Flu, COVID, or a masquerading lethal viral infection—would you be able to recognize the symptoms in time?

Hantavirus isn’t a disease most physicians think about often—until a high-profile case puts it back in the spotlight. The recent passing of Betsy Arakawa, wife of actor Gene Hackman, reportedly due to hantavirus pulmonary syndrome (HPS), has sparked renewed discussion among physicians. But the real question is: Would you have caught it in time?

Jen Caudle, MD, a board-certified osteopathic family medicine physician, broke down the case on Instagram, explaining the rarity of the disease and why it’s so deadly. “This is something that progresses rapidly, and there’s no cure. That’s why early recognition is so important,” she said.

Emergency medicine physician Joe Whittington, MD, also weighed in, discussing why physicians should keep hantavirus on their radar. “This isn’t just some obscure infection—this is a disease with a 40% fatality rate. If you miss it, you may not get a second chance,” he cautioned

The classic (and easily missed) presentation

Early hantavirus symptoms? The same symptoms as flu, COVID-19, or any other viral infection—this is why diagnosis can be so challenging.

By the time patients develop the telltale rapid progression to acute respiratory distress syndrome (ARDS), it’s often too late, shifting from flu-like symptoms to severe pulmonary edema and hypoxia fast. Many patients deteriorate so quickly they require mechanical ventilation within hours of admission.

When every test is negative

By the time you suspect hantavirus, you might be staring at normal WBC counts, thrombocytopenia, and hemoconcentration—a red flag for capillary leak syndrome. But routine viral panels? All negative.

Definitive diagnosis requires serologic testing or PCR for hantavirus, which isn’t exactly at the top of most physicians’ differential.

Dr. Whittington emphasized how this often leads to misdiagnosis. “Most doctors will rule out flu, COVID, maybe even a respiratory syncytial virus (RSV) infection—but hantavirus isn’t usually on the list. And by the time we consider it, the patient may already be in critical condition.”

Time to rethink ‘flu-like’ cases?

While hantavirus remains rare, it’s a reminder that not every viral syndrome is what it seems. In a post-pandemic world, especially, emerging and re-emerging infections can slip through the cracks.

Dr. Caudle and Dr. Joe’s breakdowns serve as a crucial reminder: Would you have diagnosed it in time?