Barely a month after ushering in the new decade, Japan never thought it would be in the spotlight, and for all the wrong reasons.
In a gesture of humanitarian goodwill, the Japanese administration did not prevent the cruise ship, Diamond Princess, from docking off the port in Yokohama on Feb. 3 even when it knew why the voyage had been cut short: a passenger had boarded the ship when it set off on Jan. 20, stayed five days then disembarked in Hong Kong. Six days later, he got sick and tested positive for the coronavirus. Allowing the ship into Japan territorial waters makes it the country’s responsibility to contain the spread of a disease, later named Covid-19, that had no established protocols for management and treatment yet.
On Feb. 4, ten people were tested and confirmed to have the disease, and the Japanese government immediately set to quarantine the ship and its more than 3,700 guests and crew. Soon thereafter, the numbers kept rising, adding up to more than 700 by the end of the two-week quarantine period on Feb. 19.
By then, Prime Minister Abe Shinzo and his government officials came under fire from international media, with medical experts criticizing and lambasting them, calling the quarantine a failure. But the alleged failure may be attributed to the possibility that some people had already been exposed to the virus before the lockdown began, and showed symptoms after, according to one expert.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, said, “The quarantine process failed…Something went awry in the process of the quarantining on that ship. I don’t know what it was, but a lot of people got infected on that ship.”
But did not Dr. Fauci think it could have been the sick man who might have unknowingly infected the people on board who had been in close proximity to the other individuals? Prior to this incident, it was already known that Covid-19 had an incubation period of as long as 14 days.
Closer to home, Professor Kentaro Iwata, an infectious diseases specialist at Kobe University, released a video (which has since been taken down) detailing the “completely inadequate” quarantine measures, lack of hygiene controls and protective gear, and the intermingling of the sick and healthy crew and passengers. Iwata added that he had dealt with the Ebola, cholera, and SARS outbreaks, and his experience on the Diamond Princess got him “so scared of getting Covid-19.”
However, the Ministry official who secured permission for Dr. Iwata to enter the ship belied the latter’s claims, saying Dr. Iwata had only been on the ship for less than two hours and was ordered out for meddling in the various teams’ operations on board.
Several experts have expressed similar views about the quarantine infecting otherwise healthy guests and crew because of the confined spaces and the absence of proper controls, further contributing to the active transmission of Covid-19 on the Diamond Princess.
But for the Japanese government, what are the alternatives to quarantine?
According to the Centers for Disease Control and Prevention, quarantine helps protect the public by preventing exposure to people who have or may have a contagious disease. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
In this context, Japan abided by the rules of quarantine since everyone on board the cruise ship had been exposed to Covid-19. It was just unfortunate that a large number of them eventually contracted the disease. Some may argue that quarantine is an outdated practice but at present, even the CDC observes and authorizes it.
Dr. Du Bin, one of China’s specialists looking into the coronavirus disease, says planning is crucial in responding to an outbreak. But Japan did not have the luxury of time to plan. The infected cruise ship was thrust upon them without prior notice.
Japanese officials have admitted that the quarantine was not perfect and isolation near impossible as there was a shortage of testing kits and the crew had to serve meals and provide basic supplies to the guests. Contact between them was unavoidable.
It’s also worth mentioning that those who had tested positive for Covid-19 were taken out of the ship and admitted to local hospitals.
Nonetheless, quite a few specialists had a more realistic view of the quarantine. Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital, says Japan was put in a very challenging situation of “finding appropriate accommodations for 3,700 people on very short notice.” Another physician, Dr. Robert Quigley, isn’t surprised by the transmission of Covid-19 on the cruise ship. Given thousands of people from different backgrounds and varying medical conditions are cooped up in a limited space, contagion is to be expected.
As for the statement of Dr. Amesh Adalja of Johns Hopkins Center for Health Security that the quarantine was not justified and was a violation of the passengers’ rights, maritime lawyer Jack Hickey refutes it by saying, “Japan has the right to quarantine a ship,” as countries have inherent police powers that may be exercised in certain circumstances.
In a quarantine situation, the critics of Japan’s handling of Diamond Princess miss the point entirely: the point of quarantine is to protect people outside it, not those within. The people on the ship were sacrificed for the greater good, and if that objective was achieved, the quarantine could be considered successful.