The WHO and the Spanish government agree that the cruise ship affected by hantavirus will disembark in the Canary Islands

BarcelonaAfter days of indecision, the luxury cruise ship MV Hondius, which is docked in Cape Verde affected by a hantavirus outbreak, will finally disembark at a port in the Canary Islands. This has been agreed by the World Health Organization (WHO) and the Spanish Ministry of Health, following an inspection of the ship by a group of epidemiologists and in compliance with international law and the humanitarian spirit. There are 147 people on board, and seven have been affected by hantavirus, three of whom have died.

In a statement released tonight, the ministry explained that the European Centre for Disease Prevention and Control (ECDC) is conducting a thorough examination of the ship "to determine which individuals should be urgently evacuated in Cape Verde itself". The rest of the passengers will set sail for the Canary Islands, heading for a port not yet defined, with the expectation of arriving "within three or four days". Once the ship docks, the crew and passengers will be appropriately examined, treated, and transferred to their countries of origin. Five of the passengers are Catalan. The process will be organized through a common protocol for case and contact management developed by the WHO and the ECDC, and will have all necessary safety guarantees. To prevent the outbreak from spreading, both medical care and transfers will take place in special spaces and transport vehicles set up for this operation, avoiding any contact with the local population. Furthermore, the Spanish government has also accepted the formal request from the Netherlands to host the ship's doctor in the Canary Islands, who is in serious condition. The transfer, like that of the other evacuees, will be carried out by a medicalized aircraft.

For days, the WHO had been in contact with various countries to find a solution for the cruise ship MV Hondius, coming from Argentina. Today, the evacuations of three infected individuals to the Netherlands and Germany were announced, but there was no agreement on what would happen to the rest of the passengers who do not present symptoms. The shipping company that owns the ship, the Dutch Oceanwide Expeditions, had indicated in a statement its intention to continue the journey to the Canary Islands, either to Gran Canaria or Tenerife.

The detection of this hantavirus outbreak –a group of viruses transmitted by inhaling particles of urine, excrement, or saliva from rodents such as the field mouse and the vole– occurred on a ship that had departed from Argentina with 147 passengers of 23 nationalities on board –59 of whom are part of the crew–. In a statement, the company assured this Tuesday that "for the moment" no new symptomatic individuals have been identified on board.

However, this situation has raised concern and worry both inside and outside the ship. Inside, because users and workers fear a virus they do not know and which has already caused the death of three people. Outside, because it is not yet known if the outbreak occurred inside or outside the ship and if it was transmitted from animals to humans or if the chain of contagion was between people. The latter is a very rare occurrence for which very few cases have been documented, all of a strain called Andes, but which the WHO now does not rule out. In fact, the ECDC considers the risk of the outbreak "to be very low, given that adequate infection prevention and control measures are being implemented on board and that hantaviruses are not easily transmitted".

Three evacuated

Throughout this Tuesday, however, the WHO had requested that the cruise ship dock in the Canary Islands, as it is a safe port, was the final stop of the route, and has advanced hospitals and epidemiology services in case it was necessary to attend to new positive cases. The Spanish government had assured in the morning that they would conduct "close monitoring" of the situation "together with the WHO and other involved countries" and that a team of epidemiologists would review the vessel to "ascertain the condition of the people on board and to know if there are more people with symptoms and what high or low-risk contacts there are". This intermediate step was intended to help the authorities decide the best way to repatriate and which route the cruise ship should follow, whether to return to Dutch lands (where the company originates) or to remain in Spain to be disinfected.

Given this situation, and if the WHO requested it, the Spanish executive had assured that they had "everything available" to attend to and evaluate the travelers and, if necessary, to act on board the ship. Even the WHO's head of emerging diseases and zoonoses, Maria Van Kerkhove, took it for granted and announced that Spain agreed. Nevertheless, after meeting with the international organization, the Ministry of Health has concluded that "there is no clinical reason" for the ship to call at the Canary archipelago and has requested the evacuation of two suspected cases and one high-risk contact who remain on board the cruise ship, with fever and gastrointestinal symptoms, without stopping in Spain.

For the ministry led by Mónica García, it would only make sense for the cruise ship to call at the Canary Islands "if new symptomatic cases appeared during the journey between Cape Verde and the Canary Islands". Only in this scenario, and "by the principle of providing assistance", would medical attention in the islands be justified. The president of the Canary Islands government, Fernando Clavijo, also stated this Tuesday in Brussels that the ship "must be attended to where it is" [in Cape Verde], before returning directly to the Netherlands, the place where the company operating the cruise ship is located.

Along the same lines, the director of the Centre for the Coordination of Health Alerts and Emergencies (CCAES), Fernando Simón, has advocated for a "reasonable way out" of the crisis. The public health threats expert maintains that only the sick or symptomatic infected individuals need to be evacuated and that the rest of the passengers do not need to be quarantined at the port. "Whether in Holland, Spain, or Europe, we must find the most humane and reasonable solution to this problem," he defended. He added that it is not a situation comparable to covid: "We cannot have 147 people locked up on a ship."

In the afternoon, it was reported that the two infected travelers who required urgent medical attention and a third who is a close contact of one of the deceased from the virus would be evacuated by medicalized aircraft to be treated and to undergo quarantine in the Netherlands – the country of origin of the owner of Oceanwide Expeditions – and Germany. The ships are already en route to Cape Verde, but the company emphasizes that it still does not know when the transfer operations will take place, which are coordinated by the WHO's Emergency Medical Team and the EU's Emergency Response Coordination Centre.

"We want to go home"

Hantavirus is the name given to a group of viruses that are mainly transmitted by inhaling particles of urine, excrement, or saliva from rodents –such as field mice and voles– that have been previously infected. For this reason, it was initially speculated that those infected on the ship would have contracted it before setting sail, but this morning the WHO admitted that they do not rule out person-to-person transmission either, a fact that would change disembarkation protocols.

Two of the people who have lost their lives due to the virus were close contacts. On April 11, a man died who began to develop symptoms of fever, headache, and mild diarrhea on April 6. Subsequently, a woman from his circle suffered gastrointestinal symptoms on April 24. Her condition then worsened during a flight to Johannesburg (South Africa) on April 25, and she died in the emergency room on April 26. On May 4, the hantavirus case was confirmed in a laboratory, and contact tracing of the flight passengers has now begun.

The user @jakerosmarin, a passenger trapped on the cruise ship, has published a video on social media where he asserts that what they are experiencing "is very real." "We are not a story, we are not just a headline," says the passenger, who asks for clarity from the authorities and for someone to take them in. "We have people waiting for us at home," he said, visibly emotional, and added that all those on board want is to "feel safe, get clarity, and go home."

The luxury ship left the Argentine port of Ushuaia on April 1 and was currently heading to Cape Verde, just before finishing its route, to the Canary Islands. On board were a total of 147 people: 88 passengers and 59 crew members. In total, there are people of 23 different nationalities, among whom there are thirteen passengers and one crew member of Spanish nationality. Of these, five reside in Catalonia.

Three of the passengers fell ill and died on board the ship and a fourth person is in critical condition. In addition, there are three more suspected cases of contagion. In total, seven cases, of which only two have been definitively confirmed as positive for hantavirus in a laboratory. The rest, however, share many symptoms, according to the WHO.