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       WHO's Farrar: Social context is key to halting bird flu spread
        
 (HTM) Source
        
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       Jeremy Farrar, now the World Health Organization's chief scientist,
       was working in Vietnam 20 years ago when the H5N1 virus started to
       spread across Asia — at that point in poultry. He recalls there was a
       reluctance among farmers to cull their chickens because they weren't
       being compensated for them. Movement of infected birds to evade
       culling only served to disseminate the virus, which in the years since
       has spread to all continents except Australia.
        
       It's important to keep that experience in mind, he told STAT Monday,
       as the H5N1 bird flu virus now spreads among dairy cattle in the U.S.
       Farrar stressed that the social context is key in responding to
       disease threats like H5N1, noting that a similar reluctance among
       dairy farmers to report outbreaks or allow testing of their workers is
       adding to the challenges in assessing how much transmission is
       occurring and the risk it poses to people.
        
       "You can't just take the virus and the biological surveillance and
       divorce it from the environment and the social construct that it's
       happening in," Farrar said in an interview from WHO headquarters in
       Geneva. "That's the reality."
        
       Though it is believed the virus has been spreading in dairy cow herds
       for months, to date the U.S. Department of Agriculture has confirmed
       only 36 infected herds in nine states. There have been no new
       outbreaks announced in the week since a federal rule went into effect
       requiring testing of a portion of the cows in a cattle shipment that
       is destined to cross state lines, if the cows are lactating. (The
       infections to date have been detected in lactating cows.)
        
       On the human health side, there have been multiple anecdotal reports
       of farm workers who've been exposed to infected cattle suffering from
       conjunctivitis and other mild symptoms. But Todd Davis, acting chief
       of the virology, surveillance and diagnosis branch of the Centers for
       Disease Control and Prevention's influenza division, told a WHO
       webinar on Monday that only about 30 people have been tested since the
       outbreak was first detected in late March. There has been one
       confirmed infection, in a farm worker from Texas who had
       conjunctivitis.
        
       Both the USDA and the CDC have acknowledged that many farmers have
       been unwilling to allow testing of their animals or to permit public
       health officials to speak with or conduct testing on their workers.
       The industry is known to employ migrant and even sometimes
       undocumented workers, which perhaps explains the unwillingness of
       those workers to comply with public health efforts to study what is
       going on in these outbreaks.
        
       "I know many people within that industry in the United States and
       other parts of the world are workers paid in a certain way, hourly or
       daily. They may be reluctant to report illnesses. It's an epidemic of
       a virus, but the social context it's happening in is just critical,"
       Farrar said.
        
       Ideally, public health workers would have drawn blood samples from the
       Texas worker who tested positive for H5N1 and from people he worked
       with and lived with, to look for undetected cases that could suggest
       onward transmission of the virus. But he and the people he lived with
       refused to allow blood samples to be taken.
        
       While he believes the risk of a human flu pandemic triggered by the
       H5N1 virus is low, should it happen, the social context will also be
       crucial, Farrar continued. The mental toll of the taxing Covid-19
       pandemic hangs over the public, health care workers, public health
       agencies, and governments. Getting people to again buy into measures
       that might slow spread, such as social distancing or school closures,
       would likely be tough, he said.
        
       "The hangover is absolutely true across all societies, I think,"
       Farrar said. "Public health agencies but also health care workers
       around the world are shattered. … It's a global phenomena and the
       world's willingness to either have vaccines, mRNA, or otherwise, and
       have any school closures, masks, whatever interventions you may talk
       about, would not be the same as they were back in 2020."
        
       All the more reason, Farrar suggested, to take the actions needed to
       ensure the spread of bird flu in cows does not trigger a worse crisis.
       "That makes the case that we better do what we can to avoid an event
       happening because I think the response would understandably be very
       different."
        
        
        
        
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