What Happened on the Hantavirus Cruise, According to a Doctor on Board

When Stephen Kornfeld set sail aboard the MV Hondius in early April, his grand plan for the cruise was to add as many new species as possible to his birding list. A medical oncologist based in Bend, Oregon, Kornfeld is also an avid birder—second on eBird’s renowned rankings of birders worldwide—and the ship would visit several remote islands, where he might spot some of the globe’s most obscure avians. But last week, Kornfeld’s trip took an unexpected twist: He stepped in to care for three people thought to be sick with hantavirus, a severe respiratory pathogen that can kill roughly half of the people it infects. Kornfeld was, and still is, “a passenger on this boat,” he told me. “But I became the doctor on this boat.” Since the MV Hondius departed, at least eight people have come down with suspected or confirmed cases of hantavirus; three have died. People typically get infected by the virus via the aerosolized feces or other bodily secretions of infected rodents. But the World Health Organization has confirmed that this hantavirus is a species called Andes virus, which has sometimes spread person to person, under conditions of close and prolonged contact—such as, say, on a cruise ship with about 150 people on board. A month ago, as the cruise departed from Argentina, Kornfeld and the other passengers—among them, dozens of birders—were buzzing about the whales, seals, and dolphins they’d spotted cavorting in the South Atlantic Ocean, and gossiping about the adventures ahead. When a 70-year-old Dutch man, one of the birders, died aboard on April 11, Kornfeld and the others were shaken but considered the incident a freak accident, with no implications for anyone else on board. But then, roughly two weeks later, the Dutch man’s wife fell sick, too, dying shortly after she was taken off the ship. After another birder, a British man, grew feverish and began struggling to breathe, he was evacuated to a South African ICU, where he remains in care. By the end of April, three other people on board had started to feel quite ill—including two crew members, among them the ship’s doctor, who had been assessing the other patients. Many people on the ship’s small crew were trained to provide some degree of medical support. But there was no official backup physician, Kornfeld said, and when the crew started asking who among the passengers had a medical background, few were able to help. Feeling the urgency of the situation, Kornfeld stepped in. He officially began assisting the crew on May 1—last Friday—at first assuming that the doctor would need aid for just a day or two while he recovered from a presumably short-lived, flu-like illness. But the situation rapidly began to intensify. The next day, the ailing passenger, a German woman, died; at about the same time, test results from sick passengers who had left the cruise were beginning to trickle back—sending the word hantavirus surging through the ship. The ship’s doctor was so stricken with symptoms that he had to confine himself to his quarters. A deadly infectious disease was likely on board, and “the ship’s doctor was not going to be able to function as the ship’s doctor,” Kornfeld said. The cruise’s main medical duties now, by default, fell to him. Kornfeld had retired from his full-time oncology job more than a decade ago, although he still picks up shifts here and there at several of Oregon’s rural hospitals. Now he was being thrust into a nerve-racking, life-or-death situation, and caring for ill and potentially infectious patients while trying to communicate with the rest of the passengers on board, all with very limited resources. Several members of the crew assisted him where they could. But although the ship had a medical facility of sorts, Kornfeld told me he found little more than the supplies that a cruise doctor would need to deal with routine illness at sea: some anti-inflammatory drugs, a few over-the-counter medications, a fleet of oxygen tanks—unsurprisingly, not the sorts of chest scanners or ventilators that could come in handy for diagnosing and managing severe respiratory illness. The ship did have plenty of surgical masks, though, plus some N95 respirators. Kornfeld strapped one on each day that he was with the sick, along with goggles, an apron, and gloves. Kornfeld’s new role on the boat put him at one of the central nodes of a global effort to save these patients—and, ultimately, contain the outbreak. In between checking on his patients, he juggled phone calls, emails, and WhatsApp messages from medical and research professionals from several groups, he told me, including the WHO and Oceanwide Expeditions, the company running the cruise. Among the experts he connected with were some of the world’s foremost hantavirus researchers; whatever questions he had, he got the answers to. (When reached for comment, the WHO pointed me to a Thursday press conference, but declined to comment on Kornfeld specifically. Oceanwide declined to comment on “individual stories” from the MV Hondius, instead pointing me to its press releases on the outbreak.) In some ways, the likely presence of hantavirus made the situation simpler. “In medicine, sick is sick,” Kornfeld said. Hantavirus doesn’t have a specific cure or treatment; helping those who had been presumably infected wasn’t a matter of administering a particular drug but of monitoring, preventing deterioration, and triaging any other passengers or crew who came to him with worrying symptoms. After the German passenger died, the ship docked off the shore of Cabo Verde to await the crew members’ medical evacuation. Doctors from the island came on board to assess the patients but did not stay for long. Kornfeld continued to attend to his patients almost around the clock: On Tuesday, he told me, he spent nearly 18 hours anxiously monitoring their fluid status and oxygen levels, hoping that their heart and lungs would not fail; that night, he estimates he cobbled together three hours of sleep. By then, Kornfeld had also become a key source of intel for his fellow passengers. They wanted to know the risks of the situation; they wanted him to tell them how concerned to be about diarrhea, a back ache, an errant cough—could some of it mean that they had the virus too? Some also approached him with worries about their medications, which were running dangerously low, conversing with him through masks between his shifts caring for patients. Eventually, he became known by many around the boat as “Doctor Steve.” With hantavirus now a clear and present threat, the ship’s crew took action, too, Peter Marsh, one of the ship’s passengers and birders, told me—“trying to contain the situation and keep the rest of us safe.” They advised masking and distancing, and asked passengers to stay in their cabin as much as they could when they weren’t carefully socializing on the outdoor deck; the crew doubled down on sanitization procedures all across the boat. Essentially, “we started adopting the previous COVID protocol,” Kenneth Petersen, another bird-watcher colleague of Kornfeld’s on the ship, told me. Kornfeld’s presence was especially reassuring to the ship’s many birders, among whom the doctor was something of a celebrity for his species-spotting prowess, Marsh, who has known Kornfeld for more than a decade, told me: “When he gave medical advice, they were very receptive.” The two sick crew members were evacuated on Wednesday, along with—out of an abundance of caution—the traveling companion of the female passenger who died aboard last week. In the meantime, no one else has come to Kornfeld with concerning symptoms, he told me. Overall, the mood aboard has remained relatively optimistic, the passengers I spoke with said: Many people are still (carefully) participating in morning outdoor exercise classes, and in the afternoons, Kornfeld still spots a bit of dancing around the deck as people enjoy their drinks. And they’ve shown up in whatever ways they can for one anot…