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This week, headlines about a cluster of hantavirus cases linked to a cruise ship have sparked public anxiety and worries about a new pandemic. While the WHO says the public health risk remains low, it’s understandable to be concerned about the rare disease. Hantavirus pulmonary syndrome, a rare rodent-borne illness, is estimated to have a mortality rate between 35% to 47%. There is no specific cure or treatment, and care is often focused on managing the symptoms, which can be very serious.
Andrew Lautz, MD, a pediatric ICU doctor at Cincinnati Children’s Hospital, has first-hand experience treating hantavirus. This is what it’s like to treat and care for one of the rarest—and deadliest—diseases.
In this two-part series, we explore what hantavirus is like—both as a patient and as a doctor treating it.
In July 2022, when 14-year-old Evie showed up in the Cincinnati Children’s emergency department, her condition started deteriorating—fast. She was admitted for concern for respiratory failure, and ended up with a breathing tube and a mechanical ventilator to support her lungs within 12 hours. Within 24 hours, she was placed on life support.
More on Hantavirus
It was clear that her lungs were very sick; she required high ventilator pressures to be able to try to keep her oxygen levels in the safe range. Over the course of that day, she developed shock, meaning her heart was unable to pump enough blood to support the needs of her increasingly sick body. Her heart was sick, and her blood pressure was low, so our team decided to place her on a life support machine called extracorporeal membrane oxygenation, or ECMO.
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ECMO is essentially a heart-lung bypass machine. The machine pumps someone’s blood outside the body to oxygenate it, get carbon dioxide out, and pump it back in—it does the job of the heart and lungs when they cannot do it themselves. ECMO is not available in every hospital, but it was critical for Evie’s survival.
While on life support, it took about a week to diagnose Evie with what she had: hantavirus.
It can be very difficult to arrive at a diagnosis for hantavirus. When she was placed on ECMO, the team still didn’t know what was behind Evie’s deteriorating condition; we just knew we needed to support her body in fighting off whatever it was. We definitely did not know she had hantavirus, though she did have pulmonary edema, or water in the lungs, which can be a symptom.
Really, what we knew was that she had a rapidly progressive pulmonary disease—one that progressed even faster than what we typically see in most critically ill children. But, one of the challenges with hantavirus is that it’s difficult to diagnose, and the testing is often not rapidly available. It’s also not endemic to Ohio. So it was definitely not on our radar initially.
Read Evie’s Own Version of Her Story:
We originally thought she just had a severe infection. In some children, we call this “culture-negative sepsis,” which is when we test blood for common bacterial and viral infections and we’re not able to identify a cause.
Our infectious disease doctors helped us cast a wide net, and as we continued searching for possible etiologies several days in, we started to think about rare causes of children falling apart. That rapidly progressive feature, along with knowing she came from North Dakota (where hantavirus does exist), helped us realize we needed to test for it. That’s when we discovered that Evie had contracted the rare disease.
Evie’s case required sophisticated, life-saving treatment—and it’s not something everyone has access to.
Though we had reached a diagnosis, there’s no direct treatment for hantavirus—no antiviral medication that can help the body fight off the infection. So, while it gave us context for what happened and explained why she was so sick, there wasn’t anything we could give her that could actually change the course of it. With hantavirus, treatment is really about finding therapies that support the patient as they get through the virus. In Evie’s case, that was ECMO.
ECMO is not a simple intervention; it requires a 45 to 60-minute surgery to get the patient connected to the machine, during which Evie went into cardiac arrest as her body got sicker and sicker in that short amount of time. For nine minutes, the staff did chest compressions while her heart was stopped. We were able to get her heart restarted, and she began her first of five days on life support.
“In the absence of ECMO, Evie would not have survived.”
When Evie came off ECMO, she still had a breathing tube and was on a ventilator because her lungs were still in recovery. Then, over a couple of days, we got the breathing tube out, and she started to recover more and more before she was able to transfer out of the ICU to the floor. In total, she spent about a month in the hospital recovering from hantavirus: a little over two weeks in the ICU and another 11 days on the floor outside the ICU.
In the absence of ECMO, Evie would not have survived. Despite initially using a ventilator and medicines to help her heart squeeze, those therapies were not able to keep her alive, so we had to escalate to greater measures. That reflected how severe hantavirus cases can get and why the mortality rate is so high—up to 50 percent, per the World Health Organization. Access to a hospital with life-saving technology was ultimately what was necessary for Evie.
ECMO is not available at all hospitals because it comes with risks. When you’re pumping blood outside of the body, the blood knows it is in plastic tubing and tries to form clots, so you have to be on blood thinners. There are multiple complications that can come on with being on ECMO, but some of the big ones include stroke, bleeding, and other organ dysfunction.
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Plus, you need a team that includes surgeons experienced in placing the cannulas, or the plastic tubing, into the artery and vein to be able to connect to the circuit, and you have to have a team of people who can manage the circuit and address complications as they arise. We have a specialist monitor a patient on ECMO 24/7 because once we give over the job of the heart and lungs to a machine, we need someone to manage that machine, given how important it is for keeping that child alive.
Because of the risks and resources needed, sick children in this country often need to be transferred for ECMO if they’re not at a major children’s hospital. What we hope is that we can get them here in time. The challenging thing is, because hantavirus is rapidly progressive, a child (or any patient) would need to arrive to a hospital fairly quickly, so that they can get transferred as soon as possible. Otherwise, it is possible that they could become too sick to transfer.
So, if you suspect hantavirus, act fast because it can progress rapidly.
If there is a concern for hantavirus pulmonary syndrome, then I would recommend a discussion about whether or not it is feasible and appropriate to transfer that patient to an ECMO center.
There’s clearly a lot of research that needs to be done to see if there are any effective treatments beyond supportive and critical care. But, at this point, a big part of how people fare once they get sick is how quickly they can get to care and how quickly they can access critical care.
Fortunately, it is relatively rare, but I think what struck me from Evie’s case is that she happened to be near a pediatric ECMO center when she got sick. Her family has reflected on the fact that had they been elsewhere or not around here when she got sick, she might not have survived.
Overall, treating hantavirus requires a coordinated approach and a big team.
Without it, outcomes can be devastating. After my experience caring for a critically ill child with hantavirus, I feel for those patients on board that ship. A lot of them were quarantined, so I’m unsure what their access to critical care has been or will be. Hopefully, most of them are adults and hopefully no more people will get sick.
This virus can be very scary and it really can make healthy people sick very quickly, such that they require a whole village, a whole team of people, from nurses and respiratory therapists and physicians of different specialties to keep them alive and get them back home with their families.
“I feel for those patients on board that ship.”
The high mortality of this virus reflects how hard it is to diagnose and how difficult it can be for people to quickly and safely access critical care, whether they’re adults or children. Ultimately, treating hantavirus requires a lot of help. We had the support of the CDC, who did some of the testing. It really takes more than just any individual hospital; it takes a coordinated effort of scientists and physicians to search for ways to help care for people with very severe viruses like this.
Olivia Luppino is an associate editor at Women’s Health. She spends most of her time interviewing expert sources about the latest fitness trends, nutrition tips, and practical advice for living a healthier life. Olivia previously wrote for New York Magazine’s The Cut, PS (formerly POPSUGAR), and Salon, where she also did on-camera interviews with celebrity guests. She recently ran the New York City Marathon.
Carina Hsieh, MPH, is the deputy features editor of Women’s Health. She has more than a decade’s worth of experience working in media and has covered everything from beauty, fashion, travel, lifestyle, pets, to health.
She began her career as an intern in the fashion closet at Cosmopolitan where she worked her way up to Senior Sex & Relationships Editor. While covering women’s health there, she discovered her passion for health service journalism and took a break to get her Masters in Public Health. Post-grad school, she worked as a freelance writer and as The Daily Beast’s first Beauty, Health, and Wellness Reporter.
Carina is an alum of the Fashion Institute of Technology and the Yale School of Public Health. She and her French Bulldog, Bao Bao, split their time between Brooklyn and Connecticut. She enjoys reformer Pilates, (slow) running, and smelling the fancy toiletries in boutique fitness class locker rooms.