Depending on your preferences, cruise ships are floating nightmares or simple, resistance-free retreats. They isolate travelers from the world and offer idealized versions of cities on land. But problems on land – like a massive outbreak of the corona virus – sometimes sneak on board.
Thousands were quarantined off the coast of Japan aboard a cruise ship, the Diamond Princess, after the virus was discovered in someone who had recently disembarked. They were only allowed to leave on February 19. The virus shot through the boat's population, and now over 600 people related to the ship are sick and two passengers have died.
Despite efforts to create a tightly controlled but effortless environment on cruise ships, cracks are easy to show when something like an infectious disease settles on board. The outbreak of the corona virus also affects other ships: the World Dream was quarantined for four days off Hong Kong. Royal Caribbean and the Norwegian Cruise Line do not allow passengers who have passports from China, Hong Kong or Macau or who have recently traveled to China for scheduled trips. The Westerdam was rejected from five countries before it was allowed to moor in Cambodia.
The new corona virus breaks the promise of the cruise ship as a bubble of independent banality in the open ocean. As the virus – and fears of the virus – spread, the problems increase and the bladder bursts. And it shows how this environment reflects the medical, political and cultural impact of epidemics.
Photo by Takashi Aoyama / Getty Images
Ships have been targets for disease control for centuries. Indeed, the combination of terrible disease and ships gives us the modern word "quarantine". When the Black Death terrorized Europe in the 14th century, the Venetian trading colony in Ragusa did not fully close. Instead, the city passed new laws for visiting ships in 1377. If they came from places where the plague was spreading, they had to stay anchored off the coast for a month to prove that they were not carrying them. Finally, the deadline was extended to 40 days and called the quarantino from the Italian word for 40.
The diamond princess was not quarantined for almost 40 days. But both the current Japanese government and the 14th-century Venetian authorities wanted to prevent passengers who might carry diseases from spreading them to the country – the fact that diseases could spread to the ship during that time was not that main concern.
The deadline was extended to 40 days and was called Quarantino
During the two-week period that the Diamond Princess was isolated in port, it had the highest concentration of people infected with coronavirus outside of mainland China. Trials began when an 80-year-old passenger who had already left the ship tested positive for the corona virus on February 1, six days after disembarking in Hong Kong. The ship redirected its planned trip and returned to the port city of Yokohama in Japan. The passengers were locked in their rooms at the start of the health check-up.
On February 4, the first day the Diamond Princess was quarantined, 10 out of 3,711 passengers and crew tested positive for the virus. By February 8, it was 16. The numbers then rose to 135 cases, 174 cases, 218 cases, and by February 17, to 454. The sick left the ship and were taken to Japanese hospitals, while the remaining passengers left theirs Watching cabin windows. When the quarantine was lifted on February 19 and patients without the virus were allowed to disembark, at least 621 people connected to the ship tested positive for the virus.
The escalating number of cases aboard this ship made it seem like it would facilitate the transfer, tweeted Alexandra Phelan, member of the Center for Global Health Science and Safety at Georgetown University.
At least 621 people connected to the ship had tested positive for the virus
Cruise ships, which focus on shared restaurants and group activities, are known as an incubator for infectious diseases. Norovirus, the highly contagious virus that causes stomach upset, is often referred to as the "cruise virus" because it spreads easily in the crowded environment on board ships. In 2008, for example, 196 people contracted the virus on a cruise ship sailing through the British Isles. Most fell ill after being in the busiest areas of the ship. Germs sit on common serving utensils, bocce balls and handles. People sweat and cough on neighboring deckchairs or on deck. And who wants to stay in their tiny cabin when there are so many things to do? Cruise ships can easily help spread pathogens from person to person.
This is especially true if the proper infection control procedures are not followed, which, according to experts, was the case with the Diamond Princess. Passengers were locked in their cabins during quarantine, but crew members continued to move around the ship – possibly spreading the beetle – and gave materials such as paper forms in and out of the passenger compartments.
As much as the quarantine was a public health crisis for those on board, it could also act as a miniature experiment: the ship acts as a small model of the larger outbreak, even though it is under accelerated artificial conditions. Scientists on Twitter are demanding a close examination of the development of symptoms in sick passengers over time and the progression of the disease in a group that tested positive for the virus but did not appear to be sick. It is not clear whether an investigation is underway at this time, but the data on board the ship would likely be valuable.
The crew are working on board the cruise ship Diamond Princess when the ship arrives at Daikoku Pier on February 12, 2020.
Photo by Tomohiro Ohsumi / Getty Images
Even though the Diamond Princess passengers were stuck in their cabins during quarantine, they were stuck with satellite television, a selection of films, children's activities, and timely food. These meals are delivered by the crew, who are still on duty to serve the international passengers and still move on the virus-laden ship.
Continued work means that crew members travel through the ship and come into contact with passengers. At least a few dozen have been infected with the virus. Since they are in regular contact with one another and live in a confined space, some fear that they have a higher risk of passing it on. (Unlike passengers, they were not isolated from each other.)
"We all eat together. There are many places where we are all together and not separated, ”crew member Sonali Thakkar told CNN. "Especially when we sit in the same fair and eat together, the place where it can spread very quickly."
"We all eat together. There are many places where we are all together and not separated. "
Cruise companies such as Carnival Corporation, which owns the Diamond Princess, often register their ships in countries with approved labor laws. Working conditions are reported to be poor, pay can be low and job security is very low. The least paid and most challenging positions on cruise ships are often given to people from low-income or developing countries.
In the world beyond Scotsman, the vulnerable always see disproportionate exposure to infectious diseases. Wealthier countries and the rich in general have the resources to protect themselves more effectively from diseases and treat them when they occur. This dynamic takes place on board the ship, with a higher (though apparently still inadequate) level of protection granted to higher-status passengers and crew members who sometimes have their own space and space. "The crew is scared to death," Arnold Hopland, a doctor on vacation on the ship, told Politico. "They are afraid and are packed up in a confined space and work from elbow to elbow."
Policy decisions made in public health emergencies are based on more than just health information. The decisions are based on politics, economy and reflect those made by others. As countries negotiate their reactions to the outbreaks, geopolitical jockeying also affects cruise ships – and the people on board.
The Westerdam cruise ship, for example, made a stopover in Hong Kong, where there are more cases than in most places outside of mainland China. When it was time to get back to the port, it was struggling to find a place to go. The ship was rejected by Thailand, Japan, Taiwan, the Philippines and Guam because of concerns that its passengers would bring the new corona virus ashore. Finally, Cambodia gave the ship permission to dock. "The corona virus makes ports more sensitive to disease," says Ross Klein, who studies the cruise industry at Memorial University of Newfoundland.
Photo by Tang Chhin Sothy / AFP via Getty Images
The Westerdam experience reflects global decisions taken in response to the outbreak. Despite the recommendations of the World Health Organization that countries should not restrict travel and trade, the political reaction tends to isolationism: the United States has introduced travel bans, Russia has closed its borders, New Zealand does not allow foreigners arriving from China to enter.
Cruise ships have a unique geopolitical position: they act as separate entities and are not subject to the laws and jurisdiction of countries with strong regulatory influence. However, the new corona virus underlines its dependence on structures and guidelines on land. For example, the Diamond Princess crew and passengers were subject to quarantine decisions from Japan. And now that they are allowed to leave the ship, they are bound by their home country regulations.
The United Kingdom said it would fly out of its citizens after being subjected to public pressure and quarantine them back home. Other countries like Australia and India have made similar calls. The U.S. State Department brought back a group of people, but the disease control and prevention centers withdrew, saying that the remaining citizens who were on the ship (around 100 people) must wait 14 days for no viruses, before they can return to Stateside.
As the global crisis unfolds, it is difficult to follow the complex web of new scientific information and policy changes – and it is even more difficult to keep track of how and why new developments take place. The Diamond Princess and other cruise ships offer pockets of the crisis that illustrate the general dynamics of virus transmission, class division and international decision-making. They show the public health machine in action.
"Can I go to a Pizza Hut or something?"
It is a machine in which passengers who streamed from the Diamond Princess on Wednesday will be trapped with the notorious distinction of surviving the largest new coronavirus hotspot outside of mainland China. Reality entered her vehicle to escape and she gets out with them, along with a lot of uncertainty about what will happen next.
There is great uncertainty about what will come next for them. Passengers worry about land restrictions, additional quarantines, and travel home. "It's a big problem," Diamond Princess passenger Kent Frasure told NBC News. "Can I walk the streets of Tokyo? Can I go to a Pizza Hut or something? Can I go to this sushi shop or are we stuck in some kind of accommodation for another 14 days? "
Your experience is still the bigger breakout. Despite the best efforts of leading scientists, the new corona virus is still a global public health crisis and the future is unpredictable.