Addressing bird flu anxiety: Here's what you need to know

With the cost of eggs rising, there have been growing fears in the public about the threat of bird flu. While the bird flu rarely affects humans, it doesn’t bypass us altogether. When it strikes, it can be deadly. Here's the latest and what to consider if patients ask about their lingering cough in connection with bird flu.

Recently, an 11-year-old girl recently died of avian flu (H5N1) in Cambodia, sparking new concern and conversation about the virus, the Khmer Timers reported. The incident was the first bird-flu-resulting death recorded since 2014 in Cambodia.^[]

If you suspect a patient is at risk for bird flu, here are a few things to evaluate before confirming or denying their case, and how to proceed with treatment. 

Educating patients on bird flu pathology can help debunk myths; calm fears

Bird flu is most commonly spread from birds to other birds. If and when it spreads to humans, it does so through poultry. Some poultry-to-human contract routes include membrane spread, like touching dead poultry, or droplet spread, like touching feces from an infected bird. This can happen if a person touches or comes in close contact with birds that have died from the virus without protective equipment. Protective equipment can include gloves, goggles, and respirators, according to the Centers for Disease Control and Prevention (CDC).^[]

“Whether it's through eyes or the hands, humans can get the bird flu, but this is a very rare thing,” says John Mourani, MD, medical director of infectious diseases at Pomona Valley Hospital Medical Center. “Viruses do not jump species easily.”

Despite its rarity, the virus is incredibly pathogenic: “the fatality rate is very high when this happens,” Mourani adds.

Bird flu can have a mortality rate of about 50 percent to 60 percent in humans, according to the World Health Organization (WHO).^[]

In the recent case in Cambodia, emergency investigators reported finding “an irregular number of dead wild animals” near the girls’ former home, according to the Khmer Times. 

People at risk for catching the virus are more likely directly handle birds or poultry—including poultry farmers and hunters, according to the CDC.^[]

If patients who live in low-risk areas express fears of the bird flu, it may be helpful to educate them about the pathology of the virus. You can also remind them that people do not catch the bird flu from eating eggs—while bird flu has been responsible for egg shortages and increased egg prices in some stores, that’s because the flu has killed off hens, not contaminated their eggs—and is rarely spread through human-to-human contact.

“If the human gets infected but is not able to transmit to another human, there's no epidemic evolving: spread stops there,” Mourani says of typical virus progression. “If the virus is fit enough to replicate and then transmit to other humans, it would become a concern.”

The recent death in Cambodia raises concerns about human transmission, as emergency teams identified 12 other people who potentially contained the virus. However, the source of transmission is unconfirmed.

With current events in mind, Mourani says human-to-human transmission is not absolutely impossible but remains highly unlikely. There has been no recent evidence of human-to-human contact in the United States, nor are there signs of that happening in the near future, he adds. If human-to-human contact was found to occur and to occur rapidly, avian flu vaccines exist that health authorities could disperse, he says. For now, he adds that the need is unnecessary. 

“So far, there's no evidence for something like becoming a true epidemic and for vaccines needing to be dispersed,” says Mourani. “If there's true concern about avian flu, then public health needs to be informed, and the patient may need to be isolated appropriately and get treated properly.” 

Bird flu symptoms can be similar to other strains of flu—and COVID-19—making it hard to diagnose by presentation alone. 

“The big thing that links this to bird flu is the exposure to poultry and farming, and exposure to birds,” says Mourani.

Treatment is likewise the same as for other types of flu, which most physicians have the tools to diagnose and treat, Mourani says. Due to the likelihood of severe cases from this strain, however, treatment would likely involve hospitalization, he adds.