Are We "Calmmongering"?

On staying measured in a post-COVID world where calm reads as complicity

A week ago, we wrote about the hantavirus outbreak aboard the MV Hondius and the tightrope that science communicators are walking in a post-COVID trust environment. Since then, the news has been overall good. The outbreak in the U.S. hasn’t grown the way some people feared, and there have been no newly symptomatic American passengers. As of Friday morning, Dr. Stephen Kornfeld, the Oregon oncologist in Nebraska who initially tested “faintly positive” and was placed in the biocontainment unit at the University of Nebraska Medical Center, has since tested negative on confirmatory PCR and, according to his own account, antibody tests. He was moved into regular quarantine. Additionally, the two Americans initially placed in the biocontainment unit at Emory University in Atlanta were transferred to the National Quarantine Unit in Nebraska on Friday afternoon. The two passengers, a couple, were originally placed in the biocontainment unit because one had developed mild symptoms. Both have since tested negative and no longer require that level of care. They join 16 other Americans in the National Quarantine Unit in Nebraska. Yesterday, both the CDC and WHO provided updates. The CDC confirmed there are currently no hantavirus cases in the United States. The WHO updated the case count from 11 to 10 after Dr. Kornfeld’s negative results reduced the initial count.

Some of us are breathing easier. Some of us are frustrated with how the rest of us are talking about this. We are arguing with each other, and this is the story we think is worth telling this week.

What we’re seeing in real time:

1. The public is uncomfortable with uncertainty, especially when it comes from trusted sources. When experts disagree in public, and there’s no federal voice to anchor the conversation, people interpret that disagreement as chaos or a cover-up rather than normal science.

2. Staying measured in a post-COVID environment reads as complicity. People who lived through false reassurance in 2020 are now demanding alarm as the price of credibility. But a false alarm is also bad communication; it just does different damage.

3. The federal communication void forces individual communicators to be everything at once. We’re asked to weigh in on pandemic preparedness, airborne transmission, masking policy, and 42-day quarantine windows, when what we actually need is a coordinated federal voice to ground the conversation.

Two pieces, two different approaches

If you’ve been following coverage closely, you may have noticed two pieces this week that are emblematic of the different approaches science communicators are taking to this outbreak.

Michael Osterholm, in a CIDRAP Q&A, makes an empirical case grounded in the available data. Person-to-person spread of Andes hantavirus is rare. He notes that a woman who flew from Argentina to Delaware while infected exposed 51 people, and none of them got sick, and that the median incubation is 18 days rather than 42, which means we are already well past the window when most additional ship-linked cases would be expected to appear. His read is that this outbreak will fade in 10 to 14 days, and that the framing that treats every quarantined passenger as a high-transmission risk is overstating what the evidence supports. (We very much appreciated this approach.)

Apoorva Mandavilli, in the New York Times, makes a precautionary case grounded in what we don’t yet know. Officials, she writes, may be downplaying the risks of this outbreak. She points to the Epuyén outbreak in Argentina in 2018-2019, where she reports that six of 34 cases had no direct contact with those who were ill, including a person infected after sharing a hospital room (with no physical contact, per her reporting) and another who, in her words, “seems to have become infected after simply saying hello as they crossed paths.” Linsey Marr at Virginia Tech and Steven Bradfute at the University of New Mexico push back on the close-contact-only framing. WHO Director-General Tedros Adhanom Ghebreyesus acknowledges to the Times that the WHO has emphasized close contact partly to avoid panicking people about rarer transmission scenarios. Mandavilli’s read is that the airborne route is being dismissed too quickly, and that the credibility cost of that dismissal will compound over time.

These two arguments are not actually diametrically opposed. Osterholm is reading the epidemiology of the current outbreak and concluding it will be self-limited, while Mandavilli is reading the gaps in what we know about the virus and arguing that messaging should not outpace evidence. Both can be true at the same time. The outbreak may be on track to fade, and the question of airborne transmission deserves more honest acknowledgment than it has been getting. These two camps represent different approaches to communicating under uncertainty. Osterholm leans risk-based by reading the epidemiology and weighing the likelihood. Mandavilli leans precautionary, emphasizing what we don’t know. At Unbiased Science, we discuss the knowns and unknowns, but we tend to lean into risk based on likelihood. We could come up with examples of when each approach proved ‘right’ or ‘wrong,’ but hindsight is 20/20. These different frameworks are not the problem. The problem is that there is no trusted, consistent federal voice for either of them to work alongside, push back on, or be accountable to.

What the audience hears versus what we’re saying

When we say “U.S. risk is low,” some readers hear “do nothing,” when what they want to hear is “low risk and public health is working hard to keep it that way.” A week of reading comments has reinforced how often that small distinction makes the difference. When Osterholm says this will be over in two weeks, some readers hear reassurance and others hear dismissal. When Mandavilli’s piece runs with a headline about officials downplaying, some readers hear vindication of their COVID-era doubts, while others hear fear-mongering.

Our followers’ responses make sense. They are the predictable outcome of asking too much of a public without the context for how scientific disagreement works. These are people who lived through COVID, watched mask guidance change three times, and were told ‘low risk’ before in ways that did not age well. Most fields disagree internally. That is how knowledge gets built. The disagreement itself is not the threat to science communication, but the absence of a trusted infrastructure to help the public make sense of it is.

Science writers like Tanya Lewis at Scientific American are trying to thread the same needle, writing carefully about what we don’t know regarding airborne transmission without triggering either false reassurance or false alarm. And still, the uncertainty itself becomes the story for some readers, while others read it as confirmation that officials are hiding something.

A pop culture example (because you know we love these): in The Office’s “Stress Relief” episode, Dwight stages a fake fire drill to test the staff’s preparedness. The fire itself is contained to a trash can, but the panic it triggers spirals quickly, and by the time Dwight reveals it was just a drill, Stanley has had a heart attack. (Can you hear it now? “SAVE BANDIT!” “The fire is shooting at us!” Pure chaos.) The damage came from the response, not the fire. We have a real outbreak with real deaths, but the broader panic is spiraling faster than the evidence warrants, because staying calm about a contained situation has become controversial in itself.

And then there’s our inbox

Some of what has come in this week, more or less verbatim:

“Why are you not saying this is airborne?!”

“Why aren’t you telling people to stop all travel and to mask 24/7?!”

“Why are you okay with ONLY a 42-day quarantine?!”

“YOU ARE CALMMONGERING.”

Calmmongering. We hadn’t encountered that one before. (And the anxiety-sized ulcer in my gut would like a word.)

Most of these messages are not coming from anti-science accounts. They are coming from people who believe they accept evidence and follow expert guidance. They are not asking us to ignore what the data shows. They are asking us to lead with the worst-case scenario every time, and they are framing our failure to do so as a kind of public health malpractice.

The accusation is that staying measured itself constitutes harm, that if we are not sounding the alarm every six hours, we are part of the problem, and that calm in the post-COVID environment reads as complicity. We understand where it comes from. People who lived through 2020 watched authorities use the language of calm to delay action that, in retrospect, should have happened sooner. The pattern recognition is doing exactly what it’s supposed to do.

But the right response to having been failed by false reassurance in 2020 is not to demand the opposite failure now. Treating a low-probability scenario as if it were the most likely scenario is not vigilance. It is a different kind of bad communication, and it does its own damage to people’s nervous systems, to their ability to make decisions based on actual risk, and to the long-term credibility of those sounding the alarms.

Public health is as much an art as a science. We interpret incomplete data, make decisions under uncertainty, and balance how we communicate risk against other real-world factors, such as cooperation, trust, mental health, economic stability, and the long-term credibility of the institutions providing the guidance. The 42-day quarantine is a good example. It is not an exact number handed down by nature; it is a judgment call. It sits at more than twice the median incubation period of 18 days, and it is broadly consistent with how monitoring windows are set for other emerging pathogens—using median incubation periods, outer bounds, and the full range of reported cases to determine where to draw the line. It is the same window being used by the UK, EU, and U.S. health agencies, not a U.S.-specific choice. (Canada is taking a different approach with a 21-day quarantine and a plan to reassess, which is a reasonable judgment call in the other direction; reasonable people can land in different places on this.)

Some have asked whether 42 is “enough,” citing rare reports of cases appearing up to 8 weeks after exposure, but those outlier cases are usually hard to interpret because exposure timing is often based on retrospective recall. The issue is that what appears to be an 8-week incubation is more likely ambiguity about when exposure occurred than evidence of an extended incubation period. The vast majority of cases appear well within 42 days, and there is a real cost to going further than the evidence supports. We saw a version of this with COVID. By the time some masking and stay-home measures extended past what the evidence at that moment warranted, large parts of the public had stopped engaging, and that loss of trust is still showing up in how people respond to public health guidance now, hantavirus included. If we tell everyone on the MV Hondius to quarantine for eight weeks and then nobody gets sick, the next time something similar happens fewer people will cooperate at all. Stretching the window further would catch very few additional cases while straining the cooperation and trust we will need if something more transmissible ever comes along.

We know hantavirus reaches humans from rodents through inhalation of aerosolized particles, so that route is biologically plausible for human-to-human spread as well. What we don’t yet know is whether infected humans shed enough virus in their respiratory fluids for long enough to efficiently transmit it to others. “We’re not yet comfortable calling it airborne” isn’t the same as “it definitely isn’t airborne.” Researchers like Linsey Marr are right to keep pressing on this question. We are not telling you to stop flying because the data on this outbreak does not support that recommendation. And on the masking question, we have written before about why absolutist masking messaging often fails the very people it is meant to protect. Individual decisions to mask, especially for people who are immunocompromised or live with someone who is, are valid and evidence-based, and we will never tell anyone not to. What we are unwilling to do is issue a universal call for 24/7 masking against a virus for which we have no current evidence of person-to-person spread in the United States, because that kind of decoupled-from-evidence recommendation is how public health loses people. Masking is a tool; it fits some risks better than others, and applying it to every risk, regardless of context, is what stops it from working.

And we are not calmmongering. We are trying to communicate proportionate risk in a moment when proportion itself has become controversial.

The federal voice that’s missing

We wrote last week about how the federal communication apparatus is essentially missing in action on this outbreak, and a week later, that remains the case. The CDC didn’t hold a briefing until nearly a month after the first passenger died, the State Department is reportedly running the U.S. response, and the U.S. withdrawal from WHO in January severed the formal channels the CDC would normally use to coordinate its response to an international outbreak.

The people doing the actual work are extraordinary, and they do not need another pile-on. The Nebraska quarantine team, the Emory clinicians, the state epidemiologists in Maryland and Connecticut and New York and at least seven other states monitoring exposed residents, the CIDRAP team putting out daily updates, the career CDC scientists who answered questions clearly at briefings on Thursday and Friday when given the chance to do so, the WHO communicators who have been the most consistent and substantive voices in this outbreak from day one—they are all doing the job well.

What they don’t have is a unified federal backbone behind them, or a clear evidence-based answer when officials are asked how the virus spreads or why some Americans are in the National Quarantine Unit while others are taking their temperatures at home. And when there is no clear federal voice, the void fills itself with cable news segments, cruise ship anxiety, and suspected hantavirus cases in states where Sin Nombre virus has quietly circulated for decades with no person-to-person spread, all treated as sudden new developments. Hantavirus has even primed people to notice every norovirus outbreak, suddenly treating routine reports as breaking news.

We’re also getting questions from people who understand the current risk is low but are thinking about longer-term vulnerabilities — viral recombination, coinfection dynamics, and what happens when people stop taking basic precautions. These are systems-level concerns that deserve to be taken seriously. But the fact that people are asking us to weigh in on pandemic preparedness while we’re writing about this week’s outbreak is itself a symptom of the void. When there’s no coordinated federal voice, people turn to whoever is in front of them and ask them to be everything at once.

Where we land this week

We went back to the formula we used in last week’s piece. Risk perception is roughly outrage multiplied by hazard. The population-level hazard here is low, and the outrage is high, which means the product will be uncomfortable no matter what we say, and pretending otherwise is what got science communication into trouble in the first place.

A question we are getting a lot is whether this could spread beyond the people on the ship. Based on what we know about previous Andes hantavirus outbreaks, we can be cautiously optimistic. Not everyone who is infected transmits it to others; in fact, most do not. Previous outbreaks in Argentina have been self-limited, meaning they did not spiral into widespread community transmission, and the pattern of cases on the MV Hondius so far is consistent with that history. That does not mean there is nothing to watch. It does mean the current response, which includes quarantine, close monitoring, and a wide net of contact tracing, is working as intended, and the historical record gives us reason to believe this outbreak can be contained.

As Dr. Abdirahman Mahamud emphasized in the WHO briefing on Friday morning, transmission here depends on the infectiousness of the infected person, the environment they are in, and whether PPE is being used. While there is still more to learn about an infected person’s infectiousness and how the environment affects it, not everyone has an equal probability of being infected. The current WHO precautions intentionally assume any infected person could be a super-spreader, so all exposed people are managed as high risk , reflecting the most conservative approach as more evidence accumulates. But that’s exactly the point — this isn’t a failure of caution, it’s caution being applied while the evidence accumulates.

The empirical case on this specific outbreak is, in our view, the more persuasive one right now. The attack rate is low, the timing is on our side, and the pattern of cases is consistent with what Andes virus has done in past outbreaks rather than something new and more dangerous.

The published NEJM analysis of the Epuyén outbreak, the largest documented person-to-person transmission of Andes virus, supports this. Documented transmission events centered on prolonged contact during social gatherings, not brief encounters. The authors identify ‘prolonged or close contact with symptomatic persons’ as the established risk factor and conclude that social and ecological factors, not fleeting exposure, drove the super-spreading. That is the pattern we are seeing on the MV Hondius.

We think this will fade. That does not make the precautionary read wrong, because the questions Marr and Bradfute are raising about airborne transmission are open scientific questions, and they will still be open when this outbreak is over. We can be honest about the limits of what we know without changing the risk assessment for the U.S. public this week, which remains low.

What we are taking from this week is that the discipline is working. People like Osterholm, Mandavilli, Marr, Bradfute, and our Evidence Collective colleagues are reading the evidence, disagreeing about what it means, and, yes, occasionally being public about that disagreement.

But the discipline can only carry so much weight on its own. Science communicators are not a substitute for a functioning public health communication infrastructure. We can clarify, contextualize, and translate, but we cannot replace the credibility that a coordinated federal voice would bring to all of this, and we are stretching ourselves thin trying to.

In the meantime, the people on the MV Hondius are in the hardest stretch of this. Three families are grieving, and that loss is real. The remaining passengers and crew are still inside their monitoring windows, watching for symptoms that may or may not come, and the noise around this outbreak is hardest on the people actually living inside it. The epidemiology suggests the outbreak is winding down, and Dr. Kornfeld is okay. That’s the update. The people at the center of this story deserve more from the rest of us than what they’ve been getting: less spectacle, more patience, and a willingness to let them go through this without being turned into a headline every day. If you read last week’s piece and wanted an update, this is it. If you have been watching the comments fight unfold and wondering whether the people you trust have lost the thread, we don’t think we have. We think we are doing the job with each other, in front of a public that deserves better infrastructure than we can build on our own.

Stay Curious,

Unbiased Science