somewhere and we
don’t know where, but that hasn’t triggered any kind of reset in
approach — just the same kind of complacency and low energy.”
Sam Scarpino, a disease surveillance specialist in the Boston area,
wondered how many other mysterious infections had gone undetected.
Surveillance outside of farms was even patchier than on them, and
bird flu tests are hard to get.
Although pandemic experts had identified the CDC’s singular hold on
testing for new viruses as a key explanation [The
United States Needs A Better Testing Playbook For Future Public
Health Emergencies] for why America was hit
so hard by covid in 2020, the system remained the same. All bird flu
tests must go through the CDC, even though commercial and academic
diagnostic laboratories have inquired about running tests themselves
since April [US
Leaders Dragged Their Feet Fighting Bird Flu. Now We Risk Another
Pandemic.]. The CDC and FDA should have tried to help them along
months ago, said Ali Khan, a former top CDC official who now leads
the University of Nebraska Medical Center College of Public Health.
As winter sets in, the bird flu becomes harder to spot because
patient symptoms may be mistaken for the seasonal flu. Flu season
also raises a risk that the two flu viruses could swap genes if they
infect a person simultaneously. That could form a hybrid bird flu
that spreads swiftly through coughs and sneezes.
A sluggish response to emerging outbreaks may simply be a new,
unfortunate norm for America, said Bollyky, at the Council on
Foreign Relations. If so, the nation has gotten lucky that the bird
flu still can’t spread easily between people. Controlling the virus
will be much harder and costlier than it would have been when the
outbreak was small. But it’s possible.
Agriculture officials could start testing every silo of bulk milk,
in every state, monthly, said Poulsen, the livestock veterinarian.
“Not one and done,” he added. If they detect the virus, they’d need
to determine the affected farm in time to stop sick cows from
spreading infections to the rest of the herd — or at least to other
farms. Cows can spread the bird flu before they’re sick, he said, so
speed is crucial.
Curtailing the virus on farms is the best way to prevent human
infections, said Jennifer Nuzzo, director of the Pandemic Center at
Brown University, but human surveillance must be stepped up, too.
Every clinic serving communities where farmworkers live should have
easy access to bird flu tests — and be encouraged to use them. Funds
for farmworker outreach must be boosted. And, she added, the CDC
should change its position and offer farmworkers bird flu vaccines
to protect them and ward off the chance of a hybrid bird flu that
spreads quickly.
The rising number of cases not linked to farms signals a need for
more testing in general. When patients are positive on a general flu
test — a common diagnostic that indicates human, swine, or bird flu
— clinics should probe more deeply, Nuzzo said.
The alternative is a wait-and-see approach in which the nation
responds only after enormous damage to lives or businesses. This
tack tends to rely on mass vaccination. But an effort analogous to
Trump’s Operation Warp Speed is not assured, and neither is rollout
like that for the first covid shots, given a rise in vaccine
skepticism among Republican lawmakers.
Change may instead need to start from the bottom up — on dairy
farms, still the most common source of human infections, said
Poulsen. He noticed a shift in attitudes among farmers at the Dairy
Expo: “They’re starting to say, ‘How do I save my dairy for the next
generation?’ They recognize how severe this is, and that it’s not
just going away.”