Diamond Princess Cruise Ship Research Articles

Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study.

Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension.

Environmental Sampling for Severe Acute Respiratory Syndrome Coronavirus 2 During a COVID-19 Outbreak on the Diamond Princess Cruise Ship.

During a COVID-19 outbreak on the Diamond Princess cruise ship we sampled environmental surfaces after passengers and crew vacated cabins. SARS-CoV-2 RNA was detected in 58 of 601 samples (10%) from case cabins 1–17 days after cabins were vacated but not from noncase cabins. There was no difference in detection proportion between cabins of symptomatic (15%, 28/189; cycle quantification [Cq], 29.79–38.86) and asymptomatic cases (21%, 28/131; Cq, 26.21–38.99). No SARS-CoV-2 virus was isolated from any of the samples. Transmission risk of SARS-CoV-2 from symptomatic and asymptomatic patients may be similar and surfaces could be involved in transmission.

COVID‐19 outbreak on the Diamond Princess Cruise Ship in February 2020

COVID‐19 outbreak on the Diamond Princess Cruise Ship in February 2020

Clinical characteristics of the coronavirus disease 2019 (COVID-19) outbreak on a cruise ship

BackgroundA large COVID-19 outbreak occurred on the cruise ship Diamond Princess in February 2020. Little information has been reported about the clinical characteristics of the patients. MethodsThis single-center, retrospective, observational study was conducted in Yokohama, Japan. We included symptomatic patients who were infected on the ship and admitted to our hospital between 5 and 19 February 2020. All the cases were confirmed with SARS-CoV-2 infection by polymerase chain reaction (PCR). ResultsWe confirmed 17 cases. The average age was 69 years; 10 patients were Asian and 7 were Caucasian. Eleven patients had one or more chronic diseases. The major symptoms were cough and fever. Chest computed tomography (CT) scans found bilateral ground-glass opacities predominantly in the peripheral area, which were similar to reports from cases in China. C-reactive protein (CRP) levels were higher in severe and critical cases than in mild to moderate cases. The moderate to severe cases reached symptomatic resolution; one of the three critical cases resulted in death due to multiple organ failure. SARS-CoV-2 was detected by PCR at an average of 7 days after symptomatic resolution. ConclusionsCough and fever, increased blood CRP levels, and CT findings of bilateral ground-glass opacities predominantly in the peripheral lung were characteristic of the COVID-19 cases in this study. These findings were compatible with those of previous reports.

Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19.

BackgroundJapan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020.ObjectiveWe aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship.MethodsReverse transcription–polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board.ResultsOf those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died.ConclusionsThere were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients’ transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships.

Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics.

BackgroundLow infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation.ObjectiveWe present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020.MethodsThe smart contact tracing–based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2.ResultsAs of February 29, a total of 67 contacts who were tested by reverse transcription–polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020.ConclusionsBig data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing.

Challenges of COVID-19 outbreak on the cruise ship Diamond Princess docked at Yokohama, Japan: a real-world story.

The event of the Diamond Princess, with a total of 712 (as of 17 March 2020) persons infected on the cruise ship, attracted global attention as the largest disease cluster outside China for the period 7 to 24 February 2020. Representing the Ministry of Health, Labour and Welfare, the authors were heavily engaged in the quarantine operation on the cruise ship ourselves. During the quarantine period from 5 to 23 February 2020, when the last group of the quarantined passengers left the ship, a series of measures have been conducted under the principles of i) zero deaths among all on board, ii) rapid establishment and thorough implementation of an infection control system, and iii) maintenance of health conditions and relief of anxieties among passengers and crew members. The case of Diamond Princess has implications of more than a cruise ship but deserves full scientific analysis to learn lessons from this operation as well as to study the characteristics, particularly the transmission of COVID-19.

Epidemiology and quarantine measures during COVID-19 outbreak on the cruise ship Diamond Princess docked at Yokohama, Japan in 2020: a descriptive analysis.

The outbreak of coronavirus disease 2019 (COVID-19) on the cruise ship Diamond Princess docked at Yokohama, Japan was highlighted due to its number of cases in the early stage of the global epidemic when the picture of the virus itself, as well as epidemiological characteristics, were being established. We conducted an observational epidemiological study of the outbreak, focusing on a total of 403 individuals who developed a fever of ≥ 37.5°C from 20 January to 22 February 2020. Quarantine measures are also discussed with a descriptive method. Of a total of 3,711 individuals (2,031 males) from 57 countries, 2,666 (71.8%) and 1,045 (28.2%) were passengers and crew with mean age of 66.0 (range: 2-98) and 36.6 (range: 19-64), respectively. Among 403 febrile individuals, 165 passengers and 58 crew members were diagnosed as laboratory-confirmed COVID-19 cases. Until 6 February, the number of confirmed cases was three or less per day. However, distribution of thermometers on 7 February revealed 43 confirmed cases, and it then started decreasing. The outbreak was initiated from decks for passengers and expanded to areas for crew. As of 17 March, when more than14 days had passed after disembarkation of all passengers and crew, there was no report of forming a cluster of infections in Japan from them. At the time of the initiation of quarantine, the outbreak had already expanded to most of the decks from those for passengers, and the results might suggest the contribution of the set of quarantine measures in unprecedented challenges of the control operation.

Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission

SummaryThe world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection.Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS.The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission.Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.

Chronology of COVID-19 Cases on the Diamond Princess Cruise Ship and Ethical Considerations: A Report From Japan.

The Diamond Princess cruise ship has been anchored at the Yokohama port in Japan since February 3, 2020. A total of 691 cases of the coronavirus disease 2019 (COVID-19) infection had been confirmed as of February 23. The government initially assumed that the infection was not spreading aboard and therefore indicated that any persons who either tested negative for the virus or were asymptomatic should immediately disembark. However, on February 5, the government set a 14-day health observation period because of the severity of the infection. Passengers confirmed to be free from infection began disembarking on Day 15 (February 19) of the quarantine. The effectiveness and validity of infection control, justification for the timing of inspections, and even the nature of COVID-19 itself now are all in question. The ethical considerations related to cruise ship infection control include the reasonable justification for isolation, the psychological fragility and quality of life of the isolated passengers and crew members, the procedural justice inherent in a forced quarantine, and the optimization of control measures.The international coordination framework and the global ramifications of such outbreaks should be reevaluated by the international community. Denying a ship's entry based on local politics is incompatible with global justice. Events such as these require an international response and global regulations that seek to reduce disparities.

Chest CT Findings in Cases from the Cruise Ship Diamond Princess with Coronavirus Disease (COVID-19).

PurposeTo evaluate the chest CT findings in an environmentally homogeneous cohort from the cruise ship Diamond Princess with coronavirus disease 2019 (COVID-19).Materials and MethodsThis retrospective study comprised 104 cases (mean age, 62 years ± 16 [standard deviation], range, 25–93 years) with COVID-19 confirmed with reverse-transcription polymerase change reaction findings. CT images were reviewed, and the CT severity score was calculated for each lobe and the entire lung. CT findings were compared between asymptomatic and symptomatic cases.ResultsOf 104 cases, 76 (73%) were asymptomatic, 41 (54%) of which had lung opacities on CT. Twenty-eight (27%) cases were symptomatic, 22 (79%) of which had abnormal CT findings. Symptomatic cases showed lung opacities and airway abnormalities on CT more frequently than asymptomatic cases [lung opacity; 22 (79%) vs 41 (54%), airway abnormalities; 14 (50%) vs 15 (20%)]. Asymptomatic cases showed more ground-glass opacity (GGO) over consolidation (83%), while symptomatic cases more frequently showed consolidation over GGO (41%). The CT severity score was higher in symptomatic cases than asymptomatic cases, particularly in the lower lobes [symptomatic vs asymptomatic cases; right lower lobe: 2 ± 1 (0–4) vs 1 ± 1 (0–4); left lower lobe: 2 ± 1 (0–4) vs 1 ± 1 (0–3); total score: 7 ± 5 (1–17) vs 4 ± 2 (1–11)].ConclusionThis study documented a high incidence of subclinical CT changes in cases with COVID-19. Compared with symptomatic cases, asymptomatic cases showed more GGO over consolidation and milder extension of disease on CT.An earlier incorrect version appeared online. This article was corrected on April 8, 2020.© RSNA, 2020

COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures.

BackgroundCruise ships carry a large number of people in confined spaces with relative homogeneous mixing. On 3 February, 2020, an outbreak of COVID-19 on cruise ship Diamond Princess was reported with 10 initial cases, following an index case on board around 21-25th January. By 4th February, public health measures such as removal and isolation of ill passengers and quarantine of non-ill passengers were implemented. By 20th February, 619 of 3700 passengers and crew (17%) were tested positive.MethodsWe estimated the basic reproduction number from the initial period of the outbreak using SEIR models. We calibrated the models with transient functions of countermeasures to incidence data. We additionally estimated a counterfactual scenario in absence of countermeasures, and established a model stratified by crew and guests to study the impact of differential contact rates among the groups. We also compared scenarios of an earlier versus later evacuation of the ship.ResultsThe basic reproduction rate was initially 4 times higher on-board compared to the n}{}{R}_0 in the epicentre in Wuhan, but the countermeasures lowered it substantially. Based on the modeled initial n}{}{R}_0 of 14.8, we estimated that without any interventions within the time period of 21 January to 19 February, 2920 out of the 3700 (79%) would have been infected. Isolation and quarantine therefore prevented 2307 cases, and lowered the n}{}{R}_0 to 1.78. We showed that an early evacuation of all passengers on 3 February would have been associated with 76 infected persons in their incubation time.ConclusionsThe cruise ship conditions clearly amplified an already highly transmissible disease. The public health measures prevented more than 2000 additional cases compared to no interventions. However, evacuating all passengers and crew early on in the outbreak would have prevented many more passengers and crew from infection.

Epidemic Growth and Reproduction Number for the Novel Coronavirus Disease (COVID-19) Outbreak on the Diamond Princess Cruise Ship from January 20 to February 19, 2020: A preliminary Data-Driven Analysis

The COVID-19 outbreak on the Diamond Princess shihas caused over 600 (still increasing) cases as of February 19, 2020 By using the growing process model, we

COVID-19 first stage in Japan - how we treat 'Diamond Princess Cruise Ship' with 3700 passengers?

COVID-19 first stage in Japan - how we treat 'Diamond Princess Cruise Ship' with 3700 passengers?

Taking Account of Asymptomatic Infections in Modeling the Transmission Potential of the COVID-19 Outbreak on the Diamond Princess Cruise Ship

Background: The COVID-19 outbreak on the Diamond Princess (DP) cruise ship provided empirical data to study the transmission potential of COVID-19 under quarantine with the presence of asymptomatic cases. Methods: We studied the changes in R0 on the DP from January 21 to February 19, 2020 based on chain-binomial models under two scenarios: no quarantine assuming a random mixing condition, and quarantine of passengers in cabins — passengers may get infected either by an infectious case in a shared cabin or by asymptomatic crew who continued to work. Results: Estimates of R0 at the beginning of the epidemic were 3.27 (95% CI, 3.02-3.54) and 3.78 (95% CI, 3.49-4.09) respectively for serial intervals of 5 and 6 days; and when quarantine started, with the reported asymptomatic ratio 0.505, R0 rose to 4.18 (95%CI, 3.86-4.52) and 4.73 (95%CI, 4.37-5.12) respectively for passengers who might be exposed to the virus due to contacts with asymptomatic crew. The overall R0 for both crew and passengers was decreased to 2.55 (95%CI, 2.36-2.76) and 2.90 (95% CI, 2.67-3.13). Results show that the higher the asymptomatic ratio is, the more infectious contacts would happen. Conclusions: We find evidence to support a US CDC report that “a high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew.” Our study suggests that the effects of quarantine may be limited if the asymptomatic ratio is high, implying that a combination of preventive measures is needed to stop the spread of virus. .

The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence.

A novel coronavirus (nCoV) spillover event, with its epicenter in Wuhan, People's Republic of China, has emerged as a public health emergency of international concern. This began as an outbreak in December 2019, and till February 28, 2020, there have been 83,704 confirmed cases of novel coronavirus disease 2019 (COVID-19) globally, with 2,859 deaths, resulting in an overall case fatality rate of 3.41 per cent (95% confidence interval 3.29-3.54%). By this time (February 28, 2020) 58 countries or territories and one international conveyance (Diamond Princess Cruise Ship) were affected. As a part of the global response to manage and contain the pandemic, major emphasis was placed on generating research intelligence to guide evidence-based responses to contain the virus, which was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to its genetic similarities with the SARS virus. This review summarizes the emerging evidence which can help guide the public health response, particularly in India. Key areas have been identified in which research needs to be conducted to generate critical intelligence for advising prevention and control efforts. The emergence of SARS-CoV-2 has once again exposed the weaknesses of global health systems preparedness, ability to respond to an infectious threat, the rapidity of transmission of infections across international borders and the ineffectiveness of knee-jerk policy responses to emerging/re-emerging infectious disease threats. The review concludes with the key learning points from the ongoing efforts to prevent and contain COVID-19 and identifies the need to invest in health systems, community-led response mechanisms and the need for preparedness and global health security.

COVID-19 AND AIR CONDITIONING - IS THERE AN ENVIRONMENTAL LINK?

As it spread globally, the new SARS-CoV-2 virus was first confirmed in Romania in February 2020, and since then over 40000 cases were diagnosed with COVID-19. Considering climate charges that showed a continuously increasing temperature and also the fact that nowadays air conditioning devices are used on daily bases not only in personal homes but also in healthcare facilities we raised the question if cooling air devices could contribute to the spread of SARS CoV-2 virus. For that, we searched data in the speciality literature regarding the potential of transmission of the virus through air conditioning. Incorrect ventilation in indoor spaces can be associated with an increased transmission rate of respiratory infections as studies suggested. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as one of the infection disease control measure. However, if those are not correctly used, they can contribute to the transmission of an airborne diseases as suggested by data from Japan, Germany, and the Diamond Princess Cruise Ship. There are no clear data that can confirm if there is a link between aerosols produced by HVAC system and transmission of SARS CoV-2 virus and further extensive studies should be performed to either confirm or infirm this hypothesis.

Gyms and Martial Arts School after COVID-19: When to Come Back to Train?

To determine with safety when and how to open gyms after the COVID-19 epidemic, it’s very important since almost all places are locked down and probably will be closed for a while or permanently. We need to keep studying options and the ways to do it, therefore the sooner we discuss it, the less damage there will be, especially for owners and professionals. This article reviews systematically all numbers available about coronavirus until 01 April 2020. Until this date, COVID-19 is affecting 203 countries and territories around the world and 2 international conveyances: the Diamond Princess Cruise ship harbored in Yokohama, Japan, and Holland America’s MS Zaandam cruise ship. Objective: To determine when will be the right moment for gyms to come back and open their doors safely and how to prevent contamination of high risk people with COVID-19 in those places, directly and indirectly. Discussion: Well-known ways to help stop the spread of infection through personal hygiene, and adequate disinfection associated to social distancing, are reported in most articles about infection preventions, which are shown to be useful measures in SARS-COVID 2 also known as COVID-19. Conclusions: Private lessons are the best options after COVID-19, with control of body temperature before each class, a high level of personal hygiene and mat and equipment disinfection between classes for all activities in a gym. In group classes or closed spaces with more than 10 people, maintain 1 meter of distance if possible, using masks and gloves all the time until we have a better understanding of this virus’s mutation. If possible and available, test coaches and instructors for COVID-19 every 14 days, the average period of incubation.

Asian Graphene Forum (AGF - 2017), Singapore

VBRI Press is pleased to announce ‘Asian Graphene Forum (AGF - 2017), Singapore during 11 – 16 March 2017, Singapore. It is a six-day international event organised by the International Association of Advanced Materials (IAAM) with the collaboration of VBRI Press AB Sweden. Forum will be held on the Diamond Princess Cruise Ship cruising from Singapore - Kuala Lumpur (Malaysia) - Penang (Malaysia) - Phuket (Thailand)- Singapore. The aim of the event is to cover the latest technology developments, applications, commercialization progress, end user requirements and challenges of Graphene and related 2D Materials.

Asian Advanced Materials Congress (ASAMC -2017), Singapore

VBRI Press is pleased to announce ‘Asian Advanced Materials Congress (ASAMC - 2017), Singapore during 11 – 16 March 2017, Singapore. It is a six-day international event organised by International Association of Advanced Materials (IAAM) in collaboration with the VBRI Press AB, Sweden. The congress will be held on the Diamond Princess Cruise Ship < /em> cruising from Singapore - Kuala Lumpur (Malayasia) - Penang (Malaysia) - Phuket (Thailand) - Singapore. The goal of congress is to provide a global platform for researchers and engineers coming from academia and industry to present their research and activities in the field of advanced materials and technology.