From the earliest days of the H5N1 bird flu outbreak in dairy cattle, experts watching the evolving situation have worried about California. 

The Golden State has the country’s largest concentration of dairy farms, roughly 1,100 herds. The concern has been if the virus got into California, the prospects for spread would be huge and containment a challenge.

And, indeed, in the roughly five weeks since California’s first infected farms were confirmed, those fears have proved to have been well-founded. As of Monday, 82 farms have tested positive for H5N1, vaulting California over Colorado as the state with the most infected herds. By comparison, Colorado has counted 64 infected herds over the course of six months. (It should also be noted that California’s Department of Food and Agriculture is actively looking for affected herds; many other states are not.)

Infected cows could in turn infect people. California has already detected three human infections in workers who had exposure to infected cows. (The Centers for Disease Control and Prevention has yet to confirm the third case.)

STAT recently spoke to Erica Pan, California’s state epidemiologist, about what public health officials are doing to monitor for human H5N1 infections. The conversation, which took place before California announced its human cases, has been lightly edited for clarity and length.

Has California been proactively looking for H5N1 infections among farmworkers and others, given the rapid rise in infected farms in the state?

Ever since March or April [when H5N1 in cows was first confirmed in the U.S.] we have been very actively watching and preparing and working with our California Department of Food and Ag. Typically, seasonal flu surveillance really decreases over the summer but we —like many other states — kept up our flu surveillance and sent out a health advisory to clinicians in California, saying: Please still test for flu, even though it’s summer. Please be asking these questions about animal exposures.

And then we were trying to reach goals of the numbers of flu specimens we would be subtyping of flu A, to confirm that the flu that is still circulating is seasonal flu and not H5N1. So we’ve been meeting our goals over the summer on that. 

In addition, once we’ve had these positive herds in California, we’ve worked closely with our local health departments on the ground where these actual farms and premises are, who are then working with the farms and the farmworkers to monitor individuals who might be exposed and monitoring for symptoms. Really working to talk to the employees and the farmers about “This is a health check. The goal is not government monitoring. It is really to do a health check to make sure you are feeling well. And if you’re not, we can help get testing and treatment if needed.” 

We, of course, had a lot of experience since 2022, when we had huge [H5N1] poultry outbreaks, so thankfully a lot of the local health departments at least had experience with that as well — acknowledging that dairy farmers are often different, though.

One of the things a lot of affected jurisdictions have had to grapple with is the fact that there’s been a fair amount of reluctance on the part of the farmers and farmworkers to interact with the public health side. Are you getting cooperation or are you facing suspicion and unwillingness to interact?

A lot of this work happens on the ground with our local health departments. And what we’re hearing from them is that it’s a big spectrum. There are definitely some farms that are the most collaborative and open and welcoming. And I think there are some that are challenging.

We’re working with some of the farmworker organizations, and I think we’re improving. I think local health departments are working more closely with their agricultural commissioners and some of these other worker organizations to really get more of their input and support — especially in areas where there may be more concern about what the role of public health is.

We are not only working on outreach and education around personal protective equipment but have distributed a lot. We’ve distributed over 300,000 respirator masks, gloves, goggles, and face shields to protect farmworkers from bird flu and have tried to offer that as well as a way to engage the workers and the worker organizations.

One of the things the CDC is also trying to do is get seasonal flu shots into farmworkers in states where it’s known that there have been outbreaks in cows. Is that happening at your level? Or is it happening at the local health department level?

Both. CDC did give us an additional allocation of CDC-funded seasonal flu vaccine for farmworkers. For our entire state, we’ve only gotten about 5,000 more doses. It’s not a huge amount. But it’s certainly helpful. So we are definitely working with the farms in the Central Valley where we have both the highest intensity of dairy farms and where our positives [herds] have been detected. And in general our local health departments are trying to figure out how to provide more influenza vaccinations in that community as well.

Five thousand doses? There are more than 1,000 dairies in California. Is that the only allocation you’re getting?

That’s the allocation that’s been associated with this bird flu H5N1 effort.

We have some state-funded vaccine that is for high-risk uninsured and underinsured people, which historically is distributed to the underinsured elderly living in congregate settings and other places. We typically do use all that vaccine in that high-risk population. So, yeah, I think we’re working on and thinking about other creative solutions, especially if there are workers in smaller farms, etc., that don’t have other health care access.

And it will be interesting to see what the uptake is [among farmworkers offered flu shots].

Do you have a sense of whether this is a population that takes flu shots normally?

I don’t offhand. I do know that in general only about half of people get a flu vaccination. So we have concerns that it may not be a population that typically has high uptake.

What about studies? There’s been a lot of interest in trying to test blood samples from farmworkers looking for antibodies to see if there have been more infections than have been detected. Is California trying to do that?

I think we’re learning from other states that have gone before us. And our understanding from Michigan, for example, is that it took them a little bit to develop these relationships, work with individuals to then get the engagement to do that. It’s still relatively early for us. It’s been about a month.

But we’re certainly interested and open to that and the CDC has indicated that they would absolutely support [that kind of work].

It is my understanding that some of the USDA resources that farms can apply for if they have been impacted also have inclusive language about collaborating with local public health and participating in CDC studies. So I think we do want to start to work on that soon. But I think right now, we’re really kind of working on just solidifying some of those relationships and working on encouraging overall health monitoring, health checks, etc.

How big an issue is raw milk in California and how worried are you about it in terms of people’s exposure to H5N1?

It definitely has been top of mind. 

For a lot of the details you’ll have to refer to the California Department of Food and Ag. But they do regulate. There are a few raw dairy farms in California and they do regulate them at the state level. And they’ve been requiring testing — for several months at this point. Definitely before we had these other commercial detections.

This is the first of three stories about the run-up to the 2024 US presidential election in Shasta county, a region of 180,000 people in northern California that has emerged as a center of the election-denial movement and a hotbed for far-right politics.

When Shasta county had to search for a new official to oversee its elections earlier this year, there was an obvious candidate.

Her name was Joanna Francescut, and she had been the assistant elections clerk and registrar of voters in this remote region in California’s far north. Francescut had worked in elections for more than 16 years, oversaw the office of the county clerk and registrar of voters for months after her boss went on leave, and was endorsed by elections officials and prominent area Republicans alike.

Instead, the ultra-conservative majority on Shasta county’s board of supervisors in June selected Tom Toller, a former prosecutor who had never worked in elections and vowed to change the office culture, improve public confidence, and “clean up” voter rolls.

Were it any other California county, the decision would have been shocking. But Shasta county in recent years has made a name for itself as a center for far-right politics and the election-denial movement, which maintains that Donald Trump, and not Joe Biden, won the 2020 presidential election. In the past year, the majority on the board of supervisors, the county’s governing body, has cast doubt on the integrity of the local elections office and sought to rid the county of voting machines.

The move fueled anxiety among some of the county’s residents. Before one of the most turbulent and consequential races in recent history, Toller will be in charge of administering the election to 114,000 voters with just a few months’ experience under his belt.

Already, challenges have been thrown his way. In September, a county advisory board, which makes recommendations to Shasta’s governing body, proposed limiting absentee ballots and returning to one-day voting. Toller rejected the proposal, pointing out the plan would violate state law.

“People are worried about it,” said Robert Sid, a Shasta county conservative who supported Francescut and has been frustrated by conspiracy theories about the elections office. “If there was any hint of scandal [at the office], I’d be the first one down there. But there’s never been anything.”

Toller declined the Guardian’s request for an interview, citing his office’s focus on preparations for early voting.

The controversy in Shasta over the elections office is a more extreme version of an issue that experts have been sounding the alarm about for years. US elections officials are leaving at increasingly high rates after facing intense harassment and threats in the aftermath of the 2020 election and are being replaced by administrators with less experience and institutional knowledge.

For 20 years, Shasta’s elections had been managed by Cathy Darling Allen, one of the only Democrats elected to office in this region where Republicans outnumber Democrats two to one.

Allen’s job, a non-partisan administrative role, radically changed after the 2020 election, when Trump refused to acknowledge his defeat. As an election-denial movement flourished locally and the county’s governing body veered radically to the right, her office came under growing scrutiny and dealt with harassment and bullying. The evening of a local election in June 2022, someone placed a camera outside her office.

Allen was re-elected with almost 70% of the vote that year. But she was frequently villainized by the far-right majority on the board of supervisors, which had set out to dramatically change how elections are conducted in Shasta county.

In early 2023, the county board of supervisors cancelled its contract with Dominion Voting Systems, the company maligned by Trump and his supporters, without a replacement, and attempted to implement a costly and error-prone hand-counting method. Soon after, the state thwarted those efforts with the passage of a bill preventing counties from using manual tallies in most elections.

Far-right county officials insisted they would use their hand-counting method in November 2023 regardless, and falsely claimed elections were being manipulated; Allen made clear she would follow state law, and the election ultimately unfolded without issue.

Many voters heralded Allen’s commitment to upholding election law in the face of unprecedented attacks. People routinely stopped her in public to express their appreciation, she previously told the Guardian, and often sent cards and notes of gratitude. But Allen’s position also made her the No 1 enemy of Shasta county’s far right, one local journalist wrote.

In February, Allen shocked the county when she announced plans to retire with two years left in her term. She had been diagnosed with heart failure, she said. “An essential part of recovering from this diagnosis is stress reduction. As many election officials could probably tell you right now, that’s a tough ask to balance with election administration in the current environment,” she wrote in a letter to the community.

Francescut, Allen’s deputy, seemed an obvious choice for her replacement, given her more than 16 years’ experience assisting with more than 30 elections in the county. She had been training for the role for years and took on Allen’s job – in addition to her own – and oversaw the March election.

She had the support of her ex-boss, elections clerks in two other counties, as well as a conservative former county supervisor.

The board of supervisors held public interviews with eight candidates, including Francescut, Toller, and Clint Curtis, an attorney and former congressional candidate who has long claimed he was once hired by a lawmaker to create a software that could rig elections.

During public comment after the first day of interviews, an air of cynicism hung over the room. Several speakers urged the board to hire Francescut while acknowledging the supervisors had likely already made their decision. “The fix is in,” one woman shouted from the audience.

Board members took a combative approach with Francescut. One supervisor, Kevin Crye, attempted to coax her into criticizing her former boss, while another, Patrick Jones, accused her of “mal-conduct”. Their tone was hostile, said Sid, who characterized the public interviews as a “dog and pony show”.

Francescut, who described the process as “humbling”, tried to focus on her values as a leader and on her work ethic, she said in an interview with the Guardian in June. “I prepared myself the best I could to get the job I’ve been striving to get for the last 16 years. Even if right now isn’t the right time. I have community support behind me.”

In his interview with the panel, Toller said he would bring what he described as necessary change to the elections office, and suggested he would not mind pushing back against state law.

“I’m a firm believer that just because the secretary of state of California tells us a statute or regulation must be interpreted in a certain way, that’s not the end of the story,” he said.

And then there was Curtis, who has advocated hand-counting and noted in his application he was a speaker at election events hosted by Mike Lindell, the MyPillow founder who has spent millions of dollars promoting lies about elections in the US.

During the public hearing in June, a group of residents who have frequently spoken publicly on their concerns about vote tampering and their beliefs that elections are being rigged expressed their support for Curtis. None of the speakers who offered public comment spoke in favor of Toller.

Still, Toller’s appointment was a win for critics of the elections office in a year with relatively few victories for them. Patrick Jones, the official who has most aggressively condemned voting machines and spread misinformation, in March lost his bid for re-election by a landslide. In June, a county judge dismissed a lawsuit from a failed supervisor candidate who sued the elections office, claiming that an error in the placement of her name on the ballot cost her the election. She had sought to change the outcome of the election.

“The lack of evidence was profound,” the judge said of the case. A state court denied her attempt to appeal the ruling.

Those who buy into conspiracy theories about voter fraud and stolen elections are not giving up on their efforts to remake the voting process in the region. The local elections commission recently recommended the county limit absentee ballots and return to one-day voting. Toller, in a move that may have surprised some of his supporters, rejected that idea and said doing so would not comply with state law. Those items will come before the board of supervisors for consideration.

With a new elections official, a deeply divided county and an intense presidential contest, the office faces busy and daunting months ahead.

Between November 2023 and June more than a third of the elections office’s 21 staffers left. But Francescut has said that she plans to stay put – at least through November – to help maintain stability in the office and support Toller as he learns the ropes.

“In the long run, ensuring that the November election is where it needs to be and the voters are able to vote, that’s the biggest priority right now in my mind,” she said. “It’s way more important than me as an individual.”

RENO, Nev. (KOLO) -A suspect in a double homicide early Friday in Redding, Calif., was arrested Sunday afternoon in northeast Reno, the Regional Crime Suppression Unit reported.

Trevon Gage Evanoff, 18, is an accessory to the shooting of five people in Redding, two of whom died, the Redding Police Department said.

Two others were treated and released and a woman was in the hospitalized, Redding police said.

The RCSU found Evanoff was on East Ninth Street near Sage Street and the special weapons and tactics team made the arrest without incident on Sunday about 1:04 p.m.

Andrew Greer-Herrera, 19, of Lookout, Calif., was the primary suspect in the shooting and he remains at large, Redding police said. The RCSU said he is not believed to be in the Reno area.

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