A 69-year-old semiretired oncologist from Bend, Oregon, found himself acting as the ship’s doctor during an unprecedented hantavirus outbreak aboard an Antarctic cruise, after the vessel’s physician became too ill to continue caring for passengers.
Stephen Kornfeld, MD, had left home on March 17 for what was meant to be an extraordinary nature-focused trip. A keen birder, he planned to spend two weeks in Argentina before joining a month-long cruise aboard the MV Hondius, travelling to Antarctica and then across the Atlantic to remote islands rarely visited by tourists.
“I like going to remote places,” Kornfeld told the medical journal, JAMA. “To me, it was about the nature.”
But toward the end of the cruise, the journey took a grave turn. According to World Health Organisation Director-General Tedros Adhanom Ghebreyesus, PhD, three passengers died and a total of 12 passengers and crew were affected by hantavirus.
You can check out our PP Health Malaysia’s (PPHM) cruise-ship linked Hantavirus dashboard for detailed cases breakdown.
The WHO’s working theory is that one passenger contracted the virus from a rodent before boarding the ship, with later cases linked to human-to-human transmission. Although hantavirus usually spreads from rodents to humans, the Andes strain — found in parts of the Americas — is the only known hantavirus strain with documented person-to-person spread, typically through close, prolonged contact.
That type of contact appears to have occurred aboard the MV Hondius, including in the care of sick passengers. The ship’s own physician later became ill, leaving the vessel without a functioning doctor.
Kornfeld, one of four physicians among the passengers, said he was the most suited to step in because of his background in internal medicine and active clinical practice.
“As the most internal medicine–oriented, active practising physician, it sort of fell to me,” he said.
First Death Initially Seen as Isolated
The first passenger became ill in early April and died on April 11. At the time, Kornfeld said, passengers were told the illness did not appear to be communicable.
“It seemed like a one-off event,” he said. “Things happen when you’re on a boat for many, many weeks.”
Concern grew later in April when the wife of the first passenger died in Johannesburg and another passenger was evacuated from Ascension Island to Johannesburg. By then, passengers were questioning whether the serious illnesses might be linked.
On May 1, Kornfeld asked whether the ship’s doctor needed help. He was then told the physician had also become ill and could no longer work.
“What started as just an innocent question quickly escalated,” Kornfeld said. “I’m now the default medical person for the ship.”
He cared for a passenger who died the following day, on May 2. He also helped assess other sick passengers and crew, while communicating with international health officials, including the WHO.
Limited Medical Supplies on Board
Kornfeld said the ship was not equipped for critical care, which made the situation especially difficult.
“The ship environment is a unique environment. It’s not created for critical care,” he said. “From the beginning, I realised how limited my supplies and my ability to really take care of critically ill people would be.”
At first, he used masks and gloves. Within about 24 hours, he found better masks, goggles and aprons to improve protection.
There was no nurse on board, but Kornfeld said ship staff were extremely helpful. One staff member effectively became his assistant.
He said much of his role involved monitoring patients, supporting evacuation efforts and helping reassure passengers.
“Ultimately, high-level medicine wasn’t being utilised,” he said. “It was more emotional and social support.”
Diagnosis Came as a Shock
Passengers initially considered more common cruise ship illnesses, including norovirus and Legionella. Hantavirus was not an obvious possibility.
“If you just do a quick Google search on diseases that affect cruises, hantavirus does not come up,” Kornfeld said.
The first hantavirus diagnosis was reported on May 2 in a passenger receiving critical care in Johannesburg. At first, Kornfeld said, many did not assume all the illnesses were connected, because most hantavirus infections do not spread between people.
That changed when another passenger who had died in Johannesburg was also diagnosed with hantavirus based on previously collected specimens.
“At that point it was clear this was a communicable hantavirus and must be the Andes form,” Kornfeld said.
The ship went into lockdown on May 4, after the second hantavirus case was diagnosed. Passengers wore masks and continued eating in the dining room with distancing measures in place.
The cruise was only about half full because some passengers had already disembarked at St Helena as scheduled, Kornfeld said.
False Positive Led to Biocontainment Admission
Kornfeld later tested potentially positive from a nasal sample taken on May 3, which was sent to the Netherlands for analysis. Although the result was not confirmed, he was treated as positive when he returned to the United States.
He was admitted to the biocontainment unit at the University of Nebraska Medical Center in Omaha. After repeated PCR tests and antibody tests came back negative, the earlier result was deemed a false positive.
He was then transferred to the National Quarantine Unit, also at the University of Nebraska Medical Center, where he remained with other US passengers.
Physically, Kornfeld said he has been well and has had no symptoms.
“I’m doing great,” he said. “I’ve had no symptoms. I’m getting a bit of daily exercise.”
Passengers in quarantine were kept in separate rooms and communicated mainly by WhatsApp or phone.
Passengers Expected to Continue Quarantine
The US Centers for Disease Control and Prevention indicated that Kornfeld and other passengers could leave the Nebraska quarantine unit on May 31 and complete their 40-day quarantine at home, though Kornfeld said plans could still change depending on further developments.
He said passengers accepted the need for quarantine, but many hoped to finish it at home.
“Hantavirus is communicable but not as easily communicable as COVID-19 or a lot of other diseases,” he said. “A lot of us have home situations that are very conducive for quarantine.”
Kornfeld said he does not view his actions aboard the ship as heroic.
“I stepped up,” he said. “I think a lot of physicians would in my circumstances.”
The post The Doctor’s Story: Inside Ground Zero of the Cruise Ship Hantavirus Crisis first appeared on PP Health Malaysia.