How a cruise turned into a nightmare

The first victim of an outbreak suspected of being caused by hantavirus had been dead for 21 days when fellow passenger Jake Rosemary posted a video of cows he had seen on a remote volcanic island in the Atlantic, showing no awareness that his cruise ship would soon be quarantined.

However, later that evening, on May 2, Rozmarin posted: “For those who have seen the latest news, yes, I am currently on board the MV Hondius,” adding that he did not wish to say more “out of respect for those involved.”

The next day, as his ship was stranded off Cape Verde, its intended final destination, but allowed to disembark passengers and crew, a visibly shaken Rozmarin said: “What is happening now is very real for all of us.” “We are not just headlines. We are people with families, with lives, with people waiting for us at home,” he added, his voice shaking as he fought back tears. “All we want is to feel safe and to get home,” he said.

This, according to Reuters, came two days after he expressed delight at seeing the endangered Wilkins' finch on Nightingale Island.

About 150 people are still trapped on the ship, which has been touring some of the most remote places on Earth.

Three people on board, a Dutch couple and a German citizen, died, the operator said.

The first infected passenger, a Dutchman, died on April 11 while the ship was sailing to Tristan da Cunha. His body remained on board until April 24, when it was “disembarked on St. Helena, accompanied by his wife who accompanied the repatriation,” the ship’s operator, Oceanwide Expeditions, said Monday.

His wife, who had gastrointestinal symptoms when she disembarked, later deteriorated on the flight to Johannesburg. She died upon arrival at the emergency room on April 26, the WHO said, adding that contact tracing among passengers on that flight was ongoing.

Another passenger, a British man, “became seriously ill and was medically evacuated to South Africa,” the company said. South African authorities confirmed that the British patient, who is being treated at a hospital in Johannesburg, has tested positive for hantavirus.

Three more people suspected of being infected are still on board the MV Hondius, which sails under the Dutch flag.

The Dutch Foreign Ministry said yesterday that it was preparing a medical evacuation of three people to the Netherlands. It is not yet clear when and where the nearly 150 other people still on board will disembark.

Hondius set sail from Ushuaia, in southern Argentina, in March on a trip advertised as an Antarctic wilderness expedition, with berth prices ranging from 14.000 to 22.000 euros.

The ship passed the Antarctic mainland, the Falkland Islands, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena and Ascension Island, before arriving in Cape Verde waters on May 3.

On May 1, ship's chef Kabir Moraes posted a cheerful video of himself and colleagues swimming in the ocean next to a rubber dinghy, while the cruise ship was anchored in the background.

“The day was pleasant and the depth was 4.700 meters,” he said, commenting in the video as his colleagues laughed as they pulled him back into the boat. Reuters could not determine whether Moraes knew about the deaths before publishing the footage.

Another passenger died the following day, the operator said in a statement on Monday, adding that the cause of death had not yet been determined and that the passenger was a German citizen.

The World Health Organization said yesterday that it suspects there has been a rare human-to-human transmission of hantavirus among very close contacts on a luxury cruise ship that has recorded seven confirmed or suspected cases of infection.

Human-to-human transmission is not common, and the UN health agency reiterated that the risk to the general public is low from the disease, which is usually spread through contact with infected rodents.

A cruise ship stricken by a deadly outbreak is stranded off Cape Verde, an island nation in the Atlantic off the west coast of Africa, which has not allowed passengers to disembark.

The WHO said it had been told there were no rats on board. People usually contract hantavirus through contact with infected rodents or their urine, feces or saliva.

However, limited spread among close contacts has been seen in some previous outbreaks of the Andean strain, which is spreading in South America, including Argentina. Although the WHO believes that strain is the cause of the infection on the cruise ship, according to Reuters, this has not yet been confirmed. Testing is ongoing.

"We believe there may be some human-to-human transmission among really close contacts, people who shared cabins," Maria Van Kerkhove, WHO's director for epidemic and pandemic preparedness and prevention, told reporters in Geneva.

"Some of the people on the ship were couples, sharing rooms, so it was quite close contact," Van Kerkove said.

The UN health agency said its working assumption was that the first cases, involving a Dutch couple who boarded a ship in Argentina after traveling in that country, were infected before they boarded the cruise ship.

It is added that it is possible that other cases were infected during birdwatching excursions on islands inhabited by birds and rodents, as part of the cruise.

Van Kerkhove said the focus now is on evacuating the two sick passengers still on board and then continuing the ship to the Canary Islands. A third suspected case still on board reported only a mild fever at one point.

"We've heard from quite a number of people on the ship," she said. "We just want you to know that we're working with the ship operators. We're working with the countries you're coming from. We hear you, we know you're scared," she said, adding that they're working hard to get people home safely.

However, while the WHO said the plan was for the ship to head to the Canary Islands, the Spanish Ministry of Health said it saw no need for the ship to dock in the Canary Islands if all the sick were evacuated to Cape Verde, unless new cases emerged.

Footage from the cruise ship, obtained by the Associated Press, shows deserted decks and common areas, as well as medical teams in protective gear.

“Our days are going almost normally, we are just waiting for the authorities to find a solution,” said 31-year-old passenger Kasem Elhato, who sent the videos to the AP, via WhatsApp. “But morale on board is high and we are busy reading, watching movies, drinking hot drinks and things like that.”

Helene Gesart, another passenger, told Belgian broadcaster VRT that everyone on board was “in the same boat, literally.” “You don't set out on a journey thinking that one of your fellow passengers won't survive,” she said.

“We get the information at regular intervals. It’s accurate. The rest is a waiting game,” she added. “Today we got fresh fruit and fresh vegetables. That was very important to us.”

The WHO estimates that between 10.000 and 100.000 cases of hantavirus are recorded annually. Argentina continues to have the most cases in the Americas region, the WHO said in December, with a mortality rate of about 32 percent, higher than average and higher than other strains of the virus.

Mortality and symptoms depend on the strain of the virus

Strains of hantavirus, which are common in different parts of the world, cause different symptoms or illnesses - and some cause none at all.

Symptoms usually begin one to eight weeks after exposure to the virus and can include fever, muscle aches and gastrointestinal symptoms, according to the WHO.

In Europe and Asia, hantaviruses can cause hemorrhagic fever with renal syndrome, which mainly affects the kidneys and blood vessels.

In the Americas, infection can cause hantavirus cardiopulmonary syndrome, which progresses rapidly and leads to fluid accumulation in the lungs, along with heart complications.

The mortality rate for hantavirus cardiopulmonary syndrome is up to 50 percent, according to the WHO, compared with one to 15 percent for infections common in Asia and Europe.

There is no specific cure for hantavirus infection, so treatment is based on symptom relief and supportive care, including rest and fluids. Patients may require breathing assistance, such as a ventilator.