Passengers start to disembark cruise ship stricken by hantavirus

The first passengers have begun to disembark from a Dutch-flagged cruise ship that was hit by a deadly hantavirus outbreak after the vessel arrived in Spain's Canary Islands early Sunday morning.

Spanish nationals disembarked first, hours after the ship initially docked at the port of Granadilla on Tenerife, the largest of the Canary Islands. They boarded a plane headed for Madrid, where they would be taken to a military hospital. The 14 Spaniards will be under quarantine after reaching Madrid, Spanish health authorities said. 

Officials said that so far, nobody left on board the ship was showing symptoms of hantavirus. There have been at least nine confirmed or suspected cases of hantavirus linked to the outbreak on the ship, including three fatalities: A Dutch couple and a German woman.

The MV Hondius, currently carrying nearly 150 people from more than 15 countries, including 17 Americans, had set sail earlier this week from Cape Verde to Granadilla, after Spain agreed to take the ship.

Oceanwide Expeditions, the ship's operator, says that all passengers and a portion of the approximately 60 crew members will begin evacuating the ship Sunday using launch boats that carry a maximum of five to 10 people. All passengers and most crew members will be evacuated Sunday and Monday.

According to a complex evacuation plan, the Spanish plane will be followed by a Netherlands-bound flight that will include Germans, Belgians, Greeks and part of the cruise ship's crew. Flights will then leave for Canada, Turkey, France, Great Britain, Ireland and the U.S. in sequence as planes are ready. The final flight will be to Australia, which has to send its own plane. That flight is set for Monday and will include some passengers from New Zealand and the Asian region. 

Although health officials have said risks from the cruise outbreak remain low for the general public, those disembarking and port workers wore face masks, hazmat suits, respirators and other protective gear during the evacuation process.

Authorities have said the passengers and crew members disembarking will be checked for symptoms, have no contact with the local population on Tenerife and will only be taken off the ship once evacuation flights are ready to fly them to their destinations. The operation in Tenerife is being supervised by Spain's health and interior ministers as well as the World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus.

After disembarkation, a skeleton crew will take on supplies and then begin the journey to Rotterdam, Netherlands, which is expected to take about five days, Oceanwide Expeditions said. The body of a passenger who died on board will also remain on the ship, which will be disinfected once it arrives in Rotterdam, according to Spanish authorities.

Quarantine protocols

The CDC said it was sending a team of epidemiologists and medical professionals to the Canary Islands to "conduct an exposure risk assessment for each American passenger and provide recommendations for the level of monitoring required."

Once removed from the Hondius, the Americans will be flown back to the U.S. in a plane that was sent by the U.S. Centers for Disease Control and Prevention and the Department of Health and Human Services.

The medical repatriation flight will land at Offutt Air Force Base in Omaha, Nebraska, and the Americans will be taken to a special biocontainment unit at the University of Nebraska Medical Center.

Michael Wadman, medical director of the National Quarantine Unit at the University of Nebraska Medical Center, said that each American will have their own room while they quarantine for an unspecified amount of time.

France's Foreign Ministry said five French passengers would be repatriated Sunday. They will be hospitalized and monitored for 72 hours once they arrive. After that, they will quarantine at home for 45 days, the ministry said.

British authorities said U.K. passengers and crew will be hospitalized for observation once they are flown home. 

A plane from Australia was expected to arrive in Tenerife on Monday, to evacuate its nationals and others from nearby countries, such as New Zealand, Spanish health authorities said.

Norway has also sent an ambulance plane to Tenerife with personnel trained to transport patients with high-risk infections, the country's Directorate for Civil Protection told public broadcaster NRK.

Officials insist the public is at low risk 

Hantaviruses are a family of diseases that are spread to people from rodents through urine, droppings or saliva, according to the CDC. It can take up to eight weeks after contact for symptoms to develop.

WHO says that the Andes strain of the virus, which is found in Latin America, is the only one that is known to be able to transmit the virus through human-to-human contact, with Tedros assessing the public risk as "low."

He told CBS News at a briefing Sunday morning that Americans "shouldn't worry" about the impending return of cruise passengers who are U.S. citizens and encouraged people to put their trust in health officials.

"This is not another COVID, and the risk to the public is low. So, they shouldn't be scared and they shouldn't panic," said Tedros. He also said several years of scientific evaluations of the virus and its behavior, in addition to how the virus has behaved so far in this particular outbreak, have informed that judgement.

Tedros' assessment was echoed by acting CDC director Dr. Jay Bhattacharya.

"Hantavirus is not spread by people without symptoms, transmission requires close contact, and the risk to the American public is very low," Bhattacharya said in a statement Wednesday.

Former FDA Commissioner Scott Gottlieb held a somewhat more cautious stance on the virus, saying Sunday that "we have to be wary that perhaps there are things we don't know fully about this virus" on "Face the Nation with Margaret Brennan." 

But Gottlieb said he ultimately agrees with global health assessments that advise the risks to the wider public are low. For the U.S. specifically, he also said "we are nearing the end of of the transmission window for the people who are being repatriated here." 

That was based on the last date a patient experienced an onset of symptoms and the virus' incubation period, which is between two and six weeks, roughly. Given that window, Gottlieb said people on the ship will be reaching the peak of the incubation cycle at some point this week.

Outbreak timeline

The source of the outbreak remains under investigation. However, prior to boarding the ship, the Dutch couple who died, a 70-year-old man and his 69-year-old wife, are believed to have spent weeks traveling through Argentina, Chile and Uruguay on a bird-watching trip in areas where the species of rodent known to carry the Andes virus is present, Tedros said this week.

The man developed symptoms on April 6 and died on the ship on April 11, WHO said, but no samples were taken because his symptoms were similar to those of other respiratory viruses, and hantavirus was not suspected at the time.

His wife then went ashore when the ship docked on the British territorial island of St. Helena. She showed serious symptoms on a flight to Johannesburg, South Africa, on April 25, and died in South Africa the following day, WHO said. Testing confirmed she had contracted hantavirus.

The German woman showed symptoms on April 28 and died aboard the ship on May 2, according to WHO.

Three other patients were flown off the ship to the Netherlands for emergency medical care this week, and a Swiss man who began showing symptoms after disembarking the ship was receiving care in Zurich. A British man was medically evacuated to South Africa, while another British national who had disembarked the ship is hospitalized on the island of Tristan da Cunha, a British territory.

Oceanwide Expeditions said 32 passengers from about a dozen countries had disembarked the Hondius in St. Helena, including the Dutch woman who died days later. Those American passengers who returned to the U.S. prior to the discovery of the outbreak were being monitored by state health agencies in California, Georgia, Texas, Virginia and Arizona.

The Hondius set sail for its cruise April 1 from Ushuaia, Argentina, which took it to several islands in the south Atlantic, including the South Georgia and South Sandwich Islands, Tristan da Cunha, Gough Island and then St. Helena from April 21 to April 24.

The vessel then anchored off the coast of Cape Verde, an archipelago located off West Africa, for several days before heading to the Canary Islands.