Psoque

1 minute ago, cruiserchuck said:

 

I believe those like Matt Smith staying on the ship also will have the quarantine extended.  What do you think?

I have no idea what WHO/Japanese Health Ministry is going to do, but I would think that they will extend the quarantine if they have enough evidence to suspect that more people have been newly infected since start of the original 14 day quarantine.  This is based on my understanding of how quarantines work.

Thank you all for the information.  I will do more research on Lindos to see if it worth it to do this. Otherwise we will probably just spend a day in town.

Thank you all for the information.  I think we will most likely spend the day in Valletta on our own.

6 minutes ago, Coral said:

I live near a city that has Wuhan people who are being quarantined. We were originally told the Pilot and Crew would also be quarantined but a paper later said: The pilots and crew of the chartered airplane are not under quarantine at the camp. Both the passengers and the crew wore appropriate protective gear on the flight.

 

Another news source said those who removed the luggage from the plane did not have to be quarantined. 

 

Our news is reporting that a coronavirus test takes 6 hours and that tests can be done locally. Though we have a hospital that is known for handling contagious diseases like this. Not sure if all hospitals can do 6 hour tests.

 

I am not a medical person - just reporting what our local news is saying.

What you are saying makes perfect sense.  The pilot/crew of the evacuation aircraft would have been fitted with properly fitting respirator masks.  What I was mentioning is that it would be not feasible to do a fitting test on all of the evacuees, so even though they will be wearing respirator masks of some kind, some of them will not have as good fit/tight seal as others, based on the shape of their faces, facial hair, etc.  This could potentially allow for transmission of virus from one evacuee to another while riding the aircraft.  I hope this makes better sense to you.

The RT-PCR based coronavirus test can be done in most hospital that can do RT-PCR, which is done in many clinical laboratories worldwide.

36 minutes ago, ed01106 said:

A few key difference.....

 

US has twice daily medical checks....Ship only if self reported symptoms.

 

US food prepared by people not in quarantine.  Ship food prepared by someone who might be infected.

 

 

I'm not arguing with you, but I think people who are not familiar with respiratory isolation procedures should know this:

In the case of respiratory virus with possible likelihood of transmission from asymptomatic host, these two key differences may not make much difference.  These two things you mentioned are good things, but they may not be enough to prevent the new facility for serving as a "petri dish."  I'm cringing while typing this term, by the way.  And I'm not sure how they are going to prevent transmission inside the evacuation aircraft.  I supposed that the pilot and staff onboard will be wearing the respirator masks, but I know for a fact that it would not be feasible to put those on all passengers and have them work properly. 

Sorry to make this long, but please let me explain for those who never had to wear these respirator masks for respiratory isolation:  There are a few types/styles of masks that are designed to prevent transmission of respiratory pathogens.  They all need to be personally "fitted" though a fairly rigorous procedure.  It's not that they need to be custom-made, but, as an example, I had to try on a few different ones before we found one that passed the test for me.  Also, things like facial hair can severely interfere with the performance of the seal of the mask, and it's sometimes a problem.

So, if the US evacuees are expecting something that is entirely NOT "petri dish," when they leave the ship, they might be disappointed.  I hope they are told of this before they agree to be evacuated to the US.  Whether they like it or not, the quarantine is primarily designed to protect those outside of the quarantine, regardless of the citizenship of the "quarantee" or the "quaranter."  Sealing individuals inside the quarantine from each other is a nearly impossible task.

7 minutes ago, Wildblue said:

Agreed that it's speculation what the source is for any given person that's sick.  But certainly, being confined on a ship with thousands of people, hundreds of which are sick, with transmissions happening multiple times a day, such as the delivery of food, increases the risk of disease transmissions.  No stateroom cabin is a CDC-approved isolation facility.

But unless the US evacuees are going to individualized respiratory isolation rooms (I don't think that US government has even 380 of those available immediately, but I could be wrong...) the situation at thew new "home" in US will not be that different.  Reading the news reports of the US evacuees from Wuhan, their quarantine facility was even more open that the situation on the ship.  And we have no idea if "transmissions happening multiple times a day" is really an accurate description either.

17 minutes ago, Wildblue said:

Oh, man.  Having sailed on the Diamond only a year ago, I'm particularly saddened to have watched this story unfold.  And that more and more passengers fall sick.  It seems like quarantining everybody onboard has had the side effect of infecting other healthy passengers (and I assume crew) onboard.  Continuing to watch this story.

We still don't know for sure if those who became ill and/or tested positive during the quarantine were exposed to and infected by the virus during the quarantine and/or because of the quarantine.  I think your statement is a bit premature at best.

21 minutes ago, Earthworm Jim said:

 

Is it though? It has the positive effect of getting them off the ship and back to the US. But they thought they'd be done the 19th. Now they'll be quarantined until sometime in early March.

 

We've questioned whether the quarantine on the ship is 100% effective, but Japan, a modern country by anyone's definition, apparently feels it is good enough that after the 19th those passengers will be released to presumably go anywhere in Japan they want to. Why is the US not accepting that? One of the two countries is wrong. It's either safe to let them be exposed to the general public on February 19th, or it's not.

 

Unless come February 19th Japan announces some further quarantine of course, which wouldn't shock any of us.

 

Or unless you meant it was good news from a world health perspective, rather than a ship passenger perspective.

I also feel very mixed about this decision to evacuate "some" US citizens from the ship.  Part of me thinks "good, now they get to go home!"  But then I realize that they are not really going "home."  They will fly to a base in California where they will be quarantined there or elsewhere for at least 14 more days.  I don't think they will be able to meet their families and friends in person during the quarantine, or even see their homes in person.  I really feel for them, and the rest of those quarantined on the ship currently.

And it is a very distinct possibility that some of these in quarantine will develop the disease or test positive for it during that 14 days.  If they are not in absolute isolation from each other, that would potentially re-set the clock.

I don't want to sound so pessimistic here, but I'm afraid that is the reality, and if you think about it, the evacuation will not change the reality that much for anyone, except that it might help the Japanese government and WHO manage the situation easier with a decreased head count.  During the quarantine, I would think that the US evacuees will continues to be at a high risk of becoming symptomatic from and/or turning test positive for the coronavirus.

I also hope that CDC will not just ditch Diamond Princess.  I'm assuming that CDC has been working together with the Japanese Health Ministry and WHO on this so far, and even after the evacuation, they should be part of the operation since this is an international situation, not just a Japanese situation.  If CDC ditches the ship after the evacuation, that would make US look very selfish.  That would be somewhat equivalent to Japanese government evacuating Japanese citizens only and sending the ship away from Japanese waters, a ludicrous scenario that never occurred, but one that I brought up to prove a point earlier.

Also, I hope people don't make this a "Japan vs. US" issue.  Japan was not keeping these US citizens (or for that matter citizens of any other country) from being repatriated.  They were (and are ) in quarantine, in accordance and with the blessing of both WHO and CDC, and if the US government wanted to evacuate them, in accordance with the WHO and CDC guidelines, they could have...they chose not to do this until this time.  Only issue the Japanese government/WHO/and CDC had was that a mass transit of potentially infected people through Yokohama/Tokyo and the commercial air service.  I am not sure exactly how the evacuation of US citizens will occur, but I would think they have to do this very carefully.  And now that Japan has agreed to facilitate this evacuation, which would definitely require use of Japanese resources (ambulances, etc. to transport the evacuees to an airport somewhere), they are now somewhat obligated to provide that assistance to other countries represented among the passengers/crew.  I would think this would be a great challenge to everyone involved.

41 minutes ago, Cruise Raider said:

 

For instance, hospitals in the US must use a reliable translation service when the patient does not speak English.  Even though a family member or close friend may be bi-lingual, the policies / regulations state that a translator must be used to ensure there is no miscommunication.  I think the caveat to that is if the medical professional, his or her self, is fluent in the language of the patient.  I'm not discounting that the fact that some of these patients may be not be met with those same 'acceptable communication standards', as, it could lead to some harm.  These are the chances we take when visiting foreign lands, though.  It is all speculation on our part ... they may have those same policies in place. ???  It sounds like a large percentage of the passengers are Japanese so no issues should arise there.  And ...  kudos to the volunteers that are helping!  

 

I was typing this in a hurry, but what I meant was that the quoted poster and the poster before that was making this flippant remark based on no evidence that a language barrier is making it difficult for non-Japanese speaking people on Diamond Princess, and that this "problem," whether it is a case or not, is unacceptable.  This is a classic case of "us vs them" echo chamber effect among the ignorant.  I had to speak up because I did not like where the conversation was going.

Of course, as healthcare provider myself, I am highly aware of a need for a (preferably live) interpreter if the provider and the patient do not speak the same language, and I do insist on having one if necessary.  Actually, I even go one more step by strongly insisting a live interpreter instead of a phone-based one with my patients.  I also insist that the translator be not a family member.

I have no idea the English language proficiency of those who are taking care of the Diamond Princess passengers.  I would assume from my personal experience that most of the physicians should be proficient enough, but I'm assuming many of the support staff may not be.  Also, because of the urgent nature and sheer scale of the situation, as well as the fact that they are in respiratory isolation (or should be in), it might be a challenge to have a live interpreter for every encounter.  And even if the caregivers are proficient enough and even the interpreter is present, there is bound to be some sort of cultural/language barrier that will continue to exist.

But my point is complaining about it (especially that may not even happening), and then commenting on this imaginary situation with comments like "that is unacceptable" is just entirely unhelpful.

17 minutes ago, Wizpharm2 said:

Providing translation services is mandatory in all US hospitals.  The translator must be certified in medical translation (Read “not a family member“). This is usually done through use of what we refer to as “a language line” and this paid service in one of costs embedded in the cost of healthcare in the US (ie no patient is billed when this service is needed, but it is absorbed in the overhead costs of the hospital/provider).

Hello neighbor!  I agree that we all should provide language translation service to our patients.  I'm a healthcare provider, and I always make the best effort to find a live, in-person translator (instead of a family member) when seeing a patient who do not speak English or Japanese.   I am not sure it is "mandatory," though it should be universal, which has not been the case in my experience.  And the telephone based translation has a lot to be desired.  In my experience, I have had multiple instances of the telephone based translation going very badly.

Actually, there is a company in Indy that provides live translator service to for a huge variety of languages.  I have had a great experience with them.

But that's beside the point.  I am saying that calling the possible/imaginary "language" barrier as "unacceptable," the person who posted it is making a somewhat unsubstantiated claim that somehow there is a language barrier that is compromising care to those in quarantine.  And criticizing those (mainly) volunteers who are putting themselves at risk, most of them not native English speakers, regarding their English skills is unacceptable.

56 minutes ago, phil the brit said:

Don't be silly, it is a fundamental necessity for SOMEONE to be on hand to translate conversations. Heck, you could at last resort get a phone translator very easily. There has to be a way to communicate between patient and doctor!

I agree with you that a translator, ideally a live one, would be ideal if the healthcare provide cannot speak the language the patient does not understand.  Believe me, I am a healthcare provider myself and consider that crucially important.  And as far as I know, younger doctors working in large cities in Japan are most likely to be decent in English.  Are they as good as native English speakers...definitely not.  Should you demand that they should be all completely "language barrier free?"  NO.   I was more offended by someone making a statement that a speculative language barrier as "unacceptable," as an implicit criticism of those healthcare workers who are working hard during this epidemic, some of them with less English skills than others.

4 minutes ago, kathy49 said:

having a language barrier when it comes to medical is really not acceptable. Hopefully they can get someone on a phone or in person that can translate with medical background.

I agree that the language barrier is a problem, and we can all agree that the ways to overcome that barrier would solve the problem.  But I am not sure exactly what you mean by "really not acceptable."  What is not acceptable.  It sounds like the barrier is not being addressed either intentionally or by neglect.  The healthcare professionals dealing with this quarantine, many of them volunteers (not getting paid at all), are doing this because they want to help.  Criticizing their possible lack of English fluency (or fluency in any other language) is inappropriate and it is coming from our sense of privilege.

2 minutes ago, kathy49 said:

At the risk of being blasted again I would encourage people to take a look at David Abel's utube of the trip prior to quarantine. He is a great photographer and he got some great shots despite HK having heavy clouds.  What did strike me is they are taking group excursions everyday in coaches etc. and at the attractions some of the visitors are wearing masks.  I believe this was as the corona epidemic was unfolding...many areas very crowded with tourist from all over (not just ship) and before travel in and out of HK was closed from mainland china.  Beyond the "one man" I don't see why passengers could not have picked up the virus while touring in just about any of the popular spots they visited...I think it was also during chinese new year where so many had traveled and they go to all these favorite Asian ports.  I saw one man on the ship bus with mask (the bus David was one) and really got me to wondering....they were there just a bit before HK was closed.  Again no facts here but wonder if anyone else had thought about this. I had not really until I watched that video. Taken before the quarantine. Link to video https://www.youtube.com/watch?v=SaYsNeW0u8c&feature=youtu.be&fbclid=IwAR02yIbj9NTTaCBuJe9lGQlhXRzHAzWIliWroyZtmcHsZST6SejcbL7Dzgw

 

In Japan, especially, it is completely normal for people to wear these masks during the influenza season, even if you are not feeling ill.  Also even outside of the influenza season, it is considered customary and considerate for one to wear a mask if you have a cold, etc., when riding a bus/train in public.

3 hours ago, Wehwalt said:

The way it's phrased, the up-front mention that food to suit preference will not be available, seems almost meant to be off-putting to Westerners.

 

Personally, I've seen Western food available even in convenience stores in Japan. 

I think it is ludicrous to think that the people who are organizing the food distribution in this operation are trying to annoy anyone.  If you really think that the Japanese govenment/CDC/WHO/Princess is actually alienating "Westerners" by serving what they can serve, I kindly suggest that you re-evaluate exactly what prompted to think that way.  The memo is to let the passengers know that you will receive what they give you, in a bento box container.   Also, these meals are not part of their vacation package from Princess Cruises.

5 hours ago, perditax said:

The CDC is a US organization and the letter is addressed at the top to US passengers.

Basically, most US based cruise ships work with CDC and routinely follow their recommendations/laws in guiding their actions regarding health and safety onboard.  So CDC is their "go to" agency on this matter, and CDC regulates the health and safety aspects of these cruise ships.  In "usual circumstances" they only work with CDC.  In this case, it would have been much better if the letter came from WHO or jointly from WHO and CDC (and possibly Japanese Health Ministry), but I think getting things like that organized is never easy (beaurocracy!!!).  But regardless of where the letter came from, I highly doubt CDC is running this particular operation by themselves, and I would think just "evacuating" just American citizens would be a good idea, either medically or for Princess.

Also, from what I am starting to understand, there is a significant contingent of passengers and their families who grew to mistrust the Japanese government and WHO, who is running the quarantine, and it is very possible that a letter coming from CDC with a signature from a US official may give a level of comfort to those who mistrust the system.  I'm not saying everyone who mistrust the system are ignorant/racist.  I think we all get a bit testy when we are under enormous stress like this. 

15 minutes ago, Stateroom_Sailor said:

 

I don't think you're understanding the situation.  We have sick people onboard not being tested, or removed.   At least up until the crew stopped prepping the food, there was mass exposure (5 food handlers taken off the ship).  We don't know how airborne this is, but it is most certainly transmissible from droplets off verandas, or walking around on deck.  We have one quarantine officer who got inflected with mask and gloves.  Someone on the ship could be contaminated tomorrow or next week for the first time.  The ship is the quarantine.  No one should be let go on the 19th unless they've already recovered, and no longer contagious.

I'm not on board Diamond Princess,  and I am not privy to all of the information regarding all of the passengers/crew onboard, but if there is a very good evidence that more people were newly exposed and infected (these are two different things, by the way) by this virus after the quarantine started, they may have to first consider extending the quarantine.  Just testing everyone (and yes, even those who recovered from the illness) for the virus, not just the antibody against it (since a typical coronavirus is known to often re-infect the same person without a huge mutation), is neither feasible or even reliable, since there will be enough false positive results when we test that many people with low pre-test probability...and there is bound to be a lot of false negative results if the person is just infected...but I'm using too many medical jargons.

13 minutes ago, kathy49 said:

i just hope plans are in the works to test each and every one that leaves the ship...they will be disbursing all over the world and are coming from the second largest concentration of reported cases. This cannot happen without definitive testing.

The hole point of quarantine is to keep those who might  be infected (everyone on Diamond Princess, in this example) on quarantine for at least the length of incubation period, then decide what to do.  Obviously, we don't know the exact incubation period or the interpersonal variations of it, I don't think testing all 3,600 people is absolutely necessary or feasible as long as the quarantine is done properly.

4 hours ago, Kmkub said:

A quarantine for the good of the entire planet. 

Thanks for correcting a rather xenophobic comment.

I'm sure many of you understanding how quarantine works, but...

The purpose of the quarantine is to protect the outside world from the pathogen.  That's the primary goal of quarantine. Technically, there's no intended benefit to the person inside the quarantine.

In the case of Diamond Princess, there is the primary quarantine (which is the whole ship), and secondary semi-quarantine where occupants of every cabin are (the best they can) quarantined from occupants from every other cabin on the ship.  The crew are not as protected.

Just now, Aus Traveller said:

Going on what happened with the Westerdam, Guam would not have accepted the Diamond Princess.

I was saying that if the US passengers wanted to be repatriated, they could have asked Guam to let them disembark there, but that became impossible.  I'm not sure about the time line, and that's not my point.  My point is that the point of quarantine is not just to protect Japan.

2 minutes ago, bluesea321 said:

 

That is not correct.

"Below decks, the situation is different. There, hundreds of crew members are eating, living and working elbow to elbow as they try to keep life as comfortable as possible for those above. They line up for simple buffet meals and then sit down together to eat. Bathrooms are shared by up to four people, and cabins often by two."

https://www.nytimes.com/2020/02/10/business/coronavirus-japan-cruise-ship.html

Actually, you are both right.  The entire ship, with both the passengers and the crew are quarantined from the rest of the world.  Also, there is a secondary measure, passengers in individual cabins are quarantined (the best they can) from passengers from other cabins.

9 minutes ago, kent9xxx1 said:

so why didn’t it provide assistance to the Westerdam being one of the few countries nearby that can provide assistance?  

What Westerdam needs is a port that is open, so that their passengers can disembark and can go home, obviously it does not need a quarantine.  I am not sure what other assistance Westerdam need.  Obviously, if they were in fact running out of fuel and food, and if they were in Japanese waters, the Japanese government would have done something to help them.

35 minutes ago, kent9xxx1 said:

And a service to their own citizens as well.  
 

Japan promptly turned away the next ship.  My own cynicism, but likely due to not many Japanese on that one.  
 

 

 

36 minutes ago, cruiserchuck said:

 

I think Japan is doing it in part because half the passengers on board are from Japan.  

I don't think these comments should be allowed in a civilized society, but that's just my opinion.

10 minutes ago, ceilidh1 said:

Right - I get that piece. BUT if passengers were tested on day 1 and found to be clear then does that mean that they would have been safe to disembark? Let's assume they had the ability and means to test each and every passenger...would that have been enough to say they did not have the virus? OR would it have been pointless to test day 1 since the virus may or may not show at that point? We have seen cases where the virus has been found but there have been no symptoms, so could it have been found (or not) before the quarantine started?

 

Just curious, that's all.....and this is the question I would be asking if I was on that ship right now...

In most viral tests, the sensitivity of the test goes up as the viral load goes up, so the chance of false negative results on someone infected on day 0, tested on day 1, for example would be very high.  Also, in a more "modern" definition of incubation period, it could be between exposure and becoming "infectious" (which has its own sets of different definitions) or between exposure and testing positive on a test (in some instances).  I was just quoting the most classic definition of incubation period.  Also, there is a difference between exposure and actual infection.

13 minutes ago, kent9xxx1 said:

And a service to their own citizens as well.  
 

Japan promptly turned away the next ship.  My own cynicism, but likely due to not many Japanese on that one.  
 

Anyway, fresh news, Beijing and Shanghai are imposing partial lock down today.  Those are big cities.  Mask is a must.  
Tiny ship, mask is not a must.  You see where this is going.  

 

https://www.scmp.com/news/china/society/article/3049891/beijing-and-shanghai-impose-new-controls-residents-china-battles

 

 

Japan closed their ports to international cruises, but it's not like they made an exception for Diamond Princess.  They did not welcome Diamond Princess to disembark.  They are providing assistance in Japanese waters because it is the right thing to do, and it is one of the few countries nearby that can provide this kind of assistance.  I wonder, in your opinion, what should the Japanese government have done to prove that it is not giving Diamond Princess any preferential treatment?

1 hour ago, ed01106 said:

The point of the quarantine is to protect Japan. 

This is not true.  If Japan wanted to just "protect Japan," they could have just given Diamond Princess more fuel and asked the ship to get the heck out of the Japanese waters.  The quarantine is to protect the rest of the world, not just Japan.  For that matter, they could have just asked them to go to Guam or somewhere and have them deal with the problem.  Despite your assumption, Japan is doing this as a service to the international community.