As passengers of the cruise ship at the center of the hantavirus outbreak disembark in Tenerife, in Spain’s Canary Islands, Americans who were onboard will be assessed, transferred to an airport and brought back to the United States — with a first stop in Nebraska, home of the highly specialized National Quarantine Unit.

The virus, typically associated with rodents, may have passed from human to human aboard the MV Hondius cruise ship, according to the World Health Organization. Since April 11, three people from the ship have died while a handful of others are sick.

This is everything we know about how the American passengers will get back to the United States and what will happen once they’re home.

Assessment in the Canary Islands

The passengers were seen wearing blue protective clothing and masks aboard smaller boats transporting them from the cruise ship to shore.

The 17 US passengers from the MV Hondius cruise ship, along with one British national who resides in the US, will be evaluated by US Centers for Disease Control and Prevention staff in Tenerife, according to a CDC official. The CDC will conduct a risk assessment on each American passenger.

None of the US passengers is experiencing symptoms so far.

One source familiar with the matter told CNN the Americans will be brought back to the US aboard a charter aircraft with a biocontainment unit, similar to those used during Covid-19 evacuations.

Once back in the US, the passengers will be brought for further assessment to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha.

The facility is “the only federally funded quarantine unit in the United States, designed specifically to safely house and monitor people who may have been exposed to high-consequence infectious diseases,” according to Nebraska Medicine.

There are 20 single-person, 300-square-foot rooms fitted with negative air pressure systems to contain any possible viruses. Doctors there describe them like hotel rooms, designed with en-suite bathrooms, exercise equipment, food delivery and Wi-Fi for patients staying for long periods.

A CDC official said the agency is not considering this a quarantine for the cruise ship passengers, but rather a brief visit to monitor their health.

The 18 passengers will be checked for symptoms signaling the early stages of hantavirus, including fever, muscle aches and diarrhea, the interim chancellor of the hospital, Dr. H. Dele Davis, told CNN.

The passengers will not be tested for hantavirus, as testing is not recommended for those without symptoms, according to a CDC official.

If anyone does fall ill, they could be transferred to the Nebraska Biocontainment Unit, which is a specialized unit on-site that has previously treated patients during the Ebola outbreak in 2014 and some of the first Covid-19 patients from the Diamond Princess cruise ship in 2020, according to Nebraska Medicine officials.

The passengers will be given the option to go home after their assessment in Omaha if safety protocols allow, National Institutes of Health Director Dr. Jay Bhattacharya told CNN’s Jake Tapper on Sunday.

Bhattacharya, who is also acting director of the CDC, said the agency will interview the passengers to determine their risk. They will be deemed “low risk” if they were not in contact with someone who was symptomatic.

Bhattacharya said the CDC’s advice to the travelers would include “an offer to stay in Nebraska if they’d like, or if they want to go back home and their home situation allows it, to safely drive them home without exposing other people on the way, and then be put in the control … under the auspices of their state and local public health agencies.”

Once the passengers get back to their own homes, they will undergo daily home-based monitoring for the next 42 days, according to a CDC official.

The goal, according to Nebraska Medicine, is to monitor the passengers during the virus’ incubation period, which can last up to six weeks, and to reduce the risk of spreading the disease.

Health officials reiterated the passengers will not be quarantined but will be advised to take certain precautions.

“If it’s a high-risk exposure … there will be some modified activities that we would recommend, limiting activities outside the house that don’t involve extensive interactions with other people,” a CDC official said. “Also, they need to be working with their departments of health … with regards to the nature around other activities.”

Bhattacharya said the agency is following the safety protocols previously used successfully during a 2018 outbreak of the same hantavirus strain.

How we got here and what’s next

The hantavirus outbreak was first reported to the WHO on May 2 and remains a low risk to the general public, the organization says.

Hantavirus typically spreads to humans through contact with rodent urine or droppings, though this strain, the Andes virus, can in rare cases spread person-to-person through very close, prolonged contact with an infected person.

The CDC has classified its hantavirus response as Level 3, the agency’s lowest level of emergency, according to a person involved in the situation.

As of May 8, there were eight total cases connected to the MV Hondius cruise ship — six lab-confirmed plus two probable cases.

Passengers were screened Sunday after the ship docked in Tenerife, and all were asymptomatic, according to Spanish health authorities. One French passenger later showed symptoms while flying home, and all five evacuees on that flight will enter isolation protocols, the country’s prime minister said.

As of May 9, three passengers — a Dutch couple and one German national — have died after contracting hantavirus, according to WHO.

Seven other American passengers who previously disembarked the ship are being monitored in five states — Arizona, California, Georgia, Texas and Virginia, officials said.

New Jersey said it is also monitoring two people who were exposed, and Utah reported that at least one passenger was from that state.

None of these people are exhibiting signs of the illness, officials said.

Symptoms can include fever, muscle aches, chills, nausea, vomiting, diarrhea, cough, difficulty breathing and chest pain.

Hoping to quell concerns before the passengers disembarked, WHO Director General Tedros Adhanom Ghebreyesus said this hantavirus outbreak is “not another Covid-19.”