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For the better part of the last decade, I have been writing on a regular basis about disease outbreaks which occur on cruise ships. In the past ten years, there have been over 120 disease outbreaks on cruise ships, involving norovirus, e-coli and other more exotic viruses, as well as measles and Legionnaires Disease.

Princess Is the Leader in Cruise Ship Disease Outbreaks

Not surprisingly, Princess Cruises has experienced the most norovirus outbreaks (and other gastrointestinal illnesses) of any other cruise line over the last decade. Not counting the recent coronavirus outbreaks on the Diamond Princess and the Grand Princess cruise ships, Princess experienced 25 disease outbreaks on its cruise ships during this period of time, as reflected in the online database maintained by the Centers for Disease Control and Prevention (CDC).

Failed USPH Cruise Ship Inspections

Princess recently experienced two back-to-back gastrointestinal outbreaks from February 2nd through March 1st which required the Caribbean Princess to return early to port in South Florida. Princess is also the only cruise line to have failed a sanitation inspection this year. The United States Public Health (USPH) gave the Regal Princess a score of only 77.  (USPH sanitation inspectors conduct inspections twice a year on cruise ships when they are in a U.S. port.  A score of 85 or below constitutes a failed sanitation score). The score of just 77 ties the lowest score ever given to a cruise ship operated by a major cruise line (like Carnival, Norwegian, or Royal Caribbean).

The Regal Princess joined the ranks of several other Carnival Corporation-owned cruise ships which failed USPH inspections in the last several years, including the Carnival Breeze (77), Carnival Fantasy (77), Carnival Triumph (78), Carnival Vista (79), Carnival Liberty (80), Golden Princess (81), Carnival Legend (83), Carnival Paradise (83), and Carnival Liberty (83).

Cruise Ship Disease Outbreaks – Why Does Princess Always Blame its Guests? 

The most likely disease outbreak on a cruise ship involves norovirus, of course, which strikes cruise ships an average of almost ten times a year given the close quarters on the increasingly huge ships. The cruise industry defends itself from criticism of what many characterize as the “cruise ship virus” by pointing out that norovirus also strikes hospitals, nursing homes and child care centers. That may be true, but it does not seem to be much of a selling point for cruise lines to compare themselves to locations where people are sick, old or infirm, or are children with poo in their pants.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have long stated that the most common reason for norovirus is contaminated food or water. Of course, scientists at these agencies also tell us that food handlers (cooks and waiters) can spread the virus as well as other ship employees (such as cabin attendants). Passengers can also become infected when they touch surfaces contaminated with the virus or by passing the virus to each other.

No matter the cause of the outbreak, cruise lines like Princess and Carnival always blame the guests’ hygiene. Rather than performing a scientific analysis of the outbreak, cruise lines will simply pull out their PR playbook and suggest that cruise passengers need to wash their hands. Of course, if the food served on the ship is contaminated with norovirus, or the cooks or servers are infected, cruise passengers will become ill no matter how many times they wash their hands.

There is entirely too short of a turn around in the cruise ship’s home port to perform a through cleaning and disinfection of the contaminated cruise ship before the next several thousand passengers board. When the Grand Diamond returned to San Francisco on February 21st following visiting a number of port in Mexico, it remained only 8 hours in port in San Francisco before embarking on the next cruise. Later testing revealed at least 19 crew members and 2 guests infected with coronavirus. The vast majority of the guests and crew have not been tested so far.

Airborne Transmission

In 2015, scientists determined that norovirus can be transmitted via the air. I wrote a series of articles at that time about this troubling information  – Norovirus Spreads by Air on Cruise Ships and Airborne Norovirus – What Now Cruise Lines?  The cruise industry has been misleading the public for years that norovirus is primarily brought aboard by passengers, whereas it is more likely caused by a combination of contaminated food and/or water, crew members working while infected, poor cleaning practices and/or airborne transmission. Passengers can wash their hands all day long but will get ill if they breathe the virus which may enter their cabins through the air.

Irrespective of how this particular virus comes onto the ship, the cruise lines have to deal with the reality that norovirus can spread by air. Some experts suggested that the use of mobile air-filtration units or the wearing of respiratory protection around patients with gastroenteritis in order to take into account the airborne transmission of norovirus. But the cruise industry, in general, and Princess Cruises and Carnival, in particular, have done nothing to address this concern.

A Cramped Floating Petri Dish Turns into a Super Incubator at Sea

This is particularly troublesome considering the cramped spaces on cruise ships. If infectious norovirus particles can float down a hallway to a nurse’s station as proven in the clinical studies, the disease can just as easily float down the ship hallways and/or find its way into the air-conditioning ducts and spread throughout the ship. The matter is particularly serious given the fact that crew members reside in cabins located in the lower bowels of the ship without windows (or balconies). Without fresh air, the crew is particularly susceptible to a airborne virus transmitted through the ship’s air conditioning.

Buzzfeed recently published an article after the Diamond Princess coronavirus debacle, when crew members living in windowless cabins were infected due to a combination of their surroundings, inadequate personal protection equipment, and poor training and health protocols. It interviewed an expert on ventilation during the virus outbreaks, who told BuzzFeed News “in ships, you cannot filter the air well enough to stop viruses.” Buzzfeed went on to write that health experts have warned for years of the potential for cruise ship outbreaks, and quoted the expert stating that a “ship’s ventilation system, which relies on recirculated air filtered by medium-strength air filters, is an efficient way of spreading virus particles from room to room aboard a ship.”

Dozens of guests about the Diamond Princess have expressed concern that they have been infected due to the air conditioning blowing the virus around the ship.

At the beginning of the coronavirus outbreak on the Diamond Princess, I asked Princess Cruises whether the virus can be spread through airborne particles. In response to my inquiry which I posted on Twitter (along with a photo of Princess crew members huddled together in a hallway in the crew area), Princess Cruises denied that the virus can be transmitted through the air. It cited to the World Health Organization for the proposition that the virus is “mainly” transmitted via droplets from close person to person contact.

However, WHO’s Director General publicly stated in a widely shown YouTube video that coronavirus is obviously highly contagious and may be transmitted in an airborne manner:

Today, CBS News published an article indicating that scientists from the National Institutes of Health, Princeton University and the University of California, Los Angeles, with funding from the U.S. government and the National Science Foundation, determined that viable coronavirus can be detected up to three hours in the air after an infected person coughs, raising concerns that it can easily be transmitted in an airborne manner into tight crew quarters with only recycled air.

In fairness to Princess Cruises, it is nor perfectly clear whether coranavirus, like norovirus, can be transmitted in an airborne manner.  The CDC has not ever stated that coronavirus can be transmitted through the air. But the CDC has never even addressed the fact that norovirus clearly can be transmitted in this manner.  In any event, Princess and its parent company Carnival have never analysed this issue. They apparently have never authorized testing regarding whether norovirus or coronavirus can be transmitted through the air and how to deal with such a serious problem.

Why Hasn’t Princess Studied Why It is the Leader in Cruise Ship Disease Outbreaks?

A month ago, I began writing that Princess Cruises has not devoted sufficient interest or funds into understanding why it experiences the most outbreaks in the industry on its cruise ships. I rightfully called it greedy, along with several other cruise lines which at the time refused to permit concerned families, particularly elderly guests, to cancel or reschedule their cruises without penalty.

Over the last decade, neither Princess nor Carnival Corporation devoted any monies from its immense tax-free profits which it enjoys (by incorporating itself outside of the U.S. or flying foreign flags of convenience on its ships) to study the science of disease outbreaks on its ships and how an infectious virus enters their ships and is spread.  Princess and Carnival have not tried to determine, from a scientific basis, whether viruses are introduced onto their ships via food or water contamination or via their infected food handlers or via unclear ship surfaces, etc. versus being brought aboard by its guests and then spread through unsanitary practices.

The public should be asking why Princess and Carnival Corporation have not employed a team of highly educated, trained and experienced epidemiologists to study disease outbreaks in their fleet of cruise ships and to answer these questions: Why do the most disease outbreaks in the cruise industry occur on cruise ships owned by Carnival Corporation and operated by Princess Cruises? Why do the second most disease outbreaks occur on ships owned by Carnival Corporation and operated by Holland America Line (HAL)?

One reasonable explanation is that neither Princess nor Carnival want to know, because an honest answer by objective scientists may undercut their PR strategy of always blaming their guests.

Ill Crew Members Trapped in the Bowels of the Cruise Ship, Again

As I write this article, there are currently nineteen crew members who are ill with coronavirus on the Grand Princess after the ship finally reached port in Oakland. Over a thousand other crew members who are at risk of infection need to be tested. But Carnival announced that its ship employees, rather than receiving medical treatment ashore in California (where Princess is headquartered in Santa Clarita), will remain quarantined on the ship. A similar quarantine was uniformly criticized as a failure that spread the coronavirus on the Diamond Princess, resulting in over 700 ill and 8 dead.

Princess has a duty under maritime law to provide ongoing medical treatment to their crew members whenever they become ill. Many reputable cruise lines meet this legal obligation and moral duty by aggressively seeking medical paroles with the U.S. Immigration to permit their foreign ship employees to enter the U.S. for medical treatment. But Princess often refuses to do so, instead sending them from the U.S. back to their home countries to avoid the expenses of medical treatment.

History will soon repeat itself on the Grand Princess. Princess and Carnival, both characterized by federal district judges as recidivist corporate felons for their pollution crimes due to widespread dumping of oil and discharging of plastics, garbage, waste and chemicals, have not bothered to learn the lessons of the Diamond Princess fiasco. For that matter, neither company learned any lessons after a decade of disease outbreaks and failed USPH health inspections. These companies should have directed a fraction of their enormous annual profits over the last decade to hire a team of epidemiologists and scientists to get to the bottom of its disease outbreaks and, in the process, protect the health and lives of its guests and crew.

So it should come as no surprise that Princess is now the poster child of the coronavirus outbreak on cruise ships.

State Department: “U.S. Citizens Should Not Cruise”

And it should have come to no one’s surprise that in the face of Princess Cruises’ negligence and recklessness, the U.S. State Department, at the urging of scientists like Dr. Anthony Fauci and other experienced scientists at the National Institute of Infection, issued an advisory over the weekend stating that “U.S. citizens, particularly travelers with underlying health conditions, should not travel by cruise ship.”

More recently, the CDC’s Dr. Fauci retreated from recommending that all Americans stop cruising, instead stressing that elderly American and particularly ones with underlying medical issues should reconsider travel or vacation via a cruise ship. But as cruise executives try to suggest that suspending cruise operations is an exaggerated response to the now declared pandemic, it’s clear that Princes Cruises and Carnival Corporation have dragged the cruise industry down in terms of income and profits. Moreover, like they did with their widespread pollution, these companies are single handedly destroying the reputation of the cruise industry.

Today Skift published an insightful essay about cruise lines and coronavirus titled Nothing Could Stop the Cruise Industry – But Then Came Norovirus, written by Rosie Spinks. She cited Princess Cruises’ lack of investigation into disease on its ships notwithstanding 25 outbreaks in the last decade. She ended her article quoting me – “without sounding like I told you so, this has been a slow train coming.”

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Photo credit: Diamond Princess – 掬茶 – CC BY-SA 4.0, commons / wikimedia.; Diamond Princess – Daily Mail; Grand Princess Crew Members – Reuters via Daily Mail.