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The outbreak of hantavirus on the Dutch cruise ship MV Hondius illuminates major gaps in the US public health system – a worrying sign for stopping this outbreak quickly and preparing for a potential pandemic of a more widespread pathogen in coming years, experts say.

Passengers and their close contacts are at risk of hantavirus and need to follow public health guidance, but the danger for most people is near zero, officials and scientists say. Experts expect more cases in this outbreak to be identified, but they are emphatic that a hantavirus pandemic is highly unlikely.

“This is not Covid, this is not influenza. It spreads very, very differently,” Maria Van Kerkhove, director of epidemic and pandemic management at the World Health Organization (WHO), said at a briefing on Thursday. “This is not the same situation we were in six years ago … It’s very different.”

The WHO has been coordinating a response with several countries. But Trump pulled out of the organization soon after taking office, and US leadership has been conspicuously absent in the global hantavirus response, experts say.

While not a virus with pandemic potential, hantavirus is a warning sign that reveals how cuts to US capacity have severely limited the ability of officials and scientists to track and understand pathogens like these, with troubling implications for rare outbreaks and for pandemic preparedness writ large.

There are now three suspected and five confirmed cases of Andes virus, a type of hantavirus that can sometimes spread with close, intimate contact but is typically spread by rodents. Three people have died, and three have been hospitalized, including in intensive care – though those patients are showing signs of improving, officials said on Thursday. One of the patients, a Dutch flight attendant, has tested negative for Andes virus, according to Inside Medicine.

The risk to global health

“My personal worry is essentially zero,” said Bill Hanage, professor of epidemiology at the Harvard TH Chan School of Public Health. “The vast majority of the world has absolutely no worry at all … What they should be doing is paying attention to public health officials and acting appropriately if they are told their risk happens to be higher.”

Hanage is concerned that health leadership cuts, growing misinformation, and distrust of public health measures could complicate that process and contribute to some onward transmission.

In the absence of trusted information, misinformation about the outbreak is swirling – including fears of another pandemic. The “radio silence” from officials is one of the most concerning parts of the outbreak for Boghuma Titanji, an infectious disease physician and assistant professor at the Emory School of Medicine, because “it just fuels the public anxiety”, she said. “People are still reeling from the trauma that was Covid-19, and a lot of people who experienced that still have a degree of PTSD. So it’s very hard to not spiral.”

The US Centers for Disease Control and Prevention (CDC) has not held a briefing or created a resource page for the public concerning the hantavirus; top officials haven’t gone on TV shows and held interviews about the risk to the American public. That is a significant departure from how the US typically communicates about an outbreak like this, Titanji said. Two Dutch physicians and an infectious disease expert were deployed by the European Centre for Disease Prevention and Control to provide medical and psychosocial support on the cruise ship.

“A [US] CDC crew would have been with them, or at least been offered. Now they’re nowhere to be found,” Titanji said.

The US Department of State is now leading the US response, according to the first and only CDC press release on the issue, sent on Wednesday evening after days of no guidance. State officials are engaged in “direct contact” with passengers, diplomacy, and coordination with domestic and global health officials, the short announcement said. That move is highly unusual, Titanji said. Typically the CDC, with decades of experience responding to Andes virus outbreaks, would take the lead on health coordination.

“CDC is aware of the reports of hantavirus on a cruise ship and is providing technical input and guidance as requested,” a CDC official said. The CDC did not grant the Guardian’s request to speak with an agency hantavirus expert and did not respond to questions about whether the agency has testing and laboratory capacity for hantavirus, what precautions passengers have been advised to take upon their return, and how the agency plans to support local health providers and officials if they encounter hantavirus patients.

When it comes to rare diseases that a physician might only encounter once or twice in their career, the first step is usually to call the CDC for advice on how to test and diagnose and how to contain further transmission, Titanji said. “We’re losing that type of support.”

Public health in the US under Trump

US health agencies have suffered body blows under Trump. Agencies are hollowed out after staff were laid off and fired, with some driven to quit; key posts are left vacant. All of the full-time cruise ship inspectors with the CDC were unexpectedly laid off last year while the teams were actively investigating two outbreaks. Research, especially the kind of virological work that might illuminate hantavirus transmission, has been heavily politicized and slashed. Funding for the rapid development of new vaccines has been halted while misinformation about vaccines flourishes.

Laboratory staff have been gutted, and it’s not clear if the US has tests and laboratory capacity for hantaviruses. States cannot send samples to the CDC for orthopoxvirus testing – like mpox – because that division has been temporarily paused, and labs can no longer test to see which parasite is causing leishmaniasis, Titanji said. In April, rabies testing at the CDC was also temporarily halted.

Research on virology itself has come under intensely politicized scrutiny and limitations. The White House issued an executive order to curb research on viruses in May, and the National Institutes of Health made sweeping cuts to this work. Lawmakers have also introduced bills to cut what they have loosely termed “gain of function” research. The scientific consensus on the origins of Sars-CoV-2 points strongly to a spillover from animals into people, yet officials continue investigating a lab leak scenario, which means scientists are facing subpoenas, arrests and prosecution.

“We should be investing in doing more to understand how these spillover events take place – and that’s actually the very opposite of what’s going on at the moment,” Hanage said.

The damage isn’t only at the federal level. More than half of US states passed laws to restrict health officials’ ability to require quarantine and isolation or recommend masks; some schools are being prevented from requiring some vaccines for attendance and are forbidden from shutting down during another health crisis.

Seeing the response to an outbreak of hantavirus, which is not considered a high-consequence virus, is disconcerting, Titanji said. “If we had a significant outbreak of a high-consequence pathogen, it would be very, very concerning to see what the response and the leadership of that response would be.”

The WHO is narrowing in on human-to-human transmission in this outbreak, but the spread is still very limited to those who had very close contact with patients. In late 2018 and early 2019, there was a similar outbreak in Argentina, when 34 people ultimately tested positive and 11 died. “We believe that’s happening” in this case as well, with transmission from the first two patients to close contacts, including the doctor who treated them on the cruise ship, Van Kerkhove said.

“If we follow public health measures and the lesson we learned from Argentina now is shared across all countries – what needs to happen in contact tracing, isolation – we can break this chain of transmission,” said Abdirahman Mahamud, infection prevention control specialist at WHO.

That kind of outbreak investigation is how the patient in Switzerland was identified, Van Kerkhove said. “This is actually public health action in the works.”

Passengers from 12 countries, including the US, disembarked from the ship before the outbreak was discovered and have now returned home. Following up with these individuals – and, if they were ill while they traveled, others they may have encountered – is critical work, Hanage said. “It’s very important to be doing some extremely aggressive contact tracing of everybody who left the boat, and they should be quarantined,” he said. It may be more complicated than the measures that worked in Argentina, he said, because “we have multiple authorities and multiple jurisdictions, which means that it may take more time to coordinate an adequate response”.

Given misinformation and mistrust in officials in the US, “it remains to be seen” how closely people will follow health guidance – and how willing authorities will be to implement it following the Covid backlash, Hanage said. “Everything that we know about both this outbreak and previous ones indicates that this is controllable, and I expect that it will be controlled. How long it will take to be controlled is another question. The appetite for that control will be a major part in deciding how easily it’s done and how long it ultimately takes.”

While the US is withdrawn from the WHO, it has not yet withdrawn from the International Health Regulations (IHR), which means officials are still receiving all the latest technical information. “In terms of collaboration with US and US institutions, it has been going very well,” Mahamud said. “The information flow is there, transparent and frank.” But, he added, “this outbreak has seen why the world needs a global entity that coordinates” the response.

“This is what makes a platform like WHO very, very important,” said Tedros Adhanom Ghebreyesus, director-general of the WHO, who expressed hope that the US and Argentina will “reconsider” decisions to leave the organization. “Any vacuum, any space which is not covered, actually gives advantage to the virus. And the best immunity we have is solidarity.”