Tag Archives: COVID-19

WHO vaccine scheme risks failure, leaving poor countries no COVID shots until 2024

By Francesco Guarascio

BRUSSELS (Reuters) – The global scheme to deliver COVID-19 vaccines to poorer countries faces a “very high” risk of failure, potentially leaving nations home to billions of people with no access to vaccines until as late as 2024, internal documents say.

The World Health Organization’s COVAX program is the main global scheme to vaccinate people in poor and middle income countries around the world against the coronavirus. It aims to deliver at least 2 billion vaccine doses by the end of 2021 to cover 20% of the most vulnerable people in 91 poor and middle-income countries, mostly in Africa, Asia and Latin America.

But in internal documents reviewed by Reuters, the scheme’s promoters say the program is struggling from a lack of funds, supply risks and complex contractual arrangements which could make it impossible to achieve its goals.

“The risk of a failure to establish a successful COVAX Facility is very high,” says an internal report to the board of Gavi, an alliance of governments, drug companies, charities and international organizations that arranges global vaccination campaigns. Gavi co-leads COVAX alongside the WHO.

The report and other documents prepared by Gavi are being discussed at Gavi’s board meetings on Dec. 15-17.

The failure of the facility could leave people in poor nations without any access to COVID-19 vaccines until 2024, one of the documents says.

The risk of failure is higher because the scheme was set up so quickly, operating in “uncharted territory”, the report says.

“Current risk exposure is deemed outside of risk appetite until there is full clarity on the size of risks and possibilities to mitigate them,” it says. “It therefore requires intensive mitigation efforts to bring the risk within risk appetite.”

Gavi hired Citigroup last month to provide advice on how to mitigate financial risks.

In one Nov. 25 memo included in the documents submitted to the Gavi board, Citi advisors said the biggest risk to the program was from clauses in supply contracts that allow countries not to buy vaccines booked through COVAX.

A potential mismatch between vaccine supply and demand “is not a commercial risk efficiently mitigated by the market or the MDBs,” the Citi advisors wrote, referring to multilateral development banks such as the World Bank.

“Therefore it must either be mitigated through contract negotiation or through a Gavi risk absorption layer that is carefully managed by a management and governance structure.”

Asked about the documents, a Gavi spokesman said the body remains confident it can achieve its goals.

“It would be irresponsible not to assess the risks inherent to such a massive and complex undertaking, and to build policies and instruments to mitigate those risks,” he added.

The WHO did not respond to a request for comment. In the past it has let Gavi take the lead in public comments about the COVAX program.

Citibank said in a statement: “As a financial advisor, we are responsible for helping Gavi plan for a range of scenarios related to the COVAX facility and supporting their efforts to mitigate potential risks.”

SUPPLY DEALS

COVAX’s plans rely on cheaper vaccines that have so far yet to receive approval, rather than vaccines from frontrunners Pfizer/BioNTech and Moderna that use more expensive new mRNA technology. The Pfizer vaccine has already been approved for emergency use in several countries and deployed in Britain and the United States, and the Moderna vaccine is expected to be similarly approved soon.

COVAX has so far reached non-binding supply agreements with AstraZeneca, Novavax and Sanofi for a total of 400 million doses, with options to order several hundred million additional shots, one of the Gavi documents says.

But the three companies have all faced delays in their trials that could push back some possible regulatory approvals to the second half of 2021 or later.

This could also increase COVAX’s financial needs. Its financial assumptions are based on an average cost of $5.20 per dose, one of the documents says.

Pfizer’s vaccines costs about $18.40-$19.50 per dose, while Moderna’s costs $25-$37. COVAX has no supply deals with either of those firms. Nor is it prioritizing investment in ultra-cold distribution chains in poor countries, necessary for the Pfizer vaccine, as it still expects to use mostly shots which require more conventional cold storage, one of the Gavi documents says.

On Tuesday a WHO senior official said the agency was in talks with Pfizer and Moderna to include their COVID-19 vaccines as part of an early global rollout at a cost for poor countries possibly lower than current market prices.

Other shots are being developed worldwide and COVAX wants to expand its portfolio to include vaccines from other companies.

Rich countries, which have booked most of the currently available stocks of COVID-19 vaccines, are also planning to donate some excess doses to poor countries, although is not clear whether that would be through COVAX.

FINANCIAL PRESSURE

To meet its target of vaccinating at least 20% of people in poor countries next year, COVAX says it needs $4.9 billion in addition to $2.1 billion it has already raised.

If vaccine prices are higher than forecast, supply is delayed or the additional funds are not fully collected, the facility faces the prospect of failure, the documents say.

So far Britain and European Union countries are the main donors to COVAX, while the United States and China have made no financial commitments. The World Bank and other multilateral financial institutions are offering cheap loans to poor countries to help them buy and deploy vaccines through COVAX.

The facility is issuing vaccine bonds which could raise as much as $1.5 billion next year if donors agreed to cover the costs, one of the Gavi documents says. COVAX is also receiving funds from private donors, mainly the Bill and Melinda Gates Foundation.

But even under the best financial conditions, COVAX could still face failure, because of disproportionate financial risks caused by its complex deal-making process.

COVAX signs advance purchase contracts with companies on vaccine supplies that need to be paid for by donors or receiving countries that have the means to afford them.

But under clauses included in COVAX contracts, countries could still refuse to buy pre-ordered volumes if they prefer other vaccines, or if they manage to acquire them through other schemes, either faster or at better prices.

The facility could also face losses if countries were not able to pay for their orders, or even if herd immunity were developed too quickly, making vaccines no longer necessary, the Citigroup report said. It proposed a strategy to mitigate these risks including through changes in supply contracts.

(Reporting by Francesco Guarascio @fraguarascio; Editing by Peter Graff)

Daily U.S. COVID-19 deaths again top 3,000 as officials scurry to distribute vaccine

(Reuters) – Daily U.S. deaths from COVID-19 surpassed 3,000 for the third time in a week as the country expanded its vaccination program and the U.S. Congress progressed toward approving financial relief for the pandemic-stricken country.

The death toll of 3,102 on Tuesday, the third highest total since the pandemic began, increased the cumulative number of U.S. fatalities to 304,187, according to a Reuters tally. The case load of 16.7 million infections represented roughly 5% of the U.S. population.

Inoculations of the newly approved COVID-19 vaccine entered their third day on Wednesday, set aside for doctors, nurses and other frontline medical workers, along with residents and staff of nursing homes.

The vaccine, developed by Pfizer Inc and German partner BioNTech SE, won emergency-use authorization last Friday. A second vaccine from Moderna Inc could get emergency-use approval this week.

U.S. officials aim to get 2.9 million doses delivered by week’s end, but it will take several months before vaccines can be obtained on demand by the public at large.

Political leaders and medical authorities have launched a two-pronged media blitz avowing the safety of the vaccines while urging Americans to remain diligent about social distancing and mask-wearing until inoculations become widely available.

Experts fear deaths and cases could further soar if people reject their advice to cancel year-end holiday gatherings. A significant portion of the American public has already shown disdain for basic public health guidance, and only 61% of respondents in a recent Reuters/Ipsos poll said they were open to getting vaccinated.

The virus has spread so fast that many California hospitals have run out of space in their intensive care units.

The state has ordered scores of refrigerator storage trailers for corpses and distributed 5,000 body bags to San Diego, Los Angeles and Inyo counties, Governor Gavin Newsom said.

The pandemic has also put millions of people out of work as states and localities imposed sweeping stay-at-home orders and closed businesses to control the spread.

Congress has failed to pass new coronavirus aid since April, but congressional leaders on Tuesday reported substantial progress toward a coronavirus deal and a bill to avert a government shutdown.

(Reporting by Reuters staff; Editing by Steve Orlofsky)

Immune system can cause broad damage in COVID-19; dogs can detect coronavirus in people

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Immune system can self-attack broadly in COVID-19

Antibodies are supposed to attack invading germs, but severely ill COVID-19 patients have so-called autoantibodies that mistakenly attack not just their own tissues and organs but even virus-fighting proteins produced by the immune system, new research shows. Scientists studied 194 COVID-19 patients, including 55 with severe disease, plus a control group of 30 people without the virus. In the sickest patients, they found a high frequency of autoantibodies created by the immune system causing injury to the central nervous system, blood vessels, and connective tissues like cartilage, ligaments and tendons. They also found a high prevalence of autoantibodies that interfere with substances involved in the functioning of the immune system itself, including cytokines and other “immunomodulatory” proteins. “The surprising extent of autoantibody reactivities” in these patients indicates that these mistakenly targeted antibodies are “an intrinsic aspect” of COVID-19. The report was posted on medRxiv on Saturday ahead of peer review.

Dogs can sniff out COVID-19

Trained dogs can identify people with COVID-19, even those with no symptoms, according to researchers. In the preliminary study published on Thursday in PLoS One, dogs who sniffed swab samples of armpit sweat could tell which samples came from COVID-19 patients and which were from people who tested negative for the new coronavirus. That study was conducted in March. More recently, the researchers have validated the findings in additional trials, said study leader Dominique Grandjean of Alfort Veterinary School in France. Dogs can identify infected individuals with 85% to 100% accuracy and rule out infection with 92% to 99% accuracy, Grandjean said. “It takes one tenth of a second for a trained dog to say ‘yes’ or ‘no’,” he said. Training requires 3 to 8 weeks depending on whether the dog is already trained for odor detection. COVID-19-detecting dogs have already been deployed in airports in the United Arab Emirates, Grandjean said. On Wednesday, the UAE and the International K9 Working Group Against COVID-19 will host a virtual workshop on the use of these trained dogs, with 25 countries expected to participate, according to the organizers.

COVID-19 not linked with Guillain-Barré syndrome

COVID-19 is not associated with the potentially paralyzing disorder Guillain-Barré syndrome (GBS), a large UK study shows. In GBS, the immune system mistakenly attacks nerves in the feet, hands and limbs. Smaller studies have suggested a link between COVID-19 and GBS. But when researchers compared the number of GBS cases recorded in the UK’s National Health Service database in 2016 to 2019 to the number recorded in the first half of 2020, they found the annual incidence was 40% to 50% lower during the pandemic. “No causal link of COVID-19 to GBS can be made,” Stephen Keddie of University College London said in a statement. His team reported on Monday in the journal Brain that they also looked for – but could not find – any genetic or protein structure in the new coronavirus that might trigger an immune response causing GBS, which is good news for vaccine development. “Most COVID-19 vaccinations are based on the (coronavirus’) spike protein, which drives a complex immune response creating antibodies to fight infection,” Keddie said. Since researchers found nothing in the virus that is known to drive GBS, “concerns that COVID vaccination might cause GBS in any significant numbers are therefore almost certainly unfounded,” he said.

Antibiotic azithromycin fails to help in severe COVID-19

The antibiotic azithromycin failed to help seriously ill adults infected with the new coronavirus, according to results from a clinical trial. Based on the result, the only COVID-19 patients who should get the antibiotic are those who also have bacterial infections, the study leaders said. The trial, conducted at 176 hospitals across the UK, involved more than 9,000 patients and tested multiple drugs to see if any would be more effective than standard hospital care in treating COVID-19. According to preliminary data published on Monday on medRxiv ahead of peer review, patients who were randomly assigned to receive azithromycin did no better than patients who got standard care in terms of deaths, duration of hospitalization, or need for mechanical ventilation. “More than 75% of hospitalized COVID-19 patients are prescribed antibiotics,” the researchers point out. “Although we detected no harm to individual patients treated with azithromycin, there is a risk of harm at a societal level from widespread use of antimicrobial agents,” researchers said. The widespread use of antibiotics in COVID-19 patients “in general must be questioned,” they concluded.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

U.S. crosses 300,000 COVID-19 deaths as vaccine rollout begins

By Anurag Maan

(Reuters) – The number of coronavirus deaths in the United States crossed 300,000 on Monday, according to Reuters tally, as the hardest hit nation rolled out its first vaccine inoculations on Monday.

The staggering death toll comes as the nation begins a historic inoculation campaign using a vaccine developed by Pfizer Inc and BioNTech SE. Moderna Inc’s vaccine could get approval as soon as this week.

The vaccine comes as COVID-19 cases explode across the nation and hospital intensive care units run out of beds. Daily coronavirus cases and deaths have set records multiple times since Thanksgiving holidays with daily fatalities topping 3,000 for the second time last week on Friday, the same day the vaccine got approval from the Food and Drug Administration.

It took 27 days to go from 250,000 total U.S. COVID-19 deaths to 300,000 – the fastest 50,000-death jump since the pandemic began. Some models project that deaths could reach 500,000 before vaccines become widely available in the spring and summer.

In recent weeks, South Dakota and North Dakota have led the nation in deaths per capita. Overall, New Jersey and New York, early epicenter of the U.S. outbreak, lead the nation in per capita deaths.

The United States recently crossed 16 million confirmed cases – the most in the world.

According to Reuters analysis, the United States is reporting 91 deaths per 100,000 people, seventh worst in the world on a per capita basis and 2.5 times the rate in Canada.

The nation’s hospitals are flooding with COVID-19 patients, threatening to overwhelm healthcare systems and providers. There are over 108,000 hospitalized COVID-19 patients, the highest since the first coronavirus case was detected in the country in January.

(Reporting by Anurag Maan in Bengaluru and Lisa Shumaker in Chicago; Editing by Bill Berkrot)

Drug combination improves COVID-19 pneumonia outcomes; five genes linked to severe disease

By Nancy Lapid

(Reuters) -The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Two-drug combo improves COVID-19 pneumonia outcomes

For hospitalized COVID-19 patients with pneumonia, treatment with Gildead Sciences Inc’s antiviral remdesivir and the Eli Lilly and Co arthritis drug baricitinib was more effective than remdesivir alone, according to a clinical trial published on Friday in The New England Journal of Medicine. Overall, the 515 patients who received baricitinib – sold under the brand name Olumiant – along with remdesivir recovered in an average of seven days, compared to eight days for the 518 who got remdesivir alone. People treated with both drugs also had fewer serious adverse events, plus 30% higher odds of showing improved health status after two weeks. They also had a lower risk of death within four weeks of starting treatment – 5.1% versus 7.8% with just remdesivir. The effect was most pronounced among patients who needed high amounts of extra oxygen but were not sick enough to require ventilators to breathe for them. In this group, the average time to recovery was 10 days with the two-drug treatment compared to 18 days with remdesivir alone. The study authors note that baricitinib, a pill, is a generally safe drug that does not interact with other medications.

Five genes linked with severe COVID-19

Scientists have linked the most severe form of COVID-19 with five genes that affect lung inflammation and the body’s ability to fight off viruses. Their findings, from a study of 2,700 COVID-19 patients in intensive care units across Britain, point to several existing drugs that could be repurposed to treat people who risk becoming critically ill. The genes – called IFNAR2, TYK2, OAS1, DPP9 and CCR2 – partially explain why some people become desperately sick with COVID-19, while others are not affected, said Kenneth Baillie of Edinburgh University, coauthor of the study published on Friday in Nature. The new information should help scientists design clinical trials of medicines that target specific antiviral and anti-inflammatory pathways. Among those with the most potential, Baillie said, should be a class of anti-inflammatory drugs called JAK inhibitors, including Eli Lilly’s arthritis drug baricitinib, which has been found to help hospitalized pneumonia patients in combination with Gilead’s remdesivir.

Online tool estimates COVID-19 mortality risk

A new online tool helps to estimate individuals’ risk of dying from COVID-19 depending on where they live in the United States, which could provide useful information on which individuals should be prioritized for early vaccinations. The calculator, developed by Johns Hopkins University researchers, incorporates a variety of factors, including age, race/ethnicity, socioeconomic conditions, underlying medical conditions such as obesity, diabetes or cancer, and local pandemic intensity to produce estimates of adults’ COVID-19 mortality risk. Currently, it does not incorporate information on occupation, such as whether individuals are frontline workers, which may increase risk, said Nilanjan Chatterjee, whose team developed the calculator. The researchers reported on Friday in Nature Medicine that they found large variations in risk across U.S. cities and counties. “This information may be helpful for local policy makers to understand the need for vaccine allocations for local communities,” Chatterjee said.

(Reporting by Nancy Lapid and Kate Kelland; Editing by Bill Berkrot)

Cuomo orders New York City restaurants to suspend indoor dining, effective Monday

(Reuters) – Indoor dining in New York City will come to a halt on Monday, Governor Andrew Cuomo said, as COVID-19 hospitalizations fail to stabilize and the infection rate rises.

The governor acknowledged indoor dining is not at the top of a list of settings driving the rise in new cases led by household gatherings, but said rising hospitalizations and New York City’s high density were worrying factors.

“You put the CDC caution on indoor dining together with the rate of transmission and the density and the crowding, that is a bad situation,” Cuomo told a news briefing on Friday.

Separately, Cuomo announced that a state review panel unanimously approved the recommendation by an FDA advisory panel to approve Pfizer’s COVID-19 vaccine, and said an additional 346,000 doses of a vaccine manufactured by Moderna are expected in New York the week of Dec. 21. A first shipment of 170,000 doses of the Pfizer vaccine could arrive in the state as soon as this weekend, Cuomo said.

(Reporting by Peter Szekely and Maria Caspani, Editing by Franklin Paul)

‘The country needs me:’ cleaner in Chicago’s COVID wards proud to fight pandemic

By Shannon Stapleton and Ana Isabel Martinez

CHICAGO (Reuters) – When hospital cleaner Evelia De La Cruz was assigned to the COVID-19 ward in March, she was afraid.

A 60-year-old immigrant from the southern coast of Mexico, De La Cruz was tasked with stripping sheets and sanitizing beds as first a handful, and then a deluge, of coronavirus patients brought infection to her Chicago hospital.

“I prayed for God to give me the courage,” she said.

Some of De La Cruz’s colleagues refused to work the COVID-19 wards, she said, leaving the hospital understaffed. She has been laboring seven days a week, at times for weeks on end.

“Every day I went to work, even on my days off, because I know that the patients need me, the hospital and the country needs me,” she said.

Throughout the northern hemisphere spring, as the coronavirus ravaged through international cities, residents of Rome, Madrid, New York City and beyond took to their balconies to applaud frontline medical workers who, often overlooked in non-pandemic years, had become symbols of sacrifice in terrifying times.

Ten months and over a million and a half global deaths later, nurses and doctors continue to risk their lives every day as they report to the hospitals.

Yet, their ability to work has relied on a less visible category of frontline staff: cleaners and janitors like De La Cruz.

These workers also risk infection and death but receive far fewer accolades.

In the United States, many are immigrants from Latin America, a population already hard-hit by the pandemic.

Since the outbreak began, the only time De La Cruz took more than the occasional day off was in July, when she herself was infected with the virus.

After a month-long recovery, she returned to disinfecting the coronavirus-contaminated areas of the hospital.

She keeps a vase filled with fresh flowers in her home, where she prays for the health of her family and for an end to the pandemic.

“I’m proud to serve the sick and this country,” said De La Cruz, who has lived in the United States for three decades.

Her neighbors sometimes stop to thank her, she said.

“‘You’re so brave,’ they tell me,” she said.

(Reporting by Ana Isabel Martinez in Mexico City and Shannon Stapleton in Chicago, writing by Laura Gottesdiener, Editing by Rosalba O’Brien)

One year on, Wuhan market at epicentre of virus outbreak remains barricaded and empty

By Cate Cadell

WUHAN, China (Reuters) – For over six years, 38-year-old Wuhan restaurant owner Lai Yun started most days the same way – with a trip to the Huanan Seafood Wholesale Market, just ten minutes walk from his house.

“I’d send the kids to school, have breakfast and then walk over to the market. It was very convenient,” he said.

That changed on Dec. 31, 2019, after four cases of a mystery pneumonia were linked to the market and it was shuttered overnight. By the end of the month, the city had begun a grueling 76-day lockdown that came with just hours notice and barred people from leaving their homes.

Almost a year since the outbreak began, COVID-19 has claimed more than 1.5 million lives, and the Wuhan wet market where it was initially detected stands empty even as the city around it has come back to life.

It’s become a symbol of the fierce political and scientific battle raging around the origin of the virus with Beijing continuing to spar with the United States and other countries, accusing them of bias.

A team of World Health Organization experts has yet to visit Wuhan, let alone the market. Health authorities in China and abroad have warned that origin tracing efforts could take years and yield inconclusive results.

In Wuhan, where the stigma of being the first coronavirus epicenter hangs heavy, over a dozen residents and business owners told Reuters they don’t believe the virus began in the city.

“It certainly couldn’t have been Wuhan… surely another person brought it in. Or surely it came from some other product brought from outside. There were just certain conditions for it to appear here,” said a wet market vendor in the city’s center who gave his name as Chen.

In recent months, Chinese diplomats and state media have said they believe the market is not the origin but the victim of the disease, and have thrown support behind theories that the virus potentially originated in another country.

RESTRICTED ACCESS

Experts say the market still plays a role in the investigation and is therefore unlikely to be demolished, though much of that research will rely on samples taken immediately after the outbreak began.

“The first cluster of cases was there, so at least it would be of interest to find out the origin of those and put forward a few hypotheses, like whether it’s more likely from the wild animals or perhaps points to a human super-spreader,” said Jin Dong-Yan, professor of virology at the University of Hong Kong.

Access to the area remains heavily restricted. People who visited before the lockdown remember a bustling building with hundreds of stalls divided into sections for red meat, seafood and vegetables.

Recently, the local government has added leafy green plants and traditional Chinese paintings to the semi-permanent blue barricades encircling the area. Inside, wooden boards line the stalls and windows.

On the second floor above the empty market, shops selling glasses and optometry equipment reopened in June.

This week, a guard at the entrance to the eyewear market took temperatures and warned journalists not to take videos or photos from inside the building.

“Maybe some people have some bad feelings about it, but now it’s just an empty building … who feels anxious about an empty building?” said a shop assistant selling contact lenses, who declined to be named because of the sensitivity of the subject.

While Wuhan hasn’t reported any new locally transmitted cases of COVID-19 since May, for some who relied on the market making ends meet is still a struggle.

Lai, who reopened his Japanese restaurant in June, says the market’s closure and subsequent public panic about the safety of imported seafood has increased the cost of procuring some ingredients five-fold.

“Our goal for the next year is to just survive.”

(Reporting by Cate Cadell; Editing by Edwina Gibbs)

Coronavirus scare on Singapore cruise ship was false alarm, authorities say

By John Geddie and Chen Lin

SINGAPORE (Reuters) – A suspected COVID-19 case aboard a “cruise-to-nowhere” from Singapore which forced the ship to return to dock and nearly 1,700 guests to isolate was a false alarm, the government said on Thursday.

Passengers on Royal Caribbean’s Quantum of the Seas vessel were held in their cabins for more than 16 hours on Wednesday after an 83-year-old man was tested positive for COVID-19 aboard the ship when he sought medical help for diarrhea.

But Singapore’s health ministry said on Thursday the man did not have the virus after three subsequent tests on land came back negative.

While authorities praised the response to the incident, tourism experts said it highlighted testing frailties and the burden that puts on businesses trying to resume operations even in a country that has largely tamed the virus.

“We have to live with less-than-perfect testing kits,” said Michael Chiam, a senior tourism lecturer at Singapore’s Ngee Ann Polytechnic. “This may be costly to businesses.”

The health ministry said close contacts of the guest to would no longer need to quarantine and that it would help review testing processes aboard the ship.

Miami-based Royal Caribbean, which had just started offering the trips after it halted global operations in March due to the pandemic, said in a statement it welcomed the news and that it would work to “refine” its protocols.

The cruises-to-nowhere were part of Singapore’s efforts to revive a tourism industry which has been battered by the pandemic as borders around the world have closed.

Singapore’s tourism board chief Keith Tan said the cruise incident was a learning experience but also a validation of precautions like pre-departure testing and requirements that guests carry an electronic contact tracing device at all times.

The mishap will be closely watched by other firms relying on testing like event venues and airlines, said Sherri Kimes of the National University of Singapore’s Business School.

The city-state, which has reported only a handful of cases in recent weeks, is rolling out rapid antigen tests for large events such as weddings and business conferences.

(Editing by Angus MacSwan)

Cabin fever: Singapore cruise passengers stuck in rooms after COVID-19 case

By Chen Lin and Yi Shu Ng

SINGAPORE (Reuters) – A Royal Caribbean “cruise-to-nowhere” from Singapore confined nearly 1,700 passengers to their cabins in port for more than 16 hours after a COVID-19 case was detected on board, before allowing some to disembark on Wednesday.

All passengers aboard the Quantum of the Seas vessel had cleared a mandatory polymerase chain reaction (PCR) test for the virus up to three days before the four-day cruise began on Monday.

Authorities said close contacts of the COVID-19 patient among the 1,680 guests and 1,148 crew members on board had so far tested negative. The passengers were stuck in their rooms while contact tracing was being conducted.

“I feel relieved, it was obviously a very boring wait,” said Isaac Lung, a 16-year-old student, who had taken the cruise with his parents.

The coronavirus patient, an 83-year-old male, had reported to the ship’s medical center with diarrhea and a subsequent onboard test revealed the infection. He was taken to hospital on Wednesday after the ship returned to port.

Other guests were awoken with the news of the infection in the early hours.

“I was like: ‘there it goes, the worst fear has happened’,” said passenger Melvin Chew, a 31-year-old business development manager, who said he learned about the infected guest via an announcement on the ship’s tannoy around 3 a.m. (1900 GMT on Tuesday).

The Quantum of the Seas returned to Singapore at 8 a.m. local time, and a Reuters witness saw some passengers disembarking at about 8 p.m. All passengers will undergo mandatory COVID-19 testing before leaving the terminal.

The ship’s captain told passengers over the tannoy that the passenger disembarkation process would start around 7:30 p.m. and would take 3-4 hours. The crew will rest overnight and take PCR tests in the morning, he added.

“I am terribly sorry that the cruise ended a day early and ended this way,” the captain said in a recording heard by Reuters.

Royal Caribbean said in an emailed statement it was cancelling its upcoming trip on Thursday “in an overabundance of caution” and plans to resume sailing on Dec. 14.

‘REALITY CHECK’

The “cruise-to-nowhere” by Royal Caribbean is one of its first sailings since the company halted global operations in March due to the COVID-19 pandemic.

The sailing in waters off Singapore is open only to Singapore residents and makes no stops.

The cruises are a part of Singapore’s plans to revive its tourism industry, which has been battered due to the novel coronavirus, which has infected more than 68 million people globally and killed 1,554,271​.

Singapore, which has reported just over 58,000 COVID-19 cases and 29 deaths, has been registering less than a handful of daily infections in recent weeks.

Part of the precautions for the resumption of cruises in Singapore involved pre-departure testing within 48 to 72 hours prior to boarding, and for guests to carry an electronic contact tracing device, wear masks and social distance at all times.

Infectious disease experts said there could be many reasons why the patient got through pre-departure screenings.

They said the PCR test may have been a false negative or failed to pick up fragments of an old virus, or the patient may have been incubating at the time or was infected between the test and boarding.

“It is a reality check that the current tests are not perfect,” said Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection.

The infected case’s close contacts will be placed in quarantine or health surveillance, Singapore’s health ministry said in an advisory sent to passengers.

Others will need to monitor their health, while continuing regular activities including going to school or work, and undergo a swab test at the end of a 14-day monitoring period.

(Reporting by Chen Lin, Yi Shu Ng, Aradhana Aravindan, John Geddie and Nivedita Balu; Writing by John Geddie and Aradhana Aravindan; Editing by Michael Perry, Raju Gopalakrishnan, Mark Heinrich and Shounak Dasgupta)