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The desperate hours: a pro baseball pitcher's fentanyl overdose

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The desperate hours: a pro baseball pitcher's fentanyl overdose

Not many victims of the opioid crisis in America make national headlines. Tyler Skaggs was different.

The 27-year-old was a professional athlete, a pitcher for the Angels, wealthy and famous. On a road trip with the team, he was found in his hotel room. He had choked on his own vomit after consuming a mix of alcohol, oxycodone and fentanyl.

His death on July 1, 2019, sent shock waves through the sports world. A highly publicized criminal investigation not only revealed that Skaggs had secretly used painkillers for years, but also led to the arrest of a team employee accused of providing him with tainted, black market pills.

Five years later, The Times has pored over hundreds of pages of court documents and cellphone records to reconstruct Skaggs’ final hours. Playing cards with teammates on a three-hour flight. Teasing rookies on the bus. Trading affectionate texts with his wife until late at night.

Even the most ordinary details tell an important story, offering an intimate look at an epidemic that has ravaged the country.

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Angels left-hander Tyler Skaggs pitches with a red uniform and Rawlings baseball glove

Tyler Skaggs pitches against the Oakland Athletics on June 29, 2019, two days before his death.

(Marcio Jose Sanchez / Associated Press)

Skaggs pitches at Angel Stadium against the Oakland A’s and is pulled after surrendering two runs in four-plus innings. CAA agent Nez Balelo texts to commiserate about “the quick hook … after cruising basically through 3 and 4.”

Skaggs is nothing if not dogged. At 6 feet 4 and 225 pounds, he has fought back from a string of serious injuries, refusing to quit, which might help explain his painkiller use. After the game, his mother, Debbie Hetman, a longtime softball coach at Santa Monica High, calls him and his wife.

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“I didn’t FaceTime him because I was – we were super busy, so we just talked really quickly,” Hetman later testifies during the team employee’s trial. “I think he was in line at In-N-Out with Carli.”

Angels star Mike Trout, left, wears a red Tyler Skaggs jersey while speaking to Eric Kay in the dugout

Mike Trout, wearing Tyler Skaggs’ number in his honor, speaks to Eric Kay in the dugout before a July, 12, 2019, home game against the Seattle Mariners.

( John McCoy / Getty Images)

Sunday, June 30. One day before his death.

(Animation by Kelvin Kuo/Los Angeles Times)

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Shortly before a 1:07 p.m. game against the A’s, Skaggs receives a text from Eric Kay, the team communications director who for years has allegedly supplied him with “blue boys” — blue, 30-milligram oxycodone pills.

Kay: “Hoe [sic] many?”

Skaggs: “Just a few like 5”

Kay: “Word”

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Skaggs: “Don’t need many”

4:25 p.m. Pacific Time

The Angels conclude their four-game home series with a 12-3 loss. It is a get-away day, meaning the team will head directly from the stadium to Long Beach Airport, where a charter plane waits for the start of the road trip.

Skaggs has previously asked his manager’s permission for the players to dress like cowboys for the flight to Texas. Before leaving the stadium, he meets his wife, Carli, so she can snap pictures of him in his black hat, bolo tie and boots.

“When did he buy that outfit?” a prosecutor later asks her during Kay’s trial.

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“The day before.”

“Did you help him pick it out?”

“Yes.”

6:11 p.m. PT

Skaggs gathers with teammates on the tarmac beside a United Airlines charter plane for another photo to show off their Western wear. He hitches his thumbs in his belt like a cowboy. Seeing the picture on Instagram, Carli comments: “So cute”

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8:07 p.m. PT

(Animation by Kelvin Kuo/Los Angeles Times)

With the Texas Rangers next on the schedule, the flight to Dallas Fort Worth International Airport lasts about three hours. Along the way, Carli texts to ask how things are going.

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Skaggs: “Good gambling … losing”

Carli: “Damn babe … How much cool … Lol*”

Skaggs: “200 bucks … I’m winning now”

Carli: “Sweet”

11:06 p.m. Central Time

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On the 15-minute ride from the airport to a Dallas-area hotel, Skaggs grabs a microphone at the front of the bus.

“So, he would have been kind of like emceeing, doing the music,” teammate Andrew Heaney later testifies. “You know, we would call younger guys up, ask them, you know, embarrassing questions or make them tell a funny story or whatever it may be, make them sing a song, something like that.”

Throughout the league, Skaggs is known as friendly, funny, eminently likable. Teammate Mike Trout later says: “The energy he brought to a clubhouse … every time you saw him, he’s just picking you up.”

11:25 p.m. CT

The Angels arrive at the Hilton Dallas/Southlake Town Square, where players receive key cards to their rooms and peruse a table of snacks, protein bars and Gatorade. A friend invites Skaggs to go out, but the pitcher remains in his room.

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11:47 p.m. CT

(Animation by Kelvin Kuo/Los Angeles Times)

Skaggs texts his room number to Kay.

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“469,” he writes, adding: “Come by”

“K,” the communications director responds.

Kay had used opioids enough to know black market oxycodone pills might be laced with dangerous drugs such as fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine. In a jailhouse call recorded after his trial, he denies giving drugs to Skaggs that night, saying he visited the pitcher to talk about something else.

“I guess he hated the rookies or something — and he was one flight up so I flipped my door and went up,” he says.

The hotel does not have security cameras in the hallway, so it is unclear how long Kay spends in room 469.

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Monday, July 1

12:02 a.m. CT

(Animation by Kelvin Kuo/Los Angeles Times)

Skaggs texts with teammate Ty Buttrey. He then trades messages with his wife.

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Skaggs: “Miss you babe”

Carli: “Miss u too”

When the two met in 2013, Skaggs reportedly fell hard. Now, they have a house and are thinking about kids. They text continually when the Angels are traveling.

12:42 a.m. CT

“What u Doin,” Carli asks.

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No answer. She tries again: “Helllooooo.”

1:09 a.m. CT

It is late in Dallas — two hours later than Los Angeles — and Carli is still waiting for a “goodnight” from her husband. She writes: “U know better than to get drunk and fall asleep without texting me”

Approx. 12:53 p.m. CT

Mike Trout, left, embraces Andrew Heaney at a desk with somber Angels teammates and the Texas Rangers logo behind them

Angels’ Mike Trout, left, embraces Andrew Heaney, who fights back tears as he answers questions about their late friend and teammate Tyler Skaggs.

(Tony Gutierrez / Associated Press)

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The night passes, followed by morning, and still no word from Skaggs. Heaney texts him: “Lunch?”

After a few minutes, Heaney stops by room 469. Light shines from under the door; the curtains must be open in there. Nearby, hotel workers are noisily cleaning a carpet. Heaney wonders how anyone could sleep through all this.

When his knock gets no response, he goes back to his room and tries calling Skaggs on the hotel phone.

1:49 p.m. CT

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Tom Taylor, the Angels traveling secretary, is having lunch with Kay at a nearby barbecue joint and recalls Carli texting him. Heaney also reaches out to Taylor.

“He hadn’t heard from him either,” Taylor later testifies.

More than 12 hours after Carli’s last exchange with her husband, she messages again: “You have a drinking problem. I’m about to text tom Taylor.”

Carli later insists these words were sent “purely out of anger” with “no truth to it.”

Irritation gives way to another emotion. Carli contacts Skaggs’ mother, Hetman.

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“She was really nervous,” Hetman later testifies. “I was really nervous because it was very unusual not to hear back from Tyler. Tyler was very good about returning text messages.” Hetman dials his number, and it sounds as if the call goes directly to voicemail. Her husband, Dan Ramos, sends a text:

“Hi kid. How r u doing. How is life treating u. How is your arm feeling”

A large photo of Tyler Skaggs and his wife, Carli, is displayed on an easel beside mourners in black at a memorial service

A photo of Tyler Skaggs and his wife, Carli, is displayed outside a memorial service for the Angels pitcher in 2019.

(Christina House / Los Angeles Times)

2:04 p.m. CT

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Now Hetman tries texting: “Hey Ty Are you okay today?”

Around the same time, Taylor returns to the hotel and knocks on Skaggs’ door. He then summons Chuck Knight, one of the team’s security men, and they ask hotel management to let them into room 469.

A former Anaheim Police Department officer, Knight enters the room alone, staying less than a minute. Taylor later recalls him emerging with “a shocked-looking face, almost like, it’s not good, what he saw.”

2:16 p.m. CT

Knight calls 911. Asked later about what he encountered in the room, he testifies: “I saw two legs hanging off the end of the bed in a position that I thought was unusual for someone that might be sleeping … I walked closer in an attempt to obtain a pulse. I reached down to grab his wrist and noticed that his skin was very cool to the touch. I did not obtain a pulse.”

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Heaney, who is getting messages from Carli, returns to the hallway outside room 469. Taylor tells him: “It’s not good.”

“I knew what was going on, but his wife didn’t,” Heaney later testifies. “And she was texting me, so it was — I just felt like I wanted her to know what was going on.”

He decides not to answer.

A call crackles over the scanner: “Medic 4-1, truck 4-1 respond. Medical emergency, Hilton Southlake Town Square.” The dispatcher adds: “It’s gonna be … a possible death investigation. PD is arriving on scene now.”

A Southlake police officer finds Skaggs’ room looking mostly undisturbed — the bed still made, a backpack and another bag on the couch, unopened beers on the coffee table. There is a white, “almost chalky” substance on the desk. Skaggs’ cellphone lies near his head.

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A ray of light is cast sidelong against a green outfield wall with a profile shot of Tyler Skaggs beside his name and number

A memorial for Tyler Skaggs on the outfield wall at Angel Stadium.

(Los Angeles Times)

2:23 p.m. CT

Cory Teague, a Southlake Fire Department paramedic, arrives at room 469. His medical supplies include Naloxone, which can be administered to reverse the effects of opioid overdose.

“Did you use it?” a prosecutor later asks at trial.

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“No.”

“Why not?”

“The patient had signs incompatible with life, unable to be revived.”

3:05 p.m. CT

Carli’s phone rings as she pulls up to her parents’ house in Santa Monica. It’s Billy Eppler, the Angels’ general manager. “I’ll never, ever forget that call,” she later says. She dials Hetman, who is at her Los Angeles home, and breaks the news. Hetman later recalls “crying and yelling and screaming.”

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Buses are scheduled to take the Angels to their evening game. Instead, players and staff are told of Skaggs’ death and shepherded into a hotel banquet room where police take statements.

“The questions that we asked were generic for each player and employee,” Cpl. Delaney Green of the Southlake Police Department later testifies. “And it was along the lines of: When was the last time that you had seen or spoken to Tyler Skaggs? Had you seen him consume any alcohol on the plane? And did you know of any drug use that you were aware of?”

Kay is among those interviewed. He tells police that Skaggs was drinking on the flight to Texas but adds, “I didn’t think he had a lot.” He says he last saw the pitcher when they collected their room keys in the lobby.

3:52 p.m. CT

The Times and other news agencies report Skaggs’ death on social media. Family members call his mother at home. She later testifies that “before I could even talk to anybody, that whole — everything was like blowing up and it was super-crazy.”

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4:11 p.m. CT

Angels manager Brad Ausmus wipes tears from his eyes while speaking near a microphone at a news conference

Angels manager Brad Ausmus speaks at a 2019 news conference about Tyler Skaggs’ death.

(Tony Gutierrez / Associated Press)

The Rangers announce the postponement of that night’s game as the Angels switch to another hotel. The team gathers for an emotional meeting. “We were able to talk about Tyler and laugh at some of the stories and some of the goofy things he did, listen to some of his music,” manager Brad Ausmus later says before breaking down.

On social media, players from around the league post messages.

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“RIP to my longtime friend and Little League teammate,” then-St. Louis Cardinals pitcher Ryan Sherriff writes. “i love you brotha.”

About 8 p.m. CT

Carli and the Skaggs family board a flight to Texas.

Tuesday, July 2. After his death.

About 10 a.m. CT

Carli and the Skaggs family visit the medical examiner’s office in Fort Worth. She later recalls kissing her husband’s cold lips as he lay on a gurney.

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11:10 a.m. CT

The medical examiner begins an autopsy. He will eventually determine that “alcohol, fentanyl and oxycodone intoxication” caused Skaggs to choke on his own vomit.

Later that morning, Carli and the Skaggs family arrive at the Southlake police station to retrieve his luggage, iPad and other belongings.

In words that underscore the anguish of losing a loved one to opioids, Hetman later testifies: “I was angry because I knew that my son loved life and he did not want to die. He did not know that there was poison in that pill that cost him his life.”

About 5:30 p.m. CT

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Team officials hold a news conference with Kay standing quietly to the side, hands clasped at his waist. At one point, he appears to take a deep breath, look toward the ceiling and exhale.

7:05 p.m. CT

Angels players put jerseys for teammate Tyler Skaggs on the pitcher's mound.

Teammates place jerseys with Tyler Skaggs’ number 45 on the mound at Angel Stadium at their first home game after his death.

(Kent Nishimura / Los Angeles Times)

The game against the Rangers proceeds as scheduled. The ballpark is eerily quiet, with the home team forgoing the usual walk-up music.

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The Angels, wearing black No. 45 patches on their jerseys, score early and cruise to a surprising 9-4 victory, but Trout says: “All I was thinking about was Tyler. It was just a different feeling, you know. Just shock.”

Epilogue

A portrait of Late Angels Tyler Skaggs posing with his left hand in a red Rawlings baseball glove and white uniform

Angels pitcher Tyler Skaggs died of an overdose in a hotel room on July 1, 2019.

(K.C. Alfred/San Diego Union-Tribune)

Federal prosecutors charged Kay with distribution of a controlled substance resulting in death and conspiracy to possess with intent to distribute controlled substances. A trial began in February 2022.

“This was a case of one, one person who went up to that room on June 30,” a prosecutor said in court. “One person who went into that room and gave Tyler Skaggs fentanyl.”

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The jury deliberated less than 90 minutes before returning a guilty verdict on both counts.

At a hearing where the judge sentenced him to 22 years in federal prison, Kay — who didn’t testify during trial — apologized to his family for the “disgrace and embarrassment” he had caused them.

Privately, however, he continued to profess innocence. In a recorded jailhouse call, he told a friend: “The worst thing, though, is that text that he sent me … because I didn’t know what he wanted. I had no idea. In my head, I think he thought I already got more [pills] for him but I told him they were going to be s—.”

By then, the Skaggs family had filed a wrongful-death suit against the Angels. The team has denied wrongdoing, and the case continues.

In the five years since Skaggs died, opioid overdoses — fueled by illicitly manufactured pills — have claimed hundreds of thousands of American lives.

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The Substance Abuse and Mental Health Services Administration has a 24-hour helpline for individuals and families facing mental and substance abuse disorders. The number is (800) 662-HELP (4357).

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Signs of avian flu found in San Francisco wastewater

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Signs of avian flu found in San Francisco wastewater

Signs of H5N1 bird flu virus have been detected at three wastewater sites in California’s Bay Area, according to sampling data.

While positive wastewater samples have been found in seven other states, California is the only one that has yet to report a bird flu outbreak in a herd of dairy cows.

Genetic evidence of bird flu was detected in San Francisco wastewater on June 18 and June 26. Additional H5 “hits” were seen at a site in Palo Alto on June 19, and another on June 10 from the West County Wastewater facility in Richmond.

According to the San Francisco Department of Public Health, officials have been closely monitoring H5N1 along with federal, state and local partners, and are “aware of the recent detections of fragments of H5N1 in San Francisco’s wastewater.”

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“As with the previous detections reported from before mid-May 2024, it is unclear what the source of H5N1 is, and an investigation is ongoing,” wrote department officials in a statement. “It is possible that it originated from bird waste or waste from other animals due to San Francisco’s sewer system that collects and treats both wastewater and stormwater in the same network of pipes.”

Health officials said the risk remains low for the general public.

The virus has not been identified in California cows, but it has been found in wild birds and domestic poultry in the state.

The finding “is concerning” because of their urban origin, said Devabhaktuni Srikrishna, an entrepreneur who is developing techniques for disease detection, and the chief executive and founder of PatientKnowHow.com. “There are not many dairy or animal farms in San Francisco.”

There are also no dairy farms in Palo Alto or Richmond.

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The plant manager from Palo Alto was out of the office Friday, so could not comment. A spokesperson for the Richmond site directed questions to the state.

A request for comment from the state’s Wastewater Surveillance Program had not yet been returned.

Although the samples from the Bay Area wastewater sites tested positive for H5, the testing was not specific to H5N1.

However, researchers say a positive genetic identification for H5 is suggestive of bird flu — whether H5N1, the virus that has been found in U.S. dairy cattle (and which has infected three dairy workers ) or H5N2, the subtype implicated in the death of a man from Mexico City this month.

Most human influenza A viruses are of the H1 and H3 variety.

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The virus has been detected in 133 dairy herds across 12 states. It has also been found in wild birds and domestic poultry flocks throughout the United States.

In recent weeks, H5 was also detected in wastewater samples in Idaho. among other states.

While there is “no threat to the general public from the H5 detection in wastewater” at this time, said Christine Hahn, Idaho state epidemiologist, “we have determined that it is important that we work to understand these recent findings as much as possible.”

The state is working in conjunction with the Centers for Disease Control and Prevention to investigate the issue.

WastewaterSCAN, the research organization that detected the virus, is an infectious disease monitoring network run by researchers at Stanford, Emory University and Verily, Alphabet Inc.’s life sciences organization.

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A review of their data — which samples from 194 locations across the country — suggests H5 has also been detected at sites in Michigan, Texas, Minnesota, South Dakota and Iowa.

California is the only one of these states that has not reported H5N1-infected cattle.

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One of Earth's oldest known plants takes center stage in California development battle

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One of Earth's oldest known plants takes center stage in California development battle

A Palmer oak in Jurupa Valley is estimated to be 13,000 to 18,000 years old. The plant, which looks like a sprawling, dark green shrub, is now at the center of a development battle.

(Aaron Echols)

After a contentious five-hour public meeting, environmentalists advocates have persuaded Inland Empire officials to delay development of a project within 400 feet of one of the oldest known plants in the state and the third-oldest in the world.

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“Tonight has been a real learning process,” Jurupa Valley City Planning Commission Chair Penny Newman said at the Thursday meeting. “I think we all need time to process the information we’ve had here tonight.”

The commission voted unanimously to table the vote. Commissioners said the developers must do more studies into the potential effects on the plant, a Palmer oak, and further explore protective measures. Commissioners also requested more details on a plan to transfer ownership of the tree and surrounding land to a local tribe, who would oversee its conservation.

“We have discovered a treasure on the world stage here in our humble city,” lifelong Jurupa Valley resident Jennifer Iyer said at the meeting. “In a city known for its toxic waste dump, the worst air quality in the nation … let’s have a plan that protects and celebrates something unique that makes us proud.”

The roughly 370-acre development would include residential housing, an elementary school, a business park and industrial buildings. It would leave the tree on a 27-acre rocky outcrop, but it would come within 400 feet of the plant. Scientists and tribal members say the oak has been around for at least 13,000 years — surviving the last ice age and, more recently, the founding of the United States.

Members of the Shiishongna Tongva Nation, the Corona Band Of Gabrieleño Indians and the Kizh Nation, Gabrieleño Band Of Mission Indians have lived in the Santa Ana River Basin for millennia as well. Both groups regard the tree as sacred.

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“We’ve known about this tree forever,” said Michael Negrete, chief and chairperson of the Shiishongna Tongva Nation. “It gives medicine. It gives oxygen. It gives life to the animals.”

Companies have been trying to develop the land since the early 1990s, with Richland Communities presenting the current plan in 2019. After discussions with the City Planning Commission and the public, it has replaced potential warehouses with light industrial space and a business park, increased the amount of open space, and committed to transfer ownership and conservation responsibilities of the land with the Palmer oak to a Native tribe or conservation organization.

Richland Communities announced at the meeting that it had reached an agreement in concept to transfer the land to the Kizh Nation and provide them with a $250,000 initial endowment for conservation. Company executives also proposed requiring the agreement to be finalized before construction begins on the industrial and business sections, which are closest to the tree.

Commissioners want additional information on the plan’s details and how conservation of the land would be legally enforced. Richland Communities did not respond to a request for comment.

Compared to rugged California live oaks, the Palmer oak looks more like a shrub and is made up of individual stems sprouting in a grove. It wasn’t until fairly recently that researchers determined its impressive age.

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Mitchell Provance, a botanist and associate researcher at UC Riverside, first noticed the oak more than two decades ago and found it odd that it lived isolated from other members of its species in an area that was much lower and hotter than where the trees usually grow. He began discussing the tree with his colleagues. They hypothesized that it was the last holdout from a time when the region was cooler and wetter — a much friendlier environment for the oaks.

To see if this was the case, the researchers collected samples from multiple dead stems —and, sure enough, they all had identical DNA. Whenever the tree was damaged by a fire, it would resprout from the base of its trunk. By using tree rings to estimate how much the trunk can grow in a year, the team was able to calculate the tree’s age by measuring the grove’s diameter.

Today, the grove measures 80 feet wide, which led researchers to estimate that the tree is between 13,000 and 18,000 years old. It’s possible that the tree has been able to reproduce with itself, instead of just resprouting from the trunk to produce clones, but this is unlikely, experts say.

While the company has worked with the environmental consultant FirstCarbon Solutions to study the impact of construction vibrations on the tree and identify potential water sources, it has not mapped the tree’s root system or confirmed its direct water source — a process that would involve chemical testing of water at the oak’s roots.

Some also worry the proposed development would expose the aged oak to the urban heat island effect — a phenomenon in which developed areas can run 1 to 7 degrees higher than shaded, natural areas during the day.

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Aaron Echols, the conservation chair of the Riverside/San Bernardino California Native Plants Society, said it was the duty of conservation groups to point out potential effects on the tree that haven’t yet been studied. “The burden to mitigate impacts … that’s on the applicant and the consultant.”

Aaron Echols walks along a dirt path in a canyon where the Palmer's Oak is located in Jurupa Valley.

Environmentalist Aaron Echols walks along a dirt path across from a giant hill where the Palmer oak is located. The development would extend up to the base of the hill.

(Gina Ferazzi / Los Angeles Times)

The portion of the environmental impact review discussing the Palmer oak — including its exact location — has been redacted from public documents. The city was required to do this by law, since the tree has sensitive cultural significance to the Native tribes. Consequently, independent scientists have been unable to scrutinize the report.

The city said it would explore “creative ways” to legally allow a select few third-party experts to view and discuss the report.

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Is bird flu in cattle here to stay?

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Is bird flu in cattle here to stay?

Despite assurances from the federal government that bird flu will be eradicated from the nation’s dairy cows, some experts worry the disease is here to stay.

Recently, Eric Deeble, USDA acting senior advisor for H5N1 response, said that the federal government hoped to “eliminate the disease from the dairy herd” without requiring vaccines.

Since the disease was first publicly identified in dairy cattle on March 25, there have been 129 reports of infected herds across 12 states. In the last four weeks, there has been a surge — jumping from 68 confirmed cases on May 28 to nearly twice that many as of June 25. There are no cases in California.

So far, however, the dairy industry has proved reluctant to work with state and federal governments to allow for widespread testing of herds.

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To some epidemiologists, this lack of close herd surveillance is a problem. They worry that the virus is spreading unchecked among dairy cows and other animals, and has taken up permanent residence.

David Topham, a professor of microbiology and immunology at the University of Rochester’s Center for Vaccine Biology and Immunology, said he considers H5N1 to be “endemic in animals in North America” — citing its prevalence in wild bird populations as well as its long staying power in domestic poultry.

No one knows how widespread it is in cattle, Topham said, because testing has largely targeted symptomatic cows and herds. “But I suspect the closer we look, the more we’ll find, and I don’t know if we’re going to cull our entire cattle herds and start over again.”

Topham said he understands the industry’s reluctance to permit government scientists onto farms “because we’re going to want to see everything, and we’re going to report everything that we see, and that might be bad for business. … But until we have all that information, I don’t think we will have control.”

Federal officials have announced a pilot bulk milk testing program that includes Kansas, Nebraska, New Mexico and Texas. Farmers in these states can voluntarily enroll to have bulk milk samples tested for the virus. If their samples test negative for three weeks, they will be able to move their herds across state lines without additional testing — something they are currently unable to do.

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So far, only one herd in each state has signed up.

A USDA “strike force” investigated 15 infected Michigan dairy herds as well as eight turkey flocks in early April. It worked with the state of Michigan as well as individual farmers.

The investigation was launched after local researchers identified a “spillover” event that went from infected cattle to a nearby poultry plant. The state — and farmers — wanted to know how it happened.

What the team found suggests the “control” Topham referred to may be elusive.

From surveys and observations, they found that cats and chickens were free to walk around without containment — potentially migrating between nearby dairies and poultry farms. Some of these animals had become infected; several died.

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Asked about their practices regarding isolation of newly introduced cattle, three out of 14 farms said they always isolated, another three said they never isolated, and the remainder didn’t respond.

Then there was the dumping of unpasteurized, contaminated milk into the open waste lagoons on several of the farms. And the feeding of non-pasteurized milk to calves on three farms. Or the potentially contaminated manure that was stored, composted or applied to nearby fields. In one case, a farmer reported they had sold or given away potentially contaminated manure.

Finally there was the issue of humans: On every farm, there were visitors, carcass removal companies, milk suppliers, veterinarians and employees — many of whom traveled between farms.

For instance, of the 14 dairies that reported information about their employees, three had employees that worked at other dairies, one had employees that worked at a poultry farm, and one had an employee who also worked at a swine farm. At four dairies, some of the employees were reported to have their own livestock at home.

As the authors reported, “transmission between farms is likely due to indirect epidemiological links related to normal business operations … with many of these indirect links shared between premises.”

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They noted there was no evidence to suggest waterfowl had introduced the virus to the Michigan herds.

Michael Payne, researcher and outreach coordinator at UC Davis’ School of Veterinary Medicine Western Institute for Food Safety and Security, said there was no one to blame for the lack of containment.

He said in the weeks and months before the disease was identified in cattle, researchers from across the nation scrambled to figure out what was happening to dairy cows in Texas that appeared listless and had diminished milk production.

“It’s not like people weren’t aware or concerned and trying to figure it out,” he said. And then once it was identified, and it didn’t seem to cause too much illness in cows or transfer to humans quickly, while there was urgency, the system fell into a series of “incremental” solutions — negotiated among dozens of federal and state agencies.

He and Topham agree that no one can say for sure what the virus will do — and where it will go — next.

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If it becomes endemic in cattle and is renamed “bovine influenza,” vaccines are likely to follow, as well as continuous surveillance and testing of dairy products.

Topham said that the biggest concern among epidemiologists now is how the virus will evolve as it continues to move — largely unabated and undetected — through cattle herds, resident farm animals and people.

There have been three human cases of H5N1 in U.S. dairy workers since March.

One key worry is that the virus may move with a dairy employee onto a small farm and then recombine inside a pig, dog or cat that is harboring another flu virus.

He and Payne agree that officials need to remain alert to signs that the virus is adapting in ways that could hurt humans.

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Wastewater is one way to detect the location of the virus.

As of Tuesday, data from the academic research organization WastewaterSCAN show that levels of H5 influenza have been rising in wastewater samples from a facility in Boise, Idaho.

Asked about whether the region’s health department was investigating, or if there was any idea where the H5 was coming from, Surabhi Malesha, communicable disease program manager at Central District Health in Idaho, said there was no way to know if the H5 signal was from H5N1 or another influenza subtype.

She said testing for H5 in wastewater had only recently started and therefore “there is no way to compare this data from last year or the year before, and so we don’t know what a baseline detection of H5 looks like.”

“Maybe we see H5 detections like this on a regular basis, and it is not of public health significance or importance. … How do we define normalcy when we have nothing to compare the data to?”

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She said the findings were “not a public health concern” and her agency and the state “do not need to really investigate into this, because this could be H5N1, or could be any other H5 strains, and it really does not affect the public in general.”

Dennis Nash, distinguished professor of epidemiology and executive director of City University of New York’s Institute for Implementation Science in Population Health, said that given the current situation, the wastewater sample should be considered H5N1 “until proven otherwise. The only other H5 we know about is H5N2. And a man in Mexico City just died from that.”

Nash said health officials should be trying to determine the source of the virus found in the wastewater: a nearby dairy herd, a milk processing site or raw milk that was dumped down the drain.

Idaho has reported 27 infected herds, although according to Malesha, none has been reported in the Central District.

“You want to do everything you can to prevent these types of viruses from emerging, because once they do, we don’t have a whole lot of control over them,” Topham said. “Because when the horse is out of the barn, it’s gone. So I think the question is, what do we need to do to keep this in check?”

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