Michigan leads the US in monitoring and investigating the bird flu outbreak | Bird flu

As questions arise about the spread of bird flu among livestock and humans, one U.S. state – Michigan – has taken the lead in monitoring and investigating the outbreak.

While other states appear cautious in tracking animal and human cases, Michigan has taken a proactive approach: sending daily text messages and phone calls to check on farmworkers who work with cows that have tested positive for H5N1 and offering free testing if symptoms develop.

Authorities were not surprised when a third person tested positive for the highly pathogenic bird flu, nor were they surprised that it happened in Michigan. Nearly two-thirds of the people being monitored for H5N1 symptoms live in Michigan, Nirav Shah, deputy director of the U.S. Centers for Disease Control and Prevention (CDC), said recently.

As of May 22, 35 of 40 tests in Michigan have been conducted on humans. That means that only five more bird flu tests have taken place in other states, including Texas, the only other state to report a human case in this outbreak.

Michigan is the state with the highest concentration of influenza A in wastewater, according to WastewaterScan. H5N1 belongs to the influenza A family, and relatively high concentrations of flu A indicate possible outbreaks of H5N1 – most likely in animals.

But that’s not the only reason Michigan keeps appearing in the news about bird flu.

“I don’t think we’re the only state that has cases. I think we’re the only state that’s recognizing our cases,” said Dr. Natasha Bagdasarian, Michigan’s chief medical officer, along with Texas. “That gives me hope that the system is working here.”

It’s not just about testing and surveillance. Michigan also invited epidemiologists from the U.S. Department of Agriculture (USDA) to study transmission of the virus. The authors of a recent USDA report thanked Michigan dairy producers for their openness and transparency. “Without them, this report could not have been completed,” the researchers wrote.

After the first detection of bird flu in cows, Michigan state officials enacted new biosecurity regulations for farms and soon began promoting seasonal flu vaccination among dairy and poultry workers to prevent flu variants from mixing and causing more severe illness.

Michigan also announced additional funding for farms affected by the flu, beyond the available federal aid. Up to 20 farms affected by H5N1 can receive up to $28,000 to participate in studies and work with health authorities.

“Michigan has put a lot of work into really understanding what is going on with H5N1,” said Marisa Eisenberg, associate professor of epidemiology and co-director of the Michigan Public Health Integrated Center for Outbreak Analytics and Modeling at the University of Michigan.

“We sometimes observe that you find something if you look for it.”

Experts say it’s important for state and local authorities to work closely with agriculture – caring for cows, chickens, pigs and other potentially affected animals – to understand how transmission occurs and how to stop it.

“It’s in everyone’s interest to be as proactive as possible,” Eisenberg said. “Because if you bury your head in the sand, like an ostrich, the disease will continue to spread and cause a wider range of problems – from a public health perspective, from a dairy production perspective and from an economic perspective.”

In Michigan, this approach includes regularly screening farmworkers for symptoms and working closely with state and local agriculture and health officials.

“We see how inextricably linked human and animal health are and are making sure we address these issues together,” Bagdasarian said.

Farm owners and workers who come into contact with sick cows receive daily text messages or calls to check for even mild or unusual symptoms.

People reporting symptoms are being tested for H5N1. In the case of two people testing positive, antiviral medication is being offered.

This program, Eisenberg said, “has been really helpful in detecting the two cases we’ve seen so far and has also helped encourage testing on farms and especially on dairies.”

A Michigan worker who tested positive developed conjunctivitis after milk from a sick cow was sprayed into his eyes.

The other worker developed more typical flu symptoms, including cough, runny nose, sore throat and watery eyes, after working in close quarters with a sick cow.

For most people, the risk of bird flu is still low, but anyone who has close contact with potentially sick animals should take precautions, officials say.

“It really shows how helpful personal protective equipment can be for people who have prolonged contact with sick animals,” Bagdasarian said.

However, when working on a farm, wearing such protective equipment can be difficult due to summer temperatures and the risk of water and milk splashes.

“One of the biggest concerns was visibility,” Bagdasarian said. “When you’re working with a large animal and there’s a risk of injury, anything that obstructs visibility can also be difficult to handle.”

When announcing new cases, authorities in Michigan are careful not to disclose details that could link affected farms or individuals.

“Michigan as a state has handled the privacy concerns pretty well, not wanting to identify specific farms on the one hand, but also sharing data in a transparent way,” Eisenberg said.

Throughout the bird flu outbreak, authorities have repeatedly stressed the importance of trust.

“One of the things we’ve learned from Covid is that you have to have relationships built before any kind of public health emergency occurs,” Bagdasarian said.

“We have many health centers and social workers working directly with farm workers, and local health authorities know the farms in their area.”

If a vaccine against H5N1 becomes available to the public, it could fall victim to the same politicization and disinformation that has increased during the pandemic, she said, such as lower acceptance of the seasonal flu vaccine.

“We are still working to restore public trust,” Bagdasarian said.

The bird flu outbreak is “worrying, but we cannot yet say whether it will really develop into a problem big enough to cause concern to the general public,” Eisenberg said.

“It’s so concerning that we should definitely do everything in our power to make sure it doesn’t become an even bigger problem.”