BETHLEHEM, Pa. — When it comes to bird flu and people, there's a number of things that health care officials know, Dr. Jeffrey A. Jahre said Wednesday.
However, certain things remain unanswered, such as whether the virus spreads more or faster through the respiratory system or through direct contact.
While the first human death attributed to bird flu was reported last month in Louisiana, health care officials, both at a local and national level, say the risk to people remains low.
“One of the main things that concerns us is that there is some reason to suspect that our general area is an epicenter, or a focus, right now for what's going on with wild birds."Dr. Jeffrey A. Jahre, an infectious disease specialist at St. Luke’s University Health Network
However, health care officials at the Lehigh Valley’s two major health networks say they are preparing for an increase in cases in people, and keeping residents informed along the way.
“One of the main things that concerns us is that there is some reason to suspect that our general area is an epicenter, or a focus, right now for what's going on with wild birds,” said Jahre, an infectious disease specialist at St. Luke’s University Health Network.
“And, therefore, if this does become an issue in humans that's more of an issue than what it is, and particularly if there ends up being human-to-human transfer, which there is not right now, then there's every reason to suspect that the Greater Lehigh Valley will be largely affected.”
'Extremely important to us'
An influenza type A virus, bird flu is highly contagious and often fatal in birds.
Since hitting the United States in 2022, the virus has jumped from birds to dairy cows as well as other mammals.
Jahre said "even a basic question" such as whether the virus spreads more or faster through the respiratory system or through direct contact — those are the same questions that happened with COVID early on — are still not absolutely, definitively answered.
“Now, having said that, it doesn't mean that there's an absolute information void on this. What we do know is, although it's been around for decades, that it recently has become more of a prominent situation.
"There has been an absolute uptick very recently in a number of wild birds that have been infected, and that has been very evident in our area.
"That's what makes this extremely important to us.”
Bird flu, also called HPAI, or highly pathogenic avian influenza or H5N1, has recently infected thousands of birds in the Valley, including about 5,000 migratory snow geese and a 50,000-bird egg-laying chicken flock on a commercial farm.
Communication, testing, treatment
So far, there have been 66 confirmed human cases of bird flu in the United States since 2024 and 67 since 2022, according to the U.S. Centers for Disease Control and Prevention.
There have been no reported positive cases of bird flu in people in Pennsylvania.
St. Luke officials already have sent out information about avian flu, specifically tailored to medical workers, to all staff, including symptoms, testing and treatment.
They also plan to releasing guidance, in addition to setting up an information hotline, for residents.
“We have taken the lead, as we always have, and the way people expect us to do to protect our community,” Jahre said.
“We want people to be concerned, but we don't want people to be overly concerned or in a panic. We want to put this in the correct perspective.”
“Most of those cases were mild."Dr. Alex N. Benjamin, chief of infection control and hospital epidemiology for Lehigh Valley Health network
At Lehigh Valley Health Network, testing and treatment strategies have been implemented, said Dr. Alex N. Benjamin, chief of infection control and hospital epidemiology for the network.
“From most of the reports that we've seen so far about humans contracting avian influenza, there has to be a pretty significant exposure,” Benjamin said.
“The majority of cases we've seen so far in the U.S. are related to people who work with infected poultry, infected cattle.
“Most of those cases were mild. A lot of patients got conjunctivitis, which is just irritation of the lining of the eye, with fatigue.”
'What to do about it'
As for the person in Louisiana who died, officials said they had underlying health conditions that could have contributed.
“Now, we've got a spectrum of disease to deal with,” Benjamin said. “We've got people on one hand to get conjunctivitis, aren't that sick and stay home — they don't have to go to the emergency room.
“And, on the other hand, you've got a very sick individual who gets a disease and has a fatal outcome. We've got to somehow prepare for all of those things, keeping in mind that we also don't want to spread panic to the general population.”
LVHN is prepared to evaluate people who have light, flu-like symptoms and also have been exposed to sick or infected animals, or work at infected poultry farms, he said.
St. Luke’s is taking a similar approach with patients testing positive for the flu.
“If you have someone who tests positive for influenza, it's also important to ask them certain basic questions, i.e., 'Have you been around any wild birds, and particularly carcasses of wild birds?" Jahre said.
"Have you had any contact with poultry? Have you been to any state agricultural affairs? Do you drink unpasteurized milk?'
“Then, I think it's important to go further than just the average influenza test, which isn't going to tell you whether it is the avian flu type.
"And that's when we have given them advice on what kind of specimens to collect, where to send them, and what to do about it, in order for us to know if that's a human case or not.”
'It also could burn out'
Treatments for bird flu are the same as for the annual version — oseltamivir, known by its brand name, Tamiflu. However, the annual flu vaccine doesn't protect against bird flu, officials said.
“I feel pretty confident that we have the right kind of processes and algorithms in place, and then it's just going to be a matter of watching what happens over the next couple of weeks,” Benjamin said.
Influenza A cases in the area have increased over the past four weeks, he said.
“We don't know what's going to happen with this increased testing strategy that we have for looking for avian flu,” he said. “It may be that we find more and more cases.
“We have to be prepared for that. It could also burn out.”
Distrust, challenges
During the heights of the COVID-19 pandemic, health care became politicized, leading to distrust in healthcare professionals and officials.
It’s also arguable that distrust exists to this day.
“There are a lot of questions, and because of a lot of different things that happened during COVID and a lot of politicization of all of this, there's a lot of distrust,” Jahre said.
“What we're trying to do is to make sure that we tell people, in a very transparent way, what we know and also what we don't know.
“And also let people know that in any dynamic situation, it's subject to change.”
That distrust has been documented and studied. An article published in July in the Journal of the American Medical Association found trust in physicians and hospitals has sharply decreased, from 71.5% in April 2020 to 40.1% in January 2024.
After COVID, residents began analyzing data and reports with more skepticism, Benjamin said.
“As health care workers, we are trusted sources of information about health and medical conditions, so we have to rely on that when we communicate information,” he said.
“As health care workers having been on the front lines of the COVID pandemic, I feel like, overall, we still have the capability to transmit the best information.
“That's our challenge — communicating in a way where we make good recommendations based on the signs we know and we trust and that we vetted, and turn those into actionable things for the general public.”
'Prepared for those situations'
At the start of the COVID-19 pandemic, officials had to create infrastructure to communicate with residents and provide health care, whether through testing sites, online case dashboards or daily briefings.
Now that the pandemic has waned, much of that infrastructure no longer exists — a challenge both doctors agreed could be an obstacle to fighting the virus and getting residents the information they need.
"That's the tip of the iceberg, and an iceberg that we have no information about — we can't see into the water to see how big this is."Dr. Alex N. Benjamin, chief of infection control and hospital epidemiology for Lehigh Valley Hospital Network
“Not having those public health infrastructures to report and give you data is worrisome, at least from our standpoint," Benjamin said.
"Because we don't have a good way to communicate information — increases, decreases, any sort of trends we see in avian flu.”
A lesson learned from COVID was that epidemiologic data is extremely important, Jahre said.
“It has to be collected accurately,” he said. “It has to be collected very much contemporaneously, and that you have to have the ability to act on that data if you want to try and confine a disease.”
Unlike COVID, there are no rapid tests, Benjamin noted.
“We have no idea if those mild cases are lurking out there and just don't get to the attention of your primary care doctor's office, the ERs, the hospital system in general,” Benjamin said.
He noted the guidance from the CDC focused on ICU patients.
“But that's the tip of the iceberg, and an iceberg that we have no information about — we can't see into the water to see how big this is," he said.
“This may be very limited. If it's not spread well between human-to-human, it's possible to say that there may be a low burden of disease.
"But from an emergency preparedness standpoint, we want to think about worst-case scenarios and be prepared for those situations.”
