Clues from bird flu’s ground zero on dairy farms in the Texas panhandle

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Amy Maxmen | KFF Health News (TNS)

In early February, dairy farmers in the Texas Panhandle began to notice sick cattle. The buzz soon reached Darren Turley, executive director of the Texas Association of Dairymen: “They said there is something moving from herd to herd.”

Nearly 60 days passed before veterinarians identified the culprit: a highly pathogenic strain of the bird flu virus, H5N1. Had it been detected sooner, the outbreak might have been swiftly contained. Now it has spread to at least eight other states, and it will be hard to eliminate.

At the moment, the bird flu hasn’t adapted to spread from person to person through the air like the seasonal flu. That’s what it would take to give liftoff to another pandemic. This lucky fact could change, however, as the virus mutates within each cow it infects. Those mutations are random, but more cows provide more chances of stumbling on ones that pose a grave risk to humans.

Why did it take so long to recognize the virus on high-tech farms in the world’s richest country? Because even though H5N1 has circulated for nearly three decades, its arrival in dairy cattle was most unexpected. “People tend to think that an outbreak starts at Monday at 9 a.m. with a sign saying, ‘Outbreak has started,’” said Jeremy Farrar, chief scientist at the World Health Organization. “It’s rarely like that.”

By investigating the origins of outbreaks, researchers garner clues about how they start and spread. That information can curb the toll of an epidemic and, ideally, stop the next one. On-the-ground observations and genomic analyses point to Texas as ground zero for this outbreak in cattle. To backtrack events in Texas, KFF Health News spoke with more than a dozen people, including veterinarians, farmers, and state officials.

An early indication that something had gone awry on farms in northwestern Texas came from devices hitched to collars on dairy cows. Turley describes them as “an advanced fitness tracker.” They collect a stream of data, such as a cow’s temperature, its milk quality, and the progress of its digestion — or, rather, rumination — within its four-chambered stomach.

What farmers saw when they downloaded the data in February stopped them in their tracks. One moment a cow seemed perfectly fine, and then four hours later, rumination had halted. “Shortly after the stomach stops, you’d see a huge falloff in milk,” Turley said. “That is not normal.”

Tests for contagious diseases known to whip through herds came up negative. Some farmers wondered if the illness was related to ash from wildfires devastating land to the east.

In hindsight, Turley wished he had made more of the migrating geese that congregate in the panhandle each winter and spring. Geese and other waterfowl have carried H5N1 around the globe. They withstand enormous loads of the virus without getting sick, passing it on to local species, like blackbirds, cowbirds, and grackles, that mix with migrating flocks.

But with so many other issues facing dairy farmers, geese didn’t register. “One thing you learn in agriculture is that Mother Nature is unpredictable and can be devastating,” Turley said. “Just when you think you have figured it out, Mother Nature tells you you do not.”

Cat Clues

One dairy tried to wall itself off, careful not to share equipment with or employ the same workers as other farms, Turley recalled. Its cattle still became ill. Turley noted that the farm was downwind of another with an outbreak, “so you almost think it has to have an airborne factor.”

On March 7, Turley called the Texas Animal Health Commission. They convened a One Health group with experts in animal health, human health, and agriculture to ponder what they called the “mystery syndrome.” State veterinarians probed cow tissue for parasites, examined the animals’ blood, and tested for viruses and bacteria. But nothing explained the sickness.

They didn’t probe for H5N1. While it has jumped into mammals dozens of times, it rarely has spread between species. Most cases have been in carnivores, which likely ate infected birds. Cows are mainly vegetarian.

“If someone told me about a milk drop in cows, I wouldn’t think to test for H5N1 because, no, cattle don’t get that,” said Thomas Peacock, a virologist at the Pirbright Institute of England who studies avian influenza.

Postmortem tests of grackles, blackbirds, and other birds found dead on dairy farms detected H5N1, but that didn’t turn the tide. “We didn’t think much of it since we have seen H5N1-positive birds everywhere in the country,” said Amy Swinford, director of the Texas A&M Veterinary Medical Diagnostic Laboratory.

In the meantime, rumors swirled about a rash of illness among workers at dairy farms in the panhandle. It was flu season, however, and hospitals weren’t reporting anything out of the ordinary.

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Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health, has worked in the panhandle and suspected farmworkers were unlikely to see a doctor even if they needed one. Clinics are far from where they live, she said, and many don’t speak English or Spanish — for instance, they may speak Indigenous languages such as Mixtec, which is common in parts of Mexico. The cost of medical care is another deterrent, along with losing pay by missing work — or losing their jobs — if they don’t show up. “Even when medical care is there,” she said, “it’s a challenge.”

What finally tipped off veterinarians? A few farm cats died suddenly and tested positive for H5N1. Swinford’s group — collaborating with veterinary labs at Iowa State and Cornell universities — searched for the virus in samples drawn from sick cows.

“On a Friday night at 9 p.m., March 22, I got a call from Iowa State,” Swinford said. Researchers had discovered antibodies against H5N1 in a slice of a mammary gland. By Monday, her team and Cornell researchers identified genetic fragments of the virus. They alerted authorities. With that, the U.S. Department of Agriculture announced that H5N1 had hit dairy cattle.

Recalling rumors of sick farmworkers, Texas health officials asked farmers, veterinarians, and local health departments to encourage testing. About 20 people with coughs, aches, irritated eyes, or other flu-like symptoms stepped forward to be swabbed. Those samples were shipped to the Centers for Disease Control and Prevention. All but one was negative for H5N1. On April 1, the CDC announced this year’s first case: a farmworker with an inflamed eye that cleared up within days.

Thirteen dairy farms in the panhandle had been affected, said Brian Bohl, director of field operations at the Texas Animal Health Commission. Farmers report that outbreaks among the herds last 30 to 45 days and most cows return to milking at their usual pace.

The observation hints that herds gain immunity, if temporarily. Indeed, early evidence shows that H5N1 triggers a protective antibody response in cattle, said Marie Culhane, a professor of veterinary population medicine at the University of Minnesota. Nonetheless, she and others remain uneasy because no one knows how the virus spreads, or what risk it poses to people working with cattle.

Although most cows recover, farmers said the outbreaks have disrupted their careful timing around when cattle milk, breed, and birth calves.

Farmers want answers that would come with further research, but the spirit of collaboration that existed in the first months of the Texas outbreak has fractured. Federal restrictions have triggered a backlash from farmers who find them unduly punishing, given that pasteurized milk and cooked beef from dairy cattle appear to pose no risk to consumers.

The rules, such as prohibiting infected cattle from interstate travel for 30 days, pose a problem for farmers who move pregnant cattle to farms that specialize in calving, to graze in states with gentler winters, and to return home for milking. “When the federal order came out, some producers said, ‘I’m going to quit testing,’” Bohl said.

In May, the USDA offered aid, such as up to $10,000 to test and treat infected cattle. “The financial incentives will help,” Turley said. But how much remains to be seen.

Federal authorities have pressed states to extract more intel from farms and farmworkers. Several veterinarians warn such pressure could fracture their relationships with farmers, stifling lines of communication.

Having fought epidemics around the world, Farrar cited examples of when strong-arm surveillance pushed outbreaks underground. During an early 2000s bird flu outbreak in Vietnam, farmers circumvented regulations by moving poultry at night, bribing inspection workers, and selling their goods through back channels. “Learning what drivers and fears exist among people is crucial,” Farrar said. “But we always seem to realize that at a later date.”

A powerful driver in the U.S.: Milk is a $60 billion industry. Public health is also bound to bump up against politics in Texas, a state so aggrieved by pandemic restrictions that lawmakers passed a bill last year barring health officials from recommending COVID-19 vaccines.

Texas Agriculture Commissioner Sid Miller said that when he heard that federal agents with the CDC and USDA were considering visits to farms — including those where farmers reported the cattle had recovered — he advised against it. “Send federal agents to dairy that’s not sick?” he said. “That doesn’t pass the smell test.”

From Texas to the Nation

Peacock said genomic analyses of H5N1 viruses point to Texas as ground zero for the cattle epidemic, emerging late last year.

“All of these little jigsaw puzzle pieces corroborate undetected circulation in Texas for some time,” said Peacock, an author on one report about the outbreak.

Evidence suggests that either a single cow was infected by viruses shed from birds — perhaps those geese, grackles, or blackbirds, he said. Or the virus spilled over from birds into cattle several times, with only a fraction of those moving from cow to cow.

Sometime in March, viruses appear to have hitched a ride to other states as cows were moved between farms. The limited genomic data available links the outbreak in Texas directly to others in New Mexico, Kansas, Ohio, North Carolina, and South Dakota. However, the routes are imprecise because the USDA hasn’t attached dates and locations to data it releases.

Researchers don’t want to be caught off guard again by the shape-shifting H5N1 virus, and that will require keeping tabs on humans. Most, if not all, of about 900 people diagnosed with H5N1 infections worldwide since 2003 acquired it from animals, rather than from humans, Farrar said. About half of those people died.

Occasional tests of sick farmworkers aren’t sufficient, he said. Ideally, a system is set up to encourage farmworkers, their communities, and health care workers to be tested whenever the virus hits farms nearby.

“Health care worker infections are always a sign of human-to-human transmission,” Farrar said. “That’s the approach you want to take — I am not saying it’s easy.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Gophers-Badgers football game moved to Black Friday for 2024

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The Battle for Paul Bunyan’s Axe has a new day.

The annual Gophers-Badgers football rivalry will be played at 11 a.m. on the Friday after Thanksgiving this year, according to a report from Matt Fortuna on Thursday. The 2024 rematch will be played in Madison, Wis.

College football’s longest-played rivalry has been on the Saturday after Thanksgiving in eight of the past nine years. The COVID-19 pandemic moved the 2020 game to December 19.

This year’s switch is expected to alter holiday plans, especially for Minnesota fans looking to travel to attend the game. The morning kickoff also puts a wrench in what has usually been an afternoon start time.

Fortuna reported that CBS will carry the Axe game, while the Nebraska-Iowa game will stay on Black Friday but will be moved to primetime on NBC this fall.

Minnesota-Wisconsin has been played 133 times, with the Badgers holding a 63-62-8 edge. Wisconsin beat Minnesota 28-14 at Huntington Bank Stadium on Nov. 25, 2023.

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FDA urged to relax decades-old tissue donation restrictions for gay and bisexual men

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Rae Ellen Bichell | (TNS) KFF Health News

The federal government in 2020 and 2023 changed who it said could safely donate organs and blood, reducing the restrictions on men who have had sex with another man.

But the FDA’s restrictions on donated tissue, a catchall term encompassing everything from a person’s eyes to their skin and ligaments, remain in place. Advocates, lawmakers, and groups focused on removing barriers to cornea donations, in particular, said they are frustrated the FDA hasn’t heeded their calls. They want to align the guidelines for tissue donated by gay and bisexual men with those that apply to the rest of the human body.

Such groups have been asking the FDA for years to reduce the deferral period from five years to 90 days, meaning a man who has had sex with another man would be able to donate tissue as long as such sex didn’t occur within three months of his death.

One of the loudest voices on lightening the restrictions is Sheryl J. Moore, who has been an advocate since her 16-year-old son’s death in 2013. Alexander “AJ” Betts Jr.’s internal organs were successfully donated to seven people, but his eyes were rejected because of a single question asked by the donor network: “Is AJ gay?”

Moore and a Colorado doctor named Michael Puente Jr. started a campaign called “Legalize Gay Eyes” and together got the attention of national eye groups and lawmakers.

Puente, a pediatric ophthalmologist with the University of Colorado School of Medicine and Children’s Hospital Colorado, said the current patchwork of donor guidelines is nonsensical considering advancements in the ability to test potential donors for HIV.

“A gay man can donate their entire heart for transplant, but they cannot donate just the heart valve,” said Puente, who is gay. “It’s essentially a categorical ban.”

The justification for these policies, set 30 years ago as a means of preventing HIV transmission, has been undercut by the knowledge gained through scientific progress. Now, they are unnecessary and discriminatory in that they focus on specific groups of people rather than on specific behaviors known to heighten HIV risk, according to those who advocate for changing them.

Since 2022, the FDA’s Center for Biologics Evaluation and Research has put changes to the tissue guidance on its agenda but has yet to act on them.

“It is simply unacceptable,” Rep. Joe Neguse, D-Colo., said in a statement. He was one of dozens of Congress members who signed a letter in 2021 that said the current deferral policies perpetuate stigma against gay men and should be based on individualized risk assessments instead.

“FDA policy should be derived from the best available science, not historic bias and prejudice,” the letter read.

The FDA said in a statement to KFF Health News that, “while the absolute risk transmission of HIV due to ophthalmic surgical procedures appears to be remote, there are still relative risks.”

The agency routinely reviews donor screening and testing “to determine what changes, if any, are appropriate based on technological and evolving scientific knowledge,” the statement said. The FDA provided a similar response to Neguse in 2022.

In 2015, the FDA got rid of a policy dubbed the “blood ban,” which barred gay and bisexual men from donating blood, before replacing it in 2023 with a policy that treats all prospective donors the same. Anyone who, in the past three months, has had anal sex and a new sexual partner or more than one sexual partner is not allowed to donate. An FDA study found that, while men who have sex with men make up most of the nation’s new HIV diagnoses, a questionnaire was enough to effectively identify low-risk versus high-risk donors.

The U.S. Public Health Service adjusted the guidelines for organ donation in 2020. Nothing prevents sexually active gay men from donating their organs, though if they’ve had sex with another man in the past 30 days — down from a year — the patient set to receive the organ can decide whether or not to accept it.

But Puente said gay men like him cannot donate their corneas unless they were celibate for five years prior to their death.

He found that, in one year alone, at least 360 people were rejected as cornea donors because they were men who had had sex with another man in the past five years, or in the past year in the case of Canadian donors.

Corneas are the clear domes that protect the eyes from the outside world. They have the look and consistency of a transparent jellyfish, and transplanting one can restore a person’s sight. They contain no blood, nor any other bodily fluid capable of transmitting HIV. Scientists suspect that’s why there are no known cases of a patient contracting HIV from a cornea transplant, even when those corneas came from donors of organs that did infect recipients.

Sheryl J. Moore has been advocating for the past decade to update the rules about gay men donating tissue since she lost her eldest son, Alexander “AJ” Betts Jr., to suicide in 2013 and his corneas went to waste. (KC McGinnis for KFF Health News/TNS)

Currently, all donors, whether of blood, organs, or tissue, are tested for HIV and two types of hepatitis. Such tests aren’t perfect: There is still what scientists call a “window period” following infection during which the donor’s body has not yet produced a detectable amount of virus.

But such windows are now quite narrow. Researchers with the Centers for Disease Control and Prevention found that nucleic acid tests, which are commonly used to screen donors, are unlikely to miss someone having HIV unless they acquired it in the two weeks preceding donation. Another study estimated that even if someone had sex with an HIV-positive person a couple of weeks to a month before donating, the odds are less than 1 in a million that a nucleic acid test would miss that infection.

“Very low, but not zero,” said Sridhar Basavaraju, who was one of the researchers on that study and directs the CDC’s Office of Blood, Organ, and Other Tissue Safety. He said the risk of undetected hepatitis B is slightly higher “but still low.”

At least one senior FDA official has indirectly agreed. Peter Marks, who directs the FDA’s Center for Biologics Evaluation and Research, co-authored a report last year that said “three months amply covers” the window period in which someone might have the virus but at levels too low for tests to pick up. Scott Haber, director of public health advocacy at the American Academy of Ophthalmology, said his group’s stance is that the tissue donation guideline “should be at least roughly in alignment” with that for blood donations.

Kevin Corcoran, who leads the Eye Bank Association of America, said the five-year abstinence required of corneal donors who are gay or bisexual isn’t just “badly out of date” but also impractical, requiring grieving relatives to recall five years of their loved one’s sexual history.

That’s the situation Moore found herself in on a July day in 2013.

Her son loved anime, show tunes, and drinking pop out of the side of his mouth. He was bad at telling jokes but good at helping people: Betts once replaced his little sister’s lost birthday money with his own savings, she said, and enthusiastically chose to be an organ donor when he got his driver’s license. Moore remembered telling her son to ignore the harassment by antigay bigots at school.

Xander and Jackson Moore look through belongings in a room dedicated to Alexander “AJ” Betts Jr. at home in Des Moines, Iowa. Sheryl J. Moore said Betts was enthusiastic about becoming an organ donor when he got his driver’s license. When he died at age 16, his heart, lungs, and liver were among the organs that helped prolong the lives of seven people, but his corneas went untouched. (KC McGinnis for KFF Health News/TNS)

“The kids in show choir had told him he’s going to hell for being gay, and he might as well just kill himself to save himself the time,” she recalled.

That summer, he did. At the hospital, as medical staff searched for signs of brain activity in the boy before he died, Moore found herself answering a list of questions from Iowa Donor Network, including, she recalled: “Is AJ gay?”

“I remember very vividly saying to them, ‘Well, what do you mean by, “Was he gay?” I mean, he’s never had penetrative sex,’” she said. “But they said, ‘We just need to know if he was gay.’ And I said, ‘Yes, he identified as gay.’”

The Iowa Donor Network said in a statement that the organization can’t comment on Moore’s case, but said, “We sincerely hope for a shift in FDA policy to align with the more inclusive approach seen in blood donation guidelines, enabling us to honor the decision of all individuals who want to save lives through organ and tissue donation.”

Moore said her son’s organs helped save or prolong the lives of seven other people, including a boy who received his heart and a middle-aged woman who received his liver. Moore sometimes exchanges messages with her on Facebook.

She found out a year later that her son’s corneas were rejected as donor tissue because of that conversation with Iowa Donor Network about her son’s sexuality.

“I felt like they wasted my son’s body parts,” Moore said. “I very much felt like AJ was continuing to be bullied beyond the grave.”

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

‘Eric’ review: Cumberbatch stars in limited drama series that packs in too much

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“Eric” is a show with a lot going on.

The limited drama series from Netflix, dropping its six episodes this week, has dirty cops, corrupt politicians, greedy businessmen and child sex traffickers. Set in mid-1980s New York City, it takes on the treatment of the homeless, as well as that of homosexuals in the time of AIDS.

At its core, though, it is a portrait of a man — Benedict Cumberbatch’s Vincent — battling personal demons after his 9-year-old son, Edgar (Ivan Howe in his first screen role), goes missing.

Who, then, is Eric? Fair question.

Eric is the colorful monster dreamed up by Edgar and brought to man-sized life by Vincent, the creator of a popular puppet-based children’s TV show. Eric ALSO becomes the imagined walking embodiment of the latter’s self-loathing. Invisible to others, Vincent talks to Eric constantly, even shouting at the invisible creature in the company of others.

Again, “Eric” is a show with a lot going on.

The tradeoff of the Abi Morgan-created series biting off more than it realistically can chew is that it is seldom boring, at least not for lengthy stretches. It jumps from plot thread to plot thread, all of which will tie together well enough by the end of its half-dozen hours. A little silly at times? Arguably. But not boring.

Vincent’s show is “Good Day Sunshine,” which has been a hit for years but is suffering from declining ratings, and so he and colleague Lennie (Dan Fogler of “The Offer”) are dealing with money men who want to see some changes made.

“We have to bridge the gap between the preschoolers and the elementary kids,” one says. “That’s where the cool kids are.”

However, Vincent is resistant to the addition of elements such as beatboxing, and he voices that to all within the sound of his voice in no uncertain terms.

After heading home with Edgar and buying him a comic book at a store where he gets some booze, Vincent engages in his latest shouting match with his increasingly exhausted wife, Cassie (Gaby Hoffmann, “Winning Time: The Rise of the Lakers Dynasty”), as Edgar hides in his room and draws. Although seemingly afraid there may be a monster living under his bed, Edgar has created myriad sketches of Eric.

Benedict Cumberbatch, left, as Vincent, and Ivan Howe, as Edgar, share a scene in the first episode of Netflix’s “Eric.” (Courtesy of Netflix)

In the morning, as his parents argue about whether he’s too young for Vincent to allow to walk to school on his own, Edgar does just that — although he never makes it to school.

In this time before mobile phones, Vincent never bothers to return Cassie’s call to his workplace that day, and he arrives home to find a cop from New York’s missing persons department, Det. Michael Ledroit (McKinley Belcher III), interviewing his wife.

McKinley Belcher III portrays police Det. Michael Ledroit in “Eric.” (Courtesy of Netflix)

After Edgar’s been missing for 48 hours, a press conference is held, during which Vincent looks into the camera and pleads with his son to come home, to prove everyone wrong who believes he’s dead.

He then decides to take matters into his own hands … by creating Eric and putting him on TV with the hope Edgar will see his creation on the screen and come home. Cassie suggests upon learning of this plan that he has lost he has lost his mind. (We agree!) Plus, he’s compulsively drinking — and abusing other substances — by this point.

Cumberbatch, an actor known for portraying Doctor Strange in the Marvel Cinematic Universe as well as for his excellent work in “Sherlock” and “The Imitation Game,” is uneven here. To be fair, he has a tall task as this show’s main character, whom we need to root for even as he’s rude to people who care about him and thrashes about the Big Apple with his equally abrasive imaginary friend. (Cumberbatch goes growly and gravelly to voice Eric, who, like many of the city’s homeless, lives below ground.)

The strongest performance is turned in by Belcher (“Mercy Street,” “Ozark”). If Vincent is the show’s pulsing heartbeat, Ledroit is its soul, a closeted gay man who lives with his secret (and ill) lover, William (Mark Gillis). A former detective in the vice unit, the well-intentioned and determined Ledroit can’t stay away from a shady nightclub on Edgar’s path to school, which angers his boss (David Denman, “13 Hours: The Secret Soldiers of Benghazi”) — especially after Ledroit has a run-in with current vice cops.

More interesting on-screen work is turned in by Bamar Kane (“Father & Soldier”) as Yuusuf, a member of one of the city’s homeless communities and who becomes important in the story.

Bamar Kane and Alexis Molnar portray members of a homeless community in mid-1980s New York City in “Eric.” (Courtesy of Netflix)

While not as steady overall as Belcher’s work, “Eric” has an unmistakable consistency as a result of all the episodes being penned by Morgan (“The Hour,” “The Iron Lady”) and directed by Lucy Forbes (“The End of the F***ing World”). There is value to this feeling like a long film but only so much.

Early on, “Eric” relies too heavily on red herrings, such as the brief interest in George (Clarke Peters, “The Wire”), the superintendent of the building where the family lives, as a possible kidnapper because, in part, he’d been friendly to Edgar and let him hang out in his place.

“Eric” keeps us guessing as to what has happened to Edgar for only so long, but it doesn’t grow any stronger after the reveal.

You can’t help but appreciate the work to bring 1980s New York to the screen, including exterior scenes chock full of extras.

One of which is the climactic scene of “Eric,” which, in being true to the rest of the show, is just too much.

‘Eric’

What: Six-episode limited drama series.

Where: Netflix.

When: All episodes available May 30.

Rated: TV MA.

Stars (of four): 2.