Sixty-thousand three-hundred sixty-one cases of COVID-19, the coronavirus which originated earlier this year in Wuhan, China, have been identified worldwide. In Yokohama, Japan, aboard the quarantined Diamond Princess cruise ship, confirmed infections have risen to 218 from 66 on Feb. 10, 2020. It is clear that the quarantine, far from protecting people, is contributing to contagion. Japan has announced a loosening of the quarantine, especially for some vulnerable elderly, but the incarceration of healthy individuals — including many children, seniors and crew members—nevertheless violates the most basic of human rights.
On board the Diamond Princess life appears tranquil, and the cruise line has expanded internet and television access to ease the anxiety of mandatory quarantine. As pleasant as this prison may be, however, this is not the vacation Princess Cruise’s customers signed up for, and the actions of the Japanese government have put lives at risk since ordering the ship to close its doors on Jan. 31, 2020. The story of the quarantine is one of misjudgment and fear, and it is plain that alternative paths were available early on which may have prevented the further spread of coronavirus about the ship.
An 80 year-old man tested positive for COVID-19 after disembarking from the Diamond Princess in Hong Kong on Jan. 25, 2020, setting in motion what would become weeks of anxiety, fear and luxury for passengers aboard the Princess company’s “jewel of the sea.” Arriving in Yokohama, the ship was put under immediate quarantine in order to prevent the disease from spreading to Japan. This process protected the Japanese from increased incidence of the virus, but condemned the passengers and crew of the Diamond Princess to suffer, afraid.
Quarantine, of course, is not a surprising response. On Jan. 31, 2020 there were already a total of 11,948 cases worldwide, and 259 people had died of coronavirus. It was an effective method. Only 28 people in Japan have come down with the illness caused by COVID-19, and there has been only one death in the country. But were there other options? Are there other options now? Could Japan have chosen a policy which protected the Japanese people without subjecting the Diamond Princess’s passengers to close-quarters contact with the infection and the anxiety of death? Yes. On-board quarantine was perhaps the only logical method in the dingy era of the Black Death, but in the 21st Century we have the technology, means and human dignity to make another choice.
As a measure of mass prevention quarantine is a method as old as civilization. The word itself can be traced to the era of the Plague, when Venice implemented a containment period of 30 days, or trentino, for all ships coming into harbor at the city of Ragusa. Over the next century, this measure was adopted by other Italian city states and extended to 40 days, or quarentino, the root of today’s English word. In the medieval world quarantine was adopted due to observational functionality, hunches and superstition, but it worked. The crudeness of the method, however, does not match the capabilities of our civilization today.
Japan is one of the most technologically advanced nations in the modern world, with a healthcare system praised by academics and citizens alike. Imposing a medieval tactic for disease control is anachronistic and foolhardy.
So what can be done? I am no epidemiologist, and I will admit I am coming at this issue from the perspective of compassion and dignity rather than the angle of a doctor or academic. Still, with approximately 50,000 U.S. Military personnel stationed in Japan, 2.4 doctors per 1000 people in the nation (for comparison: US: 2.6, China: 1.8, Cuba: 8.2) and health outcomes virtually unparalleled in the developed world, one would expect more from Japan than outmoded tactics from the middle ages.
With vulnerable people among the passengers and among the crew, more must be done to protect the safety of individuals and prevent hazards in working conditions for those serving aboard the cruise.
The Military Solution
One true alternative to on-board quarantine for the passengers of the Diamond Princess is military quarantine. Though less comfortable than a cruise ship, both the U.S. Military and the Japanese Self Defense Forces have the capability to process the 3,700 passengers and crew for individual quarantine in a military facility. The attractiveness of this option comes from its isolationist approach: instead of locking almost 4,000 people together on a floating resort where they have the opportunity to interact and spread disease, isolating patients would reduce overall quarantine time, with the added benefit of military efficiency reducing the transmission of the virus. I can’t imagine the Diamond Princess’s passengers and crew enjoying their stay at a U.S. base in Okinawa, but several weeks of isolation would prove more pleasant than contracting COVID-19.
The Selective Solution
Three-thousand seven-hundred is, to be frank, a large number people. While we cannot expect Japan to have the immediate intake capacity necessary to process all 3,700 residents of the Diamond Princess for treatment, testing and individual quarantine in its hospitals, we can certainly expect measures of selectivity to be put in place to protect the most vulnerable passengers and members of the crew.
First of all, as Japan is now doing, the elderly should be allowed to leave the ship and receive necessary testing and potential isolation on land. The old are especially at risk of dying if they contract the coronavirus, and should not be subjected to conditions which will increase the likelihood of their deaths. Likewise, pregnant women, young children and any individual with existing respiratory issues should be permitted to leave the ship and seek treatment and prevention on land in Japanese hospitals. While a quarantine period is still necessary to prevent the transmission of COVID-19 more broadly, individual quarantine is a more humane option than group quarantine, especially for those most at risk of infection or death in the case of infection.
A selective system is not at all far-fetched, and I’m happy to see Japan implementing this method in part. It does not go far enough, however, and leaves others unnecessarily in harm’s way.
The Fair Labor Solution
One issue I’ve been grappling with as I write this is the question of fair labor practices and the treatment of the crew aboard the Diamond Princess. It is unlikely that performers, cabin boys, stewards, servers, cleaners, cooks or bartenders contended with the risk of pandemic before signing on to work a cruise. Now, after a single passenger brought an infectious disease aboard, they must continue to work in significantly more hazardous conditions than those they signed up for. This, perhaps, even more so than the case of the passengers, is a violation of basic human rights.
The solution is obvious: instead of continuing to offer services, the Diamond Princess and Princess Cruises should work with Japanese authorities to process crew members on land, allowing them to leave once cleared as noninfectious. Passengers may have to sacrifice further comfort, suffer a dearth of entertainment and turn to packaged food, but the safety and wellbeing of workers should register above the creature comforts of guests.
Just as Japan should process the vulnerable separately, they should treat the crew as at-risk individuals as well. Interacting with passengers puts the lives of crew members at risk, and something must be done to remedy their situation.
I’ve laid out my case. It is unreasonable to quarantine the mass of passengers and crew aboard the Diamond Princess all together, as it is clear from the increase in COVID-19 cases that this does not halt infection. Workers’ rights are being abused by the quarantine, and vulnerable passengers are subjected to increased personal risk. I believe what is happening at Yokohama is a violation of human rights, and it is clear that medieval-style quarantine is not the only solution available.
Just days ago, on Feb. 3, the World Dream cruise ship in Hong Kong allowed cleared passengers to disembark, and sealed off the cabins used by any infected individuals. Solutions exist. Step up, Japan.