<![CDATA[Coronavirus: fears rise as Westerdam cruise passengers return to US, Canada and Europe]>
Retired American nurse Paulette Schaeffer returned to Las Vegas over the weekend after the cruise ship she was on, the MS Westerdam, docked in Cambodia on February 13 after being rejected by five ports over coronavirus fears.
She told the Las Vegas Review Journal that she and her husband Joseph had an eight-hour layover in Singapore before flying to Los Angeles, from where they drove home to the state of Nevada. They had already gone to the Costco supermarket and were running other errands, confident they did not have the coronavirus that has sickened over 73,000 people and killed more than 1,800 worldwide.
The virus was the reason the Westerdam, which had left Hong Kong on February 1 for a 14-day cruise, could not call at its scheduled ports and was effectively a pariah ship with no destination, until Cambodia allowed it to dock.
Schaeffer said they had at least three health checks on the cruise ship, where guests answered questions about their physical condition and had their temperatures taken to make sure they were not running a fever, a defining symptom of the Covid-19 disease that is caused by the virus.
"They were very thorough," Schaeffer told the Journal.
But one of their fellow passengers, who was among several hundred guests who left Cambodia on Sunday, tested positive for the virus while on transit in Malaysia. The 83-year-old woman is receiving treatment, along with her 85-year-old husband, who has pneumonia.
The discovery has left international health authorities scrambling to track guests from the Westerdam out of concern that their possible exposure to the virus would escalate the international spread of the disease that has afflicted mostly people in mainland China and parts of Asia.
The ship carried guests from 41 countries, including 651 Americans, 271 Canadians and 127 Britons, with people from parts of Europe and Australia also on board.
It is still docked in Sihanoukville, where the remaining 255 passengers and 747 crew on board are being tested for the illness. A statement from Holland America, the ship's operator, said hundreds of other passengers staying at a hotel in the capital Phnom Penh have been tested.
Cruise passengers who disembarked from the MS Westerdam in Sihanoukville sit on a bus for a visit of the capital Phnom Penh. Photo: AFP alt=Cruise passengers who disembarked from the MS Westerdam in Sihanoukville sit on a bus for a visit of the capital Phnom Penh. Photo: AFP
Late on Sunday, chief medical officer at Holland America Grant Tarling said the company was working with national health authorities "to investigate and follow up with individuals who may have come in contact with the guest".
"It seems quite likely there will be additional cases from the Westerdam," said Stanley Deresinksi, an infectious disease specialist at Stanford University. "National authorities will undoubtedly have contacted local health departments, who can contact the individuals and request that they quarantine in place."
Health officials in Canada have asked returning Westerdam passengers to keep themselves in isolation for 14 days and report to local public health authorities within 24 hours of their return to be monitored for symptoms. Two Canadians who returned via Vancouver International Airport were asked to put on protective face masks on arrival but were not otherwise isolated, Canada's CBC News reported.
An arm of the Netherlands national health ministry has said it will test all 91 Dutch citizens who were on board upon their return.
The US has not immediately announced plans to address risks posed by returning Westerdam passengers, but officials from the State Department told reporters about 300 Americans had already left Cambodia, and they were tracking those remaining behind.
Meanwhile, Thailand, Malaysia and Singapore " which had dozens of passengers pass through their airports over the weekend for their return journeys home " have said they will not allow any of the remaining Westerdam passengers in Cambodia to transit through their countries.
The Westerdam case has added to the woes of health authorities who are helping their citizens on the Diamond Princess cruise ship, which has been quarantined off Yokohama in Japan with 542 infected passengers for the past 13 days. The US has evacuated 328 Americans, including 14 who tested positive for the virus but showed no symptoms.
Foreign passengers are being evacuated from the cruise ship Diamond Princess, which is docked in Yokohama, south of Tokyo, Japan. Photo: Reuters alt=Foreign passengers are being evacuated from the cruise ship Diamond Princess, which is docked in Yokohama, south of Tokyo, Japan. Photo: Reuters
Britain, Australia, South Korea and Canada were making plans to evacuate their nationals from the ship.
Canada said 32 of its citizens aboard the Diamond Princess have tested positive for the coronavirus, according to a tweet from the Toronto Star.
Both the Westerdam and the Diamond Princess are owned by Miami-based cruise giant Carnival Corporation, which has said it will make arrangements for guests cleared by Cambodian authorities to travel home. It has given passengers a full refund of their fare and a 100 per cent future cruise credit.
But health experts say the challenges posed by the two cruise ships call into question the approaches used to contain the spread of the virus.
Many countries have enacted requirements that any foreigners who had recently been to China must be isolated upon arrival for 14 days, with some countries going as far as outright baring entry for anyone who had recently been to China. Hong Kong and Singapore have devoted enormous resources within their health care systems to tracking and isolating all known contacts of all confirmed cases of the virus.
The health experts say the case of the infected passenger on the Westerdam highlights that gaps remain in knowledge about how best to test for the virus and whether it is contagious during its incubation period.
Passengers who were waiting in Cambodia for onward flights were given a free bus tour of Phnom Penh, where they were photographed by local media without masks on.
" Rebecca Willett (@beccapiano1) February 17, 2020Cambodia's Prime Minister Hun Sen on Tuesday defended his decision to allow the Westerdam to dock in the country. "Some people say it brings the virus to Cambodia, but Cambodia has not had the disease [among its people]," he said.
Cambodia only has one confirmed case of the virus " a Chinese tourist who has since recovered.
Derensinksi said that Westerdam passengers should be monitored by local health authorities and quarantine themselves, and that the list of passengers on the ship's manifest should make the tracking possess easier.
But the Stanford doctor also was alarmed about the possibility the virus is contagious before someone shows symptoms.
"The question of transmission from asymptomatic individuals has not been agreed upon, but it is likely, although the risk is likely much lower than from symptomatic individuals," he said.
"Everyone thought the Diamond Princess was the worst case scenario, but at least the Diamond Princess was methodically contained," said Eric Feigl-Ding, a public health researcher affiliated with Harvard University. "We didn't expect a situation of this magnitude."
NO WAY ONWARD
Malaysia on Monday night confirmed that of the more than 140 passengers from the Westerdam who transited in Kuala Lumpur International Airport for their onward journey home, only the American women and her husband remain.
Malaysia's Deputy Prime Minister Wan Azizah Wan Ismail on Monday said the government would no longer allow any cruise ships that had left or transited through China to enter Malaysia.
" Christina Kerby (@ChristinaKerby) February 17, 2020In Singapore, Lawrence Wong, a minister who co-chairs the multi-ministry task force dealing with the outbreak said: "We are not allowing any more passengers to come into Singapore or transit through."
Two Singapore citizens who returned from the Westerdam are now in quarantine at a government facility, said Wong.
Thailand's ministry of health on Monday warned passengers from the ship should not transit through Bangkok, and said that if passengers from the ship did travel to Thailand they will be subject to 14 days quarantine even if they are showing no symptoms.
"Passengers on the ship are at risk and travel by aeroplane will cause risk to other passengers," said Health Minister Anutin Charnvirakul.
The cruise ship MS Westerdam is seen docked in Sihanoukville, Cambodia. Photo: Reuters alt=The cruise ship MS Westerdam is seen docked in Sihanoukville, Cambodia. Photo: Reuters
Experts say the outbreak will be a disaster for the cruise industry in Asia, which had been its fastest- growing market. Malaysia has already said it will not allow any cruise ships that had left or transited through China to enter.
South Korea and Taiwan last week imposed a temporary entry ban on all international cruise ships, and Vietnam on Thursday denied two European cruise liners entry.
Jean-Paul Rodrigue, professor of transport geography at Hofstra University in New York, said: "The cruise lines are stuck with something they could not anticipate. The cruise ship is a self-enclosed facility " it's not like an aeroplane, where the air circulation is actually more efficient. A cruise ship is pretty much the worst environment you can be stuck in, in terms of contagion factor."
Despite this, the World Health Organisation said cruise ship travel is a "manageable risk" for now, and it does not make sense to recommend a ban on it.
"People [have ideas such as saying] we should steer clear of cruise ships, or steer clear of airports or steer clear of certain ethnic groups," said Mike Ryan, executive director of the WHO's Health Emergencies Programme.
"[But] we need an approach to managing risk that allows us to continue to operate as a society."
Additional reporting by Bloomberg and Agence France-Presse
This article originally appeared on the South China Morning Post (SCMP).
Copyright (c) 2020. South China Morning Post Publishers Ltd. All rights reserved.
