The World Is Changing Rapidly So Is H1N5 Avian Influenza

I have been reporting on H5N1’s march through the mammals in the largest Zoo-pandemic on record for over two years, and the news just gets worse. We have been aware for a week now about a previously healthy teenager in Canada with critical illness due the Avian Influenza H5N1. The first important information received was that this virus is closely related the clade infecting wild birds throughout the world, and not the strain which has spread through our dairy industry, infecting cows and the people working with them. The next bit of information was that after extensive investigation, the Canadian health authorities could not find any evidence that this boy had any relevant animal exposure. That is not unheard of for respiratory viruses, and in fact there has been a previous case in the US with the same circumstances. Possible explanations could include a casual and forgotten exposure; or since this virus can infect an incredibly wide range of mammals, perhaps a minimal exposure to an asymptomatic but infected cat or dog. We will never know and, frankly it isn’t really important.

Truly alarming information arrived yesterday when Canadian officials revealed that the sequence of the virus recovered from this patient contains two mutations which evolutionary virologists have determined allow the H5N1 virus to readily spread between human beings. These are mutations which we have been told over and over have not been found in any of the previously infected people, and therefore according to the CDC and WHO, “the risk to the general population is very low”. I have to wonder if that assessment will change now—but I think probably not. For some context about these mutations, let’s review a bit about how influenza viruses manage to infect various mammals. These viruses have a protein on their surface, the hemagglutinin, which binds to certain sugar molecules (called sialic acids) present on the surface of airway and other epithelial cells, and allows the virus to enter the cell. Think of it as equivalent to the corona virus’s Spike protein docking with the ACE2 receptor on our cells—something we have all had quite enough of over the last four years. Different mammalian species have different patterns of these sugar molecules controlling the influenza virus’s ability to cause infection. The H5N1 from the very ill teenager in Canada has now acquired mutations which were predicted to facilitate its attachment to the particular receptors found in humans. A little deeper in the weeds is the fact that humans express what is called an (a2,6) molecule, while pigs express both that human molecule and (a2,3) which is found in all avians—that is what makes pigs such classically effective vehicles for recombining bird and human influenza viruses. Below is a nice picture of the critter from the CDC and a link to an in depth discussion of the particular mutations involved, and the science utilized to predict their effect ahead of time.

Emerging Infectious Diseases Potential Human Adaptation Mutation of Influenza A(H5N1) Virus, Canada

Sebastian Maurer-Stroh ^{1,2,3,4,5,✉}, Yan Li ^1,2,3,4,5, Nathalie Bastien ^1,2,3,4,5, Vithiagaran Gunalan ^1,2,3,4,5, Raphael Tze Chuen Lee ^1,2,3,4,5, Frank Eisenhaber ^1,2,3,4,5, Tim F Booth ^1,2,3,4,5

Letter. 2014 Sep;20(9):1580–1582. doi: 10.3201/eid2009.140240

One more question arises concerning why exactly this young man is experiencing such severe illness. None of the people in the US poultry industry infected by the avian clade of this virus have had severe or even moderate illness. The H5N1 clade in our poultry clearly has been behaving differently than the gH5N1 clades which have infected people in Asia with a 50% mortality figure over the last decade. Did the acquisition of these mutations allowing for potential person-to-person spread also come with an increased pathogenicity? That is certainly one possibility. Another explanation could be that this person has a subtle inborn deficiency in the Interferon pathway of innate anti-viral immunity, which rendered him uniquely vulnerable to this particular virus. Cases like that were documented among otherwise healthy young people dying from SARS2, with no other history of prior unusual susceptibility to infections—I’m reminded of the cases of twin brothers in Germany, who both died from COVID in their twenties, and were found to have this this type of immune defect. Perhaps the human honeymoon with H5N1 is drawing to a close; perhaps this Canadian with be known as Index Case #1, perhaps we will be dusting off the N95’s, if you can find them. Although his infection so far appears to be a dead end, with no other contacts infected, it seems likely these mutations will continue to appear since they open up an avenue for increased spread in yet one more mammal species, and don’t appear to impair the replicative fitness of the virus. It also appears these mutations increasing the virus’s avidity for human cells, do not impair its ability to also infect avians, so we will have to be careful not to cough on our pet parakeets.

I thought I heard someone ask how the world is doing with Polio, and the short answer is not good. The target date for the total elimination of Polio was set at the year 2000 by the WHO, way back in 1988. Pakistan just announced its 48th case of wild-type polio so far this year; that is a dismal record, since according to MMWR there was only one case in the first six months of 2023 and a total of six for the entire year. Since then there has been a resurgence of wild-type polio in Pakistan and Afghanistan—and of course the usual cases of circulating vaccine derived mutant polio (cvd-Polio) now occurring in Nigeria, Chad, Sudan, Democratic Republic of Congo, Ethiopia etc. There has been a decline in the number of vaccine derived cases over the past year so far which is encouraging, but outbreaks continue to occur, and no end is really in site for either wild-type Polio or the cvd-Polio virus. Given the magnitude of international travel, with people arriving in the US, either directly from countries with active outbreaks or after transiting through these areas, this would be a very bad time to be skipping your child’s polio vaccinations—remember that the vaccine we give in the US is the inactivated (killed) virus and never causes the problems seen with the oral polio vaccine used in many places around the world.

Let’s turn next to one of my favorite bureaucracies, the FDA. Earlier this month the FDA issued a “proposed order” that would ban the drug phenylephrine, commonly found in most OTC decongestant cold medicines. The FDA approved this drug back in 1977 and it’s anyone’s guess how many people have taken it, or how many doses have been consumed. The problem is it simply doesn’t work, as in not fulfilling the FDA “safe and effective” requirement. The data has been accumulating for years that the drug is a dud, and one year ago an advisory committee from the FDA’s Center for Drug Evaluation and Research presented the scientific data to the FDA that the drug is completely ineffective. Now the FDA has issued a “proposed order” banning the drug, which carries no weight in terms of enforcement, and indicated they plan to issue an enforceable order sometime—perhaps another year from now? Not only is phenylephrine ineffective, but like any and all drugs it has side effects. Ever feel your heart is racing after a few doses of Robitussin or Dr. John’s nasal blast formula? You can’t tell me that this ineffective stimulant hasn’t caused some cases of atrial fibrillation, or slightly raised the blood pressure of some folks who went on to have an MI or stroke. Why has the FDA dragged their feet on removing this drug that they know is useless? The only logical answer seems to be that certain pharmaceutical companies book huge profits selling a wide array of OTC products containing it, and revamping their products to remove it, and loosing the ability to claim (incorrectly) that it helps nasal congestion would be so inconvenient and costly.

This is the editorial section, so you might want to copy things down, or just turn the computer off. RFK Jr. does have some good ideas, floating along with a raft of vaccine nonsense. I know that might seem like anathema coming from me, but there you have it. Coming from the perspective of an environmental lawyer he is right about the health risks of the highly processed food products, and dangerous chemical food additives which our government has refused to protect us from. He is similarly correct about the massive quantities of carcinogenic and endocrine disruptive chemicals dumped into the environment, again with dismal government oversight and regulation. He is correct about the cozy, inappropriate relationship that exists between the FDA and the Pharma industry, as well as the gross inefficiencies and titanic financial waste in our giant government bureaucracies. Now about the vaccine nonsense—I am sure that when I speak to Bobby this week I will be able to talk sense to him about that. At the very least perhaps I can slip him a quick vaccine that will install a transmitter into the worm, and change what it is whispering. In the words of former NYC Mayor Ed Koch, “If you agree with 9 out of 12 things I say, you should vote for me, if you agree with 12 out of 12, you should see a psychiatrist”.

This week we learned that the White House approved the use of American made long range missiles by Ukraine to strike deep into Russia, which the Ukrainians apparently wasted no time in doing. Putin of course correctly said this is a dangerous escalation and could result in a direct hot war between the US/NATO and Russia, and began the nuclear saber rattling again. Putin of course is guilty of starting the war, and any number of dangerous escalations, including the importing of 25,000 North Korean troops to do his dirty work. You may have the opinion that green-lighting attacks deep into Russia is a great move, or you might be horrified about a potential outcome. My concern is that we currently have the lamest of lame duck presidents, sinking into the sand in Rehobeth, someone who the party removed from running because it became impossible to ignore the fact that he had become cognitively impaired at a serious level. I find it hard to believe (or alternatively scary) that President Biden would be making this kind of decision at this point in time. If he is not the one who made this decision, I think we have the right to know who is. It may be silly but if I find myself engulfed in a nuclear conflagration, I would like a micro-second to curse out the appropriate SOB. Alternatively, if Putin folds after seeing the Kremlin and the Bolshoi in flames, I would be happy to give credit where credit is due.

Thanks for your time, if you can find someone to forward this to, hopefully not in Washington or the Kremlin, that would be swell.