Episode 31: Understanding the Avian Flu with Key Opinion Leader Chad Roy

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I'm James Zanewicz, the Chief Business Officer for the Tulane School of Medicine.

And I'm Dr. Elaine Hamm, the Executive in Residence for the Tulane School of Medicine.

And this is Bio from the Bayou.

Today's guest is Dr. Chad Roy. He's the Associate Dean for Research and a professor of microbiology and immunology here at the Tulane School of Medicine. He also serves as the director of the Infectious Disease Aerobiology Scientific or at the Tulane National Primate Research Center, and is often the go-to person for expertise surrounding any disease that has the potential for airborne transmission. Welcome to the show, Chad.

Thanks, Sharon.

There's been a lot of news lately about the avian influenza outbreak among dairy cows in the United States, and at least 2 cases in humans that occurred as a result of contact with sick animals. Can you break down for us where the avian flu comes from, what signs to look for, And just how it makes the jump between species?

So, avian influenza is very much like the normal seasonal flu that we deal with on a yearly basis, with the exception of some important structural changes. So, the building blocks that make it up are a bit different, thankfully, than the seasonal flu. This particular one that was identified this year, the H5N1, High-path avian flu was actually identified several years ago, and it causes a midgut infection in migratory birds. It's constantly in the environment. We just see it every, you know, every once in a while. The jump between species is what we're really looking for though, and whether or not it can transmit effectively from the animals to the humans, from animal to animal, and, and that's what we're experiencing this year, as well as we have in past several years in some respects, is transferring to flocks of breeder hens and laying hens in a poultry confinement.

Do you have any reason to believe that humans could pass this on to each other?

That's one of the reasons I was brought into looking at transmission in this particular case, because of the infections that were seen in cows, now in, I think, 8 states and 20 different herds of cows. What's been described as a spillover event, potentially, to where cows were not only infected from what we think is exposure to the droppings of migratory birds, but also from cow to cow. And that's where really Hard work needs to be done to figure out the transmission of how that's happening because that's essentially a surrogate for making it from cow to, to human or human to human, which is really our concern here.

So, given the reports of the infected cows, there is a question mark hanging over our dairy products. Are we clear to keep enjoying our milk? And should we have any concerns about the broader impact on other food items Like beef or chicken?

That's a great question. So while it's known that this virus can transmit in milk products, there's 2 important things to remember. One is that the cows are monitored very closely. So when they are showing signs of disease, they're pulled off of production. Okay, so, and that's, that's done in a very modern, you know, industrialized way here in the United States. So a lot of care is taken there so they're not in the production cycle. The second thing is that most all of our milk products are pasteurized, and pasteurized, it heats the milk product to a temperature that either kills or deactivates the microorganisms that are found in the milk. We've been doing that for several years by law, and that's effective against this virus. We've got a couple of different ways that we protect the consumer. Now, the exception to that is raw milk products. And that's one of the things that the CDC, the USDA, and the FDA, which regulates milk, you know, milk as a food product, has come out with to, to make sure that everyone understands that there's no safeguards relative to pasteurization in those products. And those are all— raw milk products. So there is a risk there, and, you know, we need to be, you know, vigilant and pay attention to those things as a possibility of that being in those, those products. So I think that's really the only thing that right now they've come out against, saying there, there may be an increased risk with the consumption of raw milk products, which is just a risk in general if you're going to eat a or drink a raw milk product. For, for other microbial contamination, not just influenza virus.

So COVID cast a long shadow. It's natural for people to worry about facing another pandemic. In addition, public trust in CDC has declined significantly. So I have 2 questions for you. Number one, what should be our level of concern? And 2, how can health organizations rebuild trust while still preparing us for future health crises?

Let me climb up into an area where I can rant a little bit about this. So we are in a post-pandemic environment. It's incredibly important, incredibly important that everyone, not just the, the folks in charge or the, the folks doing the surveillance or scientists and physicians that worked hard during the pandemic, are vigilant. But everyone is vigilant in understanding and comprehending what a pandemic can do, what we need to look for, preventive measures, and supporting surveillance programs that are consistent with preventive measures for a pandemic. So everybody can kind of do their part in staying vigilant for the next one. Hopefully it's a long time from now, but, you know, in an if-not-when, but it's probably a when.

What would you say is in our medical toolkit today? Do we have vaccines, treatments, or a way to test swiftly?

So, in particular for high-path avian influenza, there's been a lot of work that's been done behind the scenes in the National Stockpile of Medical Countermeasures that we have. So, we do have some protections there in terms of vaccines that have been produced. and are in our national stockpile, the specifics of which weren't really given, but organizations, governmental organizations such as BARDA, came out and talked about the national stockpile and their ability to counteract any potential pandemic, which is great news.

Former Senator Tom Daschle, who now leads a coalition of public health organizations and vaccine manufacturers, recently said, Federal funding for pandemic influenza has not kept up with the threat, even by the government's own assessments. In your opinion, is the federal government allocating sufficient resources for preparedness against disease outbreaks? And if not, what specific actions should they prioritize to enhance response readiness?

Great question. It's a multi-part answer, and I'll try to keep it brief. Our government's ability to surveil these types of outbreaks and spillover events with all the disease agents that we worry about is there. From what I've experienced, at least working with some of these organizations, is that the working together to kind of this One Health concept to where we understand where these disease agents are living in our environment and how they can impact human health really has to take a comprehensive way of looking at things, meaning the veterinarians and the veterinary scientists sometimes don't necessarily talk to the human health scientists at the USDA and the CDC, and they're trying desperately to do this, to, to work together, all just super hardworking folks. Those surveillance programs Really need to embrace this idea of One Health, which I, I just believe in totally, that the health of the environment, the health of the animals that we live with in that environment, and, and then ultimately human health are all one. And unless we look at that comprehensively, surveil it comprehensively, we're going to constantly be playing catch-up. with that. Really hope, sincerely hope that the lawmakers and folks in charge understand that. So not necessarily understanding all the, the techie stuff associated with the science around it, but just enabling that kind of communication. That's one of the biggest hindrances. That's one of the lessons learned from COVID That we saw that this, you know, came out of the woods, right? And impacted human health. That part is a real black box and it remains a black box until we embrace this idea of a One Health idea, just in the, call it an outbreak necessarily, but the, you know, HPAI experience that we go through nearly every year now at this time of year. It's a lesson learned every year. Where the veterinarians, veterinary science are trying desperately to talk to the human health scientists involved in that, ultimately to translate into some kind of policymaking and public relations message to the public that's desperately wanting the information. And it can get garbled. And so I think we can improve. We can always improve. That's a definite area that we can improve in to combat future outbreaks.

One last question. With avian flu and the questions it brings around preparedness, is there anything that keeps you up at night?

Well, my experience, I mean, I focus in airborne transmission of disease. I have for nearly 3 decades now, first with the U.S. Army and now at Tulane. There's a lot of things that keep me up at night when I think about that and airborne transmission of disease. I guess one of the things that in this latest outbreak that was concerning is I just finished talking about, which is the—

Yeah.

One group of scientists not necessarily understanding or The absence of information about transmission of a disease that ultimately could potentially end up being in, in the human population. Once it's in the human population, kind of all bets are off. That's the part that worries me is that, wow, there's so much to know in that transmission pathway that is yet to be defined. You know, I guess I look at, you know, the experience of human population for thousands of years with something like tuberculosis. You know, if we think about that for a bit, tuberculosis has been with human beings for tens of thousands of years. It's an obligate respiratory pathogen that has to be transmitted. It's very sophisticated, but from human to human. And we still haven't figured it out. We're still struggling with it. There's endemic parts in the world, you know, like South Africa, that suffers with tuberculosis disease. So that idea, and that we haven't figured that out after thousands of years, is what kind of keeps me up at night relative, or in the context of something like HPAI.

Sorry for the curveball. Thanks so much for sharing your expertise with us. We'll be sure to continue keeping an eye on the news surrounding avian influenza. As always, we will have Dr. Roy's contact information and informational links posted in our show notes. Make sure you check them out to learn more. Thank you once again for joining us, Chad.

Thanks so much, Erin.

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