H5N1 Goes H2H (or has it?), Which I called to the Month a Year & a Half Ago (or did I?)

As was mentioned a few months ago in a previous FF2F post, back in March of 2023 I made the prediction (in the first two tweets of what has so far become a 108-tweet thread) that "a highly transmitting human-2-human strain of H5N1" would emerge in September of 2024, a year and a half henceforth.

Well, October 1^st has now arrived, and although there's no indication that it's highly transmitting just yet, it turns out that – lo and behold – H5N1 avian influenza has in fact gone human-to-human.

Or has it?

That's the big question on hardly anybody's mind, because unless you follow some of the few key epidemiologists and similar accounts on #MedTwitter, subscribe to r/H5N1_AvianFlu, or in some other manner have managed to keep abreast of the latest developments, chances are you've tuned out with most other people who just want to get back to "living their life" (which, considering the rolling onslaught of climate-induced crises, regional wars, overall economic malaise, and descent into political extremism, aren't exactly looking too hot right about now).

Because those that have been paying attention would know that while an initial case of H5N1 (whose source still hasn't been determined) was announced by the Centers for Disease Control and Prevention (CDC) on Friday, September 6^th (the fourteenth case this year in the United States, fifteenth since the outbreak began if you count the 2022 case of a Colorado individual that had cleaned up infected birds, culled on an infected poultry "farm"), subsequent Fridays have seen a drip-feed of information be meted out as more and more possible cases keep getting added to the possible infected-count.

Let's back up to that initial mystery case to get an understanding of this evolving shitshow.

See no evil, hear no evil, speak no evil, test no evil

While none of the previous 13 cases of H5N1 diagnosed in Americans this year have resulted in death or even hospitalisation, the sources of their infections have all been readily known: the first case, in March, came via an infection from cattle (a first ever) and resulted in little more than conjunctivitis (pink eye), while three others were derived from cattle and the remaining nine from chickens.

But while the actual hospitalisation of this recent fourteenth case could be chalked up to the fact that the individual had a number of underlying health issues, the fact remains that they're also the first case to have no discernible source of infection. That is, while the individual from Missouri was initially hospitalised on August 22^nd for their significant underlying medical condition with chest pain, nausea, vomiting, diarrhoea, and weakness (which aren't regular influenza symptoms) and then recovered and was discharged prior to the CDC's announcement about – and even confirmation of – their H5N1 infection, they had no known direct exposure to animals. Moreover, not only was the case not caught through specialised bird flu surveillance, but it was caught through standard flu monitoring – suggesting that H5N1 could very well be circulating under the radar (in the US at least).

And circulating it may very well be. Because although contact tracing of potentially exposed individuals was conducted by state epidemiologists, revealing no additional cases, come the next Friday, September 13^th (it seems that the CDC tends to announce these things at the time in which they'll grab the least amount of attention as possible), the CDC announced that a household contact of the index case had also begun displaying symptoms on the very same day that the index case became ill. The timing therefore suggests that there wasn't any human-to-human spread between them but rather a common exposure (although there's no guarantee of that, as some immunologists have stressed), but even that's up in the air because although the household contact has since fully recovered, they were never tested for influenza.

While serology testing for antibodies could still reveal exposure to H5N1, Missouri officials seem to have taken a page straight out of former US president Donald's Trump's "if we stop testing right now, we'd have very few cases, if any" book, having simply stated that such testing was "being considered". If in turn you're wondering why the CDC doesn't just roll in and administer tests themselves, that's because the agency's investigators can't look into the infection further unless a request for help is made by state authorities, which at the time hadn't been done.

Regardless, several weeks have since passed and there still hasn't been any indication of what may have been the source of infection. While the strain of H5N1 has been determined to be closely related to the strain currently found in dairy cattle, Missouri is not one of the 14 states that have reported outbreaks in cows (although testing isn't required in Missouri and is up to dairy owners, so its existence certainly can't be ruled out). Although raw milk and other raw milk-derived dairy products have been ruled out, several other possibilities still exist: mouse droppings, a house cat that is allowed outdoors or that ate infected cat food, downwind from a farm, consumption of under-cooked meat, a failure of the pasteurisation process, exposure to wild bird droppings via a bird feeder, attendance at public gatherings (such as a state fair), and more.

Whatever the source be, during the announcement of the household contact the CDC also announced that a health care worker (HCW) who was a close contact of the index case had also become ill, although in this case they actually were administered a PCR test and the result came back negative (which is by no means definitive as not only was the test possibly undertaken too late to pick up signs of infection, but flu tests commonly administered in hospitals are known to have a 40% false negative rate).

Not missing a beat, next Friday (September 20^th) the CDC made yet another announcement, this time that another HCW contact had developed mild respiratory symptoms, but who once again hadn't been tested for influenza, apparently due to Missouri health officials not knowing that the individual was symptomatic until after they'd recovered.

A week later, Friday, September 27^th, the CDC announced that another four HCWs who had come into contact with the index case had also come down with mild symptoms, individuals that similarly didn't get tested while they were ill either.

Here a one-off, there a one-off, everywhere a one-off

If we hadn't just gone through – and are still going through – a pandemic with an utterly piss-poor response by governments and public health agencies at large (never mind by the general public as well), you'd almost think that there's some kind of conspiracy going on whereby "the powers that be" are trying to bury the story about the emergence of yet another – and potentially much more dire – civilisation-rocking pandemic.

Because on top of all the lack of testing, while it was announced on September 13^th that the household contact and the initial symptomatic HCW had possibly been infected by the index case, it was during a press call just the day before, September 12^th, that the principal deputy director of the CDC had this to say:

None of the individuals that this individual came into contact with have developed any signs and symptoms. So we haven't seen any evidence of it at this time… We are right now of the view that this is a one-off.

Which once again – supposing we hadn't just become aware of how utterly incompetent we are as a society when it comes to responding to a pandemic – almost makes one wonder if these "one-offs" are being drip-fed on separate days so that they each appear to exist in their own little continuum, effectively concealing the truth of what is without a doubt a constantly growing public threat that's about to upend the world as we know it.

She'll be right, mate!

Non-conspiracies aside, it nonetheless seems like nobody has any idea about what's going on. For all we know, the index case could have been admitted to the hospital due to their underlying health condition, the index case and their household member (who could have brought them in) then simultaneously getting infected with H5N1 by a HCW (which would explain the lack of an infection source and the pair's simultaneous infection), making a HCW the index case. Or perhaps everybody but the index case had SARS-CoV-2, what with there being a significant wave occurring at the moment, and what with health facilities having long ago shunned the "do no harm" mantra by brazenly doing away with even the usage of piss-poor surgical masks (never mind the far superior N95s).

But we have no idea if either of those plausible scenarios might actually be the case, because virtually nobody – Missouri health officials and/or CDC staff – has been doing what any sensible outsider would deem as being their job.

Until now. Maybe. Because while the CDC stated in its September 27^th press release that results of serology testing (for antibodies to H5N1) on the positive index case and their household contact were "still pending", health and medicine publication STAT revealed on the same day that while blood samples have in fact been collected from the five most recent HCWs that were symptomatic (out of 94 HCWs that had come into contact with the index patient, all probably maskless), and will be forwarded on to the CDC's headquarters in Atlanta once safe shipment can be assured, said shipment would likely have to wait due to disruptions caused by Hurricane Helene.

No rush.

Oh, and while the second HCW who showed symptoms "will be offered" serology testing, it's unclear if the first HCW, who had the negative PCR test, will be administered a serology test at all.

No biggie.

Prediction connoisseur or prediction charlatan?

It now being October 1^st, the day after the completion of the month in which a year and a half ago I stated that "a highly transmitting human-2-human strain of H5N1" would emerge, has it? Well, it should first of all go without saying that it's all but certain that there's no highly transmitting strain of H5N1 out there at the moment, an overly descriptive detail that I could have left out of my prediction. Nonetheless, the underlying prediction, the occurrence that hasn't emerged since H5N1 first appeared in humans back in 1997 and that we've "all been waiting for", is whether or not the virus has finally crossed the human-to-human barrier. And thanks to what is arguably the outright incompetence of various agencies, we still don't know.

First off, as much as armchair epidemiologists would like to claim that the virus has gone human-to-human, there is however no epidemiological evidence to support the claim that human-to-human transmission has in fact occurred. It's possible that with the CDC's next info drop, presumably occurring on Friday (October 4^th), that we may get some information about the belated serology tests that were administered to various HCWs as well as to the index case's household contact. Or perhaps we'll have to wait until the following Friday. Who knows?

Supposing that information eventually emerges from said serology tests confirming that human-to-human transmission has in fact occurred, when it comes to my prediction there'd still be the issue of timing. What we in the public currently know about the index case is that they were admitted to hospital on August 22^nd, while their status of having had H5N1 (as well as the possibility that their household contact and a slew of HCWs also had it) was announced throughout September. Alongside that, any announcement about possible human-to-human transmission would be expected in October.

While any possible transmission would've all but certainly occurred in August (but which likely won't be specified), would the fact that the "drama" (the various announcements alluding to possible human-to-human transmission) all occurred in September validate my prediction?

I don't know about you, but I'd certainly take it.

That's of course getting way ahead of ourselves though, so while we anticipate an imminent announcement or two about the serology tests, we'll just have to patiently wait and see.

Sounds of the Pandemicene, with Fanfare Ciocărlia

It's hard not to conclude that our abhorrent response to the possibility of human-to-human H5N1 has been lackadaisical, to say the least. A bit of a clown show, one might otherwise say. That being so, while the mood of Fanfare Ciocărlia's "Hora lui Pusac" comes off as rather free-wheeling, that's not to say that you want it to be confused for the theme song for your epidemiological response to an impending disaster. But as we're forced to patiently await to figure out what exactly is going on with this latest virus so that we have a chance of trying to decipher what's in store for us globally, it does seem a bit apropos.

Fanfare Ciocărlia – Hora lui Pusac

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Hora lui Pusac can be found on the album "Baro Biao", available on Bandcamp or wherever else you purchase and/or stream music from.