COVID lockdowns are fortunately behind us, and vacations are making a huge comeback.  But how safe is it to holiday, especially on a ship?

Cruise carriers bear a duty to keep their passengers safe.

Despite the decrease in the number and severity of COVID cases, there are of course still risks in everyday life.  Masks are no longer required in most settings, but if you are continuing to mask, even N95s don’t protectunless they are properly fitted and replaced frequently. In addition, vaccination, despite high rates, is only really effective in preventing COVID (89%) if you have had a prior COVID infection, and efficacy drops to only 16% if you haven’t had a prior infection.

These risks are compounded if your holiday is on a cruise ship.  This is because you are voluntarily captive in an environment with a large number of passengers, high personnel density, periods of long gathering time, narrow internal spaces, relatively restricted diet and many ports of call. All of which make outbreaks of infectious diseases more likely than in land-based holidays. 

Of course, infectious diseases outbreaks in cruise ships are not new. Of the infections occurring on cruise ships, the most reported are norovirus (42%), respiratory diseases (14%), legionnaires’ disease (14%), and vaccine-preventable diseases, e.g., measles and varicella (10%).

Despite it being a closed environment, cruise ship-based infections do not all occur in one site. Crew cabins and restaurants are the riskiest places for respiratory infections. Legionella concentrates in showers and hand basins and varicella in unvaccinated crew members. 

Lack of oversight and the weakening of public health across the globe only heighten the risks. Cruise ships tend to be flagged in countries without health regulations relating beyond their land borders, and most ships have no public health professionals to manage the day-to-day surveillance and prevention.  This means that no reliable data exists on an individual’s risk of contracting an infectious disease onboard.

Cruise carriers bear a duty to keep their passengers safe. So, what can be done? Ideally every traveller should undergo a pre-travel risk assessment before departure. This could mean consulting your primary care physician for their advice on the risks of vacationing on the high seas and individualized precautions that may need to be taken. Some cruise lines provide checklists that that aid travellers to make their own evaluation, based on their health profile, whether cruising is worth the risk. Any assessment should consider your itinerary, and the type and duration of travel. An individual assessment is also important. We all have different risk tolerance, and a healthy 20-year-old college student may not draw the same conclusion as an obese 72-year-old with an immunodeficiency.

Infectious disease prevention is not only an individual responsibility.  Carriers bear a duty to keep their passengers safe.  For example, vigorous promotion of good handwashing can prevent or reduce outbreaks of disease; isolating sick passengers and cleanliness are beneficial.  Rigorous, mandatory and supervised testing can help contain an outbreak.

Clean water and clean air are clearly the responsibility of the carriers. Inappropriate use of heating, ventilation, and air conditioning (HVAC) systems and inadequate systems on cruise ships can lead to the spread of disease. In addition, cruise operators should provide free, clean drinking water in cabins and adequate ventilation.

Medical facilities and staff on cruise ships are geared to service acutely ill individuals. To date, most people who travel remain healthy. Fewer than 5% of travellers use these services, though a much higher percentage report post-travel infection.

There are no legally binding requirements for health services onboard cruise ships to ensure effective public health and prevention. Given the potential for epidemics with serious medical complications to arise on cruise ships and isolated locations, cruise lines and tour operators should take their obligations to keep passengers safe seriously.  At the same time, cruisers should raise their voices to insist on transparent reporting requirements and information collection to give public health professionals the data they need to make intelligent recommendations to cruise operators and passengers.