‘You just can’t get the air in’: How hantavirus turns deadly

Mr Jordan Herbst was 14 years old when he came down with what he thought was the flu. After a few days of aches and chills, though, he started having trouble breathing. The doctors who first saw him in Bishop, California, suspected it was pneumonia. But his breathing quickly worsened and his lungs began to fail.

He was rushed by air to a larger hospital, where he was put on a machine that took over for his heart and lungs.

“I imagine it’s what drowning feels like,” said Mr Herbst, who is now 26. “You’re trying to breathe, and you just can’t get the air in.”

Mr Herbst was diagnosed with hantavirus, a rare infection that can be fatal. The World Health Organization said on May 4 that there had been one confirmed and five suspected infections of hantavirus among the passengers of a cruise ship in the Atlantic Ocean.

Three of those passengers have died.

It is unclear how those sickened may have been infected; people typically contract the virus from exposure to rodent droppings, urine or saliva, though one strain can also spread among people in prolonged close contact, said Dr Gaby Frank, director of the Johns Hopkins Special Pathogens Center in Baltimore. The hantavirus strain found in the United States does not spread from person to person.

There have been a total of 890 cases documented in the US since surveillance began in 1993. Most have occurred west of the Mississippi River.

About 35 per cent of US cases have been fatal. Ms Betsy Arakawa, the wife of actor Gene Hackman, died from the effects of hantavirus in 2025.

An infection can also lead to serious complications. The symptoms can vary depending on what strain of the virus someone is infected with, as can the mortality rate, associate professor of internal medicine Steven Bradfute at the University of New Mexico Health Sciences Center said.

Both the Sin Nombre strain, which is found in the US, and the Andes strain, which is endemic to parts of South America, can cause a condition called hantavirus pulmonary syndrome.

With those strains, the infection begins with symptoms like those Herbst experienced: Fever, chills, muscle pain, headaches and gastrointestinal issues. These typically emerge between one to six weeks after exposure, Dr Frank said.

At that stage, “it’s very easy to mistake for any one of a number of viral infections”, said Dr Charles Van Hook, a pulmonologist and critical care doctor at University of Colorado Health Longs Peak Hospital.

Some people recover on their own. But for many patients, the infection becomes more severe within a few days of symptoms appearing. The virus infects blood vessels, which in turn leak fluid into the lungs.

“The lungs become essentially a completely saturated sponge,” said Dr Martha Blum, an infectious disease doctor at Montage Health in Monterey, California.

Patients can develop chest tightness and difficulty breathing. The rapid onset of breathing problems in an otherwise healthy patient who might have recently travelled to an area where the virus is common or been exposed to rodent droppings can be a telltale sign, Dr Frank said.

As fluid leaks out of the vessels, blood pressure drops. The heart beats more quickly to compensate, but is unable to squeeze properly, Dr Van Hook said. Patients who progress to this point need oxygen and may require an artificial heart-lung machine.

Other strains common in Europe and Asia can lead to hemorrhagic fever with renal syndrome, a disease that affects the kidneys.

There are no specific medications for hantavirus, Dr Blum said, so doctors use measures such as oxygen and heart-lung support to help patients “ride the wave” of the infection and allow their organs to recover.

Without a quick diagnosis and this type of supportive care, a patient who enters this severe phase of infection can die within 24 to 48 hours, according to the National Emerging Special Pathogens Training and Education Center.

Ms Kristine Musson, a 37-year-old retail manager from Pacific Grove, California, became so ill with a hantavirus infection in 2023 that she needed to be put on life support. “I just started thinking the worst” said Ms Musson, who had a 5-month-old daughter at home at the time.

A doctor told her husband that had they arrived to the emergency room just an hour later, she probably would not have survived.

Those who survive may continue to experience fatigue and have trouble breathing as their lungs continue to heal, Dr Frank said.

“Sometimes, recovery never fully takes place,” Dr Van Hook said. “People are so debilitated that they can’t recover their former levels of strength or cognition.”

Mr Herbst spent six days in a medically induced coma in order to give his body a chance to fight off the virus. Even once he was well enough to leave the hospital, he would get tired and need to sit down after walking just 15m.

Mr Herbst was supposed to be starting his freshman year of high school. Instead, he spent much of the next year and a half at home, working to rebuild his strength and feel normal again. NYTIMES