This week, the hantavirus outbreak continues in a climate of distrust toward each other and authorities. We also answer a reader question: Are cruise ships really floating petri dishes? Thereās also all the normal stuff going around: Peak tick and allergy season, norovirus surges on another cruise ship, and scientific wins worth celebrating. Hereās The Dose: whatās going on in the world of health and what it means for you. The risk to the general public remains exceptionally low, but the situation continues to march forward for the high-risk cruise passengers. Note: If you missed it, this post builds on last Fridayās. You can catch up here. And big thanks to the entire YLE team, from virologists to physicians to epidemiologists, helping keep track of this rapidly moving situation. Yesterday, 18 Americans landed safely in Nebraska by private transport after disembarking from the cruise ship in Spain. Why Nebraska? In 2019, your federal tax dollars paid to build the only national quarantine facility in the U.S. specifically designed to safely monitor individuals exposed to high-consequence disease. This facility has a college-dorm feel, complete with TVs and exercise machines (see picture below), but people are completely separated. They donāt share air and donāt mingle. This facility was built for situations just like this. Down the street, there is also a biocontainment unit, similar to a hospital room but with many more precautions to safely treat someone who becomes ill. Importantly, Nebraska isnāt the only biocontainment unit. The U.S. has a network to help distribute people in situations like this. All of these systems are activated. So, out of the 18 people: Fifteen are in the Nebraska quarantine center: They are resting, being screened, and participating in detailed interviews to establish underlying health, exposure timelines (quarantine clocks start at the last exposure, so the interview matters), and their home situations to determine whether they can safely quarantine at home (distance from a hospital, home situations, etc.). None have symptoms. One person is in the Nebraska biocontainment unit. They tested positive for hantavirus without symptoms. Hantavirus can turn positive on PCR testing before symptoms arise and before it becomes contagious. Two passengers went to the Atlanta biocontainment unit. This is a couple: one person has mild symptoms, and the other has no symptoms. Importantly, symptoms of a cold or stomach bug at this stage may warrant a visit to this unit. (Remember, there was a flight attendant who was presumed to have hanta, based on her symptoms, and she ended up testing negative and recovered.) In addition, there are seven Americans in quarantine at home across five states who were on the ship after the initial case died, but before public health authorities knew this was an outbreak. There are also ~11 people exposed to these cruise passengers while flying. None have symptoms, and all are in close contact with local public health departments. After the home assessment, if they remain symptom-free, CDC will give those in the Nebraska quarantine facility a choice: stay or return home on a charter flight (not commercial) and stay in close, daily contact with local health departments. Either way, a full 42-day quarantine is expected. A lot of people disagree with this move. After all, requiring people to stay in Nebraska reduces the risk to everyone else to zero. And, we are living in a very low-trust environment. Offering this option is asking communities to trust that those people will remain in quarantine and cooperate. But, as with any public health decision, there are real trade-offs to consider. This is both a public health and humanitarian response: Public health goal: Reduce risk to the passenger and the community. To do this, the most important thing is not necessarily where they are, but that they are monitored daily, remain quarantined (meaning they do not mix with other people), and have access to an appropriate hospital if they get sick. Humanitarian goal: Allow passengers to quarantine where they prefer, such as at home. They were in international waters and living in a nightmare for more than a month. Thereās a real psychological toll to that. It doesnāt seem any individual has made a decision yet. And there is a possibility that pressure is enough to prompt the administration to change course. But I think the best option is the least restrictive approach that still keeps communities safe. I know people are worried about this one, so letās talk about what we do and donāt know. We do know that there are two primary ways Andes hantavirus spreads: through contact with infected rodents and through āclose contactā with people who are both infected and symptomatic. We also know that the first passengers to be infected with the Andes virus were exposed in the most typical way: through contact with infected rodents off the boat. The next two cases also contracted the virus in a typical way: through close contact with infected people. (Close contact is defined by CDC as 6 feet for more than 15 minutes.) Cruise ships are notorious for putting people into close contact. But, during a 2018 Argentina outbreak, a symptomatic patient infected 5 people while sitting close at a birthday party. One case may have involved only a brief, passing interaction. That said, 94 other partygoers didnāt contract the virus, and 82 healthcare workers who cared for the resulting patients remained healthy, many without PPE. (See a deeper dive from Ed Nirenberg here.) Getting the transmission pathways matters a lot for contact tracing to ensure everyone who needs to be monitored is monitored (like on a flight). It also matters that scientists collect the right specimens on the ship so we can learn more. In general, though, the overall risk of a pandemic remains very, very small, especially when added to a few other things we know: Weāve successfully stopped Andes outbreaks in the past through standard contact and droplet precautions. This does not appear to be a highly contagious virus between people. Variants don't appear to be a concern here. Scientists confirmed this week that passenger samples were almost identical to one another and to samples from 1997 and 2018. This virus is behaving as scientists expect. I will start worrying if we start seeing new infections among people who were not on this ship and had no contact with a positive case. (We havenāt seen this yet.) Over the weekend, physicians received a HAN (a routine alert about what to watch for), and the CDC website was finally updated, followed by a press briefing yesterday morning. Better late than never, but the drip of information has made all of this genuinely difficult to track. WHO remains stellar in communications. The risk to you remains extremely low, and, thankfully, we have systems in place to address this rare disease. There is no need to cancel trips and this is not another Covid-19. The most important thing you can do is help spread accurate information. Triple-check sources, donāt spread unverified rumors, but DO share reputable and verified information. This includes information from the WHO, local health departments, and reputable public health leaders. While this small but deadly hantavirus outbreak plays out, there are four other pathogens that are more likely to affect your health right now. Tick bites are certainly earlier this year than in previous years, but itās not clear whether this will translate to a more severe season. After some exponential growth, the rate has come to a slow crawl. Regardless, we are in peak tick season. What this means for you: Prevention goes a long way. Most pathogens can only be transmitted after a tick feeds for some time, so call your physician if one has been attached for 36 hours. Use tweezers for removal (the only recommended method). And remember: nymphs are the size of a poppy seed. Common colds are approaching their spā¦
Send this story to anyone ā or drop the embed into a blog post, Substack, Notion page. Every play sends rev-share back to Your Local Epidemiologist.
70% goes to the publisher Ā· 20% to whoever forwarded this to you Ā· 10% keeps Storyflo running. Sent in USDC on Base ā gas-free for you.