Apoorva Mandavilli
Appearances
The Daily
How Close Are We to Another Pandemic?
One of the things that has to happen before we can get enough for everybody is also that the CDC scientists typically test to make sure that whatever version of the virus ends up circulating is still a good match for the vaccines that are in the stockpile. If they are, then yes, they can immediately ramp those up.
The Daily
How Close Are We to Another Pandemic?
But if it's not a match, then they have to create a new version of that vaccine and then ramp it up. All of those things take time. And so it would be a while before we were all protected.
The Daily
How Close Are We to Another Pandemic?
Yeah, that's a really good question. And we actually don't know. So when we have seen this virus in action in Southeast Asia, we've seen mortality rates of something like 50%. But I don't think we can assume that that's going to be the same here because we don't know if, for example, those people died because they were exposed to huge amounts of virus and that's why they got really sick.
The Daily
How Close Are We to Another Pandemic?
What we do know is that apart from the one person who died in Louisiana and then the Canadian teenager, most people have had relatively milder symptoms. And I say relatively because some of them did have things like pink eye, but not the pink eye that you and I think of. They had, you know, some level of hemorrhaging blood in the eyes, essentially. Oh my God. Yeah.
The Daily
How Close Are We to Another Pandemic?
So they did have some severe symptoms, but they did not get sick enough to the point of you know, needing ICU care or dying, except for the two people I mentioned.
The Daily
How Close Are We to Another Pandemic?
It wouldn't even need to be anywhere close to 50%. It could be 5% and it would still be more devastating. And it would be really just a very difficult thing to get our arms around. Also, because as you know, for flu tends to affect kids and older people. And in the past pandemics, like the 1918 pandemic, it affected young, healthy people in their 20s and 30s.
The Daily
How Close Are We to Another Pandemic?
So we don't know exactly what the virus is going to end up doing, but it's not a given that, you know, like COVID, it would be really bad for people who are older or who have certain underlying conditions and that it would mostly leave kids alone. I think we got lucky in those ways with COVID.
The Daily
How Close Are We to Another Pandemic?
We don't. I mean, we have some clues just based on what it's been doing as we've been talking about. But one thing that's really clear is that for it to become a pandemic virus, it has to change. And when it changes, we don't know what other ways it's going to change in and whether it'll have to give up some qualities like contagiousness.
The Daily
How Close Are We to Another Pandemic?
Will it become much milder in its quest to become more contagious? We don't know what trade-offs the virus is going to end up having to make.
The Daily
How Close Are We to Another Pandemic?
jumping into people and causing problems in people. In fact, at the time when you talked to Emily, there were probably only a couple of cases. Well, now we have 68. And we'll get to those 68 in a minute.
The Daily
How Close Are We to Another Pandemic?
Yeah, I mean, we do know that over the past year, you know, as little as was going on with things like testing, when there was big news, we did hear from the CDC. You know, they would hold these joint press conferences along with the USDA and the FDA, and they would talk through something like the Nevada case. And they did give out some public health messages.
The Daily
How Close Are We to Another Pandemic?
Like they did say, you know, don't drink raw milk, things like that. They may not have said it loudly or often enough, but they did say it. And I was just getting to a point with them in December where they were starting to say, More things like this is a low risk situation right now, but it could change very quickly. But now they've gone silent.
The Daily
How Close Are We to Another Pandemic?
And I don't think it's because there's nothing to say, because clearly there is. It just seems like we have not really any good visibility on what they're doing or not doing and how much information they are allowed to to give us. So it sort of is going to be incumbent upon us as citizens to be very careful.
The Daily
How Close Are We to Another Pandemic?
Yeah, I mean, I think it is very important to remember that we may never get to a bird flu pandemic. It may never happen. But the fact that we went through COVID is actually what's making us in worse shape than we were before. I think what we're seeing here is really a reaction to what happened during COVID. We're seeing it in so many different ways.
The Daily
How Close Are We to Another Pandemic?
So if you look at local public health departments, people left because they were being harassed for recommending vaccines or talking about public health measures. Public health departments have been gutted. A lot of states passed laws taking power away from public health departments. and their ability to make recommendations. People don't have trust in public health agencies.
The Daily
How Close Are We to Another Pandemic?
There's just this general antipathy toward the idea of dealing with another outbreak at all. And so that's really what I worry about, that even if we did have a situation that we would need to deal with, that too many people would be unwilling to deal with it, at least until it was too late.
The Daily
How Close Are We to Another Pandemic?
Yeah, so H5N1 is a bird flu virus, meaning it is really best adapted to infect birds. And usually, you know, you might expect to see it occasionally in a different kind of animal, just if an animal was in very close contact with an infected bird. But what we've been seeing now is that there are all kinds of animals, including mammals, that seem to be really susceptible to this virus.
The Daily
How Close Are We to Another Pandemic?
The range of animal species, we've gone from cats and deer and bears and sea mammals and raccoons and all of these animal species. And we've not really seen a virus gain that many new host species in such a short time. That's been really alarming to watch.
The Daily
How Close Are We to Another Pandemic?
According to a lot of the experts that I've talked to, they're like, we've never seen anything like this, where a virus just kind of storms through animal populations. But also then to include people in that, we've seen a lot of people get infected. So there's something about this virus that makes it quite promiscuous, if you will. And how bad is it? Like how many animals is this actually killing?
The Daily
How Close Are We to Another Pandemic?
Far too many. I mean, I have a Google alert for bird flu and every morning I see emails about, you know, this kind of new bird, these cranes, these poultry flocks in Long Island, these big cats in the zoo. I mean, every day there's news of more and more dead birds and animals that are affected. And often when it is a matter of a poultry flock, you have just a few birds that are affected.
The Daily
How Close Are We to Another Pandemic?
That means you might have to get rid of tens of thousands, maybe even hundreds of thousands of birds. So the scale of destruction is just staggering.
The Daily
How Close Are We to Another Pandemic?
Unfortunately, that's, yeah, directly related. I mean, we are seeing poultry flocks being killed at a really high rate because of infections. And so that's directly affecting egg supply. And we are going to see shortages of eggs. We are going to see those egg prices continuing to go up because we're still very much in the high circulation season for this virus. It's really everywhere right now.
The Daily
How Close Are We to Another Pandemic?
And so we're going to see more birds being affected and therefore fewer eggs.
The Daily
How Close Are We to Another Pandemic?
Yeah, that's really the number one thing that's made a lot of the scientists I talk to worry. So... We did not even really know that cattle were susceptible to this kind of influenza. That was number one, already a big surprise. And then we started to hear about how the virus was affecting the cattle. And it was doing these bizarre things.
The Daily
How Close Are We to Another Pandemic?
Like, first of all, there was a lot of virus in the milk of the cows. And the milk was turning this very thick, viscous, yellow texture that, you know, some of the veterinarians I talked to said they'd never seen anything like that before. So that was all a big surprise. And then it seemed like that's also how the virus was getting around, like between herds, is through milking machines.
The Daily
How Close Are We to Another Pandemic?
Because there was so much virus in the milk that, you know, it would contaminate the milking machines. And if they ended up using that for another herd or... you know, was transported through machines in some way or somebody's clothing, things like that. It was affecting other herds. And so it spread through the country that way.
The Daily
How Close Are We to Another Pandemic?
And one thing that's been really alarming to see most recently is that It seems like some of the cows, first of all, stay infected for a really long time.
The Daily
How Close Are We to Another Pandemic?
And then potentially some of these cows are getting reinfected, which means that the virus can then circulate in cows, perhaps indefinitely, providing lots and lots of opportunities for it to continue to mutate and potentially evolve into dangerous forms.
The Daily
How Close Are We to Another Pandemic?
That's correct. And also, the longer it stays in cows, you know, we've been hearing that potentially the second time around, the cows may not show very many symptoms. If you know that a cow is sick, you can sort of take precautions. You can make sure that the cow is isolated or the herd is isolated.
The Daily
How Close Are We to Another Pandemic?
But if you don't even know that they're sick because the symptoms are really mild, then you can't even really do much to keep them isolated and to prevent people from coming into contact with them or being careful when they do. So it just raises the stakes in a different way.
The Daily
How Close Are We to Another Pandemic?
Probably. We know that there are many cats that have gotten really sick. Some of them have died and they've gotten it either from drinking raw milk that contained the virus, which we know is not safe. But also some of them have gotten sick from eating raw pet food. And some of the experts I've talked to have pointed out if it's in raw pet food, it's probably in raw human food.
The Daily
How Close Are We to Another Pandemic?
And so people should be really careful about not eating raw meat, that they should really make sure they cook their meat really properly. They definitely should not be drinking raw milk. And they should also be careful what their pets are putting in their mouths.
The Daily
How Close Are We to Another Pandemic?
Well, they shouldn't be feeding them raw pet food, for one. But also, yeah, I mean, I have talked to experts who said it's not a great idea to let cats roam around outdoors where they might come into contact with dead birds that might be infected. You know, cats that have gotten infected have died some pretty gruesome deaths.
The Daily
How Close Are We to Another Pandemic?
They get these very severe neurological symptoms, and a lot of them end up dying.
The Daily
How Close Are We to Another Pandemic?
In most of the cases, they got infected by either being really close to and interacting with an infected animal, like a dairy cattle in most of those cases, or poultry. There were three cases where they don't know how the person got infected. And so that's a bit of a mystery.
The Daily
How Close Are We to Another Pandemic?
So far, we haven't really seen that. There was one set of people who lived in the same household in Missouri who there was some question that maybe they gave it to each other. But overall, we have not seen any signs that the virus is now jumping between people or knows how to do that. However, I will say there is a new version of the virus that's now circulating.
The Daily
How Close Are We to Another Pandemic?
And it was just seen in the cattle in Nevada. And what they discovered is that it seems to already have a mutation that makes it easier for the virus to infect people. And the thing about that particular version of the virus is that we know of at least two people who've become infected with it who got very, very sick. So there was one person in America who died of H5N1, this patient in Louisiana.
The Daily
How Close Are We to Another Pandemic?
And then there was a 13-year-old teenager from Canada who both got infected with that version of the virus, and they were both sick for many weeks, and the Louisiana patient died. But the really worrisome part about that was that in both of those people, the virus continued to mutate while it was in the person and acquired some mutations that would make it easier for it to spread between people.
The Daily
How Close Are We to Another Pandemic?
Fortunately, it did not do that. It didn't jump from them to anybody else. But it showed us that the virus is capable of doing that. And in both of these patients, the Canadian teenager and the Louisiana patient, one of the mutations was the same. Usually when you see that, it means that that mutation gives the virus some kind of advantage that it likes, that it's going to hang on to.
The Daily
How Close Are We to Another Pandemic?
And so it's just a sign that the virus is good at getting to the place where it can become better at infecting people.
The Daily
How Close Are We to Another Pandemic?
We may not be close at all. We may never get there. We may never get to a point where the virus has all the mutations it needs to set off a human pandemic. But what the experts I talked to are saying is every time the virus infects a person or a cow, it gets another shot at getting the right combination of mutations.
The Daily
How Close Are We to Another Pandemic?
And the more chances it has, the better the odds that at some point it's going to get the winning combination. And if it does that, we are not ready.
The Daily
How Close Are We to Another Pandemic?
Well, we know from COVID that the number one thing we have to do to figure out how widespread a disease is, is to test. So over the past year, we've actually not been doing the kind of testing we would need to do to know how far this virus has spread. We have not been testing enough animals. We have not been testing enough people.
The Daily
How Close Are We to Another Pandemic?
We have not been testing enough of the contacts of the people that we knew got infected. And we also have not gotten the kind of access to all of the samples we would need to see, oh, how much is this virus changing? How fast is it changing? What mutations does it have? So we're really operating quite in the dark. And that is not all on the federal agencies either.
The Daily
How Close Are We to Another Pandemic?
I mean, you know, when it comes to public health, actually, a lot of the authority on what can be done and what can't really comes from the states. And most of the states that have been affected by the bird flu outbreak have really not taken the kinds of measures that they would need to to get farmers on board, farm owners on board, make sure that people are tested, make sure that cows are tested.
The Daily
How Close Are We to Another Pandemic?
Yeah, the darkness just got even darker. Like there's just so little information coming out about what's going on. The Trump administration muted all the federal officials. They told them that they couldn't communicate with even state partners. They couldn't communicate with each other. They couldn't have group meetings, scientific meetings within the agencies.
The Daily
How Close Are We to Another Pandemic?
They couldn't talk to the World Health Organization. There was just this communications blackout. And so what it has meant is that we've gotten information just really slowly about everything. And what information we have gotten, you know, we're not even sure if it is giving us the full picture. For example, there is a set of reports that comes out from the CDC every week.
The Daily
How Close Are We to Another Pandemic?
It's been more than two weeks since they were supposed to come out. We haven't seen those yet. And that was supposed to include some papers about bird flu. So it's just really hard to know to what extent we are being stymied by this communications ban with very crucial information. Some of that may be being loosened, but at the same time, these agencies are under attack in other ways.
The Daily
How Close Are We to Another Pandemic?
We're hearing that large numbers of CDC people might actually be let go. The so-called epidemic intelligence officers are like the fellows who do a lot of the shoe leather epidemiology work. We know that... the CDC was asked to make a list of people who had been there for a short time. And many of those people have already been let go. And so that is something to really keep an eye on.
The Daily
How Close Are We to Another Pandemic?
That is what I'm saying. And we also know that Robert F. Kennedy Jr., who may end up being the secretary of the Department of Health and Human Services, so overseeing the CDC and other health agencies— is not a big fan of infectious disease research, has made many anti-vaccine comments.
The Daily
How Close Are We to Another Pandemic?
And so we're just in the situation where we really don't know if bird flu were to become a problem, whether the agencies would be empowered to do the kind of work they would need to be doing. I mean, elsewhere in the world, there's very much an acknowledgement that there may be another pandemic. There probably will be one, in fact, in our lifetimes.
The Daily
How Close Are We to Another Pandemic?
So Emily covers animals. And when you talked to her, the virus was really mainly a threat to animals and to wild birds. It was in birds all over the country. But since then, you know, it really started infecting a lot of different kinds of animals, actually, in a way that I've heard experts say they've never seen a virus do before. And then it also became quite clear that it is capable of
The Daily
How Close Are We to Another Pandemic?
And so other countries have really been trying to prepare for that by coming up with this you know, global pandemic treaty and coming up with rules that all countries abide by if there were to be an outbreak, like sharing information with each other. And the U.S. was very much a part of those discussions. But we have just announced our intention to withdraw from the World Health Organization.
The Daily
How Close Are We to Another Pandemic?
And in the same breath, President Trump also said that we would no longer really participate in these global efforts to come to an agreement on how the world would deal with the pandemic. Apoorva, what about a vaccine? Do we even have one? So we do have a vaccine. It's actually a two-dose vaccine, and we have a few million doses.
The Daily
How Close Are We to Another Pandemic?
But obviously, that would be a drop in the bucket if this were to become really big. We could get more, especially if we did mRNA, which we know can be done really quickly, as we saw in COVID. But it would still take... I think, several months before we had enough for the entire population.