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Criticism over inadequate protection for medical personnel followed reports Wednesday that a quarantine officer who screened people aboard the Diamond Princess cruise ship off Yokohama tested positive for COVID-19.

Experts are also speculating that the protective gear worn by the officer was insufficient.

Officials from the health ministry have said it was essential to check whether protective measures by medical personnel against the virus are sufficient.

“We’d like to promptly evaluate whether (the infected officer) was adequately protected or not but at this point I can’t give further comments,” a senior official told reporters Wednesday.

According to the health ministry, the officer was dispatched to collect health questionnaires from passengers on Feb. 3 and Feb. 4 and to check their temperature. The officer spent the next two days working at a quarantine station and started to feel ill Sunday. He went to a clinic the following day and tested positive Tuesday.

The man claims that he was wearing a surgical mask and gloves while on board the ship, following World Health Organization standards. He also washed his hands frequently but didn’t wear goggles to shield his eyes.

“Health authorities in China have raised alarm over risks that the novel coronavirus can be transmitted through the eyes,” stressed Masaya Yamato, director of the Infectious Diseases Center at Osaka-based Rinku General Medical Center. “Even if the officer was just collecting survey responses, he should have worn goggles.”

Emiko Iwasaki, a former director of the health ministry’s quarantine station in Sendai who was in charge of Japan’s measures against the Ebola virus disease outbreak in Africa, points to health workers’ vulnerability to the virus.

“Fatigue accumulation causes immune dysfunction,” Iwasaki said. “The worker may have contracted the virus after touching his nose or mouth if he had touched walls or handrails or gloves he used on the ship.”

Nevertheless, Iwasaki believes the officer’s role in further spreading the virus wasn’t significant.

“The number of viral particles in the human body immediately after transmission is relatively low,” she said.

However, Moriyo Kimura, who used to work at the health ministry’s quarantine station, warned of an infectious risk.

Such close contact with people infected with the virus is not envisaged in the job description of a quarantine officer. Considering this point, “this virus must be of a very high infectivity,” she said.

“Many people visit quarantine stations including those who come to perform export or import inspections or to get a vaccination shot. We need to consider the possibility that the virus may have spread outside the ship and may have been transmitted to the officer’s family members or his co-workers.”

Of the 174 infected onboard the Diamond Princess, 20 are crew members. These include restaurant and bar staff, those responsible for cleaning guests’ rooms, and some were sharing rooms with other crew members. Because quarantine inspectors and crew are in constant contact with passengers, there’s a possibility this frequent contact has become one of the infection routes.

“Even if passengers stay in their rooms, every day crew members and quarantine officers are coming in and out. If they are infected, they may spread the virus to the passengers,” stressed another former quarantine station chief. The official has gone through a quarantine drill for handling H1N1 influenza on a large cruise ship with more than 3,000 passengers.

“It’s likely that no one had envisioned a scenario in which one infected person after another would be taken from their rooms and hospitalized,” the official said.

Although a passenger from Hong Kong who disembarked in January was found to be infected Feb. 1, it is believed that passengers were able to move freely within the ship, and social events were still open, until they were requested to stay in their rooms Feb. 5.

“It is natural to think that the virus spread during the period in which recreational events were taking place there, while the symptoms started showing after the incubation period,” said Yoshiaki Katsuda, a professor at Kansai University of Social Welfare who specializes in travel medicine.

The point is how the situation will turn out after the general incubation period of 12½ days, counting from Feb. 5 when health officials applied full-scale containment measures.

“If the virus spreads further, we need to think about other transmission routes, making the situation more serious,” Katsuda said.

He emphasized that “it is essential to review what kind of work infected crew members were doing, the level of physical contact with passengers and whether infection safeguards were thoroughly enforced.”

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