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Diamond Princess Cruise Ship’ with 3700 Passengers? Acute Medicine & Surgery 2020;7:e506 doi: 10.1002/ams2.506 Letter to the Editor COVID-19 first stage in Japan – how we treat ‘Diamond Princess Cruise Ship’ with 3700 passengers? Dear Editor patients may be accepted at facilities other than these desig- We report the current situation regarding the case of multiple nated medical institutions). patients who tested positive via polymerase chain reaction (PCR) for the novel coronavirus infection and were trans- Dates Number of patients transported ported from the Diamond Princess cruise ship, from the view- (approximate: unconfirmed) point of medical facilities in Yokohama City to serve as a reference for future development of emergency medical care February 4 10 (all numbers are approximate) systems in each region. Please note that the following num- February 5 10 bers are preliminary (unconfirmed) and may change based on February 6 10 February 7 43 (on early morning of February 8, the cruise the counts determined by related organizations in the future. and 8 ship temporarily left the Yokohama port and The Medical Control Council recognizes the importance of sailed off the coast of the Boso Peninsula verifying the overall situation once the crisis has settled down. because of water generation on board) Please refer to reports from each organization to gain adminis- trative perspectives. The present report is merely one of the documents that could be used to review regional emergency Due to a rapid increase in the number of patients, the medical systems when large numbers of coronavirus disease emergency medical facilities in Yokohama City, Kanagawa (COVID-19) patients are observed in each region. Prefecture, could not meet the requirements of all patients. During this period, there were cases of life-threatening con- BEGINNING OF THE QUARANTINE ditions such as acute myocardial infarction and cerebral infarc- tion among those who were PCR-positive and those with HE DIAMOND PRINCESS cruise ship (British regis- unconfirmed test results who required urgent care (including T tered) arrived offshore of Yokohama port on the eve- passengers of foreign nationalities). Regardless of PCR ning of February 3 (Monday) and the quarantine began. results, patients requiring urgent treatment were admitted to There were 2,666 passengers and 1,045 crew members on the only advanced emergency medical center in the City (not the ship (a total of more than 3,700). a designated medical institution for infectious diseases, but the Initially, quarantine began due to one passenger (a man degree of medical emergency was prioritized: there are nine who boarded in Yokohama on January 20 and disembarked emergency medical facilities in Yokohama City, with only in Hong Kong on January 25) being tested positive for the one of them being an advanced emergency medical center). novel coronavirus infection via PCR, but eventually, many There was a case of a foreign national admitted to a medical passengers tested positive via PCR for the infection. facility in the City who developed gastrointestinal perforation, requiring an emergency surgery. Because emergency surgery TRANSPORTATION OF PATIENTS of PCR-positive patients was considered difficult in general hospitals due to lack of staff, the patient was transported to the RANSPORTATION OF THE PCR-positive patients to abovementioned medical center for emergency surgery. T the designated medical institutions for class I infectious diseases (one location in Yokohama City) and to the desig- PATIENTS TRANSPORTED OUT OF THE nated medical institutions for class II infectious diseases PREFECTURE (seven in Kanagawa Prefecture) in Kanagawa Prefecture began on February 4. However, more number of patients UBSEQUENTLY, THE NUMBER of patients requiring tested positive via PCR in the subsequent days, making it a S transport to medical facilities due to being PCR-positive physically difficult situation for such designated medical or due to other symptoms continued to increase—10 (approx- institutions to accept all the patients. This became even more imately) on February 9, 15 on February 10, and 70 on Febru- difficult when some of the patients developed severe illness ary 11—reaching a point where it was impossible for medical (the federal government announced on February 9 that the facilities in Kanagawa Prefecture to handle all patients. © 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of 1of3 Japanese Association for Acute Medicine This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. 2of3 Letter to the Editor Acute Medicine & Surgery 2020;7:e506 Japan Disaster Medical Assistance Teams (DMATs) came asymptomatic and stable PCR-positive patients to distant into the scene as of February 8 and started medical practice hospitals based on appropriate medical judgment, we were on the ship. It was reported that the medical situation drasti- able to avoid the arrival of 500 transported patients at medi- cally improved (there was an overwhelming lack of staff on cal facilities in Yokohama City all at once. the ship until this point). On February 10, full-scale stratifi- It would not be an exaggeration to say that thanks to cation of disembarking patients was performed by the mem- DMATs, it was possible to balance the regular emergency bers of the DMATs: medical system and admissions of COVID-19 patients in Patients for whom emergency treatment was deemed nec- Yokohama City, and as the chairman of the Medical Control essary regardless of PCR results ? transportation via Council of the Yokohama City, I appreciate the support pro- ambulance to an emergency hospital in Yokohama City vided by DMATs from across the country (and also many PCR-positive patients with mild subjective symp- other medical teams such as SDF medical officers, Japan toms ? transportation to medical facilities in Kanagawa Medical Association Team [JMAT], and infection control Prefecture team for providing support for medical care in Yokohama PCR-positive patients without subjective symp- City). toms ? transportation to medical facilities outside of However, I have the impression that if multiple COVID- Kanagawa Prefecture (distantly located) via DMAT vehi- 19 patients are admitted to a local medical facility (with cles, private ambulances, Self-Defense Forces (SDF) most of such facilities being hospitals that are not designated vehicles, and buses, among others. medical institutions for infectious diseases), it will be diffi- cult to maintain a system in parallel with accepting patients Stratified transportation of patients based on their condi- from regular ambulances from an infection prevention tion was led by the Coronavirus Countermeasures Head- aspect. (At this point, there is still no announcement from quarters and DMAT Adjustment Headquarters set up in the the Yokohama City Fire Bureau regarding the extended time Kanagawa Prefectural Government Office. for hospital selection by on-site ambulances.) In this manner, medical facilities of Yokohama City were able to focus on “admitting passengers who needed immedi- ate treatment.” SITUATION FOLLOWING THE Subsequently, the following numbers of passengers were DISEMBARKATION OF GENERAL PASSENGERS disembarked: HE MAJORITY OF passengers were aged ≥60 years, 37 passengers (approximate; February 12) with more than half being 70 years or older (press 27 passengers (February 13) T report). 40 passengers (February 14) After disembarkation of passengers, approximately 1,000 crew members were remaining on the ship, mainly compris- THE SUMMARY OF TRANSPORTED CASES ing Filipinos and Indians. However, these were healthy peo- (PRELIMINARY/UNCONFIRMED NUMBERS) ple without any underlying conditions, and emergency calls have drastically decreased to 1–2 per day. Because the ENERAL PASSENGERS BEGAN disembarking on Philippine government had their crews return back to their February 19. G country, it is likely that the transportation of patients from The total number of transported cases by the evening of the Diamond Princess cruise ship in Yokohama has settled February 18 was 512 (approximate). down. On the other hand, there have been reports, one after another, of new COVID-19 patients across Japan; thus, (Transportation due to the need for emergency 64 Yokohama must prepare for the next phase. medical care) To medical facilities in Yokohama City Medical facilities in Kanagawa Prefecture 102 Medical facilities outside of Kanagawa Prefecture 346 CURRENT SITUATION OF MEDICAL FACILITIES IN YOKOHAMA CITY S DISCUSSED, 64 people (approximate; as of Febru- BALANCING WITH REGULAR EMERGENCY A ary 18) from the Diamond Princess cruise ship were MEDICAL CARE SYSTEM admitted to emergency medical facilities in Yokohama City. Among these admitted passengers, some patients with a ECAUSE DMATS ASSIGNED patients in need of stable respiratory condition at the time of transport gradually B immediate treatment to local medical facilities and deteriorated, requiring ventilator support and extracorporeal © 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine Acute Medicine & Surgery 2020;7:e506 Letter to the Editor 3of3 membrane oxygenation (ECMO). (For further detail, please BALANCING WITH NORMAL EMERGENCY refer to reports from The Japanese Society of Intensive Care SYSTEM Medicine
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