After 14 days floating just off the Japanese shore, the passengers on board the Diamond Princess cruise ship have finally begun disembarking, though many are headed to additional time in quarantine in their home countries. The two-week quarantine, which public health experts have criticized as “chaotic” and an “unprecedented failure,” is the longest amount of time passengers have been contained on a ship due to a virus in recent history, Stephen Morse, professor of epidemiology at the Columbia University Medical Center, told VICE. Cruise ship passengers have previously been quarantined to their cabins during outbreaks of norovirus, and ships have been turned away from docking at certain ports, but quarantining an entire ship of people (and for two full weeks) is historically unprecedented.
Morse attributed the extreme reaction by Japanese health authorities, and similarly strong reactions in countries around the world, to fear over coronaviruses. “Our bad experience with coronaviruses in the past makes us feel that we need to be particularly cautious,” he said, referencing the 2002 outbreak of severe acute respiratory syndrome, or SARS. Because SARS was mainly transmitted in medical settings, isolating sick people, versus quarantining asymptomatic people to watch for illness, wasn’t really considered as an option for preventing its spread.
“SARS taught Chinese leaders the importance of acting swiftly when handling a disease outbreak,” Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, told the Guardian in 2014. “But I think, in doing so, they also drew the wrong lesson — that quarantine was the magic bullet in addressing any major infectious disease outbreak.” Even though SARS is also a coronavirus, Morse said this new coronavirus appears to be heartier, and more transmissible. China now has more than 46 million people on lockdown, but didn’t initially try to quarantine people who first developed coronavirus.
Even with these rigorous efforts to contain the virus, Morse agreed with a sentiment expressed by other disease experts: quarantines are only effective until they’re not. All it takes for a quarantine to fail is for a few cases to slip through the cracks, which is perhaps why Russian health officials reacted so strongly when a woman recently escaped her own quarantine.
Effectively keeping people under quarantine—testing them and watching for symptoms to develop within the 14-day incubation period—requires a significant amount of resources and personnel, and isn’t sustainable forever. And, ideally, a proper coronavirus quarantine would be twice the 14-day incubation period: Morse said that, for Ebola, health officials declare an area virus-free when it’s experienced two full incubation cycles with no new illnesses. The cruise ship quarantine—as long as it was—still didn’t achieve this standard, since there was active transmission of coronavirus on board, and people continued to become infected up to the point of disembarking.
“I think what we’re doing right now is buying time until something else, like a vaccine, becomes available,” Morse said of the global quarantines. “Which is arguably something that would happen in a year.”
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