BruceMuzz

Common misconception........there are many places and ways you could catch someone else's Norovirus, and I'd wager using a public washroom is a minority of those ways. Now, if you chose to never leave your cabin, that might be different, but the instant you hit an elevator button or a door handle (to the lido deck/bar/showroom/casino/where ever), you're just as potentially exposed.

Don't quit your day job.

Many CDC studies show that the #1 place on a cruise ship to expose yourself to NLV is the Buffet. #2 is a public toilet.

When we have outbreaks on ships, we must complete commonality reports and studies with all affected passengers and crew. We track all their movements and activities on and off the ship since they boarded, looking for common locations or causes of the illness, and cross reference timing of the events and the onset of the illness.

Buffet and public toilets are almost always the prime culprits.

A few years ago, CDC awarded HAL for coming up with the best proactive method of preventing NLV outbreaks by not allowing passengers to serve themselves in the buffet for the first (most dangerous) 48 hours of the cruise.

They also awarded NCL for the second-best proactive prevention of super-sanitizing all public toilets for the first (and most dangerous) 48 hours.

No other cruise lines have received any such awards from CDC.

I agree, though the issue of drying one's hands can be a problem. However, a proper use of hand sanitizer after leaving a public washroom would deal with that.

 

It's also amazing how many people don't wash their hands properly, so knowing a proper handwashing technique is important too.

One of the reasons people get NLV is the mis-conception you have, that proper use of a hand sanitizer will "deal with that".

Not only do most people NOT know how to PROPERLY use a hand sanitizer, but most seem to think - like you do - that these hand sanitizers will prevent them contracting a virus. You - and they - are wrong.

There is also more than one cruise terminal in Shanghai.

One is nearly downtown, near the Bund; the other is quite a distance out of town.

Which one will your ship be calling at?

Please to assist, we have never been to the cruise port in Yokohoma, and would like to spend the day in Tokyo. If we get to the train station, what line would we use to get to the Imperial Palace? Is it possible to do? Any

help would be most appreciated.

You should read the other posts on this page that already give most the instructions you are looking for.

After taking the Minato-Mirai line from Yokohama to Shibuya, you can take any number of trains, subways, buses, or taxis from Shibuya to Hibiya, Ginza, or Otemachi - which border the Imperial Palace.

You can also take the JR from Shin-Yokohama station directly to Tokyo Station, which is a short walk from the Imperial Palace.

I also agree Princess hot tubs are never more than luke warm at best. Last year on the Diamond I spoke with the deck person that's responsible for testing the chlorine content and temperature. He said the computer system gives engineering a read-out of all the pool and hot tub temperatures. In fact, you can see this information on your cabin TV.

 

He claimed the system showed that particular hot tub at 36 Celsius (About 98 degrees). I told him my wife and I enjoy our hot tub at home all the time and keep it set at 98 degrees and this hot tub is no where near that warm. He came back moments later with a handheld thermometer and confirmed it was only 33 Celsius. (Only 92 degrees and quite chilly for a hot tub)

 

At that point he said he'd have it warmed up, but throughout the voyage it never increased in temperature.

 

I just don't think they really care - it seems trivial to them

 

Or their computer system needs to be recalibrated and perhaps loses its accuracy over time.

Think again. The Center for Disease Control has ruled that overly warm hot tubs on ships are responsible for many health problems experienced by overly medicated cruisers.

Through the USPH, which governs such things on all cruise lines operating from US Ports, they have required us to reduce temperatures in hot tubs, Jacuzzis, and spa pools.

They also required us to reduce the amount of bubbles generated by these pools as they allegedly encourage the growth of Legionella disease.

No -- I still do not believe that HAL reads surveys.

After our November cruise of 14 days on the Nieuw Amsterdam we each completed our online survey. (I actually got DH to use a computer.)

We had several comments -- and we never heard from Seattle. Just like when we had the surveys on the ship -- I know ours were never read. At the end of a cruise a couple of years ago, we didn't realize that we had not gotten the surveys until we were off the ship.

HAL ships carry about 25,000 passengers every week.

HAL recently joined the growing number of cruise lines that send out emails to get customer surveys completed online. Like the other lines they probably receive around 40% responses - most of them negative.

Even of ALL the HAL employees in their Seattle Office stopped doing their regular jobs and spent every day reading and personally responding to all the online comment cards, they still would not have enough time to do it.

Draft beer on international ships is a big problem.

Due to some bizarre tax regulations, the cost of draft beer sold on a ship is much higher than the cost of the same draft beer sold on land. It is nearly impossible for a cruise ship to make a profit on draft beer. We charge too much for the beer, reducing the turnover and the freshness/quality of the beer.

Then there are the barrels. Most beer barrels from Europe and Asia require one type of connector, and barrels from North America require another connector. There is no draft beer machine available to ships that will allow them to accommodate both types of barrels.

Then there is the deposit on the barrels. In the past, cruise ships would sail away for long periods of time and not return the empty barrels. So the distributors require large deposits in order to get them back.

A ship has to store empty and full barrels for long periods of time. North American distributors will not accept empty European or Asian barrels. European and Asian distributors will not accept North American barrels. As you know already, storage on a ship is very limited, so we get stuck storing all those empty barrels for extended periods.

The draft beer dispensers belong to the distributors - not the cruise line. If and when they need servicing, we need to pay to fly a technician into do the work. If the distributor is in Miami and the ship is in China, it gets very expensive.

Then there is the USPH. They do not like draft beer dispensers, claiming that they cannot be properly cleaned. Ships inevitable lose points or get negative observations about the draft beer dispensers during USPH inspections.

All in all, it is just not worth it to have draft beer on a ship.

No...nor on ANY cruiseline! Do notify them of your needs in advance of your sailing! All cruiselines have a "special needs" dept.

Not quite correct. All the major cruise lines will go to extreme lengths to satisfy just about any special diet. If we have it onboard, or can get it onboard without too much expense, or can get it onboard at all, we are happy to comply.

But then we have that certain percentage of humanity who MUST have very special and specific expensive brands of foods, or other very unusual items that ships normally do not carry. We also have those geniuses who insist that their doctors have prescribed only lobster and caviar - or some other nonsense - for the entire voyage.

To all these "special" requests we reply that we are happy to accommodate - and we quote a price for that service. In most cases, those people who just HAD to have those special items in order to stay alive decide that they are able to survive without them if they have to pay.

Thank you, Bruce! We can always count on you to shine a light in the darkness, around here. :cool:

Just one question, about your comment that Chlorine Bleach is prohibited as a cleaning agent, onboard all cruise ships. I've been lucky never to have been on a "bleach cruise". But, when I've heard stories of pax' clothes being ruined, by leaning against railings, etc -- I just assumed they were talking about a Chlorine Bleach solution being used. Does Virox (or Virkon) leave a similar residue, capable of ruining any clothing that comes in contact it?

Good question. Virox and Virkon - and a few other commercial variations - are highly concentrated activated hydrogen peroxide. They are much stronger versions of the chemical that hair salons use to bleach hair. A much weaker and slightly different version is also sold in North America as "Oxy Clean". This is a non-chlorine bleach and it can damage clothing.

It depends on which cruise port you are going to.

There are 2 cruise terminals on Tokyo Bay, and one in Yokohama a few kilometers away.

The majority of cruise ships calling at Tokyo use the Osanbashi Terminal in Yokohama.

If you have only 2 cases to carry, there are many convenient and inexpensive subways and trains that can take you directly from Tokyo Disneyland to Yokohama.

After watching some of the ways the stewards clean the rooms I will be picking up some wipes also

Every cruise I seem to catch a cold or upper respirator infection ...I know the wipes may not help for those but it may make ne feel better

 

Just watch the room stewards take the bucket of cleaning water from your room to the next cabin & the next cabin without a fresh bucket of water ....:eek: what germs are they spreading

 

 

IMO

Wipes could not hurt

The stewards are instructed by the cruise lines - and the CDC - to clean most surfaces in your cabins with highly concentrated non-chlorine bleach (activated hydrogen peroxide), using micro-fiber cleaning cloths.

Those buckets of "cleaning water" as you call them, are filled with the hydrogen peroxide solution, which is toxic to most bacteria and viruses. They are not spreading anything. There is no need to change this cleaning water between staterooms. The strength of the cleaning solution is checked every hour with test strips. But the stewards do change micro-fiber cloths as they move from cabin to cabin.

As a healthcare professional and a self-proclaimed germophobe, I can assure you that none of the wipes available at your local store will kill noro, nor will alcohol based hand sanitizers. The only substance known to dismantle the virus is a 1:10 bleach solution. Clorox cleanup spray qualifies as that, I believe. The reality is it is very difficult to avoid catching in closed environments. I do not personally travel during peak season for the worst bugs (noro, influenza, rsv) because that is just too much money to spend to have my vacation ruined.

As a healthcare professional, you need to do a bit more research.

There are many substances known and proven to kill Norwalk Virus spores. But most of those substances also kill humans, so they are not practical.

Chlorine Bleach and non-Chlorine Bleach (better known as activated hydrogen peroxide) are the 2 chemical substances recommended by the CDC.

Cruise lines are not allowed to use Chlorine Bleach in many parts of the world, and even where it is allowed, the damage done to people and property by concentrated chlorine bleach is not acceptable.

So we all use activated hydrogen peroxide, produced by 2 Canadian companies and sold under the trade names Virox and Virkon.

These chemicals are very expensive and are not exactly healthy for humans. They cause minimal damage to hard and soft surfaces. But they do kill viral spores with just a few minutes dwell time, which is very important.

On the negative side, Virox leaves a milky film after drying on hard surfaces, corrodes some types of metal, and smells like urine after it dries.

Virkon is less corrosive, leaves less of a film after drying, and smells like vomit after drying.

Both of these chemicals irritate skin and lungs.

Both chemicals are extremely expensive.

I'd say the 4000 estimate is a little low, if you count all lines.

 

There are at least 35 ships just based out of America, which means on average, if only 2 people per day per ship report, you are looking at 2100 per month over 4 months. 14 people on a week cruise with 3000 pax would even still be probably conservative.

Excellent point.

The 4,000 estimate came from CDC. But just like their estimates on total number of Americans affected at home, I suspect that they are far too optimistic.

Let's assume that CDC is wrong by a factor of 10, and 40,000 passengers (800 per week)were actually affected by NLV last year while on a cruise.

That means that approximately 0.25% of cruisers suffered, versus the 10% (or more) of the American general population who stayed home and got sick.

The odds of staying well on a cruise still look pretty good.

We were on the CB last week, and fortunately, did NOT get sick. DH overheard a woman saying "You know the crew gave everyone Noro so they could get back to port early...." :rolleyes: I should think that the crew wants an outbreak even LESS than the passengers do! Not only, in our case, did they lose out on a day's worth of tips, they had to work harder! Once the ship went on Red Alert, crew were constantly wiping down everything, more staff had to work the buffet, the waiters had more to do, you get the picture...

When a ship goes to Code Red with an NLV outbreak, the crew loses far more than a day's tips.

A high percentage of the passengers decide not to tip at all - blaming the crew for the problems. This substantially reduces the salaries of the crew.

The tipped crew, who normally work 13 hours maximum per day, are forced to work much longer hours. We get paid a monthly salary which already includes any overtime. That salary does not go up when the working hours increase.

Many tipped crew and their management are eligible to receive a performance bonus based on guest ratings and comments.

Guest ratings and comments take a very negative turn when the ship is in Code Red, resulting in zero performance bonuses.

This isn't entirely true. Or, perhaps it isn't true for the reasons you think. People seem to think that cruise ships bear a disproportionate level of publicity when it comes to noro, but that level of attention is warranted. While you are correct that one can contract noro in a variety of places, the reason that you hear about it more on cruise ships is that cruise ships are unique in their setup such that the rate of infection is far greater than in the general population. If 10 people out of 4,500 have noro in the gereral population, the odds of 700 becoming infected over the span of a week are slim to none. If 10 people have it on a cruise ship and do not follow quarantine protocols, the odds of 700 people contracting the virus are far greater.

 

So while it might seem that cruise ships get an "unfair rap" when it comes to noro, the truth is, cruise ships are floating Petrie dishes when it comes to the virus. Sure, hospitals are known to have outbreaks too. But many hospital patients stay in their hospital rooms 23 hours a day, do not use handrails to descend stairs, do not push elevator buttons as frequently, do not go to buffets and handle food and/or utensils, and they do not roam around the entire grounds of the hospital the way passengers roam around a ship. Land-based resorts are susceptible to the same issues, but people check in and check out on a daily basis, so you don't have the same 4,500 people confronting each other for 7-10 straight days. Infected people travel back home and infect people on the plane, or back home, and the concentration of infected people gets dispersed to the point where it is largely unnoticed. Cruise ships really are different in that you have a concentrated population that does not come and go, and everyone passenger has only one or two "degrees of separation" from every other passenger.

Last year in America there were 21 Million reported cases of NLV. Many people - myself included - believe that the numbers are much higher, as many people with "stomach flu" do not report it to the CDC or local hospital.

The CDC estimates that 10% of the US general population has NLV every year. If they are correct, around 30 million Americans have NLV every year.

Last year the international cruise industry carried just under 20 million passengers.

Approximately 4,000 of them were reported to be affected by NLV.

There were probably another 4,000 who contracted NLV on a cruise, but did not report it.

That comes to around .05% of total cruisers suffering NLV, versus 10% of the American general population.

By my rough estimate, you are 20 times more likely to suffer with NLV at home in America, than you are to suffer from it on cruise.

Why doesn't someone develop an anti viral sanitizer? That is the real question.

 

Right now is is no such thing as a truly effective anti viral sanitizer; so the ships take the obvious step: they furnish each stateroom with soap and running water.

 

Better to wonder why more passengers don't use soap and running water more frequently.

We do have anti-viral sanitizers and we use them every day on just about every ship. The 2 most popular ones are made in Canada, and both contain Activated Hydrogen Peroxide as the active ingredient. We spray, fog, and wipe these products all over the ship, hoping to kill all the virus spores deposited by unclean people.

Some people call these chemicals non-Chlorine Bleach. They are sold under the brand names Virox and Virkon.

Variations on these chemicals are sold in a weaker version in North America as "Oxy-Clean".

These products are:

1. Extremely expensive.

2. Damaging to skin, eyes, and lungs.

3. Damaging to many hard surfaces.

4. Damaging to many soft surfaces.

5. Responsible for the white film you see on many surfaces.

6. Responsible for the urine smells you notice in many toilets (Virox).

7. Responsible for the vomit odors you sometimes smell in public areas (Virkon).

Considering the risks and damage associated with these chemicals, it would be far safer, less costly, and seemingly simpler to teach adults from North America to wash their hands properly after using the toilet.

China is always an enigma when it comes to officials doing their jobs efficiently. You are lucky to be trying this in Shanghai. The officials there are usually more switched on than their counterparts in ports like Xingang.

My ship calls at Shanghai about a dozen times a year. 8 or 9 of those times, the ship is clear in 30 minutes or less; the other 3 or 4 times can take as long as 3 hours to get the ship clear. You just never know.

Bruce, recently Gojo has introduced a new formula of Purell (VF481) which has antiviral properties and has been shown to be effective against Norovirus. On my last cruise I noticed that the Purell that was used onboard was the antiviral formula. Perhaps this wasn't available on your ship(s).

It is available on my ship - and still has most of the drawbacks of the previous gels.

1. It is very damaging to human skin.

2. Many people are allergic to it.

3. People still use it as a substitute for handwashing, which is far better.

4. The wet contact time for most people is still too short to allow it to be at all effective.

5. There are questions as to how effective it might be - even of used properly.

Why don't we all just wash our hands frequently and properly, and get over it?

Additionally this new product is incredibly expensive. Washing hands works far better and costs next to nothing.

There are also some claims that the new chemical is carcinogenic. That's why it is not yet approved for import into the USA.

No cruise ship can use satellite communications in Japanese waters. This includes internet and satellite telephone.

For Japanese passengers, this is not a problem. Japanese mobile telephones are very advanced and Japanese telephone charges for internet and calls are very reasonable all over Japan.

For Western passengers, internet and satellite telephone are available as soon as the ship reaches international waters; about 60 minutes after leaving port in most cases.

I really think cruise lines policies need to change in order to help reduce outbreaks and eventually they may figure this out as the bad press is costing them millions.

 

Currently, if a passenger is about to board and completes the health questionare honestly, stating they are having flu-like symptoms, they are denied boarding AND lose all of their money to boot.

 

This penality makes the health questionare completely ineffective and a waste of time.

 

If a passenger makes it all the way to the terminal for embarkation and honestly admits they are ill, their fare should be credited towards a future cruise.

This is just not true. We board people all the time who have flu-like or Norwalk-like symptoms. We only ensure that the ill people agree to isolate themselves onboard until they are no longer contagious.

The only passengers denied boarding are those who are so ill that they might need evacuation or hospitalization during the cruise.

Very good point. I wonder how well the terminal gets sanitized when they sanitize the ships???

In most cases, the terminal is NOT sanitized. The ports who own the terminals are not willing to spend the money, and in most countries (USA for example) the ships crew is not allowed to work in the terminal to clean it.

Basically, everything you do, I do the opposite. And I haven't had the virus either. I suppose that each in our own way, we've built up an immunity. Clearly you haven't avoided the virus because you've been dealing with all those sick passengers, but it looks like your body has learned how to not be ill with it.

There are still many things we do not know about viruses

But we do know that nobody has immunity - unless you have just suffered from that particular strain of a virus, and the immunity is only for that strain, and only for a very limited period of time.

The key to staying well is not so much what we do - but what we do not do.

Noroviruses have very limited ways to access our bodies.

If we don't open the door, they cannot get in.

You really do not need to wash your hands every other minute - so long as you do not use those hands to contaminate your food or drink, and do not put those hands in your ears, nose, eyes, or mouth.

Some people who get the illness were just unlucky; they happened to eat or drink something that was contaminated by another passenger or crewmember, or happened to breathe air that had been contaminated by someone with NLV vomiting and aspirating the spores.

Most people who get the illness do so because they are lazy, careless, unclean, or just plain stupid. I am very sorry to say so, but most people who get NLV could have avoided it just by being a bit more careful.

Using hand sanitizer instead of washing is not smart. It's lazy.

Using hand sanitizer from a bottle stored in a pocket or purse is really stupid. Pockets and purses are filthy places.

Using the buffet on the first 2 days of any cruise is really pushing your luck. All the sick people were there just before you.

Using public toilets on a ship is just begging to get it. That's where the sick passengers go when they cannot make it back to their cabins. It is also where the people who are too lazy to go back to their cabins - and too lazy to wash their hands - go.

Do you ever notice the crew picking up used kleenex tissues that passengers just drop on the floor? It happens hundreds of times every day.

Those crew throw away the contaminated tissues, then have to find a place to wash their contaminated hands. How many things do the crew touch on the way to a hand washing sink?

Do you ever notice all the dirty dishes and glasses left just about everywhere by lazy passengers? We find them on staircases, in bathrooms, on every desk and countertop around the ship. Hey, they are on vacation; why should they have to clean up after themselves?

No problem. The crew is quite happy to clean up the mess.

But how many of those lazy passengers were ill?

How many things are the cleanup crew going to touch after they have cleared the dirty items and go looking for some place to wash their contaminated hands?

The item in bold has me scratching my head here. If you, an expert with 1,400+ cruises, does not use the hand gel, then why are the dispensers there and why does cruise staff require that we use them before entering the dining areas?

The dispensers are there because:

1. The cruise lines believe that when dealing with many people raised by wolves (who do not wash anything, ever), it's better than nothing.

2. The dispensers are a visible reminder to at least try to be clean.

3. Our legal department and our PR people - who typically live in an alternate universe - believe that having the dispensers visible and actively promoted gives the impression that we are trying to force our passengers to be clean.

The reality is that the chemicals in the dispensers are very bad for your hands.

The chemicals do have some minor effect on viruses, but only when the "wet contact time" is extended over 2 or 3 minutes. How many passengers - or crew - squirt enough of the sanitizer on to keep it wet for 2 or 3 minutes? The answer is NONE.

My colleagues at CDC also claim that the sanitizers give people a false sense of security. After using the sanitizer only, they believe that their hands are clean (they are not), and it is safe to put those hands in places like mouths, noses, and eyes (it is not).

Those small chemical dispensers are even worse. Many people keep them in their pockets - one of the dirtiest places in the world. When they reach into their pockets to get the dispenser out, their hands get dirtier. Then they handle the dirty dispenser while sanitizing their hands, completely defeating the process. Finally they use their questionably clean hands to put the dirty dispenser back into their contaminated pockets, ensuring that their hands are once again contaminated.

1400 cruises does not make me an expert on anything. It just means I have more information than most people.

You forgot to bold one very important item. I have not used the hand sanitizers (for over 3 decades) AND HAVE NEVER HAD NLV, despite being directly exposed countless times.

Check this link below for the most hygienic cruise lines out there. Would this make you think twice when sailing you favorite cruise line if they were not as clean as you thought?

 

These cruise lines haven’t failed a CDC sanitation inspection in the past 10 years.

 

Costa

Norwegian

Oceania

Disney

Crystal

Seabourn

 

 

Check the link:

http://www.marketwatch.com/story/6-most-hygienic-cruise-lines-2014-01-30?siteid=yhoof2

I teach classes for CDC when I am not working on a ship.

CDC Scores and hygiene are just barely related.

If you actually take time to read a CDC Inspection report, you will discover that most of the items inspected have to do with back-flow preventers on water supplies, cooling and heating logs filled in correctly, the length of the handle on the shepards hook at the swimming pool, the colors of trash bins in the galleys, how long the cutlery sits on the table before use, the temperature of the water at the handwashing sinks, how often the plastic cutting boards are sanded down, how many ceramic floor tiles in the galley have cracks in them, how many times per day we test the swimming pool water, how many fruit flies were discovered in the garbage room, and how often we sanitize the shower heads with bleach.

Most if this stuff has zero direct effect on hygiene on a ship.

NONE of this stuff has any direct effect on NLV.

If you do a careful search of CDC Inspection Scores over the past 10 years, and match them to ships that have had the most outbreaks, you will discover that many of the ships with the highest CDC Scores also had most of the reported outbreaks.

The correlation between high CDC scores and increased outbreaks is not what you might think.

Newer, bigger ships typically receive higher CDC Scores. The newer technologies they have onboard are more suited to meeting CDC Regulations. Newer equipment onboard is all functioning properly. All cruise ships built over the past 10 years were supervised in the shipyards by CDC Staff, ensuring that all is up to code.

Newer, bigger ships are usually introduced in the North American market.

Ships sailing from US Ports carry more Americans.

NLV developed and was discovered in Norwalk, Ohio, USA.

America has a higher percentage of citizens (and an actual higher number) with NLV every year than any other country. When those people come onboard, they bring the illness with them.

Bigger ships carry more people - increasing the chances of more infected people taking the cruise.

So, bigger and newer ships generally receive higher CDC Inspection scores, and generally have higher numbers of NLV outbreaks.

By the way, I often make unofficial CDC inspections onboard ships, using all the current CDC standards, requirements, and regulations.

If you can give me a list of your 10 favorite restaurants, I can guarantee that all of them would fail even a very cursory CDC Inspection.

Do you still want to eat in those places? Are they clean?

Bruce, We think all you say is correct, but it still does not take away from the fact that 600+ Noro cases on a single cruise is newsworthy. And we do think there is a major difference between Noro at home and Noro at sea. As home, if you hear about a Noro outbreak you can take some precautions such as not going out as often, avoiding restaurants, the mall, etc. But on a cruise we are all "stuck on the same boat" so to speak and there is no escape. Sure, we can all increase our onboard precautions and the crew can work their fingers to the bone scrubbing every surface on the ship. But we are all still trapped in that confined space and there is no escape. We think the smart folks go about their daily cruise activities (washing hands more often and never touching their face) while praying to King Neptune to "please don't let it be me." Others cannot help but obsess on the virus and find themselves staying confined in their cabins, avoiding any public contact, and having a miserable time (even though they are not sick).

 

So the Noro saga goes on and we all know this will not be the last such incident. Unfortunately, nothing is going to change until some drug company develops an effective Noro vaccine.

 

Hank

Things could change much more quickly if someone could teach adult Americans how to properly wash their hands after wiping their butts, and not to behave like animals when they eat.

I am "trapped" on a ship for 9 months every year, exposed to all the same things everyone else is. But I choose to be clean and careful. I have never contracted NLV in 37 years on ships - with people sick all around me.

Are you saying that we need to scare the public with these dire news stories in order to make them behave in a civilized manner when they travel?