How poor bird flu tracking puts dairy workers at risk

Even as it becomes increasingly clear that the outbreak of bird flu on the nation’s dairy farms began months earlier — and is likely much more widespread — than previously thought, federal officials have stressed that the virus poses little risk to humans.

Yet there is one group of people who are at high risk of infection: the approximately 100,000 men and women who work on these farms. There has been no widespread testing to determine how many people might be infected. None have been vaccinated against bird flu.

This leaves workers and their families vulnerable to a poorly tracked pathogen. And that poses broader risks to public health. If the virus were to make its way to the general population, experts say, dairy workers would likely be the way to go.

“We don’t know if this virus will evolve into a pandemic strain, but we know today that farmworkers are exposed, and we have good reason to believe they are getting sick,” said Jennifer Nuzzo, director from the Pandemic organization. Center at the Brown University School of Public Health.

The majority of dairy farm workers are Spanish-speaking immigrants, often undocumented, who don’t necessarily have paid sick leave or are not protected by workplace safety laws. They may not have access to medical providers and their employers may not tolerate absences.

“This sector of workers is not only exposed to the highest risk, because they have this direct and intimate contact with rejects, raw milk, with infected animals, but they are also exposed to the highest level of risk in terms of of the lack of a social safety net,” said United Farm Workers organizer Elizabeth Strater.

Interviews with more than three dozen federal and state officials, public health experts, farmers and worker organizations show how little is known about what’s happening on farms: how many workers may be affected, how the virus evolves and how it spreads among cows. .

So far, the virus, called H5N1, has been detected in cattle herds in nine states. Although veterinarians said there are unconfirmed reports of flu-like symptoms in farm workers, only 30 of them were tested Wednesday.

Barring extraordinary circumstances, state and federal health officials do not have the authority to require access to farms. Instead, the Food and Drug Administration and 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’s spreading so much among people that they’re showing up in hordes to emergency rooms, or do you want to catch it on farms so you can treat people and slow the spread? ” said Rick Bright, chief executive of Bright Global Health, which focuses on responses to public health emergencies.

A tangled regulatory system complicates the situation, said Dr. Jay Varma, who worked in the CDC’s foodborne illness branch and oversaw food safety as a deputy commissioner at the New City Health Department. York.

The Agriculture Department regulates large commercial farms and can mandate testing on animals – although it has not yet done so – but not on farm workers. The department “never wants to find itself in a position where it has to declare that the food supply coming from the United States is unsafe, because some of these food products may be exported to other countries, which can impact huge economic,” said Dr. » Varma said.

The CDC has authority over ports of entry in 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 roles to play, but each has its own bureaucratic layers and institutional culture.

This mosaic can pose a barrier during an outbreak, some experts said. In 2009, the response 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 to investigate the people who had become victims. I will.

Dr. Nirav Shah, principal deputy director of the CDC, rejected the idea that bureaucracy would be a barrier, calling it “too simplistic,” and said agencies responding to the outbreak were talking several times a day to coordinate their activities and work with state partners.

“This stuff is hard,” he said. But “we are working together on this subject because we have common objectives”.

Due to the relatively small number of cases – 36 flocks affected out of some 26,000 across the country and one farm worker infected – some farmers view bird flu as a distant threat. Even those who support public health efforts are reluctant to let federal officials onto their properties.

Jason Schmidt owns Grazing Plains Farm in Whitewater, Kansas, a “tiny little” farm as he calls it, with 70 dairy cows that he raises himself. Mr. Schmidt said he supports the government’s role in public health, but he doesn’t want officials walking around his farm.

If he saw a sick cow, “I sure hope I would report it,” he said. “But there’s this little devil on my shoulder who tells me: ‘Shut up, divert the milk from these sick cows, throw it down the drain and don’t say anything.'”

Mitch Breunig, owner of Mystic Valley Dairy in Sauk City, Wis., said if his veterinarian determined it was “prudent,” he would test a cow showing bird flu symptoms, but “I really don’t want that the CDC is coming to my house.” farm.”

So far, the outbreak has not affected small farms, but the giant dairies that increasingly dominate the sector and often rely on migrant workers.

The owners of these farms “don’t care about our health, they just care that we do our jobs,” said Luis Jimenez, who works at a dairy in upstate New York and founded a group support for undocumented immigrant agricultural workers.

“The health of their cows is more important to them than that of their workers,” he added.

Farms are often geographically remote and workers – who sometimes live on site – may not have transportation to access medical care. And for many, the types of symptoms attributed to bird flu infection don’t 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 have broken this and that,” said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Even without access to farms, health officials could support migrant workers in other settings, advocates note. “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 Migrant Clinicians Network.

To make testing more attractive, community centers could offer other health care services, legal assistance and food, and educate workers on ways to 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 agricultural workers. “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 farmworkers, and to collaborate with trusted community organizations to educate them about the importance of this equipment in the prevention of infections.

Despite the risks to their health, farmworkers are not required to wear protective equipment. “It’s not a mandate, no one is obligated to do anything here,” Dr. Shah said.

But the nature of agricultural work and the environments in which it is performed (dairies that quickly render masks wet and useless, for example) can make wearing protective gear difficult.

A few states have taken steps to contain the outbreak, with limited success.

Texas offered to provide protective equipment to dairies, but only four came forward, according to a spokesperson for the state health department. Idaho has also offered protective equipment since the outbreak began, but no farms have accepted the offer.

Idaho health officials have not asked to visit farms “for privacy and biosecurity reasons,” Dr. Christine Hahn, the state epidemiologist, said in an email, although they helped test a farm worker for infection.

Michigan bans dairy cow and poultry shows until the outbreak subsides. The state does not require testing of cows or farmworkers.

The current situation shows that dairy farms can generate new outbreaks that will spread quickly, as has long been the case in poultry and pig farms, several experts said.

“If you were to hide the emergence of a new virus in the United States, one of the best places to hide it would be among animal workers in rural America,” said epidemiologist Dr. Gregory Gray. of Infectious Diseases at the University of Texas Medical Branch. .

Surveillance of these workers is “nowhere near as strong as we might see for other population groups,” he said.

To build surveillance networks that include farmworkers and their families, federal, state and local agencies will first need to establish trust, said Dr. Andrew Bowman, a veterinary epidemiologist at Ohio State University.

“If you look at the influenza surveillance we’ve done in pigs, it didn’t happen overnight,” Dr. Bowman said. “It took a decade to build it.”

While surveillance is important, some experts caution against testing farmworkers without first addressing their needs.

“If we’re setting ourselves up to collect information that will only benefit other people and not necessarily protect them directly, I just think that’s a very difficult thing to do ethically,” Dr. Nuzzo said.

Miguel Salazar reports contributed.