The coronavirus pandemic was still in its infancy a year ago when the eyes of the world — preoccupied by a burgeoning outbreak in China — turned to a quarantined cruise ship in Yokohama.
In January 2020, the world watched as mainland China struggled to contain a deadly new virus that appeared to be spreading from Wuhan, the capital of Hubei province.
On Feb. 5, the Diamond Princess docked in the port of Yokohama with more than 3,700 passengers and crew members who, upon arrival, were largely confined to their quarters for the next two weeks after a passenger tested positive for COVID-19 upon disembarking earlier in Hong Kong.
By then, however, the virus had already begun to spread.
Within 14 days, the cruise ship had become a floating incubator. By the time it was eventually evacuated, more than 700 people on board had become infected.
Reporters film the Diamond Princess cruise ship as it approaches the port of Yokohama on Feb. 6, 2020. | REUTERS
Japan had been cast unwittingly into the limelight by the Diamond Princess outbreak and, 12 months later, the episode represents a watershed moment in the country’s ongoing struggle to contain the virus.
The episode offered several lessons, not only by demonstrating the mercurial qualities of COVID-19, but also by exposing one country’s naive response to a virus that was — and, in many ways, remains — largely unpredictable.
Some experts believe those lessons have been learned. Others say they’ve been forgotten, or ignored altogether.
Cabin fever
Kent and Rebecca Frasure are cruise ship veterans.
Kent, an engineer, and Rebecca, a health care worker, have taken 10 cruises together, and wanted to spend their 11th aboard the Diamond Princess.
The couple flew from Oregon in the lush Pacific Northwest region of the United States to bustling Tokyo and stayed in a hotel near the port of Yokohama, where the ship awaited them.
They were excited to spend 16 days at sea aboard a luxury vessel with everything from live music, theatrical performances and swanky bars to tennis courts and a casino.
Buses wait for disembarking passengers to leave the coronavirus-hit Diamond Princess cruise ship in Yokohama. | RYUSEI TAKAHASHI
At each of the six stops in Hong Kong, Vietnam, Taiwan and other parts of Japan, including Okinawa, passengers left the ship to enjoy the local cuisine and explore.
Many went to Hong Kong Disneyland during the Lunar New Year, shopped in Okinawa or took part in guided tours.
Reports of a novel coronavirus outbreak in mainland China trickled in, but the trip continued without many significant interruptions. That is, until the ship reached the final stretch of its round trip. Getting off the ship for sightseeing in Okinawa took longer than usual since, this time, not only were passengers having their temperature taken, they were also asked to fill out a questionnaire and disclose whether they had recently traveled to mainland China.
Several local tours were postponed or canceled, which was “very unusual,” Kent Frasure says. “Our concern was that it was more serious than they were leading us on to believe.”
That concern began to materialize as the ship began to make its way back to Yokohama. A day after the Diamond Princess reached Tokyo Bay, Capt. Gennaro Arma officially announced the ship had been placed under quarantine, and that passengers would have to stay in their rooms.
Not all cabins had windows, and many passengers were traveling with elderly relatives or children. Some were periodically escorted to the deck for fresh air for about an hour once every two or three days.
Crew members left food and drinks outside each room. Between meals, passengers passed the time with exercise and conversation, or by finding new hobbies. Apparently, televised Zumba classes and origami tutorials were popular among passengers.
Englishman Alan Sanford was quarantined aboard the Diamond Princess with his wife, Vanessa. | COURTESY OF ALAN SANFORD
Many passengers were from the United States, South Korea, Australia, Canada, Hong Kong, Israel and the United Kingdom. Owing to the diversity of the ship’s inhabitants, developments on board drew attention from international media.
Sparse communication was possible between passengers, some of whom talked to each other from balconies attached to their rooms. Others spoke across the hallways when meals were being delivered.
At one point, passengers started a wave — the kind normally seen among spectators at sporting events — along adjacent balconies.
“I think it was the Canadians who started it,” chuckled Alan Sanford, an Englishman who was quarantined aboard the ship with his wife, Vanessa.
For those aboard, the pleasant aftertaste of a lavish getaway was quickly erased by two weeks of isolation, tedium, anxiety and fear.However, the fun only served as a temporary distraction from what was happening inside.
Every day, new reports emerged of passengers or crew members testing positive for COVID-19, many of whom could be seen from the ship being carried into ambulances and taken away.
Just three days in, Rebecca Frasure tested positive and was removed from the ship, leaving Kent alone for the remainder of the quarantine.
Meanwhile, Alan and Vanessa Sanford were beginning to feel anxious.
They had only one mobile phone between the two of them, and became concerned about what could happen if either tested positive and they were separated in a foreign country.
“The longer we were on the ship, we could feel our spirits declining,” Alan recalls. “We realized it wasn’t going to get any better.”
Neither tested positive for COVID-19, and the pair were able to leave the Diamond Princess disheveled but unscathed.
Passengers dance in an event space on the Diamond Princess cruise ship on Feb. 2, 2020. | PHILIP AND GAY COURTER / VIA REUTERS
However, disembarking from the ship wasn’t the end of their ordeal. Far from it.
Many foreign nationals were asked to quarantine for two weeks before flying home and an additional two weeks upon landing.
Others were evacuated by government charter flights and quarantined upon arrival. Dozens tested positive during or after their trips home.
All told, the Sanfords were quarantined for more than 60 consecutive days.
“We just couldn’t wait for it to end,” Alan says.
Containment criticism
Whether authorities could have done more to contain the Diamond Princess outbreak is debatable.
Whatever understanding the public had regarding the health ministry’s efforts to contain the virus, however, appeared to largely dissipate after Kentaro Iwata, a professor in the Kobe University Hospital’s Division of Infectious Diseases, published an incendiary video detailing inadequate containment measures aboard the ship.
On Feb. 18 — a day before passengers would begin disembarking from the vessel — Iwata posted a video of himself explaining that, having boarded the ship at the invitation of health ministry officials, he saw no clear separation between supposedly isolated “green zones” and potentially contaminated “red zones.”
He also claimed that, while medical staff were wearing gloves, face shields, masks and other protective equipment while they were aboard the ship, he saw several remove their equipment but continue to wear gloves while eating lunch or using their smartphones.
Passengers chat with neighbors on adjoining balconies on the Diamond Princess cruise ship in Yokohama on Feb. 16, 2020. | REUTERS
Following the ship’s evacuation, the health ministry admitted that several staff members who boarded the vessel had returned to work without being tested.
“The cruise ship was completely inadequate in terms of infection control,” Iwata said in the video.
One year later, his views on the government’s response to the outbreak haven’t changed much.
“Not only was the health ministry unprepared,” Iwata says. “The response was poor and officials failed to adequately consult experts when trying to figure out how to deal with the situation.”
While the world kept a close eye on the situation in Yokohama, a nearly identical story was unfolding in San Francisco.
On Feb. 21, the Grand Princess, a sister ship of the Diamond Princess, returned to San Francisco from a 10-day cruise to Mexico, and would leave the same day for another trip with multiple stops in Mexico and Hawaii. In early March, public health officials reported that an older resident who died after testing positive for COVID-19 had been a passenger aboard the Grand Princess on its first trip to Mexico.
The ship was then ordered to dock in San Francisco. U.S. President Donald Trump wanted the 3,500-plus passengers and crew members to stay aboard so they wouldn’t officially count as American cases. Nonetheless, the evacuation process began on March 9. Within a few days, almost all of the passengers were removed from the ship and taken to facilities on land while crew members were quarantined onboard.
Although many passengers from the Grand Princess declined to be tested, more than 122 tested positive for COVID-19 and seven died.
By comparison, 705 passengers and crew members on the Diamond Princess tested positive, and 14 lost their lives.
Passengers look out from on board the coronavirus-hit Diamond Princess cruise ship docked at Yokohama Port on Feb. 20, 2020. | REUTERS
The Diamond Princess, Iwata says, is just one of the many episodes that have shed light on the health ministry’s incompetence.
Perhaps passengers and crew members should have been evacuated and moved to onshore facilities immediately after the ship arrived in Yokohama.
Maybe the quarantine countdown should have been reset each time someone on board the vessel tested positive, and the health ministry could have tested everyone aboard or, at the very least, made sure quarantine measures were actually in effect.
It’s unclear whether the government had the time, resources or capacity to do any of that. The Diamond Princess came out of the blue and presented the government with an epidemiological timebomb. From the moment the ship dropped anchor in Yokohama, the clock was ticking.
“The health ministry did the best it could,” says Motoya Hayashi, an expert on spatial design and an engineering professor at Hokkaido University’s Laboratory of Environmental Space Design. While the ship was under quarantine, Hayashi was a professor at the National Institute of Public Health, a public institution.
“Back then, we knew little to nothing about the virus, how it spread, the danger of unregulated airflows in enclosed spaces — any of that,” Hayashi says. “The Diamond Princess was a harsh lesson in the early stages of the pandemic.”
Medical teams wait to evacuate a passenger from the Diamond Princess cruise ship in February. | COURTESY OF ALAN SANFORD
At the time, experts said the Diamond Princess would serve as a model for the rest of the world.
But the outbreak seemed to produce more questions than answers.
Why weren’t more people tested? Why didn’t the government act faster? When, and how, will the virus be contained?
Japan has now confronted three waves of the virus, each bigger than the last. Twelve months later, the same questions remain largely unanswered.
Beset by anxiety
The evacuation of the Diamond Princess wasn’t the end of the fiasco, not for the passengers or the crew members or, for that matter, the hundreds of journalists who spent days watching the cruise ship from behind a fence.
And it certainly wasn’t the end of the virus.
A police officer escorts a passenger away from the media as she disembarks from the Diamond Princess cruise ship in Yokohama on Feb. 19, 2020. | REUTERS
In the weeks that followed, the number of new cases in South Korea quickly overtook that of Japan as the virus traveled through East Asia before eventually reaching Europe and the Americas, where it continues to spread like wildfire.
On Jan. 19, the cumulative numbers of deaths caused by the coronavirus in the United States reached 400,000, the highest of any country by a large margin. At present, it’s almost double the death toll in Brazil and quadruple the number of lives lost in the United Kingdom.
The outbreak in Japan is worsening as well.
It took more than 10 months for the country’s total coronavirus infections to reach 100,000, but less than two months for that figure to double and a matter of weeks for it to triple.
The ongoing third wave has pushed the Japanese economy close to breaking point.
Economic measures designed to resuscitate domestic tourism had to be abandoned when a surge of new infections forced Prime Minister Yoshihide Suga to declare in early January a state of emergency in the greater metropolitan Tokyo area.
The order was expanded the next day, making it effective in 11 prefectures until Feb. 7. It has since been extended by another month for 10 of those areas and is now set to expire on March 7.
It’s impossible to know whether the number of new cases will rebound after the order is lifted.
It’s unclear when, and how quickly, the central government will be able to begin vaccinating the public.
It’s also unclear if the Tokyo Olympic and Paralympic Games will be canceled and, if the games go ahead, whether the virus can be sufficiently contained by the opening ceremony in July.
Indeed, the passengers and crew members of the Diamond Princess escaped an isolated outbreak only to join the rest of the world in bearing witness to the beginnings of a global pandemic.
A passenger talks with reporters outside Yokohama Station on Feb. 19, 2020, after disembarking from the coronavirus-hit Diamond Princess cruise ship. | RYUSEI TAKAHASHI
Yardley Wong and Carlos Pineda described an aggravating two weeks aboard the Diamond Princess, beset on all sides by anxiety as they tended to the needs of their 6-year-old son as well as Wong’s parents and two relatives, all the while trying to maintain their own sanity.
Fortunately, all seven were able to evacuate the ship and make it back to Hong Kong without becoming infected.
On the ship, seeing so many separated loved ones — couples, friends, children and their parents — changed Wong’s perspective.
“This is real. This is really happening to us,” she says, recalling how she felt while quarantined aboard the cruise ship.
“Life is so fragile,” she says. And yet, the family that beat the odds will soon welcome an additional member.
Wong is pregnant.
For all the uncertainty and despair, few things offer more hope to a world under siege than the arrival of new life.
The Diamond Princess cruise ship sits anchored off the port of Yokohama on Feb. 4, 2020. | REUTERS
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