Everything "That Friend" Wants You to Know About H5N1 Bird Flu

An article with ongoing updates.

Photo by National Institute of Allergy and Infectious Diseases on Unsplash

The USDA has finally announced that it’s requiring unpasteurized milk to be tested for avian flu. This news comes as a major study has revealed that the virus now stands one mutation away from “binding more efficiently to human cells.” A piece in Mother Jones has said H5N1 will “define Trump’s second presidency.”

Yes, and it has already defined the outgoing one.

This news comes after the virus hospitalized a healthy teenager in Canada. Even as we see growing evidence of respiratory spread among humans, health officials insist there is “no evidence” of that so far, while refusing to talk about mitigation measures like N95 masks and clean air technologies, steps that should already be in place against existing diseases. Remember, these statements come from the same network of agencies that failed to catch H5N1 in cattle and spent the last year largely watching it spread while playing biosecurity theater.

It’s also in pigs now.

Agriculture Secretary Tom Vilsack once said his agency would “corner” the virus. He was wrong. Instead, the virus cornered us. We now have multiple clades threatening spillover from multiple directions. As Katherine Eban confirmed in a bombshell Vanity Fair report, these same agencies have also presided over a culture of complicity and fear, censoring their own veterinarians and forcing them to choose between their careers and speaking the truth.

Experts are beginning to predict H5N1 could start spreading among humans at scale this flu season. One healthcare worker even said, “My medical billing app just added it, novel avian influenza is now a billing option when I code acute hypoxemic respiratory failure. It was never there before last week.” You can always count on the healthcare industrial complex to be on their toes as agencies like the CDC and the FDA behave increasingly like PR agencies, telling the public to wash their hands while they roll back infection protections in hospitals and stall progress on promising vaccines by companies like Novavax.

Last month, the CDC also announced that they’re partnering with Walgreens to develop a test for bird flu in humans. As their release says, the program wants to prepare for “the symptoms and risk factors for infection with H5N1 bird flu among higher-risk populations,” including dairy and poultry workers. Bird flu promises us a pandemic as the incoming president makes plans to infuse our top healthcare institutions with an army of conspiracy theorists that includes Janette Nesheiwat as surgeon general, a woman who has written about “miracles” in medicine and sells her own brand of sketchy diet pills.

We’ve seen this movie before.

Not only did we watch these same mistakes five years ago, the 1918 flu appeared mild at first, so mild that doctors around the world dismissed it as harmless. Then it mutated into something highly contagious and deadly. The Woodrow Wilson administration devoted their energy to censoring information and manipulating public sentiment instead of preparing. As historian Guy Beiner notes in Pandemic Re-Awakenings, the 1918 flu caused more devastation than currently understood, with higher mortality and disability tolls than reported, and it likely altered the course of human history, beginning with the rise of fascism.

It might be about to happen again.

This time, a bird flu will ignite a pandemic in a global population whose immune systems are already beaten down by another disease.

As this virus continues to make headlines, we’re all left wondering what’s going to happen, whether it will become airborne, whether it’s safe to consume meat or dairy products, and what we should do to prepare.

We’re not getting clear answers.

So, here they are:

Ugh, are we going to have lockdowns again?

No, we’re probably not going to have lockdowns.

Not one single politician or healthcare official endorses that idea. We at least know how to stop viruses from spreading without shutting everything down. Four years ago, nobody had the slightest clue what to do.

Even if we needed lockdowns, it’s not happening.

So, relax…?

Should you be training your immune system?

No, you can’t “train” your immune system. You can protect your immune system. You can take treatments and therapies to help your immune system. You can teach your immune system with vaccines.

You can’t train it by deliberately catching diseases.

Most Americans base their knowledge of the immune system on lore, including standup comedy by George Carlin. He was right about a lot of things, but he was wrong about your immune system. It sounds good to say your immune system gets stronger with practice, but that’s misleading. Your immune system develops a memory of specific strains and variants of pathogens it has seen before. Sometimes, just a slight mutation can throw it off.

You have an innate immune system that doesn’t benefit from “practice” or training. That goes double for anyone with a dysregulated or weak immune system. Thanks to Covid, that pretty much includes everyone…

Even if they don’t know it.

If you want to understand how your immune system actually works, read Phillip Dettermer’s Immune.

Can you get sick from dairy products?

Yes, you can get sick from drinking raw milk.

Pasteurization works for now.

Studies have found that cats and mice can both catch bird flu from raw milk. A recent study in Emerging Infectious Diseases found that infected milk killed several cats, leading the authors to conclude that raw milk "might potentially transmit infection to other mammals via unpasteurized milk." Another recent study in the New England Journal of Medicine found that not only does raw milk infect mice, but it remains infectious for up to five weeks when it's refrigerated.

If you’re concerned about cheese, you can buy hard cheeses like sharp and extra sharp cheddar aged for a year or longer.

You can also find plant-based cheeses and sour cream.

(They taste just fine.)

Public health officials and major media outlets have ensured everyone that meat and dairy products remain safe, but they're just guessing. One recent study suggests that the normal pasteurization process isn't always enough to kill the virus, and that we should be upping our standards.

The USDA refuses.

According to Alexander Tin's notes from a conference call with public health agencies, officials don't want to raise the standards of pasteurization for milk because it could hurt the flavor. They also don’t want to test more. The principal deputy director of the CDC (Nirav Shah), said they have plenty of testing capacity for bird flu, but they're not using it because they're worried about "happening just to pick up a stray amount of virus from their nasal passage..."

For the record, infections begin in your nasal passage.

So, that’s your risk from dairy products.

Can you get sick from meat?

Yes, you can.

That's why we have publications like The Journal of Food Protection, dedicated entirely to protecting our food from dangerous diseases. Very recently, they published a study explaining that if you're going to insist on eating chicken, eggs, and beef, make sure you cook them thoroughly to an internal temperature of 71.1C (160F). Don't eat them raw or even rare. Also, fun fact: About 10 percent of American beef products come from culled dairy cows.

Other mammals can get sick from eating infected meat. We know for a fact that bears, foxes, seals, sea lions, and dogs have gotten sick and died from bird flu by eating dead birds. As experts tell us about these infections, "we see carnivores...particularly those that are known to scavenge."

The H5N1 virus doesn't care if you're a fox or a human.

How long can bird flu last in meat?

Generally, it can last for weeks.

A 2021 study in The Lancet found that the H7N9 strain of highly pathogenic bird flu can survive in raw poultry for up to nine days at -20C degrees and up to four days at 25C degrees. The H5N1 strain of bird flu lasts much longer. A 2017 study in Applied and Environmental Microbiology found that "tissue type could strongly affect viral survival." H5N1 can survive in muscle tissue (meat) for 100 to 160 days at 4C degrees and 8-14 days at 20C degrees. The virus can survive longer in feathers, up to 240 days at 4C degrees. The authors review previous studies that found H7N1 virus can survive for 135 days in meat at 4C degrees. Other studies of similar viruses found survival lengths of 40-81 days in poultry meat at 0C degrees, 11 to 14 days at 10C degrees, and 2-3 days at 20C degrees.

So we have a good sense that H5N1 lasts for months in the refrigerator, and probably even longer in the freezer. That's not great news for meat lovers, and it puts extra pressure on them to cook their meat properly.

Or maybe just give it up.

Is bird flu airborne?

We're seeing the early signs of airborne respiratory spread.

A study in the Journal of General Virology found that H5N1 can now replicate in "bovine airway epithelial cells." The researchers documented "rapid increases in viral genome loads and infectious virus during the first 24 hours post-inoculation." Their discussion confirms that the more practice this virus gets at infecting mammals, the better it gets at replicating and shedding in respiratory tracts and airways. Another study in Nature found that H5N1 has started mutating to infect human airways. So, it’s learning to jump from cows to humans.

Why is all this taking so long?

One little gene called BTN3A3 protects the upper and lower respiratory tracts of humans from infection. Researchers at the University of Glasgow Center for Virus Research discovered it last year and published their findings in Nature. The lead author did an interview with Reuters, where he said, "About 50 percent of H5N1 strains circulating globally so far in 2023 are resistant to BTN3A3." Once the virus overcomes that barrier, human cases will go up.

Most of the corporate media coverage has emphasized how "mild" the infections are, but they’re wrong. They describe eye bleeds as “pink eye,” and they’ve downplayed the fact that cases of bird flu have been resulting in hospitalization. Furthermore, as history shows, the 1918 bird flu began as a mild infection and then evolved to become more contagious and deadly.

We’re on that path.

What symptoms should you look for?

Look for neurological symptoms, not just cold symptoms.

In 1918, doctors misdiagnosed the flu as a dozen other major diseases. It caused severe organ and brain damage. We think of the flu as a respiratory virus. It’s not. It’s a multi-system infection that does lasting damage.

(Does that remind you of anything…?)

An article in Science News reviews the research on H5N1 outbreaks in wildlife, including the lesions they're finding in the lungs, hearts, livers, kidneys and brains of infected animals. It's causing seizures and paralysis, just like H1N1 did in 1918. This family of viruses "is exceptionally good at making copies of itself inside a variety of cells, including nerve cells." Lucky us, our brains are "covered in birdlike sialic acid proteins." Similar cells line our nasal passages, creating "a direct entry route to the brain from your nose." You could say we're bird brains.

So we shouldn't just be looking for respiratory symptoms or pink eye. We should also be watching out for neurological signs like disorientation, paralysis, lack of coordination, uncontrolled shaking, and tremors.

It will happen.

How long does H5N1 last on surfaces?

One disturbing study from 2010 in Environmental Science & Technology found that H5N1 can last for two weeks on glass and steel surfaces at temperatures around 39F (3.9C), and up to two months under even cooler temperatures. A 2022 study in Emerging Infectious Diseases found that H5N1 can last longer than most other flu viruses, up 24-26 hours on plastic surfaces and 3-4.5 hours on human skin. Fortunately, disinfectants with 40 percent alcohol solution killed H5N1 and other flu viruses within 15 seconds.

Studies on other viruses have shown that flu and coronaviruses can last several days or up to several weeks. They last longer on hard surfaces like plastic, glass, and steel than porous surfaces like cardboard.

Some people want to know if it's time to start wiping down groceries again. Well, that doesn't sound weird to me. If you want to build a UVC decontamination box to make life easier, this 2020 article in the Journal of Medical Systems explains how. You can also make disinfectants with alcohol or hypochlorous acid to help with surface transmission. You can read more here and here. You can also find various online stores that sell HOCl generators.

Should you wear a mask?

Yes, masks work.

Aaron Collins can help you up your mask game.

Despite widely misinterpreted studies about their effectiveness, overwhelming evidence indicates that an N95 mask works when you wear it properly. A major study in eBioMedicine (a Lancet Journal) reached similar conclusions, stating that “an N95 is significantly better than the other options.” The authors of the study have stated very clearly that “N95 masks should be the standard of care in high-risk situations, such as nursing homes and healthcare settings.” They work even without training or fit-testing. How do surgical masks stack up? Not well. In this study, even cloth masks with a good fit outperformed them.

A review of studies by Michael Klompas and Chanu Rhee in the Journal of Infectious Diseases also shows that “surgical masks provide substantially less protection against viral inoculation of the respiratory tract compared to fitted N95 respirators” and refers to “a wealth of real-world studies that document failures of surgical masks worn by healthcare workers… to prevent transmission, as well as case-control studies that found respirators to be more protective than surgical masks.” In fact, the authors end by declaring it’s time for the CDC to update its infection control guidelines in the face of such overwhelming evidence.

In fact, we had a growing body of evidence in favor of N95 masks before the pandemic began. One 2017 study in Influenza and Other Respiratory Viruses found that N95 masks “provide superior protection” for droplets.

You have to keep it on. You can’t take it down to eat or drink in public. You can’t take it down to say hello to someone. You can’t take it down because you think you’re alone. Virus particles remain in the air for hours. That’s why we need clean air, and why we need cities and counties to stop passing mask bans. These efforts actively undermine everyone’s efforts to keep each other safe.

Our governments should be encouraging masks.

They won’t.

Should you wear eye protection?

You should start thinking about eye protection. Don’t just pick up goggles from the hardware store. You need lab safety goggles.

Here’s a breakdown on that.

Is there a vaccine?

The U.S. will only have 10 million doses of a targeted H5N1 vaccine by spring 2025. That’s not going to be enough. Meanwhile, you can go ahead and get your seasonal flu shot. Contrary to what the CDC says, several studies do indicate that a regular shot offers some degree of cross-over protection. That’s because H5N1 shares some genetic similarities with earlier flu viruses.

It won’t keep you from getting infected, but it could very well reduce your likelihood of severe illness and death.

It sure beats nothing.

Should you clean the air?

Yes, absolutely.

We have an overwhelming amount of information that HEPA air purifiers work. They don’t stop transmission in cases where someone is sitting or standing right next to you without a mask, but they remove anywhere from 70 to 99 percent of the virus in the air, when they’re installed properly.

They significantly reduce your risk.

Carl Van Keirsbilck has written an extensive review of studies on the effectiveness of air purifiers. Nina Notman provides an extensive overview on the benefits of clean air, including air purifiers and why certain people might be so reluctant to embrace them. So does Andrew Nikiforuk.

First, the CDC found that adding two HEPA air purifiers “reduced overall exposure to simulated exhaled aerosol particles by up to 65 percent without universal masking.” When you add masks, it goes up to 90 percent. They recommend HEPA purifiers as part of an overall clean air strategy.

A review of more than 50 different studies in Indoor Air found that “when HEPA filters were utilized, regardless of the type of ventilation, number of ACH [air changes per hour] or hospital area, minimal surface-born and no airborne SARS-CoV-2 RNA was detected.” HEPA filters can significantly reduce the amount of virus in the air, even when you might struggle to ventilate a space.

A study in Environmental Science: Processes & Impacts found that portable air cleaners used in classrooms “reduce the mean aerosol intake of all students by up to 66 percent.” A study in Physics of Fluids found that using multiple HEPA purifiers in a classroom led to a reduction in viral aerosols “between 70% and 90%.” A study reported in Buildings & Facilities Management found that using a HEPA purifier in combination with open windows led to a 73 percent drop in the risk of infection in classrooms. A study in Virology found that a HEPA filter could remove between 80 and 99 percent of viral aerosols from a room.

A study in Aerosol Science and Technology found that when researchers installed four air purifiers in a high school classroom, “the aerosol concentration” of Covid “was reduced by more than 90 percent within less than 30 min” and the reduction “was homogeneous throughout the room…”

A study in the Journal of Hospital Infection found that HEPA filters can “reduce the viral load in air” by as much as 99 percent and that “air purification systems can be used as an adjunctive infection control measure.” A brief article in Nature reported that an ICU in Cambridge used HEPA purifiers to largely remove Covid and other pathogens from their wards. That brief report turned into a full study published in Clinical Infectious Diseases, showing that not only do these filters remove Covid but also “significantly reduced levels of bacterial, fungal, and other viral bioaerosols on both the surge ward and the ICU.”

A study in Infection Control & Hospital Epidemiology found that by using two HEPA air purifiers, “99% of aerosols could be cleared within 5.5 minutes.”

A study in Building and Environment found that combining air purifiers with ventilation in a gym “can reduce aerosol particle concentrations” by up to 90 percent, “depending on aerosol size.” Another study in the same journal found that adding a portable air purifier to a hospital patient’s room “could prevent the migration of nearly 98% of surrogate aerosols…”

So, they work.

What happens if you get sick?

If you get sick, and you can’t get proper medical attention, there’s a chance that you’ll be dealing with it on your own. It wouldn’t be a bad idea to dig into plant-based treatments, find something that suits your needs, and have some on hand for yourself and the ones you care about.

Here’s a list.

Should you panic?

It’s fine to feel fear. Fear drives appropriate action. In this case, appropriate action means masks, vaccines, treatments, and clean air. We live in an age of increased threats from a range of viruses, not to mention wildfires and pollution. Unfortunately, our government has taken money from public health and wasted it on police and military spending while convincing the public to “remain calm.”

That’s the situation.

What’s going to happen next?

According to John Barry’s history of the 1918 pandemic, the government did absolutely nothing to prepare for the flu, even as a first “mild” wave circulated the globe and sent up warning signals. Virtually no politician said a word. Newspapers who dared to report the truth were threatened with prosecution. The U.S. was entirely focused on war as death swept over cities. Public health agencies told the public to wash their hands and chew their food properly.

The truth spilled out, after it was too late.

In 1976, the Ford administration earned an enduring badge of shame for taking a rare, proactive approach to prevent a swine flu pandemic. It was one of the most successful public health campaigns in history, and it resulted in very few hospitalizations and deaths. The public came to see the preparations as a waste of time. This misperception fueled a tragic level of indifference to HIV in the 1980s, since no politician wanted to risk humiliation by mounting a response. While the public ignored HIV, the government obsessed over cold war politics and coups, and Americans fixated on the imaginary threat of satanic cults infiltrating towns and suburbs. They indulged a moral panic over board games.

The incoming president’s picks for healthcare are a solid staircase down from the current bureaucracy, but it’s important to remember that outgoing clowns like Mandy Cohen blazed the way forward for H5N1 bird flu, spreading their own misinformation and undermining trust in public health.

It just wasn’t as blatantly unhinged…

We’re less prepared for a pandemic than ever. We don’t have clean indoor air in most public spaces. The public has become skeptical of N95 masks. As we head into this year’s viral infection season, only 35 percent of Americans have updated their flu shots, and 18 percent have gotten Covid boosters.

Since most of our governments won't do anything, we have to protect ourselves and each other. That means the usual, masks and clean air. This time, we also have to start paying attention to fomites again. And given that bird flu has a propensity for airborne spread, and our eyes have bird flu receptors, we should be talking about whether we need goggles as well.

Since 2020, H5N1 has led to the death of 50-60 million birds and counting. It's an ecological disaster, unparalleled in scale. Our politicians campaign on the promise of listening to science. Then they don't. On the other hand, you have most of the information you need now.

Get ready.