The feel-good story of how Cambodia allowed a cruise ship to dock after it was turned away elsewhere in Asia for fear of spreading the deadly virus that began in China has taken an unfortunate turn after a passenger released from the ship tested positive for the virus.
News over the weekend that an 83-year-old American woman who was on the ship and flew from Cambodia to Malaysia was found to carry the virus froze further movement of the passengers and crew of the MS Westerdam. Some are now in hotels in Cambodia's capital, Phnom Penh, while others are still aboard the ship.
The American woman was among several hundred passengers who were flown out of Cambodia on Friday and Saturday. According to authorities in Malaysia, 143 continued their flights home from that country, while the woman and her 84-year-old husband, who was diagnosed with pneumonia, remained behind for treatment.
The virus has infected more than 71,000 people globally and killed more than 1770, with the vast majority of the cases in China, where the outbreak began two months ago.
The dispersal around the world of passengers from the ship with possible exposure to the virus has sparked concern.
"I think now given that there is a confirmed case that is suspected to have acquired infection on board the ship, the other passengers should be asked to quarantine themselves at home and alert health authorities if they develop fever or respiratory symptoms within the 14 days since disembarkation," said Professor Benjamin Cowling from the School of Public Health at Hong Kong University.
Dr. Gagandeep Kang, executive director of India's Translational Health Science and Technology Institute, said it is unclear whether the woman's infection could result in an outbreak in another part of the world.
"We will have to wait and see," she said, adding that it would depend on where the woman got the infection, and at what stage of the infection she was in while in contact with other people.
The ship's operator, Holland America Line, said in a statement Sunday that it was working closely with government and health officials in Malaysia and Cambodia and experts with the USCenters for Disease Control and the World Health Organization.
“At this time, no other guests or crew, either onboard or on their way home, have reported any symptoms of the illness,” the statement said. "Guests who have already returned home will be contacted by their local health department and be provided further information."
The statement pointed out that the American woman who tested positive in Malaysia was not one of the 20 people onboard the Westerdam who had reported symptoms to the ship's medical center. It was those 20 who were tested specifically for the virus by Cambodian health officials, and all those results were negative.
The rest of the passengers and crew had health checks that included filling out a written health questionnaire and having their temperatures checked, which has become standard procedure for air and sea passengers considered at risk.
Several Westerdam passengers from the United States and elsewhere have already returned home and spoken to the media.
Two of the passengers, Joseph Schaeffer and his wife, Paulette, a retired nurse, told the Las Vegas Review-Journal from their home in Henderson, Nevada, that they felt the hue and cry over the released passengers was not totally merited.
"It doesn't seem to me that the whole world should be jumping at this," Joseph Schaeffer said.
"There are more deaths from the flu than there have been from this particular virus," his wife said.
The couple said they were screened on their way home at airports in Phnom Penh and Singapore by thermal scanners that remotely monitor arrivals.
On arrival in Los Angeles, they said, they were among a large crowd getting screened that included fellow cruise passengers. They said they answered questions given by someone from the Centers for Disease Control and Prevention that included whether they felt sick, had visited mainland China or knew anyone who had contracted the virus.
Two Canadians who returned via Vancouver International Airport were asked to put on protective face masks on arrival but were not otherwise isolated, Canada's CBC News reported.
"We were asked a few questions and filled out an immigration form, and they very nicely helped us bypass the usual lineups and let us out the door," said Joseph Hansen, who took the cruise with his wife. “We're feeling fine.”
Hansen, from Surrey, British Columbia, told CBC that he did not hear about the American woman in Malaysia with the virus until he landed in Vancouver on Sunday.
“I guess on the one hand it's upsetting to know that there was one case, but we're feeling fine,” he said. “We've had health scans, temperature scans and we don't have any concerns for our own health.”
Cambodia's government had originally earned kudos from the head of the UN's World Health Organization and the USambassador there for allowing the ship to dock at the port at Sihanoukville on the Gulf of Thailand after being turned away by Japan, Taiwan, the Philippines, Guam and Thailand.
The move was seen as a victory for the image of Cambodia's authoritarian prime minister, Hun Sen, who welcomed the ship's passengers with handshakes and flowers. He boasted that although Cambodia is a poor country, it “has always joined the international community to solve the problems that the world and our region are facing.”
WHO Director-General Tedros Adhanom Ghebreyesus had said he was pleased Cambodia had agreed to accept the Westerdam and described it as an example of the international solidarity advocated by the UNhealth agency.
"The one thing I can say is we're very, very grateful that Cambodia has opened literally its ports and its doors to people in need," USAmbassador to Cambodia W. Patrick Murphy said Saturday when he took his family to the port to meet passengers. “We think this sends a strong message. We all have to help each other.”
In hindsight, however, Cambodia's handling of the ship's passengers has been criticised on social media, though it also has gotten some support.
According to Cowling, the Hong Kong University professor, it's a good idea to let passengers leave and monitor them after disembarkation.
Since there were no known cases onboard the Westerdam at the time passengers left the ship, it was reasonable to allow them to travel home, he said.
"I think it would not be appropriate to keep passengers on the ship for 14 days, as it could be a high-risk environment," Cowling said.
"We have seen the consequences of holding passengers on a cruise ship with the Diamond Princess outbreak," he said, referring to another cruise ship that is quarantined in Yokohama, Japan, with hundreds of cases among the passengers.