[Telegraph.co.uk] Woman tests positive for coronavirus after two weeks stuck at sea on Westerdam cruise
An American woman who disembarked a cruise ship in Cambodia and travelled to Malaysia has tested positive for the coronavirus, raising concerns that the virus' incubation period could be longer than 14 days.
The 83-year-old was among some 2,250 people trapped on the Westerdam cruise for almost a fortnight, after the ship was denied entry to ports in five countries amid coronavirus fears - despite no reported cases.
The ordeal came to an end on Friday when Cambodia, one of China's closest allies, offered the cruise safe harbour - a move that was praised by the World Health Organization as a symbol of "solidarity".
But the jubilant scenes as passengers began to disembark - and were met by Cambodia's strongman Prime Minister with flowers and scarves - were short lived.
While health officials in Cambodia gave travellers the all clear, Malaysian authorities said on Sunday that two separate tests had confirmed that the American woman was infected with the coronavirus, known as Covid-19.
More than 140 other Westerdam passengers arrived in Kuala Lumpur on the same plane as the American woman and the vast majority caught connecting onward flights - including to airports in the US, the Netherlands and Australia.
Seven others were isolated and screened for the coronavirus, but the tests came back negative.
Malaysia has since added that it will not allow any other Westerdam passengers to enter the country and that cruise ships which have travelled to China will not be able to dock.
But the unexpected case prompted some suggestions that the incubation period - the time between picking up an infection and developing symptoms - could be longer than previously thought, as experts question how the woman caught the virus whilst trapped on the ship.
Most governments have been operating on evidence pointing to a maximum incubation period of 14 days - which is why two week long quarantines have been enforced. But a provisional paper published last weekend by Chinese scientists found that it might take as long as 24 days for some patients to display symptoms.
Paul Hunter, professor in medicine at the University of East Anglia, said that such a long incubation period "would be problematic" for efforts to contain the outbreak.
"With incubation periods there's always some degree of uncertainty, as it can be hard to establish when a patient came into contact with [another infected person]," he told The Telegraph.
"But even with the Westerdam case, as it stands I think the 14 day quarantine period remains appropriate. It is too early to change advice, we don't have the evidence, and a 28 day quarantine would be incredibly difficult to enforce."
Concerns over the unexpected infection in Malaysia come as the global case count surpassed 69,000 and a taxi driver in Taiwan became the fifth fatality outside mainland China - 1,670 people have now died in total.
But in China, authorities reported a decline in new cases for the third consecutive day, raising hopes that the severe interventions imposed by the government are effective.
"Dropping cases appears to be a result of the lockdown efforts made in Hubei and Wuhan," said Jonathan Ball, professor of molecular virology at the University of Nottingham. "But of course we've seen the virus spread to other parts of the country and world.
"I'd be surprised if we didn't see peaks elsewhere and if it doesn't become a pandemic," he added.
Other experts have also suggested that the epidemic might be "starting to run out of new people to infect" in Wuhan - it is thought that catching and recovering from Covid-19 offers short term protection from the disease.
"This is only likely if... there has been a very large number of unreported mild or asymptomatic infections," said Mark Woolhouse professor of infectious disease epidemiology at the University of Edinburgh. "In other words, if most people have had the infection already and have developed immunity to further infection."
But Prof Woolhouse added that public health measures could also play a significant role, meaning "they cannot be relaxed without risking an upturn in the new infections."
"Peak or no peak, efforts to combat Covid-19 must continue," he said.Protect yourself and your family by learning more about Global Health Security. And sign up to our weekly newsletter here.
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