Where should hantavirus cruise ship passengers quarantine? Experts are divided

Eighteen Americans are now in quarantine in two federal centers after having returned home from the MV Hondius cruise ship.

How long they’ll stay in quarantine or where isn’t clear yet. Now that the passengers have had time to rest up, U.S. health officials are interviewing them to get a better sense of how close the American passengers may have been to infected people — and whether they have the resources, such as separate rooms, to quarantine safely at home.

“We want to do this in the least restrictive way possible,” Dr. Brendan Jackson, acting director of the high-consequence pathogens and pathology division at the Centers for Disease Control and Prevention, said at a media briefing Monday.

It can take up to 42 days after exposure to the virus for symptoms to appear. If passengers are allowed to leave the federal quarantine centers and stay home instead, they would need to be symptom-free. They’d also need to check in with local health officials regularly, Jackson said.

The Andes strain is the only hantavirus that can spread from person to person. While there are some reports of people’s catching it through casual contact, most scientists that say it doesn’t spread easily and that there’s no clear proof that people are contagious before they have symptoms.

“We have no evidence of sustained community transmission outside of close contact settings, no evidence of efficient airborne spread in public spaces and no recommendation for general travel restrictions,” Dr. Bobbi S. Pritt, chair of the division of clinical microbiology at the Mayo Clinic, said Tuesday at a briefing by the College of American Pathologists.

Eleven cases of hantavirus are reported among the nearly 150 passengers. Three people have died.

Sixteen of the 18 Americans are at the National Quarantine Center in Omaha, Nebraska. Two are in a quarantine facility at Emory University in Atlanta. One of the quarantined people in Atlanta has had mild symptoms but tested negative for hantavirus. None of the other passengers in Omaha or Atlanta have tested positive.

Dr. Michael Mina, an epidemiologist and former professor of immunology and infectious diseases at the Harvard T.H. 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 prevent one fatality, that’s worth quarantining the whole ship,” Mina said.

An ambulance and shuttle buses take U.S. passengers from the MV Hondius to the University of Nebraska Medical Center Davis Global Center in Omaha on Monday.Nikos Frazier / Omaha World-Herald via Getty Images

More Andes cases are expected

Dr. Abraar Karan, an infectious disease physician at Stanford Medicine, said having passengers quarantine at home “opens up unnecessary risks.”

“What happens if they go home to quarantine and they start to get sick? Now you have to transport them to a center that has a biocontainment unit, which very few do,” Karan said. “Having people go back home doesn’t seem to make very much sense.”

World Health Organization Director-General Tedros Adhanom Ghebreyesus has already acknowledged that additional cases could occur, given the virus’ long incubation period.

“It’s possible we will see more cases within the next few weeks,” he said at a media briefing. The WHO recommends that people who quarantine at home remain separated from family members in different rooms. If a physical interaction with another person is necessary, passengers from the ship should wear N95 respirators.

How other countries are handling quarantines

Zimbabwe’s health ministry said its citizens from the cruise ship will “remain together in a designated private isolation facility during the quarantine period.”

Health officials in the United Kingdom and the Netherlands, however, said some passengers may isolate themselves at home as long as they can do so safely.

Katelyn Jetelina, an epidemiologist who tracks illnesses 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 and humanitarian response.”

The passengers “were in international waters and living in a nightmare for more than a month. There’s a real psychological toll to that,” Jetelina said. “I think the best option is the least restrictive approach that still keeps communities safe.”

At least seven Americans who previously got off the ship are said to be quarantining at home in multiple states, where health departments have said they are in regular contact with passengers to help them monitor for symptoms.

It’s possible that quarantine guidance for the 18 passengers could change in the coming days.

Dr. Mara Jana Broadhurst, medical director for the Nebraska Biocontainment Unit Laboratory, said her team and U.S. health officials are trying to “strike a balance” between monitoring the passengers in the facilities and monitoring at home.

Recommendations for quarantine are “based on what we understand about the incubation period,” Broadhurst said at the pathologists briefing Tuesday. “The use of facilities here in Omaha will be available for that duration of the incubation period.”

UNMC’s quarantine rooms are set up to feel more like a hotel than a hospital, with exercise equipment and the ability to order out for 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 has had no symptoms of hantavirus. “I’m happy to be in a place where I know we are well cared for and, if anything happens, we have the medical attention that we need.”