This spring, a goat on a Minnesota farm tested positive for bird flu — the common name for highly pathogenic avian influenza (HPAI). It was the first known incidence in the U.S. of the current bird flu outbreak involving a goat.
Earlier this month, Minnesota became the 11th state to find bird flu in a cow, when a farmer in Benton County noticed symptoms in a handful of animals.
Sahan Journal talked to public health experts to identify who is at risk, what protections they can take and what to watch for.
So, should you be concerned?
For Minnesotans who don’t live or work near farm animals, there’s no need to worry about your personal risk right now, experts agree. So far, only three people in the United States — none in Minnesota — have tested positive for this bird flu, and all three recovered.
But Minnesota’s farmers and farmworkers should be on alert.
“I am very worried about these workers,” Jennifer B. Nuzzo, director of the Pandemic Center at the Brown University School of Public Health, said on a call with health and science reporters across the U.S. “So far the infections that have happened have been mild, but I do not see anything in the data to give me hope that future cases will necessarily be mild. I’m also worried that this virus could mutate and become a pandemic threat … but before we even get to that, I think we need to be talking more about the workers who are in harm’s way.”
In Minnesota, that includes about 112,000 Minnesotans who work in agriculture, on some 68,000 farms. In southern Minnesota, between 8,500 and 21,000 farmworkers immigrated from Mexico, Honduras, El Salvador, and Guatemala, according to research from Hispanic Advocacy and Community Empowerment through Research (HACER). Roughly half of those workers are undocumented.
Bird flu is an infection from a virus that has usually spread in birds. The current type — avian influenza A virus H5N1 — has caused widespread outbreaks in wild birds and poultry flocks since 2022. Minnesota also leads the country in the number of turkey flocks infected. Bird flu usually kills poultry; millions of Minnesota turkeys and chickens have been lost; Minnesota egg and poultry producers have received over $135 million from the federal government in relief, according to the Star Tribune.
Recently, infections from the virus have spilled over into mammals, including goats, cows, and also humans.
So far, the infections in cows and humans have been much milder than in birds. But influenza viruses are notorious for changing quickly, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. So the currently low risk to humans could “change in a heartbeat,” Osterholm said.
Because bird flu has the capacity to infect humans and because influenza viruses can change so quickly, public health officials monitor it closely. The U.S. government maintains a stockpile of vaccine for H5N1, although the stores of current inoculation would need to be scaled up and possibly adapted depending on how much the virus changes. (The annual flu shot you may have gotten for the 2023-24 season does not protect you against bird flu.)
“Since the beginning of its emergence in 1996-97 in Asia, there have been 907 human cases documented around the world, and half of those have died,” Osterholm said.
Crucially, there hasn’t been any evidence of human-to-human transmission of avian flu since 2005. It’s likely some cases have occurred but haven’t been identified and reported, Osterholm said. But there don’t appear to be clusters of symptomatic people, indicating that the virus is unlikely to be circulating widely in humans.
Minnesota has done more testing than most states. But still only 46 people have been tested since 2022, when the current outbreak started.
One of the challenges, Osterholm said, is that many of the farmworkers at risk are undocumented — and essential to the industry.
How can farmworkers best protect themselves?
The jump of bird flu from cattle to humans has prompted new guidance from the Centers for Disease Control and Prevention. The agency recommends a protocol that involves seven layers of personal protective equipment for anyone working with sick or dead animals, animal feces, or raw milk.
That’s the ideal, but health officials recognize that a 17-step process is not always realistic. Hospital workers who wear that much PPE report getting hot and uncomfortable, said Stacy Holzbauer, the State Public Health Veterinarian for the Minnesota Department of Health.
“Here we have people working on a dairy farm,” she said, “and it’s hot, dirty, wet, work. We have to allow people to have flexibility.”
Prioritize covering your mucous membranes, she said — that is, your eyes, nose and mouth — with goggles, an N95 mask and/or face shield, and gloves. “If you can do those, that is great,” she said.
Minnesota is offering free N95 respirators, goggles, face shields, and gloves to farms through MDH, the Board of Animal Health, the Department of Agriculture, and the University of Minnesota Extension. Anyone who works on a farm can request a one-time shipment of supplies.
But so far, only 43 farms in Minnesota have requested PPE.
And many questions remain about the best and most appropriate forms of PPE, Osterholm said. Beyond the practical considerations, how effective will an N95 mask be in an environment that can get moist and humid?
“We need to have a lot of humility here,” Osterholm said. “We have to admit that we have many, many more questions than answers at this point.”
Bird flu symptoms and testing
For now, the most important thing farmworkers can do is pay close attention to any potential symptoms. (If you work on a farm where animals have tested positive for the virus, the state health department will contact you.)
What to watch for:
- Eyes that look red or pink
- Upper respiratory symptoms such as runny or stuffy nose, cough, sore throat
- Muscle or body aches
- Headaches
- Fatigue
- Difficulty breathing
- Fever
If you develop any of the above, make sure to tell your health care provider that you work with animals, Holzbauer said. The provider can send a sample from your nose or throat to the state health department, which has the only lab in Minnesota that is testing for the virus.
“We want people to have a low threshold for seeking care and testing,” she said. “In most situations, it’ll be benign…but then you know.”
If you don’t have a regular health-care provider, you can find a health center that treats people without insurance.
Legal rights for Minnesota farmworkers
Many of Minnesota’s farmworkers may not have paid time off to seek health care or take sick leave. If they do report an illness, they may worry about losing their job, experts said.
“We don’t want to scare them off from continuing to work,” Osterholm said. “We need to provide some kind of protection — both from a legal and health perspective.”
You are not required to provide immigration status to medical providers, said Holzbauer of MDH.
Even if a doctor does know your immigration status, they are not allowed to contact ICE to disclose that information. Federal privacy laws broadly protect patients and doctors from revealing immigration status.
What should farmworkers expect if they’ve been near animals that have tested positive for H5N1, the virus that causes bird flu? Holzbauer says the state health department will monitor symptoms as long as the animals are in quarantine. But health officials won’t ask about immigration status or residency, Holzbauer said.
“We only ask about your job duties, what kind of PPE you were wearing, and how you are feeling,” she said.
What does everyone else need to know about bird flu?
The risk is currently low, especially for people who don’t work on farms. But everyone should avoid raw milk and cheese made from unpasteurized milk. That includes many types of queso fresco, a popular Mexican cheese, the CDC’s Dr. Jay Butler noted in a recent media call. Queso fresco was the culprit of a recent listeria outbreak. Pasteurization kills pathogens like listeria -– and H5N1 –- which protects consumers from dairy-based illnesses.
Public health officials emphasize that while the current risk is low, monitoring is essential. They worry that a reassortment, or mutation, of the virus could allow for transmission from one human to another.
“That could create a new virus with pandemic potential,” Osterholm said.
Pigs are often the vehicle where viruses mix and evolve, because they are susceptible to both avian and human flu viruses. Signs of sick pigs could be a red flag. New research, which has not yet been peer reviewed, suggests that the udders of cows are also susceptible to both avian and human viruses, Osterholm said. This might be another route for cross-species infections.
Clusters of symptoms in certain geographic locations would be another red flag, Osterholm said.
To detect these red flags as early as possible, public health experts have called for better surveillance. Although Minnesota has done more testing than most states, the testing represents just a fraction of farmworkers.
Of some concern, Osterholm added, is that the third known human case caused respiratory symptoms, whereas the first two cases caused only conjunctivitis, or pink eye.
States are also monitoring wastewater, but the technology isn’t advanced enough to make meaningful use of the results. (When water tests positive, for example, it’s not clear whether the virus is from animals or humans).
Ideally, the disease will be controlled in animals, Holzbauer said, keeping it away from humans.
“At this point in time, it’s a concern for those who work in these industries — it’s not a general public health concern,” Holzbauer said.
