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Treating the latest cruise ship disease - wash it out

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Published on: Thursday, May 02, 2013

By Llewellyn Toulmin

If you watch CNN or read the general press, you probably believe that the following statements are true:

•    Norovirus is the “cruise ship disease” which affects a high percentage of cruises annually

•    As a result, it is reasonable to avoid cruising

•    The cause of the disease is generally poor ship cleanliness

•    The best thing to do to avoid the disease is to use disinfectant gel frequently.

I think I can show you that every one of these statements is false or at least misleading.  Along the way, I will also show you what the facts are, and how to protect yourself from this disease, at sea, on land, and in the air.

Norovirus is a very annoying but not life-threatening virus, as contagious and almost as common than the  “common cold.”  It is often erroneously called stomach flu, but it has nothing to do with influenza.  According to the US Centers for Disease Control (CDC), norovirus “causes your stomach or intestines or both to become inflamed” often leading to stomach pain, nausea, diarrhea and vomiting.  You can get it from “an infected person, contaminated food or water, or by touching contaminated surfaces.”   

All that sounds bad, and it is.  But notice the CDC never mentioned “cruise ship.”  This is because norovirus is actually quite common on land, and regularly attacks hospitals, nursing homes, college campuses, and anywhere people congregate.  For example, in early 2012 a number of colleges in the Northeast experienced attacks, and in 2009 and 2010, norovirus was the number one culprit in infectious outbreaks in hospitals in the US.  In fact, norovirus used to be called “Norwalk-like virus,” and was named after a 1968 outbreak on land, in a Norwalk, Ohio school, 1000 miles from the sea.  

According to the CDC, only 16 voyages of 14 different ships were affected by norovirus in 2012, such that more than three percent of persons on board got the disease.  (Crown Princess and Ruby Princess were hit twice.)  Since CDC’s Vessel Sanitation Program covers about 180 cruise vessels, and most vessels sail about 51 voyages per year (one week is usually devoted to repairs), there are roughly 9180 voyages per year.  Thus your chances of being on a voyage where there is an outbreak are about 16 in 9180, or a bit more than one tenth of one percent.  (The year 2012 was not an aberration.  There were only 14 outbreaks in 2011 and 14 in 2010.)  Furthermore, in one of the worst outbreak in 2012, aboard the Crown Princess, the percentage of passengers on that one voyage who became ill was only 9.4 percent.  The average percentage of passengers in 2012 in the 16 outbreak ships who became ill was only 7.2 percent.  Hence the actual chances of you taking a voyage, being in an outbreak ship, and contracting the disease, are about one one-hundredth of a percent.  In other words, the odds are 1 in 10,000.  

The chances of you being in a ship that has to reduce its voyage time due to the illness is about the same, about 1 in 9,000.  This is based on the fact that one Crown Princess voyage is the only one (of 9180) in 2012 where a voyage was cut short, in this instance by two days.  No voyages were totally cancelled in 2012.   

By the way, your odds of getting injured in a traffic accident over the next year are about 1 in 1,000, according to DisasterCenter,com.  So you are 10 times safer once on the ship than driving to it!  And all you risk on board is discomfort, while in driving you could be seriously injured or killed.

Of course those ships that do have outbreaks of norovirus are by definition unclean, right?  Nope.  Consider that the Queen Mary 2, a top cruise ship, scored 100 on the challenging 2012 CDC Vessel Sanitation Program (VSP) inspection.  Yet soon thereafter, the vessel experienced a norovirus outbreak.  And consider that the lowest scoring vessel in the last two years, the M.S. Columbus 2 of Hapag Lloyd, which scored an abysmal 69 out of 100 (86 is passing) on the VSP, did not report a norovirus outbreak.  

The cause of an outbreak is almost always passengers who arrive with the disease, and spread it through touching objects on board.  Thus the outbreak is not vessel cleanliness, it’s more the luck of the draw in terms of the number of unhealthy passengers that walk up the gangway.  

Notice I have been talking about passenger outbreaks.  This is because the percentage of crew members who get norovirus in an outbreak ship is almost always less than half of the percentage of passengers who contract it.  The average is that passenger s are more than six times more likely to get norovirus than crew.  Why?  What is happening is that crew are trained to really, really keep their hands clean.  Passengers often forget to undertake this elementary procedure.  

What’s the best way to clean your hands?  Surprisingly, not a gel.  The official statement on this is that “CDC recommends that cruise ship passengers use soap and warm water to wash their hands” and this is “always best.”   CDC states that “if soap and water are NOT available…[then] use an ethanol alcohol-based hand sanitizer…with at least 62 percent ethanol.  Hand sanitizers do not get rid of all kinds of germs.”  

According to the CDC, you should wash your hands before eating, smoking, drinking, brushing your teeth, or touching your mouth , and after going to the bathroom, changing diapers, blowing your nose, returning to your cabin, helping a sick person, or touching high contact surfaces.   Don’t ruin all that great washing by opening the public toilet door with your bare hand.  Use a paper towel.  

Cruise crew are now highly trained to combat norovirus.  On a recent Holland America Line cruise in the Caribbean our boarding was delayed by several hours, while the crew went through a “code red” triple sanitizing of all surfaces in the ship.  This was in addition to the normal once a day cleaning of all surfaces.  This extra cleaning was caused by the fact that the previous load of passengers had had a number of ill passengers.  Other standard precautions were taken during the first few days of our voyage, including installing additional gel dispensers, issuing a “welcome letter” warning us to wash our hands regularly, closing the hot tubs, not allowing self-service in the buffet (so we wouldn’t touch serving utensils touched by other passengers), and removing salt and pepper shakers.  After three days it became clear that the triple cleaning had worked, and most of these restrictions were relaxed.  

Additional techniques I use to stay norovirus-free are:

•    Hit elevator buttons with my knuckle, not my finger tip

•    Don’t touch handrails unless I really need to because the ship is rolling.  I just hover my hand above the rail, ready to grab it if necessary.

•    Don’t shake hands with fellow passengers or crew, even the Captain!  On many cruises the new protocol is to touch elbows.

•    Don’t fly to join the ship.  In my opinion, airplanes are much more prone to norovirus, colds and other infections than cruise ships.  If I have a choice, I drive.  If I do have to fly, I am careful to follow all those hand-washing precautions, especially when using the plane’s toilet.  While I have seen cruise ship crew putting in thousands of hours cleaning every surface in sight, I have never once seen an airline crewmember sanitize a plane’s toilet in flight.

If there is a serious attack, the ship will be triple sanitized, and very stringent methods may be used to kill all particles of the virus, including washing all the casino chips, throwing out all the pillowcases, and cleaning all the TV remotes, balcony railings, light switches, and even Bibles.

But suppose that you go cruising, are incredibly unlucky, and are aboard a ship in which the cruise is cut short or cancelled by a norovirus attack.   Are you entitled to a refund?  This depends on your cruise contract.  The small print will often give you very few rights, but in practice most lines are fairly generous with affected passengers, and you will likely get a 50 percent refund and a 50 percent discount on a future voyage.  If you get norovirus and are quarantined in your cabin for one to three days (a standard precaution), but the cruise is not affected, you are unlikely to get a refund.  Does that sound unreasonable?  Well, suppose you got sick in a hotel and stayed in your room for three days – would you expect a refund from the hotel?  Not likely.

So I hope I have given you some facts to make rational decisions.  All this raises the interesting question: if our perceptions are so wrong in this one little area, how right are our perceptions in much more important issues?  And how did this come to pass?   Hmmmm………

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