Inside Medicine: Five on Friday (May 10, 2024).
This week in medicine, what I'm thinking about, etc. You know, an actual newsletter.
We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Below are the top-of-mind things that I’m thinking about right now.
Also, please vote in the poll at the end!
If you value this feature—and Inside Medicine in general…
Here we go…
Item 1. H5N1 update.
Bird flu (H5N1) continues to be a concern for its spread in cattle. Human-to-human transmission has not been reported so far. Here are some updates.
The fact that large quantities of bird flu remnants (but neither live virus nor components that pose a threat to us) has been found in a lot of milk—despite increased testing among symptomatic cows—suggests that asymptomatic disease and spread are likely occurring. Not a surprise.
What should be done? 1. Test milk trucks (as per Dr. Carter Mecher, whom I mentioned last week). 2. When testing on farms, test asymptomatic cows (especially in large facilities) randomly, rather than waiting for symptomatic ones to appear. This is the same argument Dr. Harlan Krumholz and I made in USA Today four years ago on how to best use our limited Covid-19 tests back then.
Relatedly, a recent story reported that officials tested H5N1 to make sure that the virus is killed by pasteurization (and therefore poses no threat to humans exposed to any remnants that have made their way to grocery stores). Okay, obviously pasteurization worked. The reason I mention this is that even doing this test is a reminder of the extent to which fear breaks our feeble little brains. A question like, “Does pasteurization kill bird flu?” is a perfectly fine one for a child (or even a non-scientist adult who is rusty on virology) to ask. But for grownup adult scientists? Oh my goodness. H5N1 is a virus! It’s an influenza strain! Of course pasteurization works! It is not some alien entity from outer space. Jeez! It would be a lot easier to respond to novel threats if we didn’t lose our collective minds when they start making trouble. Alright, rant over.
There has been pushback in the farm industry regarding the federal government’s involvement in monitoring the situation. Clearly, local farmers do not want a bunch of CDC and FDA officials showing up and poking around, nor do they feel that filling out lengthy questionnaires are good uses of time (or likely to yield accurate or useful information). Meanwhile, the USDA seems to have a more favorable reputation in the farm industry. I am sympathetic to both viewpoints. On one hand, it makes sense for disease experts (CDC) to be engaged in this. But, as above, a less burdensome footprint focusing on smart (and widespread) testing would probably be the best approach.
Item 2: Bacteria on the space station.
NASA announced that bacteria on the International Space Station have mutated, showing resistance to a whole slew of antibiotics. This is not terribly surprising, but it does underscore the need to figure out how an outbreak on longer missions to places like Mars might be handled. It’s one thing to assemble a mobile pharmacy and bring it along for the ride. It’s another to confront the possibility that a pathogen we’ve never even thought about (and that can’t be treated with the antibiotics we have), could pop up on a vessel that is millions of miles from the nearest ICU.
Item 3. Mortality disparities affect US youth.
There are mortality disparities by race and ethnicity among children ages 1-19 in the US, just like in every other age group. A new study in the Journal of the American Medical Association looked at the first 20 years of the century and found striking disparities in both medical causes of death (e.g., cancer, and Covid-19) and external causes (firearm deaths, motor vehicle accidents). This is quite sobering, and it matches my own team’s research on the topic.
Item 4: Cystic Fibrosis Awareness Month.
May is Cystic Fibrosis Awareness Month. While CF remains the most fatal inherited disease in North America, there has been good news in recent years. Life expectancy for people with CF has increased dramatically. Once considered a childhood disease with relatively few survivors into adulthood, better treatments have enabled many people with CF to live into their 50s and well beyond. In fact, there are now more adults with CF than children, which certainly was not true in the past. Still, it is a debilitating disease, and a good target for gene therapy in the future, owing to its particular cause.
Item 5. Poll of the Week.
Results from last week:
Last week, I asked you about your alcohol use. Thank you for your answers. I selected “most days,” as I’d estimate I have a glass of wine with dinner around 4-6 days per week (lately a bit less than in the past, but it’s still more than weekly for me).
Item 5a. Poll of the Week for this week!
With H5N1 circulating widely in farm animals without any sign of human-to-human transmission so far…
Thanks for chiming in.
That’s it. Your “Friday Five!”
Feedback! Do you like the “Five on Friday” format? Have any ideas for next week’s Poll of the Week? Any great articles you read elsewhere that you want to share with the Inside Medicine community? Other musings or thoughts?
Please contribute to the Comments!
So far bird flu isn't spreading among humans or pigs, and the virological details suggest it would need multiple mutations in multiple genes to do so. But if it does evolve the ability to spread in pigs that would be ominous because pigs have often been the "mixing vessels" where avian, bovine, and human strains swap genes to create a new pandemic strain.
We should be monitoring pigs with great urgency and intensity so we learn right away if this virus becomes able to spread in pigs.
I feel this is an extremely ambiguous question. I answered "Alot" because of the devastation this virus has done to wildlife. Both birds and mammals.
The human implications have not concerned me yet. However, I would say monitoring porcine infection levels is critical.
I am a retired veterinarian .