Sixty-six more people, including another 11 Americans, have fallen ill on the Princess Cruises cruise ship that is quarantined off the coast of Japan, meaning at least 135 passengers onboard have been diagnosed with coronavirus. At least 20 Americans in total have been diagnosed onboard.
The ship was carrying 2,666 guests and 1,045 crew onboard when it set sail on Jan. 20.
Due to the quarantine, "it was not unexpected that additional cases would be reported involving individuals who were exposed prior to the start of the quarantine," Princess Cruises said in a statement provided by Negin Kamali, director of public relations. The cruise line is working to confirm the total number of cases and the nationalities of all those infected.
Princess Cruises is working with authorities to plan for the passengers who have recently become ill to disembark so that they can be taken to a hospital.
The cruise ship is one of several affected by the deadly coronavirus outbreak, which has prompted cruise lines to issue quarantines and perform screenings onboard. Meanwhile, some ports are denying at least one cruise ship entry over fears of the virus.
The coronavirus, which was first identified in Wuhan, China, has spread across the globe with more than 42,763 confirmed cases and 1,013 deaths as of Monday evening. The majority of the cases are in mainland China. Common signs of infection include fever, cough, shortness of breath and breathing difficulties.
The Diamond Princess is scheduled to remain under quarantine until Feb. 19, pending any unforeseen circumstances.
'It's almost like we're on the ship alone'
Passengers on the ship have been instructed to stay in their suites or cabins during the quarantine.
Those in interior cabins with no window or outdoor access have been able to go on deck for up to an hour and a half but must stay at least a meter (about 3 feet) from fellow passengers, Matt Smith, an attorney from Sacramento, California, told USA TODAY on Friday.
Smith says the situation is “inconvenient,” but that he and his travel companion, Katherine Codekas, are comfortable on board, with fresh water, electricity and meals dropped off at the door by the ship’s crew.
Internet service has sometimes been spotty, but he said the cruise line has provided more on-demand movies and added live TV channels to help passengers while in quarantine. They requested and received clean sheets but changed the bed themselves after crew dropped them at the door to avoid close contact.
Status updates from the ship’s captain have increased and improved as the quarantine has gone on, Smith said.
On Monday, Smith told USA TODAY that they are still doing fine, though they had a moment of worry hearing about more confirmed cases. As for how the atmosphere is on the ship, he said it's hard to tell, isolated in their cabin.
"It's almost like we're on the ship alone except for the crew who bring us food and things and occasional voices from nearby balconies," he said.
All guests will receive a full refund for the cruise including airfare, hotel, ground transportation, pre-paid shore excursions, gratuities and other items. No guests will be charged for incidental charges during the added time on board, Princess Cruises said in a statement Sunday afternoon.
And Princess Cruises will provide guests with a future cruise credit equal to the cost of the cruise, which was scheduled to end on Feb. 4.
Though all gratuities will also be refunded to guests, Princess Cruises said that the company will make sure that crew members receive their designated gratuities for their work.
Holland America ship will disembark on Thursday
Meanwhile, Holland America's MS Westerdam cruise ship has now been scheduled for disembarkation later this week.
The ship is sailing to Laem Chabang, Thailand, according to a release from Holland America Line issued early Monday. It is scheduled to arrive in port on Thursday. Guests will continue on their routes home from Bangkok and will be fully refunded for their cruise and provided with a future cruise credit.
The Westerdam, which has 1,455 guests and 802 crew members, made a stop in Hong Kong last week. It was subsequently denied entry to ports in Guam, the Philippines and Japan.
There are no known cases of coronavirus on board despite reports to the contrary, the cruise line said, and the MS Westerdam is not in quarantine.
"We have no reason to believe there are cases of coronavirus on board," Erik Elvejord, Holland America's public relations director, said in an email Friday morning.
The next scheduled cruise on Feb. 15 has been canceled. The cruise line is assessing the impact of port restrictions in Asia on cruises departing Feb. 29 or later.
World Dream passengers have disembarked
Passengers aboard the World Dream disembarked Sunday at Hong Kong's Kai Tek Cruise Terminal after tests revealed no one on board had coronavirus.
"Dream Cruises is pleased to report that the Department of Health has confirmed that all guests and crew on board World Dream have passed extensive health screenings and temperature checks, and all of the samples taken from the 1,814 crew members have tested negative for the 2019 Novel Coronavirus (2019-nCoV)," the cruise line said in post on its website.
"Guests onboard World Dream have been cleared to disembark the ship this afternoon, and Dream Cruises will be arranging shuttle transportation and assisting international guests with complimentary hotel accommodations and the rebooking of onward travel arrangements."
The ship spent Saturday under quarantine near Hong Kong while it waited for the test results to come back. As of 5:30 p.m. Sunday local time, all passengers had disembarked.
World Dream operations will be suspended until further notice, according to the cruise line.
Royal Caribbean ship cleared of coronavirus concern, scheduled to depart Monday
Another ship affected by the coronavirus is Royal Caribbean's Anthem of the Seas, which is docked in Bayonne, New Jersey, where four passengers were sent to a hospital to be tested Friday.
The ship is now likely to depart Monday afternoon after the passengers tested negative for coronavirus. The itinerary has been changed from a Bahamas cruise to Bermuda, in light of the delayed departure.
Passengers who do not want to reembark on the cruise will receive a refund from Royal Caribbean, the cruise line said. Passengers choosing to embark on the cruise will receive a 50% refund and a 50% future cruise credit, Royal Caribbean announced Saturday.
Meanwhile, the Costa Smeralda, one of Costa Cruises' ships, had a coronavirus scare at the end of January that locked down the ship for almost a day in Civitavecchia, Italy. The scare turned out to be a case of the flu.
Cruise industry bolstering coronavirus screening; some ships ban China, Hong Kong passport holders
Norwegian and Royal Caribbean International cruise lines announced Friday they would bar passengers holding passports from China, Hong Kong or Macau.
Royal Caribbean listed new health screening protocols on its website Friday, noting "these steps are intentionally conservative, and we apologize that they will inconvenience some of our guests."
This protocols included, "all holders of China, Hong Kong and Macau passports, regardless of residency."
Norwegian Cruise Lines updated its coronavirus procedure Friday, also stating that "any guest that holds a Chinese, Hong Kong or Macau passport will be unable to board any of our ships, regardless of residency." This ban extended to crew members, as well.
Cruise Lines International Association, an industry group representing most of the ocean-going cruise ships around the globe, said Friday its members would restrict boarding access to anyone who may have come in contact with coronavirus.
Member ships will deny boarding to anyone who has been in close contact with or helped to care for someone suspected or diagnosed with coronavirus. Those who are being monitored for potential exposure to the virus are also to be turned away.
Ships are also to deny boarding to all who have traveled from, visited or been through airports in China, the epicenter of the outbreak, within a two-week period prior to embarkation. That includes Hong Kong and Macao in addition to mainland China.
CLIA cruise member ships are to conduct screening before boarding. Enhanced screening and medical support are to be provided by ships as needed to anyone with coronavirus-like symptoms.
Crew members and passengers alike are subject to these precautionary measures.
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Contributing: Bill Keveney, Jayme Deerwester, Grace Hauck, USA TODAY.
This article originally appeared on USA TODAY: Coronavirus: Diamond Princess cruise ship in Japan now has 135 cases