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Three of the Canadians — a couple from the Yukon and a person who lives off island — are isolating at secure locations overseen by Island Health, Henry said. 

While the fourth lives alone in the region and is therefore self-isolating at home, she said. 

"They're being monitored in appropriate places separately," Henry said. 

The B.C. Provincial health director said that while she had been at first unnerved by news of people developing serious illness on a cruise ship, saying she felt "a bit of a sinking feeling," her concerns eased once investigators confirmed the illness was hantavirus — which though rare, is well known. 

"I probably have as much traumatic stress from that as anybody else in this province, in this country," she said, reflecting on the COVID-19 pandemic. 

Henry also provided a tally of Canadians who are self-isolating, including six former passengers from the ship: the four who arrived in B.C. Yesterday and two in Ontario. Other travellers in Ontario, Quebec and Alberta are also being monitored after sharing flights with infected passengers, she said. 

The four Canadians in B.C. Will be isolating for a minimum of 21 days, but possibly twice that long.

Henry said that the known incubation period for hantavirus is about six weeks, or 42 days — but the first 21 days is the highest risk period. 

"It might be extended as far as the full 42 days. But as you can imagine, that's quite a burden on people, and it's challenging to stay in one place for that period of time, especially as the risk diminishes over time," she said. 

"So we'll be reassessing that on an ongoing basis, depending on how people are feeling, depending on whether anybody develops symptoms, and depending on what's happening globally."

Henry said there are plans in place to support the four Canadians for the full 42 days with daily monitoring. 

No Canadians on board the MV Hondius had "known direct contact" with any of the ill people onboard the hantavirus-hit cruise ship, says B.C. Provincial Health Officer Dr. Bonnie Henry. 

Henry is giving an update in Victoria, where the four Canadians who were passengers on the ship arrived yesterday after disembarking from Tenerife, Spain. 

The four passengers — two Yukon residents in their 70s, another B.C. Resident in their 70s and a person in their 50s currently living abroad — remain asymptomatic, Henry said. 

"This is reassuring," Henry said of the lack of symptoms, "but as we talked about yesterday, we are in a very critical phase of the incubation period."

They were transported from the airport under "very controlled conditions" while wearing personal protective equipment and have now begun "a minimum of 21 days" in secure isolation accommodations monitored by Island Health teams.

Henry said the Yukon couple were brought to B.C. Because the territory does not have the testing capacity or specialized facilities needed to care for someone who develops severe symptoms associated with the Andes strain of hantavirus.

The passengers will receive daily monitoring, symptom checks and wellness assessments throughout their isolation period. Henry said the group appeared "exhausted" after weeks aboard the ship but also "very relieved and grateful to be back here in Canada."

She said none of the evacuees came into contact with the public after landing and that all health-care workers involved wore appropriate PPE at all times. 

While officials say none of the Canadians had known direct contact with infected passengers aboard the ship, Henry cautioned that "in a closed environment like a cruise ship it’s very difficult to know for certain."

As 28 passengers and crew members were driven away from the Port of Granadilla, some waved out the bus window and others made a heart symbol as they headed to the airport where they will be flown straight to the Netherlands.

WHO Director-General Tedros Adhanom Ghebreyesus said the priority was to get the passengers off of the boat as soon as possible. He said everyone was quite distressed after the deaths and medical evacuations earlier.

He also said the French passenger who started experiencing symptoms on a Sunday flight back to France is now in hospital in a critical state.

The Hondius is now docked at the Port of Granadilla, as waters were too rough to disembark passengers into the smaller boats. 

As part of the negotiations around the vessel's arrival here, it was agreed that it would stay offshore. However with strong winds the decision was made to dock it. The ship is expected to depart here in an hour or so.

How the WHO handles hantavirus cases, including 'weakly positive' ones

Boris Pavlin, an epidemiology team lead with the World Health Organization, says genetic testing for hantavirus can produce 'weakly positive' or inconclusive results. In the case of the American passenger who had a weakly positive hantavirus test, U.S. Health authorities acted out of an abundance of caution and treated the person as if they had tested positive.

A WHO epidemiologist who is helping manage the hantavirus outbreak from a cruise ship that has been sailing through the Atlantic Ocean happens to have intimate knowledge of the MV Hondius. 

Boris Pavlin was on that very ship last year to celebrate his birthday. 

Pavlin says the cruise ship industry is well-versed in virus outbreaks and getting rid of rodents. 

"This is an expedition vessel designed for ecological tourists to sensitive areas. There can be no shortcuts taken in places where there are bird colonies, and rats would decimate the place." 

The Andes strain of hantavirus has been identified as causing the outbreak. It is known to be transmissable between humans, but Pavlin says he wants to reassure people that person-to-person transmission requires sustained contact. 

"We don’t expect to see a lot of onward cases," he said, adding health officials are "not surprised" additional infections have emerged among former passengers because many were exposed to symptomatic people onboard the ship.

Pavlin noted one of the American passengers had returned an inconclusive test result before leaving the Canary Islands, with one lab finding a "really weakly positive" PCR result and another returning a negative.

"This is difficult to interpret," Pavlin said. "The PCR test can be very sensitive. Sometimes it picks up the smallest traces or fragments of the virus." 

He says new samples have since been taken in the U.S. And additional test results are expected soon.

Because that passenger and another mildly symptomatic American were considered to be in a "grey zone," Pavlin says U.S. Officials treated both as potentially infectious during the evacuation flight to Nebraska. 

He said the Americans used a specially configured Boeing 747 equipped with isolation containers to separate the two passengers from others onboard.

U.S. Health officials in contact with all returned passengers from hantavirus-hit ship

U.S. Health officials from the Centers for Disease Control and Prevention and the Nebraska Biocontainment Unit took questions on Monday about how they were ensuring public safety after passengers who had been aboard a cruise ship hit with cases of hantavirus returned to the country.

At the news conference in Nebraska, Dr. Brendan Jackson, a senior advisor with the U.S.'s Centers for Disease Control and Prevention, said U.S. State health departments are conducting daily symptom and temperature checks on returning passengers and have plans in place to ensure they can isolate safely if they become ill.

"This is not a brand new virus," Jackson said, noting there have been previous hantavirus outbreaks in the U.S. "It is a virus that has been known for decades." 

He said that current evidence suggests person-to-person transmission happens when infected people are symptomatic, adding that this gives health officials "one layer of added protection."

Jackson said passengers who are not showing symptoms are not receiving medical treatment, though they may be evaluated or tested if their condition changes. He also noted that current guidance focuses on testing symptomatic people, but authorities are continuing to reassess protocols as they learn more about the outbreak.

Dr. Angela Hewitt of the University of Nebraska Medical Center said doctors are now interviewing evacuees individually about their possible exposure risks before deciding whether broader testing is needed. 

One passenger with a previous "equivocal positive," or ambiguous, test result is being tested in the hospital's biocontainment unit, she said, while decisions on testing others in quarantine will be made on a case-by-case basis.

U.S. And Nebraska health officials said Monday that 18 American passengers were evacuated from the MV Hondius and are now isolating in Nebraska and Georgia.

Sixteen of the 18 passengers are undergoing assessments and monitoring at the University of Nebraska Medical Center (UNMC) in Omaha. The remaining two have been taken to Atlanta for monitoring, one of whom has presented mild symptoms.

One person is in the UNMC's "bio-containment unit" after testing positive for the virus, officials said, but did not present with any symptoms.

Asymptomatic patients will eventually be able to choose whether to stay at the centre in Nebraska for the full 42-day quarantine period or spend the remainder of it in self-isolation at home.

U.S. Assistant Secretary for Health Brian Christine said the Andes strain linked to the outbreak "does not spread easily" and "requires close contact with someone already symptomatic" to spread, and emphasized that authorities are closely monitoring potentially exposed individuals.

Christine said the U.S. Centers for Disease Control and Prevention (CDC) activated its emergency operations centre, deployed medical teams and issued guidance to health officials across the U.S. After the outbreak emerged.

"No one who poses a risk to public health is walking out the front door onto the streets of Omaha," said Nebraska Governor Jim Pillen. 

Ontario Health Minister Sylvia Jones confirmed a Canadian couple who were on board the MV Hondius and live in Grey Bruce, Ont., are self-isolating at home. 

Taking questions from reporters Monday, Jones said the couple have not developed any symptoms of the virus. 

She said a third Ontarian in Peel Region is now also self-isolating. All three are being monitored by their local public health units. 

The minister was asked whether the three are being tested. She said Dr. Kieran Moore, Ontario's chief medical officer of health, suggested testing may not be an effective monitoring method for people who have not developed symptoms. 

"That's why these three individuals are self-isolating so we can see if there are any symptoms that come forward," Jones said. 

Reuters

A Swiss crew member of the MV Hondius is in quarantine in the Netherlands, and a Swiss national is self-isolating in Switzerland, Swiss authorities said on Monday.

The cases are in addition to that of a Swiss man who travelled on the cruise who tested positive for the Andes strain of the hantavirus, a spokesperson for the Federal Department of Home Affairs and Federal Office of Public Health said. 

He is currently being treated at a hospital in Zurich and his wife is self-isolating, according to authorities.

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