Coser to a Cure for H5N1 Avian Influenza

Covid-19 has killed over 1.23 million Americans - 47,500 in 2024. That is more than in all U.S. wars.

H5N1 highly pathogenic avian influenza (HPAI) potentially could kill ten or twenty times that many. Chances are it will kill far more than Covid did, especially if health authorities continue to ignore the science. 

  Far less likely, as Donald Trump predicted for Covid-19 in early 2020, “It will all go away by Easter.” 

Tens of millions of Americans could die of H5N1. Or not. Viruses are tricky. Today, the only thing we know for sure is that American health authorities are almost totally unprepared to meet the immense historic challenge of a potential H5N1 pandemic that most epidemiologists believe eventually will strike – perhaps soon. 

How unprepared are we? The Trump administration is extremely unprepared. What can we do to fix that?

Besides physically protective barriers including masks, shields, social distancing, quarantines, shutdowns and hand sanitizer, the two main things people can do to protect themselves from infection, illness, and death during a viral pandemic are to get vaccinated and take effective medications as soon as they start to feel sick. Vaccines take time to develop, test, approve, manufacture and then distribute. Antiviral treatments are far quicker to access. Where are we now with those two critical aspects of pandemic defense?      

Scientists have already developed several candidate vaccines for H5N1 influenza. Five million doses of one are stored in our national medical strategic reserve. But those stored vaccines are calibrated to older versions of H5N1. Like a two-year-old seasonal flu shot, they will not offer maximum protection. They will not be an exact fit for the current viral genotype. Today no one can predict which variant will emerge as pandemic until it finally begins to transmit person to person. That genotype does not even exist yet.  

Although H5N1 flu has been endemic in China and Southeast Asia since 1997, it did not spread to Central Asia, the Middle East, Europe, and Africa until 2006. That year the World Health Organization issued its first international emergency warning about its spread. Although to date it has infected and killed almost one thousand people, some after they had eaten infected fowl, it has not made the final jump to being contagious in humans.     

Waterfowl are the natural reservoir for all influenza viruses. H5N1 is an avian flu, so other bird species are easily infected, but not most mammals. Unless a person eats an infected bird or works on a chicken or dairy farm and receives a heavy dose of the virus from direct contact with an infected animal, its feces, or milk, people are unlikely to be infected. Since 1997 48% of all those who have been hospitalized with serious H5N1 flu have died. Luckily, American dairy workers who have been infected by milk droplets being splashed or by them rubbing it in their eyes have avoided serious infection and have suffered mostly from conjunctivitis – red eye.   

First evolved through genetic reassortment of two other H5N1 variants in Egypt in 2021, migratory geese carried the 2.3.4.4b clade from the Netherlands to Canada in late 2023. It quickly spread from Canada to Argentina where it almost totally wiped out some colonies of seals and sea lions. Today H5N1 has infected most species of birds in the Americas and has killed half the American bald eagles in some states. The virus initially jumped from birds to cattle in Texas via bird defecation on the grass, silage, or hay cattle ate. Then it spread cow- to-cow through milk residue left on milking machines. Cow udders concentrate the virus in milk. Although virologists say the current HPAI flu virus is only one mutation away from becoming transmissible between people, no one can predict when that final mutation will occur. It could be weeks away, or maybe years. However, once that final leap to human transmissibility is completed, if health authorities are not adequately prepared it will be a historically disastrous pandemic. The critical question is, what will the case-mortality rate be – 2%, 48%, or somewhere in between? With Covid-19 it was 1.2% in the U.S. With H1N1 avian flu in 1918 it was 2%. 

The latest science news is that 90% of infected cats die. Cats can get infected by eating infected raw pet food, drinking raw milk, or by eating infected birds or mice they have caught. Domestic cats have transmitted the virus to their owners. The question is, how? That has not been determined. Could any American household with cats become our own American version of the Wuhan Wet Animal Seafood Market?    

Becoming transmissible could happen anywhere in the world, but with the recent prevalence of the virus in North America it is likely to occur here. How bad could a pandemic be? That depends on several factors. 

There are currently two genotypes of the 2.3.4.4b clade of H5N1 circulating in North America. The first is B1.13 that has killed sea mammals, chickens, cats, and bald eagles, but none of the more than seventy humans it has infected. That is probably because the preponderant route of transmission has been through the eye. Evidently, B1.13 is not very lethal for people. However, as we learned with Covid-19, different variants exhibit different characteristics. For humans, the newest D1.1 variant is far more deadly than B1.13 ever was. 

The first known victim of genotype D1.1 was a teenage girl in Western Canada. Although they could not determine how she was infected, she required intensive care in an ICU for six weeks and barely survived. 

The second known person with the D1.1 variant was a man in Louisiana who died several days after he was infected from backyard chickens. The third person who died with D1.1 was someone in Mexico. If three out of three establish a trend, then the trend is that D1.1 is much deadlier than B1.13. D1.1 only began circulating in American birds in late 2024 but is already the dominant variant in the wild. That genotype currently presents the greatest danger to humans, but viruses never stop mutating and evolving – especially influenza.          

  RNA viruses like influenza mutate every time they replicate. Unlike DNA, RNA does not have a proofreading mechanism. Every time it copies its genes, one out of a hundred is miscopied – a mutation. However critical, major mutations seldom occur. Thus, the more likely way H5N1 eventually will become transmissible is through reassortment. That can happen when two different influenza viruses – a seasonal flu virus and an avian flu virus – concurrently infect the same cell. After both virus release their RNA, they can exchange gene segments, and one virus can acquire traits from the other. Thus, an untransmissible virus can gain the ability to transmit person-to-person. When that will occur with H5N1 is anyone’s guess. However, while everyone is waiting, no one is preparing - especially the Trump-Kennedy health team. The H5N1 pandemic won’t be gone by Easter. It may not even start by then. But because flu pandemics gradually peter out after two years, effective intervention from the start is the key to saving lives and reducing the pandemic’s health and economic impacts.  

The CDC claims it is prepared. It is not. They offer two antiviral drugs – Tamiflu and Xofluza. While both those are initially effective, all flu viruses become resistant to them within days. Just as in the last flu pandemic in 2009, after a few months those drugs will be completely useless. No one will be protected. 

Kennedy has hired Steven Hatfill, a proponent of ivermectin (IVM) and hydroxychloroquine (HCQ) to lead the Office of Pandemic Preparedness. IVM and HCQ are effective antiparasitic drugs. Neither is truly effective against viral infections. Especially avoid HCQ because it can even promote viral replication.   

What about vaccines? A half-dozen H5N1 candidate vaccines are in development. With mRNA technology a good fit for a newly emerging contagious variant could be available in as little as 42 days, the time it took Operation Warp Speed to develop an excellent vaccine in 2020 using the advanced mRNA technology platform that had been painstakingly developed over the previous twenty years. But JFK Jr. promises to protect the American people from vaccines and says he will require months-long, unethical, placebo-controlled clinical trials before the FDA will approve a new vaccine. Kennedy refuses to accept mRNA technology that allows mass production of vaccines months faster than the older egg-based production method. That alone would delay vaccine supply availability by six months. However pharmaceutical companies in Europe, China, and Russia will rush ahead and the European jab should be approved by the European Medicines Agency as quickly as they approved the Covid vaccines in 2020. Then it will go into production in India and be distributed worldwide - except in the U.S.  Americans can fly to Canada, Mexico, or Europe to get their injections or take their chances without one here. Even if vaccines are approved here, Kennedy’s Luddism still may delay Americans getting vaccinated by up to one year. If Kennedy delays approval as he says he will, what will thinking people do? 

There will be no H5N1 vaccine available. There will be no effective antiviral drugs from the CDC. People will be totally out of options except for going to Canada, Mexico, or the ICU. Well almost. What about SAN therapy – three medicines that all inhibit the proviral, inflammatory protein NF-kappaB?   

SAN therapy is a combination of three, broad-spectrum antiviral drugs specifically designed to reduce the H5N1 case mortality rate by an estimated 80%. It consists of using selenium, low-dose aspirin, and naproxen together as soon as flu symptoms develop. It is safe, and costs $10 for a full course of treatment. 

Selenium is a broad-spectrum antiviral, anti-inflammatory, antioxidant supplement that modulates the immune system and retards viral disease progression. It helps prevent or even reverse sepsis and organ failure. 

Aspirin has been used as an antiviral since before Hippocrates. It works via multiple immunological mechanisms but especially prevents platelet activation and aggregation. Preventing platelet activation with low-dose aspirin helps prevent the cytokine storm that leads to sepsis, multiorgan-failure, and death.

Scientists have shown that naproxen is one-third stronger against influenza than Tamiflu. Naproxen fits snuggly into the influenza viral groove, blocking its replication. It is highly effective against all flu strains. Unlike with Tamiflu and Xofluza, influenza viruses do not develop resistance to any component of SAN therapy. 

Trump and Kennedy ignore the existential danger of replacing science with pseudoscience. They push snake-oil solutions including the ineffective anti-parasitic drugs ivermectin and hydroxychloroquine. However, people can  protect themselves by investing $10 in pandemic preparedness by purchasing selenium, aspirin, and naproxen at their local pharmacy. If worse comes to worse, wise people will be prepared to greatly reduce their chance of serious illness, hospitalization, and death from H5N1 avian flu.