Given the enormous toll of the COVID-19 pandemic — responsible for more than 1.2 million U.S. deaths and a complete upheaval of Americans’ lives — infectious disease experts aren’t surprised hantavirus outbreak on an international cruise ship stoked fear.
The exotic virus that caused a cruise ship death and spread from person to person before it was discovered “has all the fingerprints of the next pandemic” in the public imagination, but the science so far doesn’t back that up, said Dr. Ali Kahn, an epidemiologist and dean of the University of Nebraska Medical Center College of Public Health.
Kahn, a former assistant U.S. surgeon general, said the measured response is appropriate given that scientists don’t yet know everything there is to learn about the Andes strain of hantavirus identified in the outbreak aboard the Dutch cruise ship MV Hondius earlier this month. Three passengers died, and nearly a dozen others were sickened.
“We’ve known about Andes virus itself for over 30 years, and it’s the same as it has always been. We have not seen national or regional outbreaks, let alone a global pandemic,” Khan told Patch. “It’s very close to the original virus, and not something that has become more infectious, like the Delta variant of COVID.”
Andes is the first known strain of hantavirus that spreads from human to human, and that increases its perceived threat level.
Kahn said “there’s very little if any, evidence of people getting infected at a distance through airborne spread,” as as the case with COVID.
Current scientific evidence shows the Andes virus, unlike North American hantaviruses, including the Sin Nombre virus, can be spread when people are in extremely close contact. That puts sexual partners, people who live in the same household and health care workers “who take really good care of their patients” at enhanced risk, Kahn said.
Both the South American and North American strains of hantavirus are carried by rodents and both cause Hantavirus Pulmonary Syndrome, a severe respiratory illness with a high mortality rate. The Andes virus is considered more dangerous because of its unique capability for person-to-person transmission.
About two dozen countries are repatriating citizens who were aboard the ship at facilities such as the National Quarantine Unit at the University of Nebraska Medical Center, where 16 U.S. passengers on the ship are now quarantined, including one person who showed mild symptoms. Two other American passengers, one of them showing symptoms, are staying in biocontainment at a specialized facility at Emory University in Atlanta.
Khan said that’s an appropriate response that should give the public confidence.
“The reason we like to shut these outbreaks down is, every one we shut down is one less that can cause a variant,” he said.
Another 23 people are being monitored in their homes. Including seven passengers who left the ship before the outbreak was identified, and 16 people who may have been exposed during flights where a symptomatic case was present, the CDC said Thursday.
These people are encouraged to take their temperatures daily, isolate if symptoms occur, and work directly with local officials who track cases.
Dr. David Fitter, incident manager for CDC’s hantavirus response, said the federal government is not using its authority to impose quarantines on these cases.
“Our approach is based on risk and evidence. We are working closely with passengers and public health partners to ensure monitoring and rapid access to care if symptoms develop,” he said.
Those individuals are in a dozen states: Arizona, California, Illinois, Kansas, Maryland, Minnesota, New Jersey, Virginia and Washington. The suspected case in Illinois is not connected to the cruise ship, Patch previously reported.
U.S. health officials have not ordered widespread molecular-level testing, such as genomic sequencing, as part of the hantavirus response tied to the cruise ship outbreak. Some epidemiologists and infectious-disease experts question whether the U.S. response is relying too heavily on symptom monitoring without enough aggressive surveillance or sequencing, such as the World Health Organization and European labs are conducting.
That makes what’s not yet known about the Andes virus is the wild card, according to Jennifer Nuzzo, director of the Pandemic Center at Brown University of Public Health.
“One of the things that concerns me is that Argentina has been seeing more and more infections with this virus, which suggests it may be becoming more common,” Nuzzo told Patch, emphasizing, though, that the Andes virus is still very rare.
She is discouraged that last year, the Trump administration “shut off what should be an American strength” by cutting a federal research network studying hantaviruses, including the Andes strain. The canceled project was part of the National Institutes of Health-backed Centers for Research in Emerging Infectious Diseases, which studied how viruses jump from animals to humans.
Researchers told Scientific American the cuts left critical gaps in understanding transmission and pandemic preparedness as the outbreak aboard the MV Hondius, and also stalled work on potential treatments and vaccines for hantaviruses, which have no approved cure.
When a virus behaves in a confusing or concerning manner and scientific answers remain elusive, it underscores the necessity of research and the importance of a rapid response to stay ahead of the threat, Nuzzo said.
Conducting these types of research projects is vital for staying proactive against this specific virus and other lethal pathogens. A virus does not need to reach pandemic proportions to be a significant issue, she said.
Both Kahn and Nuzzo said the cruise ship outbreak raises questions about the United States’ readiness to respond to future outbreaks of more infectious diseases, like another coronavirus pandemic or widespread influenza.
What Americans should be most worried about is “just how weak the U.S. response has been for something that should be a slam dunk," Nuzzo said.
In past outbreaks of little-known diseases, Centers for Disease Control and Prevention and other federal health officials could be counted on for a measured response on the threat level based evidence available at the time.
“What I saw instead was the U.S. was very late in even commenting, despite having Americans aboard the ship they would likely have to bring home,” Nuzzo said. “There’s no real risk to the broader public, but the broader public needs to be assured of that.”
Public trust in science, government and even the validity of information itself are lingering casualties of the COVID pandemic, and that’s affecting public perception of the Andes virus outbreak, experts said.
“COVID undermined our trust in what most of us used to trust,” Elisa Jayne Bienenstock, a research professor and sociologist at Arizona State University, told The Associated Press. “When general trust goes down, when there’s a lot of cynicism, who are people looking to, to explain what to do and how the world works?”
The mistrust of science got ammunition not because scientists were making mistakes in their processes but because nonscientists didn’t have the same understanding, she said.
“Most people don’t think of science as a process. In their mind, science is an answer, it’s a fact. And so when those facts showed that they weren’t 100 percent reliable and assured, it started undermining trust in the science,” she said.
“One of the problems with COVID is it undermined that confidence in science for people who don’t understand how science works. It showed the process. And it showed that scientists don’t always have the answer,” Bienenstock said. “A lot of people in crisis, when they fear things, don’t care what the answer is, as long as there’s a definitive answer. And science doesn’t provide that when it doesn’t know.”
Nuzzo said the federal government’s “glib assurances” based on limited data did little to rebuild public confidence and trust in health agencies.
“I don’t believe this virus is going to spread further. I do think the data still show it is not particularly easy spread,” she told Patch. “There’s still a lot we don’t know about this virus, and it could surprise us.”
Kahn said the hantavirus outbreak is “a really good live fire exercise for the next pandemic,” which scientists believe will likely be another coronavirus or influenza strain. The response emphasizes the critical necessity of robust state and federal public health funding and seamless coordination between the CDC, WHO and other global agencies, free from political influence, he said.
“We might hear about it more often, and want the government to do more meaningful things to be ready for it, rather than offer glib assurance,” Nuzzo said. “Hantavirus was a drill and an exercise that we failed.”
The Associated Press contributed to this report.
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