C1 · Advanced
19 min
infectious diseaseglobal healthexpedition travelepidemiology
The Ship and the Virus: Hantavirus at Sea
El barco y el virus: hantavirus en alta mar
A Canadian passenger aboard the expedition vessel MV Hondius tests positive for the Andes strain of hantavirus and is hospitalized along with their spouse. Fletcher and Octavio dig into the little-known history of this virus, its uniquely dangerous behavior, and what this case reveals about the invisible risks of expedition travel.
Un pasajero canadiense a bordo del buque de expedición MV Hondius da positivo por la cepa Andes del hantavirus y es hospitalizado junto a su pareja. Fletcher y Octavio se adentran en la historia de este virus poco conocido, su comportamiento único y lo que este caso revela sobre los riesgos invisibles del turismo de aventura.
8 essential C1-level terms from this episode, with translations and example sentences in Spanish.
| Spanish | English | Example |
|---|---|---|
| hantavirus | hantavirus | La cepa Andes del hantavirus es la única conocida que puede transmitirse de persona a persona. |
| cepa | strain (of a virus or bacteria) | Los investigadores identificaron una nueva cepa del virus con características inusuales. |
| reservorio | reservoir (in epidemiology: the natural host of a pathogen) | El ratón de cola larga actúa como reservorio principal de la cepa Andes en la Patagonia. |
| período de incubación | incubation period | El largo período de incubación del hantavirus complica enormemente el rastreo epidemiológico. |
| insuficiencia respiratoria | respiratory failure | Los pacientes con síndrome cardiopulmonar pueden desarrollar insuficiencia respiratoria en cuestión de horas. |
| epidemiología | epidemiology | La epidemiología de las enfermedades zoonóticas resulta especialmente difícil de rastrear cuando afectan a viajeros internacionales. |
| a menos que | unless (always followed by subjunctive) | No podremos controlar el brote a menos que se mejore el sistema de vigilancia epidemiológica regional. |
| zoonótico | zoonotic (relating to diseases transmitted from animals to humans) | La mayoría de las enfermedades zoonóticas siguen siendo poco conocidas fuera de las regiones donde son endémicas. |
Picture this: an expedition cruise ship, somewhere in the remote southern latitudes, and a passenger comes home to Canada carrying a virus that most doctors in North America have never seen in a clinical setting.
El caso es extraordinario por varias razones, Fletcher.
The case is extraordinary for several reasons, Fletcher.
Las autoridades sanitarias canadienses confirmaron ayer que un pasajero del MV Hondius, un buque de expedición que opera en regiones como la Patagonia y la Antártida, ha dado positivo por la cepa Andes del hantavirus.
Canadian health authorities confirmed yesterday that a passenger on the MV Hondius, an expedition vessel that operates in regions like Patagonia and Antarctica, has tested positive for the Andes strain of hantavirus.
Lo que hace que esto sea especialmente alarmante es que su pareja también fue hospitalizada, lo cual apunta a algo que los epidemiólogos llevan décadas estudiando con inquietud.
What makes this especially alarming is that their spouse was also hospitalized, which points to something epidemiologists have been studying with concern for decades.
And that detail, the spouse being hospitalized, that's the thing that makes this particular strain different from every other hantavirus on the map.
Exacto.
Exactly.
La cepa Andes es, hasta donde sabemos, el único hantavirus que se transmite de persona a persona.
The Andes strain is, as far as we know, the only hantavirus that transmits from person to person.
Todos los demás hantavirus conocidos requieren el contacto directo con roedores infectados o sus excrementos, su orina, su saliva.
All other known hantaviruses require direct contact with infected rodents or their droppings, their urine, their saliva.
Pero el Andes puede pasar de un ser humano a otro, y eso lo convierte en una categoría completamente distinta de amenaza.
But Andes can pass from one human to another, and that puts it in a completely different category of threat.
Which raises an obvious and uncomfortable question about a ship full of passengers in close quarters.
Sí, aunque hay que ser preciso aquí.
Yes, although we need to be precise here.
La transmisión persona a persona de la cepa Andes parece requerir un contacto bastante estrecho y prolongado, principalmente mediante el contacto íntimo.
Person-to-person transmission of the Andes strain appears to require fairly close and prolonged contact, primarily through intimate contact.
No es como la gripe, que se propaga con un estornudo al otro lado de un comedor.
It's not like the flu, spreading with a sneeze across a dining room.
Pero en un contexto de pareja, de convivencia en un camarote durante semanas, el riesgo es real.
But in the context of a couple sharing a cabin for weeks, the risk is real.
Y eso es probablemente lo que explica el caso del cónyuge.
And that's probably what explains the spouse's case.
Let me back up for a minute, because I think a lot of people hear hantavirus and their mind goes straight to 1993, the Four Corners outbreak in the American Southwest.
That's when most people in the States first heard the word.
Un brote que sembró el pánico precisamente porque nadie sabía al principio de qué se trataba.
An outbreak that caused panic precisely because nobody knew at first what it was.
Jóvenes perfectamente sanos, muchos de ellos de la comunidad navajo, que desarrollaban una insuficiencia respiratoria fulminante.
Young, perfectly healthy people, many from the Navajo community, developing sudden, catastrophic respiratory failure.
La tasa de mortalidad inicial superaba el cincuenta por ciento.
The initial mortality rate exceeded fifty percent.
Y el agente causante era desconocido durante semanas.
And the causative agent was unknown for weeks.
The CDC eventually traced it to the deer mouse, Peromyscus maniculatus, and identified it as a new hantavirus strain, which they called Sin Nombre, literally 'without a name.' Which is either very poetic or very unsettling depending on your mood.
Aunque en realidad el hantavirus tiene una historia mucho más larga que 1993.
Although in reality, hantavirus has a much longer history than 1993.
Ya en la Guerra de Corea, miles de soldados estadounidenses desarrollaron lo que llamaban 'fiebre hemorrágica con síndrome renal', una enfermedad misteriosa que durante décadas se atribuyó vagamente al estrés de combate o a toxinas ambientales.
Already during the Korean War, thousands of American soldiers developed what they called 'hemorrhagic fever with renal syndrome', a mysterious illness that for decades was vaguely attributed to combat stress or environmental toxins.
No fue hasta los años ochenta cuando los científicos comprendieron que era hantavirus, transmitido por los ratones de campo coreanos.
It wasn't until the 1980s that scientists understood it was hantavirus, transmitted by Korean field mice.
I knew about the Korean War angle but I'd forgotten it predated the naming.
So the disease existed for decades before we had a word for it.
Y probablemente mucho antes.
And probably much earlier than that.
Hay registros de enfermedades con síntomas compatibles en China que se remontan al siglo doce.
There are records of illnesses with compatible symptoms in China going back to the twelfth century.
El nombre en sí viene del río Hantan, en Corea del Sur, donde en los años setenta un virólogo llamado Ho Wang Lee aisló el virus por primera vez.
The name itself comes from the Hantan River in South Korea, where in the 1970s a virologist named Ho Wang Lee first isolated the virus.
El hantaan, la cepa original identificada científicamente.
The Hantaan strain, the first one scientifically identified.
So now let's come back to the Andes strain specifically, because geographically this is where the MV Hondius story gets very interesting.
That ship operates in Patagonia, in the tip of South America, and the Andes strain is endemic precisely to that region.
Claro, el reservorio principal de la cepa Andes es el ratón de cola larga, el Oligoryzomys longicaudatus, que habita los bosques templados del sur de Argentina y Chile.
Right, the main reservoir of the Andes strain is the long-tailed pygmy rice rat, Oligoryzomys longicaudatus, which inhabits the temperate forests of southern Argentina and Chile.
Y la Patagonia es uno de los destinos más populares entre los turistas de aventura, los que buscan precisamente alejarse de todo, dormir en el campo, acampar junto a ríos, explorar zonas silvestres.
And Patagonia is one of the most popular destinations for adventure tourists, precisely those who want to get away from everything, sleep outdoors, camp next to rivers, explore wilderness.
El contacto con roedores, aunque sea indirecto, forma parte del paisaje de ese tipo de viaje.
Contact with rodents, even indirect contact, is part of the landscape of that kind of travel.
And you don't have to handle a mouse to get it.
Disturbing a pile of dried grass where rodents have nested, sweeping out a cabin that's been closed all winter, breathing dust in an old barn.
The virus can remain viable in dried excreta for days.
Lo cual hace que la epidemiología del Andes sea particularmente complicada de rastrear.
Which makes the epidemiology of Andes particularly complicated to trace.
Un turista que pasa dos noches en una cabaña rústica en el lago Puelo, en la provincia del Chubut, puede infectarse sin haber visto jamás un ratón.
A tourist who spends two nights in a rustic cabin on Lake Puelo in Chubut Province can get infected without ever having seen a mouse.
Y el período de incubación puede llegar hasta las seis semanas, así que cuando los síntomas aparecen, el paciente ya lleva semanas de vuelta en casa, en otro continente, sin ninguna conexión obvia con el origen.
And the incubation period can stretch to six weeks, so when symptoms appear, the patient has been home for weeks, on another continent, with no obvious connection to the origin.
That six-week window is haunting.
You're home, you feel fine, you go back to work, you tell your friends about the glaciers.
And then the fever starts.
Y cuando empieza, puede ir muy rápido.
And when it starts, it can progress very quickly.
El síndrome cardiopulmonar por hantavirus, que es la forma que presentan las cepas americanas como el Sin Nombre y el Andes, comienza con fiebre, dolores musculares, fatiga, síntomas que cualquier médico de urgencias atribuiría a una gripe normal.
Hantavirus cardiopulmonary syndrome, which is the form presented by American strains like Sin Nombre and Andes, begins with fever, muscle aches, fatigue, symptoms any emergency doctor would attribute to a normal flu.
Y luego, en cuestión de horas a veces, los pulmones empiezan a llenarse de líquido.
And then, sometimes within hours, the lungs begin to fill with fluid.
La transición puede ser devastadora.
The transition can be devastating.
The mortality rate for hantavirus cardiopulmonary syndrome sits somewhere between thirty and forty percent even with modern intensive care.
That's not a disease you want to be misdiagnosed with for three days while doctors run flu panels.
Y ahí está el verdadero problema para los sistemas de salud fuera de América del Sur.
And that's the real problem for healthcare systems outside South America.
Un médico en Toronto o en Londres que ve a un paciente con fiebre y disnea no va a pensar en hantavirus como primera hipótesis.
A doctor in Toronto or London seeing a patient with fever and shortness of breath is not going to think of hantavirus as the first hypothesis.
Ni como quinta.
Not as the fifth either.
Así que el diagnóstico depende completamente de que el propio paciente mencione que ha viajado recientemente a Patagonia, y de que el médico tenga la formación necesaria para conectar los puntos.
So the diagnosis depends entirely on the patient themselves mentioning they recently traveled to Patagonia, and on the doctor having the training to connect the dots.
I want to talk about the MV Hondius itself for a moment, because this is not your average cruise ship.
This is an expedition vessel, the kind that takes birders and naturalists and adventure travelers to places like the Falklands, South Georgia, the Antarctic Peninsula.
The whole point is to get close to nature.
Es una paradoja interesante.
It's an interesting paradox.
El turismo de expedición se vende precisamente como una forma de escapar del mundo masificado y experimentar lugares vírgenes.
Expedition tourism sells itself precisely as a way to escape the overcrowded world and experience pristine places.
Pero esa autenticidad tiene un precio que los folletos no mencionan.
But that authenticity has a cost the brochures don't mention.
Cuando te adentras en ecosistemas silvestres poco estudiados, cuando pasas noches en refugios remotos o manipulas suelo en zonas de alta densidad de roedores, te expones a patógenos que los sistemas sanitarios urbanos no están equipados para reconocer.
When you enter into little-studied wild ecosystems, when you spend nights in remote shelters or handle soil in areas with high rodent density, you expose yourself to pathogens that urban healthcare systems aren't equipped to recognize.
There's a version of this story I find genuinely troubling, which is that the growth of expedition tourism into remote South America, Patagonia, Tierra del Fuego, even parts of the Amazon, is essentially a real-time experiment in bringing urban immune systems into contact with pathogens those immune systems have never encountered.
Sí, y no es solo el hantavirus.
Yes, and it's not just hantavirus.
En la misma región, en los últimos años, hemos visto casos de leptospirosis, de brucelosis, incluso de rabia silvestre en zonas que los turistas consideran perfectamente seguras.
In the same region, in recent years, we've seen cases of leptospirosis, brucellosis, even sylvatic rabies in areas that tourists consider perfectly safe.
El riesgo no está en que esos ecosistemas sean peligrosos en sí mismos, sino en la brecha entre lo que los turistas saben y lo que necesitarían saber para protegerse.
The risk isn't that these ecosystems are inherently dangerous, but in the gap between what tourists know and what they'd need to know to protect themselves.
And I suspect most people who board a ship like the Hondius get extensive briefings about hypothermia, about falls on ice, about wildlife viewing protocols.
But a briefing about rodent-borne viruses and how to handle dust in a shore cabin?
I'd be surprised.
En Argentina, las autoridades sanitarias de las provincias patagónicas llevan años publicando guías de prevención para turistas.
In Argentina, the health authorities of the Patagonian provinces have been publishing prevention guides for tourists for years.
Hay carteles en las áreas de camping, hay información en los centros de visitantes.
There are signs in camping areas, there's information in visitor centers.
Pero la realidad es que cuando eres un turista extranjero que no habla español, o que no lee los carteles porque está mirando el paisaje, esa información llega demasiado tarde o no llega en absoluto.
But the reality is that when you're a foreign tourist who doesn't speak Spanish, or who doesn't read the signs because you're looking at the scenery, that information arrives too late or doesn't arrive at all.
There's something almost darkly funny about that, standing in front of a sign about a potentially lethal virus and not reading it because the mountain behind it is beautiful.
That is the most human thing possible.
Absolutamente humano.
Completely human.
Y es que el problema de fondo no es la ignorancia maliciosa, sino que el cerebro humano es pésimo evaluando riesgos abstractos en contextos de placer.
And the underlying problem isn't malicious ignorance, it's that the human brain is terrible at evaluating abstract risks in contexts of pleasure.
Estás de vacaciones, el paisaje es espectacular, llevas meses planificando este viaje.
You're on vacation, the scenery is spectacular, you've been planning this trip for months.
El riesgo de un virus transmitido por ratones de campo simplemente no cabe en ese marco mental.
The risk of a field-mouse-borne virus simply doesn't fit into that mental frame.
Now, the Canadian public health agency is reporting this case and apparently monitoring others from the same voyage.
What does the response protocol look like for something like this?
Because hantavirus isn't in the standard playbook for most national health systems.
Es un protocolo que depende de la coordinación entre varios países, lo cual siempre es complicado.
It's a protocol that depends on coordination between several countries, which is always complicated.
Tienes pacientes que pueden ser de diez nacionalidades distintas en el mismo crucero.
You may have patients from ten different nationalities on the same cruise.
Tienes que identificar a todos los que estuvieron en los mismos excursiones en tierra, en los mismos lugares, los mismos días.
You have to identify everyone who was on the same shore excursions, the same locations, the same days.
Y tienes que hacerlo con la urgencia suficiente para que quienes aún no muestran síntomas puedan recibir seguimiento médico antes de que sea demasiado tarde.
And you have to do it with enough urgency so that those not yet showing symptoms can receive medical monitoring before it's too late.
And there's no vaccine.
That needs to be said clearly.
No antiviral specifically approved for hantavirus, no vaccine.
Treatment is supportive care: get the patient on oxygen, manage the fluid in the lungs, keep them alive long enough for their own immune system to mount a response.
Aunque hay que decir que hay investigación en marcha.
Although it must be said that research is ongoing.
Hay candidatos a vacuna que llevan años en desarrollo, algunos bastante prometedores.
There are vaccine candidates that have been in development for years, some quite promising.
Pero el hantavirus afecta de manera desproporcionada a poblaciones rurales en países de ingresos medios y bajos, lo que históricamente ha significado que recibe mucho menos inversión en investigación de lo que merecería.
But hantavirus disproportionately affects rural populations in middle and low-income countries, which historically has meant it receives far less research investment than it deserves.
Es el patrón de siempre: las enfermedades que afectan a los pobres no generan el mismo retorno económico para la industria farmacéutica.
It's the same pattern as always: diseases that affect the poor don't generate the same economic return for the pharmaceutical industry.
That point about research investment is worth sitting with.
Because this same story, a wealthy Canadian on an expensive expedition cruise, is probably going to generate more public health attention than fifty cases in a village in Chubut Province would.
Sin duda.
Without a doubt.
Y es una crítica legítima al sistema global de vigilancia epidemiológica.
And it's a legitimate critique of the global epidemiological surveillance system.
Los brotes que afectan a turistas occidentales activan mecanismos de respuesta que los mismos brotes en comunidades rurales latinoamericanas no activan, o tardan mucho más en activar.
Outbreaks affecting Western tourists activate response mechanisms that the same outbreaks in rural Latin American communities do not activate, or activate much more slowly.
Lo hemos visto con el ébola, lo hemos visto con el zika, lo vemos aquí con el hantavirus.
We've seen it with Ebola, we've seen it with Zika, we see it here with hantavirus.
La geografía del sufrimiento sigue determinando la velocidad de la respuesta.
The geography of suffering continues to determine the speed of the response.
I spent time in the northeastern Argentine provinces back in 2008 reporting on something else entirely, and I remember how remote those communities felt, how far from any kind of medical infrastructure.
A serious illness out there wasn't an inconvenience, it was a potential death sentence.
Y sigue siendo así en muchas zonas.
And it still is in many areas.
Argentina ha mejorado su red de vigilancia del hantavirus considerablemente desde los grandes brotes de los años noventa, pero las brechas persisten.
Argentina has considerably improved its hantavirus surveillance network since the major outbreaks of the 1990s, but the gaps persist.
Sobre todo en la Patagonia andina, donde las distancias son enormes y los centros de salud con capacidad diagnóstica real están muy concentrados en las ciudades.
Especially in the Andean Patagonia, where distances are enormous and healthcare centers with real diagnostic capacity are very concentrated in the cities.
Let me ask you something directly.
When you look at this case, the Hondius passenger, what worries you more: that this individual got infected, which is a tragedy, or what this case might signal about patterns we're not tracking well?
Lo segundo, sin duda.
The second, without a doubt.
Un caso aislado es un caso aislado.
An isolated case is an isolated case.
Lo que me preocupa es que el turismo de expedición hacia el hemisferio sur no ha dejado de crecer, y que la educación sanitaria específica para viajeros que van a zonas endémicas de hantavirus sigue siendo terriblemente deficiente.
What worries me is that expedition tourism to the southern hemisphere hasn't stopped growing, and that the specific health education for travelers going to hantavirus-endemic zones remains terribly deficient.
Las clínicas de medicina del viajero advierten sobre la malaria, sobre el dengue, sobre el tifus.
Travel medicine clinics warn about malaria, about dengue, about typhus.
El hantavirus apenas aparece en las consultas previas al viaje, a pesar de que la ruta Patagonia es ahora uno de los destinos turísticos de mayor crecimiento en el mundo.
Hantavirus barely comes up in pre-travel consultations, even though the Patagonia route is now one of the world's fastest-growing tourist destinations.
That's a genuinely practical gap.
The information exists, the epidemiological knowledge is there, but the translation into routine pre-travel advice just hasn't happened.
The infrastructure of knowledge isn't connecting to the infrastructure of care.
Y el mensaje preventivo tampoco es complicado.
And the preventive message isn't complicated either.
No barras ni limpies espacios cerrados sin ventilación en zonas rurales sin mascarilla.
Don't sweep or clean enclosed, unventilated spaces in rural areas without a mask.
Evita el contacto con roedores y sus rastros.
Avoid contact with rodents and their traces.
Si tienes fiebre alta y dificultad para respirar en las semanas posteriores a un viaje a Patagonia, díselo a tu médico explícitamente.
If you develop high fever and difficulty breathing in the weeks after a trip to Patagonia, tell your doctor explicitly.
Son tres frases.
It's three sentences.
Caben en cualquier hoja informativa.
They fit on any information sheet.
Three sentences that could save a life, and they're not making it into the standard pre-departure briefing.
That's not a scientific failure, that's a communication failure.
Completamente.
Completely.
Y cuando hablamos de pandemias, de preparación global, tendemos a pensar en escenarios cinematográficos de virus de alta transmisibilidad.
And when we talk about pandemics and global preparedness, we tend to think in cinematic scenarios of high-transmissibility viruses.
Pero la amenaza más persistente no es ese escenario.
But the most persistent threat isn't that scenario.
Es la acumulación silenciosa de casos individuales de enfermedades prevenibles en personas que nunca recibieron la información adecuada.
It's the silent accumulation of individual cases of preventable diseases in people who never received adequate information.
El hantavirus no va a ser la próxima pandemia.
Hantavirus is not going to be the next pandemic.
Pero sus víctimas son igual de reales.
But its victims are just as real.
Right.
And those victims tend to be invisible in exactly the places they're most vulnerable.
The Canadian passenger will get excellent care and probably survive.
The subsistence farmer in Chubut who gets infected this month may never receive a confirmed diagnosis at all.
Oye, Fletcher, antes de que terminemos, me di cuenta de algo que dije hace un rato.
Hey Fletcher, before we wrap up, I noticed something I said a little while ago.
Usé la expresión 'a menos que se tomen precauciones' y luego 'para que quienes aún no muestren síntomas puedan recibir seguimiento'.
I used the expression 'a menos que se tomen precauciones' and then 'para que quienes aún no muestren síntomas puedan recibir seguimiento'.
¿Notaste el subjuntivo ahí?
Did you catch the subjunctive there?
I did actually, and I was going to ask about it.
'A menos que se toman' would sound wrong to me as a learner but I couldn't have told you why.
It's 'tomen,' right?
With the subjunctive.
Exacto.
Exactly.
En español, ciertas conjunciones exigen subjuntivo de manera prácticamente automática, y 'a menos que' es una de las más claras.
In Spanish, certain conjunctions require the subjunctive almost automatically, and 'a menos que' is one of the clearest.
Siempre va con subjuntivo porque introduce una condición hipotética que aún no se ha cumplido.
It always takes the subjunctive because it introduces a hypothetical condition that hasn't yet been fulfilled.
'No mejorarás a menos que descanses.' 'No podemos actuar a menos que tengamos más datos.' La condición no es un hecho, es una posibilidad que todavía no es real.
'You won't get better unless you rest.' 'We can't act unless we have more data.' The condition isn't a fact, it's a possibility that isn't yet real.
So the subjunctive is doing the work of signaling unreality, the 'not yet true' quality of the thing.
In English we handle that with 'unless' itself, the grammar doesn't change.
In Spanish the verb has to change too.
Bien resumido.
Well summarized.
Y 'para que' funciona igual.
And 'para que' works the same way.
'Para que puedan recibir seguimiento' en lugar de 'para que pueden'.
'Para que puedan recibir seguimiento' instead of 'para que pueden'.
Siempre subjuntivo, porque estás hablando de un propósito, de algo que deseas que ocurra pero que todavía no ha ocurrido.
Always subjunctive, because you're talking about a purpose, something you want to happen that hasn't happened yet.
El subjuntivo, en el fondo, es el modo de lo que todavía no existe.
The subjunctive, at its core, is the mood of what doesn't yet exist.
Una vez que lo piensas así, empieza a tener una lógica muy clara.
Once you think of it that way, it starts to have a very clear logic.
The mood of what doesn't yet exist.
That might be the most useful way anyone has explained the subjunctive to me in two years of trying to learn this language.
Although I'm fully expecting to use it wrong at the next Madrid family dinner and have you hear about it secondhand.