Thank you, Dr. Jetelina, for your somewhat reassuring comments on this Hantavirus outbreak. There are some reasons to believe this will not become the next pandemic. As a retired practicing MD, I know there's a need to reassure people and prevent panic. I also get your humanitarian take on allowing these people to quarantine at home. But this is a different situation than the 2018 Argentina one. Here we have exposed people going all over the place, with differing measures being taken to prevent spread. We may have a very different situation in terms of ability to contain it. We have seen photos of exposed folks taking off their masks and/or wearing less-than-ideal PPE. If they do that now, what will they do when they arrive at their homes? We also have less-than-stellar communication and health leadership (to put it mildly). I myself do not trust what comes from "official" sources. These people should be kept (comfortably) in the Nebraska facility until they are past the incubation period. (As for the ones who left the ship early, we can try to trust them and God - or a more benign viral behavior pattern - to contain this.)
I tend to believe (hope?) that the case fatality rate of hantavirus is so high compared to measles, for example, that it dramatically changes health behavior. Thankfully, everyone is cooperating so far.
If you are talking about the patients in this case, they typically don’t have the level of knowledge (or see the world as “worse case scenario”) that public health officials have. And they weigh that perceived risk against loss of job/income, loss of friendships or romantic relationships. Fourteen days? Maybe. 30 days, not likely. Forty-two days? If I was betting on the prediction markets, I would say chance of completing the quarantine voluntarily is 0%.
Really great point. Well word is that a few people have confirmed they are going to stay in Nebraska for the whole quarantine. I think this sample of people may also be a bit different than the general population given the cruise they were on.
It is also worrisome that health precautions have become politicized after COVID. Otherwise intelligent people can feel angry and put upon by being asked to stick to logical precautions. I have a friend with cancer who wore a mask to pick up takeout outside a restaurant and was yelled at by a person for imposing PPE on others (the yelling was unprompted - the friend said nothing to the mean person about keeping distance or mask wearing).
I agree that it is too hard to quarantine at home effectively. Remembering for 42 days not to pat your dog - not likely. Leave dishes outside your room for a PPE protected family member to pick up - then a child or pet jumps on it. Will everyone remember to put contaminated items in a hard to open box? or do a tub clean cycle with bleach every time after the person's laundry is done? What if the quarantined person is the one whose job allows for food to come into the home at all and cannot afford to stay home?
If we have to allow home quarantine, I would love to see communities come together to donate needed items to the families affected... after all those who are quarantined are doing a public service for their neighbors.
I still think, though, that the best solution is to keep all risk in one state and not spread it around the country.
Also referring to your comment about handwashing before and after eating on a cruise ship, make sure you are extra vigilant washing your hands after using the bathroom so that you are not the one “donating” norovirus to the rest of the ship.
When my father was a child (in the 19-teens) he was thought to have possibly contracted polio and quarantine was begun. The area had separate family homes (and they had the first interior bathroom in town), so the entire family was quarantined at home. Food was delivered outside in baskets. At quarantined homes the grocer would ring a handbell when putting down groceries outside near a closer marked perimeter, then ring it again once past the further away general marked perimeter. All supplies came that way.
I got norovirus on a cruise ship, and know of people who got COVID-19 on a cruise ship. In addition to the close contact one has on board, there tend to be a lot of people on board who care only about themselves, and don't care what they pass on. My experience has been on what I would call mid-size ships, with about 1200 passengers.
As previously cautioned, hand sanitizer, even though with alcohol and especially those with benzalkonium are not sufficient to cleanse the hands of the norovirus contact. Soap and water to dissolve the viral envelope is what I understand. How many of these cruise ships have many hand sanitizer stations versus access to soap and water beyond one’s state room/cabin (I’m not familiar with the term since I have no interest in cruising). Even small packets of soap wipes plus rinse wipes might even help. (Think alcohol wipes or lens wipes, but not for handwashing purposes, of course).
As one who has cruised a lot, I can tell you that there is soap and water available in the public restrooms on board, so that's better than just in your cabin.
In regards to cruise travel and health risks related to “shared air”, may I suggest researching those lines which have, and advertise, individual cabin ventilation? My favourite lines do - Viking and Scenic - and I suspect that Emerald does too. Avoiding those floating city-sized monsters is also a useful point to watch, as is the passenger to crew ratio - the closer to one or greater, the better and more individualised service on board.
I would like to know more about the differences are between Andean hantavirus and the kind that exists in the SW US. I lived in NM for decades and the precautions and public health messaging changed a lot over that time.
I worked as an archaeologist and exposure to hantavirus was an occupational hazard. In the early 90s no precautions were taken when taking samples of desert rat midden;, a decade later (after 1998) everyone wore N95 masks and gloves. Now there are public health blasts occasionally about taking precautions when cleaning barns and storage areas. The culprit is dust + rodents. When people do get hantavirus it is usually children playing outside (in the desert.) It is rare, fortunately, but there are a couple cases every few years. (This kind is not known to be transmissible from person to person.)
If "Covid-19 airborne transmission likely accounted for more than half of disease spread on the ship" then wouldn't "the single best thing you can do" be to wear a mask on board to protect against COVID and other airborne viruses including hanta? Seems like washing your hands is only the second best thing to do.
Thanks for your ongoing work on this. Are we doing anything at all to fast-track a vaccine or anti-virals that might be used as prophylaxis? I understand there are some good candidates, including an mRNA vaccine and a drug approved in Japan for influenza - Favipiravir.
I'm happy to have never had an interest in cruise ships. I'll admit I've always viewed them as floating petri dishes — perhaps more harshly than they deserve, given that most onboard viruses amount to little more than a miserable week or two. Still, I'll pass.
It's naive to believe people will do the right thing... There are just too many slobs, pigs & germ-spreaders who were spreading/cross-contaminating Covid19 & KNOWINGLY killing people then bitching & moaning about "Gasp! Being controlled by the govt!/Being "forced" to stay home! Oh my! The horrors!" Instead of following basic cleanliness rules about CROSS-CONTAMINATION, BASIC PREVENTION HYGIENE TO SNEEZE/COUGH INTO THE ELBOW/NOT INTO THE AIR.... STAY HOME IF YOU'RE SICK, ETC. these morons continue to complain about "CONSPIRACIES" instead of realizing THEY ARE THE ONES THAT HELP KEEP PANDEMICS ALIVE & GOING STRONG! Germs & pathogens don't spread unless you help spread them!!!! (How about accountability with the slobs, pigs & morons who are more "terrified" about their wrinkles, a fat arse, body odor & gray hair.... than they are about dying from deadly pathogens?) MAKE EVERY STUDENT IN HIGH SCHOOL TAKE BASIC ZOONOTICS THEORY & LAB!
Thank you for this excellent summary! Could you please explain why it has been determined that the rodents who started this outbreak were not on the ship?
Interesting article and important perspective to consider provided by Josh Allen in the May 12th edition of The Atlantic re: “The Close, Prolonged Contact Myth”.
Thank you, Dr. Jetelina, for your somewhat reassuring comments on this Hantavirus outbreak. There are some reasons to believe this will not become the next pandemic. As a retired practicing MD, I know there's a need to reassure people and prevent panic. I also get your humanitarian take on allowing these people to quarantine at home. But this is a different situation than the 2018 Argentina one. Here we have exposed people going all over the place, with differing measures being taken to prevent spread. We may have a very different situation in terms of ability to contain it. We have seen photos of exposed folks taking off their masks and/or wearing less-than-ideal PPE. If they do that now, what will they do when they arrive at their homes? We also have less-than-stellar communication and health leadership (to put it mildly). I myself do not trust what comes from "official" sources. These people should be kept (comfortably) in the Nebraska facility until they are past the incubation period. (As for the ones who left the ship early, we can try to trust them and God - or a more benign viral behavior pattern - to contain this.)
My past experience trying to do home quarantine with a measles outbreak leads me to say leave them in Nebraska. Risk/benefit is too high on this one.
I tend to believe (hope?) that the case fatality rate of hantavirus is so high compared to measles, for example, that it dramatically changes health behavior. Thankfully, everyone is cooperating so far.
If you are talking about the patients in this case, they typically don’t have the level of knowledge (or see the world as “worse case scenario”) that public health officials have. And they weigh that perceived risk against loss of job/income, loss of friendships or romantic relationships. Fourteen days? Maybe. 30 days, not likely. Forty-two days? If I was betting on the prediction markets, I would say chance of completing the quarantine voluntarily is 0%.
Really great point. Well word is that a few people have confirmed they are going to stay in Nebraska for the whole quarantine. I think this sample of people may also be a bit different than the general population given the cruise they were on.
Are the individuals choosing whether they want to stay in quarantine or is the CDC deciding?
It is also worrisome that health precautions have become politicized after COVID. Otherwise intelligent people can feel angry and put upon by being asked to stick to logical precautions. I have a friend with cancer who wore a mask to pick up takeout outside a restaurant and was yelled at by a person for imposing PPE on others (the yelling was unprompted - the friend said nothing to the mean person about keeping distance or mask wearing).
I agree that it is too hard to quarantine at home effectively. Remembering for 42 days not to pat your dog - not likely. Leave dishes outside your room for a PPE protected family member to pick up - then a child or pet jumps on it. Will everyone remember to put contaminated items in a hard to open box? or do a tub clean cycle with bleach every time after the person's laundry is done? What if the quarantined person is the one whose job allows for food to come into the home at all and cannot afford to stay home?
If we have to allow home quarantine, I would love to see communities come together to donate needed items to the families affected... after all those who are quarantined are doing a public service for their neighbors.
I still think, though, that the best solution is to keep all risk in one state and not spread it around the country.
Also referring to your comment about handwashing before and after eating on a cruise ship, make sure you are extra vigilant washing your hands after using the bathroom so that you are not the one “donating” norovirus to the rest of the ship.
When my father was a child (in the 19-teens) he was thought to have possibly contracted polio and quarantine was begun. The area had separate family homes (and they had the first interior bathroom in town), so the entire family was quarantined at home. Food was delivered outside in baskets. At quarantined homes the grocer would ring a handbell when putting down groceries outside near a closer marked perimeter, then ring it again once past the further away general marked perimeter. All supplies came that way.
Thank you for an outstanding explanation of the current infectious disease landscape! Very, very helpful. :-))
I got norovirus on a cruise ship, and know of people who got COVID-19 on a cruise ship. In addition to the close contact one has on board, there tend to be a lot of people on board who care only about themselves, and don't care what they pass on. My experience has been on what I would call mid-size ships, with about 1200 passengers.
As previously cautioned, hand sanitizer, even though with alcohol and especially those with benzalkonium are not sufficient to cleanse the hands of the norovirus contact. Soap and water to dissolve the viral envelope is what I understand. How many of these cruise ships have many hand sanitizer stations versus access to soap and water beyond one’s state room/cabin (I’m not familiar with the term since I have no interest in cruising). Even small packets of soap wipes plus rinse wipes might even help. (Think alcohol wipes or lens wipes, but not for handwashing purposes, of course).
Addendum: wipes with Castile Soap for example.
As one who has cruised a lot, I can tell you that there is soap and water available in the public restrooms on board, so that's better than just in your cabin.
In regards to cruise travel and health risks related to “shared air”, may I suggest researching those lines which have, and advertise, individual cabin ventilation? My favourite lines do - Viking and Scenic - and I suspect that Emerald does too. Avoiding those floating city-sized monsters is also a useful point to watch, as is the passenger to crew ratio - the closer to one or greater, the better and more individualised service on board.
I would like to know more about the differences are between Andean hantavirus and the kind that exists in the SW US. I lived in NM for decades and the precautions and public health messaging changed a lot over that time.
I worked as an archaeologist and exposure to hantavirus was an occupational hazard. In the early 90s no precautions were taken when taking samples of desert rat midden;, a decade later (after 1998) everyone wore N95 masks and gloves. Now there are public health blasts occasionally about taking precautions when cleaning barns and storage areas. The culprit is dust + rodents. When people do get hantavirus it is usually children playing outside (in the desert.) It is rare, fortunately, but there are a couple cases every few years. (This kind is not known to be transmissible from person to person.)
If "Covid-19 airborne transmission likely accounted for more than half of disease spread on the ship" then wouldn't "the single best thing you can do" be to wear a mask on board to protect against COVID and other airborne viruses including hanta? Seems like washing your hands is only the second best thing to do.
Thanks for your ongoing work on this. Are we doing anything at all to fast-track a vaccine or anti-virals that might be used as prophylaxis? I understand there are some good candidates, including an mRNA vaccine and a drug approved in Japan for influenza - Favipiravir.
I'm happy to have never had an interest in cruise ships. I'll admit I've always viewed them as floating petri dishes — perhaps more harshly than they deserve, given that most onboard viruses amount to little more than a miserable week or two. Still, I'll pass.
Dr Jetelina,
Would you comment on this The Atlantic article, please. Thank you.
https://www.theatlantic.com/ideas/2026/05/hantavirus-outbreak-cruise-ship/687140/?gift=xCzDungx91ZpD68UyiDkU4p_WTwuHoquiH0i6TlMRE0&utm_source=copy-link&utm_medium=social&utm_campaign=share
It's naive to believe people will do the right thing... There are just too many slobs, pigs & germ-spreaders who were spreading/cross-contaminating Covid19 & KNOWINGLY killing people then bitching & moaning about "Gasp! Being controlled by the govt!/Being "forced" to stay home! Oh my! The horrors!" Instead of following basic cleanliness rules about CROSS-CONTAMINATION, BASIC PREVENTION HYGIENE TO SNEEZE/COUGH INTO THE ELBOW/NOT INTO THE AIR.... STAY HOME IF YOU'RE SICK, ETC. these morons continue to complain about "CONSPIRACIES" instead of realizing THEY ARE THE ONES THAT HELP KEEP PANDEMICS ALIVE & GOING STRONG! Germs & pathogens don't spread unless you help spread them!!!! (How about accountability with the slobs, pigs & morons who are more "terrified" about their wrinkles, a fat arse, body odor & gray hair.... than they are about dying from deadly pathogens?) MAKE EVERY STUDENT IN HIGH SCHOOL TAKE BASIC ZOONOTICS THEORY & LAB!
Thank you for this excellent summary! Could you please explain why it has been determined that the rodents who started this outbreak were not on the ship?
Interesting article and important perspective to consider provided by Josh Allen in the May 12th edition of The Atlantic re: “The Close, Prolonged Contact Myth”.