I was on the team that received American Ebola patients at the Nebraska Biocontainment Unit in October 2014. I am back at the unit now. I have never been more afraid in thirteen years of doing this work.
There are sixteen Americans inside a sealed corridor at the University of Nebraska Medical Center as I write this. Most of them came off a Dutch expedition cruise ship called the MV Hondius. Three of their fellow passengers are already dead. I am one of the physicians inside the same corridor, taking care of them.
I am writing this from a hotel room across the parking lot from the hospital at 1:14 AM Sunday because the rotation protocol requires me to stay within forty miles of the facility and the only place I have been since May 8th that does not have a stranger's air recycling through the vents is this hotel room. I am required to be back at the unit at 5:45 AM. I have approximately three hours before I have to walk back across that lot.
I am not going to identify my hospital or my colleagues or the federal agencies coordinating the response. I have a public-statements clause in my employment contract. I am not going to violate it. What I am about to describe is publicly verifiable from CDC, university, and federal records.
What I am about to describe is the gap between the institutional response inside the building and the language being used outside of it.
In October 2014, when our unit received the American Ebola repatriations of that year, we held public briefings. The lead physician of our program stood in front of cameras at a hospital briefing room and answered questions from reporters every other day. There was a dedicated information channel. There were daily updates published on the university's website. There were named clinicians available for interviews. There was a level of public transparency about what we were doing inside the unit that, by current standards, looks like science fiction.
That was twelve years ago for an outbreak that killed roughly eleven thousand people in West Africa and resulted in two confirmed transmissions on American soil.
The current outbreak has, on American soil so far, killed three confirmed people and infected approximately eleven additional confirmed cases. The numbers are smaller. The transparency is also smaller — by a factor I do not have language for.
There have been no public briefings from our unit since the current activation. There have been no named physicians available for interviews. The information channel published in 2014 has not been updated for the current event. The hospital's communications office has issued a single sentence. The federal agencies have issued a small number of advisories — including HAN-528, which I will get to — and one routine situation update.
The CDC's official position to the public, in case I need to remind you, remains, verbatim: "extremely low public health risk to the general American population."
I was on the activation pager rotation in 2014 and I am on it now. The page that came to me on October 6, 2014 was four characters long. It read: "ETA 1400." The page that came to me on May 7, 2026 was four characters long. It read: "ETA 1400."
I sat at my kitchen table the morning of May 8th and I looked at my phone for a long time. Both pages were on my screen. I had pinned the 2014 one in a folder marked "Reference." It is the page I think about more than any other communication I have received in my career. It is the page that means a small unit at a Midwestern hospital is about to do something only four buildings in the country can do.
I packed a bag.
Here is what is publicly verifiable about the current event.
On May 2nd, a Dutch expedition cruise ship called the MV Hondius docked carrying a strain of hantavirus called Andes virus. The only hantavirus on earth ever documented spreading from one human being to another through respiratory transmission. Three of the passengers are dead. Sixteen American passengers were transferred to our biocontainment unit through a federal repatriation arrangement. Twenty-three additional American passengers flew home on commercial flights before screening protocols existed. They are now in Arizona, California, Georgia, Texas, Virginia, and Nebraska. A KLM flight attendant in Amsterdam who was never on the ship is hospitalized with confirmed infection after a few minutes of contact with one of the disembarked passengers on a connecting flight.
The Andes incubation window is six weeks. We are entering week four.
The case fatality rate is between 35 and 40 percent. In adults over 60 with comorbidities — which is roughly the demographic of the average expedition-cruise passenger — the mortality rate is meaningfully higher. There is no vaccine. There is no antiviral. The CDC has activated its Emergency Operations Center for the response, which is the part the public does not understand the weight of.
The CDC's Emergency Operations Center has four tiers of activation. The lowest is a watch posture, where staff monitor an event but do not deploy. The next level is Standby. Then there are activation levels — Level 3, Level 2, and Level 1, in increasing intensity. Level 1 is the highest tier and is reserved for full-mobilization responses requiring multi-agency coordination, deployment of CDC field staff, and twenty-four-hour operational support across multiple time zones.
The previous Level 1 activations in the past two decades were H1N1 in 2009, the Ebola epidemic in 2014, and COVID-19 in 2020.
The Andes response was activated to Level 1 on May 9th.
The previous time the CDC activated to the highest tier for a hantavirus event was never. The first time in agency history. That is publicly verifiable in the CDC's activation history.
The CDC press briefings continue to use the phrase "extremely low public health risk."
I am writing this because the institutional response inside the federal architecture has been at the maximum activation tier for three weeks and the message to the general public has been calibrated to the second-from-bottom tier. That gap is the gap I am writing from.
I will not describe the patients. I will not describe specific clinical details. I will tell you what the operational picture is, because the operational picture is the same for every Level 1 federal biocontainment activation regardless of the pathogen.
When I report for a shift, I go through a personnel airlock. I remove my street clothes and put on hospital scrubs. I then put on a Level C powered air-purifying respirator suit with its own HEPA breathing system. The suit weighs nine pounds with the battery pack. I cannot wear it for more than four hours at a stretch without rotation. I work the unit in four-hour patient-care blocks with two-hour breaks. There are seventeen nurses and four physicians on rotation at this facility. Across all four federal-tier biocontainment facilities in the country combined — Nebraska, Emory, NIH, Bellevue — there are roughly two hundred and twenty biocontainment-credentialed nurses and approximately fifty physicians with the training to operate inside this kind of unit. That is the entire national capacity. If the case load goes above that, the country runs out of qualified hands. That is the math I think about during the two-hour breaks.
I have two parents. They are 79 and 81 and they live in a small condo in Sarasota, Florida. My father spent thirty-seven years as a union carpenter. He has chronic restrictive lung disease from a lifetime of wood dust and from a generation of being told that masks were optional. He carries a portable oximeter in his pocket. His baseline saturation on room air is 92 percent. If he were to contract this disease, he would not survive the first seventy-two hours. Florida has confirmed monitored cases from the Hondius — Tampa is roughly an hour from my parents' building.
I have not been able to visit them in eleven days because the rotation protocol requires me to stay within forty miles of the unit. I called my mother on May 11th. I called her again last Tuesday. I am supposed to call her tomorrow afternoon. She is going to ask me when I am coming to visit. I am not going to be able to answer her honestly. The post-rotation observation period is seven days after the last patient is cleared. I have no way to estimate when that will be.
I mailed them a fifty-pack of respirators on May 8th, before I drove to the airport for the activation flight. I mailed a fifty-pack to my sister and her two kids in Phoenix. I mailed a twenty-five-pack to the friend who took care of our dog during the 2014 rotation. I mailed five additional packs in the last week.
The CDC published a Health Alert Network advisory this month — HAN-528 — and the entire actionable guidance for the general public at the point of entry is one phrase, verbatim: "an N95 or higher-level respirator."
The CDC named one specific construction class in that advisory. A five-layer respirator manufactured to the GB 2626-2019 standard with two melt-blown polypropylene electrostatic filtration layers in the middle. It is the same construction class we wear in the outer ring of this unit — during transit, ambulance handover, and family-area coverage. It is what the medical crew on the MV Hondius has been wearing at every shift since the ship's second death. The crew is not sick. The passengers were not given it. Three of them are dead.
The brand I ordered is at the link below. I am not going to type the brand name in this post because every comment section on the internet turns into a fight about whether the poster is paid. Look at the construction specifications. Cross-reference the GB 2626-2019 standard against CDC HAN-528. Decide for yourself.
→ aerolab.shop/products/aerolab-kn95-respirator
I have to walk back across that parking lot in three hours. I will close this.
I did this work in 2014. The response then was loud — press briefings, named physicians, public situation updates, dedicated agency communications. The response was loud because the agencies understood that public confidence in the institutional response depends on public communication about the institutional response. The repatriations resulted in zero secondary transmissions on American soil because of the work that was done inside this unit by the same colleagues I am working with right now. We did our job. The system worked.
This time the response is institutionally the same — the same Level 1 EOC activation, the same biocontainment protocol, the same staff I worked with twelve years ago — and the public communication is institutionally quiet. The same federal apparatus is in motion. The press briefings are not happening. The named-physician interviews are not happening. The CDC director has not addressed the activation in any public forum I have been able to find. I do not have an explanation for the gap and I am not going to speculate about it.
I do know what the publicly verifiable signals are. The activation level. The biocontainment unit. The construction class named in HAN-528. The infection in Amsterdam from a few minutes of contact on an airplane. The three dead passengers. The twenty-three Americans who flew home without screening.
I do know what I am doing for my own household. I mailed the respirators on May 8th.
— Dr. M.
Biocontainment-credentialed ICU physician, thirteen years
Federal-tier facility, midwestern United States
Posted from a hotel room across the parking lot at 1:14 AM Sunday
Not paid. Not affiliated. Not posting through any hospital system, device, or network.
Account will be deleted by 5:30 AM.
P.S. If you only read one paragraph of this post, read this one. The CDC's Emergency Operations Center was activated to the highest tier in agency history for a hantavirus event on May 9th. The previous Level 1 activations were H1N1 in 2009, Ebola in 2014, and COVID-19 in 2020. Our biocontainment unit was activated for live-patient care on May 7th — only the third such activation in the unit's nineteen-year operational history. The first was Ebola in 2014. The second was a Lassa fever person-under-investigation in 2019 who was ultimately ruled out. The third is the event we are working right now. The respirator construction the CDC named in HAN-528 is in the link above. The press conference that admits the public should be paying attention to this event has not happened yet. Order one.
