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| Cruise Ship’s Coronavirus Outbreak Leaves Crew Nowhere to Hide | Cruise Ship’s Coronavirus Outbreak Leaves Crew Nowhere to Hide |
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| YOKOHAMA, Japan — In the passenger decks of the quarantined Diamond Princess cruise ship, more than 2,500 travelers are carefully isolated. Meals are delivered to their cabins. They have permission to walk on deck, six feet apart, for a few minutes a day. | YOKOHAMA, Japan — In the passenger decks of the quarantined Diamond Princess cruise ship, more than 2,500 travelers are carefully isolated. Meals are delivered to their cabins. They have permission to walk on deck, six feet apart, for a few minutes a day. |
| Down below, more than 1,000 crew members live and work elbow-to-elbow, preparing the passengers’ dishes and eating simple buffet-style meals together, with as many as four sharing a bathroom — and sharing the risk of possible infection from the coronavirus. | Down below, more than 1,000 crew members live and work elbow-to-elbow, preparing the passengers’ dishes and eating simple buffet-style meals together, with as many as four sharing a bathroom — and sharing the risk of possible infection from the coronavirus. |
| The risks to all aboard were reinforced on Monday as Japan’s health ministry said that an additional 65 people had tested positive for the virus, nearly doubling the total to 135. According to Princess Cruises, which operates the ship, at least 20 of them are American. The ship already has the largest number of coronavirus cases outside the epicenter in China, where more than 40,000 have been infected. | The risks to all aboard were reinforced on Monday as Japan’s health ministry said that an additional 65 people had tested positive for the virus, nearly doubling the total to 135. According to Princess Cruises, which operates the ship, at least 20 of them are American. The ship already has the largest number of coronavirus cases outside the epicenter in China, where more than 40,000 have been infected. |
| While the quarantine slapped on the Diamond Princess was meant to contain the virus, the conditions facing the crew could end up doing the opposite and help spread the illness, disease experts say. | While the quarantine slapped on the Diamond Princess was meant to contain the virus, the conditions facing the crew could end up doing the opposite and help spread the illness, disease experts say. |
| At least 10 crew members have been infected, with five cases announced on Sunday and five more on Monday. And according to employees, the infected crew members identified on Sunday had been eating in the mess hall alongside their co-workers. | At least 10 crew members have been infected, with five cases announced on Sunday and five more on Monday. And according to employees, the infected crew members identified on Sunday had been eating in the mess hall alongside their co-workers. |
| It is not even clear how many people on the ship have the coronavirus because the authorities in Japan have only tested a fraction of all aboard, asserting they currently lack the resources to test them all. | It is not even clear how many people on the ship have the coronavirus because the authorities in Japan have only tested a fraction of all aboard, asserting they currently lack the resources to test them all. |
| Under a two-week quarantine in the port of Yokohama since Feb. 4, the Diamond Princess is now a floating, mini-version of Wuhan, China, the city of 11 million that is the epicenter of the outbreak and has been subjected to a lockdown for weeks. | Under a two-week quarantine in the port of Yokohama since Feb. 4, the Diamond Princess is now a floating, mini-version of Wuhan, China, the city of 11 million that is the epicenter of the outbreak and has been subjected to a lockdown for weeks. |
| The Diamond Princess is like a “small city,” Binay Kumar Sarkar, an Indian citizen who prepares meals and washes dishes in the galley, said Monday in a Facebook chat, making it “very easy” to spread the virus. | The Diamond Princess is like a “small city,” Binay Kumar Sarkar, an Indian citizen who prepares meals and washes dishes in the galley, said Monday in a Facebook chat, making it “very easy” to spread the virus. |
| In a video posted to Facebook, he asked the Indian government to help get him and his co-workers off the ship before the virus spread further. The crew, overwhelmingly from developing countries in Asia, includes 132 Indians. | In a video posted to Facebook, he asked the Indian government to help get him and his co-workers off the ship before the virus spread further. The crew, overwhelmingly from developing countries in Asia, includes 132 Indians. |
| Unlike the passengers they serve, most from wealthy nations, the ship’s employees have not received the same global attention as passengers from countries like the United States, Australia and Britain, whose social media posts have been widely read. | Unlike the passengers they serve, most from wealthy nations, the ship’s employees have not received the same global attention as passengers from countries like the United States, Australia and Britain, whose social media posts have been widely read. |
| In response to emailed questions, a representative of Princess Cruises, which operates the Diamond Princess, said that all crew members “are highly trained in safety and public health standards.” | In response to emailed questions, a representative of Princess Cruises, which operates the Diamond Princess, said that all crew members “are highly trained in safety and public health standards.” |
| Without offering specifics, the representative added that the company was “implementing processes developed in coordination with public health officials to support the elevated requirements of this situation.” | Without offering specifics, the representative added that the company was “implementing processes developed in coordination with public health officials to support the elevated requirements of this situation.” |
| Some experts said that keeping all of the passengers and crew members on board could exacerbate the rate of infection. In the city of Wuhan and the surrounding province, Hubei, the authorities have barred close to 50 million people from leaving, and cases there are still rising as family members infect one another. | Some experts said that keeping all of the passengers and crew members on board could exacerbate the rate of infection. In the city of Wuhan and the surrounding province, Hubei, the authorities have barred close to 50 million people from leaving, and cases there are still rising as family members infect one another. |
| “Similar to the situation in Wuhan, but at a smaller scale, by quarantining the ship, the crew members are being forced to stay together, which increases the likelihood of transmission,” said John B. Lynch, an associate professor of infectious diseases at the University of Washington. “We have to remember that quarantines protect those outside the quarantine, not those within.” | “Similar to the situation in Wuhan, but at a smaller scale, by quarantining the ship, the crew members are being forced to stay together, which increases the likelihood of transmission,” said John B. Lynch, an associate professor of infectious diseases at the University of Washington. “We have to remember that quarantines protect those outside the quarantine, not those within.” |
| Other experts said supervisors on the ship needed to enforce strict hygiene policies, including frequent hand-washing. Both passengers and crew members should also be “keeping distance from others and avoiding congregating,” said Dr. Peter Rabinowitz, who is co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security. | Other experts said supervisors on the ship needed to enforce strict hygiene policies, including frequent hand-washing. Both passengers and crew members should also be “keeping distance from others and avoiding congregating,” said Dr. Peter Rabinowitz, who is co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security. |
| Crew members, who spoke on the condition of anonymity for fear of losing their jobs, said they had been provided with masks, gloves and hand sanitizer, but given little training on how to reduce their chances of infection in a situation of this magnitude. | Crew members, who spoke on the condition of anonymity for fear of losing their jobs, said they had been provided with masks, gloves and hand sanitizer, but given little training on how to reduce their chances of infection in a situation of this magnitude. |
| Like passengers, they have been given thermometers and told to monitor their own temperatures and report back if they develop a fever. They have received no new guidance since the quarantine began a week ago, according to one employee. | Like passengers, they have been given thermometers and told to monitor their own temperatures and report back if they develop a fever. They have received no new guidance since the quarantine began a week ago, according to one employee. |
| Passengers said they were grateful to the crew but also worried that the employees, despite wearing protective gear when they enter cabins, might be passing the infection to people isolated inside. | Passengers said they were grateful to the crew but also worried that the employees, despite wearing protective gear when they enter cabins, might be passing the infection to people isolated inside. |
| On Monday, passengers were given new masks designed to filter out 95 percent of airborne particles, as well as packages of alcohol wipes. The Centers for Disease Control and Prevention in Atlanta also sent a letter to passengers advising them to wear face masks if they shared cabins with other passengers and to avoid sharing personal household items. | On Monday, passengers were given new masks designed to filter out 95 percent of airborne particles, as well as packages of alcohol wipes. The Centers for Disease Control and Prevention in Atlanta also sent a letter to passengers advising them to wear face masks if they shared cabins with other passengers and to avoid sharing personal household items. |
| Japan’s health ministry said on Monday that so far it had tested 439 people on the ship for the coronavirus. That leaves more than 3,000 who have not been tested, receiving only initial health checks. | Japan’s health ministry said on Monday that so far it had tested 439 people on the ship for the coronavirus. That leaves more than 3,000 who have not been tested, receiving only initial health checks. |
| Japanese officials have said they do not have the capacity to test everyone on the ship. On Sunday, the health minister, Katsunobu Kato, said his ministry needed to consider how it would respond to the challenge of administering thousands of tests. | Japanese officials have said they do not have the capacity to test everyone on the ship. On Sunday, the health minister, Katsunobu Kato, said his ministry needed to consider how it would respond to the challenge of administering thousands of tests. |
| In Hong Kong, where another cruise ship, the World Dream, has been held at port, about 1,800 crew members aboard were tested for the coronavirus after the authorities said that infected passengers had disembarked on Jan. 24 in Guangzhou Province, China. | In Hong Kong, where another cruise ship, the World Dream, has been held at port, about 1,800 crew members aboard were tested for the coronavirus after the authorities said that infected passengers had disembarked on Jan. 24 in Guangzhou Province, China. |
| When the ship arrived in Hong Kong last Wednesday on a subsequent journey, the health authorities first tested those who had fevers or showed symptoms of the virus. All of those initial tests came back negative, but out of an abundance of caution, the Hong Kong health authorities decided to test all crew members. | When the ship arrived in Hong Kong last Wednesday on a subsequent journey, the health authorities first tested those who had fevers or showed symptoms of the virus. All of those initial tests came back negative, but out of an abundance of caution, the Hong Kong health authorities decided to test all crew members. |
| Experts said the authorities should also test everyone on board the Diamond Princess in Yokohama. | Experts said the authorities should also test everyone on board the Diamond Princess in Yokohama. |
| “It is extremely possible that the infection has been transmitted on the ship,” said Harue Okada, a professor of public health at Hakuoh University in Tochigi Prefecture. She added that it was difficult to identify who had been exposed to infected people, including those who came into contact with other people during shore excursions. | “It is extremely possible that the infection has been transmitted on the ship,” said Harue Okada, a professor of public health at Hakuoh University in Tochigi Prefecture. She added that it was difficult to identify who had been exposed to infected people, including those who came into contact with other people during shore excursions. |
| Updated June 12, 2020 | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| “Furthermore, as it is assumed that there are asymptomatic but infected people, the virus test is necessary,” Dr. Okada said. | “Furthermore, as it is assumed that there are asymptomatic but infected people, the virus test is necessary,” Dr. Okada said. |
| The cruise ship terminal where the Diamond Princess is docked has been closed to the public. On Monday, a sort of war room had been set up where around a dozen people sat at computers and on phones. | The cruise ship terminal where the Diamond Princess is docked has been closed to the public. On Monday, a sort of war room had been set up where around a dozen people sat at computers and on phones. |
| Some of them wore jackets that identified them as members of a psychological support team. The room’s walls were plastered with long strips of butcher paper, where information about the patients and a timeline had been scribbled in thick black marker. | Some of them wore jackets that identified them as members of a psychological support team. The room’s walls were plastered with long strips of butcher paper, where information about the patients and a timeline had been scribbled in thick black marker. |
| At the port, the daughter of a passenger tried to deliver food and water to her elderly mother, who she said had a fever and was having trouble getting attention from the medical staff. | At the port, the daughter of a passenger tried to deliver food and water to her elderly mother, who she said had a fever and was having trouble getting attention from the medical staff. |
| “She feels sick. I hope she can disembark soon,” the woman, Etsuko Takashima, said through tears as she spoke about her mother, Ayako Jinnai, 84. “At least, I hope she can get a drip infusion in the medical room on the ship. I don’t think her current condition is known to the staff.” | “She feels sick. I hope she can disembark soon,” the woman, Etsuko Takashima, said through tears as she spoke about her mother, Ayako Jinnai, 84. “At least, I hope she can get a drip infusion in the medical room on the ship. I don’t think her current condition is known to the staff.” |
| Ben Dooley reported from Yokohama, and Motoko Rich from Tokyo. Makiko Inoue, Eimi Yamamitsu and Hisako Ueno contributed reporting from Tokyo. | Ben Dooley reported from Yokohama, and Motoko Rich from Tokyo. Makiko Inoue, Eimi Yamamitsu and Hisako Ueno contributed reporting from Tokyo. |