There is a particular kind of dread that comes not from a thing that is happening to you, but from a thing that is happening somewhere else and could, under the right circumstances, find its way to you. Most of us felt that dread during COVID. And now, once bitten, twice shy, it is knocking again.
A Dutch cruise ship left Argentina on the first of April, and by the eleventh, a passenger was dead. By early May, six cases were confirmed, three of them fatal. The pathogen responsible was the Andes virus, a strain of hantavirus.
Almost immediately, the World Health Organization (WHO) started scrambling to contact-trace across continents, and the Centers for Disease Control (CDC) raised an emergency flag. Passengers were hospitalised across South Africa, Germany, Switzerland, and the Netherlands.
The world, including Pakistanis, reasonably shrugged. But that shrug deserves some examination.
Hantavirus is not new. It has existed in rodents for a very long time, occasionally jumping to humans who come into contact with infected urine, droppings, or saliva. It is carried by mice and rats, animals that have been cohabiting with human civilisation for millennia.
In Asia and Europe, it attacks your kidneys and blood vessels and case fatality runs between one and fifteen per cent. In the Americas, it hits your lungs and heart, and the fatality rate climbs to fifty per cent. Fifty! That is not a number you read past quickly.
The Andes virus, which caused the cruise ship outbreak, is the only hantavirus known to spread person to person. Every other strain requires you to actually encounter a rodent or its waste. But Andes moves through close, sustained contact with an infected person, through saliva, respiratory secretions, and bodily fluids. Whether it is airborne remains under investigation, which is precisely the kind of sentence that should make your stomach drop a little.
There is no cure or vaccine. Treatment is mostly supportive: intensive care unit, ventilators, careful management of symptoms… and hope.
Now, why should a Pakistani in Lahore or Karachi or Quetta care about a virus that appeared on a luxury cruise ship in the South Atlantic?
Because the index case, the first patient, was a Dutch man who had spent four months road-tripping through Chile, Uruguay, and Argentina before boarding that ship.
He almost certainly contracted it from a rodent encounter somewhere along that route. So the virus did not originate on the ship. It arrived on the ship and then did what viruses do in enclosed spaces with recycled air and communal dining.
The people most at risk from hantavirus in any country are the people handling grain, clearing debris after floods, and working in poorly ventilated factories and warehouses
Pakistan is not Argentina. But Pakistan is a country where rodent populations are enormous. Almost every household has heard shrieks of women (or men!) finding a rat in their kitchen. Our grain storage is often informal, urban flooding drives rats into homes, and healthcare infrastructure outside of major cities is genuinely thin. We are not insulated from animal-linked disease. We are, if anything, overly exposed to the conditions that produce it.
Here is where hantavirus is genuinely different from COVID-19, and where the comparison is worth making carefully rather than reflexively.
COVID was respiratory and spread with remarkable ease between people who had done nothing more dangerous than breathe the same air. Hantavirus requires sustained close contact. The Andes virus has been spreading in small clusters in Argentina and Chile for decades, and it has never exploded into a pandemic. The WHO's current risk assessment is low, and that, for all we know, sounds accurate.
But the cruise ship case is unsettling for a specific reason that has nothing to do with case counts. It demonstrated that a single person, infected in South America, could board a vessel, interact with hundreds of people from dozens of countries, and seed an international contact-tracing operation before anyone realised what was happening. The infrastructure of global travel is also the infrastructure of global transmission. This lesson was supposed to be COVID's permanent gift to public health institutions everywhere. It is worth asking how well it was actually absorbed.
Pakistan's answer to that question is slightly uncomfortable. Our disease surveillance systems are weak. Our point-of-entry health screening is inconsistent at best. During COVID, we improvised repeatedly, and I admit that improvisation was often impressive given the constraints. But constraints are not a basis for confidence.
If a hantavirus case entered through Karachi or Lahore airport tomorrow, the chain of detection would depend heavily on whether the treating doctor had encountered the virus in training, which is unlikely. It also depends on whether they thought to test for it, which is also unlikely.
There is also a financial dimension here that rarely gets discussed in outbreak coverage, perhaps because it feels callous, but is actually quite important. Diseases that jump from animals to humans are, in large part, a product of how humans organise land, food, and labour. Poor sanitation in dense urban settlements amplifies rodent populations.
Informal labour in warehouses and fields puts working-class people in proximity to rodents in ways that middle and upper-class Pakistanis in apartments never experience. The people most at risk from hantavirus in any country are the people handling grain, clearing debris after floods, and working in poorly ventilated factories and warehouses. Meaning, they are the poorest people in a given place.
In Pakistan, that means the risk, if God forbid it ever materialises, will not be distributed evenly. And COVID demonstrated this with clarity: the people who could work from home did, while the daily wage working class and masons carried the risk.
A hantavirus emergence in Pakistan would follow the same logic. The farmer in rural Sindh sleeping in a room with grain sacks is more exposed than the Karachi professional reading about it on their phone.
And we are not set up to protect that farmer. Not through early warning, not through accessible treatment, and certainly not through someone whose first healthcare contact is a Basic Health Unit that may or may not be staffed that week.
I am not trying to scare anyone. Hantavirus is not COVID; it spreads rather inefficiently. The WHO is right to assess the global risk as low. But the cruise ship case is a useful stress test of something broader: how do health systems respond when a rare and poorly understood pathogen surfaces in a globalised, mobile world? The honest answer, watching the situation unfold across, is: slowly, and with a great deal of reactive improvisation.
For Pakistan, the lesson is not to panic but to notice that the infrastructure of health is something you build before the outbreak, not during it.