Farm workers are at high risk of exposure to bird flu, but testing is not reaching them. •Nebraska Examiner

Farmworkers face some of the most intense exposures to the bird flu virus, but advocates say many of them would have no resources to fall back on if they got sick.

So far, only two people in the United States have tested positive after being exposed to a wave of bird flu that spread among cows. These people, workers on dairy farms in Texas and Michigan, experienced eye irritation.

Scientists warn that the virus could mutate and spread from person to person like the seasonal flu, which could cause a pandemic. By monitoring farmworkers, researchers can track infections, discover how dangerous they are and be alerted if the virus becomes more contagious.

People generally get tested when they seek treatment for a disease. But farmworkers rarely seek treatment because many lack health insurance and paid sick leave, said Elizabeth Strater, director of strategic campaigns for the national group United Farm Workers. They are unlikely to see a doctor unless they become very ill.

Strater said about 150,000 people work in U.S. dairies. She said many worker advocates believe the virus has spread to more people than testing shows. “The method used to monitor at-risk workers has been very passive,” she said.

The FBI would pay for the testing

Federal officials told reporters on May 22 that only 40 people associated with U.S. dairy farms had been tested for the virus, although others are “actively monitored” for symptoms.

Federal authorities recently announced they will pay farm workers $75 each to be tested for the virus, part of a new program that also offers incentives for farm owners to allow testing of their dairy herds.

Officials with the federal Centers for Disease Control and Prevention said they recognize the importance of gaining cooperation and trust from dairy workers on the front lines.

CDC spokesperson Rosa Norman said in an email that the incentive compensation compensates employees for their time helping monitor how many people are infected, how sick they get and whether people spread the virus to each other.

She noted that the CDC believes the virus currently poses a low risk to public health.

But Strater is skeptical about the incentive for farmworkers to be checked for the virus. If an employee tests positive, they will likely be instructed to go to a clinic and then stay home from work. She said they couldn’t afford it either.

“That sounds like a really bad deal for $75 because at the end of the week they have to feed their families,” she said.

Missing work is a bigger concern

Katherine Wells, public health director in Lubbock, Texas, said health officials in her state would provide short-term medical care, such as giving farm workers the flu treatment Tamiflu. These arrangements do not necessarily include hospitalization if necessary, she said.

She said employees’ bigger concern seems to be that they would have to stay home from work or even lose their jobs if they tested positive.

Many agricultural workers come from other countries and often work in appalling conditions for little pay.

They may fear that attention to cases among them will fuel anti-immigrant fervor, says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Societies have a long history of blaming marginalized communities for the spread of infectious diseases. For example, Latino immigrants were verbally attacked during the 2009 H1N1 “swine flu” pandemic, and some media personalities used the outbreak to push for a crackdown on immigration.

Bethany Boggess Alcauter, director of research and public health programs at the National Center for Farmworker Health, said many dairy farm workers have been told very little about the spread of this new disease in the cows they handle. “Education must be part of the testing effort, with time for employees to ask questions,” she said.

These conversations need to be had in the language of farmworkers, with people they are likely to trust, she said.

Georges Benjamin, executive director of the American Public Health Association, said public health officials should make it clear that workers’ immigration status will not be reported as part of the investigation into the new flu virus. “We will not be the police,” he said.

Dawn O’Connell, administrator at the Department of Health and Human Services, said at a May 22 news conference that nearly 5 million doses of a vaccine against H5N1, the avian flu virus circulating among livestock, are in the pipeline, but that officials still have has not been decided whether the shots will be offered to farmworkers later this year when they are ready.

The CDC asked states in early May to share personal protective equipment with farm owners to help them protect workers from the bird flu virus. State health departments in California, Texas and Wisconsin, which have large dairy industries, all said they have offered to distribute such equipment.

Chris Van Deusen, spokesman for the Texas Health Department, said four dairy farms had requested protective equipment from the state’s stockpile. He said other farms may already have what they need. Spokespeople for the California and Wisconsin health departments said they did not immediately receive requests from farm owners for additional equipment.

Personal protective equipment

Strater, the United Farm Workers official, said the supply of protective equipment must be practical.

Most dairy workers already wear waterproof aprons, boots and gloves, she said. It wouldn’t be realistic to expect them to also wear N95 face masks in the wet, hot conditions of a milking operation, she said. Plastic face shields appear to be a better option for that environment, especially to prevent milk from squirting into workers’ eyes where it could cause an infection, she said.

Other types of farm workers, including those who work with chickens, also face potential infections. But scientists say the version of the virus spreading among cows could be particularly dangerous because it has adapted to live in mammals.

Strater said she’s most concerned about dairy workers, who spend 10 to 12 hours a day in enclosed spaces with cows.

“Their faces are about 6 inches away from the milk and udders all day long,” she said. “The intimacy of it, having their face so close to the infectious material, is different.”

This article first appeared in KFF Health Newsformerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism on health issues and is one of the primary operating programs at KFF – the independent source for research, polls and journalism in the field of health policy.