The COVID-19 pandemic may have delayed the diagnosis of rare diseases on Arizona’s tribal lands, according to a new study published by the Centers for Disease Control and Prevention in the Emerging Infectious Disease journal.

The report follows the death of a mother and son who lived on the White Mountain Apache Tribe reservation in March 2020. Both the mother and son were infected with hantavirus, a rare disease transmitted primarily through the saliva, urine and feces of infected rodents. However, as determined by the study, the COVID-19 pandemic was a likely factor in delayed detection of the virus due to how the pandemic affected healthcare and public health.

At the time of diagnosis, an emergency department physician noted that the mother’s x-rays “looked suspicious for hantavirus, COVID-19, or diffuse bacterial pneumonia.” She was then transferred to another hospital for a higher level of care, where she then died on March 19, 2020. But, according to the report, “medical records showed no evidence of hantavirus testing ordered at either hospital.”

The son then passed away just two days later after feeling unwell, facing symptoms such as difficulty breathing. The county medical examiner conducted a nasal swab test on the son to see if the cause of death was COVID-19, but the test came back negative. It was not until months later, after submitting tissues to the CDC for analysis, that it was determined that COVID-19 was a factor in the son’s death. The Indian Health Services did not determine hantavirus to be a contributing factor as well until September 15, 2020, nearly six months after his death.

As a response, in October 2020, IHS visited the former residence of the mother and son, where a team conducted an environmental investigation to see if the disease had spread. While there was no detection of an outbreak, IHS still held hantavirus prevention announcements to local health officials and the community.

Testing delays, the focus on response to COVID-19 in the region and delays in case identification all caused the environmental investigation to be conducted seven months after the case first started, according to the report.

“The rodent population might have changed during that period, preventing identification of the vector and exposure,” the report says.

The report suggests that testing delays may have come from the CDC's requirement that testing be done on all confirmed or suspected COVID-19 deaths.

The study now suggests the adoption of the 5-point hantavirus screening tool for areas outside the Four Corners region, where the disease is normally found. It also urges public health partners to monitor and respond to other potential diseases, even during a pandemic, to ensure prompt action.

AZPM reached out to the Arizona Department of Health Services to discuss the findings of this study. AZDHS declined an interview.

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