How Risky Is Cruising?

After nearly 700 people got the heaves and diarrhea aboard a Royal Caribbean cruise ship last week, followed by 170 victims on a Princess Cruise a few days ago, you may wonder about the safety of cruising. It seems that large-scale outbreaks of intestinal distress assail cruise ships with some regularity (no pun intended). If you’re debating about whether or not you should take the risk and go on a cruise, here are some things to consider.

First of all, let’s look at what it is that makes passengers sick aboard these boats. For the most part, the outbreaks are caused by “norovirus,” a common form of “food poisoning.”  (E. coli and salmonella are two other common forms.) Once infected, victims experience severe diarrhea and vomiting.  The disease infects up to 21 million annually, and it hospitalizes about half a million, making it the most common foodborne illness in the US. About 800 people die annually from the disease.

According to the CDC, “Norovirus is a very contagious virus. You can get norovirus from an infected person, contaminated food or water, or by touching contaminated surfaces.”¹ http://www.cdc.gov/norovirus/about/overview.html   The virus typically lasts for two very unpleasant days, although kids and the elderly may have lingering symptoms. Victims remain contagious for several days after recovering, meaning you shouldn’t let anyone who has had the virus cook or kiss you for at least a few days.² Lallanilla, Marc. “What is Norovirus?” 29 January 2014. Live Science. 29 January 2014. http://www.cdc.gov/norovirus/about/overview.html As stated above, you can get norovirus from food or beverages, or from coming in contact with a contaminated surface and then touching your mouth, nose, or eyes. Unfortunately, the virus also travels through the air, so if you’re near someone who vomits, coughs, or flushes a toilet, you’re in the line of fire.

Cruise ships make excellent breeding grounds for norovirus, given the fact that thousands of people are confined to shared indoor spaces, shared surfaces, shared HVAC systems, and, of course, a great deal of close contact. (This is not the first time we’ve written about norovirus outbreaks on cruise ships.) The experts pretty much agree that on cruise ships, the virus typically starts with contaminated food or a sick kitchen worker and then spreads via person-to-person contact. The fact is, if you’re on a cruise ship where the virus has been unleashed, you’re a sitting duck. On the other hand, keep some perspective. Out of 12 million passengers who cruised in 2012, only 1200 got norovirus. That’s a one in 10,000 chance of infection. The virus typically causes about 21 million illnesses on land annually, so it can happen anywhere–at a restaurant, in a dormitory, or at a nursing home.

Still, you don’t want to be one of the cruising 1300–and not only because of the discomfort of getting sick. You save for a vacation; you take vacation time off from work; it’s your chance to relax; and getting sick means forfeiting all that. Royal Caribbean is giving passengers aboard the aborted norovirus cruise a 50 percent refund and 50 percent credit toward a future trip. That’s not much compensation for ruined vacation time and going through the suffering of vomiting and diarrhea.

If you want to cruise but you’d like to minimize your chances of contamination, there are some steps you can take. First of all, you need to pick a cruise ship with a clean history. Certain cruise lines routinely fail sanitation inspections and have periodic norovirus outbreaks, whereas others have a history of comparatively few incidents. In the previous three years, nine Princess Cruise ships and eight Celebrity Cruise ships reported norovirus outbreaks, making these lines the most notorious.³ http://www.cdc.gov/nceh/vsp/surv/gilist Holland America had four incidents, and Royal Caribbean, which had the most recent outbreak, actually did fairly well, at least compared to Princess and Celebrity, with only three incidents. Norwegian led the large-ship pack for safety, with only two reported outbreaks, although a Norwegian Star ship did just have a norovirus outbreak in early 2014. Then again, it is worth noting that Princess is part of Carnival, the world’s largest cruise line controlling 52% of the cruise market, and Celebrity is part of Royal Caribbean, which is the second largest line controlling 25%. In other words, proportionally, the higher number of incidents on their cruise ships may not be out of sync with the other lines.

The CDC conducts regular inspections of cruise ships to insure good sanitation practices and cleanliness. Out of 900 inspections since 2010, 27 ships have failed to meet minimal standards.⁴ Hill, Catey. Six most hygienic cruise lines.” 30 January 2014. Market Watch. 30 January 2014. http://www.marketwatch.com/story/6-most-hygienic-cruise-lines-2014-01-30 On the other hand, six cruise lines have never failed an inspection: Norwegian, Costa, Oceania, Disney, Crystal, and Seabourne. Obviously, passing inspection doesn’t guarantee anything, as illustrated by the fact that Norwegian has had norovirus outbreaks in spite of a perfect sanitation record.

Part of the issue is that norovirus is an exceptionally resilient little bug, and so normal hygiene procedures don’t necessarily kill or prevent it. Washing with soap and water, for instance, might knock it off of your hands, but the bug can remain alive. It also resists alcohol-based hand sanitizers. The one cleanser that does kill norovirus is bleach, but even scrubbing down with bleach doesn’t guarantee that an outbreak will be stopped. In 2012, after being thoroughly sanitized, Princess Cruises’ Crown Princess had a second norovirus outbreak on the next consecutive sailing. And in 2010, a Celebrity cruise ship had three consecutive outbreaks.

The experts insist that at least some of the problems occur not because the ships are unclean. The Royal Caribbean ship with the recent norovirus outbreak scored a 98 out of 100 on its most recent sanitation inspection in July, 2013.⁵ Hunter, Marnie. “Are Cruise Ships Floating Petri Dishes?” 29 January 2014. CNN Travel. 31 January 2014. http://www.cnn.com/2014/01/29/travel/cruises-sanitation/index.html So either the inspections aren’t doing the job, or a passenger or crew member carries the bug aboard and it rips through the ship from there.

If you’re on a cruise and you want to stay healthy, you need to keep the virus off of your hands, and the best way to do that is to wash your hands not just often, but for an extended time. You want to rinse the bug completely off of yourself, so wash up to your wrists and let the water run over your hands so you flush germs off of yourself and down the sink. And use a paper towel when you leave the room to protect your hands in case the virus is lingering on the doorknob. Using an antibacterial soap won’t really help, and it comes with its own set of problems.

Finally, it’s wise to bolster your immune system before taking a cruise, just as you might do before a flight. But keep in mind, simply popping Airborne might not be enough. As Jon Barron recently wrote, to keep your immune system functioning, don’t count on simply taking immune boosting formulas. “How good can your immune system be (taking all the supplements in the world that you want) if your colon is packed with old fecal matter? A substantial portion of your immune system then has to combat the effects of self-toxicity. Clean up your intestinal tract, and you free up your immune system.” In other words, it might be smart to do a full-body cleanse before taking the cruise.

It might be smart to bring an intestinal detoxification formula containing charcoal with you, just in case. But most important of all, it would be smart to pack several bottles of a pathogen-destroying formula as well when heading off on a cruise. This will significantly shorten the time you are sick if you come down with food poisoning. Look for a formula that contains garlic, olive leaf extract, and oil of oregano, as they have all been proven effective against norovirus.