2024-Week 15

Contents:
H5N1
COVID Topics:
Group A Strep
Psitticosis
Disability

H5N1

H5N1 continues to be a growing problem. Thus far, we have seen “Bird-to-cow, cow-to-cow and cow-to-bird transmission have also been registered during these current outbreaks, which suggest that the virus may have found other routes of transition than we previously understood” according to Wenqing Zhang of the WHO.

We have known about the risks of H5N1 for a very long time. CDC guidance from 2013 stated “Work with HPAI H5N1 virus should be conducted, at a minimum, at biosafety level 3 (BSL-3), with specific enhancements to protect workers, the public, animal health, and animal products.”

One interesting publication by the CDC this week sends a bit of a warning.

The question then becomes one of if dairy products are safe. Per the USDA Animal and Plant Health Inspection Service, “We know that the virus is shed in milk at high concentrations; therefore, anything that comes in contact with unpasteurized milk, spilled milk, etc. may spread the virus. Biosecurity is always extremely important, including movement of humans, other animals, vehicles, and other objects (like milking equipment) or materials that may physically carry virus.” In other words, raw milk is dangerous as are fomites that come in contact with it.

Raw milk products should never be consumed because of the disease risk they pose. It is unclear if pasteurization will make dairy products safe, although influenza viruses tend to be destroyed by pasteurization. I really hope that’s the case, because this is from an expert in the field I trust.

A major warning bell should sound if there are cases of H5N1 in humans who are not connected to agriculture.

Another interesting thing to think about is the impact of infected waterfowl on marine life. While H5N1 is not known to infect fish and invertebrates, they can become transiently colonized. I think this could pose a problem in shallow oyster beds and for those who enjoy raw oysters, among other marine foods. If seafood is part of your diet, you might want to read this thread that links to a number of studies.

While not a food animal, it is also interesting that H5N1 has been detected in a marine mammal for the first time, in this case, bottlenose dolphins in Florida.

COVID

Group A Strep

There was a very interesting tweet this week about invasive Group A streptococcus (GAS) in a hospital in New Brunswick. It dovetails very well with the immune system damage from COVID. When GAS is invasive, it can cause necrotizing fasciitis, or what is sometimes more commonly called flesh eating disease.

I was curious if I could find more info from the area due to the alleged public health response and sure enough, I found a story on two deaths including a picture of the hospital, confirming that this account is likely true.

Psitticosis

In a similar vein that could be related to COVID immune damage, psitticosis, or parrot fever, is erupting both in South America and Europe.

From ProMED: “In the past 30 days there appears to have been an increase in severe atypical pneumonia requiring critical care in Buenos Aires [Argentina]. The affected individuals are mostly young people without major risk factors. Bilateral consolidative infiltrates are seen on chest CT scans with patients often requiring mechanical ventilation and pronation. Informally, 20 of the 60 cases collected presented evidence of psittacosis with 10 positive by PCR. Many of the affected patients have no apparent history of contact with birds.”

For perspective, Argentina was hit by COVID roughly as badly as the US, which was one of the worst performers during the pandemic. Case number became pretty useless after the original omicron wave in 2022.

It also appears to be showing up in Europe in unusual numbers. This is an excellent thread with linked citations.

Disability

One of the things that has made COVID so difficult is that people think that COVID is just an acute illness, with some exceptions among people with long COVID. This is particularly true among those who minimize it and think that death is the only real adverse outcome. The truth is that COVID sets people up for a number of diseases in the future.

The Lancet published a study this week titled Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021.

“In 2020 and 2021, global health outcomes, as measured by age-standardised DALY rates, worsened for the first time in three decades. From 1990 to 2019, GBD analyses showed consistent and rather encouraging improvements in overall health outcomes at the population level. During this period, achievements by the global health community included reductions in vaccine-preventable deaths and improvements in under-5 mortality rates, contributing to the trend of people living longer. However, as a global epidemiological transition occurs wherein the greatest share of disease burden shifts from communicable diseases to non-communicable diseases, populations are living longer but in poorer health. GBD 2021 reports a new global trend: the global number of DALYs and age-standardised DALY rates increased in both 2020 and 2021.”

It really comes down to those who continue to play the roulette wheel with COVID are going to be facing a considerably reduced quality of life and shortened lifespan. That is the problem with COVID. Most of the impact of the pandemic is going to show up years in the future, which is why there is so much temporal discounting.

For example, in January, Murata et al. published “The human iPS cell-based cardiac tissue model established in the present study is the first report to experimentally demonstrate SARS-CoV-2 persistent infection of the human heart exhibiting functional deterioration caused by the opportunistic intracellular reactivation of viral infection. We experimentally demonstrated that cardiac tissues under persistent infections with SARS-CoV-2 are at high risk of cardiac dysfunction with additional hypoxic stress. In other words, the explosive increase in the number of virus-infected patients due to the COVID-19 pandemic may have led to an enormous increase in the number of patients at potential risk for future heart failure.”

The healthcare system cannot handle the burden of the diseases that are currently in the pipeline as a result of COVID.