Quarantined passengers on board the Diamond Princess cruise liner were dealt another blow on Monday when 60 more people tested positive for the coronavirus, almost doubling the total number of cases to 130.
The cruise ship, which is docked in the Japanese port of Yokohama, has strictly confined thousands of passengers to their cabins since last Wednesday. They face a total lockdown until February 19 and are only allowed to exercise on deck for 1.5 hours a day in small groups.
Two New Zealanders who were on the ship have tested positive for the virus.
The Japanese health authorities began testing on board the ship after an elderly holidaymaker from Hong Kong, who disembarked in late January, was found to be carrying the deadly coronavirus, which has killed 908 and infected more than 40,000 since it emerged from China in mid-December.
Following the high spike in cases, the Japanese government said it was planning to test dozens more elderly people on board and to investigate whether there were any issues with hygiene control.
"We are considering testing, if possible, all those over 80 years old who are in ill health," Yoshihide Suga, the Chief Cabinet Secretary told a news conference, reported the Japan Times.
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The Health, Labour and Welfare Ministry said that it would consider testing all of the approximately 3600 people aboard the ship when the two-week quarantine ends, allowing them to leave the vessel if their results are clear.
"We need to properly address the unease and concerns of our citizens," said Katsunobu Kato, the health minister.
Some passengers over the weekend already called for more health checks, questioning why fewer than 300 people have been tested in full, although every passenger has been asked to check their temperature and fill out health questionnaire forms.
"The worrying thing to me is that they have tested relatively few people on the ship," Kent Frasure, 42, from Oregon, told the Telegraph. "The symptoms are still minor. They need to be doing more and testing more people."
On Friday, Mr Frasure's wife Rebecca, 35, was one of the passengers escorted from the ship after being diagnosed with the virus even though she only had a minor cough and slight fever.
Alan Steele, 58, was the first Brit to test positive on the ship last Thursday. On Monday, he posted the good news that doctors had were already planning his discharge.
"As long as I pass the tests I will be free on Friday… heard bad news on more cases on ship but possible good news is all will now be tested so if your free of virus they should let you go," he wrote on his Facebook page.
Princess Cruise Lines Ltd., which operates the luxury liner, has now offered to fully refund all passengers who were trapped on board because of the outbreak. The refund will include accommodation prior to and following the cruise, onshore excursions and services used on board.
However, David Abel, a British pensioner posting regular livestream broadcasts from his room, said that passengers are starting to display signs of "cabin fever."
A counselling hotline has been set up to help people, especially those with inside cabins and no natural light, cope with the ordeal.
The risks of the virus spreading through the confined spaces of cruise ships and being transmitted across Asian ports has led to other liners being denied entry to ports.
Multiple excursions by Diamond Cruise passengers in the Taiwanese port of Keelung and Taiwan's capital, Taipei, at the end of January, has put the island on high alert.
Taiwan has since banned the docking of cruise ships that have recently visited Hong Kong, Macau or China. On Monday, South Korea also placed a temporary ban on liners entering its ports.
The new restrictions have left thousands of passengers adrift at sea.
The Westerdam, a ship carrying some 2,000 people, is not under quarantine and has no confirmed cases but has been denied entry to multiple ports in Japan, the Philippines and Taiwan since it left Hong Kong on February 1.
"We are floating around the ocean," American passenger Steve Muth told the Detroit Free Press on Sunday.
"I think we're headed toward Vietnam, maybe Malaysia, Cambodia, not sure — they won't tell us just yet," he added. "We have no known cases onboard, but there's just a lot of fear that someone may have it and bring it to their country."
Fears about the rapid transmission of the disease, which can cause fever and breathing difficulties have been heightened by a report by a team including renowned Chinese epidemiologist Zhong Nanshan that the virus incubation period can last for up to 24 days.
The report, which extracted data from 1,099 patients from 552 hospitals in 31 provinces, also found that the median age was 47, and 41.9% were female. Only 1.18% of patients had a direct contact with wildlife, whereas 31.3% had been to Wuhan and 71.8% been in contact with people from Wuhan.
An advance team of international experts working for the World Health Organisation has now set off for China.
But concerns remain that the Chinese authorities are not being fully transparent about the extent of the crisis.
Chen Qiushi, a citizen journalist, who has been doing critical reporting and posting YouTube videos from Wuhan, the epicentre of the outbreak, went missing on Thursday, his friends and family said.
He disappeared as the nation was mourning the death of Li Wenliang, a doctor who had been admonished for alerting colleagues to the spread of a new virus in early January.
Mr Chen, 34, went missing as hundreds of thousands in China started to demand freedom of speech on social media platforms. The police reportedly said he had been forced into quarantine but his family said they had been unable to speak to him and did not know if he would be released after the mandatory 14 days.