Two groups of US Diamond Princess passengers, two disparate experiences: 'I feel ill-used by my country'

Two groups of American travelers who were stuck on board the Diamond Princess cruise ship due to a coronavirus quarantine have disembarked. But both groups remain in limbo: One that's under quarantine at two U.S. military bases and at a medical facility in Nebraska and another that's still in Japan, prohibited from returning home for two weeks.

Public health experts have expressed alarm and disbelief at the chaotic response and lack of coordination by Princess Cruises, the Japanese government and U.S. officials. And passengers who were aboard the ship say communication has been lacking. 

As the two-week, onboard quarantine was set to end Feb. 19 in Yokohama, Japan, the State Department sent two charter planes to evacuate the roughly 400 U.S. citizens on the ship. The passengers were given a choice: Take a charter flight home or stay on the ship.

Most of the Americans chose to take the flight. But at the last minute, 14 of those 382 passengers tested positive for coronavirus. Rather than sending them to quarantine, officials split them up and put seven of the passengers on each plane.

The group of 100 Americans who stayed behind were given a completely different directive: Stay in Japan for 14 days, but not under quarantine, then return home as long as you don't test positive.

U.S. health experts have questioned how the situation was handled from start to finish.

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said the Diamond Princess quarantine "failed."

"The quarantine process failed," Fauci told USA TODAY's Editorial Board and reporters. "I'd like to sugarcoat it and try to be diplomatic about it, but it failed. People were getting infected on that ship. Something went awry in the process of the quarantining on that ship. I don't know what it was, but a lot of people got infected on that ship."

The Backstory:We asked one of the nation's top coronavirus officials some direct questions

Lawrence Gostin, a professor of global health law at Georgetown University, said the inconsistent treatment of the Americans who were on the ship put them at greater risk and threatens to expose more people to infection.

"We’re trying to stop the spread of a novel, emerging disease that could turn into a global pandemic," he said. "We know how to do this."

Yet Gostin, who's also director of the World Health Organization's center on public health law, said the response to the Diamond Princess crisis, "was virtually medieval."

"Literally, it was the opposite of what you should do," he said.

The ship's quarantine began Feb. 5 due to coronavirus. It remains docked in Yokohama. As of Monday, at least 691 people who had been on the ship had tested positive for the virus, out of 3,711 quarantined passengers and crew.

Two Japanese cruise ship passengers in their 80s with coronavirus who were on the Diamond Princess have died, according to Japan’s health ministry.

A health ministry official confirmed to the Associated Press that the passengers had been previously hospitalized in serious condition and had existing chronic diseases. The official spoke anonymously, citing office protocol.

A third passenger, an 80-year-old Japanese man, died of pneumonia, the health ministry announced in a news release Sunday.

A total of 18 American passengers from the ship are infected, according to a Friday press briefing by the Centers for Disease Control and Prevention. Eleven of them are hospitalized in Nebraska. Five are under quarantine in Texas, as are another two in California, said Dr. Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases.

Gostin faults Princess Cruises for keeping the passengers on board a ship that was not designed to contain an infection. He faults the Japanese government for allowing passengers to disembark without a quarantine. And he said U.S. officials erred by putting the 14 Americans who tested positive on two evacuation planes with others who had tested negative.

"It was a comedy of errors," he said.

The whole process has left the ship's American passengers confused, frustrated and uncertain going forward. 

Matthew Smith, an attorney from Sacramento, California, and his wife, Katherine Codekas, are part of the group stuck in Japan.

Smith and Codekas opted out of the charter flight back to the states. He told USA TODAY he didn't think the evacuation plan was safe. 

"They want to take hundreds of people off the ship before the quarantine here has been completed and without them ever being tested, and they want to throw them on buses together, then a plane, then force them to serve another 14-day quarantine under unknown circumstances," he said ahead of the U.S. evacuation.

Smith, who's been keeping in touch with USA TODAY throughout the ordeal, said he and Codekas were back on land around 1:20 p.m. local time Thursday and had checked into a Tokyo hotel. 

The couple received their negative test results the night before on a form slipped into their stateroom, according to a tweet from Smith. 

Smith and Codekas will hang out in Tokyo for "at least two weeks" while they wait to hear from the CDC about when they can return to the United States and "what the conditions for that return may be" apart from the additional 14 days outside of the nation's borders. The couple originally boarded the ship Jan. 20. 

"The only contact we have from the Embassy so far are the daily emails from them," Smith said, noting the most recent indicated the CDC would follow up.

Smith and Codekas are among the approximately 100 Americans who were on the Diamond Princess, now stuck overseas.

Contrast that with the 328 American passengers from the ship who are now back on U.S. soil but under quarantine.

Linda Levell, 71, from Vincennes, Indiana, is one of the Diamond Princess passengers who evacuated on a charter flight from Japan to the states Feb. 16. Now she's quarantined at Lackland Air Force Base in Texas with her husband, Jim, 72.

While she said they are grateful to be back, Levell has questions and told USA TODAY Thursday no one is giving her adequate answers.

"There’s no communication with (the CDC) unless they come and take our temperature, and when they do that, I just bombard them with questions," she said.

She wants to know if after the 14-day quarantine they will be able to go home safely? What will the protocol be? Will they need to be tested again? Will the quarantine be extended? Will they be made to complete an additional quarantine in their own homes if they do get to leave? 

No one has been able to give her definitive answers. Neither the CDC nor the State Department would answer USA TODAY's additional questions about how the evacuation was carried out.

High risk, but no quarantine

Smith said that they received an email last week from the Department of Health and Human Services that informed them the agency had assessed the situation and found crew and passengers to be at a high risk of exposure, much like people in the epicenter of the outbreak in Wuhan, China.

But rather than flying them back home to complete an additional 14-day quarantine, like the first group evacuated, U.S. officials instead instructed those who opted to forego the charter flight and finish out the initial 14-day quarantine on the ship to stay put for 14 days, with no quarantine.

The inconsistency in how U.S. officials treated his group of Diamond Princess passengers has left Smith's head spinning.

"It reflects a lack of international cooperation," he said.

Health Minister Katsunobu Kato initially said those disembarking the ship with negative virus tests had fulfilled the Japanese quarantine requirement and were free to walk out and go home on public transportation. Later Wednesday, he urged the former passengers to refrain from nonessential outings and try to stay home for about two weeks. 

"COVID-19 is not 100% known, and a lot of people got infected on the Diamond Princess. Taking those factors into consideration, we believe taking extra caution will contribute to preventing the risk of future infections," he said.

The opportunity to explore Tokyo has become a silver lining for Smith, but he said he feels resentful toward U.S. officials for barring some American passengers from coming home for another two weeks.

"The biggest problem, from my perspective, is that the U.S. changed its mind so quickly about the effectiveness of the onboard quarantine."

The American response to the quarantine and its success changed over the course of the containment period.

Fauci said the original idea to keep people safely quarantined on the ship wasn't unreasonable. But even with the quarantine process on the ship, virus transmission still occurred.

"The bottom line is that I feel ill-used by my country – or at least by the government bureaucrats in charge of the decision-making – because they have barred me from returning without adequately explaining why they came to think what they initially called the best thing to do was, in fact, worth nothing at all," Smith said.

Eat, sleep and worry

In this image from a video taken on Monday, Feb. 17, 2020, U.S. passengers who evacuated off the quarantined cruise ship the Diamond Princess and officials wait for the takeoff of a Kalitta Air airplane bound for the U.S.

Her unanswered questions aren't the only thing gnawing at Levell during the endless hours in a small hotel-style room. While she tries to stay active lifting water bottles and doing small exercises, her time is more occupied with worries about becoming infected.

"We pretty much eat, sleep a little bit and worry a lot," she said. 

Their flight had seven people infected with coronavirus, and since they've arrived, she's heard of five more going to the hospital to receive care. But she didn't hear it from the CDC employees helping monitor the quarantined passengers' temperatures.

"They don’t tell us; they don’t announce it," she said. Instead, she's heard news of people leaving in ambulances from other passengers who have a front-facing window – they had been on the same floor on board the Diamond Princess.

"The big worry is constantly with you," she said. "Every minute, it's 'Am I going to start feeling bad?' Every time you cough or sneeze or feel like you’re hot, you wonder if you’re getting the virus."

It's been challenging, she said, to stay positive, but they're trying.

"We are so thankful that the United States came to get us, there is no question about that," she said. "If we are going to have the virus, no question we want to be in the USA."

She doesn't think the CDC is doing a bad job with the current quarantine, she just thinks the agency needs to send more people and communicate better.

Dr. Sommer Gunia, a breast surgeon based in Scottsdale, Arizona, is another one of the passengers on Diamond Princess who evacuated on the charter flight and is now in quarantine at Lackland Air Force Base. 

Gunia told The Arizona Republic, which is part of the USA TODAY Network, she is feeling the physical and mental effects of limited activity and access to the outdoors. "I feel so unconditioned," she said. "I walked around outside the other day and I was out of breath. You know what I have to look forward to every day? My meal. That's it." 

Contributing: Jamie Landers, The Arizona Republic; David Oliver, USA TODAY; The Associated Press