Outside a farm in Michigan in early May, an RV pulled up and parked. Registered nurse Aracely Nerio and others helped set up a canopy, where nearby farmworkers could find shade or bottles of water, and check their blood pressure and glucose levels. Health care is often out of reach for these laborers.
Those quick check-ins “are the 10 minutes that this person has with you, and that’s all they’re going to have for the next year” to learn how ro stay healthy and on the job, said Nerio, whose own migrant family moved from Texas to Michigan for a better life.
“They’re going to work through colds,” she said. “They’re going to work through all this stuff until they are exhausted or basically can’t.”
This season, health care workers like Nerio are focused on how these patients will be affected by one emerging concern specifically: H5N1, also known as highly pathogenic avian flu or bird flu, which has been confirmed in multiple outbreaks among wild and domesticated animals in the United States. People who work closely with those animals or at food processing plants face higher exposure to risk of infection. And migrant workers face disproportionate risk, compared to the general population. According to Amy Liebman, chief program officer for workers, environment and climate at the Migrant Clinicians Network, these workers make up the bulk of the agricultural and food processing industries. They also are more likely to lack affordable access to health care, and may hesitate to report symptoms if it means not working.
“Worker health and safety is a public health issue, and it needs to be treated that way,” Liebman said.
In the United States, other strains of bird flu began to circulate among poultry in 2020 – the height of the COVID pandemic, when public health experts were already overwhelmed. Meanwhile, H5N1 started to spread in Europe and to several other continents before the first cases in the U.S. were detected in wild birds in 2022. More than 90 million birds in the U.S. alone have been affected by this strain.
In the last two years, this flu has jumped from birds to cows and been confirmed twice in humans in the U.S., most recently in a Texas dairy worker in March. Public health officials, veterinarians and epidemiologists have worried for two decades that something like this – the jump from bird to mammal to human – could happen, and eventually explode into another full-on pandemic.
The virus is extremely dangerous for birds (and the business of poultry farmers by extension), but infected cows have typically regained health within two weeks. Continued testing has shown that pasteurization of dairy products is effective at eliminating risk of infection to this heat-sensitive virus, despite the presence of viral fragments even in commercially available milk.
But the workers on the front lines may be handling animals and food products before they have been treated. And each exposure to the virus carries the possibility of transmission, which allows it to mutate, evolving for its own survival.
“The more this virus circulates, the more there is a chance for mutations,” said Dr. Jennifer Nuzzo, a professor of epidemiology who directs the Pandemic Center at the Brown University School of Public Health. And more mutations could mean a bigger risk of the virus becoming highly infectious among more people.
Some 70 dairy farm workers in Colorado alone were being monitored this month for symptoms and possible illness, CBS News recently reported.
So far, the Centers for Disease Control and Prevention says it has identified no unusual patterns in new flu infections based on available data. Health Secretary Xavier Becerra urged at-risk workers this month to “pay attention to how you feel,” and to look for symptoms that include coughing, fever, sore throat, muscle aches, shortness of breath or eye redness or irritation for 10 days after contact with an animal.
Working at their own risk
Each year in Michigan, where farmland makes up a quarter of the entire state, migrant laborers come to harvest the food that ends up on tables nationwide – no matter what it takes. Farmworkers often wake at 5 a.m. to prune cherry branches, pluck strawberries or milk cows, Nerio said of the patients she typically sees through her work with InterCare Community Health Network, headquartered in Bangor, Michigan.
Sixteen-hour work days are common. By 9 p.m., many workers return from farms to modest camps where entire families may crowd into a single room and share bathrooms. They chase the growing seasons in Michigan, Florida, Texas and beyond, keeping enough of their earnings to pay for food, rent and fuel while sending the rest of their money home. Homemade remedies, like cinnamon tea, along with ibuprofen and Vicks VapoRub amount to health care for many workers when they feel unwell.
Despite lessons the nation learned during the COVID pandemic, there is no paid sick leave option for these essential workers, Liebman said. When pandemic dollars that had once funded public health awareness campaigns dried up, outreach about how to stay healthy during a pandemic grew more haphazard.
On April 5, the CDC issued a health alert to clinicians to look for people with symptoms of respiratory illness, eye irritation and exposure history, as well as how to diagnose and treat people with the virus. The Texas patient had presented doctors with what appeared to be severe conjunctivitis, and further testing showed he was sick with bird flu.
With those realities in mind and a virus at risk of infecting more humans, the Biden administration on May 10 offered up to $28,000 per affected facility over the next four months to buy personal protective equipment, cover expenses to launder uniforms for workers, pay for shipping costs for animal testing samples, and provide funding to heat-treat milk products. These measures are part of a $101 million package dedicated to H5N1 response.
Dr. Nirav Shah from the CDC said they would compensate farm workers who agree to nasal swabs, blood samples and an interview, all in an effort to understand what makes someone more susceptible to developing symptoms of this type of flu.
“We’re building trust in the only way it has ever been built, which is one conversation at a time,” Shah told journalists during a briefing.
What remains unclear is whether health officials have enough time to build that trust before the situation worses.
What public health experts want to see
As the federal government’s response gains momentum (along with efforts by more state and local authorities, commercial farms and businesses), public health officials are hoping for a more coordinated network of resources to support farmworkers and their employers – without stirring unnecessary alarm or fear-mongering. More needs to be done to create clear communication, build relationships and relay updates about the virus through trusted messengers in affected communities, Liebman said.
The CDC is tracking influenza data collected through wastewater surveillance to gauge how H5N1 is developing, and its public dashboard is expected to be available online this week. That is a step in the right direction, said Dr. Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials.
“It’s a tool that could help us know if we’re moving in the right direction,” he said, but its data should be interpreted with other factors, including more widespread testing.
Availability of rapid testing needs to be prioritized to allow public health officials to pinpoint where these outbreaks are happening with greater nuance, Nuzzo said, but also to allow workers to return to work when they are well. More widespread testing also would help the public assess the threat that H5N1 poses to humans, she said. “If a lot of people are infected and don’t have a serious infection, that would be important information to know.”
Nuzzo added that farmworkers and workers in food processing plants need incentives to come forward, especially if doing so could potentially cost them in lost wages or their jobs.
In Michigan, Nerio said she is going to keep showing up for workers, telling them what she and other health workers learn about H5N1 and the risk it poses to humans. Right now, education is her most effective tool to help people working to make a better life in this country.
“If we empower the farmworker to care about their own health, that’s going to go a long way.”
Even after COVID, the nation’s pandemic response is hobbled by inconsistent financial support and fickle political will, said Dr. Shira Doron with the Infectious Diseases Society of America.
when “we need a constant stream of funding.”
“Resources get put into pandemic preparedness when there’s a clear and present threat and get pulled back when the threat recedes,” she said.
Looking across decades of crises in public health, a version of this story has been told with frightening repetition. H5N1 is just the latest edition.
