Passengers of the cruise ship Diamond Princess got more than they bargained for when they left Japan on Jan. 20 for a luxury vacation to Vietnam, China, Taiwan and back—an extra two weeks aboard the ship, all expenses paid, room service included. 

This bonus vacation, though, was anything but. 

Since Feb. 4, the ship has been in quarantine in Yokohama, Japan, because of an outbreak of the coronavirus disease, COVID-19. As of Thursday, 634 cases of the virus have been confirmed among the 3,711 passengers and crew originally aboard the ship. Two passengers died after contracting the virus on board.   

Wednesday marked the end of the two-week quarantine. About 500 passengers who tested negative for the virus left the ship, and another 2,500 are expected to disembark in the next few days.

The handling of the quarantine has been heavily criticized by public health officials, with the consensus being that although the quarantine wasn’t an unreasonable idea, it did not succeed in preventing the transmission of the virus on the ship. 

“One of the essential components of an effective quarantine is making sure there’s an adequate number of medical professionals who can attend people, and not just those who are demonstrating symptoms,” says Neil Maniar, a professor of the practice and director of the Master of Public Health program. “That’s one of the main problems with this quarantine—3,700 people is the size of a small town.” 

The Diamond Princess outbreak is the largest site of COVID-19 outside of China, where most of the world’s 75,000 cases have been reported and more than 2,000 people have died. Additional cases have been reported in 26 other countries and resulted in eight deaths.

Passengers on the ship were instructed to stay in their rooms. Those who were staying in rooms without windows were allowed on deck for an hour and a half each day so long as they remained three feet away from each other. The ship’s crew dropped off meals, prescriptions and other necessities daily. 

But Maniar says this strategy was probably doomed from the start. 

“There are plenty of ways illnesses spread on cruise ships, not just because of the proximity that individuals have to another, but think about all the common surfaces touched by people, the dining spaces, the social events,” he says. 

From the start, a better strategy would have been to separate people who tested positive and showed symptoms from those who did not. 

“For the people who tested negative, what you want to do during that incubation period, ideally, is move them off the ship into a facility that’s lower risk so they don’t contract the disease,” Maniar says. 

While only people who tested negative for COVID-19 were allowed to leave the ship on Wednesday, there are concerns that some of those people could be infected despite health officials’ best efforts. 

This fear comes after 328 American evacuees left the ship on Monday and returned to the U.S. on chartered planes under the agreement that all evacuees test negative for the virus. But because of a miscommunication, 14 of those evacuees actually tested positive.

American officials in charge of coordinating the evacuees did not wait for test results to come back before loading busses. By the time the results were relayed to American officials, the evacuees were already en route to the airport. 

Their solution? Separate healthy and infected passengers on the plane with a plastic sheet. 

“Anyone who has used a sheet of plastic to protect against dust, for example, knows that some particles always escape,” Maniar says. Plus, “the problem on a plane is that the air is circulated throughout the whole plane,” regardless of the sheet. 

As the Diamond Princess quarantine ends, a new quarantine begins for many passengers and crew who will have to restart the 14-day incubation period at hospitals in Japan or elsewhere.

“I worry about the people from countries that are in less of a position to come to their aid,” says Wendy Parment, the Matthews University Distinguished Professor of law and director of the Center for Health Policy and Law at Northeastern. “Every country is pulling out their own, so people on the ship from poorer countries are going to be the ones left to suffer.” 

“This is not a problem of passports and nationality. This is a problem about human beings,” she says. “Until the global community sees this as a global problem, that everybody needs to work together in terms of resources and dollars and having a coordinated response, then we’re going to have a problem.” 

For media inquiries, please contact media@northeastern.edu.