Rising infection cases on board a quarantined cruise ship in Japan — likely evidence passengers are spreading the virus to one another — is raising concerns about their safety and sparking anger among the thousands still confined.
There are now 174 infections aboard Carnival Corp’s Diamond Princess, the largest infection cluster outside China. The surging numbers are fueling concerns that rather than keeping passengers safe, the quarantine is allowing the virus to spread through the ship. There were 39 new cases announced on Wednesday, including 10 members of the crew.
“The quarantine is working to keep the virus offshore — it’s obvious the quarantine is not working on the ship,” said Stanley Deresinski, a Stanford University professor of infectious disease and a specialist at a hospital connected to the school. “With these infection rates, it’s very likely that there’s on-going transmission.”
Lacking the capacity to test thousands of passengers and crew at once, Japan is struggling to cope with the crisis on the Diamond Princess, which has been quarantined since February 5 in Yokohama, just 26 kilometres from central Tokyo. Experts say more testing needs to be done to protect those on board.
About 3,500 people are being kept in quarantine on the cruise liner, and 492 have been tested for the virus, which has killed more than 1,100 people since emerging in China’s Hubei province in December.
While some cruise passengers and their families — who hail from the U.S., Australia and other countries as well as Japan — have urged that they be allowed to disembark, Japan’s government plans to keep most of them in place until Feb. 19. Passengers are being allowed out of their rooms, some of which have no windows, in small groups to exercise in the open air.
There’s growing concern that despite Carnival’s strict measures, the virus may be spreading through the vessel’s close quarters — increasing the potential for passengers to contract it despite stopping it from reaching Japanese soil.
The infection of a quarantine official, announced separately Wednesday, has caused more disquiet. The worker wore gloves and a mask and disinfected his hands regularly when he spent a day collecting health questionnaires and taking people’s temperatures on the ship Feb. 3-4, according to Japan’s Health Ministry.
Deresinski and other medical experts recommend all on board are tested for the coronavirus, which would allow health authorities to separate those who are infected from those who are virus free. They say that if authorities can identify all those who tested positive, they can remove them or quarantine them on the ship, enforce a stricter quarantine and minimize the spread of the virus.
Already, four men taken to the hospital from the Diamond Princess after being found to have the virus are in serious condition, according to Japan’s Health Ministry. All four are in their 60s or 70s, three of them Japanese and one of another nationality, it said.
Infections aboard the cruise ship form the overwhelming majority of cases detected in Japan, which have now reached a total of 203.
“If you’re trying to control a transmission, you have to find everyone who can be producing or shedding the virus,” said Stephen Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health in New York and a specialist in infectious diseases. “There’s research that show people can be asymptomatic or have very mild symptoms and be infectious.”
Japanese Prime Minister Shinzo Abe said he planned to bolster testing capacity from the current 300 samples per day to 1,000 a day by Feb. 18. For the moment, Japan is focusing its scant testing resources on elderly passengers and those with underlying conditions, and sending those who are infected to hospitals in Tokyo and surrounding areas.
His health minister, Katsunobu Kato, said Wednesday that he wasn’t in a position to make a decision on blanket testing and that he was considering sending a hospital ship to support Japan’s efforts, which already involve the military.
Some aboard have called lawyers who in turn have contacted John H. Hickey, a Miami, Florida-based lawyer who specializes in maritime law and cruise ships. He said the ship’s operator needs to do more for them and test all passengers, even if Japanese authorities can’t, as well as working with authorities to get both the sick and healthy off the ship as soon as possible.
“The cruise line should not be able to throw up its hands and say that the authorities in Japan have directed the ship to be quarantined so what can the cruise line do,” said Hickey, who represented cruise lines early in his career. “The cruise line has obligations, duties, to its passengers. And time is wasting.”
Seeking to stem other sources of infection, Japan said that from Thursday it would ban entry by foreigners who have visited China’s Zhejiang province. This adds to an existing bar on those who have visited Hubei province, the epicenter of the infection, within the past 14 days.
“It is essential that we take more comprehensive and flexible border measures to stop the flow of infections into our country,” Abe said as he announced the expanded travel ban.
Despite being taken off the ship, 35-year-old Rebecca Frasure, from Oregon, remains frustrated. After being diagnosed with the virus, she was initially taken to a hospital in Tokyo and put in a room accessible only by sealed plastic chamber, then moved to single quarters. She said her symptoms were gone, though she had no idea when she might be allowed to leave.
“The hospital staff are as much in the dark as I am,” she said. “No one can tell me how long I will be here or what needs to be done for me to be released.”