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On Tuesday, Spencer Fehrenbacher received a knock on his door at Travis Air Force Base near Fairfield, Calif. He’s been under quarantine there after evacuating from the Diamond Princess cruise ship, docked in Yokohama, Japan.
At the door were two Centers for Disease Control and Prevention (CDC) officials with his printed test results for the novel coronavirus. “You’re either Santa Claus or the angel of death, and I’m really hoping you’re Santa Claus,” Fehrenbacher joked with the officials. His test results came back negative.
“Once that door closed, I crashed on that chair, and I shed a couple tears and … gave thanks to God for continuing to protect me,” he said. “If somehow within the next six days I do become symptomatic … I understand that that is just as much in God’s plan as for me to leave here without ever having it.”
The test result came after eight days of quarantine at the base in addition to a 12-day quarantine on the cruise ship, where 705 of the 3,711 passengers and crew became infected with the novel coronavirus, which causes the respiratory disease now known as COVID-19. Three passengers died. The cluster of infections is the third-largest in the world outside China and South Korea.
A graduate student in Tianjin, China, 29-year-old Fehrenbacher had gone on the 15-day cruise with three friends right as the coronavirus began rapidly spreading in China and nearby countries. On Feb. 3, the captain announced the cruise would return to port early after a passenger had tested positive for the coronavirus while in Hong Kong. Fehrenbacher grew concerned: He had a fever earlier during the cruise, so he and his cabinmate got tested for the virus.
On the morning of Feb. 5, Japanese health authorities ordered everyone to quarantine in their cabins for 14 days while the crew delivered food to each room.
Each morning, the captain would announce the number of positive cases and take those infected off the ship and to a Japanese hospital. For three days Fehrenbacher waited and worried he’d be next. But no one had come for him, so he realized he had tested negative: “That was the first breath of fresh air.”
Initially Fehrenbacher stayed optimistic, believing the quarantine was working. By the ninth day inside the cabin he shared with his friend—which thankfully had a balcony—the captain had stopped listing the number of new cases. Fehrenbacher believed it had stopped spreading. Yet seconds before doing a live interview with a Canadian news outlet on Feb. 15, he heard the anchor announce 67 new cases on the Diamond Princess that day.
He was shocked—the spread of the virus hadn’t stopped. The captain had just stopped informing the passengers. He felt betrayed. A day earlier, the United States had announced it would evacuate U.S. citizens from the ship as long as they spent another two weeks in quarantine after arriving in California. Fehrenbacher agreed.
A total of 40 American passengers of the Diamond Princess have tested positive for the virus, raising the number of infected in the United States to almost 60. They stay in isolation in hospitals, and thus far the virus has not spread to local communities. But on Tuesday, federal health officials called on Americans to prepare for the “inevitable” spread of the coronavirus in the country. Researchers started the first clinical trial in the U.S. for a drug to treat the coronavirus Wednesday.
“Ultimately, we expect we will see community spread in the United States,” Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the CDC, told reporters. “It’s not a question of if this will happen, but when this will happen, and how many people in this country will have severe illnesses.”
The warning comes as the novel coronavirus, which originated in Wuhan, China, is quickly spreading around the world: South Korea saw a rapid rise in cases in the past week with its number rising from 31 to 1,261. In Iran, 19 people have died from the virus, the highest number of fatalities outside China, with 139 more infected. Italy now has 374 cases and 12 deaths as the virus spreads to other countries in Europe.
“We are on the verge of a pandemic,” said Dr. Gregory Poland, director of Mayo Clinic’s Vaccine Research Group. “I think it’s important to call it a pandemic, not to cause panic but preparation. When you know what you’re facing, you’re better prepared to deal with it.”
In South Korea, the outbreak centers around the southeastern city of Daegu, where half of the cases are clustered among a heretical Christian sect called Shincheonji Church of Jesus. Followers believe its leader is the second coming of Christ. The sect forbids them from wearing glasses or face masks during weekly gatherings. Leaders tell them to attend services even when sick, which has led to the quick spread of the virus.
An infected 61-year-old woman disobeyed doctor’s orders and attended two services at the Shincheonji Church, exposing 1,000 people. Afterward, authorities failed to track down hundreds of other Shincheonji members for health inspections. Experts believe they have gone into hiding because of the stigma attached to their cultish church.
Daegu officials have urged citizens to stay home but, unlike in China, they have not completely shut down the city: Businesses are still open, and people can enter and leave the city. The mayor plans to test all citizens who have flu-like symptoms in the next month. Churches, schools, and public spaces have closed.
The outbreak in Iran is spreading throughout the region. Cases in Iraq, Bahrain, Kuwait, Oman, Lebanon, and the United Arab Emirates trace back to Iran. A health ministry official believes the virus may have spread through Chinese workers building a solar-power plant in Qom.
As of Wednesday, Iran’s government said the country had 95 cases of infection—including the deputy health minister, Iraj Harirchi—and 16 fatalities. But an official from Qom, the epicenter of the outbreak, claimed 50 people died in the city. The central government rejected that figure.
Hundreds of Muslim pilgrims from all over the region visit a holy shrine in Qom each week, increasing the likelihood that the virus could quickly spread throughout countries in the Middle East that lack the medical infrastructure to fight it. Neighboring Iraq, Turkey, Afghanistan, Pakistan, and Armenia have closed their borders with Iran.
Authorities have closed schools and universities, including some religious schools. Some have called for the closure of the shrine in Qom, but some senior clerics pushed back on the idea, according to Financial Times. Others also fear Iran’s healthcare system won’t be able to deal with the coronavirus outbreak due to a lack of diagnostic equipment amid U.S. sanctions.
In Europe, cases are spreading from an outbreak in Italy, where all but three of 322 people infected tested positive since last Friday. The outbreak centers around the northern regions of Lombardy and Veneto, where the governments of several cities and towns placed about 100,000 people in quarantine. Venice canceled the last two days of its annual carnival.
The first three cases were all people who came to Italy from China, but public health officials are struggling to find the cause of the latest outbreak: None of those people have been to China or been in contact with anyone who had. “We are (now) even more worried because if we cannot find ‘patient zero’ then it means the virus is even more ubiquitous than we thought,” Luca Zaia, governor of Veneto, told reporters.
Austria, Croatia, Switzerland, Brazil, and Algeria all announced their first cases of the coronavirus linked to Italy, but neighboring countries have not yet closed its borders.
Poland, the Mayo Clinic doctor, believes the Diamond Princess’s quarantine created the worse possible situation as officials “holed up a bunch of healthy people with a few sick people under inadequate conditions.” He pointed out cruise ships are not ideal for quarantines because of ventilation systems and untrained staff.
“It’s no surprise that when you put people in a petri dish that this is going to happen,” Poland said. “It was a terrible decision made with the best of intentions, but unfortunately people’s health and politics are not a good mix.”
Instead of keeping everyone on the same ship, Poland said he would have isolated the sick in one area while quarantining the rest in another.
When Fehrenbacher and the other 327 Americans finally stepped off the Diamond Princess on Monday, Feb. 17, their journey was far from over. The buses taking them to the airport idled for hours while United States officials at the State Department and the CDC debated what to do with 14 passengers who had tested positive for the coronavirus, according to The Washington Post.
They decided to bring them home, although no one told passengers that infected people sat among them. After the plane touched down in California, Fehrenbacher said a man in a hazmat suit asked the couple seated behind him to stay on the plane. He later realized they had tested positive and needed treatment. Fehrenbacher again felt betrayed, losing hope that the officials had the situation under control.
“There were a couple days that this wall of optimism came crashing down and I felt scared and vulnerable,” Fehrenbacher said. “But … there were hundreds of people who were sending messages saying, ‘We’re praying for you’ … and it helped me know God was there in the midst of something I couldn’t really comprehend.”
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