A passenger of a cruise ship that was struck by an outbreak of hantavirus has shown symptoms of the disease while being repatriated to France, the country's prime minister has said.
Sébastien Lecornu said the French national developed symptoms while on a chartered flight from Tenerife to Paris, and so all five evacuated from the MV Hondius had been "immediately placed in strict isolation until further notice".
The French citizens are among more than 90 tourists to be ferried home from the Dutch vessel on Sunday, which anchored off the Canary Islands before dawn.
Three passengers have died after travelling on the ship, two of whom were confirmed to have had the virus.
After the French flight touched down at Le Bourget Airport, officials wearing personal protective equipment (PPE) could be seen meeting them on the tarmac. Ambulances then took them to the Bichat hospital in the French capital.
There, they will be quarantined for 72 hours and given a full assessment, before being sent home to self-isolate for 45 days, France's Ministry for Europe and Foreign Affairs said in a statement.
Fourteen Spanish nationals flown from Tenerife to Madrid now face mandatory quarantine at a military hospital in the Spanish capital.
British nationals have been flown back to Manchester. None of the Britons have reported symptoms but they are being monitored, the UK Health Security Agency (UKHSA) said.
A plane carrying 26 passengers and crew – including eight Dutch nationals – has arrived in the Netherlands.
A flight departed on Sunday for the US carrying 18 people – all of the American passengers from the cruise and one British national who resides in the US.
One of the Americans began showing mild symptoms of hantavirus and another tested mildly positive for the Andes strain of the virus after being evacuated from the cruise ship, the US Department of Health and Human Services said.
Both passengers were "travelling in the plane's biocontainment units out of an abundance of caution," HHS said.
Flights for Turkish and Irish citizens were also scheduled on Sunday, while Spanish Health Minister Mónica García said the final two evacuation flights would depart on Monday afternoon.
Six passengers are returning to Australia and another 18 will be flown to the Netherlands. Both planes are also taking passengers from other countries which did not send their own repatriation flights.
Spain's Health Secretary Javier Padilla said more than 90 of the 150 passengers and crew of the Hondius will have been sent home by the end of Sunday. A flight to Australia is expected on Monday.
The cruise ship dropped anchor in the port of Granadilla earlier on Sunday, and medical teams went aboard at around 07:00 local time (06:00 GMT).
This began the carefully choreographed process of removing those aboard and repatriating them devised by the Spanish government and the World Health Organization (WHO).
Passengers could be seen from afar wandering around on the deck of the ship, or at the windows, all in white medical face masks, as the first evacuations took place on Sunday morning.
Several sat socially distanced on the first evacuation boat, filming and taking photos as they approached land, where they were met by officials in white protective suits.
While being couriered to the airport, some British passengers – clad in blue PPE – waved and gave thumbs up as they drove past the assembled media.
The arrival of the Hondius was met by opposition from some, including the Canary Islands' regional president, who expressed concerns over the virus spreading to Tenerife.
Hantaviruses are usually carried by rodents, but human transmission of the Andes strain – which the WHO believes was contracted by some of the ship's passengers while in South America – is possible.
Symptoms can include fever, extreme fatigue, muscle aches, stomach pain, vomiting, diarrhoea and shortness of breath.
Helen Clark, co-chair of the Independent Panel for Pandemic Preparedness and Response (IPPR), told the BBC there were lessons to be learnt about how viral outbreaks on ships should be managed.
"Passengers disembarked and dispersed to the four winds when there had been a death of a potentially infectious pathogen on board," she said.
When asked if the world was ready to deal with another pandemic, she said there was still work to be done.
"There's not yet enough financing to support lower income countries to build capacities for early detection, surveillance, response," she said.
She added "the direction is right if countries come together to make it possible to do far, far better than we did with Covid". The IPPR evaluated the global response to Covid-19.
The first passenger death occurred on 11 April and another on 2 May. A 69-year-old Dutch woman who left the ship in St Helena on 24 April travelled to South Africa, where she died two days later.
Two British men with confirmed cases are receiving treatment in the Netherlands and South Africa.
A third Briton is being treated for a suspected case on the remote Atlantic island of Tristan da Cunha, onto which British Army medics parachuted with fresh supplies to treat him.
British nationals arriving back in the UK will be taken to an isolation facility where they will be kept for up to 72 hours. Medics will then assess whether they can isolate at home or at another suitable location based on their living arrangements.
Once all the passengers and crew have disembarked, the Hondius will continue on to the Netherlands, where the body of one of the passengers who died and their belongings will be disinfected before being removed.
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