Four years after a novel coronavirus swept through New York in what has been called a once-in-a-century event, public health officials are beginning to prepare for the possibility that a much worse pandemic is on the way.
The avian flu virus, H5N1, does not spread among humans. But the city is already preparing as if it could.
He plans to create isolation and quarantine hotels. A New York City hospital system is taking steps to begin testing its wastewater for the virus, to learn whether bird flu is circulating silently among patients and staff.
But some epidemiologists worry that once again, the public health response in New York will be too slow in the early stages, should there be an outbreak in the city.
The virus worried epidemiologists because of its pandemic potential even before the first human patients were detected in Hong Kong in 1997. In the years that followed, it spread via migratory birds and spread periodically in chicken farms. Fewer than 1,000 people are known to have been infected in the past 20 years. But just over half of those infected died.
Today, the disease has been detected in dairy cattle herds in 12 US states. Human-to-human transmission has not yet been detected, but the concern is that the virus could evolve.
“There is still enormous uncertainty about when human-to-human transmission will pass,” said Dr. Jay Varma, a former epidemiologist at the Centers for Disease Control and Prevention who helped guide New York City’s response during the COVID-19 crisis. Covid. pandemic.
His guess: maybe months, maybe years.
How exposed is New York City?
New York City – visited by some 50 million Americans each year – could well be one of the first American cities to be hit hard if a bird flu pandemic breaks out among the population, as was the case during the arrival of the new coronavirus.
But for now, we are far from the front lines. Although New York is one of the nation’s top dairy-producing states, the virus does not appear to be circulating among its cattle. The state agricultural department has imposed a number of testing requirements. Last week, he announced mandatory testing for the H5N1 virus for dairy cattle attending regional fairs.
Would there be tests to determine who has bird flu?
Epidemiologists fear a worrying repeat of the early days of Covid-19, when only restricted categories of people – such as travelers returning from China or their contacts – were eligible for testing. Other New Yorkers have had difficulty getting tested. As a result, public health authorities have been slow to detect the virus – or act.
Currently, there is no readily available and widely available H5N1 test outside of government laboratories. The tests relied on by doctors’ offices and hospitals do not distinguish H5N1 from certain seasonal flus, if they detect it at all. For now, only people with specific risk factors – such as those who have been around sick farm animals or birds – are likely to have their samples immediately sent to government public health labs for H5N1 testing.
Without better diagnostics, the virus would “go unnoticed for some time,” said Professor Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai.
State officials have said they are not worried about testing. The state public health laboratory “has more than sufficient testing capacity for H5N1 – several hundred samples per day – and substantial additional surge capacity if needed,” a spokesperson said. word from the Ministry of Health, Erin Clary.
But what the government should do, epidemiologists say, is encourage and authorize commercial and academic labs to develop H5N1 tests, so that government public health labs don’t become a bottleneck.
Wastewater monitoring could also be helpful. A research team is working to establish a specific H5N1 test on wastewater samples in four of the city’s 11 public hospitals. If the virus were detected, it would most likely mean a patient, staff member or visitor was infected, said Professor Denis Nash, an epidemiologist at the CUNY School of Public Health, part of the project team.
Does New York have enough vaccines and antivirals?
Public health authorities have been preparing for a deadly flu pandemic for decades. Federal health officials have identified two vaccine viruses that they hope will prove effective against a pandemic H5N1 strain.
The number of vaccine doses in the national stockpile is less than one million, although an additional 4.8 million doses have been ordered. If necessary, federal officials are optimistic that within 130 days, manufacturers could make more than 100 million doses, enough for more than 50 million people.
During the Covid pandemic, children were vaccinated last. But young children are particularly vulnerable to the flu and would most likely be prioritized in the event of a flu pandemic.
The federal government has also built up a huge stockpile of antiviral flu drugs. New York has its own stockpile outside the federal system, and the city and its public hospital system have theirs as well — in total, enough for more than 10 percent of the state’s population.
Are hospitals ready to treat avian flu patients?
Doctors in the city’s public hospital system have expressed confidence in their ability to handle a flu pandemic without the health care system collapsing.
In interviews, doctors noted that the Covid pandemic had taught valuable lessons, such as how to quickly build makeshift intensive care units and the importance of trying to avoid intubating patients when it was possible.
“A lot of the issues have been resolved,” said Dr. David Silvestri, a South Bronx emergency physician who oversees emergency planning for the public hospital system. “In the worst case scenario, we could pull the same levers. »
Will there be lockdowns and school closures?
If the H5N1 virus triggers a pandemic, public health experts expect a return to social distancing and confinement, especially if death rates are as high as feared.
“That’s going to be the reality and that’s what’s going to slow transmission,” said Dr. Bruce Farber, an infectious disease specialist at Northwell Health, the state’s largest hospital system. “Just because we are tired of pandemics and don’t want to think about another one doesn’t mean viruses care,” he added.
What can I do to protect myself and my family?
Professor Krammer, a flu expert, said he did not think the next pandemic was “imminent”. But, he added, “make no mistake, this is not a good situation.”
Experts have advised people to take some basic precautions in the meantime.
In recent years, raw milk, as unpasteurized milk is called, has grown in popularity from Brooklyn to Iowa. But cow udders can be a reservoir for the H5N1 virus. The CDC advises drinking pasteurized milk.
Experts also advised staying away from wild birds and making sure pets stay away from them too.