# Talk:1993 Four Corners hantavirus outbreak

When HPS first occurred it was frequently referred to as "Navajo Flu" in the media.  This led to complaints from the Navajo Nation tribal government, but it remained a common informal name for the disease among people in the Four Corners area.
For example:
http://www.ajr.org/article.asp?id=2130
http://www.ph.ucla.edu/epi/bioter/doctorontrail.html  — Preceding unsigned comment added by 75.167.200.196 (talk) 15:46, 4 November 2013 (UTC) 

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### 1993 Four Corners hantavirus outbreak
I've listed this article for peer review because I'd like to get it to Featured Article status. I'm wondering what else can be done to improve it.
Thanks, Velayinosu (talk) 03:50, 31 March 2025 (UTC)

I have taken some time to polish the lede. Here are some initial comments, which are quite detailed considering you aim for FA:
The sentences are too long, especially in the lede. There are too many subordinate clauses, with the flow sometimes the reverse of what is relevant. Start with the most interesting and relevant points first, following with details. Omit excessive details in the lede.
I've tried to do this and rewrote some of the lead. I trimmed or split some other sentences in the article that may have been too long.
There is inconsistent use of tenses. Try to stick to one or two, and do not change in the middle of a sentence.
I re-read the article as I wrote it (before your changes) and tried to fix any grammar issues I found. The grammar should be fine.
A map of cases or epi-curve would be useful as the first image of the article. I can potentially assist you here if you find the appropriate data.
I wanted to include a map of cases by state but don't know how to make the image. The CDC has a map on their Reported Cases page[1] (the same source I use for the bar graph). You can sort the map by year to see cases in 1993 and can even make a month-by-month progression gif by adjusting the time by month.
Using Template:Infobox outbreak would be very useful.
I left this template out for various reasons. It's not clear when the outbreak starts and ends (just that it's in 1993). There's no index case. Numbers don't exist (or they're just very hard to find) for specifically the Four Corners area, just state-level and national numbers, etc. But I am not inherently opposed to its inclusion and I added more info to it.
Media mentions, as well as media names and colloquial names should be included.
Some colloquial names of the disease are mentioned in the "Social impact" section. The only prominent media mention of the outbreak I know of (apart from news coverage), is one episode of Forensic Files (season 4 episode 12). I'm unsure about including it though because of MOS:TRIVIA.
There is excessive mention of who conducted investigations. What is more important than that it was "medical staff" is from what body they were. CDC? State health authorities? County officials? They should be assumed to be competent in the appropriate area and we do not need to repeat their qualifications.
The background section details the geography - but jumps from geography to the virus. The background should start with the virus, potential information about prior circulation, and then why the geography is relevant - to the natural reservoir etc. The "Before the outbreak" section includes a lof of this, and should be moved up and merged with the background section.
I know the geography paragraph jumps to the virus paragraph abruptly but I haven't found a way to address that. The "Before the outbreak" section would be nonsensical if the information were moved up to the Background section. It's written in a retrospective style (which is how the sources write it), many of the happenings described in the section occurred after the outbreak, and in your order some things are stated in the section but introduced later on. For example, in your order, Tempest was quoted and then introduced six paragraphs later. I put it back where it was and renamed it "Retrospect".
The article needs to better abide by Wikipedia:Manual of Style/Medicine-related articles, with better organization of sections. I know this does not contain details on outbreaks, but I suggest you use multiple levels of headings, starting by moving "Initial cases" and "The investigation expands" under a larger "Outbreak investigation" header. I understand you want to keep it in a chronological order, but I am uncertain if this is the best format.
I kept some of your structure but reverted some of it for reasons. About chronological order, I wrote the article in roughly the same order as sources. I think it being in mostly chronological order is fine given it is a historical event. And I've gone through MOS:MED a few times. I know I use the word "case" a lot, but I've replaced it where possible with other words and people probably aren't too bothered by the word because of how common it was in COVID-19 news coverage. If there are other specific issues with MOS:MED then you can point them out.
Parts of the article are US-centric. It should not be assumed that an intricate knowledge of states, regions and state boundaries is required for readers. I have amended this in part by stating that the outbreak was in the United States.
I worked on this a lot. Wikilinked states and cities, got rid of the lists of states, partially rewrote the "Aftermath" section, etc.
The section on geography should describe why this outbreak was assumed to be isolated to this region, and was not observed outside. If this is not known or if it was by chance - this should be stated.
Isn't this explained throughout the article? The early cases were in the Four Corners, most cases occurred there, El Nino affected the region greatly, etc.
Course of the outbreak should be the second section after Background.
I was going back and forth on if "Course of outbreak" should go where you put it or where I had it. You moving it created some issues with the order of information and references, so I fixed that.
Check that all statements have the best possible sources. For each statement on medical symptoms all sources should be WP:MEDRS-compliant. For statements on case count, these should preferably all be from the CDC, State Public Health authorities, or county case counts. Reports from media should be prefaced with the detail that they are from media, and can be accepted if official sources are lacking.
I've improved the sourcing a good bit since my last edit. All of the medical claims from news sources should be backed with recent secondary sources. I also put all the titles in title case, put url= after title=, put the quotation marks on names everywhere (is this necessary?), and put spaces in the references like what you did.
The aftermath and social impact sections could be combined to a larger section (with subheadings) - and make more sense to keep together once you have moved "Before the outbreak".
I disagree because the "Social impact" section is talking about the immediate effects of the outbreak during the outbreak, whereas "Aftermath" is talking about after the outbreak over the course of decades. Your proposed change blurs the distinction. This also goes back to chronological order. The events of "Social impact" occurred before the events in "Retrospect" (I renamed the section), which occur before "Aftermath". And "Response" and "Social impact" occurred at the same time, so it's fitting to have them next to each other if going by chronological order.
I can give it another pass once this has been started. CFCF (talk) 10:05, 31 March 2025 (UTC)
After another reading, I have to say this is a very compelling article, and I agree this likely has a high chance of passing FAR. I have struck one of the points above. CFCF (talk) 13:00, 1 April 2025 (UTC)
I reverted a lot of the prose changes you made because I didn't think they were productive. For example:
"The warmer-than-usual 1992–1993 winter and increased rainfall in the spring of 1993, linked to the 1991–1992 El Niño, is considered to have indirectly caused the outbreak. An increase in vegetation, used by rodents for food and shelter, is assumed to have led to a 10-fold increase in the rodent population in the region." – These two sentences are disconnected from each other because you removed the chain-of-events connection from El Nino to the outbreak. "is considered to", and "is assumed to" are against MOS:WEASEL, the researchers aren't exactly "assuming" that environmental conditions had a role in the outbreak, passive voice is used when the active voice could/should be used, same sentence structure in back-to-back sentences, etc.
But I appreciate the input and worked on making the article (hopefully) better. Velayinosu (talk) 02:44, 3 April 2025 (UTC)
I want to commend you for writing a strong article on a historical outbreak for which it must have been very difficult to find the sources that you have. I have no strong opinions regarding the changes I made, and think your updates have improved the flow of the article considerably.
I will admit that this article piqued my interest in particular as I work at the government level in infectious disease control, including quite a bit with zoonotic diseases.
In the coming days, I'll give it another pass, and a shot at creating a map, and perhaps an image of an epi-curve for the "Course of outbreak" section (as the current one does not work on phones). With a few more passes, I think this has a very good chance of passing FAR (which is no small feat, especially in case this is your first). CFCF (talk) 21:47, 3 April 2025 (UTC)
Yes this is the first article I've tried to bring up to FA (I helped save one from demotion years ago, but it needs some work so I'm going to return to it.) and also the first historical article I've written. I rewrote the main hantavirus articles earlier this year and this one I found the most interesting, so I've put the most effort into it. Right now I'm doing a close reading to see if what I've written matches the sources, if anything else could be added, etc. I've found some minor issues which I will fix, but I think the article is pretty good overall. Velayinosu (talk) 03:59, 5 April 2025 (UTC)
I realized that I didn't use any books as sources, so I found some and am going to go through them to see if I missed anything. Velayinosu (talk) 02:50, 6 April 2025 (UTC)

@CFCF: I am done with major edits for now if you want to look through it again. Velayinosu (talk) 03:00, 8 April 2025 (UTC)
Unfortunately I have gotten into 4 pressing deadlines for April. I will see if I have time to give it another round, even though I also think it would be useful for some additional input, perhaps from WhatamIdoing?
However, I know I promised to produce the images for you, I will try to get around to it, but here is a first:
 CFCF (talk) 09:15, 8 April 2025 (UTC)
It was bugging me, so I finished up the file in R, with some manual modifications.  CFCF (talk) 09:41, 8 April 2025 (UTC)
@CFCF: The bar graph you uploaded has some issues. The died should be on the bottom of bars and lived top (or did the CDC do it wrong?), and it's probably not necessary to have the values to the right of the bars if there is a y-axis. I did that because my original graph had issues with MOS:NOHOVER. Do you think it would be better to download and crop the CDC's bar chart like you did for the map? It's probably easier than trying to recreate my bar chart. Velayinosu (talk) 03:01, 10 April 2025 (UTC)
There we go:
 CFCF (talk) 18:51, 12 April 2025 (UTC)
For another pass of questions to prepare this for FAR:
This is more of a question than a criticism. The Aftermath section now almost exclusively discusses the epidemiological and medical impact on HPS response/treatment. Was there any broader impact on outbreak response or medical treatment? ECMO was very much in its infancy in the 1990s, and has developed tremendously since. Did this outbreak in any way influence that? Did the outbreak influence CDC policy or guidelines, in regards to early warning systems, local partnerships, increased collaboration with tribal communities? Does anything from this experience generalize beyond HPS?
I'm generally very cautious about saying that something caused something else. Do the sources really say that El Niño caused the outbreak? Or is it implicated as one of the causes? This may be nitpicky - but attribution studies for climate events are hard.
The lede section does not really have anything on the social impact and the scientific developments. Maybe just a 1 sentence summary of these two last sections?
I still don't think it is clear what is meant by Retrospect and Aftermath. I mean I can read the sections, but just from the headers - I can not assume what is going to be in the sections. Think about this from the perspective of a reader who is entirely new to the topic, and is looking to brush up on how the outbreak impacted society - or how it impacted medicine/epidemiology - and just wants to find this information quickly.
The aftermath section could use something on further developments if there are any, such as rodent control policies etc.
Can anything be said about the name "Four Corners Outbreak" - when cases were not isolated to this region, and when Utah had no cases. Were the cases primarily in counties that are part of the Four Corners area? To me this is not immediately clear, because Crownpoint, NM and McKinley County for instance do not directly border the three other states.
CFCF (talk) 19:10, 12 April 2025 (UTC)
@CFCF: I've added your images now and made some changes at Commons. Addressing your comments:

About ECMO, I've changed the wording to be about treatment more broadly. For CDC policy or guidelines, the CDC just keeps track of HPS cases and gives out typical rodent control advice. For early warning systems, there is research trying to create early warning systems based on environmental factors such as rainfall. I don't want to include them because they're primary sources and including active research in articles doesn't seem like a good idea in general. I added some information about local partnerships/increased collaboration with the Navajo and reorganized the final section some.
About El Nino causing the outbreak, that's what Van Hook and the CDC say. You can read them and see.last paragraph before "HPS Today" section;"Why Did the Outbreak Occur in the Four Corners Area?" section I also use Borowski and Fimrite there (news reports) which are about both the 1993 outbreak and the 2012 outbreak in Yosemite Park. They say the same thing and note that similar environmental factors were responsible for the 2012 outbreak. Fimrite cites the CDC on this.
About the lede, I've rewritten it a bit to include information from all sections.
About the naming of the last two sections, I've renamed them to hopefully be more clear, but the penultimate section is difficult to name.
About further developments of rodent control policies, I've added some info with regards to the Navajo Nation and about hantavirus surveillance in general.
About the name "Four Corners outbreak", sources use "Four Corners" when talking about both the immediate spot where the four states meet and more broadly to the general area, so I've edited the geography paragraph to say this.
Velayinosu (talk) 03:05, 19 April 2025 (UTC)

I'm impressed by your work and dedication. There are some minor stylistic points, such as that the now joint case count graph and map have lost their reference, and that the images have different heights, that I would get to updating - but I think this is soon ready for FAR-submission. I will get back to you if I have anything else. CFCF (talk) 21:29, 22 April 2025 (UTC)


#### Notes from WhatamIdoing
I have added links and made a few copyedits.  I have not looked at the quality of any sources.  You should remove any that you think are inappropriate.
This:  By August 13, twenty-three cases of hantavirus infection had been confirmed in the Four Corners region. Throughout the Southwest, there were 30 confirmed cases, 20 of which (67%) resulted in death mixes spelled-out numbers ("twenty-three") and digits ("20 of which"), but there's a logic to the choices.  If there is a specific MOS rule about this, then it might be best to conform pre-FAC nomination.  But if there isn't, then I think it's fine.
MOS:NUMNOTES says to avoid "awkward juxtapositions" and to spell out numbers if they occur immediately after a date, which is why "August 13, twenty-three" exists.
There are a few places, such as Tests came back negative for known infections that could have caused her death that feel a bit news style.  Maybe focus on the results (no known infections), instead of 'what's new' (test results just came back!)?  For this sentence, that could sound something like "The hospital conducted tests for known infectious agents, but found none" or even "She had no known infections that could have caused her death".
I'm having a hard time finding the "newsy" sentences. Maybe I read too much news or it's just my writing style but it all seems natural to me and I've tried hard to make sure the prose flows well from sentence to sentence, paragraph to paragraph. But I tried rewording that one sentence a bit while retaining the meaning.
About this:  Malone contacted McFeeley, who was on duty the morning of May 14, and she agreed to perform an autopsy on the man once permission was obtained from his family because of how similar the two cases were and following paragraph.  First, I'm not sure if she agreed to do this because she happened to be on duty (if not, that should be removed) or because of the similarities.  Second, this spends a lot of time talking about who phoned whom and who gave permission, and that could be shortened.
I think I fixed all of this. There is still some "who phoned whom" and permission stuff but I've toned it down.
Why are the images left-justified?  We normally do that only if there are a fairly large number of images nearby.
MOS:PORTRAIT says that if people are facing right then it might be better to put the image on the left, so I figured this would also apply to buildings (and animals). I've also tried to avoid sandwiching text between images while also using them to try to even out the appearance of adjacent paragraphs where possible (not actual length (though most adjacent paragraphs are similar in length), but appearance of length, i.e. the number of lines a paragraph takes up).
WhatamIdoing (talk) 23:44, 13 April 2025 (UTC)
@WhatamIdoing:. Velayinosu (talk) 03:05, 19 April 2025 (UTC)


### Query
@Velayinosu: It has been over a month since the last comment on this PR. Are you still interested in receiving comments? If so, I suggest asking for comments at the Wikiprojects attached to this article and reviewing other PRs and FACs. If not, can you close this? Z1720 (talk) 14:07, 21 May 2025 (UTC)

I'm going to close this peer review. I think the bulk of the work is done and I can do the remaining stuff without having this discussion open. Velayinosu (talk) 00:17, 22 May 2025 (UTC)

It was a pretty good episode. Armando Jones (IND.) (talk) 23:57, 7 April 2025 (UTC)

This review is transcluded from Talk:1993 Four Corners hantavirus outbreak/GA1. The edit link for this section can be used to add comments to the review.
Nominator: Velayinosu (talk · contribs) 03:47, 3 June 2025 (UTC)
Reviewer: ZKevinTheCat (talk · contribs) 19:25, 17 June 2025 (UTC)

This looks interesting. Beginning the GA review.
— ZKevinTheCat
Some notes:
This article is very well written. It lays out everything in a easy-to-follow structure, and even for someone like me who isn't super knowledgable on this sort of thing it was pretty easy to understand and follow. All of your sources are reliable, and at least from my spot check (see below) back up what is said in the article. There doesn't seem to be any copywrited media and this is a pretty uncontroversial subject so no problems with any warring or stuff like that. There is some copyediting stuff that could be done but other than that I really don't have anything against your nomination. Good work!
Spot check:
[54] - good
[56] - good
[62] - good
[34] - good