The Cruise G.I. Blues: Why We Don't Handle Gastrointestinal Virus Cases
The last several articles on this blog have involved gastrointestinal (G.I.) virus outbreaks on cruise ships.
The cruise ships involved are Holland American Lines’ Volendam and Veendam, (HAL ships, historically, are the most likely to be contaminated with norovirus), the Discovery cruise ship which was held up in Liverpool for what the cruise lines describe as “enhanced cleaning,” and most recently the Celebrity Millennium which arrived in Alaska with a bunch of sick passengers who went ashore and coughed all over the city of Seward.
These ships join the list of other sick cruise ships this year. There are seven official reports of 
G.I. cases so far this year documented by the U.S. Centers for Disease Control and Prevention (CDC). But the list is incomplete. The CDC requires cruise lines to report outbreaks only when a certain percentage (more than 3%) of the passengers become ill. If the cruise ship does not call upon a U.S. port, then the CDC has no jurisdiction and there is no obligation to report any G.I. cases to the U.S. federal government.
Most countries around the world don't require reporting of cruise G.I. cases. So when you read the CDC database of G.I. outbreaks on cruise ships, remember that this is only those cruises which dock at a U.S. port and where at least 3% of the passenger report to the infirmary.
My partners at my law firm ask me why I blog about G.I. cases because our firm rarely handles such cases. Why don’t we handle G.I. cases? For a couple of reasons:
It is usually impossible to prove where the virus originated. The CDC and the Food and Drug Administration (FDA) concluded long ago that most norovirus outbreaks are due to contaminated food and water. No, not due to the dirty hands of the cruise passengers as the cruise lines want you to believe, but noro-laden food or contaminated water.
But general propositions are no help in a particular case. The CDC makes no real effort to pinpoint the epicenter of the outbreak on the cruise ship.
The CDC usually can figure out the causative agent (i.e., noro, e-coli, etc.) but that’s where the federal agency’s inquiry ends. The CDC has but a few hours to board the cruise ship and conduct its 
investigation once the ship returns to a U.S port. It does not have the time or the resources to perform a full blown epidemiology assessment during the limited time the ship is in port.
Was the water well used to irrigate the potatoes or lettuce which were loaded onto the cruise ship contaminated by noro-infected swine feces that leeched into the well supplies? You will never know because no one is doing any investigation to find out.
The cruise lines don’t want such sophisticated analysis either, because the most likely cause of norovirus outbreaks is not bad passenger hygiene but contaminated food and water. It’s bad for cruise business for an official U.S. agency to point the finger at contaminated water or infected food, or to conclude that food handlers worked while infected with noro and, in turn, contaminated 150 plates of salad consumed by the passengers.
Illnesses due to e-coli or norovirus are nasty. You’re afraid that you are going to die and then you’re afraid that you’re not going to die, the joke goes. But it’s no joke. Sick passengers do die, particularly elderly passengers with suppressed immune system and especially those who are ignored by the ship doctors or those who receive bad care while on the cruise ship.
The rights of ill or dying passenger infected with norovirus on cruise ships are limited. The Death on the High Seas Act (DOHSA) prohibits the recovery of damages for elderly retirees. Their deaths are financially meaningless if they become sick during a cruise and then later die either on or off of the cruise ship. Cruise lines love DOHSA. Also, sick passengers who receive bad medical care by the ship doctors usually have no recourse against the cruise lines because the ship doctors are legally considered to be “independent contractors” for whom the cruise lines have no responsibility. And neither the cruise lines nor the CDC or FDA are trying to find out where the norovirus came from in the first place.
Cruise lines are cutting back on the testing of water, placing increasing demands on its crew members who often work while sick, hiding dirty galley equipment from CDC inspectors, and pushing their ships and staff past reasonable limits leaving little time and resources to maintain a clean and hygienic environment.
It’s easier for the cruise lines to blame the passengers for poor hygiene and then stand behind the CDC’s and FDA’s indifference and archaic laws like DOHSA which have insulated the cruise industry from the consequences of their negligence and recklessness for decades.
In a nutshell, we don’t handle G.I. virus cases because the deck is stacked against the cruise passenger. Cruise passengers typically don’t know when they board a noro-infected ship that they have few rights and that the cruise line will blame them if they get sick. We blog about the problem because it is an insight into the way which the cruise industry operates its business and treats its customers.
The cruise lines say that the “health and safety of cruise passengers are its highest priorities.” That’s not true. We prefer that the cruise passengers understand that before they walk up the gangway into a noro-contaminated ship.
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chances that they will infect other crew members and the passengers that they come into contact with. The problem is particularly critical when the infected crew are food handlers. 
with gastrointestinal illness. Two CDC Vessel Sanitation Program environmental health officers and an epidemiologist boarded the ship on arrival in Fort Lauderdale on April 1, 2013 to conduct a targeted environmental health assessment and evaluate the outbreak and response activities. 
According to the 
You can read the report of the Century .jpg)
Cruise Critic.jpg)
obviously ill in the morning. An assistant buffet steward was suffering from GI problems but worked the buffet from 9:30 Am and did not report to the ship infirmary until 4:00 PM. There were inadequate reports regarding potable water facilities. The ship had dirty and soiled areas, including the signature Princess restaurant Sabatini's. 
The 
Cruise Critic reports today that just one month after HAL's Veendam flunked an inspection by the Centers for Disease Control (CDC), the Blount Small Ship Adventures Grand Mariner's 100 passenger cruise ship also failed a CDC inspection: 
Flies. Dirty and malfunctioning ice machines, refrigerators & dishwashers. More flies. Dust, dirt, food residue, and debris. Flies and more flies. Flies where food is prepared. Flies where food is stored. Ugh. These unsanitary problems are part of a ridiculously long list that the U.S. Centers for Disease documented during a surprise inspection last month aboard the Holland America Line's Veendam cruise ship.
lines are required to make the report only when 3% or more of passengers or crew reported symptoms of diarrheal disease to the ships medical staff during the voyage. Under-reporting occurs regularly because many passengers can't make it away from their toilets due to diarrhea, and some passengers don't want to be confined to their cabins. 
In a story widely reported in the national media, the Centers for Disease Control failed Royal Caribbean's Monarch of the Seas after conducting a surprise vessel sanitation inspection last month. .bmp)
It is rare for a cruise ship based in the U.S. to fail a CDC inspection.
about this latest outbreak 
experienced a sickness outbreak as the cruise reached in Rio de Janeiro. .jpg)
be served by the staff and they were constantly wiping down everything and making announcements about hygiene. We asked if something was going on and we were told no however by that night 3 of the seven people in our party were very sick and once we walked in on an employee in the bathroom vomiting very badly. A casino employee told us that night many of the crew and passengers were very sick. .jpg)
utensils, ice machines and drinking fountains, failed to quarantine infected passengers and crewmembers and failed to warn Mr. Gavigan about the virus. 
This particular cruise had a passenger vomit in a public area during boarding, as well as 7 other incidents where passengers vomited in public. The Centers for Disease Control ("CDC") investigators concluded that some sick passengers may have been infected by the vomit (through aerosolized vomit or by touching contaminated surfaces) or they were infected by person-to-person contact, particularly by an ill cabin mate. 
Tampa Local 13-News station has the headline "
If this information is accurate, five cases of gastrointestinal sickness is not particularly significant. The Centers for Disease Control (CDC) "
from Charleston." 
This is now the third cruise on the Mercury where passengers have become sickened with a gastrointestinal sickness. 
such measures can’t prevent a sick passenger from coming aboard and infecting others." Ms. Higgins suggests that " the best defense is simple: wash your hands.".jpg)
The issue of eating oysters and other shellfish on cruise ships presents a double whammy. Cruise ships dump sewage 12 miles from shore, and the fecal material can contaminate shellfish which filter-feed. Both cruise passengers and people ashore can then be infected by eating contaminated shellfish. 
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norovirus as the "cruise ship sickness."
ship sickness in an article entitled "Sickness Again Plagues Charleston Cruise Ship:" 
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Well finally we have a credible report. Not some pile of propaganda from the PR people at the Cruise Line International Association, whose "facts" are usually dubious, but from highly trained health care professionals. The medical and hygiene experts covertly evaluated the thoroughness of disinfection cleaning on fifty-six (56) cruise ships over the last three years. .jpg)
These experts secretly tested whether objects with high potential for fecal contamination, such as toilet seats in cruise ship public restrooms, could be a cause of norovirus breakouts.
Jim Walker is a maritime lawyer who has attended seven Congressional hearing on issues of cruise ship crime, passenger disappearances,
