Diamond Princess passenger "tested positive for Wuhan coronavirus"

[hal2008]

22 minutes ago, bluesea321 said:

The number of infected on the Diamond has now been raised to 691 with 3 deaths.  This likely includes newly diagnosed crew members.

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

 

Most of them are crew members who have been requesting to get better protection for many days.

Whoever is left on the ship needs to be put in hotels or military camps - just get them off that ship.

 

If country like combodia can test 2000 people in 2-3 days, why is Japan struggling after 17 days?

What role Princess is playing (if any) in advocating on behalf of its emplyees?

Edited February 23, 2020 by hal2008

[hal2008]

5 hours ago, npcl said:

The representative from State are also professionals, just a different category of professional.  It is State not CDC that would have negotiated the departure agreement.  It is State not CDC that bears any responsibility for failing to live up to that agreement.  I would expect that CDC would have, in consultation with State, approved the departure list.  In hind sight maybe they should have only included on the list those that had already tested negative (keeping in mind that not all of those tests were recent), but they did not.  However, the agreement was for anyone that wanted to leave that had not tested positive and the planes manifest was established using that criteria.

 

They could have delayed taking anyone, until test results were back for everyone.  Of course that did not occur until the quarantine was over and people were being released from the ship.

 

As the saying goes no good deed goes unpunished.

 

They are NOT medical professional.

CDC decision to not carry infacted pax behind a plasytic curtain should not have been overruled by these non-medical State department people.

 

It was NOT a good deed. It was a boneheaded deed.

 

Japan wud not have agreed to take these 14 people to hospitals (in spoite of them having done hundreds before and after) because paperwork was done is as weak an argument one can make.

[kathy49]

5 minutes ago, hal2008 said:

 

They are NOT medical professional.

CDC decision to not carry infacted pax behind a plasytic curtain should not have been overruled by these non-medical State department people.

 

It was NOT a good deed. It was a boneheaded deed.

 

Japan wud not have agreed to take these 14 people to hospitals (in spoite of them having done hundreds before and after) because paperwork was done is as weak an argument one can make.

to be honest that is 14 less cases reported for Japan...no country wants even one more reported...it is toxic...not just physically but for their economy....Tokyo has summer Olympics coming up as well as thousands for trade fairs to say nothing of just tourism...

[npcl]

6 minutes ago, hal2008 said:

 

They are NOT medical professional.

CDC decision to not carry infacted pax behind a plasytic curtain should not have been overruled by these non-medical State department people.

 

It was NOT a good deed. It was a boneheaded deed.

 

Japan wud not have agreed to take these 14 people to hospitals (in spoite of them having done hundreds before and after) because paperwork was done is as weak an argument one can make.

If it was just a disagreement between government departments you would have both departments holding news conferences detailing their logic.  In this case the only thing you hear is that State over ruled CDC.  Which State would not do on a whim.  The reason why you do not hear any details on that discussion is because it involved Japan and the agreement with Japan.  State certainly will not talk about it because it involves Japan and the nature of that disagreement would have a negative impact on our relationship with Japan.

 

Now I spent 8 years on a committee that involved negotiations between the US, the EU and Japan. What is your experience that results in your determination that the decision was made by someone in State on a power trip.

[npcl]

12 minutes ago, hal2008 said:

 

They are NOT medical professional.

CDC decision to not carry infacted pax behind a plasytic curtain should not have been overruled by these non-medical State department people.

 

It was NOT a good deed. It was a boneheaded deed.

 

Japan wud not have agreed to take these 14 people to hospitals (in spoite of them having done hundreds before and after) because paperwork was done is as weak an argument one can make.

One other things is while State made the decision to transport them, CDC is the group that would have made the decision on how, including separating off the cabin using the plastic curtain.

[dog]

11 hours ago, kathy49 said:

Because I have been following their facebook https://www.facebook.com/khtsradio/?__tn__=%2CdkC-R&eid=ARDdJloVT_d1DdN91oRpBGD4fuyXCRfoDZtxdr6z9IEyawJeU-dBgYtMOLMJ777EqAwJx20hI-QrRVpp&hc_ref=ARQKjZDTXs24ldZ-lbK25AIy_Cm4vC7n4Pu1RbnGQgOyDN3k3M6WnN91lUMvxXoVJIQ

 

It is all there. They even joked about the masks.....the spouses have not tested positive yet and hopefully they do not...

Carl says in his blog his wife is negative, but Jeri in Japan hospital has tested positive for the virus again. He sounds like he is getting excellent care in Omaha. 

[JennAngel9]

NPCL-- I appreciate your extended explanation, sounds like they would have been much better off if they listened to you-- though I also think they should have tried the meal prep system (that they eventually landed on) much earlier-- no later than when the crew started testing positive.

I recall a week or two ago someone shared a cute video of the crew dancing in the kitchen thinking "the people in charge on board have no idea how contagious this is or how important it is to make every effort to avoid cross contamination."

Please note I do NOT blame the crew, but especially with video conferencing technology being what it is, they should have had more monitoring and guidance and strategy coming from docs who had experience in controlling flu outbreaks as well as the implications for disease spread when you can be an asymptomatic transmitter for 10+ days.

[npcl]

37 minutes ago, JennAngel9 said:

NPCL-- I appreciate your extended explanation, sounds like they would have been much better off if they listened to you-- though I also think they should have tried the meal prep system (that they eventually landed on) much earlier-- no later than when the crew started testing positive.

I recall a week or two ago someone shared a cute video of the crew dancing in the kitchen thinking "the people in charge on board have no idea how contagious this is or how important it is to make every effort to avoid cross contamination."

Please note I do NOT blame the crew, but especially with video conferencing technology being what it is, they should have had more monitoring and guidance and strategy coming from docs who had experience in controlling flu outbreaks as well as the implications for disease spread when you can be an asymptomatic transmitter for 10+ days.

Keep in mind that a cruise ship is about as much of a worst case scenario that one can find. At least it wasn't Ebola which would have been truly worst case.

 

I really think that no one thought that it would spread that quickly on the ship.  I know I was thinking maybe 150 cases, not 600.

 

Maybe after this outbreak countries will be better prepared. 

 

I think they are going to outside meal prep to put as many of the crew in isolation during the next stage. 

Edited February 24, 2020 by npcl

[ceilidh1]

2 hours ago, npcl said:

No I don't think he is lying.  I put the difference down to what an academic would expect, in a hospital setting, where you have a clean area to start and you can designate red and green areas.  With the cruise ship, they were starting with a ship that already had the virus present, for several days.  There is no effective way to guarantee a virus proof area.  For all practical purposes the entire ship was a red area.  What he was pointing out was pretty obvious, but it was also what happens when you have to make the best of a real world situation.

 

The medical staff though should not have been continuing to see passengers.  That is where I would have, either the Japanese or Princess, used out side staff with a tent medical facility either just inside or outside of the gangway area.

 

As far as spreading certainly in  those not isolated  (the crew). The data shown in the report I listed early would tend to show that it was not spreading among passengers that did not have a cabin mate develop disease.  One thing about the data once someone develops the illness it does not seem to go away quickly.  Even mean time to death is 2 weeks after symptoms develop. So a asymptomatic person could develop in the first 14 days and continue to carry the virus for weeks. 

 

You have over 2000 passengers that completed the quarantine several days ago.  Out of that 2000 you have one that has now tested positive, and that person was one of the 23 that had received their negative test fairly early and due to an administrative screw up was not properly retested at the end of the quarantine.  At this time the ones that finished quarantine have a substantially better numbers than the ones that left and went back to their home countries.

 

I will point out that the ones that are now testing positive are those that did not finish the quarantine period. That were transferred off of the ship before the end of the period.  Many of them had negative tests, but considering that MHW did not complete the final round of tests until after the quarantine period  we do not know if their negatives were early,  middle or late.  Also there are some that were offered the ability to leave, even with a cabin mate showing positive just before departure.

 

As far as the Japanese health workers, that is the risk anytime people enter an area like the cruise ship.  That is why the Japanese limited movement back and forth and why food prep was done on board, and why crew, even though not individually isolated was used.

 

From my background there are a few things that I would have done differently.

 

1. Once Corona Virus is confirmed on board remove people based upon symptoms and save the initial limited testing capacity, though move to build up capacity (I am very interested in what the Pasteur Institute did in Cambodia.  Though pretty well known and very active in viral research they are still a fairly small lab with limited capabilities so how they pulled off that many tests for a new virus is pretty impressive)

2. In addition to the passenger Cohort 1,

I would split the crew into 3 Cohorts. 

3A. those crew that are necessary for the operation of the ship and cannot be isolated.

3B. Those that are needed to run passenger facing services such as food prep and food delivery.  I would do what ever is possible to isolate that group as much as possible from other crew.  If necessary putting beds into public spaces and feed them out of the passenger food prep areas. I would use the limited initial testing on this group. I would also require this group to be substantially monitored for both proper use of safety equipment as well as any indications of symptoms.

3C. Take those crew that are not necessary for ship operation and also isolate them as much as possible, considering the much tighter quarters and shared bathrooms between each two cabins.  It should be possible to provide some degree. 

 

Focus on cleaning the the kitchen and other areas used to support the passengers and make it as virus free as possible.

 

Set up a NBC decontamination facility  at the entrance to the entrance to the ship (the Japanese Defense force does have CBD units).  Anyone entering or leaving the ship must wear full gear and go through decon procedure. This was probably not done because it would send a rather frightening message.  Any that entered the ship would need to stay in their own quarantine facility. Trailers next to ship, also could be handled by JDF.

 

As more testing because available then start testing those in the High Risk groups based upon age and pre-existing conditions. 

 

At day 14 do full testing of everyone in Cohort 1.  Any that are asymptomatic at that time that test positive get removed, any sharing a cabin would be moved to Cohort 2 for additional quarantine. At day 16 second round of testing.  If negative on both sets and still in Cohort 1 release.

 

By this time you will have removed most of the passengers, you would have crew relatively isolated, but not enough to avoid second quarantine round (depending upon the actual number of symptoms and testing). At this time you can clean the passenger cabins hard surfaces and replace linens and towels and then put each crew member in their own cabin.  You would still need 3A to run the ship, 3B can be reduced in size and place the expanded 3C in the same isolation that the passengers were in.

As a bystander with VERY limited medical knowledge...I have one question. Would you have recommended that governments step in asap and got all of their people off (as is happening now) and quarantined them on land? I realise this is a huge undertaking, but can't help still feeling this would have been a better solution....

 

[npcl]

25 minutes ago, ceilidh1 said:

As a bystander with VERY limited medical knowledge...I have one question. Would you have recommended that governments step in asap and got all of their people off (as is happening now) and quarantined them on land? I realise this is a huge undertaking, but can't help still feeling this would have been a better solution....

 

no I would not have. at the time this started not enough capacity existed. The US had around 500 when this started, but it was filled with evacuees from wuhan. when the groups from wuhan were released the passengers from the diamond moved into that space. Japan was not ready for it nearly 2000 passengers. 

 

Look how complex the transfer was, with a number of issues, 10 days into it.

 

 

[ceilidh1]

8 minutes ago, npcl said:

no I would not have. at the time this started not enough capacity existed. The US had around 500 when this started, but it was filled with evacuees from wuhan. when the groups from wuhan were released the passengers from the diamond moved into that space. Japan was not ready for it nearly 2000 passengers. 

 

Look how complex the transfer was, with a number of issues, 10 days into it.

 

 

Thank you. As I say, I have very limited knowledge in this field but it pains me to see what these people endured and are still having to deal with. I 100% get the notion of the good of the many over the few....but, at the end of the day, they are still someone's parents/children/siblings...

 

From my own standpoint, I cruise in 2 weeks. Only Mexico. I have no worries about getting sick. I DO have concerns about someone else on my ship getting sick (and it only takes one) and resulting in my life being turned upside down...

[fragilek]

1 hour ago, rickays said:

 

I think people are confusing testing (as per a lab test) and screening (as per temp & illness screening)  Westerdam passengers were not lab tested before the initial passengers left Cambodia, only the remaining passengers and crew had lab tests.  I think, not all Diamond Princess passengers that were evacuated by different countries actually had a lab test but only had screening, that could be why some are now having lab tests and coming up positive.

 

See below

 

https://worldmaritimenews.com/archives/291186/cambodia-781-westerdam-passengers-test-negative-for-coronavirus/

        Westerdam was allowed to dock in Cambodia on February 13 after it had been banned from several other   ports due to the coronavirus threat. Prior to arrival in Sihanoukville, all 2,257 passengers and crew were screened for illness including the taking of individual temperatures. No individual at that time was identified with an elevated temperature. On February 14, Westerdam received clearance to begin disembarkation.

All UK Hk and Aus had to have an actual test that was negative before being allowed to board. At least 10 have been retested on arrival home and are now positive. I have been following a few on twitter while they awaited results and they all knew a negative was a condition of being allowed on their repatriation flights.

I do not know about others except that us did not require testing

[Pushka]

Raised on another forum. Did one of the Quarantine officers testing positive develop the illness between Feb 3 and 6 then take it back onboard from the 19th onwards. Sorry, no source other than the poster seems to have interesting and Accurate info so far. 

[phil the brit]

13 hours ago, npcl said:

The representative from State are also professionals, just a different category of professional.  It is State not CDC that would have negotiated the departure agreement.  It is State not CDC that bears any responsibility for failing to live up to that agreement.  I would expect that CDC would have, in consultation with State, approved the departure list.  In hind sight maybe they should have only included on the list those that had already tested negative (keeping in mind that not all of those tests were recent), but they did not.  However, the agreement was for anyone that wanted to leave that had not tested positive and the planes manifest was established using that criteria.

 

They could have delayed taking anyone, until test results were back for everyone.  Of course that did not occur until the quarantine was over and people were being released from the ship.

 

As the saying goes no good deed goes unpunished.

 

Please explain whose good deed you are talking about.

[phil the brit]

8 hours ago, npcl said:

If it was just a disagreement between government departments you would have both departments holding news conferences detailing their logic.  In this case the only thing you hear is that State over ruled CDC.  Which State would not do on a whim.  The reason why you do not hear any details on that discussion is because it involved Japan and the agreement with Japan.  State certainly will not talk about it because it involves Japan and the nature of that disagreement would have a negative impact on our relationship with Japan.

 

Now I spent 8 years on a committee that involved negotiations between the US, the EU and Japan. What is your experience that results in your determination that the decision was made by someone in State on a power trip.

 

So you are saying the bureaucrats at the state department risked the lives of the negative results people coming home to USA on repatriation flight for political reasons so as not to destroy US relationship with Japan?

Do me a favour, are you for real?

[seapals2]

As expected confirmed cases are now mostly crew bringing the total to 691 

 

Those crew who have tested negative to be allowed home.  Surely this can’t be true .. some crew may just not have started to show symptoms.  Up until they went into isolation they would have had contact with infected crew.  The quarantine period should have started at day 1 for them at that point.  
 

https://www3.nhk.or.jp/nhkworld/en/news/20200223_35/

 

[seapals2]

 

https://worldmaritimenews.com/archives/291436/diamond-princess-crew-allowed-to-return-home-as-coronavirus-claims-3rd-life-in-japan/

 

 

[fragilek]

Just now, seapals2 said:

 

https://worldmaritimenews.com/archives/291436/diamond-princess-crew-allowed-to-return-home-as-coronavirus-claims-3rd-life-in-japan/

 

 

May be next phase of quarantine now seen as something their home countries need to deal with. Not sure any commercial airline will be too happy to fly them.

Need to watch and see I suppose , just hoping mo more strange descion are made.

 

[seapals2]

Likely they can not get staff to continue the services necessary to maintain the crew in isolation.  Even if food is prepared land side someone would need to deliver it to hundreds of crew now in their balcony cabins.  Waste would need to be taken away.  

 

We have not seen the ship move from it’s dock for over a week.  So what’s happening to the essential work that initially was reported to be needed with the ship at sea.  
All toilet waste must be considered infected.  How is that being dealt with.  
 

[chengkp75]

43 minutes ago, seapals2 said:

All toilet waste must be considered infected.  How is that being dealt with.

How do you think that toilet waste in a land quarantine is "dealt with"?  Just the same as the sewage from the rest of the facility where the quarantine is located, and the rest of the sewage from the city where the facility is located.  It is treated.  The ship has onboard treatment facilities, most ships have waste water systems that treat the water to near fresh drinking water standards, and that incinerate the sludge remaining.

[seapals2]

It cant really be considered in the same way as city waste .. have you never seen a blocked toilet being sorted ... or a ‘wet’ patch resulting from pipe work.  No .. it’s entirely different when onboard a ship.  Initially we were told the ship had to go out to sea to desalinate water and deal with waste.  This is a floating mini city not connected to land sewerage systems.  There must be miles of pipe work which will need thorough cleaning and testing.  

[chengkp75]

28 minutes ago, seapals2 said:

It cant really be considered in the same way as city waste .. have you never seen a blocked toilet being sorted ... or a ‘wet’ patch resulting from pipe work.  No .. it’s entirely different when onboard a ship.  Initially we were told the ship had to go out to sea to desalinate water and deal with waste.  This is a floating mini city not connected to land sewerage systems.  There must be miles of pipe work which will need thorough cleaning and testing.  

Having worked for 45 years as an engineer on ships, I know what is different and what is the same between ships and shore.  I've done my fair share of unblocking ship's toilets, and if there were a "wet spot" in a carpet, the carpet could be replaced.  And a blockage in a land based high rise would result in more overflow than a ship's system, since the ship's toilet has a valve between the toilet bowl and the piping system, while a land toilet does not, and a blockage on the floor below would result in everything from the floors above pouring out of the toilet.  You've never had a toilet overflow on land?

 

Secondly, unlike land sewage systems, where everything is common (sinks, showers, baths, toilets), the toilets on a ship are a completely separate system from the "gray water" drains (sinks, showers, laundry, galley, deck drains).

 

The ship has a waste treatment plant that is typically better than most municipalities.  Most ports will allow treated sewage from ships to be discharged into the water, some don't, so ships also have the ability to store treated sewage onboard.  There is also piping for the ship to be able to discharge either treated or untreated sewage to land facilities (most commonly directly into the port's sewers) via hose.

 

Yes, the ship needs to be at sea to desalinate water, but that is merely a cost decision.  The ship is perfectly capable of taking water from the port's municipal supply, and sanitizing it to international standards for use onboard.

 

Would a hospital that has an infectious disease ward on the third floor need to clean and test their sewage piping after a quarantine for some outbreak?  You and I both know they don't.

[chengkp75]

5 minutes ago, phil the brit said:

Any thoughts on this about quarantined cruise ship toilet system..............

 

https://pubsonline.informs.org/do/10.1287/orms.2020.02.01/full/

And, as noted, the infection was believed to be transmitted because of breaks in the plumbing system that allowed vapors to escape the piping.  This can happen on a defective land based system, where the sewage drain piping also acts as the system vent piping, to allow air to follow the sewage down the pipe.  A ship's toilet system, as most anyone who has been on a cruise ship knows, is different, just from the noise it makes.  The entire piping system is under a vacuum, so any break in the system will have air flow into the piping system, not out, and there is no "vent" function to the waste piping, or that would defeat the vacuum in the piping.  A break in the piping as was found in Hong Kong would result in loss of toilet function for a large section of the ship, and would result in immediate repair to get the toilets working again, while the toilets in Hong Kong continued to function perfectly well, even with a break in the piping.

 

The speculation with regards to cruise ships shows that this person does not have a knowledge of shipboard systems, nor of plumbing systems in general.  To say that floor drains do not have an S-trap like shore drains is foolish, every one of them does, for the same reason, to keep gases from backing up.  And, again, they fail to understand that the "black water" (toilet) system is completely segregated from the "gray water" (all other sewage drains) on a ship.  He also blames AC systems, seeming to have a former head of WHO agree, when in fact the expert quoted makes absolutely no mention of the AC systems, only the tight confinement of people.

 

And, finally, really?  Farting can spread the virus?

[mayleeman]

1 hour ago, chengkp75 said:

The speculation with regards to cruise ships shows that this person does not have a knowledge of shipboard systems, nor of plumbing systems in general. 

 

It is enlightening to read your posts.

 

So many others, like the author of that article, start out with "I'm not an expert, but...." and then go on to prove they aren't. 

 

Half of the posts on this thread are efforts to correct misinformation. Thank you for having the patience to continue to do so. 

[npcl]

6 hours ago, phil the brit said:

 

Please explain whose good deed you are talking 

5 hours ago, phil the brit said:

 

So you are saying the bureaucrats at the state department risked the lives of the negative results people coming home to USA on repatriation flight for political reasons so as not to destroy US relationship with Japan?

Do me a favour, are you for real?

 

what I am saying is that there was an agreement with the japanese. there was a list developed and agreed to. Custody was transferred from the Japanesr to the US. At that point it is a problem for the US to deal with. Leaving them there would have required the Japanese to allow the transfer of custody back to Japan. So at that point the choices were 1. get Japan to accept custody and leave them there 2. transport them back to the US 3. get another plane to put them on.  The choice taken was 2 with as much separation as possible.

 

Item 1 would have needed Japans approval and would have ment the US failing to live up to its side of the agreement, which ment taking all of the passengers on the agreed upon list. 

 

As far as risk to the other passengers they had already spent several hours intermixed with those same passengers in very close quarters on the buses. At least on the planes they were somewhat isolated. Separated from the other passengers by at least 6 feet and plastic sheeting. So while there might be some air flow it was not direct, no direct contact, and sufficient distance to avoid direct droplet transmission. None of which can be said for the time already spent on the busses.