Public Health

Bird flu in Missouri, newest strain of COVID XEC variant and when to test for COVID 2024

. 11 MIN READ

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

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AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the bird flu outbreak in Missouri, FDA COVID testing guidelines, and new XEC COVID strain making its way through Europe. AMA Chief Experience Officer Todd Unger hosts.

Editor’s note: Stay informed on highly pathogenic avian influenza (HPAI) A(H5N1) with the latest updates from the AMA’s bird flu (H5N1) resource center.

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  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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Transcript

Transcript

Unger: Hello and welcome to the AMA Update video and podcast. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea. 

Garcia: Thanks, Todd. Really appreciate the opportunity to be here today and share an update. 

Unger: Well, we have a lot on tap, including a disturbing new update on bird flu, learning how to get free COVID tests and what a new COVID strain could mean for a fall surge. Let's start with bird flu. A lot of headlines this week about potential human-to-human transmission in Missouri. Andrea, tell us more about what's going on there. 

Garcia: The last time that we talked about H5N1 or bird flu, there was that confirmed case in Missouri and a patient that was hospitalized last month. That patient was that first case we've seen where the person had no known exposure to an infected animal, and that source of transmission for that case still remains unclear. 

We also have learned that one household member of the patient had become ill around the same time but was not tested for bird flu. And shortly after that, we learned of one hospital professional who became sick, was tested and tested negative, and then another health care professional who became sick but was not tested. That cluster has since grown to include a total of eight people. All of the latest additions are health care professionals who were in contact with the infected patient at some point. This does have people very concerned that it may be the first example of person-to-person transmission of the virus, which, obviously, is not something that we want to see. 

Unger: So, what do we know so far? That's pretty distressing news. 

Garcia: Well, while H5N1 has infected an array of birds and animals, including mammals, over the past few years, so far, it has not proved capable of easily spreading among people. The 13 other human cases we've seen in this outbreak so far had a very clear connection to infected dairy, cattle or poultry. It's important to note that in the Missouri case, investigators have not yet confirmed whether any of the seven individuals in this cluster were in fact infected with bird flu, which does leave open the possibility that they had COVID or some other illness with flu-like symptoms. 

According to experts quoted in a recent New York Times article, it's not time to push the panic button just yet. But if any one of these seven individuals does test positive for bird flu, we could be inching closer to a pandemic-like virus. The immediate priority here is to figure out exactly what's going on. 

Unger: And so, Andrea, in that regard, what is the CDC doing to determine that? 

Garcia: Well, Todd, right now this investigation is being led by Missouri health officials with remote assistance from the CDC. Only one of the seven individuals who developed symptoms was tested for H5N1. That test came back negative, but they may have also been tested too late to pick up signs of the infection. All six of the health care professionals and the housemate had respiratory illness, mild symptoms and have since recovered. Health officials are now analyzing the results of antibody tests that would reveal whether these individuals were exposed to the virus. And I think once we have those results back, we'll certainly know a lot more. 

Unger: Absolutely. Andrea, last time we talked, the CDC was able to partially sequence virus from the hospitalized Missouri patient. What did we learn from that? 

Garcia: Well, like you said, they were only able to sequence a portion of the virus. But that analysis suggested that the virus had not diverged from the version circulating in dairy cattle, nor had it acquired mutations that would allow it to spread readily from person to person. As we know when we've talked about before, every new infection does give the virus opportunities to acquire mutations and evolve into a form that could be more easily transmissible. 

Now we're heading into respiratory viruses, and cases of seasonal flu, COVID and RSV could certainly confuse this picture even more. It could make it more difficult for us to identify H5N1 cases. Wastewater analyses will be important. So far, that analysis has shown spikes in several states that don't appear to be linked to animals or birds. But those peaks have really been transient. We'd expect a consistent signal if a large number of undetected cases were circulating. 

Unger: Well, that is certainly something we're going to continue to keep an eye on. Andrea, you mentioned earlier that we're now heading into respiratory season. And as in past seasons, free COVID tests have once again been made available. How can people get them and are those tests still effective? 

Garcia: Yeah, Todd, so starting last Thursday, people could once again order those free COVID tests from the government. Every household in the U.S. will be able to order for tests from covidtest.gov, and that's between now and the end of the year. People can also get those tests by calling 1-800-232-0233. 

All tests are going to be shipped for free starting this week through the U.S. Postal Service. I actually received mine in the mail yesterday. It was very fast. Those tests are still effective. The FDA estimates that they will detect the virus at least 80% of the time when someone is infected with the mixture of viruses that we likely will see heading into respiratory viruses. And it's important to test so you can determine what virus you have, take appropriate precautions, and of course, seek treatment accordingly. 

Unger: Now, Andrea, I think there's still some confusion out there about when to test. What's the latest thinking on that? 

Garcia: Well, The New York Times did a really nice job of breaking this down and explaining it. Generally, the thinking is if you were exposed to COVID, but you're feeling fine, you're going to want to wait a few days to test because we know that it can take a few days for the virus to build up in our bodies. So the FDA currently recommends that people who stay symptom free take at least three tests total. Each time you're going to want to wait 48 hours before you take another one. 

If you have symptoms, you're going to want to take a test right away. If it's negative, take another one two days later. It's important not to consider your initial negative test as a free pass. Consistent with other viruses, if you do test positive, you're going to want to stay home and stay away from others until your symptoms subside and you've been fever free for at least 24 hours. We know that even if you're feeling better, you can still spread that virus. So, it's important to take added precautions over the next five days. So, steps for cleaner air, masking or testing when you're going to be around other people indoors. 

If you test positive but you have no symptoms, you may still be contagious. So again, for the next five days, you should take those added precautions when you're going to be around other people indoors. 

Unger: Andrea, what about preventive testing? You talked about what happened if you thought you got exposed. But let's say people want to test before they see elderly relatives or anybody else for example. What's the best time to do that? 

Garcia: You're going to want to test as close as possible to the time that you're going to see them that morning for example. You don't need to worry about taking a test two days before because your test on the day of will be far more accurate. And if you have symptoms but are testing negative, you're likely going to want to stay home. This is important to protect, of course, people with factors that increase their risk of severe illness from respiratory viruses. 

Unger: That's good to know. And Andrea, how are we looking with COVID cases right now? I feel like a lot of people were getting sick a couple of weeks ago, but it seems to have subsided a little bit. Is that true? 

Garcia: Todd, I think that's exactly what's happening. We're likely past the peak of that summer surge. And I think if we take a broader look at viruses, on Friday, the CDC said that a seasonal influenza and RSV activity are low nationally, and COVID is elevated still, but it's declining in that weekly variant update that the CDC provides. They noted that the KP.3.1.1 Omicron subvariant is accounting for about 58.7% of infections over the last two weeks. 

Unger: Along with a little bit of cooler weather, we're going to enjoy maybe what might be a respite before any kind of fall surges along several lines. Andrea, I have seen headlines about another strain called XEC. Is that something we should be concerned about right now? 

Garcia: Well, for comparison's sake, the XEC strain is accounting for about 6% of new cases in the U.S. over the last two weeks. I wouldn't say it's necessarily something to be concerned about right now, but it's definitely something to watch. We don't know much about it yet. It's still too early to tell whether it's going to drive a fall or winter surge. We do know that so far, at least 25 states have reported at least one case that is driven by that strain. It's been spreading quickly in parts of Europe and other parts of the world in recent weeks. That's true for Germany, France, the Netherlands and Denmark. 

Unger: Now, Andrea, I know you mentioned that we don't know a lot yet, but do we know anything so far about this new strain? 

Garcia: Well, we know XEC is a recombinant of two previous variants, so KP.3.3, which is a descendant of the FLiRT variants and KS.1.1, when a person is infected with two different variants, you can get what we call a recombination, where pieces of the genetic material from one recombine with the other and that can create a new strain. XEC is similar to its parental strains, but it has additional mutations that may give it an advantage over other variants. So far, it doesn't appear to be causing any distinctive symptoms or more severe disease. Even if it does end up gaining traction, our updated COVID vaccines are expected to be effective against it and current tests for COVID do appear able to detect it. 

Unger: Well, that's really good news. And in fact, that wraps up this week's episode. And as always, Andrea, thank you so much for being here and sharing this information. 

If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. And you can always find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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