“We’re not just a story. We’re not just headlines, we’re people with families, with lives, with people waiting for us at home.” These words from one emotional passenger on the MV Hondius, the Dutch-flagged cruise ship at the centre of an international hantavirus outbreak this week, could have come straight from the worst years of the Covid-19 pandemic.
Then, as now, having people confined on a ship as serious illness broke out heightened fears of further infection.
In February 2020, the Diamond Princess – a cruise liner moored at the Japanese port of Yokohama – had the most Covid infections anywhere outside China, with more than 600 confirmed cases. Questions were later raised about the authorities’ response, which included keeping passengers on board for two weeks before allowing disembarkation.
A month later, several Japanese experts writing in the Disaster Medicine and Public Health Preparedness journal queried the “effectiveness and validity of infection control” and called for a re-evaluation of international rules on such outbreaks. Now another difficult scenario is playing out on the Hondius.
The ship set off from Argentina on April 1 carrying almost 150 passengers and crew from more than 20 countries. The World Health Organisation said that, as of Monday, seven confirmed or suspected cases of hantavirus had been identified. So far there have been three deaths, the WHO added, along with one critically ill patient and three more people reporting mild symptoms.
Unlike the coronavirus that causes Covid-19, hantavirus rarely spreads from human to human and is usually transmitted by exposure to rodent urine, droppings or saliva. It is unclear if the three fatalities succumbed as a direct result of hantavirus infection, but when the cruise ship arrived at the West African country of Cape Verde on Sunday, the authorities there turned down a request for the vessel to dock, citing public health concerns.
Since then, a WHO official has confirmed that two ill crew members and one other person are being evacuated from the ship, which will then sail onwards to the Canary Islands, one of Spain’s autonomous communities. However, it was reported yesterday that the president of the territory is also opposed to allowing the Hondius to dock there.
Although there is no suggestion yet that any rules have been broken, the Hondius’s situation highlights the need for more clarity about the response to disease outbreaks at sea and who bears responsibility for protecting people caught up in such precarious circumstances. Although myriad regulations, protocols and frameworks exist, the nature of the challenge is inherently complex. A rapidly developing infection among passengers and crew from different countries, sailing across an ocean to different jurisdictions on a ship registered in another nation is a fast-moving logistical, legal and health challenge.
