Influenza, and Bird Flu, and TB, Oh My!

The United States is currently experiencing its worst flu season in 15 years, with the Centers for Disease Control and Prevention (CDC) reporting at least 29 million cases - the highest number since the 2009-2010 season. This surge in seasonal influenza coincides with an expanding outbreak of H5N1 avian influenza that has now infected 67 people across multiple states, marking the first sustained transmission of bird flu to humans in the U.S.

Against this backdrop of escalating disease threats, the federal public health infrastructure faces unprecedented disruption. On January 20, 2025, the Trump Administration ordered an immediate halt to external communications from federal health agencies, including the CDC's primary vehicle for disseminating critical public health information - the Morbidity and Mortality Weekly Report (MMWR).

The timing is… concerning. As noted by Stephanie Psaki, former U.S. coordinator for global health security, these restrictions come as public health officials also grapple with outbreaks of Marburg virus in Tanzania and Ebola in Uganda. The convergence of multiple disease threats with diminished public health response capabilities creates dangerous gaps in our ability to detect, track, and contain emerging outbreaks.

Public Health Infrastructure In Disarray

The dismantling of federal public health systems has proceeded with striking speed. On January 21, 2025, acting Health and Human Services (HHS) Secretary Dorothy Fink issued a directive halting all external communications from federal health agencies, requiring presidential appointee review of any document intended for publication. By January 31, federal health agencies had removed over 8,000 webpages from public access - including mission-critical resources like HIV prevention guidelines and clinical trial diversity databases. Though U.S. District Judge John Bates ordered the CDC and Food and Drug Administration (FDA) to restore these resources on February 11, ruling their removal likely violated federal law, the disruption to public health operations remains significant. As one federal health official noted, "It was a double waste for us because we took them offline, put some of them back, edited others and now are putting it back again."

The administration's intervention in the CDC's Morbidity and Mortality Weekly Report signals an even deeper assault on scientific independence. This cornerstone publication has served as the primary vehicle for disseminating public health information and recommendations since 1952, continuing without interruption even during government shutdowns - until now. Multiple federal health officials report that Trump Administration appointees have taken direct control over the journal's content, dictating coverage priorities and withholding completed studies about the expanding bird flu outbreak - including critical research about transmission patterns that could help prevent further spread.

As former CDC director Tom Frieden notes, "MMWR is the voice of science." The journal ranks among the most-cited health publications globally, with health officials, clinicians, and researchers relying on its studies for disease treatment and prevention guidance. The current interference represents a tectonic shift in how public health data and science are controlled and disseminated in the United States.

While Trump's first administration sought to influence public health messaging during the COVID-19 pandemic through selective pressure on specific reports, his second administration has taken direct editorial control over the entire infrastructure of public health communication and surveillance. This shift from attempting to shape the narrative to controlling the flow of scientific information itself represents a fundamental threat to public health practice and undermines the ability to detect, track, and respond to disease outbreaks.

Impact on Disease Surveillance

The impact of these system disruptions on disease surveillance became clear when the CDC finally released its delayed study of H5N1 infections among veterinarians. The research, conducted in September 2024 but held from publication until February 2025, revealed that three out of 150 cattle veterinarians tested positive for H5N1 antibodies despite having no known contact with infected animals. More concerning, one veterinarian practiced exclusively in Georgia and South Carolina - states with no previously reported cases of H5N1 in dairy cattle.

These findings expose serious gaps in our surveillance capabilities. As Lauren Sauer, professor at the University of Nebraska Medical Center College of Public Health, explains, "Any detection of asymptomatic or mild cases in this study just tells me we're missing cases." None of the infected veterinarians reported respiratory symptoms or conjunctivitis, suggesting that focusing surveillance only on symptomatic cases substantially underestimates the true spread of the virus.

Unfortunately, surveillance problems are likely to get worse with the removal of demographic data collection capabilities from federal health agencies, crippling our ability to identify and address emerging disease patterns across different populations. When researchers cannot track where problems exist or evaluate which solutions work, targeted interventions become impossible to develop or assess.

The dairy industry illustrates these compounding challenges. Recent research shows that tracking human infections has been persistently difficult throughout the bird flu outbreak, with health agencies having limited authority to conduct disease surveillance on farms and workers often reluctant to get tested. Current restrictions on data collection and analysis magnify these existing barriers.

Time matters in disease surveillance. When we cannot accurately track disease spread or identify emerging patterns, we lose the ability to implement timely interventions that could prevent broader transmission. It’s a dangerous cycle where reduced surveillance leads to delayed responses, allowing outbreaks to expand unchecked before detection.

Consequences In The Field

Healthcare providers face mounting challenges in responding to multiple disease threats amidst systemic disruptions to public health infrastructure. While the CDC's recent health advisory provides guidance on expedited influenza A subtyping for hospitalized patients to identify potential H5N1 cases, the broader erosion of public health systems and communications channels complicates coordinated response efforts.

The impact of these systemic weaknesses is evident in Kansas, where the state faces one of the largest tuberculosis outbreaks ever recorded in the United States. The power granted to public health officials at both state and federal levels has been sharply curtailed, limiting officials' ability to mandate tests, isolation, or closures due to infectious disease. “You can think of TB outbreaks like a canary in the coalmine of our public health infrastructure,” said David Dowdy, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

“What causes them to happen is a weakening of our public health infrastructure.”

Healthcare facilities struggle to adapt while managing mounting disease pressures. Many hospitals have implemented temporary visitor restrictions in response to rising influenza cases, but without coordinated federal guidance, each facility must develop its own protocols. The resulting patchwork of inconsistent response measures places additional burden on already strained healthcare workers and creates confusion for patients and families seeking care across different facilities.

The loss of access to regularly updated and trustworthy federal guidelines and surveillance data forces healthcare providers to make critical decisions about testing, treatment, and infection control with incomplete information. This compromises not only their ability to provide optimal care but also undermines efforts to prevent disease spread within healthcare settings and the broader community.

A Record Flu Season

The current flu season illustrates how quickly policy decisions translate into public health outcomes. With 370,000 hospitalizations and 16,000 deaths so far, seasonal flu has overtaken COVID-19 in both metrics for the first time since the pandemic began. For the first time since the 2017-2018 season, the CDC has classified this as a high-severity season for all age groups.

The toll on children has been particularly severe, with 68 pediatric deaths reported and rising cases of serious neurological complications. These deaths are especially tragic given that influenza vaccination significantly reduces flu-related mortality across all age groups, cutting death rates by up to four times among vaccinated people.

The severity of this flu season cannot be separated from the broader erosion of trust in public health institutions and preventive measures. As Dr. Anice Lowen explains, influenza viruses follow predictable patterns that inform vaccine development and public health responses. When trust in these institutions is undermined and fewer people seek vaccination or follow prevention guidelines, it creates a cycle where reduced prevention leads to increased transmission, straining healthcare systems and potentially fostering even greater distrust in public health measures.

The political and policy implications extend beyond the federal chaos. In Louisiana, for example, health officials have been explicitly forbidden from promoting or advertising COVID, influenza, or mpox vaccines - a directive that strikes at the core mission of public health. As we face multiple concurrent disease threats, maintaining public confidence in science-based interventions becomes increasingly critical for protecting public health.

Critical Questions for Public Health

The dismantling of public health infrastructure through systematic defunding, deregulation, and politicization raises fundamental questions about the future of disease prevention and control in the United States. As the Trump Administration installs anti-vaccine activist Robert F. Kennedy Jr. at the helm of Health and Human Services, while simultaneously threatening to withhold federal funding from schools with COVID-19 vaccine requirements, we confront a sobering reality: federal public health leadership can no longer be relied upon as a consistent source of evidence-based guidance and response coordination.

The impact of this leadership void is already evident. The Department of Government Efficiency (DOGE) continues to remove experienced staff from critical positions across federal health agencies, creating dangerous gaps in expertise. Even when forced to reverse course - as with the United States Department of Agriculture’s (USDA) attempt to fire and then re-hire staff working on the bird flu response - the disruption to public health operations remains significant.

The transformation of public health into a political battleground makes scientific evidence and established prevention measures casualties of ideology. When political appointees amplify medical misinformation or withhold and reframe public health data to fit political narratives, they erode trust in the very institutions designed to protect population health.

As federal and state public health infrastructure faces unprecedented disruption, the public health community must grapple with several pressing questions:

How can state and local health departments maintain effective disease surveillance when federal systems prove unreliable?

What mechanisms can healthcare facilities develop to share data and clinical guidance without depending on federal channels?

Which legal frameworks best protect scientific integrity and public access to health data? While recent court orders have restored some removed resources, deeper questions remain about safeguarding public health information from political interference.

How can public health practitioners rebuild trust in science-based interventions when prevention measures become political battlegrounds? The record-breaking flu season highlights the human cost when evidence-based recommendations face systematic undermining.

What role should professional organizations and academic institutions play in maintaining disease surveillance and response capabilities? As federal expertise drains, alternative networks may need to fill critical gaps.

These questions reflect fundamental challenges to public health practice in the United States. When political pressure shapes which data gets collected, analyzed and shared, it compromises our ability to detect and respond to disease threats. The most vulnerable communities often bear the heaviest burden of these systemic failures.

The path forward requires careful examination of how public health systems can adapt while upholding scientific integrity and protecting population health. As multiple outbreaks strain our fractured infrastructure, finding answers to these questions becomes increasingly urgent.

Return of the Flu: Flurona, a Co-occurring Infection that is NOT

The beginning of 2022 brought about an ominous rise in COVID-19 cases as the Omicron variant began to ravage the United States in earnest, with the Centers of Disease Control and Prevention reporting about 1.3 million new cases on January 10th. While this report is inclusive of a weekend backlog, representing the majority of states’ reporting for 2 days, rather than 1, this kind of report for any respiratory transmission is truly startling. In the background, another virus with a respiratory transmission mode, influenza, had been crushed to near non-existence during the 2020-2021 season, according to the CDC’s FluView surveillance report. Indeed, on the surface, what appears to stop COVID transmission, stops flu transmission even better. But with the relaxing of mitigation measures, “pandemic fatigue”, and society eagerly looking to move on, the flu has begun to mount its seasonal return.

In comes the frightening shadow of “flurona”! Social media sites buzzed with the dire warning experts had given in 2020: a ghastly winter with two very dangerous, highly communicable diseases ripping through the nation. The difference in late 2021 and early 2022, compared to the year before, is obvious: wide access to COVID-19 vaccinations (in the United States, at least) and a continuation of annual influenza vaccination availability. This co-occurring infection, however, isn’t new. Indeed, the United States likely experienced some combined infections during the early days of the COVID pandemic in 2020, prior to the wide availability of diagnostic COVID tests, and again in the 2020-2021 flu season. While the instances may have been relatively rare due to the decrease in influenza transmission, the situation was not entirely unknown. It was, after all, the CDC’s FluView surveillance that shaped our initial tracking of community transmission of SARS-CoV-2 (the virus that causes COVID-19); the surveillance program tracks weekly reports from health care providers and local and state health departments of influenza like illness (ILI) incidence and the results of flu screenings in order to ascertain key metrics of public health response.

Let’s pause for a moment to acknowledge just how remarkable the 2020-2021 flu season was. A key measure in tracking influenza is pediatric mortality. In both the 2018-2019 and 2019-2020 flu seasons, the CDC reported 144 and 199, respectively, pediatric deaths attributed to the flu. In the 2020-2021 season, the CDC reported only 1 pediatric flu death (CDC data application). The total national percent positivity (or number of reactive tests relative to total tests administered) for influenza during the 2020-2021 flu season never crested the national baseline for the season of 2.6% positivity compared to only being about half way through the season this year and already having crested the national baseline (2.5%) for the last 5 weeks. In the 2019-2020 flu season, percent positivity for the flu crested the national baseline (2.4%) for 22 weeks.

We shouldn’t be dismissive of influenza. It is still a serious illness that hospitalizes many, especially vulnerable populations. National vaccination programs have done a great deal to help curb the potentially deadly impacts of influenza, though, schools have been known to be shut down due to flu outbreaks, including in early 2019. The idea of selective mitigation efforts coming and going in order to address outbreaks, isn’t new.

So here we are with Flurona – an incidence which may well have been happening this whole time, but because we don’t specifically track this particular co-occurring infection, we can’t say for sure. While there’s limited data on what to expect with a co-occurring flu and COVID infection, that data is a tad concerning; mortality did not necessarily increase but the symptomology of this type of situation did require frequent use of mechanical ventilation.

The catchy combined name of these viruses went…well…viral, even if only for a short period of time. As the project director for CANN’s HIV-HCV Coinfection Watch, the idea of a co-occurring viral infection didn’t surprise me. And it probably doesn’t surprise many of our readers here. The fact that it did surprise many members of the public, even after Dr. Anthony Fauci and other officials had previously mentioned the possibility, is indicative, inditing even, of how information is delivered and disseminated in today’s world. Numerous studies have been done on the amount of stress and anxiety people are experiencing in light of the COVID-19 pandemic. The CDC has also dedicated a page to “Coping with [pandemic-related] Stress” and many states have adopted mental health helplines for residents to dial into. The relationship between the public, experts, and news media is deeply damaged by practices of all parties – a busy public less interested in reading longer, more detail articles, a news media competing for clicks and attention in order to fund their outlets, and experts competing for space and importance because of outlet bias and lack of vetting have all harmed our ability to cohesively respond to the COVID-19 pandemic.

I’m not usually one to say “can’t we all just get along”, my job, in fact, is often about digging deep into spaces of disagreement or interest conflict and hammering out mutually beneficial concessions. This place we’ve found ourselves in as a society, where we’re all operating out of scarcity and competition at all costs is ultimately how we all “lose”; be it this pandemic, the next, or even in combatting long standing ills already needing address. Patient advocates and public health officials having to divert time and resources to educate patients and the public when a panic-inducing headline aimed at derailing the reader’s tasks is, in fact, derailing to multitudes of efforts to better the world around us if by sheer inability to focus on our tasks at hand.

If you’re struggling with coping with stress of the pandemic, flurona headlines, COVID variant headlines, any headlines, please, take a moment to review the National Alliance on Mental Illness (NAMI) COVID Resource and Information guide, or give them a shout on their hotline to be directed to area specific resources by calling 800-950-6264 or by clicking “chat with us” at the bottom of this page.

There’s little in this world that can’t be made a tiny bit more manageable with a snack, a nap, or a hug. Check those boxes, take a deep breath, and know you’re not alone.