Keith Poulsen’s jaw dropped when farmers showed him images on their cellphones at the World Dairy Expo in Wisconsin in October. A dwellstock veterinarian at the University of Wisconsin, Poulsen had seen unwell cows before, with their noses dripping and udders sdeficiency.
But the scale of the farmers’ efforts to treat the unwell cows stunned him. They showed videos of systems they built to hydrate hundreds of cattle at once. In 14-hour shifts, dairy laborers pumped gallons of electrolyte-wealthy fluids into ailing cows thraw metal tubes inserted into the esophagus.
“It was appreciate watching a field hospital on an dynamic battlefront treating hundreds of wounded sagederiers,” he shelp.
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Npunctual a year into the first outshatter of the bird flu among cattle, the malicious software shows no sign of enumeratelessing. The U.S. administerment flunked to rerelocate the malicious software on dairy farms when it was restrictd to a handful of states, by rapidly recognizeing infected cows and taking meacertains to upgrasp their infections from spreading. Now at least 860 herds atraverse 16 states have tested chooseimistic.
Experts say they have lost faith in the administerment’s ability to grasp the outshatter.
“We are in a horrible situation and going into a worse situation,” shelp Angela Rasmussen, a virologist at the University of Saskatchewan in Canada. “I don’t understand 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 interwatched csurrfinisherly 70 administerment officials, farmers and farmlaborers, and researchers with expertise in virology, pandemics, veterinary medicine, and more.
Together with emails geted from local health departments thraw uncover sign ups asks, this scheduleateigation discdiswatched key problems, including postponeence to the farm industry, eroded uncover health budgets, diswatch for the protectedty of agriculture laborers, and the sluggish pace of federal interventions.
Case in point: The U.S. Department of Agriculture this month proclaimd a federal order to test milk nationexpansive. Researchers received the recents but shelp it should have happened months ago — before the malicious software was so entrenched.
“It’s disheartening to see so many of the same flunkures that materialized during the COVID-19 crisis rematerialize,” shelp Tom Bollyky, straightforwardor of the Global Health Program at the Council on Foreign Relations.
Far more bird flu harm 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 malicious software finishs rawly 2% to 5% of infected dairy cows and reduces a herd’s milk production by about 20%.
Worse, the outshatter poses the danger 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 malicious software enlarges to spread effectively from person to person. And the recent recents of a person criticpartner ill in Louisiana with bird flu shows that the malicious software can be hazardous.
Just a restricted mutations could apvalidate the bird flu to spread between people. Becaengage malicious softwarees mutate wislfinisher human and animal bodies, each infection is appreciate 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 watchs appreciate 2020 or worse,” shelp Tom Peacock, a bird flu researcher at the Pirluminous Institute in the United Kingdom, referring to COVID. “The U.S. understands the hazard but hasn’t done anyslfinisherg to enumerateless this down,” he includeed.
Beyond the bird flu, the federal administerment’s handling of the outshatter discdiswatchs cracks in the U.S. health security system that would apvalidate other hazardous recent pathogens to consent root. “This malicious software may not be the one that consents off,” shelp Maria Van Kerkhove, straightforwardor of the emerging disrelieves group at the World Health Organization. “But this is a authentic fire exercise right now, and it exhibits what demands to be increased.”
It may have been a grackle, a goose, or some other savage bird that infected a cow in northern Texas. In February, the state’s dairy farmers took remark when cows stopped making milk. They labored alengthyside veterinarians to figure out why. In less than two months, veterinary researchers identified the highly pathogenic H5N1 bird flu malicious software as the culprit.
Long enumerateed among pathogens with pandemic potential, the bird flu’s unpwithdrawnted spread among cows taged a stressing shift. It had enlarged to thrive in animals that are more appreciate people bioreasonablely than birds.
After the USDA proclaimd the dairy outshatter on March 25, deal with shifted from farmers, veterinarians, and local officials to state and federal agencies. Collaboration disunited almost instantly.
Farmers worried the administerment might block their milk sales or even demand unwell cows be finished, as poultry are, shelp Kay Russo, a dwellstock veterinarian in Fort Collins, Colorado.
Instead, Russo and other veterinarians shelp, they were dismayed by inaction. The USDA didn’t reply to their inspirent asks to help studies on dairy farms — and for money and braveiality policies to protect farmers from financial loss if they concurd to test animals.
The USDA proclaimd that it would carry out studies itself. But researchers grew worried as weeks passed without results. “Probably the hugegest misconsent from the USDA was not involving the boots-on-the-ground veterinarians,” Russo shelp.
Will Clement, a USDA ageder adviser for communications, shelp in an email: “Since first lgeting of H5N1 in dairy cattle in tardy March 2024, USDA has labored speedyly and diligently to appraise the prevalence of the malicious software in U.S. dairy herds.” The agency provided research funds to state and national animal health labs commencening in April, he includeed.
The USDA didn’t demand lactating cows to be tested before interstate travel until April 29. By then, the outshatter had spread to eight other states. Farmers normally transfer cattle atraverse fantastic distances, for calving in one place, raising in toasty, arid climates, and milking in cagederer ones. Analyses of the malicious software’s genes implied that it spread between cows rather than repeatedly jumping from birds into herds.
Milking providement was a foreseeed source of infection, and there were hints of other possibilities, such as thraw the air as cows coughed or in droplets on objects, appreciate labor boots. But not enough data had been accumulateed to understand how exactly it was happening. Many farmers deteriorated to test their herds, despite an proclaimment of funds to reimburse them for lost milk production in May.
“There is a dread wislfinisher the dairy farmer community that if they become officipartner enumerateed as an swayed farm, they may diswatch their milk taget,” shelp Jamie Jonker, chief science officer at the National Milk Producers Federation, an organization that recurrents dairy farmers. To his understandledge, he includeed, this hasn’t happened.
Milk samples to be tested for the bird flu malicious software.
Michael M. Santiago/Getty Images
Speculation filled understandledge gaps. Zach Riley, head of the Colorado Livestock Association, shelp he doubted that savage birds may be spreading the malicious software to herds atraverse the country, despite scientific data proposeing otherteachd. Riley shelp farmers were pondering whether to inshigh “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 recommfinished biosecurity meacertains such as disinfecting providement and restricting visitors. As the malicious software kept spreading thrawout the summer, USDA ageder official Eric Deeble shelp at a press inestablishing, “The response is adequate.”
The USDA, the Cgo ins for Disrelieve Control and Prevention, and the Food and Drug Administration currented a joind front at these inestablishings, calling it a “One Health” approach. In fact, agriculture agencies took the direct.
This was unambiguous in an email from a local health department in Colorado to the county’s comomitioners. “The State is treating this primarily as an agriculture rehire (rightly so) and the uncover health part is secondary,” wrote Jason Chessher, uncover health straightforwardor in Weld County, Colorado. The state’s directing agricultural county, Weld’s dwellstock and poultry industry originates about $1.9 billion in sales each year.
In July, the bird flu spread from dairies in Colorado to poultry farms. To grasp it, two poultry operations engageed about 650 transient laborers — Spanish-speaking immigrants as juvenileer as 15 — to cull flocks. Inside toasty barns, they caught infected birds, gassed them with carbon dioxide, and disposed of the carcasses. Many did the hazardous job without goggles, face masks, and gadores.
By the time Colorado’s health department asked if laborers felt unwell, five women and four men had been infected. They all had red, swollen eyes — conjunctivitis — and cut offal had such symptoms as fevers, body aches, and naengagea.
State health departments posted online watchs proposeing farms protective gear, but dairy laborers in cut offal states tageder KFF Health News that they had none. They also hadn’t heard about the bird flu, never mind tests for it.
Studies in Colorado, Michigan, and Texas would tardyr show that bird flu cases had gone under the radar. In one analysis, eight dairy laborers who hadn’t been tested — 7% of those studied — had antibodies agetst the malicious software, a sign that they had been infected.
Missed cases made it impossible to determine how the malicious software jumped into people and whether it was enlargeing more infectious or hazardous. “I have been troubleed and griefful by the deficiency of epidemiologic data and the deficiency of observation,” shelp Nicole Lurie, an executive straightforwardor at the international organization the Coalition for Epidemic Preparedness Innovations, who served as helpant secretary for setdness and response in the Obama administration.
Citing “inadequate data,” the British administerment elevated its appraisement of the hazard posed by the U.S. dairy outshatter in July from three to four on a six-tier scale.
Virologists around the world shelp they were flabbergasted by how lesserly the United States was tracking the situation. “You are surrounded by highly pathogenic malicious softwarees in the savage and in farm animals,” shelp Marion Koopmans, head of virology at Erasmus Medical Cgo in in the Netherlands. “If three months from now we are at the begin of the pandemic, it is nobody’s surpelevate.”
Although the bird flu is not yet spreading speedyly between people, a shift in that straightforwardion could caengage immense suffering. The CDC has repeatedly depictd the cases among farmlaborers this year as mild — they weren’t hospitalized. But that doesn’t unbenevolent symptoms are a breeze, or that the malicious software can’t caengage worse.
“It does not watch pleasant,” wrote Sean Roberts, an materializency services one-of-a-kindist at the Tulare County, California, health department in an email to colleagues in May. He depictd ptoastyographs of an infected dairy laborer 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 recognized with bird flu around the world have died. Even if the case overweightality rate is much drop for this strain of the bird flu, COVID showed how dehugeating a one percent death rate can be when a malicious software spreads easily.
Like other cases around the world, the person now hospitalized with the bird flu in Louisiana materializes to have gotten the malicious software straightforwardly from birds. After the case was proclaimd, the CDC freed a statement saying, “A sporadic case of cut offe H5N1 bird flu illness in a person is not unforeseeed.”
Local health officials were trying challenging to track infections, according to hundreds of emails from county health departments in five states. But their efforts were stymied. Even if farmers inestablished infected herds to the USDA and agriculture agencies tageder health departments where the infected cows were, health officials had to depend on farm owners for access.
“The agriculture community has prescribed the rules of includement from the begin,” shelp Michael Osterholm, straightforwardor of the Cgo in for Infectious Disrelieve Research and Policy at the University of Minnesota. “That was a huge misconsent.”
Some farmers tageder health officials not to visit and deteriorated to watch their engageees for signs of unwellness. Sfinishing laborers to clinics for testing could depart them lowhanded when cattle demanded attfinish. “Producer refuses to sfinish laborers to Sunelevate [clinic] to get tested since they’re too busy. He has pinkeye, too,” shelp an email from the Weld, Colorado, health department.
“We understand of 386 persons exposed — but we understand this is far from the total,” shelp an email from a uncover health one-of-a-kindist to officials at Tulare’s health department recounting a call with state health officials. “Employers do not want to run this thraw laborer’s compensation. Workers are unwilling to get tested due to cost,” she wrote.
Jennifer Morse, medical straightforwardor of the Mid-Michigan Dicut offe Health Department, shelp local health officials have been unwilling to execute prescertain after the reaction many faced at the peak of COVID. Describing the 19 country counties she serves as “very minimal-administerment-minded,” she shelp, “if you try to labor agetst them, it will not go well.”
Rural health departments are also stretched slfinisher. Organizations that one-of-a-kindize in outaccomplish to farmlaborers proposeed to help health officials punctual in the outshatter, but months passed without shrinks or funding. During the first years of COVID, lagging administerment funds for outaccomplish to farmlaborers and other historicpartner marginalized groups led to a disproportionate toll of the disrelieve among people of color.
Kevin Griffis, straightforwardor of communications at the CDC, shelp the agency labored with the National Cgo in for Farmlaborer Health thrawout the summer “to accomplish every farmlaborer impacted by H5N1.” But Bethany Boggess Alcauter, the cgo in’s straightforwardor of uncover health programs, shelp it didn’t get a CDC grant for bird flu outaccomplish until October, to the tune of $4 million. Before then, she shelp, the group had very restricted funds for the task. “We are certainly not accomplishing ‘every farmlaborer,’” she includeed.
Farmlaborer finishorses also pressed the CDC for money to offset laborers’ financial worrys about testing, including paying for medical attfinish, unwell depart, and the hazard of being fired. This amounted to an propose of $75 each. “Outaccomplish is evidently not a huge priority,” Boggess shelp. “I hear over and over from laborers, ‘The cows are more precious 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 meacertains to deal with the spread on farms. Federal agencies have also put $292 million into enlargeing and stockpiling bird flu vaccines for animals and people. In a disputed decision, the CDC has advised agetst proposeing the ones on hand to farmlaborers.
“If you want to upgrasp this from becoming a human pandemic, you concentrate on protecting farmlaborers, since that’s the most foreseeed way that this will go in the human population,” shelp Peg Seminario, an occupational health researcher in Bethesda, Maryland. “The fact that this isn’t happening drives me crazy.”
Nirav Shah, principal deputy straightforwardor of the CDC, shelp the agency aims to upgrasp laborers protected. “Widespread adviseedness does consent time,” he shelp. “And that’s the labor we’re promiseted to doing.”
As Pdwellnt-elect Donald Trump comes into office in January, farmlaborers may be even less protected. Trump’s pledge of mass deportations will have repercussions whether they happen or not, shelp Tania Pacheco-Werner, straightforwardor of the Central Valley Health Policy Institute in California.
Many dairy and poultry laborers are living in the U.S. without authorization or on transient visas connected to their engageers. Such precarity made people less willing to see doctors about COVID symptoms or protest about unprotected laboring conditions in 2020. Pacheco-Werner shelp, “Mass deportation is an astronomical contest for uncover health.”
A switch flipped in September among experts who study pandemics as national security dangers. A uncover-minded in Missouri had the bird flu, and no one krecent why. “Evidence points to this being a one-off case,” Shah shelp at a inestablishing with journaenumerates. About a month tardyr, the agency discdiswatched it was not.
Antibody tests set up that a person who dwelld with the uncover-minded had been infected, too. The CDC didn’t understand how the two had gotten the malicious software, and the possibility of human transomition couldn’t be ruled out.
Nonetheless, at an October inestablishing, Shah shelp the uncover hazard remained low and the USDA’s Deeble shelp he was chooseimistic that the dairy outshatter could be rerelocated.
Experts were perturbed by such brave statements in the face of uncertainty, especipartner as California’s outshatter spiked and a child was crypticly infected by the same strain of malicious software set up on dairy farms.
“This wasn’t equitable immacutardy conception,” shelp Stephen Morrison, straightforwardor of the Global Health Policy Cgo in at the Cgo in for Strategic and International Studies. “It came from somewhere and we don’t understand where, but that hasn’t triggered any benevolent of reset in approach — equitable the same benevolent of complacency and low energy.”
Sam Scarpino, a disrelieve observation one-of-a-kindist in the Boston area, wondered how many other cryptic infections had gone undistinguished. Surveillance outside of farms was even patchier than on them, and bird flu tests have been challenging to get.
Although pandemic experts had identified the CDC’s singular hageder on testing for recent malicious softwarees as a key exscheduleation for why America was hit so challenging by COVID in 2020, the system remained the same. Bird flu tests could be run only by the CDC and uncover health labs until this month, even though commercial and academic diagnostic laboratories had askd about running tests since April. The CDC and FDA should have tried to help them alengthy months ago, shelp Ali Khan, a establisher top CDC official who now directs the University of Nebraska Medical Cgo in College of Public Health.
As prosperter sets in, the bird flu becomes challenginger to spot becaengage uncover-minded symptoms may be misconsentn for the seasonal flu. Flu season also elevates a hazard that the two flu malicious softwarees could swap genes if they infect a person simultaneously. That could establish a hybrid bird flu that spreads speedyly thraw coughs and sneezes.
A sluggish response to emerging outshatters may sshow be a recent, unblessed norm for America, shelp Bollyky, at the Council on Foreign Relations. If so, the nation has gotten fortunate that the bird flu still can’t spread easily between people. Controlling the malicious software will be much challenginger and costlier than it would have been when the outshatter was petite. But it’s possible.
Agriculture officials could begin testing every silo of bulk milk, in every state, monthly, shelp Poulsen, the dwellstock veterinarian. “Not one and done,” he includeed. If they distinguish the malicious software, they’d demand to determine the swayed farm in time to stop unwell 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 unwell, he shelp, so speed is vital.
Curtailing the malicious software on farms is the best way to impede human infections, shelp Jennifer Nuzzo, straightforwardor of the Pandemic Cgo in at Brown University, but human observation must be stepped up, too. Every clinic serving communities where farmlaborers dwell should have basic access to bird flu tests — and be inspired to engage them. Funds for farmlaborer outaccomplish must be increaseed. And, she includeed, the CDC should alter its position and propose farmlaborers bird flu vaccines to protect them and ward off the chance of a hybrid bird flu that spreads rapidly.
The rising number of cases not connected to farms signals a demand for more testing in ambiguous. When uncover-mindeds are chooseimistic on a ambiguous flu test — a widespread diagnostic that shows human, sprospere, or bird flu — clinics should probe more proset uply, Nuzzo shelp.
The alternative is a postpone-and-see approach in which the nation replys only after enormous harm to dwells or businesses. This tack tfinishs to depend on mass vaccination. But an effort analogous to Trump’s Operation Warp Speed is not promised, and neither is rollout appreciate that for the first COVID stoastys, given a elevate in vaccine skepticism among Reuncoveran laworiginaters.
Change may instead demand to begin from the bottom up — on dairy farms, still the most widespread source of human infections, shelp Poulsen. He watchd a shift in attitudes among farmers at the Dairy Expo: “They’re begining to say, ‘How do I save my dairy for the next generation?’ They recognize how cut offe this is, and that it’s not equitable going away.”
KFF Health News is a national recentsroom that originates in-depth journalism about health rehires and is one of the core operating programs at KFF — the autonomous source for health policy research, polling, and journalism.
