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Cambodia’s Coronavirus Complacency May Exact a Global Toll Cambodia’s Coronavirus Complacency May Exact a Global Toll
(3 days later)
SIHANOUKVILLE, Cambodia — When Cambodia’s prime minister greeted passengers on a cruise ship amid a coronavirus scare on Valentine’s Day, embraces were the order of the day. Protective masks were not.SIHANOUKVILLE, Cambodia — When Cambodia’s prime minister greeted passengers on a cruise ship amid a coronavirus scare on Valentine’s Day, embraces were the order of the day. Protective masks were not.
Not only did Prime Minister Hun Sen not wear one, assured that the ship was virus-free, his bodyguards ordered people who had donned masks to take them off. The next day, the American ambassador to Cambodia, W. Patrick Murphy, who brought his own family to greet the passengers streaming off the ship, also went maskless.Not only did Prime Minister Hun Sen not wear one, assured that the ship was virus-free, his bodyguards ordered people who had donned masks to take them off. The next day, the American ambassador to Cambodia, W. Patrick Murphy, who brought his own family to greet the passengers streaming off the ship, also went maskless.
“We are very, very grateful that Cambodia has opened literally its ports and doors to people in need,” Mr. Murphy said.“We are very, very grateful that Cambodia has opened literally its ports and doors to people in need,” Mr. Murphy said.
But after hundreds of passengers had disembarked, one later tested positive for the coronavirus. Now, health officials worry that what Cambodia opened its doors to was the outbreak, and that the world may pay a price as passengers from the cruise ship Westerdam stream home.But after hundreds of passengers had disembarked, one later tested positive for the coronavirus. Now, health officials worry that what Cambodia opened its doors to was the outbreak, and that the world may pay a price as passengers from the cruise ship Westerdam stream home.
Before the Westerdam docked in Sihanoukville, fearful governments in other countries had turned the ship away at five ports of call even though the cruise operator, Holland America, assured officials that the ship’s passengers had been carefully screened.Before the Westerdam docked in Sihanoukville, fearful governments in other countries had turned the ship away at five ports of call even though the cruise operator, Holland America, assured officials that the ship’s passengers had been carefully screened.
Prime Minister Hun Sen’s decision to allow it entry appeared to be a political calculus as much as anything else. The region’s longest-serving ruler and a close ally of China, he is known for his survival skills.Prime Minister Hun Sen’s decision to allow it entry appeared to be a political calculus as much as anything else. The region’s longest-serving ruler and a close ally of China, he is known for his survival skills.
But Mr. Hun Sen’s critics worry that the aging autocrat might have acted rashly.But Mr. Hun Sen’s critics worry that the aging autocrat might have acted rashly.
“Of course, he had to do the dictator thing: photo op, roses, exploit this for its maximum value,” said Sophal Ear, an expert in Cambodian politics at Occidental College. “Whatever is in the best interest of Cambodians is completely irrelevant to him.”“Of course, he had to do the dictator thing: photo op, roses, exploit this for its maximum value,” said Sophal Ear, an expert in Cambodian politics at Occidental College. “Whatever is in the best interest of Cambodians is completely irrelevant to him.”
It is too early to tell whether the decision to let hundreds of passengers from the Westerdam fly off has the makings of an epidemiological disaster. Cambodian health authorities said that 409 of the 2,257 passengers and crew had left Cambodia for their homes scattered across the globe. The rest remain in hotels in Phnom Penh, the capital, or on the ship.It is too early to tell whether the decision to let hundreds of passengers from the Westerdam fly off has the makings of an epidemiological disaster. Cambodian health authorities said that 409 of the 2,257 passengers and crew had left Cambodia for their homes scattered across the globe. The rest remain in hotels in Phnom Penh, the capital, or on the ship.
But deficiencies in screening for the coronavirus aboard the ship, along with continued complacency about the epidemic in Cambodia, are raising fears this small Southeast Asian nation could prove to be a surprising vector of transmission for a virus that has already killed more than 1,700 people, mostly in China, the epicenter of the outbreak.But deficiencies in screening for the coronavirus aboard the ship, along with continued complacency about the epidemic in Cambodia, are raising fears this small Southeast Asian nation could prove to be a surprising vector of transmission for a virus that has already killed more than 1,700 people, mostly in China, the epicenter of the outbreak.
Many health experts urge people who have been in contact with coronavirus patients to self-quarantine for 14 days, lest they add another spoke to the contagion network.Many health experts urge people who have been in contact with coronavirus patients to self-quarantine for 14 days, lest they add another spoke to the contagion network.
But on Monday, Mr. Hun Sen directed officials in Phnom Penh to treat passengers from the Westerdam to a sightseeing jaunt.But on Monday, Mr. Hun Sen directed officials in Phnom Penh to treat passengers from the Westerdam to a sightseeing jaunt.
“To tour the city is better than staying in rooms or at the hotel feeling bored or scared,” said a post on Mr. Hun Sen’s Facebook page.“To tour the city is better than staying in rooms or at the hotel feeling bored or scared,” said a post on Mr. Hun Sen’s Facebook page.
The lack of urgency in Cambodia, where officials milled around the ship on Monday without protection, points to the obstacles in trying to contain a virus that experts warn is spreading faster than SARS or MERS.The lack of urgency in Cambodia, where officials milled around the ship on Monday without protection, points to the obstacles in trying to contain a virus that experts warn is spreading faster than SARS or MERS.
“This is influenza-like transmission,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s like trying to stop the wind.”“This is influenza-like transmission,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s like trying to stop the wind.”
Last week, when the Westerdam docked in Sihanoukville, the Cambodian government and the cruise operator deemed the vessel virus-free.Last week, when the Westerdam docked in Sihanoukville, the Cambodian government and the cruise operator deemed the vessel virus-free.
The declaration was at a minimum premature.The declaration was at a minimum premature.
Only 20 people out of the 2,257 onboard were tested for the virus before disembarking, and that was because they had reported themselves to ship medical staff with various ailments.Only 20 people out of the 2,257 onboard were tested for the virus before disembarking, and that was because they had reported themselves to ship medical staff with various ailments.
The woman who twice tested positive after traveling on to Malaysia, an 83-year-old American, was not among those 20, Holland America said.The woman who twice tested positive after traveling on to Malaysia, an 83-year-old American, was not among those 20, Holland America said.
Health monitoring for the rest of the passengers was limited to a handful of temperature checks conducted with infrared thermometers, passengers said. In a statement, Holland America said that during one of those screenings, not a single person on board recorded an elevated temperature.Health monitoring for the rest of the passengers was limited to a handful of temperature checks conducted with infrared thermometers, passengers said. In a statement, Holland America said that during one of those screenings, not a single person on board recorded an elevated temperature.
On Monday, an announcement broadcast to passengers remaining on the Westerdam warned that they should avoid the ship’s hot deck and return to their air-conditioned rooms to avoid falsely high temperature readings.On Monday, an announcement broadcast to passengers remaining on the Westerdam warned that they should avoid the ship’s hot deck and return to their air-conditioned rooms to avoid falsely high temperature readings.
Some health experts have questioned the efficacy of infrared thermometers, also known as temperature guns, saying they measure the heat emanating from the surface of the body, rather than core body temperature.Some health experts have questioned the efficacy of infrared thermometers, also known as temperature guns, saying they measure the heat emanating from the surface of the body, rather than core body temperature.
Various environmental factors can distort thermometer gun reading, said Gary Strahan, who runs a small infrared device company in Texas.Various environmental factors can distort thermometer gun reading, said Gary Strahan, who runs a small infrared device company in Texas.
“In Cambodia, you have warmer background temperatures,” he said. “It could impact the measurement. That’s the issue with any noncontact thermometer.”“In Cambodia, you have warmer background temperatures,” he said. “It could impact the measurement. That’s the issue with any noncontact thermometer.”
Even if temperatures are accurately gauged, people may be taking medications that lower their temperature, like some arthritis drugs.Even if temperatures are accurately gauged, people may be taking medications that lower their temperature, like some arthritis drugs.
And in any case, people who are asymptomatic can still pass on the coronavirus, scientists have found.And in any case, people who are asymptomatic can still pass on the coronavirus, scientists have found.
“A person who does not present as feverish is not necessarily uninfected with a disease or a virus,” said Jim Seffrin, an expert on infrared devices at the Infraspection Institute in New Jersey.“A person who does not present as feverish is not necessarily uninfected with a disease or a virus,” said Jim Seffrin, an expert on infrared devices at the Infraspection Institute in New Jersey.
In the wake of the positive test in Malaysia, Cambodian health officials said they would be relying on a domestic lab to test all passengers and crew members still in the country for the coronavirus.In the wake of the positive test in Malaysia, Cambodian health officials said they would be relying on a domestic lab to test all passengers and crew members still in the country for the coronavirus.
On Monday evening, passengers celebrated news from Cambodian health officials that a first batch of 406 people in Phnom Penh had tested negative, although there was no certainty they would not later test positive.On Monday evening, passengers celebrated news from Cambodian health officials that a first batch of 406 people in Phnom Penh had tested negative, although there was no certainty they would not later test positive.
Updated June 5, 2020 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.
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.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.
“People on the ship are very grateful to the people of Cambodia,” said Tammie Graves, an American from Kansas. “I was a bit worried that they might be afraid of us, even at the hotel, but it hasn’t been like that at all.”“People on the ship are very grateful to the people of Cambodia,” said Tammie Graves, an American from Kansas. “I was a bit worried that they might be afraid of us, even at the hotel, but it hasn’t been like that at all.”
On Monday afternoon, more than 100 Westerdam passengers took up Mr. Hun Sen’s offer of a capital tour, piling in buses to see the royal palace and other sites.On Monday afternoon, more than 100 Westerdam passengers took up Mr. Hun Sen’s offer of a capital tour, piling in buses to see the royal palace and other sites.
In pictures of the excursion, posted on a government-linked website, only one person can be seen wearing a mask.In pictures of the excursion, posted on a government-linked website, only one person can be seen wearing a mask.
Despite cases of coronavirus popping up in Southeast Asia, Mr. Hun Sen has campaigned against masks, arguing that they are better at spreading fear than stopping germs. At a news conference last month, he announced that he would kick out anyone who dared wear a mask.Despite cases of coronavirus popping up in Southeast Asia, Mr. Hun Sen has campaigned against masks, arguing that they are better at spreading fear than stopping germs. At a news conference last month, he announced that he would kick out anyone who dared wear a mask.
Even as other governments instituted China travel bans that angered Beijing, Mr. Hun Sen traveled to the Chinese capital and met with Xi Jinping, China’s leader, in another photo op.Even as other governments instituted China travel bans that angered Beijing, Mr. Hun Sen traveled to the Chinese capital and met with Xi Jinping, China’s leader, in another photo op.
And as other countries organized airlifts of people trapped in Wuhan, the city where the virus is believed to have originated, Mr. Hun Sen said he would not ferry Cambodian students home because they should be “joining with Chinese to fight this disease.”And as other countries organized airlifts of people trapped in Wuhan, the city where the virus is believed to have originated, Mr. Hun Sen said he would not ferry Cambodian students home because they should be “joining with Chinese to fight this disease.”
The sense of solidarity makes sense in a country heavily dependent on China for its fortunes, after having turned its back on a West that was demanding progress in human rights in return for aid and investment.The sense of solidarity makes sense in a country heavily dependent on China for its fortunes, after having turned its back on a West that was demanding progress in human rights in return for aid and investment.
A torrent of Chinese cash has remade Cambodia, nowhere more so than in Sihanoukville, a once sleepy beach town that is now a sprawling construction site of gilded casinos and towering residential blocks. More than 90 percent of businesses in the city are now Chinese owned.A torrent of Chinese cash has remade Cambodia, nowhere more so than in Sihanoukville, a once sleepy beach town that is now a sprawling construction site of gilded casinos and towering residential blocks. More than 90 percent of businesses in the city are now Chinese owned.
On Monday, Oeun Yen, a masseuse here, worried about the massages she had given three female passengers from the Westerdam before the virus case was confirmed by Malaysia. She was not afraid at first, she said, because the prime minister had assured people all was fine.On Monday, Oeun Yen, a masseuse here, worried about the massages she had given three female passengers from the Westerdam before the virus case was confirmed by Malaysia. She was not afraid at first, she said, because the prime minister had assured people all was fine.
“Now I am more concerned,” she said.“Now I am more concerned,” she said.
In a country where Mr. Hun Sen has dissolved the biggest opposition party and political assassination is not uncommon, such mild concern is as much as many ordinary residents are willing to muster.In a country where Mr. Hun Sen has dissolved the biggest opposition party and political assassination is not uncommon, such mild concern is as much as many ordinary residents are willing to muster.
But there is also widespread skepticism of the government’s contention that only one person in Cambodia has so far tested positive for coronavirus, a Chinese citizen who has since returned home.But there is also widespread skepticism of the government’s contention that only one person in Cambodia has so far tested positive for coronavirus, a Chinese citizen who has since returned home.
“There is a natural lack of credibility and trust associated with the Cambodian government,” said Ou Virak, a human-rights activist and founder of the Future Forum, a local think tank. “This is Hun Sen’s Westerdam problem, because even if he was doing the right thing, purely as a humanitarian, he will be seen as the puppet of China instead.”“There is a natural lack of credibility and trust associated with the Cambodian government,” said Ou Virak, a human-rights activist and founder of the Future Forum, a local think tank. “This is Hun Sen’s Westerdam problem, because even if he was doing the right thing, purely as a humanitarian, he will be seen as the puppet of China instead.”
On Monday, Mr. Hun Sen announced yet another publicity stunt: He wants to invite the passengers of the Westerdam to a party.On Monday, Mr. Hun Sen announced yet another publicity stunt: He wants to invite the passengers of the Westerdam to a party.
Masks won’t be welcome.Masks won’t be welcome.
Reporting was contributed by Sun Narin in Sihanoukville; Roni Caryn Rabin and David Yaffe-Bellany in New York; and Richard C. Paddock in Denpasar, Indonesia.Reporting was contributed by Sun Narin in Sihanoukville; Roni Caryn Rabin and David Yaffe-Bellany in New York; and Richard C. Paddock in Denpasar, Indonesia.