Japan faces mounting criticism for its handling of a coronavirus-afflicted cruise ship, with questions over a patchy quarantine, incremental testing and the decision to let people walk away after 14 days.

The 3,711 people on the Diamond Princess went into quarantine off Japan on February 5, after it emerged that a former passenger had tested positive for the new coronavirus.

Passengers were confined to cabins except for brief outings on deck, when they were required to wear masks and gloves and keep their distance from each other.

But doubts soon emerged about whether the measures were working. Dozens of people on board were quickly diagnosed with the virus, and by Tuesday, 542 cases were reported.

While passengers were confined to their cabins, those with balconies could sometimes be seen talking to neighbours without masks.

And crew were not quarantined, sharing working spaces, living quarters and bathrooms, and simply donning masks and gloves when interacting with passengers.

At least two government officials themselves contracted the virus while working on the ship.

Kentaro Iwata, a professor at the infectious diseases division of Kobe University, told AFP the on-ship quarantine was a "major failure, a mistake".

"It is highly likely secondary infections occurred," he said.

In videos that racked up hundreds of thousands of views, Iwata later said he had been on board the ship Tuesday and observed "completely chaotic" conditions.

"The cruise ship was completely inadequate in terms of infection control," he charged, saying he now was placing himself into a 14-day self quarantine for fear of infecting his family.

- Japan 'is not perfect' -

But Japanese officials defended their approach, with Shigeru Omi, a former WHO regional head advising the government, saying the quarantine had "a very positive effect" on reducing infections.

"(The) majority of the infections, we believe, occurred before the date when the quarantine measures started," he told reporters.

That does not appear to have convinced foreign governments, with Washington evacuating hundreds of Americans from the ship and Australia, Britain, Canada and Hong Kong all planning to repatriate citizens.

The US embassy warned that US health officials have "concluded that despite efforts of quarantine there is a high risk that passengers... have been exposed to COVID-19".

And in an indication that foreign governments do not believe the on-ship quarantine has worked, those being repatriated will undergo another quarantine of two weeks -- the presumed virus incubation period.

Japanese officials have pointed out there were no guidelines for dealing the unprecedented situation.

Other countries have simply turned away cruise ships over the virus, and Cambodia is now scrambling after welcoming a ship that turned out to have at least one infected passenger on board.

"There was no established international agreement as to how to respond to and who is responsible for and when to disembark," Omi told reporters.

"No organisation is perfect, Japan is no exception."

Michael Ryan, head of the WHO's health emergencies programme, acknowledged there "has been much more transmission than expected on the ship".

But, he added, "it is very easy in retrospect to make judgements on public health decisions made at a certain point".

- 'A bit scared' -

Pinpointing when infections began on the ship was made harder by the slow rollout of testing, with fewer than 300 people initially tested and the pool only gradually expanded to include at-risk groups.

Japan said it was constrained by limited testing capacity, but it waited days to ask the private sector for help, and only completed onboard testing of passengers a day before the quarantine ended.

And as many of those of who test positive do not have symptoms, officials concede it is hard to prove when they contracted the virus.

Despite the doubts, Tokyo allowed around 500 people who meet conditions including testing negative in the quarantine's final days to leave the ship on Wednesday.

Officials say there is little evidence that tests produce false negatives.

"As far as we know, once the test is negative, they remain negative," Takaji Wakita, director-general of Japan's National Institute of Infectious Diseases, told AFP.

Domestically, the government's handling of the crisis appears to have dented Prime Minister Shinzo Abe's popularity, already battered by a cronyism scandal.

And a recent poll found 52 percent disapproved of the government's response to the outbreak, but in Yokohama where the ship is docked, there was sympathy for those on board.

"It must be really tough," 17-year-old student Shoya Horiuchi told AFP. "I want them to hang in there."

But, he conceded, he has started to think of the virus as "a threat"

"I am a bit scared."

Passengers leave Japan virus ship as China toll tops 2,000
Yokohama, Japan (AFP) Feb 19, 2020 - Hundreds of relieved passengers finally disembarked a coronavirus-stricken cruise ship in Japan Wednesday after testing negative for the disease that has now claimed more than 2,000 lives in China and spread panic worldwide.

With 542 positive cases, the Diamond Princess is easily the biggest cluster outside China, and Japan has faced mounting criticism for its quarantine arrangements as the passengers disperse into the wider world.

"I'm relieved... I want to take a good rest," said a 77-year-old Japanese passenger, who declined to give his name. He said he would be boarding Japan's famously crowded railway system home.

A fleet of yellow-dotted city buses, plus a dozen or so taxis, whisked away the passengers, many of whom dragged their luggage behind them and waved to former ship-mates on balconies as they disembarked.

Fresh figures from China showed the death toll surging beyond 2,000 with more than 74,000 infected, although the rate of new cases continued to slow.

Hundreds more cases have been reported in two dozen countries, including 15 in South Korea -- a 50-percent rise -- with a cluster of at least 11 around the southern city of Daegu.

Hong Kong also reported its second death from the virus, which has proved extremely infectious.

For the 500 passengers disembarking the Diamond Princess after testing negative, a difficult 14-day quarantine period has come to an end after their dream cruise turned into a nightmare of fear and boredom confined in many cases to small windowless cabins.

"Our last deep gratitude to the crews and captain for such an amazing care... during the epic crisis... we can't wait to see you again soon on board again," tweeted passenger Yardley Wong, who left after 14 days cooped in a small cabin with her six-year-old son.

- 'Major failure' -

Many were left onboard with an anxious wait for test results that would allow them to disembark.

Asked how he felt seeing others disembark while remaining on the ship, American lawyer Matt Smith told AFP: "I need an emoji for envy."

Michael Ryan, head of WHO's health emergencies programme, said the outbreak was "very serious" and could grow, but stressed that outside China's Hubei, it was "affecting a very, very tiny, tiny proportion of people."

But in Japan, some have raised concerns about allowing people from the cruise ship to board flights home or spread out into the notoriously busy Japanese capital.

Kentaro Iwata, a professor at the infectious diseases division of Kobe University, blasted the on-ship quarantine as a "major failure, a mistake".

"It is highly likely secondary infections occurred," Iwata told AFP, saying scepticism from abroad of the quarantine was "only natural".

He later said in a video published online that he was self-quarantining after a brief visit to the ship where he raised major concerns about the procedures on board.

"It was completely chaotic," he said.

- 'Hugs and flowers' -

Elated passengers also began disembarking from a second cruise ship that has been at the centre of coronavirus fear, the Westerdam, which made shore in Sihanoukville in Cambodia.

Hundreds were departing after receiving a clean bill of health, as Prime Minister Hun Sen greeted the first passengers with hugs and flowers.

American Christina Kirby, fretted about the stigma some Westerdam passengers could face once they return home. "I want people to remember that... there's a human behind each of these stories and those who are ill deserve compassion," she told AFP.

Several countries appear to have lost patience with the quarantine on board the Diamond Princess and chartered planes to repatriate citizens.

In the first such evacuation Monday, more than 300 Americans flew home even though 14 had tested positive.

Britain, Hong Kong and Australia are among other countries that have vowed to repatriate people from the ship but will insist on a further 14-day quarantine on home soil.

Nathalie MacDermott, a medical expert at King's College London, recommended a further 14-day self quarantine for those leaving.

"Given the circumstances on board the Diamond Princess, those passengers leaving the boat should be managed in a similar manner to those individuals departing a highly affected city or region," said MacDermott.

South Korea vowed to block foreigners who have been on board the Diamond Princess from entering the country.

Disembarkation is expected to take around three days as more test results become available. The crew will begin a new quarantine when the last passenger has left.

People in Yokohama appeared supportive of the decision to allow the passengers out despite the virus fears.

"I am sure those people on board must be really worried. I hope they can go back to their normal life soon," said 51-year-old Isamu Habiro.

"As a Yokohama resident, I don't want them to be treated unfairly. I want to cheer for them," Habiro told AFP.

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