Egg Prices Up: Hear From Experts About Why

Mark Masselli (00:04)
The CDC reports that bird flu is widespread in wild birds worldwide and is leading in outbreaks in poultry and
US dairy cows. There have been several recent human cases involving dairy and poultry workers. What do you
need to know now?

Michael Osterholm (00:19)
Will this cause the next pandemic? We don't know, but I can tell you with certainty there will be another
influenza pandemic and we're very ill-prepared for one if were to happen now. And so we do need to keep a
very, close watch on what's happening with the current H5N1.

Margaret Flinter (00:35)
Our guests are going to fill us in on the latest. Dr. Michael Osterholm has nearly 50 years of investigating
infectious disease outbreaks and public health threats. Apoorva Mandavilli reports on science and global health
for the New York Times with a focus on infectious diseases, pandemics, and the public health agencies that try
to manage them.

Apoorva Mandavilli (00:54)
I think one thing that's been really frustrating for me as a reporter is the lack of communication from federal and
state agencies to reporters and also among themselves. Cause one thing I reported was there were a lot of
scientists wondering, you know, is are cows getting reinfected with this virus?

Margaret (01:13)
This is conversations on healthcare.

Mark (01:26)
Well, welcome back, Dr. Osterholm and, Apoorva Mandavilli to Conversations on Healthcare. Good to see you
both.

Michael (01:33)
Thank you.

Apoorva (01:34)
Thank you. Nice to be back.

Mark (01:35)
Yeah. And let's start with, Apoorva. You recently reported in the times that cows have been infected with a
second form of the bird flu called H5N1. and this version of the virus seems to be widespread now and wild
birds, but had not previously been detected in cows. I'm wondering if you could share more with our listeners.

Apoorva (01:57)
So just to be clear, they're both versions are H5N1. They're just different subtypes of H5N1, and we've been
seeing one of them for over a year now in dairy cattle. Um, and then the second one has come up much more
recently, is all of a sudden in wild birds everywhere. And then we've just seen it in cattle again. So now it means
we have two versions of H5N1 circulating in the country that are both capable of jumping from birds to cattle,
which they've already done, and from cattle to people, which also seems like it has happened.

Margaret (02:30)
Well, Apoorva, you've reported on the CDC posting, and then deleting data on the bird flu spreading between
cats and people. And there are other reports that the government is holding back a study about veterinarians who
treat cattle and if they've been unknowingly infected by the bird flu virus. What can you tell us about the
situation? It seems so important to get this information out there.

Apoorva (02:52)
Yeah, I think that the key there is actually the fact that we haven't had the information, the fact that cats maybe
transmitted to a person and that maybe a person transmitted to a cat, that in itself is not super surprising because
we expect if they're in close proximity, maybe there is a way that that could have happened. But the fact that we
don't even really fully know, because we haven't seen the full paper. What I wrote is based on one data table that
happened to be by accident, maybe on purpose, who knows in a paper about, um, wildfires in LA and the air
quality, that table just happened to be there for a very brief period of time, and I happened to get ahold of that.
So all of this, that information is based on that one table, but really, as Dr. Osterholm will say, I'm sure we need

to see the all of the data to see what exactly has been going on there. And do we need to be more worried, do we
not? It's impossible to say without seeing the rest of the water flu papers that we've heard are at the CDC but
have not yet seen the light of day.

Mark (03:51)
Well, Michael, you say that we need to see the data because in part, you're the director of the Center for
Infectious Disease Research and Policy at the University of Minnesota. You stated that we should be
surprised… or we should not be surprised that a new spill over to cattle, given the very significant activity in
waterfowl across much of the United States. And you have somewhat of a graphic way of explaining that.
Remember, we're a family show here. I wonder if you could share that with our audience.

Michael (04:19)
Well, first of all, this is un an unprecedented event in all the influenza world. You know, I've been very involved
with influenza for more than 40 years, had worked with H5N1 in Southeast Asia, way back in 2003, four and
five, and, have worked with it ever since. And what's happened is in the last three years, we've had a brand new
strain of the H5N1 emerge. And within that strain, what we've seen then are these two different genotypes. The
D 1.1, which is the one that's primarily in mi, wild migratory birds spilling over, and then what spilled over into
the, dairy cattle, which was B three 1.13. And so they're both H5N1s. What's really challenging right now is for
us to understand what's happening in cattle because we've seen very little information from the USDA over the
course of the last month as to understand what's happening there. There appears to be only limited of any new
human infections in that area, but we're now hearing about additional new infections in Nevada and California
in cattle. In terms of the other side of the ledger here with the D 1.1, I think this is the more remarkable story.
right now North America is swimming in H5N1 from wild migratory waterfowl. it turns out that there are about
40 million of these birds in con the continental United States and Canada. And, normally you would think of
migratory birds leaving from northern Canada and northern states like Minnesota and heading to the south to
the, Gulf and so forth. But that's changed over recent years as more and more warm bodies of water have been
made by man, either electrical generating plants or heating plants, in addition, large sewer lagoon that are
operating from cities as well as even large dairy cattle operations where the water never freezes. We have right
now in Minnesota, a plenty of wild waterfowl here, in the first week of February, despite temperatures way
below zero, as long as there's open water, they'll be there. So that's why you're seeing also all these outbreaks in
in poultry production facilities throughout much of the United States because the waterfowl are largely infected.
This should not surprise us and we'd see more spillovers into, for example, cattle, or that we would see 'em in in
humans. I think we're gonna see more sporadic cases showing up in humans that are really tied to inhaling, what
is basically bird poop. these waterfowl, are well known for, for leaving behind that, wherever they're at. And I
think that that's a huge challenge right now for us.

Margaret (06:53)
Michael, I wonder if I could get you maybe, we'll, go up a thousand feet and, look at what people need to know.
We've talked about CDC, there being maybe papers at CDC that we'd like to get. We've talked about, not having
access to all the information. What's the role of the state health departments, in this in terms of reporting what's
happening in Minnesota or what's happening in Connecticut and reporting on the human, cases as well? Are the
states doing that reporting independently, or do we all have to depend on CDC for this information?

Michael (07:26)
Well, the states are reporting that, and again, it's really important to remember that, as far as public health goes,
it's a state's rights issue, meaning public health is not described in the constitution, which automatically means it
defers to the state for primary authority. The problem with it is that states have invested very little in public
health. in our own state, here are 95% of all the support we have at our state health department comes from
federal sources. So in many instances, we're really caught in terms of the state conducting their business and
what they can report and not report in. Additionally, we've seen a growing number of states, particularly red
states, where they just aren't making information available. and so it's, it's a real challenge for us in public health
to know exactly what's going on and in a situation where, you know, will this cause the next pandemic? We
don't know, but I can tell you with certainty there will be another influenza pandemic and we're very ill-prepared
for one if were to happen now. And so we do need to keep a very, close watch on what's happening with the
current H5N1, but knowing that tomorrow we could be surprised by another flu virus that emerges and causes
the next pandemic.

Mark (08:32)
You know, just to give our audience a sense of the scope of the problem, H5N1 has affected over 156 million
commercial backyard and wild birds in our country during the past three years. Michael, you've discussed the

poultry industry's need to do more to stop infections. Maybe be a little more specific of what type of actions
they should take.

Michael (08:54)
Sure. Well, you know, I was actually involved back in 2015 with the first, culling or depopulation activities
around, that entering into poultry in Minnesota when in that year, over 20 million, birds here in the upper
Midwest died as a result of the virus getting into poultry production facilities and egg lane facilities. And at the
time, a lot of the effort was, really, really aimed at biosecurity. It was defined by making sure people didn't go
from one farm to the other that, they, you know, had clean clothes, boots, washed, trucks, et cetera, all that kind
of thing. But it was clearly not enough. And there was data from a study done in the, by Iowa State University
showing that it was likely predicted what, barns would break next downwind from previous barns that broke in
the days or two before. And it was classic, airborne transmission of this virus. And I think that there is much
more of it than we realized. And once it gets inside one of these barns and they're not airtight, then these birds
are highly susceptible to that virus. And of course, the only thing you can do is call the entire, flock of birds
because they're all gonna die anyway. and so I, my recommendation back in 2015 hasn't changed 10 years later,
they need to make these barns airtight with HEPA filter air in, intakes so that they can screen out this virus. So if
it's blowing across fields, and again, if you've ever been to a location where a flock of Canadian geese have just
been there is, you know, all over the environment, you're gonna see, bird poop, and it's going to basically over
time, dry and be able to be air, put into the air and breathed in. So I think you're not gonna see a real change, in a
meaningful way in terms of the risk for poultry operations till they understand this airborne risk.

Mark (10:47)
And has that jump to humans at that point? What's the pathway jump to animals?

Michael (10:52)
Well, I think it's, yeah, I think at this point, mark, what's gonna happen is that, we're gonna see more isolated
human cases. I'm confident we haven't missed a lot right now. Right? On an average week, there's about 3,500
specimens in the United States of flu A cases, meaning either influenza, a H1N1, or H3N2, or now also looking
for H5N1. And, over the past several weeks, even with all those tests, they've all been H1N1 or H3N2. There's
been no evidence of H5N1. So I don't think we're seeing a lot, but it wouldn't surprise me if we start seeing more
isolated cases. And if you're thinking of a model for this, think of, basically co I mycosis those fungal disease,
the San Johan Valley, you know, valley fever, where it blows in the air and people inhale it. I think you're gonna
start seeing more of that with this, because there's just so much virus out there, in, in these 40 million wild
migratory birds. And then on top of that, remember they're continuing to have new chicks every year. And so,
they at this point, they are gonna have fresh new, birds for infection that are gonna keep happening.

Margaret (12:03)
Wow. Well, the critical question on, people's minds, of course, is how it, affects humans. but I understand, it's
mild to severe respiratory symptoms are possible in pink eye, Apoorva, how do you, communicate with patients
about this? What parts of the country should a patient with respiratory symptoms in pink eye be thinking that
this could be the cause or their care teams thinking this could be the cause? I can tell you where we live. I don't
think it's on the radar, and we're one big open country kind of imagine it's gotta be all over the country at this
point. Tell us about that.

Apoorva (12:42)
It is all over the country at this point. There's the, the wild birds are everywhere, and so is the virus. So I don't
think there's any particular part of the country where we can feel like, oh, if, you know, if you have flu A, it's
probably not H5N1. I mean, just, a couple of days ago they shut down the wild bird markets in the, um, poultry
markets in New York City because they found H5N1 here. So that's happened in the cities many, many months
ago. I wrote about birds that were found in Central Park in New York City that had H5N1. They're in Idaho,
they're in California. They're, you know, down south. There's not really a part of the country that is safe. Um, so
far, I think what has been somewhat reassuring is that most cases have seemed relatively mild. I don't wanna say
mild as if nothing happened, because even when we've talked about conjunctivitis, it's a pretty severe
conjunctivitis. It looks like they've got blood in their eyes, um, but it's not fatal. And it, the only person we've
seen die of it so, so far has been one person in Louisiana who had this, the D one one version that we were just
talking about, the newer one that's been in the Nevada herds. Um, there's no reason to think that that's why that's
more severe. It's because that of that particular subtype. But it does seem as if most people have been able to get
away with just respiratory symptoms in some conjunctivitis. And we haven't seen the kind of fatality we worried
about with this virus because in Southeast Asia when we've seen cases, we've seen, mortality rates of something
like 40 to 50%. And, um, we are not prepared for anything close to that. but so far at least we are not seeing any

signs of that. I do wanna get back to one thing that Dr. Al mentioned about the states. I think one thing that's
been really frustrating for me as a reporter is the lack of communication from federal and state agencies to
reporters and also among themselves. Cause one thing I reported was there were a lot of scientists wondering,
you know, is, are cows getting reinfected with this virus? And that's information that's really valuable because
we need to know, will they keep getting infected or will this barn itself out at some point? And apparently there
was a reinfected herd in Idaho, maybe more than one, but that's not information that came from the federal
government. And in fact, when I went to ask them that, they said, oh no, we, we have, we don't know of, of any
new herds infected in Idaho since October. Meanwhile, Idaho is saying they did find them in November and that
those were reinfection. So that lack of clarity, the confusion, the the lack of communication between federal and
state, all of that has been extremely frustrating to follow along what's going on,

Mark (15:07)
Maybe to both of you. And while the, this is an issue across the country, it's really not a kitchen table issue at
this point, except I noted in the above the fold in our statewide paper today, the headlines was egg cost, bringing
turbulent times. It was really talking about the 7 dollar and 50 cent on average cost for a dozen eggs maybe
hitting to, to 15 bucks in June. Walk me through what the of crosswalk might be from that reality to getting
people more educated about what's happening. What, what's your sense of, what it should be? A kitchen table
conversation, but often isn't around healthcare, but certainly, the economy of this is, is, taking a big toll, right?

Michael (15:57)
Right. You know, and if I could just comment on the human side, then I'll comment on the egg side. You know,
people are very confused. You have CDC saying that this is a very low risk situation for humans, and you had a
state like California declaring a public health emergency over this issue. And guess what? They're both right. the
California situation was all about trying to move, resources into the agricultural community that required an
emergency declaration to try to deal with the herd infected in California at the same time. CDC is right. This
still is a very low risk situation for any serious illness in humans. The problem with this is think of this model
where you're walking across this very, very flat piece of land for days and days and days. Seems like it's pretty
predictable what's gonna happen until you take one long step and you fall down 150 foot ravine. Okay? All of a
sudden, you're over the edge. If we're gonna see a pandemic of influenza in humans, it's likely to occur quickly.
whatever changes that the virus requires to make it that pandemic strain are gonna happen overnight. And I
think we're gonna find ourselves in that situation. Our problem is we don't know when that's gonna happen. As I
say, often, you know, the pandemic clock is ticking, we just don't know what time it is. And H5N1 may never
do it. H5N1 may have already done it today, and we didn't know it yet. And so I think that's the challenge that
people have is when is this really, an important issue for me or not? But the issue that they do know and
recognize is that around what are egg prices? And that's even if they can find eggs, let alone whatever they cost.
And that's gonna continue to be a problem. you know, we have such widespread infection right now throughout
the country in these migratory waterfowl that they're continuing to spread this into these barns, as we've just
talked about. And I just don't see any break coming in the future till the agricultural community changes what
they're doing. Maybe the buildings there surely is some potential role for vaccines in these chickens. But on a
whole, it, it's not one that I think is gonna get solved soon.

Mark (17:58)
Apoorva?

Apoorva (17:59)
You know, you mentioned earlier too, that there were 156 million birds infected. And I wanna point out that's
not the number of birds infected. That's the number of birds killed because there were some that were infected.
And so that I think is the real issue here is even when you have some birds that are infected, you have to end up
calling the entire flock. And so you end up wiping out massive number of birds in one fell swoop. You know,
we just had a, a farm in Long Island that had to kill a hundred thousand birds in one weekend. So it, it really
makes a huge impact, and that is going to really play into the availability of eggs. I think you saw Denny was
charging extra for eggs. I mean, this is, this is the thing that people will start to notice, but it's also not a bad
thing for them to notice as long as there's not panic because they do need to take certain precautions, right? We
don't want people necessarily eating raw eggs at this particular moment in time. It's probably okay, but may not
be. And it's also, you know, you don't want people eating raw meat and drinking raw milk and doing things that
are unnecessary risks at a time when we are seeing so much of the virus out in the environment.

Margaret (18:59)
Well, of course, you've just mentioned a few things that have come back into sort of public consciousness with
some of the trends we're hearing, in the media about everything from raw milk to raw eggs and pursuit of health.

But I, I think I wanna, back up again maybe and, and remembering, Michael, that we, had the opportunities to
talk many times during CIDI remember, one conversation, you know, what would we want to learn from this
that will help us the next time, right? How, how do we learn from our experiences with public health issues to be
better prepared? And what, what should we be doing today? What, what could we have done if we'd only known
back in the covid days that we might be thinking about now in terms of communication? Why, you know,
protection across the board, local preparedness, and how, how is that playing out, do you think?

Michael (19:52)
First of all, I think it's really an important point to note that we're probably less prepared to respond to a
pandemic today than we were in 2020 with, COVID. And that is in part due to the fact that, we just really have a
lack of trust in our public health system today. And much of what is gonna have to happen during a pandemic,
again, is gonna be a series of recommendations about how do we get through this. And so, as one who has really
pushed forward for having a major review of covid and how we responded, not to blame or point fingers, but to
have lessons learned, we haven't done that. Mm-hmm. The second thing is I don't think people realize how
fragile the immunization potential is against, COVID. And I say that because today we have the ability to make
about 3.8 billion doses of influenza vaccine every year. And that's a year. that means that if when the new virus
emerges, we'd have to put that into production. 3.8 million sounds like a lot till you realize it's a two dose
vaccine. And so we can only vaccinate right now about a fourth of the world in the first year, and we'd be hard
pressed to even have enough vaccine by the third year for the world itself. So we're in trouble that way, and we
just haven't recognized the need to invest in that kind of infrastructure. We're doing more work with, mRNA
vaccines, and hopefully that can surely help us. But I think right now, we would have many challenges trying to
get, safe effective vaccines to the public if a pandemic were to emerge tomorrow.

Mark (21:21)
You know, I wanna get into the mRNA in a minute, but Apoorva, you've been talking about trust in, in, in the
healthcare system, in the public health system, how it's diminished in terms of, people's faith in the FDA or the
CDC, but you do note that there still continues to be faith in your primary care provider, right? but walk, walk
us through sort of the challenges any pandemic or any large medical issue is gonna have when we've seen this
diminution in, in, support for, the public health system.

Apoorva (21:56)
I mean, I think it's not a surprise or that we've seen all of this, this the very heavy political influence on how
public health is viewed. And so there are so many people in this country now who don't trust the CDC for advice
on how to protect themselves. There are so many people who don't, trust in the FDA to make decisions free of
commercial interests. We have, people who are incoming in the administration, like RFK Junior, who looks like
he's probably going to be the head of HHS, who has said very critical things about childhood immunizations. He
has even called the, board flu vaccines, the H5N1 vaccines that we have in the, the, um, stockpile, he's called
them dangerous. Um, and even though he did reassure people during his confirmation that he would back a bird
flu vaccine, there are all these questions about what would actually happen if we were to have a pandemic. I
think a big part of the issue during covid was that people did not trust that they were being given all of the
information. Some of that was unavoidable because information was changing, but it, it created this, this
perception that the CDC was lying to them and telling them one thing one day and saying something else
another day. That is true. They literally were doing that. But part of that is because the information changed.
However, I do wanna point out, there were times when they didn't say everything they could have, or they said it
in with maybe more confidence then was warranted by the information available to them. And I think there was
some amount of wanting to keep everybody calm by only giving them certain amounts of information. Um, and
that seems to also be an overarching theme now, you know, it's only, I would say, I've been talking to the CDC
very regularly for the past year plus about this particular bird flu outbreak, and it's only in the last conversation I
had with them where they said, yeah, it's, it is low risk right now, but that could change. As Dr Ostrom just said
earlier, it took them, it took them that long to say that before that it always just was, it's low risk. It's low risk.
And that is true at that point in time. But without that, but that could change. It doesn't really give people the
sense that they are in good hands, that they will be the treated with honesty and candor when the time comes,
that they will get all the information they need to protect themselves. But I do think it's interesting that while the
public health agencies are not trusted, people do really trust their physicians. So if that messaging can at least go
to their own doctors, that's still a way that you can reach people.

Mark (24:15)
Might simple apologies have worked for both the, CDC and, and, and some of the other agencies? It didn't seem
like they, they ever had an honest conversation, with the American public.

Apoorva (24:28)
I think that would've gone a long way to say, we should, we did not give you all the information you needed as
soon as we had it. And next time we will do better.

Mark (24:35)
Yeah. Yeah.

Margaret (24:36)
Well, into the breach, others will step with information or communication, to, keep these issues before us. And I
know the Kaiser Family Foundation conducted a poll in January and found that most people said they're not
concerned that they're a family member would get sick from bird flu, but almost half or 44% said they are
somewhat are very concerned about a widespread outbreak in the United States. That in and of itself kind of
surprised me that it was at that level of consciousness in a general, poll. Do you think this is a good sign that
people are paying attention but not panicking? you know, COVID, we had no such ramp, right? It was nothing,
and then it was here in front of us, and, and we all remember those early days. Do you think, we'll, we'll do
better with people just keeping calm, but educating and learning, educating themselves and learning what's
going on?

Michael (25:29)
Well, you know, I actually think that this is a challenge relative to the fatigue issue. Um, you know, I'm
beginning to hear from people who are saying, oh, you guys are just all crying, fire in a crowded theater. You
know, we've heard this over and over again from you. And again, you know, my message has been
continuously, this is all about the next influenza pandemic, which will happen. We just don't know when it's
gonna occur and which virus is gonna cause it. You know, I, as I've noted earlier, have been very involved with
H5N1 dating back to Thailand, Vietnam, and Indonesia back in 2003 and four. In 2012, I was on the National
Science Advisory Board for biosecurity, where two researchers brought data to us saying, we're only one
mutation away from, this virus causing the next pandemic. then we saw in, the Nile River Valley in 2000 fifteen,
sixteen, a hundred and fifty plus cases, and duck farmers, half of them died. Oh, now it's gonna do it. And
actually, it was really from that time until really the two years ago that it was the quietest period for H5N1, in
the entire history since 1996 and 97. And so I think even those of us who work on this issue very closely don't
really know what it means, will it in fact, basically become the next pandemic. So that's hard to convey to the
public. So my message to the public is, we gotta be ready. It is going to happen. we will have a pandemic. I just
don't know which one is gonna be.

Mark (26:57)
I wonder what…

Apoorva (26:58)
I wanna be a slightly more optimistic there and think that maybe because we, people are familiar with the flu
because they're familiar with the 1918 pandemic because they know that the, there is an idea of another flu
pandemic. And I think because it affects kids, it generally has affected kids. I think when they see that there will
be a bit more of taking seriously than there was with Covid where it was sort of easy to dismiss as, oh, you
know, it only affects people of a certain age group or with certain conditions and everybody else is fine. I think
when people see that it actually, that's not the case, that young people can be affected, kids can be affected, that
maybe that will turn the tide. But I might be really optimistic there.

Mark (27:35)
is there any best practice that you're seeing around the globe? Anything at the EU or World Health Organization
in terms of how they're addressing this issue that we might learn from? Not that we're gonna learn from other
parts of the world. Sometimes we tend to be stubborn here, but, um, where, where, might we look?

Michael (27:53)
I think right now the Europeans are way ahead of us in terms of vaccinating poultry and successfully holding
back infections from, really evolving inside the poultry industry. Now, that doesn't take it outside of the wildlife,
though, of course we're still seeing a substantial amount of virus there. But I think we have lessons to learn from
them about potentially using poultry vaccines.

Mark (28:16)

President Trump has appointed Gerald Parker, to be the new head of the White House Office of Pandemic
Preparedness and Response policy. Can we take this as a good sign? Because previously the president said he
wanted to shut the office down.

Michael (28:29)
Yeah, I think it's a good sign. Someone who's worked with Jerry for the last 20 years, I think he can bring some
important leadership there. And I think the fact that the office still exists is obviously very important.

Apoorva (28:40)
We're not talking to the WHO right now, and we're also not talking to the CDC, the CDC's not allowed to talk to
anybody. So those are some big obstacles that we would need to get past if we had something serious to do
With.

Michael (28:52)
I, I would agree. And I think the other issue is that realizing the time sensitive nature of this interview, we're all
on bated breath right now. There's gonna be a major reduction in force at CDC. There surely appears to be every
indication that's gonna occur. And should that occur, like, probably just said about WHO, these are gonna be
major challenges in terms of maintaining public health activities, major challenges.

Margaret (29:16)
Right. Well, we appreciate that we are still talking with you and want to thank you, Michael and Apoorva for
joining us. Thank you to our audience for being here. Just a reminder, be sure to subscribe to our videos on
YouTube, find us on Facebook and X, and please do share your thoughts and your comments about this
program. Take care, and be well.

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