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Code Red: Norovirus aboard ship

Posted by Anita Dunham-Potter On June - 18 - 2007

New Jersey resident Larry Harris was enjoying his second cruise aboard Royal Caribbean International’s brand-new ship, Liberty of the Seas, when things started to go awry. His first cruise, the ship’s inaugural sailing, had been relaxing and uneventful, but on the second night of this second sailing, passengers started receiving correspondence from the ship’s captain — not at all a usual occurrence. The problem? The ship’s doctor had reported several passengers with symptoms of infection with a norovirus.

Noroviruses, once called the “Norwalk virus,” are a family of highly contagious viruses that cause a number of gastrointestinal symptoms, including nausea, diarrhea, vomiting and cramping, along with headache, fever, muscle aches and chills. In the confined quarters of a ship, a norovirus can spread quickly. It can definitely ruin your cruise.

By the time Liberty of the Seas ended its cruise in Miami on June 2, 200 passengers and 12 crew members had reported symptoms of norovirus infection. The wonder is that there weren’t more people afflicted. Noroviruses can produce very high infection rates. For example, during an outbreak in April at an assisted-living facility near Washington, D.C., 61 percent of the residents fell ill. The incidence aboard Liberty was just 4 percent. So, how did Royal Caribbean keep the other 3,646 passengers and 1,413 crew members from getting sick?

The Outbreak Prevention Plan

Five years ago, Royal Caribbean was the first cruise line to develop a comprehensive program to help prevent the spread of norovirus infections. Vince Warger, director of medical services for Royal Caribbean and Celebrity cruise lines, worked directly with the Vessel Sanitation Program of the Centers for Disease Control and Prevention (CDC) to come up with the Outbreak Prevention Plan, OPP for short — a comprehensive disinfection program that helps keep passengers from spreading the virus aboard ship. The program has since been adopted by all cruise lines that report to the CDC.

The plan was put into play early on the second day of the Liberty cruise. Michael Sheehan, Royal Caribbean’s associate vice president of corporate communications, says that several passengers reported to the infirmary with norovirus-like symptoms just hours after the ship set sail from Miami. Noroviruses have a one-to-two-day incubation period, so it appears that the passengers had been infected before boarding; unfortunately, they had already spread the virus among the passengers and crew. Seeing the potential for an outbreak, the captain set the OPP in motion.

What exactly does the OPP program entail?

“It’s a three-step process that is color-coded,” says Sheehan. “Code Green is our standard operating procedures — cleaning of cabins twice a day, wiping down handrails, etc. Code Yellow requires more enhanced cleaning of all high-touch areas such as elevator buttons, handles, railings, restrooms, phones, computer keyboards and so on. We may stop passengers from using tongs at the buffet and have only kitchen staff serve guests. Handshaking is also discouraged as this is the most common way the virus is transmitted. Code Red means even more cleaning, more frequent curtailments.”

Larry Harris saw the protocol unfold firsthand. In a series of dispatches from the ship, he noted a proliferation of hand sanitizers and bleach crews all over the ship. He reported that the touch-screen monitors in the common areas were disabled, as were the self-serve ice cream machines, and that the children’s video arcade was closed. Food-service areas got special attention. The Sorrento’s pizzeria and the Johnny Rockets restaurant were closed, and food from the Windjammer Buffet was prohibited on deck. Salt and pepper shakers were replaced by single-serve packets in the buffet area, and as soon as diners finished their meals, staff descended on the tables with bleach in hand.

“The crew is working extremely hard and working overtime,” Harris reported. “They are doing everything they can to keep the ship clean.” Royal Caribbean also brought aboard three additional doctors and one additional nurse. It was a full-scale assault.

Passengers handled with care

Meanwhile, passengers who had contracted the virus were asked to remain in their cabins in order to prevent any further spread of the illness to other passengers and crew.

“We ask guests to have compassion towards their fellow passengers and not spread the illness,” Sheehan says, stressing that the approach is one of voluntary isolation: Guests can either stay in their cabin or leave the ship. If they leave the ship, the cruise line will assist them with travel expenses. In fact, most passengers who became ill in this outbreak chose to stay in their cabins and ride it out.

“We do as much as possible to make them comfortable,” Sheehan says of the cruise line’s policy for cabin isolation. “We call to check on them and whatever they want — be it special room service items or free movies — we try to keep them comfortable.” Guests also receive daily compensation in the form of cruise credits for each day they are isolated and the cruise line takes care of all infirmary expenses associated with treatment for the norovirus infection.

Stopping noroviruses

Both Sheehan and the Centers for Disease Control and Prevention say that frequent hand washing with soap and water is the best and most important preventative against a norovirus infection. “Hand-sanitizing gels are not a substitute,” Sheehan stresses. Many people are surprised to learn that hand sanitizers don’t do as thorough a job as hand washing, but they are just the “icing on the cake,” says Sheehan, not the main line of defense.

If you suspect you have picked up a norovirus before getting on the ship, for heaven’s sake don’t board. Let the cruise line staff know and they will assist you in trying to get better and in making different arrangements for your cruise.

According to Sheehan, Royal Caribbean delayed the departure of Liberty’s next sailing by five hours to provide additional time for cleaning and sanitizing the ship. Those new passengers were given an onboard credit of $25 per person to cover any expenses they incurred while waiting to board. Furthermore, any passengers uneasy about sailing on the ship because of the earlier outbreak were able to cancel without penalty.

As for Larry Harris, he escaped the nasty virus, and he thinks the crew of Liberty of the Seas handled the situation with utmost professionalism. Moreover, the norovirus outbreak didn’t deter him from sailing with Royal Caribbean again. In fact, he has already booked a cruise for next year on its new ship, Independence of the Seas.

Filled Under Ombudsman