David Miles discusses his book Sneeze: The History and Science of the Common Cold, arguing that “the common cold” is best understood as a broad category of respiratory viral illness that can include influenza and COVID-19, because the same kinds of viruses can cause anything from mild symptoms to severe disease. The conversation covers COVID immunity, Omicron, rhinovirus, hantavirus, virus transmission, masks, folk remedies, long COVID, airborne prevention, and the history of cold research, emphasizing that viruses are diverse, often poorly understood, and can have serious individual and social consequences. Miles stresses that prevention matters: better ventilation, HEPA filtration, masks in high-risk settings, staying home when sick, and stronger public health responses can reduce transmission and protect vulnerable people.

David Miles on the Hantavirus:

We asked David to write an assessment of the current hantavirus outbreak:

At the time of writing (10th May 2026), there have been eight cases of Andes virus, a species of hantavirus, on the cruise ship Hondius.

It’s carried by rodents and causes a very serious disease, with fatality rates estimated between one and three-fifths. If that looks like a very wide range of estimates, it is. That’s because Andes virus infections are so rare that there’s a lot about them that simply isn’t known.

The pandemic potential of Andes virus, as with any infectious disease, depends on its capacity for human-to-human transmission: whether it can pass from one person to another or whether it hits a dead end when it passes from a rodent to a human. Right now, that’s one of the things that is still not clear. Several previous Andes virus outbreaks have involved multiple cases – and far less media coverage – but it’s never been entirely clear whether they involved transmission to one person who infected everyone else or whether everyone was exposed to the same infected rodents.

Part of the difficulty is that the time between infection and the first symptoms ranges from one to six weeks. It’s such a long time period that it isn’t possible to narrow down the possible sources of infection. With a narrower time window, it might be possible to work out what or who an infected person was exposed to but there’s no way to tell whether someone has come too close to a rodent in a five-week window.

In the case of the Hondius outbreak, that means that we don’t know how those eight cases caught Andes virus. Maybe they were all exposed before they set sail. Maybe some infected rodents sneaked on board and everyone is now stuck on a ship with the infectious source. Maybe the passengers and crew are in fact transmitting it among themselves.

It’s only the latter case that would imply any pandemic potential because only a virus that can transmit from one person to another can cause a pandemic. Even in that case, I would rate the pandemic potential as extremely low, albeit with a caveat.

The reason for the extremely low rating is that if there’s doubt about Andes virus’s ability to transmit from one person to another, it certainly can’t do it very well. Outbreaks in the past have been contained and because this outbreak is on a ship, it’s clear who has been exposed. So far, the public health response has been following the precautionary principle of assuming human-to-human transmission and isolating anyone who might be infectious.

The caveat is that the precautionary principle has not been extended to getting everyone off the ship as quickly as possible. Keeping a large number of people exposed to an infectious source, whether it’s rodents or each other, is a very good way to maximise the damage caused by an outbreak. Apart from the very real danger to the passengers and crew themselves, their close proximity means that even if the virus isn’t good at passing from one person to another, it has plenty of opportunity to do so. As soon as human-to-human transmission becomes a possibility, there is an evolutionary pressure to do it better. No such evolutionary pressure would exist if there were no human-to-human transmission at all.

In conclusion, it is very unlikely that the Andes virus will infect anyone other than the passengers and crew of the Hondius but to be on the safe side, the sooner they’re off that ship and in isolation, the better for them and for everyone else.

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David Miles on the Hantavirus:

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