TOKYO (NYTIMES) - The ground rules were clear. A day before 328 Americans were to be whisked away from a contaminated cruise ship in Japan, the US Embassy in Tokyo told passengers that no one infected with the coronavirus would be allowed to board charter flights to the United States.
But as the evacuees began filing onto reconfigured cargo planes early on Monday (Feb 17) for departures to military bases in California or Texas, some noticed a tented area in one of them that was separate from the rest of the cabin.
Then reality hit: After 12 days stuck on the cruise ship as more and more people tested positive for the virus, they would now be sharing a plane with those carrying the same pathogen they were desperate to escape.
"I didn't know until we were in the air," said Carol Montgomery, 67, a retired administrative assistant from San Clemente, California. "I saw an area of plastic sheeting and tape."
While the planes were aloft, the US State Department and the Department of Health and Human Services said in a joint statement that the results for 14 passengers who had been tested two or three days earlier came back positive just as they were boarding buses to the airport. After consultations with health experts, the US government decided to let the infected evacuees, who were not yet exhibiting symptoms, board the flights.
The reversal was the latest chaotic turn in a two-week quarantine of the ship that has become an epidemiological nightmare.
Even as the Americans were flying home and countries like Australia, Canada and South Korea were preparing to evacuate their own citizens, the Japanese Health Ministry announced Monday that 99 more cases had been confirmed on the cruise ship, bringing the total to 454.
Among them was the third Japanese public health official to contract the virus while tending to passengers and crew members aboard the ship, the Diamond Princess.
The unstinting rise in infections raised questions about how Japanese authorities would handle the offloading of passengers in two days when the quarantine period is supposed to end. Health officials have already raised the possibility that the quarantine could be extended for some passengers.
"The quarantine on the ship ended up being an unprecedented failure," said Eiji Kusumi, a doctor specialising in infectious diseases at Navitas Clinic in Tokyo. "We should learn from this lesson that a quarantine on a ship is impossible, and we should not repeat this in the future."
US authorities had strongly encouraged American passengers to accept the offer of a flight out. Getting them off the ship took several hours as they were screened, their passports were checked, and they were loaded onto buses that took them from the port of Yokohama to Haneda Airport in Tokyo.
The State Department said the infected passengers "were moved in the most expeditious and safe manner to a specialised containment area on the evacuation aircraft to isolate them in accordance with standard protocols." The US passengers were taken to either Travis Air Force Base in California or Joint Base San Antonio in Texas, and they will remain under quarantine for an additional 14 days.
Epidemiologists said US officials had made a difficult decision to allow infected passengers onboard the charter flights.
"The degree of difficulty in getting someone sick home is much greater than repatriating people who are otherwise well and possibly incubating," said Dr Allen Cheng, an infectious disease specialist at Monash University in Melbourne, Australia.
Cheng added: "You don't want to expose anyone on the plane who hadn't otherwise been exposed before on the boat."
Australia is planning to take approximately 200 passengers off the Diamond Princess on Wednesday. Cheng said that Australia had decided that "anyone who is sick or becomes sick in the next 48 hours will stay in Japan and stay in the hospital."
With Australia and other countries preparing to help transport their citizens off the boat, the captain told the more than 2,000 people still on board that Japanese health authorities could swab everyone for the coronavirus by the end of Monday and begin letting guests leave the ship Wednesday.
"This disembarkation will be an ongoing process" until Feb 22, the captain said in an onboard announcement.
According to the Japanese Health Ministry, at least 55 Americans on the ship were infected with the coronavirus. Many of them remain in hospitals around Japan.