Tokyo • The ground rules were clear. A day before 328 Americans were to be whisked away from a contaminated cruise ship in Japan, the U.S. Embassy in Tokyo told passengers that no one infected with the coronavirus would be allowed to board charter flights to the United States.
But as the evacuees began filing onto two reconfigured cargo planes early Monday for departures to military bases in California or Texas, some noticed tented areas separated from the rest of the cabin.
Then reality hit: After 12 days stuck on the cruise ship where more and more people were testing positive for the virus, they were now sharing planes with people carrying the same pathogen they were desperate to escape.
“I didn’t know until we were in the air,” said Carol Montgomery, 67, a retired administrative assistant from San Clemente, California. “I saw an area of plastic sheeting and tape.”
While the planes were aloft, the State Department and the Department of Health and Human Services said in a joint statement that the results for 14 passengers who had been tested two or three days earlier had come back positive — just as they were heading to the airport in buses.
U.S. officials, it turned out, had started bringing the passengers home without actually knowing their test results. But because the evacuation had already begun by the time Japanese officials relayed those results, officials decided to let the infected evacuees, who were not yet exhibiting symptoms, board the planes and sit in the back, separated from other passengers by plastic sheets about 10-feet-tall.
The reversal was the latest chaotic turn in a two-week quarantine of the ship that has become an epidemiological nightmare.
Even as the Americans were flying home and countries like Australia, Canada and South Korea were preparing to evacuate their own citizens, the Japanese Health Ministry announced on Monday that 99 more cases had been confirmed on the cruise ship, bringing the total to 454.
Among them was the third Japanese public health official to contract the virus while tending to passengers and crew members aboard the ship, the Diamond Princess.
The unstinting rise in infections — and the scramble to bring American passengers home, even after some were discovered to be infected — has led to tough questions, and some withering criticism, about the handling of the outbreak aboard the ship, home to the largest number of coronavirus cases outside China.
“The quarantine on the ship ended up being an unprecedented failure,” said Eiji Kusumi, a doctor specializing in infectious diseases at Navitas Clinic in Tokyo. “We should learn from this lesson that a quarantine on a ship is impossible, and we should not repeat this in the future.”
Countries around the world are now struggling to figure out what to do with cruise ships during the coronavirus outbreak.
Another ship, the Westerdam, was turned away from port after port in Asia until it was welcomed in Cambodia. The cruise line insisted that no one was ill and passengers started heading home, yet one of them, an American woman, later tested positive for the virus, worrying experts that the epidemic will get only worse.
After the long quarantine in Japan, U.S. authorities had strongly encouraged American passengers on the Diamond Princess to accept the offer of a flight out. Getting them off the ship took days of planning and hours of screening, checking passports and loading passengers onto buses for the 40-minute bus ride from the port of Yokohama to Haneda Airport in Tokyo.
The goal was to ensure that passengers who were symptomatic remain in Japan, U.S. officials said. Medical experts examined American passengers on the ship and determined that at least 328 of them could be evacuated. Meanwhile, Japanese medical experts had done testing of the passengers, but did not have all the results ready.
In the end, 61 Americans remain on board, officials said.
Asked why U.S. officials began evacuating passengers without knowing their test results, Dr. William Walters, managing director of operational medicine at the State Department, told reporters on Monday that it was “unpredictable” when the results would come back.
The Americans were put on about 15 buses to the airport. Once it became clear that some had the coronavirus, the State Department said, the infected passengers “were moved in the most expeditious and safe manner to a specialized containment area” in the rear of the planes.
“In the isolation area, they posed no additional risk,” Walters said.
After landing, the 14 infected evacuees went to hospitals for monitoring and treatment. Most ended up being flown to Omaha, Nebraska for medical treatment by experts at the University of Nebraska. Another five returning passengers were also put into isolation because they developed symptoms.
The remaining U.S. passengers were taken either to Travis Air Force Base in California or Joint Base San Antonio in Texas, and they will remain under quarantine for an additional 14 days.
When one of the planes landed in California, a line of officials from the military, the Centers for Disease Control and Prevention, and the Department of Homeland Security greeted passengers with banners that read “Welcome home.”
After being ushered through an isolation tent, they were assigned to apartments on the base.
“They have flown in specialists from across the country,” said one evacuee, Sarah Arana, 52, a medical social worker from Paso Robles, California. “It’s a phenomenal amount of resources. I’m kind of blown away.”
Epidemiologists said U.S. officials had made a difficult decision in allowing infected passengers onboard the charter flights.
“You don’t want to expose anyone on the plane who hadn’t otherwise been exposed before on the boat,” said Dr. Allen Cheng, an infectious disease specialist at Monash University in Melbourne, Australia.
Australia is planning to take approximately 200 passengers off the Diamond Princess on Wednesday. Cheng said that Australia had decided that “anyone who is sick or becomes sick in the next 48 hours will stay in Japan and stay in the hospital.”
With Australia and other countries preparing to help transport their citizens off the boat, the captain told the more than 2,000 people still on board that the Japanese health authorities could swab everyone for the coronavirus by the end of Monday and begin letting guests leave the ship on Wednesday.
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“This disembarkation will be an ongoing process” until Feb. 22, the captain said in an onboard announcement. The captain said the cruise line was “coordinating closely with your embassies.”
In a briefing on Monday, Shigeru Omi, president of the Japan Community Healthcare Organization, said that Japan had made the right decision to put the ship in quarantine based on the information available when the ship arrived in Yokohama on Feb. 3. “At that time, the international community was trying to contain the virus,” Omi said.
According to the Japanese Health Ministry, at least 71 Americans on the ship were infected with the coronavirus. Many of them remain in hospitals in Japan.
John Haering, 63, a retired operations manager for Union Pacific Railroad who lives in Tooele, Utah, was taken to a hospital in Chiba prefecture last week with a fever and tested positive for the virus. He said he felt stranded as he lay in an isolation room.
His wife, Melanie, left on one of the charter flights.
“I’m happy for her that she got out of here and that she’s going to get some attention in the U.S.,” said John Haering, who retired in November and was about a third of the way through a six-month trip around the world. “But at the same time I’m sad. You feel that loss of somebody leaving.”
John Haering, who said that he no longer had any symptoms or a fever but that a CT scan showed signs of pneumonia, was not sure how much longer he would have to stay.
“They did swab me today again, and I’ll get my test back tomorrow,” he said. “I asked the doctor if the swab shows that I’m negative, and he just shook his head and said, ‘I don’t know.’ There’s a lot of stuff that they don’t know.”
John Haering said he had not heard from anyone at Princess Cruises, the company that operates the Diamond Princess, since he arrived at the hospital. Until Sunday, he had not heard from anyone at the U.S. Embassy in Tokyo, either.
He received a call and a follow-up email urging him to get in touch with the cruise ship company for further information about how he will get home.
“It’s very scary,” he said. “It feels like a little bit of abandonment.”
Tung Pi Lee, 79, a retired physician, was left in a Tokyo hospital with a coronavirus infection while his wife, Angela, flew to California on one of the charter flights. Several of her siblings and their spouses were among the 14 infected passengers who flew home. Two were taken to Nebraska, and another was in California for treatment.
“I am glad for my aunts and uncles to be in the U.S. and to be receiving treatment here,” said JoAnn LaRoche Lee, one of Lee’s daughters. “Had they been left in Japan, I wonder what would have happened to them.”
Trying to coordinate her father’s care in Tokyo with her siblings in the United States, she said, “feels like a never-ending nightmare.”