--:-- Sean Rameswaram: Welcome to Today Explained, I'm Sean Rameswaram.
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--:-- Sean Rameswaram: There are these two cruise ships that give us two very different and very scary glimpses into how coronavirus is spreading in the world right now. You've heard of the Diamond Princess from Princess Cruises. That's the one off the coast of Japan where almost everyone's stuck on the ship. And now this ship has the biggest outbreak of coronavirus outside of mainland China. Then there's ship two, the Westerdam from Holland, America. After trying to dock in five other countries and being turned away, the Westerdam finally anchored in Cambodia and everyone disembarked. Almost as soon as that happened, one of its passengers, an American, tested positive for coronavirus. Now, there's this scramble to find everyone who was on the ship and track down every single person they've interacted with since.
--:-- Sean Rameswaram: Today on the show, we're going to take a closer look at how coronavirus was handled on each of these ships and all the related ethical, moral, and scientific concerns, because the world has never quite seen this. A brand new, unfamiliar virus spreading on cruise ships and now probably on land because of cruise ships. We're going to start with the Diamond Princess.
--:-- Julia Belouz: So it's a luxury cruise liner that was supposed to go on this two-week journey around East Asia. And 3,700 people on the ship, 1,000 of them are crew. And the passengers and the crew hail from countries all over the world. So some of the passengers are from Canada, Australia, the U.S., Japan, Britain. and the crew members also come from many different places, the Philippines, India. So it's a ship with people from all over the world.
--:-- Julia Belouz: And when was the virus first detected on the Diamond Princess? When did they realize they had coronavirus on the cruise? So an 80-year-old passenger, he got off the ship in Hong Kong and a few days later on February 1st, he tested positive for the virus. And that's what set off this massive public health experiment.
--:-- Julia Belouz: So what does the crews do once they figure out they got coronavirus on board? They decide to basically quarantine everyone. So by February 4th, the remaining 3,700 passengers and crew are just asked to stay on the ship under quarantine orders. And the ship's been docked in Yokohama, Japan, a port city in Japan ever since.
--:-- Julia Belouz: Who makes the decision to quarantine the whole ship and keep it in this port city of Yokohama, Japan? The decision was made by the Japanese government and officially their idea was basically like let's keep these people who are potentially sick on this boat and keep the virus from spreading on land. And this is especially important in Japan right now considering they're about to host the Summer Olympics in Tokyo in July. So they had this objective to keep the virus outside of Japan on the ship.
--:-- Julia Belouz: And the numbers keep growing. I mean, there was one case. And now, I mean, as of Monday morning, there's like 542 cases on board. It's the largest outbreak right now outside of mainland China. And so the people who have tested positive for the virus have been allowed to leave the ship for treatment in Japan. And the rest have remained on board and they're supposed to be there until at least February 19th.
--:-- Julia Belouz: But wasn't there some situation this weekend where like a bunch of Americans were allowed to leave? What exactly happened there? Yeah, so the American government seemed to be deliberating about what to do about this cruise ship. And over the weekend, they announced that the situation on board had escalated and they wanted to get Americans off the cruise ship. So those who wanted to be evacuated and flown back to the U.S. could. and whoever decided to stay on the cruise ship would have to basically remain there until the CDC, the Centers for Disease Control in the U.S., decides what to do with them.
--:-- Julia Belouz: So on Sunday, this group of Americans was flown back to the U.S. And just as they were leaving, so after they got off the cruise ship and they were ready to leave, 14 of them tested positive for the virus. So Americans were allowed to leave irrespective of whether or not they had the virus. They were just saying, any American on board can leave and we'll figure out whether you have the virus once you get off the boat? Well, first, the government said that those who tested positive for the virus should stay in Japan for treatment. But apparently this group of 14 weren showing symptoms and they made the decision to just let them go
--:-- Julia Belouz: And the State Department has said that on this flight they also being quarantined from the other passengers and they're being monitored for symptoms. But how well now this phase of the trip will go, I'm not sure either. It's a respiratory virus. What's supposed to happen to these Americans once they're stateside? Another quarantine, two weeks at Travis Air Force Base in California or Lackland Air Force Base near San Antonio, Texas.
--:-- Julia Belouz: And just to reiterate here, we already know that some of these people definitely have coronavirus and may have even spread it to the other people who didn't while being evacuated from the ship. So on the flight, I assume like CDC has completely state-of-the-art techniques for keeping infectious diseases under control and they're absolutely world-class. So I assume that they're taking precautions, but they seem to have been put in a really difficult position with these people testing positive for the virus just as they're about to evacuate.
--:-- Julia Belouz: And so how well they're able to control the spread of the virus on the flight, I don't know. and then at the same time, who knows how many people this group of 14 were exposed to during their trip and whether they've also spread the virus to other people along the way. So we have no idea how many people that this group of people may have infected, but we do know that they're far, far away from this ship now.
--:-- Julia Belouz: Did the Americans receive some sort of special treatment here? Why is it that just one country is evacuating its citizens off of this ship? America has this incredible tradition of pulling its citizens out of kind of extraordinary circumstances in many different places around the world, often faster than other countries. And probably has something to do with just the resources they're able to marshal. But Canada and Hong Kong are also trying to evacuate their citizens. And the Philippines is working on the same thing for crew members from the Philippines. so we might be hearing more in the coming days.
--:-- Julia Belouz: What's life aboard the Diamond Princess cruise ship like for those who remain? So the people on the cruise ship who have been under quarantine now for almost two weeks, they've been asked to basically stay in their rooms. They've been given extra entertainment on TV and newspapers and whatnot. They're asked to wear masks and only walk on the deck for a couple minutes at a time. and when they are on the deck to keep a distance from the other passengers. And they're having to eat their meals in their rooms.
--:-- Julia Belouz: And the interesting thing now is that because of social media, people have been able to broadcast what their experiences have been like. And I think as the case toll mounted, you kind of see this increasing anxiety and worry about basically what is a hypochondriac's worst nightmare. You're sort of stuck. You can't move and you know that this virus is swirling around you.
--:-- Julia Belouz: We've got reading. We've got movies to watch. I'm just glad that we are together as a family. I know some other families who, because they've got separate rooms with kids, are unable to see their kids. Health-wise, we're good. We take our temperatures a couple times a day. They deliver thermometers and they've told us what they're worried about. Lots of people went off today. Lots of more doctors came on. And I get more upset every day because the numbers of victims go up every day. You know, we feel like we're sitting ducks here.
--:-- Julia Belouz: we have not eaten since 7 p.m last night all the services on board the ship including food have been stopped because the source of the virus has not been determined and they now think it could be the food that is spreading it. If I do not receive food soon, I will be in a diabetic coma. And then it'll make real news, won't it? But it'll be too bloody late.
--:-- Julia Belouz: I've never felt less loved by my home country than right now. Can I just tell you, UK, it feels that we have been forgotten, that you don't really care about us, and that you're actually not wanting us to come home. That's how it feels. This is going to be my final time at begging you to get us off ASAP.
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--:-- Sean Rameswaram: Chime feels like progress. Chime is a financial technology company not a bank. Banking services and debit card provided by the Bancor Bank N or Stride Bank N.A. Members FDIC. Spot me eligibility requirements and overdraft limits apply. Timing depends on submission of payment file. Fees apply at out-of-network ATMs. Bank ranking and number of ATMs according to U.S. News and World Report 2023. Chime checking account required. Not all journalism is the same. Take The Guardian. Our coverage has something unique. Fierce independence. Nobody owns us or tells us what we can and can't say. So we're free to report the whole picture. We connect what's happening in Washington to the rest of the globe. Expose corruption wherever we find it. And give fresh perspective on everything. From wellness and soccer to culture, the climate and more. Read, watch, and listen to The Guardian for free at theguardian.com.
--:-- Julia Belouz: Julia, let's talk about this other ship, the Westerdam. This is a Holland America cruise line. What's the story with this one? Yep, so it's another luxury cruise liner that was supposed to be having an enjoyable trip, sailing throughout Asia, and they ended up getting caught in the coronavirus cruise ship crosshairs. So while this drama on the Japanese cruise ship was unfolding, the Westerdam began to have trouble being accepted at any ports in Asia. The vessel had been turned away from Japan, Guam, the Philippines, Taiwan and Thailand over fears it was carrying someone with the coronavirus. Then finally the government of Cambodia decided to let them in.
--:-- Julia Belouz: So on Thursday the ship was finally allowed to dock. Hundreds of passengers cheered on Friday as they disembarked a cruise ship that was stranded at sea for two weeks over virus fears. We are so happy that Cambodia have made this possible, that we can go home to our family. We're going to the beach now on a shuttle, which the ship are providing, and we're coming back this afternoon. And I think tomorrow we'll probably be leaving. We don't have much wealth, but we have sympathy to save those stranded on the ship.
--:-- Julia Belouz: Why did Cambodia agree to take this ship when so many other countries refused it? It might have been a political decision. So apparently Cambodia and China are political allies. The Cambodian prime minister has been casting doubt about the seriousness of this outbreak. and it's possible that he opened Cambodia's doors to the cruise ship passengers to do China a favor.
--:-- Julia Belouz: So what happens once this ship docks in Cambodia? So everyone was cleared of the virus, they were let off the ship, and then they kind of dispersed around the world going home or onward with their travels. One American who was headed to Malaysia promptly tested positive for the virus. The 83-year-old American woman was one of 145 passengers from the cruise ship on board a flight from Sienokville in Cambodia to the Malaysian capital.
--:-- Julia Belouz: On arrival at Kuala Lumpur International Airport, both she and her husband were found to have worrisome symptoms. Tests confirmed the woman was positive for COVID-19. How did the American passenger test positive for the coronavirus in Malaysia, but not on the boat in Cambodia? That's the key question. So the Cambodian government said that everyone was adequately screened and that they took all the necessary precautions. So I guess it's possible she didn't have enough virus yet in her system to test positive a few days earlier. That is a possibility.
--:-- Julia Belouz: It's also possible that Cambodian officials didn't take the necessary precautions and allowed people to get off the ship, creating this problem for many, many other countries. So we don't yet fully know how thorough Cambodia's testing was? No, we don't know yet.
--:-- Julia Belouz: So what does Cambodia, Malaysia, Holland, America, anyone do once they realize that one person was let off this ship that definitely had coronavirus, which means perhaps many more were as well? Up until this point in the outbreak, a lot of the effort has been on containing the virus, stopping it from spreading on cruise ships, quarantining people, keeping them from disembarking in other countries and spreading the virus there.
--:-- Julia Belouz: And now with what happened on the Westerdam and this American already testing positive, it feels like we're at a turning point. With every passing day, we've been seeing more and more people test positive for the virus outside of China. So the vast majority of the cases are still in China, but there's this mounting toll in countries around the world. China has reported 70,635 cases of COVID-19 to WHO, including 1,772 deaths. Outside China, WHO has received reports of 694 cases from 25 countries and three deaths.
--:-- Julia Belouz: And now with all these passengers just being let off these ships to travel back around the world, potentially carrying the virus with them, we're likely to see that toll outside of China mount even further. It's this highly contagious respiratory virus and it seems like it's doing a very good job of spreading among people and we might be at a point where containing it is impossible.
--:-- Julia Belouz: It feels like we have these two very distinct case studies here of how to handle coronavirus on a cruise ship One quarantine everyone for a long time to make sure it gets off the boat but letting it spread on the ship Two let people off the ship without thoroughly testing them and then we have no idea how far this thing will spread. That's right. It's this coronavirus cruise ship conundrum, and again, it gets out how difficult I think it is to contain this virus.
--:-- Julia Belouz: you know and it also shows we're in this moment of global travel and trade hopping on a plane to go to the other side of the world and in that same time period potentially bring a disease with us and you know you see in real life countries struggling with what to do about this and the Japanese quarantine was far from ideal so while their intention may have been to keep the virus from spreading among the passengers, quarantining them on the ship.
--:-- Julia Belouz: These reports have been emerging for the last 10 days to suggest that they didn't do the quarantine properly. So, for example, there was this upstairs-downstairs dynamic, kind of a Downton Abbey where you had the crew members downstairs serving the passengers on the upper decks and the passengers upstairs while they were staying in their room and might have been adequately quarantined.
--:-- Julia Belouz: There were crew members under the ship who were testing positive for the virus and still working together, eating together, potentially spreading the virus among themselves, and then coming upstairs to serve and clean and take care of the ship and potentially spreading it up there.
--:-- Julia Belouz: I think what the Japanese case also shows is that the government in Japan valued the health of its citizens over the health of the people on the cruise ship. They didn't want the virus spreading in Japan and decided to allow this experiment to play out on the cruise ship and potentially spread the virus there.
--:-- Julia Belouz: I guess what you're talking about there are ethical questions. And I guess in both cases, the Diamond Princess cruise ship and the Westerdam cruise ship, you have serious ethical questions. Was it ethical for Cambodia to let the ship dock and then let everyone get off the ship? Is it ethical for Japan to make everyone stay on the ship and not disembark and potentially infect to Japanese people.
--:-- Julia Belouz: Has anyone taken stock of all the ethical questions at play here? Yeah, I talked to a researcher who works on these issues, and what he said was that quarantines can be really effective for stopping the spread of disease, but they have to be done properly. So you can't quarantine potentially sick people with people who aren't sick and hope for the best, which seems like that's what happened in the Japanese case.
--:-- Julia Belouz: You have to make sure that people who are sick or who have potentially been exposed or separated from the healthy people. And so, yeah, this raises huge ethical questions. And it also, I think, raises diplomatic questions for relations between the U.S. and Japan.
--:-- Julia Belouz: At the same time, while this virus might have caught us off guard, sort of incredible to see all these countries and businesses scrambling and seemingly, you know, unable to mobilize and to have a proper plan to protect public health. For years, people have been talking about another potential pandemic, the danger of another respiratory virus spreading really fast throughout the world. We knew this was coming. And it's amazing that people, including the cruise ship industry, haven't been ready with better plans to deal with something like this.
--:-- Julia Belouz: Have we learned anything at least from these two cruise ships? Do we learn how this virus can spread from one cabin to another, from one passenger to another? Is it more than just through sneezing and coughing? Is it just breathing? Do we know anything more than we did a month ago? So we already know that cruise ships can be these ideal environments for transmitting diseases.
--:-- Julia Belouz: And we're seeing here that the virus seems to be highly contagious, but we don't yet know exactly how the virus spreads. And it seems like it could incubate in the body anywhere from two days to 14 days. That's what the CDC is saying now. So we don't know exactly how many people were already sick before the quarantine or how many got sick during the process of the quarantine.
--:-- Julia Belouz: And hopefully some of the data that comes out of this crazy cruise ship situation is that we learn more about exactly how the virus spreads, how it moves from person to person, whether it was being passed through the ventilation system on the ship. These are the things that we're going to learn in the coming days.
--:-- Julia Belouz: And this fundamental question of whether the quarantine created more diseases than it stopped. In the meantime, the one lesson we've learned is don't take a cruise. No, actually, I talked to one researcher who studies disease spread on cruise ships. And she said she felt that the focus on cruise ships might be a bit artificial, that, you know, maybe there are outbreaks that are happening like this in small hotels or restaurants that we just don't hear as much about.
--:-- Julia Belouz: but what we do know from people like her is that these cruise ships seem to be an ideal environment for disease spread and she actually found that when you have outbreak events on cruise ships when you see a new virus taking off like that usually it's a precursor for a much larger outbreak happening on land and so yeah maybe it does mean we're in for something much bigger.
--:-- Sean Rameswaram: Julia Blues has been covering this coronavirus for Vox since the beginning of the year. You can find and read all of her great work at vox.com.
--:-- Sean Rameswaram: I'm Sean Rameswaram. This is Today Explained.
