The University of Nebraska's Mark Rupp, MD, weighs in on his institution's facilities where passengers are being housed during the quarantine protocol, insights on how they are monitored, and their current medical conditions.
As of this morning, there are now 11 people infected with the hantavirus (Andes species) from the cruise ship. The Andes virus is the only hantavirus species known for limited human-to-human transmission via respiratory droplets.1 The hantavirus is classified as a high-consequence infectious diseases (HCID) and maintains a high mortality rate—estimates range from 20-40%.
Eighteen passengers from that cruise ship linked to the hantavirus outbreak have returned to the United States and are being monitored at specialized medical units. Sixteen passengers, including one who tested positive for the virus, are at the University of Nebraska Medical Center and remain asymptomatic, while 2 others are being monitored at Emory University Hospital in Atlanta, where one individual is currently experiencing symptoms, according to health officials.
In Nebraska, these individuals will be observed in the National Quarantine Unit (NQU), which is housed inside the Dr. Edwin G. & Dorothy Balbach Davis Global Center, and located on the campus of the University of Nebraska Medical Center (UNMC). Nebraska Medicine and UNMC are working closely with the Douglas County Health Department, Nebraska Department of Health and Human Services, and federal health partners to coordinate the effort.
The NQU is the only federally funded quarantine unit in the United States, designed specifically to safely house and monitor people who may have been exposed to high-consequence infectious diseases. It is important to note this is not a medical facility.
For the casual observer, the individual patient rooms look like hotel or dorm rooms, explains Mark Rupp, MD, executive vice chair, UNMC Department of Internal Medicine, professor, UNMC Division of Infectious Diseases. Rupp works at the institution, but is not treating these patients that are quarantined. Rupp says they have exercise equipment and Wifi so they can stay in contact with their family members.
While he says it looks comfortable for patients, it is engineered to be protective of the environment.
“It has negative pressure air-handling. All of the air in the hallway is sucked back into the patient rooms. It is passed through a HEPA filter before it gets exhausted to the outdoors. It does not mix with air for any other person within that building.”
For the time being, the patients are confined to their rooms. With a long incubation period, Rupp explains it is good for public health officials in helping with biopreparedness; however, the downside of the long period is that people must wait for some weeks before they are considered out of the danger zone.
“The shortest period of incubation for the Andes virus is within that first week or so, but the longest period of incubation can be up to 6 weeks,” Rupp said.
Rupp says it is yet to been determined how long these patients will be there and that decision will likely be made by public health officials.
Unfortunately, there are no FDA approved antivirals or therapies for the virus and patients are given supportive care when needed. If any of these patients do start to experience symptoms the patients can be transferred to the nearby Nebraska Biocontainment Unit, which is a highly specialized facility designed to care for patients with HCID.
Rupp says all the patients are monitored multiple times a day, checking their vital signs and seeing if they become symptomatic. To his knowledge, none of the patients’ conditions have changed.
“My understanding is all the people in the quarantine unit at the current time have not had a change in status,” Rupp said. They still have just one patient who is in the biocontainment unit.
For healthcare personnel caring for the patients who are not testing positive and are in the NQU, they are wearing personal protective equipment.
“You would be wearing gowns, gloves, and an N95 respirator. The setting really minimizes the risk with the negative pressure and the filtration of the air.”
Rupp points out the personnel in this unit are volunteers who are highly trained for these situations.
