Although it has become increasingly clear that the bird flu outbreak on the nation’s dairy farms began months earlier — and is likely much more widespread — than previously thought, federal authorities have stressed that the virus poses little risk to the man.
However, there is one group of people at high risk of infection: the estimated 100,000 men and women who work on these farms. There has been no extensive testing to see how many may be infected. No one has been vaccinated against bird flu.
This leaves workers and their families vulnerable to an underdiagnosed pathogen. And it poses wider risks to public health. If the virus were to find its way into the wider population, experts say, dairy workers would be a likely route.
“We have no idea if this virus is going to evolve to become a pandemic strain, but we know today that farmers are being exposed and we have good reason to believe they are getting sick,” said Jennifer Nuzzo, director of Pandemic. Center at Brown University School of Public Health.
The majority of dairy farmers are Hispanic immigrants, often undocumented, who may or may not have paid sick leave protected by occupational safety laws. They may not have access to medical providers and their employers may not tolerate absences.
“This sector of workers is not only at the much, much higher risk because they have this direct, close contact with secretions, raw milk, with infected animals, but they’re also at the much, much higher level of risk. conditions so we don’t have a social safety net,” said Elizabeth Strater, an organizer for the United Farm Workers.
Interviews with more than three dozen federal and state officials, public health experts, farmers and labor organizations show how little is known about what happens on farms: how many workers may be affected, how the virus evolves and how it spreads to cows.
So far, the virus, called H5N1, has been detected in cattle herds in nine states. While the vets they have said There are unconfirmed reports of farmers with flu symptoms, only 30 have been tested as of Wednesday.
Except in emergency circumstances, state and federal health officials do not have the authority to require access to farms. 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 learn about a virus when it spreads among people so much that they’re flocking to emergency rooms, or do you want to catch it on farms so you can treat people and slow the spread?” said Rick Bright, CEO of Bright Global Health, which focuses on responding to public health emergencies.
A confusing regulatory system complicates the situation, said Dr. Jay Varma, who served in the CDC’s foodborne disease division and oversaw food safety as deputy commissioner at the New York City health department.
The agriculture department regulates large commercial farms and can mandate animal testing — though it hasn’t yet — but not farmers. The department “never wants to be in a position to have to say that the U.S. food supply is unsafe because some of that food may be exported to other countries and that could have a huge economic impact,” said Dr. Varma said.
The CDC has authority at ports of entry into the United States, but domestically the agency needs state approval to do much of its work. The FDA, the Occupational Safety and Health Administration, the Environmental Protection Agency, and Citizenship and Immigration Services all have a role to play, but each has its own layers of bureaucracy and institutional culture.
That patchwork can be a barrier during a disease outbreak, some experts said. In 2009, the answer to a cluster of bacterial infections in a salami product was delayed because the Department of Agriculture regulated the meat, the FDA was responsible for the cracked black pepper that coated it, and the CDC was responsible for investigating the people who got sick.
Dr. Nirav Shah, the CDC’s principal deputy director, dismissed the idea that bureaucracy was an obstacle as “overly simplistic” and said agencies responding to the outbreak are talking multiple times a day to coordinate their activities and work with state partners .
“These things are hard,” he said. But “we are working together on this because we have common goals.”
Because of the relatively small number of cases — 36 affected herds from about 26,000 across the country and an infected farmer — some farmers see bird flu as a distant threat. Even those who support public health efforts are reluctant to let federal officials on their properties.
Jason Schmidt owns Grazing Plains Farm in Whitewater, Kan., “a small farm” as he puts it, with 70 dairy cows that he raises himself. Mr Schmidt said he supported the government’s role in public health, but he would not want officials stuck around his farm.
If he saw a sick cow, “I definitely hope to report it,” he said. “But there’s that little devil on my shoulder that says, ‘Just keep quiet and divert the milk from those sick cows and put it down the drain and don’t say anything.’
Mitch Breunig, who owns Mystic Valley Dairy in Sauk City, Wis., said that if his veterinarian thought it was “wise,” he would test a cow with avian flu symptoms, but “I really don’t want the CDC on my own farm.”
So far, the outbreak has not affected small farms, but the giant dairies that increasingly dominate the industry and often rely on migrant workers.
The owners of such farms “don’t care about our health, they just care about doing our job,” said Luis Jimenez, who works at a dairy in upstate New York and founded a group that supports undocumented immigrants to farmers.
“The health of their cows is more important to them than their workers,” he added.
Farms are often geographically remote, and workers—who sometimes live on site—may lack transportation to get to medical care. And to many, the kinds of symptoms attributed to bird flu infection may not seem particularly urgent.
“We’re talking about an eye infection or a cough, and these are people who have back pain and arm pain and break this and that,” said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.
Even without access to farms, health workers could 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 manager at the Migrant Clinicians Network.
To make testing more attractive, community centers could offer other health care services, legal help and food, and educate workers about ways they can protect themselves and their families, Ms. Liebman said. .
Dr. Shah said the CDC is working with veterinarians and organizations like the Migrant Clinicians Network to reach out to farmers. “We would also like to offer testing to more workers,” he said.
On Monday, Dr. Shah asked state health officials to provide goggles, face shields and gloves to farmers and work with reputable community organizations to educate them on the importance of the equipment to prevent infection.
Despite the risks to their health, farmers are not required to wear protective equipment. “It’s not a mandate, nobody is forced to do anything here,” Dr Shah said.
But the nature of farm work and the settings in which it is performed—dairies that quickly render masks wet and useless, for example—can make wearing provocative protective equipment.
Some states have taken measures to contain the outbreak, with limited success.
Texas offered to provide protective equipment at dairies, but only four showed up, according to a state health department spokesman. Idaho has also offered protective gear since the outbreak began, but no farms have taken up the offer.
Idaho health officials were not asked to go to farms “for reasons of privacy and biosecurity,” Dr. Christine Hahn, the state epidemiologist, said in an email, although they did help test one farmer for the infection.
Michigan is prohibitive exposure of dairy cows and poultry until the outbreak subsides. The state does not require testing of cows or farmers.
The current situation has shown that dairy farms can seed new outbreaks that spread quickly, as has long been the case on poultry and pig farms, several experts said.
“If you had to hide the emergence of a new virus in the United States, one of the best places to hide it would be in animal workers in rural America,” said Dr. Gregory Gray, an infectious disease epidemiologist at the University of Texas Medical Branch. .
Surveillance of these workers “is not as strong as we might see for other population groups,” he said.
To create surveillance networks that include farmers and their families, federal, state and local agencies will first need to build trust, said Dr. Andrew Bowman, a veterinary epidemiologist at Ohio State University.
“If you look at the influenza surveillance we did in pigs, this didn’t happen overnight,” Dr. Bowman said. “This took a decade to build.”
While surveillance is important, some experts cautioned against testing farmers without first addressing their needs.
“If we set ourselves up to collect information that will only benefit others and not necessarily directly protect them, I just think that’s a very difficult thing to do ethically,” said Dr. Nuzzo.
Miguel Salazar contributed to the report.