Chapter 1: What recent hantavirus cases have been reported?
First though, the UK Health Security Agency this morning said that a new suspected case of Hantavirus in a British national has been reported. The new case was reported on Tristan da Cunha in St Helena where passengers on the cruise ship had disembarked last month. Two other British nationals are already confirmed cases of Hantavirus.
Health authorities are currently racing to trace dozens of people who also recently disembarked from the Dutch vessel MV Hondias. Dr Ian Norton is Managing Director of Respond Global. He was also head of the World Health Organisation's Emergency Medical Team Initiative where he led responses to the Ebola, diphtheria and measles outbreaks in various countries.
He also advises several cruise lines on their health and safety protocols. Good morning, Ian. Lots of talk this morning about confirmed and suspected cases, contact tracing and isolation, bringing back a lot of bad memories to a lot of people.
It is. It's different, as the WHO said yesterday. At least I suppose we now understand what those words mean to some extent.
Yeah. Now, you, as I said in the introduction, you've extensive experience of managing health crises of various sorts for the WHO. This situation where we have an outbreak, a cluster of hantavirus cases on a ship, how unusual is this?
Yeah, this is super unusual. It's probably one of our Worst case scenarios with a dangerous disease, high mortality rate, requires a lot of intensive care if you catch it. And we don't know enough about this particular strain as to really... no hands transmitted for sure.
So we'll have to be very careful with the way personal protective equipment is worn and particularly how we look after the staff and the crew as well as the passengers on board.
Yeah, I mean, it doesn't bear thinking about those poor people, both staff and passengers on that ship. Given your experience of how these things work, how do you think they'll be able to manage in a situation like this?
Yeah, we had to run a few of these during COVID. Of the first big three cruise ships, I managed two of them in San Francisco and also in Sydney. And it's very tough. We have to create a sort of green zone on a certain deck. So there will be an area which is considered safe, as it were, where the crew members are having to go door to door and check on each passenger in their rooms.
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Chapter 2: How does Dr. Ian Norton describe the unusual outbreak on a cruise ship?
Certainly, St Helena has limited medical care out there on that island, so if anybody does show positive signs, then they will need to be medevaced somewhere with higher level of care. But once we know who's on the list, now finding that this person has gone positive is actually a sign that surveillance is working. So in a way, I'm more reassured by that.
Okay. And the Andy strain, obviously the key thing about it, unlike other variants of antivirus, it can be transmitted from person to person. But I think from what I've heard, and you'll correct me if I'm wrong, it's not particularly efficient at passing from human to human.
Correct. Yes, absolutely. And this is why you're seeing, you know, effectively pouring cold water on the Adalas to become an epidemic or a large outbreak because it doesn't usually transmit. In these cases, it has. But once we know, even with Ebola, once we know where the cluster was, and we know the context or even the context of the context, that's sort of the second tier.
If we have control of that, then we can get on top of this. It's in the initial phase, if we didn't know what this disease was, or if these people were scattering to the wind and we didn't know where each one was, then we'd have a bigger problem. But if, you know, passenger manifests, especially on these kind of ships, are very, very robust.
OK. And I mean, you mentioned Ebola and your experience in dealing with Ebola outbreaks, which is far more transmissible than something like this. And your experience would suggest that if you get on top of it in time, it can be controlled. Anything can be controlled.
Yeah, absolutely. Yes. No, we I mean, higher case fatality, 50 or 60 percent in Ebola cases. This one's 30% to 40%. You know, Ebola also is relatively difficult to catch. It is person-to-person contact, doesn't get aerosolized. Not really sure for the NDs yet whether there is any element of that. But certainly as long as we give these crew members, I mean, remember they're not medically trained.
They've done a first aid course perhaps with some of their marine tickets, some of that many, many years ago. And there'll be one poor doctor really having the worst weeks of their, his or her life at the moment out on that ship. So I do feel for them.
Yeah, absolutely. The other aspect of the Andes variant is the incubation period, which seems to be quite long.
It is. That's going to be the tough part. I mean, I'm thinking of the two Irish citizens coming home hopefully soon. They will, you know, right out to eight weeks. So that's an incredibly long period, certainly in Ebola. After 21 days, COVID, we used to use about 14, and then it gradually shrunk from there. But eight weeks, that's incredibly long. Very tough. And also...
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Chapter 3: What challenges do health authorities face in managing the outbreak?
When we get these outbreaks, learning from each other is really part of this. Norovirus is much more common. Gastroenteritis, running through a ship. Those are things that people have dealt with a long time. But these kind of ones, this is tough. And now the question will be, do we carry extra bales of PPE, of masks and gloves on every single ship? You know, how far do you go?
Yeah. I suppose just to circle back to something you were saying earlier about this isn't COVID. The WHO was at pains yesterday to reassure people that this is not the start of a pandemic. This is not the same situation that we had with COVID-19 yesterday. What is it now, six years ago? But obviously people are still worried.
This is getting a lot of media attention to which we are obviously contributing. But you really just want to let listeners know that they do not need to be worried. Is that right?
Absolutely. As long as we know who were contacts of these poor patients, we have control of this. This is the key thing. There is nothing to fear. As long as people home isolate, manage their symptoms, and the moment they have symptoms, they get tested and see if they're positive.
It's when we lack that control, we don't know enough about the disease, for example, or we don't know where everybody's gone, that's when we should worry. And that is not the case here. So I definitely would reassure people. And I do feel for the company and the people involved as well, it's become almost a sideshow.
And it's good to highlight outbreak preparedness and things, but I think in some cases it goes a little far. And I reassure everybody, this is not going to become an epidemic or a pandemic.
OK, Dr Ian Norton, thank you for that reassurance. Ian Norton, Managing Director of Respond Global, former head of the WHO's Emergency Medical Team Initiative. Thank you very much indeed for joining us this morning.
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