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Mild symptoms
Orla O’Sullivan looks at how the cruise industry has reacted to
H1N1 – swine flu – in light of modest contagion rates.
From the extent and tone of early
media reports of the H1N1 virus, it
seemed that ‘swine flu’ was as
ominous as a modern-day plague.
The disease broke out in Mexico City
in March 2009, resulting in a swift death
toll that drew attention from around the
world. By late April, all major cruise lines
had discontinued travel to Mexico,
following an advisory from the US Centers
for Disease Control (CDC).
However, by December an update by the
World Health Organisation (WHO) reported
that the H1N1 death toll was fewer than
10,000 people. According to a WHO report
published in 2003, normal or ‘seasonal flu’
kills up to half a million people.
While the virus may not have caused the
high death toll predicted by many, its
presence and perceived threat made the
cruise industry sit up and take notice,
especially when, in May, two cases were
confirmed on an Alaskan liner.
Indeed, the threat of the virus on cruising
was heightened when the Pacific Dawn, a
unit of Carnival’s Princess line, became
dubbed the “swine flu ship” after it became
known that some of the 2,000 passengers
were confirmed to have H1N1 and
Australian authorities had diverted the
South Pacific cruise from its intended
course to the Barrier Reef. The company
issued a statement at the time of the
outbreak detailing its “abundance of
caution” on board its vessels.
Government protectionism soon hit
Royal Caribbean Cruise Lines (RCCL). The
Ocean Dream, operated by Pullmantur, a
Spanish unit of RCCL, had to cut short a
Caribbean cruise after being denied dock in
Barbados and Grenada and delayed
embarkation in Venezuela.
“When you think of a large cruise you
think of a biological island,” notes Dr
Phyllis Kozarsky, an expert consultant in
the CDC’s division of global migration and
quarantine. But she warns against singling
out cruising. “It’s no different from people
being in any other space for a long time;
planes, buses or crowded shopping malls
before Christmas.”
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Preventive medicine
Michael Crye, executive vice-president of
technology and regulatory affairs with the
Cruise Lines Industry Association (CLIA),
is realistic about the threat of the virus.
“The morbidity rate of this virus is way
less than with avian flu,” he notes, “The
important thing is that more people are
susceptible to this illness than a normal
seasonal flu.”
It’s not surprising that cruise industry
sources suggest that their biggest
challenge is the perception of H1N1 and
arbitrary government reaction to it rather
than the virus itself. “As our knowledge of
the virus has evolved, our concern has
diminished,” says Dr Art Diskin, vicepresident
and global chief medical officer
with RCCL.
Gary Bald, corporate senior vicepresident
of safety, security,
environmental, medical and public health
with RCCL, adds: “There’s a reaction that
isn’t consistent with the concern. For
example, a particular port that reacts in an
unexpected way can cause challenges and
disruptions. We call ahead to the port to
ensure that we won’t have surprises, if a
particular island or nation has never had
H1N1 and we’re coming in with one case
on board.”
The recommended ways to prevent
people catching H1N1 are the same
as for regular flu, or most communicable
diseases: an array of hand-washing;
cleaning and sanitising common areas;
and isolating the infected as early and as
much as possible.
One industry-wide change CLIA
initiated in the spring of 2009 was a
questionnaire and secondary screening at
the point of embarkation. Depending on
how passengers answer and look, they
may be further evaluated by medical
personnel, including, for example, having
their temperature taken. MSC cruises
has even installed thermal-imaging
cameras in Italy to detect possible fever/
flu at embarkation.
Carnival spokesman Vance Gulliksen
echoed others in saying that the numbers
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of those turned away at embarkation
would be “extremely small”.
As with other operators, Carnival has
educated crew and customers on H1N1
and carries anti-viral medications on board.
Since the disease is viral, not bacterial,
drugs will not kill it, but can lessen
sufferers’ symptoms and their duration.
However, Carnival has not added any
new sanitation procedures specifically to
address H1N1 beyond those routinely used
to prevent communicable diseases.
Gulliksen says the company’s protocols are
“extremely effective” already.
Kozarsky is more cautious: “Most think
H1N1 doesn’t take the form of tiny droplets
that become airborne, but it’s hotly
debated.” She stresses vaccination and
hand washing as the best protections and
warns that consumers might be disinclined
to admit that they are ill and forfeit their
vacation plans.
Bald says RCCL has impressed on
staff to pay closer attention to tell-tale
signs that someone might be sick:
“someone not coming out of their cabin or
cancelling dinner.”
Even if cruise officials get involved,
Diskin says, “We don’t know if they have
H1N1, only that they have flu-like
symptoms.” The screening tests on board,
are very inaccurate, with just a 15% to 50%
hit rate, he adds.
Cruise operators have the right to isolate
contagious passengers and to put them off
the ship if they do not comply. They are also
urged to minimise the number of crew
catering to sick passengers.
“It’s not altogether an honour system,
because we’re obliged to contain diseases,
but we do a lot of things, like providing
movies, to help make the time pass,”
Bald says.
With the worse of the virus seemingly
passed, there is still concern for the future.
“Our biggest concern is that the virus
could mutate, grow and become resistant to
medication,” Diskin says, but he hopes the
worst is over. “Historically, pandemics have
three waves, so we may have one next year.
The third wave tends to be mild.”
Kozarsky is also cautious. “We have to
see. We have yet to go through the typical
influenza season, which peaks in the
New Year.”
All she can say with certainty about the
cruise industry overcoming H1N1 is that
“Everyone is making a good effort and a
stronger effort than ever.” �