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Japan’s coronavirus response on cruise ship ‘completely inadequate,’ says health expert

Passengers disembarking from the Diamond Princess cruise ship docked at Yokohama, Japan, on Feb. 19. (Kyodo/Reuters)

TOKYO — A Japanese infectious disease specialist who visited the quarantined Diamond Princess decried "chaotic" and "scary" conditions on the cruise liner that gave the coronavirus more opportunity to spread.

Kentaro Iwata, a professor from Kobe University, said he was left troubled by the lack of virus-control protocols, such as designated “red zones” on the ship, which has been on lockdown at a dock in Yokohama for more than two weeks.

“It was completely chaotic,” Iwata said in a YouTube video posted late Tuesday, after he spent several hours on the ship as part of an assessment team.

“I was so scared of getting covid-19 because there was no way to tell where the virus is, no green zone, no red zone — everywhere could have the virus,” he said in English, describing the normal practice of cordoning off separate contaminated and virus-free areas. Another video, in Japanese, was viewed more than 1.3 million times.

Infectious disease specialist Kentaro Iwata said he was appalled by a “completely inadequate system of infection control on board," the Diamond Princess. (Video: Kentaro Iwata)

For Japan’s government, it was another stinging critique of its handling of the outbreak, including what critics call sluggish responses in imposing border controls earlier this month and ramping up virus testing.

In the past few days, the number of covid-19 cases — even outside the quarantined Diamond Princess — has more than doubled to 79, with many of the new cases not traceable to China.

That has forced health officials to acknowledge that “local transmission” has begun and it’s now “impossible” to prevent the virus from spreading.

The biggest questions about the coronavirus

The virus has put politicians on the defensive all over the world as they struggle to react to a fast-evolving threat — with Japanese Prime Minister Shinzo Abe and his government the latest to feel the heat.

Here, the criticism echoes that leveled at the country during the 2011 Fukushima nuclear disaster — a reluctance to admit the scale of the problem, a lack of firm political leadership and a famously cautious bureaucracy.

'So scared'

On the Diamond Princess, meanwhile, at least 542 people have been found to have the virus, out of 2,404 people tested, with results still awaited on the final 1,300 tests.

Four people working on or around the ship during the quarantine period have also contracted the virus: a quarantine officer, a Health Ministry official, an ambulance driver and a medical staffer.

A Japanese man and woman — both in their 80s, who were passengers on the ship — died Thursday, according to Japanese public broadcaster NHK, marking the first time one of the cruise ship passengers has died.

The Japanese government insists the quarantine was a success and began letting its citizens who have tested negative off the ship Wednesday. They were allowed to take public transport home.

But the fact that the U.S. government evacuated its citizens before the quarantine period ended — and will subject them to an additional 14-day confinement in the United States — was an acknowledgment that it has a very different view.

“My deep worry has been that we are essentially condemning [people on board] to infection because of the close quarters in which they’re staying,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore. “And to what end are we doing this? Is it because we’re trying to keep the virus out of the country? Japan already has local transmission.”

Iwata, the health expert, called the ship’s infection-control measures “completely inadequate.”

“Bureaucrats were in charge of everything” without a single professional infection control specialist on board, he said.

“I never had fear of getting infection myself, for Ebola, SARS, cholera, because I know how to protect myself, how to protect others and how infection control should be,” he said, describing his past work in Africa and with teams dealing with severe acute respiratory syndrome (SARS) in the early 2000s.

“But inside the Diamond Princess,” he said, “I was so scared.”

He has since returned to his home in Kobe but has isolated himself in a room for fear of infecting his family.

Responding to Iwata’s complaints, Japanese chief government spokesman Yoshihide Suga said the government had been “implementing measures to prevent the spread of the infection thoroughly.”

Falling support

Two opinion polls published Monday show support for Abe’s government falling by five percentage points and significant levels of dissatisfaction with the government’s handling of the outbreak.

The cost to Japan’s already struggling economy could be catastrophic, while the possible implications for the Summer Olympics in Tokyo are almost unthinkable.

The new coronavirus has moved fast, but the government’s response has been slow and misguided, many experts say.

As virus spreads, public health decisions come into focus

On Jan. 23, Japan began using monitors to check temperatures of passengers flying in from China, but it didn’t starting denying entry to people from Hubei province until Feb. 1, a day after the U.S. administration barred all foreign travelers from China.

By then, thousands of tourists from Hubei had entered the country, some bringing the virus with them.

Critics said Abe appeared keener to avoid offending China ahead of a visit by President Xi Jinping planned for April than tackling the problem head on.

“The government seems to have been inordinately complacent when it should have been implementing sensible countermeasures and preparing for an outbreak,” said Jeff Kingston, director of Asian studies at Temple University Japan.

Masahiro Kami, executive director at Medical Governance Research Institute in Tokyo, said it was apparent the virus was spreading in Japan as early as Feb. 4, after a Thai couple returned home with the disease after a vacation in Japan.

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Instead of relying on border controls, Kami argues the health ministry should have moved much more aggressively to work with private sector companies to expand virus testing capacity instead of relying on the ministry’s own overburdened National Institute of Infectious Diseases.

“It’s all about risk management at the expense of the larger crisis itself,” said Koichi Nakano, a political science professor at Sophia University in Tokyo.

The politics of China

In response, Foreign Minister Toshimitsu Motegi said Japan has consistently taken action in line with the changing situation in China and intends “to continue to tackle the situation with all our might.”

A new “aggressive” strategy announced by Japan’s Health Ministry this week recognized that a change of approach was required.

Test kits supplied by private-sector companies are finally going to be used to expand testing to more than 3,000 assessments a day, while beds in specialist hospitals will be reserved for more severe cases, rather than trying to isolate people with mild symptoms.

A public education campaign has begun and citizens are being discouraged from attending nonessential mass gatherings. Attention must also shift on how to protect Japanese over 65 years old, who make up a quarter of the population, experts say.

Instead of restricting tests to people who can show some link to China or another infected person, tests are now being made available to anyone with symptoms of the disease — one of the reasons for the recent jump in cases.

“With many emerging infections, when they’re first recognized, there are so many unknowns,” said Jeffrey Duchin, a professor of medicine and infectious diseases at the University of Washington. “You’re almost always in a no-win situation. But you have to really adjust your tactics and your strategies as you go.”

Akiko Kashiwagi contributed to this report.

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