Over 3,500 people quarantined on Diamond Princess cruise

[FigmentSpark]

I think this speaks to some of the concern. From the CDC's "Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection" [https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html]:

QUOTE
Clinical Course

Clinical presentation among reported cases of 2019-nCoV infection varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness. In one report, among patients with confirmed 2019-nCoV infection and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days).

Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. Between 23–32% of hospitalized patients with 2019-nCoV infection required intensive care for respiratory support. Some hospitalized patients have required advanced organ support with invasive mechanical ventilation (4–10%), and a small proportion have also required extracorporeal membrane oxygenation (ECMO, 3–5%). Other reported complications include acute cardiac injury (12%) and acute kidney injury (4–7%). Among hospitalized patients with pneumonia, the case fatality proportion has been reported as high as 11–15%. However, as this estimate includes only-hospitalized patients, and therefore is biased upward.
END QUOTE

Extrapolate out those numbers. Say you have a city of a million people and say you get widespread community transmission of the virus in that hypothetical city. Say just 1,000 people (thats 1/1000 of your population) need to be hospitalized from the virus and the rest who are infected are not that severely ill. Using the numbers above, 1000 hospitalized patients would mean 230-320 people needing an ICU for respiratory support. And 40-100 people needing intensive mechanical ventilation and 30-50 needing ECMO.

The city I live in is about 1,000,000 people. Our largest hospital has "comprehensive care, multi-disciplinary, Level 1 Intensive Care Unit which provides care for patients ranging from the routine to the most advanced.. The Intensive Care Unit is comprised of a total of thirty-two dedicated critical care beds." We have have five hospitals total including a pediatric hospital, with 32, 32, 12, 12 beds plus the kids hospital with 10. The two hospitals with 12 are tertiary care facilities who normally would transfer a patient needing intensive mechanical ventilation to a higher level hospital within 48 hours. But lets go with the 98 beds total. That would not be enough to deal with just 1000 patients needing hospitalization if they keep to the ratios CDC described.

For our entire PROVINCE of 14 million or so people people, in 2006 there were "213 critical care units spread across 127 acute care hospitals. These units contain 1,789 critical care beds, of which 1,057 are capable of providing patients with invasive mechanical ventilation." The numbers may have increased since, but not *that* much. And most of those beds at any given time are already full of existing patients as our hospitals generally run at over capacity.

So where are those "new" coronavirus patients going to go ? There simply aren't enough beds/resources for all of the sickest ones. Which means rationing limited resources and making decisions about who gets the support and who doesn't (and thus may be allowed to die). THAT is the reality in a widespread pandemic that has a significant ratio of hospitalized patients needing advanced care, let alone hospitalized but with a less intense level of care. There simply aren't enough beds and resources to treat everyone who needs treatment. :-(

It puts into a different light China's rush to build two (or is it three now?) new hospitals in record time for Wuhan. And makes one wonder if they are telling the truth about the numbers of infected -- but even if they are telling the truth, do the math and look at the strain it would be putting on their system [or any country's systems] just dealing with those who are symptomatic.

One question I had... the hospital is built in 10 days. What about the systems and the medical personnel? Where are they coming from and how efficient can they be working in a new environment all of a sudden? Maybe China has a military medical branch that is deployed? How does that work?

 

[Starwind]

One question I had... the hospital is built in 10 days. What about the systems and the medical personnel? Where are they coming from and how efficient can they be working in a new environment all of a sudden? Maybe China has a military medical branch that is deployed? How does that work?

According to media reports they deployed the military to them as well as to provide relief at the existing hospitals.

See https://www.businessinsider.com/wuh...-to-staff-the-facility-state-media-reported-5

For the first new hospital they built and opened in Wuhan: "The People's Liberation Army sent 1,400 doctors, nurses, and other medics to staff the facility, state media reported." The article above has additional info and pictures about its capacity etc.

 

[QueenElinor]

I think this speaks to some of the concern. From the CDC's "Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection" [https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html]:

QUOTE
Clinical Course

Clinical presentation among reported cases of 2019-nCoV infection varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness. In one report, among patients with confirmed 2019-nCoV infection and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days).

Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. Between 23–32% of hospitalized patients with 2019-nCoV infection required intensive care for respiratory support. Some hospitalized patients have required advanced organ support with invasive mechanical ventilation (4–10%), and a small proportion have also required extracorporeal membrane oxygenation (ECMO, 3–5%). Other reported complications include acute cardiac injury (12%) and acute kidney injury (4–7%). Among hospitalized patients with pneumonia, the case fatality proportion has been reported as high as 11–15%. However, as this estimate includes only-hospitalized patients, and therefore is biased upward.
END QUOTE


So where are those "new" coronavirus patients going to go ? There simply aren't enough beds/resources for all of the sickest ones. Which means rationing limited resources and making decisions about who gets the support and who doesn't (and thus may be allowed to die). THAT is the reality in a widespread pandemic that has a significant ratio of hospitalized patients needing advanced care, let alone hospitalized but with a less intense level of care. There simply aren't enough beds and resources to treat everyone who needs treatment. :-(

While your calculations are technically correct, a critical variable that is missing is time. I'm not trying to downplay the numbers, because of course resource constraint will be a terrible problem during an epidemic. However, all the cases won't hit at once.

That's one of the purposes of things like the travel ban (in the US), social distancing, hand washing, etc. They're not just to prevent cases, but also to slow down the epidemic. Outcomes are a lot different if the population is exposed over the course of one month (as in China) vs. months, or even years (the rest of the world). Even the 1918 flu epidemic actually took two years to infect everyone that it did end up infecting.

Consequently, even if the epidemic can't be contained, the above-mentioned efforts should not be construed as failures at all. They allow the medical community to buy time, and that's very, very important.

 

[FigmentSpark]

According to media reports they deployed the military to them as well as to provide relief at the existing hospitals.

See https://www.businessinsider.com/wuh...-to-staff-the-facility-state-media-reported-5

For the first new hospital they built and opened in Wuhan: "The People's Liberation Army sent 1,400 doctors, nurses, and other medics to staff the facility, state media reported." The article above has additional info and pictures about its capacity etc.

That's 1400 people not working their regular jobs, which, presumably is at other hospitals. I don't know if that kind of deployment is possible in too many countries. In the U.S., you could probably get military medical personnel, but I don't know about other countries, even in the west.

 

[Starwind]

That's 1400 people not working their regular jobs, which, presumably is at other hospitals. I don't know if that kind of deployment is possible in too many countries. In the U.S., you could probably get military medical personnel, but I don't know about other countries, even in the west.

In a media report I read several days ago they had a photo of a group of medical military personnel from (one of?) the PLA's military medical university that were preparing to be sent to Wuhan, so at least some of those they sent are trainees. Media coverage of the 1400 also notes many have experience having dealt with SARS, so some are certainly also more senior experienced personnel.

 

[disneyholic family]

I think this speaks to some of the concern. From the CDC's "Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection" [https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html]:

QUOTE
Clinical Course

Clinical presentation among reported cases of 2019-nCoV infection varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Some reports suggest the potential for clinical deterioration during the second week of illness. In one report, among patients with confirmed 2019-nCoV infection and pneumonia, just over half of patients developed dyspnea a median of 8 days after illness onset (range: 5–13 days).

Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%. Between 23–32% of hospitalized patients with 2019-nCoV infection required intensive care for respiratory support. Some hospitalized patients have required advanced organ support with invasive mechanical ventilation (4–10%), and a small proportion have also required extracorporeal membrane oxygenation (ECMO, 3–5%). Other reported complications include acute cardiac injury (12%) and acute kidney injury (4–7%). Among hospitalized patients with pneumonia, the case fatality proportion has been reported as high as 11–15%. However, as this estimate includes only-hospitalized patients, and therefore is biased upward.
END QUOTE

Extrapolate out those numbers. Say you have a city of a million people and say you get widespread community transmission of the virus in that hypothetical city. Say just 1,000 people (thats 1/1000 of your population) need to be hospitalized from the virus and the rest who are infected are not that severely ill. Using the numbers above, 1000 hospitalized patients would mean 230-320 people needing an ICU for respiratory support. And 40-100 people needing intensive mechanical ventilation and 30-50 needing ECMO.

The city I live in is about 1,000,000 people. Our largest hospital has "comprehensive care, multi-disciplinary, Level 1 Intensive Care Unit which provides care for patients ranging from the routine to the most advanced.. The Intensive Care Unit is comprised of a total of thirty-two dedicated critical care beds." We have have five hospitals total including a pediatric hospital, with 32, 32, 12, 12 beds plus the kids hospital with 10. The two hospitals with 12 are tertiary care facilities who normally would transfer a patient needing intensive mechanical ventilation to a higher level hospital within 48 hours. But lets go with the 98 beds total. That would not be enough to deal with just 1000 patients needing hospitalization if they keep to the ratios CDC described.

For our entire PROVINCE of 14 million or so people people, in 2006 there were "213 critical care units spread across 127 acute care hospitals. These units contain 1,789 critical care beds, of which 1,057 are capable of providing patients with invasive mechanical ventilation." The numbers may have increased since, but not *that* much. And most of those beds at any given time are already full of existing patients as our hospitals generally run at over capacity.

So where are those "new" coronavirus patients going to go ? There simply aren't enough beds/resources for all of the sickest ones. Which means rationing limited resources and making decisions about who gets the support and who doesn't (and thus may be allowed to die). THAT is the reality in a widespread pandemic that has a significant ratio of hospitalized patients needing advanced care, let alone hospitalized but with a less intense level of care. There simply aren't enough beds and resources to treat everyone who needs treatment. :-(

It puts into a different light China's rush to build two (or is it three now?) new hospitals in record time for Wuhan. And makes one wonder if they are telling the truth about the numbers of infected -- but even if they are telling the truth, do the math and look at the strain it would be putting on their system [or any country's systems] just dealing with those who are symptomatic.

yes, it is truly a serious threat.
epidemiological experts agree on that point. They may disagree on details, but there isn't anyone who doesn't recognize the potential threat and the implications.

.

 

[Dreams&wishes]

Can we spare a moment to think about those cruisers blocked on the Westerdam ship who still cannot find a port to take them! Stuck in the middle of the ocean ..

 

[Karin1984]

Can we spare a moment to think about those cruisers blocked on the Westerdam ship who still cannot find a port to take them! Stuck in the middle of the ocean ..

And there are no cases of Coronavirus on this ship. People are not quarantined. But still they cannot go anywhere, Japan and Thailand both refused to let the people disembark.

 

[Gentry2004]

Yes Thailand originally said yes but changed their mind. At least they are not quarantined, but still.

 

[Kennywood]

Coronavirus: Thailand reportedly turns away Holland America, leaving cruise in limbo
by Morgan Hines and Julia Thompson



Thailand has reportedly turned away Holland America's MS Westerdam which had been previously scheduled for disembarkation in Laem Chabang on Thursday, according to the cruise line.

On Tuesday morning, Thailand's public health minister, Anutin Charnvirakul, announced on Facebook that he had prohibited the ship's entry.

"I have issued orders. Permission to disembark refused," he wrote. Thailand currently has 32 confirmed cases of the virus.

"We are aware of the reports regarding the status of Westerdam’s call to Laem Chabang (Bangkok), Thailand," the cruise line said in a statement provided to USA TODAY by Holland America's director of relations, Erik Elvejord. "We are actively working this matter and will provide an update when we are able. We know this is confusing for our guests and their families and we greatly appreciate their patience."

Passengers who had already begun booking return flights from Bangkok based on the announcement that they'd be getting off the ship in Thailand now find themselves back in limbo.

The ship had already changed its disembarkation point from Shanghai to Yokohama before Japanese Prime Minister Shinzo Abe denied the MS Westerdam entry last week. It was subsequently turned away from Guam, a U.S. territory. The Philippines also barred the ship from making a scheduled port call earlier in the sailing.

There are no known cases of coronavirus among the 1,455 passengers and 802 crew on board despite reports to the contrary, the cruise line said, and the MS Westerdam has not been in quarantine.

"We have no reason to believe there are cases of coronavirus on board," Erik Elvejord, Holland America's public relations director, said in an email Friday morning.

The next scheduled cruise on Feb. 15 has been canceled. The cruise line is assessing the impact of port restrictions in Asia on cruises departing Feb. 29 or later. The current passengers have been promised a full refund and a credit toward a future cruise.

Source: USA Today

 

[QueenElinor]

And there are no cases of Coronavirus on this ship. People are not quarantined. But still they cannot go anywhere, Japan and Thailand both refused to let the people disembark.

That's real panic right there. Those countries should be ashamed of themselves. Especially Thailand who pretty much admitted they're going to be overwhelmed and don't really have a plan.

As an aside, with almost 2 dozen American military facilities in Japan, I'm perplexed as to why we don't get our own people off of the Diamond Princess, and quarantine them ourselves, or bring them the #$@* home. Seriously, come on, part of our military's mission is humanitarian.

It is making me very angry. If they can't do that, they should at least explain why.

 

[ladyofthetramp]

That's real panic right there. Those countries should be ashamed of themselves. Especially Thailand who pretty much admitted they're going to be overwhelmed and don't really have a plan.

As an aside, with almost 2 dozen American military facilities in Japan, I'm perplexed as to why we don't get our own people off of the Diamond Princess, and quarantine them ourselves, or bring them the #$@* home. Seriously, come on, part of our military's mission is humanitarian.

It is making me very angry. If they can't do that, they should at least explain why.

I have to agree. Being US citizens and with the ship docked in Japan, they really should remove them from that situation, which is just awful. I know they can't just let everyone loose, but the answer to this situation, for me, is not what they are doing.

 

[ladyofthetramp]

Geeezz... And no one has the virus... Not good.

 

[tink1970]

In the U.S., you could probably get military medical personnel,

I promise you there aren't enough military medical personnel (active and reserves) to cover those kinds of numbers in certain important roles (critical care/pulmonology/internal medicine/infectious disease) while also fulfilling the deployment and other mission essential tasks. It's a nice thought but not feasible.

 

[tink1970]

If they can't do that, they should at least explain why.

My best guess would be some international and/or Japanese laws which prohibit it. Otherwise, I strongly suspect some other options would have been explored and executed.

 

[MarkLT1]

I have to agree. Being US citizens and with the ship docked in Japan, they really should remove them from that situation, which is just awful. I know they can't just let everyone loose, but the answer to this situation, for me, is not what they are doing.

What you need to remember- this ship is not docked at a US port. The US government is not calling the shots here, the Japanese gov is. I'm sure there are diplomatic discussions that have or are still going on.

And if you don't think that the US government would do the same thing (quarantine a foreign vessel, carrying mostly foreign nationals, with a known highly contagious virus onboard that we know very little about), I've got a bridge to sell you. My guess is, if a cruise liner from Asia, with known infected individuals, with mostly non-US citizens, was trying to dock in say, Seattle, there would be a very similar response by our government.

Does it suck? Absolutely. Does the Japanese Gov want to cause harm to those on board? I highly doubt it, and with how much this bug seems to spread, and the high level of uncertainty as to how bad it is, I can't exactly fault the Japanese gov for their response.

 

[smmco]

https://www.reddit.com/user/Handfullofkeys/This is from someone on the ship.

 

[Maggie'sMom]

I promise you there aren't enough military medical personnel (active and reserves) to cover those kinds of numbers in certain important roles (critical care/pulmonology/internal medicine/infectious disease) while also fulfilling the deployment and other mission essential tasks. It's a nice thought but not feasible.

Plus, you can only really count active duty military as being available to supplement our health system because the medical personnel in the reserves are employed in the medical profession in their day to day lives. So they aren't available to be extra help in a pandemic situation.

 

[QueenElinor]

My best guess would be some international and/or Japanese laws which prohibit it. Otherwise, I strongly suspect some other options would have been explored and executed.

I think that's it, too. They are in Japanese waters. Though this doesn't exactly cover them in glory, either.

I can't exactly fault the Japanese gov for their response.

Well, I can. I guess I'm just not as charitable as you are.

If even I could predict this situation would go pear-shaped (which I did, over a week ago in the News & Rumors thread) the the Japanese could have, too. I'm not even an epidemiologist. But they've got great medical & scientific minds over there, much sharper than mine. I think they engaged in a fair amount of wishful thinking. They've turned what was a tough logistical problem into what could be an international catastrophe.

I get it, it's an unprecedented situation. However, there's still time to fix things. The folks that are already sick have been removed. The ones remaining are not ill, at least not right now. How much of a burden they'd be to our mission in Japan is hard to say, but we definitely can say that the only direction this can head is downhill. If folks could be removed, quarantined and repatriated as soon as possible, in the end that will be easier for everyone. Thousands of sick passengers, on the other hand, is a nightmare for everyone.

We got many, many more people out of Wuhan. Surely, evacuating the ship should be do-able. The situations are similar- they're in a high-risk situation, have been exposed and need to be brought home.

 

[ladyofthetramp]

What you need to remember- this ship is not docked at a US port. The US government is not calling the shots here, the Japanese gov is. I'm sure there are diplomatic discussions that have or are still going on.

And if you don't think that the US government would do the same thing (quarantine a foreign vessel, carrying mostly foreign nationals, with a known highly contagious virus onboard that we know very little about), I've got a bridge to sell you. My guess is, if a cruise liner from Asia, with known infected individuals, with mostly non-US citizens, was trying to dock in say, Seattle, there would be a very similar response by our government.

Does it suck? Absolutely. Does the Japanese Gov want to cause harm to those on board? I highly doubt it, and with how much this bug seems to spread, and the high level of uncertainty as to how bad it is, I can't exactly fault the Japanese gov for their response.

No I can't either. I do agree with everything you stated. I just wish, for those aboard that ship, it was different. Bad situation-all around