Enlarge /. YOKOHAMA, JAPAN – FEBRUARY 19, 2020: A bus carrying passengers boarding the flight chartered by the Government of the Hong Kong Special Administrative Region of the People's Republic of China drives past the quarantined cruise ship Diamond Princess, which is docked at Daikoku Pier.
The first 14-day quarantine on board a coronavirus-infested cruise ship docked in Yokohama, Japan, officially ended on Wednesday. However, the exhausting saga does not seem to be over for the 3,711 passengers and the crew of the ship.
When the quarantine period expired, Japanese officials still reported dozens of new cases of COVID-19 on board. As of Wednesday, the number of coronavirus infections associated with the ship was 621 – by far the largest group of COVID-19 infections outside of China. The next largest cluster outside of China is Singapore, where 84 cases have been confirmed.
Japanese health officials are criticized internationally for their handling of the ship's quarantine, the Diamond Princess. Quarantine was designed to curb disease spread by keeping people on board isolated from one another and from the public on land. As the cases increased over the two weeks, it became clear that the control efforts only allowed the new coronavirus to spread. In fact, among the 621 cases, there were at least three Japanese health officials who were there to support the quarantine efforts but who infected themselves.
"The quarantine process failed," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, on Monday. "I would like to gloss it over and try to be diplomatic, but it failed. People got infected on this ship. Something went wrong during quarantine on this ship. I don't know what it was. But a lot of people did got infected on this ship. "
Floating petri dish
Arnold Hopland, a family doctor from Tennessee, gave some clues as to what went wrong. In an interview with the Wall Street Journal, Dr. Hopland passengers drying their laundry on cabin balconies and leaning forward to chat with neighbors without wearing face masks.
Although passengers were largely confined to their cabins during the 14-day quarantine, they were allowed to walk on the decks. They were instructed to wear face masks and keep their distance from other passengers during the walks, but health professionals are skeptical that everyone was compliant.
In addition, Dr. Hopland contacts crew members up to ten times a day when they go door-to-door and hand-deliver food and supplies to guests.
As the Associated Press emphasized, crew members were not isolated. They continued to share rooms, ate together in a mess, served guests and entered guest cabins for cleaning.
Just before Dr. Hopland and his wife attempting to board an evacuation plane chartered by the US State Department on Sunday returned test results that indicated that his wife had been infected with the virus. She was taken to a local hospital and Dr. Hopland remains on the ship in an expanded quarantine.
The charter flights now repatriated over 300 other American cruise ship passengers, 14 of which tested positive for the virus on their way to the USA.
"I was surprised to be negative because I knew that the virus had swept through this boat like wildfire," said Dr. Hopland the journal. "My analogy is that they put us in a petri dish to infect us."
The case underscores the complexity of the outbreak control and the continuing uncertainty that people on board the cruise ship are now facing.
An article published late Tuesday in the New England Journal of Medicine described the troubling case of two travelers who had passed symptom-based tests for the virus before being confirmed by a subsequent laboratory test. The two people belonged to a group of 126 mostly German citizens who were evacuated to Frankfurt from the Hubei province – the epicenter of the outbreak.
"We found that a potentially infectious virus can be excreted in people who have no fever and no signs or slight signs of infection," the authors concluded.
Almost at the same time that the newspaper was published, U.S. disease control and prevention centers announced on Tuesday that all passengers and crew members of the Diamond Princess – including the more than 100 American citizens still on board – were for At least 14 years are excluded from entry days after you have left the ship.
"While the quarantine may have significant public health benefits in slowing transmission, the CDC believes that preventing transmission between people on the ship may not be sufficient," the agency said in one Explanation. "CDC believes that the rate of new infections on board, especially those with no symptoms, is an ongoing risk."
Cruise ship passengers who have already returned to the U.S. are subject to a 14-day quarantine order and are held in one of two military bases.
By Wednesday, the COVID-19 outbreak had reached over 75,000 cases with 2,009 deaths worldwide.