Passengers reveal what it's like inside cruise ship's virus purgatory

From emotional to mundane, passengers on board a luxury cruise ship stranded off the coast of Africa have begun giving the world a glance into their purgatory amid a rare and deadly hantavirus outbreak.

Their insights, including a plea to remember they are people, not just headlines, emerged as the World Health Organisation revealed the virus may have been passed between humans.

That's particularly rare for a virus that is normally only spread by close contact with rats, their urine or droppings. It may help to explain how the number of suspected cases has reached seven, including a Dutch couple and a German man who have died.

US travel blogger Jake Rosmarin was the first passenger to comment on the outbreak, posting a quick confirmation on May 2 that he was one of the dozens of passengers, including four Australians, on board the MV Hondius.

By that stage it had already been 21 days since the first patient, a Dutch man, had died, but the news had not spread widely.

On Monday, he shared an emotional video seated on the bed in his cabin, arms crossed, describing the situation as "very real for all of us here".

"We're not just a story, we're not just headlines, we're people, people with families, with lives, with people waiting for us at home," he said, voice quavering.

"There's a lot of uncertainty, and that's the hardest part.

"All we want right now is to feel safe, to have clarity and to get home.

"So if you're seeing coverage about this, just remember that there are real people behind it, and that this isn't something happening somewhere far away. It's happening to us right now."

Passengers have been told to stay in their cabins, leading to slightly eerie scenes on the luxury ship, as seen in photos sent to the Associated Press by passenger Qasem Elhato.

Long wooden dining tables sit empty on a deserted deck. The same picture is repeated inside, where a carpeted room is full of armchairs and couches but completely empty of people.

Another image shows four people clad head-to-toe in the PPE medical staff have been ordered to wear while on board, as one grasps the hand of a woman on the edge of the deck.

Medical teams from the nearby archipelago of Cape Verde have been on board the ship providing support as two sick crew members, who the cruise operator says require "urgent medical care", prepare for medevac to The Netherlands.

"Our days have been close to normal, just waiting for authorities to find a solution," Elhato said via WhatsApp.

"But morale on the ship is high and we're keeping ourselves busy with reading, watching movies, having hot drinks and that kind of things."

Helene Goessaert, another passenger, told Belgian broadcaster VRT that everyone onboard is "in the same boat, literally".

"You don't embark on a trip with the idea that one of your fellow passengers won't make it," she said.

She said they were regularly updated with accurate information.

"For the rest, it is a waiting game," she said.

"Today we received fresh fruit and fresh vegetables. That was very important to us."

'Blown out of proportion'

Elhato, also known as Kasem Hato and Ibn Hatutta, said the situation on board had been "blown out of proportion partly because of one person panicking on the ship whose video has been circulating the media".

"While his reaction is valid, it doesn't represent the situation on board, everyone else (148 out 149) has been calm, the situation is under control and we just wish those who are sick a speedy recovery," he said, in an Instagram Story posted on Tuesday.

"I'm just a passenger on the ship and I don't represent the company but I can see they've been doing all they can to help us and to find a solution with our safety being their priority.

"We all feel very sorry for those who passed away as we shared with them a beautiful journey and send their families our condolences."

More recent images from Rosmarin's Instagram show a spectacular sunrise, waves crashing against a rocky coastline and craggy mountain peaks jutting into a washed-out blue sky above the coastal city of Praia, which means beach in Portuguese.

"I'm feeling well, getting some fresh air, and continuing to be well fed and taken care of by the crew onboard," he said.

"Just trying to focus on the positive, think about the good things, and keep a smile on my face.

"Hope to have more updates soon. Thank you again for all the love and support, it truly means a lot."

WHO suspects human transmission

WHO director of epidemic and pandemic preparedness Dr Maria Van Kerkhove said medical experts were working under the assumption that the first man who died and his wife were infected in Argentina before joining the cruise.

She travelled from St Helena, where her husband's body was removed from the ship, to South Africa but collapsed at a Johannesburg airport and died at a hospital on April 26, more than two weeks after her husband.

She said while hantavirus was normally spread by rats, there had been cases of human-to-human spread in what's known as the Andes strain of the virus present in Argentina.

"The cruise did stop at many different islands up the coast of Africa, and again, seeing a lot of different wildlife on those islands," she said.

"There are birds. Some islands have a lot of rodents. Others don't. So there could be some source of infection on the islands as well for some of the other suspect cases.

"However, we do believe that there may be some human-to-human transmission that's happening among the really close contacts, the husband and wife, people who've shared cabins etc."

She said officials have been told there are no rats on board.

Only the Dutch woman who died and a British man who Van Kerkhove said was in a critical condition in a South African hospital but improving have been confirmed through lab testing to have the virus, while five other people are suspected to have fallen ill from it.

What happens next?

In its latest update on Tuesday afternoon (early Wednesday AEST), cruise operator Oceanwide Expeditions said discussions with the relevant authorities regarding the ship's next steps remained ongoing.

Van Kerkhove said the ship would "continue on to the Canary Islands" once the sick passengers were moved.

But Spanish health officials said in a statement that they were monitoring and that "the most appropriate port of call will be decided".

"Until then, the Ministry of Health will not adopt any decision, as we have informed the World Health Organisation," a spokesperson said.

Officials in Argentina — where hantavirus led to 28 deaths nationwide last year, according to the health ministry — said they confirmed no passengers had symptoms when the Hondius departed. Symptoms can appear up to eight weeks after exposure, officials have said.

In South Africa, authorities said they have started contact tracing — another practice used extensively in the coronavirus pandemic. But officials have emphasised that the chance of a major public health threat is low.

- Reported with Associated Press and Reuters

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