Cruise ship coronavirus infections double, exceeding the total for any country but China

The Washington Post ^ | February 10, 2020 | Simon Denyer, Carolyn Y. Johnson, Hannah Sampson and Lenny Bernstein

[Jim Noble]

TOKYO – The number of people with coronavirus on a cruise ship in the port of Yokohama nearly doubled to 135 Monday, prompting imperiled crew members to plead for help and setting off debate among experts over whether the more than 3,700 people quarantined aboard should be taken ashore or left on the ship...

Eleven Americans were among the 65 people aboard the Diamond Princess who were newly diagnosed with the respiratory infection, giving the ship the largest number of infections outside China...

The cruise ship company, Princess Cruises, said that because the quarantine was imposed a few days ago, “it was not unexpected that additional cases would be reported involving individuals who were exposed before the start of the quarantine. The quarantine end date remains at February 19, unless there are any unforeseen developments.”...

An official with the U.S. Department of Health and Human Services said Monday that an infectious-disease specialist from the Centers for Disease Control and Prevention is en route to Tokyo to help with the cruise ship crisis. The official was not authorized to discuss the assistance and spoke on the condition of anonymity. The official was not aware of any plans to begin evacuating the Diamond Princess...

The source of new infections is still unclear. Many people on the ship may have been infected before the quarantine began and could be showing symptoms now, as the disease incubates. But the virus also could be spreading, particularly if the crew doesn’t have sufficient training or protective equipment, experts said...

“It’s a really tricky situation,” Mina [Harvard School of Public Health] said. “If they can reasonably and carefully manage to deboard the ship and get them into hotel rooms, I think that would be optimal. The question is, what’s it going to take to do that?”

[Jim Noble]

I know it's WaPo, but it's very good. You really need to read the whole thing before commenting, the cut to 300 words left out a lot of important detail. Containment remains possible - but not if governments give in to pressure and allow 4000 people to get off vessels like this. The fate of the passengers and crew on the Diamond Princess is a real time preview of how large and complicated this crisis is going to become, and everybody should follow this story closely.

[Jim Noble]

There’s no ping list, I did the best I could. I know I left people out, please ping others as you see fit.

[Pikachu_Dad]

the are idiots... “They might be quarantined in hotels, one said.”

[Jim Noble]

Containment of this disaster will cause many innocents to suffer, not just these people on the ship.

I do not think we are up to it.

[Pikachu_Dad]

Major idiots... Yes, lets spread the disease to Hotels.

“Michael Mina, an infectious-disease expert and epidemiologist at the Harvard T.H. Chan School of Public Health, said one option for the government is to start controlled evacuations of people off the ship.

“It’s a really tricky situation,” Mina said. “If they can reasonably and carefully manage to deboard the ship and get them into hotel rooms, I think that would be optimal. The question is, what’s it going to take to do that?””

[FreedomPoster]

Nully has been doing great work.

[Jim Noble]

Yeah, I wish there was a ping list. Sorry, null and void.

[CIB-173RDABN]

Everyone on the ship will get the virus!

Why do I say this? Simple. You have untrained people not familiar with proper isolation procedures interacting with the passengers.

While the passengers are not getting together, the crew members are. The stewards that deliver food and pick up the dishes are exposed to the virus. If they are not changing gloves, mask, gowns, botties between every interaction with the passengers, the virus is going to be shared.

If the passengers’s dirty dishes are not sterilized before returning to the kitchen the virus will be shared.

The basic problem is that while they are trying to do the right thing it is difficult to follow proper isolation procedures without making mistakes and that is by trained professionals.

The ship has become a real life experiment on just how fast this virus can spread in an enclosed environment.

[nathanbedford]

The ethical questions raised in this article concerning the housing of these poor people on the cruise ship, and by extrapolation all of the people under quarantine in China, cannot be intelligently addressed until we know the death rate.

I have seen numbers that range all the way from 2% to 30%. At 2% we have one kind of a disease and at 30% we have quite another. We cannot get honest data out of China and, apparently, we do not have enough time for cases in the Western world to tell us much about the death rate.

My feeling is that the Japanese and much of Asia is assuming the worst concerning the death rate and acting accordingly. We in America have the facilities properly to treat a few cases.

Our ability to act ethically in treating cases extends only so far as our healthcare facilities suffice. The evidence coming out of China, anecdotal as it may be, indicates that the RO is so high that we will be unable to check the contagion. At 2.0 RO the contagion is probably going to double every 6.9 days (about once a week) and it is virtually impossible to contain.

If coronavirus requires intensive hospitalization to survive, and if the rate of contagion is as high as it appears to be, we are in big trouble.

[Reno89519]

...and these people are quarantined in their staterooms. Now 135 sick. Is the ship flying a black flag? It should be.

[21twelve]

“The number of people with coronavirus on a cruise ship in the port of Yokohama nearly doubled to 135 Monday, prompting imperiled crew members to plead for help and setting off debate among experts over whether the more than 3,700 people quarantined aboard should be taken ashore or left on the ship.”

Just weld the main doors shut like they do in China. (The Chinese know how this thing spreads throughout a building. And now Hong Kong does too - or at least rooms that share the same plumbing, ventilation.)

I would think separate tents, small cabins or other similar thing could be set up fairly quickly to get them under a quarantine, but also so they aren’t sharing the same systems. I guess they would have to have their own bucket for the sanitary “system”. With some poor soul to gather the buckets for disposal.

Seriously though - the news from this ship is terrible. Now multiply a million times for each of those huge buildings in China, their new “hospital” (more like a huge gym).

So, so far on the ship it is 2.5% of the total people have the virus. Assume that 6 million stayed in Wuhan, that translates to 150,000 people infected. And using the 2.1% fatality rate of those infected - comes to about 3,150 people dead.

That would make sense for the drastic measures that China is taking. And I forget what the Tencent Company figures were - but I think it was similar.

I don’t even want to run the calculations for the 400 million under quarantine in China.

[Reno89519]

The ship shows spread in a relatively controlled and quarantined environment with good medical care nearby, unlike China and other cesspools. This will establish the low end of mortality rate for the Chinese Coronovirus Plague.

[Jim Noble]

They use Lima now:

[eartick]

I believe this super bug is airborne.

Have never been on a cruise liner (and do not ever intend to be) but have spent lots of time on crew/work boats going off shore.

If these liners are anything like those, the air handling units are already a compromised mold spreader much less able to stop a viral contagion.

[Jim Noble]

There is an excellent paper online (not peer-reviewed and not accepted for publication) from a number of hospitals in China reporting on 1099 cases with a lot of clinical detail.

Clinical Characteristics of 2019 novel coronavirus infection in China.

[HollyB]

I feel pretty bad for the crew.

I’d also hate to be confined to the room, however they would be confined to another room elsewhere, which would be equal size.

Bad situation altogether.

[RealVirginia]

Saw a youtube interview of an American woman who tested positive and was pulled off the Diamond Princess and placed in isolation in a Japanese hospital. She said her symptoms are like a mild cold. She looks to be in late twenties or early thirties. Her husband tested negative and is still on the ship.

[JonPreston]

Everyone on the ship will get the virus!

That would mean the R0 in a contained environment like the cruise ship would be 100%.

[Reno89519]

Thanks, as follow-up to your correction, just now read up on this at https://www.maritimeprofessional.com/blogs/post/quarantine-flag-13441 which writes:

The quarantine flag, also called the “Yellow Jack”, is the international signal flag LIMA. It is square in shape. Its display is divided into four smaller squares, with two on top and two on the bottom. The smaller squares are alternately yellow and black in color. The flag is flown from a ship that is either arriving in port with known serious health problems or that has been placed under quarantine by the local port authorities. Once the local authorities have determined that the ship’s health problems have been resolved and removed the quarantine order, the ship may fly the free pratique flag (e.g., the international signal flag QUEBEC), which is solid yellow. The concept of quarantine is ancient and is mentioned in the Old Testament. The term itself is derived from the practice of the city-state of Venice during the Middle Ages of requiring ships arriving from locations known to being experiencing diseases such as the plague to anchor or moor off the port for 40 days (quaranta giorni) so that any disease on board might run its course. The practice of quarantine has varied over the centuries, but the concept of protecting the public health by restricting the movements of individuals who are suspected of possibly harboring serious disease has remained constant. The World Health Organization (WHO) provides guidelines on how and when quarantine should be used, but its actual implementation is left to the discretion of individual nations. In the United States, the Center for Disease Control and Prevention (CDC) administers the federal quarantine program, but the separate states and local communities also have broad powers. Ships arriving in a US port with serious disease on board are required to provide advance notification. The ship may be required to undertake certain sanitary measures and to exercise various controls over all persons on board to prevent them from serving as disease vectors potentially infecting the local populace. The closest we have come recently to a general quarantine affecting the maritime industry was during the 2002 SARS epidemic, which heavily impacted southeast Asia. A future pandemic, whether the result of avian flu or otherwise, may see widespread implementation of quarantine measures and flying of the quarantine flag.

[PIF]

Assume that 6 million stayed in Wuhan

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The 5 M odd that left might have just left the city proper and be in the immediate countryside - when they got sick they may have just taken a car walked biked etc the few miles back to the city center so they may for the most part all be there - how many that is would be a guess