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.
One passenger, who described being treated like a leper, said: "I was on a ship which had norovirus and in the end it took four days to clean it, so I cannot see how four hours will help."
the course of the cruise. At three percent, Health Canada could launch a full investigation but will not because the reported cases did not reach this percentage.
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. 
ship departed.
A Galveston television station reports that a Princess Cruises' ship, sailing from Venice, Italy with a final destination in Galveston, has stricken nearly one cruise passengers with the dreaded norovirus..jpg)
won't do too much good if the nasty bug is in the food and/or water. 
December 22, 2012 Update: I am informed that there was a "red alert" for disease outbreak aboard the Crown Princess throughout the Atlantic crossing. The cruise ship is now in Galveston (as you can see from the ship's bridge cam) and the CDC will board. If you were on the cruise, how do you think the cruise line handled the outbreak? Is around 100 sick passengers an accurate number of guests affected by the norovirus? 
Nancy also commented on the absence of any mention of the disease outbreak: "The outbreak didn't rate a mention on TV or news papers ($$ damaging to tourist trade)." (The image of the Voyager of the Seas to the left was from an earlier norovirus outbreak when the ship was sailing out of New Orleans in February). 
cleaning is not much good if there is contaminated food or water or a sick crew member in the galley or waiting on tables. 
We received complaints from cruise passengers that there was a gastrointestinal outbreak on the Celebrity Solstice at the end of August. One cruise passenger contacted us and stated: .jpg)
The Jewel of the Seas had widespread sickness (diarrhea and vomiting) last March, but the Center for Disease Control (CDC) could not determine the type of pathogen. You can read the CDC analysis 
.jpg)
municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships."
Jim Walker is a maritime attorney who has attended seven Congressional hearing on issues of cruise ship crime, passenger disappearances,
