Good morning. It's Wednesday. Today we'll look at New York's preparations for a bird flu pandemic. We'll also get details on $54 million that Gov. Kathy Hochul is allocating to get work on the long-awaited extension of the Second Avenue subway going again.
One infectious disease expert says it could be an Achilles' heel someday: New York's plan for fighting bird flu, if it begins spreading among people, largely depends on one drug developed in the 1990s. A newer antiviral drug is now available, but the state has not stored a single dose of it in case there's an emergency. The bird flu outbreak has spread through dairy cows in the United States over the past few months. Federal officials have repeatedly said that the risk to the general public is low. But some infectious disease experts are worried. I asked Joseph Goldstein, a Metro reporter who covers public health and health care in New York, to discuss whether New York has too much riding on a single drug — without a fallback plan. Why are some public health experts worried that New York State has only Tamiflu on hand to counter a large outbreak of bird flu? The hope is that Tamiflu would be quite effective in treating bird flu patients if H5N1 began spreading from one person to another. But it might not work as well as anticipated. In 2018, the F.D.A. approved a new flu antiviral medication. It works in an entirely different way than Tamiflu, so it could be a good fallback if Tamiflu isn't so effective. But New York State hasn't stockpiled any of this newer medication, baloxavir marboxil. It's sold as Xofluza. To be clear, it's not certain that it would work any better than Tamiflu. But some public health experts say the state should at least consider stockpiling it. Given all the unknowns, it's just basic risk reduction, they say. Is a bird flu pandemic coming? Hopefully not anytime soon, but it might. And there will be another flu pandemic eventually. Flu pandemics can occur when the genetic material from a bird flu mixes with genetic material from another flu virus, one more infectious to people. This process is called "reassortment." It can happen when a pig or some other mammal is infected with two flu viruses at once. The result can be a pandemic strain. Is that how the 1918 pandemic, which killed somewhere between 20 million and 50 million people, happened? There is debate as to whether the 1918 pandemic, the deadliest in recorded history, was the result of an avian flu virus that jumped directly to people or the result of a hybrid virus — part avian, part something else. The H5N1 virus is far more prevalent among wild birds now than before. And it has jumped to dairy cattle, which provide an entirely new animal reservoir for the virus, one that virologists did not expect. So H5N1 would appear to be closer to sparking a global pandemic than it was in the past. But it doesn't have the ability to transmit efficiently between people. That could change, of course. You mentioned baloxavir, which is newer than Tamiflu. Why hasn't New York State bought any? The vast government stockpiles of flu antivirals were amassed in the 2000s, a decade before baloxavir was approved. The federal government and states bought tens of millions of courses of Tamiflu, the leading flu antiviral available. Once they did, there was an understandable sense that the job was complete. The F.D.A. even extended the shelf life of those doses of Tamiflu so that they could be kept 20 years, long after their original expiration dates. Baloxavir is expensive, perhaps $180 at the pharmacy. But the government could presumably get a far better price by buying in bulk. And it seems likely that New York will have to spend some money on its antiviral stockpile at some point soon: Its Tamiflu stockpile, manufactured in 2006-7, will soon expire. Does New York City have its own stockpile, separate from the one the state maintains? Yes, but the state stockpile is significantly larger. New York State has more than two million courses of Tamiflu, enough Tamiflu to treat roughly 10 percent of the state. The city stockpile has 427,000 courses of Tamiflu. Like the state, the city has no baloxavir. Would either of these drugs be effective if H5N1 evolves to where it's transmitted from person to person? There is no way to know how effective Tamiflu will be against a pandemic flu strain that hasn't yet evolved. It might be effective in higher doses than the standard dosage, in which case the stockpile would not cover as many people. Or the virus might end up being resistant to Tamiflu. The same goes for baloxavir. What's the difference between them? The two drugs work in different ways. They target different enzymes and different stages of the viral replication cycle, so it's possible that if one is less effective than hoped for, the other would work. Having both medications available in sufficiently large quantities during the next pandemic could well prove more effective than having just one of them. It's worth noting that it could take some time for a vaccine to become widely available during the next flu pandemic. Until one is, having access to effective antiviral medication could mean the difference between life and death for many people. WEATHER Expect showers and thunderstorms throughout the day with temperatures climbing to the high 80s. Look for a partly cloudy sky tonight after evening thunderstorms move on. The low will be in the mid-70s. ALTERNATE-SIDE PARKING In effect until Aug. 13 (Tisha B'Av). The latest New York news
We hope you've enjoyed this newsletter, which is made possible through subscriber support. Subscribe to The New York Times. $54 million for the Second Avenue subway extension
Gov. Kathy Hochul said she had found $54 million in state funds to restart work on the $7.7 billion extension of the Second Avenue subway. The work was to have been covered by congestion pricing, which she suspended last month. The Metropolitan Transportation Authority, the state agency that runs the subways, halted work on the extension after Hochul put an indefinite hold on the congestion pricing plan, which had been expected to generate $3 billion to push the Second Avenue line to East Harlem. Hochul, who described the allocation as a sign of her commitment to the city's transit system, called the money "the first step to building this transformational project." But transit advocates scoffed at what they said was a relatively small sum for the Second Avenue work. METROPOLITAN DIARY Extra
Dear Diary: I was hired as an extra for a "John Wick: Chapter 2" shoot in Central Park. My part called for me to dress like a person who was down on his luck. I reported to the set appropriately dressed in torn jeans, a beat-up Army jacket, an old cap, a scarf and finger-less gloves. Before being assigned a place in the scene, I grabbed some coffee from the craft services table. I drank it quickly and was holding the empty paper cup in my hand until I could find a trash can. As I stood to the side waiting, an Italian tour group approached me and asked excitedly whether they could take pictures with me. I happily obliged, and then they moved on. I looked down into my coffee cup. I had just made an extra $7 for the day. — Alan Cory Kaufman Illustrated by Agnes Lee. Send submissions here and read more Metropolitan Diary here. Glad we could get together here. See you tomorrow. — J.B. P.S. Here's today's Mini Crossword and Spelling Bee. You can find all our puzzles here. Francis Mateo and Ed Shanahan contributed to New York Today. You can reach the team at nytoday@nytimes.com. Sign up here to get this newsletter in your inbox.
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N.Y. Today: Is New York ready for bird flu?
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