Are cruise ships unsafe – and will they change?
LOS ANGELES – One of the last cruise ships bound for the USA arrived Monday with 115 passengers after an around-the-world cruise cut short by coronavirus fears.
The Pacific Princess will join the fleet idled by the Centers for Disease Control and Prevention's order that all cruise ships stand down for more than three months before setting sail again. It's hoped that will be enough time to get over the worst of the pandemic that swept through passengers and crews with devastating results.
The coronavirus is a crisis like no other. Not another economic downturn. Not another outbreak of norovirus. It's yet to be seen whether the industry can find a way to reassure passengers, many of them senior citizens who are in a high-risk group for COVID-19, that cruising is safe and to formulate a comeback, which could include health safety improvements.
The CDC lists 20 vessels in which the coronavirus became an uninvited guest when they visited U.S. ports under its jurisdiction. There were many more ships ravaged by the virus around the world. With COVID-19 cases aboard, some ships became unwanted nomads that country after country refused to let anchor or tie up to discharge passengers.
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Coronavirus invades cruise ships
Two passengers died aboard the Coral Princess, and another passed away at a hospital after the ship tied up in Miami. Passengers became ill after the ship left Chile, and countries refused to allow them to disembark as it sailed north.
After COVID-19 cases were identified on Princess Cruises' Grand Princess, the ship was forced to steam in circles off San Francisco while a plan was formulated to isolate passengers coming ashore.
Four passengers died aboard Holland America's Zaandam as it worked its way up from Chile, eventually being allowed to discharge passengers in Florida. Three of the deaths were linked to COVID-19.
The Pacific Princess left Fort Lauderdale, Florida, for its global voyage Jan. 5. Sailing west, its 111-day cruise was cut short when fears of the coronavirus swept through the industry. Most passengers flew home from Fremantle, Australia. The rest, deemed unfit to fly but not infected by the coronavirus, came home to Los Angeles with the ship.
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Why do cruise ships get a bad rap?
Cruise ships place hundreds or thousands of guests into a relatively small space, and megaships play a prominent role in the industry. Royal Caribbean's 1,188-foot Symphony of the Seas, for instance, can accommodate nearly 9,000 passengers and crew.
"Like other close-contact environments, ships may facilitate the transmission of respiratory viruses from person to person through exposure to respiratory droplets or contact with contaminated surfaces," Aimee Treffiletti, chief of the CDC's Vessel Sanitation Program, told USA TODAY.
Cruises, which have a more-the-merrier philosophy, are never a solitary affair. The fun centers around myriad group activities in a nonstop party atmosphere. It might be sipping cocktails around the pool, filling showrooms for Las Vegas-style revues, dancing, lectures, playing games or other activities. Lavish buffets, a cruising mainstay in which guests crowd around serving tables, are another opportunity for viruses to spread.
"The nature of cruise ships is when there is a virus, it spreads like wildfire," said Michael Winkleman, a Miami-based maritime attorney who filed lawsuits seeking class-action status against cruise lines concerning the coronavirus on behalf of passengers and crews.
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Viruses have struck before
The cruise industry already had a reputation for outbreaks. Norovirus sickened 129,678 cruise ship passengers out of 74 million who set sail from 2008 to 2014, the CDC said. The virus, leading to nausea, stomachaches, vomiting and diarrhea, ruined many a vacation, but it's rarely fatal.
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Norovirus is spread by contact with an infected person, contaminated food or water or a contaminated surface, which can happen on land as well as sea. Besides close quarters, passengers aboard cruise ships constantly go between decks and have to steady themselves by grabbing handrails, chair backs or any other fixed object when a ship rocks in heavy seas.
Coronavirus is more dangerous. Since it's spread primarily through tiny droplets produced by coughing or sneezing, it can be contracted not only from touching surfaces but also from merely being downwind of an infected person. Many people who contract coronavirus may not show symptoms immediately, or at all.
COVID-19 is unlike anything the cruise industry has ever encountered.
"COVID-19 is a new disease, and we are still learning about how it spreads and the severity of illness it causes," Treffiletti said. "Like outbreaks in shoreside communities, COVID-19 cases on cruise ships may not have been able to be avoided at the beginning of the pandemic."
Some aboard may be more vulnerable to viruses than others, a report found. Those in crew cabins and congregating in restaurants are most at risk for respiratory infection, according to a study in 2015 in the journal Indoor and Built Environment by Qingyan Chen, a Purdue University professor, and two others.
An 'inherently high-risk setting'
There are no easy defenses. Quarantining passengers suspected of having a respiratory illness or requiring masks for crew members "could reduce the attack rate only to a moderate extent," the study warned.
"It's an inherently high-risk setting," said Claire Panosian Dunavan, professor of medicine emeritus in the infectious diseases division of UCLA's School of Medicine. "Everyone was worried about norovirus. Respiratory infection has always been the scariest prospect as far as I was concerned."
Panosian Dunavan saw it firsthand aboard an otherwise well-maintained ship with ample hand sanitizer dispensers a couple of years ago. She said her husband contracted human metapneumovirus, a respiratory illness, toward the end of the cruise.
A cruise ship involves "a lot of people crammed together touching the same surfaces," Panosian Dunavan said. As for COVID-19, "I think this is the virus that is revealing the inherent vulnerability of this popular form of travel."
The cruise industry could do a better job of filtering air aboard ships, though there is no proof air-conditioning systems can transmit the coronavirus. Modern jetliners, such as Boeing's 787 Dreamliner, run cabin air through high-efficiency particulate air, or HEPA, filters. Boeing said they are "effective at removing bacteria, viruses, fungi."
The CDC's and industry's answer to health issues on cruise ships, both now and long before COVID-19 came along, is the Vessel Sanitation Program, or VSP. It was created by the CDC in the 1970s in response to gastrointestinal outbreaks on cruise ships. It sets a standard for health practices from stem to stern, whether it's food contamination, pool and spa water quality, ventilation or pest control.
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Industry says it faces tough inspections
The industry's trade group, the Cruise Lines International Association, points to VSP as putting ships a cut above, "a level of federal scrutiny that is unique within the travel and hospitality industry," said Bari Golin-Blaugrund, senior director for strategic communication at CLIA. "There is no similar federal program for hotels, airlines or restaurants."
She said crews regularly clean and sanitize handrails, door handles, faucets and other commonly touched surfaces multiple times a day. Crews attack the possibility of an outbreak in other ways, such as "strict laundry protocols" aimed at eliminating viruses and bacteria on soft surfaces such as sheets. After a cruise ends and before the next passengers arrive, ships are cleaned from top to bottom, she said.
Against the coronavirus, even those procedures and others, such as checking passengers' temperatures as they came aboard, weren't enough.
Princess Cruises' Grand Princess started having suspected cases of the virus reported last month after a passenger on a previous cruise became ill. Though that man had disembarked, dozens of passengers remained on board for a second voyage on the ship. On its second sailing, 21 people had tested positive by the time the ship was allowed to dock in Oakland, California. Passengers who weren't infected were sent to military bases to go into quarantine.
The CDC said the Carnival Valor had three back-to-back cruises in which cases of the coronavirus were reported.
In an interview with Axios on HBO last month, Carnival CEO Arnold Donald said that although there is "lots of social interaction," overcrowding isn't the issue on ships. They are "not a theater. It is not an arena. It is more like Central Park. There's a lot of natural social distancing, the ships are large, people are not always gathered and clumped together."
In an interview with CNBC, Donald predicted cruising will bounce back despite multiple cruise ships having been stuck at sea with ill passengers and turned away from ports in multiple countries. "Social gathering at some point will return, and when it does, people will want to cruise,” he said, noting reservations for cruises next year are up even though ships shut down operations after the CDC issued a 100-day "no sail" order that went into effect April 15.
Cruisers are still booking
A Morgan Stanley industry note to investors April 8 obtained by USA TODAY revealed customers are optimistic. They are still booking cruises from July onward. Many of them are rebookings of canceled cruises.
Veteran cruisers aren't deterred from taking vacations at sea.
Alan Podrid and his wife, Sharon, endured the ordeal aboard the Coral Princess without becoming ill, though they were confined to their cabin for six days.
The Podrids have taken 45 cruises. After returning home to Marietta, Georgia, they started to put the experience into perspective.
"People either love it or they hate it," Podrid, 70, said of cruising. "I don't think the bad publicity is really warranted when you consider the state of affairs through the country and throughout the world. Everyone is kind of finding their way through it."
Another Coral Princess passenger, John Hutton, 71, remained gung-ho about cruising after returning home to Oak Island, North Carolina.
"We are cruisers through and through," he insisted. The retired school teacherstill plans to take a Princess Cruise to Tahiti in November and to the Baltics in August 2021.
Tanner Callais, founder of Cruzely.com, cruises about four times a year, for work more often than vacation. He said the risk is no worse than "being at a concert or a crowded airport."
He's looking for assurances about how the industry would deal with an outbreak of similar magnitude.
"I'd also like to know there is a plan to deal with any potential illness instead of seeing ships stranded for days, looking for a port to accept them," he said.
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How cruises could change
Though CLIA has not announced any long-term changes on ships in response to the coronavirus outbreak, some may be on the table.
“As cruise lines begin planning for the future, they are exploring ways to go further still to improve upon their already robust public health protocols, including additional screening requirements and enhanced sanitation measures," Golin-Blaugrund said Monday.
The CDC confirmed that plans are coming and noted they will be similar to protocol already in place to address gastrointestinal illnesses on board.
When the CDC issued its no-sail order extension April 9, it required all ships in U.S. waters to create plans to address coronavirus prevention and response.
"Ships are currently formulating similar plans to address outbreaks of COVID-19, and these plans could also be modified to prevent and respond to other communicable illnesses in the future," said Treffiletti, chief of the CDC's Vessel Sanitation Program.
It's yet to be seen what those tougher measures could include. If rapid testing for the coronavirus becomes more readily available, that's a possibility. It's unclear whether crew or passengers would be required to wear masks on board.
Cruise lines "have a duty to mitigate foreseeable risks," said Jeff Ment, an attorney who specializes in representing travel companies. It "requires a plan, screening people, kicking off people who are sick."
Any obvious health risks, such as shared serving spoons for buffets, are likely to disappear, he said.
Cruise operators may feel compelled to require more social distancing, especially in dining rooms or theaters. But limiting the number of customers plays havoc with profitability.
Ment said cruise lines may improve air filtration on ships and beef up medical facilities. Some luxury cruises attract a high-end clientele, yet "you don't know much about what's in a medical facility on ships."
Attorney Winkleman hopes the industry will make necessary improvements.
"I think the industry has to learn its lesson," he said.
This article originally appeared on USA TODAY: Coronavirus on cruises: Are cruise ships unsafe? Can they change?
April 21, 2020