Chinese health officials said the death toll from COVID-19 rose by nearly 100 over Monday as governments rushed to evacuate citizens from a cruise ship off Japan's eastern coast that's home to the world's second-largest and still growing cluster of patients.
Chinese health officials increased China's total death toll on Tuesday to 1,868, including 98 new deaths, which is a drop from the 105 deaths tabulated over the day prior.
The total number of cases reached 72,436.
Outside mainland China, five people have died, including a Taiwanese man, despite having no history of travel to the mainland.
Japanese health officials late Monday reported 99 new confirmed cases among passengers of the Diamond Princess cruise ship, which has been under quarantine in Yokohama Port, near the capital Tokyo, since Feb. 3 with 2,666 passengers and 1,045 crew. The total number of infected from the ship is 454. Outside China, the next highest number of cases is 77 in Singapore.
The increased tally of infected came after the landing of two U.S. chartered planes with 328 American evacuees from the cruise ship back in the United States where they will be subjected to a second 14-day quarantine.
Among the passengers were 14 who tested positive for COVID-19, nearly doubling the number of confirmed cases in the United States to 29.
On Saturday, the U.S. Embassy in Tokyo informed American Diamond Princess passengers in a letter that none who tested positive for the coronavirus would be allowed to board.
However, the State Department said in a statement that it made the call to return the infected passengers, who were moved to a "specialized containment area" of the aircraft, following consultations with health officials.
"All passengers are being closely monitored by medical professionals throughout the flight, and any who become symptomatic will be moved to the specialized containment area, where they will be treated," the department said in a statement.
Officials told reporters in a special briefing about the repatriation Monday the test results confirming the 14 infections came back only after the American citizens were taken off the cruise ship and loaded onto buses to be moved on to the aircraft.
"It was only once they were loaded onto the buses, and the buses were in motion that we were made aware that these positive results had come back from the government of Japan," said Dr. William Walters, executive director and managing director for operational medicine for the Bureau of Medical Serves at the State Department.
The COVID-19 patients were then placed in the final 18 seats in the tail of the plane that had cordoned off with plastic sheets to create an isolation area, Walters said.
The officials decided to stick with the plan, he said.
"The question was simply this: Are these evacuees?" he said, referring to the 14 passengers contaminated with the virus. "And do we follow our protocol? And the answer to that was yes on both accounts."
One flight landed late Sunday at California's Travis Air Force Base, deplaning 177 people, seven of whom had been confirmed positive for the coronavirus and three others who were isolated during the flight with an elevated fever.
The other flight landed early Monday at Lackland Air Force Base in Texas, where 151 passengers deplaned, including seven confirmed cases who were insolation during the fight. Two other passengers were also isolated due to fevers detected while in the air, the officials said.
Thirteen passengers sicken with the virus were transported to Omaha, Neb., where they will be quarantined at the University of Nebraska Medical Center and further monitored and receive treatment.
"Those who have tested positive for this novel coronavirus, are only showing mild symptoms of the disease," the university said in a statement.
Those transferred to Omaha as "high-risk patients," Walters said.
The evacuation aircraft were to return to Atlanta where they had departed from for decontamination, he said.
Those who deplaned at the airbases have been processed and put into quarantine, said Dr. Robert Kadlex, assistant secretary for preparedness and response at the State Department.
"These individuals will spend the next 14 days under the joint supervision and oversight of CDC and ASPR to monitor their health, and at which point in time, after 14 days, they'll be cleared to return to their home of record," he said.
Sixty-one Americans still remain on the ship in Japan, a number that does not include the 44 who were removed to local hospitals in the Asian nation after tests proved they were positive for the disease.
Walters said they're also tracking more than 300 American citizens who remain in Cambodia where a second cruise ship has been moored since Thursday after an 83-year-old American passenger who disembarked from the ship was confirmed sickened with the disease in Malaysia.
A total of 92 American passengers remain on board the ship, Walters said with another 260 at hotels in Phone Penh.
On Monday, cruise ship operator Holland America Line said the Cambodian Health Ministry was on board testing for COVID-19.
"We anticipate this will take several days and greatly appreciate the thoroughness of all authorities involved in resolving this situation," the cruise liner said in an update.
Meanwhile, Australian Prime Minister Scott Morrison announced Monday more than 200 Australians on the ship will be evacuated on Wednesday. On return to Australia, they will be subjected to another 14-day quarantine due to the virus' spread upon the ship despite it being under a nearly two-week lockdown, Morrison said in a press conference.
"At this stage, it is not clear how further cases of infection have occurred on that vessel ... but because of the nature of the quarantine not being able to be assured, for those more than 200 Australians who will be returning to Australia, we are going to have to require a further 14-day quarantine period."
He said he was "very frustrated" about having to impose a second quarantine measure, "but our first responsibility ... is to protect the health and safety of Australians here in Australia."
Nearly 250 Australians evacuated earlier this month from the virus' epicenter of Wuhan, China to Australia's remote Christmas Island were released Monday following their 14-day quarantine period.
Chief Medical Officer Brendan Murphy said the second quarantine is necessary due to the rate the disease is spreading on the ship.
"We cannot be sure, and if we cannot be sure, we have to take precautions," he said.
Data from China suggesting that a decline in new COVID-19 cases over the past two weeks will likely continue but must be interpreted "cautiously," World Health Organization director-general Tedros Adhanom Ghebreyesus said in a press conference Monday.
"Trends can change as new populations are affected," he said. "It's too early to tell if this reported decline will continue. Every scenario is still on the table."
Based on data from more than 44,000 patients published by health officials in China over the weekend, he added, COVID-19 may be "not as deadly as other coronaviruses," including SARS and MERS.
The data suggest that more than 80 percent of patients have mild disease and will recover fully, while approximately 14 percent will experience severe disease, similar to pneumonia and 5 percent will suffer from respiratory failure, septic shock and multi-organ failure. The virus is fatal in roughly 2 percent of cases, he added.
"The risk of death increases the older you are," he said. "We see relatively few cases among children. More research is needed to understand why."
Canada also announced Saturday that it will be sending aircraft to evacuate its citizens from Princess Diamond.
"Our consular team at Global Affairs Canada has been in contact with all Canadians and their families on cruise and in hospital," Canada's Minister of Foreign Affairs Francois-Philippe Champagne said via Twitter Monday. "This is an extremely challenging situation and we are there to assist."
The Canadian Armed Forces medical personnel, experts with the Public Health Office, and four members of the Standing Rapid Deployment Team are in Japan to assist, the Canadian Embassy in Japan said.
Meanwhile, Japan's fifth government charted flight landed in Wuhan early Monday, according to Japanese broadcaster NHK News. The flight was to return later in the day with several dozen people on board, the government said, adding it will be its last chartered flight.
