May 25, 2020

Zoonotic

Instead of joining the CDC EpidemicIntelligence Service (EIS) when I finished my residency in 1993, I joined the United Stated Public Health Service as a commissioned officer. When I left in 1996 I was a Lieutenant Commander. That’s right, I’m a Veteran. I spent my entire time assigned to the Indian Health Service unit in Keams Canyon, Arizona, which is inside the Hopi Reservation, surrounded by the Navajo Reservation. I worked alongside both Hopi and Navajo and our patients were from both tribes. Those three years were some of the most interesting and influential years of my life.

And just before I arrived there, a mysterious illness started claiming the lives of young, healthy people. This illness progressed to respiratory failure quickly. Members of the same family were stricken. A deadly illness with an unknown cause is frightening, as we all know. But the CDC and the dedicated people of the Indian Health Service and University of New Mexico solved the mystery in weeks by working together and working with the heartbroken families in a culturally sensitive way. They were able to identify a previously unrecognized zoonotic virus, the “Sin Nombre” Hantavirus. Zoonotic means that the illness infected humans from an animal host. People got exposed from deer mice droppings that aerosolized when they cleaned out sheds or picked the bumper crop of piñon nuts that year- there had been more rain than usual, thus more food for the deer mice and their populations exploded. Hantaviruses are not related to coronaviruses, but the similarity they share is that they are both zoonotic. A big difference with Hantavirus is that humans can’t transmit it to other humans, something to be grateful for. As it turns out, there had been more unexplained deaths in various parts of the country over many years, that were caused by hantavirus but had never been identified, because those deaths did not occur in a cluster like this did.

I am thinking so much about that time in my life now, when I read about the devastating effect COVID-19 is having on the Navajo reservation. The extended families often live in isolated sheep camps that are several miles down a dirt road, with no electricity or running water. Times have not changed much for them in the past 25 years since I left. They are tough, stoic people, not asking for help unless they really need it. We warned the new docs that if an elderly Navajo man came to the emergency room and said he “felt some way”, you should get ready for a cardiac arrest or some other catastrophic illness. I imagine that this has not changed. My heart bleeds.

Wash your hands and cover your nose.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.discovermagazine.com/health/death-at-the-corners#.UVDARxmzI7A

https://en.wikipedia.org/wiki/United_States_Public_Health_Service_Commissioned_Corps

https://abcnews.go.com/US/navajo-nation-covid-19-claims-families/story