More than 440 passengers disembarked the Diamond Princess cruise ship at Yokohama Bay on Wednesday, February 19, after they tested negative of the novel coronavirus during the 14-day quarantine.
However, over 3,100 more are left on board for further testing and observation, even as debate mounts over how Japan handled the emergency. Particularly, was keeping passengers under quarantine a good idea in the first place, and were conditions on the ship ideal?
Since February 4, when the British ship docked at Yokohama Bay off Tokyo, infected patients were diagnosed almost daily, totaling 621 as of Wednesday, February 19.
On Monday, February 17, Dr. Takaji Wakita from the National Institute of Infectious Disease explained that experts were examining the data. He said: ”Members of quarantine station, epidemiologist, mass modelling scientists are joining us to analyze the situation… We would like to send a message out of what is happening on the ship very shortly.
However, other experts were beginning to question the idea of having placed the ship on quarantine.
Doctor Kentaro Iwata, from the division of Infectious Diseases at Kobe University, considered the handling of the health emergency a “major failure, a mistake,” Agence France-Presse reported.
In a 12-minute video uploaded on YouTube in the evening of February 18, he detailed the conditions on the cruise ship after the Ministry of Health, Labor and Welfare invited him to work there.
Iwata said the conditions on the ship were not adequate to prevent the spread of infection: “I looked into several places inside the ship and it turned out that the cruise ship was completely inadequate in terms of the infection control. There was no distinction between the green zone, free of infection, and red zone, which is potentially contaminated by the virus.”
Dr. Iwata said there was no consistent use of Personal Protective Equipment (PPE) by passengers and Disaster Management Assistance Team (DMAT) staff. People were allowed to walk around without much protection. Health ministry authorities didn’t listen to his suggestions on how to improve the protective conditions, like avoiding the exchange of paper consent forms, or enforcing the use of protective equipment. He claims he was told Tuesday that his services were no longer required by 5 P.M..
Despite having experience dealing with infectious diseases, he said the precarious conditions made him afraid he would get infected.
“I never had fear of getting infection myself, for ebola, SARS, cholera, because I know how to protect myself, and how to protect others, and how infection prevention should be. I was so scared of getting COVID-19 because there was no way to tell where the virus is, no green zone, no red zone, everywhere could have the virus, there was nobody in charge of infection prevention as a professional,” he said.
Professor Hiroshi Oshitani of the Department of Virology in Tohoku University Graduate School of Medicine agreed that, while it was an understandable government response at the time, the method of quarantine was antiquated: “If everyone were coming by boat, then it would be effective, but now people come by plane, lockdown of a city [as well as quarantine] is also 19th century.”
People Already Infected Before the Quarantine?
On the government side, Chief Cabinet Secretary Yoshide Suga on February 19 replied to the criticisms raised by Dr. Iwata. “We are working thoroughly to prevent the spread of the virus,” he said.
In a press conference Wednesday morning, Minister of Health, Labor and Welfare Katsunobu Kato also replied: “We will have the team of Prevention from Infectious Diseases inspect the boat. If there are any reports we will address them accordingly.”
As of February 17, Dr. Shigeru Omi, chief director at the Japan Community Health Care Organization, argued that the decision of adopting the quarantine was justified as, at the time, there was no established agreement on the international level. He added that, given the pattern of outbreak on the ship, it was most likely that most people were already infected before the quarantine period.
The passenger from Hong Kong who was suspected of having brought the virus to the ship was an 80-year-old who boarded from Yokohama on January 20, then disembarked in Hong Kong on January 25. He later visited a hospital and tested positive for the novel coronavirus six days later. By that time, the ship had sailed back to Japan.
What Steps Is the Japanese Government Taking?
Inland, the Japanese government announced on February 17 it would no longer limit the testing to people with a history of travelling to China and were showing symptoms.
The new measures call for anyone with fever over 37.5 degrees Celsius for more than four days to visit designated facilities to test for the illness. More than 500 centers are allocated for people with severe conditions, and another 800 are for lighter symptoms. For the latter, to avoid a mass panic surge, the names are only disclosed after contacting the Ministry of Health hotline. Those with previous conditions, like diabetes, pregnant women, or the elderly are called to consult the hotline before. Furthermore, on February 18, the government called on anyone who thought they might be infected to not to go to work or school.
In a press briefing on February 17, Dr. Takaji Wakita, director-general of the National Institute of Infectious Diseases, and Dr. Shigeru Omi, chief director of the Japan Community Health Care Organization, explained the countermeasures taken by the government.
Dr Shigeru Omi explained: ”My view is that we are just about entering the accelerating stage. Our response should be modified and adjusted according to this stage — that is the principle of response strategy. You cannot continue the same strategy forever. Particularly the early stage, and early stage quarantine is one of the options…. But we were wrong; the level of expansion is on the rise, and, moving to the accelerating stage, we need to adjust and shift our focus from quarantine to community.”
Why Has the Virus Spread So Quickly?
Answers differ as to why the virus spread so quickly. Dr. Oshitani said, “This virus is tricky.”
Experts identified several elements that could’ve contributed to this.
Firstly, while many agree that the Chinese government’s response to the novel coronavirus was not as slow as with SARS, it was still delayed to have an effect.
Dr. Omi said: “When you ask how to evaluate China [response], it’s mixed. The government is currently working very hard, that is the area that we can congratulate positively, but the reality is that the response in Wuhan was delayed in comparison with the things stipulated in the international protocols.”
Secondly, the nature itself of the virus and the method of transmission are still unclear.
Professor Oshitani explained how the nature of contagion differed from other coronavirus varieties like SARS and MERS. “In types of viruses where the victims are most contagious at late stage, quarantine and then isolation is effective, but in the case of coronavirus, it might be too late,” he said.
He condemned the slowness of the response of the international community as a whole: “Everyone was too late, the WHO was too late, China was too late, Japan was too late.”
Dr. Oshitani elaborated on broader causes: “Because of globalization, the risk of these emerging diseases is increasing, and as we have seen the spread of disease is much, much faster. I’m sure if SARS happened, Japan would be one of the first countries to have the virus. We cannot go back to the Edo period, we need to work with this risk, and the international community.”
Author: Arielle Busetto