Javier Padilla: "The US has left the WHO, but has benefited from the organization to remove its citizens from the cruise ship"

BarcelonaSince November 2023, public health specialist Javier Padilla (Madrid, 1983) has been the Secretary of State for Health. Last week he led the unprecedented operation to disembark the ship MV Hondius in the Canary Islands, affected by a hantavirus outbreak that, to date, has caused ten infections and three deaths. He speaks to ARA via video call.

Secretary, how is the Spanish passenger infected with hantavirus?

— He is stable and seems to be showing some improvement in symptoms. We hope it continues this way.

Is there any news from the 13 remaining passengers?

— They have no symptoms and have negative PCRs. They will likely have their second test on Monday. The positive cases have emerged from very close contacts. We cannot say the situation is under control until we see that people are not infected [the incubation period can be more than 8 weeks], but it is reasonable to think that [the virus] will not spread from those in quarantine.

Does it reassure you that the scope of the outbreak is limited to the ship?

— Yes. This virus does not have an infectious capacity like covid or measles. The Andes strain can be transmitted from person to person, a ship is a facilitating place as a closed environment with a very specific number of people interacting, but transmission chains usually take a while to establish. That said, we must take into account that measures were taken on the ship days before disembarkation, especially since it set sail from Cape Verde. And the measures in the disembarkation operation have been very important, even exceeding what would be strictly necessary. You can never say never, and we will have to see if during the quarantine any of the contacts start with symptoms and test positive. We hope not.

Measures exceeding those strictly necessary?

— We are in a complicated situation, we made the decision we believed was correct and reality has confirmed it was. If it had not been so, probably the French patient who needed to be admitted to the ICU a few hours after starting with symptoms could have died on the ship, and the Spanish person who started with symptoms, instead of being in one of the most specialized hospitals in Europe for this type of pathology, would be in the middle of the sea.

Can people who were on planes with positive cases feel at ease? 

— There have been no contact situations on a commercial airplane. About 20 days have passed since April 25, and the onset of symptoms is mostly between the second and fourth week. This means we would be in the middle of it right now and we haven't found any more positives. People with common symptoms, such as a cough, have come out and tested negative. In the case of the women isolated in Barcelona and Alicante, it will soon be a week that they have been in quarantine, and if they have a negative PCR test, they will be able to start receiving visitors. Although caution must be maintained, the news is favorable.

Has feared the Spanish government an overestimation of hantavirus due to the memory of covid?

— Previous experiences determine or at least notably influence the present. Much has been said about mutations, tests, and trials, and not so much about the fact that it is a known virus, that the outbreak occurred in a very specific context. I also believe there is a second important element and that is that there has never been an operation like the one in Tenerife. We are talking about a ship with 148 people on board, 121 who disembarked and the majority were repatriated to 23 countries. We had three days to prepare and deploy this plan, and some measures were to mitigate the possibility that something might not go entirely well. What is controllable had to be very well controlled. In this case, no situations outside of what was foreseen have occurred, but one of the buses could have broken down halfway and the passengers might have had to wait longer.

There has been a very visible clash between the Spanish and Canary governments. Do you think the operation has been instrumentalized?

— There haven't even been ideological elements, there has been a very large part of bread-dipped-in-oil politicking, like a B-movie. There was no divergence of opinion based on epidemiological knowledge. There was an evident lack of solidarity, but not even that was the discursive axis; it was the attempt of someone who had no competence to make themselves noticed. Those who deviated from the decisions endorsed by the experts did so through the only loophole they could, which was that of irrationality or political noise. Notice that the president of the Community of Madrid has also said that she was happy with her government's management, when she had no competence to do absolutely anything. She said that her counselor guided the Ministry of Health, and that is curious because before she said that we did not provide her with any information. I think this shows how good the management has been, because not even those who want to criticize it can do so.

Do you understand the concern of the Canarian president, Fernando Clavijo?

— Clavijo has gone through the phase of fear, anger, and victimhood. Fear due to lack of knowledge can be understood, but it is unacceptable to leave a ship adrift with an outbreak with no less than 14 Spaniards when you have the capacity to manage the circumstances. Nor if there were no Spaniards. I believe it is only a concern based on ignorance that was later attempted to be amplified with sui generis arguments, such as that of swimming rats. He was totally detached from reality. I believe it should be understood as another sign of impotence from someone who does not know how to cooperate in an area that is not their responsibility, such as external health and port management.

Last March, the PP and Junts parties blocked the creation of the State Public Health Agency. Would having it operational have prevented situations like those experienced with the cruise ship?

— The general public health law of 2011 already mandated the creation of the agency. The PP governed for seven years and did nothing. After the pandemic, it had two opportunities to vote in favor of it and did not. And now they are throwing their hands up. Having said all this, I am not particularly fetishistic about the administrative form in which institutions are organized. Of course, having it will allow us to have more autonomy and agility in management, but it is still a scientific and technical body; the decision to manage risk will ultimately be made by the general directorate of public health. What we hope is that it will serve for the preparation of proposals and the generation and compilation of evidence. But I think it can hardly matter to a president who says that rats will swim 300 meters to get to the port whether there is an agency or not.

The deceased Dutch couple continue to be considered the zero patients, and Argentina is looking for the origin of the outbreak. Is that so?

— Yes. All confirmed cases originate from the same animal, so genetic studies favor saying that the origin is common and in Argentina. It would be necessary to reflect whether the budget cuts in epidemiological surveillance and vector control [of the Argentine government] may have some correlation with hantavirus, either for this case or in future cases. I would also like to mention something: an important part of the passengers come from the United States and this country has also left the WHO, but it has benefited from it to remove its citizens from the ship.

Upon learning of the infection and the first death, some passengers disembarked halfway, on the island of Saint Helena. Do you believe that avoidable errors were made onboard the cruise ship?

— I for the crew, especially the captain of the ship, I can only have positive words. When I was leaving for the Netherlands, I wanted to send him a message of thanks because he was a total facilitator of the management. Regarding the actions prior to boarding, we will have time to evaluate it. We were not facing a notably frequent outbreak; it is not like a norovirus on a cruise, as has happened now and which is very frequent. We are facing a much rarer infection, with a complex diagnostic confirmation. It is true that the fact that passengers disembarked once a positive was confirmed is an escape route, but it also happened in a place where we do not entirely know the capacity of the authorities to take measures there; whether the ship could truly limit someone's departure.

Diseases transmitted from animals to humans [zoonoses] demonstrate, once again, that they are one of the main threats to public health. 

— We must consider to what extent it makes sense to establish tourism activities that involve an increase in interaction between humans and ecosystems where we are not usually present. If we truly believe the evidence, we must try to modify unnecessary actions that increase interaction between humans and vectors and seek more responsibility in promotional activities.