Complex and unprecedented, the Spanish authorities are calling it. Antes del desembarco, asintomáticas. Passengers who'd been stuck aboard the Hanta or maybe Hantavirus-stricken Dutch cruise ship disembarked in the Canary Islands this weekend, prompting the highest stakes game of where are they now since maybe COVID? Some of the evacuees, American and French, have since tested positive for the virus, and yet public health officials seem remarkably calm. We do have one individual who was taken to the biocontainment unit early this morning, and we assess that individual. They are doing well. Possibly because this is not the one to freak out over. Coming up on Today Explained from Vox answers to the age-old question, how bad is it really? What's up y'all? I'm Skyler Diggins, 7-time WNBA All-Star, Olympic gold medalist, and mom. And I'm Cassidy Hubbard, host and reporter for nearly 20 years, covering the biggest names and stories in sports and mom. And this is AmMom, a community for athletes, game changers, and moms of all kinds. Dropping May 14th. Tap in with us. Will America recover its political decency after Trump leaves office? I think the bigger concern I have than Trump staying power is, let's say he's cratering. He has had an effect on the civic mind that is not going to go away. I'm Preet Bharara, and this week, George Packer of The Atlantic joins me to discuss Trump's lasting effect on the American mind. The episode is out now. Search and follow, stay tuned with Preet wherever you get your podcasts. You're listening to Today Explained. My name is Laurel Bristow, and I am an infectious disease researcher. And now I work for the Emery Rollins School of Public Health and Communications and have a weekly radio show and podcast show all about public health called Health Wanted. So we are speaking early Monday morning. Yesterday, the passengers that were on board the cruise ship that got hit by Hantavirus, they got off the ship. And what happened next? What has been happening in the meantime with those people? So all of the Americans who were on the cruise ship who were waiting to see their fate are now in a containment facility in Nebraska that is run by the University of Nebraska. It's the only government-funded facility that can handle people who have been exposed to potentially novel or pathogenic viruses that have emerged. And so they are there to get monitoring and assessment from a care team. And then hopefully they won't stay there for too long. They're going to make a decision in conjunction with their care team about where they're next going to spend the 42-day quarantine that is being recommended, but they are not being forced to stay in that facility. Though I think there's a possibility that some might choose to if they want to. All right. So 42 days of confinement, that is a long time. And it suggests that what we're dealing with here is something that is kind of serious. What is Hontavirus? So Hontavirus is actually a family of about 40 different kinds of viruses and they are primarily spread by rodents coming into contact with the infected, feces, urine, or saliva of rodents who are carriers. And just to be clear, not all rodents are carriers of Hontavirus. You know, people I have seen have been really scared about saying New York is full of rats. Yeah. I live in New York City. That is the mecca for rats and rodents. Because rat poop is always over here in New York City. We run it all rampant around here in the city. And that's why I drink out of a straw in New York City out of every can I get for a pizzeria. Not every kind of rodent carries Hontavirus. In the U.S., it's primarily deer mice and they are usually found in the southwest of the America. That's where we see our Hontavirus cases. What's unique about this is that the Andes kind of species of Hontavirus is the only one that we have seen be able to transmit person to person. Yes, it has spread person to person, but that has been in the context of very prolonged, close context of people who are sexual partners, people sharing a bed. And even then, it's still considered rare for this to happen. So this isn't like COVID. It doesn't spread as easily and you can't get it through casual contact like while out of the supermarket. And because it happened to get into an environment that is conducive for the spread of infectious disease the way the close confined quarters of cruise ships are, that's why we're seeing such a kind of profound spread within people who are on this cruise in a way that we haven't really seen before. Is it a very deadly disease? It can be. It depends on what kind of Hontavirus it is, but the case fatality tends to be up to 40%. I think Andes virus is 38% currently. And that's because it can do things like cause pulmonary syndrome, which causes severe pneumonia that can cause people to die and it also can cause renal failure. Okay, so how did the Andes version of Hontavirus get on this cruise ship? What do we know? We're not sure that investigation is ongoing, but I think the most likely working theory at this point is that one or two people who got on the cruise ship were infected with Hontavirus on land in Argentina before they got on the ship. And then on the ship there was some degree of person-to-person transmission. Prior to boarding the ship, the first two cases had traveled through Argentina, Chile, and Uruguay on a bird-watching trip, which included visits to sites where the species of rat that's known to carry Andes virus was present. The first case was a seven-year-old man who passed away on the ship and it just seemed, nothing seemed out of the ordinary. And then of course two weeks later, his wife got off the ship or his partner got off the ship and then she became ill and died. And on the same day that she got off, someone else became extremely ill and had to be medevacked. And I think around that time there started to be the suspicion that something was going on that was not just a fluke. The past few weeks have been extremely challenging to us all, as I'm sure you know. What's happening right now is very real for all of us here. We're not just a story. We're not just headlines. We're people. People with families, with lives. How does a person get this? Like what are the symptoms and then how are they passed? One of the problems with the hantavirus outbreak is that the symptoms overlap a lot with influenza, so it's not going to be the first thing that you suspect. Early symptoms often feel like many other common illnesses and include fever, headache, muscle ache, stomach pain, nausea or vomiting. In these cases you really have to think about what your actual exposure risk is with something like this. And then person-to-person spread, we don't know a ton about that yet. I think this outbreak in particular is going to teach us a lot. Have been outbreaks in Argentina before that were limited person-to-person spread. So I can't really say for sure, but it does appear that this spreads similar to an influenza, but less so. Like you do need fairly close contact or to be in a room that has no ventilation with someone who is sick for a significant period of time. Oh, that's interesting. So this, what happened on the cruise ship is actually helping our understanding of how this thing spreads. Unfortunately, but yeah. Yeah. If you want to find a silver lining for it, it's that this is going to allow us to learn a lot more about how this particular type of hantavirus spreads, which will help us in the future. And we see and hear that the people have been let off the ship and that they're in a containment facility in Nebraska. That feels good. I mean, we don't like that anybody's sick, but good that they're all in one place. But you do know that there are like real outstanding fears here. What happens if one of them leaves the Nebraska facility too early? Or what happens if somebody somewhere drops the ball? How much of a concern is that really? I am honestly really not concerned about there being significant onward spread of this disease. I mean, I think it's a small number of people. They are, you know, acutely aware of the severity of the situation. They have been stuck on this boat, probably reading headlines about them and stories and posts about people saying, keep them on the boat forever. So the people on the boat with the hantavirus and they want to get off. Well, I ain't trying to be heartless and cruel, but no, no, no, y'all can't get off. Stay out there. Bomb that fucking ship. It's actually quite simple and logical. When there is an illness aboard a ship, you quarantine the ship until the illness is gone for the greater good. I think that is a pretty good deterrent for them to not do anything too crazy to be the villain or, you know, the potential cause of an outbreak, which again, I don't think will happen just from the way this virus functions. But there are also, they are being taken care of by professionals. They're going to be monitored by professionals. And people don't like to think about it, but this sort of stuff is not as uncommon as you think, you know, I worked for the San Francisco Department of Public Health when there was an Ebola outbreak in West Africa. And we monitored people who had been there caring for patients when they came home, you know, and they got to quarantine in their homes and we called them to check on their symptoms and make sure everything was good until they were out of that incubation period. So this is something that does happen behind the scenes. You're just getting a lot more information about it because it is such a strange situation for a hantavirus to be on a cruise ship. Okay. Okay. That's somewhat comforting. Yeah. In the realm of less than comforting, President Trump was asked late last week if Americans should be worried. And he said... It should be fine. We hope. I hope not. I mean, I hope not. It was not what we've come to expect from presidents when there is one of these sort of situations. But, hey, it's President Trump. How would you rate the public health response coming from the administration, coming from the top of the food chain in Washington to this point? Yeah. I mean, I would like there to be more regular updates. We're getting to that point now where the CDC is starting to put out more regular updates about what is happening. I think that the people who are actually working on it are some wonderful, well-qualified people. The Epidemic Intelligence Service is a wonderful program that is very good at disease tracking outbreaks. I think it's unfortunate it took us this long to be involved because we have left the WHO that has really limited our ability to get information quickly and to be involved as quickly as we should have been or as had the level of involvement that we should have been having, which is really unfortunate. And I just want to be very clear. My concern about this hantavirus outbreak becoming pandemic level or even spreading really to anyone outside of the cruise line is incredibly low. But I am worried about our capacity to respond to an illness or a pathogen that transmits more readily if one should present itself in the future. All right. So it seems pretty clear if you look online that there is a lot of misinformation spreading about hantavirus. Some of it is kind of in a jokey way. Let's blow up the boat. Some of it is people claiming, and I've seen a lot of this people claiming to be public health experts or doctors and saying, you know, it's time to panic. It's time to freak out. As people are consuming news about this, how should they best make sure that what they're getting is accurate? It's sober. It's not hysteria. Yeah. I mean, unfortunately, science communication requires a lot of nuance. So if people are communicating things without any nuance, that is a pretty good sign that that is not someone that you should be investing a lot in because there are so many unknowns in this situation. You know, there are things that we know for certain. There are things that we don't know. There are things we were waiting on. And I think for someone to present something as black and white is a really good sign that they are, you know, not being cautious about where the information is at this point. Also anyone who appeals to emotion, who tries to get you to panic is probably not a trustworthy source because anyone who works in infectious disease outbreak, anyone who works in research knows that there is no point to panicking. It's not going to change a situation. What you need is to arm yourself with information to make the best choices for yourself and for your family and to feel comfortable. So I think this appeal to emotion that's happening with a lot of people is a good way to get engagement, especially because people are so heightened after having experienced COVID. But I think it's really important to think about if someone is presenting information to you that is going to inform you or that it is just causing an emotional reaction in you. Laurel Bristow, she's an infectious disease researcher with the Emory Rollins School of Public Health. Coming up, what we did and didn't learn from COVID. Support for Today Explained comes from Built Rewards. 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You can get simple online access to personalized affordable care for ED, hair loss, weight loss and more. You can visit Hymns.com slash explained. That's Hymns.com slash explained for your free online visit Hymns.com slash explained. Prescription required. See website for details and important safety information. Sildenafil is the generic version of Viagra FYI. Viagra is a registered trademark of Viatris FYI specialty LLC. Hymns is not affiliated with or endorsed by Viatris FYI. You're listening to Today Explained. Lawrence Gostin is a professor of global health at Georgetown and also directs the World Health Organization's Center on Global Health. He's been thinking a lot about COVID these days. All right, so you've said and you've written that what happened early on in this outbreak raises some very real concerns for you. What are the concerns? So, you know, I think the easiest way for your listeners is suppose it wasn't a hantavirus, which is really hard to transmit. But suppose instead of that, it was a highly transmissible virus. Suppose it was a coronavirus or an influenza virus. These viruses that can mutate quickly, rapidly transmit, we would now be looking at a potential pandemic because what happened was is that the initial reporting of the first cases was very much delayed after the first death. People disembarked in large numbers and flew to all quarters of the world. Since the deaths and since the reporting of hantavirus, more people have disembarked and also flew to every region in the world. And so you can imagine you would have an infectious disease novel of pandemic potential rapidly scattered across the globe. If this was a stress test of our pandemic preparedness, in my view, we failed quite badly. Alright, a reasonable person might say, doctor, but it's not COVID. It's not Ebola or influenza. It's something that, as you said, is harder to transmit. So is that the reason why people are being let off the ship and let travel? I mean, is the system responding to the virus that we have, which is hantavirus, hard to transmit, or was there a real failure that you can point to here? Well, there are several real failures. I mean, as I mentioned, people disembarked and went across the globe before we knew it was hantavirus. Ah, okay. Okay. And after somebody had died of hantavirus. And so that was the first breakdown. The other breakdown was in Cape Verde where nobody would let any passengers who needed care and treatment get off the ship for that purpose. And it just reminded me of the global paralysis that occurred with cruise ships early in the COVID pandemic, and particularly the Diamond Princess. The outbreak aboard a cruise ship in Japan is getting worse, with more than 130 cases confirmed, including nearly a dozen Americans. We're now learning two passengers from the Diamond Princess cruise ship have died. It was just a disaster waiting to happen. I feel that we're sitting in a Petri dish waiting to get infected. Japan initially would not let anybody board. There was complete confusion and chaos. Ultimately, they did board rather than quarantining them. They went on their merry way to various parts of the world in planes, which are crowded vessels. And in any case, even if we know it's a relatively less transmissible disease, this is a disease that hantavirus, it's person to person transmitted. And it is a disease that's far more lethal than coronavirus ever was. It's a really severe pathogenic illness. And so even with that disease, you send them on an eight hour plane ride cooped up with a lot of other passengers. That doesn't sound like using public health precaution to me. That sounds like an unplanned, uncoordinated response. All right. So I hear you saying that some things went wrong in 2020. It was the responsibility of the ships, the Diamond Princess. I remember that very well, actually. And here we are in 2026. And again, we have the person running the ship, responsible for the ship, letting people off the ship, letting them travel. So the issue seems to be the same, different ship, of course. What should have changed between 2020 and 2026 to stop this from happening? And did any laws actually change? Did we update anything and say, from now on, if 10 people on a ship have a fever, y'all are out in the middle of the ocean until we figure out what the hell's going on? Yeah, we did. In light of the failures during COVID, many of them global failures, including the cruise ship fiascos, the governing instrument that direct how we should prepare for and respond to global health emergencies were reformed, called the International Health Regulations, their Binding Treaty. It was the United States and the Biden administration that actually pushed for the reform. We can do this if we come together. That's why, ultimately, our plan is based on unity. It requires reasserting our global leadership, which is why I took an action yesterday for the United States to rejoin the World Health Organization. We have made clear from the beginning of this administration and in rejoining that we believe that WHO does need to be reformed. Some of those reforms are more programmatic and bureaucratic. They relate to ensuring greater efficiency and effectiveness in responding to things like the outbreak of COVID-19. I was in Geneva at the World Health Assembly and at the very, very last day of the assembly after two years of negotiations on amending these IHR or International Health Regulations, they were going to fail. The United States, actually, Secretary Becerra, went personally and said, you'd better adopt these. We did. I was on the WHO International Health Regulations Review Committee, so I was very closely involved. That reformed the rules for governing outbreaks. Today, there is a pretty good blueprint for how we should deal with these kinds of outbreaks. The problem is that the World Health Organization has no enforcement power. It can't sanction and countries routinely fail to comply because they're all looking out for their own self-interest. What in an ideal world should happen? We start with the fact that cruise ships are kind of the perfect storm for the spread of infection. They're owned by a private company. They're often flagged by a particular state. They go to ports where the countries at that port are in charge. They're also traveling internationally and they're in very congested, crowded conditions. How do you make all of that safe? You start with rules and we have them, but they're just not followed, of a certificate of sterilization, sanitation, hygiene. There needs to be really good medical care and public health expertise on board. There needs to be a state-of-the-art ventilation and filtration system. There needs to be rodent control. That would make ship travel much safer, not completely safe, but much safer. We have no way to require compliance. I'm tempted to think that because there has not been a high death toll here, even though there's a lot of attention drawn to the hand-to-virus outbreak, it seems likely that this will not be the thing that makes us change our behavior. This will not be the time that makes us wake up. But I could be wrong. Do you think we're waking up? Well, if COVID didn't do it, I don't know what would. It certainly caught people's attention, but if all of the death and suffering of COVID wasn't enough to really make us wake up from our lethargy and really prepare to have pandemic preparedness and good response. If it didn't put us all behind a strengthened WHO, if it didn't pull us together as a coordinated global community, I don't know what will. Instead, COVID seems to have ripped us apart. And that's very sad to me. Laurence Gostin. He teaches global health at Georgetown and directs the World Health Organization Center on Global Health. Hadi Moag, the produced today's show, Amine El-Sadi, edited. David Tadishor and Bridger Dunnegan engineered, and Gabriel Dunne-Tove checked the facts. I'm Noelle King. It's Today Explained. Security program on spreadsheets, new regulations piling up, an audit dread. It's time for Vantor. Vantor automates security and compliance, brings evidence into one place, and cuts audit prep by 82%. Less manual work, clearer visibility, faster deals. Zero chaos. Call it compliance, or call it calm-pliance. Get it? Join the 15,000 companies using Vantor to prove trust. Get started at vantor.com.
