Japan faces mounting criticism for its handling of a coronavirus-afflicted cruise ship, with questions over a patchy quarantine, incremental testing and the decision to let people walk away after 14 days.
The 3,711 people on the Diamond Princess went into quarantine off Japan on February 5, after it emerged that a former passenger had tested positive for the new coronavirus.
Passengers were confined to cabins except for brief outings on deck, when they were required to wear masks and gloves and keep their distance from each other.
But doubts soon emerged about whether the measures were working.
Dozens of people on board were quickly diagnosed with the virus, and by Tuesday, 542 cases were reported.
While passengers were confined to their cabins, those with balconies could sometimes be seen talking to neighbours without masks.
And crew were not quarantined, sharing working spaces, living quarters and bathrooms, and simply donning masks and gloves when interacting with passengers.
At least two government officials themselves contracted the virus while working on the ship.
Kentaro Iwata, a professor at the infectious diseases division of Kobe University, said the on-ship quarantine was a “major failure, a mistake”.
“It is highly likely secondary infections occurred,” he said.
In videos that racked up hundreds of thousands of views, Iwata later said he had been on board the ship Tuesday and observed “completely chaotic” conditions.
“The cruise ship was completely inadequate in terms of infection control,” he charged, saying he now was placing himself into a 14-day self quarantine for fear of infecting his family.
But Japanese officials defended their approach, with Shigeru Omi, a former WHO regional head advising the government, saying the quarantine had “a very positive effect” on reducing infections.
“(The) majority of the infections, we believe, occurred before the date when the quarantine measures started,” he told reporters.
That does not appear to have convinced foreign governments, with Washington evacuating hundreds of Americans from the ship and Australia, Britain, Canada and Hong Kong all planning to repatriate citizens.
The US embassy warned that US health officials have “concluded that despite efforts of quarantine there is a high risk that passengers have been exposed to COVID-19”. And in an indication that foreign governments do not believe the on-ship quarantine has worked, those being repatriated will undergo another quarantine of two weeks — the presumed virus incubation period.
Japanese officials have pointed out there were no guidelines for dealing the unprecedented situation. Other countries have simply turned away cruise ships over the virus, and Cambodia is now scrambling after welcoming a ship that turned out to have at least one infected passenger on board.
“There was no established international agreement as to how to respond to and who is responsible for and when to disembark,” Omi told reporters. “No organisation is perfect, Japan is no exception.”
Michael Ryan, head of the WHO’s health emergencies programme, acknowledged there “has been much more transmission than expected on the ship”. But, he added, “it is very easy in retrospect to make judgements on public health decisions made at a certain point”.
Pinpointing when infections began on the ship was made harder by the slow rollout of testing, with fewer than 300 people initially tested and the pool only gradually expanded to include at-risk groups.
Japan said it was constrained by limited testing capacity, but it waited days to ask the private sector for help, and only completed onboard testing of passengers a day before the quarantine ended.
And as many of those of who test positive do not have symptoms, officials concede it is hard to prove when they contracted the virus.
Despite the doubts, Tokyo allowed around 500 people who meet conditions including testing negative in the quarantine’s final days to leave the ship on Wednesday. Officials say there is little evidence that tests produce false negatives.
“As far as we know, once the test is negative, they remain negative,” Takaji Wakita, director-general of Japan’s National Institute of Infectious Diseases, said.
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