This is not a drill: Inside the Johns Hopkins unit prepping for hantavirus

Every few months on the eighth floor of Johns Hopkins Hospital in East Baltimore, teams of specialists help each other into plastic protective coverings, face shields and gloves according to very specific protocols.

They enter a small area with its own HVAC system to check breathing equipment and medical supplies needed to care for patients infected with some of the world’s worst pathogens.

These drills, sometimes complete with fake patients, help keep some 100 clinicians in 20 specialties in the hospital’s biocontainment unit at the ready.

But today, the unit is on alert. And it’s not a drill.

Around 20 Americans in recent days returned to the country from the Dutch-flagged cruise ship MV Hondius, the epicenter of a hantavirus outbreak. All are quarantined or monitored, and two more have already been sent to a similar unit in Atlanta.

Two Marylanders possibly exposed to an infected cruiser while on a plane together are being monitored by state health officials.

“If we were to come up with a scenario to train, we really might have come up with that scenario,” said Dr. Gaby Frank, director of Hopkins’ Special Pathogens Center, which houses the biocontainment unit.

Frank has been coordinating daily with the National Emerging Special Pathogens Training and Education Center. It’s a federally funded consortium of the country’s 13 biocontainment units and participating public health agencies, formed in 2015 during the Ebola outbreak.

The need to rely on such a steadfast network comes at a time when federal funding for pandemic preparedness, and public health in general, has been scaled back under President Donald Trump’s administration. The Hopkins unit’s budget remained steady last year at $1.6 million for staff, equipment and training.

The system has coordinated in response to outbreaks and threats from COVID-19, Lassa fever, influenza, mpox, hemorrhagic fever — and now hantavirus.

In this outbreak, there have been 11 infections and three deaths among the cruise passengers with the relatively rare but potentially dangerous Andes strain, which can progress quickly from flu-like symptoms to respiratory failure. There’s no approved treatment, but medical providers can still provide supportive care, especially if the infection is diagnosed early, according to Frank.

The cruise operator reported that 18 American cruise passengers disembarked Sunday and most have gone to a quarantine facility in Omaha, Nebraska, where they may have to wait weeks during the virus’s 42-day incubation period.

Two more passengers — one with symptoms and another just testing positive — have gone to a biocontainment unit in Atlanta similar to the one in Baltimore. Several more Americans who left the ship early are quarantining at home in several states, including Virginia, and are being monitored.

The Maryland Department of Health said Monday that there were two local residents who were not on the ship but briefly shared a plane with an infected cruise passenger. They are now being monitored, though officials did not disclose their location.

If any more patients test positive or have symptoms, they could be transported to Hopkins or another unit aboard a specially outfitted ambulance or plane.

The units are typically small; Hopkins’ unit has four beds but can accommodate up to 10 patients with respiratory conditions. That was the case in the early days of the coronavirus pandemic, when cases were climbing and there was no vaccine or specific treatments.

The unit has also housed patients who were infected or exposed to mpox and hemorrhagic fever. These days, COVID and mpox patients are less of a threat and wouldn’t require such a secure unit.

Frank notes that the unit is staffed entirely by volunteers, who leave their day jobs in the hospital for extensive and ongoing training to keep patients and the wider community safe.

Viruses can be unpredictable — see the COVID-19 pandemic — and hantavirus is already testing the nation’s public health system.

But Frank said this is different from the pandemic. The Andes strain of hantavirus, unlike the novel coronavirus that emerged in 2019, has been known for more than three decades. Human-to-human transmission normally takes close and prolonged contact.

“But until we know a little more, it’s good to monitor people,” she said. “I think the people from the ship want to know someone is watching them. It’s good for them and the community.”

If there are no more cases in the coming weeks, the unit will stand down.

Frank already has another drill planned, this one with her sons, ages 16 and 19, who will hole up in the unit. The young men will report to staff about what might make an extended stay more tolerable for patients who are fully aware they have been quarantined.

“Maybe they’ll ask for a PlayStation,” she said.