What is in ship Medical Center for Covid?

[generichandle]

Does anyone know what HAL medical facilities stock to interdict Covid diagnosis'? Monoclonals? Paxlovid? 

 

I cannot reach anyone at HAL who knows; perhaps someone who has been aboard knows or can ask?

 

Doug

[chengkp75]

Just remember that drugs that are approved, whether completely or for emergency use, in the US may not be approved for use by the flag state of the ship.  That country is the one that the medical center is operating under.

[Oceansaway17]

well that just gives me food for thought.  If carrying USA passengers, then have the medicine that is allowed for them too.

Me thinks some of the medical facilities are a joke perhaps.

[chengkp75]

18 minutes ago, Oceansaway17 said:

well that just gives me food for thought.  If carrying USA passengers, then have the medicine that is allowed for them too.

Me thinks some of the medical facilities are a joke perhaps.

Unbelievably, US laws don't follow US citizens around the world.

[Shmoo here]

30 minutes ago, Oceansaway17 said:

well that just gives me food for thought.  If carrying USA passengers, then have the medicine that is allowed for them too.

Me thinks some of the medical facilities are a joke perhaps.

When you board a ship, you have left the US.  Like, if you travel to, say, Germany, would you expect the pharmacies there to be able to fill your script?  

[CruiserBruce]

1 hour ago, Oceansaway17 said:

well that just gives me food for thought.  If carrying USA passengers, then have the medicine that is allowed for them too.

Me thinks some of the medical facilities are a joke perhaps.

They should? Really? In other parts of the world, Americans aren't always the majority on board. I can remember a huge number of Aussies on Noordam on our Med cruise a number of years ago. Like close to half the pax. You might find a good number of Canadians on cruises out of the US in the winter months here.

 

And, as we know a few medical staff on HAL ships in the past, and the requirements they must meet to work on the ships, me thinks your comment on the ship's medical center is out of line by a good margin.

[boone2]

1 hour ago, Oceansaway17 said:

well that just gives me food for thought.  If carrying USA passengers, then have the medicine that is allowed for them too.

Me thinks some of the medical facilities are a joke perhaps.

As a previous member of Hal’s medical staff I really am ticked off by this statement.  

[Oceansaway17]

well excuse me folks.  But ships leaving from USA ports should have USA medicines and actually, they should have a wide variety of medicines for ALL people from all countries.

 

So, if ships carry whatever they like and not those FDA approved medicines, then I think that is wrong And wouldn't the CDC/FDA like to know this.  USA folks have to settle for things not approved by FDA. 

If ships want to sail out of USA ports, then at least have a variety of medicine.  The OP has a right to know and I was responding to him or her about my opinion on that subject.  Food for thought that only non FDA stuff would be in stock.  come one not good practice for USA folks.

 

And yes medical centers are a bit of a joke from what I am reading on various threads about those getting covid and how they are treated.  Like if a wife tests positive, they won't test the husband.

 

 

[Oceansaway17]

Just now, boone2 said:

As a previous member of Hal’s medical staff I really am ticked off by this statement.  

I said some and perhaps.   Even on land we have good and not so good hospitals.

 

[Oceansaway17]

58 minutes ago, Shmoo here said:

When you board a ship, you have left the US.  Like, if you travel to, say, Germany, would you expect the pharmacies there to be able to fill your script?  

actually yes.  I was on a bus tour in UK and the guide said if anyone is low on medicine, he can go and get some since it is free to UK citizens and he can on behalf of folks on the tour if they show the prescription bottle.

[Wendy-Europe]

I think they carry usual things, used in many countries under different brand names.

 

When we ve been on a transatlantic cruise we had the situation that one passenger with Parkinson lost or forgot his pills. Holland America sent all passengers a notice to the cabin if anybody has enough supply to help - they would reimburse the passenger and refill the medicine at the next port.

In the letter was the US name of the medicine, several generic names, the name of the "active ingredient".

 

My friend's father has Parkinson's, so he knew the ingredient - even though the brand name in Germany is completely different.

The doctor on board then certainly verifies the drug again based on the ingredients before the patient on board receives that.

 

The shipping company has normal medicines in stock in the hospital, because they are not only for the passengers, but (and this should not be forgotten) also presumably first of all the "family doctor" for the hundreds of crew members. And, of course, they have to deal with the same things that occur in the practice of a general practitioner in any small town: colds, accidents at work, cuts.

[chengkp75]

9 hours ago, Oceansaway17 said:

And wouldn't the CDC/FDA like to know this.

Trust me, they do know this, and have for decades.

 

9 hours ago, Oceansaway17 said:

Food for thought that only non FDA stuff would be in stock.

Here you are misunderstanding again.  There may well be many FDA approved drugs onboard, if those drugs are also approved by the flag state.  And, just like on the bus tour you mention, the drugs provided by the pharmacy in the UK would have been approved by the UK, not the FDA, even though the name may have been the same, and if the drug was FDA approved, but was not approved by the UK, then it would not have been available.

[ontheweb]

10 hours ago, Oceansaway17 said:

well excuse me folks.  But ships leaving from USA ports should have USA medicines and actually, they should have a wide variety of medicines for ALL people from all countries.

 

So, if ships carry whatever they like and not those FDA approved medicines, then I think that is wrong And wouldn't the CDC/FDA like to know this.  USA folks have to settle for things not approved by FDA. 

If ships want to sail out of USA ports, then at least have a variety of medicine.  The OP has a right to know and I was responding to him or her about my opinion on that subject.  Food for thought that only non FDA stuff would be in stock.  come one not good practice for USA folks.

 

And yes medical centers are a bit of a joke from what I am reading on various threads about those getting covid and how they are treated.  Like if a wife tests positive, they won't test the husband.

 

 

There once was a book The Ugly Americans by IIRC Vance Packard. This is the kind of attitude the book bemoaned.

 

And they do not carry "what they like". Rather they carry the medicines approved by the country they are flagged under. So, if you want to definitely have FDA approved medicines onboard, sail on a US flagged ship. I guess that lives you with the choice of the NCL Pride of America and various river cruises within the USA.

[Wendy-Europe]

It must be clear to every traveler: each traveler is responsible for his or her own personal needs. Of course, this also applies to medicines.

 

By the way, the traveler is also responsible for checking whether the medication can be legally imported into the country one is visiting. Even if it is for personal use. In the case of some prescription medicines, it is essential to carry a certificate of necessity from the doctor. And there are medications that are actually not allowed to be imported into other countries. This applies in particular to opiate-containing drugs, strong tranquilizers, and also strong sleeping pills.

 

For example: cannabis is legal in the US (and without a prescription) in many states and many people use it for medical purposes. It is illegal to bring it into many countries. Sometimes the penalties are moderate - but there are also countries with very strict penalties! Of course, then non-U.S. laws apply.

 

For an existing illness every guest is responsible himself. For a sudden illness, the doctor on board will try to cure with on-board remedies. If the diagnosis is clear, but the right medicine is not on board, the port agent will try to get the right medicine with the right active ingredient and give it to the guest. If the guest does not agree to take a drug he does not know and does not trust the shipboard doctor, the guest will probably have to leave the ship.

 

[ontheweb]

2 hours ago, ontheweb said:

There once was a book The Ugly Americans by IIRC Vance Packard. This is the kind of attitude the book bemoaned.

 

And they do not carry "what they like". Rather they carry the medicines approved by the country they are flagged under. So, if you want to definitely have FDA approved medicines onboard, sail on a US flagged ship. I guess that lives you with the choice of the NCL Pride of America and various river cruises within the USA.

I should also add even if they carried drugs approved by the FDA, they cannot possibly carry all of them. For instance, a prescription was called in recently for DW, and we received a phone call from the local Walgreens that it was not on hand, though they would get it soon (which they did). This would not be as easy for a ship at sea.

 

I suppose that the poster who wants them to have FDA approved drugs would complain if his or her prescription drug was not among those available on the ship.

[Homosassa]

There are many misconceptions about the use of Paxlovid.  My comments only apply to use in the USA as I have no knowledge of use in other countries.

 

Paxlovid for developed and tested against the original strains of covid and the Delta variant. At the time of the US FDA granting an EUA (not an approval, just limited use in an emergency), there was no data about effectiveness against the omicron variant or any other variants.

 

The use was only for those who had a positive Covid test AND was at risk for developing a severe case because of comorbidity that would lead to hospitalization and possibly death.

 

Here is the actual Paxolvid labeling as approved by the US FDA: 

 

https://www.fda.gov/media/155050/download

 

The labeling also includes some information about other antivirals  and links for information on those products.

 

 Notice all the  contraindications for use and the known drug interactions with other drugs. There is a reason why patients need to contact their personal physicians  who know their medical history before deciding that the patient fits under the indications for use.

 

Again, the drug is not an "approved" drug for marketing. It is available under a EUA with the restriction as in the labeling.

 

This leads to  reasons as to why the drug is not available on cruise ships and should not be expected to be available:

 

1. Fitness for travel.  All cruise lines have this caveat in there cruise contract. If a passenger is at risk for the development of severe disease that might lead to hospitalization or death, they should not be cruising and should not expect  a cruise line to be responsible for the intense care they may require.

 

2. The required familiarity with the patient's medical history that the use of Paxlovid requires before use. While the highly qualified medical personnel on board ship can take a history before prescribing any drug, there is the problem of accurate information being given by someone who is determined to obtain Paxlovid.  Again, read the indications for use and the contraindications in the labeling.

 

3. Cost. While the drug might be "free" in the US. It is not free as the US government has negotiated a price of $590 for each five day course of treatment that the US government pays for those available treatments in the US.  This may not be the price available to cruise lines (probably much higher) which means the ship would need to have in stock a very expensive drug that neither the crew or passengers should be qualified to use under the prescribing restrictions (see my first point on "Fitness to Travel).  Even if it was available for use on board, it would not be "free." The cost would be paid by the passenger.

 

4. To repeat again, Paxlovid is not an approved drug for general marketing in the US. It is only available for use under the conditions of the Emergency Use Authorization . For those arguing that "approved" drugs should be carried on board ship , Paxlovid is not an approved drug.  (I hope the horse is dead and no longer needs to be beaten). There is also the need, as explained in previous posts, for the ships to comply with the restrictions of their home country.

 

 

 

 

  

Edited May 12, 2022 by Homosassa

[janmcn]

Homosassa’s response should end this thread. Absolutely correct! 

[Oceansaway17]

13 hours ago, chengkp75 said:

Trust me, they do know this, and have for decades.

 

Here you are misunderstanding again.  There may well be many FDA approved drugs onboard, if those drugs are also approved by the flag state.  And, just like on the bus tour you mention, the drugs provided by the pharmacy in the UK would have been approved by the UK, not the FDA, even though the name may have been the same, and if the drug was FDA approved, but was not approved by the UK, then it would not have been available.

I am not misunderstanding I merely replied it would be food for thought when I saw your comment

on what may or may not be approved which makes one wonder just what is available and what is carried.  You in a way planted the seed for my "food for thought" as to just what would really be available.  I did not need long lectures on the subject and really we don't know what each ship does carry right now for covid patients.   Makes me still wonder. 

 

[Oceansaway17]

7 hours ago, Homosassa said:

 

Paxlovid for developed and tested against the original strains of covid and the Delta variant. At the time of the US FDA granting an EUA (not an approval, just limited use in an emergency), there was no data about effectiveness against the omicron variant or any other variants.

 

The use was only for those who had a positive Covid test AND was at risk for developing a severe case because of comorbidity that would lead to hospitalization and possibly death.

 

Again, the drug is not an "approved" drug for marketing. It is available under a EUA with the restriction as in the labeling.

 

4. To repeat again, Paxlovid is not an approved drug for general marketing in the US. It is only available for use under the conditions of the Emergency Use Authorization . For those arguing that "approved" drugs should be carried on board ship , Paxlovid is not an approved drug.    

appreciate your comments.  I did not know it was not FDA approved yet it is talked a lot about on tv and in newspapers.

In all this time of two years, too many things have been confusing.  I thought vaccines were the answer but I think covid drugs are still of concern for the FDA as well as future strains.

 

I would still be interested in what certifications and reviews any medical center has to go through in order to sail out of the USA.  And yes of course folks should not travel if they have serious illnesses as the medical center is not a free hospital ward nor can they do a lot of surgeries.

 

My only "food for thought" was in regards to covid and it sounds like it is still developing. I would like to think that a lot of FDA approved medicines are available as needed though.

 

 

[chengkp75]

16 minutes ago, Oceansaway17 said:

I would still be interested in what certifications and reviews any medical center has to go through in order to sail out of the USA. 

The only certifications and reviews of cruise ship medical centers is based on the flag state, regardless of whether the ship sails out of US ports.  The ship is not part of the US, and for the most part, not subject to US law.  The standard of international law is that when a foreign ship is in a US port, US law can apply to things external to the ship, like pollution, or commerce.  Otherwise, unless the safety or "good order" of the port state is in jeopardy, the flag state laws apply to things internal to the ship.

 

As an example, while the ADA applies to foreign flag cruise ships insofar as non-discrimination against disabled, and requiring accessible cabins, SOLAS trumps accessibility if need be, and SCOTUS has ruled that the "internal policies and procedures" of the ship do not fall within the ADA.

[Wendy-Europe]

Thanks for the clarifications - while I am familiar in broad strokes with the laws and implications for cruises (let's not kid ourselves - perhaps more detailed than some US citizens), these are not laws of my country - and a very complex subject area to boot. In Europe, we have different - certainly no less complicated - regulations...... Just thinking about when VAT is due on drinks on a ship and when it is not - and what tax rate is applied - that keeps whole squadrons of tax lawyers busy.

 

[VMax1700]

2 hours ago, Wendy-Europe said:

Just thinking about when VAT is due on drinks on a ship and when it is not

One very good reason to purchase or book with Have it All. 

[Homosassa]

Here is additional information released by Pfizer about a clinical trial testing the development of disease after exposure to Covid. It was found there was not significant difference between the use of Paxlovid and a placebo.

 

The article also goes over again the limited indication of use of the drug under its EUA.

 

Paxlovid will not be available on cruise ships any time in the near future.

 

https://www.pfizer.com/news/press-release/press-release-detail/pfizer-shares-top-line-results-phase-23-epic-pep-study

[Oceansaway17]

19 hours ago, chengkp75 said:

There will never be a new shipyard built in the US, there are too many environmental regulations, and too many NIMBY people.  There are also too few people in the US who want to work in shipyards, the average age is 65.  Most shipyards in the US are far too wedded to the US Navy, where time constraints are in months, not days, making it easier to bid jobs, and where contracts are predominately on a "cost plus" basis, not firm quotes ahead of the job.  We have sadly lost our competitiveness in shipyards, and will never regain it.  Even when a US flag ship needs repair, and US customs imposes a 50% duty on all repairs done outside the US, it is still cheaper for the US flag ship to go to a foreign shipyard over the US one.  And, since foreign ships pay zero taxes in the US, there is no way that cruise lines would flag US.  The other factor is operating cost, where even the US Maritime Administration admits it costs over 3 times the operating cost of a foreign flag ship to be US flag.

ok but it is a shame that due to our laws we have lost that business.  Never have I felt we were the greats nation more and more now.

[chengkp75]

55 minutes ago, Oceansaway17 said:

ok but it is a shame that due to our laws we have lost that business.  Never have I felt we were the greats nation more and more now.

Contrary to what most think, it was not the PVSA or Jones Act that destroyed the US shipbuilding industry.  It was the Merchant Marine Act of 1936, that President Roosevelt enacted in order to prepare the US for WW2.  It did exactly that, giving construction subsidies to build ships in US shipyards (and operating subsidies for flagging ships in the US). The subsidy paid for the difference in construction cost between a US shipyard and a foreign shipyard.  However, the shipyards and shipowners after the war found out how to "game the system", whereby it was cheaper and more beneficial to the yards and owners to continue to build ships in the US with antiquated technology and production methods, than to invest in research that would lead to the technology that European yards have since "discovered" and which saves vast amounts of money.  We gave up the US's greatest strength, our innovative nature, to allow the taxpayer to fund less productive methods.  These subsidies continued until repealed by President Reagan.