COVID-19 Coronavirus, HPAI H5N1 and other virus UK and World News Update 10th January 2025
Happy New Year! I hope you had a good festive break, and I'm delighted to say that the world didn't become overrun by virus during the last 3 weeks, not entirely anyway...
"NHS England says there were over 5,000 patients in hospital with flu at the end of last week. The average...was almost 3.5 times higher than the same week in 2023. NHS England says the number quadrupled since the end of November."
BBC Health Editor Hugh Pym on 3rd January.
"NHS England says average flu patient numbers in hospitals at 5,400 last week - up on previous week. A&E attendances in 2024 up 7 per cent on the year. NHS leaders say strain on staff at times as bad as height of pandemic."
Hugh Pym on 9th January.
Flu levels are currently abysmal in the UK, but some suggestions we may soon peak - I hope so.
"We are currently seeing more Norovirus cases than in any season since we started our current reporting system."
UKHSA
What fun! Norovirus is a nasty tummy bug and if you get it you need to keep drinking sips of room temperature fluids so you don't dehydrate - use a teaspoon if necessary, or suck ice or ice lollies. Use rehydration solution if possible, or make your own with 6 level teaspoons of sugar (30g) and 1/2 level teaspoon of salt (2.5g) added to 1 litre of water (WHO). If a patient cannot rehydrate, they're very young or you are worried, call 111 for advice.
We are also reminded to stay at home for another 48 hours after vomiting or diarrhoea has finished, and USE ACTUAL SOAP to wash your hands, NOT antibacterial gloop, because Norovirus has a thick fatty shell you need to dissolve.
UKHSA VirusWatch:
"Our latest report shows that we are continuing to see high levels of Flu with some signs of stabilisation over the Christmas period following previous increases. RSV has decreased to low levels and COVID19 has remained stable at baseline levels."
“If you have symptoms and need to leave the house, our advice remains that you should wear a face covering. Washing hands regularly and using and disposing tissues in bins can reduce the spread of respiratory illnesses."
Professor Susan Hopkins of the UK Health Security Agency with a somewhat surprising message yesterday. I didn't think the UK would be so quick to recommend masking, but it's very wise.
Unsurprisingly UK hospitals are struggling to cope with the sheer number of patients - most pressure is from respiratory illnesses and Norovirus.
Among them Gloucestershire Royal activated highest alert on New Year's Eve, with photos of 22 ambulances queued outside appearing on social media.
Great Western in Swindon went to Level 4 on 2nd January.
Royal Liverpool activated a "full capacity" alert on 6th Jan, reporting that the longest wait in A&E was 91 hours.
By Wednesday (8th Jan) at least 11 UK hospitals had moved to the highest alert level and patients are asked to attend A&E alone wherever possible.
Subtle-but-clever change in messaging from the UKHSA. We were told to 'stay at home if you're ill with a fever or tummy problems' as late as 24th November, and now the message is 'stay at home if you feel unwell'.
The UK aren't the only ones with hospitals creaking under the weight of patients. Some US hospitals are reporting problems due to numbers of flu, RSV and COVID patients, with Influenza A(H3N2) and A(H1N1)pdm09 the main culprits.
Influenza A(H1N1)pdm09 is a more severe strain of flu - the swine flu responsible for the 2009 pandemic alert. (Remember it - we'll come back to it later.)
People are asked to avoid hospital visiting if they have respiratory symptoms (coughs, runny nose etc).
Japan has reported their highest weekly flu numbers since comparable records began in 1999. From 23-29 December 317,812 people were diagnosed with flu, more than 3 times the same week in 2023.
China is getting press for their respiratory illnesses. Videos show waiting rooms full of patients and comments about 'mystery virus'. No mystery.
Hospitals are full of patients primarily with hMPV (Human Metapneumovirus), particularly in northern Chinese provinces. They are also facing lots of patients with mycoplasma pneumoniae, COVID and flu - the same as the rest of us.
The World Health Organisation are among those agencies stressing that hMPV is NOT NEW. It usually circulates in Winter, and in most cases causes symptoms similar to the common cold. For whatever reason, this year it's hitting China hard (cough, we're all less robust because of COVID, cough).
The UK HSA were quick to reassure UK public:
"You may have seen news stories about hMPV cases in China. Our weekly surveillance report routinely tracks hMPV and the latest data show it continues to follow the expected pattern for this time of year. Cases routinely peak in winter."
For your real mystery virus, let's look at DRC (Democratic Republic of Congo). This has also turned out not to be a mystery.
On 27th December the World Health Organisation released an update. Up to 16th December 891 cases reported, deaths remained stable at 48 total.
Laboratory results from 430 samples indicated positive results for malaria and several common human respiratory viruses, including Influenza A (H1N1)pdm09 (told you we'd mention it later), plus rhinoviruses, COVID, human coronaviruses, parainfluenza viruses, and human adenovirus.
"These findings suggest that a combination of common and seasonal viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths, disproportionally affecting children under five years of age".
Children under five years represent 47% of all cases and 54% of all deaths, but only 18% of the population.
Because of the severity of the outbreak, an Influenza A (H1N1)pdm09 virus - swine flu virus - epidemic has been officially declared in DRC.
The UK Government has released their plan to cut NHS waiting lists.
- Where possible Community Diagnostic Centres (CDCs) will open 12 hours a day, 7 days a week, (an extra 500,000 appointments a year). They'll offer a bigger range of tests, and some same-day tests and consultations
- 14 new surgical hubs within existing hospitals by June and 3 others expanded - focussing on common, less complex procedures.
- Target of 65% of patients treated within 18 weeks by December 2026
- Use of NHS app. for appointments, results and waiting times
- GPs to get specialist advice before making referrals
- Cutting non-essential follow up appointments
- More community appointments for high pressure specialities (e.g. Ear Nose and Throat)
- Roll out of ‘collective care’. E.g. one stop clinics for single day assessment, diagnosis and review, group appointments for some long term conditions, and ‘super clinics’ where a range of clinicians oversee patient care under a consultant.
Sounds good, but I'm disappointed.
A lot of this will be completed by the private sector. 'Renting' is more expensive and we have a shortage of medical staff. Paying the private sector to do NHS work won't help, it'll poach staff from the NHS and leave less money for NHS infrastructure. It is far from a perfect solution, nor is it 'saving the NHS', however more people will be treated before their conditions deteriorate beyond repair.
France has detected its first case of the more dangerous Clade 1b Mpox. The patient had been in contact with travellers from central Africa.
China yesterday reported their first detection of Clade 1b Mpox - a cluster of 5 cases in a returned traveller and 4 of their close contacts. All have mild illness.
As a reminder:
Clade 1b is recently discovered and spreads with close human to human contact - household, medical carers etc.
Clade 1a is endemic to some African countries, notably DRC, spreading from wild animals to humans, to close contacts.
Clade 2 Mpox is the less dangerous strain spread mostly through sexual contact.
The UK has detected 5 x Clade 1b cases (up to 29th Nov 2024)
US CDC has detected 1 x Clade 1 patient (Nov 2024)
According to WHO / US CDC data 16 countries reported Clade 1 Mpox in 2024 (including UK, USA, Germany).
Sadly after a break since last February, H5N5 (1 case) and H5N1 (15 cases) bird flu is back affecting England, with confirmed cases in Norfolk, Yorkshire and Cornwall.
A UK Government order has come into force requiring all poultry and other captive birds across Hull, East Yorkshire, Lincolnshire, Norfolk and Suffolk to be kept indoors.
Please DO NOT touch sick or dead birds, and report them to DEFRA if they are large or numerous.
The US Department of Health and Human Services (HHS) has announced $306 million to bolster monitoring ($111m) and preparedness ($183m) for H5N1 avian flu.
Additional funds will be distributed within 2 weeks, not least because Trump said he would disband the White House preparedness office.
Good news, and bad.
We've been told, via a study in New England Journal of Medicine, the Canadian teenager seriously ill with H5N1 bird flu is home and "fully recovered".
The 13 year old girl deteriorated over 5 days from conjunctivitis to severe gastric problems, difficulty breathing and hemodynamic instability (unable to maintain consistent blood flow and pressure). By day 6 she had respiratory failure, pneumonia, acute kidney injury, thrombocytopenia (low platelet numbers) and leukopenia (low white blood cell count).
She was intubated and put on ECMO/heart and lung machine, given anti-virals and plasma exchange therapy.
By day 14 she was in recovery, and breathing by herself on day 20.
She had D1.1 avian flu, wild bird type. It thrived in her lower lungs, and during her illness mutated within her body to become more suited to humans.
The severely ill Louisiana patient also had D1.1 and unfortunately they have not survived their infection. My thoughts with their family.
The H5N1 also mutated inside the Louisiana patient, with an identical important mutation to the Canadian teenager. It became more able to bind to the upper respiratory tract - easier to exhale, and as it can latch on immediately, it's easier to catch. Both patients were already in isolation by that time and neither passed it to anyone else.
On their own these cases don't make chance of a pandemic more likely, but are concerning because if it can do it twice...
There were 66 known human cases of H5N1 in the USA during 2024. All but one were mild. Almost every patient was exposed to infected poultry or dairy cattle, and had conjunctivitis. Around half had fever, a third respiratory problems, and no contacts tested positive.
No new human cases have been officially reported in the USA so far in 2025, although I'm waiting for the CDC to update their page, and we have suspected cases in Michigan (11 people exposed to an infected backyard flock, 2 with symptoms).
Latest US H5N1 stats
924 infected dairy cattle herds across 16 states (plus 1 alpaca and 1 swine)
Last 30 days, 86 new cattle herd detections in 3 states
No new human cases have been reported in the USA so far in 2025.
28 US states are now taking part in the USDA's H5N1 milk testing (it is going to be national), and the FDA have announced they will begin testing raw cheese.
The Californian State Vet (animal doctor not ex-military person, although they may also be...) has issued a ban on all cattle and poultry shows "until the outbreak is under control".
Very wise. 149 new infections in poultry farms (65) and dairy cow herds (84) have been reported in California in the last 30 days. Who in their right mind would want to take their prize livestock out to mingle?
There are reports of some egg shortages in the USA. Any stores in areas where poultry are heavily affected by bird flu risk shortages. It's also possible eggs may be diverted to create flu vaccinations.
This could have a knock on effect. Not only will the price of raw eggs go up if supply is short, the cost of products made with eggs could rise.
Trump is famously promising cheaper eggs, but he may have met his match.
Northwest Naturals frozen Raw Turkey cat food has been recalled after testing found H5N1 bird flu contamination, which was linked to an indoor cat's death in Oregon.
Your reminder freezing preserves viruses, it does not kill them.
Possibly in relation to concerns over bird flu, Shanghai has banned all live poultry sales and movement into the city until December 31st 2027. 3 years.
Not messing about there at all...
Large cats really are not doing well with highly pathogenic avian influenza (HPAI or bird/avian flu). Outbreaks at several sanctuaries and zoos have had a heavy toll. An outbreak at the Wild Felid Advocacy Centre of Washington in December infected over half of their cats, and by the end of December had killed 20 (including cougars, lynx, bobcats, servals, Bengal tiger, Caracal etc). Utterly heartbreaking.
Large cats will eat sick or dead wild birds who end up in their living space, but we have no clear evidence for cause of any of these outbreaks. The owners of Project Survival Cat Haven in Dunlap have been warning other keepers that until we know better, be cautious with the raw meat they feed to their cats...
We are seeing cats in the USA dying from drinking HPAI H5N1 infected milk or eating raw meat, and large cat species cope incredibly badly when they catch avian flu, however domestic cats have been catching it for years and a lot of them don't even have symptoms.
A French study found of 13/578 cats had been exposed to H5N1.
A Netherlands study found of 83/701 stray cats and 4/871 domestic cats had been exposed. (Additionally 40 domestic cats had been exposed to human influenza viruses.)
Cats have potential as a melting pot, where human and avian flu could mix, creating a strain that would have the capacity to spread human to human.
So far only 1 person is known to have caught an avian flu from a cat, back in 2016, so it's not time to panic, it's time to pay attention, and maybe don't kiss your cat if it's ill...
In better news, scientists at Cornell University School of Veterinary Medicine are already working on a HPAI H5N1 cat vaccination...
The UK's Porton Down laboratory has officially launched the Diagnostic Accelerator. This is a big part of our pandemic preparedness, and aims to ensure a vaccine is available within 100 days of any new pathogen emerging as a genuine threat. They've recently been working on such delights as Mpox, swine flu, and of course avian flu.
Professor Sir Andrew Pollard and the team who created the Oxford/AstraZeneca COVID jab have created a jab for Bubonic Plague. Early trials have shown it to be safe and trial subjects developed antibodies.
You may think Bubonic Plague wouldn't be something to bother with, but it does still exist in parts of the world, occasionally infecting humans and strains in Madagascar and Peru have even developed antibiotic resistance. The UK Government decided it's probably something we should keep a stockpile of vaccines against, just in case... fatality without very swift treatment ranges from around 30% (bubonic - swellings) to 100% (pneumonic - lungs or septicaemic - infected), so I'm all for it...
30th December 2019: Dr. Li Wenliang warned his colleagues that 7 people in Wuhan had been diagnosed with COVID. He was arrested for "spreading rumours" and on 7th February succumbed to COVID himself.
31st December 2019: WHO’s Country Office in China picked up a media statement by the Wuhan Municipal Health Commission on cases of ‘viral pneumonia’.
1st January 2020: WHO employees activated emergency systems
4th January 2020: WHO informed the world
9-12 January 2020: WHO published its first comprehensive country guidance
13th January 2020: with partners, WHO published the blueprint for the first SARS-CoV-2 laboratory test
10th January 2025... you are here.
It is the weekend! Sorry that was so big, there was a lot more I could have added! Now you can relax, and hopefully you aren't ill, or in LA, or Ukraine, or anywhere else in the world beset by natural or man-made disaster, and can enjoy the privilege of some time out. Don't forget to treat yourself, the festivities are over and that's all the more reason to have something nice, and something to look forward to. You've earnt it.
I'll be back in 2 weeks. Until then...
Wear A Hat, Use Soap, and for goodness sake Wes, Save The NHS...
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Sources:
Reference COVID
https://www.worldometers.info/coronavirus/
https://coronavirus.data.gov.uk/
https://ourworldindata.org/covid-vaccinations
https://www.gov.uk/coronavirus
Reference pages H5N1
https://www.paho.org/en/topics/avian-influenza
https://www.cdc.gov/bird-flu/situation-summary/index.html
Infectious disease tracker
Bird flu updates and news
https://www.birdflualerts.com/
UK NOIDS
PAHO
Image sources
UK NHS flu image
Norovirus images
New year image Charlie Makesy
UKHSA stay home image
Raw cat food recall image
UKHSA weekly flu surveillance images
https://x.com/NHSEngland/status/1877318206299226320?t=fb4xsTnIAnbJ36PJCPeexg&s=09
https://x.com/UKHSA/status/1877378753665413611?t=EEHVCqgcXgCUcFDGdBNSNQ&s=19
UK hMPV following usual pattern amd image
Text sources
Flu quote Huw Pym
Flu peaking
https://open.substack.com/pub/paulmainwood/p/thank-god-nhs-edition?utm_source=share&utm_medium=android&r=354hjt
Norovirus UK
https://x.com/UKHSA/status/1877028265371529591?t=OfBuyEAZCWgExU4OWV-glw&s=09
Rehydration
https://pubmed.ncbi.nlm.nih.gov/2456720/
UKHSA weekly flu surveillance
UKHSA says 'wear face masks' as thousands fall ill with flu
Stats on UK Flu hMPV etc
Hospital pressure UK
Royal Liverpool Hospital longest wait for a bed in A&E is 91 hours!! 28 patients on corridor
Swindon
Gloucestershire hospital at highest alert level as ambulances queue outside - BBC News
https://www.bbc.co.uk/news/articles/clykx7xxlgro.amp
WEDNESDAY
Usa respiratory illness
https://abc11.com/post/duke-university-health-system-limits-patient-visitors-hospitals-surgery-centers-due-rise-flu-rsv-covid-19/15751645/
Japan biggest flu outbreak in 25 years
China respiratory illness
WHO hMPV
China hospitals overwhelmed
https://www.ndtv.com/world-news/china-faces-new-virus-outbreak-five-years-after-covid-crisis-7385802
HMVP China
https://youtu.be/0uoQSMTQi6k?si=N0HtK3FtvByxA2nx
https://www.reddit.com/r/ContagionCuriosity/s/Uyr2q9vQ8K
https://hongkongfp.com/2024/12/30/cases-of-respiratory-virus-hmpv-remain-low-in-hong-kong-epidemiologist-says-amid-mainland-china-outbreak/
https://x.com/XTechPulse/status/1875909347504767177?t=TnvgoAOe0bHIE8R3A0IuTA&s=19
Influenza A H1N1 (pdm09) swine flu epidemic officially declared in DRC
https://actualite-cd.translate.goog/index.php/2024/12/26/kwango-lepidemie-virus-influenza-ah1n1-officiellement-declaree-apres-des-deces-dans-la?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=wapp
https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547
DRC
DRC Swine flu and malaria and malnourished
Stay home messaging NHS
UkGov plan to cut waiting lists
https://www.bbc.co.uk/news/articles/ckgxqnr8yw4o?s=09
Actual plan
Private sector
France 1st case 1b Mpox
https://www.gov.uk/government/news/ukhsa-detects-first-case-of-clade-ib-mpox
China 5 cases clade 1b mpox
UK bird flu poultry
https://www.bbc.co.uk/news/articles/c4gjp0nepddo
https://www.bbc.co.uk/news/articles/c74xnxjw3pmo
H5N1 funding USA
https://www.nytimes.com/2025/01/02/us/politics/bird-flu-biden-trump.html
https://www.cidrap.umn.edu/avian-influenza-bird-flu/hhs-directs-306-million-avian-flu-response-virus-strikes-more-us-flocks
H5N1 Canadian Teen Louisiana pensioner
Louisiana patient has died
Canadian teen and Louisiana patient
Same mutation
"The mutation seen in both viruses is believed to help H5N1 adapt to be able to bind to cell receptors found in the upper respiratory tracts of people. Bird flu viruses normally attach to a type of cell receptor that is rare in human upper airways, which is believed to be one of the reasons why H5N1 doesn’t easily infect people and does not spread from person-to-person when it does."
https://www.nytimes.com/2024/12/27/health/bird-flu-mutations-louisiana.html
https://x.com/HelenBranswell/status/1872437264518946860?t=H0qhhHDaBHRJNEjMi2nREQ&s=09
A134A/V (Alanine 88%, Valine 12%), N182N/K (Asparagine 65%, Lysine 35%) and E186E/D
(Glutamic acid 92%, Aspartic Acid 8%)
E186D is the one also found in the Canadian sequence
Scientists are concerned that viruses could evolve to recognize human-type cell receptors in the upper airways and acquire the ability to infect people and spread between them."
Angie Rasmussen
https://nymag.com/intelligencer/article/h5n1-bird-flu-mutation-louisiana.html
US farm worker cases mild and self-limiting
H5N1 dairy cow surveillance
https://x.com/HelenBranswell/status/1877073676664750576?t=ZDASkbBakE6GeHDuAM9BBQ&s=09
FDA begins testing raw cheese
California bans poultry and cow shows
https://www.cdfa.ca.gov/AHFSS/Animal_Health/docs/ca_h5n1_hpai_2022-25_ca_poultry_and_dairy_exhibition_ban_final.pdf
Egg shortages in USA
Californian shops limiting egg products
Cat food recall
Shanghai bans live poultry sales for 3 years.
H5N1 big cats dying by the dozens - food source contamination?
20 wild cats die at a single sanctuary Washington State
https://www.reddit.com/r/H5N1_AvianFlu/s/6Osis6V68a
Also geese dropping fro m the sky
Cornell University’s cat vaccine H5N1
Domestic Cats
https://flutrackers.com/forum/forum/europe/h5n1-tracking/france/1003749-france-h5n1-has-been-detected-in-a-significant-proportion-of-cats-according-to-a-virologist
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.44.2400326
Wiltshire testing lab to increase pandemic preparations - BBC News
Bubonic plague vaccine
Exactly 5 years since Li Wenliang warned colleagues of 7 Coronavirus / SARS patients
Also exactly 5 years since WHO’s Country Office in China picked up a media statement by the Wuhan Municipal Health Commission from their website on cases of ‘viral pneumonia’ in Wuhan, China.
_________________________
The Conversation excellent post on flu types
Predominant in humans
H1N1
H3N2
Influenza A and B can cause severe symptoms, Influenza C generally only mild symproms (no vaccines necessary for type C).
H1 - more likely vomit and cough
H3 - more fever
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