Sea sickness: what ails the cruise industry

For decades now the cruise ship industry has been a popular and widely embraced outlet for those seeking a relaxing summer holiday or an escape from northern winters. The cruise ship market is the fastest growing sector of the world’s travel industry and has been widely embraced by Australian’s and New Zealander’s over the last 10 years. Cruise travel is booming like never before. It is an $80 billion industry and the ships are getting bigger and bigger, the number of passengers greater, the locations visited more exotic, and the onboard facilities continuing to expand.

Possibly 18 million people round the world travelled on cruise ships last year and the number continues to grow each year. In 2012 more than 700,000 Australian’s chose to embark on such a cruise as did possibly as many as 200,000 New Zealander’s. Witness the number of large cruise ships that visited Australian ports during 2012 and will do so over 2013. More than 270 large cruise ships alone are expected to visit Sydney during 2013.

There is no doubt that cruising the ocean offers many attractions. The latest cruise ships are mini-cities of more than 200,000 tons providing an extraordinary array of decks, lifts, shops, lounges, bars, restaurants, theatres, casinos and swimming pools. Luxury accommodation and food provide the opportunity to simply relax away from the hastles of home and workplace. But for some the ‘Love Boat’ and ‘Bon Voyage’ scenario can quickly turn out to mean something else entirely. Just how safe is cruising?

Cruise ships by their very nature bring together large numbers of people from a variety of backgrounds. In many ways modern cruise ships resemble an upmarket version of POW camps. They are crowded, semi-enclosed environments involving large numbers of people drawn from different backgrounds and with different disease exposure histories. The ‘inmates’ or passengers are dependent upon pre-prepared food (admittedly upmarket), served at specific times, and in some cases utilise shared wash and toilet facilities near bars, lounges and restaurants, as well as being daily exposed to the transmission of infectious disease from fellow passengers and crew. But are today’s travellers more at risk from sexual violence than they are at home?

Evidence presented a few years ago at a U.S. Congress hearing suggested that one was 50 per cent more likely to be sexually assaulted on a cruise ship than on land and that nearly 70 per cent of such assaults involved the ship’s crew. Regrettably, most attacks go unreported.

There is also little doubt that overall contaminated food and water and poorly maintained environmental surfaces, play an important role in exposing travellers to a range of infections. The actual stresses of travel, particularly among the old, who make up at least 50 per cent of all cruise passengers, can also play an important part. In such an environment communicable disease has a heyday. Infectious disease can be easily introduced by embarking passengers, acquired during stopovers, or produced by poor ship procedures governing sanitation, food preparation, storage and handling.

Crew members, particularly those from parts of the developing world, have also on occasions acted as transmitters of infection, effectively maintaining a reservoir of infection from cruise to cruise. In the USA the Centre for Disease Control (CDC) carries out regular health and sanitation inspections of cruise ships. The evidence thrown up by these surveys tells us much about the underlying reasons why infectious disease outbreaks are becoming so common aboard many cruise ships. For example, recent surveys of some of the world’s largest cruise ships indicated a large number of health and sanitation deficiencies including things like raw food being kept alongside cooked food, food items being stored alongside soiled pool towels, food prepared days in advance and just “freshened” on the day it is served as well as food items being stored on deck in high temperatures.

Cleaning of food and drink utensils also raised many issues such as cleaned glasses and plates retaining food debris, large accumulations of fat and grease on the inside and base of toasters, fryers and grills, clean plates being stored on warming trolleys that were soiled with grease and food debris and hand sanitisers and housekeeping cleaning liquids stored next to food items.

Given the number of passengers aboard many cruise ships and the very short turnaround time between cruises, it is perhaps not surprising that routine cleaning is sometimes done in a perfunctory and hurried manner. In such circumstances it is not surprising that several illnesses continue to ravage the cruise ship industry, food and water-borne infections being the most common. The most common virus linked to gastro-intestinal outbreaks is the norovirus. Norovirus outbreaks aboard cruise ships have over the last few years become almost legend reflecting loose standards in hygiene, sanitation and food preparation, handling and storage. In 2011-12 there were more than 50 outbreaks of norovirus aboard the world’s largest cruise ships. In 2012 between 4 per cent and 15 per cent of passengers aboard many cruise ships went down with illness, as well as up to 6 per cent of crew members. Given the conditions that often exist on many cruise ships why should we be surprised. Adding to the problem is the fact the norovirus is a very nimble and difficult virus to control and capable of mutating from time to time.

In 2012 there were more than 5,500 cases of infectious disease officially reported aboard cruise ships and the vast majority related to gastro-intestinal infections. It would seem according to studies by the U.S CDC that the officially reported number of cases significantly understates the real situation, and that quite possibly there were somewhere between 7,500 and 10,000 cases occurred during 2012. One of the problems is that many sick passengers do not report their illness. Many because they did not feel sick enough or have access to their own medications. More concerning for the cruise industry perhaps, is that a number of passengers do not report their symptoms because they fear being ordered into formal isolation while on holiday. Still others do not report for fear that they might be forced to pay for medical treatment.

Travel by sea has been an integral part of Australian and New Zealand history. Today, the image of cruise ships epitomises the enjoyable side of travel. But there is a darker side, so remember that those who cruise together can also get ill together.