Ocean PrincessThe Centers for Disease Control and Prevention (CDC) reported that there is a gastrointestinal outbreak on the Ocean Princess cruise ship, with 43 of 603 (7.13%) of passengers ill during the cruise and 5 of 387 (1.29%) crew members sick.

The Princess cruise ship is currently sailing on a February 13 – March 7, 2016 itinerary. The cruise ship is scheduled to go into dry dock on March 7th.

Princess has 50% of the four cruise ship norovirus that meet the CDC’s criteria so far this year. This should be no surprise to anyone who follows gastrointestinal outbreaks on cruise ships.

As I pointed out in my last article about a gastrointestinal outbreak on a Princess cruise ship (the Crown Princess), during the six year period from 2010 to the current date, Princess Cruises experienced the most norovirus outbreaks on its cruise ships calling on a U.S. port, according to the CDC. Including this most recent outbreak, Princess has reported twenty (20) cases to the CDC during this time period.

In contrast, Carnival cruise lines reported just two (2) cases during the same time period.

Celebrity Cruises reported 15 cases (and Royal Caribbean reported 9). HAL also reported a high number (12) during the 2010 to 2016 time period. Cunard reported 4; NCL -3; Oceania – 3; and Crystal – 2.

Anyone have an explanation why there have been 10 times as many CDC-reported GI outbreaks on Princess cruise ships compared to Carnival cruise line ships?

Photo Credit: Pjotr Mahhonin – CC0, Wikipedia

Passengers on the Anthem of the Seas are stating that as of Monday, as the cruise ship continued to head back to New Jersey for deep cleaning, the captain informed them that 109 passengers are sick with norovirus.

Other passengers also tell me that there are more than this sick, but they don’t want to go to the medical facility.    

According to the CDC, cruise lines are required to provide notification to the federal agency when the gastrointestinal illness (GI) count exceeds 2% of the total number of passengers or crew onboard. The CDC-required notification is for totals for the entire voyage.

There are between 4,180 passengers (double occupancy) and 4,905 passengers (maximum occupancy) on the cruise ship so 2% turns out to be between 83 and 98 passengers. So expect Anthem of the Seas - Norovirusthe CDC to officially announce that the Anthem to be the fourth U.S. based cruise ship with an norovirus outbreak this year. 

The much ballyhooed "severe storm" that supposedly caused Royal Caribbean to cancel two days of the cruise is nowhere to be seen, as passengers report good weather and calm cruising. 

Royal Caribbean, which didn’t mention the topic of norovirus until passengers went to Twitter complaining of the virus outbreak, denied on Twitter that the outbreak was the reason behind returning to port in New Jersey early. But many news sources blended norovirus into the story after an executive with the Associated Press aboard the cruise ship said that the ship’s captain and its cruise director made announcements about norovirus sickening people on the ship.

The AP executive was also quoted saying that the cruise ship "workers are scurrying around like ants, scrubbing down handrails, tables and any other surfaces that can be washed" – an apt although somewhat derogatory description. This is hardly what the cruise line wants the passengers to think about on a cruise marketed as a relaxing pleasure cruise.  

Whoever you believe, whether the Anthem of the Seas is returning to avoid the so-called storm or because of a virus outbreak, there is no doubt that the Anthem’s reputation is being mauled in the court of public opinion.  New York Magazine called her the "bad luck cruise ship."  CNN calls her the seemingly perpetually "storm battered" cruise ship. Some people on Twitter are asking "Anthem of the Seas: Cursèd ship of doom, or just a run of bad luck?"  

Of course, any mention of the Anthem today is accompanied by photos and video of the raucous cruise earlier this month which reminds everyone of the fact that the ill-fated ship sailed into the violent storm.

The "cursed" cruise ship theme was blasted in the headlines of the popular U.K. tabloid newspaper the Daily Mail which asked "Is the Anthem of the Seas Cursed?" The Inquisitr, Newsmax, and the Examiner, among others, all joined the Daily Mail in labeling the Anthem "cursed" in their news Anthem of the SEas Norovirusarticles.   

So the overworked crew members continue to spray and scrub everything in sight. Photos sent to me from the ship show the crew members wiping all rails and counters (photo top) and wrapping a rack of cookies-(photo bottom) with a Saran-Wrap like film, apparently to keep the surfaces and food clean. (I have never seen this before).  

Regarding the crew members who had to deal with storm-frazzled passengers three weeks ago, and are now pressed into non-stop noro-eradication measures, I’m sure that they feel that the Anthem of the Seas may indeed be cursed.

March 1, 2016 Update 5:00 PM:  The CDC disease data-base just listed the Anthem of the Seas. It lists "unknown" rather than norovirus so we may find out that there is some other source of infection like e-coli or something more exotic. 125 passengers and 16 crew members are infected at this point. The CDC recommends sending 10 more crew members and 10 contract cleaners to the ship as well as 4 Hotel and Housekeeping Operations Managers, 3 Public Health staff, one nurse from the cruise line corporate office.   

A newspaper in New Jersey published a story that quotes a passenger on the cruise ship saying that the CDC came on the ship in Puerto Rick and tested for e-coli.  

This evening Royal Caribbean announced via Twitter that that it’s "closely watching a large storm off the coast of Cape Hatteras. We want to be extra cautious when it comes to weather in the area." The cruise line decided that it is canceling the last two days of the current Anthem of the Seas cruise which will skip Barbados and St Kitts in order to "avoid a severe storm & provide guests with a comfortable journey back home."

Is this the same cruise line which recklessly sailed into a much larger storm three weeks ago?

The forecasted wind and wave conditions seem modest compared to the weather conditions forecast prior to the disastrous cruise on February 6th when the cruise ship sailed into waves over 30 feet and encountered hurricane strength winds.

So why the cautious approach today? Is this a cruise line that really learned its lesson?  Is this the result of new decision makers back in Miami who decide whether the Royal Caribbean ships will encounter rough weather? Remember, Royal Caribbean announced that the last storm revealed what the cruise line said were "gaps in our planning system that we are addressing."

Royal Caribbean also said that it was strengthening its storm avoidance policy, and allegedly added resources at its corporate headquarters in Miami to provide additional guidance to its captains. 

So is the decision this evening to cut the cruise short the result of more cautious meteorologists and fewer macho captains?  I doubt it. The weather reports seem pretty tame. 

It seems that the decision to cancel the remainder of the Anthem cruise is motivated more in order to avoid bad press than bad weather. Why? Passengers are reporting that over 65 people have come down with symptoms of the dreaded norovirus. A code red is underway. If there are 65 official reports, chances are that the true number is much higher. There will be what the cruise lines call "enhanced" cleaning when the ship returns to New Jersey on Wednesday in an effort to kill the noro.  Royal Caribbean’s reputation can’t take a massive noro outbreak on the heels of subjecting its guests to a massive storm earlier this month.

So what happens when the cruise ship returns to port 2 days early?  If this were truly just a weather related event, then the passengers, whose flights home are still scheduled two days later, should be able to stay on the ship. But if passengers are forced to leave the ship early for the anticipated super cleaning, it would seem that Royal Caribbean is more concerned with eradicating norovirus from its huge cruise ship than risking its guests encountering another round of rough weather.  

Anthem of the Seas Captain's Letter

The first norovirus outbreak on a cruise ship calling on a U.S. port this year has been reported to the Centers for Disease Control and Prevention (CDC). And, no surprise to anyone that follows cruise ship outbreaks, it involved a Princess Cruises cruise ship. 

The Crown Princess just returned to Los Angeles following a two week cruise from January 3 – 18, 2016. 180 of the 3,060 passengers (5,88 %) aboard the cruise ship were sick with symptoms of vomiting and diarrhea. 24 of 1,168 crew members (2.05%) became ill with gastrointestinal symptoms which the CDC confirmed were due to norovirus.  You can read the CDC report here.

During the six year period from 2010 to the current date, Princess Cruises experienced the most Princess Cruise Ship Norovirus Outbreaknorovirus outbreaks on its cruise ships calling on a U.S. port, according to the CDC. Princess reported nineteen (19) cases to the CDC during this time period. Carnival cruise lines reported just two (2) cases during the same time period.  

Celebrity Cruises reported 15 cases (and Royal Caribbean reported 9).  HAL also reported a high nummber (12) during the 2010 to 2016 time period.

Cunard reported 4; NCL -3; Oceania – 3; and Crystal – 2.  

The Crown Princess alone has suffered through five (5) norovirus outbreaks since 2010 to the present. Before the current outbreak, the last outbreak on the Crown Princess was from October 18 to November 16, 2014. Prior to that, it was February 5 to 12, 2014. It also experienced back-to-back outbreaks from January 29 to February 4, 2012 and February 4 to February 9, 2012 (photo above).

The Crown Princess alone experienced two and one-half time more norovirus outbreaks that the entire fleet of Carnival cruise lines from 2010 to the present!

So why is Princess Cruises far more prone to norovirus outbreaks than Carnival cruise lines, for example?

The cruise industry always blames the passengers for bringing the virus aboard, rather than its food handlers, or contaminated food or water. So are Princess Cruises customers the sickest and the least hygienic cruisers around? Do they wash their hands the least of any cruisers?  That seems like a absurd argument to make.

Is there a correlation between the age of the cruise ships and gastrointestinal outbreaks?  Are different food sources and food handling techniques a more reasonable explanation?  How about different sanitation procedures?  I’m not sure. The CDC doesn’t have time to determine the source of the norovirus outbreak (sick food handlers versus contaminated food or water or a sick passenger) so it is of no help.  

But blaming the passengers when one cruise line (and one cruise ship in particular) has far more gastrointestinal outbreaks than its competitors is certainly not the answer.  

Zika VirusThe U.S. Centers for Disease Control and Prevention (CDC) added eight (8) more destinations to its recent Zika virus travel alert yesterday.

In addition to the 14 countries already on the CDC list (Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti , Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname, and Venezuela), the CDC added these 8 more countries:

Barbados, Bolivia, Ecuador, Guadeloupe, St. Martin, Guyana, Cape Verde, and Samoa.

The Center for Infectious Disease Research and Policy (CIDRAP) states that the move to add countries where a traveler could be injected "follows the CDC’s initial Jan 15 travel advisory recommending that pregnant women and those trying to become pregnant consider postponing travel to countries where Zika virus is circulating, and if they must travel to the destinations they should follow strict steps to avoid mosquito bites."

As we explained in our first article, there is a risk of to pregnant women of having a baby with a small, underdeveloped heads (microcephaly).

This latest development comes at a time when "three travellers who returned to the UK from South and Central America have been diagnosed with the Zika virus."

So far, we have heard of some cruise lines which are cruising to one of the countries subject to the CDC warning are refusing pregnant women to cancel their cruises.  We do not know whether those travel insurance companies are providing coverage when a pregnant cruiser cancels and submits a claim.

The CDC’s Recommendations for Pregnant Women Considering Travel to an Area of Zika Virus Transmission

Because there is neither a vaccine nor prophylactic medications available to prevent Zika virus infection, CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing. If a pregnant woman travels to an area with Zika virus transmission, she should be advised to strictly follow steps to avoid mosquito bites. Mosquitoes that spread Zika virus bite both indoors and outdoors, mostly during the daytime; therefore, it is important to ensure protection from mosquitoes throughout the entire day. Mosquito prevention strategies include wearing long-sleeved shirts and long pants, using U.S. Environmental Protection Agency (EPA – registered insect repellents, using permethrin-treated clothing and gear, and staying and sleeping in screened-in or air-conditioned rooms. When used as directed on the product label, insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women. Further guidelines for using insect repellents are available online (http://wwwnc.cdc.gov/travel/page/avoid-bug-bites).

January 26, 2016 Update: The CDC added  the United States Virgin Islands and the Dominican Republic to the list of destinations with Zika virus disease outbreaks.

Photo Credit: "Aedes aegypti CDC-Gathany" by James Gathany – PHIL, CDC. Licensed under Public Domain via Commons Wikipedia

ZIKA VirusThe New York Times published an article yesterday that should alarm women who are pregnant and thinking about taking a cruise calling on ports in the Caribbean or South America or Central America. CDC May Warn Pregnant Women Against Travel to Countries With Zika Virus written by science and health reporter Donald G. McNeil Jr., says that test results from the CDC seems to establish a link between the mosquito-borne virus and Brazil’s rise in babies born with abnormally underdeveloped heads (microcephaly).

According to Helen Bramswell, an infectious diseases and public health reporter from STAT News, there have been  "at least 3,530 cases of microcephaly and 46 deaths in Brazil since the increasing number of cases was recognized last October. The country saw fewer than 200 cases of microcephaly annually over the previous five years." 

The CDC is thinking about issuing a warning for pregnant travelers against travel to Brazil, as well as other Latin American and Caribbean countries where the virus has spread.  According to the Times, the virus has been located in 14 countries in the Western Hemisphere: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti , Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Suriname, and Venezuela.   

The Times spoke to corporate communications representatives of Carnival. Princess and Royal Caribbean cruise lines who reportedly denied knowing anything about the Zika virus and directed inquiries to their trade association, the Cruise Line International Association.  CLIA suggestions include the same general things suggested to prevent the infection with the chikungunya virus – using mosquito repellents and wearing protective clothes.

According to Caribbean 360, the Zika virus was first detected in humans about 40 years ago in Uganda. It is spread by the same Aedes aegypti mosquito as dengue and chikunguya. The disease was first identified in the South Americas less than two years ago and has spread rapidly across South and Central America.

January 15 2016 Update: It’s Official. U.S. issues travel alert over Zika virus in Latin America, Caribbean.

January 16 2016 Update: CDC alert for Zika virus may curb Caribbean ‘babymoon’ vacations. "The CDC had been urging all travelers visiting areas of Latin America and the Caribbean to take extra precautions against mosquito bites to avoid contracting the virus. But officials upgraded the warning late Friday to a Level 2 travel notice and are now advising pregnant w.men and women trying to become pregnant to consider avoiding travel to the affected areas out of concern that Zika may cause a catastrophic birth defect called microcephaly.

"We likely will see a significant decline in trips by women who are pregnant or trying to conceive to these regions in light of the apparent link between the virus and birth defects,"

CBS Pregnant women warned about Zika virus

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Photo Credit: "Aedes aegypti CDC-Gathany" by James Gathany, CDC, licensed under Public Domain via Commons / Wikipedia.

The accounts of the gastrointestinal outbreak on the P&O Pacific Eden portrayed in today’s Daily Mail are disgusting: overflowing toilets on a dirty ship with barfing, sick kids.  Ill passengers, who paid handsomely for a family cruise vacation over Christmas, complain that not only did their complaints fall on the deaf ears of surly cruise staff members but the cruise captain blamed them for the outbreak in the first place.

Long ago, the cruise industry elected a “blame the passenger” public relations strategy whenever a ship become infected with norovirus. When an outbreak takes place due to contaminated food, the cruise lines accuse the passengers of not washing their hands and ignoring the “washy, washy” p&o Pacific Edeninstructions of the cruise hostesses stationed at the entrance to the dining room who spray sanitizers (which are worthless against norovirus) on the passenger’s hands.

Admittedly, the cruise lines face a PR headache when norovirus breaks out on the high seas. Invariably, the cruise industry faces sensational news accounts from online newspapers that blast cruise-from-hell headlines which include references to “floating petri dishes.” The cruise lines seemingly feel compelled to respond to the media with the same old, worn-out blame-the-passenger game.

Travel agents and travel publications perpetuate the cruise industry’s talking points. Just today Travel Agent Central covered the recent outbreak of an gastrointestinal illness on the Holland America Line Veendam by writing this whopper: “most cases of norovirus are brought onboard by guests.” There is absolutely no empirical evidence of this. Indeed, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration concluded that norovirus is primarily caused by contaminated food or water.

But the last thing that the cruise industry ever wants to admit is that there is a problem with food poisoning on their fleet of ships, or that a cook or food handler, like a waiter who works primarily on tips, worked after exhibiting signs of a gastrointestinal illness and infected the paying guests.

Determining the causative source of an outbreak is the business of an epidemiologist, but have you ever heard of the CDC ever coming to a scientific determination that the cause of a cruise ship outbreak was traced back to a salad which contained contaminated bean Cruise Ship Norovirussprouts eaten by 100 passengers?  Of course not. The CDC does not have the time or inclination to perform such an analysis during the short turn-around in port when the ships quickly re-rack with thousands of other passengers and head out to sea without a firm understanding of the scientific nature of the disease that just sickened its passengers. The lost revenue of a “sick ship,” shut down for a comprehensive epidemiological analysis, far exceeds any legal claims contemplated by sick passengers.

Can you imagine Chipotle, with its recent norovirus and e-coli outbreaks, blaming its customers like the cruise industry does? Instead, Chipotle has already recognized and admitted that it is facing a “food safety” issue. It immediately began to work on an enhanced food safety program. It retained an independent laboratory to reassess its food safety practices that included a “farm-to-fork assessment of each ingredient we use with an eye toward establishing the highest standards for safety.” It also is considering whether the outbreaks are caused by “food poisoning” or “bad employee hand washing.”

The cruise industry, on the other hand, has chosen to focus on short term PR efforts. The only enhancements it engages in are “enhanced cleanings” of its infected ships where everything is sprayed down by crew members, some not even wearing protective suits, in a couple of hours. It’s an impossible task to enlist already overworked crew members to eradicate the billions and billions of noro microbes which are puked in every nook and cranny of the bathroom and into the fabrics of the carpets, couches and blankets in hundreds of cabins in just a few hours. The cruise industry has never dedicated itself to getting to the root of the noro problem which may well point to it’s ships which are always on the go or its sick crew members as the primary source of the problem.

After all, this is the same industry where the exclusive Silversea Cruises brand duped USPH inspectors and hid food in crew member cabins. Butt the real surprise came when I asked crew members on Facebook: Do cruise lines hide pots & pans, galley equipment and food from USPH inspectors? Of the first 100 crew members who answered the poll (admittedly unscientific), around 90% said yes, cruise lines routinely hide galley items from inspectors. One crew member said: “There will be more equipment in the crew cabin during the inspection then in the galley that’s for sure!!!”

That’s not to say that sick passengers are never the cause of an outbreak. Sometimes passengers don’t admit that they are ill and lie on the pre-cruise medical questionnaires. This becomes a real problem when the cruise lines refuse to permit passengers to re-book their cruises when they become ill. And some passengers refuse to report ill to the ship infirmary to avoid the exorbitant shipboard medical bills that follow their arrival. There is no doubt that that shipwide contamination can become worse and the virus can spread via passengers when they refuse to be confined to their cabins.

So yes, passengers are not immune from blame. But every single time there is an breakout, the cruise lines blame the passengers! The blame is automatic and often leveled against the passengers even before it is possible for the CDC to even test the nature of the disease and notwithstanding the fact that the ship may have experienced outbreaks during prior cruises.

One of the books written by cruise expert Professor Ross Klein, “Cruise Ship Squeeze,” addresses this issue. Professor Klein has been recognized as an expert regarding cruise line issues by both the House of Representatives and the Senate before whom he has testified several times. In chapter 8 of Dr. Klein’s book, at pages 179 – 183, he discusses Princess Cruises always blaming the passengers. A dozen years ago during a 2003 cruise, passengers were stricken with a gastrointestinal illness. Princess accused their guests sick with norovirus of “bringing it with them.” But the truth is that during the prior cruise, the cruise ship had experienced passengers sickened with the same sickness. No scientists arrived at this conclusion. And there was nothing remotely scientific about what Princess represented to the public.

Ever since then, Princess says the same thing over and over every time norovirus sickens its guests.

Who needs epidemiologists when the cruise line PR teams and their friends in travel publications have already figured out what to say?

 

Photo Credit:  “Pacific Eden, Fremantle, 2015” by Bahnfrend licensed under CC BY-SA 4.0 via Commons / Wikipedia.

Don’t forget to read:

Another cruise ship hit by norovirus, blames passengers.

“Worse than a one-star motel”: P&O Pacific Eden cruise sees 60 hit with gastro.

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.

 

Tonight I received the following message from a Princess Cruises’ passenger just off the Star Princess:

"I just arrived in Vancouver on the Star Princess. Cruise was September 19 – October 4 2015 Vancouver-Hawaii-Vancouver. I contacted the worst type flu of my life on the 21 September afternoon. By the third day I notified Medical Services after 2 days in bed running a unbelievable fever and was given tamiflu medication. I was sick almost the total cruise and was still coughing when I left the Star Princess.

I am a totally healthy individual, normal weight, & have no history of illness in years. Later, I heard many were sick on the ship, the Captain announced 2 separate viruses on board. We were 3 days from Star Princess returning to Vancouver before they started taking precautions in the dining areas.

We have traveled by ship for many years & all has been great until this trip. The worst & most expensive holiday of my life. The cruise ship needs to be held accountable for their careless hygiene on board & should give some compensation to individuals suffering such a miserable vacation. They keep piling them on larger & larger ships without any regard for the individuals exposed to all the germs being circulated. Extreme cleanliness was exercised only when there is a outbreak on board.

I feel for the elderly who are not in good health & are being exposed to these terrible viruses."

The press in Canada has picked up on the story. CBC News reports that a least one norovirus-stricken Star Princess passenger flew home from Hawaii, instead of cruising back to Canada. When the Princess cruise ship docked this morning in Vancouver, two passengers were transported by ambulance from the dock to hospital with norovirus. 

Princess told the newspaper that there were allegedly 78 people infected with norovirus during the two week cruise. The actual number is probably higher than that because many passengers do not report their symptoms and the cruise lines are quick to under-report the disease outbreaks.

Despite the extended outbreak during the last 2 weeks, the Star Princess is scheduled to depart tonight after a so-called "enhanced cleaning." 

The Star Princess had a noro outbreak last May.  

Princess Cruises has experienced 4 of the last 11 cruise ship norovirus outbreaks reported to the Centers for Disease Control (CDC).

Photo Credit – Jim Walker

RyndamCruise Critic is reporting that the Holland America Line (HAL) Ryndam cruise ship is a code red situation with a gastrointestinal virus sickening passengers sailing from the U.K.

The HAL cruise ship is returning to port in Harwich a day early, this Friday July 3rd, in order for the crew members to conduct what is called a "deep cleaning" before the next round of passengers arrive, according to Cruise Critic. 

HAL says that a "high number of guests reported to the infirmary" during the current cruise. HAL has not disclosed the actual number of sick guests or crew members.

HAL thinks that norovirus is involved. 

As is the case with virtually all cruise-related norovirus cases, there has been no disclosure of the cause of the viral outbreak (i.e., contaminated food or water, crew members working while ill, or – the cruise industry’s favorite excuse, cruise passengers who don’t wash their hands).

There have been nine norovirus cases officially reported to the U.S. Centers for Disease Control and Prevention (CDC) in the last six months of this year.  Many other outbreaks have occurred outside of the U.S. jurisdiction.  

Photo Credit: Roger Wollstadt CC BY-SA 2.0 via Wikimedia Commons