Vol. 16 •Issue 16 • Page 20
Cruise Ship Virus
Not Exactly What Doctor Ordered
Will you be sharing a bottle of champagne, enjoying a beautiful sunset while relaxing with that special someone on the deck of your cruise ship, or will you be held captive in your stateroom hugging the toilet, praying to the porcelain god for relief?
Recent international events remind us that travel can be risky business these days, especially on the floating palaces frequenting the high seas or the sky liners flying high above the clouds overhead. So much risk is involved that global organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have announced travel warnings and restrictions to those who plunk down hard cash or credit cards in an attempt to live out their dreams to become temporary seafaring adventurers or cloud surfers.
People movers, whether airplanes or ships, must be considered probable hosts for infectious diseases and a possible mode of global transportation for microbial neighbors.
People who congregate in large groups in any confined spaces like apartment buildings, hotels or cruise ships are at risk of exposure to respiratory and gastrointestinal infections and a host of other illnesses.
Such encapsulated accommodations can be dangerous because they are often serviced by complex air conditioning and plumbing systems which require meticulous maintenance if they are not to be a source of infections and diseases. Because of their complex nature, the systems’ quality assurance and maintenance programs must be rigorous and methodical to prevent their use as a form of transportation for stowaway microbial passengers.
NO SAFE PORTS
Passengers sailing the high seas remain in a unique, isolated situation until they go ashore in a port. But they are not necessarily safer on shore. Once they have disembarked, the passengers are then vulnerable to any infectious diseases plaguing the local geographical area.
Often the passengers may come in contact with a local bug and not show any symptoms until they have already transmitted the bug to numerous others. So a word of warning is necessary. If you do go off on your own, try to get whatever knowledge of the area you can in advance and always remain observant of conditions around you. An ounce of prevention is worth a pound of cure, as they say.
In May, my wife and I embarked on a two-week Mediterranean cruise. Having a cautious nature, I took what precautions I could to ensure our cruise would be a healthy one. As a beginning point, I surfed the Internet for warnings and CDC updates concerning cruise ship infections. Along the way, an article titled “Sailing the Sickening Seas” caught my attention.
The article mentioned the CDC was looking into outbreaks of gastrointestinal illnesses aboard cruise ships, the performance records of various cruise lines and their quality control programs.
The numbers began to tell the tale. In 2000, approximately 10 million people traveled on cruise ships. That number is expected to double by the year 2010. To compound the problem, many of the passengers are elderly and considered to be at high risk for respiratory and gastrointestinal problems.
For this reason and because the liners could be targets of bioterriorist attacks, the CDC and WHO are both taking a special interest in the cruise line industry, especially in its ability to monitor and protect patients and crew.
Problems aboard ship are nothing new at all. From June 23 to July 5, 2000, the MS Rotterdam recorded a breakout of influenza B virus. By June 29, some 38 crew members and 26 passengers with influenza symptoms had visited the ship’s sick bay.
Since the beginning of this year, the CDC has responded to four outbreaks of gastrointestinal illnesses aboard cruise ships:
• On the Sun Princess (Princess Cruise lines), 267 of 2,029 passengers and 29 of 877 crewmembers reported being ill from an gastrointestinal illness.
• On the Sundream (Sun Cruises UK), 95 of 1,085 passengers and 12 of 403 crewmembers reported a gastrointestinal illness.
• On the Olympia Voyager (Royal Olympic Cruise Lines), 35 of 756 passengers and five of 356 crewmembers reported gastrointestinal illness.
• On the Carnival Spirit, 102 of 2,143 passengers and 10 of 902 crewmembers reported gastrointestinal illnesses.
Armed with this knowledge, I interviewed several crewmembers of our ship in an attempt to substantiate what I had read. A visit to the ship’s infirmary was interesting but not really rewarding. While I waited at the reception counter for a chance to speak with the health care staff, there were at least four passengers seeking medications and requesting to see the doctor.
When I finally did have an opportunity to discuss my concerns with a nurse, I discovered she was reluctant to discuss any specifies with me but she did say the ship had three nurses and two doctors. Beyond that, I was asked to contact the cruise line’s corporate office for further information.
At that point, I sought to interview a ship’s officer in the state room area. While we discussed the ship’s sanitation policies, a woman apologetically interrupted our conversation with a request that clean sheets be brought to her cabin because her travel companion was ill and the sheets were soaked. The officer complied with the request which he apparently believed was rather routine.
While the medical crew and officers were not comfortable discussing my concerns, one fitness coordinator felt confident enough to share his version of the crew’s living conditions aboard the luxury liner. He said he had not been able to shake a respiratory ailment he had had for over two weeks. Numerous other crewmembers exhibited similar symptoms, he explained.
Meanwhile, he and many other crewmembers in the fitness center routinely detoxified themselves to offset illnesses caused by exposure to others with illnesses, poor quality food, cramped living compartments and extremely long and continuous workdays.
It didn’t take long for me to figure out there were some major differences between paying passengers and paid workers aboard our luxurious floating condominium.
The long-term advice emerging from investigations is that surveillance, disease prevention and sanitation control are imperative to health and safety of those aboard ships and planes. Many disease outbreaks may go undetected or may not be reported. These facts raise our concerns to a higher level, especially after two crew members of a luxury liner were recently taken off a ship and treated for suspected SARS.
In Malaysia, a crew member on board a cruise ship had been previously diagnosed as a probable SARS victim and hospitalized in a local hospital. Thirteen other crewmembers were later quarantined aboard the ship until it docked in another port.
Beyond SARS, an old nemesis still alive and well is Legionnaires’ disease with its pneumonia-like symptoms. CDC investigators said Legionnaires’ disease was the cause of 50 cases of infection aboard one cruise ship. They determined the source of the outbreak in that particular case was the whirlpool spas.
Our world has definitely taken a turn for the surreal today. This doesn’t mean that hiding in the attic or stocking up on DVDs is a good way to stay out of line of fire. Cruise ships, after all, are fun and still live up to the old analogy of giving up to the air and the sea.
Michael Donnellan is a California practitioner.