Expert Says US Isn't Ready for Bird Flu

Leonard Mermel, DO, professor of medicine and medical director of the Department of Epidemiology and Infection Prevention at Brown University Health, said uncertainty and unpreparedness are among his chief concerns underlying a potential bird flu pandemic among humans.

Even in a post-COVID pandemic world, Mermel said that leaders at both the state and federal levels still have considerable work to do in preparing for a potential H5N1 pandemic. A lack of stockpiles of PPE, antiviral agents, and other medications all contribute to poor outcomes, some of which were experienced during the spread of COVID-19.

“I think we’re behind where we should be as a nation,” Mermel told medical students at a lunchtime seminar on Feb. 4.

The US Centers for Disease Control and Prevention has reported 67 human cases in the current outbreak and one death. While there are no reported cases of the pathogen jumping from human to human, Mermel stressed that a single mutation could allow avian influenza viruses to attach to human cell receptors in the respiratory system. The virus has already lept from avian species to cows and other mammals, including possible mammal to mammal spread among minks at a farm in Finland and elephant seals in South America.

Mermel said that he and other experts are tracking “warning signs” that could suggest the start of a pandemic such as increasing numbers of avian flu cases in people who weren’t exposed to farm animals or raw milk products or increasing severity of illness in patients who present to hospitals with influenza.

“We have a sophisticated health care system, but the fatality rate since H5N1 was first discovered is quite high,” Mermel said—a 50 percent mortality since 2004.

Last June, Mermel wrote an op-ed in the Providence Journal highlighting ways the US can prepare for another pandemic, while also focusing on concerns with federal oversight. He cited a lack of authority and ability for the US government to approach farms where infections have spread among animals and screen the animals or farm workers for the avian flu virus.

“This is just spreading rampantly and we’re really not doing much about it—that’s shocking to me,” he said.

Mermel said he and his team at Brown Health hospitals are taking steps to prepare for another pandemic, with special considerations for H5N1. Such planning accounts for everything from isolation methods, testing, cleaning, visitation, when to pause elective surgeries, how to address child care, and other considerations. He said they continually refine their plans as more data emerges alongside case studies like a teenager infected with H5N1 in British Columbia.

“Usually we think with the flu that, after seven days, we can take them out of isolation precautions, but they tested the viral load in her respiratory secretions,” Mermel said. “Despite triple antiviral therapy, she still had a very high load of virus in respiratory secretions for 11 days. As such, I changed our policy to keep patients in airborne and contact isolation precautions for at least two weeks.”

Mermel advised all Rhode Island state hospitals to ask those seen in urgent care or emergency departments with influenza-like symptoms and/or conjunctivitis whether they have had any contact with farm animals or birds that may have been sick, and if they drink raw milk, along with other triage questions. Identifying cases in the event of a pandemic is also important for understanding vaccine needs—which Mermel is also concerned about.

The US has available only 4.5 million doses of H5N1 vaccine, Mermel said, and a population of more than 340 million; based on previous models, it would take about four months to ramp up mRNA vaccine production, which means a global pandemic could essentially be over by the time most of the population could be vaccinated. 

Furthermore, Rhode Island’s pharmacies and hospitals do not stockpile large quantities of antiviral drugs. As health leaders prepare for future protections for both workers and patients alike, Mermel said maintaining these stockpiles will be essential should a worst-case scenario arise.

“Unfortunately, we haven’t learned lessons from COVID,” he said.