A8 EZ SU THE WASHINGTON POST.SATURDAy, MARCH 21 , 2020
The Coronavirus Outbreak
DANIEL COLE/ASSOCIATED PRESSBy the time the costa Luminosa docked in Marseille on Thursday, five passengers and two crew members had flu-like symptoms, the company said. Passengers were screened by French authorities.
line.
frizzell, the carnival executive,
said princess cruises was not
aware that the passenger had
been hospitalized until days after
the cruise had departed. guests
had been given “a general health
notice with their boarding mate-
rials as additional precaution for
coronavirus as part of our compa-
ny’s enhanced safety and health
protocol,” he said.
on march 3, health officials in
placer county, calif., announced
the former passenger had tested
positive for the coronavirus.
the following morning, the
grand princess issued a “health
advisory letter” to guests that
said the centers for disease con-
trol and prevention was investi-
gating a “small cluster of coVid-
19 (coronavirus) cases in north-
ern california connected to our
previous Grand Princess voyage.”
the notice said the ship was
skipping a stop in mexico and
heading directly back to San
francisco. the passengers who
had gone on the previous voyage
were asked to retreat to their
cabins until cleared by medical
staff.
the coronavinus-infected for-
mer passenger died that day, be-
coming the state’s first fatality
from the virus. california gov.
gavin newsom (d) declared a
state of emergency.
But the vast majority of the
approximately 2,400 grand prin-
cess passengers were not quaran-
tined in their cabins until the
afternoon of march 5.
Health experts say cruise ships
are fertile ground for infectious
diseases because they pack thou-
sands of people into close quar-
ters for days at a time, encourag-
ing them to eat and socialize
together. cruises also cater to the
elderly, who are particularly vul-
nerable.
amesh adalja, an infectious
disease doctor who serves as se-
nior scholar at t he Johns Hopkins
university center for Health Se-
curity, said the positive test on
march 3 should have led to a more
serious response.
“the confirmed case should
have triggered social distancing
measures at that point,” adalja
said. “Because of the high conse-
quences of this infectious disease
and attention to it in light of what
happened with the diamond
princess in Japan, they really
should have been prepared for
what could happen.”
frizzell said passengers “were
alerted within hours” about the
positive coronavirus test.
“upon being alerted of the is-
sue, the grand princess looked
closely to the cdc and health
officials for direction,” he added.
continued on next pagecess in early february after it left
Yokohama harbor.
despite a feb. 5 quarantine,
700 people aboard eventually
te sted positive.
an initial cdc study published
tuesday found that the virus
quickly spread through food ser-
vice workers, particularly those
cooking for other members of the
crew. “this investigation under-
scores the need for swift epidemi-
ologic investigation as soon as a
coVid-19 case is detected in an
area or group where a large num-
ber of persons gather in a closed
or crowded setting,” the study
said.
on feb. 21, as quarantined pas-
sengers were still trying to get off
the diamond princess, diane and
Steve Houghton of pleasant Hill,
calif., were eagerly boarding a
sister ship, the grand princess, on
the other side of the pacific
ocean, for a 15-day cruise to Ha-
waii.
Steve Houghton said the pas-
senger screening in San francisco
was limited. the brief question-
naire handed to passengers as
they boarded asked about fever,
persistent cough or recent travel
to coronavirus hot spots like chi-
na.
His document went into a stack
along with hundreds of others,
Houghton said.
on his form, Houghton wrote
that he coughs all the time and
has difficulty breathing due to
chronic asthma. “no one asked
any questions. they said not a
single word,” he said.
the ship set sail for Hawaii
with roughly 3,500 people
aboard. as it passed beneath the
majestic golden gate Bridge, pas-
sengers crammed the decks to
take in the view, drinks in hand.
Several days of relaxation and
merriment followed, with little or
no awareness of the virus’s creep
around the world, according to
passengers interviewed by the
post.
“We never thought coronavirus
was in america. We never dreamt
of it,” said 65-year-old Howard
Lewis of Wales, who said he and
his wife met couples aboard who
had booked the cruise to Hawaii
after canceling trips to asia.
What they didn’t know: the
day before, as the ship’s previous
voyage to mexico was winding
down, a passenger came into the
medical center “with a six- to
seven-day history of symptoms of
acute respiratory illness,” grant
ta rling, carnival’s chief medical
officer, said in a call with report-
ers two weeks later.
crew members and 62 passen-
gers who had possibly interacted
with that guest on the earlier trip
remained aboard for the cruise to
Hawaii, according to the cruisewhich have already disembarked
travelers who were then not quar-
antined.
Some customers and their fam-
ily members now say the industry
held back information and
should have reacted more quickly.
“to avoid a panic that might
collapse the industry, the cruise
lines continued to mislead their
passengers,” said ashley ecker,
whose San diego-based parents
are aboard the costa Luminosa,
which continued on a voyage
across the atlantic earlier this
month after a woman, later diag-
nosed as positive for the virus,
disembarked with breathing
problems. By the time the ship
reached a port in france on
thursday, five additional passen-
gers and two crew members had
flu-like symptoms.
it t urned out some of them had
contracted the coronavirus: on
friday, an airplane carrying more
than 300 americans and canadi-
ans from the ship landed in atlan-
ta. the cdc said they included
three passengers who had tested
positive for covid-19 and a fourth
who would be evaluated at a local
hospital.
“ this needs to be investigated
— certainly before we even con-
sider an industry bailout,” ecker
said.‘They didn’t want to scare
anyone’
the cruise industry got an ear-
ly warning of how easily the virus
could spread on its massive ocean
liners when the first cases
emerged on the diamond prin-pandemic mounted, even as some
top administration officials were
urging a suspension of operations
before the voluntary shutdown,
as the Washington post p revious-
ly reported.
Vice president pence, who
leads the coronavirus task force,
touted the industry’s initial plan
to beef up passenger screening
and quarantine protocols. “We
want to ensure americans can
continue to enjoy the opportuni-
ties of the cruise line industry,” h e
said at a march 7 meeting with
industry executives.
trump has long-standing con-
nections to the industry, includ-
ing through carnival corp. chair-
man micky arison, a friend whose
company helped sponsor trump’s
reality show franchise “the ap-
prentice” over the years. on
thursday, trump said he spoke to
arison, who had offered up his
ships to house non-coronavirus
patients.
the president has repeatedly
said he wants to help cruise lines
with a financial rescue package,
along with airlines and hotels.
“You don’t want to lose indus-
tries like this,” he said thursday.
“these are incredible industries.
You can’t lose them.”
meanwhile, the centers for
disease control and prevention
boosted its warning this week
against cruising to a higher level,
advising any recent travelers to
isolate themselves for two weeks.
it also put local health depart-
ments on notice for the first time
about six ships that carried infect-
ed passengers in the last month —rea and regions of italy to the
no-sail list.
“to my k nowledge, this was the
first such restriction like this ever
established in the cruise indus-
try,” he said. “in reality, the cruise
industry acted collectively and
independently well before other
industries when it came to the
initial outbreak of coronavirus in
china in december 2019.”
But in the weeks following the
outbreak on the diamond prin-
cess, major cruise lines missed
several opportunities to mitigate
the crisis, according to health
experts and passengers aboard
the vessels.
after it was clear the coronavi-
rus was spreading around the
world, passenger screening was
limited. even on cruises where
officials knew of positive tests,
such as the grand princess, strict
quarantines confining passen-
gers to their rooms were not im-
posed immediately.
inconsistent deboarding pro-
cedures also meant thousands of
passengers who traveled on a ship
that had carried a passenger who
tested positive for the coronavi-
rus went home with little or no
medical screening — possibly tak-
ing the virus back to their com-
munities.
and companies stopped sailing
only when the pandemic had
reached a crisis point, with some
countries closing their harbors,
leaving ships with potentially sick
people adrift.
compounding the problem
was a White House reluctant to
crack down on cruises as theopinion on how big the risks are,”
said university of chicago epide-
miologist Katelyn gostic. “it was
sluggish decision-making, and
they should have responded earli-
er.”
the crisis has put the spotlight
on an industry that critics say for
years has skirted labor regula-
tions, such as minimum wage,
and federal income taxes by in-
corporating overseas. Y et when
disasters strike, or when people
get sick or fall overboard, federal
agencies such as the u.S. coast
guard come to the rescue.
the trump administration is
now pushing to spend billions to
prop up the cruise industry and
other hospitality and travel busi-
nesses that have been crushed by
the pandemic.
“through the years, a huge
amount of federal staff resources
have been diverted to dealing
with cruise ship health out-
breaks,” said nicole Lurie, who
served as a top official at the
department of Health and Hu-
man Services during the obama
administration. “given all the de-
mands on public health resourc-
es, it may be worth asking about
the public investment we make in
protecting cruise ship passengers
by putting in place better strate-
gies to prevent future outbreaks
involving cruise ships.”
cruise line officials said opera-
tors are subject to robust inspec-
tion by u.S. and foreign regula-
tors. and the industry defended
its response to the pandemic, not-
ing the singular nature of the
crisis.
Bari golin-Blaugrund, a
spokeswoman for the cruise
Lines international association,
said “the agility and responsive-
ness of cLia cruise line members
has been on full display over the
past two months.”
Within 24 hours of the World
Health organization’s declara-
tion of a global health emergency,
cruise line operators rapidly ad-
opted enhanced protocols that
she said “were repeatedly elevat-
ed as circumstances evolved over
time.”
that, along with extensive
cleaning and sanitation, helped
limit the number of coronavirus
cases aboard cruise lines, she
said.
roger frizzell, chief communi-
cations officer of carnival corp.,
the world’s largest cruise opera-
tor and the owner of the line that
operates the diamond princess
and the grand princess, said
cruise l ines in January began bar-
ring passengers who had been to
china in the previous two weeks.
they later added recent travelers
to Hong Kong, macao, South Ko-
cruises from A
Passenger screening was limited even as virus circled globe
EUGENE HOSHIKO/ASSOCIATED PRESS
Despite a Feb. 5 quarantine, 700 people aboard the Diamond Princess eventually tested positive for the
novel coronavirus. Here, staffers load passengers’ luggage on a bus in Yokohama, Japan, on Feb. 21.