AdoniaThe Centers for Disease Control and Prevention (CDC) reports that there was an illness outbreak on Fathom’s Adonia this past week (October 16 – October 23, 2016).

The CDC states that 23 of 668 (3.44%) passengers reported being ill with diarrhea and vomiting during this voyage which returned to Miami from Cuba yesterday. Only 2 out of the 388 crew members were reportedly sick.   

A CDC environmental health officer boarded the ship when it returned to Miami.

The CDC has not determined the cause of what appears to be a gastrointestinal outbreak.  

Fathom increased its cleaning and disinfection procedures for the cruise ship.

Fathom’s historical first cruise on the Adonia cruise ship to Cuba was plagued by a norovirus outbreak. The captain of the ship announced a gastrointestinal outbreak with the passengers experiencing symptoms consistent with norovirus on the ship last May. Carnival later contradicted the captain and said that there was no confirmation that the passengers were sickened by norovirus.   

The Adonia also suffered a complete blackout last May and was ordered to return to the port of Miami when it regained power.  It had earlier failed U.S. Coast Guard inspections in April when it arrived in Miami from P&O Cruises when it was being readied for cruises to Cuba and the Dominican Republic.

The Adonia is currently sailing to Amber Cover in the Dominican Republic.

Photo credit: By Alessandro Ambrosetti from Rome, Italy – Fathom Adonia, CC BY 2.0.

Majesty of the SeasA passenger from Ohio who sailed aboard the Majesty of the Seas last November and developed Legionnaires’ disease has filed suit against Royal Caribbean. The passenger alleges that only after he boarded the cruise ship in Miami, and the ship had set sail, did the cruise line notify him, via a notice placed under his door, that Legionella had been discovered in the ship’s water system on prior cruises.

Legionnaires’ disease is one of the most serious diseases a passenger can contract on a cruise ship. Legionnaires’ disease is a severe pneumonia caused by inhalation or possibly aspiration of warm, aerosolized water containing Legionella organisms. According to the Centers for Disease Control (CDC), contaminated ships’ whirlpool spas and potable water supply systems are the most commonly implicated sources of shipboard Legionella outbreaks. Symptoms include a cough, shortness of breath, high fever, muscle aches and headache. Although prompt antibiotic treatment can kill the bacteria, 5% to 30% of people infected with Legionella will die from the infection.

After the cruise ended on November 13, 2015, Royal Caribbean sent an email to the disembarking passengers, stating that they may have been exposed to Legionella during the cruise. It stated that if passengers become ill, they should seek medical attention and undergo testing for Legionella.

Royal Caribbean stated that two passengers had been confirmed to be infected with Legionnaires’ disease from the cruise ship, and that one person was possibly infected. One person was infected during a cruise in July 2015 and one other person was infected during a cruise in October 2015. The email stated that Royal Caribbean had shut down the whirlpools on the ship after it confirmed the first case of Legionnaires’ disease associated with the July sailing. The cruise line claimed that it treated the ship’s water supplies with extra chlorine (the email mentions “two rounds of treatment with chlorine”), but water samples taken from showers confirmed the presence of Legionella.

Royal Caribbean also sent the email to those people who had booked cruises on the Majesty on future dates, advising that the risk of illness is “low but not zero” and suggesting to future cruisers that they may want to reschedule their cruises for a later date depending on their individual risk factors.

A few days after returning home, the passenger began experiencing symptoms consistent with Legionnaires’ disease. He visited his doctor on an urgent basis and he was immediately hospitalized. His lawsuit lists kidney, heart and pulmonary failure among other complications which he suffered as a result of the disease which he contracted on the cruise ship.

The lawsuit alleges that Royal Caribbean was on actual notice of Legionella on its ship but notified the passengers only after Majesty sailed and was at sea. In addition to alleging that the cruise line was negligent, the lawsuit states that the cruise line “acted with deliberate and wanton recklessness” in refusing to advise passengers of the Legionella prior to the cruise. Royal Caribbean, the lawsuit alleges, acted in “callous disregard” of the dangers to the passenger’s health in order to promote its economic interests.

The lawsuit seeks punitive damages, in addition to compensatory damages, due to the cruise line’s intentional misconduct.

The lawsuit was filed by Miami maritime lawyer Domingo Rodriquez.

There was a discussion regarding Legionnaires’ disease and this particular cruise last year on the Cruise Critic boards. If the comments are accurate, some of the passengers apparently were not notified of the Legionella on the ship during the cruise but were notified only after the cruise was over. At least one person commenting said that he sailed on the cruise ending November 13, 2015 but never received an email from the cruise line. One poster mentioned that a family member who was on the cruise was allegedly admitted to the hospital with Legionnaires’ Disease. She stated at the time: “we did not get the email about the ship being contaminated until the afternoon of Nov. 13, after we had just gotten off the ship . . . This was very irresponsible and unethical on Royal Caribbean’s part.”

In my opinion, it is outrageous that Royal Caribbean kept sailing the Majesty if it knew that the ship’s water supply was still contaminated with Legionella after multiple “extra-chlorine” treatments. It is Legionellaprobable that some of the passengers or crew members would become sick because, obviously, passengers are going to shower during cruises. Unfortunately, we have seen this cruise line take the “show-must-go-on” attitude to extremes over the years, whether it is recklessly sailing into hurricanes or repeatedly exposing its passengers to noro virus on successive cruises.

There have been a number cases of Legionnaires’ disease on cruise ships over the years. The most infamous case involved the Horizon cruise ship operated by Royal Caribbean’s sister cruise line, Celebrity Cruises (before it was purchased by Royal Caribbean), back in 1994.

Following a deadly shipboard outbreak which caused Celebrity to cancel cruises and fly passengers back from Bermuda, passengers sued Celebrity alleging that the company defrauded them by refusing to disclose that Legionella was present on the cruise ship. An Associated Press writer wrote that: “on Saturday passengers on the cruise ship Horizon were told the risk of contracting Legionnaires’ disease on board was low. On Tuesday they were hustled off the ship in Bermuda as a precaution.” (Numerous passengers were nonetheless infected). The AP quoted passengers as saying at the time: “everyone is entitled to a worry-free vacation and this has been anything but that” and “the people who operate this line should be chastised” and “what they did to the passengers is unconscionable.”

Celebrity subsequently sued the manufacturer of the ship’s pool and whirlpool equipment, alleging that extensive press coverage of the disease outbreak stigmatized the company, thus hurting its reputation and reducing its profits. Celebrity obtained a $193 million verdict, although an appellate court subsequently reduced the verdict.

Regarding the recent outbreak, if Royal Caribbean was uncertain whether the Majesty of the Seas still had Legionella in its water system, merely warning future passengers that the risk of illness was “low” but not canceling cruises was, at a minimum, irresponsible. Not informing passengers who cruised on the ship of the disease until after they sailed is truly reprehensible conduct.

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Photo credit: Top –  CC-BY-SA-3.0/Matt H. Wade at Wikipedia; bottom – By CDC (PHIL #1187) – CDC Public Health Image Library, Public Domain.

Legionella Royal Caribbean Email

Legionella Royal Caribbean Email

 

Norwegian GemEarlier this week, we reported that health officials banned the Norwegian Gem from calling on St. Maarten because a number of passengers were ill with a gastrointestinal illness. The NCL cruise ship then sailed on to Tortola where it called on the port there.

The Centers for Disease Control and Prevention (CDC) is now officially reporting that 128 of 2,882 cruise passengers (4.44%) and 7 of 1,100 of crew members (0.64%) on the Gem have been ill during the cruise with norovirus. 

Although it was suggested on the cruise ship that the cause of the outbreak may be contaminated water, there has been no information released to the public confirming or excluding this possible cause. Norovirus is primarily a food-borne disease. Outbreak News Today correctly states that "norovirus is typically spread through contaminated food and water, touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth and close contact with someone who is vomiting or has diarrhea."

Unfortunately, the CDC has limited resources and does not attempt to conduct an epidemiology assessment regarding the source of the norovirus outbreak.    

Photo credit: Corgi5623 at English Wikipedia, CC BY-SA 3.0.       

The Centers for Disease Control and Prevention (CDC) states that fifty-seven (57) of 1429 passengers (3.99%) and ten (10) of 588 crew members (1.70%) have been reported ill with gastrointestinal illness aboard the Veendam cruise ship operated by Holland American Line.

The CDC has yet to figure out what type of outbreak is involved. It is probably norovirus, as was the case in the last 11 GI cruise ship outbreaks this year. A CDC environmental health officer will board the HAL cruise ship at the end of the cruise in San Diego, California on December 27, 2015.

The Veendam had its last norovirus outbreak in 2014, in February.

 

Cruise lines owe their crew members the absolute legal duty of providing medical treatment when the crew become sick or injured on the company’s cruise ships.

Pursuant to the “maintenance and cure” doctrine, the cruise line is required to provide “maintenance” (room and board) and “care” (medical care and treatment) to the point that the crew member reaches his or her “maximum medical improvement.”

This ancient legal doctrine of protecting seafarers can be traced back to the Medieval Sea Codes. It was introduced into United States Maritime Law by the Supreme Court in 1823. Under the doctrine, Hotel Food Greasy Salty Disgustingthe cruise lines has an affirmative obligation of taking care of their injured employees in a manner which is no different than the natural responsibility of a mother or father to a child, the courts have analogized.

But putting pleasant-sounding legal theories aside, in reality the practice of the cruise lines today is quite different. When a crew member hires a lawyer, the cruise lines put the sick crew member in dirty, low-rent hotels where they feed them disgusting food. Unfortunately, the Miami-based cruise lines act like resentful uncaring parents who neglect their responsibilities.

Royal Caribbean: When I first began representing crew members in the 1990’s, Royal Caribbean used to house their injured crew members in a hotel close to South Miami Hospital. It was a nice, safe hotel with good food where crew members could go to and from the hospital with little inconvenience. But as soon as the crew member hired a lawyer, the cruise line would retaliate against their sick employee. Royal Caribbean would immediately kick the crew member out of the hotel and send them to a dump-of-a-hotel near I-95 and 163rd Street.  The area was known as a hang-out for drug dealers and prostitutes. The hookers would use the dirty hotel rooms on an hourly basis. It was a dangerous and demoralizing location for ill crew members to try and recuperate.

More recently, Royal Caribbean uses a hotel in Miami hear 8th Street. Here are some of the descriptions on Trip Advisor:

“This hotel is absolutely horrible! Do not stay here. Management is awful. Toilet overflows constantly and cleaning crew does not help. . . Stay away from this hotel. Don’t even spend a $1 on this hotel.”

“Nothing good about this place . . . the room has no air conditioner or working fan. The bathroom was disgusting and had a terrible odor coming from the sink. Next thing, it was 11 pm and there were people just screaming for ages in the hallways . . .  Don’t stay here!!!

Crew members at this hotel complain regularly about roaches, no hot water, inedible greasy salty food (photo above by crew member), extra charges for bottled water, malfunctioning televisions, and unsanitary bathrooms.

Carnival:  We receive the same type of complaints from crew members on sick leave in the hotels which Carnival selects especially for its injured crew members who are represented by lawyers. It’s a disgraceful practice. One crew member undergoing back surgery sent us a video below of a rat that lives under the buffet in the crew member dining room.

We complained to Carnival, but it could care less.

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The Centers for Disease Control and Prevention (CDC) has documented passengers sailing on Royal Caribbean’s Grandeur of the Seas out of Baltimore have been sickened on two consecutive cruises. 

The CDC website reflects that 97 passengers and 8 crew members on the Grandeur of the Seas became ill with vomiting and diarrhea. It left April 5 for a seven-day cruise and returns to Baltimore today.

Royal Caribbean Cruises notified passengers who will be boarding today to arrive late at the port Grandeur of the Seas - Baltimore - Noro Virusbecause the cruise ship will undergo another round of the so-called "enhanced cleaning."

The Associated Press indicates that Royal Caribbean believes norovirus to be the cause.

As is the situation with virtually all gastrointestinal outbreaks on cruise ships, the CDC has not announced an explanation how the outbreak took place. Contaminated food? Contaminated water? Sick crew members working while ill in the galley or dining rooms? Cruise passengers not washing their hands? (the cruise lines’ usual excuse). Your guess is as good as mine.  

This is the second consecutive cruise on the Grandeur with a illness outbreak, The CDC reported that 111  passengers and 6 crew members became ill with norovirus on the Grandeur during its cruise from March 28 to April 5. You can read our report here.

The CDC has documented a total of 8 gastrointestinal illness outbreaks on cruises returning to a U.S. ports so far this year. (There was also a norovirus outbreak aboard the P&O Oriana recently). There were just 9 outbreaks in all of last year. Norovirus is cited as one of the reasons the public has less confidence in the safety and reliability of cruising, especially from people who have never cruised before.

This week we were contacted by many cruise passengers asking whether they could cancel the cruise which leaves today because of the ongoing outbreak. Unfortunately the cruise lines hold all of the cards in cases like this.  Fear of becoming sick is not a legally recognized reason to cancel a cruise and expect a refund. However, it all depends on the goodwill of the cruise line. A FOX News report indicates that the spokesperson for Royal Caribbean, Cynthia Martinez, said "if passengers don’t want to take Saturday’s cruise, Royal Caribbean staff will help them reschedule." 

You can contact Ms. Martinez on Twitter – @CrisisCommChick / telephone (305) 982-2458 / email cynthiamartinez@rccl.com

Suing a cruise line for compensation when exposed to a gastrointestinal virus is a losing proposition because the CDC does such a poor job trying to determine the cause of the outbreak. In this most recent case the CDC has not determined the type of virus much less how the virus came on the cruise ship.

The last message we received was last night: "I will be traveling on the Grandeur this Saturday as well and our check in time was delayed 4 hours! I will be bringing my own bleach wipes on board. Wish us luck!"

Good luck!

Photo Credit: WBAL Baltimore

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Multiple news sources are reporting that an outbreak of a gastrointestinal illness has stricken "at least 66 passengers and 17 crew members" aboard Princess Cruises’ Crown Princess.

A spokesperson for Princess Cruises says that the nasty digestive bug is likely norovirus. 

There have been 6 prior gastrointestinal outbreaks on cruise ships calling on U.S. ports this year. There were just 9 in all of last year.

We have been contacted by passengers complaining that passengers were sick and there was a strong smell of vomit in the hallways.

Norovirus has plagued the image of the cruise line. There was a massive outbreak aboard Royal Caribbean’s Explorer of the Seas in January. A recent Harris Poll revealed that norovirus was one reason why the public does not perceive cruising as safe or reliable.  

We previously reported on a norovirus case involving the Crown Princess – Here We Go Again: Norovirus Sickens 100 Passengers on Crown Princess Sailing to Galveston

April 10 2014 Update:  The infected count is now at 104 passengers and 25 crew members on the Crown Princess. 

 

http://edition.cnn.com/video/api/embed.html#/video/health/2014/04/10/mxp-norovirus-princess-cruise-ship-california-coast.hln

 

The Centers for Disease Control and Prevention (CDC) reports that 111 out of of 2122 passengers (5.23%) and 6 out of 790 crew (0.76%) have reported ill with gastrointestinal illness involving vomiting and diarrhea. The Royal Caribbean ship was on a 7 day cruise from Baltimore.

You can read the CDC report here. The CDC hasn’t figured out yet whether the gastrointestinal outbreak was caused by norovirus. 

Cruise expert Professor Ross Klein reports that cruise passengers have received the following Grandeur of the Seasinformation in an email:

"Hello, this is Royal Caribbean International. We would like to provide you with some important information regarding your Saturday, April 5th, sailing onboard Grandeur of the Seas out of the Port of Baltimore. During the ship’s last sailing, a number of guests experienced a gastrointestinal illness. We will conduct enhanced sanitizing onboard the ship and within the terminal to help prevent any illness from affecting your cruise. Therefore, your check-in and boarding will be delayed. Because space and seating in the terminal is limited, we ask that you not arrive to the port before 2:00 PM. Check in will take place between 2:00 PM and 4:30 PM."

I always wonder about the effectiveness of "enhanced cleaning" when the CDC can’t determine what the disease is much less how it can aboard the cruise ship.

Any passengers cruising this week please let us know whether the virus was eradicated or whether the outbreak continues.

 

 Photo Credit: Wikipedia / J. Glover

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. 

Cruise Ship NorovirusWhen 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 Cruise Norovirussick. 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 Cruise Ship Noroviruspassengers.

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. 

Explorer of the Seas Norovirus CleaningThe Explorer of the Seas arrived back in port in New Jersey yesterday.

ABC news interviewed some of the sick passengers. Its video below shows one passenger being taken away in an ambulance. ABC calls the incident a "horrific outbreak at sea." 

Incredibly, even though this is the largest gastrointestinal illness outbreaks on a cruise ship in 20 years, the Centers for Disease Control and Prevention (CDC) still has not officially announced what is causing the widespread illnesses.  In addition, the CDC has not declared how the virus came on the ship. It is an impossible task for a single epidemiologist to make such a determination. Without figuring out where and how the virus started, it seems difficult to take steps to eradicate the virus and make certain that the ship is safe to sail on.

The cruise line crew members are busy spraying, wiping and scrubbing. The ship sets sail again tomorrow. I say good luck to the next round of guests.