Hantavirus is not Covid-19, but ‘calm-mongering’ risks triggering post-Covid anxiety
By Brenda Goodman, CNN
(CNN) — Since the first sign of an outbreak, the reminders have come from government officials, health agencies and plenty of experts: There’s no reason to worry. Don’t panic. It’s under control.
“We have this under control, and we’re not worried about it,” US Health and Human Services Secretary Robert F. Kennedy Jr. said at a briefing Monday when asked about the hantavirus outbreak that has moved from cruise ship to quarantine.
“The thing about this one,” President Donald Trump said in the same briefing, “it’s much harder to catch. It’s been around for a long time. People are very familiar with it. I hope it’s fine.”
In a society with still-fresh memories of the loss and disruptions of the Covid-19 pandemic, federal and state officials have repeatedly assured the public that the hantavirus – even the Andes strain, which can be transmitted from person to person – is not the menace the world was facing six years ago.
It’s true that it’s no Covid. Although the illness the Andes virus causes can be serious and even deadly, it’s not as contagious as measles or even the flu, which means it may be contained more easily. Officials also point out that Covid was a brand-new virus, while this one is not. Knowledge of the Andes virus is limited, but it has been studied in outbreak settings before.
More cases are expected to be identified, but both the US Centers for Disease Control and Prevention and the World Health Organization say the risk to the general public remains low.
Still, some health experts say that at points, the messaging has been overly confident and too willing to dismiss the possibility of a threat. Statements meant to quell anxiety instead risk undermining trust if they later turn out not to be true.
There’s a difficult balance, too, in trying to keep it simple and ending up too vague.
Late Sunday, after the return of 18 passengers from the cruise ship MV Hondius to the United States, HHS announced that one person had tested “mildly PCR positive” for the Andes strain of hantavirus.
That phrasing launched a barrage of criticism.
“Fortunately, the receiving facility is equipped to handle this. But whoever wrote that someone tested ‘mildly positive’ is an idiot,” wrote Dr. Jeremy Faust, an ER doctor at Brigham and Women’s Hospital in Boston and editor of the doctor-focused news site MedPage Today. “They have it.”
On Monday, the CDC’s Dr. Brendan Jackson explained in a news briefing that the person had two tests before arriving in the United States: one positive, one negative. Follow-up testing will help doctors make a more definitive diagnosis, he said.
Even so, to some, it exemplified the communications problems around the hantavirus outbreak.
“What does ‘mildly PCR positive’ mean? Symptomatic or not? Confirmed or suspected? What testing was done? Clear, precise public health communication matters,” said Dr. Krutika Kuppalli, an infectious disease expert at UT Southwestern Medical Center who has also worked as a medical officer for the World Health Organization, on social media. “This is another example of the leadership void we are seeing and when messaging is vague, misinformation fills the gaps.”
Confident or ‘calm-mongering’?
Dr. David Berger, an Australian physician who was once the ship’s doctor on an Oceanwide Expeditions cruise, the same operator the MV Hondius, says this was a communications lesson that health officials should have learned after the early days of Covid, when so many statements turned out to be incorrect or in flux.
He pointed to assurances from WHO last week about the effectiveness of control measures on the cruise ship.
“We haven’t seen further onward spread. … Once those control measures were put in place, the control is effective,” Nyka Alexander, manager of health emergencies communication at WHO, told Sky News.
“Well, maybe they are, but you’ve got a condition with an incubation period that appears to be up to six to eight weeks,” Berger said, noting that any control measures are going to look effective in the first few days of a hantavirus outbreak because it takes so long to show symptoms.
“When you’ve known about this situation for four or five days, you can’t then go and say, ‘Oh, yes, all the measures are effective.’ … Any informed observer looks at that and goes, ‘Well, you’re just bullshitting, because you can’t absolutely say that,’ ” he added.
Berger cites this as an example of what he and others have called “calm-mongering.”
Dr. Peter Sandman, who was a professor at Rutgers University for almost two decades and is one of the founding fathers of the field of crisis and risk communication, said that to be effective now, health officials first need to earn the right to explain why this hantavirus outbreak isn’t Covid.
“Every reassuring message should have a verbal asterisk: ‘We don’t know as much about hantaviruses as we wish we did,’” Sandman said in an email to CNN.
Health communicators would be wise to start every news conference by acknowledging that this feels like Covid redux, he said. “Mention a few ways it echoes Covid and agree that people are wise to be a bit skeptical about official ‘nothing to worry about’ messaging,” Sandman wrote.
Then acknowledge the uncertainty and describe the decision-making process. For example, “’We’re thinking about worst case scenarios, checking and double-checking to make sure we still think this is a big deal only if you were on that ship or came into close contact with someone who was,’” Sandman wrote.
One point public health officials have repeatedly emphasized is that hantavirus normally infects people who come into contact with urine or droppings from infected rats. It doesn’t normally spread from person to person, except in the case of the Andes strain, which is what was spreading on the cruise ship.
Even then, WHO Director-General Dr. Tedros Adhanom Ghebreyesus said Thursday that transmission between humans has been limited to situations where people have been in “close and prolonged contact” such as intimate partners, household members and people providing medical care.
In a briefing the same day hosted by the Infectious Disease Society of America, CEO Dr. Jeanne Marrazzo, an infectious disease expert who headed the National Institute of Allergy and Infectious Diseases, pushed back on that kind of certainty.
“This whole issue of transmissibility, we have to emphasize what we know might change tomorrow” or even in an hour, Marrazzo said. “We really have to have humility here in terms of making pronouncements about definitive routes and percentages and transmission in particular, because this is changing very rapidly.
“We’re going to learn a lot from this outbreak – unfortunately, at the cost of lives – but we really need to sort of approach this cautiously in terms of giving people advice and coming up with some policies,” she added.
In a detailed study of a 2018 outbreak of Andes virus in Argentina, published in the New England Journal of Medicine, there were documented cases in which people were infected after only brief interactions. In one instance, a person was infected after saying a quick hello to a symptomatic person on their way to the restroom at a birthday party.
Dr. Stephen Kornfeld, an Oregon physician who took over on the Hondius as the ship’s doctor after the previous physician got sick, has said that while some passengers were infected after close, prolonged contact, others spent time with infected people only in communal spaces like the dining hall and a lecture area.
Dr. Joseph Allen, a professor of exposure science and environmental health at Harvard University, said that getting the messaging wrong on the virus’ spread could prolong the outbreak.
“If we get this wrong, those in quarantine take the wrong precautions (or we don’t isolate them…) and the spread continues,” Allen posted on X.
Hearing the echoes of Covid
It’s easy to understand the urge to use to reassure. This almost certainly won’t become the global health emergency that Covid was. Outbreaks are magnified in confined spaces, like cruise ships and airplanes. Transmission dynamics onboard ships are bound to be more intense than they would be elsewhere. The long incubation period – the time between when a person is exposed and when they get sick, which can be up to two months with the Andes virus – should help interrupt transmission, too.
“What makes Covid and flu spread so quickly is that they have such a short incubation period,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University’s School of Public Health. The incubation period for the flu is one to four days; for Covid, it’s two to 14 days.
“When you have a very short incubation period, it just becomes harder to intervene between generations of cases,” Nuzzo said. On the other hand, a long incubation period “does give you a little bit more of a runway to try to find somebody who may have been exposed and make sure that you get to them before they develop symptoms,” she added.
But the echoes of Covid will be hard for health officials to escape.
“I think we’re definitely in a post-covid fatigue moment,” said Dr. Traci Hong, a professor of media science at Boston University’s College of Communication. On her social media feeds, she sees headlines referring to the “rat virus” and decrying “calm-mongering.”
“And there is this real sort of tug of war,” Hong said. “You don’t want to frighten people.”
It’s not just messaging in the moment that’s needed.
“I think there is a lot of hard work where we have to communicate to the public that science isn’t certainty. Science lives on uncertainty, but people aren’t accustomed to that,” she said.
“I think it’s a harder lift. It’s not just messaging today. It’s really teaching the public to recognize that ‘this is what we know now, and we all have to stay aware and be prepared that there might be a new update,’” Hong said. “That’s a possibility we need to live in.”
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