7 states prepare to receive cruise ship passengers

The U.S. has entered emergency response mode as a cruise ship hit by a deadly hantavirus outbreak sails toward Tenerife, one of Spain’s Canary Islands, where it will evacuate nearly 150 passengers on board, including at least 17 Americans.

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State and local health officials in the U.S. are monitoring at least eight passengers who disembarked on April 24 and returned home. For the time being, those individuals are not being told to isolate, since they have not developed symptoms.

As early as Sunday, global health authorities will help transport passengers still on board the ship — all of whom are currently asymptomatic — to their respective home countries. Passengers will be taken to a “completely isolated, cordoned-off” area in Tenerife, then board guarded vehicles to transport them to a section of the local airport that will also be cordoned off, Virginia Barcones, Spain’s head of emergency services, said Thursday at a press conference.

The Centers for Disease Control and Prevention said Friday in a statement that it is sending a team of epidemiologists and medical professionals to the Canary Islands to meet the Americans on board, who will fly to Nebraska upon arrival.

“Because the disease status of the exposed passengers is unknown and responders will be in close contact with potentially symptomatic individuals, it makes sense for emergency responders to don gloves (rubber or latex), a respirator mask like 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. The repatriated passengers will then be transported to the National Quarantine Unit at the Nebraska Medical Center in Omaha. It’s unknown how long the quarantine will last.

“We are prepared for situations exactly like this,” Dr. Michael Ash, chief executive officer of Nebraska Medicine, said in a statement released Friday. “Our teams have trained for decades alongside federal and state partners to make sure we can safely provide care while protecting our staff and the broader community.”

Dr. Michael Wadman, the medical director for the National Quarantine Unit, said there are 20 available spaces in the quarantine unit and each individual will have their own room and get food delivered to them. The passengers will have their vital signs monitored daily and have access to a team of health care workers, including infectious disease specialists and critical care physicians.

“Each of the rooms looks very much like a hotel room, with the addition of availability of Wi-Fi, of exercise equipment. If the quarantine is prolonged, those would be important in terms of making sure they’re comfortable,” Wadman said at a press conference on Friday evening.

Nebraska Medical Center also has a biocontainment unit that housed some of the first Covid patients who’d been aboard the Diamond Princess cruise ship in early 2020, as well as several Ebola patients in 2014. If passengers become ill, they will move from quarantine into the biocontainment unit.

A U.S. State Department spokesperson said the repatriation flight is part of a coordinated effort between the CDC, the U.S. Health and Human Services Department 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 engagement with states, particularly repatriation efforts.”

At its Atlanta headquarters, the CDC has activated its Emergency Operations Center — a physical site where public health experts can track updates and coordinate their response to the outbreak. The agency has classified the hantavirus outbreak as a “level 3,” which is the lowest level of concern.

While many of these efforts are standard responses to an international health threat, some public health experts said it’s unusual that the CDC has not held a public briefing on the outbreak yet. Many experts also worry that the U.S. departure from the World Health Organization in January means the country won’t be first to receive hantavirus updates. When asked about these concerns, HHS pointed to a statement on the CDC website that said the government is “working closely with our international partners” and the White House said the administration “remains vigilant.”

Hantavirus causes fever, fatigue, nausea and trouble breathing. Infections are rare, but often deadly: The fatality rate in the Americas is up to 50%, according to the World Health Organization.

Since the start of April, six passengers on the Dutch-owned ship, known as the MV Hondius, have been confirmed to have infections and two more cases are suspected. Three deaths have been reported: a Dutch husband and wife and a German woman.

Because the virus’ incubation period can last up to six weeks, state and local health departments are watching for symptoms among the American passengers who disembarked on April 24.

Georgia and Texas have each said they are monitoring two residents who were on the cruise ship. Arizona and Virginia are monitoring one each. Virginia’s health department said in a statement that “a small number (<5) of other potentially exposed Virginians might be identified in the days ahead.”

California’s health department said Friday in a statement that at least one California resident remains on board the ship and one other returned to the state after disembarking.

New Jersey’s health department also said that two New Jersey residents who were not passengers on the ship were potentially exposed to an infected person “during air travel abroad.”

State health departments have not announced plans to isolate or test the returned passengers, citing the fact that none of them is showing signs of infection.

The Texas Department of State Health Services (DSHS) said Thursday in a statement that the two residents who were on board are monitoring themselves for symptoms with daily temperature checks and will contact public health officials at any sign of possible illness.

“The passengers from Texas are not sick and did not have documented contact with a sick person on the ship, so there is no restriction on their movement,” Chris Van Deusen, director of media relations for Texas DSHS, said Friday in a statement. “If they develop any symptoms, they will contact public health and isolate. I don’t believe asymptomatic spread in the home is a concern.”

Arizona state health officials said Thursday at a press briefing that the resident there who returned from the cruise is being monitored for symptoms and having their temperature checked daily as well. The monitoring will last for 42 days, starting when the person departed the ship, said Ken Komatsu, Arizona’s state epidemiologist.

State health officials said it’s up to the local health department to decide whether to test the Arizona resident for hantavirus, but noted that any test results would likely be negative since the person is asymptomatic. The officials declined to share what 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 be cautioned to not travel. Local health authorities would also monitor household members and locate anyone outside the home whom the person had potentially exposed, the officials said.

“In order for this individual to create a potential risk for the public, there has to be very close contact,” said Dr. Joel Tariquez, the Arizona medical director for preparedness.

The strain of hantavirus involved in the cruise ship outbreak, known as the Andes strain, is the only version known to be transmissible between humans. Its primary route of transmission is contact with rodents or their urine, feces or saliva. The animal that carries the strain — the pygmy rice rat — is found in South America, not the U.S.