Something Came Aboard

Si el médico no sabe que ese paciente estuvo en una expedición polar hace diez días, no va a pensar en hantavirus.

If the doctor doesn't know that patient was on a polar expedition ten days ago, they won't think of hantavirus.

Va a pensar en gripe, en COVID, en lo que sea más común esa semana.

They'll think flu, COVID, whatever's most common that week.

The travel history is doing a lot of work there.

And the question I'd ask is, are the passengers on these expedition cruises even warned?

Is there any kind of pre-departure briefing about rodent exposure risk?

Depende de la compañía y del destino.

It depends on the company and the destination.

En las expediciones antárticas mejor organizadas hay protocolos de bioseguridad bastante estrictos, precisamente para proteger el ecosistema local de los humanos, no al revés.

In better-organized Antarctic expeditions there are fairly strict biosecurity protocols, specifically to protect the local ecosystem from humans, not the other way around.

Pero la amenaza para el propio pasajero a veces recibe menos atención de la que merecería.

But the threat to the passenger themselves sometimes gets less attention than it deserves.

That's a telling inversion.

We're worried about us contaminating the penguins, but maybe less worried about what the local fauna is carrying.

Exacto.

Exactly.

Y eso refleja una ceguera histórica bastante arraigada en cómo pensamos sobre los entornos remotos: los vemos como prístinos, como puros, cuando en realidad son entornos con su propio repertorio de patógenos, perfectamente adaptados a la vida allí, que simplemente no estaban preparados para encontrarse con turistas.

And that reflects a fairly deep-seated historical blindness in how we think about remote environments: we see them as pristine, as pure, when they're actually environments with their own repertoire of pathogens, perfectly adapted to life there, that simply weren't prepared to encounter tourists.

That's something I kept running into as a correspondent.

You'd go somewhere genuinely wild, and the assumption was always that the danger was political or human.

The microbiological risk barely registered.

Hay un patrón histórico muy claro ahí.

There's a very clear historical pattern there.

La mayoría de los grandes brotes de enfermedades emergentes del siglo XX y XXI, desde el ébola hasta el SARS pasando por el nipah, tienen en común ese mismo momento: un ser humano que entra en un ecosistema que no le era familiar y encuentra algo para lo que su sistema inmunitario no tenía respuesta preparada.

Most of the major emerging disease outbreaks of the twentieth and twenty-first centuries, from Ebola to SARS to Nipah, share that same moment: a human entering an ecosystem that wasn't familiar to them and encountering something their immune system had no prepared response for.

And what's changed is the speed at which that encounter then moves.

In 1918 you could have a novel pathogen and it might take months to circle the globe.

Now it takes a connecting flight.

Aunque aquí hay que ser precisos, porque el hantavirus no funciona así.

Though we should be precise here, because hantavirus doesn't work that way.

No se transmite de persona a persona, salvo la cepa andina, el virus Andes, que es la única excepción conocida.

It doesn't spread person to person, except for the Andes strain, which is the only known exception.

Así que el riesgo no es una pandemia al uso.

So the risk isn't a conventional pandemic.

Es algo distinto: es la dispersión silenciosa de casos individuales que pueden llegar a cualquier hospital del mundo sin que el médico sepa lo que está viendo.

It's something different: it's the silent dispersal of individual cases that can arrive at any hospital in the world without the doctor knowing what they're looking at.

Which is in some ways more insidious, because it never hits the threshold that triggers an emergency response.

It's just scattered cases, each one looking like something else.

Eso es exactamente lo que preocupa a los epidemiólogos cuando hablan de este caso español.

That's exactly what concerns epidemiologists when they discuss this Spanish case.

No es que haya un brote en España.

It's not that there's an outbreak in Spain.

Es que un sistema sanitario tuvo que ser lo suficientemente perspicaz para hacer las preguntas correctas, para conectar los puntos entre un paciente febril en Madrid y un barco de expedición en algún lugar del hemisferio sur.

It's that a health system had to be sharp enough to ask the right questions, to connect the dots between a feverish patient in Madrid and an expedition ship somewhere in the southern hemisphere.

And credit where it's due, it sounds like the Spanish system caught it.

Identified it, reported it.

That's not nothing, given how easy it would be to file it under 'unusual fever, cause unclear, discharged.'

Sin duda.

No doubt.

Y eso es el resultado de años de inversión en vigilancia epidemiológica, en formación de médicos para que pregunten siempre por el historial de viajes recientes.

And that's the result of years of investment in epidemiological surveillance, in training doctors to always ask about recent travel history.

España tiene una red de alerta sanitaria que no es perfecta, pero que en este caso parece haber funcionado.

Spain has a health alert network that isn't perfect, but that in this case seems to have worked.

Lo cual contrasta bastante con lo que sabemos del brote de ébola en el Congo, donde la respuesta no está siguiendo el ritmo del virus.

Which contrasts quite sharply with what we know about the Ebola outbreak in Congo, where the response isn't keeping pace with the virus.

Let's stay with the ship for a moment though, because I want to understand the quarantine dimension.

These passengers were evacuated.

Some were quarantined at a hospital in Madrid.

What does a hantavirus quarantine actually accomplish if it doesn't spread person to person?

Es una pregunta muy buena, y la respuesta honesta es que la cuarentena en sí misma no está justificada por el riesgo de contagio entre humanos, dado lo que sabemos.

That's a very good question, and the honest answer is that quarantine itself isn't justified by the risk of human-to-human transmission, given what we know.

Lo que sí justifica el aislamiento y la vigilancia estrecha es otra cosa: la incertidumbre diagnóstica.

What does justify isolation and close monitoring is something else: diagnostic uncertainty.

Hasta que no confirmas que es hantavirus y no algo que sí se contagia, tratas el caso con el máximo nivel de precaución.

Until you confirm it's hantavirus and not something that does spread, you treat the case with maximum precaution.

Es una postura defensiva ante la ignorancia.

It's a defensive posture against ignorance.

Prudent ignorance, essentially.

You act as if it's the worst case until you can prove otherwise.

Exactamente.

Exactly.

Y eso tiene un coste, claro, para el paciente, para el personal sanitario, para los recursos del hospital.

And that has a cost, of course, for the patient, for healthcare staff, for hospital resources.

Pero el coste alternativo de equivocarse con algo que sí se contagia es mucho mayor.

But the alternative cost of getting it wrong with something that does spread is much higher.

Es una asimetría de riesgos que la epidemiología ha aprendido a gestionar a base de errores históricos muy costosos.

It's a risk asymmetry that epidemiology has learned to manage through very costly historical mistakes.

The bigger picture here, the one I can't stop turning over, is what this says about adventure tourism and infectious disease risk.

Because the expedition cruise market has exploded in the last fifteen years.

More ships, more passengers, more remote destinations.

Y los pasajeros de esos cruceros no son mochileros jóvenes acostumbrados a las incomodidades.

And the passengers on those cruises aren't young backpackers used to rough conditions.

Son en su mayoría personas mayores, con mayor fragilidad inmunitaria en muchos casos, que pagan mucho dinero precisamente para acceder a lugares a los que antes solo llegaban los investigadores científicos o los exploradores.

They're mostly older people, with greater immune vulnerability in many cases, who pay a lot of money precisely to access places that previously only scientists or explorers reached.

El mercado ha democratizado el acceso a ecosistemas que antes estaban de facto cerrados al turismo.

The market has democratized access to ecosystems that were previously de facto closed to tourism.

Which sounds wonderful until you frame it the way you just did.

You're essentially creating a pipeline between immunologically naive populations and disease reservoirs that evolved in complete isolation.

Y hay otro factor que complica aún más el cuadro: el cambio climático está alterando las poblaciones de roedores.

And there's another factor that complicates the picture further: climate change is altering rodent populations.

En muchas regiones del mundo, el aumento de temperaturas y las perturbaciones en los ecosistemas están expandiendo el rango geográfico de especies que antes estaban confinadas a zonas concretas.

In many regions of the world, rising temperatures and ecosystem disruption are expanding the geographic range of species that were previously confined to specific areas.

El hantavirus no se queda quieto porque nosotros queramos que se quede quieto.

Hantavirus doesn't stay put because we want it to.

There was a study a few years back, I want to say published in Nature, linking El Niño cycles to hantavirus outbreaks in the Americas.

The logic being that El Niño boosted vegetation, which boosted rodent populations, which put more infected rodents in proximity to humans.

The scale of that causal chain is something.

Sí, ese vínculo está bastante bien documentado.

Yes, that link is fairly well documented.

Y lo que demuestra es que la epidemiología no puede operar solo en el nivel humano.

And what it demonstrates is that epidemiology can't operate only at the human level.

Necesita entender la ecología, la climatología, el comportamiento animal.

It needs to understand ecology, climatology, animal behavior.

Es lo que se llama el enfoque One Health, una salud, que trata la salud humana, animal y del ecosistema como un sistema integrado.

This is what's called the One Health approach, which treats human, animal, and ecosystem health as an integrated system.

No es una moda académica;

It's not an academic trend;

es una necesidad operativa.

it's an operational necessity.

And here's what frustrates me about how this gets reported, when it gets reported at all.

A story like the MV Hondius barely makes a ripple.

One confirmed case in Spain, small item.

But the questions it opens up are enormous.

Es el problema estructural del periodismo de salud pública: las historias que merecen más atención son precisamente las que no generan urgencia visible.

That's the structural problem with public health journalism: the stories that deserve most attention are precisely the ones that don't generate visible urgency.

Un caso de hantavirus en Madrid no es una emergencia.

One hantavirus case in Madrid isn't an emergency.

Pero es una señal, y las señales hay que leerlas antes de que se conviertan en emergencias.

But it's a signal, and signals need to be read before they become emergencies.

You spent years at El País.

Did you feel like you had the space to tell those slow-burn stories, the signals rather than the alarms?

Honestamente, a veces sí y a veces no.

Honestly, sometimes yes and sometimes no.

Depende mucho del momento, del editor de turno, de si había otra crisis compitiendo por el espacio.

It depends a lot on the moment, the editor at the time, whether there was another crisis competing for space.

Lo que sí recuerdo es que las historias de salud que más impacto tuvieron, las que realmente cambiaron algo, no eran las que describían el brote cuando ya era grande.

What I do remember is that the health stories that had the most impact, the ones that actually changed something, weren't the ones describing the outbreak when it was already large.

Eran las que habían rastreado el problema semanas o meses antes, cuando todavía había margen para actuar.

They were the ones that had tracked the problem weeks or months earlier, when there was still room to act.

That's exactly the gap.

The story becomes newsworthy when it's too late for the story to matter.

Y volviendo al MV Hondius, lo que espero es que las autoridades sanitarias de todos los países con pasajeros a bordo estén compartiendo información de manera sistemática.

And coming back to the MV Hondius, what I hope is that health authorities in all countries with passengers aboard are sharing information systematically.

Porque este barco no llevaba solo españoles.

Because this ship wasn't carrying only Spanish citizens.

Llevaba personas de muchos países distintos, cada una de las cuales volvió a un sistema sanitario diferente, con distintos niveles de alerta y distintas capacidades diagnósticas.

It was carrying people from many different countries, each of whom returned to a different health system, with different alert levels and different diagnostic capacities.

Which brings us back to where we started, really.

The speed and reach of modern travel means a ship's passenger list is a public health document.

You just don't know that until something goes wrong.

Oye, me ha parecido interesante que antes dijiste algo sobre que los médicos tienen que hacer las preguntas correctas para conectar los puntos.

Hey, I found it interesting that you said earlier that doctors need to ask the right questions to connect the dots.

En español clínico hay una expresión que se usa mucho en ese contexto: anamnesis.

In clinical Spanish there's an expression used a lot in that context: anamnesis.

No es una palabra cotidiana, pero aparece constantemente en todo lo relacionado con diagnóstico.

It's not an everyday word, but it appears constantly in anything related to diagnosis.

Anamnesis.

I know that word, actually, from Greek.

Aná, up or back, and mnesis, memory.

It's the act of recalling, of recovering a history.

In medicine it's the patient history, right?

What the doctor draws out by asking questions.

Exacto.

Exactly.

Y lo que me gusta de esa palabra es que en español médico se usa en frases como 'la anamnesis reveló que el paciente había viajado recientemente.' Tiene algo que el inglés 'patient history' no captura del mismo modo: la idea de que el médico está haciendo un trabajo activo de recuperación de memoria, no solo rellenando un formulario.

And what I like about that word is that in medical Spanish it's used in phrases like 'the anamnesis revealed that the patient had recently traveled.' It has something that the English 'patient history' doesn't quite capture: the idea that the doctor is doing active work of memory retrieval, not just filling out a form.

That's a real distinction.

The history doesn't arrive on its own, someone has to go back for it.

And in a case like the MV Hondius, that act of going back, asking about the ship, the shore excursions, the rodent burrows someone maybe photographed a bit too close, that's the thing that saves a life or catches an outbreak early.

Bien visto, Fletcher.

Well spotted, Fletcher.

Y mira, si algún oyente llega a urgencias con fiebre después de un viaje de expedición, ya sabe qué palabra usar: 'doctor, en mi anamnesis conviene que sepa que estuve cerca de unos roedores en la Antártida.' A ver cómo reacciona el médico.

And look, if any listener ends up in the emergency room with a fever after an expedition trip, they now know what word to use: 'doctor, in my anamnesis you should know I was near some rodents in Antarctica.' Let's see how the doctor reacts.

I'm filing that one away for my next polar cruise.

Which, now that I think about it, I'm considerably less eager to book.