Dealing With Flu Outbreaks
Cruise Ships Could Do Much More
On a recent cruise from Australia that included six sea days we witnessed a minor outbreak emerge with almost no reaction from the ships onboard management. It started on day 2 with a couple of people coughing in the theater. By day four it grew to dozens more and few people seemed to care if their coughing might be spreading the flu to others. By half way through the cruise it seemed as if a full 20% of the passengers were infected including me.
In my case we did the responsible thing and I self quarantined in our stateroom. That raises the question – why are so many others not acting responsibly?
In my opinion the ship bears much of the responsibility, After the experience of dealing with Covid-19 it would seem that the cruise industry and its many cruise ships would have learned a lesson or two on how to deal with onboard illness? Today, besides Covid there is only one other outbreak that will produce an “all hands on deck” response – the Norovirus!
We’ve been on a cruise when a Norovirus outbreak occurred and it’s no laughing matter. Passengers are quickly identified and restricted to their staterooms. Out come chemical sprayers as disinfectant is sprayed everywhere. Everywhere you go there’s a crew member with a sprayer. Walls and railings are dripping wet and we joked that if we stood still too long we’d get sprayed down too…
One difference is that when a norovirus outbreak occurs on a cruise ship, the cruise line is required to activate its prevention and response plan in collaboration with the US CDC. The CDC’s Vessel Sanitation Program (VSP) typically involves increasing cleaning and disinfection procedures onboard, isolating sick passengers to staterooms along with crew, and notifying everyone on board of the situation. The CDC VSP monitors outbreaks remotely and will provide guidance on additional actions to take as the outbreak progresses.
The Norovirus is an intestinal infection that spreads easily and has serious symptoms. Outbreaks are common in school and business environments and can create serious disruption. Generally norovirus outbreaks do not marshal the forces of public health to manage an outbreak and it does not make the news outside a local community paper. Oddly a cruise outbreak still often does hit national media. Why? Are cruise ships more likely to spread an illness than a public school? The short answer is no – in fact a school outbreak is many times more likely to spread out into the broader community than a cruise ship. So why the difference? Here the short answer is more about the nature of the news business than the actual public health situation. The media makes cruise ships big news, while a local middle school simply is not news.
So Norovirus and Covid-19 are taken very seriously on cruise ships while the flu seems to be mostly ignored. Again why? The answer has more to do with PR for the cruise line than the illness problem. Norovirus and Covid-19 reequire government notification while the flu does not and cruise companies would prefer to keep those out of the news.
Since a large number of people come into close contact with one another on cruise ships, respiratory viruses, including flu, have the potential to spread easily and quickly. Respiratory outbreaks on cruises, including those caused by influenza (flu) viruses, are not uncommon, especially since cruise ship travelers originate from both the Northern and Southern Hemispheres, with opposing flu season timing. This means that flu outbreaks on cruise ships can occur year-round and be of several mixed strains at once.
As a cruise ship policy toward flu the approach is mostly low key and preventative, like giving a flu vaccine to the ships staff, requiring boarding passengers to report illness and promoting washing hands.
All right that explains the ships attitude, but why are passengers so inclined to actually facilitate the virus spread?
Several recent surveys suggest that a major reluctance in using onboard doctors is the high cost of onboard medical services. While most cruise ships have experienced medical staff on call 24-7 who are equipped to provide emergency care and stabilize sick patients, but your domestic health insurance may not cover emergency care you receive on a cruise ship. Medicare doesn’t cover health care services when the ship is outside the U.S. and you may have to pay out of pocket.
The cost of using the Medical Facility on a cruise ship can vary depending on the services you require. Basic consultations with the onboard doctor typically start around $125 to $200 during regular hours, with higher fees for after-hours visits or more specialized care.
Having cruise insurance typically covers onboard medical expenses but in most cases you will have to pay the onboard charges and submit a claim to be reimbursed (even if you purchased your insurance through the cruise company). Specifics can vary depending on policies. Most cruise emergency medical insurance will reimburse for doctor visits up to a certain limit, although it’s crucial to read the policy details carefully to understand any exclusions, particularly regarding preexisting conditions. It’s also important to note that most cruise lines will not accept land-based health insurance, meaning that if you need medical attention while onboard, you may have to pay out-of-pocket initially and then submit a claim to your insurance provider for.
The truth is that cruise ships have a number of options available to reduce or slow the spread of the flu onboard, but unfortunately choose not to take action. Understanding the attitude of passengers who get sick and their reluctance to use onboard facilities should be taken into consideration. Crew should contact people who are showing symptoms while on a cruise and should explain the options for visiting the ship’s medical facility or doing self isolation. They should suggest that medical staff can evaluate passengers for flu, provide care, and prescribe flu antiviral medications if needed. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that can make illness milder and shorten the time people are sick. Antiviral medications are most effective if used early within the first 2 days of symptoms. Cruise ship medical personnel are advised to treat passengers with flu illness who have severe illness or who are at high risk for influenza complications with antiviral drugs as soon as possible. Travelers who become ill on a cruise should be respectful of other passengers and stay in their room, away from others, so as to prevent spread of disease. Travelers who have recently been sick or become sick at the time of planned travel should postpone travel until they are feeling better. CDC specifically recommends people wait at least 24 hours after their fever has resolved without the use of fever-reducing medications before traveling. Traveling while you are sick may put your health at risk or put others around you at risk for getting sick. While sick, passengers should limit contact with others as much as possible to keep from infecting them. Cruise ship staff often will separate ill passengers from other passengers for the duration of their illness. Travelers who are still sick at the end of their cruise should consider delaying further travel on airplanes, buses or trains to avoid spreading the infection to others.
The Intentional Travelers 