The last hantavirus cruise passenger still locked down by Dr. Jay Bhattacharya and the CDC.
The results of a hearing last week remain in limbo.
On May 11th, 18 Americans entered the National Quarantine Unit in Omaha, Nebraska. They had just been repatriated from the MV Hondius, the ill-fated cruise ship where a rare and deadly outbreak of Andes hantavirus had just occurred. They were told that after 72 hours there, they could stay put or travel home (via non-commercial travel) to complete a 42-day watch-and-wait period to see if they had contracted the virus. That was both the CDC’s guidance, and what they were explicitly told.
But that’s not what happened.
After the 72-hour period, anyone who actually wished to depart would be served with a federal quarantine order. So, sixteen initially “elected” to stay. Two voiced their desire to leave. They were promptly served with orders, signed by the CDC’s top official, Dr. Jay Bhattacharya, preventing them, by law, from leaving. The two, Angela Perryman and a New York State resident, formally protested. Their protests were not successful. Naturally (because every accusation by this administration seems to be a confession) they had been locked down by none other than Dr. Jay Bhattacharya, the very face of the anti-lockdown movement during the early days of Covid-19.
Some departures begin…
After May 31st, the halfway point, officials finally began to let some of the “guests”—their official designation—choose between staying and going. Those who wished to leave could complete what amounts to quarantine in their homes, provided that local authorities approved the move. In other words, when officials had initially said that guests were required to stay at the NQU for 3 days, they really meant 21.
By May 31st, the number who wanted out of the NQU had grown from 2 to 9, half the cohort. Over the course of early June, eight guests have departed the unit, including one on Wednesday. So, one person currently remains at the NQU against her will: Angela Perryman—the very person who has spoken on-the-record about the ordeal. She is also one of the two people who had wanted to leave as soon as 72 hours had elapsed. (The other departed for New York State last week.)
Not safer.
While all of the former MV Hondius cruise passengers take this situation seriously—people they know died due to this outbreak—at least some of them have figured out that the 42-day quarantine period would not only be more comfortable in their own homes, but it would likely be safer.
Indeed, staying at the NQU might sound safer than being home, but that’s not the case, typically. In fact, being at the NQU likely raised the risk for the guests, to say nothing of the staff (though with adequate PPE, it would be safe, even if anyone were to test positive.) While not reported until now, several former cruise passengers told Inside Medicine that in the first few days of their stay at the NQU, a tornado warning necessitated a partial evacuation of the entire 18-person cohort. Because there is no tornado-proof individual lodging for the guests (and due to the structure of the building), NQU guests convened in a hallway during the alert period. Ms. Perryman estimates that she and the other guests spent about an hour together, ostensibly seated in chairs six feet apart (but, instead, socializing), wearing surgical masks only. “We hadn’t seen each other in person that wasn’t in full PPE since we had been locked in, so we all enjoyed this as a social activity.” But she also noted that this was a risk that didn’t seem to bother NQU experts. “Nobody seemed terribly concerned about the fact that all eighteen of us were crowded into the hallway,” she noted. If any of the guests had started to become symptomatic at that time, it would have been a major exposure, as early symptoms are believed to correlate with peak contagion. Perryman and others concluded not only that going home was safe, but that staying at the NQU was, in this case, not obviously the safest approach.
In addition, the mental health of at least one passenger deteriorated substantially in late May—which has also not been reported until now—adding complexity, if not instability, to the situation. That passenger is now completing the monitoring period at home, and he told Inside Medicine that since leaving the confines of the NQU, his seemingly rapidly progressing psychiatric symptoms have “entirely” resolved.
Meanwhile, another former MV Hondius passenger who returned to New York now describes home-based management as “Fine. Much better.” He notes that the guard the government requires to remain in his driveway is not a bother. “I feel sorry for them having to sit there,” he told Inside Medicine, “but they have access to my WiFi.”
Another former passenger, a physician who had sprung into action on the ship, told Oregon Live that “home quarantine is night and day compared to facility quarantine…I can eat whenever I want. I can sleep on my own bed.” He said that life at the NQU was like being “a prisoner.”
In fact, in many ways it was worse. It wasn’t until the second week that NQU guests were permitted to get some fresh air—brief rooftop excursions with up to four others at a time.
It’s no surprise that the CDC itself has long advocated for home-based quarantine, whenever possible. It’s also proven effective during this situation. As of June 4, the dozens of US residents who were engaged in home monitoring following high-risk exposures to the Andes hantavirus had completed their 42-day stints without incident.
Not least restrictive.
In order for the government to lock a person down, it is legally obligated to demonstrate that doing so is the “least restrictive means.” That is, if preventing the spread of a dangerous virus can be achieved with home-based monitoring/quarantine, requiring individuals to stay in a government facility is not legally permissible. This was (and is) the basis of the protest waged by Ms. Perryman and another passenger.
As the 21-day mark approached, guests began coordinating their departures for their home states. However, a last-minute hurdle appeared. While not an explicit requirement, the federal government had made it clear that it wanted former passengers leaving the NQU to have 24-hour-per-day surveillance. They literally wanted a public health officer or someone from law enforcement to be parked outside their house to make sure the former cruise passengers didn’t leave. The federal government also wanted in-person checks, twice per day. Initially, some of the states buckled, but eventually all of them went along with this, except Florida.
Until these new requirements appeared, Florida had been working with Ms. Perryman so that she could come home. It was not that Florida had opposed her return. Rather, the new demands by the federal government changed its decision.
Below is a copy of a memorandum sent by the State Surgeon General of Florida, Dr. Joseph Ladapo (of anti-vaxxer infamy) and provided to Inside Medicine. His argument basically reaffirms the CDC’s official guidance and prior practices.
The document explicitly refutes the need for continuous in-person surveillance and check-ins. It seems that this is the reason that Ms. Perryman has been unable to leave the NQU, while seven others have. It seems that the other states eventually went along with the new federal requirements (although they were not official policies). But, ever committed to states’ rights, Florida would not go along with the federal government’s “request.”
So, Angela Perryman remains at the NQU. She finds it “ironic that Florida would not bend to the federal government,” but doesn’t mind that the result is that one of its residents is now, in her words, “a hostage.”
Not efficient.
Last Friday, a special hearing was held. The purpose was to determine whether the government had demonstrated the medical necessity of forcing Ms. Perryman to remain at the NQU. As a part of that process, my colleague Dr. Demetre Daskalakis and I provided our expert opinion in support of Ms. Perryman’s case.1
The document that we submitted to her legal team can be found here:
Our argument was simple. We didn’t need to prove that home-based monitoring was the least restrictive means. The government had already proven that because it had permitted “home-based management” for the literal dozens of other US residents with high-risk exposures related to the MV Hondius cruise hantavirus outbreak.
According to Perryman, the CDC’s own experts did not contradict any part of our argument, nor those advanced by her or her lawyers. According to her, “they didn’t make a case…They just asserted that this is their expectation, and that other states have agreed, so there.” In other words, because other states went along with the federal government’s requests, their argument was that Florida should too. (Note: a transcript was supposed to be available within 24 hours of the hearing. Now, almost a week later, no transcript has materialized.)
More than a transcript, what’s also missing is a decision. Under federal rules:
“At the conclusion of the review, the medical reviewer shall, based upon his or her review of the facts and other evidence made available during the medical review, issue a written report to the Director (excluding the CDC official who issued the quarantine, isolation, or conditional release order) concerning whether, in the medical reviewer's professional judgment, the Federal quarantine, isolation, or conditional release should be rescinded, continued, or modified. The written report shall include a determination regarding whether less restrictive alternatives would adequately serve to protect public health. The written report shall be served on the individual and the individual's authorized advocate or representatives.” —The Code of Federal Regulations, title 42, Chapter 1, Subchapter F, Part 70. § 70.16
Left unsaid is how quickly this must happen. The hearing was six days ago. Meanwhile, the 42-day quarantine period ends on June 21-22, 10 days from now. So, it could be that the CDC is just hoping to run the clock out here. While another 10 days may not sound like much, for those confined to very small rooms, the days are trying. In fact, the mental health strains of quarantine have been written about by NQU officials themselves.
Ms. Perryman made it clear to me that she isn’t resigned to staying at the NQU for the next 10-11 days. She continues to await a decision on the medical determination hearing. And she’s engaging on something of a media blitz—including recording a segment for NBC’s The Today Show, which she was told would air today.
She continues to respect the seriousness of her hantavirus exposure. But her opinion of current CDC and HHS leadership is low. “The one person still here is the one who spoke out from the beginning,” she points out. “Is that a factor? I don’t know.”
Thank you for reading! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
I acknowledge that participating in this manner straddled the line between journalism and advocacy. I don’t attempt to hide this. Rather, I embrace it as a strength of this platform.
Are either of the two quacks involved (Federal and State) board-certified fascists? It would seem so.
Wow! I really don't have the words. The total incompetence is just staggering.