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Quarantined Cruise Passengers Have Many Questions. Japan Has Few Answers. Quarantined Cruise Passengers Have Many Questions. Japan Has Few Answers.
(2 months later)
TOKYO — The 3,600 people aboard the Diamond Princess, locked down for more than a week and desperate for information, have been reduced to peering out windows as hazmat-suited workers take away the newest coronavirus patients and mysterious buses, their interiors shrouded by curtains, come and go from the port.TOKYO — The 3,600 people aboard the Diamond Princess, locked down for more than a week and desperate for information, have been reduced to peering out windows as hazmat-suited workers take away the newest coronavirus patients and mysterious buses, their interiors shrouded by curtains, come and go from the port.
They have Wi-Fi, but it is spotty, and even if it were not, they might search in vain for information about their plight from tight-lipped Japanese authorities.They have Wi-Fi, but it is spotty, and even if it were not, they might search in vain for information about their plight from tight-lipped Japanese authorities.
Experts in crisis management said the government was offering a textbook example of how not to handle a public health crisis.Experts in crisis management said the government was offering a textbook example of how not to handle a public health crisis.
“Repeatedly explain what is known, and what is unknown, and when people can get more information about what remains unknown,” said Dr. Hana Hayashi, a public health strategist at McCann Healthcare Worldwide Japan. “It sounds very simple, but by continuing to do this, people’s concerns will be reduced.”“Repeatedly explain what is known, and what is unknown, and when people can get more information about what remains unknown,” said Dr. Hana Hayashi, a public health strategist at McCann Healthcare Worldwide Japan. “It sounds very simple, but by continuing to do this, people’s concerns will be reduced.”
With 174 of their number known to be infected — the most cases anywhere outside China — one of the biggest questions for those stuck on the Diamond Princess off Yokohama is: Why won’t Japan test everyone on board for the virus?With 174 of their number known to be infected — the most cases anywhere outside China — one of the biggest questions for those stuck on the Diamond Princess off Yokohama is: Why won’t Japan test everyone on board for the virus?
As of Tuesday, only 439 had been tested, and the Japanese authorities have sent mixed messages.As of Tuesday, only 439 had been tested, and the Japanese authorities have sent mixed messages.
For days, officials have said the country simply does not have the ability to test everyone on the ship. But on Tuesday, as demands grew, Dr. Masami Sakoi, an assistant health minister, said at a news briefing that the health ministry was considering expanding its testing capacity.For days, officials have said the country simply does not have the ability to test everyone on the ship. But on Tuesday, as demands grew, Dr. Masami Sakoi, an assistant health minister, said at a news briefing that the health ministry was considering expanding its testing capacity.
Japan’s insistence that it is an issue of practicality has been met with some skepticism.Japan’s insistence that it is an issue of practicality has been met with some skepticism.
Critics of the government’s handling of the outbreak say that officials simply are not explaining enough of their thinking as they face an epidemiological challenge with no easy playbook. The government’s communications strategy has undermined trust, and speculation has sometimes filled the void, including about whether there could be alternatives to keeping so many people locked inside a contaminated vessel.Critics of the government’s handling of the outbreak say that officials simply are not explaining enough of their thinking as they face an epidemiological challenge with no easy playbook. The government’s communications strategy has undermined trust, and speculation has sometimes filled the void, including about whether there could be alternatives to keeping so many people locked inside a contaminated vessel.
“Here you have people locked down on a pseudo prison on a cruise ship,” said Kyle Cleveland, a professor of sociology at the Tokyo campus of Temple University who has studied Japan’s response to another crisis, the Fukushima nuclear meltdowns. “Is it really a matter of not having enough tests?”“Here you have people locked down on a pseudo prison on a cruise ship,” said Kyle Cleveland, a professor of sociology at the Tokyo campus of Temple University who has studied Japan’s response to another crisis, the Fukushima nuclear meltdowns. “Is it really a matter of not having enough tests?”
In China, after all, where more than 44,000 people have been infected and deaths have surpassed 1,100, health officials are performing thousands of coronavirus tests a day. Unlike Japan, China has been confronting the outbreak since December, and has had time to produce test kits. Even so, it is contending with a shortage.In China, after all, where more than 44,000 people have been infected and deaths have surpassed 1,100, health officials are performing thousands of coronavirus tests a day. Unlike Japan, China has been confronting the outbreak since December, and has had time to produce test kits. Even so, it is contending with a shortage.
Some passengers say that if it were just a matter of logistics, Japan could look for outside help.Some passengers say that if it were just a matter of logistics, Japan could look for outside help.
“I’d prefer if our countries pitch in and help test everyone,” said Vera Koslova-Fu, an Australian on the ship.“I’d prefer if our countries pitch in and help test everyone,” said Vera Koslova-Fu, an Australian on the ship.
Still, there is far from universal agreement that Japan should test everyone on board the Diamond Princess, even if it could.Still, there is far from universal agreement that Japan should test everyone on board the Diamond Princess, even if it could.
Olivia Lawe-Davies, a spokeswoman for the World Health Organization, said that its experts agreed with the way Japan was handling the quarantine.Olivia Lawe-Davies, a spokeswoman for the World Health Organization, said that its experts agreed with the way Japan was handling the quarantine.
“No country or entity has had to manage this novel coronavirus, for which there are still many unknowns, on an international conveyance with this many people,” she said. “The most important thing is to ensure that people who are ill receive proper treatment, which the Japanese authorities are doing.”“No country or entity has had to manage this novel coronavirus, for which there are still many unknowns, on an international conveyance with this many people,” she said. “The most important thing is to ensure that people who are ill receive proper treatment, which the Japanese authorities are doing.”
Some infectious disease experts questioned whether testing everyone on board would in fact be effective.Some infectious disease experts questioned whether testing everyone on board would in fact be effective.
“In reality, people are in the incubation period right now,” said Mitsuyoshi Urashima, a professor of molecular epidemiology at Jikei University Hospital in Tokyo. “The tests are not absolutely always right.”“In reality, people are in the incubation period right now,” said Mitsuyoshi Urashima, a professor of molecular epidemiology at Jikei University Hospital in Tokyo. “The tests are not absolutely always right.”
(Proof of that came from a different set of coronavirus patients on Tuesday. The health ministry announced that two Japanese citizens who had previously tested negative after leaving Wuhan, China, where the epidemic began, were now infected.)(Proof of that came from a different set of coronavirus patients on Tuesday. The health ministry announced that two Japanese citizens who had previously tested negative after leaving Wuhan, China, where the epidemic began, were now infected.)
The tests themselves pose their own obstacles.The tests themselves pose their own obstacles.
They are not simple throat swabs, but instead require cells from hard-to-reach parts of the respiratory tract.They are not simple throat swabs, but instead require cells from hard-to-reach parts of the respiratory tract.
The simplest test, a nasopharyngeal swab, “is not surgery, but it comes close,” said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville. “It’s an aggressive medical procedure.”The simplest test, a nasopharyngeal swab, “is not surgery, but it comes close,” said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville. “It’s an aggressive medical procedure.”
The alternative requires pumping saline solution deep into the lungs.The alternative requires pumping saline solution deep into the lungs.
“You could not do it on healthy people by the thousands, or just go from cabin to cabin doing it,” Dr. Schaffner said.“You could not do it on healthy people by the thousands, or just go from cabin to cabin doing it,” Dr. Schaffner said.
Both procedures are risky for the medical personnel doing them, because they can send the patient into a retching or coughing fit, spewing out virus.Both procedures are risky for the medical personnel doing them, because they can send the patient into a retching or coughing fit, spewing out virus.
And even then, he said, concerns would remain.And even then, he said, concerns would remain.
“I’m sure a lot of people on board think, ‘If I’m negative, I’m cleared,’” Dr. Schaffner said. “It’s not that — you could be positive tomorrow.”“I’m sure a lot of people on board think, ‘If I’m negative, I’m cleared,’” Dr. Schaffner said. “It’s not that — you could be positive tomorrow.”
Even if the tests are not scientifically warranted, some public health experts said, they might help calm anxious people on the ship.Even if the tests are not scientifically warranted, some public health experts said, they might help calm anxious people on the ship.
“If it puts people’s minds at ease, it has merit,” said Eiji Kusumi, a doctor specializing in infectious diseases at Navitas Clinic in Tokyo. “We’re dealing with people who are operating out of emotion.”“If it puts people’s minds at ease, it has merit,” said Eiji Kusumi, a doctor specializing in infectious diseases at Navitas Clinic in Tokyo. “We’re dealing with people who are operating out of emotion.”
Updated June 1, 2020
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.
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.
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.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
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.
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.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
One passenger, Sarah Arana, a 52-year-old medical social worker from Paso Robles, Calif., said, “I think it would provide peace of mind.”One passenger, Sarah Arana, a 52-year-old medical social worker from Paso Robles, Calif., said, “I think it would provide peace of mind.”
Peace of mind has been hard to come by for many passengers, in no small part because of the Japanese government’s limited communications.Peace of mind has been hard to come by for many passengers, in no small part because of the Japanese government’s limited communications.
Passengers isolated in their cabins have been checking their phones for news updates and social media posts, while their families back home are frantically pressing for information.Passengers isolated in their cabins have been checking their phones for news updates and social media posts, while their families back home are frantically pressing for information.
By failing to hold regular and timely news briefings and doling out cryptic information, the government “has made the problem seem much larger than it looks,” said Hiromi Murakami, an expert on health policy at the National Graduate Institute for Policy Studies in Tokyo.By failing to hold regular and timely news briefings and doling out cryptic information, the government “has made the problem seem much larger than it looks,” said Hiromi Murakami, an expert on health policy at the National Graduate Institute for Policy Studies in Tokyo.
“It’s mostly bureaucrats who have to deal with a lot of things, and they don’t know how to respond sometimes,” Ms. Murakami said. “They’re not used to dealing with questions. They don’t know how to answer them, and they think if they can’t answer them, what’s the purpose of having a press conference. So they avoid these situations.”“It’s mostly bureaucrats who have to deal with a lot of things, and they don’t know how to respond sometimes,” Ms. Murakami said. “They’re not used to dealing with questions. They don’t know how to answer them, and they think if they can’t answer them, what’s the purpose of having a press conference. So they avoid these situations.”
That may soon prove harder to do. Experts say the Diamond Princess may be only the beginning of Japan’s challenges with the coronavirus.That may soon prove harder to do. Experts say the Diamond Princess may be only the beginning of Japan’s challenges with the coronavirus.
“Probably it’s a tiny portion of our problem in Japan,” said Hitoshi Oshitani, a professor of virology at Tohoku University. “If we have a few hundred cases in Japan and there are probably thousands of contacts around these few hundred, the numbers will increase every day.”“Probably it’s a tiny portion of our problem in Japan,” said Hitoshi Oshitani, a professor of virology at Tohoku University. “If we have a few hundred cases in Japan and there are probably thousands of contacts around these few hundred, the numbers will increase every day.”
The government has been saying little. On Sunday and Monday, it waited hours to confirm that there were new infections on board, even as the captain of the Diamond Princess announced them to the ship.The government has been saying little. On Sunday and Monday, it waited hours to confirm that there were new infections on board, even as the captain of the Diamond Princess announced them to the ship.
By Wednesday, Japanese officials moved more quickly to say that 39 additional passengers had tested positive and that a health ministry employee had also been diagnosed with the illness after administering a survey to those aboard the ship.By Wednesday, Japanese officials moved more quickly to say that 39 additional passengers had tested positive and that a health ministry employee had also been diagnosed with the illness after administering a survey to those aboard the ship.
Still, rumors abound.Still, rumors abound.
Early Tuesday, Japanese news outlets reported that the health authorities were considering taking some elderly passengers off the ship, but officials refused to comment. Passengers on the ship could see that at least two buses, their windows covered in curtains, had pulled up to the port, and claims spread that some people were being allowed to leave.Early Tuesday, Japanese news outlets reported that the health authorities were considering taking some elderly passengers off the ship, but officials refused to comment. Passengers on the ship could see that at least two buses, their windows covered in curtains, had pulled up to the port, and claims spread that some people were being allowed to leave.
In the absence of official communication, some have found their own way to communicate: Japanese passengers, who make up about half of the 2,666 guests on board, unfurled cloth signs off their balconies.In the absence of official communication, some have found their own way to communicate: Japanese passengers, who make up about half of the 2,666 guests on board, unfurled cloth signs off their balconies.
“Serious lack of medicine, lack of information,” read one.“Serious lack of medicine, lack of information,” read one.
Reporting was contributed by Makiko Inoue, Hisako Ueno and Eimi Yamamitsu from Tokyo, and Donald G. McNeil Jr. from New York.Reporting was contributed by Makiko Inoue, Hisako Ueno and Eimi Yamamitsu from Tokyo, and Donald G. McNeil Jr. from New York.