The complexity of trying to arrange the medical evacuation of two ill crew members for treatment, while protecting passengers trapped aboard the MV Hondius amid an outbreak of hantavirus, has been shared by the operator.
There are 149 people on the ship, representing 23 different nationalities, who are in isolation amid efforts to contain the spread of the disease.
Dutch-registered Oceanwide Expeditions has disclosed that the medical drama has been unfolding since April 11 when a passenger died of unknown causes.
His wife and another passenger have since died of the rat-borne disease. Another passenger is in a critical condition in hospital in South Africa.
The ship is berthed off Cape Verde, where local authorities have conducted an inspection but not allowed anyone to disembark.
Two staff members who have acute respiratory symptoms, one mild and one severe, are still aboard. Both require urgent medical care, the operator said. They are of British and Dutch nationality.
“The atmosphere on board MV Hondius remains calm, with passengers generally composed,” Oceanwide Expeditions said in an update late on Monday night. “At this time, no other persons with symptoms have been identified.”
Passenger Jake Rosmarin took to his social media platforms to share the stress of being aboard the ship amid the medical emergency.
“We are people with families, with lives, with people waiting for us at home. All we want right now is to feel safe, to have clarity and to get home. I ask for your kindness and understanding,” the travel content creator said.
“I also want to acknowledge that Oceanwide Expeditions and the entire crew onboard have been handling this situation to the best of their ability, and I’m very grateful for their efforts throughout.
“It’s not easy for me to talk about this, but I am doing well.”
Oceanwide Expeditions advised its guests that it was working to expedite their disembarkation and medical screening, while its staff are doing their best to offer support and uphold health and safety procedures.
This includes isolation measures, hygiene protocols and medical monitoring, it confirmed.
“Dutch authorities are actively preparing a medical evacuation of the two symptomatic individuals along with the individual associated with the guest that passed away on May 2. This will involve two specialised aircraft equipped with the necessary medical equipment and staffed by trained medical crews.
“The disembarkation of passengers, medical evacuation and medical screening require permission from, and co-ordination with, the local health authorities.
“We can confirm that guests will not be disembarking in Cape Verde, except for the three individuals who are planned to be medically evacuated. At this stage, a definitive disembarkation point for the remaining guests on board MV Hondius has not been finalised. Sailing on to Las Palmas or Tenerife is being considered, where further medical screening and handling could take place, organised and supervised by the World Health Organisation (WHO) and Dutch health services. This is yet to be confirmed.”
It is not yet known how, where or when the passengers became infected with the virus.
The vessel departed Ushuaia, Argentina, on April 1 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions, including mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena and Ascension Island.
The extent of passenger contact with local wildlife during the voyage, or before boarding in Ushuaia, remains undetermined.
Two of the passengers had travelled in South America, including Argentina, before they boarded the ship.
Illness onset occurred between April 6 — when the first passenger showed symptoms of fever, headache and mild diarrhoea — and April 28, the WHO estimates.
It was alerted on May 2 that there was “a cluster of passengers with severe respiratory illness” aboard the cruise ship.
Two of these cases have since been laboratory confirmed as hantavirus, with five suspected cases, characterised by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.
“Further investigations are ongoing. The outbreak is being managed through a co-ordinated international response, and includes in-depth investigations, case isolation and care, medical evacuation and laboratory investigations,” the WHO said.
Human hantavirus infection is primarily acquired through contact with the urine, faeces or saliva of infected rodents. Though uncommon, limited human-to-human transmission has been reported in previous outbreaks of Andes virus (a specific species of hantavirus).
Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. The WHO said human cases are most commonly reported in rural settings, such as forests, fields and farms, where rodents are present and opportunities for exposure are greater.
“Symptoms typically occur from two to four weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure.”
An updated timeline of how the medical situation unfolded on the ship has been provided by Oceanwide Expeditions:
- On April 11, a passenger died on board. The cause of death could not be determined on board. On April 24, his body was disembarked on St Helena, with his wife accompanying the repatriation.
- On April 27, Oceanwide Expeditions said it was informed that the wife had become unwell during the return journey and had later died. Both passengers were Dutch nationals. On May 4, it was established she had a variant of hantavirus.
- On April 27, another passenger became seriously ill and was medically evacuated to South Africa. The British man is being treated in the intensive care unit in Johannesburg and is in a critical but stable condition. He is confirmed to have hantavirus.
- On May 2, another passenger on board died. He was of German nationality.
The WHO said tracing is under way to reach the people who came into contact with the affected patients.
This includes passengers on a flight from Saint Helena to Johannesburg on April 25.
Passengers onboard the ship have been advised to practise maximal physical distancing and remain in their cabins where possible.
Active symptom monitoring for 45 days is recommended.
“Vigilance among travellers; crew, including those involved in implementing ship sanitation measures; or other personnel returning from areas where hantavirus is known to be present, as well as on conveyances engaged in eco-tourism on a journey from and through those areas, is essential,” the WHO said.
When hantavirus pulmonary syndrome (HPS) is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management.
TimesLIVE
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