▼ A video titled "Diamond Princess is COVID-19 mill. How I got in the ship and was removed from it within one day." by Professor Kentaro Iwata (Twitter) of Kobe University, released on February 18, 2020. 

▼ It is very serious content. Please share this on SNS such as Twitter or Facebook etc.

▼Here's Japanese Ver.（日本語版はコチラ）

▼Translation Below▼

Hello, my name is Kentaro Iwata.
I am a professor specializing in infectious diseases at Kobe University Hospital, Kobe Japan.

Today I boarded the cruise ship Diamond Princess, which besieged with a massive amount of COVID- 19 infections at present, and I was removed from the cruise ship on the same day. I'm going to tell you why this happened.

▼Video was deleted on 20th Feb▼

1. Fear of Spreading Infection

I had been worrying about the measures against infection in the Diamond Princess were not going well, as I had been hearing news of the rapid increase of COVID-19 infected persons on the cruise ship.
I heard that the Japanese Society for Infection Prevention and Control (JSIPC) boarded the cruise ship, and then the Field Epidemiology Training Program (FETP) of the National Institute of Infectious Disease entered the cruise ship, but both got off the cruise ship quickly so I could not figure out what was going on there.

I got several messages from people onboard, and they actually asked for help saying “I am so scared,” “I suspect the infection will spread,” etc., so I had been trying from various routes on means of myself going into the cruise ship somehow.

Then, a person who works for the Ministry of Health, Labour and Welfare (MHLW) called me and said I would be able to get on the cruise ship but he also said we should think about how.

First, I was supposed to get onto the ship as a member of the JSIPC, however, since the JSIPC has set a rule that they would not send any more people onto the cruise ship anymore, they refused the plan, as they could not make an exception to the rule for me, and in the end, the MHLW suggested that I might be able to go onto the cruise ship as a member of a Disaster Medical Assistance Term (DMAT), and I agreed and left for Shin-Yokohama from Shin-Kobe on the morning of February 18.

On the way there I got a phone call from the person at MHLW, saying that somebody, whose name could not be said by that person, was extremely opposed to my going onto the cruise ship, so the plan for me to go as a member of a DMAT was almost cancelled.

I was seriously perplexed but kept waiting at Shin-Yokohama for a while since the person said he would think of some other way, and then I got an extremely strange call, saying that they would allow me to get onto the cruise ship not as an expert on infectious disease measures under the DMAT staff, but as just as an ordinary member of the DMAT, just to do DMAT work.

I have no idea why they came to such a conclusion, but I thought that anyway I would accept the offer because if I followed those instructions and worked inside the DMAT, and after people recognized who I am, I might get to do infection-related work as well. So, I agreed to it, as I had no other way to get onto the cruise ship, even though it was an extremely strange request.

And I got on board the Diamond Princess.

First I gave a greeting to the staff and then I was told to work under somebody, so I thought I should follow that person all the time, however, when I talked with the chief doctor in the DMAT, he advised me by saying, “I am not expecting DMAT work from you at all, as you are not an expert, and you are expert on infections so you should do infection-related work.” This is the top DMAT person of on the site.

As I promised to obey what I was told, so, since I was told to be in charge of infection-related work, I would do just that. So, I was showed around the site, checking on a variety of problems.

2. Situation Inside Diamond Princess is So Incredibly Terrifying

It is extremely terrible. I have been doing this work for over 20 years. I have encountered various infectious diseases, including Ebola in Africa and SARS in China. Of course, many times I felt some danger, but I have never felt fear about myself getting infected to this extent, thus far.

The reason is that I am a professional, so I know exactly how I can avoid being infected with Ebola, or SARS.
Also, I know precisely how I can stop causing other persons from being infected with Ebola, or SARS, or by what methods I can stop the spread of infection in a facility.
Because I have the knowledge, I don’t feel afraid even in the midst of an infection.

I never felt afraid in Africa or in China, but situation inside the Diamond Princess is unbelievably miserable, and I felt incredibly terrified.
I seriously thought that there would be no way I could avoid being infected with COVID-19.

We make a clear separation between the safe zone that is free from virus from the dangerous zone where the virus might exist, what we call the “Red Zone” and the “Green Zone,” and in the Red Zone we use PPE (personal protective equipment) fully while in the Green Zone we do not have to do anything. By distinctive separation like this, we protect ourselves from virus. This is an ironclad rule in our world.

3. Green Zone and Red Zone are Chaotically Mixed

However, inside the Diamond Princess, there is no Green Zone or Red Zone, it’s totally mixed and we cannot tell at all what is safe and what is not.

Since the virus is invisible, unless we do such a complete “classification” we can’t protect ourselves, however, the situation on the ship is that there’s no way we can tell which handrail, or which carpet has the virus, and people are randomly wearing PPE, or gloves, or masks, or not wearing those, with no set rules.

In the same way, some of the crews are wearing N95 masks and some are not, meanwhile, I have heard that people with fevers are leaving their rooms and going to the infirmary, just as an ordinary practice.

I have heard that DMAT staffers, then people from MHLW, and also quarantine officers have tested PCR positive, but (after I came to the ship) I thought that would have to be inevitable.

I was so surprised when I interviewed staffers that they said “We think we will be infected.” Because when we go on such a mission involving infectious disease measures, the first requirement is to protect ourselves, the medical workers, without fail. Encountering general persons, including patients, with no concern over the risk of getting infected ourselves is forbidden. That is a violation of the rules.

4. Prof. Iwata Isolated Himself

When I heard that JSIPC or FETP specialists entered the cruise ship and then left in a few days, I was wondering why, and some people on the cruise ship implied to me that “Perhaps they were afraid of getting infected themselves,” and now I totally get it.

Any infectious disease professional entering such an environment would definitely feel extremely afraid.

I also felt afraid.

At present I am staying in some place that I cannot identify exactly, but I personally think I must isolate myself and stop seeing patients or family members.
It would not be at all strange now for me to be infected with COVID-19 virus.
No matter how many PPE or gloves, etc. you use, unless a “safe zone and unsafe zone” are clearly separated, they will not be helpful at all.

We can only protect our safety when we observe the process of using PPE without fail only in the Red Zone and then taking it off safely.

When we cannot guarantee our safety, we cannot protect the safety of others.

5. Officials Won’t Listen

As they were sending test positives to Fujita Health University/Okazaki Medical Center, DMAT staffers were very busy today, and when I walked with the quarantine station staff, I sometimes passed by some patients.

Then the staffers laughed and said, “Oh, we have just passed patients by.”
In other words, even though they were doing extremely thoughtless things from the professional viewpoint, nobody considers about the risk of infection. When I asked, I found out that no infection control professionals are permanently stationed in the cruise ship.

Actually, there are some professionals who sometimes appear, and they also consider the situation as quite serious, but they are not asked to give advice, and even if they do officials won’t listen.
It is bureaucrats from MHLW who are in charge, and I myself talked to the responsible person of MHLW there, but he looked so disgusted and clearly showed he would not listen.

In other words, he acted like “who brought you here?” “why are you saying that to me?” and ignored me. He had an extremely cold attitude.

I asked DMAT persons if I could make some proposals at conference in the evening, and I got an answer of such being accepted, however, I had sudden phone call around 5 p.m., and told to leave, with my temporary permission and status as quarantine officer being canceled, so I was taken to the quarantine station and saw the person of MHLW who called me first. I was told “Why didn’t you work for DMAT under DMAT?” and “I told you not to be involved in infection control.”

I said, “DMAT staff is the one who asked me to perform infections control,” however, he said that there is somebody who is extremely mad about myself, and he cannot tell me who, but anyway that person is extremely mad about me so I have no way but leave.

I told him that without me, after I left there would be no infection control professionals, and also said test positives would increase and DMAT staffers might get infected as well if the situation remains as is.
I don’t have any intention of accusing DMAT staff at all. As they are not at all professional in terms of infection, I heard that when JSIPC people entered the cruise ship the DMAT staff was told so many things, and thus DMAT staff had bad experiences by infectious disease professionals

For that matter I feel sorry for them, however, I do not think they should be to blame at all.
This is just an issue of difference of specialized field.

Regardless, DMAT staffers are in fact facing a terrible risk.
They might get infected.

It is possible to prevent that, as there is definitely a method.

Nonetheless, the method is not provided to them, and they are putting themselves under the risk, and (if I leave ) they will be deprived of the chance to know about that.

6. Possibility of Further Infection Caused by Healthcare Employees

The healthcare employees working on the cruise ship will go back to their own hospitals where they work at. The infection could spread further from there.
This would be…horrifying needless to say, and would be considered much worse than how Africa or China(2003 SARS epidemic) would have handled the situation.

It was much better handled even in Sierra Leone(2014-2015 ebola outbreak).

Even though Japan doesn’t have CDC (Center for Disease Control), I never thought Japan would be so bad. I would have thought proper specialists would come in, take responsibility, take leadership, set proper rules to prevent infection. I thought this was all being done, but it was nowhere close to it. It was just horrific.

This is the English video I took. My English isn’t so great, but I just wanted to spread what is happening in Diamond Princess.

▼Youtube Video by English(deleted...)▼
(Transcript)

7. Doctor Who Blew the Whistle

My editing is bad so it may be hard to read. Come to think of it, it was also crazy when I was in Beijing during the 2003 SARS epidemic. The biggest struggle I had back then was that “the Chinese government did not release enough information”, so no one knew what exactly was happening. Being in Beijing that time was really scary.

Even then, the information coming in was organized and at least in terms of their strategy it was clear. The risk in which each one of us were in (though fatality rate of SARS being 10% was fearsome) was much better than the current COVID-19 case, well at least in the chaos happening in the Diamond Princess cruise ship.

Thinking back, when the COVID-19 began spreading in Wuhan, the doctor who blew the whistle was brave enough to mention the severity of the situation using social network.
▼Reference article▼
Li Wenliang: Coronavirus kills Chinese whistleblower doctor（BBC NEWS）

Reference article: Li Wenliang: Coronavirus kills Chinese whistleblower doctor

China would never have allowed such message to be spread in the past, but when you watch BBC news etc., the recent trend in the country is to promote “openness” and “transparency”.

Who knows how accurate this is, but they are starting to realize how important it is to publicize information when it comes to earning international trust.
China is doing its best to gain great world power, so they are making great effort to do so.
In contrast, Japan is not making it clear about what is happening on Diamond Princess.

8. Data Management

When determining whether or not a hospital infection has occurred, a statistical method called “epi-curve” is usually performed in which the onset (date and time) of fever is recorded and then a curve is made. I found out today that this data is not being kept at all.
This means that the state of infection is unknown even if you count the day when the PCR (Polymerase Chain Reaction) was performed.

I’ve actually mentioned this to the Ministry of Health few days ago. Now that I know the data is not being collected, we won’t know how much the infection is spreading…nor we won’t know what to do with no specialist in the field.

The situation is kind of a mess.

9. If No One is Doing It

The Japanese people or the world will continue to not know about this. Especially for the foreign passengers, they are forced to endure the risk of infection on a cruise ship with management worse than their home country.

This is indeed failure of Japan, but hiding the information will be worse.
Exposing Japan’s handling mess might be embarrassing, but covering it up is much more embarrassing. Releasing information much more crucial.

I’ve decided that if no one is releasing information, I would do it here.

I would like everyone to know this sad reality, in hopes that the passengers on Diamond Princess, DMAT, DPAT, and ministry officials, or quarantine workers can receive professional protection and work safely.

I really feel sorry for them.

I decided to make this video because I felt bad that I couldn’t do anything, and wanted to share the bigger problem we still need to face.

This was Kentaro Iwata.

▼END▼

▼Thanks for Helpful Translators▼
akiko(@koriari / chapter1-4)
Tewatashi Books(@tewatashibooks / chapter4)
Hiro(chapter 5-9)

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