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When Norovirus Attacks
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"Under the Captain's Table" is Cruise Critic's original series of stories penned by Joyce Gleeson-Adamidis. Joyce knows the ins and outs of life onboard -- both as a cruise ship staff member and as the wife of Celebrity Cruises' venerable Captain Adamidis -- and offers a behind-the-scenes perspective on issues facing cruisers and the cruise industry....
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When Norovirus Attacks

Many travelers -- particularly cruise passengers -- are increasingly worried about the possibility of catching Norovirus, a form of gastroenteritis that spreads easily in enclosed spaces. It seems that, until recently, the media only covered outbreaks that occurred on cruise ships -- and I flinch every time I hear it referred to as the "cruise ship virus." But of late the message seems to have been learned that the virus, which lasts from 24 to 48 hours, is an equal opportunity offender: Resorts, hospitals, schools and other places also must confront the dreaded Norovirus. In fact, the Centers for Disease Control and Prevention, which monitors outbreaks, notes that 39 percent of the people who get Norovirus get it from restaurants and catering services, 30 percent while in nursing homes, 12 percent from schools, and 10 percent at vacation sites or on cruises.

And let me say this: Though cruise ships rate as one of the least common sites for outbreaks, they alone are required to report on a regular basis to the CDC. The ships exchange thousands of people each week and travel to various ports with varying hygiene levels, making it easy for any passenger to carry on some of the existent multi-strains of the virus.

The cruise lines do not wish this on anyone, let alone themselves. The passengers suffer from an unfulfilled vacation, the virus spreads rapidly, and it comes with an extremely high cost to all involved. The crew suffers immeasurable pain when there is an outbreak of the virus. They are as vulnerable as the passengers to contract it. They cannot work, and their already long daily hours become even longer during a prolonged and massive clean up.

Onboard, the battle to combat Norovirus is one that never ends. In the past few years, cruise lines have become much more sophisticated in preventative efforts, and I thought I'd give you a look at how it impacts voyages -- from the ship's point of view (see the CDC Web site for information on the virus itself).

How do you get this?

The primary source is fecal-oral spread; secondary is person to person; and the third is food/water and industrial size air conditioning. One reader asks if onboard drinking water is a major concern in the spread of this virus. The water for the ships is the least likely to be the reason for its spread. Water is treated at three levels; one, when coming onboard the vessel, two, when in the holding tanks, and three, when on its way for consumption.

What are the symptoms?

They include nausea, vomiting, diarrhea, muscle aches, stomach cramping, some headache and fatigue. Norwalk Virus is, by definition, a virus, and therefore it's unaffected by antibiotics. It can strike within 12 hours after contact; the usual incubation period is 24 - 72 hours and symptoms can last 48 - 60 hours. There are no long-term health effects and hospitalization is rare. Dehydration is a primary concern, especially in infants and the elderly. Drinking juice and water is a must.

Precautions and Steps taken:

There are three codes the ships follow: Green means daily standard procedures using Microbac® cleaning products for all frequently touched areas. Yellow means heightened alert with extra cleaning and precautions; the percentage of chlorine in cleaning products is increased dramatically, and all are asked to voluntarily and regularly clean hands. Red means high alert and an intensely high maintenance mode goes into immediate effect with required sanitizing of hands when entering the ship and food areas. Crew and passengers alike are then served their food. Self service is banned in the buffet areas.

The ships not only follow the recommended guidelines of the CDC, but also take extra measures to combat the virus. A required report is given to the CDC at the end of every voyage stating the types of sicknesses found when entering U.S. waters with American passengers. If the number rises the next week, the ships will then volunteer a daily report, even when sailing outside U.S. waters and including all nationalities.

A normally long working day suddenly becomes longer for all crew with around-the-clock non-stop usage of approved EPA and CDC chlorinated and disinfectant products. Water used for cleaning is also chlorinated and heated, and goggles/gloves are added for protection. The crew scrubs the ship from top to bottom. I have seen the crew with tired red eyes and spirits down, dozing in the service elevators from working so hard to combat this virus. Anti-bacterial stands have become permanent installations strategically placed to enable all passengers to sanitize but I'll say this: It doesn't work if you ignore it!

Pamphlets are distributed to crew and passengers giving a thorough explanation of the virus, including preventive guidelines. Crew members are required to attend extra seminars covering hygiene and cleaning measures. Any crew or passenger infected or suspected of infection during the cruise is isolated for the incubation time period. If the virus continues to spread, officials from the CDC will board the vessel to lend more investigative help in trying to find a method of arresting the spread of the Norovirus -- as they did in January 2007 when a particularly strong outbreak occurred on Cunard's QE2. These officials have the authority to hold and quarantine the vessel -- recall in December 2006, Royal Caribbean's Freedom of the Seas, battling a severe outbreak of Norovirus, canceled several days of a cruise in order to have extra time to sanitize the ship.

Some lines -- Cunard and Princess among them -- have created teams of crew members whose only job is to fight the passing on of Norovirus; they're the ones on cabin patrol. Some clean for those who are quarantined, others handle room service deliveries. No others crewmembers are allowed to serve that stateroom during quarantine time, and this helps prevent the spread to passengers' regular team of crew.

All of this comes at astronomical price, involving cancellation of future cruises, scrambling of flight/hotel schedules for thousands of people, medical treatments and purchase of additional cleaning products. It is essential that we all do our part in helping combat this virus.

What happens to the Crew when they are hit with the virus, and who has the responsibility of control?

If a crew member is suspected to have contracted the virus, he (or she) will be quarantined to his (or her) cabin until the incubation period has been completed. Typically, an assistant will step into their position until they return to active duty. They are not docked in pay during their sickness, and payment continues as per contract.

As well, the responsibilities are on each department to keep their most touched areas clean; in other words, galley takes care of galley, casino takes care of casino, but housekeeping still takes the brunt end of the work by continuing to go throughout the whole ship to keep the proactive and aggressive measures moving. It is a full onboard community of cooperation.

Though some cruise lines have various teams onboard to combat just this virus alone as I mentioned above, others put their faith and support in the entire crew to help combat the issue when it arises. To show that indeed the numbers are low for ships, I have been extremely lucky when traveling on board so many different ships (involving several months at a time) and I never encountered any significant number of this virus.

How can we help to prevent the spread of this virus?

Don't touch your mouth, don't share drinking glasses or utensils, avoid shaking hands, and be vigilant in cleaning your hands all the time, not only when on the ship and visiting the ports, but at home as well.

Should you let fear of Norovirus prevent you from the enjoyment of cruise travel? No way! Norovirus can strike any place, at any time. Remember, this virus is brought onboard; it does not originate onboard the ship. Be aware and take precautions on the plane, your hotel, at a restaurant and while onboard your ship. Go on your cruise -- just remember to wash your hands.

Enjoy and Bon Voyage!

Norovirus - What You Need to Know
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