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Five passengers from the hantavirus cruise ship have been allowed to leave a secure quarantine facility in Nebraska and continue being monitored at home, but 13 others remain at the secure facility, the U.S. Department of Health and Human Services told Healthbeat on Monday.
At least two of those released to home quarantine on Monday will be under around-the-clock monitoring and have been put under an official quarantine order, New York officials said.
Multiple media outlets have reported that federal officials had wanted to require that state health departments ensure a police officer or public health worker was stationed 24/7 outside each of the individuals’ homes. That is an unusual step that may stigmatize people who have shown no signs of infection.
Officials at HHS and the Centers for Disease Control and Prevention did not answer questions about why some passengers are being allowed to leave the facility after 21 days of a 42-day quarantine or why others are remaining inside a secure, institutionalized setting. Nor have they provided any public health or scientific basis for how potential risks from former passengers of the M/V Hondius are being managed.
The lack of transparency and inconsistency in the federal government’s approach to managing potential public health risks in the wake of a deadly outbreak of Andes hantavirus is drawing concern from legal experts and public health officials.
Testing so far has not found any of the U.S. passengers being held in quarantine to be infected with the virus.
“The administration is being quite secretive and arbitrary in its use of quarantine powers,” said Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University.
“Quarantining a person is a massive infringement of civil liberties and must be done using a clear and science-based process,” Gostin said Monday. “I do not think the administration is acting in a transparent or rational fashion.”
The 18 U.S. passengers from the cruise ship were evacuated last month to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha after three people who had been aboard an international nature cruise died from severe respiratory illness caused by an unusual type of hantavirus that has the potential for “limited” spread between people.
So far, health officials in multiple countries have identified 10 additional cases of Andes hantavirus among people who were among the nearly 150 passengers and crew aboard the ship, according to the World Health Organization’s latest update on May 28.
It’s unclear what the terms and conditions are for the five U.S. passengers who on Monday were allowed to leave the Nebraska facility, and whether federal health officials have issued any new or renewed federal quarantine orders to force any of the other passengers to remain in the facility.
Neither HHS nor the CDC would say. Officials at the University of Nebraska Medical Center also did not answer questions from Healthbeat.
“All five remain symptom-free and have met public health criteria to safely continue monitoring outside the NQU,” HHS said in an email to Healthbeat. The department did not respond to questions about what those criteria were.
The five people being released to home quarantine will not travel on any commercial flights, HHS said. The department said “appropriate biocontainment measures are in place during transport,” but no details were released.
Once these five people are home, HHS said that state health departments will continue “daily symptom monitoring, maintain 24/7 oversight, and provide guidance throughout the remainder of the 42-day monitoring period.”
HHS officials did not answer questions about how the monitoring and oversight would be carried out.
“CDC encourages the public to support the people and families affected by this situation,” HHS said. “Public health monitoring is a precautionary measure that helps safeguard the health of potentially exposed individuals and protect communities.”
Two of the passengers beginning home quarantine have returned to their private residences in undisclosed locations outside of New York City, Dr. James McDonald, New York state health commissioner, said in a statement Monday afternoon. He said they will remain under “around-the-clock surveillance” and under a quarantine order.
A third New York passenger has chosen to complete the remaining 21 days of their quarantine in Nebraska, McDonald said.
Another Hondius passenger who has chosen to stay at the Nebraska facility is Jake Rosmarin, an Instagram content creator who switched from documenting sightseeing aboard the ship to documenting his time in quarantine.
“This whole experience has totally traumatized me,” Rosmarin said in a video posted Sunday to his Instagram account explaining why he’s choosing to stay at the National Quarantine Unit. “I’m afraid to leave this room until I know that I will not get sick. I do not want to leave here until I know that there is a 0% chance of me getting sick, a 0% chance of me risking my family and friends getting sick, or the general public getting sick.”
He said he also wants to be at a facility that can quickly treat him should he develop any symptoms of Andes virus before the quarantine period ends.
Rosmarin said the process that federal officials have set up to allow some Hondius passengers to leave the facility is complex and involves federal, state, and local authorities.
“The media is making it out to be much simpler than it actually is logistically to get people home to self isolate,” he said. “It is a really complicated process, and there’s a lot of factions that have to agree upon us going home to make that work.”
HHS noted that no cases of Andes virus have been confirmed in the United States. The risk to the public remains low, officials said.
The Andes virus is typically spread by rodents in South America, but has in some cases been able to spread from one infected person to another, according to the CDC. But this person-to-person spread usually requires close contact, such as having direct physical contact with the sick person, spending “prolonged” time in close or enclosed spaces, or being exposed to the infected person’s body fluids.
It can take between four and 42 days from when a person is exposed to the virus to when they start showing symptoms, such as fatigue, fever, achy muscles. People who are infected can become seriously ill with Hantavirus Pulmonary Syndrome. There is no specific treatment or vaccine. For those who are sickened, medical care focuses on managing symptoms.
Last month, the CDC issued federal quarantine orders to two of the 18 people being monitored at the Nebraska facility. Those orders were based on a disease list that does not include hantavirus.
The passengers had initially been “requested” to stay at the facility for testing and monitoring through May 31. When two of them began making arrangements to leave and quarantine at home, the CDC issued two federal quarantine orders against them, requiring that they stay in the facility.
CDC and HHS officials did not answer Healthbeat’s questions about the status of these quarantine orders.
Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health, called the approach to managing the U.S. passengers’ risk unusual and concerning.
“Every American should be concerned about the somewhat quixotic and a bit arbitrary approach that they have taken in dealing with these passengers,” Nuzzo said.
Nuzzo noted that some passengers who disembarked the Hondius cruise ship after the first passengers died but before health officials were aware of an outbreak, have been allowed to quarantine at home since their return to the United States.
“To tell some passengers you can’t leave Nebraska, and to tell other passengers it’s okay to be home, that doesn’t make any sense. There’s no public health rationale for that,” she said.
She also questioned why the federal quarantine orders were issued last month to two of the patients who sought to quarantine at home.
“I have not heard a single assertion that these patients don’t want to quarantine,” Nuzzo said.
“The general public health practice, the ethical practice, the historical practice is we impose measures by the least restrictive means necessary,” Nuzzo said. “Quarantining in facilities is not typical, and only done under extreme cases, usually because someone has refused to comply with other measures.”
Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48
