Thousands of tourists were kept in a coronavirus ‘incubator’ during a ‘failed’ cruise ship quarantine which should never have taken place, experts have said, after more than 500 people were infected during the two-week lockdown.
Scientists have lined up to savage Japan’s efforts after another 88 people on the Diamond Princess tested positive today, bringing the total to 542.
One expert said boats were ‘notorious places for being incubators for viruses’ as he bemoaned Japan’s failure to take the passengers off the ship from the start.
‘It’s only morally justified to keep people on the boat if there are no other options,’ said Arthur Caplan of the New York University School of Medicine.
The new patients include British couple David and Sally Abel, whose son Steve today lashed out at the UK government for its handling of the case.
Steve Abel said his parents were ‘feeling very unloved’ and ‘not getting any communication’ from the Foreign Office despite repeated pleas for help.
Mr and Mrs Abel are now being taken into a further quarantine on the mainland just a day before their stay on the cruise liner was due to end.
The Abels will also be unable to join an evacuation flight which the British embassy is preparing today, amid growing pressure after the US evacuated 340 of its citizens.
Steve Abel urged the Foreign Office to rescue his parents despite the positive test but officials have already quashed those hopes.
‘We are ensuring those who have been diagnosed with coronavirus receive the best possible care in Japan and are organising a flight back to the UK for other British nationals on the Diamond Princess as soon as possible,’ an FCO spokesman said.
The couple’s son also joined scientists in blasting the ‘failure’ of Japan’s quarantine measures after the number of patients spiralled despite the two-week lockdown.
The lockdown officially ends tomorrow, but Japanese health officials expect that only around 500 passengers will leave the ship in Yokohama on Wednesday.
Any passengers who were close to virus patients will have to finish a 14-day quarantine from the date of their last contact, while Japan says it may take days to complete the departure process for the others.
British cruise ship passenger David Abel and his wife Sally (pictured in their cabin on the Diamond Princess) have tested positive for coronavirus in Japan
Steve Abel (pictured today) said his parents David and Sally Abel were ‘not getting any communication’ from Whitehall and were ‘feeling very unloved’
The Diamond Princess (pictured today) remains in lockdown and hundreds face a longer spell in quarantine even after the official incubation period ends tomorrow
Dr Anthony Fauci, director of America’s National Institute of Allergy and Infectious Diseases, told USA Today that the quarantine process had ‘failed’.
‘I’d like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship,’ he said.
‘Something went awry in the process of the quarantining on that ship. I don’t know what it was, but a lot of people got infected on that ship.’
The two-week quarantine was largely for the passengers, because crew members kept sharing double rooms with their colleagues.
They also continued to serve the guests by delivering food, letters, towels and amenities, and entering passenger cabins for cleaning.
Crew members also cooked their own food and ate in groups in a crew mess hall.
‘I suspect people were not as isolated from other people as we would have thought,’ said Dr. Paul Hunter, a professor of medicine at the University of East Anglia.
‘It’s difficult to enforce a quarantine in a ship environment and I’m absolutely sure there were some passengers who think they’re not going to let anyone tell them what they can and cannot do.’
Dr Nathalie MacDermott, an outbreak expert at King’s College London, said the ship had now become a ‘source of infection’.
‘We need to understand how the quarantine measures on board were implemented, what the air filtration on board is like, how the cabins are connected and how waste products are disposed of,’ she said.
‘There’s no reason this should not have worked if it had been done properly,’ she said.
‘There could also be another mode of transmission we’re not familiar with.’
Passengers are seen on the Diamond Princess today where a two-week lockdown is due to end tomorrow
How David Abel became Britain’s virus cruise celebrity
David Abel became the face of the Diamond Princess lockdown in early February by providing cheerful daily updates from his ninth-deck cabin.
The 74-year-old initially embraced the two-week lockdown, making light-hearted requests for a daily banana and a glass of whisky.
‘I take Talisker, 10-year-old single malt, no ice, no water. It would be fantastic if that could be arranged,’ he laughed.
His upbeat manner won him a large following on Facebook.
‘Come on folks, have a wonderful day wherever you are in the world. Keep smiling, make the best of every circumstance. Make the most of whatever life throws at you,’ he said in one video.
David and Sally Abel (pictured together) were on board the Diamond Princess
The British passenger was travelling on the ship with his wife Sally.
The couple, from Northamptonshire, planned the Japanese voyage as one of several holidays to celebrate their 50th wedding anniversary this year.
Mr Abel also used his videos to raise more serious concerns with the cruise operator, especially when he felt he was not receiving enough food.
A diabetic, Mr Abel said he would fall into a coma without proper sustenance.
The British tourist said that many of his online followers had made contact with Princess Cruises to raise the issue after seeing his videos.
The 74-year-old became a valuable source of information for the world’s media – but said he most wanted to be interviewed by ITV’s Holly Willoughby.
Although he has frequently appeared on TV shows including BBC Breakfast and ITV’s Good Morning Britain, his wish has yet to be granted.
When asked about the British Government’s treatment of his parents, Steve Abel described it as ‘appalling’.
‘They haven’t done anything,’ he told BBC Breakfast.
‘They aren’t communicating with us, the Foreign Office have my number, my wife’s number, my brother’s number, my sister’s number and they haven’t got back to us on anything and we have been calling them every day for four or five days.’
Steve Abel said he could hear his father vomiting when he spoke to his parents the phone, although he thought the sickness might be ‘shock’ rather than a virus symptom.
He added: ‘They are very high-spirited people. There are cracks in the armour and they are getting down.’
‘My mum breaks down in tears frequently, my dad is short-tempered.
‘They are not getting any communication from our country, so they are in the dark and feeling very unloved.’
Expanding his point on ITV’s This Morning, he said: ‘What I want now is for the UK authorities to still go and get them.
‘I know they tested positive but I’d like it ideally if whatever they’re going to be doing in Japan, why can’t that happen here in the UK where my dad can get the right kind of food, all the right treatments?’.
Describing conditions on the ship, Steve Abel said: ‘The quarantine in Japan has been a failure, that is obvious, so [they] are obviously going to have to go through it again.
‘I would like them to go through it here where the food is more suitable for my dad.’
He added: ‘I’m not actually that worried about the virus – looking at the recovery stats. It is more about the stress, the diet.
‘The recovery rate is actually quite good, but he’s type 2 diabetic, insulin dependent, and he’s also got a tooth infection.
‘I’ve had messages from people all over the world who are concerned, saying this is more serious than the virus itself for him, having an infection and being diabetic at the same time.’
Clothes hang out to dry on a balcony of the Diamond Princess where passengers have been confined to their cabins for two weeks
An angler fishes close to the Diamond Princess cruise ship, which has around 3,000 people quarantined onboard
David Abel earlier revealed the couple’s diagnosis on Facebook, where he has been providing regular updates from on board the ship but now expects a ‘time of quiet’.
‘We have been proved positive and leaving for hospital soon. Blessings all,’ the 74-year-old said.
In the last of his regular Facebook videos, Mr Abel had said he was ‘confident we will test negative’ after medics screened the couple for the virus.
After receiving his test results, Mr Abel initially said the pair were heading for hospital but later said they were destined for a ‘hostel’.
‘That’s where partners are sent waiting out their quarantine. No phone, no wi-fi and no medical facilities,’ he claimed.
Mr Abel had also been leading calls for London to organise a rescue flight after the US pulled out its citizens and other countries lined up similar flights.
After growing frustration from British passengers, the UK embassy in Tokyo said today it was hastily making arrangements to repatriate them.
‘Given the conditions on board, we are working to organise a flight back to the UK for British nationals on the Diamond Princess as soon as possible,’ the embassy said.
‘Our staff are contacting British nationals on board to make the necessary arrangements.’
Virgin supremo Richard Branson had said his company was ‘in discussions’ with the Government over whether he could help those stranded.
Liberal Democrat acting leader Ed Davey condemned the government for a ‘lack of support’ for UK citizens which he said was making Britain a ‘global laughing stock’.
‘While other countries seem ready and able to act for their people, our ministers have been caught napping and left British citizens stuck in limbo for weeks, with no idea when they will be able to get home,’ he said.
‘As soon as it was clear that people could be repatriated, ministers should have acted as the US did on Sunday.’
Japanese authorities confirmed another 88 cases today, bringing the total on the ship to 542 out of 2,404 people who have been tested.
Sixty-five of those who tested positive were not yet showing symptoms.
Some 169 people had tested positive in the previous two days, meaning that the total has almost doubled in the last 72 hours.
A bus carrying US citizens leaves the Daikaku Pier Cruise Terminal in Yokohama port early yesterday after Washington organised an airlift
Nearly 3,000 people are still on board the Diamond Princess and were told that their quarantine would end on February 19, which is tomorrow.
The captain told passengers today that disembarkation would begin at around 10.30am local time on Wednesday.
However, Japanese health minister Katsunobu Kato said the process of leaving the ship would last two to three days.
‘We have done tests for everyone’ on board the ship, he told reporters.
‘Some results have already come out… and for those whose test results are already clear, we are working to prepare disembarkation from the 19th,’ he said.
Many disembarking will be Japanese passengers, a health ministry official said.
‘They will go home on public transport but they will be taken by bus to places such as stations,’ he added.
Those who leave the ship will not face any restrictions, the official said. ‘They won’t be forbidden to go out.’
But not all those who have tested negative will be getting off immediately because several countries have said they will evacuate their citizens from the ship, and many of those being offered repatriation are likely to stay on board until evacuation flights arrive.
In a letter sent to passengers, authorities explained that some test results would take time to process and that therefore ‘we plan the disembarkation to take place from February 19 to 21’.
‘If you and your roommate are both negative and have no fever of respiratory symptoms, you will be able to prepare for disembarkation,’ the letter said.
However, passengers were informed that ‘not everyone may be offered a chance to disembark before the end of the quarantine period’.
Passengers who had close contact with the more than 450 virus patients on board will have to finish a 14-day quarantine from the date they last saw them.
The ship’s crew, many of whom have been supervising guests and delivering food, are also expected to observe another quarantine after the last guests have left.
Medical staff wearing protective suits are seen at Daikoku Pier Cruise Terminal where the Diamond Princess is anchored
US passengers wearing masks look out from the window of a coach which took them from the Yokohama port to an airport from which they flew across the Pacific
Mr and Mrs Abel were among 3,711 people taken into quarantine when the ship arrived in Yokohama two weeks ago.
Mr Abel quickly won praise for his good-humoured Facebook videos which became a valuable source of information for the world’s media.
Japanese authorities ordered medical tests after an 80-year-old passenger who left the ship in Hong Kong last month was found to have the virus.
Passengers have been confined to their cabins amid a spiralling number of cases which has sparked growing criticism of Japanese authorities.
More than 1,800 people have now been screened for the virus on the Diamond Princess with more than 400 of them testing positive.
As a result, the cruise liner is now the largest cluster of virus cases outside mainland China.
Another Briton, Alan Steele, was separated from his wife Wendy and taken off the ship ten days ago after testing positive for the virus.
A total of 78 Britons were on board the ship when it was taken into quarantine, it is believed.
More than 300 Americans were evacuated from the ship early on Monday, among them over a dozen who have tested positive for the virus.
The evacuees are now facing another 14-day quarantine after they landed in North America yesterday.
The two British tourists are among 169 people confirmed to have the virus over the last 48 hours, taking the total on board the Diamond Princess (pictured) to more than 500
Canada said today it had ‘secured a chartered flight to repatriate Canadians on board the Diamond Princess’ but gave no further details.
There were 256 Canadians on board the ship, with 32 so far testing positive for the virus.
South Korea will send a presidential aircraft on Tuesday to fly back four nationals and one Japanese spouse, an official told reporters.
There are 14 South Koreans on board in total, but the other ten have declined to be evacuated because they live in Japan, the Yonhap news agency reported.
While foreign governments have couched their decision to remove citizens as an attempt to reduce the burden on Japanese authorities, many have interpreted the evacuations as criticism of Tokyo’s handling of the situation.
The US and Australia have told citizens that if they decline repatriation and an additional 14-day quarantine, they will not be allowed home for at least two weeks, suggesting they do not believe the ship-based quarantine has worked.
Experts say that cruise ships are vulnerable to the spread of viruses because of the high number of elderly passengers who are confined together.
A study by the Chinese Centre for Disease Control and Prevention has found that the elderly and sick are most at risk from the virus.
In addition, passengers who have shelled out large sums of money for a holiday may not want to flag up their medical problems and jeopardise their trips.
Health officials in protective suits on a shuttle bus transporting U.S. passengers who have chosen to leave the Diamond Princess cruise ship
There are nearly 3,000 people on board the Diamond Princess, which has been held at a port near Yokohama, Japan, since February 3 with passengers not allowed to leave
Japan has also confirmed at least 65 cases domestically, including many involving people with no history of recent travel to China.
Authorities have said the virus is being transmitted locally now, and have asked citizens to avoid crowds and non-essential gatherings.
On Monday, the amateur portion of the Tokyo Marathon, which had been expected to attract some 38,000 runners, was cancelled. Only elite athletes will now be able to take part.
The public celebration for Emperor Naruhito’s birthday has also been scrapped over virus fears.
The coronavirus outbreak has killed more than 1,800 people in total with nearly 72,500 people confirmed to have the virus.
The official death toll in China hit 1,868 today after another 98 people died, mostly in Wuhan and the surrounding province of Hubei.
Five people have died outside mainland China – in France, Japan, the Philippines, Taiwan and Hong Kong.
The virus is believed to have emerged in a market selling wild animals in Wuhan last year before spreading across China.
Why the Diamond Princess cruise ship is the ‘perfect breeding ground’ for coronavirus: Experts reveal how mix of elderly passengers in cramped conditions breathing ventilated air is ‘haven’ for contagious bugs to spread
By Sam Blanchard, Senior Health Reporter for MailOnline
Infections are known to be able to spread easily on cruise ships because the boats have large numbers of people cooped up in a relatively small space and using the same facilities for days or weeks on end.
This raises the risk of a passenger getting close to someone who is already infected with a virus, whereas on land they may only pass them in the street.
More than 3,000 holidaymakers and crew members are still in quarantine on-board the Diamond Princess and all are expected to face further quarantine when they are finally let off
Past research has found that holidaymakers on-board cruise ships are less likely to maintain good hand hygiene or isolate themselves in their rooms if they become ill.
This is particularly problematic when it comes to viruses like the coronavirus which infect the lungs and spread on someone’s breath or by coughing and sneezing.
Dr Jimmy Whitworth, a disease expert at the London School of Hygiene and Tropical Medicine, told MailOnline: ‘Obviously keeping all the people in one place increases the risk for them.
‘Cruise ships are crowded and people are very close to each other. This is a respiratory virus so it’s going to be spreading by droplet spread [breathing/coughing], close contact and contaminated surfaces about the place.
‘This virus is highly transmissible and is tough to control in this circumstance. It was worth a go [the ship quarantine] but it’s simply not worked.’
The cruise ship has been held at the port near Tokyo since February 3, when it emerged that a passenger who got off in Hong Kong had been diagnosed with the virus
Alan Steele, pictured with his wife Wendy, was on board the ship and is in hospital after being diagnosed with the coronavirus. He has recovered and expects to be released on Wednesday
David and Sally Abel, from Northamptonshire, are among those pleading for the UK Government to bring them home. They announced on Tuesday that they had tested positive for the coronavirus and were being taken off the ship
Writing in a scientific paper titled ‘Infections on Cruise Ships’, disease expert Dr Vivek Kak, from Jackson, Michigan, said: ‘The isolated environment of a cruise ship, with close interaction between a vast [group] of individuals, increases the risk of a passenger being exposed to various respiratory secretions and, potentially, to infectious respiratory viruses.
‘The presentation of these infections… can range from an upper respiratory tract infection to life-threatening pneumonia.’
Sharing the ship with so many others also makes it more likely someone will touch a surface which has been contaminated by someone who is ill.
The COVID-19 coronavirus is known to be able to survive on hard surfaces for hours – some estimates suggest days – before it stops being contagious.
Handrails, sunbeds or gym equipment, for example, may be a haven for the viruses to live on, and people may catch the infection from contimated surfaces in places like swimming pools or hot tubs.
THE MIX OF PEOPLE ON CRUISES MAY CONTRIBUTE TO AN OUTBREAK
Dr Kak also suggested in his paper, which was published in the journal Microbiology Spectrum by the American Society for Microbiology, that the types of people who take cruises may contribute to the spread of illness.
People on the Diamond Princess have been told they cannot leave the ship until they are tested for the virus by Japanese authorities, removed by their own government or taken to hospital if they’re diagnosed
He added: ‘The typical cruise passenger is often an elderly individual and may have chronic illnesses, which can make him or her more susceptible to infection and its complications.’
The immune system naturally gets worse with age, meaning people are less likely to fight off illness and get sick quicker and stay sick for longer.
There are also people from all over the world who join together on cruises, meaning that seasonal viruses and different strains of illnesses are all mashed together in one place.
Dr Paul Hunter, a professor in medicine at the University of East Anglia, said: ‘Cruise ships take passengers and crew from all over the world, often passengers are relatively elderly, they spend most of their time on board indoors mixing with others.’
Dr Kak, from Michigan, added: ‘The individuals are often from different cultures, with different immunization backgrounds and health statuses.’
THE FOOD AND WATER SUPPLIES PROBABLY DIDN’T SPREAD THE VIRUS, BUT VENTILATION AND SEWAGE MUST BE INVESTIGATED
Cruise ship passengers have to drink from the same water supplies and eat food from the same kitchens, meaning that if a virus or bacteria gets into these the consequences could be devastating.
However, the coronavirus is a respiratory infection – meaning it takes hold in the lungs – so this is not considered to be a major contributor to spread on the Diamond Princess.
Dr Whitworth said: ‘[This is not a worry] for a respiratory virus.
‘It’s classic for gastrointestinal infections such norovirus but I don’t think that would be affecting this situation.’
Diarrhoea and vomiting bugs such as noroviruses and salmonella could spread through food or water but the coronavirus is believed to infect people only when it is inhaled.
There remains, however, the possibility that the virus could spread on contaminated crockery or cutlery if it is not cleaned thoroughly with soap and hot water.
Experts have also questioned whether the ventilation or sewage systems could have been implicated in spreading the airborne disease.
‘Obviously the quarantine hasn’t worked, and this ship has now become a source of infection,’ said Dr Nathalie MacDermott, an expert at King’s College London.
‘We need to understand how the quarantine measures on board were implemented, what the air filtration on board is like, how the cabins are connected and how waste products are disposed of.’
One expert said there were likely to be people on board who had ignored the instructions given to them by crew
The ship will have to have a ‘military-style’ deep clean before it can be used again after this ordeal, one expert told MailOnline
‘There could also be another mode of transmission we’re not familiar with,’ she said, noting the possibility of environmental spread and the importance of ‘deep-cleaning’ the entire ship to prevent people from touching contaminated surfaces.
During the 2002-2003 outbreak of SARS, a related virus, experts discovered that more than 300 people were infected through a defective sewage system in a Hong Kong housing estate.
Dr MacDermott said it was possible there was a similar issue aboard the Diamond Princess, but that a full investigation was needed.
‘There’s no reason this should not have worked if it had been done properly,’ she said.
WAS THE SHIP QUARANTINE A BAD IDEA?
Experts now agree that the quarantine on board the Diamond Princess has not worked, but they say it was a good idea and ‘worth a try’.
Infectious diseases expert at the US National Institutes of Health, Dr Anthony Fauci, said quarantining the cruise ship had been a good idea at the start but had failed.
He told USA Today : ‘The quarantine process failed. I’d like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship.
‘Something went awry in the process of the quarantining on that ship. I don’t know what it was, but a lot of people got infected on that ship.’
Dr Whitworth told MailOnline: ‘I think it was absolutely right to attempt to control [the virus] in this way.
‘The primary thing the quarantine was trying to do was stop the infection getting into the general public, which it has done.
‘This is an unknown virus and we don’t know precisely how to control it. It was worth a go but it’s simply not worked.’
Dr Hunter, who said it was disappointing that the quarantine had failed, added: ‘It’s difficult to enforce a quarantine in a ship environment and I’m absolutely sure there were some passengers who think they’re not going to let anyone tell them what they can and cannot do.’
Countries have started to evacuate their citizens from the cruise ship. Pictured, a South Korean presidential jet landed in Tokyo to pick up five Korean nationals
Buses carrying US passengers who were aboard the quarantined cruise ship the Diamond Princess, seen in background, leaves Yokohama port, near Tokyo, early Monday. The cruise ship was carrying nearly 3,500 passengers and crew members
HOW CAN OTHER QUARANTINE ZONES AVOID INTERNAL SPREAD?
Dr Whitworth said people having space to move away from other people is the key to stopping the virus from spreading.
Although it is not always possible – or reasonable – to keep people completely alone in rooms or cells, making sure they are not treading on the toes of others is the most important factor.
And places must be kept clean if they have been visited by people with the coronavirus or those suspected of having it.
In the UK, people are being quarantined in groups of around 100 in apartments or hotel rooms, with access to outdoor space.
Australia is using a former immigration detention centre which has large outdoor grounds around it, and the US is using military bases.
Dr Whitworth said: ‘[Quarantine should be in] a situation where people can have more space. Distancing is more important. My limited understanding of cruise ships is that they have lots of narrow corridors.’
He added that, once all the crew and passengers were off the Diamond Princess, the company would have to ‘do a military-style deep cleaning of the ship… really go to town.’