Covid lessons remain unlearned as avian flu infects cattle, hospitals say

Hospital leaders say the health system won’t be ready if the avian flu that’s infected American dairy cattle becomes widespread among humans.

In discussing a hypothetical scenario, the hospitals have struck a different tone than the Biden administration. It says the risk is currently low to most people and that agencies are closely monitoring for any sign of danger to Americans.

Still, hospital officials told POLITICO they’re dismayed that they don’t feel better prepared, just four years after Covid-19 caught them unawares. They’re not confident that the health care system — including the government agencies that have wound down Covid responses — can avoid the missteps around tests, bed space and communication that plagued the last public health emergency, should this strain of flu, H5N1, become more of a threat.

“I don't think that we would do well if we were to be hit by a pandemic right now,” said Dr. Payal Patel, an infectious disease specialist at Intermountain Health in Utah. “What we’ve learned over the last few years is that it’s really hard to predict what turn things will take — and also that it's important to learn from the past.”

The H5N1 virus has mainly caused mild illness among the animals and isn’t currently spreading between humans, as far as health leaders know. There has been one confirmed case of avian flu in a person amid this outbreak: a farmworker in Texas, whose only symptom was conjunctivitis, from which he recovered. That suggests there’s little risk of widespread infection at the moment, according to infectious disease experts. But it’s difficult to predict whether it could mutate and trigger a public health emergency, they add.

It’s also difficult to know how virulent the disease would be, though some experts suspect it could cause illness more severe than Covid. The CDC has said that H5N1 has sometimes caused severe illness and death in other countries, and other avian flu strains have killed millions dating back to the 1918 pandemic.

Dr. Bruce Farber, chief public health and epidemiology officer at Northwell Health, New York’s largest hospital system, said the possibility of the disease spreading among humans remained a “black swan event.” But then again, so was Covid. Northwell’s workforce and revenues were hammered during the early months of the pandemic as it treated an influx of patients. 

Farber said the transmission among cattle is “alarming” and that “we’re far from ready” if the disease spreads widely among humans. “There doesn't seem to be enough political motivation. I mean, quite the contrary: The politics are, if anything, further against public health than they were before the pandemic.”

Biden administration officials cite improved disease surveillance and healthier stockpiles of medical supplies. Leaders across the major health agencies have regularly updated reporters on ongoing virus tracking and say they’re moving in the right direction to prepare for wider spread.

“There’s a head start, which is good — more than we had in Covid, when it comes to pandemic flu,” said Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services. “But there will be work that needs to happen — and decisions that will need to be made and funding that needs to come quickly, if we ramp up.”

But infectious disease experts at major health systems say they haven’t had time to recover from Covid. Some veteran care providers left the medical profession, and many of the doctors and nurses who remain are at risk of burnout were they to face another crisis.

“We just simply do not have the manpower — currently — to care for the people that are coming in through our doors,” said Dr. George Diaz, an infectious disease specialist at Providence health in Washington state. “We don’t have an adequate supply of the people to care for the people.”

Trust in health systems also remains battered from the Covid wars over lockdowns, masks and vaccines.

"One big limiting factor" in vaccinating the public, were it to become necessary, "would be whether or not people actually take it,” Diaz said. “The Covid pandemic taught us a lot of lessons, but also harmed us.”

And if a lockdown were needed again?

“Society right now — It's not a consideration,” Farber said. “The politics are such that it will never happen.”

Covid lessons

Covid, at least, showed where the health system’s weaknesses lie when a new disease emerges.

Hospital officials said they have a better familiarity with the supply-chain bottlenecks that slowed the deployment of personal protective equipment and testing supplies early in the pandemic.

But that understanding doesn’t mean the response would be better if avian flu were to blow up, they said. Hospitals worry about buying testing supplies that will expire before they’re used, and should the threat of H5N1 escalate, many health systems would have to bid for a limited stock. And some providers were concerned that antivirals could also have many providers vying for a relatively limited supply.

Pitfalls remain because the supply chain is complex, involving players across the globe. “It's like you have to fix 25 different parts of the pipe to make sure that it doesn't leak,” Patel said.

Disease surveillance is ahead of where it was early in the Covid pandemic. Monitoring the changes in spread through animal populations — as well as decades of experience tracking avian flu — could serve the health system well.

But communication throughout the health system isn’t as rapid as it needs to be, said Dr. Katelyn Jetelina, an epidemiologist who advises the Centers for Disease Control and Prevention.

“Data is the key to visibility and action,” she said. “Unfortunately, the past month and a half has not calmed my nerves that we’ve learned our lessons.”

‘Not flat-footed’

Health providers relied on the government for critical resources through the Covid pandemic — something they’d have to do again if another pandemic comes.

Government officials said they’re ready to help.

Millions of doses of the vaccine that they believe could be useful for H5N1 are in government stockpiles, they said, some of which could be in arms in a matter of weeks. Antivirals that target influenza that may also be helpful are on hand, available through commercial channels and in government storage.

“We’re not flat-footed,” O’Connell said.

But officials concede there are some ways in which an escalated response to H5N1 wouldn’t be as easy as some Covid actions were, at least without the trillions in funding Congress appropriated during the pandemic and is less likely to provide again.

And there’s another critical question for government officials and health providers alike that could make the difference in not repeating the mistakes of 2020: when to act.

“If we get it wrong, there are some major implications,” Jetelina said.

Before Covid-19, Farber predicted influenza would cause the next pandemic — and though he was wrong (Covid was caused by a coronavirus) — Farber “would still bet on influenza the next time around."

“I think we'd be very foolish if we weren't paying very close attention to this virus,” he said.

David Lim contributed to this report.