JONATHAN M. METSCH, Dr.P.H. – Tracking Emerging Public Health Challenges – June 20, 2026 – Bird Flu
“It began on her thirteenth birthday. The red, sore, itchy eyes. The next day, the fever. Her mother took her to emergency, at their local hospital in Surrey, British Columbia. The doctor confirmed conjunctivitis (or pink eye) but said it didn’t need treatment.”
“He checked the patient history and noted the conjunctivitis, a flag for the flu that had been infecting American dairy and poultry workers in recent months. Goldfarb rushed the swab to the BC Centre for Disease Control, requesting urgent analysis. Within hours, he knew they were dealing with the H5N1 bird flu, and his patient was the first person ever infected in Canada.
The result triggered alarm. Historically, the mortality rate among people stricken by H5N1 has been exceptionally high. And it is feared that H5N1 could cause the next pandemic. With every human case—seventy-one in the United States, including one death, since 2022—the question looms: Is this the beginning?
BC Children’s Hospital instituted infection control protocols, requiring Joselynn’s parents and her sister to be isolated in her room for several weeks. They were tested repeatedly until it was clear they hadn’t been infected. Public health officials searched their home to find where the virus came from, analyzed their food, inspected their dog, traced Joselynn’s movements before she got sick. They never found the source.”
“Joselynn’s case offers a glimpse of the nightmare an H5N1 outbreak could become. BC Children’s has just six life-support machines—and is the only hospital in the province that can provide them for children. If the virus tore through the population, the resources needed for lifesaving care would simply not be there.
Virologists and public health specialists have warned about the pandemic threat for years. H5N1, a problem in chickens for decades, first infected humans in 1997, in an outbreak in Hong Kong. Eighteen people got sick; six died. It surfaced in humans again in 2003, and since then the World Health Organization has recorded 478 deaths among 997 cases worldwide, a case-fatality rate of around 50 percent. Just last year, out of thirty who became ill, twelve died, mostly in Cambodia.”
“Fortunately, when H5N1 causes illness in humans, it’s a one-off. Humans aren’t spreading it to each other. For a pandemic to occur, there must be sustained human-to-human transmission. The worry is, with so much of the virus around, in animals near to us, a pandemic could strike at any time.””
“But Webby says the virus is just a few mutations away from enabling human-to-human transmission. “This is an incredibly nasty virus in terms of its ability to cause disease in a lot of things it infects,” he says. “It is going to be a hard task for the virus to make the change, but if it does, it is going to be potentially horrific.”
“And then there’s the problem of reassortment. That’s when two different strains of the influenza virus collide in the same host and swap genetic parts to create a new version. If a person contracted seasonal flu and bird flu at the same time, a novel virus, from which we are not immune, could emerge and spread globally—fast. The more H5N1 there is around us, the greater the chance of reassortment.
It’s happened before. We’ve had four pandemics in the past century. Reassortment caused three of them: in 1957, 1968, and 2009. The 2009 outbreak resulted from a triple reassortment involving swine flu, which created a new form of H1N1, the virus behind the 1918 Spanish flu. That pandemic, still the benchmark for how catastrophic influenza can become, killed over 50 million people worldwide.
The threat is real. And the most frightening thing may be how little we can say with confidence about what comes next.”
“Incorporating lessons from COVID, the federal government is currently coordinating with provinces, Indigenous leadership, and experts to update its pandemic preparedness plan, which provides guidance to the health sector. It has a contract with Seqirus to ensure 15 million doses of vaccine within three months of a pandemic onset. It has funded a new Centre for Research on Pandemic Preparedness and Health Emergencies.
But down at the nitty-gritty hospital level, Allison McGeer says bluntly, “we are a long way from being prepared.” McGeer is an infectious disease specialist at Toronto’s Sinai Health, with considerable front-line experience: SARS in 2002, the 2009 flu pandemic, and COVID. A key piece of pandemic planning, she says, is figuring out which scenarios to prep for.
What do we do when there are no beds left, when the ICU is full? How many staff will get sick? How do we share resources with other hospitals? How many patients can we realistically see in one day? It’s hard, in a beleaguered health system, to find the time or the money to worry about these details until the crisis arrives. She says philosophically, “You just have to keep working on the best you can do for the most people in the circumstances.”
“Is it inevitable that H5N1 will be the one that successfully adapts to humans? No one can say. One thing is certain: mutations, reassortments can happen at any moment. And so can a pandemic.”
“The H5N1 strain of bird flu has for the first time been found in Australia, the country’s agriculture ministry confirmed. It means the highly contagious variant has now reached every continent.” (2)
1.The Next Pandemic May Already Be Brewing, BY RENÉE PELLERIN, https://thewalrus.ca/the-next-pandemic-may-already-be-brewing/
2.Australia confirms first case of H5N1 bird flu as virus reaches every continent, Yvette Tan, https://www.bbc.com/news/articles/c4gykxklvl5o
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai