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Canadian Study Shifts Transmission Blame

Air Transmission More Likely The Cause In Common Areas

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Cruise Ship Norovirus
Canadian Study Shifts Transmission Blame

Air Transmission More Likely The Cause In Common Areas

New Norovirus Study Shows Cause Of Transmission: Air

May 9, 2015 - In this day of get rich quick lawsuit mentality, the first thought some people have when it comes to a Norovirus outbreak is to hire a lawyer and sue the cruise line. While most lawyers wouldn't touch a Norovirus lawsuit, because there is no big money it, class action lawsuits have been filed on behalf of cruise ships full of passengers who were sick, had their cruise "ruined" and need to blame somebody, anybody, with deep pockets preferred.

Lawsuits are based upon three elements, somebody had a loss, another person/entity is to blame and that person has the means to provide compensation for the alleged loss. Then, the burden of proving the person responsible was negligent, known or should have known or acted with deliberate malice will determine the outcome, when those three criteria are met. As a rule, most lawyers will not take a case worth less than $10,000. In their view, it's not worth their time. In maritime law, most lawyers like to have a minimum lawsuit value of $75,000.

This makes the cruise lines a preferred target for the "somebody has to pay for my unhappiness" sector of society. Norovirus is estimated to cause 23 million cases of acute gastroenteritis. That's a lot of deep pocket corporations who can be blamed, for a price. The reality is this. Of those 23 million cases the number of cases which end up in lawsuits each year is almost nil, because people get what is commonly called "the stomach flu" every year. They lose work, they miss college classes, they cancel plans, miss parties, nurse sick kids while they are sick too and sometimes they die as a result. It 's called "life".

While Norovirus lawsuits are not low hanging fruit for lawyers, in 2010, a class action lawsuit was filed in the United Kingdom against Thomson Holidays for a Norovirus outbreak aboard their cruise ship Island Escape. Litigants claimed a loss of cruise happiness, "ruining" the cruise experience for over 200 passengers. One of the litigants was a bride who blamed the cruise line for ruining their honeymoon. The lawsuit was settled four years later and just this past month passengers received the equivalent of about $2.00 to 4.00 a day, for a four year battle. The real victor was the lawyer who sued the cruise line.

It isn't just the cruise industry being sued for Norovirus illnesses. Lawsuits have targeted hotels, resorts, restaurants and even amusement parks. In March 2015, the wife of a 43-year-old man who died after allegedly eating food contaminated with the norovirus filed a $2.9 million lawsuit.

In 2008, a New York class action lawsuit was filed on behalf of hundreds of people who became ill as a result of a 2008 norovirus outbreak at the Six Flags Great Escape Lodge & Indoor Waterpark.

Now, a new study from Quebec Canada shows Norovirus is airborne, filling the air with the unpleasant germs, every time somebody coughs, sneezes and even exhales, if they are infected with the Norovirus. Previously, the Norovirus germ was believed to be passed from person to person by touch, including touching surfaces in the ship where germs were lying in wait, just itching to attach to fingers placed upon elevator buttons, handrails, buffet serving spoons, restroom doors, sinks and toilets.

After the Quebec, Canada study Published by Oxford University Press on behalf of the Infectious Diseases Society of America was released, the United States Government National Institute Of Health, (NIH) put out a publication on April 21, 2015 which stated the following:

  • "Norovirus are responsible for at least 50% of all gastroenteritis outbreaks worldwide. Norovirus GII can infect humans via multiple routes including direct contact with an infected person, contact with fecal matter or vomitus, and with contaminated surfaces. Though norovirus is an intestinal pathogen, aerosols could, if inhaled, settle in the pharynx and later be swallowed."


  • A total of 48 air samples were collected during norovirus outbreaks in 8 healthcare facilities. Samples were taken 1 meter away from each patient, in front of the patient's room and at the nurses' station. The resistance to aerosolization stress of murine norovirus MNV-1 bioaerosols was also tested in vitro using an aerosol chamber. Concentrations of the virus ranged from 13 to 2,350 particles per cubic meter of air. The study authors pointed out that a dose of just 20 norovirus particles is usually enough to infect someone.

    CONCLUSION: Norovirus genomes are frequently detected in the air of healthcare facilities during outbreaks, even outside patients' rooms. In addition, in vitro models suggest this virus may withstand aerosolization.

    The basis of past lawsuits against the cruise lines was cruise ship cleanliness and hygiene practices not being met, with dirty restrooms, nightclubs, restaurants being the blame for Norovirus transmission. While it's a fact, the common areas of the cruise ship are places Norovirus is transmitted, it's mostly due to the population density of people who don't cover their mouth when they cough or sneeze sharing the air. In generations past, everyone carried a washable handkerchief in their pocket to cover their mouth. Somewhere along the line, it was decided handkerchiefs were a dirty solution and the idea of paper, disposable tissues became popular, which are obviously less available to people at a moment's notice.

    Since large, enclosed, common areas are the perfect place for infection, the same could be said about malls, big box retailers, theatres, convention centers, colleges, hospitals, schools, day care centers which all have one thing in common, large population density in an enclosed area. Proving infection in those areas, is a little more troublesome, for the same reasons, it's impossible to prove where patient #1 in an outbreak was infected.

    Maybe he was infected at the store where he shopped before the cruise, or at the hotel he stayed in the night before the cruise. Perhaps he was infected in the restaurant at the port where he dined the night before the cruise, or caught it at a nightclub in port before embarking. Then, there was the taxi ride, the shuttle bus and the airline and airport, all of which were part of the worldwide germ factories within the pre-cruise experience. Can it be EASIL and, QUICKLY proven, is there a person to blame and do they have the means to compensate? It's not low hanging fruit.

    He might have caught it at work, the last day before his vacation, or from his child who was infected at school or the daycare center, or from the gym back home where he works out everyday. The whole family could have been infected at church or their community center during a celebration such as a wedding or reception or other well-attended activity before they embark on the cruise. All of these scenarios are as likely as catching it aboard the cruise ship. Suing and getting money at any of those other probable locations is nearly impossible, the profitable, low hanging fruit. solution is to sue the cruise line.

    Past cases show, Norovirus is brought aboard cruise ships by passengers, who became ill before they boarded the cruise ships. This we knew. There are clusters of outbreaks in cruise ship ports, where ships calling at or embarking from a port see large numbers of cases in Norovirus outbreaks, while most other port cities have never, ever had a Norovirus outbreak aboard cruise ships calling in their ports.

    This year so far, it's been San Diego, Miami and Ft .Lauderdale where the cluster of outbreaks took place, disrupting cruises aboard Oceania Cruises, Holland America Cruise Line, Princess Cruises, Celebrity Cruises, Norwegian Cruise Lines and Royal Caribbean Cruise Line from February to April.

    Cruise Bruise reported on April 14, 2015, "We saw a similar incident back in 2012, with three cruise ships, Crown Princess, Celebrity Constellation and Ruby Princess all departing Ft. Lauderdale, Florida all having confirmed Norovirus outbreaks. The three ships had reported to the CDC an excessive amount of sick cruise ship passengers. An amount of passengers equal to 3% or more is CDC reportable." This supports the theory of passengers bringing it aboard.

    Popular Science Monthly, in part, covered the topic in October 1913 while discussing the topic of immigrants and their diseases. These immigrants had arrived by sea on passenger ships. The bottom line is dirty people and Sick people take voyages and infect others on the voyage and some die. This is not a new problem, it's not a cruise line problem, it's the human problem.

    Supporting Information & Resources:
    Featured or New Cruise Ship Illness

    Cruise Bruise Investigations - Cruise Ship Illness

    Suggested Reading Cruise Ship Illness