Public Health

H5N1 news, CDC wastewater surveillance for bird flu, FLiRT variants, and the latest COVID symptoms


AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Is bird flu spreading in U.S. dairy cows? Is it safe to drink milk? Is COVID going around again? How dangerous is the new COVID variant? Is diarrhea a symptom of COVID?

Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.

Garcia: Thanks, Todd. It's great to be here.

Unger: So we're going to kick off with some more discussion about bird flu. Obviously, a lot talk about that still out in the headlines. And now the government is stepping in with financial support. Andrea, tell us what that covers.

Garcia: Yeah. So last Friday, the federal government announced that it would be offering financial incentives to dairy farm owners. That's up to 28,000 per farm, and that's to encourage broader testing of cattle and expanded biosecurity measures to control the growing outbreak.

Collectively, it's a $98 million incentive package from the Department of Agriculture. It's only available to farms with infected herds. And as we've discussed before, testing of both cattle and farm workers is absolutely key to controlling this outbreak. We cannot control it if we don't have an accurate picture of spread.

Unger: All right. So I understand that the incentive itself is for farms where there are infected cattle. How do we break down that incentive in terms of how that's going to be distributed?

Garcia: The farm owners with infected herds who encouraged their workers to take part in a federal workplace and farm worker study can receive up to 2,000 per farm per month. That money would go toward things like supplying PPE to employees or laundering their uniforms to help prevent spread. They can also receive up to 10,000 per farm as reimbursement for veterinarian-related costs for treating cows with the virus and up to 2,000 per farm per month to use heat treatment approved by the FDA for disposing of milk waste infected with the virus. In addition, HHS is planning to spend 101 million to prevent and treat the H5N1 virus, bringing the government's total contribution to contain this virus nearly to 200 million.

Unger: Now, Andrea, the HHS portion of that, how is that contribution going to be used?

Garcia: So the majority of it, around 93 million, will be utilized by the CDC to analyze the virus for any concerning changes to help public health labs increase their testing capabilities, to manufacture and distribute 1,000 diagnostic test kits, and to boost contact tracing efforts. And it'll also be used to start a program to evaluate the use of wastewater surveillance for bird flu. The remaining 8 million would go to FDA to continue to study the safety of the commercial milk supply.

Unger: All right. And I know you said up front how important it was to have that kind of testing among farms and cattle to make sure that we contain the spread of this. I want to talk a little bit more about two of the things that you just mentioned in your last comments. When we talked a couple of weeks ago, wastewater surveillance was still in question. Andrea, has that thinking shifted?

Garcia: It has. The CDC is now planning to post data on influenza A found in wastewater in a public dashboard. It'll be unveiled this week. And that could help offer some new clues about the outbreak. And the CDC wastewater team lead, Amy Kirby, told Reuters last Thursday that the agency has already identified spikes of influenza A, of which H5N1 is a subtype, and that's in a handful of sites. And they're currently investigating the source. Wastewater tests can detect many types of influenza A, including that H5N1 subtype.

But the findings don't indicate the source of the virus or whether it came from a bird, cow, milk or from farm runoff or humans. While there is currently no indication of further human infection with H5N1, the dashboard will allow individuals to check for increases in influenza A in their area and, of course, compare it to historical data where available. Since we know seasonal influenza cases have fallen off sharply, any spikes that we see now could indicate unusual flu activity.

Unger: All right. And Andrea, you also talked about how some of the funding is going to the FDA to study the safety of our commercial milk supply. I know that is a concern among many people. Has there been any new evidence to indicate that it's unsafe?

Garcia: No. In fact, it's the opposite. On Friday, the FDA said final testing of U.S. retail dairy samples came back negative for viable H5N1 virus. The agency said it's completed its laboratory research into 297 retail dairy samples tested for bird flu.

After previously reporting that, preliminary results showed the commercial milk supply was safe. Now, as we've talked about previously, these are samples that have gone through pasteurization. It's still not advised to consume raw dairy products. And that was obviously the case before this outbreak as well.

Unger: All right. And Andrea, before we switch gears, what do the numbers look like this week? Have we seen any kind of further spread?

Garcia: Well, we know that more than 40 herds in 9 states have been infected. Those are the same nine states that we talked about last week. So we haven't seen much additional spread. However, that could change certainly as we increase testing. And just as a reminder, until a couple of weeks ago, testing for bird flu and dairy herds was voluntary. It wasn't until we saw that April 29 federal order requiring 30 dairy cattle in a herd to be tested before moving across state lines.

Last week, the USDA-accredited labs conducted about 905 tests, of which 112 were presumed positive for H5N1. However, multiple samples may be taken from a single animal and may be tested more than once. So it's difficult to use that number of tests performed to measure the virus's spread.

Unger: Well, thank you, Andrea. It's something we're going to continue to watch and track as we learn more. Andrea, something we haven't talked about in a while, and that's very interesting, is COVID. Why is that making headlines this week?

Garcia: Well, COVID is back in the news because two newer variants are spreading across the U.S. These variants are part of a new family of variants that are called FLiRT. And, yes, you did hear that right. Scientists have nicknamed this new group of variants FLiRT based on the technical names for their mutations.

One of these variants known as KP.2 is really driving the increasing proportion of cases, which has some experts concerned about a potential summer wave. Last month, we saw KP.2 overtake JN.1, the Omicron subvariant that drove that surge in COVID cases this past winter. And KP.2 became that dominant strain here in the U.S.

According to the latest data from the CDC, KP.2 is now accounting for about 28% of infections nationwide. And then the other FLiRT variant called KP.1.1 is also circulating here in the U.S. It's less widespread than KP.2. It currently accounts for about 7% of infections nationwide based on CDC data.

Unger: That's interesting. Between the two, that's about a third of the cases there. Andrea, do we know much about these new variants?

Garcia: Well, although cases and hospitalizations are down and we appear to be in the middle of a COVID lull, both based on early indicators and severity indicators, the new FLiRT variants are definitely something to watch. Scientists are warning that they may be better at evading the immune system due to mutations in the spike protein. And of course, the waning immunity and poor uptake of the latest COVID vaccine have also made us more susceptible. If we look at the CDC data as of April 27, only about 22% of adults and 14% of children have received the updated COVID vaccine that was released back in September.

However, there's currently no indication that these variants are causing more serious disease. It is too soon to know what impact this will have. We are seeing some early lab studies that are suggesting that the COVID vaccines currently recommended in the U.S. may be less effective against KP.2 than they were against JN.1. The plan is to have a new updated COVID vaccine this fall that could be a closer match. And I would just note that we did see FDA postpone their advisory committee meeting for a few weeks to give them some additional time to obtain surveillance data to inform their discussions and recommendations for the updated vaccines.

Unger: All right, Andrea, most of these different variants have had reasonably similar symptoms. Are there any symptoms that are different with these two new variants?

Garcia: They don't appear to be. Both the FLiRT variants and JN.1 cause symptoms that include sore throat, cough, fatigue, congestion, runny nose, headache, muscle aches and then fever or chills. People could also experience that new sense of loss of taste or smell, shortness of breath, or difficulty breathing or even GI issues like nausea, vomiting or diarrhea.

According to the CDC, the type and severity of symptoms a person experiences usually depends more on a person's underlying health and immunity rather than the variant that caused the infection. All current PCR and at-home tests do detect these new variants, and antivirals such as Paxlovid also appear to be working well.

Unger: All right, that's good news. Andrea, should people be doing anything different right now to protect themselves or others?

Garcia: Well, the variants have changed, but the message really hasn't. Stay up to date with your COVID vaccines, test if you have symptoms or an exposure, stay home when you're sick, and only return to normal activities after you've been fever free and symptoms have been improving for a minimum of 24 hours. And of course, good hand hygiene, proper ventilation and wear your mask in a crowded indoor space. That also helps.

Unger: All right, all good advice. Well, that wraps up today's episode. Andrea, thanks again for being here and keeping us informed. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at We'll be back soon with another AMA Update. And in the meantime, you can find all our videos and podcasts at Thanks for joining us today. Take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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