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.
Featured topic and speakers
Is bird flu still a danger? What does avian flu do to humans? Are there still cases of bubonic plague? Is bubonic plague curable? Where is COVID surging?
Our guest is the American Medical Association's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally in patient care. Join now.
- Looking for a COVID map? Get the latest CDC COVID Tracker map, charts and data.
- Searching for "COVID vaccine near me"? Find vaccines in your area.
- Googling "COVID testing near me"? Find where to get COVID test kits.
- Wondering how long are COVID tests are good for or do expired COVID tests work? Check FDA COVID test expiration date extensions.
- COVID Wastewater data via CDC National Wastewater Surveillance System (NWSS).
- CDC current avian flu map.
- For bird flu news visit Centers for Disease Control and Prevention CDC H5N1 Bird Flu Current Situation Summary (CDC H5N1 technical report).
- If the CDC issues new health warning, get the latest CDC health alert 2024 via the Health Alert Network (HAN CDC website).
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
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. Andrea, good to see you.
Garcia: Good to see you, too. Thanks for having me back.
Unger: Well, the big news this week is more human cases of bird flu. Andrea, tell us what's going on.
Garcia: Yeah, Todd. So that number of human cases has increased over the weekend. It was three new cases. On Monday, that number grew to four. And now at the time of this filming, five additional cases of highly pathogenic avian influenza or H5 bird flu virus infections have been identified, all of them in Colorado.
The cases were identified by the Colorado Department of Public Health. And so far, four of them have undergone confirmatory testing by the CDC. All five of those cases occurred in workers on the same poultry farm in northeastern Colorado. Dairy cattle was not the source of spread, like it was in previous cases we've seen.
As a reminder, though, prior to this announcement, we had seen four human cases related to this outbreak—two in Michigan, one in Colorado, one in Texas. Now, this brings the total to nine human cases of bird flu in the U.S., more than doubling the number of people infected in just a few days' time.
Unger: So Andrea, that's a big change once you have bird flu actually transmitted by birds to humans here. Is the virus becoming more adaptable? What's changing?
Garcia: Well, research is ongoing to determine how the virus is evolving. However, these workers are believed to have been exposed to the virus through direct contact with infected birds. All nine cases reported this year have been mild, consisting of conjunctivitis and/or a runny nose and other mild respiratory symptoms.
The numbers really, though, remain too low to say anything for certain about the disease. We know that flu symptoms can range from mild to severe. And they vary from person to person. So although these case numbers are low, the number of people who have gotten the virus from poultry or cattle could actually be much higher.
We know that only about 60 people have been tested for novel influenza A over the past four months. So testing hasn't exactly been widespread. And some workers, of course, may not have reported symptoms, either because they weren't comfortable doing so or the symptoms were so mild that they didn't even think it was worth mentioning.
To get a better grasp of the extent of this outbreak to understand whether cases are going undetected, some researchers in Michigan have sent the CDC blood samples from workers on dairy farms. And if bird flu antibodies are detected, people may be more easily infected by cattle than previously believed. So we'll have to wait and see to learn more.
Unger: Well, Andrea, given the changes that we've been talking about, in the meantime, is the CDC changing their risk assessment based on these new cases?
Garcia: No, they're not. The CDC still says that that risk to the general public is low because each of these cases that we've seen so far, the workers were directly exposed to an infected animal. In a statement that was posted in response to these new Colorado cases, the CDC said that an assessment of these cases will help inform whether the situation warrants a change to that human health risk assessment. There is a CDC team in Colorado on the ground supporting this assessment of the poultry outbreak and associated human cases.
Unger: Now, Andrea, you mentioned cattle up front as well. Have the cases among cattle continued to spread?
Garcia: They have. And earlier this week, we added a 13th state to the list of those that have infected dairy herds. That's Oklahoma. The disease has now been detected in more than 150 dairy herds nationwide. However, the samples sent in from the Oklahoma dairy farm date back to April. And the dairy sent them to USDA for testing after the farm learned that it could receive financial assistance for lost milk production from bird flu.
So as we've talked about before, the USDA has launched a program to compensate farmers with sick cows for 90% of lost milk production per cow. And that's as a way to encourage farmers to test herds and report infection.
We have seen some public health officials pitch another tactic to persuade resistant dairy farmers. And that's anonymized testing. So in that scenario, results from individual farms would be anonymized and sent to the USDA. And that would offer a snapshot about disease spread and how the virus is mutating. There are, of course, drawbacks to this approach. And I think one of those is that we wouldn't be able to address transmission at the source.
Unger: Well, we'll certainly keep an eye on that as we get more data. Unfortunately, Colorado made the news for another reason this week. It reported a case of bubonic plague. We've talked about this once before, Andrea. But I know to a lot of people, this doesn't sound real. Andrea, what can you tell us about the disease and if we need to be concerned?
Garcia: So you mentioned, Todd, we have talked about this before. Bubonic plague is a bacterial infection. It was historically very deadly, but is now far more treatable with the help of antibiotics.
It earned its reputation as Black Death back in the 14th century. It had a devastating effect, wiping out tens of millions of people in Europe. However, according to the CDC today, we only see about seven human cases a year in the U.S., with most of those occurring in the West, especially in northern New Mexico and in Arizona.
According to the WHO, human-to-human transmission of bubonic plague is now very rare. The reason that this is making news right now is that case that you mentioned in Colorado, which was just confirmed a few days ago.
Unger: So Andrea, if human-to-human transmission is rare, how are these folks getting it?
Garcia: Well, the plague is caused by a zoonotic bacteria known as Yersinia pestis. It's transmitted by fleas. And it cycles naturally among wild rodents. So it can infect both humans and their pets. People get plague from the bites of infected fleas, by touching infected animals, or by inhaling droplets from the cough of an infected person or animal.
In February of this year, there was a case of human plague that was confirmed in rural Oregon. That patient was thought to have been infected by their pet cat that was showing symptoms.
Even though the disease is now rare, it is important to get tested and treated immediately if you develop symptoms. And that's because plague can progress quickly and can cause serious complications or even become deadly.
Unger: So Andrea, what symptoms do people need to watch out for?
Garcia: Well, painful swollen lymph nodes or buboes are the telltale symptom. The bacteria typically multiply in a lymph node close to where the flea bite occurred and then can spread in the bloodstream if untreated.
Other symptoms to watch for are sudden fever and chills, severe headaches, muscle aches, nausea and vomiting. These symptoms generally develop after an incubation period of about one to seven days.
Again, plague is very rare. There's no cause for concern. Overall, our improved sanitation, better living conditions and effective antibiotic treatments have helped keep this disease under control.
People can, of course, reduce their chance of contracting the disease by eliminating places where rodents can hide and breed around your home, your garage, your shed or recreational area. And then treat your dogs or cats for fleas regularly.
Unger: Well, that's good to know. Andrea, our last topic today is something that, unfortunately, has become far more wide spread of late. And that is COVID. Andrea, what can you tell us right now about what's happening?
Garcia: Well, you may be hearing about more people around you getting COVID. And that's because the numbers are steadily increasing. There was a CBS News article and CDC figures published last Friday indicating that more than half of states are now seeing high or very high levels of COVID. Based on their wastewater testing on a national level, the CDC says that the overall level of COVID in wastewater is high. And that is for the first time since this past winter. Friday's update was the first that we've seen in about a month because of the Fourth of July holiday. So there was a delay in the data.
According to the CDC, DC and 26 states are now seeing substantial increases in COVID emergency room visits nationwide. The average share of ED patients with COVID is the highest that it's been since February. It's increased 115% from a month ago.
Unger: Andrea, put this in perspective for us. Is this worse than we've seen in previous summers?
Garcia: No, it's not worse. And there was a deputy director from the CDC who said that what we are seeing, these patterns—they're consistent with what we've observed over the last couple of years in the summer, where we've seen upticks in activity that have occurred around this time of year that are not quite as large as what we see during the winter peaks. In previous years, cases have peaked around July or August.
So while this steady increase is not surprising, I think it is a good reminder that there are precautions we can take to protect ourselves and those around us. If you test positive, stay home. Many people will be able to treat their symptoms with over-the-counter medications. But for those who are more likely to develop severe disease, prescription medications, such as Paxlovid and remdesivir, are available. Those do need to be started within about five days of symptom onset to be effective. So it is smart to contact your physician as soon as you know that you are sick.
Unger: Well, thank you for that update. And that's all we have time for this week. Andrea, thanks for being here and sharing all your perspective and information. For those of you out here listening, if you found the discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. And as always, you can find 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.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
