Why experts are divided over where hantavirus cruise passengers should quarantine
Eighteen Americans are now in quarantine at two federal centers after returning home from the MV Hondius cruise ship.
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How long they will stay in quarantine or where is not yet clear. Now that the passengers have had time to rest, U.S. health officials are interviewing them to get a better idea of how close the U.S. passengers were to the infected people — and whether they were infected. have the resources, such as separate rooms, to safely quarantine at home.
“We want to do it in the least restrictive way possible,” Dr. Brendan Jackson, acting director of the division of pathogens and high-consequence conditions at the Centers for Disease Control and Prevention, said during a press briefing Monday.
It can take up to 42 days after exposure to the virus for symptoms to appear. If passengers are allowed to leave federal quarantine centers and stay at home, they should not show any symptoms. They should also check in regularly with local health authorities, Jackson said.
The Andes strain is the only hantavirus capable of spreading from person to person. Although there are some reports of people catching it through casual contact, most scientists say it does not spread easily and there is no clear evidence that people are contagious before they show symptoms.
“We have no evidence of sustained community transmission outside of close contact settings, no evidence of effective airborne spread in public spaces, and no recommendations for general travel restrictions,” Dr. Bobbi S. Pritt, chair of the division of clinical microbiology at Mayo Clinic, said Tuesday at a College of American Pathologists briefing.
Eleven cases of hantavirus were reported among the nearly 150 passengers. Three people died.
Sixteen of the 18 Americans are at the National Quarantine Center in Omaha, Nebraska. Two of them are in a quarantine facility at Emory University in Atlanta. One of the people quarantined in Atlanta had mild symptoms but tested negative for hantavirus. None of the other passengers in Omaha or Atlanta tested positive.
Dr. Michael Mina, an epidemiologist and former professor of immunology and infectious diseases at the Harvard TH Chan School of Public Health, said a strict quarantine is a “small price to pay” to prevent more cases and potential deaths.
“If you could avoid one death, it’s worth quarantining the entire ship,” Mina said.
More cases in the Andes expected
Dr. Abraar Karan, an infectious disease physician at Stanford Medicine, said quarantining passengers at home “opens up unnecessary risks.”
“What happens if they go home in quarantine and start getting sick? Now you have to transport them to a center that has a biocontainment unit, which very few people do,” Karan said. “Bringing people home doesn’t seem to make much sense. »
World Health Organization Director-General Tedros Adhanom Ghebreyesus has already acknowledged that additional cases could arise, given the virus’s long incubation period.
“It is possible that we will see more cases in the coming weeks,” he said during a press briefing. The WHO recommends that people quarantined at home remain separated from their family members in different rooms. If physical interaction with another person is necessary, ship passengers must wear N95 respirators.
How other countries handle quarantines
Zimbabwe’s health ministry said the cruise ship citizens “will remain together in a designated private isolation center during the quarantine period.”
Health officials in the United Kingdom and the Netherlands, however, said some passengers could self-isolate at home provided it was safe to do so.
Katelyn Jetelina, an epidemiologist who tracks diseases for a website called Your Local Epidemiologist, said that “as with any public health decision, there are real trade-offs to consider. This is both a public health response and a humanitarian response.”
The passengers “were in international waters and living in a nightmare for over a month. There is a real psychological toll to that,” Jetelina said. “I think the best option is the least restrictive approach that keeps communities safe. »
At least seven Americans who had already gotten off the ship are believed to be quarantining at home in several states, where health departments said they were in regular contact with passengers to help monitor them for symptoms.
It is possible that the quarantine guidelines for the 18 passengers may change in the coming days.
Dr. Mara Jana Broadhurst, medical director of the Nebraska Biocontainment Unit laboratory, said her team and U.S. health authorities are trying to “strike a balance” between monitoring passengers at facilities and monitoring at home.
Quarantine recommendations are “based on what we understand about the incubation period,” Broadhurst said at the pathologists’ briefing Tuesday. “Use of the facilities here in Omaha will be available for this duration of the incubation period.”
UNMC’s quarantine rooms are set up to look more like a hotel than a hospital, with exercise equipment and the ability to order food, said one of the passengers quarantined in Nebraska.
“It might not be able to be delivered right away, but you can get things delivered, care packages,” Jake Rosmarin told NBC’s “TODAY” show Tuesday. He said he had no symptoms of hantavirus. “I’m happy to be in a place where I know we’re well taken care of and that if something happens we have the medical care we need.”
