Cruise ships: death on the High Seas

CRUISE SHIPS: DEATH ON THE HIGH SEAS
8 April 2020

Diamond Princess: "Carnival Cruise Line makes dreams a reality" 

From the late 20^th century, giant cruise ships became a popular choice for affluent holiday makers, many of them elderly. From the time of the “Love Boat” TV series in 1977-87, cruises and cruise ships have become a peculiar symbol of globalisation and good times, with its affluence, indulgence and inequality.

The largest of the ships are compact floating cities with up to 5400 passengers and more than a thousand crew. They somewhat resemble casino complexes, with numerous ethnically themed restaurants, live and cinema theatres, bars, nightclubs, pools, spas, skating rinks, sky-diving simulators and even roller coasters and parks stocked with exotic plants. 

The transportation and hospitality staff are separately managed. Hotel staff are sourced from developing countries, and have low pay - but no expenses while they are on board. 

  

The ships can be aspirational opportunities for people who feel they have ‘arrived’ and deserve a reward. The largest age bracket is 60-69 years, and there may be people well into their eighties on board. My only CSIRO research colleague to make significant amounts of money spent much of the last ten years of his life on cruise ships, finding campervan travel now to be too uncomfortable.

When a cruise ship pulls into port, wandering tourists fill the streets and occupy transit vehicles seeking local colour. The sale of onshore excursions is a major income spinner for the cruise companies. An entire destination in Alaska has been created solely for cruise ships.

The crowded, high density environment of a cruise ship has in the past been rumoured to be conducive to the spread of viruses such as norovirus, which causes gastroenteritis. The mix of nationalities in the clientele as the ships take on passengers, the proclivity of inbound passengers for travel, and the clients roaming freely around ports, might read as a recipe for breeding and spreading plagues. The ships are also not well shielded – contaminated areas cannot be easily separated from virus-free areas, and they do not use the HEPA filters of modern airplanes, which can effectively screen particles.

In practice, it has turned out that the giant ships were literally the perfect vehicle for running their own COVID epidemics – Petrie dishes or small laboratories for what was to happen later on a larger scale. 

Early in the COVID-19 crisis,  on 4 February 2020, ten cases were found among passengers of the British-registered Diamond Princess. The ship was then quarantined at Yokohama for nearly a month, drawing headlines worldwide. There were 712 infections detected, including 150 crew members. Infections peaked fairly typically on Day 10 after the quarantine. The ship is shown as the second “country” to have an epidemic, accounting for more than half of the reported infections outside of China in February (it was later ascertained most of the infection had taken place before the 4 February Wuhan quarantine).

Passengers and crew were evacuated by their country of origin, and the ship was finally emptied on 1 March. Its sister ships Grand Princess and Ruby Princess also had substantial infections later in March, so the luxury Princess line of ships appears to be particularly vulnerable.  

The table shows the cruise ships with more than 30 COVID cases. Eleven more cruise ships have recorded infections – plus a number of Navy ships.

Ship	People	Cases	Docked
Diamond Princess	3711	712	4 Feb, Yokohama
River Anuket	171	41	7 March, Luxor
Voyager of the Seas	4320	39	7 March, Sydney
Grand Princess	3533	103	9 March, Oakland CA
Ovation of the Seas	3500	79	18 March, Sydney
Ruby Princess	3800	662	19 March, Sydney
Artania	1300	41	27 March, Fremantle
Greg Mortimer	227	128	27 March, Uruguay

Source: Wikipedia, plus media reports. List is probably incomplete

In March, many countries began refusing entry to cruise ships, whether they had infections or not. They were stranded at sea, or clustered for weeks around ports, offloading passengers when they were given the chance to be flown home. Despite the situation, a number of firms continued taking bookings through March.

One of the worst cases has been the Greg Mortimer, an Australian cruise ship travelling to Antarctic waters, where over 60% of those on board are infected.  Uruguay has until now denied permission for the ship to dock. Today, passengers have been flown back to Australia in an emergency flight at a cost of $6600 each. Evacuations have now been arranged for 35 cruise ships.

Ruby Princess

A luminous jewel and a romantic destination. Discover a world of relaxation and exhilaration as you sail toward new adventures on this stylish retreat. Ruby Princess online.

The most controversial case has been the Ruby Princess, where thousands of passengers were allowed to disembark into Sydney due to an immigration error. An Australian Border Force officer instructed a Sydney harbour master to allow the cruise ship to dock and disembark, despite it having up to 140 passengers in isolation on board. The Department of Health was told the ship was ‘low risk’. Almost 2700 passengers from the ship were dispatched with no testing into central Sydney on March 19, to make their way home across Australia and abroad. Reports of associated cases have grown ever since – up to 600 in every State of Australia according to one report, and found in every mainland State.

The Ruby Princess then spent a fortnight in NSW waters, off the central coast, before being permitted to dock at Port Kembla on 5^th April. There were 1000 crew from 50 countries remaining on board, and by then, more than 200 reported had coronavirus symptoms. Criticising the handling, the New South Wales shadow health minister told the ABC:

We simply don’t have the capacity in terms of ICU beds or resources at our local hospitals. Why would anyone think it’s smart to move a cruise ship with hundreds of people sick, away from where the major hospitals are in Sydney? It’s appalling and all about out of sight out of mind.

The buck was rapidly passed by Border Force, who said their responsibility was only visas and contraband, and the Department of Agriculture had biosecurity responsibility.

Shocking allegations of murder and corruption were made, and quasi-military responses soon emerged.. On 6 April, a criminal probe was launched by the NSW government.  Strike Force Blast, a task force of 30 detectives from backgrounds as widespread as counter-terrorism, special tactics and marine area command, was rapidly assembled. The ship was raided on 8 April to seize evidence, including the ship’s black box, and to question the crew.

Conclusions

Cruise ships, only two months ago a playground for holidaymakers, have become the most visible symbol of the COVID pandemic, and the one that will survive in people’s minds. Cruise ships have been a rather strange anomaly in history – like something out of science fiction, giant floating fun palaces, enclosed holiday cities where most of the residents appear and disappear in a few weeks. 

Many ships are registered in tax havens and not therefore subject to oversight or regulation. The harsh COVID environment has rapidly revealed their technical and regulatory weaknesses – and it is beginning to show the shadowy background of their business arrangements.

In terms of epidemiology, the ships have provided a microcosm of society, a social mini-laboratory. Many have now been fully tested for CV, giving a measure of how COVID-9 infections actually progress. It appears that in this environment the "R0" of numbers infected by a single case approaches 9 rather than the more normal 2. Only in one case have the ships reached the ‘herd immunity’ level of 60% infection. 

Given the lack of medical intervention, the death rates have been low, less than 2% of those infected, and the number of symptomless has been surprisingly high at over 50%. Confirmed cases were much higher in over-60s, suggesting that not only the chance of mortality but the chance of infection is much higher in this age group.
 

Nearly a third of Australia’s COVID deaths have been Ruby Princess passengers. The much higher number of COVID cases in NSW is largely due to this incident.

What goes around comes around, and the high number of infections and deaths on these ships is oddly reminiscent of “horror ships” like the Ticonderoga and Java bringing settlers to Australia in the 1840s and 1850s. In one case half of these passengers died on board or soon afterwards.

The poor record of some companies such as Princess Cruises  in taking action has been particularly troubling. The industry, even more than carnivals and other public entertainment venues, will be scrambling to survive.

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