BARCELONA — Pulmonary and critical care specialists are re-evaluating how life-threatening viral infections are managed in intensive care after the recent outbreaks of Andes hantavirus and Ebola (Bundibugyo virus). Speaking at the European Respiratory Society (ERS) Congress 2026, experts warned that testing, information, and applying traditional bacterial sepsis management protocols to acute viral pathogens is failing patients.

While global health systems have advanced diagnostic speed, gaps in scalable clinical care, therapeutic availability, effective collaboration, and public health communication threaten preparedness for the next pandemic. “The experts sometimes add more confusion,” Juan Soriano, MD, PhD, professor of medicine at the University of the Balearic Islands in Palma, Spain, told Medscape Medical News. “Apart from having vaccines ready, apart from face masks and personal protective equipment gear, there should be designated speakers that are experts in that particular virus, in that particular strain, talking to media.”

The Tale of Two Outbreaks

In April 2026, an outbreak of Andes hantavirus unfolded aboard the expedition cruise ship MV Hondius, which departed from Ushuaia, Argentina, with approximately 150 passengers and crew members of various nationalities. Between April 3 and April 30, several passengers developed a fever and acute respiratory symptoms.

The outbreak triggered an international public health response following an Early Warning and Response System notification on May 2, 2026. Initial medical evacuations were attempted near Cabo Verde, but local authorities denied permission for the sick crew members to disembark. The vessel was subsequently diverted to Tenerife in the Canary Islands, where Spanish authorities and global health agencies coordinated a mass evacuation. Passengers were disembarked by May 11 and repatriated via specialized flights to their home countries, while a skeleton crew sailed the ship onward to Rotterdam for sanitation. The shipboard cluster ultimately resulted in 13 cases, including the ship’s onboard doctor, and three fatalities. More than 317 high-risk contacts were actively monitored across 33 countries and territories and subjected to a strict 42-day quarantine before the outbreak was declared officially over on July 2, 2026. 

Genomic sequencing confirmed high genetic similarity among the isolates and with strains circulating in South America, supporting the primary hypothesis of a single zoonotic spillover event in Argentina, followed by direct human-to-human transmission through close physical contact on board.

“Ships offer favorable environments for pathogen transmission, but that we already know since the Middle Ages,” said Tamas Bakonyi, PhD, an expert in Emerging and Vector-borne Diseases at the European Center for Disease Prevention and Control. “Andes virus might pose a higher public health risk than other hantaviruses due to the possibility of person-to-person transmission. From the public health perspective, this outbreak and the management of this outbreak required timely international cooperation, although the available scientific evidence was very limited at the time.”

Concurrently, a major outbreak of the Bundibugyo Ebola virus strain resurfaced in Central Africa, resulting in more than 4000 confirmed cases and over 2000 reported deaths across the Democratic Republic of the Congo and Uganda.

Bin Cao, MD, physician-scientist, vice president of the China-Japan Friendship Hospital, and director of pulmonary and critical care medicine in Beijing said that the Bundibugyo Ebola virus strain presents a stealthier challenge than classic filoviruses. “It is not the typical hemorrhagic fever,” he said. Although patients have some typical symptoms such as headache, vomiting, myalgia, and diarrhea, overt bleeding is uncommon, and the early disease is not distinguishable from malaria, typhoid, or even flu.

Furthermore, outbreak of the infection among healthcare workers intensified the crisis. Also, persistent skepticism and lack of trust in the public health system meant that many patients arrived at treatment centers late in the disease course when capillary leak and multi-organ failure were already firmly established.

Viral Sepsis vs Bacterial Sepsis

Recognizing viral sepsis as a distinct pathology from bacterial infection early is fundamental to save patients’ lives. “Severe viral infections could kill through viral sepsis,” said Cao. “We have to think at the very beginning that [viral] sepsis is not [bacterial] sepsis. Antibiotics have no role in viral infection.”

In ICUs, standard sepsis management guidelines, such as the Surviving Sepsis Campaign, emphasize immediate fluid management and early broad-spectrum antibiotics within one hour. However, applying this approach to severe viral infections can prove fatal. 

Unlike bacterial sepsis, where profound vasodilation leads to severely depressed blood pressure, viral sepsis often presents with initially preserved hemodynamics. Instead of vasoplegic shock, the primary driver of mortality in viral sepsis is progressive capillary leak syndrome, leading to massive fluid extravasation, severe hypoxemia, pulmonary edema, and acute respiratory failure.

An Evaluation of Preparedness

Cao evaluated global outbreak response readiness across six distinct operational domains. He constructed the evaluation as a matrix that pairs qualitative verdicts (partly, yes, or no) for each domain against direct empirical evidence from the 2025-2026 outbreaks of Bundibugyo Ebola virus in Central Africa and Andes hantavirus in Europe and South America.

• Detection and sequencing (partly prepared). Molecular diagnostics and high-throughput sequencing are available within days, but early detection in community settings remains delayed, allowing undetected transmission for weeks before initial laboratory confirmation.
• Emergency governance (prepared). Systems such as WHO Public Health Emergencies of International Concern declarations and regional body co-leadership (eg, Africa Centres for Disease Control and Prevention) function rapidly.
• Research in response (prepared). Adaptive trial platforms (such as the PARTNERS trial evaluating therapeutics like MBP134 vs remdesivir) can enroll patients within weeks of an outbreak declaration.
• Countermeasures (not prepared). Nineteen years after the discovery of species such as Bundibugyo Ebola virus strain, there are still no licensed vaccines or targeted antivirals.
• Safe, scalable clinical care (not prepared). Referral pathways remain fragile, and care capacity in local facilities fails to scale, with shortages of oxygen, monitoring equipment, and trained ICU staff remaining the ultimate limiting factors.
• Community trust and financing (not prepared). Misinformation, civil conflict, and delayed disbursement of response funds continue to undermine public health interventions on the ground.

Session chair Alberto García-Basteiro, MD, PhD, an associate professor, a consultant physician, and co-director of the International Health and Emerging Infectious Diseases Program, at the Barcelona Institute for Global Health, Barcelona, Spain, and at the Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, commented that while the world is better prepared than 10 years ago in some areas, significant gaps remain in others. He asked Cao what could be done to accelerate the scale-up of improved clinical care and community trust, two key areas where global preparedness is still failing.

Cao responded that improving these areas requires action across three main fronts:

• Early diagnosis and healthcare education. Achieving early diagnosis depends on continuous engagement with the community and healthcare workers through media and hospital settings, ensuring rapid identification and single-room isolation as soon as human-to-human transmission is suspected.
• Decentralized testing infrastructure. Every hospital needs local PCR testing capacity to detect cases early and isolate contacts promptly.
• Physician familiarity with antivirals. While physicians are highly familiar with antibiotics for bacterial infections, there is limited clinical experience and training with antivirals for viral pneumonia and viral sepsis, necessitating greater focus on antiviral therapeutics at clinical congresses.

“Preparedness that exists for the pathogen we last fought is preparedness for history, not for the next outbreak,” Cao said.

Fear Spreads Like a Virus 

Beyond clinical ICU management and molecular epidemiology, experts at the congress highlighted public health communication as a critical pillar of outbreak response. Soriano said that miscommunication during health emergencies can exacerbate harm. “Preparedness is something that even in medieval times we started doing,” he said. “Why are we doing the same mistakes? Fear is a virus. Every time that there is an outbreak, there is fear, even among nurses and doctors.”

Communicating complex science to the general public requires specific communication skills, he said. “It was not in our training to talk to the media. When we talk to the media, we have to remove some of the technical stuff and lower the wording to something that is understood by the average people listening to the radio or reading a newspaper.”

Cao, Soriano, Bakonyi and García-Basteiro reported receiving grant funding from Merck. Jones reported no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, New Scientist, The Guardian, MIT Technology Review, and others.