Monday, June 13, 2011

Staying Healthy: The Norovirus And You

Disinfected seating in a dining room aboard ship: workers in protective clothing wiped every surface with Virox, and sprayed what couldn't be physically wiped

Today's topic isn't the most pleasant one, but it's relevant for all travelers. It's about the viruses that cause varying degrees of stomach and intestinal distress. I'll spare you the graphic details out of consideration for those with weak stomachs in general, but it's information that may come in handy for anyone who travels at some point, so I hope you'll at least make minor mental note of it.

If you've followed news from travel websites or have traveled on cruise ships over the past few years you've certainly heard about the most common culprit - that little dickens known as the Norovirus, part of the taxonomic family of viruses classified as Calicviridae; a highly contagious virus that easily causes a troublesome but very rarely fatal illness many would pass off as the "stomach flu".

The norovirus is more often than not passed along by someone with the virus preparing food that is then eaten by others, or by leaving the virus on a surface that is then touched by another and then transferred to the mouth. That can mean directly - such as a pressing an elevator button - or indirectly, like coughing or sneezing out tiny droplets of virus-carrying moisture that land wherever. The next person then can press the same button on their way to the dining room, pick up a bit of pastry, put it into their mouth, and boom... they become the new host. The incubation period is 12 to 24 hours, and it then reigns supreme for one or two days. Intestinal distress causing problems out both ends is the most delicate way I can think to put it.

The close quarters of a hotel dining room, a cruise ship cafeteria or any place where many are in close proximity is a fertile breeding ground, and you don't build up an immunity to this microscopic vacation spoiler.

Now, if you're squeamish don't think too long about this, but the most common way of spreading the norovirus is via contamination of foodstuffs by people who will defecate and then not properly sanitize their hands by washing thoroughly afterwards. A single food worker at your local all-you-can-eat buffet could potentially lay hundreds low in a single shift.

On the cruise I just finished we were cautioned as we boarded that there had been a few folks sick with the norovirus on the ship that had just disembarked its passengers four hours before we boarded, but we were assured that it was probably "inadvertently brought aboard by passengers on the previous cruise" and that the ship had been thoroughly sanitized top to bottom. My cabin steward confided a few days later that it most certainly had not been, but that's another issue. [As a side note, two days before we returned to port the US Center for Disease Control (CDC) had come aboard and taken steps to make damn good and sure that it was given a sanitizing before it was allowed to go out on the next cruise, delaying embarkation by six hours and departure by another six.]

It's an incredibly labor-intensive task. EVERYTHING that a passenger might touch needs to be sanitized. Think for a minute about a cruise ship with, say, 1,500 cabins and 2,000 passengers on twelve decks (including lodging for the approximately 700 crew members). Forget the countless food service and cabin doorknobs, drawer pulls and surfaces; the handrails in the corridors alone make up miles of surface that needed wiping down by hand, and in the case of my ship they also wiped down the walls from knee height to ceiling during the last few days at sea. Not just once, but several times.

A few years ago there was an instance or two where a ship reached what I've been told is the limit of 10% of those aboard being stricken and the ships were called back to port and evacuated, but that's extremely rare. The latest reported figures for my ship show a total of less than 150 passengers (around 6%), but it's still a concern.

The cases aboard my ship overwhelmed the available medical staff at times. One couple I spoke with related the story of calling to ask for Dramamine (a common seasickness medication) and being told that they couldn't be seen but that since they couldn't rule out the norovirus that the sick half of the couple was to stay in their cabin for 48 hours - period. They said they were told if they were caught out of their cabin that they'd be put ashore. It seemed rather extreme to me, and again it's just hearsay, but it made a good story nonetheless.

This isn't intended to be a hatchet job on cruise lines in any way, shape or form; there were what appeared to be stringent precautionary measures in place throughout the ship during the entire cruise. The biggest worry were the other passengers themselves. At breakfast the first morning out I saw four or five people sitting at tables in the dining room with their faces in white air-sickness bags, doing what you'd imagine comes naturally in such situations, not having the good grace (or sense) to stay in their cabins. This caused what I quickly dubbed the HazMat teams to come scampering over with their carts and scoop up all of the dishes, utensils and glasses from the table, dump them into a red plastic bag and spray/wipe/sanitize the area as you saw in the image at the beginning of today's post.

Gel hand sanitizer dispensers were placed at the entrance to any food area, and a uniformed staff member was in place to bar you from entering if you didn't first sanitize your hands. There were also staff members outside each public lavatory, and I was a bit unsettled to learn from one of them early on that they were stationed there to send folks back inside who didn't have the common sense (or decency) to wash their hands after using the facilities. "How do you know if they've washed their hands?" I asked one young Indonesian man, standing outside one ladies' room. "I can see the sinks," he smiled, pointing into the open doorway at a strategically placed mirror. "Oh, I bet they love you looking into their bathroom," I said, laughing - and he replied "Some have complained, but all I can see is the sinks," - which was true.

Note the guy on the left, holding a yellow sanitizing towel and the latex gloves they wore if they were to be in direct contact with food. Only 5 of over 800 crew members fell ill.

Numerous announcements were made via the public address system and daily mentions advising cautionary procedures were published in the newsletters and schedules, in both English and Chinese (for the benefit of the many - perhaps 15% Chinese/Asian aboard the ship - who seemed to be less than cooperative, based only on my own observations and comments by a few crew members.

The most labor-intensive precaution at the buffets were the servers stationed at each and every serving counter: you didn't dish up your own food, you told the server what you wanted and they put it onto your plate. Beverages, too.

Should this scare anyone away from taking a cruise? In no way, shape or form. Take note of the CDC pages rating cruise lines, if you wish, but use your head and you ought to be safe. Regularly washing one's hands thoroughly with soap and warm water for 20 seconds (about the length of time it takes to sing all of "Twinkle Twinkle Little Star") and making use of a liquid sanitizer often should be enough.

Would I go aboard on another cruise tomorrow? In a heartbeat. Just take responsibility for your health as you would in any other situation, take precautions as you should anywhere, and be aware.


krobbie said...

Bao-Bao, obviously Thailand has been a good training ground over the years of how to keep yourself from getting ill.

We both know from experience that it doesn't always work but at least we are aware of such and know to seek help immediately.

It sounds as if you had a good time at least - the illness of one of your bunch notwithstanding.

Cheers and welcome home,

Sam said...

Slightly off topic as I don't know if it would do much for norovirus related sickness but I've found an upset stomach can be almost instantaneously/miraculously cured with apple cider vinegar. Sounds a bit far fetched but it seems to work. I think it's most likely to be its acidity rather than any magical component touted by some of its fans. About a tablespoon in a small glass of water is about the right ratio.

khunbaobao said...

If you find it effective you may want to consider taking a small amount with you as I'm not remembering it as being a common item in Thailand. Also, if the distress is caused by "bad" food remember it's often better to allow the body to purge itself of whatever it finds offensive before attempting to stop the elimination with Immodium, Lomotil or the likes. Good suggestion, though - thank you!