600 disembark from coronavirus-quarantined Diamond Princess; more waiting to be cleared

Hundreds began to return to land Wednesday after a two-week quarantine due to coronavirus on Princess Cruises' Diamond Princess cruise ship, which remains docked in Yokohama, Japan.

Approximately 600 guests disembarked on Wednesday and another several hundred guests were expected to be cleared to disembark on Thursday, according to a statement from Princess Cruises shared by Negin Kamali, director of public relations.

Although the ship's quarantine period was scheduled to end on Wednesday more than 100 American passengers on board will have to wait another 14 days to return home.

The ship was originally quarantined on Feb. 4 due to coronavirus. As of Tuesday morning, at least 542 people had tested positive for the virus, out of 3,711 quarantined passengers and crew, making the ship the site of the most infections outside of China.

Japanese soldiers helped escort some passengers, including an elderly man in a wheelchair who wore a mask and held a cane. Some passengers got on buses to be transported to train stations. Some people still in their ship cabins waved farewell from their balconies to those who’d already departed.

While 328 Americans had already evacuated the ship – including 14 who tested positive for the virus, there were still many on board who chose to finish their quarantine on the ship.

According to a letter to American passengers still on the ship from the Centers for Disease Control and Prevention, all Americans must remain symptom-free and not have any positive tests for an additional 14 days before they can re-enter the U.S.

"Under this restriction, you will not be issued a boarding pass at the airport, nor will you be allowed to board a flight inbound to, outbound from, or within the United States until you are no longer at risk of spreading infection during travel," the letter said.

Princess Cruises said in a statement provided by Kamali that the embassies of Canada, Australia and Hong Kong will be transporting their citizens – both passengers and crew members – home via charter flights. Australia and Hong Kong's charter flights will arrive on Wednesday or Thursday, with Canada's scheduled to be back Friday. An additional 14 days of quarantine will be required in the respective countries.

Princess Cruises provided passengers who remain quarantined with information on next steps.

"A number of guests are beginning to disembark Diamond Princess as part of their individual countries' responses," Rai Caluori, an executive vice president for Princess Cruises, said in a video message published Monday. "We are providing information to those who disembark so we can remain in full contact and provide travel support once the quarantine requirements in their home countries are complete."

He continued, "Embassy officials in many countries are now reaching out to their citizens directly, and we urge everyone who is contacted to read those communications very closely. These messages provide critical information about the resources being made available as well as additional requirements that may impact someone's return home in the event they decline their country's repatriation offer. We will also shortly provide our guests more detail about the resources we can provide once the shipboard quarantine period is complete."

Matthew Smith, an attorney from Sacramento, California, who has been in touch with USA TODAY throughout the quarantine, shared a photo of a four-page letter concerning the end of the isolation period distributed to those who remain on board. Smith chose not to depart when the U.S. sent a charter flight to evacuate American passengers on board.

Disembarkation was scheduled to begin Wednesday and estimated to end Friday, according to the letter.

Smith and his wife, Katherine Codekas, had not yet received their test results on Wednesday. "Tom Petty said it best: the waiting is the hardest part," he said.

How does the end of the quarantine work?

All passengers are to be tested before leaving the ship – those who test negative will be allowed to depart, according to the letter. Then, on the morning of disembarkation, guests will need to take their temperatures and report any fevers. A separate fever scan will be used as each passenger disembarks. Common signs of infection include fever, cough, shortness of breath and breathing difficulties.

"Tests were all completed yesterday," Smith said Tuesday, noting that saliva samples were taken during the screening.

Japan’s health minister, Katsunobu Kato, confirmed to reporters Tuesday that all passengers who remained on the cruise ship have had their samples taken and that those who tested negative would start getting off the vessel beginning Wednesday, when their required 14-day quarantine is scheduled to end.

“They all want to go home as early as possible, and we hope to assist them so that everyone can get home smoothly,” Kato said.

Guests have been required to submit a form to the cruise line regarding their travel plans. If a guest has tested negative for the virus, they will receive a document from the Yokohama Quarantine Station with their final test results, permitting them to disembark. However, that document does not guarantee that a commercial airline would allow the passengers to board – or for them to re-enter their home country, for that matter.

Guests will be able to go home via charter flights provided by their home countries – Princess Cruises included a list of countries considering sending a charter flight – or they can fly home commercially, according to the letter. According to the letter, the U.S. was considering a possible second charter flight.

In the letter, Princess Cruises warns that passengers that have had or will have the option to take a chartered flight home and choose not to will be subject to their home country's quarantine rules upon return. They also pointed out that if a passenger chooses to travel to another country they should check travel advisories given they may be prohibited from entering a country or boarding a flight due to that nation's quarantine requirements.

Additionally, the letter reminded passengers that the situation is fluid and that means that quarantine requirements by country may be fluid, too – they could change at any time.

Why did the quarantine fail?

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told the USA TODAY Editorial Board and reporters Monday that the original idea to keep people safely quarantined on the ship wasn't unreasonable. But even with the quarantine process on the ship, virus transmission still occurred.

"The quarantine process failed," Fauci said. "I'd like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship. Something went awry in the process of the quarantining on that ship. I don't know what it was, but a lot of people got infected on that ship."

The Japanese government has repeatedly defended the effectiveness of the quarantine. But some experts suggest it may have been less than rigorous.

“There are sometimes environments in which disease can spread in a more efficient way,” said Dr. Michael Ryan, executive director of the World Health Organization's health emergencies program. Ryan said cruise ships in particular were known to occasionally accelerate spread.

“It's an unfortunate event occurring on the ship, and we trust that the authorities in Japan and the governments who are taking back people will be able to follow up those individuals in the appropriate way," he said.

“Obviously the quarantine hasn't worked, and this ship has now become a source of infection,” said Dr. Nathalie MacDermott, an outbreak expert at King's College London.

She said the exact mechanism of the virus' spread was unknown. Although scientists believe the disease is spread mostly by droplets — when people cough or sneeze — it's possible there are other ways of transmission.

“We need to understand how the quarantine measures on board were implemented, what the air filtration on board is like, how the cabins are connected and how waste products are disposed of,” MacDermott said.

“There could also be another mode of transmission we're not familiar with,” she said, noting the possibility of environmental spread and the importance of “deep-cleaning” the entire ship to prevent people from touching contaminated surfaces.

“There's no reason this (quarantine) should not have worked if it had been done properly," she said.

MS Westerdam passengers test negative for coronavirus; hundreds allowed to depart Cambodia

Passengers from the Holland America's MS Westerdam – the ship that finally docked in Cambodia last week after being turned away from multiple ports and later had one passenger diagnosed with coronavirus, prompting a new round of testing – can officially get on with their lives.

On Wednesday, the cruise line reported that the 781 passengers still in Cambodia tested negative for the virus.

"The Cambodian Ministry of Health has issued a press release confirming that 781 Westerdam guests have tested negative for COVID-19. This completes the guests’ testing," Holland America said in a release shared with USA TODAY by spokesperson Erik Elvejord on Wednesday.

"Given the announcement just this morning of all the negative test results which cleared people for travel, we are rapidly working on air arrangements and their details will be communicated to them once finalized," Elvejord said in an email to USA TODAY Wednesday morning. "Airports will vary and any restrictions taken into consideration when making those arrangements.

Elvejord didn't have exact numbers but said several hundred had already begun the journey home. "They have been cleared to travel by Cambodian Health Ministry to travel," he said. "A letter will be given to each guest from them as to this test result."

An additional 747 crew members will remain on board the ship while their testing is completed, meaning MS Westerdam will stay docked at the port in Sihanoukville for at least a few more days.

Coronavirus hold-ups put passengers' careers on hold

On Wednesday morning, Steve Muth, a Westerdam passenger from Michigan, told USA TODAY that he and his family had made a hasty exit from Cambodia the night before.

"We had to catch a midnight flight to Dubai. We had 15 minutes to pack and go," he said in a text. "There was talk of a charter flight the next day. My wife couldn't wait so we went. Flight was packed and uncomfortable."

Muth explained that they received certificates from the Cambodian government that showed they are all virus-free and they have presented those documents several times while on their way home. They are scheduled to touch down in Boston on Wednesday night.

Muth says he has "mixed feelings on the escape." While he is relieved, he's also a little sad that "the adventure is over." Now his primary concerns are the social, career and financial consequences that may come with being associated with the Westerdam.

And those fears are already being justified. Muth's daughter, who was also on board the Westerdam, received an email from her county asking that she self-quarantine upon her return.

And in a previous interview, Muth said, "My career as a consultant is on hold," adding that the quarantine is likely to cost him two seminars, if not a client.

His wife, a nurse, has had setbacks, as well. Now he says she "will lose pay – possibly an additional two weeks if quarantine is required."

He said Wednesday that he just hopes they won't be impacted permanently.

'Something went awry': Why did US break Diamond Princess coronavirus quarantine?

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Contributing: The Associated Press, Julia Thompson, Hannah Yasharoff, David Oliver USA TODAY

This article originally appeared on USA TODAY: Coronavirus quarantine: 600 disembark Diamond Princess cruise ship