One hundred and fifty passengers reported ill on the Explorer of the Seas on Tuesday January 22, 2014, according to the cruise line’s records. The following day, Wednesday, another 300 passengers reported being sick. In the first couple of days into the 10 day cruise, the Royal Caribbean cruise ship was faced with a full blown gastrointestinal epidemic. 

The numbers increased from 450 to 684 by the end of the cruise, including crew members.

The Centers for Disease Control and Prevention (CDC) announced that it sent one CDC sanitation inspector and one epidemiologist to the cruise ship when it arrived in St. Thomas, USVI on Sunday, Janaury 26, 2014. 

When I heard this news about the arrival of the CDC, I thought "just one epidemiologist?" The ship is huge – 15 stories high and longer than 3 football fields! It has over 4,200 people on board. How can one scientist possibly conclude not only the exact type of virus which was sickening the people on the enormous ship but also make an accurate determination how the virus came aboard and spread so quickly? There needs to be a team of a dozen epidemiology experts to handle such a task.

So the Explorer is back in New Jersey. Over 3,000 passengers will board tomorrow.

What type of virus sickened the ship and its passengers? The CDC has not yet concluded, assuming it will make a determination.

The CDC could not figure out the last two cruise ship GI outbreaks. The "causative agents" for the outbreaks on the NCL Star last week and the NCL Gem in November are listed as "unknown."  

The cause of the recent Explorer of the Seas outbreak may end up "unknown" as well.

If you look at the CDC data over the years, you will see that usually the CDC will at least figure out what type of pathogen is involved. It’s usually norovirus, or e-coli or a combination of the two. But what you will never see is the CDC figuring out where the virus came from and how it spread.

Why? I believe that the CDC resources are so minimal and the time to conduct an investigation is so limited that it is virtually impossible to make a meaningful scientific analysis of the problem. All of the guests scatter back to their homes around the world. It’s impossible to interview all of them. And the cruise line wants to re-rack the ship quickly. Ships don’t make money sitting idle. The cruise lines depend on continuous rounds of customers buying booze, spending money on excursions and gift shop purchases, and gambling their money away. Investigating a cruise ship disease outbreak is completely different from an outbreak at a nursing home or child care facility where investigators can take their time, interview and test everyone and get to the truth of the matter.     

Look at the CDC data and you will learn that the CDC has not determined how norovirus comes aboard cruise ships for the last 50 outbreaks. Not one single time. They have failed miserably time after time in determining this causal issue.

The first two primary objectives of a CDC investigation are to:

• determine the etiology of the outbreak; and
• determine the method of transmission among the passengers.

There are a number of possible causes for a norovirus outbreaks. The CDC and FDA say that the most likely cause is often contaminated food or water.  The CDC has also flunked cruise ships during their sanitation inspections when they find evidence that galley employees kept working after they were sick. Earlier this year, a south Florida TV station aired a special about "Cruise Ship Workers Breaking Rules & Making Passengers Sick."

We also know that some galley employees hide food and cooking equipment from the CDC inspectors. Silversea Cruises was caught hiding 15 large trolleys of meat, fish, cheese and deserts down in the crew quarters. We revealed this last year and then CNN aired a special last year. Don’t think that just Silversea plays hide-the-salami from the CDC sanitation inspectors. Unfortunately, the CDC inspects cruise ships which come into U.S. ports only twice a year.

Of course, passengers can be infected before they cruise and bring the virus onboard with them. They can also fail to wash their hands when they go to the buffet and make pigs of themselves at the buffet. Many passengers know that if they disclose their sickness they can be left behind. Many don’t have insurance and the cruise lines never provide a refund to someone showing up ill. Some don’t want to report sick to the infirmary because they are afraid of being quarantined and billed for the medical services.

The determination of exactly what caused the initial onset of the sickness and caused it to spread is a scientific / medical process. It should have nothing to do with the litigation blame game or public relations / reputation-protection issues.

But the cruise industry will always blame the passengers for bringing the virus onto the ship. They will not wait for the CDC to finish its investigation. The cruise trade organization, the Cruise Line International Association (CLIA), issues the same talking points after every single outbreak. The passengers need to wash their hands, CLIA will say. The 16,000 CLIA travel agents say the same thing, over and over, like trained parrots.

Today a well know travel agent tweeted: "It is the passengers!" as the only possible explanation for the outbreak on the Explorer.  Two days ago, Royal Caribbean Chairman Richard Fain was asked about the outbreak on the Explorer during a TV interview . He responded by saying that his cruise ship was "amazingly safe" and that the cause of the viral outbreak was because "they’re having a lot of cold up in the north."  Of course norovirus has nothing to do with having a cold or cold weather. The cruise executive’s off-the-cuff comments were just another way of delivering the "blame the passengers" message and diverting attention away from the ship and the crew. 

Passengers and crew members deserve to know why they are sick. 

Anecdotal stories, tall tales, PR statements and blame games will never solve the problem. Only scientific analysis from educated, trained and experienced epidemiologists will get to the bottom of the problem.

If I oversaw the cruise industry, which collects 35 to 40 billions dollars, tax free, every year, I would not be satisfied with the CDC never determining why a virus came aboard on my fleet of cruise ships and spread like wild fire, sickening my hard working crew and ruining the vacations of my guests. "Unknown" is not an acceptable answer. I would hire my own team of experts to get to the bottom of the matter. Then I would transparently tell my employees, customers and the public exactly what the scientists concluded, whether it was attributable to the ship food, or water, or the crew, or the passengers.

But the cruise industry will never do that. They fear that perhaps 2 or 3 times out of 5, a group of experts may point to the cruise ship or crew rather than the dirty hands of the passengers as the cause of the outbreak.

That would be bad for the cruise industry’s reputation and image. That would permit personal injury lawyers to file class action lawsuits. That would permit passengers to be fully compensated rather than having to accept 50% refunds and credits to sail on another cruise ship that they may never want to go on again.

As matters now stand, a scientific process designed to lead to the truth and the attendant medical and legal consequences gives way to a public relations effort full of speculation, untruthful talking points and finger pointing. 

And so the cause of viral outbreaks on cruise ships remains a mystery. And that’s exactly what the cruise lines want.