The fourth thing to know is that transmission does not appear to happen as easily as with other respiratory viruses but that it also doesn’t seem to require an enormous amount of close contact. From the 2018 to ’19 outbreak, we have evidence of several cases arising when an infected partygoer merely sat a few feet away from or briefly greeted other guests, and the precise dynamics of transmission are not perfectly understood. In such situations, Paul Sax wrote this week in The New England Journal of Medicine’s Voices blog, the temptation is to be categorical and unequivocal in issuing guidance rather than acknowledge what is uncertain — and what, as a result, is possible.
And the fifth point to emphasize is that on each of the first four points, public messaging has been at least confused, often misleading and in many ways counterproductive in this initial window. “In any outbreak, the single most important question is: How does it spread?” Harvard’s Joseph Allen wrote in The Atlantic on Tuesday. Hantavirus is not new or unknown, and neither is this strain. But the W.H.O. issued its first piece of guidance about the outbreak on May 4, three weeks after the first patient died, and was not able to offer a clear or comprehensive answer to that question.
Over the weekend, the W.H.O. suggested that not all passengers should be treated as high-risk candidates for infection. It did not recommend that all passengers be quarantined upon leaving the ship and did not offer a strong framework for member countries, with the result that different countries have adopted markedly different protocols — and have already begun shifting them. In Britain, hospital workers don’t appear to be working with up-to-date guidance about the way the disease spreads. In the Netherlands, health care workers have made errors in protocol handling blood draws and urine disposal.
In the United States, for instance, only two passengers have been placed in hospital biocontainment units, and asymptomatic Americans returning from the cruise ship are apparently being given the option to isolate and self-monitor at home if they remain asymptomatic. There is a kind of vacuum of public-health leadership in America at the moment, with Marty Makary resigning as the Food and Drug Administration commissioner on Tuesday and no permanent head of the Centers for Disease Control and Prevention or surgeon general in place. And over the weekend, Dr. Jay Bhattacharya — the head of the National Institutes of Health and the acting head of the C.D.C. — suggested that no new protocols were necessary to prevent the spread of the disease. Perhaps it should not surprise us. It was just this past fall that he was arguing that the country should scrap its pandemic playbook, declaring that “the best pandemic preparedness playbook for the United States is making America healthy again.”
But it’s not just ideologically driven Americans who seem focused on downplaying risks, even at the cost of enabling further spread. In their presentations over the past week, world health leaders characterized the disease in such incomplete terms that the International Hantavirus Society was compelled to publish a corrective, challenging prevailing guidance about transmission before symptom onset, the long incubation period and the required proximity to pass the disease from one person to another. The W.H.O. has since modified some of that guidance, but on Sunday it defended passengers who had failed to properly wear masks. “Many of these passengers are elderly, and you can imagine how uncomfortable it could be,” the director general of the W.H.O. said, as though the discomfort of 150 passengers should override worries about the spread of an essentially untreatable and terrifyingly lethal disease.
