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As days went by and the quarantine continued, the world learned more about the COVID-19 virus itself. Aboard the ship, on the other hand, there seemed to be a general lack of understanding about the severity of the virus. The lack of knowledge meant a lack of action to tackle the growing situation. As the quarantine continued, there were more examples of just how uninformed the crew truly was.

Despite this acknowledgment, there is still no clear answer on who should be in charge in future situations that mimic this one. The Japanese government and the Diamond Princess corporate leadership disagreed from the beginning about who was in charge. At the time, the Japanese officials feared bringing potentially infected passengers onshore, since there was no clear place to quarantine everyone. And, they did not want the virus to spread throughout Japan.

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After 39 days on the ship (and over three weeks in quarantine) the last of the 2,666 passengers finally disembarked and began their journeys home on February 27th; only to reset the clock and begin an additional two-week quarantine in their home countries. However, the ship remained docked in Japan for another three months while the company focused its efforts on quarantining and repatriating the remaining crew members who had not yet departed on government charter flights[9].

[9]The final guests just left the coronavirus-struck cruise ship Diamond Princess after 39 days, but hundreds of crew are still on board -princess-coronavirus-quarantine-ends-after-39-days-at-sea-2020-2

Background: Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020.

Results: Of those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died.

Conclusions: There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients' transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships.

On January 25, hundreds of passengers boarded the ship in Hong Kong for the start of an adventure taking in Vietnam, Taiwan and Okinawa. An 80-year-old male passenger from Hong Kong was diagnosed with the virus on February 1 after the ship returned from Japan on January 25. A few days later the vessel was quarantined by Japanese authorities until February 19.

The vessel is a British cruise ship owned and operated by Princess Cruises. It primarily travels around Asia during the northern hemisphere summer. The ship has been in quarantine since arriving in Yokohama on February 4

On 1 February, the ship called at Naha Port in Okinawa and was quarantined.[5] On the same day, the 80-year-old man who disembarked in Hong Kong six days earlier tested positive for COVID-19. Having a fever, he went to the hospital and got tested.[5][8]Hong Kong's Department of Health immediately contacted the agent of the ship's operating company, but the ship did not inform the passengers until 3 February, two days later.[9]Over the next few days, the cruise ship had shows and dance parties as usual and also continued to open public facilities that attract large crowds, including fitness clubs, theatres, casinos, bars, and buffet-style restaurants.[9]

On the evening of 3 February, the cruise ship returned to Yokohama Port and anchored off the coast of Daikoku Pier without docking.The Japanese government decided to re-quarantine the ship. Officials of the Ministry of Health, Labour and Welfare boarded the ship for quarantine.[5][9][10]

On 4 February, tests revealed infections of 10 out of 31 people tested. The authorities immediately decided to isolate all passengers on board for 14 days.[9] On 5 February, the authorities announced positive test results for SARS-CoV-2 for 10 people on board, the cancellation of the cruise, and that the ship was entering quarantine for 14 days based on World Health Organization guidelines.[11][12][13][14][15]A total of 3,700 passengers and crew were quarantined by the Japanese Ministry of Health, Labour and Welfare for what was expected to be a 14-day period, off Yokohama.[16]

On 7 February, the total number of people on board with confirmed SARS-CoV-2 infections grew to 61.[17]Another three cases were detected on 8 February, bringing the total to 64.[18]On 9 February, six cases were detected,[19] while another 65 were detected on 10 February, bringing the total to 135.[20]The numbers overwhelmed local medical facilities, and stricken passengers were divided into three groups according to condition, and evacuated to suitable locations, allowing intensive care to perform as intended.[21]On 11 February, 39 more people tested positive for the virus, including one quarantine officer, bringing the total to 174.[22]Passengers with confirmed cases were reported to be taken ashore for treatment.[23]On 13 February, 44 more people tested positive for the virus, bringing the total to 218.[24]On 15 February 67 more people were reported to be infected, bringing the total to 285.[25]On 16 February 70 more people were reported to be infected, bringing the total to 355.The next day on 17 February, the Ministry of Health, Labour and Welfare confirmed 99 more cases, raising the total to 454, 33 of whom were crew members.[26][27]On 18 February, another 88 cases were confirmed, bringing the total to 542.[28]

On the morning of 17 February (Japan time), two U.S. government-chartered planes departed for the United States, carrying hundreds of U.S. citizens who were passengers of the cruise ship. Among about 400 American passengers, 328 boarded the planes, excluding those who expressed their intention to stay on the ship and 44 under treatment in Japan.[29][30]The U.S. government initially asked Japan to keep them on board for 14 days based on the CDC guideline despite the proposal by the Japanese government to bring American passengers back home early.[31]The U.S. government, however, changed its policy to return home on 15 February.[32]The first plane landed at Travis Air Force Base in California at midnight on 16 February (U.S. time), and the other plane landed at Joint Base San Antonio in Texas on the early morning of 17th (U.S. time).[30][33]Canada, Hong Kong, Australia and Italy also followed the United States within a few days.[29] There were 164 Australian passengers, of whom 24 were infected, and all Australian passengers were sent for 14 days quarantine to Darwin.[34]

On 18 February, Michael J. Ryan, executive director of the World Health Organization's Health Emergencies Programme, said that Japan's measures to quarantine passengers and staff on board at the Yokohama Port for two weeks were preferable to having them scattered throughout the world. However, he said that he was disappointed at the continued increase in the number of infected people.[35]

In early March 2020, Indonesia evacuated 69 Indonesian crew of Diamond Princess, after their COVID-19 test results in Japan were negative. However, an Indonesian naval hospital ship bringing them to Sebaru Island for a mandatory quarantine period had two crew ill. All were tested again; 67 passed the second test, but two did not and were retested with a more accurate, different test, with one negative and one positive result. The 68 people with negative tests disembarked at Sebaru Island for observation and the one positive case was evacuated by helicopter to Persahabatan Hospital.[40][41]Eventually, all 69 crew members received negative COVID-19 test results.[42]

There are many criticisms of Japan's epidemic prevention measures of quarantine on cruise ships.[45]There is the possibility that quarantine in a cruise ship is dangerous, because the cruise ship does not use HEPA filters which can effectively screen 99 percent of the particles, as is used in modern aircraft.[46]

The site of the quarantine station, now Diamond Point but then known as Clallam Point, was part of a military reservation established by President Andrew Johnson (1808-1875) in 1866 and dissolved in 1870. The Diamond Point land was then privately owned until 1892, when the federal government purchased 156 acres on which to build the quarantine station.

The need to inspect incoming passengers, and for facilities to quarantine those with infectious diseases, was demonstrated frequently in the pages of early newspapers. The October 12, 1868, issue of The (Olympia) Territorial Republican, for example, reported, "It is rumored that the bark Glympse, at Port Discovery, had one death from smallpox, and four other cases on her passage up from San Francisco, and that the disease is now at Seabeck" ("It is rumored...").

The same report set out a budget to establish a quarantine station at Port Townsend: "Purchase of site: $5,000; Disinfecting machinery: $20,000; Warehouse and wharf: $10,000; Small boats: $500; Annual expenses: $10,000; Hospital building and officers' quarters: $10,000; Total: $55,000."

Eventually the Diamond Point Quarantine Station included some 27 structures, including the hospital, a detention facility, the surgeon's house, attendants' houses, a wharf, a water storage tank, a small graveyard, and other facilities. All vessels arriving from foreign ports were required to pass through quarantine. When deemed necessary, vessels were fumigated with burning pots of sulphur (after 1929 by cyanide gas) in order to kill fleas, rats, lice, and other vermin. Passengers were inspected for any symptom of infectious diseases such as influenza, cholera, malaria, smallpox, yellow fever, diphtheria, and leprosy. 17dc91bb1f