Updates from quarantined ship; doctor reacts to hantavirus outbreak

[0:00] Three people are dead, and at least three others are sick after a suspected outbreak of what's called Hantavirus aboard a cruise ship. [0:07] Now, the vessel is currently anchored off the coast of Africa with nearly 150 people on board while health officials try to figure out next steps. [0:14] Here's CNN's Larry Madowa. [0:16] A suspected outbreak of Hantavirus on board this cruise ship crossing the Atlantic Ocean. [0:23] The MV Hondias, operated by ocean-wide expeditions, departed Ushuaia on the southern tip of Argentina over a month ago. [0:30] Details of the suspected outbreak emerged as it was anchored in Praia, the capital of Kivverd, an island nation off the coast of West Africa, on Sunday. [0:39] One American travel blogger on board issued this tearful message. [0:42] We're not just a story. We're not just headlines. [0:47] We're people, people with families, with lives, with people waiting for us at home. [0:57] There's a lot of uncertainty, and that's the hardest part. [1:00] All we want right now is to feel safe, to have clarity, and to get home. [1:10] Cape Verdean authorities have refused to allow anyone to disembark. [1:13] However, local health authorities visited the ship and assessed two symptomatic crew members requiring urgent medical care, Oceanwide Expedition said in a statement. [1:23] There are 17 Americans among the 149 people on board, according to Oceanwide. [1:27] The company told CNN it is, quote, currently focused on the health and safety of passengers and crew. [1:33] Humans most commonly get infected with Hantavirus through contact with rodents like mice or rats, especially their urine droppings and saliva, according to the Centers for Disease Control and Prevention, CDC. [1:44] Early symptoms include fatigue, fever, and muscle aches, as well as headaches, dizziness, chills, and abdominal problems. [1:51] Human-to-human transmission is rare, the World Health Organization says. [1:55] To have this many people clustered together on a ship, most public health officials would be looking and looking for human-to-human transmission. [2:06] And I'm sure this is going to be investigated tremendously. [2:10] But that would be where the arrows are pointing right now. [2:14] So far, it's not clear how the suspected infections on the ship occurred. [2:18] The first death on board this ship happened April 11. [2:21] The body of a 70-year-old Dutch man was taken to the island of St. Helena, a remote island in the South Atlantic, according to South Africa's Department of Health. [2:30] His wife later collapsed at an airport while trying to fly home and died in hospital. [2:35] At this time, it is not confirmed that these two deaths are connected to the current medical situation on board, the operator said. [2:41] The World Health Organization says it is facilitating between member states and the ship's operators on a full public health risk assessment, but added, quote, [2:49] The risks to the wider public remain slow. [2:51] There is no need for panic or travel restrictions. [2:54] Larry Medowa, CNN. [2:57] Thanks to Larry Medowa for that report. [2:59] Joining us now to discuss, Dr. Megan Ranney, the dean of Yale Medical School. [3:03] It's so good to see you again, Dr. Ranney. [3:05] Last time you were here, we were talking about, I believe, a different virus altogether, the coronavirus. [3:09] If hantavirus is not normally transmitted from person to person, how is it possible, do you think, that multiple people on the ship have the virus? [3:21] Yeah, a hantavirus outbreak on a cruise ship was not on my top 50 or even 100 things that I would worry about for a cruise ship. [3:28] I and other experts really think there are three possibilities here. [3:32] The first is that a bunch of folks were exposed when they were traveling off the ship. [3:36] Maybe they went to a cave or to a house that had rodent droppings that got aerosolized and they all got infected there. [3:44] The second possibility, which would worry me if I were a cruise ship owner, is that there were mice or other rodents on the cruise ship that were running around and exposed a bunch of folks. [3:55] The third possibility and the one that most worries folks like me, public health experts, emergency physicians, is the possibility that there could be person to person transmission. [4:05] And, Jake, here's the important part. [4:07] There has been a report of one strain of hantavirus in Argentina, known as the Andes strain, which is known to cause limited person to person transmission. [4:20] Many of us are worried that it may be that strain that got onto the boat and that may be spreading. [4:25] But it's far too early to know. [4:27] So hantavirus is highly deadly. [4:30] The CDC says more than a third of people who develop respiratory systems may then die. [4:34] There's also no cure for hantavirus. [4:37] So the passengers and crew who are being treated right now and they may have the virus, what does that care? [4:42] What does that treatment look like? [4:46] So we would care for them just as we would for anyone with a severe critical illness. [4:51] If they're having breathing trouble, we might put them in a medical coma and put in a breathing tube. [4:56] If their blood pressure is having trouble maintaining itself, we'd give them fluids and medications to support their blood pressure. [5:03] We might treat their kidneys. [5:05] We'd probably give them antibiotics. [5:07] An important thing to know about a hantavirus diagnosis is that it is tough to make. [5:12] It's almost always a lab that we have to send out of the hospital. [5:16] It's not my first, fifth, or even tenth thing on my differential diagnosis. [5:20] And so you want to treat folks for everything that could be causing their symptoms while waiting for that send-out test to come back. [5:28] So passengers are not currently allowed to get off the ship. [5:32] Once they finally dock, will there have to be some kind of extensive testing to make sure the virus is contained? [5:38] What do the next steps look like? [5:41] So trying to figure out what the next steps are as we speak, I will say this is where I am so grateful for other great public health experts [5:49] and particularly for the expertise of the World Health Organization and other folks that work on pandemic preparedness. [5:56] As Larry said, this is a very rare virus. [5:59] We've had less than 1,000 cases in the United States in the last 20 years. [6:04] The fact that we have international experts working to figure out what's happening with spread [6:09] and what we should do next is amazing. [6:13] Most likely, when folks get off of that ship, there will be some quarantine, but it is far too early to tell. [6:20] We'll know a lot more in coming days as we start getting genomic data about whether this spread between people, where it came from, and so on. [6:28] How is the World Health Organization responding to this suspected outbreak? [6:32] Joining me now is Dr. Hans Klug. [6:35] He's the Europe Director for the WHO. [6:37] Thank you so much for joining us. [6:38] I imagine you're very busy with this. [6:42] What's the current plan whilst you figure out how to contain the virus? [6:46] Is it to keep everyone on the ship and certain individuals isolated? [6:52] Well, this is the first reported outbreak of the Hunter virus on a cruise ship. [6:57] So that's a bit of new territory, but the virus itself is not new. [7:03] Indeed, it's carried by rodents. [7:06] People get contaminated through inhaling particles, mostly from fishes or urine. [7:12] There were five suspected patients or people. [7:17] Three unfortunately pass away. [7:18] Two people are on the ship but are under medical care by the authorities of Gabi Verdi. [7:24] And one laboratory confirmed patient is in the intensive care unit in South Africa. [7:32] Now, it's very important for the public to realise that the overall risk to the public remains low. [7:38] It's very tough to be transmitted human to human, though not impossible. [7:44] When will people be allowed off the ship? [7:45] So there is an international coordination between all the authorities 24-7, which also, by the way, shows why international collaboration in these times are so important. [8:01] And new information will be available very, very soon. [8:05] So they have no idea when they're going to be allowed off. [8:08] I'm just assuming once you get the all clear that everyone's got better, they will be allowed to get off. [8:15] Or is the plan not to allow anyone to get off in case it spreads beyond the ship? [8:21] As we speak, the medical authorities of Gabi Verdi are on the spot, examining the people, making the diagnosis. [8:31] We're in touch with them. [8:33] And immediately, if there's new information, we will share that one. [8:36] But you're not going to allow people off, are you, presumably, until you know? [8:40] Well, the examinations have to be obviously concluded and the relevant authorities are following the protocols. [8:50] What we're doing is connecting, putting all the data together, but also already making some progress with some medical evacuations of severely ill people. [8:59] Because the symptoms don't appear for weeks, do they? [9:02] I'm just thinking it could be weeks before you know who's got it. [9:08] Indeed, the incubation can sometimes take up to eight weeks. [9:12] And that's why the basic hygienic and sanitary measures are to be put in place. [9:19] But it doesn't mean that there will be a waiting time for eight weeks. [9:23] So let's do the, let's say, the next update as soon as we have the new information. [9:30] But give meanwhile, I think I would like to stress that one, that the overall risk to the public remains low. [9:36] I mean, low risk does not mean no risks. [9:38] And we are treating the situation as such.