On a recent summer afternoon, Randy and Vera Tom prepared a stir-fried lunch in their Redwood City home with their “sous chef,” a 17-year-old Bichon Frise named Munchies, afoot.

Randy, 70, recently overhauled his lifestyle after the couple participated in a Stanford Medicine study tracking their metabolic responses to carbohydrates in real time with a continuous glucose monitoring device.

The recently published research tracked the glucose levels in the blood of 55 study subjects as they consumed precooked meals starring different carbohydrates such as grapes, jasmine rice, potatoes, pasta and bread. It was led by genetic deep data specialist Mike Snyder, metabolic expert Tracey McLaughin and research dietician Dalia Perelman at Stanford.

The results could lead to better prevention, diagnoses and treatment of prediabetes, diabetes and other metabolic diseases that lower quality of life and raise health care costs.

According to the Centers for Disease Control and Prevention, 38.4 million people, or 11.6% of the U.S. population, had diabetes in 2024.

Most common is Type 2 diabetes, which occurs when the body develops resistance to insulin because of diet, lifestyle, weight and family history. Type 1 diabetes is an autoimmune disease attacking cells of the pancreas, disabling the body’s production of insulin, the hormone that orchestrates the body’s food-processing functions. Both types of diabetes are life-threatening without intervention.

According to the CDC, more than a third of the 250 million people 18 or older in the U.S. and almost half of the 60 million who are 65 or older are prediabetic — the vast majority unknowingly.

“How would you know, if you can only know with a test that you get only if there seems to be a problem?” asked Randy, cleaver in hand, chopping neatly organized piles of lean pork and technicolor-green bok choy.

The opportunity to access more personalized health information while contributing to science attracted the Toms to Stanford’s genomics studies about a decade ago. They’ve been in more than five long-term studies since — the latest was the first involving food.

When the research team asked Randy what he ate over Christmas after seeing spikes in his blood sugar data, the culprit was tamales. Now, he enjoys just one of the corn-based treats per sitting.

For Snyder, the advancement of physiologically specific care has been personal. From 2009 to 2011, he and Stanford profiled his own descent from prediabetes into type 2 diabetes — the first time the phenomenon was documented at the molecular level.

Snyder, who is svelte and active, said, “When I first became diabetic, everybody looked at me and said, ‘No way, it’s gonna go away.’”

But the proof was in his integrative Personal “Omics” Profile, or iPOP, an unprecedented analysis of billions of individual bits of molecular genetic data collected by powerful cutting-edge technology.

This level of analysis allows researchers to understand people by metabolic subtype and tailor treatment to match.

Right now, doctors begin to classify metabolic shifts or prediabetes when glucose levels in the blood exceed 5.7%, with no information as to why the abnormality exists.

But there are four different pathways to metabolic disease — two where the body doesn’t produce enough insulin and two where the body doesn’t respond properly to insulin.

In the study, McLaughlin and Snyder looked for soft slopes in blood sugar. Jagged peaks are generally normal responses to food or sugar.

Everyone’s blood sugar spikes in response to grapes and rice. But the scientists found that people with metabolic problems spiked higher and for longer to potato starch than people who lacked problems. The “potato-to-grape” reaction ratio correlated with different underlying metabolic dysfunctions.

These differences call for precision medicine and targeted preventative measures. Some people might need weight loss. Others might need exercise. Yet others may need sleep — something that lowers blood glucose levels across the board.

“If we understand where the problem lies, we can treat it more effectively,” Perelman said.

The researchers are looking for markers in cells that can identify these problems more easily through simple blood tests.

In the meantime, continuous glucose monitoring offers actionable information for people who want to be proactive about their metabolic health.

“You see what spikes you, you see what doesn’t spike you, so you eat what doesn’t spike you,” Snyder said.

After the study wrapped, the Toms obtained their own monitoring devices. Vera, 71, reacted moderately to her data; Randy took things further.

He avoided foods that caused sustained spikes in his blood sugar and joined a master’s swimming team. The retiree and part-time model dropped 25 extra pounds, shed numbers from his high cholesterol count and reversed his prediabetic condition.

“I don’t think people know that you can reverse it,” he said. “It’s just hard to do. You don’t just take a pill.”

Last fall, continuous glucose monitors became available over the counter. A drawback is the $80 monthly cost because insurance only covers the devices for diabetics.

Snyder, who wears multiple devices tracking his body’s functions and removes them only before getting weighed, thinks everyone should try one.

Perelman said the monitors are not a replacement for clinical consultation. McLaughlin added that the devices can yield false metrics in certain situations.

The next phase of the research will test different foods and “mitigators” — proteins or fats that can lower blood sugar fluctuations when consumed with carbohydrates. Toasted bread, for example, is easier on the system for some people when eaten with meat or a fat source like heavy cream. Mitigators don’t work as well for people with metabolic disorders — another crumb for research. Cornflakes and milk? Bad for nearly everyone.

This time, study participants will receive interventions, from medicine to personalized instructions for diet and lifestyle modifications.

Perelman said, “I want people to know that there’s delicious food that’s incredibly healthy.”

But this device, a low-vibration belt that resembles a fanny pack, received approval last year from the U.S. Food and Drug Administration. It just hit the market as the first and only non-drug intervention for osteopenia–low bone density affecting mostly older people, especially postmenopausal women.

Developed by Redwood City-based Osteoboost Health, the product applies 30 hertz of oscillations per second and 0.3-g of gravitational force to the most vulnerable parts of the skeleton, regulated by pressure sensors and accelerometers that respond to individual bodies.

RELATED: How to be proactive about your bone health

“I barely even feel it,” quipped Los Altos resident Rachel Corn, who said she’s been wearing hers at the standing desk in her office or while constructing calcium and protein-rich Greek yogurt dishes at home.

The clinical trial that led to the belt’s FDA approval showed an average 85% reduction in bone loss in study participants.

Just like weight-bearing exercises, the vibrations stimulate osteocytes, which send signals to the two other types of bone cells–osteoblasts and osteoclasts–to create new bone matter and recycle the old.

The technology of using vibration to counteract bone loss came from NASA, which knew since the Soviet cosmonauts that suspension in a zero gravity environment sucks away bone matter.

According to the Centers for Disease Control and Prevention, 54% of postmenopausal women have osteopenia. Corn, 55, is smack in the middle of that 52-57 age bracket when women experience precipitous bone density loss but received her diagnosis at 40.

“It’s a death sentence if you’re active,” recalled Corn.

There was nothing she could do about her progressing bone loss but maintain a calcium, protein and fiber-rich diet, exercise and take a drug that blocks the body’s absorption of bone cells. The pills made her nauseated and stole her sleep. After a few years of enduring these side effects on top of her lifestyle alterations, her bone density plateaued.

“It was clear that this would lead to osteoporosis pretty quickly and it wouldn’t get better on its own,” she said.

Then, she met Laura Yecies, CEO of Osteoboost Health.

Osteoboost was personal for Yecies. During college summers, she had volunteered in the nursing home directed by her father, seeing the demise of people with musculoskeletal frailty. With a family history of osteoporosis and after receiving her own diagnosis of osteopenia, she wanted to break the chain.

Curiously, bone health had never been a “sexy” area for medical innovation despite the widespread need for it. Most people still only address their bone health after a fragility fracture — broken bones in situations a healthy skeleton would withstand.

Yecies said the collapse of fractured vertebrae in the lower back is what makes “little old ladies” little and that a hip break in older age leads to loss of independence and heightened chances of pneumonia, bedsores, depression and even death. “It can be sort of a cascade,” Yecies said.

Patty Hirota-Cohen, in her seventies, has been preoccupied with osteopenia for at least 15 years. She’s seen peers go downhill after breaking bones. “So, I’m trying really hard not to fall,” she said, after a fall prevention class at a community center in San Leandro.

Hirota-Cohen, a respecter of Eastern and ancient medicine as much as conventional medical science, said Osteoboost reminds her of the shaking and bouncing exercises in the Qi Gong ancient Chinese practice for overall well-being.

“There’s so much wisdom there–now, it’s in a belt,” she said.

Earlier this year, one of her yoga students told her about Victor Lau, a Tai Ji Quan instructor. Lau’s discipline is the physical extension of a whole philosophy of muscle development, harnessing of qi (energy) to help people know and control their body. Lau gears classes toward increasing strength, balance, awareness and confidence among his pupils to reduce their risk of injury.

Dr. David Karpf is a Stanford endocrinologist and internationally recognized osteoporosis expert who has been advising Osteoboost Health since 2021. He helped develop the first alendronate sodium medications that accompanied astronauts to space to slow down the breakdown of their bones and also emphasizes the living nature of bones.

Karpf has not pushed the product whose development he advised but has prescribed it for patients who inquire since the device is proven, non-invasive and has negligible health risks.

For now, Osteoboost is labeled as a treatment for postmenopausal women with osteopenia but Yecies already knows of doctors electively prescribing it to other populations such as people with full-blown osteoporosis. The company is researching more labeled uses for the device, such as treatment for men with low bone density, and breast cancer survivors who have undergone chemotherapy and take estrogen blockers to prevent recurrence.

The cost of the device, $995, is not covered by insurance but Osteoboost Health is working on changing that.

“I’ve heard so many women say bone loss is a part of getting old, but I don’t think we need to accept that women get frail,” Yecies said.

Corn, who has been using Osteoboost for a month now, said, “I like the image of women being strong.”

She completed her first triathlon in Napa a couple of years ago in her early fifties, then took on a muddy Spartan race. She trained with her son to shimmy up a rope in less than 10 seconds flat — something readily demonstrated in the gym in her garage.

“People don’t understand how hard it is to do this when you’re older,” she said, expressing pride and wonder at the athletic feats she has accomplished. She’s far from done.

“I want to be swimming and running when I’m 70 for sure,” she said.

Unlike any other “ginger” mammals, orange cats’ coloration owes to a sex-linked gene, which is why 80% of orange felines are fellas.

The unique sex-linked orange genetic mutation remained enigmatic for years while scientists tried to figure out what induced cats’ pigment cells to produce yellow, orange or red coloration instead of the usual brown and black.

Researchers from Brown University, the Frederick National Laboratory for Cancer Research and Auburn University also contributed to the study. A team at Kyushu University in Japan published similar findings by studying the DNA of cats in Asia, furthering the understanding that the reason for orange cats is consistent worldwide.

The only exception is the Norwegian forest cat, which manifests as orange because of the same genetic trait that causes red hair in humans.

Stanford Medicine’s Christopher Kaelin, a senior scientist in genetics, Greg Barsh, an emeritus professor of genetics and pediatrics, and genetics researcher Kelly McGowan shared cat DNA samples with these groups to get a strong global sample.

The team also attended dozens of cat shows from California to Brazil, approaching hundreds of orange cat owners for help collecting cat DNA.

Kaelin found breeders and owners to be deeply supportive of cat research even if the collection process was challenging. At one large, three-day show in Cleveland, Ohio, Kaelin and crew swabbed 100 cats on-site by sticking a cotton swab into their mouths to collect a small bit of DNA from the inside of their cheeks.

Spay-and-neuter clinics also contributed tissue after surgically sterilizing feral cats.

The scientists sequenced the genomes from 200 out of 3,000 collected samples of orange cat DNA with non-orange DNA to extrapolate the differences. They found 51 possible variants on the X chromosomes of male orange cats and eliminated 48 of them after finding the genomes in some non-orange cats as well.

Of the three remaining variants, a gene called Arhgap36 came into focus. Researchers in cancer and developmental biology were already studying this gene because its over-expression in neuroendocrine tissues led to tumors in various mammals. No one previously had made any connection to pigment cells.

The mechanism they found, Kaelin said, “is not located on a gene — it’s located near a gene.”

In cats only, a small deletion of information on the X chromosome activates Arhgap36 in pigment cells where it is normally not active, triggering orange fur.

Males have XY sex chromosomes and females have XX. Male cats with an orange X chromosome will be orange, whereas females need to inherit this trait on both of their chromosomes to be completely orange.

Females with just one orange X chromosome can present as tortoiseshell or calico. These mottled and patchy coats are a visual manifestation of the genetic phenomenon of “random X inactivation” in all female mammals. In each cell of a female organism, one of the X chromosomes is “turned off.” In female cats, coat color shows whether the sex-linked orange is the chromosome that’s “on” or “off” in the underlying pigment cells.

“Our ability to do this has been enabled by the development of genomic resources for the cat that have become available in just the last five or 10 years,” Kaelin said.

He has received a flurry of congratulatory texts from orange cat owners, breeders and fans whose cats participated in the study.

“It’s an interesting mutation and unlikely to happen twice,” said Kaelin, explaining why cat lovers and researchers want to know more. McGowan said that about 10% of cats in Northern California today are orange.

The research publication cites the appearance of orange cats in 12th-century Chinese paintings and Renaissance paintings. Kaelin said scientists who examine ancient cat DNA continue seeking the origin of the first orange cats. The biobank of cat genes remaining from his team’s orange cat research could aid in this pursuit, as well as further research about adaptation and evolution on the molecular scale in other mammals, including humans.

Laura Birdsall, director of behavior and medical services at Pets in Need in Redwood City, said the shelter is having an unusual wave of orange cats during this spring’s delayed “kitten season,” when a new generation of feral cats blooms.

Birdsall said that prospective cat adopters go by color and size preference when choosing kittens, and consider personality more when evaluating full-grown cats. She said orange cats found homes quickly for reasons of both standout appearance and personality.

“I’m partial to orange cats,” she shared. “I grew up with an orange cat — that was my baby. This is just my opinion, but they seem to be more outgoing and friendly.”

Kaelin, Barsh and McGowan haven’t found any other physical or behavioral quirks linked to Arghap36 other than coat color so far. For now, Kaelin hypothesizes that orange cats’ reputation as “friendly agents of chaos” might have something to do with their being mostly male.

But who knows — Kaelin pointed out that there haven’t been too many scientific studies about orange cats’ personalities, but that citizen studies often surveyed the public for commentary on their perceived quirks.

“I remember sitting in a parking lot and hearing this sad piece by Miles Davis,” he said. “I haven’t been able to listen to it since without feeling what I felt then.”

Twenty-eight years later, as a political science professor emeritus at Stanford, Krehbiel just became the first person in the U.S. to receive adaptive Deep Brain Stimulation (aDBS) therapy as a part of regular care. It had previously been available only on an experimental basis.

The therapy is akin to a pacemaker for the brain, counteracting beta waves and other arrhythmias relating to the immobility, stiffness and trembling associated with Parkinson’s. The device functions in a closed loop within the body, responding in real-time to feedback from the brain while documenting these interactions.

None of this was possible until Stanford researchers developed it in 2015 by implanting the first-generation sensing neurostimulators. Now, the personalized treatment is poised to touch millions of lives.

Parkinson’s disease diagnoses have doubled since the 1990s, affecting 10 million people around the world, including “Back to the Future” icon Michael J. Fox and science communication advocate Alan Alda of M*A*S*H fame.

A study published this month predicts that 25 million people worldwide will be living with the disease by 2050. The U.S., where a million people have the disease, reports 90,000 new diagnoses each year.

The emerging aDBS therapy is a quantum leap from earlier treatments, approved by the FDA in 1997, the same year Krehbiel was diagnosed. In both, currents from a battery-powered neurostimulator in the chest are sent to two electrodes in the brain via wires extending up the neck, behind the ear, and into the head.

Dr. Helen Bronte-Stewart, the Stanford neurologist whose research contributed to the development of the new therapy said older versions were “basically blind and deaf to the brain’s own rhythms.”

The over quarter-century-long road to aDBS began when Bronte-Stewart was growing up in the U.K., training to be a ballerina. When she chose science, her fascination with movement brought her to lead Stanford’s movement disorders center in 1999.

Her work gravitated toward Parkinson’s because of how kinetically complex and common the disease is — second only to Alzheimer’s in prevalence among degenerative neurological conditions and fastest-growing globally.

In 2011, Medtronic, a medical device company headquartered in Dublin, Ireland, sought programming for their new sensing neurostimulator. They had the platform, Stanford had the technology and Bronte-Stewart had the science.

By 2018, projects across the U.S., Canada and Europe catalyzed an international multi-center pivotal trial for market approval of aDBS.

“This was fairly radical,” said Bronte-Stewart, whose team went from applying aDBS for 20 minutes at a time in the lab to sending subjects home with it.

In 2020, Krehbiel was originally scheduled for the earlier treatment, cDBS but qualified for experimental aDBS after the COVID-19 pandemic delayed his implantation.

Neurosurgeons drilled two holes into his skull while Krehbiel was fully conscious — a “creepy” experience despite the absence of pain. After a night at home with bandages securing the “manhole covers” in his head, he returned to the hospital, went under general anesthesia, woke up while doctors fit electrodes into his brain, and slept again.

Minus a slight headache when he awoke, Krehbiel felt better even before the system was on.

“My tongue felt like it had helium in it — it levitated to the top of my mouth,” he said, of the “tweaking” process that acquainted aDBS to his unique biology.

Krehbiel gradually went from six or seven pills of dopamine agonists a day to one, freed from the “awful” side effects of the drugs commonly prescribed for Parkinson’s.

Krehbiel’s disease continues to progress, in the forms of vocal deterioration, fainting spells and falls, but life is better, he said.

“It’s definitely a game changer but it’s not a cure,” he said.

Across the Bay, on Alameda island on a recent Friday afternoon, John Lipp, another Stanford research subject, unbuttoned the pink sateen shirt under his blue blazer. Standing in the open doorway to the dog kennels of Friends of the Alameda Animal Shelter where he is the CEO, he asked his colleague to cue up a “stripper song” — “You Gotta Have A Gimmick” from the musical “Gypsy.”

He flashed a red line on his chest, where surgeons slid a fresh neurostimulator under his skin in an outpatient procedure in December. Soon, he won’t have to go under the knife to recharge the device.

Lipp learned he had Parkinson’s in 2015. He was 49. A harbinger had been when he was on his way to meet friends and his hand clenched into a fist. “I literally stopped in the middle of the street and talked to myself: ‘Hey, relax.’”

After diagnosis, Lipp ran his first marathon at Disneyland in 2016 but soon had to stop running because of severe muscle cramping.

In 2019, his care team told him about a study in which he could receive cutting-edge treatment while advancing medicine.

He went into surgery ready, panicking only when he realized his head was locked to the operating table. Establishing care afterward was rocky. When he worried about travel plans with his husband, researchers told him he could quit the trial. But, he thought, I’ve come this far.

The aDBS treatment banished Lipp’s cramping and helped him shed most medications. Last November, he completed the 2024 New York City Marathon.

“Even if the DBS is working, the Parkinson’s is progressing, even hour by hour,” Lipp said. Anxiety, insomnia, stress and a gait that’s slightly off remain part of his reality. He can no longer open his eyes in the morning without prying them open manually.

Lipp is retiring this June, in part, to focus on his health and advocate for the Parkinson’s community.

“One thing I’ve learned about this disease – any disease – is that it doesn’t change your nature. If you’re an optimistic person before your diagnosis, you’re going to be after it,” he said.

Brian Fiske, chief scientist at The Michael J. Fox Foundation for Parkinson’s Research, which funded some of Bronte-Stewart’s early aDBS research, said no approved treatment exists to slow Parkinson’s. “But we see these advances in symptom management to be just as critical,” he added.

An international registry will follow participating aDBS patients to inform further advancements. The pre-existing treatment is still in use in some patients — its steady signal is still optimal for some, especially if their neural signals are too weak for aDBS responses.

Bronte-Stewart expressed gratitude for supporters of research, and human subjects who spend years in trials with no guarantee of benefit. She wants the new treatment to reach everyone who needs it.

“Only 2% of doctors become neurologists, and yet, neurological diseases are increasing exponentially. So you can immediately see there’s a supply and demand problem,” she said.

If Bronte-Stewart ever finds free time, she dances — keeps it moving.

“This is just the beginning,” she said.

Q: What is measles and why are we hearing about it now?

A: The World Health Organization identifies measles as one of the most contagious diseases, killing up to three out of every thousand children globally. The disease has been preventable since 1963, when American researchers developed a vaccine. In 2000, measles was considered eliminated in the U.S., though occasional cases and outbreaks impacted mostly unvaccinated people. Currently, there are outbreaks in Texas and New Mexico.

On March 6, an unvaccinated man in New Mexico died of measles. An unvaccinated school-aged child in West Texas died of the virus last month.

The Texas state health department reports that 90% of non-immune people become infected just by being near someone with the airborne sickness. The rubeola virus that causes measles can linger in midair for up to two hours.

Q: What are the symptoms of measles and when do they appear?

A: The Centers for Disease Control and Prevention says that measles symptoms — fevers of 104 degrees Fahrenheit or above, cough, runny nose, and red, watery eyes — appear within 14 days after an infection. Next come tiny white “Koplik spots” on the inside of the mouth, and a rash that starts at the hairline and spreads down the body.

Medical complications can include pneumonia, deafness, blindness, encephalitis (brain swelling) and subacute sclerosing panencephalitis, a progressive neurological disease. Children 5 and under, adults over 20, pregnant women, and immunocompromised people such as chemotherapy patients and those living with leukemia or HIV are most vulnerable to complications.

Q: What are the vaccine requirements?

A: Federal requirements for Measles, Mumps, and Rubella (MMR) shots don’t exist, but all 50 states enforce some form of measles inoculation for children before they enter childcare or public schools. Some states, such as Texas, allow vaccination exemptions for religious and personal beliefs. California had a similar exemption until it was eliminated in 2016.

A CDC-recommended measles vaccination includes two shots delivered at 12-15 months and 4-6 years of age. Together, the doses are 97% effective against measles infections. By contrast, unvaccinated people represent about 94% of the 222 measles cases in the U.S. this year, and one in five unvaccinated people with measles requires hospitalization.

But these statistics have not deterred a persistent anti-vaccination movement that expanded during the COVID-19 pandemic. Lawmakers in Texas and numerous other states continue pushing bills to dislodge routine vaccination from public health policy.

A February meeting of the CDC’s Advisory Committee on Immunization Practices has been indefinitely postponed and U.S. Health Secretary Robert F. Kennedy Jr. is stoking skepticism and confusion around vaccines.

Q: If I got vaccinated as recommended, am I OK? Isn’t the MMR vaccine good for life?

A: MMR vaccinations or natural immunity after a measles infection theoretically lasts a lifetime, according to Dr. Monica Gandhi an infectious disease doctor at UC San Francisco.

But Gandhi said there has been no way to test this in the absence of the disease. “We haven’t put an 80-year-old in the situation where they’re in the middle of an outbreak in 2025,” she said.

Q: Should older vaccinated adults, and those born before 1957 and presumed immune from the widespread infections of the pre-vaccination era, get another MMR vaccine?

A: Gandhi said those vaccinated decades ago should consider a measles booster if they live near an outbreak, are 65 or older, or are preparing to travel internationally, especially for the first time.

The Yale School of Medicine recommends that at-risk people vaccinated prior to 1968 (57 or older) might also want a new shot, because they received doses that are less effective than vaccines that became the standard after that year.

Q: Should people who work in childcare or early education get boosters?

A: This depends on local risk levels, Gandhi said. Vaccination rates at more kindergartens have been dipping below the 95% level previously recommended (and in California, currently enforced) for herd immunity.

Q: Can children be vaccinated ahead of schedule, and can the gap between the two doses be shorter?

A: In the event of an outbreak, Gandhi said, the first dose can be given to infants under a year old. They must be re-vaccinated on or after their first birthdays with two more doses of MMR vaccine separated by 28 days or more, or two more doses of the measles-mumps-rubella-varicella (MMRV) vaccine separated by 3 months or more. The CDC has additional guidance for infants traveling internationally.

Q: Is there anyone for whom vaccination is unsafe?

A: Severely immunocompromised people and pregnant women should not receive the live vaccine, Gandhi said. If exposed to measles, this population receives immunoglobulins — protein antibodies that help the immune system fight off harmful agents.

Q: Kennedy has been touting vitamin A and cod liver oil as alternatives to combating measles. Scientists have debunked these suggestions, but is there any credence to claims that vitamin A or other nutrients can help reduce susceptibility to severe measles?

A: “I really want to downplay vitamin A as a treatment. Prevention by vaccination is the best way to combat severe measles,” Gandhi said.

“Two deaths in this country over the last month are a very big deal for a preventable infectious disease,” she said. “It’s a very big deal to lose someone in your family — it’s a lifelong tragedy. There’s simply no reason not to get the vaccine.”

An estimated 11.6 million households in California own 23.3 million cats. A growing number of these and an unknowable population of free-roaming “community cats” have been contracting avian flu, or H5N1.

According to the U.S. Department of Agriculture (USDA), 19 out of 39 — nearly half — of non-livestock mammals in California infected over the course of the ongoing H5N1 outbreak have been domestic cats. The majority of these cats, including a stray taken in by a Half Moon Bay family and confirmed with H5N1 infection last month, have died or been euthanized.

With kitten season around the corner, this news organization herded together cat experts for advice on how to reduce the spread of bird flu among felines and the species that interact with them.

Q: Can cats spread H5N1 to people?

A: A written statement by the California Department of Public Health (CDPH) said there have been no reports of humans contracting bird flu from cats. But animal-to-human transmission of the virus has already been taking place. California leads the country in human H5N1 infections, mostly from infected dairy cows. Dr. Jane E. Sykes, a specialist in infectious diseases in dogs and cats at the UC Davis School of Veterinary Medicine, said, “If the virus was to change in the future, as it’s shown it can do, then it could have more serious implications for humans in terms of pandemic development.”

Q: Why are cats so susceptible to the virus?

A: Susceptibility relates to the density and location of specific viral cell receptors in the respiratory tracts and other organ systems of cats, Sykes said, and underlying characteristics of their immune systems.

Q: What about bird flu risk in dogs, and dogs close to cats?

A: For now, very few domestic dogs have been reported with bird flu infections. Sykes said that this is probably because they are less susceptible to H5N1. This does not mean that they are immune.

Q: Should cat owners worry yet?

A: According to CDPH, “Human interaction with domestic cats is more intimate and ongoing than with livestock and poultry species.” This closeness exponentially increases the potential for cat-to-human and eventually human-to-human contagion, and scientists say that testing capabilities and mRNA human vaccine research are not prepared for this.

Q: How are cats getting bird flu?

A: The majority of domesticated cats infected during this outbreak consumed raw milk or commercially marketed raw food products. The cause of infection in the Half Moon Bay stray was never determined, raising concern over feral (wild) and stray (lost, abandoned) community cats. These animals have a greater chance of exposure to other infected cats, wild birds or black rats, which joined the list of H5N1-affected animals in California at the beginning of this year.

Q: What is the incubation period for bird flu in cats?

A: Clinical signs usually appear in infected cats after a few days to a week, according to Sykes.

Q: Can cats spread bird flu while asymptomatic?

A: “There is no evidence that healthy cats can be infected with H5N1 and spread the virus without showing symptoms,” according to CDPH. But Sykes said that there are too many unknowns to be sure. “We don’t know how many cats are getting exposed and recovering without showing signs of illness. We still don’t have big studies available to understand what proportion of cats are, for example, fed raw food diets, and have antibodies to the virus,” she cautioned.

Q: Is there a vaccine for bird flu yet?

A: On Feb. 14, the Zoetis pharmaceutical company announced conditional approval from the USDA for a vaccine currently limited to poultry.

Q: How can I prevent my pet from getting bird flu?

A: Scientists, veterinarians, public health officials and animal lovers are all urging cat owners to keep their pet cats indoors at all times if possible. “It’s just much safer and healthier for them overall,” said Dr. Katherine Mills, medical director of the Friends of the Alameda Animal Shelter (FAAS). Mills also recommended not feeding cats raw milk or raw food, even if the products are commercially packaged, frozen or freeze-dried.

Q: How do I know if my cat has avian influenza?

A: They may present upper respiratory symptoms, like sneezing, coughing or congestion and difficulty breathing, or runny discharge from the eyes, nose and mouth, plus lethargy and loss of appetite. Mills said to look out for neurological signs, such as “just mentally not seeming alert, maybe stumbling when they’re walking.” Ultimately, only testing can confirm what is ailing an animal, so it is important to bring sick cats to the vet.

Q: Do I need to wear personal protective equipment (PPE) to handle a sick cat?

A: Mills said “it would never be wrong to wear gloves plus or minus a mask to get the cat in its carrier and get to the vet.”

Q: Up until now, poultry have been “culled” — killed — if even one bird has avian influenza. Will my pet cat or a stray I bring in be summarily euthanized in the interest of public health?

A: There is no protocol for the routine euthanizing of cats with H5N1 infections, but experts say that supportive care has rarely been able to help cats with rapidly progressing symptoms of bird flu.

Q: Are free-roaming community cats a public risk?

A: The statewide Integrated Pest Management Program (IPM) at the University of California Division of Agriculture and Natural Resources states that outdoor cats, comprising anywhere from 18-49% of the U.S. cat population, are already one of the100 worst invasive species worldwide because of their environmental impact and intractability.

Q: If I find a cat that appears healthy, can I take it home?

A: CDPH says to avoid contact with unfamiliar animals regardless of their apparent condition. Encounters should be reported to the California Department of Fish and Wildlife at (916) 358-2790, or the nearest animal control department, shelter or humane society. Mills said found cats can also have ringworm, fleas and a host of contagions other than bird flu.

Q: What are authorities doing about the emerging risk of free-roaming cats as a bird flu spreader?

A: CDPH has not issued H5N1-specific guidance for managing stray cat populations. Counties continue to manage community cats at their discretion, often in cooperation with shelters and humane societies.