Some Thoughts on Containing Norovirus Outbreaks

norovirus

Norovirus is in the news again with several ships having a few hundred sick passengers.  The  ships were sanitized between cruises to prevent further spread.   While I do believe that the media tends to over sensationalize the cruise ship outbreaks, I wanted share some thoughts and information on the issue.

This week Princess took drastic measure to insure sanitation of one of their ships.   They announced they would be ending the cruise two days early the current cruise on the Crown Princess, issuing refunds to all passengers, and assisting with accommodations and airline change fees.   Ending this voyage two days early will allow them to sanitize the ship for two days before the next group of passengers boards the ship.  However with the CDC reporting outbreaks throughout the US, it will be hard to avoid new passengers boarding the ship carrying the virus.   They do screen for carriers, but not everyone is honest when questioned about such illness because they don’t want to be denied boarding.

Most importantly cruisers need to keep in mind that Norovirus is not unique to cruise ships, but as individuals they can take steps lessen their chance of getting it while cruising.     Most cases occur on land especially in institutional  settings like schools and nursing homes.

Simply stated, Norovirus  is a stomach flu that causes vomiting and diarrhea.  Usually, the infected person feels awful for about two days and then symptoms subside.   It can result in more serious symptom or even death, especially in the extremely young, elderly, or immune compromised.  However, even after the patient has recovered, the affected person may be contagious for several more days.

Quarantine Passengers?

There in lies the problem.  Cruise ship passenger who still want to make something out out of their vacation may want to get back to regular activities once they have no symptoms but are still contagious.  The same may be true for cruise ship employees who are eager to get back to work.

This puts the cruise line in a difficult position.   If the person has reported to sick bay to seek treatment and they are now feeling better, should the cruise staff still confine them to their state room?   Are they still contagious?  Maybe, Maybe not.   If they are thoroughly washing their hands after taking care of the “bathroom business” then they are probably not a danger, but is someone going to follow them around and make sure they wash their hands for 2 minutes with soap and water every time?  If the cruise line starts restricting infected people’s activity on the ship even when they are feeling better do they run a higher risk of a PR problem than they would if a few more people got sick?

I tried to look a for a better solution and I could see the dilemma that the cruise lines must be in.   If they confine infected passengers to their cabin even when they are feeling better, those passengers won’t be happy.   If they let them have full access to the ship they risk further spread.  Would a quarantine policy exasperate the problem with fewer people reporting their illness?  Many people don’t want to be restricted to their cabins if they are only having fairly mild symptoms, so those people would be less likely report their illness to the ship’s medical staff.   This might further result in more spread.

Preventing the Spread

Most cruise ships have adopted plans that are designed to lessen the likelihood of contamination spreading.    These measures include constant sanitation of surfaces with bleach and removal of shared items like serving spoons on the buffet and salt and pepper shakers.   When an outbreak begins they require gloved staff to serve items at the buffet rather than self serve.

I wondered if a further step could be offered such as compensation packages for those who become ill and agree to stay in their cabins for 5 days.   That plan sounds like an absolutely miserable way to spend a cruise, but might allow those who need to be isolated during this cruise the opportunity to cruise again at a reduced cost.

Because the virus is not airborne, the best way for cruisers to protect themselves is to eliminate direct or indirect contact with the virus.  This can be done by thoroughly washing hands with soap and water.   The soap doesn’t kill viruses but will wash them away.    Some of the recent news reports emphasized that alcohol based hand sanitizers, like Purell, will kill bacteria like e-coli, but are not effective against viruses.

Noro Specific Hand Sanitizers

However, those same reports fail to mention the sanitizers that DO kill Noro.  Germstar manufactures a hand sanitizer specifically designed to kill Norovirus called Germstar Noro.   This is the product you will find on your cruise ships at the entrances to the buffet and to the dining rooms.  If you visit their website, at germstar.com,   you will immediately recognize their product and the dispensers used on many cruise ships.   To make sure the product is effective in killing the virus, the manufacturer directs the use the product for at least 20 seconds.  They also have the product available in 6 2 oz bottles for $18.   Cruisers will want to generously use this type product before they dine, touch food or utensils, or even touch their hands to their mouths.  A person who has been recently infected, if they are not going to stay in their rooms,  should be extra vigilant about the hand washing and sanitizing so that they don’t spread the virus.      On many of my cruises, the cruise line has assigned  their friendliest waiter to greet guests by name and give them a squirt from the squishy bag of gel.  The friendly waiter helps passengers feel more comfortable with the process and makes sure that ever passenger is  sanitizing his or her hands.   For extra caution passengers may want to even get a second squirt after they have gone through the buffet line and touched other surfaces.

Concluding Thoughts

It seems the course of containment that is most effective is the sanitation of the vessel surfaces, avoidance of contact with serving utensils and condiment containers, and disinfecting of hands with a Noro specific solution.   Following these steps will slow and avoid the spread of the virus and make cruising a better experience for all.  We invite our readers to share their experience with such outbreaks or effective measures that they have observed in the prevention of the spread of this virus.   We’d love to hear your thoughts and ideas on addressing this issue.