By Peter A. McCullough, MD, MPH
I had a chance to catch a glimpse of the Davis Cattle Ranch in Northern Georgia and put together some thoughts on what has been occurring in the highly pathogenic avian influenza H5N1 outbreak.
Helen Branswell, Senior Scientific Writer wrote in STAT November 18, 2024:
H5N1’s hemagglutinin preferentially binds to cells with receptors known as alpha 2-3, which are abundant in wild birds and domestic poultry, but are also found in the conjunctiva, the tissue surrounding human eyes. The receptors that predominate in human upper airways are known as alpha 2-6, the type to which the human influenza A viruses H1N1 or H3N2 attach. It’s thought that to become a virus capable of spreading easily among people, H5N1 would need to acquire the ability to attach to this latter type of receptor.
This may have just occurred via two genetic adaptations: 1) the D1.1 mutation and 2) genetic reassortment. The fatal Louisiana case was infected with H5N1 virus of the D1.1 genotype virus that is closely related to other D1.1 viruses recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington State. This avian influenza A(H5N1) virus genotype is different from the milder B3.13 genotype spreading widely and causing outbreaks in dairy cows, poultry, and other animals, with sporadic human cases in the United States. Spontaneous mutations may have played a role in a human case with severe illness detected in British Columbia, Canada, suggesting they emerged during the clinical course as the virus replicated in the patient.
Genetic reassortment is possible as suggested by a fatal human case in Cambodia with a hemagglutinin gene from the 2.3.2.1c clade. Genetic reassortment is the process by which influenza viruses exchange genetic material when they infect the same cell. Reassortment is a major factor in the evolution of influenza viruses, particulary over a prolonged outbreak.
Garg et al (NEJM, 2024) demonstrated that poultry to human transmission occurs during the biosecurity process of culling. As the outbreak wears on, it is becoming clear that biosecurity measures are failing. Intensified efforts with personal protective equipment for workers may not be sufficient.
US government agencies, poultry, and livestock stakeholders could be supported by:
1) Risk mitigation and early therapeutics from a 50-state medical provider with 50-state licensed large-capacity pharmacy distribution center.
2) Pre-assembled, individually prescribed kits
3) Experience in 24x7 health emergency management with HIPPA compliance
4) Medical experience with prevention and early treatment protocols to help those with zoonotic contact reduce the risk of hospitalization and death.
At The Wellness Company, we stand ready and well positioned to serve stakeholders and protect the public at this inflection point in the bird flu crisis.
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Peter A. McCullough, MD, MPH
Chief Scientific Officer, The Wellness Company
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