Are Preventive Noro Practices Effective?

[fabby50]

So, some reviews have been posted about what is now being called the "Crown Noro Cruise" since it got so much press.

 

We were on the cruise, had a good time, found somethings annoying, but to us, the cruise was certainly not as bad as the reviews that have been posted make it out to be.

 

It did make me start to ponder a question and I wondered if anyone had seen any information published about it.

 

Are the practices the cruise lines are employing actually effective? Does not letting people touch salt shakers, have a bread basket on the table, etc., do any good? I realize to use the scientific method, they'd have to try each one of these things individually, but I just wonder if overall, once noro is detected do employing these tactics actually work OR is what works is that flu season runs it's course and not only do people on land stop sharing their various flu viruses, but people on ships do too.

 

One of the things for exampe I got a kick out of was if you asked for coffee in the speciality restaurant, each indivdual got a pot of coffee. My husband and I could share a bed, but don't touch my coffee pot :)

 

Are the cruise lines just employing these methods because they make people feel like something is being done, but it really doesn't have much/any effect? Kind of like the "duck and cover" campaign of my school days. Did we really think huddling under our desks was going to save us from an atomic attack?

 

I found the way one of the reviews ends with "someone owes us some money" amusing. I wonder if they do get a cash reward for the grousing, if they'll use it book another cruise during flu season?

Edited April 23, 2014 by fabby50

[skynight]

So, some reviews have been posted about what is now being called the "Crown Noro Cruise" since it got so much press.

Are the practices the cruise lines are employing actually effective? Does not letting people touch salt shakers, have a bread basket on the table, :)

Are the cruise lines just employing these methods because they make people feel like something is being done, but it really doesn't have much/any effect?

 

Noro (norwalk virus) can be passed along by touching a surface that has the virus present and then touching your mouth. So it makes sense to reduce those possibilities as much as possible in the dining areas and other areas of the ship. Cruise lines follow guidelines developed for the industry by the industry and by the CDC. We were on a ship once that after any activity, for example bingo, the lounge was totally emptied and a crew came in and wiped down the entire lounge. Crew are really stressed during an outbreak. Crew that normally don't interact with passengers, like the theatrical entertainers, are required to stay isolated in their areas. Other crew are assigned to constant cleaning and the crew get very tired. The only real way to combat this virus would be the development of a vaccine. I've read where some progress is being made in this area with the hope to someday include the noro strains within the normal flu shot.

[MauiLvrs]

Are the practices the cruise lines are employing actually effective? Does not letting people touch salt shakers, have a bread basket on the table, etc., do any good?

 

YES!

 

If one noro person touches the cheese shaker at the pizza bar ... and 10 other persons touch the shaker 10 more people are sick (if they don't follow the other health practices - don't wash their hands, etc.).

 

If those 10 people touch the salt shakers at the table ... there are now over 100 people sick and it is on the news.

 

The spread rate bocomes exponential.

Edited April 23, 2014 by MauiLvrs

[Pam in CA]

This is Noro "season," it seems to me. You used to hear about cruise ship Noro problems all the time on the news. Now, it's not as often and becomes a bigger deal.

 

I've been on several cruises that implemented Noro prevention and while slightly inconvenient at times, it works.

 

What the media doesn't report is that in most cases, Princess has been able to contain the outbreak within a couple of days. Even with the Crown outbreak, most of the cases were within the first few days and by the end of the cruise, the number was in the teens still infected. That means to me that preventive measures work. The biggest issue is people self-medicating and not reporting their illness. All the preventive measures are ineffective against irresponsibility. :(

[Loonbeam]

The answer to the question is a qualified yes. Anything that limits potential spread of the virus can help contain an outbreak. So limiting contact of communal surfaces can help a lot.

 

The downside is it lures people into a false sense of security, which sometimes means they don't follow the even more effective protocols (quarantine, hand washing, limit use of public restrooms.

 

And of course, there is no way to sanitize the air.

[rjack22]

I have a related question.

 

If they remove the salt and pepper shakers to help prevent the spread of Noro, does this mean you can't salt your food or do they then provide packets of salt and pepper for you to use? Or don't they want you touching them either?

[chengkp75]

So, some reviews have been posted about what is now being called the "Crown Noro Cruise" since it got so much press.

 

We were on the cruise, had a good time, found somethings annoying, but to us, the cruise was certainly not as bad as the reviews that have been posted make it out to be.

 

It did make me start to ponder a question and I wondered if anyone had seen any information published about it.

 

Are the practices the cruise lines are employing actually effective? Does not letting people touch salt shakers, have a bread basket on the table, etc., do any good? I realize to use the scientific method, they'd have to try each one of these things individually, but I just wonder if overall, once noro is detected do employing these tactics actually work OR is what works is that flu season runs it's course and not only do people on land stop sharing their various flu viruses, but people on ships do too.

 

One of the things for exampe I got a kick out of was if you asked for coffee in the speciality restaurant, each indivdual got a pot of coffee. My husband and I could share a bed, but don't touch my coffee pot :)

 

Are the cruise lines just employing these methods because they make people feel like something is being done, but it really doesn't have much/any effect? Kind of like the "duck and cover" campaign of my school days. Did we really think huddling under our desks was going to save us from an atomic attack?

 

I found the way one of the reviews ends with "someone owes us some money" amusing. I wonder if they do get a cash reward for the grousing, if they'll use it book another cruise during flu season?

 

The noro sanitation protocols are defined by the USPH/CDC. They have been proven over the years. Most are just stricter forms of what the USPH requires of the crew every day. If you are interested in what the USPH requires of a ship, go to their website, and find both the Vessel Sanitation Program Operations Manual and Construction Manual. Section 4 of the Ops manual lists the reporting, testing, and investigation requirements for any IG case presented to the medical center. All through the manual, you will find the things like crew hygiene that are required every day, and more for the IG control measures.

 

Particularly soft, porous surfaces like sugar packets and bread baskets are difficult to sanitize properly, and anything that is multi-user is a prime candidate for transmission. Just remember, if someone with the virus on their hands touches the tongs in the buffet, and then you touch the tongs, you are now contaminated. Now, you can say, "well, I never touch my face while eating", but if you used the tongs to pick up a burger bun, when you pick up the burger, you have just contaminated the bun, and you eat that.

 

What many don't realize about the raw numbers that are reported both to the media and USPH/CDC, is that really, the total number of cases is not the important factor, it is the distribution curve of cases/day. If the cases/day spikes 2 days into the cruise, and then continues to drop for the rest of the cruise, the mitigation measures are working. If the cases/day stays constant, or continues to rise, then there is a need for more mitigation measures.

 

Every ship must make a report to USPH/CDC every cruise, telling how many, what kind, what day, etc, of GI illnesses were on that cruise. Included in these "normal" reports, as well as the "special" reports at 2% and 3% total illnesses, must include the mitigation procedures being used, and the USPH/CDC will advise if they are satisfied with those measures or whether they feel more needs to be done.

 

Contact transmission viruses are very difficult to control, so making person to person (or indirect person to person, via some item) contact as limited as possible is one of the most effective measures.

[BruceMuzz]

Every time we have some sort of NLV action on a ship - which is more and more often these days, the "experts" come out of the woodwork.

 

As chengkp75 already mentioned, the prevention measures taken are designed, mandated, and audited by the CDC. They have done extensive - and expensive - research (using your tax dollars) to determine the best practices.

 

But are these the BEST POSSIBLE practices?

The so-called "experts" tell us that we could do far more.

They tell us that we should close the Casino, stop the Art Auctions, close the Spa, Close the Buffet, close all public toilets, and cancel all shore tours if we are really serious about stopping this.

And they are correct.

 

Since NLV is primarily spread by human contact, we could eliminate all human contact on ships during outbreaks by confining everyone to their staterooms, deliver all food to cabins, and have service staff wear bio-hazard suits to service the cabins. All the additional staff required to do this would double the price of your cruise and you would not be too happy about that cruise when you got home. But you would be healthy and un-infected onboard the ship.

 

So where do we draw the line?

Should we destroy your cruise completely with extreme measures to ensure that you are completely protected from an uncomfortable short-term illness spread by your not-too-clean fellow cruisers?

 

Should we inconvenience you for a few days in order to ensure a reasonable chance for you to avoid an uncomfortable short-term illness spread by your not-too-clean fellow cruisers?

 

Should we ignore the problem entirely (like the airlines and hotels do) - and as most people do with colds and other viruses - and hope you are lucky and clean enough to avoid an uncomfortable short-term illness spread by your not-too-clean fellow cruisers?

[Salacia]

It seems generally acceptable to repeat the claim that gastrointestinal illness is caused solely by the poor hygiene of our fellow passengers. Yet we know - because health experts have told us - that the illness can come from other sources.

 

Obviously, good hygiene is very important - both on the part of the passengers and the crew. But, please, can we not accept the facts regarding possible modes of transmission?

Edited April 23, 2014 by Salacia

[chengkp75]

It seems generally acceptable to repeat the claim that gastrointestinal illness is caused solely by the poor hygiene of our fellow passengers. Yet we know - because health experts have told us - that the illness can come from other sources.

 

Obviously, good hygiene is very important - both on the part of the passengers and the crew. But, please, can we not accept the facts regarding possible modes of transmission?

 

And which modes of transmission are these? The food safety requirements that the USPH/CDC have are far stricter than any local or state health code, just ask the USPH inspectors, who tend to be ex-local health inspectors, so if the food is treated in a safer manner, wouldn't noro in restaurants, resorts, and conventions on land be more prevalent than on ships? Oh, that's right, it is.

 

And crew can be disciplined for not following good hygiene, while passengers cannot. And except for multi-cruise outbreaks, where infected crew can be one possible causative agent, it has been shown that a new "patient zero" can come onboard within hours of a deep-cleaning and recontaminate the entire ship. It's also simple statistics, there are about 3-4 times as many passengers as crew.

 

The cause of noro outbreaks, that you claim on the other thread not able to be determined, are in fact studied, and the CDC can determine if it was food that caused the illness (many of the first cases ate the same food, or in the same venue), or whether it started in passenger or crew areas (localized areas of cabins, or common public space usage by patients).

[Loonbeam]

Based on simple numbers and spread patterns, the claim that passengers are the primary source and vector of noro is quite reasonable.

 

The difference is that an infected crewmember in the wrong location can greatly affect the severity and rapidity of the outbreak, particularly if that employee works in food service. That's why the lines are so strict with crewmember sanitation.

 

Every outbreak can have different factors, and its almost impossible to say X is the reason for any particular episode. So you have to go with the law of averages and say that the pax are more likely responsible for new and re-introductions of the virus than crew.

 

 

It seems generally acceptable to repeat the claim that gastrointestinal illness is caused solely by the poor hygiene of our fellow passengers. Yet we know - because health experts have told us - that the illness can come from other sources.

 

Obviously, good hygiene is very important - both on the part of the passengers and the crew. But, please, can we not accept the facts regarding possible modes of transmission?

[KarenCL]

We just disemarked the Star Princess after a 15 day cruise. Shortly into the cruise, we were advised by the Captain that there had been a few reported cases of Noro. He quickly instituted high level cleaning and appropriate changes in the dining experiences. Birex solutions were used frequently on all countertops and passengers no longer handled food or condiments in any of the dining facilities. We reached the reportable 2% level, but it was contained to a maximum of 2.7%. Captain McBain reported to us at 5PM daily on the progress and consistently commended both crew and passengers for following the protocol. We never witnessed any complaints by the crew for the additional workload. I brought my own salt shaker along "just in case," as I use a lot of salt of my food and didn't want to be at the mercy of a crew member shaking it on my food! Two thirds of the way thru the cruise, the CDC guidelines would have allowed the ship to go back to normal operations, but it was the Captain's decision to keep us on the high level disinfection protocol as a precaution. It really was not a problem and no one seemed to complain. I'd rather deal with a little inconvenience than be sick on my vacation.

[caribill]

I have a related question.

 

If they remove the salt and pepper shakers to help prevent the spread of Noro, does this mean you can't salt your food or do they then provide packets of salt and pepper for you to use? Or don't they want you touching them either?

 

Packets are provided.

Edited April 23, 2014 by caribill

[caribill]

But are these the BEST POSSIBLE practices?

 

 

So where do we draw the line?

 

A point not mentioned so far is that the CDC says people are still able to spread the norovirus days after symptoms are gone. In fact, the CDC web site says:

 

You are most contagious

o when you are sick with norovirus illness, and

o during the first 3 days after you recover from norovirus illness.

 

So, even passengers who have "recovered" and no longer confined to their cabins can continue to spread the virus.

[hardel]

Packets are handed out by a crew member wearing gloves.

[KarenCL]

In the dining rooms, you had to ask for salt and the steward would bring over the shaker and salt the food for you. Salt packets were given if requested at the Trident Grill.

[KarenCL]

In the dining rooms, you had to ask for salt and the steward would bring over the shaker and salt the food for you. Salt packets were given if requested at the Trident Grill.

[more cruises]

Doesn't HAL follow code red (did I get that right?) for the first 3 days to try to limit any possible spread? How has that affected their infection rates?

 

I went to a land based sushi restaurant last week. They gave me one of those buzzers while we waited for our table. Luckily it occurred to me that many, many people had handled that buzzer before me and I washed my hands before dining.

[Colo Cruiser]

Doesn't HAL follow code red (did I get that right?) for the first 3 days to try to limit any possible spread? How has that affected their infection rates?

 

I went to a land based sushi restaurant last week. They gave me one of those buzzers while we waited for our table. Luckily it occurred to me that many, many people had handled that buzzer before me and I washed my hands before dining.

 

 

Its everywhere.

[rbslos18]

Everything I have read suggests the use of the hand sanitizer before eating is a waste of time. I am happy to comply but do not get the science behind the hand sanitizer.

 

Every place I read states the best approach is to regularly wash ones hands before eating and throughout the day. And yet every ship we have been on has a hand sanitizer before entering the buffet. What is the logic?

Edited April 24, 2014 by rbslos18

[Loonbeam]

It's better than nothing (at least it deals with other illnesses) and gives the appearance of doing something.

 

Everything I have read suggests the use of the hand sanitizer before eating is a waste of time. I am happy to comply but do not get the science behind the hand sanitizer.

 

Every place I read states the best approach is to regularly wash ones hands before eating and throughout the day. And yet every ship we have been on has a hand sanitizer before entering the buffet. What is the logic?

[brianlojeck]

Remember, the most disease ridden things in most hotels are the exit knob to the restroom and the remote in your room.

 

As for the policies, they may seem silly, and I'm no great fan of big governmental agencies, but noro is transmitted by touch, so if you limit touching you limit the disease...

[brianlojeck]

Also, the CDC says hand gel works.

http://www.cdc.gov/features/norovirus/?mobile=nocontent

[PescadoAmarillo]

I do think some of the practices are overkill, such as sanitizing the pedestals on dining tables. When we're on a ship under Code Red, DH and I stop eating anything with our hands, which generally means no toast, rolls, popcorn, etc. for the duration. That's the simplest thing to do and it requires no crew member involvement at all. We had both our assistant waiter and cabin steward get it at the same time this past winter and miss three days of work, and the ship was not even at Code Yellow at the time. I thought for sure we'd get it then, but we resorted to the "no food by hand" rule and skated right through it.

 

Certainly what the cruise line does is effective. I'm just not certain of the return on time invested.

[cflutist]

Can someone provide a credible link that specifically states that Purrell kills norovirus?