Limiting spread of COVID 19 from cruise ships lessons to be learnt from Japan
Venue: QJM monthly journal of the Association of Physicians
Year: 2020

Spread of COVID 19 infection on a Cruise Ship in Yokohama, Japan Japan's response to the novel coronavirus (COVID 19) infection has been problematic since the outbreak was first reported in China A typical example was the case of a cruise ship "Diamond Princess," anchored in Yokohama, Japan As of March, 6, the WHO officially reported that there were 17,481 laboratory confirmed cases of Covid 19 infection globally outside China In Japan, there were 1,045 such cases, but there were 696 laboratory confirmed cases on the Diamond Princess 1 The Japanese government have quarantined the ship's 3,711 passengers and crew members since February 5, 2020 until February 19, under the Japan's Quarantine Act enacted in 1951, effectively prohibiting the disembarkation of anyone onto Japanese soil We have three primary concerns about this quarantine action First, the quarantine in the cruise ship may not be effective enough to prevent the contagion of the virus in Japan Although the disease has a relatively low case fatality rate (currently 0 3% in China) each COVID 19 infected individual is reported to infect 2 2 people, similarly to the influenza virus, a basic reproductive number of which is 1 4 4 0 2 Given the fact that Japan has received hundreds of thousands of Chinese tourists since the start of the outbreak in earlyDecember, several of whom may have been from the Wuhan region, it is obvious that COVID 19 is already in Japan, as evidenced by the 13 locally transmitted individuals, including a taxi driver and bus driver who had transported Chinese tourists at the time when the quarantine was initiated Second, quarantine in the cruise ship could accelerate a contagion of the virus in the ship since it has been reported that cruise ships can become incubators of the viruses because a large number of people are packed in the semi enclosed space, with limited sanitation as we as restricted water and food supply 3 Indeed, the infection on the cruise ship appears not to have been well controlled, and the number of infected people has been steadily rising, with 137 new confirmed cases on February 16, according to WHO's daily update Third, care for the passengers and crew members has been poor The majority of the passenger of the ship are the elderly, with more than 200 people over the age of 80 As Japan has learned from past emergencies, the elderly, especially those with existing with comorbidities, are at grave risk not just from the emerging Covid 19 infection, but from the physical and psychological stress that may make their existing ailments worse, actually jeopardizing their health and well being With increased international criticism of the poor management of the those on board, the Japanese government allowed some elderly passengers to leave the ship on February 14, rather than wait until the quarantine ends on February 19 As of February 23, 36 severe cases of the COVID 19 have been reported among the passengers, requiring treatment in land based intensive care units After this quarantine on the cruise ship, hundreds of others on board had been repatriated to their home countries, where they will start another 14 days of quarantine There is growing global concern about how illegal immigrants and individuals such as the potentially infected on the "Diamond Princess," are being treated We believe that the response of the authorities to the cruise ship dilemma has not been patient oriented with respect to those on board While it is important to respect the concept of quarantining people who could pose a significant danger to the nation's entire population, which is the government's overriding responsibility, alternative solutions may be possible The reported development of a 15 minute https:/mc manuscriptcentral com/qjm Downloaded from https:/academic oup com/qjmed/advance article abstract/doi/10 1093/qjmed/hcaa092/5805396 by Kobbe University Library user on 16 March 2020 blood based Covid 1 test kit by Chinese scientists may help in future, if it is accurate and does not produce repeated false negatives as the existing test does Similarly, creation of a purposebuilt mass quarantine facility somewhere in Japan would be useful We hope learned from this experience in Japan would be help improve the situation on a cruise ship "Grand Princess" off the coast of California, where 21 Covid 19 cases were confirmed on March 5