Wait. Wait some more. Keep waiting.
More than a dozen American cruise passengers returned to the U.S. Monday and went straight to a quarantine facility at the University of Nebraska Medical Center.
Jake Rosmarin, a travel influencer from Boston, is one of them. He's been posting about his experience on Instagram.
The first few days have been OK, he said. On Tuesday, nurses brought him his first iced coffee from Starbucks in over six weeks. "I'm literally in heaven," he said in a posted video, sipping on an iced horchata oat milk shaken espresso with vanilla cold foam. "This is everything I needed right now."
Rosmarin gave a tour of his room: a closet, bathroom, TV and exercise bike. He keeps the window shades drawn against the media trucks outside.
The Americans in Nebraska were among around 150 cruise passengers who spent weeks aboard the MV Hondius, a ship hit with a deadly hantavirus outbreak that has infected at least 11 people, including three who died, according to the World Health Organization.
The people who were transported to Nebraska have been potentially exposed to the hantavirus, but they have no symptoms. On returning to the U.S., they started a 42-day quarantine period, starting May 11, where they are monitored daily, in case symptoms such as fatigue, headaches, fever and chills arise.
U.S. health officials say it takes prolonged contact with someone who is showing symptoms to spread the virus. Minimizing contact with those who may have been exposed is meant to stop any unprotected interactions that could lead to the possible spread of hantavirus.
For now they're in Nebraska's specialized medical facility. "They're being encouraged to stay," said Dr. David Fitter, incident manager for the Center for Disease Control and Prevention's hantavirus response, in a press call this week. Passengers there are close to top medical care, and have staff looking after them, he pointed out.
Home quarantine
In the coming days, some may be able to continue quarantining at home, according to Fitter. "We're developing plans with the passengers and the jurisdictions (in which they live)," he said. "We want to ensure that a good plan is in place for the passengers and for the jurisdictions to ensure everyone remains safe and healthy and that all communities also remain safe and healthy."
They would join around 20 Americans who already returned home. Several left the cruise ship at an earlier point, after a passenger had died but before the outbreak was discovered. Others were potentially exposed after sharing a plane with a sick cruise passenger, later confirmed to have hantavirus, on a flight from the island of St. Helena to Johannesburg.
The exposed Americans are dispersed across a handful of states, including Texas, California, Washington and Virginia. They're quarantining at home, per guidance from the CDC.
"Even though they were identified as contacts, they are not considered contagious because they currently do not have symptoms," said Dr. Sandra Valenciano, health director for Seattle-King County in Washington state, in a video statement this week, confirming that two are currently in the Seattle area.
Home quarantine involves daily temperature and symptom checks with the local health department, said Dr. Erica Pan, director of the California Department of Public Health, which is helping to monitor two people in the state who were exposed.
If they must be around people indoors, they should keep their distance, wear a well-fitting respirator or mask, and ensure good ventilation, Pan says. "They're not to share a bed with someone else," she said. "They should not share personal items like towels, bedlinens, clothing. They should not share food out of the same plate with anyone else or share beverages. They shouldn't attend social events, and they should not visit any crowded venues."
If those quarantining at home follow the guidance, it should adequately protect those around them, said Dr. Donald Milton, professor of environmental health at the University of Maryland School of Public Health. Past research suggests those with hantavirus could be contagious before they develop obvious symptoms, Milton said, making the mask guidance critical.
Milton has called for the World Health Organization to issue more stringent protocols for healthcare settings, since healthcare workers are handling sick patients and transmission is more common. For those without symptoms monitoring at home, he said, "I think the approach we're taking is going to work."
Voluntary, for now
Hantavirus is not easy to catch, but the disease can worsen quickly. Another consideration for those monitoring at home is proximity to medical care. "These patients can get so critically ill with their pulmonary and lung symptoms that they need a heart-lung bypass," Pan said. "We want to make sure someone could get to a place that could offer that if they do get that ill."
So far, health authorities say those in quarantine have been cooperative, and they haven't issued any legal orders. It's a tool that can be used either voluntarily or through a legal authority, said Dr. Marty Cetron, former director of the CDC's Division of Global Migration and Quarantine.
While federal, and many state and local authorities could issue quarantine orders, they may try voluntary agreements first. "[But] if you fail to meet that commitment, they may come back and say, now we feel like we have to issue an order. There's a lot of room for thinking about how this gets done," Cetron said.
The fact that this disease has a high death rate may persuade people to comply, but being cooped up for 42 days could test their patience, he said.
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