12.7% of the 838 passengers aboard the Viking Neptune cruise ship are experiencing abdominal cramps, vomiting and diarrhea, according to the Centers for Disease Control and Prevention (CDC). Nearly 2% of the crew are also experiencing these symptoms of gastrointestinal illness (GI). Cruise lines are required to report GI cases to the CDC whenever 3% or more of the passengers experience symptoms.

The Viking Cruises ship is currently in Halifax, Nova Scotia Canada and is scheduled to arrive in the United States ( Cape Liberty in Bayonne, New Jersey) on Tuesday. (The Viking ship actually arrived at Pier 90 on Manhattan’s west side for her 2023 summer cruise season from New York City).

As we previously reported, there has been a substantial increase in the number of GI outbreaks (thirteen) on cruise ships in the first six months of this year, compared to previous years. There have been an average of around eleven outbreaks per year for the three year period before the pandemic: 2019 (10), 2018 (11) and 2017 (11).

For the first six months of 2023, Royal Caribbean has been the GI leader with four outbreaks on its cruise ships (Jewel of the Seas, Brilliance of the Seas and two back-to-back outbreaks on the Enchantment of the Seas). Celebrity Cruises has had three outbreaks (Celebrity Summit, Celebrity Equinox and Celebrity Constellation), as did Princess Cruises (Grand Princess, Emerald Princess and Ruby Princess), followed by Holland America Line (Nieuw Amsterdam), P&O Cruises (Arcadia) and Virgin Cruises (Virgin Neptune).

Regarding this latest GI outbreak on the Virgin Neptune, the CDC was unable to determine the “causative agent.”

The Washington Post covered the increased number of cruise ships GI cases two week ago in Stomach Viruses Are Back Up On Cruise Ships, With Hundreds Falling Ill.

The cruise industry’s trade association, the Cruise Lines International Association (“CLIA”), says incidents of gastrointestinal illness are “quite rare” on ships. Cruise lines typically say the symptoms are often mild and resolve quickly. Another talking point of CLIA is the argument that GI outbreaks are always caused by guests failing to wash their hands.

Despite what CLIA says, the fact of the matter is that both the CDC and the Federal Food and Drug Administration (“FDA”) concluded long ago that contaminated food and/or water are the main explanations for norovirus outbreaks.

Recent federal studies show that sick employees were behind a majority of food contamination and foodborne illness outbreaks in the U.S. The CDC found that among outbreaks where a contributing factor was identified, 41% were caused by food contamination from ill or infectious employees.

“If a food worker stays on the job while sick and does not wash his or her hands carefully after using the toilet, the food worker can spread germs by touching food,” according to the CDC’s website. Norovirus is the leading cause of foodborne illness in the United States.

The CDC report concluded that only around 43% of businesses provided paid sick leave to sick workers, resulting in many employees working while contagious.

In the cruise line context, many waiters and food handlers, who are paid almost exclusively by tips, are often reluctant to go to the ship infirmary when they are ill. No cruise line, to our knowledge, provides paid sick leave to their crew members. Unfortunately, there’s an incentive to work while sick on a cruise ship in order to be paid. Two weeks ago, we were contacted by a HAL officer who confirmed that HAL food handlers don’t receive tips (their main source of income) when they are ill. That creates an obvious disincentive to report to the ship doctor and creates the danger of contaminating food being contaminated.

Expect CLIA and the cruise lines to downplay the foodborne illness explanation for this norovirus outbreak and to encourage cruise fans to think that it’s actually their unwashed hands which are to blame.

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June 20, 2023 Update:

Image Credit: Viking NeptuneViking Cruises; CDC logo and artwork – CDC.