The “quarantine” of passengers on the cruise ship, Diamond Princess, drew toward an end yesterday when several hundred people were allowed to disembark.
Those who were released tested negative for Covid-19. They’ll be issued a certificate by Japanese health authorities stating that they were not infected at the time they left the ship. When the passengers left, they were, according to Japan’s health minister Katsunobu Kato, going to “have to find their own way home to from the port” which most likely means public transport for many of the passengers.
Is it possible that all the Diamond Princess quarantine did was infect more people with Covid-19 and that the aftermath of the poorly-executed quarantine will spread the virus across the globe?
Was this quarantine done correctly?
The entire quarantine of this ship seems to have run contrary to my understanding of what “quarantine” actually means.
First of all, being on that ship cooped up in tiny quarters with all of the sick people in rooms next door had to be nightmarish to people who only wanted to go on a nice vacation. The entire time, I wondered why a more suitable facility was not made available for quarantining passengers who were at risk.
There on the ship, people were constantly exposed, even though they had to stay in their rooms. The food had to be prepared by somebody and delivered by somebody. Fresh towels? Somebody laundered and delivered those too. Drinking water? Also delivered. From staff onboard a ship where literally 4-5 people per hour were confirmed to be infected.
With a rate of infection like that, the likelihood of contracting the virus was extremely high. I can’t imagine that keeping 3700 people on board a floating death trap was the best way to contain the outbreak. That ship was the site of the largest cluster of infections outside of China.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told USA Today bluntly that the quarantine effort had been a failure.
…the original idea to keep people safely quarantined on the ship wasn’t unreasonable. But even with the quarantine process on the ship, virus transmission still occurred…
…”The quarantine process failed,” Fauci said. “I’d like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship. Something went awry in the process of the quarantining on that ship. I don’t know what it was, but a lot of people got infected on that ship.” (source)
And Dr. Fauci is not the only public health expert who felt the quarantine was not carried out correctly.
Kentaro Iwata, professor at the infectious diseases division of Japan’s Kobe University, described the situation on board as “completely inadequate in terms of infection control”.
After visiting the ship, Prof Iwata posted a video to YouTube stating that the quarantine measures he witnessed failed to separate the infected from the healthy.
The expert said he was more afraid of catching the virus on board than he had been working in the field in Africa during the Ebola epidemic and in China during the Sars (severe acute respiratory syndrome) outbreak. (source)
We have to remember, this quarantine was carried out by folks who work on a cruise ship, not by infectious disease specialists. While I’m sure they did the best they could given the circumstances, the quarantine seems to have been poorly conceived.
The continued spread throughout the quarantined passengers and crew led the United States to evacuate American citizens from the ship and fly them back to the US. About 300 passengers are being further quarantined in Omaha, Nebraska. Fourteen Americans who were infected on the ship are hospitalized. According to Dr. Fauci, health officials expect to see more cases among the quarantined evacuees.
I think that the US had the right idea. Leaving people on that floating death trap for a longer period of time just puts them at higher risk of contracting the virus.
While the quarantine was poorly executed, the end of the quarantine is even worse.
I don’t think just letting people disembark and hop into the nearest taxi is the best way to “end the quarantine.” Granted I’m certainly no public health expert, but the biggest question I have is this:
If people aboard that ship are being infected at the rate of 4-5 per hour, shouldn’t the clock restart on the quarantine after the most recent infection? Shouldn’t it be fourteen days after the most recent confirmation?
I guess they don’t think so in Japan. Because they’re releasing several hundred people per day based on a negative test (a test that may not be reliable – keep reading) after those people have been in a veritable petri dish of novel coronavirus.
The released passengers made their way onto waiting coaches or into taxis, reports the BBC’s Laura Bicker, who is at the port in Yokohama.
They will be allowed to return to life as normal, but will be contacted over a period of several days to check on their health, Japan’s health ministry said. (source)
The only folks who are remaining in quarantine are those who were sharing a cabin with infected people and each day a few hundred more people will be released willy-nilly into Japan’s public transportation system to make their way back to 50 different countries – most likely on public transportation.
In her best-selling book, The Wuhan Coronavirus Survival Manual, Cat Ellis wrote about ending quarantines:
A person is quarantined for the entire duration of the illness’ incubation (latency) period. For Wuhan coronavirus, the current guidance for a quarantine for a person for 14 days.
However, there was one study suggesting the incubation period is actually 24 days. If this is the real incubation period, then our current measures for quarantine are insufficient, and may be allowing the virus to spread. This is not the only explanation. It could also mean that the initial exposure opportunity did not result in an infection, and then there was a subsequent exposure opportunity when infection did happen. If this is the case, the 14-day period is probably the correct one.
As always, err on the side of caution. I would quarantine for 24 days until this is proven incorrect. (source)
So if one were to follow this advice, the people disembarking from the Diamond Princess should really be isolated at the very least, not hopping on a plane.
How sure are we that the folks disembarking are truly not infected?
We don’t know a lot about this illness yet – it’s brand new. But one thing we do know is that the Covid-19 nucleic acid test is not extremely reliable. According to Medicinenet:
Reports suggest some people test negative up to six times even though they are infected with the virus, according to the BBC and Chinese media. Such was the case with Dr. Li Wenliang, the ophthalmologist who first identified the outbreak and was reprimanded by Chinese authorities when he tried to warn others…
…False-negative test results, where patients are told they do not have a condition when they actually do, cause several problems. Patients may be turned away from hospitals and medical facilities when they require care. They may infect others at home, work, school, or in the community. Patients’ conditions may also worsen without treatment.
When faced with a highly infectious, potentially deadly pathogen, even a small number of false negatives can have a potentially serious and widespread impact on the larger population. (source)
This, of course, is the reason that the people repatriated to the United States are being put into further quarantine.
Although the folks who were released all tested negative and are not showing symptoms, it seems extremely likely we will see more cases sprouting up all over the world from former passengers of the Diamond Princess.
The CDC agrees and is not allowing any of the disembarking passengers to return to the US without restrictions.
CDC believes the rate of new infections on board, especially among those without symptoms, represents an ongoing risk. Therefore, to protect the health of the American public, all passengers and crew of the ship have been placed under travel restrictions, preventing them from returning to the United States for at least 14 days after they had left the Diamond Princess.
Currently, there are more than 100 U.S. citizens still onboard the Diamond Princess cruise ship or in hospitals in Japan. These citizens have been placed under the restrictions, as have the ship’s other passengers and crew.
After disembarkation from the Diamond Princess, these passengers and crew will be required to wait 14 days without having symptoms or a positive coronavirus test result before they are permitted to board flights to the United States.
If an individual from this cruise arrives in the United States before the 14-day period ends, they will still be subject to a mandatory quarantine until they have completed the 14-day period with no symptoms or positive coronavirus test results.
Because of their high-risk exposure, there may be additional confirmed cases of COVID-19 among the remaining passengers on board the Diamond Princess. (source)
South Korea has also said they’re blocking entry to Diamond Princess passengers.
The BBC reports that “Japanese officials have defended their approach, saying that the majority of infections likely occurred before the quarantine period.”
Will this lead to new clusters of Covid-19 outside of China?
This morning, the day after the quarantine officially ended, 79 more people who are still on the Diamond Princess tested positive for the novel coronavirus, bringing the total of infected people to 621. Meanwhile, those leaving the quarantine are “finding their own way home.” Zero Hedge sums it up:
As we’ve noted several times, the notion that thousands of people are about to be released while hundreds of cases of the virus are still being confirmed seems like insanity. While most of the patients will face two more weeks of quarantine when they return home, how are they planning on getting there? There’s been no word of an official government transport. (source)
I think it’s a pretty safe bet to believe that out of several thousand exposed people heading to 50 different countries, at least a few of them are going to be bringing a little something with them.
It’s difficult to imagine this won’t make its way to the United States and elsewhere. I suggest you pick up this book and get prepared for the possibility of real quarantines before the word becomes official.
If we’ve learned anything throughout this debacle, it’s that governments will try to cover their rears and “not cause a panic.” Unfortunately, this means that we don’t get crucial information until it’s too late to act on it. There are already shortages in the United States of things like gloves and masks – they’re practically nowhere to be found. Look for bleach, antibacterial product, and hand sanitizer shortages next.
This whole thing could end up being like the Ebola scare of 2014, something legitimately unnerving, but ultimately not widespread outside of the hot zone. We may get lucky and Covid-19 may by some miracle be contained.
But I wouldn’t bet my family’s lives on it.