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What a Party in Japan May Tell Us About the Coronavirus’s Spread What a Party in Japan May Tell Us About the Coronavirus’s Spread
(4 days later)
Rain was falling on the night of Jan. 18, so the windows of the Tokyo party boat were shut. Inside were about 90 guests of a local taxi association who were celebrating the new year as the vessel floated down the Sumida River. Also on board, unbeknown to them, was a coronavirus capable of spreading ferociously.Rain was falling on the night of Jan. 18, so the windows of the Tokyo party boat were shut. Inside were about 90 guests of a local taxi association who were celebrating the new year as the vessel floated down the Sumida River. Also on board, unbeknown to them, was a coronavirus capable of spreading ferociously.
It did just that. A driver in his 70s soon fell ill with fever; he later tested positive. The same day as his diagnosis, his mother-in-law died; she also was infected. Officials then discovered that 10 others from the boat were, too, including an employee who had served passengers from Wuhan, China. Still more who did not attend the party caught the virus after coming into contact with those who did.It did just that. A driver in his 70s soon fell ill with fever; he later tested positive. The same day as his diagnosis, his mother-in-law died; she also was infected. Officials then discovered that 10 others from the boat were, too, including an employee who had served passengers from Wuhan, China. Still more who did not attend the party caught the virus after coming into contact with those who did.
As public health officials look for clues to one of the biggest uncertainties about the new coronavirus epidemic — whether it will eventually expand rapidly beyond its center in China — they are closely studying clusters of cases that have emerged recently in Japan.As public health officials look for clues to one of the biggest uncertainties about the new coronavirus epidemic — whether it will eventually expand rapidly beyond its center in China — they are closely studying clusters of cases that have emerged recently in Japan.
[Update: Japan shocks parents by moving to close all schools in response to coronavirus.][Update: Japan shocks parents by moving to close all schools in response to coronavirus.]
The issue has taken on more urgency as passengers have begun walking off a contaminated cruise ship in Yokohama where 634 people have tested positive for the virus and two later died. Experts fear that some who were cleared to leave an onboard quarantine could later test positive, spreading infections on land in the same way that the party boat has done.The issue has taken on more urgency as passengers have begun walking off a contaminated cruise ship in Yokohama where 634 people have tested positive for the virus and two later died. Experts fear that some who were cleared to leave an onboard quarantine could later test positive, spreading infections on land in the same way that the party boat has done.
Alarmed officials are rushing to learn more about how the virus is transmitted, including how many of those infected experience mild symptoms or none at all, and whether it can be spread by people who are symptom-free.Alarmed officials are rushing to learn more about how the virus is transmitted, including how many of those infected experience mild symptoms or none at all, and whether it can be spread by people who are symptom-free.
Katsunobu Kato, Japan’s health minister, said the country had entered “another phase” in its fight against the coronavirus.Katsunobu Kato, Japan’s health minister, said the country had entered “another phase” in its fight against the coronavirus.
“Doctors at the medical institutes share the recognition that the numbers of infection cases will increase in the future and that it’s necessary to take firm measures,” he said at a news conference on Sunday. The government announced a $139 million package of urgent measures to contain the outbreak, including strengthening its testing and quarantining capacity.“Doctors at the medical institutes share the recognition that the numbers of infection cases will increase in the future and that it’s necessary to take firm measures,” he said at a news conference on Sunday. The government announced a $139 million package of urgent measures to contain the outbreak, including strengthening its testing and quarantining capacity.
Concern about the transmission of the virus has grown with cluster cases in Japan, which has reported 94 infections outside the cruise ship, as well as in Singapore, where 84 infections have been confirmed, and in South Korea, which has had 156. China has reported more than 75,000 cases and more than 2,200 deaths.Concern about the transmission of the virus has grown with cluster cases in Japan, which has reported 94 infections outside the cruise ship, as well as in Singapore, where 84 infections have been confirmed, and in South Korea, which has had 156. China has reported more than 75,000 cases and more than 2,200 deaths.
The figure in South Korea has nearly tripled over the course of three days, and officials tied 77 cases to a church in the city of Daegu. In Singapore, the government has identified five clusters and is investigating the connections within them. The virus has been detected in at least 25 other countries, with most infections involving people who had traveled from China.The figure in South Korea has nearly tripled over the course of three days, and officials tied 77 cases to a church in the city of Daegu. In Singapore, the government has identified five clusters and is investigating the connections within them. The virus has been detected in at least 25 other countries, with most infections involving people who had traveled from China.
“What we are worried about is sustained transmission in the community in countries outside China,” said Raina MacIntyre, head of the biosecurity program at the Kirby Institute of the University of New South Wales in Sydney.“What we are worried about is sustained transmission in the community in countries outside China,” said Raina MacIntyre, head of the biosecurity program at the Kirby Institute of the University of New South Wales in Sydney.
“Because once it becomes widespread and there’s transmission happening in two continents, that means it’s a pandemic.”“Because once it becomes widespread and there’s transmission happening in two continents, that means it’s a pandemic.”
Public health experts say most viral clusters are hard to investigate, and that is especially true with the current coronavirus outbreak, in which many infected people say they have no symptoms. If asymptomatic people can spread the virus, it will be much harder to slow its spread, as carriers transmit it unwittingly.Public health experts say most viral clusters are hard to investigate, and that is especially true with the current coronavirus outbreak, in which many infected people say they have no symptoms. If asymptomatic people can spread the virus, it will be much harder to slow its spread, as carriers transmit it unwittingly.
“There are ongoing silent transmissions” because of the very nature of the virus, Shigeru Omi, regional director emeritus of the World Health Organization’s Western Pacific region, said in a news conference on Monday.“There are ongoing silent transmissions” because of the very nature of the virus, Shigeru Omi, regional director emeritus of the World Health Organization’s Western Pacific region, said in a news conference on Monday.
David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, said there was no definitive evidence yet that people who are asymptomatic can pass on infections.David Heymann, an epidemiologist at the London School of Hygiene and Tropical Medicine, said there was no definitive evidence yet that people who are asymptomatic can pass on infections.
He said experts who are trying to understand the virus are waiting for information from countries outside China that are closely documenting cases.He said experts who are trying to understand the virus are waiting for information from countries outside China that are closely documenting cases.
“China has such an overwhelming number of patients that they are not able to do it meticulously,” said Dr. Heymann, a former chief of communicable diseases at the World Health Organization.“China has such an overwhelming number of patients that they are not able to do it meticulously,” said Dr. Heymann, a former chief of communicable diseases at the World Health Organization.
“How easily does it transmit from person to person?” he said. “We don’t know that yet.”“How easily does it transmit from person to person?” he said. “We don’t know that yet.”
Virologists see two likely explanations for the spread of clusters. In one, a “superspreader” — a person who has the propensity to spew more germs than others — transmits the virus to a large group of people. Some of these superspreaders have no symptoms and feel well enough to go out, or they encounter a group of people with low resistance.Virologists see two likely explanations for the spread of clusters. In one, a “superspreader” — a person who has the propensity to spew more germs than others — transmits the virus to a large group of people. Some of these superspreaders have no symptoms and feel well enough to go out, or they encounter a group of people with low resistance.
During the outbreak of SARS in 2002-03, the biggest reported superspreader was a 26-year-old airport worker admitted to Prince of Wales Hospital in Hong Kong. He infected 112 people, including every doctor and nurse who treated him.During the outbreak of SARS in 2002-03, the biggest reported superspreader was a 26-year-old airport worker admitted to Prince of Wales Hospital in Hong Kong. He infected 112 people, including every doctor and nurse who treated him.
Alternatively, people can independently catch a virus from contaminated surfaces. It is unclear how long the new coronavirus can survive on surfaces, but studies of other such viruses have found they can stay active for a week or more.Alternatively, people can independently catch a virus from contaminated surfaces. It is unclear how long the new coronavirus can survive on surfaces, but studies of other such viruses have found they can stay active for a week or more.
Outside the Diamond Princess cruise ship, the largest human-to-human cluster in Japan involves the Tokyo party boat.Outside the Diamond Princess cruise ship, the largest human-to-human cluster in Japan involves the Tokyo party boat.
Four days after the river cruise, on Jan. 22, the mother-in-law of the taxi driver in his 70s said she felt fatigued. Six days later, the woman, who was in her 80s, sought medical help but was told to monitor her condition. On Feb. 1, she was hospitalized after being given a diagnosis of pneumonia.Four days after the river cruise, on Jan. 22, the mother-in-law of the taxi driver in his 70s said she felt fatigued. Six days later, the woman, who was in her 80s, sought medical help but was told to monitor her condition. On Feb. 1, she was hospitalized after being given a diagnosis of pneumonia.
Her respiratory condition worsened, and she was moved to another hospital on Feb. 6. She was given the coronavirus test on Feb. 12. A day later, she died, and the results of her test soon came back positive. Her death was the first from the virus in Japan.Her respiratory condition worsened, and she was moved to another hospital on Feb. 6. She was given the coronavirus test on Feb. 12. A day later, she died, and the results of her test soon came back positive. Her death was the first from the virus in Japan.
After health officials in Tokyo discovered that the infected taxi driver was the son-in-law of the woman who had died, they started tracing his contacts. They discovered that he had attended the boat party, and tested everyone who had been there. Seven others who were confirmed infected said they had no symptoms.After health officials in Tokyo discovered that the infected taxi driver was the son-in-law of the woman who had died, they started tracing his contacts. They discovered that he had attended the boat party, and tested everyone who had been there. Seven others who were confirmed infected said they had no symptoms.
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.
Others, like a female employee of the taxi drivers association who did not attend the party, contracted the virus after having casual interactions with those who did. In yet another case, a doctor in his 60s tested positive after dining with a nurse — the wife of a taxi driver — who had been at the party. He, too, did not have symptoms.Others, like a female employee of the taxi drivers association who did not attend the party, contracted the virus after having casual interactions with those who did. In yet another case, a doctor in his 60s tested positive after dining with a nurse — the wife of a taxi driver — who had been at the party. He, too, did not have symptoms.
Another cluster of cases in Japan has occurred in Wakayama Prefecture, where a surgeon in a hospital, a colleague of his, the colleague’s wife and their child tested positive for the virus, as well as two patients who visited the hospital. One of them was a farmer in his 70s who went to the hospital after the first doctor had stopped working.Another cluster of cases in Japan has occurred in Wakayama Prefecture, where a surgeon in a hospital, a colleague of his, the colleague’s wife and their child tested positive for the virus, as well as two patients who visited the hospital. One of them was a farmer in his 70s who went to the hospital after the first doctor had stopped working.
The mother, wife and younger brother of a patient in his 60s from the same hospital also came down with the coronavirus, as did a nurse in his 30s who had temporarily worked on the Diamond Princess as part of the disaster response.The mother, wife and younger brother of a patient in his 60s from the same hospital also came down with the coronavirus, as did a nurse in his 30s who had temporarily worked on the Diamond Princess as part of the disaster response.
Yoshinobu Nisaka, the prefecture’s governor, said he could not rule out the possibility that infections had occurred within the hospital. “We’re having trouble tracking down how these people were infected,” he said at a news conference on Saturday.Yoshinobu Nisaka, the prefecture’s governor, said he could not rule out the possibility that infections had occurred within the hospital. “We’re having trouble tracking down how these people were infected,” he said at a news conference on Saturday.
In another cluster in Japan, four people from Aichi Prefecture were found to be infected: a couple who had traveled back from Hawaii and their friends.In another cluster in Japan, four people from Aichi Prefecture were found to be infected: a couple who had traveled back from Hawaii and their friends.
Takaji Wakita, the head of Japan’s National Institute of Infectious Diseases, said that while it would be difficult to stop the transmission of the virus, the outbreak could be contained. He urged people during a news conference to consider telecommuting and to refrain from having meetings that are not urgent.Takaji Wakita, the head of Japan’s National Institute of Infectious Diseases, said that while it would be difficult to stop the transmission of the virus, the outbreak could be contained. He urged people during a news conference to consider telecommuting and to refrain from having meetings that are not urgent.
Dominic Dwyer, a medical virologist at the University of Sydney in Australia, said it was reassuring that governments were identifying clusters, because that was a sign that their public health surveillance was working.Dominic Dwyer, a medical virologist at the University of Sydney in Australia, said it was reassuring that governments were identifying clusters, because that was a sign that their public health surveillance was working.
“I suppose what one is concerned about is, are there other clusters going on that they haven’t recognized?” he said. “Identifying clusters is a sign of good laboratory investigation. But as for how good that is, time will tell.”“I suppose what one is concerned about is, are there other clusters going on that they haven’t recognized?” he said. “Identifying clusters is a sign of good laboratory investigation. But as for how good that is, time will tell.”