A North Carolina resident was among the passengers exposed to the deadly hantavirus outbreak that tore through a trans-Atlantic cruise last month, but the risk to the state remains “extremely low,” state health officials and infectious disease experts say.
The North Carolinian, who has not been named, was taken with 15 other American passengers from the ship to a Nebraska quarantine facility, where none have yet shown symptoms or tested positive, but are being closely monitored.
The news of the outbreak has prompted opposing reactions in a public still scarred from the COVID-19 pandemic, from fearful expressions of ‘Oh no, not again,’ to defiant refusals to never wear a mask again or take another vaccine.
But while the hantavirus outbreak demands attention, it does not warrant panic, Dr. Carl Williams, North Carolina’s state public health veterinarian, said in a news conference on Tuesday. There is no evidence so far to suggest that this is a rerun of the brutal opening to the COVID-19 pandemic.
“It’s really not something we’d suggest that people should worry about here in North Carolina,” Williams said.
For one, hantavirus is a known entity, not some emergent contagion.
“[Hantaviruses] are not new viruses,” Williams said. “It’s something we’ve known about for a long time.”
And though hantavirus has a higher death rate than COVID-19, it does not spread as easily.
“This is not something that’s going to become a pandemic,” he said.
Dr. Nicholas Turner, an assistant professor of medicine at Duke University and an infectious disease expert, echoed these thoughts in an interview with Cardinal & Pine on Thursday, though he added more caveats.
“As a North Carolinian, I would not be worried about this particular ship outbreak unless you had … direct contact,” Turner said.
He added, “It seems to me this is very unlikely that this is going to be a virus that turns into a pandemic-type situation.”
But he was also quick to point out a principle of epidemiology that doesn’t translate well to online debates or the desire for easy answers: There is no such thing as certainty, and this virus is very serious for the people who get it.
“Most things in real life are not black and white, they’re not 100% or 0%,” Turner said.
“Anybody who does get identified as a contact for one of these cases, I would take that seriously … We obviously have to watch those carefully,” he said. “If we totally missed the boat, no pun intended, and failed to do contact tracing and whatnot, this could sustain for a while.”
Hantavirus is native to rodents, and it is usually transmitted when humans breathe in aerosolized particles from rodent droppings. Only one strain of the hantavirus can be transmitted human to human, the Andes strain, and that’s the one that broke out on the ship.
Some uncertainty
Epidemiologists agree that hantavirus doesn’t really spread until a patient exhibits symptoms, though it’s likely the virus is most contagious right at the onset, and maybe a little before.
That makes it very easy to contain if quarantines go immediately into place. But that is not what happened here.
The first passenger to die from the ship outbreak died onboard, but his wife was the second person to die, and she left the ship before hantavirus was suspected and before she showed symptoms.
She then flew to Johannesburg, South Africa, fell ill on the plane, collapsed in the airport, and died the next day. US health officials say an additional 16 Americans from that flight, who were never on the ship, have also been isolated and are being monitored.
That adds extra uncertainty to the larger equation, Turner said.
“The only way to get total control over [the outbreak] is if you had all cases quarantined before the onset of symptoms, so we should be clear that we do expect to see some more cases here,” he said.
“That’s exactly why there’s so much interest in contact tracing for those individuals.”
But since federal officials have isolated the passengers, there is still little danger under the known conditions for a mass outbreak, he said.
“Given all of the experiences in previous South American outbreaks, this virus has had a chance to do similar things before, and thankfully it didn’t. And so I think that is part of what reassures me that this is unlikely to have a lot of secondary spread here in the US. It’s unlikely those are gonna turn into bigger things,’ Turner added.
The basics
There are currently 41 Americans being monitored in separate locations. In addition to the 16 passengers in Nebraska and the 16 from the flight, a cruise passenger who was exhibiting symptoms but who tested negative was taken along with his partner to a facility in Atlanta. Seven other cruise passengers who flew home on their own before the outbreak was fully understood are being monitored by local officials.
Kimberly Clement, an assistant chief of preparedness and strategic operations for North Carolina’s Office of Emergency Services, said in a press conference this week that North Carolina health officials were in contact with their federal counterparts, and that Centers for Disease Control and Prevention officials had been keeping them informed of the developments at the Nebraska facility.
State and federal officials would work together, she said, to transport the North Carolina resident home either after the all-clear is given or if they ever developed symptoms.
“ We are in close contact with a lot of different partners, local, state, federal, on what the transportation would look like,” Clement said.
“That has not been finalized at this point, but we would ensure that any plans that we put in place make sure that both the patient, the healthcare workers if they’re involved, and the public are completely safe.”
A serious disease, but familiar patterns
Hantavirus is not the common cold or flu. It kills between 30% to 50% of the people who get it, Turner said.
But like a cold, it starts with a mild cough and aches. Then it accelerates rapidly, and can cause severe respiratory distress, cardiac arrest, and kidney failure. There are no specific antiviral medications that work, and there is no vaccine.
So deliberate, due diligence is required, Turner said, even if the risks of a huge outbreak are small.
“We suspect from the reports that have occurred in South America before that there is some element of respiratory and maybe even a bit of aerosol spread … and that’s how we presume some of those cases on the ship had occurred,” Turner said.
Even if hantavirus is capable in some circumstances of spreading between people who have only brief contact, he said, it is also true that a cruise is the very definition of the close and sustained contact that all viruses need to spread.
Hantavirus outbreaks are nowhere near as common on cruise ships as norovirus, but this outbreak fits squarely into established patterns of how viruses operate in close quarters, he said.
Narrow hallways, small cabins, frequent meals, and drinks with the same strangers over a condensed amount of time are all prime conditions for person-to-person spread, Turner said.
“Those are similar to the types of contact that were seen in the South American clusters previously,” he said.
‘A long time to wait’
Patience is a four-letter word in the online echo chambers clamoring over the outbreak online, but there’s no other choice for the health officials monitoring the risks, Turner said.
Hantavirus has an absurd incubation period of up to 42 days, and epidemiologists double that time frame before they issue the all-clear.
“All of us are going to be watching what happens in Nebraska right now rather closely to see, do we get any other cases,” Turner said.
“It can be 42 days in the slowest cases before symptoms come on, and epidemiologically, we like to wait two full incubation cycles before we consider something to be reliably over. And so that means that a lot of us are going to be watching this for 84 days before we decide that there are no more cases that we’re going to see.”
So settle in, North Carolina.
“It’s a long time to wait, right?” Turner said. “And that can be a hard thing to do, to be patient and not know exactly when we can declare this thing safely over.”
While you wait, he added, be deliberate about your sources of information.
“Anybody who tells you something in black-and-white absolutes, that’s generally not the way our world works,” he said.
“I hope people pay attention to that when you’re looking at sources,” he added.
“Those big, catchy absolutes make social media really well, but don’t always reflect where real-life truth lies.”
