By Dr Ingrid Johnston, Senior Policy Officer, Public Health Association of Australia.
The features of cruises and cruise ships, closed environments, close contact between travellers from many countries, and the transfer of crew (and sometimes passengers) between ships, mean that cruise ships are a susceptible to the spread of infectious diseases. Given this knowledge, cruise ship companies have a responsibility to be aware of the dangers, respond accordingly to a global outbreak.
A closer look at the timelines of the spread of the virus and cruise ship operations globally over the past few weeks raises some questions.. A cruise ship currently hitting the headlines in Australia is the Greg Mortimer, which over the Easter weekend was allowed to dock in Uruguay, with more than two thirds of the passengers and crew infected and eight already transferred to intensive care. This cruise departed Argentina on 15 March. The world has been changing so fast, it may be difficult to remember what was happening then. It was more than a month after the canary in the coalmine – the Diamond Princess – was quarantined in Japan, with the largest outbreak outside Japan at the time with more than one-fifth of passengers infected and 8 deaths. It’s after the World Health Organization declared a global pandemic on 11 March as the number of countries reporting infections passed 110. After Spain and Italy had gone into near total lockdown. And after Ireland cancelled St Patrick’s Day celebrations. As the world was grappling with the crisis with quarantining, distancing and isolation measures being introduced to various extents across the world, a cruise, with perfect conditions to spread the virus, was departing with a new load of passengers from across the world.
Unfortunately the Greg Mortimer isn’t alone. As of 9th April, there were still 6,000 passengers on cruise ships around the world, including six which left after the USA’s Centers for Disease Control (CDC) advice against cruise ship travel on 8 March, and two (including the Greg Mortimer) which left after the WHO pandemic declaration.
The Ruby Princess, which is responsible for over 10 percent of Australian COVID cases and the subject of a criminal investigation by NSW police, left Sydney on 8 March. Ovation of the Seas, responsible for at least 13 cases departed on 11 March. The Zaandam departed on 7 March and docked one month later with four people dead. The Coral Princess departed on 5 March, and had two deaths before it finally docked again on 4 April. The Voyager of the Seas ship, thought to be responsible for at least seven cases, arrived in Sydney on 7 March with one reported case, and left again the same day. One passenger from that second trip died a week after arriving home. The Artania, which has added more than 50 cases to the list accepted hundreds of new passengers in Sydney on 13th March.
By 18 March, COVID-19 had affected more than 30 cruises. Exact numbers are difficult to ascertain, with discrepancies between the reports of cruise ship operators, and those of passengers. The Celebrity Eclipse docked on 30 March with no reported cases, but one passenger was immediately hospitalised and tested positive for COVID-19, and reports soon emerged of more than 50 passengers on board being unwell. Similar questions are being asked in Australia of the Ruby Princess and the Artania, among others.
The legal consequences are beginning to emerge. The Florida Attorney General is investigating reports that the Norwegian Cruise Line advised passengers that “The coronavirus can only survive in cold temperatures so the Caribbean is a fantastic choice for your next cruise”. A class action lawsuit has been launched against the operators of the Costa Luminosa, which departed on 5 March and had seven deaths.
Questions about the role of cruise ships in the spread of COVID-19, and the impact on resources will continue. In Australia, police and military helicopters transported doctors to eight cruise ships near Sydney in early April to test 9,000 crew members. It is legitimate to ask whether this is an avoidable expense. Cruising is big business, with 30 million passengers on 272 ships every year, and global revenue in the region of $40 billion in 2017 and growing. How have decisions about that big business been made over the past few months? Should cruises have been stopped earlier? Would that have been possible? What risk reduction measures were taken? What levels of risk were deemed acceptable?
Cruise ships have been the source of significant outbreaks of COVID-19 and are being used to teach us more about the virus. While that may have a certain benefit to science, it is difficult to argue the benefit continuing to operate cruises during this time has had on public health.