Over 3,500 people quarantined on Diamond Princess cruise

[Adventurelawyer]

Haha, possibly. But we don't ever email protected health info at work, since fax is more secure and less likely to get lost. It's my natural default, even if it's old-fashioned.

Its also more reliable than email. Hi-five!

 

[MarkLT1]

There was an interesting info from the CDC director regarding containment, where he essentially was saying that the CDC will consider it contained in the US, if the spread stays below 4 'generations' of infected people. E.g.- if A infects B infects C, they are able to track and isolate, but as soon as it hits the 4th generation (individual C infects someone) the growth is too big, and they would need to move away from containment, and towards mitigation.

I think the part of this outbreak that is concerning to me in the US, is that it feels like this could very quickly go from contained, to the wheels falling off, without us even realizing it. And with news such as the person from China who tested positive the day after he returned from Hawaii, or the person who tested positive after traveling off the Westerdam... it almost seems like a matter of when (not if) those barriers are broken. Hopefully the case load stays low, and with the various travel restrictions and quarantines in place, we don't see an outbreak.

 

[Karin1984]

The Dutch Health Institute (RIVM) has denied access to travel to Amsterdam to 11 passengers of the Westerdam. They were supposed to travel via/to Amsterdam (the article isn't clear on this), but have been in contact with the American woman who has been diagnosed in Malaysia. They say the chances that they have gotten infected are small, but they are not taking any chances.

More Dutch people have been travelling from Cambodia to Dubai to Amsterdam yesterday, arriving this morning at the airport. They do not have to go into quarantine like the Dutch people who have been repatriated from Wuhan. My manager's quarantine should end this weekend and back at the office on Monday (Luckily I'm working from home ;-) )

All Dutch people arriving back are screened by the Health Institute.

 

[Starwind]

Explanation of the total numbers on the ship, from Japanese government website: https://www.mhlw.go.jp/stf/newpage_09542.html

per Google translation of the webpage:

QUOTE


New Coronavirus Infections Confirmed on a Cruise Ship Quarantined at Yokohama Port (Part 9)
The cruise ship Diamond Princess, which arrived at Yokohama Port on February 3, is undergoing quarantine at sea, but due to its long-term stay on board, it is considered high risk from the viewpoint of ensuring health. A new coronavirus test was carried out, mainly by one, and positive results were confirmed for 67 (including 38 asymptomatic pathogen carriers) of the 217 patients whose results were found. In the future, it will be transported to medical institutions with infectious disease wards. Positive cases were confirmed in 285 of the 930 patients tested (including 73 asymptomatic pathogen carriers).

Those who are transported include elderly people and foreign nationals, and it is necessary to take measures that take into account physical conditions. The press is requested to give special consideration to coverage of this matter.

Quarantine of the cruise ship continues to be implemented. A new coronavirus test is conducted for those who need it, and the results will be announced later.


END QUOTE

 

[QueenElinor]

.....
I think the part of this outbreak that is concerning to me in the US, is that it feels like this could very quickly go from contained, to the wheels falling off, without us even realizing it. And with news such as the person from China who tested positive the day after he returned from Hawaii, or the person who tested positive after traveling off the Westerdam... it almost seems like a matter of when (not if) those barriers are broken. Hopefully the case load stays low, and with the various travel restrictions and quarantines in place, we don't see an outbreak.

I spend a lot of time on twitter reading pre-published manuscripts. And it is scary. Things are much worse in China than those "official" numbers show & no one believes them. I think very few epidemiologists hold out hope for containment because it is so contagious. The next few weeks should be very telling.

The thing is, the travel ban works against China, most probably. Thank God for that. But Europe does NOT have a travel ban, nor does Canada, or most of the rest of the world. After the virus gets a toehold there, it will be here. Hopefully by then we'll have a vaccine. The good news is that the fatality rate outside of China is low, probably just because their system is overwhelmed, but also the virus may be less virulent in non-Asians. Which is pretty weird.

(including 73 asymptomatic pathogen carriers).

Well, that's no good.
I guess we just have to hope that if they're not symptomatic, they're not infectious.

 

[MarkLT1]

I spend a lot of time on twitter reading pre-published manuscripts. And it is scary. Things are much worse in China than those "official" numbers show & no one believes them. I think very few epidemiologists hold out hope for containment because it is so contagious. The next few weeks should be very telling.

The thing is, the travel ban works against China, most probably. Thank God for that. But Europe does NOT have a travel ban, nor does Canada, or most of the rest of the world. After the virus gets a toehold there, it will be here. Hopefully by then we'll have a vaccine. The good news is that the fatality rate outside of China is low, probably just because their system is overwhelmed, but also the virus may be less virulent in non-Asians. Which is pretty weird.

This.. so much this. My education is in engineering systems risk assessment, and while many of the projects I worked on were quite different from this (risk of structural failure in earthquakes and hurricanes) there are many parallels. Other risk vectors (in this case, individuals traveling through non-blocked countries) is what we spent 90% of our time focusing on.

Re Asians vs non-Asians, as I mentioned earlier, a buddy of mine from grad school who works in epidemiology was theorizing that it might be an environmental factor. Not only the high prevalence of smoking (especially among males) in China, but also the poor air quality. Further, yesterday he was mentioning that there is a much higher prevalence of TB in China, which would also make ones lungs more susceptible it respiratory infections.

 

[QueenElinor]

This.. so much this. My education is in engineering systems risk assessment, and while many of the projects I worked on were quite different from this (risk of structural failure in earthquakes and hurricanes) there are many parallels. Other risk vectors (in this case, individuals traveling through non-blocked countries) is what we spent 90% of our time focusing on.

Re Asians vs non-Asians, as I mentioned earlier, a buddy of mine from grad school who works in epidemiology was theorizing that it might be an environmental factor. Not only the high prevalence of smoking (especially among males) in China, but also the poor air quality. Further, yesterday he was mentioning that there is a much higher prevalence of TB in China, which would also make ones lungs more susceptible it respiratory infections.

I'm a huge believer in interdisciplinary study. That's often where the breakthroughs are. My BS degrees are completely unrelated and I personally think I've benefited quite a bit from that.

All of those points about life in China seem valid to me. And also crowding, which I believe is not really comparable to US or even European cities.

In addition, another unusual thing about this virus, (and other coronaviruses, I think) is it attaches at ACE2 receptors. Which Asian men have much more of in their respiratory tract. These are generally linked to cardiovascular disease. ACE inhibitors are very commonly used drugs for lowering blood pressure.

And here's where it gets interesting- the "risk factors" and "other conditions" that increase the mortality rate, which you hear mentioned in the media, seem different with COVID19. They're cardiovascular risk factors, hypertension, etc.. Now this is hard to tease out from the usual suspects, like diabetes, but it's just odd. It should be people who are immunosuppressed who are at risk, but there have even been two cases of ppl with HIV who recovered. So it will be very interesting to see how this shakes out. This is one strange bug.

 

[MarkLT1]

This is one strange bug.

Perhaps.. Although part of me is skeptical that we really have a handle on what this bug even is, so to speak. In my (admittedly) limited reading of articles so far, it seems like one day a paper says "X" and the next day a new paper says "Not X, but rather Y", and rinse and repeat. I know we have amazing tools, technology, and people working on this around the clock, and I also know that when you are studying something novel, it can take weeks or months to even figure out the right angle to be looking at it. Recall how what we knew about SARS changed during that pandemic. Much of what we know about SARS, its actual rates of mortality, how it spread, etc.. came towards the end, and even in the months following the pandemic. It definitely seems like a weird bug, but how much of that is actual novelty, and how much is just not having all the puzzle pieces yet?

Edit- also, I am VERY skeptical of the numbers from China, as is most of the world.. and if we start only looking at cases outside of China, the numbers small enough, that I think it is hard to say very much at all regarding how this thing spreads on a large scale.

(Definitely take all this with a grain of salt, as I am waaaay out over my skis here)

 

[mom4fun]

A Japanese man who visited Hawaii with his wife tested positive after returning to Japan.

https://www.hawaiinewsnow.com/2020/...r-recently-hawaii-confirmed-have-coronavirus/

• The adult male traveler did not have any symptoms while visiting Maui from Jan. 28 to Feb. 3.
• But he did begin to exhibit “cold-like symptoms” while on Oahu from Feb. 3 to Feb. 7.
• On Oahu, he stayed at the Grand Waikikian by Hilton Grand Vacations. The state is still seeking more details on his exact itinerary, including which flights he was on.
• He was diagnosed with the virus on Feb. 8, after returning to Japan. Japanese news reports say that he had a fever of about 102 degrees.

This one concerns me a bit. How many people in Hawaii could end up infected by this couple and they were from Japan not China.

 

[Karin1984]

This one concerns me a bit. How many people in Hawaii could end up infected by this couple and they were from Japan not China.

That's how the virus spread. Probably someone infected from China travelled to Japan, infected this couple, they travelled to Hawaii and came in contact with people at customs, at the hotel, in shops, in tourist attractions, taxis...

But the good thing is, not everyone who is in contact with an infected person gets infected. The husband of the American woman on the Westerdam didn't get infected while he was probably in very close contact with her.

In the UK there is a man (now recovered) who went to Singapore on business, caught the virus there, and then went to France before going back to the UK, he infected at least 9 people, while most likely he has been in contact with many more people.
https://edition.cnn.com/2020/02/11/europe/steve-walsh-uk-coronavirus-patient-intl-gbr/index.html

 

[QueenElinor]

That's how the virus spread. Probably someone infected from China travelled to Japan, infected this couple, they travelled to Hawaii and came in contact with people at customs, at the hotel, in shops, in tourist attractions, taxis...

But the good thing is, not everyone who is in contact with an infected person gets infected. The husband of the American woman on the Westerdam didn't get infected while he was probably in very close contact with her.

In the UK there is a man (now recovered) who went to Singapore on business, caught the virus there, and then went to France before going back to the UK, he infected at least 9 people, while most likely he has been in contact with many more people.
https://edition.cnn.com/2020/02/11/europe/steve-walsh-uk-coronavirus-patient-intl-gbr/index.html

There was a pretty good study that just came out from China which suggested the infection rate of close contacts was about 34%. So one would think it would be substantially less for shopkeepers, waiters, and others who would only have been in brief contact with the Japanese traveler. Perhaps higher for the housekeepers, but at least those people could be quickly identified.

 

[Starwind]

An additional 70 cases found on Princess Diamond.

In addition to USA, Canada and HOng Kong have said they will evacuate their citizens off.

See: https://www.mhlw.go.jp/stf/newpage_09547.html

Per Google translation:

QUOTE

About new coronavirus infectious disease confirmed in cruise ship during quarantine in Yokohama Port (the tenth report)

The cruise ship Diamond Princess, which arrived at Yokohama Port on February 3, is undergoing quarantine at sea. A new coronavirus test was conducted, including those who are considered to be at high risk from the viewpoint of ensuring health due to long-term stay on board, including those with symptoms such as fever, and the results were found. Out of 289, 70 (including 38 asymptomatic pathogen carriers) were confirmed positive for the new coronavirus. In the future, it will be transported to medical institutions with infectious disease wards. Positive cases were confirmed in 355 (1,111 asymptomatic pathogen carriers) out of a total of 1,219 persons tested.

Those who are transported include elderly people and foreign nationals, and it is necessary to take measures that take into account physical conditions. The press is requested to give special consideration to coverage of this matter.

Quarantine of the cruise ship continues to be implemented. A new coronavirus test is conducted for those who need it, and the results will be announced later.

END QUOTE

I think there is an error in the "1,111" asymptomatic pathogen carriers and there is an extra "1" in there ?

See also:

Federal government to evacuate Canadians on board quarantined cruise ship
https://www.cbc.ca/news/world/coronavirus-1.5465349
" Canadians who are not showing symptoms of COVID-19 infection will be flown from Japan to Canadian Forces Base Trenton, in Ontario, after which they will be assessed and transported to the NAV Canada Training Institute in Cornwall, Ontario, to undergo a further 14-day period of quarantine. "

 

[Karin1984]

HAL has requested a new test for the American passenger who tested positive in Malaysia, as she didn't test positive in Cambodia.

 

[GlamMistress]

Some of the Americans are now getting off Diamond Princess. Flights back to the US happen very soon. This tweet is from an American is who is not leaving.

https://twitter.com/x/status/1229037215184932865

 

[GlamMistress]

HAL has requested a new test for the American passenger who tested positive in Malaysia, as she didn't test positive in Cambodia.

Unfortunately she did test positive again it seems. https://www.straitstimes.com/asia/s...ip-westerdam-tests-positive-again-in-malaysia

 

[Silvermist999]

I am very impressed with how quickly (relative to other countries) the US evacuates their citizens. Always the first to react and respond.

 

[Adventurelawyer]

HAL has requested a new test for the American passenger who tested positive in Malaysia, as she didn't test positive in Cambodia.

TBH, they were at see, unable to disembark for 14 days, it’s possible she was exposed in Cambodia. Some new reports are suggesting less than 24 hours from exposure to symptoms or a positive test. Take that with a grain of salt though, those are coming from China, which is so overrun at this point, they can no longer tell for certain when an exposure actually happened.

 

[Dreams&wishes]

TBH, they were at see, unable to disembark for 14 days, it’s possible she was exposed in Cambodia. Some new reports are suggesting less than 24 hours from exposure to symptoms or a positive test. Take that with a grain of salt though, those are coming from China, which is so overrun at this point, they can no longer tell for certain when an exposure actually happened.

But Cambodia has only 1 case. Seems extremely unluckily that she would have contracted it there.

 

[Dreams&wishes]

This graph is very good to show why this virus is so bad. Hospitalisation is so high and recovery so slow. Look how many people have been diagnosed compared to how many have been discharged in Singapore. Which has an admirable health system.

 

[Adventurelawyer]

But Cambodia has only 1 case. Seems extremely unluckily that she would have contracted it there.

That Cambodia only has one case seems unlikely in that it is sandwiched between two countries that have lots of cases and porous borders, and many thousands of know potential exposure under home quarantine. She tested negative, then positive, then positive. It is possible she incubated for the full 14 days or even 15 and then popped a (+) result, that is, she could be an outlier on either end. But everyone onboard would also have to be an outlier because they were at sea and unable to dock for 14 days. No one else on the ship, has had a positive result, yet. Leaning toward Cambodia.

In any event, I’m glad they are all off the ship and I am hopeful the others will self quarantine on return to their homelands as a precaution. I’d also like to remind everyone that most people are recovering rather than dying or even getting pneumonia, and that is because we are quarantining, and isolating as necessary (not overwhelming the system). Of the 11 in the UK, 9 have gone home and in the US the majority have not needed hospital isolation or advanced care, but very little reporting has been done on this fact because clicks drive the revenue stream.

(Edited for clairity and my fat thumbs because precoffee. Sorry.)