The United States Department of Agriculture last week reported that a pig on a backyard farm in Oregon was infected with bird flu.

As the bird flu situation has evolved, we’ve heard about the A/H5N1 strain of the virus infecting a range of animals, including a variety of birds, wild animals and dairy cattle.

Fortunately, we haven’t seen any sustained spread between humans at this stage. But the detection of the virus in a pig marks a worrying development in the trajectory of this virus.

How did we get here?

The most concerning type of bird flu currently circulating is clade 2.3.4.4b of A/H5N1, a strain of influenza A.

Since 2020, A/H5N1 2.3.4.4b has spread to a vast range of birds, wild animals and farm animals that have never been infected with bird flu before.

While Europe is a hotspot for A/H5N1, attention is currently focused on the US. Dairy cattle were infected for the first time in 2024, with more than 400 herds affected across at least 14 US states.

Bird flu has enormous impacts on farming and commercial food production, because infected poultry flocks have to be culled, and infected cows can result in contaminated diary products. That said, pasteurisation should make milk safe to drink.

While farmers have suffered major losses due to H5N1 bird flu, it also has the potential to mutate to cause a human pandemic.

Birds and humans have different types of receptors in their respiratory tract that flu viruses attach to, like a lock (receptors) and key (virus). The attachment of the virus allows it to invade a cell and the body and cause illness. Avian flu viruses are adapted to birds, and spread easily among birds, but not in humans.

So far, human cases have mainly occurred in people who have been in close contact with infected farm animals or birds. In the US, most have been farm workers.

The concern is that the virus will mutate and adapt to humans. One of the key steps for this to happen would be a shift in the virus’ affinity from the bird receptors to those found in the human respiratory tract. In other words, if the virus’ “key” mutated to better fit with the human “lock”.

A recent study of a sample of A/H5N1 2.3.4.4b from an infected human had worrying findings, identifying mutations in the virus with the potential to increase transmission between human hosts.

Why are pigs a problem?

A human pandemic strain of influenza can arise in several ways. One involves close contact between humans and animals infected with their own specific flu viruses, creating opportunities for genetic mixing between avian and human viruses.

Pigs are the ideal genetic mixing vessel to generate a human pandemic influenza strain, because they have receptors in their respiratory tracts which both avian and human flu viruses can bind to.

This means pigs can be infected with a bird flu virus and a human flu virus at the same time. These viruses can exchange genetic material to mutate and become easily transmissible in humans.

Interestingly, in the past pigs were less susceptible to A/H5N1 viruses. However, the virus has recently mutated to infect pigs more readily.

In the recent case in Oregon, A/H5N1 was detected in a pig on a non-commercial farm after an outbreak occurred among the poultry housed on the same farm. This strain of A/H5N1 was from wild birds, not the one that is widespread in US dairy cows.

The infection of a pig is a warning. If the virus enters commercial piggeries, it would create a far greater level of risk of a pandemic, especially as the US goes into winter, when human seasonal flu starts to rise.

How can we mitigate the risk?

Surveillance is key to early detection of a possible pandemic. This includes comprehensive testing and reporting of infections in birds and animals, alongside financial compensation and support measures for farmers to encourage timely reporting.

Strengthening global influenza surveillance is crucial, as unusual spikes in pneumonia and severe respiratory illnesses could signal a human pandemic. Our EPIWATCH system looks for early warnings of such activity, which can speed up vaccine development.

If a cluster of human cases occurs, and influenza A is detected, further testing (called subtyping) is essential to ascertain whether it’s a seasonal strain, an avian strain from a spillover event, or a novel pandemic strain.

Early identification can prevent a pandemic. Any delay in identifying an emerging pandemic strain enables the virus to spread widely across international borders.

Australia’s first human case of A/H5N1 occurred in a child who acquired the infection while travelling in India, and was hospitalised with illness in March 2024. At the time, testing revealed Influenza A (which could be seasonal flu or avian flu), but subtyping to identify A/H5N1 was delayed.

This kind of delay can be costly if a human-transmissible A/H5N1 arises and is assumed to be seasonal flu because the test is positive for influenza A. Only about 5% of tests positive for influenza A are subtyped further in Australia and most countries.

In light of the current situation, there should be a low threshold for subtyping influenza A strains in humans. Rapid tests which can distinguish between seasonal and H5 influenza A are emerging, and should form part of governments’ pandemic preparedness.

A higher risk than ever before

The US Centers for Disease Control and Prevention states that the current risk posed by H5N1 to the general public remains low.

But with H5N1 now able to infect pigs, and showing worrying mutations for human adaptation, the level of risk has increased. Given the virus is so widespread in animals and birds, the statistical probability of a pandemic arising is higher than ever before.

The good news is, we are better prepared for an influenza pandemic than other pandemics, because vaccines can be made in the same way as seasonal flu vaccines. As soon as the genome of a pandemic influenza virus is known, the vaccines can be updated to match it.

Partially matched vaccines are already available, and some countries such as Finland are vaccinating high-risk farm workers.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney and Haley Stone, Research Associate, Biosecurity Program, Kirby Institute & CRUISE lab, Computer Science and Engineering, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

It’s a shock when we realise our parents aren’t managing well at home.

Perhaps the house and garden are looking more chaotic, and Mum or Dad are relying more on snacks than nutritious meals. Maybe their grooming or hygiene has declined markedly, they are socially isolated or not doing the things they used to enjoy. They may be losing weight, have had a fall, aren’t managing their medications correctly, and are at risk of getting scammed.

You’re worried and you want them to be safe and healthy. You’ve tried to talk to them about aged care but been met with swift refusal and an indignant declaration “I don’t need help – everything is fine!” Now what?

Here are four things to consider.

1. Start with more help at home

Getting help and support at home can help keep Mum or Dad well and comfortable without them needing to move.

Consider drawing up a roster of family and friends visiting to help with shopping, cleaning and outings. You can also use home aged care services – or a combination of both.

Government subsidised home care services provide from one to 13 hours of care a week. You can get more help if you are a veteran or are able to pay privately. You can take advantage of things like rehabilitation, fall risk-reduction programs, personal alarms, stove automatic switch-offs and other technology aimed at increasing safety.

Call My Aged Care to discuss your options.

2. Be prepared for multiple conversations

Getting Mum or Dad to accept paid help can be tricky. Many families often have multiple conversations around aged care before a decision is made.

Ideally, the older person feels supported rather than attacked during these conversations.

Some families have a meeting, so everyone is coming together to help. In other families, certain family members or friends might be better placed to have these conversations – perhaps the daughter with the health background, or the auntie or GP who Mum trusts more to provide good advice.

Mum or Dad’s main emotional support person should try to maintain their relationship. It’s OK to get someone else (like the GP, the hospital or an adult child) to play “bad cop”, while a different person (such as the older person’s spouse, or a different adult child) plays “good cop”.

3. Understand the options when help at home isn’t enough

If you have maximised home support and it’s not enough, or if the hospital won’t discharge Mum or Dad without extensive supports, then you may be considering a nursing home (also known as residential aged care in Australia).

Every person has a legal right to choose where we live (unless they have lost capacity to make that decision).

This means families can’t put Mum or Dad into residential aged care against their will. Every person also has the right to choose to take risks. People can choose to continue to live at home, even if it means they might not get help immediately if they fall, or eat poorly. We should respect Mum or Dad’s decisions, even if we disagree with them. Researchers call this “dignity of risk”.

It’s important to understand Mum or Dad’s point of view. Listen to them. Try to figure out what they are feeling, and what they are worried might happen (which might not be rational).

Try to understand what’s really important to their quality of life. Is it the dog, having privacy in their safe space, seeing grandchildren and friends, or something else?

Older people are often understandably concerned about losing independence, losing control, and having strangers in their personal space.

Sometimes families prioritise physical health over psychological wellbeing. But we need to consider both when considering nursing home admission.

Research suggests going into a nursing home temporarily increases loneliness, risk of depression and anxiety, and sense of losing control.

Mum and Dad should be involved in the decision-making process about where they live, and when they might move.

Some families start looking “just in case” as it often takes some time to find the right nursing home and there can be a wait.

After you have your top two or three choices, take Mum or Dad to visit them. If this is not possible, take pictures of the rooms, the public areas in the nursing home, the menu and the activities schedule.

We should give Mum or Dad information about their options and risks so they can make informed (and hopefully better) decisions.

For instance, if they visit a nursing home and the manager says they can go on outings whenever they want, this might dispel a belief they are “locked up”.

Having one or two weeks “respite” in a home may let them try it out before making the big decision about staying permanently. And if they find the place unacceptable, they can try another nursing home instead.

4. Understand the options if a parent has lost capacity to make decisions

If Mum or Dad have lost capacity to choose where they live, family may be able to make that decision in their best interests.

If it’s not clear whether a person has capacity to make a particular decision, a medical practitioner can assess for that capacity.

Mum or Dad may have appointed an enduring guardian to make decisions about their health and lifestyle decisions when they are not able to.

An enduring guardian can make the decision that the person should live in residential aged care, if the person no longer has the capacity to make that decision themselves.

If Mum or Dad didn’t appoint an enduring guardian, and have lost capacity, then a court or tribunal can appoint that person a private guardian (usually a family member, close friend or unpaid carer).

If no such person is available to act as private guardian, a public official may be appointed as public guardian.

Deal with your own feelings

Families often feel guilt and grief during the decision-making and transition process.

Families need to act in the best interest of Mum or Dad, but also balance other caring responsibilities, financial priorities and their own wellbeing.

Lee-Fay Low, Professor in Ageing and Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.