Remdesivir for Andes Virus During the 2026 Multinational Outbreak: Mechanistic Rationale for Urgent Therapeutic Investigation

The 2026 multinational outbreak of Andes virus (ANDV) linked to the cruise ship MV Hondius represents an unprecedented epidemiological event with established person-to-person transmission. As of mid-May 2026, 11 confirmed cases (with 2 probable) have been identified across multiple countries, with 3 documented fatalities (case fatality ratio 27%). This outbreak underscores urgent clinical need for novel therapeutics against ANDV-induced hantavirus cardiopulmonary syndrome (HCPS), for which no FDA-approved antivirals exist.This perspective synthesizes structural, genomic, and clinical evidence to support urgent investigation of remdesivir as a therapeutic candidate for ANDV infection.Key findings: (1) ANDV L protein (RdRp) shows 72% amino acid identity with HTNV, with 70–75% conservation of catalytic residues; (2) Remdesivir mechanism depends on nucleotide-binding pocket geometry, substantially conserved across hantavirus species; (3) New ANDV strain shows high genomic stability with selective constraints on RdRp evolution; (4) Meta-analysis of New World hantavirus mortality identifies urgent clinical prognostic markers; (5) Cross-species nucleoside analogues demonstrate efficacy against both Old-World and New-World hantaviruses.Conclusion: Combined structural, genomic, and clinical evidence provides compelling rationale for immediate experimental evaluation of remdesivir against ANDV.