Miriam van Gool

The transition has started. More & more people get it: we have #OnePlanet. Astronauts call it the '#OverviewEffect'. vimeo.com/planetarycolle…

@TheShiftJournal It's all of the above

What is life? • Picasso: It’s art. • Gandhi: It’s love. • Freud: It’s death. • Marx: It’s the idea. • Socrates: It’s a test. • Dostoevsky: It’s hell. • Steve Jobs: It’s faith. • Nietzsche: It’s power. • Aristotle: It’s the mind. • Einstein: It’s knowledge. • Stephen Hawking: It’s hope. • Schopenhauer: It’s suffering. • Kafka: It’s just the beginning. • Bertrand Russell: It’s competition.

@SDSLLC_USA only PCR tested positives (= actually have the virus) of Andes following outbreak on the Hondius ship so far, are people that were on the ship (and those that tested positive and have traveled are now in isolation).

Can anyone explain to me how a cruise ship with a few Hantavirus infected people has now spread to so many different countries that had nothing to with this cruise ship or even coming to port in their countries and how it's spreading in the United States so fast? This feels like it's been planned and is intentional and if that's the case, I want to know who is going to be held accountable for it?

@FondOfBeetles see also livescience.com/health/live/ha…

@FondOfBeetles I'm also confused, but see the caption on the screen... puzzling.

On hantavirus #ANDV #hantavirus I think the Andes hantavirus data is being misread right now. Claims are circulating that the evidence doesn’t seem to support. I want to walk through them carefully.

@MackayIM Note dr Kornfeld, passenger on the ship who helped out especially when ship doctor became ill. He had certain symptoms ±10 April, which went away, and was at least once tested positive (possibly the case where 'mildly positive' was reported): x.com/OutFrontCNN/st…

Version 6. Corrected an error about Case 4 death date (my apologies). Coloured yellow the now-symptomatic Spanish case. Note that the "mildly positive" US "case" has since tested negative.

@FondOfBeetles makes sense. I've always thought that asymtomatic or pre-symptomatic infectiousness is hard to pin down, related to when people notice / report symptoms. Grey area. Have you seen this of dr Kornfeld - passenger who helped, esp once ship doctor got sick? x.com/OutFrontCNN/st…

The Birthday Party outbreak suggests transmission while symptomatic (or at least, when you feel a bit crap coming down with something). This feels obvious, given how viruses in general work (ESCAPE! FIND NEW HOST!). Given the lack of data, I'm not clear there's any way to get a handle on asymptomatic/incubation period/post-viral transmissibility (there is some sperm data showing PCR signal at nearly-two years post-infection).

@FondOfBeetles great thread! One question I have is about the timing of peak infectiousness (and any possible variability of tranmission modes in different phases). When & how (just) before symptoms, with mild symptoms, with strong symptomes, later etc. Anything you've seen on this?

The evidence across multiple cohort studies points toward transmission requiring intimate contact or fomite-mediated hand-to-mucous membrane transfer, not efficient airborne spread. Look at the healthcare worker data. It’s almost the best we have to test the hypothesis that ANDV is airborne. And it doesn’t fit.

Interesting thread, with arguments for a much lower CFR than previously suggested, and for main transmission via fomites based on earlier events. Do note the words of caution at the end (until more certain about whether or not airborne, good to take precautions). #hanta #Andes

So far no Hanta positives outside passengers #Hondius (and some of the below were in close contact with sick woman 25 April). Long incubation period leaves weeks to be sure, but still small bits of good news.

@j_g_allen "An essential lesson from COVID is that officials should be candid about communicating that we are often learning in real time, and we should shy away from making bold pronouncements that may prove dangerously misleading weeks or months later" 💯

"In any outbreak, the single most important question is: How does it spread? The answer informs the guidance for everything else, including how to stay safe, which protective measures to put in place, and who should be notified during contact tracing. Get it wrong and everything else breaks down." Me, for @TheAtlantic [link in thread]

Disease detectives are usually invisible. Their work is patient, quiet, and methodical, and it saves more lives than almost any other profession. The Hondius outbreak will end sooner because dozens of them did this work well. tomfrieden.substack.com/p/what-disease…

@outbreakupdates x.com/oldfshndanne/s…

JUST IN: A 25 year old male from Calabria (Italy) who was on the KLM plane, and now under quarantine, is showing symptoms of hantavirus infection and is being transferred to the Spallanzani Hospital (Rome)

@quay_dr x.com/oldfshndanne/s…

@quay_dr x.com/Ayjchan/status…

Andes Hantavirus analysis: This chart suggests Cases 2-8 were all a single H-to-H jump from Case 1, since all of the incubation periods cluster at 22 days from Case 1 symptoms. We are now 13 days from the 'mean' date of symptoms from Cases 2-8. If there is to be a new generation of cases they should appear, on average, at about May 19 or 22 days from Gen 2. Strict protocol would support a 42-day quarantine from last contact or about June 21st for all exposed individuals.

@DrNeilStone x.com/oldfshndanne/s…

@DrNeilStone x.com/Ayjchan/status…

Hantavirus so far 11 cases 9 confirmed 2 suspected 3 deaths Number of people infected who were not on the MV Hondius? Zero

@ajlamesa The first Hanta PCR was done on a British patient in Joburg on 2 May. So noone knew 25 April! This woman was hoping to finally fly home after husbands death 11 April. Grief and symptoms.... and she WAS helped off the KLM flight (had been on 45min-1hr?) for medical assistance.

I'll confess to wondering what happened at the Johannesburg airport. I hope South African officials are reviewing why the woman was allowed to board a flight instead of being provided with medical assistance.

@ooitkomthij 🤣

Wie is Wie? K. Laheye: Sinds 2020 zijn er meer dan 70 brieven van deze "persoon" gepubliceerd. Peter de Quaack: (of de Quaak) uit Vlissingen: een van de meest actieve schrijvers met naar schatting meer dan 100 bijdragen over uiteenlopende onderwerpen. M. van den Brink: Een naam die eveneens vaak boven drijven W. Duk: Opinie maker #telegraafgate

@NickKristof thank you the braveness of your reporting

I appreciate the intense interest in my column. For skeptics, why not agree on Red Cross and lawyer visits for the 9,000 Palestinian "security" prisoners? If you think these abuse allegations are false, such monitoring visits would be protective. So why not?

@quay_dr also am thinking those that showed symptoms around 10 May or later might already be next gen from case 2 showing symptoms around 24 April

@quay_dr detail but for next version: case 2 passed away 26 April not 25 (she was on board the KLM flight to A'dam on the 25th scheduled to depart 23:15, before she was helped off that plane and to hospital Joburg, where she passed 26).

May 12 Hantavirus Update: Read quickly and then go live your lives. Risk very low; CDC/UNMC/Emory U are on this. -11 cases, 3 deaths: Index case, his wife, one other -One new PCR+ Spanish case overnight; early symptoms -History of previous outbreaks indicates PCR+ occurs 5-15 days before symptoms -The situation remains within the window of the first generation of human-to-human transmission from the Index Case -That window closes about May 19th, when new cases need to begin to be attributed to a Gen 2 H-to-H transmission, if they occur -The four sequenced cases are nested within prior cases from Argentina; nothing remarkable about their genomes to predict abherent behavior -The 4 sequences are identical, indicating a single source, the Index Case, and not consistent with multiple rodent-to-human cases, as suggested by some -UNMC National Quarantine Center is responsible for observation of 18 non-symptomatic exposees -The Center personnel train quarterly for just this event -We have this National Center based, in part, on the visionary leadership of Senator @BenSasse, Senators Fischer & Ricketts, Congressmen Flood, Bacon, and Smith, and Nebraska Governor Pillen. -Thank you on behalf of the American people. -Outbreak likelihood remains extremely low and unchanged from yesterday