Hundreds of US citizens who have spent nearly two weeks exposed to the coronavirus and quarantined aboard the Diamond Princess cruise ship docked near Tokyo were evacuated today.
They were taken by bus to a nearby airport, where two chartered planes are scheduled to return them to the US.
Forty-four Americans who were travelling on the Diamond Princess have been infected, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said.
About 400 Americans were on the cruise ship when it docked in Japan, and the Japanese Defence Ministry said 300 of them had disembarked, the Associated Press reported. Once they land on US soil, the passengers will be quarantined and monitored for an additional 14 days at military bases in Texas and California.
The number of coronavirus diagnoses has continued to rise sharply among the 3700 passengers and crew members originally on board. Japanese Health Minister Katsunobu Kato said that the quarantined ship floating near Tokyo has 355 confirmed cases, or about 30 per cent of the 1219 people who have been tested so far. That represents one of the highest infection rates in the world.
"The degree of transmissibility on that cruise ship is essentially akin to being in a hot spot," Fauci, who is also a member of the White House task force for coronavirus, told CBS.
The Diamond Princess has been quarantined since February 5. Those who elected to forgo the chartered flight back to the US are expected to leave the ship on February 19, but officials have said that they will not be able to find a different flight home until at least March 4.
Their motivations to stay behind varied. Some passengers have sick family members being treated for coronavirus in Japanese hospitals. Others feared they could be exposed to the virus on the confined plane or were opposed to escaping one quarantine only to enter another, according to a Reuters report.
Cheryl and Paul Molesky of Syracuse, New York, told AP that they were willing to risk it.
"We are glad to be going home," Cheryl Molesky said. "It's just a little bit disappointing that we'll have to go through quarantine again, and we will probably not be as comfortable as the Diamond Princess, possibly."
"The biggest challenge has been the uncertainty," she added.
Video footage showed several buses lined up alongside the cruise ship as American passengers disembarked.
Canada, South Korea, Italy and Hong Kong announced they would also arrange charter flights.
Three Israelis on board have been found positive for the virus, according to the Israeli Health Ministry, but their condition is mild and they are now in a hospital in Japan. The ministry added that an expert physician has been sent to liaise with Japanese health officials.
The Diamond Princess and another cruise ship, the Westerdam in Cambodia, are posing logistical and public health challenges for governments as they try to contain the spread of the disease known as covid-19 and to repatriate citizens.
Concerns mounted that authorities in Cambodia, including US Embassy officials, had allowed passengers infected by the coronavirus to disembark from the Westerdam cruise ship and depart for other cities and countries around the world after Malaysian officials confirmed that a second exam for an ill passenger returned positive.
Malaysian Deputy Prime Minister Wan Azizah Wan Ismail told reporters that an 83-year old American passenger on the cruise liner tested positive for the coronavirus - once on Friday and once on Saturday - after she landed in Kuala Lumpur despite being screened earlier by Cambodian health officials.
"The results were the same. That is positive for the wife and negative for her husband," Wan Azizah told reporters at a news conference, adding that Malaysia will now bar entry for all passengers from the cruise ship, according to Reuters.
The unexpected finding upends a basic assumption by several governments, including the United States, that the ship was virus-free and that passengers could be greeted at proximity without protective gear and allowed to travel.
The American woman, whose identity has not been disclosed, was among hundreds of relieved passengers who were let off the Westerdam on Friday and welcomed and embraced by Cambodian Prime Minister Hun Sen, who has downplayed the epidemic's threat and described the decision to bring them onshore as an act of humanitarian goodwill.
The ship had been stranded at sea for nearly two weeks and was running low on provisions after it was denied entry to Taiwan, Japan, the Philippines, Thailand and the US territory of Guam.
The US ambassador, Patrick Murphy, also brought his family onboard the cruise ship and posed for pictures with American passengers. Murphy and other passengers did not appear to be wearing a mask in photos shared on the embassy's Twitter account.
Disembarkation, which was set to continue over the weekend, was halted, according to Cambodian journalists at the scene.
Holland America, the cruise operator, said in a statement that no other passengers or crew who were on the ship have reported any symptoms of the coronavirus. About 1000 people remain on the ship, with the rest on their way home.
Grant Tarling, Holland America's chief medical officer, said in the statement that the company was working with health experts to contact national health authorities around the world to investigate and follow up with individuals who may have come into contact with the American woman found to carry the virus.
Cambodia's health minister had issued a public statement urging the public to "not be overly afraid" but to take protective measures. That night, charter flights that were originally scheduled to take Westerdam passengers to Kuala Lumpur were cancelled by Malaysian authorities.
Authorities worldwide have tallied roughly 69,000 cases of the illness and 1669 deaths. The overwhelming majority of infections remain in mainland China, which reported 2009 new cases.
In Taiwan, authorities reported the first death, a man in his 60s with diabetes and hepatitis but no recent history of overseas travel, according to the state-run Central News Agency. Officials said they were still investigating how the man contracted the virus while living in the central part of Taiwan, which has so far recorded 20 confirmed cases across the island.
Chinese officials said they believed that measures taken across the country to control the epidemic were paying off. Several cities in the central region have declared strict "wartime measures" that allow residents to leave their homes only several times a week and upon approval from neighbourhood authorities.
Guards in Hubei are required to check identification 24-hours a day at the entrance to residential compounds and driving is also banned for all nonessential purposes under new regulations.
The number of new cases across China, including in Hubei, have been falling, said Chinese National Health Commission spokesman Mi Feng, who noted that doctors in the worst-hit province had broadened their diagnosis criteria for patients suspected of suffering from the disease and were able to treat them more quickly.
"The effects of our counter-coronavirus measures in every part of the country are already becoming apparent," Mi said.
The Westerdam was believed to have no infections onboard among the 2200 crew, and passengers who were stranded at sea for weeks as countries rejected their entry following a stop in Hong Kong where they took on hundreds of new passengers.
Health experts have warned that the coronavirus is difficult to contain precisely because symptoms are often mild and the coronavirus could replicate inside the human body and infect others for more than two weeks before showing symptoms at all.
The US Embassy in Phnom Penh said Cambodian officials individually screened all disembarking passengers for fever with the help of embassy staff this week, and any passenger who reported feeling ill had received lab tests, all of which returned negative. The tests were processed by a lab trusted by the US Centres for Disease Control and Prevention, the U.S. Embassy said.