Topline: A cruise ship that was turned away from several ports in Asia over coronavirus fears—despite no cases onboard—will now dock in Cambodia after days of uncertainty and mounting anxiety among passengers.
The Holland America Line’s MS Westerdam was banned from docking by Thailand earlier this week, over concerns about coronavirus on the ship. Holland America Line, which is owned by Carnival Cruise, says nobody onboard has reported symptoms.
It will now dock in Sihanoukville in Cambodia on Thursday, where passengers will disembark over a few day and will be transported to the capital, Phnom Penh, and flown home. Holland America Line says it will pay for the flight sand refund passengers their entire trip.
The MS Westerdam had planned to disembark its passengers in Thailand after Japan, The Philippines and Guam turned away the cruise ship. The Thai government on Tuesday offered fuel, food, and medicine to the cruise ship.
Stephen Hansen and his wife are two of the 1,500 passengers stuck on the vessel, which sailed from Hong Kong on February 1st and had been scheduled to end its cruise in Japan on February 15.
Hansen told Forbes: “While I can understand that countries want to protect their own citizens first before helping us their decisions to turn us away are based more on misinformation and fear than facts.”
Holland America said in a statement on Wednesday: “All approvals have been received and we are extremely grateful to the Cambodian authorities for their support…All guests on board are healthy and despite erroneous reports there are no known or suspected cases of coronavirus on board, nor have their ever been.”
Passengers had been calling for political intervention, with Hansen saying that the countries’ decision to reject the vessel was down to “misinformation and fear,” rather than facts.
Key background: Cruise ships have become an unlikely flashpoint in the battle to stop the international spread of the coronavirus. The British-owned Diamond Princess cruise was quarantined in Tokyo last Monday, with 174 out of the 3,700 passengers on board now ill with the pneumonia-like illness. Around 3,600 passengers and crew were held aboard the World Dream cruise ship for four days in Hong Kong over concerns the ship staff had contracted the virus from infected passengers on an earlier cruise. Cruise Lines International Association, the industry’s trade organization, announced last week its members would bar passengers who had visited China, Hong Kong, or Macau, 14 days before their cruise, from boarding.
News peg: Coronavirus, this week renamed Covid-19, has now killed more than 1,000 people and infected at least 42,000 more. The outbreak is concentrated in mainland China, after the virus was first detected in patients who are thought to have visited a Wuhan market in December. Airlines have also been badly disrupted, with some international carriers suspended their flights to and from China, and a number of international companies and manufacturers have been impacted by the Chinese government’s move to extend the Lunar new year holiday in a bid to restrict the spread of the virus. Tens of millions were placed under lockdown by Chinese health authorities in cities like Wuhan that have seen the highest number of reported cases.
I am a breaking news reporter for Forbes in London, covering Europe and the U.S. Previously I was a news reporter for HuffPost UK, the Press Association and a night reporter at the Guardian. I studied Social Anthropology at the London School of Economics, where I was a writer and editor for one of the university’s global affairs magazines, the London Globalist. That led me to Goldsmiths, University of London, where I completed my M.A. in Journalism. Got a story? Get in touch at firstname.lastname@example.org, or follow me on Twitter @bissieness. I look forward to hearing from you.
“Everyone knows that pestilences have a way of recurring in the world,” observes Albert Camus in his novel The Plague. “Yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet plagues and wars always take people by surprise.”
Camus was imagining a fictional outbreak of plague in 1948 in Oran, a port city in northwest Algeria. But at a time when the world is reeling from a very real microbial emergency sparked by the emergence of a novel coronavirus in Wuhan, central China, his observations are as pertinent as ever.
Like the global emergency over Zika in 2015, or the emergency over the devastating West African Ebola outbreak the year before – or the global panic sparked by SARS (another coronavirus) in 2002-2003, the Wuhan coronavirus epidemic has once again wrong-footed medical experts and taken the world by surprise.
Whether the Wuhan outbreak turns out to be a mild pandemic like the 2009 swine flu, or a more severe one like the 1918 Spanish flu, which killed 50 million people worldwide, at present no one can say.
But if a century of pandemic responses has taught us anything, it is that while we may have gotten better at monitoring pandemic threats in what used to be called the “blank spaces” on the map, we also have a tendency to forget the lessons of medical history.
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The first of these is that epidemics of emerging infectious diseases appear to be accelerating. In the 19th century it took several years for cholera and plague to spread from their endemic centers in India and China to Europe and North America following the trade routes plied by caravans, horses and sail ships.
That all changed with the advent of steam travel and the expansion of the European railway network. For instance, it was a steam ship, sailing from Japan via Honolulu, that most likely brought rats infected with plague to San Francisco in 1900. And ten years earlier, it was steam trains that spread the so-called “Russian” influenza throughout Europe. The result was that within four months of the first report of an outbreak in St Petersburg in December 1889, the Russian flu had been introduced to Berlin and Hamburg, from where it was carried by ocean-going liners to Liverpool, Boston and Buenos Aires.
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The Russian flu sparked two further global waves of illness in 1892 and 1893, resulting in an estimated one million deaths, though the true casualties from the pandemic were probably higher. By contrast the three-waves of Spanish flu occurred during a brief 11-month period between the summer of 1918 and the spring of 1919. The pandemic, which coincided with the First World War, was almost certainly fueled by the rapid passage of American soldiers to the front lines in northern Europe via Atlantic troop carriers.
But the big game-changer has been international jet travel and the greater global connectivity that has come with it. Located at the centre of China’s airline network, Wuhan is both a domestic and international hub, with more than 100 non-stop flights to 22 countries worldwide. The result is that whereas during the 2002 SARS outbreak it took five months for the coronavirus to spread worldwide, this time it has taken just four weeks for the world to catch China’s cold.
Another important lesson from the recent run of epidemics is that by focusing too narrowly on microbial causation, we risk missing the wider ecological and environmental picture.
Seventy percent of emerging infectious diseases originate in the animal kingdom. Beginning with the AIDs pandemic of the 1980s, and continuing through SARS, and the recent Ebola and bird flu scares in the early 2000s, most outbreaks can be traced to so-called spillover events from animals to humans. Some of these can be prevented by better hygiene and regular inspections of wild animal markets. But others can be traced to the disturbance of ecological equilibriums or alterations to the environments in which pathogens habitually reside. This is especially true of viruses such as HIV and Ebola that are believed to circulate in discreet animal reservoirs.
For instance, the West African Ebola epidemic very likely began when children in Guinea dined on a local species of bat, known as lolibelo, that had taken up a roost in a rotten tree stump in the middle of their village. The bats usually reside in dry savannah on the edge of woodlands but appear to have been driven from their normal habitat by climate change and deforestation due to the activities of logging companies.
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Bats are also thought to be the ultimate reservoir of coronaviruses, but the virus has also been isolated from snakes and palm civets, a game animal resembling a cat prized by the Chinese for its heat-giving energy. The SARS epidemic was almost certainly sparked by civets traded at a wild animal market in Shenzhen in southeast China. Likewise, the Wuhan outbreak appears to have begun at a wholesale seafood market which, despite its name, also sold wild animals, including wolf cubs, crocodiles, snakes and bats.
A third lesson is that China’s mega-cities – like vast urban conurbations in Asia, Africa, and South America – provide the ideal breeding grounds for the amplification and spread of novel pathogens by concentrating large numbers of people in cramped and often unsanitary spaces. Sometimes technology and alterations to our built environment can mitigate the risks that such overcrowding presents for the transfer of pathogens to people. Thus the plague abatement measures that followed the outbreaks of plague in San Francisco in 1901 and in Los Angeles in 1924, were effective at removing the rats and squirrels that harbored plague fleas from domestic homes and businesses.
Likewise, tower blocks and air conditioning systems are very effective ways of insulating people from the mosquitoes that transmit Zika and other diseases. But as became clear during the SARS outbreak when Hong Kong saw scores of infections at the Amoy Gardens apartment complex in Kowloon, our built environment can also present new disease risks.
Indeed, time and again, we assist microbes to occupy new ecological niches and spread to new places in ways that usually only become apparent after the event. In such circumstances, it is worth keeping in mind the view expressed by George Bernard Shaw in The Doctor’s Dilemma, namely that “The characteristic microbe of a disease might be a symptom instead of a cause.”
But perhaps the biggest lesson from the recent run of epidemics is that while scientific knowledge is always advancing, it can also be a trap, blinding us to the epidemic just around the corner – the so-called Disease X’s.
Thus, in the case of SARS, our delay in realizing we were dealing with a dangerous new respiratory pathogen, was due in no small part to the WHO’s conviction that the world was on the brink of a pandemic of H5N1 avian influenza—a view that seemed to be confirmed when ducks, geese, and swans suddenly began dying in two Hong Kong parks.
Similarly, the 2014 Ebola outbreak was initially missed by the WHO, not least because few experts suspected that the virus, which had previously been associated with outbreaks in remote forested regions of central Africa, might pose a threat to West Africa, much less to cities such as Monrovia, Freetown, New York and Dallas.
In each case, what was “known” before the event that Ebola can’t reach a major urban area, much less a city in North America; that coronaviruses do not cause atypical pneumonias – was shown to be wrong and the experts were left looking foolish.
The good news this time round is that the new coronavirus was quickly identified by Chinese scientists, and despite the Chinese government’s initial suppression of warnings posted on social media by medics at the frontline of the outbreak, they rapidly shared the genetic sequence. This gives us hope we will be able to develop a vaccine, something that didn’t happen during SARS.
However, those efforts will certainly not be aided by misinformation about the efficacy, for instance, of face masks over sensible measures such as frequent hand-washing. Nor is it helpful to refer to the “exotic” Chinese taste for wild animals or, as one French newspaper did last week, post scare headlines about a “yellow alert.”
A final lesson of medical history is that during epidemics we need to choose our words carefully, lest language becomes a motor for xenophobia, stigma and prejudice, as occurred in the early 1980s when AIDs was wrongly labeled “the gay plague.” This is especially the case in our era of instantaneous digital communications, where misinformation and fake news travels faster and more widely than any virus.
A typical room has a ceiling fan, striped wallpaper and floral curtains. Above a neatly made bed is a chintzy print showcasing a cobblestone alley. In communal areas, residents have space to watch big-screen TVs or throw around a football or read a book under a tree, and the U.S. Marshals Service is providing security.
Such are the conditions at the March Air Reserve Base in Riverside County, Calif., where 195 people are subject to the first mandatory quarantine orders issued by the Centers for Disease Control and Prevention (CDC) in more than 50 years. Like more than 600 other people assigned to five other military bases around the country, these Americans were recently evacuated from China’s Hubei province, the site of the novel coronavirus outbreak that has now claimed more than 600 lives.
All but two of those deaths have occurred in mainland China, where more than 31,000 cases have been confirmed. The crisis is now creeping around the world, with cases reported in more than 24 other countries, including 12 in the U.S.
There is widespread anxiety about sickness, and much is still unknown about the virus, including whether people without symptoms are capable of spreading it. Facing such uncertainty, the CDC took the extraordinary measure on January 31 of drawing on legal authority that the department hasn’t used since the 1960s — when officials were combatting smallpox — to impose a mandatory, 14-day quarantine on recently repatriated Americans who had been in Hubei. Two weeks is the likely incubation period for the virus.
“We are taking measures to minimize any contact. We expect confirmed infections among these and other returning travelers from Hubei province,” Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, said in a briefing on Feb. 5. “Now is the time to act so that we can slow the introduction and impact of this virus in the U.S.”
A few days earlier, when the federal government announced the quarantine, Messonnier called the action “unprecedented.”
There are several good reasons that ordering a quarantine is something that U.S. public health officials rarely do.
Finding quarters can be a challenge
For starters, the government does not have dedicated quarantine facilities just waiting to be used, explains Arthur Reingold, professor of epidemiology at the University of California, Berkeley’s School of Public Health.
Quarantine refers to the containment of apparently healthy people who may be incubating a virus they’ve come in contact with. (Isolation is the term for confining someone who is already sick.) In previous eras, this was often done on sea-going vessels. Passengers who might have a sickness like the plague would wait out the likely incubation period on a ship before being allowed to land. “But quarantine vessels went out of business a long time ago,” Reingold says.
Faced with a need to suddenly house hundreds of people, the Department of Health and Human Services turned to the Department of Defense, and six military bases were made available. The main criteria in choosing them, a DoD spokesman says, was their ability to comfortably house approximately 250 people in one or two buildings, like an on-base motel where everyone has their own bathroom, and close proximity to a hospital. Locations in the West, given the shorter flight distance from China, were also preferable, which is why half of the bases are in California, with one more in each of Colorado, Texas and Nebraska.
Quarantines are expensive
Even with locations secured, executing humane quarantines involves a lot of logistics, and that doesn’t come cheap. There are transportation and ongoing housing costs. Individuals need to be fed and regularly checked for symptoms. It requires medical care on-demand. And there’s security and maintenance to consider.
The CDC and HHS have not responded to requests from TIME asking about cost estimates for the current quarantines or whether the department will cover all costs. The HHS, which oversees the CDC, announced on Feb. 3 that it was making $250 million in emergency funds available to generally cover response, including screening and monitoring of U.S. citizens returning from various parts of China.
Tabulating the bills may also be a messy business. The DoD, for example, tells TIME that it expects full reimbursement for all costs from HHS. So does the state of California. A spokesman for Riverside County, meanwhile, says that while they hope to get reimbursed, it’s not been made clear if it will be.
With five county departments supporting the quarantine at March Air Reserve Base, including the provision of staff that includes doctors, nurses, behavioral health specialists and epidemiologists, as well a mobile health clinic that is at the base in case individuals get a migraine or scrape a knee, the estimated costs for the county alone are an estimated $115,000 per day.
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“Clearly the cost element of it is not a factor when we’re asked to provide services on an urgent basis. Our first priority is to figure out how to do it and then do it,” Riverside County spokesman Jose Arballo, Jr., says. That said, he adds, “The county isn’t in a situation where it’s flush.”
Putting aside the incalculable value of preventing an outbreak of the coronavirus, quarantines can potentially be cost-saving in the long run. “While expensive it’s more than worth it,” Larry Gostin, an expert in public health law and professor at Georgetown University, writes in an email. “It prevents spread of disease and serious illnesses. And it’s far less costly than having to hospitalize many patients who could contract the coronavirus infection.”
People’s freedom must be limited carefully
Another reason mandatory quarantines are uncommon in America is that they are, of course, coercive. Though federal and state governments have the legal ability to impose quarantines in the name of public safety, the ACLU has raised concerns about the government controlling people’s freedom of movement and noted that individuals’ livelihoods can be put at risk if they’re unable to work for weeks at a time. (The CDC has not responded to a request from TIME about whether the department will cover lost wages for individuals under quarantine orders.) It can also cause disruptions in childcare.
Soon after the 195 people arrived at March Air Reserve Base, one individual did attempt to leave and was ordered back. Otherwise, Arballo says, the individuals in quarantine have been cooperative and “appreciative of the work being done.” Attitudes may have been tempered by gratitude that the U.S. government helped them escape the epicenter of the coronavirus outbreak, as well as knowledge that spread of the disease would be harmful. The U.S. Marshals Service says that agents have not had to stop anyone from leaving — that no one is revolting — but in the unlikely event that someone did, they would intervene.
Georgetown’s Gostin has noted that there is a world of difference between today’s relatively small quarantines at American military bases, where people are housed in the equivalent of a modest hotel room, and what is happening in China, where the government has essentially put 56 million people on lockdown in an attempt to stop the spread of the coronavirus. Such extreme actions can cause panic, drive the epidemic underground and potentially make it worse, leading to cross-infection and social isolation, he explains. People may have difficulty accessing basic necessities, much less sufficient medical care.
The Americans quarantined at the March Air Reserve Base, in contrast, requested and were brought beer to enjoy while watching the Super Bowl.
The efficacy is unclear
Even when quarantines are imposed on narrow populations and rolled out compassionately, it’s not clear how effective it is to limit the movement of people who aren’t showing symptoms, Berkeley’s Reingold says. “For many infectious diseases, transmission basically is limited entirely or almost entirely to people who are symptomatic,” he explains. “Quarantining asymptomatic individuals has generally been viewed as a low priority.”
Yet, in the case of the new coronavirus, there has been conflicting evidence about whether asymptomatic people are contagious. “Until we know more, given the concerns, given the anxiety, this is a reasonable measure to take,” Reingold adds.
W. Ian Lipkin, director of the Center for Infection and Immunity at Columbia University, recently traveled to Beijing and Guangzhou. Upon returning to the U.S., he was mandated by the government to self-quarantine for 14 days because the CDC views those areas of China as medium risk, he says. He is currently in his cabin in upstate New York, writing in to the government with temperature and status reports.
When asked for his thoughts on the quarantines, he responded with concerns about being objective given that he has been personally affected. “The new coronavirus is highly transmissible,” he wrote in an email. “Thus, I appreciate the concern underlying the decision to impose quarantines. I’m not sure that we need 14 days.”
While mandating quarantines could be an expensive and cumbersome overreaction, CDC’s Messonier suggested the department would rather be remembered for doing too much rather than doing too little as scientists race to learn more about the virus. And experts say Americans should feel reassured that they live in a wealthy country where expensive overreactions are an option. Populations who live in poor countries in Asia or Africa, where officials have more limited capabilities of response, are at higher risk if the coronavirus starts to spread.
At the March Air Reserve Base, two individuals — both children — have been found to have fevers. One was transported to a nearby hospital on Feb. 3, with a parent, and was transported back to the base when tests for the virus came back negative. A second was transported on Feb. 5. As of Friday morning, they remained in isolation at the hospital awaiting test results.
195 Americans are under quarantine as blood samples and throat cultures get tested by the CDC after the group was evacuated to California from the epicenter of the coronavirus outbreak in China. 6,000 passengers stuck on cruise ship over coronavirus fears READ MORE: https://abcn.ws/392BsP1#ABCNews#Coronavirus#China
The coronavirus is endangering South Korea’s automotive industry—its biggest and most visible export after semiconductors.
The reason is simple. Hyundai Motor and its sister company Kia Motors, as well as three smaller competitors, are not getting wiring that’s made in China by the Korean subsidiary of Leoni, a German car-parts maker. Leoni, like many other companies, has shut down operations in China at least until next week.
The first Hyundai vehicle to suffer was the top-of-the-line Genesis, a luxury sedan that’s manufactured at the company’s historic plant in Ulsan, on the southeastern coast of South Korea, about 190 miles southeast of Seoul.
Hyundai said its plants in Ulsan and two other cities would be slowing down and possibly halting operations until early next week or unless wiring production resumed in China or domestic Korean companies could begin to fill the need. The company asked workers not to report for normal overtime shifts producing its Palisade sports utility vehicle.
There were also concerns that other components might soon be in short supply. Bosch, the German manufacturer, has had to close its two plants in Wuhan until next week. Volkmar Denner, Bosch’s CEO, told reporters in Stuttgart there had been “no disruptions” so far. But “if this situation continues, supply chains will be disrupted,” he added.
Similarly, Kia, which manufactures a number of vehicles on similar platforms as Hyundai vehicles, has had to cut down production at its plants in Korea while suspending work in China.
Together, Hyundai and Kia theoretically produce more than 9 million vehicles a year at plants in Korea and abroad—5.5 million produced by Hyundai and 3.8 million by Kia, according to Yonhap. Their goal this year has been 7.5 million, up from 7.2 million last year, but the coronavirus is already cutting into production and sales in China and may lower expectations elsewhere.
Hyundai Motor, South Korea’s second-largest conglomerate after the Samsung empire, revealed the problems as South Korea counted 16 people so far stricken by the coronavirus, which has claimed more than 400 lives in China. The latest case here was that of a 42-year-old woman who had returned from a trip to Thailand, where 25 people have been diagnosed with the disease, the most outside China.
Besides Hyundai and Kia, Ssangyong Motor, already troubled by severe losses, had to suspend production at its plant at Pyeongtaek, 40 miles southwest of Seoul. GM Korea, Korea’s third-largest motor-vehicle maker, and Renault Samsung Motors both said they were watching to see what to do next, though the latter said it could obtain wiring from its Japanese partners, Nissan and Mitsubishi, reported Yonhap.
The virus is also hitting Korea’s tourism industry. The government stopped granting visa-free entry to foreign travelers wishing to visit the highly popular tourist destination of Jeju, a scenic island province off Korea’s southern coast that’s connected directly by air to major Chinese cities; Chinese nationals accounted for almost all the foreign visitors to the island without visas last year. Lotte Duty Free and Shilla Duty Free, immense attractions for Chinese tourists, have both had to suspend operations on Jeju.
Just as devastating, Samsung Electronics has had to suspend its newly opened flagship store in Shanghai after rival Apple already closed most of its operations in China. Yonhap quoted a Samsung official as saying the store, which opened in October, had closed “for safety.”
I have reported from Asia since covering the “Year of Living Dangerously” in Indonesia, 1965-66, and the war in Vietnam, Cambodia and Laos in the late 1960s-early 1970s for newspapers and magazines, including the Chicago Tribune and the old Washington (DC) Star. I also wrote two books from that period, “Wider War: the Struggle for Cambodia, Thailand and Laos” and “Tell it to the Dead.” In recent years I’ve reported from Korea for the Christian Science Monitor, International Herald Tribune, Forbes Asia, etc. while writing “Korean Dynasty: Hyundai and Chung Ju-yung,” “Korea Betrayed: Kim Dae-jung and Sunshine” and, in 2013, “Okinawa and Jeju: Bases of Discontent.” I’ve also reported a lot from Japan, the Philippines and Iraq and spent much of 2013 as a Fulbright-Nehru senior research scholar in India.
Any Americans likely grew a little nervous after the U.S. Centers for Disease Control and Prevention (CDC) announced Thursday that a novel coronavirus has spread for the first time within the U.S. But agency officials and other doctors have a simple message for Americans: keep doing what you’re doing to stay healthy.
“The best things that you can do are the things that we generally recommend at this time of year to prevent the spread of infectious diseases,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said during a Jan. 30 call with reporters. “Wash your hands, cover your cough, take care of yourself and keep alert to the information that we’re providing, because we’ll provide new information as it becomes available.”
In Asia, the novel coronavirus known as 2019-nCoV is spreading rapidly, and has reached far enough to warrant being designated a public health emergency of international concern by the World Health Organization. As of noon Friday, it has infected nearly 10,000 people, most of them in mainland China, and killed 213. But public health officials have emphasized that risk to the American public remains low, and spreading within the U.S. has so far been limited to one wife-to-husband transmission.
While 2019-nCoV has never been seen before, it’s part of a family of viruses that are well-known both to doctors and the public; the common cold, for example, can be caused by certain coronaviruses. And while influenza is not a coronavirus, it isn’t so different from 2019-nCoV, either. Both result in symptoms including cough and fever, and—from what scientists can tell so far—both seem to be spread mainly via respiratory droplets and close person-to-person contact.
For those reasons, experts are recommending prevention measures in keeping with those deployed during a normal flu season. The CDC has not recommended that Americans wear protective masks or take dramatic measures against coronavirus. Messonnier did emphasize during Thursday’s call that people who have been in Wuhan, China—where the outbreak originated—or spent time around people who have traveled from the area should monitor themselves for symptoms of coronavirus, such as cough, fever and respiratory distress. These people should call their health care provider and stay home from work or school if any symptoms develop.
Aside from that, though, there’s not much Americans can or should do at this point, beyond the usual measures.
“Good hand-washing helps. Staying healthy and eating healthy will also help,” says Dr. Sharon Nachman, a pediatric infectious disease specialist at New York’s Stony Brook Children’s Hospital. “The things we take for granted actually do work. It doesn’t matter what the virus is. The routine things work.”
And while the flu shot won’t protect against coronavirus—and there’s no vaccine for the new virus yet—experts are still recommending that people get vaccinated against influenza if they haven’t yet, since the likelihood of getting the flu in the U.S. is far higher than contracting coronavirus. (For context, the CDC estimates that around 19 million Americans have gotten the flu so far this season, compared to only a handful who have developed coronavirus domestically.) As long as flu virus is still circulating, it’s not too late to get a flu shot.