Farmworkers are among the most at risk from the bird flu virus, but advocates say many of them would lack resources to fall back on if they became ill.
So far, only two people in the United States have tested positive, after being exposed to a wave of bird flu spreading among cows. These people, farm workers in Texas and Michigan, experienced eye irritation.
Scientists warn the virus could mutate to spread from person to person like seasonal flu, potentially triggering a pandemic. By monitoring farmworkers, researchers could track infections, find out how dangerous they are, and be alerted if the virus becomes more contagious.
But people usually get tested when they seek treatment for an illness. Farmworkers rarely do that because many don’t have health insurance or paid sick leave, said Elizabeth Strater, director of strategic campaigns for the national group United Farm Workers. They are unlikely to see a doctor unless they become seriously ill.
Strater said about 150,000 people work in U.S. dairies. She said many worker advocates believe the virus has spread to more people than testing shows. “The method used to monitor at-risk workers has been very passive,” she said.
Federal officials told reporters on May 22 that only 40 people linked to U.S. dairy farms had been tested for the virus, although others were being “actively monitored” for symptoms.
Federal authorities recently announced they would pay farmworkers $75 each to get tested for the virus, under a new program that also offers incentives to farm owners to allow testing on their herds dairy.
Officials with the federal Centers for Disease Control and Prevention said they recognize the importance of gaining the cooperation and trust of front-line dairy workers.
CDC spokeswoman Rosa Norman said in an email that the incentive payment compensates workers for the time they spend monitoring how many people are infected, how sick they are and whether if humans transmit the virus to each other.
She noted that the CDC believes the virus currently poses a low risk to public health.
But Strater is skeptical about encouraging farmworkers to get tested for the virus. If a worker tests positive, they will likely be asked to go to a clinic and then stay home after work. She said they couldn’t afford to do that either.
“It’s starting to seem like a really bad deal for $75, because at the end of the week they’re supposed to feed their family,” she said.
Katherine Wells, public health director in Lubbock, Texas, said that in her state, health officials would provide short-term medical care, such as giving farmworkers the flu treatment Tamiflu. These provisions would not necessarily cover hospitalization if necessary, she said.
She said workers’ biggest concern seems to be that they would have to stay home from work or that they could even lose their job if they tested positive.
Many farm workers come from other countries and often work in harsh conditions for little pay.
They might worry that attention to some cases among them will inflame anti-immigrant fervor, said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.
Societies have long blamed marginalized communities for the spread of contagious diseases. Latin American immigrants were verbally attacked during the H1N1 “swine flu” pandemic in 2009, for example, and some media figures took advantage of the outbreak to push for an immigration crackdown.
Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health, said many dairy farm workers have had very little awareness of this new disease that is spreading among the cows they manipulate. “Education must be part of testing efforts, giving workers time to ask questions,” she said.
These conversations should be conducted in the language of farm workers, with people they are likely to trust, she said.
Georges Benjamin, executive director of the American Public Health Association, said public health officials must make clear that workers’ immigration status will not be reported as part of the investigation into the new flu virus . “We’re not going to be the police,” he said.
Dawn O’Connell, administrator of the Department of Health and Human Services, said at a May 22 press conference that nearly 5 million doses of a vaccine against H5N1, the avian flu virus circulating in cattle, are being prepared, but officials have It is not yet decided whether vaccines will be offered to farmworkers when they are ready later this year.
In early May, the CDC asked states to share personal protective equipment with farm owners, to help them protect workers from the avian flu virus. State health departments in California, Texas and Wisconsin, which have large dairy industries, have all said they have offered to distribute such equipment.
Chris Van Deusen, a spokesman for the Texas Department of Health, said four dairy farms have requested protective equipment from the state’s stockpile. He said other farms may already have what they need. Spokespeople for the California and Wisconsin health departments said they did not immediately receive requests for additional equipment from farm owners.
Strater, the United Farm Workers official, said offers of protective equipment must be practical.
Most dairy workers already wear waterproof aprons, boots and gloves, she said. It would not be realistic to expect them to also wear N95 masks in the humid and hot conditions of a trafficking operation, she said. Plastic face shields seem to be a better option for this environment, especially to prevent milk from getting into workers’ eyes, where it could cause infection, she said.
Other types of agricultural workers, including those who work with chickens, also face potential infection. But scientists say the version of the virus spreading in cows could be particularly dangerous because it has adapted to live in mammals.
Strater said she was more worried about dairy workers, who spend 10 to 12 hours a day in enclosed spaces with cows.
“Their faces are about 5 inches from milk and udders all day,” she said. “Intimacy, where their face is so close to the infectious material, is different.”
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