The Bird-Flu Tipping Point – The Atlantic

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Top U.S. health official Robert F. Kennedy Jr. recently mused about a novel way to contain bird flu, which is to let it “run through the flock so that we can identify the birds, and preserve the birds, that are immune to it.” Just to be clear, this could involve millions of birds dying slower, more horrible deaths. Just to be more clear, this would not be the recommendation of most scientists, because it would only give the H5N1 virus that causes bird flu more opportunities to evolve, which it’s already doing at what experts see as an alarming rate. So far, the outbreak has caused one human death in the United States and several others overseas.

There was a moment last year when bird flu was detected in a small number of cattle herds and could have been contained more easily, but the U.S. government basically missed that moment. Now birds, cows, and the rest of us could be at the mercy of government officials who are suspicious of mainstream science.

What’s the tipping point, when we might need to change our daily behavior? Who is coming up with broader solutions? What do Kennedy and others mean when they call for more “natural” solutions?

And how is it possible that we may be worse prepared than we were before COVID? In this episode of Radio Atlantic, we talk with Greg Herbruck, an egg farmer who’s already dealt with millions of deaths in his flocks, and the Atlantic science writer Katie Wu.

The following is a transcript of the episode:

Hanna Rosin: Last year, on the day before Easter—America’s most egg-centric holiday—Greg Herbruck lost 70 hens.

Now, to lose several chickens on a large-scale farm—not that big a deal. Just part of the process, which Greg knows because he’s the CEO of the largest egg producer in Michigan and the 10th largest in the country. His family’s been in the business for more than three generations.

So Greg knows his chickens.

Rosin: Greg has known chickens his entire life.

Rosin: But losing 70 hens in one day? That was unusual. And then the next day, that number went up.

Rosin: And then the day after that—

[Music]

Rosin: This is Radio Atlantic. I’m Hanna Rosin.

By now, you don’t have to be the CEO of an egg farm to know about bird flu. It’s all over the news, and possibly showing up at your local supermarket.

Rosin: Both Costco and Trader Joe’s have put restrictions on how many eggs you can buy. Other grocery stores have, too, depending on the location.

Last month, Waffle House put a 50-cent surcharge on every egg it sells, which seems like a new tier to the Waffle House disaster index. If it hits a dollar, we are officially in the Bad Place.

But it’s not just about the cost of eggs. Bird flu has been spreading to mammals. Cows have been dying. Some farm workers have been getting ill. And then in January:

Rosin: Scientists are starting to talk about a pandemic worse than COVID lurking. So I asked staff writer Katie Wu—

Rosin: —who covers all things science for us at The Atlantic, to make me feel better.

Rosin: I was kind of kidding, although she never explicitly said everything was going to be okay.

I did want to ask Katie, though, about how concerned we should actually be, on a scale of one to 10: one being, like, Don’t worry at all, and 10 being, We are canceling the NBA Finals.

[Music]

Wu: I think about this a lot. And I think we’re probably still in the middle ranges here, depending on all else that is going on, because I think also relative threat is important here. You know, five, six is fair, but I think much more important is the fact that that number has ticked steadily up since this time last year.

Rosin: Ah, okay.

Wu: And I think that is really telling. It says that the threat is growing and that there’s not necessarily anything stopping it from ratcheting upward, closer to 10. And the other thing is that we had time to contain it and keep it at a two or three, and never let it get beyond that. And we did not.

Rosin: Okay. So what would avoiding it have looked like? What could we have done in that critical moment?

Wu: Yeah, so to be clear, the moment I’m referring to: Last spring was the first time that the U.S. detected this virus in dairy cattle. And I’ve started referring to that moment as the “cow-tipping point.”

Rosin: (Laughs.) That’s pretty bad. That’s a good mom joke, dad joke.

Wu: I’m sorry. (Laughs.) At that time, it was really detected in just a small number of herds [such] that the government could have really intervened. They basically could have done more to keep the virus from spreading to other herds.

Instead, they kind of let business proceed as usual and dairy cattle move all over the place throughout their lifetime. They gave the virus more opportunities to spread. That should have been five-alarm-fire level of: We need to ratchet up this response and make sure that the virus does not move any further than it already has. And that did not happen.

Rosin: Got it. Okay. Let’s say for some reason—maybe this is a sci-fi scenario; maybe this is biologically realistic; we’ll get into that—but if it became suddenly zoomed to a realistic threat, it sounds like you’re not sure that we’d be ready.

Wu: Oh, absolutely not. And I think the right question to be asking is: How prepared would we be if this truly escalated to that point? And the answer is: not at all. Like, not even a little bit. It’s impossible to say with any kind of certainty, Oh, there’s exactly, you know, a 14.7 percent chance this is going to turn into a pandemic. Or, There’s exactly a 72 percent chance that we’re going to see this spreading from human to human in a sustained way. We can’t know those things. A lot of this is about randomness, about how we continue to respond, about just vagaries of the virus that people don’t fully understand yet.

I think what needs to be happening is more on the prevention side and more about preparedness, which are two things that the U.S., especially when it comes to infectious disease, is just catastrophically bad at.

Rosin: Interesting. I have this sense that because of COVID, we would be better at it. We’ve been down this road, and it was only five years ago, so the infrastructure is in place, and somebody just flips a switch and, Here we go.

You know, we’re not going to wake up one morning and be told, This is upon us. Don’t go back to work. But it sounds like that’s not how it’s rolling out.

Wu: No. I think in a lot of ways, we’re even worse prepared now than we were at the start of the COVID pandemic, for several different reasons: I think, in part, because the public is still really fatigued from having to respond to all of that—there was a lot of trust in public health and science eroded during that time—and I think because of the nature of the slow burn of all this, just slowly percolating through animals, affecting certain farm animals, maybe sort of affecting some aspects of the food supply.

But for the most part, it’s not that difficult to ignore that this entire situation is going on, and I think that makes it much easier for people to, in general, just keep tuning this out. It’s become normal to hear just slight murmurings about bird flu in the news and then to move on with your day. We didn’t have that luxury with COVID. It was forced upon everyone. Everyone’s lives changed radically and almost instantaneously. And now there’s just this general sense of, Oh, a lot of stuff is wrong, but I don’t have anything to worry about yet, when this is exactly the time to be doing something about it, so things don’t get catastrophically worse.

And I think from the federal-government side, there absolutely has not been enough of a response, and I don’t know how much of that is issues with resources being drained from COVID and that still being an ongoing threat; changes in leadership that are introducing, maybe, ideological barriers to being more prepared; and also, maybe some sense of, Well, we don’t want to overalarm people and be accused of overblowing this threat. It’s a really tough balance to strike, and I certainly feel for the people who are trying to communicate those messages, but I would not argue that the national response has been adequate.

Rosin: Yeah. Okay. So we’re journalists, and it’s our job to help inform people. So why don’t we try and bridge the gap as best we can. What is bird flu?

Wu: So it is a flu that has originated, as far as we can tell, in birds, hence the name: bird flu. That’s kind of how these things are named. And it is a flu virus, so it is related to the seasonal flus that pass through our population every year. But because this is primarily a version of the flu that is really well adapted to birds, and that’s where it spent most of its time evolving, it is not yet the kind of flu that is going to pass really easily from person to person.

But the reason that this is scary is we have seen this particular version of bird flu jump into mammals, including mammals that interface a lot with humans (i.e., dairy cows). And the fact that this virus is making those moves, jumping across those species barriers, like, huge species barriers—I’m not talking duck to pigeon; I’m talking birds to mammals—that’s a massive jump in terms of biology and the type of host that this virus can manage to infect and spread between. So the possibility that the virus will keep evolving and become a real threat to humans is really just growing every day.

Rosin: Okay. You’ve mentioned a few times the jumps and the sort of ratcheting up. What’s the rough timeline of events? Like, as someone who’s tracking this, I just want to understand: Is it very fast? How has it gone? Has it been over the course of 30 years or five years? What’s the timeline?

Wu: So there are probably two relevant timelines here. The first is, just to remind people, that this particular version of bird flu that scientists also call H5N1—you might hear about other bird flus, but this is a very specific one that we’re talking about right now. Scientists have known about this for decades, and it has, for most of that time, stayed primarily in birds. Very occasionally, it was causing some problems in people when it was transmitting directly from birds into people. These included poultry workers, people working very closely with wild or domesticated birds. And it would cause sickness, sometimes very severe sickness, in people.

But what is happening on a much more accelerated timeline is, all of a sudden, after decades of still mostly being a bird virus and causing limited problems in people—limited in terms of spread—this virus is now jumping across species barriers into animals like us very, very, very frequently. And this has only happened in the past couple of years. And to see those types of changes—those types of unprecedented jumps on a much shorter timeline—has made a lot of scientists nervous.

They don’t know what this virus is fully capable of in an evolutionary sense. And it may actually even depend on the subtype of this particular bird flu that is moving around. There are actually already two subtypes of H5N1 that have been detected in people. The one that seems to be jumping into people from birds, for instance, seems to be causing much more severe illness so far than the one that’s jumping into people from cattle. And so it depends on all these different biological factors, which scientists are still figuring out. But I guess the scary part of that is: We don’t fully know what the average human sickness with this particular bird virus is going to look like.

Rosin: But it has shown up in humans, right? So what do we know so far about what it could look like?

Wu: Right. So let me again split that into the two categories that we roughly know about so far. So the most common cases in the U.S. so far have still been in dairy workers who appear to be catching the virus directly from the infected dairy cattle that they’re working with.

And it seems like a lot of this is through exposure to the cow’s milk. As they’re milking them, maybe the milk gets sprayed onto their face, gets in their eyes, might be inhaled as the milk sort of aerosolizes into the air. And most of those cases do seem pretty mild on the spectrum of things. People are getting conjunctivitis—effectively, pink eye. They do have, maybe, some respiratory symptoms, but it’s pretty quick to resolve. There haven’t really been too many really serious cases when the virus seems to be jumping over from cattle.

But a slightly different version of the virus is also jumping over from poultry, and those cases have been severe. This virus, since it started spilling intermittently into people in the 1990s, has caused multiple deaths worldwide. But if we’re looking just at deaths in the U.S., it has only been one so far, and I hope it stays that way.

Rosin: I mean, this is probably obvious, but an important line that everybody’s watching is the jump into humans. There are tragedies when a chicken dies—both economic and otherwise—when cows die, other mammals die. But people are tracking the line into humans.

What’s happening internally? What does that look like internally, and how has that happened in the past? How is the virus transmuting?

Wu: Let me start by explaining what the virus would effectively have to accomplish to start spreading from person to person, and for there to be, like, huge epidemic or pandemic potential here.

So for a virus to successfully spread between people, it has to be able to get into our cells, make more of itself inside of them, get back out of those cells, and then get out of that host—that person—and spread to someone else, and then do the same thing, over and over and over and over again.

A virus that’s super well adapted to doing basically that whole process in birds is going to have to figure out how to do all that stuff in a totally new set of cells. And so this virus will have to check off a lot of evolutionary boxes to adapt itself to us: It has to bind successfully to our cells. It has to get into our cells. It has to avoid specific parts of our immune system that might be different from a bird’s immune system. It has to survive stably in our airways, and then get expelled out of those airways and survive long enough in the air to get into another person. That is a pretty long, complicated process, and it’s actually not totally clear if the virus’s genome is totally capable of making all those changes.

But the more times that it has the opportunity to infect our cells, basically to infect a person, the more opportunity it is going to have to stumble upon the right number of combinations, if they exist, to start that process, if that makes sense.

Rosin: Yes. Totally. I read a quote that because of dairy workers, the virus—as this person put it—has more shots on the goal. So I guess that’s what you’re describing, just, like, more chances to figure out how to adapt.

Wu: Right. I think what is really important to remind people of here is that just because this is currently a bird-adapted virus does not mean it’s going to stay that way. Like, you can sort of imagine: If you keep throwing a bouncy ball against a wall, it’s going to keep bouncing off. Unless there’s a fundamental change in the composition of that ball, it’s not gonna stick to that wall permanently.

But in this case, we are throwing a ball that won’t necessarily stay bouncy. That ball is changing constantly and randomly, and it’s totally possible that it will get sticky on its own.

[Music]

Rosin: After the break: what happens when the ball sticks.

[Break]

Rosin: Now that I understand better, I’m going to ask you a very I’m-your-friend-at-the-party kind of question. So in my current profession, I don’t work with birds. I’m not a dairy farmer.

But you read things like, Oh, you could get it from a bird feeder, or, It might be in food products. What is the kind of thing you would tell your average friend to do or not do? Are there any such things? Your average friend who’s not a dairy worker.

Wu: I’d say most people still don’t have to change their day-to-day behavior. I would certainly encourage everyone to continue paying attention to the news and to take things like seasonal-flu vaccines seriously. We can come back to that in a moment. But I don’t think people generally have to worry about what they’re eating or the local birds that they see in the park.

The two exceptions I can think of to that is if you are a raw-milk drinker—

Rosin: (Gasps.) I was just going to ask you about raw milk! Like, what is it about raw milk?

Wu: (Laughs.) Yes. I would like you to stop.

Rosin: Yes. (Laughs.)

Wu: I mean, it’s hard because it’s not like I am guaranteeing a threat, but we know that dairy workers have very likely been infected by interacting with raw milk. The virus has been detected in active form in milk coming out of infected cows. That milk gets sprayed in the face. It gets in the eye. It gets in the nasal passages—whatever, however it’s doing that. Milk is concerning.

Now, most of the milk in the U.S. is pasteurized, and that includes dairy products like cheeses and yogurts. The vast majority is pasteurized, which means it is heated and treated so that infectious agents are killed. That’s the whole point of that process, and so that stuff is safe. It’s people who are very explicitly going out of their way to buy raw milk that has not been treated in such a fashion that are at higher risk right now.

Rosin: Right. And obviously, don’t touch a dead bird.

Wu: Definitely not.

Rosin: Yeah.

Wu: If your cat is bringing that home, first keep your cat indoors, and second, please don’t touch that bird. (Laughs.)

Rosin: Interesting, okay. Oof. I feel seen. I do not keep my cat indoors. I’m sorry.

Okay. I want to talk about the government response, which you mentioned up top. In a different circumstance, I would trust that there were infrastructures somewhere that you could turn on, as I said. But we now have Robert Kennedy Jr., who’s overseeing Health and Human Services and is a person who’s skeptical of the usual epidemiological tools that we use to control viruses, like masking and, especially, vaccines.

From your reporting, what have you found the Trump administration doing or saying that pricks up your ears when it comes to bird flu? What are you tracking about what they’re doing?

Wu: Yeah. And I mean, to be fair, this does stretch back to actions that were taken—or, more accurately, not taken—during the Biden administration. You know, not a lot, frankly, has happened from the federal government, so some of the comments that I make will kind of stretch backward in time, as well, to before the Trump administration took over.

I think from the start, even when this was starting to spread among mammals over the past two and a half years, the response from the federal government was pretty muted. That was especially the case when this started to be detected in dairy cattle. That should have been a huge, huge, huge red flag. This was not typical. It hadn’t happened before for this particular bird flu. And that is an animal that is in really close proximity to us, shares a lot of biology with us.

That is kind of the moment that a lot of experts told me should have been the most clear inflection point—the point at which the government should have really, really cracked down on this issue and been able to do something about it. But because they didn’t—at the time, there wasn’t enough testing; there wasn’t enough outreach to farm workers who were in close proximity to the virus—because they sort of let that moment go and allowed the virus to spread to more and more dairy herds, the situation has now become so much more difficult to contain. And some researchers are worried that we might never be able to really get rid of this virus on this continent.

Rosin: So are you saying these conversations aren’t happening, or that there isn’t necessarily a strategy in place? Because I saw in one of your stories that the government has disputed that its response was too slow or inadequate.

Wu: I mean, I’m sure conversations are happening. I’m sure someone in the government would argue that that is the case, but definitely not enough. And I think one really challenging space to be talking about right now is still vaccines, not just because there aren’t obvious answers there about how and when and to whom and in what species to deploy those vaccines. That’s certainly controversial, even among scientists who have worked in this field for a very long time.

But also, because our new HHS secretary doesn’t have the best track record with vaccines, and certainly not with advancing the most important public-health narrative, which is collective action for the public good. Right now, everything I am hearing from HHS is about personal choice, individual liberty, and just letting things flow naturally, and hoping for the best.

Rosin: Yeah. A person seeing this train coming down the tracks, like, what I think about is the sort of general anti-scientific-establishment sentiment—this mistrust of the scientific establishment, which is not just in certain members of the administration but spread among the public during COVID, as you mentioned.

What happens if the train crashes and we still are living in that moment? Like, what does natural mean? When you hear that, what goes through your head?

Wu: I guess my reaction to that is: What level of natural are you willing to accept? I would say that in human history, there were and still are, depending on what part of the world you live in, periods of human existence where it was perfectly natural to not see your child live to the age of 1. Is that the kind of natural that we want to see?

There have been periods where it was natural to see bacterial infections completely take over a person’s body and kill them, and that was just the expected outcome because we weren’t using antibiotics. Or it was natural to expect bloodletting to be a sufficient medical intervention. There are things that have been natural over the course of history that aren’t necessarily what has served us best as a species. Medical interventions are arguably not the most natural thing in the world, just because we have invented them and not simply allowed them to manifest themselves into existence.

But, I mean, is naturalness necessarily optimized? I certainly don’t think so. That is part of the reason that innovation is so important. We are racing ahead of biology to make sure that we are keeping as many people healthy as possible. That’s the whole point here.

Rosin: Yeah. This is such an important point you’re making, because I used to think of people who had tremendous tolerance for “natural” as being of certain religious sects, who don’t believe in medical intervention, and so you’d have a real reason and framework and worldview that would have you be extremely committed to natural, even if your child died, say, which is the ultimate test.

But during COVID, I mean, there were plenty of people who did not vaccinate their children, and children died. I mean, that did happen during COVID, so it is really hard to say what the American tolerance is for natural right now.

Wu: Right. And I think it is also important to say that I feel like people end up homing in on really strict definitions of natural that I feel like draw these really false boundaries on what can be allowed. I actually find vaccines to be incredibly in tune with what the human body, quote-unquote, “naturally does,” because the whole point of a vaccine is to basically nudge the immune system into mounting a protective response that it would otherwise mount if it encountered that disease, the pathogen causing that disease.

It’s not like we’re putting an artificial device in someone’s body and leaving it there—also important for other medical interventions. But I guess what I’m saying is: It’s not the most unnatural intervention out there. That’s the beauty of it. Vaccines are very much an intervention that is about teaching a person to fish instead of just handing them a fish for the day. It’s teaching the body to mount a sustained defense that it can use again in the future. It’s a nudge. It’s not a forced coup of someone’s body.

Rosin: That is such a lovely description of a vaccine and such an interesting pushback. I really hadn’t thought of that.

You looked into the current measles outbreak. What does the government’s response to that tell you about how this administration might respond to a potential bird-flu outbreak?

Wu: Yeah. That is one of the things that has me most concerned. Let me just start off by saying that the MMR vaccine—the measles-mumps-rubella vaccine, especially the measles component—is one of the best vaccines we have. It’s so safe, so effective. That vaccine is the intervention that is most single-handedly responsible for eliminating measles from this country. And yet there has been a really muted response from the federal government.

This is one of the largest outbreaks we’ve had in the past couple of decades, since measles was eliminated. Already, a 6-year-old unvaccinated child died, and that should not be happening. These are the kinds of things that were supposed to be gone and over forever. And yet, it took the CDC a month to issue its first public statement on the outbreak. In that, there wasn’t even a direct urging for parents to get their kids up-to-date on the measles vaccine.

Kennedy, who is the head of HHS, which oversees the CDC, the FDA, the NIH, has basically said, Sure. Vaccines are an option, but really, really pressed at least as hard, if not more hard, on alternative ways to combat measles, such as, you know, nutrition, steroids, antibiotics. There is really only one answer to the question of what can prevent measles and what can stop an outbreak, and that’s vaccines.

And I am just not hearing that message from the government. There should be a clear order of priority here, and that is not being followed.

Rosin: Right. That actually is worrisome. I mean, the way you just laid that out—that is worrisome. It should have been, No. 1: Get your child vaccinated. And maybe No. 2: This is an emergency. And that wasn’t the attitude particularly.

Wu: No. It wasn’t. And I think what may make this even more difficult if we get into a bad situation with bird flu is, our baseline for measles vaccination was 95 percent uptake for a very long time. And that is what we need. Our baseline with flu vaccination is, like, 40 to 50 percent uptake, depending on the year. There are people who happily get other vaccines who don’t get the flu vaccine.

I don’t know how people are going to react if we get into that situation and they’re asked to vaccinate. Also, we know that the flu vaccine is not as effective as the measles vaccine. That is just simply a product of how quickly these viruses change and the nature of immunity to them. I worry that those differences will make it even more difficult for misinformation to seep through and for people to take their cues from the government and really run with them in the event of a flu pandemic. It could get so much worse so much more quickly.

Rosin: Right. So with COVID, there was a day, you know? Will we know when we’ve reached the tipping point? Will it be totally obvious to us? Like, there’ll be giant headlines in the newspaper? Or it won’t be totally obvious?

Wu: I think it depends on what we consider the tipping point. Arguably, there is kind of a biological tipping point when the virus starts spreading from person to person. That won’t be noticed in real time or, at least, it’s highly unlikely, right? The virus would have to start doing that, and then scientists would catch it because it has already started happening. And we may never know the day that that starts happening, if it ever does.

Then I think there is kind of the public-consciousness tipping point, which is going to just have to be the more relevant thing. To draw the comparison to COVID, we still don’t know exactly how, exactly when, what animal first passed it to a human, what exactly happened after that. And we probably will never know. That stuff is gone. Scientists learn that information retroactively, and they can’t go back in time and recreate that timeline. What we do know is: Public attention started focusing on the pandemic in the months that followed. And that’s what I would expect here.

But I think the most important takeaway here is that that inflection point—the one that would command public awareness—hasn’t yet happened, which means there’s still time to act. And I think that requires people to hold two realities in their brain at once: One is about the present moment, during which the risk to most of the public is still low. But the second thing that people have to hold in mind is: That won’t necessarily stay true.

[Music]

Rosin: Katie, thank you for joining us.

Wu: Thank you so much for having me.

[Music]

Rosin: By the way, after we taped with both Katie and Greg Herbruck—the poultry CEO—we heard news that RFK Jr. was suggesting that, instead of culling chickens who were sick, farmers should maybe let bird flu, quote, “run through the flock so that we can identify the birds, and preserve the birds, that are immune to it.”

Basically: Let the virus run its course.

We asked Greg what he thought of that plan, and he told us this via email, quote: “Letting an outbreak run through the flock in an uncontrolled manner is not a practical or humane solution and would lead to needless suffering while increasing the risk of AI”—meaning Avian Influenza—“spreading to other species and animals, and ultimately putting humans at greater risk.”

This episode of Radio Atlantic was produced by Jinae West and edited by Claudine Ebeid. We had engineering support from Erica Huang and fact-checking by Sara Krolewski.

Claudine Ebeid is the executive producer of Atlantic audio, and Andrea Valdez is our managing editor.

Listeners, if you like what you hear on Radio Atlantic, remember you can support our work and the work of all Atlantic journalists when you subscribe to The Atlantic at theatlantic.com/podsub. That’s theatlantic.com/podsub.

I’m Hanna Rosin. Thank you for listening.