I can’t stop thinking about how this would play out in the US, after reading this very informative Science article about the near term likelihood of a bird flu pandemic:
If the world finds itself amid a flu pandemic in a few months, it won’t be a big surprise. Birds have been spreading a new clade of the H5N1 avian influenza virus, 2.3.4.4b, around the world since 2021. That virus spilled over to cattle in Texas about a year ago and spread to hundreds of farms across the United States since. There have been dozens of human infections in North America. And in some of those cases the virus has shown exactly the kinds of mutations known to make it better suited to infect human cells and replicate in them.
No clear human-to-human transmission of H5N1 has been documented yet, but “this feels the closest to an H5 pandemic that I’ve seen,” says Louise Moncla, a virologist at the University of Pennsylvania. “If H5 is ever going to be a pandemic, it’s going to be now,” adds Seema Lakdawala, a flu researcher at Emory University.
Others are more sanguine, noting that similarly menacing avian flu viruses, such as one called H7N9, have petered out in the past. “Why didn’t H7N9 end up being easily human-to-human transmissible and cause a pandemic?” asks Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “I feel like there’s really no way to estimate and it could go either way.”
There’s a scenario from the executive director of the American Public Health Association which sketches out what this might look like in practice, in this thought provoking Politico feature on potential ‘black swan’ events for 2025:
An infectious disease outbreak occurs in a small rural community that is poorly vaccinated. The initial symptoms are “flu like” with fever, headache, muscle aches and sore throat. Local officials initially believe it is a seasonal influenza outbreak, but initial test results for typical viral illnesses like flu, Covid and RSV are all negative.
Health officials eventually identify patient zero as someone who has just returned from overseas where an outbreak of an undiagnosed disease has sickened and killed over one hundred people. The state health department is called in to investigate and after a couple of days, so is the Centers for Disease Control and Prevention. Local officials are reluctant to impose traditional public health measures like contact tracing, masking, social distancing and quarantine of exposed individuals because of fears of community hostility; in fact, the impacted community recently passed a law limiting the health department’s powers to control infectious outbreaks.
As a result, public health officials can do little. Social media, meanwhile, is full of misinformation, and at least one post that says the disease is spread through the mail has been identified as being amplified by a hostile foreign actor. The outbreak continues to spread and there are now several reported deaths. Over the next few weeks, the outbreak spreads to surrounding communities including one big city and two other states, and the death toll climbs. Despite the reluctance to close schools and businesses, the number of sick individuals means that many have to shut down anyway because of lack of workers.
The disease is found to be one for which there is an experimental vaccine, but using it would require an emergency use authorization. The Health and Human Services leadership is now full of vaccine skeptics and so the administration’s health leadership becomes paralyzed by an intense internal debate about whether to use the experimental vaccine. Other therapeutic options are available, but pharmaceutical companies are nervous in this new climate and reluctant to produce the drugs without a guarantee of legal protections and financial support. The Food and Drug Administration struggles with the decision because the advisory committees that normally review vaccines and therapeutics have been dissolved.
Because of this, the outbreak soon reaches epidemic proportions across the United States. Other nations respond by imposing travel bans on U.S. residents. The economy is negatively impacted as goods and services become scarce and commodities stack up in the ports of entry. An epidemic that we had the tools to control winds up killing thousands and sending the economy back into a Covid-like downward spiral.
https://www.politico.com/news/magazine/2025/01/03/15-unpredictable-scenarios-for-2025-00196309
Mark Carrigan 