Over 3,500 people quarantined on Diamond Princess cruise

[Lisa F]

While I agree that your explanation is likely what the prior poster was referring to regarding additional deaths, let's all remember that these passengers did voluntarily embark on a 14 day cruise to begin with and presumably believed they were healthy enough to do so without "access to high level medical facilities."

yup and people sometimes die on these cruises as a result. I bet more die unexpectedly on 14 night cruises than 7 night cruises and more on 7 night than 3 night. It's just the odds. The longer you keep people all in one spot the higher the chance is that someone is going to have an unexpected episode. I don't think most people who have a major cardiac event anticipate it's going to happen to them and for diabetics it is easier to manage your blood sugar when you have all of the plenty of food choices in a buffet vacation setting vs. being confined to your cabin and having food passed through the door - one report by a guy on that quarantined cruise stated that it took a couple of days for them to work out giving him any food he could eat as a diabetic. Stuff like that is a very real byproduct of the unplanned situation.

I'm not saying I think people will die necessarily but I do think that the risk from a pure numbers standpoint the risk of 3700 people being all kept together for a month or more does raise the odds that some unplanned for medical episode might happen and at this point the odds of dying from coronavirus if you are not in an area that is overrun by the virus and has sufficient medical facilities to deal with any respiratory issues is not that much more than a middling virulent flu outbreak. I also think that it's not a good idea to set a few thousand people who have been exposed free in an urban area, and that a cruise ship is as good a place as any for a quarantine as it has people settled into sleeping quarters already. I'm not sure land based quarantine facilities would be all that much better. It does sound like after the first few days they are being more mindful of people's medical issues though. But that doesn't make that poster wrong that if people die odds are that it would be from anything but coronavirus. That said, the other options of just letting everyone out and about are potentially much worse.

 

[QueenElinor]

We also use Medjet. I too find it significant that Medjet won’t extract from China, however, if you consider thay use 3rd party chartered aircraft to do their repatriations, its not terribly surprising. If you can’t get the pilots to fly or the clearance to land, how do you get there?

in terms of spread, its likely they were infected days ago. Thats the reason they are locked down in their rooms. They either picked it up in port or from the infected patient in ship as its fecal oral and droplet transmission, and are just now popping symptoms or positive results. This isn’t coming from the water supply or the vents and having them anywhere on land would have further spread it to the local population.

I didn't mean that they would just be released, rather that they would be quarantined on land, as the ship itself may be the vector.

There have been outbreaks of SARS (another coronavirus) transmitted via plumbing, and this virus appears to be significantly more infectious than SARS Also, the passengers do get out of their rooms for 90 minutes each day. If surfaces are contaminated it can be spread at that time.

I think they made some hasty assumptions about how this virus is transmitted, and are coming to regret that decision, which is why they are now thinking of testing everyone. With the sheer number of cases it's very possible that this is not person-to-person transmission, unless the index patient was exceptionally gregarious, or if they are already in to second generation transmission.

 

[Gentry2004]

Plus if they test the asymptomatic passengers too soon, it soundsl like they will end up with a lot of false negatives and will need to retest anyway.

 

[QueenElinor]

Sorry I just thought I would share this with you.
The #3UK case, who infected 5 people during his ski holiday in France, 2 in Spain and 4 people while being back in the UK. Flew back to the UK after having infected the 5 people in France, so obvuosiy he was infectious. Who knows how many he infected on the plane and in Gatwick Airport!

That person picked it up at a business meeting in Singapore. He's a great illustration of how viruses can travel all around the world in no time. Singapore, to France, to the UK.

Also, his friend who was infected in France, is a doctor. They all appear to be from Brighton, UK. So now the clinic there is shut down and it's unclear how many patients have been exposed.

 

[disneyholic family]

in china, 97 people more people died from the virus yesterday ..
according to CNN that brings the total deaths thus far to 910..
i was pooh poohing this virus, but maybe it's more dangerous than i thought?

.

 

[JARNJ3]

What really is just so sad, is that the doctor who discovered it - has passed away from it. And he was young and healthy.

I appreciate the world's efforts is stemming the transmission of the disease. In the olden days, it would have wiped out populations of people.

Cruising & flying to Orlando in May. Betting on it being contained & completely avoidable by then.

 

[Adventurelawyer]

they made some hasty assumptions about how this virus is transmitted, and are coming to regret that decision, which is why they are now thinking of testing everyone. With the sheer number of cases it's very possible that this is not person-to-person transmission, unless the index patient was exceptionally gregarious, or if they are already in to second generation transmission.

So initially, when medical teams were attempting to determine the R0, the ground zero Chinese team determined the infection rate at 1:5-9. That number was mysteriously revised down and the data used was scrubbed. I think the rate of transmission is probably north of 2.5 which is where the current R0 is set. Just given the spread on the ship and the lack of direct data from China. The sample sizes outside of China are just too small to really make that call accurately, but mathematical models using the infection and fatality numbers from China have not added up. Again, infection rate is too low.

In terms of how it is spreading, I read an article the other day on virus being present in stool, which would indicate a fecal oral transmission route, just like Noro and we know how fast that moves. Additionally, they are finding that prior to the onset of respiratory symptoms, patients have reported lower GI distress. If this is the case, it explains why its transmitting so rapidly; droplets carry in the winter and people are nasty and don't wash their hands. There was a cell outbreak during SARS that happened because of bad sewer lines, humidity and .... you get the "drift," literally. So I'm back to my recommendation of alcohol based hand dani and washy washy.

 

[disneyholic family]

What really is just so sad, is that the doctor who discovered it - has passed away from it. And he was young and healthy.

I appreciate the world's efforts is stemming the transmission of the disease. In the olden days, it would have wiped out populations of people.

Cruising & flying to Orlando in May. Betting on it being contained & completely avoidable by then.

yes, that's so sad that he died. And the fact that he wasn't old is worrisome, although given how angry china was at him for raising the alarm, i wouldn't put it past them to hasten his demise.

.

 

[JARNJ3]

yes, that's so sad that he died. And that fact that he wasn't old is worrisome, although given how angry china was at him for raising the alarm, i wouldn't put it past them to hasten his demise.

.

Right - I just read an article about it - local Chinese officials were mad & tried to suppress. The greater government was praising him & reprimanding the local authorities.

https://www.buzzfeednews.com/articl...oronavirus-li-wenliang?bfsource=relatedmanual

 

[smmco]

I think all they are saying is that they don't think the quarantine is the right way to handle it and that it could ultimately result in deaths not related to coronavirus at all for people who have medical issues... what if someone has a heart attack and if they were at work right now they could get medical care quickly but could not get it very quickly on a quarantined ship and died because of the difficulty in a quick emergency response and access to high level medical facilities? Or if a diabetic has trouble modulating blood sugar? Stuff like that, not that the CIA is going to kill people. By alphabet soup agencies I read it as "no matter what the CDC or WHO says..." ie the experts, they still disagree that quarantine is the way to handle it... all of which you could argue with but I don't think they are saying what you think they are.

The only conspiracy type thing I've heard with this is that perhaps the point of the quarantine is not all about immediate public safety but also having a more controlled place to get a handle on how this thing spreads. Which is entirely possible, not cool for the guinea pigs who have no say in the matter but still not CIA assassinations on board a cruise ship

Thank you. I’m not sure how the leap was made to CIA assassinations. I think youd have to a conspiratorial mind to infer that. I didn‘t mention the CIA. I did mention bad Hollywood apocalyptic movies. Is there a movie where the CIA kills people on a cruise ship? LOL.
Yes I do disagree with quarantining the ship. As someone who has taken 25 cruises and just got off a ship yesterday I can’t imagine being imprisoned in an inside stateroom for two weeks or more. I was on the TA in September in an inside room. We had crappy weather and had to spend a lot of time indoors. A couple hours a day in a tiny room with no windows is enough to make me nuts. You lose all sense of time and it’s very depressing. I do genuinly feel for the people going through this.

It tends to be the older population that does these type of longer cruises. Many of them I’m sure take multiple medications and have chronic health issues CHF, COPD, CKD etc all the alphabet soup medical problems. Of course you always think your healthy enough, but things can change quickly.

I hope if this happens in the US we have a plan to get them off the ship and to a better facility for quarantine.

 

[Dreams&wishes]

That person picked it up at a business meeting in Singapore. He's a great illustration of how viruses can travel all around the world in no time. Singapore, to France, to the UK.

Also, his friend who was infected in France, is a doctor. They all appear to be from Brighton, UK. So now the clinic there is shut down and it's unclear how many patients have been exposed.

I know my husband is in Singapore atm and I'm terrified! He said that they measure the temperature before entering the office every morning and that there are not many people around, but who knows. He is going to Indonesia soon where apparently there are no cases. I said apparently because I read an article saying how it's very very dubious that indoonesia, a country so close to other nations that have many cases and where many Chinese people vacation, hasn't reported any cases yet. They think that they are just not testing or that don't want to create panic because they wouldn't have the facilities. Worrisome

 

[QueenElinor]

I know my husband is in Singapore atm and I'm terrified! He said that they measure the temperature before entering the office every morning and that there are not many people around, but who knows. He is going to Indonesia soon where apparently there are no cases. I said apparently because I read an article saying how it's very very dubious that indoonesia, a country so close to other nations that have many cases and where many Chinese people vacation, hasn't reported any cases yet. They think that they are just not testing or that don't want to create panic because they wouldn't have the facilities. Worrisome

Well, you know, one good thing is that the virus seems to be very infectious, but maybe not so deadly as first believed. There are many cases and deaths in China because there are simply so many people there to begin with. I mean, there are several cities as big as NYC that most of us have never heard of! Although it's early yet, people outside of China who have it seem to have done pretty well.

So the personal risk to an individual might be quite small. Also, the health system is Singapore is very good, I'm sure they're as on top of things as they can be. Here is a link to an article your husband might find helpful: The Wuhan Virus- How to stay Safe

 

[Dreams&wishes]

Well, you know, one good thing is that the virus seems to be very infectious, but maybe not so deadly as first believed. There are many cases and deaths in China because there are simply so many people there to begin with. I mean, there are several cities as big as NYC that most of us have never heard of! Although it's early yet, people outside of China who have it seem to have done pretty well.

So the personal risk to an individual might be quite small. Also, the health system is Singapore is very good, I'm sure they're as on top of things as they can be. Here is a link to an article your husband might find helpful: The Wuhan Virus- How to stay Safe

I told him that when he gets back I will put him in quarantine in the spare bedroom I have 4 children to think about!!

 

[MarkLT1]

I told him that when he gets back I will put him in quarantine in the spare bedroom I have 4 children to think about!!

You should pick him up at the airport wearing a full-on biohazard suit

 

[QueenElinor]

I told him that when he gets back I will put him in quarantine in the spare bedroom I have 4 children to think about!!

My DH is a doctor and I told him it's very convenient that we happened to have just remodeled the basement, complete with kitchenette. Hope he likes it down there!

 

[sethschroeder]

While I understand the emergency about this virus. I feel its all a little out of control. Its not a deadly virus, only dangerous to those with underlining issues. What about the flu or like say dengue?
I do believe that the spread will continue. What do you guys think?

People keep bringing up the flu. It's night and day the Flu typically will have a death rate of less than 0.1% while this is still ranging around 1%-2%.

There is also a wide range of information out there so take a look but there is a reason China has quarantined essentially what equates to the state of Florida.

So if it makes everyone feel better I was texting back-and-forth with a colleague of mine that is an ex pat right now in Shanghai with his family. I asked if he was going to try and get out and head back and he said no. He commented that they were just washing their hands a lot and that people outside of China are making a bigger deal of it in the Chinese People themselves. So I would assume the feeling within China is not the end of the world is coming

They are more tolleriable to the government possibly withholding information.

I just simply point to. If this wasnt a big deal why the quarantine of so many people? Why does the death toll also spell such a high fatality rate early on?

Also China needs to keep its boarders, factories, and economy open. So it serves them no purpose to frighten the public further within their boarders.

 

[QueenElinor]

People keep bringing up the flu. It's night and day the Flu typically will have a death rate of less than 0.1% while this is still ranging around 1%-2%.

There is also a wide range of information out there so take a look but there is a reason China has quarantined essentially what equates to the state of Florida.



They are more tolleriable to the government possibly withholding information.

I just simply point to. If this wasnt a big deal why the quarantine of so many people? Why does the death toll also spell such a high fatality rate early on?

Also China needs to keep its boarders, factories, and economy open. So it serves them no purpose to frighten the public further within their boarders.

I agree with all of this. These quarantines in China (and our travel ban) really are unprecedented. Also, people who are possibly infected (the gov't doesn't have enough test kits to actually diagnose them) are simply rounded up and sent to isolation units- you know, those military tent cities, sports arenas, & convention centers they've been stuffing with beds. They've built hospitals, to be sure, but these types of facilities are obviously NOT hospitals.

 

[Starwind]

People keep bringing up the flu. It's night and day the Flu typically will have a death rate of less than 0.1% while this is still ranging around 1%-2%.

There is also a wide range of information out there so take a look but there is a reason China has quarantined essentially what equates to the state of Florida.

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.

 

[sethschroeder]

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.

That sounds terrible if that were to happen. I can only go based on how people are reacting because I am 100% not in a medical field.

If what you are saying is correct and matches to what the CDC is thinking that also could have a severe impact to survival rate.

Just very hopeful that they can get this under control.

 

[Starwind]

That sounds terrible if that were to happen. I can only go based on how people are reacting because I am 100% not in a medical field.

If what you are saying is correct and matches to what the CDC is thinking that also could have a severe impact to survival rate.

Just very hopeful that they can get this under control.

That is one of the concerns with an epidemic/pandemic with a bug like this. If the scale gets big enough, you run out of medical capacity to deal with it and then some horrific hard decisions start having to be made, and the fatality rates go up. What might have been survivable severe illness in the early days of the pandemic, when there are enough resources, may not be further into it when the resources run out or are already in full use. Fortunately with this coronavirus it appears that MOST people who get it have a milder version that does not require hospitalization.

Or imagine if it hits and goes widespread in a country or community that just doesn't have robust high-level-of-care medical infrastructure for whatever reason - e.g. rural, isolated, or in a developing country. There are real concerns being expressed right now about what if it hits Africa and goes widespread, for example. Until the last couple weeks, only two countries (South Africa and Senegal) even had the lab ability to do the testing for the virus. WHO has provided test kits and is providing training in a number of other African countries now, just in case. See https://www.bbc.com/news/world-africa-51403865 and https://www.nytimes.com/2020/02/06/world/africa/africa-coronavirus-china.html