The United States has activated the emergency protocol upon the arrival in Tenerife, one of the Canary Islands, of a cruise ship affected by a deadly hantavirus outbreak, where the almost 150 passengers on board will be evacuated, including at least 17 Americans.
State and local health authorities in the United States are monitoring at least eight passengers who disembarked on April 24 and returned home. At this time, these people have not been told to isolate themselves, as they have not developed symptoms.
Starting Sunday, global health authorities will help transport passengers still aboard the ship — all of whom are currently asymptomatic — to their respective home countries.
People will be transferred to a “completely isolated and cordoned off” area in Tenerife, and then board escorted vehicles that will take them to a section of the local airport that will also be cordoned off, Virginia Barcones, Spain’s Director General of Civil Protection and Emergencies, said Thursday at a press conference.
The Centers for Disease Control and Prevention (CDC) said in a statement Friday that it is sending a team of epidemiologists and medical professionals to the Canary Islands to meet with the Americans on board, who will fly to Nebraska upon arrival.
“Given that the health status of exposed passengers is unknown and that emergency personnel will be in close contact with individuals who may be symptomatic, it is recommended that emergency personnel wear gloves (rubber or latex), a respiratory mask such as an N95, a protective gown, and eye protection,” a CDC epidemiologist who did not speak on behalf of the agency said in a text message.
The flight will land at Offutt Air Force Base, in Omaha, Nebraska. Repatriated passengers will then be transferred to the National Quarantine Unit at the Nebraska Medical Center in Omaha. It is unknown how long the quarantine will last.
“We are prepared for situations exactly like this,” Dr. Michael Ash, CEO of Nebraska Medicine, said in a statement released Friday. “Our teams have trained for decades alongside federal and state partners to ensure we can safely provide care while protecting our staff and the broader community.”
Dr. Michael Wadman, medical director of the National Quarantine Unit, said there are 20 spaces available in the quarantine unit and each person will have their own room and food will be delivered. Passengers will have their vital signs monitored daily and will have access to a team of healthcare workers, including infectious disease specialists and intensive care doctors.
“Each of the rooms is very similar to a hotel room, with the added advantage of having Wi-Fi and exercise equipment. If the quarantine is prolonged, that will be important to ensure your comfort,” Wadman said at a press conference on Friday night.
The Nebraska Medical Center also has a biocontainment unit that housed some of the first COVID-19 patients who had been aboard the Diamond Princess cruise ship in early 2020, as well as several Ebola patients in 2014. If passengers get sick, they will be moved from quarantine to the biocontainment unit.
A State Department spokesperson said the repatriation flight is part of a coordinated effort between the CDC, the Department of Health and Human Services (HHS) and the Government of Spain.
A CDC official told NBC News that the agency’s Global Migration Health division — which includes hantavirus experts — is “leading most of the collaboration with states, particularly repatriation efforts.”
At its headquarters in Atlanta, the CDC has activated its Emergency Operations Center, a physical location where public health experts can follow developments and coordinate their response to the outbreak. The agency has classified hantavirus as “level 3,” which is the lowest of concern.
Although many of these measures are common responses to an international health threat, some public health experts said it is unusual that the CDC has not yet held a press briefing on the outbreak.
Many experts are also concerned that the United States’ departure from the World Health Organization (WHO) in January means the country will not be the first to receive updated information on the hantavirus.
When questioned about these concerns, HHS pointed to a statement on the CDC website that said the Administration is “working closely with our international partners” and the White House said the Administration “remains vigilant.”
Hantavirus causes fever, fatigue, nausea, and difficulty breathing. Infections are rare, but often fatal: the mortality rate in the Americas is up to 50%, according to the WHO.
Since early April, six passengers on the Dutch-owned ship, known as the MV Hondius, have been confirmed to have the infection and two more cases are suspected. Three deaths have been reported: a Dutch couple and a German woman.
Since the incubation period for the virus can last up to six weeks, state and local health departments are watching for symptoms among American passengers who disembarked on April 24.
Georgia and Texas reported that they are monitoring two residents who were on the cruise ship. Arizona and Virginia are doing the same, one each. The Virginia Department of Health said in a statement that “a small number (<5) of other potentially exposed Virginians could be identified in the coming days.”
The California health department said in a statement Friday that at least one resident of that state remains aboard the ship and that another returned after disembarking.
The New Jersey health department also advised that two of its residents, who were not passengers on the ship, were potentially exposed to an infected person “during overseas air travel.”
State health departments have not announced plans to isolate or test returned passengers, saying none of them show signs of infection.
The Texas Department of State Health Services (DSHS) said in a statement Thursday that the two residents who were on board are monitoring themselves for symptoms with daily temperature checks and will contact public health authorities for any signs of possible illness.
“The Texas passengers are not sick and had no documented contact with a sick person on the ship, so there are no restrictions on their movement,” Chris Van Deusen, director of media relations for the Texas DSHS, said in a statement Friday. “If they develop any symptoms, they will contact public health and isolate. I don’t think asymptomatic spread in the home is a cause for concern.”
The health authorities of the state of Arizona detailed on Thursday in a press conference that the resident of that state who returned from the cruise is being subjected to symptom monitoring and daily temperature checks. This will last 42 days, starting from the time the person disembarked from the ship, explained Ken Komatsu, Arizona state epidemiologist.
State health officials said it is up to the local health department to decide whether to test the Arizona resident for hantavirus, but noted that any test result is likely to be negative since the person has no symptoms. They declined to reveal which county the Arizona resident is located in, citing respect for the person’s privacy.
If the resident develops symptoms, state health officials said, they would likely be quarantined at home and warned not to travel. Local health authorities would also monitor members of the household and locate anyone outside the household to whom the person may have exposed, officials said.
“For this person to pose a potential risk to the public, there has to be very close contact,” said Dr. Joel Tariquez, Arizona’s chief medical preparedness officer.
The hantavirus strain implicated in the cruise ship outbreak, known as the Andes strain, is the only version known to be transmissible between humans. Its main route of transmission is contact with rodents or their urine, feces or saliva. The animal carrying the strain—the rice pygmy rat—is found in South America, not the United States.
