Global response to coronavirus puts effectiveness of quarantines to the test

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The first hint of a quarantine arrived at 6:30 a.m. Wednesday, when an announcement told early risers aboard the Diamond Princess to return to their cabins from breakfast.

Ninety minutes later, the captain announced that everyone – about 3,700 people, including 251 Canadians – would be confined to the cruise ship off the coast of Japan for two weeks because 10 aboard had tested positive for the novel coronavirus that began in Wuhan, China, and has spread to more than two dozen countries. Since then another 10 passengers, including two Canadians, have tested positive.

On Thursday, local time in Yokohama, an onboard announcement informed passengers that the ship was negotiating with Japanese officials to allow small groups of people out of their rooms for fresh air. Staff would distribute face masks to passengers, the announcement said.

“We’re stuck in the cabins,” said Kent Frasure, an electronic technician from Oregon who was on board the ship with his wife.

He spent most of the day in his cabin eating the food provided – ham sandwiches for lunch, chicken breast with vegetables and rice for dinner – and staring at electronic devices (iPads, phones, Nintendo Switch) as he prepared for 14 days of monotonous confinement.

Mr. Frasure and his fellow passengers, along with passengers on a second cruise ship floating near Hong Kong, are now among the thousands of people outside mainland China who are in quarantine, or will be soon.

Canada is preparing to quarantine hundreds of evacuees from Wuhan at a Canadian Forces Base in Trenton, Ont., for 14 days. The United States, which has already quarantined one planeload of evacuees, will quarantine citizens from more flights at four Air Force bases in California, Texas and Nebraska. Australia is holding its repatriated citizens at a detention centre on Christmas Island, 1,500 kilometres off the coast.

It all amounts to a sweeping test of the effectiveness of quarantine, a public-health measure that fell out of widespread use after the Spanish flu pandemic of 1918-1919.

As many as 20,000 Canadians quarantined themselves voluntarily during the severe acute respiratory syndrome (SARS) outbreak in 2003, but in that case they were kept at home, not at an army base or on a cruise ship.

Canadians were so co-operative that only 27 official quarantine orders had to be issued during the crisis, according to the final report of the SARS Commission. Studies later found that community quarantine – defined as people who may have been exposed to a pathogen confining themselves at home when they’re not symptomatic – reduced the spread of SARS.

Some experts say that quarantines are more likely to slow down outbreaks than stop them, especially if victims can spread the virus before they fall seriously ill, something that still isn’t clear when it comes to the new coronavirus, known as 2019-nCoV.

“Once you are dealing with a respiratory viral infection with the typical transmission dynamics of most respiratory viruses, save for SARS, quarantine is an ineffective strategy," said Neil Rau, a medical microbiologist, infectious disease specialist and assistant professor at the University of Toronto. "It won’t work. It feels good, it looks good. It’s political theatre.”

Still, a senior official with the U.S. Centers for Disease Control and Prevention argued on Wednesday the novel coronavirus outbreak is different from previous outbreaks, such as the 2009 pandemic caused by the H1N1 influenza virus, because this time public-health leaders outside China knew the virus was coming.

“We had this window of time in which we could intervene to slow it down,” said Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. "I think that is different from other situations that we’ve faced.”

Canada is planning to house its evacuees in individual rooms at the Yukon Lodge, a motel on the grounds of CFB Trenton. To date, Canada has had five cases of the novel coronavirus, with no deaths.

On the Diamond Princess, meanwhile, passengers confined to their cabins are occupying themselves with the free WiFi the cruise ship is offering during the ordeal. Staff, wearing gloves and masks, deliver simple meals to each cabin. Prescription medication is being refilled, free of charge, for passengers running low.

Taiwan’s health authority banned all international cruise ships from docking at the island from Thursday amid increasing threat of the coronavirus outbreak.

Gay Courter, a novelist from Florida, said she has kept herself busy corresponding with family and friends.

“The arrival of the food trays is a big moment of the day,” she wrote in an e-mail to The Globe and Mail. “It’s fascinating how days ago they were pumping out 5,000 gourmet meals three times a day and suddenly they are having trouble producing a sandwich.”

David Abel, a passenger from Britain, said he went more than 18 hours without a meal and was worried he would go into a diabetic coma. He posted video updates about his plight on Facebook, which led to readers contacting cruise ship staff on his behalf. He soon received some bread and butter, followed by a more proper lunch of sandwiches and a bit of dessert.

Mr. Abel said he is glad he opted for a “slightly larger” cabin with a balcony, and that he and his wife are now just trying to make the best of the situation.

“It’s just an extended two week cruise, but it’s not going to be a luxury cruise; it’s going to be like a floating prison,” he said with a chuckle in one video.

With a report from Reuters