French doctors say hantavirus symptoms are just anxiety

A French woman who tested positive for hantavirus after being evacuated from a cruise ship reported her symptoms to doctors on board but was told it was probably just anxiety, Spain's health minister said, according to The Guardian.

Javier Padilla Bernaldez said the woman, who was traveling on a ship at the center of a deadly hantavirus outbreak, had flu-like symptoms but they seemed to be easing and she had no fever. The World Health Organization later said the woman was in “very critical” condition.

The MV Hondius left port on the Canary island of Tenerife on Monday evening, after 120 people from 23 countries were repatriated over 48 hours in an operation that Spanish authorities described as “complex” and “unprecedented.” On Tuesday evening, the last two evacuation planes carrying passengers and crew from the Hondius landed in the Netherlands.

Twenty-six crew members and two health workers remain on board as it sails towards Rotterdam, where it will dock for disinfection. The vessel is also carrying the body of a German passenger who died during the voyage.

Despite the deaths of three people on board and eight other confirmed cases, doctors from the European Centre for Disease Prevention and Control and the Spanish International Health Service examined the French woman and dismissed her symptoms as anxiety or stress, Padilla said.

"They didn't think those symptoms were compatible with hantavirus. Why? Because what she was telling them was that she had a coughing episode a few days ago that went away, and what she was having at that time was something like stress, anxiety or nervousness. That's why it wasn't classified as hantavirus," Padilla said.

Speaking as the ship left Tenerife, Dr Tedros Adhanom Ghebreyesus, WHO director-general, thanked Spain for coming to the aid of the people on board and added that the French passenger was now in a “very critical” condition. “Imagine if she had stayed on the ship longer,” he said.

There is "nothing for people in countries that have received the travelers to fear," he continued, adding that he hopes they will show "compassion and solidarity with their citizens."

The French woman was one of five French passengers who disembarked from the MV Hondius in Tenerife on Sunday, before being airlifted to a hospital in Paris, according to the Guardian.

French Health Minister Stéphanie Rist said the woman began feeling very unwell on Sunday evening and that “the tests were positive.” Rist told France Inter radio: “Unfortunately, her symptoms worsened during the night.” She is being treated in a specialized infectious diseases unit at a Paris hospital.

Staff wearing full-body protective suits and breathing masks began escorting passengers from the ship to shore in Tenerife, in the Canary Islands, on Sunday.

The WHO and the Spanish government assured the public on Saturday evening that all 149 passengers and crew members were free of symptoms of the infection, which causes flu-like symptoms and can lead to respiratory failure.

Padilla defended this approach, saying that there would likely be cases without severe symptoms and that this was why all passengers and crew members were recommended to be in isolation for 45 days from their last exposure, which was agreed to be counted from May 6.

In Spain, evacuees from the ship were transferred to a military hospital, while 22 Britons, one German and one Japanese were taken to Arrow Park Hospital in Merseyside for quarantine and testing.

British health officials said clinical assessments and testing were “well underway” at Arrow Park for the passengers, who will remain at the facility for a total of three days before being sent home to continue their isolation for a further 42 days. If they are unable to go home, they will be placed in another facility to serve the remainder of their isolation.

Each of the 23 countries from which passengers and crew members originate is responsible for deciding on its own measures.

"I don't think you can say that you landed them and now they're spreading the situation," Padilla said.

"What happened with France, I think, is an example of good practice in public health management of an epidemiological alert, because if we thought it was not possible for someone to develop the disease, we would not have quarantined people."

He said the woman's condition worsened between the ship and the plane. "It wasn't like the patient was feeling unwell and saying, 'Okay, I'm not going to say anything because I want to be on the plane.' It was like, 'Okay, we took your temperature, it wasn't high, then you got on the plane, the plane took off, you started feeling unwell, we took your temperature and it was high.'"

An American passenger who was transferred to Nebraska on Sunday night along with 16 others also tested positive but did not have symptoms. The U.S. Department of Health and Human Services said one American citizen evacuated from the ship tested positive for the Andes strain — the only strain of hantavirus that is transmitted between people — and another had “mild symptoms.” Both the WHO and the Spanish government said the positive result was not strong enough to be conclusive and did not include the American case in the official tally.

Padilla said passengers could not be tested on the ship because there were no rapid PCR tests for hantavirus. Any testing would have involved sending samples by plane to Madrid, to a specialized laboratory, which would take 24 hours. Those delays would have made it impossible to rescue people on the ship because of extremely strong winds forecast from Monday night, which were expected to be “hellish” on Tuesday, he said.

The strong winds forced the ship to dock on Monday afternoon for safety reasons. The Spanish government had previously insisted that this would not happen, after the president of the Canary Islands, Fernando Clavijo, argued that the ship's docking increased the possibility of rats carrying hantavirus spreading to the mainland and endangering the local population.

Of the two planes that landed in the Netherlands on Tuesday, the first was carrying six former Hondius guests: four from Australia, one from New Zealand and a Briton living in Australia. The six are expected to remain in a quarantine facility near the airport before being repatriated to Australia.

The second plane was carrying 19 crew members, one British doctor and two epidemiologists.

The cause of the outbreak on the ship is not yet known, but it is believed that the virus spread from person to person and was brought onto the ship after a birdwatching trip in Argentina, which included a Dutch husband and wife who became the first victims, according to the Guardian.

A spokesman for Clavi said Monday evening that the president did not believe enough precautions had been taken to prevent the spread of the virus, but that he hoped "everything would end well for passengers and operators."

There are no vaccines or specific treatments for hantavirus, which is endemic in Argentina, where the ship departed in April. But health officials have said the risk to global public health is low and have downplayed comparisons with the Covid-19 pandemic.

Health authorities in several countries are tracking passengers who have already left the ship, as well as anyone who may have been in contact with them.