The virus has — so far — caused only minimal illness among humans, yet has spread rapidly among birds, sea mammals and other species with devastating effect.

Although U.S. health officers have repeatedly assured Americans that H5N1 bird flu poses little risk to their well-being, some experts have become increasingly critical of what they see as the government’s failure to aggressively monitor the spread of virus among cattle and other farm animals. The virus has been reported in 145 dairy herds across 12 states, but critics say this is likely an underestimate.

They point to stories they have heard anecdotally from physicians and veterinarians in farming communities about mystery illnesses and cover-ups. And they point to perplexing “hits” of H5N1 in municipal wastewater far from any infected dairy herds.

“I think our government officials are are not doing the thorough investigation they should be doing,” said Rick Bright, a virologist and the former head of the U.S. Biomedical Advanced Research and Development Authority. “I think they are continually minimizing this outbreak and this virus.”

The worry among some experts is that H5N1-infected farm animals could serve as “mixing vessels” for new viral strains that could more easily infect people. They point to research released this week showing that the virus has receptors for both birds and humans. And they note that up to 75% of human infectious diseases are derived from pathogens that originated from animals.

Now, amid this heated debate over viral monitoring, a raw milk dairy farmer and longtime critic of the Food and Drug Administration has accused the government of ignoring his tip about a suspected H5N1 outbreak among a herd of dairy cows in early May.

Although it remains unclear whether an outbreak actually occurred, neither federal nor state officials investigated the matter for weeks. Only after inquiries by The Times did officials announce Tuesday that they would look into the report.

The delayed response, some experts say, suggests a disturbing lack of oversight on the part of government officials.

“I think that once everybody decided it wasn’t going to kill people and pasteurized milk and herds could get over it, then all that was left was to take these stopgap measures — voluntary reporting, voluntary testing, testing when going across state lines — that don’t look anything like a really serious effort to go ahead and stamp it out,” said Michael Payne, a researcher and outreach coordinator at the Western Institute for Food Safety and Security at UC Davis.

The outbreak claim comes from Mark McAfee, owner of Raw Farms, a raw milk dairy producer with herds in Fresno and Hanford. On June 17, McAfee — who is also the president of the Raw Milk Institute, an advocacy group — emailed the FDA’s acting director, Donald Prater, to say that he’d been told a raw milk dairy herd had been infected and that people had probably consumed the contaminated milk.

According to McAfee’s email, which was shared with The Times, a subset of a farmer’s cows were suffering yellowish, runny diarrhea; low milk production; thick, yellowish colostrum; and general weakness. The farmer told McAfee he had separated the sick cows — about 10% of his herd — and discontinued milking them.

Mark McAfee walks by cows feeding at his raw milk dairy.

(Tomas Ovalle/For The Times)

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“The farmer reported that for certain, humans had consumed the raw milk at some level,” McAfee wrote to Prater, adding that the farmer’s veterinarian “told the farmer to not report anything to anyone” because the virus would pass and “he did not want the FDA to swoop in and cause a media frenzy.”

McAfee said he fields lots of questions and calls from raw milk farmers around the nation. Because he’s president and founder of the Raw Milk Institute — and the largest producer of raw milk in the country — his advice and counsel is often sought by smaller dairy farmers.

Within 90 minutes of sending the email, Prater responded that he appreciated the time McAfee had taken to write the note and “for sharing these perspectives.” He then added that he and his agency would “take note of the points you raised and come back to you if we have any questions.”

According to McAfee, the FDA did not follow up with him. The state of New Mexico, where McAfee says the herd was infected, was made aware of the tip only last week, after the Times inquired.

The U.S. Department of Agriculture and the Centers for Disease Control and Prevention would not comment for the record on the matter, referring questions to the state.

Critics say whether the outbreak occurred or not, the lack of an immediate, or even timely, response underscores the absence of urgency and leadership in the face of a potential health threat.

“If you turn your back on this virus, you’re kind of inviting it in to bite you in the ass,” said Bill Hanage, associate professor of epidemiology and co-director of the Center for Communicable Disease Dynamics at Harvard University’s T.H. Chan School of Public Health.

Bright, the virologist, said the delay was a problem.

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1. Carlos Rodriguez squeezes a cows teat to check the quality of the milk coming out of it. 2. Alvaro Hernandez hangs a milking cluster high to avoid contamination after a cow has been milked. 3. Mark McAfee checks bacteria levels in his raw milk every day and spends over $300,000 on testing. (Tomas Ovalle/For The Times)

“This is the stuff that drives me crazy,” Bright said. “I always tell people, it’s not necessarily the data that we have in front of us that’s most concerning. It is what’s being hid from us that’s most concerning.”

Farmers do not have to let government officials test their cattle, he said, which makes it hard to verify weeks after the fact whether an outbreak had occurred. If a dairy farmer allowed it, researchers could check for H5N1 antibodies in the blood.

“I really don’t think they want to know,” he said of the U.S. government, and the FDA in particular.

To be sure, the FDA and McAfee’s Raw Milk Institute have had a long, contentious history.

“To be quite frank, your source, Raw Milk Institute, are known advocates for repeatedly amplifying what they say is a lack of evidence that drinking raw milk with H5N1 is bad for you,” said Janell Goodwin, an FDA spokeswoman.

Indeed, McAfee said he reported the outbreak because he believed it showed that unpasteurized, yet infected raw milk was not a threat.

“No one got sick from that outbreak,” he insisted.

Mark McAfee, a raw milk dairy farmer and longtime critic of the FDA, has accused officials of ignoring his tip about a possible H5N1 outbreak among dairy cows.

(Tomas Ovalle/For The Times)

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But epidemiologists The Times spoke with expressed skepticism on this point, suggesting that maybe nobody had “reported” being sick, noting that many dairy workers are migrants who may not relish a government visit. And they pointed to experimental and observational studies of barn cats that consumed H5N1 contaminated raw milk and “had about a 50% mortality rate and really unpleasant symptoms,” said Hanage, the Harvard professor.

Drinking raw milk is “something that is a risk that we would rather people didn’t take just for their own sake,” he said.

McAfee noted that he has received a certificate of good standing by California’s Department of Food and Agriculture for voluntarily testing his cows’ milk for H5N1. A spokesman for the agency confirmed that as of July 1, the farm’s milk was clear of the virus.

By the time that Dennys Rene Rivas Williams had fallen so ill that he needed new lungs, physicians at Olive View-UCLA Medical Center expressed little doubt about what was to blame for his sickness.

Doctors had diagnosed the 36-year-old with silicosis: an incurable disease caused by inhaling tiny bits of lung-scarring silica. It was an affliction that had debilitated dozens of workers in Los Angeles County like him, who had toiled cutting countertops bound for kitchens and bathrooms.

Health officials had sounded the alarm that a new epidemic of the illness was killing young laborers amid the rising popularity of engineered stone, which is typically much higher in silica than natural slabs. In recent years, more than a dozen California workers who cut countertops have lost their lives to the disease.

Rivas Williams’ medical records state that his silicosis was due to “engineered stone fabrication/cutting,” with a doctor advising him to quit his job to prevent further damage.

Yet Rivas Williams had been turned down when he applied for workers’ compensation, which is supposed to cover medical care and other benefits for laborers injured on the job. Attorneys representing the young father were galled, asking where else he would have inhaled so much silica.

Rivas Williams said that the Pacoima shop where he worked was blanketed in dust, and that he and other workers were offered only flimsy masks, rather than protective respirators. In January, he received a double lung transplant — a lifesaving surgery but one that often means only an additional six years of survival.

Silicosis has been known as an occupational illness for centuries, afflicting miners, stonecutters and others exposed to silica dust.

The overwhelming majority of cases are tied to work, said Dr. Jane Fazio, a pulmonary critical care physician and UCLA researcher. Among countertop cutters, if “someone has this job and they have silicosis, it should clearly be presumed to be work-related.”

Yet as California sees surging numbers of young workers suffering from the disease, many have not successfully tapped workers’ compensation. Assistance can include medical care, disability payments and death benefits for families.

Fazio and other researchers analyzing dozens of cases of California countertop workers suffering silicosis found that only 13% had workers’ compensation benefits when diagnosed and treated. Nearly half kept working in the industry even after getting the diagnosis.

Workers’ compensation is supposed to ensure that if workers are harmed on the job, “they don’t have to swap their livelihood for their health” and “can get access to medical care and time away from work and disability and other kinds of resources they may need to make themselves whole again,” said Kevin Riley, director of the UCLA Labor Occupational Safety & Health Program.

California employers are required to provide workers’ compensation benefits for their employees, typically by buying insurance coverage. A state fund can handle such claims if a business flouts the requirements, but advocates say many workers — especially immigrants — fear retaliation for even pursuing the benefits.

And workers’ compensation attorneys say lodging a claim is no guarantee that laborers will get aid quickly, even for a disease roundly recognized as stemming from work. Lawyer Gary Rodich said this summer that his firm was representing more than a dozen workers with silicosis who were denied workers’ compensation benefits when they applied — including Rivas Williams.

Before he got his diagnosis, Rivas Williams had filed a claim that mentioned damage to his lungs along with “repetitive work” injuries to his knees, shoulders and other parts of his body, aided by a different attorney. The denial letter from Amtrust North America said there wasn’t enough evidence that “your alleged injury resulted from your employment at Primus Marble,” the shop where he was working.

Shortly after he was diagnosed with silicosis, Rivas Williams submitted an amended application with the help of Rodich. In medical reports obtained for his case, doctors have drawn a direct line to his work cutting countertops. One wrote that his silicosis was “100% work related.”

Amtrust said in May that his case “involves several complex issues our claims team is working diligently to resolve.” It did not respond to questions from The Times about what those issues were.

Rivas Williams’ state disability payments ran out last year. In January, his attorneys accused the insurance company of “unreasonable and/or frivolous delay” in a court filing, saying it had left him on the verge of homelessness. At that point, nearly a year and a half had passed since his initial claim.

That same month, according to his attorneys, Amtrust agreed to pay temporary benefits as the two sides continued negotiating. Amtrust said in a May email that “we are confident a resolution will be reached soon.”

Rivas Williams has to take an array of pills morning and night to prevent his body from rejecting the new lungs. The medications disarm his immune system, leaving him vulnerable to other threats. His doctors warn him to avoid cigarette and marijuana smoke, so he shuts the windows of his South Los Angeles home.

“I’m shut up almost all the time,” Rivas Williams said in Spanish in an April interview. “I’m afraid to go out because I have no defenses.”

He knows three men who have already died of the disease. When he went to say goodbye to one of them, “that mentally ruined me. I spiraled. I saw his kids cry. And I felt like I was seeing my own kids cry.”

The 36-year-old said his goal was to support his children, whom he brought to the U.S. from Guatemala. Rivas Williams said he burned through savings and piled up debts after falling ill.

“Not everything in this life is money,” Rivas Williams said. “But imagine if I’m not here.

“Their lives are going to change.”

In June — nearly two years after Rivas Williams first filed for workers’ compensation — the two sides reached a settlement. Rodich said his client declined to publicly disclose the amount.

Primus Marble, where Rivas Williams once worked, did not respond to messages seeking comment.

As of early July, the California Department of Public Health had identified 156 cases of silicosis related to engineered stone in recent years — more than 90 of them among residents of Los Angeles County. Nearly half of those cases were identified last year alone, amid growing awareness of the silicosis epidemic.

Public health officials believe many more cases have gone undetected as immigrant workers go without care or are misdiagnosed with other lung ailments. Outbreaks of the deadly disease have erupted worldwide as engineered stone has soared in popularity.

In Australia, where an alarming surge in cases led government officials to ban engineered stone, silicosis has been categorized among “deemed diseases” for workers’ compensation — those assumed to be caused by work unless there is strong evidence to the contrary.

If an Australian worker has silicosis, “I diagnose somebody. I fill out” the paperwork, said Dr. Ryan Hoy, lead physician for the occupational respiratory disease clinic at Alfred Hospital in Melbourne. “It goes to the regulator and they accept the claim. They can’t deny it.”

That doesn’t exist for countertop cutters here. California has granted “presumptive eligibility” for workers’ compensation for some ailments — such as COVID-19 illness suffered by health workers and first responders earlier in the pandemic — but not for silicosis claims from stonecutters.

In the U.S., workers’ compensation differs from state to state, but the problems that silicosis sufferers in California have encountered are not unique. In one study of silicosis patients in Wisconsin, researchers found many had run into problems getting workers’ compensation “and are frustrated by having to prove the work-relatedness of silicosis — a condition which seldom is acquired outside of work.”

Almost all were initially rejected because medical records lacked information about their work histories, which is not routinely gathered by many clinicians, the study noted.

Rivas Williams says he doesn’t go out much because he takes medications that suppress his immune system after his double lung transplant.

(Al Seib / For The Times)

Too often, “doctors either don’t have the time, don’t take the time, or don’t know how to take a complete occupational history,” said Dr. Cecile Rose, an occupational pulmonologist at National Jewish Health in Denver.

Silicosis may show up years after someone is exposed, requiring doctors to also probe into past employment.

Many patients never pursue the process. One analysis of silicosis patients in Michigan, where the disease has sickened people whose work involves metal casting or abrasive blasting, found only 35% had applied for workers’ compensation — and the percentage had tumbled over time. Other studies involving a range of industries have put the numbers even lower.

“Even for clear-cut injuries, only about 50% of individuals apply for compensation,” said Dr. Kenneth Rosenman, chief of the division of occupational and environmental medicine at Michigan State University.

Rivas Williams with his wife, Monica Abigail Santos. He worries about his family. “Not everything in this life is money,” Rivas Williams said. “But imagine if I’m not here.”

(Al Seib / For The Times)

Experts said the California system tends to be smoother for workers lodging claims involving one-time injuries than for those facing diseases that developed over time. Rand senior economist Michael Dworsky estimated roughly 1 in 8 claims for workers’ compensation are initially denied in California, but said rejection rates have tended be higher for illnesses tied to workplace exposure, such as cancer or heart disease.

If injured workers fail to get workers’ comp, “it puts the burden on other resources. It puts the burden on your health insurance,” said attorney Cheryl Wallach, a board member with the advocacy group Worksafe.

Like many California workers stricken with silicosis, Rivas Williams said he was insured through Medi-Cal, California’s Medicaid program. State officials did not promptly provide figures for how much Medi-Cal pays for such care, but physicians estimated the costs of a double lung transplant exceed $1 million.

As more workers grow ill, “it’s a huge strain on taxpayers, when it really should be workers’ comp” shouldering those costs, said Dr. Sheiphali Gandhi, an assistant professor of medicine at UC San Francisco who has studied silicosis.

When Ali Weiss, 30, shares a selfie on Instagram, she often adds a disclaimer: This is a face that hasn’t had any work done.

“The most punk thing you can do in 2024 is not f— with your face,” the New York City-based on-air host and podcaster writes via email. Surrounded by peers who got fillers early and often, she believes her choice puts her in “the minority,” especially for those working in front of the camera. “The fact that people seem to be more shocked by a-30-year old who hasn’t gotten work done than a 30-year-old whose entire face is frozen is bonkers,” she says.

Weiss writes of her filler-less face with pride, but she still cares about her youthful appearance. She has several less-invasive treatments in her arsenal, including a red-light therapy gadget, laser facials and facial massages. In a few years, she hopes to try more invasive laser treatments that cost thousands. Anything before considering injectables.

For the last few decades, the consumer base for neuro-modulators like Botox and dermal fillers like Juvuderm has grown exponentially. In 2010, more than 5.3 million people got Botox and more than 1.7 million received filler in the U.S. In 2022, 8.7 million received Botox and more than 6.2 million received filler, according to the American Society of Plastic Surgeons. Especially in recent years, these procedures have gone from an indulgence for the wealthy and famous to casual and frequent appointments that cost a few hundred dollars.

“They are incredibly effective, relatively low cost and have become part of an accepted mainstream lexicon for self care,” said Dr. Steven Williams, president of the plastic surgeons’ group.

But now, a number of beauty-conscious consumers are saying “no” to injectables and directing their money toward expensive natural treatments instead.

Marta Freedman, 33, is one of them.

“I grew up in the era of excess injections and the Kardashian era, so for me, it makes sense that the pendulum would swing the other way as people investigate alternatives,” the L.A.-based entrepreneur said.

Weiss and Freedman are among a chorus of anti-injectable sentiment on social media and in beauty publications that has intensified in recent years.

TikTok and Instagram feature thousands of videos of (mostly) women chronicling the process of dissolving their filler. The sometimes painful process can take multiple sessions and is done by injecting an enzyme called hyalase that can cause facial features like lips to bruise and balloon before settling back into their original shape.

Many Los Angeles-based practitioners are noting filler fatigue among their clientele. They’ve seen more patients who are asking not only for their fillers to be dissolved but also seeking alternative procedures to maintain an enhanced, albeit more technically natural, look.

“There is a pendulum swing back to the more natural, best version of yourself, similar to the ‘no makeup makeup look,’” said Dr. Ava Shamban, founder of Skinfive Medical Spa in Pacific Palisades. “The art is in making the work disappear and look like nothing has happened.”

So what are the beauty-obsessed, but Botox-averse doing instead? Some will pay top dollar for all-natural ancient practices, while others opt for high-tech, sometimes painful treatments — just so long as they can say they’re toxin-free.

Julie Civiello Polier has amassed more than 120,000 followers on Instagram by espousing noninvasive anti-aging facial massage techniques. Before the pandemic, the Los Angeles-based aesthetician and Chinese medicine practitioner offered in-person facials to her celebrity clientele, including Goldie Hawn, Miranda Kerr and Christy Turlington, but has since moved her practice online, teaching clients massage techniques for facial lifting and sculpting.

Her Instagram videos — with titles like “Support for ovaries and eyebrow lift” and “No Botox needed forehead sculpting” — have built her a dedicated audience . The services she provides range from live-streamed classes on DIY face-lifts (that cost $100 per ticket) to one-on-one coaching packages, priced at more than $2,000.

Angela Cravens, a 45-year-old copywriter based in San Diego who prefers chemical-free beauty products and Eastern-inspired natural practices, is one of her followers. Since finding Polier’s free tutorials on Instagram, she’s built a gua sha and facial routine that works for her. She says people often mistake her for being younger than she is — something she posits may be because she avoids injectables, “not the other way around.”

Polier says her clients come for the aesthetic benefits but find unexpected emotional release from her techniques. Inspired by traditional Chinese medicine, she believes inner traumas can affect parts of the face.

“This one client kept getting surgeries on one part of the face and it kept kind of drooping back down or kept kind of being really inconsistent with the other side, until we started looking at her relationship with her father,” Polier said. “That left side of the face is where our relationship to [our] father is stored.”

In West Hollywood, a three-year-old cosmetic acupuncture practice called the Reset caters to people in their late 20s to 40s who don’t want to try injectables. Owner Toni Weinrit, a board certified and licensed doctor of acupuncture and Chinese medicine, says that although some of her older clients still use injectables, the younger generation is thinking twice.

Freedman, the L.A.-based entrepreneur, found Weinrit on Instagram and did weekly treatments at the Reset for about 10 weeks last year. She plans to resume them there soon. (In the meantime, she’s supplementing with at-home electrocurrent devices, Frownies wrinkle reducing patches and professional facial massages).

“I don’t feel aligned with filler or Botox. I prefer myself with a more natural look,” she said.

Weinrit charges $250 a visit for the service, advising a regimen of 10 sessions across five to 10 weeks (after which she recommends once-a-month maintenance, combined with occasional $500 microneedling, which she said aids in improving skin texture).

The American Institute of Alternative Medicine says cosmetic acupuncture “operates on the belief that the face reflects the body’s internal balance and health.” While the practice is rooted in more than 2,000 years of traditional Chinese medicine, there have been limited scientific studies investigating its benefits on facial skin elasticity.

Though Weinrit’s services are significantly more expensive and time-consuming than your average Botox or filler treatment, her schedule is booked. She theorizes that that’s because the results are gradual.

“If you get Botox, 24 to 48 hours later, you have a different face,” said Weinrit. “This is not that.”

Some clinics have begun counseling patients about the changes they want to make, going so far as to refuse requests that won’t look natural.

Cosmetic nurse Vanessa Lee nearly left the industry after being asked to give lip injections to a teenage girl with her mother’s approval. In 2018, she opened The Things We Do, a medspa in downtown’s Arts District (now with locations in Chino Hills and Venice too) that focuses on a moderate approach. Lee, who has more than a decade of experience, says the medspa receives so many requests to dissolve filler done by other practitioners that she has had to begin charging for the once-complimentary service.

The Things We Do has a naturopathic doctor, a licensed healthcare provider on staff who is trained to address skincare through gut health. Lee says she has turned away patients who request excessive work and has referred them to a therapist.

“If somebody comes in and they’re saying things like ‘This guy just broke up with me’ or ‘I’ve been through the hardest year,’ maybe they’re not at a place to be making a big decision about full facial balancing while they’re in this emotional state that needs a bit of support,” she said. “Let’s start somewhere else first.”

Even so, Lee is running a business. For patients who are seeking a youthful refresh, she and her nurses first suggest bio-stimulating treatments like platelet-rich fibrin matrix.

The treatment, which clinical studies have shown can reduce wrinkles and hyperpigmentation, involves drawing a patient’s blood, extracting the plasma from it and either injecting it in the face for those with volume loss in a specific place or using it with microneedling devices for patients with thin or dull skin.

One session starts at $1,100 for results that can last up to two years when done twice. Yes, needles are used, but no foreign bodies are injected into the face, a technicality that is meaningful to clients who want to avoid chemicals.

The procedure is proof that, though the pendulum may be swinging toward a more natural approach and look, one thing will never go out of style: the willingness to pay — and suffer — for the promise of beauty.