Even though it is becoming increasingly clear that outbreaks of avian influenza on dairy farms across the country began months earlier than previously thought and are likely spreading much more widely, federal officials do not believe the virus is spreading in humans. It is emphasized that there is little risk to
However, there are groups of people who are at higher risk of infection. An estimated 100,000 men and women work on those farms. There is no widespread testing to confirm the number of infected people. No one has been vaccinated against bird flu.
This leaves workers and their families vulnerable to poorly tracked pathogens. And it poses broader public health risks. Experts say dairy workers are a likely route of transmission if the virus spreads to a wider population.
“We don't know if this virus will evolve into a pandemic strain, but we know today that farmworkers are being infected and there is good reason to think they are getting sick.” said Jennifer Nuzzo, director of pandemic affairs. Center at Brown University School of Public Health.
The majority of dairy workers are Spanish-speaking immigrants, often undocumented, who do not receive paid sick leave and may not be protected by occupational safety laws. They may not have access to health care providers and employers may not tolerate absenteeism.
“Workers in this sector are not only at very high risk due to their direct and close contact with excreta, raw milk and infected animals, but also at very high levels of risk. They're exposed in the absence of a social safety net,” said Elizabeth Strater, an organizer with United Farm Workers.
Interviews with more than 30 federal and state officials, public health experts, farmers, and labor organizations reveal what's happening on farms — and how many workers could be affected. , it became clear that little is known about how the virus evolved and how it spreads among cattle. .
So far, the virus, called H5N1, has been detected in cattle herds in nine states. Veterinarians say there are unconfirmed reports of farm workers showing flu-like symptoms, but only 30 have been tested as of Wednesday.
State and federal health officials do not have the authority to request access to farms unless there are special circumstances. Instead, the Food and Drug Administration and the Department of Agriculture are testing milk and ground beef on grocery store shelves for the virus.
The Centers for Disease Control and Prevention is waiting for infected people to show up at clinics.
“Do you want to know about a virus that is spreading among people and flooding emergency rooms in droves? Or do you want to catch it on the farm so you can treat people and slow the spread? '' said Rick Bright, CEO of Bright Global Health, a company focused on responding to public health emergencies.
Dr. Jay Varma, who works in the CDC's Food Poisoning Division and oversaw food safety as deputy commissioner of the New York City Department of Health, said a confusing regulatory system complicates the situation.
The Agriculture Department regulates large commercial farms and can (and does not yet) require testing of animals, but not farm workers. “We never want to be in a position where we have to declare that food supplies from the United States are unsafe, because some of those foods may be exported to other countries, which could result in significant economic costs,” the department said. “This is because it can have an impact,” he said. Varma said.
Although the CDC has authority over ports of entry into the United States, many of its activities within the country require state approval. The FDA, Occupational Safety and Health Administration, Environmental Protection Agency, and Citizenship and Immigration Services all have roles to play, but each has its own bureaucratic hierarchy and organizational culture.
Some experts said this patchwork could become a hindrance during disease outbreaks. In 2009, the response to a cluster of bacterial infections in salami products led to the Department of Agriculture regulating the meat, the FDA taking responsibility for the cracked black pepper coated on salami products, and the CDC taking responsibility for the cracked black pepper coating on salami products. Because I was in charge of the investigation, the response was delayed. disease.
Dr. Nirav Shah, CDC's senior deputy director, dismissed the idea that bureaucracy was an obstacle as “simplistic,” saying agencies responding to the outbreak must coordinate efforts and work with national partners. He said they have discussions multiple times a day.
“This is difficult,” he said. But “we're working together on this because we have a common goal.”
Some farmers see bird flu as a distant threat because of the relatively small number of cases, with 36 infected animals out of a national herd of about 26,000 animals and one infected farm worker. Even those who support public health efforts are hesitant to allow federal agents on their property.
Jason Schmidt owns Glasing Plains Farm in Whitewater, Kansas, which he describes as “a nice little farm” where he raises his own 70 dairy cows. Schmidt said he supports the government's public health role but doesn't want officials walking around farms.
If he saw a sick cow, “I'm sure he would report it,” he said. “But I have a little devil on my shoulder that says, 'Shut up, divert the milk from the sick cow and throw it down the drain, and don't say anything.'”
Mitch Brunig, who owns Mystic Valley Dairy in Sauk City, Wis., said he plans to test cows with symptoms of bird flu if a veterinarian deems it prudent, but added, I really don't want to come here,” he said. farm. “
So far, the outbreak has affected not only small farms but also large dairy farms, which increasingly dominate the industry and often rely on migrant workers.
Luis Jimenez, who works on a dairy farm in upstate New York and founded an organization to support undocumented immigrant farmworkers, said the owners of such farms “don't care about our health. All they care about is doing their jobs.”
“The health of the cows is more important to them than the workers,” he added.
Farms are often geographically remote, and although workers may live on-site, they may not have transportation to access medical care. And for many people, symptoms from an avian influenza infection may not seem particularly urgent.
“We're talking about eye infections and coughs, but they're having back pain and arm pain and they're all over the place,” said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security. These are the people who destroyed it.”
Even without access to farms, health officials may be able to support migrant workers in other settings, advocates noted. “They go to church, they go to stores, they go to restaurants, and there are other ways to reach them,” said Amy Liebman, program director for the Immigrant Clinician Network. Ta.
To make testing more attractive, Liebman said community centers could provide other medical services, legal aid, food and educate workers on how to protect themselves and their families. Ta.
Dr. Shah said the CDC is working with veterinarians and groups such as the Immigrant Clinician Network to reach farmworkers. “We also want to offer testing to more workers,” he said.
Dr. Shah on Monday called on state health officials to provide goggles, face shields and gloves to farmworkers and work with trusted community organizations to educate them about the importance of the equipment in preventing infection.
Despite the health risks, farm workers are not required to wear protective equipment. “This is not mandatory. No one is forced to do anything here,” Dr. Shah said.
However, the nature of agricultural work and the environment in which it takes place (for example, in milk parlors where masks quickly become wet and useless) can make it difficult to wear protective equipment.
Several states have taken measures to contain the spread, but the effects have been limited.
Texas offered to provide protective gear to dairy farms, but only four companies came forward, according to a Texas Department of State Health Services spokesperson. The state of Idaho has also offered protective equipment since the beginning of the outbreak, but no farms have responded to the offer.
Idaho health officials helped test one farm worker for infection, but did not ask him to enter the farm “for privacy and biosecurity reasons,” state epidemiologist Dr. Kristin Hahn said in an email. Stated.
Michigan has banned dairy cattle and poultry exhibitions until the outbreak subsides. The state does not require testing of cattle or farm workers.
Experts said the current situation could lead to new infectious diseases emerging and spreading rapidly in dairy farms, just as in poultry and pig farms.
“If we had to hide the emergence of a new virus in the United States, one of the best places to hide it would be among rural American animal workers,” said Dr. Gregory Gray, an infectious disease epidemiologist at the University of Texas Medical Branch. Deaf,” he said. .
Surveillance for these workers is “not as strong as we see for other population groups,” he says.
Dr. Andrew Bowman, a veterinary epidemiologist at Ohio State University, said federal, state and local agencies must first establish trust before building a surveillance network that includes farmworkers and their families.
“If you look at the influenza surveillance we've done in pigs, it didn't happen overnight,” Dr. Bowman said. “It took 10 years to build it.”
While monitoring is important, some experts cautioned against testing without first addressing the needs of farmworkers.
“If you're preparing to collect information that just benefits other people and doesn't necessarily directly protect them, I think that's a very difficult thing to do ethically,” Dr. Nuzzo said.
miguel salazar Contributed to the report.