Bad news/good news about the hantavirus outbreak

I’ve been following the hantavirus outbreak with great interest and a little trepidation. Great interest because my day job– public health ethicist– means I want to see how this is being handled to think, write and teach about it; a little trepidation because, well, it’s an an outbreak of a scary virus on a large moving vessel (the MV Honius) driving around the ocean with 175 people aboard. Yeah.

There is overall good news coming out of reliable sources (e.g. the World Health Organization websites, public health substacks like Your Local Epidemiologist, which I read and trust). That news is that the case count as of May 13 was 11 cases and 3 deaths. The passengers have all disembarked, and their countries have made arrangements for their sequestration and/or surveillance during the roughly 6-week incubation period.

But I think we need to know what’s working well and what’s not in public health these days. After COVID, we learned a lot. But some lessons we still keep having to go back to, again and again.

Bad news/good news one: The bad news is that a hantavirus outbreak on a ship was not on anyone’s radar. Yale epidemiologist Katelyn Jetelina said on this podcast on her substack that this scenario was not on her top-100 list of Bad Things to Happen on a Cruise Ship.

The good news is that as soon as hantavirus was confirmed in one of the sick passengers, the WHO swung into action, coordinating reporting to health authorities, sharing knowledge, helping arrange safe dockage for the ship, and contact tracing for the 34 passengers who had disembarked after the virus came aboard.

Bad news/good news two: Where was the CDC (Centers for Disease Control) in all this? Well, pretty much in the dark because

Trump fired or forced out many/most of the senior scientists who have leadership experience in infectious disease;
Trump pulled out of the WHO, so the CDC isn’t officially in the loop on their activities (the Your Local Epidemiologist folks said that US public health people were getting info from WHO friends as a favor to them);
current leadership of the CDC isn’t even requiring the American passengers from the cruise ship to quarantine at home during the 42-day incubation period. According to this article, “the CDC is currently taking a “conservative approach” that involves “encouraging” people to stay home during the monitoring period.”

But but… what about the good news? Here it is: state and local public health authorities are on the scene, and they are monitoring the passengers, communicating regularly with the communities where the affected passengers are staying, and being completely transparent about the processes they are using the manage the crisis. This happens every day, all day, for all manner of infectious diseases, including flu, pertussis, measles hepatitis, all over the world. Local public health folks deserve a yearly parade. And yes, my sister of one of those folks– she’s a public health epidemiology nurse, working hard in an understaffed agency (also thanks to Trump and RFK). If it weren’t a major privacy violation, I’d ask you all to send her a thank-you card…

Bad news/good news three: Cruise ships and viruses– man, this just keeps happening! Yes, it’s true that cruise ships seem to be floating petri dishes for nasty bugs like norovirus. E coli outbreaks happen, too. But, in this case, the MV Honius folks did everything they could to minimize health and environmental impact of their travel (other than being an energy-intensive mode of transportation): they had sanitation protocols designed to keep contaminating biomatter from leaving or entering the ship, especially as their destinations are often fragile ecosystems. It was just a very unfortunate happenstance that the only form of hantavirus with human-to-human contact showed up from two passengers who likely contracted it in Argentina. The ship authorities responded promptly and fully, cooperating with the WHO and affected countries.

Bad news/good news four: there is no treatment for hantavirus (other than supportive care), and it has a case fatality rate of 25–40%. Oh, and this variant– the Andes version– is the only known one with human-to-human contact. Okay, let’s make sure to breathe here. The good news is Andes virus outbreaks have happened before and been stopped through old-fashioned public health means of isolation and contact tracing. Also, this virus isn’t highly contagious– it’s much less contagious than COVID.

Bad news/good news five: with the CDC in a leadership and knowledge vacuum and political leadship refusing to back up or fund public health infrastructure, it’s harder than ever to get accurate and relevant and trustworthy information. Yes, that’s true. But the good news is that there are both official sites (like the WHO, international news outlets) and substacks are out there and on the job (like Your Local Epidemiologist and dozens of others by conscientious experts who care about the public’s physical health and emotional well-being when crises happen). I posted this clear and reassuring flow chart on FB that the YLE folks made. It reassured me, and I hope it will reassure you.