Contents:
H5N1 in Dairy Cattle
Group A Strep in Japan
Transportation Incidents
Dengue in the Americas
COVID in the US
I’ve decided to write a weekly summary of my thoughts on publications and news sources around COVID and other public health/public policy interests during each week. Some of these might seem familiar to those who follow me on social media.
H5N1 in Dairy Cattle
One of the biggest news items of the year so far started on March 20th, with the announcement that a goat had died of H5N1 avian influenza in Minnesota. This is the first death from this virus among ruminants in the US. I posted my concerns on social media about the impacts on the food supply should something like this take hold in other ruminants.
We learned on Monday that H5N1 had been detected in dairy cattle in two different states. The Texas Department of Agriculture had recognized sickness had been occurring, but like we have seen repeatedly among organizations, took a minimizing stance related to this news.
It was detected in herds in both Idaho and Michigan as well, strongly suggesting that this is a widespread problem that is already underway. This coincides with the start of the annual northward migration of waterfowl.
This is concerning for many reasons. First, given that we have seen it in ruminants in multiple states, this implies that this strain of H5N1 is already widespread. Most likely, it is in waterfowl flocks spreading it across North America. I suspect that the fecal-oral transmission is the most likely cause. Waterfowl land in water sources and defecate where ruminants later use for drinking. This means that containing spread is almost impossible.
Second, influenza viruses undergo genetic shift and drift quite regularly. This is part of the reason we need new human influenza boosters each year. While the current strain of the virus infecting ruminants appears to only cause illness for 7-10 days, it is also likely that this virus will mutate. That could make things better, or perhaps much worse, which could have devastating impacts on food supplies.
The most concerning thing though has to do with waterfowl migration across continents.
My biggest concern is those with migration routes including NW Canada and Alaska. That is because it shares space with waterfowl from SE Asia. Introducing this strain into waterfowl from that region increases the risk to humans considerably.
SE Asia has the densest human, waterfowl, and pig populations in the world. The problem lies in introducing this virus into pig populations in that area. The reason is that pigs are more unique in that their physiology is much more similar to humans than other animals. In addition, they can be easily infected by both human and avian influenza strains.
Influenza is a promiscuous virus. It will incorporate genetic sequences into its genome from the environment and is a very sloppy replicator, which introduces mutations readily. This also means that a pig can act as a petri dish to mix the genes from a human virus that makes influenza readily transmissible among humans and mix it with the genes of an avian strain that could make the virus much more deadly to humans as well. In 2013, H5N1 was repeatedly entering human populations and had a 60% fatality rate.
Dairy products that are pasteurized should be safe for human consumption and would be low risk. However, unpasteurized milk products are high risk for both this and other diseases:
- Unpasteurized milk or cream
- Soft cheeses, such as Brie and Camembert, and Mexican-style soft cheeses such as Queso Fresco, Panela, Asadero, and Queso Blanco made from unpasteurized milk
- Yogurt made from unpasteurized milk
- Pudding made from unpasteurized milk
- Ice cream or frozen yogurt made from unpasteurized milk
Problems with Possible COVID Links
Group A Strep in Japan
Group A strep is responsible for strep throat which can normally be easily treated with antibiotics. If it spreads systemically through a bloodstream infection, it can cause streptococcal toxic shock syndrome (STSS), which can cause organ failure and leads to about a 30% mortality rate, hence the need to treat strep throat early.
There has been a massive surge of STSS in Japan in Q1 2024 (941 cases so far this year compared to 894 for the entire year of 2019). This is very unusual and could be a result of some of the immune system damage from COVID infections.
Transportation Incidents
There have been a LOT of airline incidents related to maintenance and manufacturing this year that have received plenty of media attention, as well as some that haven’t.
In addition, there was also the container ship that hit the Francis Scott Key bridge in Baltimore.
Obviously, we don’t know with any certainty if any of these are related to COVID. However, we do know about brain fog and other neurological issues that arise after a COVID infection. Even the Aircraft Owners and Pilots Association has spoken to the brain fog risk.
Let’s use motor vehicle accidents (MVAs) as a proxy for commercial incidents. We know that infections can increase MVA risks. For example, “The result…suggests that subjects with latent toxoplasmosis had a 2.65 (C.I.95= 1.76–4.01) times higher risk of a traffic accident than the toxoplasmosis-negative subjects.”
Motor vehicle deaths were climbing quickly starting in 2020.
One thing that had gotten my attention was a study using the Rey–Osterrieth complex figure (ROCF) test.
In the study, “We observed significant cognitive impairment only in the ROCF, a drawing task test used to assess visuospatial abilities, executive functions and memory. The deficits observed in the ROCF could not be explained by socio-demographic factors, ophthalmologic deficits or psychiatric symptoms, suggesting cognitive deficit secondary to SARS-CoV-2 infection. Other factors which may influence performance, such as motor coordination, spatial neglect, visual attention, semantic knowledge, intelligence and executive functions were not likely to explain the observed difficulties, since we did not find any significant differences in other non-verbal (Trail Making Test and Five Points Test) and verbal tests (verbal fluency, digit span) also related to these processes.
Visuoconstructive deficits are usually defined as an atypical difficulty in using visual and spatial information to guide complex behaviors like drawing, assembling objects or organizing multiple pieces of a more sophisticated stimuli. In drawing a complex figure, as in the ROCFT, the patient must organize visual and spatial information in a planned manner to execute the drawing per se, a processes that demand several more specific cognitive abilities related to perceiving, processing, storing and recalling visuospatial information, both regarding shape and position, as well the planning and execution of the drawing per se.”
People that have visuospatial deficits could have difficulties estimating speeds, directions, and other variables that are important in operating transportation, especially in circumstances where quick action is required. This is why I have concerns about public and commercial transportation as well as shipping.
It’s not just an issue in the US either. Other countries have a similar trend in the aggregate. What is particularly interesting though is how much the US contributes to the aggregate numbers. It’s not surprising given that we already have a distracted driving problem here as well as unmitigated COVID. I worry that these kinds of problems are only going to become more prevalent.
Could there be problems with both manufacturing and maintenance because of the pandemic? Perhaps…
Dengue in the Americas
Dengue cases are surging across both continents. It is a vector borne disease spread by Aedes aegypti or Aedes albopictus mosquitoes. It is also known as breakbone fever due to the severity of muscle spasms and joint pain, dandy fever, or seven-day fever because of the usual duration of symptoms.
There have been 549 cases this year in Puerto Rico so far, compared to a total number of 1,283 in 2023. During the first six months of 2023, there were 5,492,755 passengers out of the capitol, San Juan. The range for the incubation period of Dengue is 3-10 days, which suggests that there could be a number of arrivals in the US that are not yet symptomatic.
Puerto Rico has issued a public health emergency.
COVID in the US
This is weekly US COVID admissions. The dotted lines that drop in June last year is due to the requirement for reporting suspected admissions, so after that time, this data is only representing about 1/3 of the actual numbers.
This means that there are about 45,000 COVID admissions/week up to 3/17. About 1% of COVID cases need hospitalization, suggesting around 450,000 cases/week. However, this is also a gross undercount. This image shows the percentage of patients being screened from a sample of hospitals. Note the caveat on the chart, but we can then assume that the figures are closer to double that.
It also suggests that there are about 900,000 new cases/week based on hospital data alone. However, with better treatments including drugs like Paxlovid in play, the 1% hospitalization rate is likely a bit of an overestimate compared to the past.
I’ll ballpark that this means that there are about 150,000-200,000 new cases/day in the US. I’m old enough to remember when there was a big push to use NPIs because these numbers seemed insane. Now the country seems to give a big collective shrug. That doesn’t end well, especially for those who have gotten repeat infections.
