Concerns have been raised over the handling of passengers who disembarked from a cruise ship in Cambodia on Friday after one of them was confirmed to have the new coronavirus following a second test carried out in Malaysia.
Scores of passengers who left the MS Westerdam, which had been at sea for two weeks after leaving Hong Kong on 1 February, have since travelled on to other destinations.
The director general of Malaysia’s health ministry, Noor Hisham Abdullah, said he believed further precautions should have been taken when passengers disembarked.
“Only 20 passengers had their tests done. That was what we were told,” he said. “The fact one case is positive, [means] all other passengers [have] exposure.”
Cambodia was praised by the head of the World Health Organization for allowing entry to the ship, which had been turned away by five other countries despite there being no confirmed cases onboard at the time.
The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the Wuhan coronavirus, for which there is no specific cure or vaccine.
The UN agency advises people to:
Frequently wash their hands with an alcohol-based hand rub or warm water and soap
Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
Avoid close contact with anyone who has a fever or cough
Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.
Despite a surge in sales of face masks in the aftermath of the outbreak of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided they are used correctly.
The Foreign and Commonwealth Office has advised UK nationals to leave China where possible. It is also warning that travellers from Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan and Thailand who develop symptoms of cough or fever or shortness of breath within 14 days of returning the UK should contact the NHS by phone.
The confirmation that an 83-year-old American passenger has since tested positive for the disease after travelling on to Malaysia has prompted questions about whether enough preventive measures have been taken.
Cambodian authorities initially called for the test results to be reviewed by Malaysia, while the ship’s operator, Holland America, described the tests as preliminary. On Sunday, the Malaysian authorities confirmed the patient had been tested for a second time and that the results confirmed she had the virus.
Cambodia’s government said its own tests on passengers from MS Westerdam had been done in collaboration with the WHO and the US Centers for Disease Control and Prevention.
The American woman flew to Malaysia with 144 other cruise ship passengers. Only she and her husband showed symptoms. Her husband has since tested negative.
Most of the passengers have left Kuala Lumpur. A further six were tested and confirmed to be negative before they were allowed to leave.
Malaysia’s deputy prime minister, Waz Azizah Wan Ismail, said the country would not allow entry to any more Westerdam passengers “taking into account that all those passengers were in close contact with the earlier positive case.”
The female patient suffered from a cough but did not have a fever or difficulty breathing. A chest X-ray showed signs of pneumonia, officials said. Malaysian authorities are tracing people who had close contact with the patient.
The MS Westerdam had been turned away by Taiwan, Guam, the Philippines and Thailand as well as Japan, where another cruise ship, the Diamond Princess, remains quarantined.
Passengers onboard the Diamond Princess have been mostly confined to their cabins since 3 February following confirmation that a passenger who had disembarked in Hong Kong tested positive for the virus. More than 350 people onboard are confirmed to have the disease, in what is the biggest cluster of cases outside China.
The death toll across mainland China rose to 1,665 on Sunday, with 68,500 infections.
Tedros Adhanom Ghebreyesus, the director general of the WHO, said last week that Cambodia’s decision to welcome the MS Westerdam exemplified “international solidarity”, adding: “It’s time for solidarity, not stigma.” Cambodia’s prime minister, Hun Sen, greeted and shook hands with passengers as they disembarked.
Some health experts have raised concerns over how effectively Cambodia, which has close economic links with China, is monitoring cases of the virus. A research paper by academics at Harvard University, which analysed air traffic from Wuhan, the centre of the outbreak, suggested that the single case identified in Cambodia was below what might be expected. The study was published quickly to improve scientists’ understanding of the outbreak and so has not been peer-reviewed.
Hun Sen has refused to ban flights from China or to evacuate citizens from Wuhan, stating that doing so would damage diplomatic relations and the country’s economic interests. At a press conference last month, he threatened to throw out any journalists or officials wearing masks.
Holland America said in a statement that on 10 February all 2,257 passengers and crew were temperature-tested and “not one person had an elevated temperature”.
It said: “Disembarking guests also completed a written health questionnaire and the passports of everyone onboard were reviewed to ensure no one had travelled through mainland China in the prior 14 days.
It said there had been no indication of Covid-19 on the ship. Two hundred and 36 passengers and 747 crew remain onboard the vessel.