(CNN) — It was a miraculous rescue that brought tears to eyes: All 12 boys and their coach on the Wild Boar youth soccer team have been rescued from a flooded cave in Thailand after more than two weeks trapped inside.
The final boy and the coach were pulled out of the cave early Tuesday and were treated at an on-site medical center, marking the end of an international rescue effort. Three other boys were transported to a nearby hospital to join eight of their teammates who were recuperating in an isolation ward after being rescued Sunday and Monday.
With their rescue at a triumphant end, their road to recovery now begins.
‘Your body starts to change’
To get a better understanding of how the boys and their coach are faring medically, doctors probably will refer to the timeline of how long the soccer team was trapped in the cave, said Dr. Sanjay Gupta, CNN chief medical correspondent.
“With regard to the basics — hydration, malnutrition and body temperature, or the hypothermia — they’ll get a pretty good idea of what shape the boys are in and how quickly they will feed and rehydrate them, based on the timeline,” Gupta said.
“It is very emotional, certainly, to see and hear that these boys are all coming out when we just didn’t know the certainty and possibility,” he said. “What’s so amazing beyond that is that this was a really difficult rescue plan to execute. … It’s just very remarkable when people are risking their own lives to save others.”
The boys, ages 11 to 16, and their coach went missing while exploring a cave network in northern Thailand on June 23. Heavy seasonal rains flooded the cave entrance, trapping them inside. Their sudden disappearance sparked a desperate search and rescue effort.
One diver participating in the rescue effort died while navigating the dangerous, water-filled passageways inside the caves.
Eight boys who were rescued on Sunday and Monday were placed in an isolation unit in the Chiang Rai hospital.
Jedsada Chokedamrongsook, the permanent secretary of the Thai Health Ministry, said the boys in the first group, rescued on Sunday, were ages 14 to 16. Their body temperatures were very low when they emerged from the cave, and two might have lung inflammation.
Their families have been able to see them through a window in the isolation unit, Chokedamrongsook said, and they were able to talk on the phone. Family members will be allowed to enter the unit if tests show that the boys are free of infection.
The boys in the second group, rescued Monday, were 12 to 14. One had a very slow heartbeat but responded well to treatment, Chokedamrongsook said.
Regarding both groups, medical officials said Tuesday that the boys are healthy, fever-free, mentally fit and “seem to be in high spirits.”
The boys are all likely to stay in the hospital for seven days due to their weakened immune systems.
They remain in an isolation ward to protect their bodies from any risk of infection, Gupta said.
“The reason they’re in isolation is, when your body is without natural light for that long — since you’re literally living in a cave — your body starts to change. Certain things get ramped up. Certain things get ramped down. One thing that often gets ramped down is the immune system,” Gupta said.
With a weakened immune system, “a pathogen might be more dangerous for them,” he said. “That’s why they don’t let the parents touch them, because anything is a potential threat.”
Along with checking for new infections, doctors probably will look for signs of certain infections that stem from being in the cave, such as histoplasmosis or cave disease, Gupta said. That infection is caused by breathing in the spores of a fungus often found in bird and bat droppings.
“It’s a real disease, and people who are spelunkers are at risk of that,” he said.
The diseases that lurk in caves
There are various degrees of cave disease infection, said Dee Carter, a professor in the School of Life and Environmental Sciences at the University of Sydney, in a statement from the Australian Science Media Centre.
“Generally, in a healthy child or adult the immune system will deal with the disease and they will only show flu-like symptoms if any symptoms at all. The boys in Thailand should have healthy immune systems but may perhaps be compromised by malnourishment, and their quarantine may be to deal with any potential contamination of hair, clothing or other belongings,” Carter said.
“If histoplasmosis does progress — which can sometimes happen even in otherwise healthy people and it’s not known why this happens in some cases and not in others — the initial flu-like symptoms can turn into a pneumonia-like condition,” she said.
“In a very small number of cases, there is dissemination to other organs and this is a very grave condition. There is a small number of drugs that can be used in treatment but at the latter stages these aren’t terribly effective and can have serious side-effects,” she said.
It’s no surprise that there is concern about the children developing pneumonic histoplasmosis, but caves also can be fertile grounds for many other infectious diseases, such as rabies, leptospirosis or tick-borne relapsing fever, said Hosam Zowawi, a research fellow and group leader at the University of Queensland Centre for Clinical Research, in a statement from the Australian Science Media Centre.
“Caves make excellent environments for bats and bats make excellent reservoir for many viruses. That is why virologists are studying bats from caves for their potential carriage for lethal viruses, such as Ebola and Nipah viruses,” said Zowawi, who has done research in caves.
“Yet, it is also very important to consider that a very small portion of the caves on planet earth have been discovered and the microbial ecology of the discovered caves are heavily understudied,” he said, adding that the risk of encountering other undiscovered pathogens remains very likely.
All in all, Zowawi said, “I really hope that the cave kids story in Thailand will stimulate the public and funding agents to support scientists to carry out more research to study innovative ways to tackle infectious diseases, particularly those occurring from exposure to the environment.”
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