key: cord-0923957-64s6yqbg
authors: Tokuda, Yasuharu; Sakihama, Tomoko; Aoki, Makoto; Taniguchi, Kiyosu; Deshpande, Gautam A.; Suzuki, Satoshi; Uda, Sakon; Kurokawa, Kiyoshi
title: COVID‐19 outbreak on the Diamond Princess Cruise Ship in February 2020
date: 2020-07-29
journal: J Gen Fam Med
DOI: 10.1002/jgf2.326
sha: e061ebd468c90f86206e58416920be6cfaf9437a
doc_id: 923957
cord_uid: 64s6yqbg

nan

The COVID-19 outbreak on the Diamond Princess cruise ship (2666 passengers, 1045 crew; total 3711) resulted in 712 infected persons, or about 20% of the ship's population. Since the outbreak first began, thirteen deaths (case fatality rate, 1.8%) associated with the COVID-19 outbreak on the ship have been reported. Numerous sources have suggested that quarantine measures on the Diamond Princess, which docked off Yokohama, Japan, on February 4, 2020, were inadequate to control a COVID-19 outbreak, and allowed further spread of the virus among passengers, crew, healthcare providers, and quarantine officers. 1, 2 Despite these claims, detailed information on the actual activities related to infection prevention measures undertaken on the ship remains unclear. Thus, we conducted an interviewing survey with 12 healthcare providers who participated in quarantine activities on the ship during this outbreak, identifying several salient issues regarding enacted infection control measures (Figures 1-4 ). In addition, we provide learning points formulated as recommendations for future control of infectious disease outbreak.

First, crew were allowed to remain working on the ship during the quarantine, even after identification of close contact between some of these crew and the index patient, who disembarked in Hong Kong on January 25 and was subsequently found to be positive for SARS-CoV-2. Several crewmembers, later identified as infected, had continued to work in roles allowing for potential further spread, including providing guest services and meals to passengers during the quarantine. This may have been a potent route of continued transmission, as at least five passengers with close contact to these crewmembers subsequently developed COVID-19 symptoms.

LEARNING POINT: Early isolation of exposed staff may be crit- 

We thank the healthcare workers for providing interviewing data. 

COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures

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Top Japanese government adviser says Diamond Princess quarantine was flawed

Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission

Japan's response to the coronavirus is a slow-motion train wreck. The Washington Post