First-ever confirmed case of H5N2 influenza in human reported. It was fatal.

Your "Five on Friday" lead story for June 7, 2024...

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Item 1: First-ever case of H5N2 influenza in a human confirmed—and it was fatal.

There are many types of influenza, some worse than others. The H5N2 version has been known to circulate in birds, but yesterday, the WHO announced that the first-ever human case has been detected in Mexico. The infected man died in May.

This alarms me, in some ways more than the other bird flu that has been making headlines this spring, the H5N1 strain.

Why? Because there is so much H5N1 circulating in animals that if the current variant of this virus were as contagious to us as something like Covid-19, we’d be in dire straits. While I agree with Dr. Deborah Birx that asymptomatic spread could already be happening in humans, it’s not yet clear how widespread that is, nor whether the virus possesses the horrific combination of features that made a pandemic like Covid-19 nearly inevitable once it left a confined area. In addition, while H5N1 can certainly cause deadly disease, so far, the two US cases during this outbreak have been mild. I’m not exactly sure what that augers for the future, but it may just mean that in the past, we only detected severe cases and that mild ones have been there all along.

But H5N2 influenza is a virus about which we have literally no knowledge with respect to humans. The fact that this is the first documented case ever and it was fatal? That doesn’t sit well.

There’s mixed news on the epidemiological side. The good news is that officials in Mexico tested a bunch of close contacts to the man who died of H5N2. So far, none tested positive. This bodes well for contagiousness. (Also, shout out to the authorities in Mexico. Their description of the case was fairly detailed. A model for transparency, it would seem.) The bad news is that nobody has any idea how this man acquired the infection. H5N2 is known to circulate in birds, including in nearby parts of Mexico, but this patient had no known exposure.

Item 2: Science under attack in Congress and everywhere else.

This week, Dr. Anthony Fauci testified to the House Oversight Committee that ostensibly is looking into the origins of the Covid-19 pandemic. Much was said by certain members of Congress looking to turn the session into a circus or witch hunt—and very little of it added up to anything other than finger-pointing. Worse, we literally have members of Congress calling for Dr. Fauci to be imprisoned for his role in the pandemic response.

Was the US Government’s response to Covid perfect? No. Was it based on the available science? Yes. Was it based on the best science that was hypothetically possible (i.e., could there have been better science before and even during the pandemic)? No. In fact, to this day there are studies that I’d like to see done. But does that mean that people like Fauci had malice or caused more harm than good? Absolutely not.

Meanwhile, my friend Dr. Peter Hotez—a physician-researcher who has devoted himself to the creation of low-cost, patent-free vaccines for global use—is getting harassed with death threats against himself and even his children.

Former White House Coronavirus Director Dr. Ashish Jha summarized my precise feelings perfectly this week. In short, as Dr. Jha says, we could have done better—but why would the next Dr. Fauci or Dr. Hotez want to serve our nation and the public interest if the “reward” they can expect is to be demonized instead of appreciated for the lives they had a hand in saving.

Item 3: My Q&A with Fmr. US Surgeon-General Dr. Jerome Adams.

Recently, I had the chance to interview former US Surgeon-General of the United States, Dr. Jerome Adams. Our conversation mostly centered on Dr. Adams’s recent essay in MedPage Today, in which he described an unexpected $10,000 bill he received after being a patient in an emergency room. I’m really happy with how this conversation turned out, so I hope you’ll check out our three-part series:

Part I: Dr. Adams and I discuss his case, and why an ER doctor like myself likely ordered so many tests, even though the likely diagnosis (dehydration) was fairly obvious.

Part II: We discuss the EMTALA law and the prospect of single payer healthcare in the US. While I think we are both in favor of universal healthcare, it would appear that we agree that in the US, it might not go that well—at least not given the current situation.

Part III: The discussion turns to medical debt and why high deductible health insurance plans might actually perpetuate healthcare-related inequities.

This was one of my favorite interviews I’ve done over at MedPage Today. The reason is that Dr. Adams and I had a genuine conversation that flowed as if we were two friends colleagues having a cup of coffee and genuinely just talking shop. While I try to make my Q&A’s conversational, a lot of times its hard to achieve it. Here, we really explored some challenging areas and felt that the interactions truly illuminated these complex and important issues. I hope you check it out (see links above).

Item 4: Another brief update on me.

My first Covid-19 illness finally seems to be over. After 10 days, I finally tested negative on my rapid tests. I feel a lot better, but honestly, still not quite at 100%. Now, it’s worth pointing out that if we did a PCR test for Covid on me right now, it would almost certainly be positive. That does not mean I am contagious, nor that rapid tests are not good enough to use. In fact, it’s highly likely that I have a very low viral load right now, as many Covid-recovered patients do for weeks. I’ll write more about this and some other thoughts on my overall experience going from frontline Covid clinics and researcher to its latest patient on Sunday. Again, thank you so much for your lovely words of support, and for checking out my pieces about this experience so far.

Item 5: Poll of the Week.

Here are the results from last week’s poll. It turns out that our little poll was a good lesson in something called “conditional probability.” Someone could read this poll and think that only 12% of people who have had Covid more than once had it easier on the 2nd or 3rd bouts. But that’s not what the poll says, because this readership is anything but average. 78% of you said you’ve either never had Covid or had it once. So, of the people who had Covid, 55% said that subsequent illnesses were not as bad as the first one. Still, the 18% (4/22=18%) who said their 2nd infection was worse than the first gives me a little bit of concern, because that’s not exactly a tiny figure.

Item 5a: Poll of the Week for this week!

Recently I asked whether the gender of your physician was a consideration for you when making a choice about who to see. Let’s try the same question, but with age. Now, there are some people who say that some medical fields should have mandatory retirement ages but not others. But many experts argue that age does not matter and what really matters is that clinicians provide good care, regardless of age. That said…

Please chime in with your more nuanced answers in the Comments sections.

That’s it. Your “Friday Five!”

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