How to Stay Healthy at Sea
Norovirus facts--and fictions--and ways that cruise passengers can avoid getting sick.
Jaret Ames, acting chief of the vessel sanitation program at the Centers for Disease Control and Prevention (CDC), sheds light on the contagious gastrointestinal virus.
Q: What are some of the symptoms of norovirus, and why have there been more cases in recent years?
A: The standard symptoms that you find are vomiting or diarrhea--sometimes both--and there may be some associated symptoms like stomach cramps and nausea. It usually lasts about 24 hours, and then the symptoms dissipate and you come back to a normal status. As far as the cases and what's going on, I don't really have a good answer to that question. It is, in my view, absolutely a universal matter. Essentially, we're having increased outbreaks onshore just like we're having them on the ships. It's not something isolated to a ship or one part of the world.
Q: How does the virus spread?
A: The transmission routes are a fecal-oral route, a contaminated food or water source, or a sick person; those are the three ways you typically transmit the virus. It could be an ill food worker or just an ill person who happens to share the same living space as you. Obviously if it's a tighter space like a ship or a school, then you may see clusters of cases. It's transmitted through the food people contact or, the common one we see, transmitted through a surface. Maybe someone who is ill didn't wash his hands at all when he had a bowel movement and he touched surfaces and inanimate objects, whether a handrail or a button for an elevator, and when someone who is well touches that surface, the virus is transmitted to his hands.
Q: What are some of the ways that people can stay healthy while on a cruise?
A: If you're a person who's on a ship and you're trying to prevent transmission, hand-washing is the primary way to do that, and that means a good 30 seconds. It needs to happen quite often throughout the day even if you just have a snack, especially if from a self-service source. If you're a smoker, you should certainly do a hand-washing before that hand-to-mouth activity. Products like Purell can be of some use, but they don't replace hand-washing. Even if you do carry something like that, you should make sure that you still wash your hands often.
If you're a person who's ill, the key is to stay in your cabin and keep washing your hands throughout the day. When you do have to circulate with other people, wash your hands. Even at home when you're ill, you need to do a very good, 30-second hand wash.
Of course, you can have water or foodstuffs with contaminated fecal matter. Normally those cause quite large cluster outbreaks. We had some highly suspect waterborne outbreaks, but they were back in 2000 or 2001.
Q: What are some of the myths about norovirus?
A: One of the primary misconceptions people have is that the only people who need to really do proper and thorough and regular hand-washing is the crew aboard. They think that's where the breakdown is and don't see themselves as people who could transmit illness, but they are.
The second one is that people think that because they wash their hands once a day that will cover it. People don't truly understand the timing of it. Some people turn the water on, pass their hands under it, and quickly turn it off.
People should pay close attention when they use the hand-wash sink faucets; ideally they should shut the faucet off with a paper towel and use a paper towel to open the door when they leave the bathroom.
Habits make you a more risky person--a person who bites his nails or chews and plays with his gum or smokes. From a transmission perspective, those people are going to be more likely cases.
Q: How do cruise ships typically react when passengers become sick?
A: One response that's very common when there are elevated illness counts is for a ship to do increased cleanings. You'll see people with a rag that has a disinfectant chemical that they're wiping on surfaces that people touch routinely. The ships will position people there to have them wiping those surfaces continually throughout the day. Passengers will also notice that the self-service buffet that they used to go to freely and serve themselves has been replaced with served buffets once the crew sees elevated cases (which are typically reported to medical staff by sick people).
Q: What determines a ship's medical staff and capabilities?
A: It's generally a decision by each company or cruise line as to how many doctors or nurses to provide. Some will have literally what amounts to an EMT as their medical person and they may only have 100 passengers, but that's probably a ship that visits a port of call every day and is sailing through U.S. river systems, so they're never more than 24 hours away from pulling into a port and getting hospital care as needed.