Norvirus hysteria is in full swing once again, with reports that 200 people on two cruise ships suffered from outbreaks of the disease in the same week.
On Royal Caribbean’s Legend of the Seas, 142 of the 2,494 passengers and crew aboard reported illnesses. And on Celebrity Cruise’s Infinity, 112 of the 3,081 people on board were sickened. Both ships are owned by Royal Caribbean. And both had left Fort Lauderdale at the end of March for ill-fated 15-night cruises.
So now, we’re treated to a new round of headlines blasting cruises as norovirus incubators; in its headline on the story, Salon referred to the stricken cruise ships as “Vomit Ships.” Never mind that the CDC says the vast majority of the nation’s 20 million annual norovirus cases occur on land, particularly hospitals, nursing homes and dormitories (only about 1 percent of the national cases occur on cruise ships). Or that last year there were only about 1,500 passengers stricken by norovirus out of the more than 21 million people who went on cruises.
“Norovirus is not a cruise ship illness,” says Dr. John Bradberry, an Atlanta area physician and the former medical director for Carnival Cruise Lines. “It’s a land-based illness that gets brought on to cruise ships by passengers for the most part.”
Still, fairly or unfairly, bad perceptions exist. And then there’s the fact that the year isn’t even half over and the CDC says we’ve already had four confirmed cruise ship norovirus outbreaks. In each of the past two years, there were eight.
With all that norovirus information out there, it can be hard for cruisers to know for sure what you need to be concerned about and what’s merely overblown hype — to say nothing of how to protect yourself. So Yahoo Travel is taking a just-the-facts approach to look at the seven things that can help you guard against norovirus.
A cool look at an ugly disease: Norovirus (Photo: Thinkstock)
Using the “knowledge is power” philosophy, the first line of defense against norovirus is knowing what it is.
“Norovirus is a fiercely contagious virus with a relatively short incubation period,” says Dr. Bradberry, referring to the time it takes to become ill after getting infected with the virus (usually 12 to 48 hours, says the CDC). “That’s why so many people can get sick, for example, on a cruise ship. They get infected with the virus and within 24 hours they’re typically ill.”
The CDC says that in cases where they were able to identify the source of contamination, 70 percent were caused by infected food workers. While it can also be transmitted via the air and through human-to-human contract, Dr. Bradberry says there’s one means of transmission that’s extremely common on cruise ships.
“It’s usually passed on indirectly, typically though surface contamination,” he says. “So somebody who has the virus will have it on their hands and contaminate a surface — a hand rail, the button on the elevator, eating utensils. And then another person comes along and touches that same surface, gets it on his or her hands, and ends up contracting it.
Cruise ships are full of surfaces touched by hundreds of people — surfaces that could be contaminated with the norovirus. (Photo: Thinkstock)
Unfortunately, Dr. Bradberry’s knowledge of norovirus is more than professional. “I’ve had it three times,” he says, quickly adding that it was never on a cruise ship. “In nine years of eating three meals per day while working on board the fleet of Carnival cruise ships, I never once contracted an illness from [norovirus].”
While Dr. Bradberry says norovirus is only a mortal threat to the very old, the very young and the sick, it is a miserable experience. “It makes you feel like you’re going to die,” he recalls. “I remember thinking, ‘I’m glad I’m a doctor and understand what’s going on. Because I would otherwise think I’m going to die.’ That’s how bad a person feels.”
Norovirus likely won’t kill you. It’ll just feel like it could. (Photo: Thinkstock)
Fortunately, he says, norovirus tends to leave as quickly as it came in, usually after about 24 to 48 hours. During that time, Dr. Bradberry says it’s extremely important to stay hydrated.
Washing your hands
Not to sound like a broken record, but washing your hands really is the best defense against norovirus. (Photo: Thinkstock)
Hand washing is the number one way to protect yourself on a cruise ship. “Never eat without washing your hands immediately before going to dinner,” Dr. Bradberry says. “Hand sanitizers can help but they absolutely cannot replace hand washing.”
And what about the self-serve buffets that you see on cruise ships, where you’re getting your food with tongs, ladles, and spoons that had just been touched by hundreds of fellow passengers? I have yet to suffer a cruise ship illness (knock on wood), and I shared with Dr. Bradberry how I deal with buffets when I’m on a cruise. Not only do I wash my hands before entering the buffet; after I get my food, I put my plate on the table for my friends to watch, and then I go out and wash my hands again.
Your hands may be clean, but what about the last guy to touch those tongs in the buffet line? (Photo: Scott/Flickr)
Yes, it’s a little OCD, but the doctor was impressed. “The buffet line is identified as a high-risk area,” he says, approving of my dual hand washing routine. “Anyone who does that, their odds of getting norovirus on a cruise… I wouldn’t say they’re zero but they would be very, very close to nil.”
Watching your hands
Watch what you touch! (Photo: Thinkstock)
There’s no reason to walk around a cruise ship in a hazmat suit. But while you’re on board, it’s not a bad idea to always be mindful where you put your hands. I try to catch myself whenever I find myself absent-mindedly running my hands along a railing. Dr. Bradberry is also careful. “Try to use your elbow whenever possible,” he says. “When I’m in a public restroom I will not touch the toilet; I’ll use my foot if need be to flush the toilet.” That’s a pretty good rule for land, too.
Make a new friend on the cruise? Great! Pound it out! (Photo: Thinkstock)
“In the past, cruise captains would have a greeting line when they would shake hands with everybody,” says Dr. Bradberry. But now that the entire cruise industry is hyper-vigilant about illnesses, that tradition has mostly gone overboard. “Shaking hands is so high-risk,” says Dr. Bradberry. He prefers the standard fist bump as an alternate way to greet the new friends you meet on board. It’s healthier. And it makes you look cooler.
Watching What You Eat in Ports of Call
Something you’ll never see Dr. Bradberry doing: eating from a street vendor at a port of call. (Photo: Thinkstock)
Remember: on the whole, norovirus is primarily a foodborne illness. And Dr. Bradberry feels passengers are pretty well protected on cruise ships, especially when it comes to dining. “Main line cruise ships typically adhere to rigid food sanitation standards,” he says.
But once the ship docks and passengers disembark to see the sites and sample the local cuisine, the game changes entirely.
“In ports of call with food and restaurants there, pretty much all bets are off,” Dr. Bradberry says. And while Dr. Bradberry says well-known hotels and restaurants and/or major city ports of call generally are safe, food preparation can be a gigantic question mark in other places.
“I emphatically recommend to never, ever consume food procured from a street vendor in ports of call — especially in third world ports of call,” Dr. Bradberry says. “There’s no telling what sanitation procedures they’re taking. A food handler that has norovirus can contaminate plates of food. It’s much safer to go back on the ship to eat.
Respecting the Quarantine
Sick passengers often are ordered to stay in their cabins. Whether they actually do is another matter. (Photo: Thinkstock)
In serious cases when passengers are showing norovirus symptoms, the ship will confine them to quarters to keep them from spreading it throughout the ship. Unfortunately, some passengers don’t comply — and cruise ships generally won’t force them to.
“It certainly puts the hotel department and the ship’s command in an awkward situation,” he says of passengers who break their quarantine. “I’ve seen times when [the ship’s command] would turn a blind eye to it; they’d just kinda shrug their shoulders and say, ‘Well, we’re not gonna put somebody in jail.’”
Dr. Bradberry continues. “That was frustrating,” he says, recommending the cruise industry find better ways to ensure passengers comply with isolation orders. “It is very irresponsible and inconsiderate for someone with norovirus to not adhere to the isolation order from the ship’s doctor,” he says. “Some people are more concerned about their vacation than about public health.”
A cruise ship crew member wipes down the deck in 2002. Since then, cruise ship disinfecting methods have gotten more high-tech. (Photo: AP)
Earlier this year, I had a chat with Adam Goldstein, President and COO of Royal Caribbean Cruises and chairman of the cruise industry trade group, Cruise Lines International Association (CLIA). He detailed how seriously CLIA and all the cruise lines are taking norovirus and trying to find new ways to fight it. “There’s a lot of effort and inquiry into technology,” he said, “what types of technologies exist today, or could exist, that can demonstrably kill the virus and stop it from being spread.”
Last year, Golstein’s cruise line, Royal Caribbean, invested an additional $2 million in a company, ByoPlanet, that markets high-tech disinfectant sprayers that use an electrical charge to get disinfectants into hard-to-reach areas like under tables.
High-tech spray is a good start, says Dr. Bradberry. But the problem is the same as with all disinfectants: yes, they kill the germs on contact, but then they dry out. “Shortly thereafter, the surfaces can get re-contaminated by people carrying the virus,” he says.
A new sprayer uses electrostatic technology to get cruise ship disinfectants into hard-to-reach places. (Photo: ByoPlanet International)
The key, Dr. Bradberry says, is to find a disinfectant that kills viruses even after they’ve dried out. “There’s one company, Next Level 11, that has a product called MicrobeCare that, preliminary evidence indicates, even after it dries it has a long-term anti-viral effect — potentially months.” says Dr. Bradberry.
But Dr. Bradberry cautions that technology is still in its developmental stages. In my chat with Royal Caribbean’s Adam Goldstein, he also warned against the danger of getting too gung-ho over technology, especially when it comes to this tricky illness.
“You know, like in a lot of things in medicine and health, you really have to be careful not to over-promise and under-deliver,” Goldstein said. “I can’t tell you there’s going to be some monumental breakthrough in the next few months or even the next few years. I can tell you that there’s an effort in place — A lot of really smart people working on this together.”
So for now, the effort to fight norovirus on cruise ships will rely on the same methodical, but stubbornly imperfect, tactic: stopping the virus one passenger, and one contaminated surface, at a time.