B.C. doc reflects on treating teen with bird flu for two months

She was in respiratory distress, but there was no “clear flag”

They sent diagnostic tests to the hospital lab to determine the type of influenza that had sickened the teen.

They all came back negative.

1/ "This child needed a lot of support, basically the maximum amount of respiratory support that we're able to provide in a modern ICU,"

She started an antiviral the day of her diagnosis. The team initiated a combination therapy that added two other antivirals

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Been thinking about the risk of an H5N1 pandemic

1/ Humans are masters of self-sabotage.

Faced with low-probability, high-consequence events, we consistently make the same mistake.

We cling to the illusion of stability.

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Oregon has just delivered a new chapter in our ongoing saga of negligence.

Raw feline pet food contaminated with the B3.13 genotype of H5N1.

A strain tied to dairy cattle outbreaks.

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https://twitter.com/rajlabn/status/1873226145879212433

This is a strain explicitly associated with agricultural livestock, and now it’s showing up in household pet food in a state that, officially, has no documented presence of B3.13 in its dairy cattle, poultry, or wildlife.

So where did it come from?

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Backyard chickens are one of the most underrated threats to public health today 🧵

With H5N1 bird flu making global headlines, it’s becoming clear that these flocks are pandemic incubators.

1/ A chicken with diarrhea?

A rooster that can’t lift its head?

Liquid pouring from a dead bird’s beak?

Red flags.

Owners shrugging off these symptoms and relying on guesswork are gambling with their flock’s health.

And their own safety.

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Humanization of avian influenza 🧵

Low-frequency receptor-binding mutations similar to those seen in Louisiana were the precursors to one of the deadliest pandemics in human history.

The early stages of adaptation are already happening.

1/ We are witnessing genetic changes that demand attention.

We don’t know if a pandemic will happen tomorrow.

But we do know that the Louisiana case represents one of multiple evolutionary pathways converging toward a singular catastrophic outcome.

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If this sounds alarmist, good.

Cuz it should.

Bringing sick birds indoors is a disastrous decision that creates the perfect storm for zoonotic spillover.

A confined space, high viral load, and direct human exposure.

This is how pandemics are born 🧵

1/ The sudden death of your chicken, coupled with respiratory and neurological symptoms in the remaining birds screams H5N1.

A virus that poses catastrophic consequences not just for your flock but for you and anyone nearby.

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H5N1’s Mammalian Adaptation 🧵

PB2 E677K mutation in macaques is a warning we shouldn’t ignore.

The last time the world ignored such signs, 50 million died in 1918.

1/ H5N1 B3.13 is a highly pathogenic strain of avian influenza that primarily infects birds but is now increasingly concerning due to its ability to spill over into mammals.

In a recent experiment, researchers infected macaques (a close model for human biology) with this strain.

They discovered a mutation in the virus (PB2 E677K) present in the animals’ lung tissue.

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H5N1 is a warning sign 🧵

Our systems are broken.

We can’t keep treating industrial farming like a machine that runs without consequences.

1/ This virus thrives in the conditions we’ve created to feed billions.

But these same systems could spark a global food collapse.

Industrial farming is a necessity.

With nearly 8 billion people on Earth, we need efficient systems to produce food at scale.

Poultry and livestock farms are a cornerstone of global nutrition, especially in regions where affordable protein is scarce.

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The Louisiana case isn’t important because it’s severe.

It’s important because it confirms H5N1’s trajectory.

An entrenched, mutating virus with growing access to human hosts.

The window for proactive intervention is closing 🧵

1/ The first severe human case of H5N1 in the US is a signal event.

It’s not unexpected, but it is pivotal.

This case brings the virus into direct contact with a population and infrastructure unprepared for its trajectory.

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Wastewater does not lie 🧵

If genomic sequencing reveals that this surge is driven by seasonal strains, the implications are serious but manageable.

If sequencing reveals H5N1 or, worse, a reassortant virus, it is the first signal of a pandemic in the making.

1/ Pandemics appear hindsight-perfect.

Their emergence suddenly obvious.

Their warnings conveniently clear.

Then, everyone becomes an expert at recognizing what was missed.

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The emergence of D158N and N193K mutations in H5N1 near Poyang Lake has shifted the virus into a dangerous new phase.

It’s transforming it from a pathogen primarily infecting birds into a credible threat to human populations

🧵

1/ This evolutionary leap is no accident.

N193K establishes a hydrogen bond with human receptor structures.

It’s effectively unlocking H5N1’s ability to target human respiratory systems.

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The USDA’s recent findings are concerning 🧵

H5N1 samples from dairy cows in California and swine in Oregon have revealed the virus is not only infecting unexpected mammalian hosts.

It’s also mutating in ways that should set off alarms.

1/ S110N has been previously associated with changes in receptor specificity.

It means potentially enabling the virus to interact with alpha-2,6 receptors.

This is the evolutionary groundwork for a host range expansion.

A prerequisite for efficient human-to-human transmission.

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Mild isn’t a synonym of safe 🧵

Many recent H5N1 cases in humans have been described as mild.

On the surface, this might sound reassuring, especially for a virus historically associated with a fatality rate of 50-60%.

But make no mistake.

This isn’t good news.

1/ This is a red flag that the virus is adapting to human biology.

The slow creep of H5N1 human cases is a silent alarm few are hearing, and even fewer are prepared to confront.

What began as a virus largely confined to birds is now repeatedly spilling over into humans.

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The H5N1 outbreaks in the U.S. are no longer isolated incidents 🧵

Human cases in California and Missouri appear to share the same clade, B3.13.

This link raises the possibility of a novel transmission pathway.

Milk products.

1/ Both cases are classified as “unknown origin” since there is no evidence of direct exposure to poultry, which is the traditional reservoir for H5N1 in humans.

This lack of an avian connection points to a new, potentially mammalian host.

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The situation unfolding in the Democratic Republic of the Congo is serious 🧵

Dozens are dead in a matter of weeks, and we don’t even know what’s killing them.

Here’s why this is truly concerning.

1/ The official count is probably a fraction of the reality.

Many die at home, never making it into any statistics.

The symptoms (fever, cough, anemia) are vague, but the lethality isn’t.

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H5N1 is no longer a distant threat confined to birds.

It’s becoming a clear and present danger to humanity.

It’s closing the gap between animal-to-human transmission and the one thing we all dread:

Sustained human-to-human spread.

🧵

1/ The findings on H5N1’s 2022 strain are a brutal warning.

Rhis virus is becoming more adept at targeting humans.

It binds to cells in the human respiratory tract with greater efficiency than H5N1 from 2005, and even rivals the attachment and replication ability of H3N2.

Which caused the deadly 1968 pandemic.

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The teenager in British Columbia is a preview of what pandemic risk truly looks like 🧵

A single critical case, no clear source, and the absence of a transmission chain.

It’s a script we know too well, and one we’re doing nothing to rewrite.

1/ A single human infected with H5N1, a virus notorious for its catastrophic mortality in avian and human hosts, now lies in airborne isolation, lungs failing, held alive by machines.

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H275Y mutation in Canada's H5N1 poultry strains is a red flag.

This mutation, linked to Tamiflu resistance, doesn’t typically show up in North American wild bird influenza strains.

And it's likely driven by human intervention.

1/ H275Y cripples the effectiveness of our main antiviral.

In a pandemic scenario, we lose one of the only tools to slow the virus in humans.

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The 1918 flu wiped out 90% of adults in Brevig Mission, Alaska. 🧵

It carried a key mutation: PB2 E627K.

Now, H5N1 is showing signs of similar adaptation.

The strain detected in a Canadian teenager also carries PB2 E627K.

1/ In 1918, this mutation was pivotal in the virus’s jump from birds to humans and its ability to spread rapidly.

Despite lacking other mutations (Q226L / G228S) commonly associated with avian viruses adapting to human-like receptors, the 1918 virus exploited the mutations it had to devastating effect.



2/wwwnc.cdc.gov/eid/article/9/…

The real threat posed by Mpox 🧵

I believe that diseases that disproportionately affect marginalized groups cannot be left to burn out on their own.

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https://twitter.com/joshuamcclure/status/1849424911908888781

The social and moral costs of neglect far exceed the apparent savings in resources.

Failure to act reinforces a hierarchy of value.

Some lives are considered less worthy of protection.

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Let’s cut through the nonsense.

This isn’t about some noble fight for individual liberty.

The question, “When can I take off my mask?” is pure self-interest masquerading as a legitimate ethical concern.

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https://twitter.com/michaelmindrum/status/1848786116528284034

Let’s call it what it is.

An excuse to dodge responsibility.

You’re not genuinely worried about some profound moral principle.

You’re irritated that you still have to inconvenience yourself for the sake of others.

The real motivation here is to find a convenient moral loophole that lets you prioritize your own comfort over everyone else’s safety.

All while pretending to engage in some deep ethical debate.

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