The big one they forgot

[beentothere]

The biggest safety omission, in my opinion, is not having a quasi hospital built for the specific needs 

of an infectious diseases. Perhaps by isolating patients to a cabin, the quality and efficiency of medical care and observation

are reduced to the barest minimums. I see all these procedures exhibiting the processes before but nothing after contagion.

Except to confine the patient to an isolated room where medical service efficiency and quality would be reduced to a

small fraction of the amounts realistically defined by contemporary professional standards.

 

As I am not a doctor or nurse I cannot qualify those with appropriate detail. But having written a complete hospital system that ran

two hospitals for a number of years, the interactions of quality of service and efficiency are well known. Patients confined to a cabin

might be expected to otherwise experience an insufficient minimum of observational review likely leading to a potentially unnecessary

deteriorating condition. Worse, as there would unlikely be any electronic monitoring of condition, the timeliness of emergency assistance

would likely be poor or worse.

 

Just an old man's musings.

 

 

 

[Bo1953]

Thank you for the musings.

 

This would mean a 'skills' upgrade for sick bay staff on all ships....

 

The financial impact, along with enlarging the sick bay would be expensive.

 

I, personally, would prefer an active pre-boarding screening and re-screening to prevent one of us 'sick' ones from slipping through even to the point of a possible denial of boarding because of potential infection.

 

Yes, we will need to be ready for any false positive and false negatives and upset passengers... including ourselves.

 

Better to give a FCC and weather the ire of a passenger, than possibly infect a whole ship. IMO

 

In health and bon voyage

[hcat]

I think ships are having some upgrades and expansion made to the medical area including isolation area ; and also more and better trained med staff. -(Can't recall source)

 

,  Not sure what CDC or ship regulators require,.but hopefully we will hear more as actual cruises start up.

[beentothere]

1 hour ago, hcat said:

I think ships are having some upgrades and expansion made to the medical area including isolation area ; and also more and better trained med staff. -(Can't recall source)

 

,  Not sure what CDC or ship regulators require,.but hopefully we will hear more as actual cruises start up.

What was said to my knowledge was limited to the added training of course and only to quarantine infected 

into single occupant cabins. I have not seen any mention of a hospital expansion or any new medical

quarantine construction or modification.

[beentothere]

1 hour ago, Bo1953 said:

Thank you for the musings.

 

This would mean a 'skills' upgrade for sick bay staff on all ships....

 

The financial impact, along with enlarging the sick bay would be expensive.

 

I, personally, would prefer an active pre-boarding screening and re-screening to prevent one of us 'sick' ones from slipping through even to the point of a possible denial of boarding because of potential infection.

 

Yes, we will need to be ready for any false positive and false negatives and upset passengers... including ourselves.

 

Better to give a FCC and weather the ire of a passenger, than possibly infect a whole ship. IMO

 

In health and bon voyage

I am not sure that enlarging the sick bay would even be possible as the physical partitioning in the lower regions may not

permit significant modifications. But the elephant in the hall is staring at us! Best efforts to prevent an infection to creep into

the ship are likely to be the case, and they are complex and difficult to achieve 100%. But I am sure they will try.

 

However, the probability of an infection in a population of thousands given imperfect testing and limits of other

diagnostic tools is very high. On the other hand, the probability of their being no infection on any ship is likely to be close to

100%. On board control is what would prevent a mass outbreak. Single cabin isolation is also highly unlikely to prevent

progressive contamination as the room cannot be kept sterile and the air seepage is again likely to be significant.

 

Back to creating a quarantine subhospital in my aged opinion.

 

[1025cruise]

We don't know what's going to happen when cruising resumes. For all we know, there might segregation built in for this. But until there is a formal announcement, there is no need to speculate on what may or may not happen.

[Bo1953]

1 minute ago, 1025cruise said:

We don't know what's going to happen when cruising resumes. For all we know, there might segregation built in for this. But until there is a formal announcement, there is no need to speculate on what may or may not happen.

Actually the OP was only 'musing' about what they thought could happen, not what should or needs to happen.

 

Many of us are keenly aware that 'official' guidelines are needed before any plan can be implemented.

 

In health and bon voyage

[mom says]

I have absolutely no idea what you mean by a "quasi hospital" or a "sub hospital", nor do I really care. But what information has led you to conclude that no one (on the panel of experts that has been formed) has thought to develop plans and protocols for the safe handling of infectious pax on board? Seems like a rather big assumption on your part, unless you have a factual basis for this line of possible concern.

Edited July 25, 2020 by mom says

[mom says]

1 minute ago, mom says said:

Double post. Sorry.

 

Edited July 25, 2020 by mom says

[WrittenOnYourHeart]

49 minutes ago, mom says said:

I have absolutely no idea what you mean by a "quasi hospital" or a "sub hospital", nor do I really care. But what information has led you to conclude that no one (on the panel of experts that has been formed) has thought to develop plans and protocols for the safe handling of infectious pax on board? Seems like a rather big assumption on your part, unless you have a factual basis for this line of possible concern.

 

I agree with you!

 

On this and other boards, I see a lot of people operating on "If they haven't said it, they don't have plans for it." when in reality it is far more likely that they are working on plans, possibly even at the approval stage, but do not want info floating around on the internet (where things are pretty much forever thanks to screenshots) that is subject to change until such policies and procedures are approved.

 

Look at the newly announced "individual muster" thing that they unveiled yesterday. Had anyone heard rumblings of it? Not that I'd been aware of - and you know it would have been rumored on here. They did not just suddenly create it the night of July 23 - I'm sure they've been working on it for a while, getting it to the point they could submit it for approval. But imagine if there was talk of it and then it hadn't gotten approved...people would be irate.

 

Lack of communication about plans in process does NOT indicate there are no plans in process.

[C-Dragons]

There's plenty of information here, if interested.

Lots to read:

 

https://www.cdc.gov/quarantine/maritime/recommendations-for-ships.html

[WNcruiser]

4 hours ago, C-Dragons said:

There's plenty of information here, if interested.

Lots to read:

 

https://www.cdc.gov/quarantine/maritime/recommendations-for-ships.html

Thanks for getting the thread back on topic. Lots of good information contained in there although some of it seems unrealistic to me. 

[npcl]

13 hours ago, beentothere said:

I am not sure that enlarging the sick bay would even be possible as the physical partitioning in the lower regions may not

permit significant modifications. But the elephant in the hall is staring at us! Best efforts to prevent an infection to creep into

the ship are likely to be the case, and they are complex and difficult to achieve 100%. But I am sure they will try.

 

However, the probability of an infection in a population of thousands given imperfect testing and limits of other

diagnostic tools is very high. On the other hand, the probability of their being no infection on any ship is likely to be close to

100%. On board control is what would prevent a mass outbreak. Single cabin isolation is also highly unlikely to prevent

progressive contamination as the room cannot be kept sterile and the air seepage is again likely to be significant.

 

Back to creating a quarantine subhospital in my aged opinion.

 

Keep in mind that the major cruise ship outbreaks occurred when the number of infected people outside of China was pretty small.  It only takes 1 to get through.

 

To put it into perspective in the US we know have about 2 million cases considered to be active.  The actual number of infected individuals is probably somewhere between 5 to 10X that number based upon studies that I have seen. So that means that anywhere from 3% to 6% of the US population is infected.  So if you put 1500 people on a ship (the people willing to go are also those that are willing to under take riskier behavior, the more cautious folks would stay home) so in general that would mean 45 to 90 cases on board. Most not showing active infection so temp screens pretty useless. Even testing for COVID has a 40% false negative rate so anywhere from 18 to 36 would be likely to slip through and make it on board.

[beentothere]

18 hours ago, Bo1953 said:

Thank you for the musings.

 

This would mean a 'skills' upgrade for sick bay staff on all ships....

 

The financial impact, along with enlarging the sick bay would be expensive.

 

I, personally, would prefer an active pre-boarding screening and re-screening to prevent one of us 'sick' ones from slipping through even to the point of a possible denial of boarding because of potential infection.

 

Yes, we will need to be ready for any false positive and false negatives and upset passengers... including ourselves.

 

Better to give a FCC and weather the ire of a passenger, than possibly infect a whole ship. IMO

 

In health and bon voyage

The probability of an infected person boarding some ship within the next 6 months would appear to be very close

to a certainty. One would hope for onboard testing with minimum error. I personally would not hold my breath

especially near the Elizabeth NJ refinery. 

The high infectious capacity and the long incubation period present a major medical challenge to an anti-viral.

Thus while some anti-viral is likely with some capacity, the highly advanced mathematical systems are just beginning

their sojourn to what may be a multiple decades investigation for the ultimate cure.

I think my conspiratorial outlook was expanded to its current high state by an old crazy Princeton prof, you

know....the one with a beautiful mind.

 

 

[Bo1953]

1 minute ago, beentothere said:

The probability of an infected person boarding some ship within the next 6 months would appear to be very close

to a certainty. One would hope for onboard testing with minimum error. I personally would not hold my breath

especially near the Elizabeth NJ refinery. 

The high infectious capacity and the long incubation period present a major medical challenge to an anti-viral.

Thus while some anti-viral is likely with some capacity, the highly advanced mathematical systems are just beginning

their sojourn to what may be a multiple decades investigation for the ultimate cure.

I think my conspiratorial outlook was expanded to its current high state by an old crazy Princeton prof, you

know....the one with a beautiful mind.

 

 

😎

 

bon voyage

[beentothere]

12 hours ago, WrittenOnYourHeart said:

 

I agree with you!

 

On this and other boards, I see a lot of people operating on "If they haven't said it, they don't have plans for it." when in reality it is far more likely that they are working on plans, possibly even at the approval stage, but do not want info floating around on the internet (where things are pretty much forever thanks to screenshots) that is subject to change until such policies and procedures are approved.

 

Look at the newly announced "individual muster" thing that they unveiled yesterday. Had anyone heard rumblings of it? Not that I'd been aware of - and you know it would have been rumored on here. They did not just suddenly create it the night of July 23 - I'm sure they've been working on it for a while, getting it to the point they could submit it for approval. But imagine if there was talk of it and then it hadn't gotten approved...people would be irate.

 

Lack of communication about plans in process does NOT indicate there are no plans in process.

Simple is as simple does. If there were any substantial changes then the ships would have to have been

in at least a quasi drydock for reconstruction. That implies only cosmetic retrofits to me.

Forest Gump said it like it is......

 

 

[ipeeinthepool]

3 hours ago, beentothere said:

The probability of an infected person boarding some ship within the next 6 months would appear to be very close

to a certainty. One would hope for onboard testing with minimum error. I personally would not hold my breath

especially near the Elizabeth NJ refinery. 

The high infectious capacity and the long incubation period present a major medical challenge to an anti-viral.

Thus while some anti-viral is likely with some capacity, the highly advanced mathematical systems are just beginning

their sojourn to what may be a multiple decades investigation for the ultimate cure.

I think my conspiratorial outlook was expanded to its current high state by an old crazy Princeton prof, you

know....the one with a beautiful mind.

 

 

 

I'll have a Covid vaccination before I board another cruise ship and I suspect most people will also have the vaccination so it really won't affect me if someone gets through other on-board screening protocols.   I'll be at the Sunset Bar having a drink and enjoying the ocean views.

 

 

[ipeeinthepool]

21 hours ago, hcat said:

I think ships are having some upgrades and expansion made to the medical area including isolation area ; and also more and better trained med staff. -(Can't recall source)

 

,  Not sure what CDC or ship regulators require,.but hopefully we will hear more as actual cruises start up.

 

Based on the last CDC report you are a lot more optimistic that the cruise lines are making changes then I am.   The last CDC report indicated that the cruise lines were having a tough time following the rules to protect the crew and I doubt they've made any changes to affect future passengers.   I think most of the ships are down to a minimum crew of less than 50 people so I doubt they have the capability to make any significant changes even if they knew what changes to make.

[beentothere]

21 hours ago, mom says said:

I have absolutely no idea what you mean by a "quasi hospital" or a "sub hospital", nor do I really care. But what information has led you to conclude that no one (on the panel of experts that has been formed) has thought to develop plans and protocols for the safe handling of infectious pax on board? Seems like a rather big assumption on your part, unless you have a factual basis for this line of possible concern.

1) I assisted the CDC officer on the Queen Mary 2 US inaugural sailing from Miami to the panama Canal round trip. They

had a major noro outbreak and were not taking sufficient precautionary steps, as they were not as well known at that

time. Also I worked with the officer on contact tracing and mapping outbreak locations which effectively determined

active cluster locations and the "culprits".

2) Education: 5 doctoral specialties, only 3 normally required. Included were pandemic mathematic models of the

1918 Spanish flu and more. Mathematical model that formed the basis of A1C, life cycle of red blood cells (diabetes).

3) Leukemia research Mayo Clinic Rochester Minnesota, triggers of remission.

4) Personally programmed an entire hospital software system from admission to discharge, including pharmacy,

OR, ER, Surgical Scheduling, Nurse staffing by quantity and specialization, Drug interactions, Surgical quality control

CDC reporting, and more. 2 hospitals used the system. 

5) Specialty in binary mathematics and statistical inferential logic.

6) Chat periodically with old friends and friends of friends and they do share.

 

Incidentally neither the CDC nor any cruise line adopted any of the accomplished results on the QM2. Much of which, if not all,

is still valid today, and still not followed. Voodoo science they say.

 

The air filtration systems on the ships is marginal to poor in my opinion. My cousin manufactured hospital air filtration technologies.

 

 

[C-Dragons]

9 hours ago, beentothere said:

Simple is as simple does. If there were any substantial changes then the ships would have to have been

in at least a quasi drydock for reconstruction. That implies only cosmetic retrofits to me.

Forest Gump said it like it is......

 

 

Kind of hard to do any dry dock reconstruction when most are closed due to the pandemic.

They are slowly beginning to open up. But there’s still the problem of dealing with protocols to keep the workers from catching/spreading the virus, so things are moving very slowly.

[mom says]

1 hour ago, beentothere said:

1) I assisted the CDC officer on the Queen Mary 2 US inaugural sailing from Miami to the panama Canal round trip. They

had a major noro outbreak and were not taking sufficient precautionary steps, as they were not as well known at that

time. Also I worked with the officer on contact tracing and mapping outbreak locations which effectively determined

active cluster locations and the "culprits".

2) Education: 5 doctoral specialties, only 3 normally required. Included were pandemic mathematic models of the

1918 Spanish flu and more. Mathematical model that formed the basis of A1C, life cycle of red blood cells (diabetes).

3) Leukemia research Mayo Clinic Rochester Minnesota, triggers of remission.

4) Personally programmed an entire hospital software system from admission to discharge, including pharmacy,

OR, ER, Surgical Scheduling, Nurse staffing by quantity and specialization, Drug interactions, Surgical quality control

CDC reporting, and more. 2 hospitals used the system. 

5) Specialty in binary mathematics and statistical inferential logic.

6) Chat periodically with old friends and friends of friends and they do share.

 

Incidentally neither the CDC nor any cruise line adopted any of the accomplished results on the QM2. Much of which, if not all,

is still valid today, and still not followed. Voodoo science they say.

 

The air filtration systems on the ships is marginal to poor in my opinion. My cousin manufactured hospital air filtration technologies.

 

 

Interesting. So you're a mathematician who sailed on a cruise ship 16 years ago.  Not a virologist, epidemiologist, infectious disease specialist,  marine engineer or architect,  or with any other marine qualification. And have apparently no concrete evidence that the assembled panel isn't already considering how to handle the inevitable pax and crew who develop COVID 19 onboard. Pardon me if I prefer to listen to the concerns voiced by those who have actual knowledge of, and experience with the problem.

[beentothere]

Mathematics, economics, chemistry, physics, pharmacology, cdc infection control, political science, foreign languages,

engineering, architecture design, and maybe a little duck soap also. Learned in many things, expert in none. But I 

know how the puzzles pieces fit together for maximum harmony whereas not an expert in any one piece. You see.

 

Worked in 72 industries, over 100 cruises to my experiences. 

 

And just for no humor, Certificate from the Madame Curie Institute. Do your research Madame or Mademoiselle.

But that was a long long time ago. 

 

It is located in Paris, France.  https://institut-curie.org

 

As Mr. Gates said on TV, we had all the knowledge and all the capacity to stop this thing dead in its

tracks. And didn't and we still haven't stepped up to the plate and swung. We know what to do, we know

how to do it, so do a million people here need to die over the next decade before we finally do what

we have to do?

 

In one month alone in 1918, 200,00 died  here in the US. Some scientists believe that our annual flu is a variant of that

original killer from 100 years ago. We might be with this one for a generation or more.

 

 

 

 

 

 

 

 

[Etta1213]

6 hours ago, beentothere said:

 

I can't tell you how much I appreciate your contributions over the years, and today by your willingness to express your thoughts here. We need all great minds to pool their wisdom, but maybe ego stands in the way sometimes, or just ignorance. People don't know what they don't know.

[kearney]

I have wondered if some of the treatment rooms in the spa could be converted into isolation rooms... for someone who is ill. As I recall the CDC orders.. they wanted 'hospital level care'... one of their goals is to avoid over taxing local communities with a sudden influx of sick cruise ship passengers. So they wanted ships to have ventilators.. I am not a medical professional, but that would strike me as requiring 24 hour supervised care of some sort... not sure current medical staffs have sufficient people or training to provide that level of care for multiple patients. Since I doubt there will be hands on spa treatments for a while... I thought this might be a good place to have ill passengers treated. Perhaps those with a positive test.. but no symptoms could be placed in isolation in veranda cabins... (Keeps some empty near the spa area). If this UVC technology can safely kill viruses... and do so quickly.. perhaps these lights could be placed in air filtration system... in the elevators and in places where people board the ship or wait to go dinning or in the casino where people might sit for longer periods of tim. If the technology is there for a true quick test... if passengers could be tested a day before boarding (arrive early) and then again a few times during the cruise... eg. after a few days at sea before the first stop... and then again a day before final departure...  Some random thoughts.

 

But here is another question.... under what conditions could we go back to no masks and no social distancing? If everyone tested negative and passed through UVC periodically and all baggage and surfaces disinfected using UVC... is that enough... and if not... what would be enough? If we aimed at 100% certainty with automobile or air travel.. we wouldn't do either. I have no idea what the answer is to this question.

 

Outside of getting this dreaded illness... my fear about cruising is that it wont be fun anymore. Back before the recent surge... we thought we should consider a quick trip to Hilton Head... but then the thought of staying in a room the size of a cruise ship cabin with only one view and no restaurant service... we decided to stay home..... 

[Fouremco]

7 minutes ago, kearney said:

But here is another question.... under what conditions could we go back to no masks and no social distancing? If everyone tested negative and passed through UVC periodically and all baggage and surfaces disinfected using UVC... is that enough... and if not... what would be enough? If we aimed at 100% certainty with automobile or air travel.. we wouldn't do either. I have no idea what the answer is to this question.

For many of us, nothing short of all crew and passengers having been vaccinated.