Police officers walk past an arriving ambulance taking a German patient to the infection centre at Düsseldorf University Hospital. Photo / Getty Images
At the southernmost tip of South America, the resort town of Ushuaia, in Argentina’s Tierra del Fuego archipelago, is commonly referred to as “the end of the world”.
It is the world’s major point of departure for tourist and scientific expeditions to the Antarctic Peninsula and the remote islands of the South Atlantic.
It is also believed to be ground zero for the outbreak of hantavirus, the rat-borne disease that has been carried across the Atlantic on the cruise ship MV Hondius and now threatens to spread across the globe.
Passengers from the ship, or travellers exposed to them on flights they took after disembarking, have now been traced to the US, the UK, France, Switzerland, the Netherlands, South Africa and Turkey.
Argentine investigators believe that a Dutch couple, who have both since died of the virus, may have contracted it in the days before boarding the cruise vessel at Ushuaia.
The couple, both aged 69, who have not been named, had spent four months travelling around Argentina, Chile and Uruguay by car before arriving in Ushuaia at the end of March.
While in the town, they went on a bird-watching outing to a landfill site, where investigators believe they may have been exposed to rodents carrying the infection.
Days later, they boarded MV Hondius, which departed from Ushuaia on April 1.
The Polar Class 6 vessel, described as providing “hotel comfort, expedition class”, with suites costing as much as £25,000 ($55,940), started its journey across the South Atlantic with 114 passengers and 61 crew members.
After a few days at sea, it reached the island of South Georgia by April 5, where passengers were able to disembark and view king penguin colonies and Antarctic fur seals.
The vessel then continued its journey towards Tristan de Cunha, the most remote inhabited island in the world, which is viewed as one of the highlights of the trip.
Yet tragedy would strike just days before its arrival. On April 11, the Dutchman who had visited the landfill site died.
The boat continued to Tristan de Cunha, where passengers were again able to disembark, posting photos and videos on Facebook of themselves exploring the island.
Six additional passengers joined the boat at Tristan de Cunha.
Its next stop was St Helena, where the Dutchman’s body was removed from the ship. His wife also disembarked on the island on the same day, along with 28 other passengers.
Many of the passengers, including the Dutch woman, then boarded a flight to Johannesburg on April 25, which the South African carrier, Airlink, said was carrying 82 passengers and six crew.
On the day of her arrival in Johannesburg, the Dutch woman planned to take a connecting flight to the Netherlands, but began feeling worse shortly after boarding a plane operated by KLM and was not allowed to fly by the Dutch airline’s staff.
She then fainted at Johannesburg airport and was taken to a medical centre, where she died the next day. Several people who came into contact with the Dutch woman are now being monitored by health officials.
On Thursday, France’s health ministry confirmed that a French national was being monitored as a “contact case” after he travelled on the plane to Johannesburg with her.
It has also been confirmed that a Dutch woman who was a flight attendant on the KLM flight was taken to hospital in Amsterdam after showing possible symptoms of a hantavirus infection.
The country’s health ministry said she had mild symptoms and was being tested while in isolation.
Oceanwide Expeditions, which operates the MV Hondius, said 29 people disembarked the vessel at St Helena.
It has not been confirmed where these passengers travelled afterwards, but it is likely that they also travelled to Johannesburg, which is the only regular flight from the island.
Meanwhile, back on the ship, a British passenger fell ill on April 27 and was evacuated at Ascension Island and taken to South Africa, where he remains in intensive care. A German passenger died a few days later, on Saturday.
The vessel then travelled to Cape Verde, where it arrived on Sunday.
The authorities there did not allow passengers to disembark, and the boat was anchored off the coast of Praia, the capital, on Sunday. More than 140 passengers and crew members remained on board.
Three suspected hantavirus patients were evacuated on Wednesday and flown to the Netherlands to receive specialist care.
They included Martin Anstee, a 56-year-old expedition guide from Bedfordshire, a 41-year-old Dutch colleague who was the ship’s doctor, and a German passenger, 65, who is believed to have a relationship with the other German passenger who died.
The ship finally left Cape Verde on Wednesday evening and will begin a three-day journey to the Canary Islands, despite opposition from the islands’ president, who warned that the threat to the Canarian population was “very real”.
Officials say those still on board show no symptoms.
On Thursday, the World Health Organisation said it had informed 12 countries that its nationals had disembarked the MV Hondius at Saint Helena.
Director General Tedros Adhanom Ghebreyesus named the countries as Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden, Switzerland, Turkey, the UK and the US.
Ruhi Çenet, a Turkish travel blogger, was one of the passengers who disembarked at St Helena. He travelled to South Africa on the same flight as the Dutch woman and has travelled back to Turkey.
“When we got to Turkey, we were told that as long as we don’t show any symptoms, at this point we don’t have to be quarantined,” he told French media outlets. “We are trying to isolate ourselves as much as we can.”
On Wednesday, authorities in Switzerland said a former passenger who left the MV Hondius at St Helena had tested positive for the virus and was being treated at a Zurich hospital.
It was not clear when or how he travelled to Switzerland, and how many other countries he might have passed through.
In the UK, two British people who also left the vessel at St Helena are self-isolating at home after potential exposure to the virus, the UK Health Security Agency said.
In the US, people in at least three states are being monitored for potential hantavirus infections, according to reports.
The New York Times reported that none of those being monitored had shown signs of illness, and that Georgia was monitoring two residents and California an undisclosed number.
The Georgia Department of Public Health told Reuters it was monitoring two people who had returned home after leaving the cruise ship. Both are in good health, show no signs of infection and are following recommendations from the Centres for Disease Control and Prevention.
In a separate statement, the Arizona Department of Health Services said it was monitoring one resident who was a passenger on the ship. That person is not showing symptoms.
Concerns about the infection spreading are not just related to former passengers on the ship.
The South African health ministry is attempting to trace 62 people it believes had contact with the two infected passengers – the Dutch woman and the British passenger – and then travelled there.
Officials have traced 42 of them so far, including health workers – but 20 still need to be traced, including five who may have been on flights to South Africa with some of the passengers as well as flight crew members.
Some may now have travelled overseas, the ministry said.
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