Four years after a new coronavirus swept through New York in what was called a once-in-a-century event, public health officials are beginning to prepare for the possibility that a far worse pandemic is on its way.
The bird flu virus, H5N1, is not spreading among people. But the city is already preparing as if it could.
It is considering plans to set up isolation and quarantine hotels. One New York City hospital system is taking steps to start testing its sewage for the virus, so that it will know if bird flu is silently circulating among patients and staff.
But some epidemiologists worry that once again, the public health response in New York will be too sluggish in the early phases, should an epidemic break out in the city.
The virus has worried epidemiologists for its pandemic potential even before the first human patients were detected in Hong Kong in 1997. In the years since then, it has spread via migratory birds and periodically torn through chicken farms. Fewer than 1,000 people are known to have been infected in the past 20 years. But slightly more than half of those infected have died.
Now the disease has been found in herds of dairy cattle in 12 U.S. states. Human-to-human transmission has not yet been detected, but the worry is that the virus could evolve.
“There is still a huge amount of uncertainty about when it will jump to human-to-human transmission,” said Dr. Jay Varma, a former epidemiologist at the Centers for Disease Control and Prevention who helped guide New York City’s response during the Covid pandemic.
His guess: maybe months, maybe years.
How exposed is New York City?
New York City — visited by some 50 million Americans annually — could well be among the first U.S. cities to be hard hit if a bird flu pandemic breaks out among people, as it was when the novel coronavirus arrived.
But for now, it is far from the front lines. Though New York is one of the nation’s leading dairy-producing states, the virus does not appear to be circulating among its cattle. The state’s agricultural department has imposed a number of testing requirements. Last week it announced mandatory H5N1 tests for dairy cattle appearing at county fairs.
Would there be tests to determine who has bird flu?
Epidemiologists fear a worrisome repeat of the early days of Covid-19, when only narrow categories of people — such as travelers returning from China, or their contacts — were eligible for testing. Other New Yorkers struggled to get tested. As a result, public health authorities were slow to detect the virus — or to act.
At present, there is no readily available H5N1 test in wide supply outside government laboratories. The tests that doctors’ offices and hospitals rely on do not distinguish H5N1 from some seasonal flus, if the tests detect it at all. For now, only people with specific risk factors — such as those who have been around sick farm animals or birds — are likely to have their samples immediately referred to government public health laboratories for H5N1 testing.
Without better diagnostics, the virus “would fly under the radar for some time,” Prof. Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai, said.
State authorities said they were not worried about testing. The state’s public health laboratory “has more than sufficient testing capacity for H5N1 — several hundred specimens per day — and substantial additional surge capacity if needed,” a spokeswoman for the Health Department, Erin Clary, said.
But what the government should do, according to epidemiologists, is encourage and authorize commercial and university laboratories to develop H5N1 tests, so that government public health laboratories would not become a bottleneck.
Wastewater surveillance could also help. A research team is working to set up an H5N1-specific test for wastewater samples at four of the city’s 11 public hospitals. If the virus was detected, it would most likely mean a patient, staff member or visitor was infected, said Prof. Denis Nash, an epidemiologist at CUNY’s School of Public Health, who is part of the team on the project.
Does New York have enough vaccines and antivirals?
Public health authorities have been planning for a deadly influenza pandemic for decades. Federal health officials have identified two vaccine viruses that they hope will prove effective against a pandemic H5N1 strain.
The number of vaccine doses in the national stockpile is under a million, though 4.8 million more doses have been ordered. If it becomes necessary, federal officials are optimistic that, within 130 days, manufacturers could make more than 100 million doses — enough for more than 50 million people.
During the Covid pandemic, children were vaccinated last. But small children are especially vulnerable to the flu and would most likely be prioritized in an influenza pandemic.
The federal government has also amassed a huge stockpile of influenza antivirals. New York has its own stockpile apart from the federal one, and the city and its public hospital system also have their own — in all, enough for more than 10 percent of the state’s population.
Are hospitals ready to care for patients with bird flu?
Doctors in the city’s public hospital system expressed confidence that it could handle an influenza pandemic without the health care system collapsing.
In interviews, doctors noted that the Covid pandemic had taught valuable lessons, such as how to rapidly build makeshift ICUs and the importance of trying to avoid intubating patients where possible.
“A lot of the kinks have been worked out,” said Dr. David Silvestri, an emergency room physician in the South Bronx who oversees emergency planning for the public hospital system. “In an absolute worst-case scenario, we could pull on all the same levers.”
Will there be lockdowns and school closures?
If H5N1 sparks a pandemic, public health experts said to expect a return to social distancing and lockdowns, especially if the fatality rates are as high as feared.
“That will be the reality and that’s what slows down transmission,” said Dr. Bruce Farber, an infectious disease doctor with Northwell Health, the state’s largest hospital system. “Just because we’re tired of pandemics and don’t want to be thinking about another, that doesn’t mean the viruses care,” he added.
What can I do to protect myself and my family?
Professor Krammer, an influenza expert, said he did not think the next pandemic was “imminent.” But, he added, “don’t get me wrong — it’s not a good situation.”
Experts have advised people to take some basic precautions in the meantime.
In recent years, raw milk, as unpasteurized milk is called, has been rising in popularity from Brooklyn to Iowa. But cows’ udders can be a reservoir of H5N1 virus. The C.D.C. advises drinking pasteurized milk.
Experts also advised staying away from wild birds and making sure pets steer clear of them, too.