An American woman who disembarked from a cruise ship in Cambodia last week has twice tested positive for the coronavirus since flying on to Malaysia, officials in that country said on Sunday.
Officials also said that more than 140 other passengers from the ship, the Westerdam — which Cambodia allowed to dock after several other countries turned it away over concerns about the coronavirus — had flown from Cambodia to the airport in Kuala Lumpur, Malaysia’s capital. All but eight were allowed to continue to their destinations, including airports in the United States, the Netherlands and Australia.
Six of the passengers were in Malaysia under surveillance awaiting results of coronavirus tests, officials said.
Eyal Leshem, the director of the Center for Travel Medicine and Tropical Diseases at the Sheba Medical Center in Israel, called the disclosures “extremely concerning” and said the passengers’ travel onward from Kuala Lumpur substantially increased the risk of a global pandemic. “We may end up with three or four countries with sustained transmission of the virus,” he said.
“It may be more and more difficult to make sure this outbreak is contained only within China,” Dr. Leshem said.
Malaysia’s deputy prime minister, Wan Azizah Wan Ismail, announced at a news conference Sunday afternoon that the American woman, 83, had tested positive a second time.
Updated Feb. 10, 2020
What is a Coronavirus?
It is a novel virus named for the crown-like spikes that protrude from its surface. The coronavirus can infect both animals and people, and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
How contagious is the virus?
According to preliminary research, it seems moderately infectious, similar to SARS, and is possibly transmitted through the air. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
How worried should I be?
While the virus is a serious public health concern, the risk to most people outside China remains very low, and seasonal flu is a more immediate threat.
Who is working to contain the virus?
World Health Organization officials have praised China’s aggressive response to the virus by closing transportation, schools and markets. This week, a team of experts from the W.H.O. arrived in Beijing to offer assistance.
What if I’m traveling?
The United States and Australia are temporarily denying entry to noncitizens who recently traveled to China and several airlines have canceled flights.
How do I keep myself and others safe?
Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
The woman and her husband, 85, were both hospitalized and in isolation. The husband has also been tested twice for the virus, and the results were negative both times. But he is suffering from pneumonia, which is often a sign of the virus before it can be identified through testing.
The Westerdam, a Holland America Line ship, departed from Hong Kong on Feb. 1, carrying 1,455 passengers and 802 crew members. It was at sea for just under 14 days, the time frame that is believed to be the maximum incubation period for the highly transmissible coronavirus.
Japan, the Philippines, Taiwan, Thailand and the United States territory of Guam all refused to let the ship dock amid the global concern over the coronavirus, though Holland America insisted that no one on the ship was infected. Cambodia finally agreed to let the ship dock on Thursday.
The American woman and her husband, also a United States citizen, were among 145 passengers from the ship who flew from Cambodia to Malaysia. All went through thermal scanning at the Kuala Lumpur airport, and 137 were allowed to fly on to other destinations, officials said. But the American couple and six other passengers were stopped and tested for the virus.
After the American woman initially tested positive, both Holland America and Cambodia questioned the result, calling for further testing and confirmation. Malaysia carried out a second round of testing, which officials said Sunday had confirmed that the woman was infected.
The six other passengers who underwent testing were awaiting results and were under surveillance, but were not quarantined, a Malaysian health official said.
Ms. Wan Azizah said that the country would not accept any more passengers from the Westerdam, which is still docked in Sihanoukville, Cambodia. By late Saturday, 236 passengers and 747 crew members were still on the ship, Holland America said. An unknown number were in Phnom Penh, the Cambodian capital.
“If there’s one passenger who is confirmed, the others are potentially in trouble,” said David Hui, director of the emerging infections disease center at the Chinese University of Hong Kong. He recommended that the other passengers be quarantined in their home countries for 14 days.
Cambodia’s prime minister, Hun Sen — who has argued that fears about the virus are overblown, at one point refusing to evacuate Cambodian students from Wuhan, the Chinese city where the coronavirus emerged — personally greeted many of the Westerdam passengers with flowers when they disembarked on Thursday. The United States ambassador, Patrick Murphy, was also on hand to welcome them. President Trump tweeted his thanks to Cambodia for allowing the ship, more than 600 of whose passengers were Americans, to dock.
Many of the passengers went sightseeing in Sihanoukville after they docked, visiting beaches and restaurants and getting massages. On Sunday, after Malaysia’s announcement, the remaining passengers and crew members were restricted to the ship, and buses that had been scheduled to transport them were parked nearby.
Attempts to contact Cambodian officials and Holland America for comment were not immediately successful.
The Cambodian government had said earlier that passengers and crew members were screened using World Health Organization and Centers for Disease Control protocols before being allowed to disembark. Their temperatures were checked, and about 20 people who had reported being sick during the trip were tested for the coronavirus, according to a statement issued Sunday by the United States Embassy in Cambodia. All of them tested negative.
It was unclear if the woman and her husband, both United States citizens, were among the 20 who were tested at that point.
Christina Kerby, 41, a communications director with BlueShield in California, said she was among a group of passengers who had nasal and throat swabs taken in Phnom Penh, Cambodia’s capital, on Sunday. Ms. Kerby was supposed to fly to Singapore on Sunday and then back to San Francisco.
“The stress has absolutely taken its toll,” Ms. Kerby said by telephone. “I certainly don’t feel like myself after the roller coaster that we’ve been through.”
Ms. Kerby said her temperature was taken two or three times during her time on the ship, and that passengers were required to fill out health questionnaires detailing whether they had symptoms such as cough, fever, and diarrhea.
“I can’t really comment on how this was missed, but I did feel very safe and well cared for on the ship,” she said, adding that she believed Holland America “was operating appropriately given the situation.”
Ms. Kerby said she had discussed the risk of going on the cruise with her family. She boarded the ship in Hong Kong and traveled with her 75-year-old mother and her brother.
“We made the decision that it’s not worth passing up the potential to have a lot of fun and see the world just out of fear,” she said. “That’s why I joined, and I think the other passengers have the same feeling.”
Sun Narin contributed reporting.