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Covid was spreading easily from person to person when it arrived in the US in 2020, but bird flu has been lurking for years, mostly as a problem for animals. Scientists also know a lot more about H5N1 bird flu than they did the SARS-CoV-2 virus, and the US has been preparing for the threat of a new flu outbreak for a long time.

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You may have heard of H5N1 only recently, but it’s not a new virus. Scientists have been tracking it for almost three decades.

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It wasfirst identifiedin geese in Southern China in 1996. Over the years, it has caused sporadic outbreaks in wild and farmed birds around the globe.

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It has caused mass die-offs ofmarine mammalstoo, including 24,000 sea lions that died in South America in 2023. In February 2024, Dr. Jeremy Farrar, who is chief scientist at the World Health Organization,called the ongoing spreadof H5N1 “a pandemic of animals.”

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Each time a virus infects a cell and copies itself, it makes mistakes. Usually, these mistakes are benign or even harmful for the virus, but occasionally, there’s a genetic change that helps the virus become better at infecting cells. Given the right set of circumstances, that version of the virus may outcompete others and continue to survive, going on to infect new hosts or new kinds of hosts.

Each virus has eight segments, and like kids in a lunch room, they are always looking to swap. When two viruses trade whole segments, it’s called a reassortment, and it result in quick and sometimes dramatic changes to a virus’ abilities.

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In cows, for example, the H5N1 virus primarily infects the mammary glands. This causes a dramatic drop in milk production but usually doesn’t kill the cow. In people, the main route of infection seems to be through the eyes; conjunctivitis, or red, inflamed eyes, seems to be the telltale symptom of infection.

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Given enough time in the human body, the bird flu virus has shown the ability to change to become better at infecting different kinds of cells and tissues, spreading from the eyes to the respiratory tract, for example.

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If you become ill within 10 days of contact with sick or dead animals or their droppings, make sure to alert a health care provider to your exposure.

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Birds shed the virus through their saliva, mucus and feces, and it can become airborne when their litter and feathers are churned up in barns, particularly during culling operations.

“It can be in the air,” Osterholm said. “So it’s not even just contact touching the birds, but just the dander and all the dust that occurs when you’re dealing with birds.”

One of the most prominent symptoms in infected farm workers has been red, irritated eyes. Arecent studyof the first 46 human cases in the current outbreak in the US found that 93% had conjunctivitis.

For about a third of the total, that was their only symptom. The second most common symptom, experienced by about half of infected farm workers, was a fever. About a third of people with H5N1 had respiratory symptoms, but these were most common among poultry workers who were exposed during bird depopulation activities.

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Both of these patients had the D1.1 strain of the virus, which is circulating in wild birds. It’s different from the B3.13 virus that has been infecting workers on dairy farms. Researchers are investigating whether the D1.1 strain might cause more severe disease.

Even before H5N1 was a consideration, health officials cautioned against drinking raw milk or eating undercooked meat because both can harbor nasty germs like salmonella and E. coli.Cats have died from drinking raw milk on farms.

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