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Mina Kim: Welcome to Forum. I’m Mina Kim. State health officials confirmed last week that a fifth Californian is being monitored for exposure to hantavirus. That person is currently in the South Pacific, while the other four are in Santa Clara, Sacramento, and Omaha, Nebraska.
Officials say none are reporting symptoms so far, and the risk of spread to the public is low. But the global and national response to the hantavirus outbreak — which killed three and sickened a dozen others on a Dutch cruise ship — is raising questions about our readiness for the next contagion, just as the World Health Organization declares an Ebola outbreak in the Democratic Republic of Congo an international health emergency.
Listeners, what are your questions about hantavirus and Ebola? What do you want to know about how U.S. and global health leaders are responding to these outbreaks?
Joining me now is Dr. Peter Chin-Hong, an infectious disease specialist at UCSF. Peter, thanks so much for being here.
Dr. Peter Chin-Hong: Thanks for having me on, Mina.
Mina Kim: So can you remind us what hantavirus is, and what’s notable about the Andes hantavirus that caused the cruise ship outbreak?
Dr. Peter Chin-Hong: Yeah. So hantavirus is a virus transmitted by exposure to rats or mice — rodents.
And we in California know about hantavirus, of course, because of several high-profile cases in Yosemite in 2012, then in Lake Tahoe and Mammoth Lakes. What happens is hikers go into a cabin that hasn’t been inhabited for a while, see rodent excreta, try to sweep it up, inhale it, and then get sick very quickly with nonspecific symptoms followed by organ failure, particularly in the lungs.
Mina Kim: And the thing that’s really different about the California one is that it does not get transmitted person to person. Is that right? It’s like rat to person.
Dr. Peter Chin-Hong: Exactly. All of the hantaviruses that we know about — and there are twenty-four types around the world — are primarily transmitted from rodent to human. Andes virus is the only one we know of that is potentially transmitted from human to human as well.
Mina Kim: Wow. And the concern is that the fatality rate is high with hantavirus?
Dr. Peter Chin-Hong: Yeah. The fatality rate with hantavirus can be up to 40 percent. And part of the problem is many people who get it are far away from intensive care units and specialized treatment that can really have an impact on survival rates.
Mina Kim: And there is no real treatment or vaccine for this?
Dr. Peter Chin-Hong: Right. No vaccine, no antivirals — just supportive care.
One of the main ways we take care of people with hantavirus is essentially giving them a replacement lung. It’s a machine called ECMO — E-C-M-O. Because the lungs get flooded with fluid, you take the patient’s blood, oxygenate it, and put it back into the patient.
Mina Kim: Wow. Well, actually that sounds a lot like our editor-in-chief’s experience to some degree. Ethan Tobin-Lindsey actually had hantavirus, and he sent us this comment:
“In the summer of 2009, I checked into a hospital in Bend, Oregon with what I thought was the flu. Nine days later, I woke up from a medically induced coma to learn I was the ninth person ever diagnosed with hantavirus in the state of Oregon and only the third to survive.
The doctors had no idea what was attacking my body, so they put me on an oscillating ventilator borrowed from the neonatal ICU, packed me in ice baths to break my fevers, and essentially kept my organs running while my immune system did the fighting.
I’d contracted the virus, they think, from kicking up deer mouse droppings in my garage while pulling out a suitcase for my bachelor party. I got married four weeks later after I left the hospital, forty pounds lighter.”
Wow.
Listeners, have you had hantavirus? What was your experience if you have? What are your questions about it and Ebola? And what do you want to know about how U.S. and global health leaders are responding to these outbreaks? You can email forum@kqed.org.
So one thing about hantavirus that is causing public health leaders to say spread to the public is low is that it’s not that easy to transmit — even the person-to-person version.
Dr. Peter Chin-Hong: Yes. There are a few features, Mina.
The first is that it’s not airborne. It’s not COVID or flu, so that makes it less easily spread in the community.
The second reason is that people tend to spread Andes virus when they’re symptomatic, unlike COVID or some other respiratory illnesses. We know a lot about this from a 2018–19 outbreak in Argentina.
The third reason is that once people get sick, they tend to get sick very, very quickly. It’s often just a matter of hours between the initial flu-like symptoms and when they can’t breathe. So they’re less likely to be out and about unknowingly spreading disease.
Mina Kim: I see. But you’re saying once symptoms start — I understand that the incubation period for Andes virus can be as long as forty-two days?
Dr. Peter Chin-Hong: Yes. It can be quite long.
Although most people in Argentina and Chile who got Andes virus developed it at a median of nineteen to twenty-three days, the tail is long — up to six weeks or so.
Mina Kim: I understand that while it usually requires close contact, there have been caveats I’ve heard doctors make — that hantavirus is complicated and can be unpredictable. So it’s not entirely out of the question that you could get it without direct or sustained close contact?
Dr. Peter Chin-Hong: I would say most cases involve close, personal contact. That’s because it’s in saliva and lung fluid, so you really need to be that close — intimate contact, kissing, et cetera.
But where this concern about outlier transmission comes from was a birthday party in Argentina during the 2018–19 outbreak. There were three superspreaders. One person went to this birthday party, passed someone in the bathroom, and apparently spread it that way.
But of course, that person was very symptomatic.
Mina Kim: Right now, the CDC says it’s monitoring about forty-one people across the country who were either exposed on the cruise ship or on flights with people known to have been infected with Andes hantavirus.
Do you think more positive cases are likely and that we’ll hear about them soon because of the long incubation period? Or is this over?
Dr. Peter Chin-Hong: I think it’s not over, unfortunately, Mina. But I don’t think we’ll see many more cases.
We just heard of one over the weekend from British Columbia involving a Canadian couple — one of them had it. But people on the plane are probably less likely to have been exposed than people on the cruise ship because of the likelihood of exposure to someone symptomatic.
Mina Kim: One of the things that was coming up in our meetings was whether the bigger concern is cruise ships — and whether cruise ships should be doing more around disease prevention.
For a lot of people, the quarantined cruise ship with hantavirus certainly echoed the early days of the COVID-19 lockdown, when the Diamond Princess cruise ship was held here in the Bay.
Dr. Peter Chin-Hong: Yes, definitely. It brought back a lot of memories — for me and many others — of 2020 and the Oakland cruise ship situation.
The cruise ship setting is kind of like a traveling city. You generally have an older population, high density, prolonged close contact, shared infrastructure, laughing, talking.
It’s almost like those TV shows Silo or Paradise on Hulu — that kind of enclosed city where you’re sharing a lot of things while visiting places with different exposures like mosquitoes, rodents, and so on.
Mina Kim: Oh, I see. So it’s just much easier to spread things in those environments.
I’m wondering overall how you’d characterize your level of concern about hantavirus spread, given that it’s not over yet, as you say.
Dr. Peter Chin-Hong: My level of concern is pretty low for general transmission. It doesn’t have many of the features associated with pandemic potential.
But it is a test case — almost a dry run — of how the world responds to an outbreak. And it was pretty controlled, so it was interesting to see how people responded.
Perception often has outsized importance compared to the science of epidemiology, especially after our experiences with COVID.
It also had a somewhat happy ending. We had enough rooms at the University of Nebraska to quarantine the highest-risk people from the cruise ship. We had experts talking publicly and reassuring people. Politically, both sides were aligned in trying to reassure the population.
But I think it also exposed a few vulnerabilities and raised questions about how we’d respond if something bigger happened — especially something airborne like avian flu.
Mina Kim: What jumped out at you, Peter?
Dr. Peter Chin-Hong: To me, the biggest thing was that the CDC wasn’t really in the driver’s seat.
Usually during global outbreaks, the CDC is right there with the WHO providing technical and financial support. That up-close sharing of expertise wasn’t quite there this time. It felt more siloed.
The second issue was timeliness. In this era of social media and instant communication, we’re used to much more coordination between the WHO and CDC — how they communicate updates, issue alerts, and involve scientists and clinicians in sharing information.
Just a year or two ago, when we were talking about bird flu, Mina, we were part of CDC calls that brought together clinicians, scientists, and agricultural experts to share information and better understand what was happening.
Those things have virtually disappeared.
Mina Kim: We’re talking with Peter Chin-Hong about the recent hantavirus outbreak and what it tells us about the state of global and national health response.
We’ll have more with him — and with you, listeners — right after the break.
You’re listening to Forum. I’m Mina Kim.
