Are Preventive Noro Practices Effective?

[chengkp75]

Chenkpt, in reply to your question "How do you know how much advance notice the ship has about VSP inspections? I've been involved in them, and generally, the only notice there is happens when someone on the ship sees the inspectors in their khakis on the dock" - I did not say ships had advance notice, I said "they have a fair idea about when the CDC will inspect the ship". For example, obviously, there's no expectation of a CDC inspection while at sea or at ports that are not in the US. For ships that have recently been inspected and received a good score, there is little likelihood of another inspection from the VSP for some amount of time and conversely, ships that have had serious violations after an inspection can expect to be re-inspected at some point in the not too distant future. Of course, there are inspections conducted by other countries' health authorities, but our conversation was about the VSP.

 

You do know that the VSP inspection requires that it include at least one full meal service? If the crew are not practiced in USPH procedures, to the point where it is second nature, they will not be able to "prep" for it to the point where every crewmember follows every procedure during the stress of a meal service. I'm sorry, but if it were possible to "cram" to pass a USPH inspection, there would never be a poor score, and certainly the Silver Shadow debacle wouldn't have happened. The ship is too large, too complex, and the regulations too all-encompassing to be crammed for, on the off chance you'll get inspected.

 

So, when a ship home ports out of Miami, it is in a US port, and subject to a possible USPH inspection 52 times a year, are you saying that they spruce up the ship every time in Miami? While undergoing turn-around? And, because most ships only call at US ports for turn-around, most USPH inspections are done on turn day, so there is the added stress of that. The USPH is based in Miami, and so they could walk down to any of the dozens of cruise ships in port or nearby, at any time.

 

Most ships will have weekly inspections of all areas, by the senior staff, who are all trained in USPH requirements, to identify and correct any problems. Generally, there will be one staff from the department being inspected, and one from a different department, to get a fresh set of eyes looking for possible problems. Any ship where USPH protocols are just a nuisance, and not "a way of life" tend to get poor scores. Look at ships that cruise away from the US for a few months or a couple years, and when they come back they tend to have poor scores, because the crew has lost the "USPH way of life".

 

You do also realize that a great deal of a USPH inspection is checking records, from temperature logs of food as it is received, to blast chiller logs for cooling cooked food, to medical logs, to potable water chlorination charts, to pool chlorination charts, to maintenance records for a/c systems. Unless you are implying that there is a massive amount of false record keeping in the industry. And you do also realize that the VSP was designed by the CLIA membership, i.e. the cruise lines themselves , so why would they create a comprehensive package of regulations just to not follow them? USPH came to CLIA and asked: what do you recommend, what is doable. Remember, the USPH mandate is not to keep cruisers healthy, but to prevent the importation of disease into the US. If the cruise lines can keep the passengers healthy while cruising, then no one brings disease back into the US, which satisfies the USPH.

Edited April 25, 2014 by chengkp75

[caribill]

Remember, the USPH mandate is not to keep cruisers healthy, but to prevent the importation of disease into the US. If the cruise lines can keep the passengers healthy while cruising, then no one brings disease back into the US, which satisfies the USPH.

 

Ironic since most disease is brought onto the ship by embarking passengers.

[Salacia]

... And you do also realize that the VSP was designed by the CLIA membership, i.e. the cruise lines themselves , so why would they create a comprehensive package of regulations just to not follow them? USPH came to CLIA and asked: what do you recommend, what is doable. Remember, the USPH mandate is not to keep cruisers healthy, but to prevent the importation of disease into the US. If the cruise lines can keep the passengers healthy while cruising, then no one brings disease back into the US, which satisfies the USPH.

 

 

As regards to your statement that "And you do also realize that the VSP was designed by the CLIA membership, i.e. the cruise lines themselves" - no, I do not realize that. What I have read is the Forward contained in the 2011 Vessel Sanitation Program Operations Manual, signed by Jaret Ames (CAPT, USPHS), Vessel Sanitation Program. Captain Ames, while giving credit to various cruise lines and the CLIA, also gives credit to other contributors. Perhaps Captain Ames lacks the depth of your experience and is mistaken in crediting other sources.

 

Be that as it may, anyone who has an interest can view and/or download the Vessel Sanitation Program 2011 Manual. The Forward by Captain Ames regarding the history of the Vessel Sanitation Program might be of interest.

 

To view the 2011 Operation Manual, go to http://www.cdc.gov/nceh/vsp/desc/aboutvsp.htm

scroll down to the heading "How Does VSP Operate?"

[Colo Cruiser]

Ironic since most disease is brought onto the ship by embarking passengers.

 

 

Yes it is.

[Salacia]

Yes it is.

 

One asymptomatic food handler can be the source of an outbreak. But let's stick with the idea that all outbreaks are the fault of passengers.

[Colo Cruiser]

One asymptomatic food handler can be the source of an outbreak. But let's stick with the idea that all outbreaks are the fault of passengers.

 

 

I know right.

[Salacia]

I know right.

 

Roger that. Stick with the Party Line.

Edited April 26, 2014 by Salacia

[caribill]

One asymptomatic food handler can be the source of an outbreak.

 

True, but the 3000+ new passengers will far outnumber a handful of new crew members.

 

And at ports along the way, relatively few crew members go ashore while 75% or more of the passengers will.

[PescadoAmarillo]

One asymptomatic food handler can be the source of an outbreak. But let's stick with the idea that all outbreaks are the fault of passengers.

The Emerald Princess went to Code Red and made the national news just three days after the end of its dry dock where there had been hundreds of contractors on board and the crew was allowed extra time off to hit the bars, restaurants and beaches around Freeport.

 

I never did believe that passengers were responsible for that one.

[chengkp75]

One asymptomatic food handler can be the source of an outbreak. But let's stick with the idea that all outbreaks are the fault of passengers.

 

I thought the agenda might be going this way, now its a bit clearer.

 

I don't believe that I or anyone here ever said that the passengers were the only source of outbreaks, or even that crew were never part of the transmission chain. I do believe in statistics, and the probability of whether a crew member or a passenger brought the virus onboard leans towards a passenger. Why do ships have an outbreak one cruise, but not the one before, or the one after? Sure a crewmember could have been infected on that cruise, but why not the other cruises? Their habits are pretty regular, so their exposure ashore would be constant across cruises. What changes from one cruise to the next? The passengers.

 

Could one food handler cause the outbreak? Sure, but statistically, that one food handler would be liable to continue to spread the virus cruise after cruise, and do we see this? Not often. Most back to back outbreaks are indicative of significant crew infections, as these are the ones who will carry the virus across the turn-around, but do these happen every time there is an outbreak? No.

 

If you look at investigations, you see that most crew cases are non-food crew, who get it the same way the passengers do, from contact surfaces.

 

Since the crew not only have their own internal guidance towards personal hygiene, but are also supervised by several layers of staff all throughout their working day, and can be disciplined for failure to follow proper hygiene, their likelihood of causing an outbreak, or increasing its severity is reduced. Balance that against the passengers who are only responsible to their own internal guidance on hygiene, are not supervised nor can they be "fired" by being put off the ship for failure to follow proper hygiene.

 

Again, if the crew's hygiene was an issue, there would be continual issues with noro cruise after cruise.

 

I'm not an epidemiologist, just a guy who works on ships. But I guess that I must be stupid to "follow the party line" and believe those epidemiologists who are world recognized, and who say that statistically the vast majority of noro outbreaks are caused by and continued by passengers. I didn't realize until now, that I must be a drone, because obviously it is never the passenger's fault. I should have seen that coming from the thread about respiratory disease, that it must be the ship's fault as well, and that the ships are simply germ breeding grounds waiting to infect the unsuspecting passenger.

[BruceMuzz]

Chenkpt, in reply to your question "How do you know how much advance notice the ship has about VSP inspections? I've been involved in them, and generally, the only notice there is happens when someone on the ship sees the inspectors in their khakis on the dock" - I did not say ships had advance notice, I said "they have a fair idea about when the CDC will inspect the ship". For example, obviously, there's no expectation of a CDC inspection while at sea or at ports that are not in the US. For ships that have recently been inspected and received a good score, there is little likelihood of another inspection from the VSP for some amount of time and conversely, ships that have had serious violations after an inspection can expect to be re-inspected at some point in the not too distant future. Of course, there are inspections conducted by other countries' health authorities, but our conversation was about the VSP.

 

Your past experiences are no longer valid. Over the past 18 months the USPH Team has announced a new, more agressive schedule of inspections that follows no predictable trends. As a result, quite a few ships have had multiple inspections over very short periods of time - completely unpredictable - and this resulted in more ships failing the inspections than we have seen in many years.

 

When my ship returned to the USA this year, we expected to be inspected almost immediately - as we always have been. Instead, we were not inspected for 4 months. But then we were inspected again just one week later. Even though we have now been inspected twice in one season - fulfilling our yearly quota -as we always have - Captain Ames assured me that we could expect to see him at least one more time before we leave.

Edited April 26, 2014 by BruceMuzz

[Salacia]

Your past experiences are no longer valid. Over the past 18 months the USPH Team has announced a new, more agressive schedule of inspections that follows no predictable trends. As a result, quite a few ships have had multiple inspections over very short periods of time - completely unpredictable - and this resulted in more ships failing the inspections than we have seen in many years.

 

When my ship returned to the USA this year, we expected to be inspected almost immediately - as we always have been. Instead, we were not inspected for 4 months. But then we were inspected again just one week later. Even though we have now been inspected twice in one season - fulfilling our yearly quota -as we always have - Captain Ames assured me that we could expect to see him at least one more time before we leave.

 

It is certainly good news that ships are being inspected more than twice a year. Since, as you indicated, an increase in inspections "has resulted in more ships failing the inspections than we have seen in many years" - a change in the frequency and timing of inspections was clearly warranted.

 

BTW, perhaps the VSP/CDC should update their website to show the policy you described. This is what their website currently states...

 

"How often are ships inspected?

Cruise ships under VSP’s jurisdiction are subject to two inspections each year. If a ship sails outside of the United States for an extended period of time, it may not be inspected twice a year, but it will be inspected again when it returns to the United States.

Do ships know when the inspection will occur?

No. The twice-yearly inspections are unannounced." - copied from http://www.cdc.gov/nceh/vsp/desc/about_inspections.htm#question3

 

No doubt many of us read the inspection reports for ships as we're planning our cruises; now we know to check more frequently since there might be multiple reports. BTW, last year, the only ships that I noticed being inspected more than twice were those that failed inspection, but I've only read inspection reports for ships I was thinking of sailing on.

[Loonbeam]

Not normally a big fan of me too posts, but you basically covered what I was about to say.

 

No one is saying the crew is NEVER the source of outbreaks, or that ONLY passengers are. Statistically and operationally however, the odds of a passenger being the root cause of a NEW chain of infection is significantly higher than it being a crew member.

 

I thought the agenda might be going this way, now its a bit clearer.

 

I don't believe that I or anyone here ever said that the passengers were the only source of outbreaks, or even that crew were never part of the transmission chain. I do believe in statistics, and the probability of whether a crew member or a passenger brought the virus onboard leans towards a passenger. Why do ships have an outbreak one cruise, but not the one before, or the one after? Sure a crewmember could have been infected on that cruise, but why not the other cruises? Their habits are pretty regular, so their exposure ashore would be constant across cruises. What changes from one cruise to the next? The passengers.

 

Could one food handler cause the outbreak? Sure, but statistically, that one food handler would be liable to continue to spread the virus cruise after cruise, and do we see this? Not often. Most back to back outbreaks are indicative of significant crew infections, as these are the ones who will carry the virus across the turn-around, but do these happen every time there is an outbreak? No.

 

If you look at investigations, you see that most crew cases are non-food crew, who get it the same way the passengers do, from contact surfaces.

 

Since the crew not only have their own internal guidance towards personal hygiene, but are also supervised by several layers of staff all throughout their working day, and can be disciplined for failure to follow proper hygiene, their likelihood of causing an outbreak, or increasing its severity is reduced. Balance that against the passengers who are only responsible to their own internal guidance on hygiene, are not supervised nor can they be "fired" by being put off the ship for failure to follow proper hygiene.

 

Again, if the crew's hygiene was an issue, there would be continual issues with noro cruise after cruise.

 

I'm not an epidemiologist, just a guy who works on ships. But I guess that I must be stupid to "follow the party line" and believe those epidemiologists who are world recognized, and who say that statistically the vast majority of noro outbreaks are caused by and continued by passengers. I didn't realize until now, that I must be a drone, because obviously it is never the passenger's fault. I should have seen that coming from the thread about respiratory disease, that it must be the ship's fault as well, and that the ships are simply germ breeding grounds waiting to infect the unsuspecting passenger.

[bob brown]

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 was curious about this, too....I believe HAL calls it 'code orange', where they allow no self service at the buffet's for the first 2 or 3 days of a cruise, and then if there are no reported cases, they go to normal 'code green', and allow self service...

Seems like a good idea...

 

Speaking of the hand-washing vs. hand sanitizer controversy, several new ships, (and some older ones have retrofitted), hand-washing station's right at the buffet area....

[MrJulius]

It's the PENS.

I just got off of the Ruby a half hour ago. We had the Ultimate drink package. We must have signed a hundred chits using staff pens. How many hands are on those pens? All of them.

 

 

Sent from my iPad Mini Retina

[Gail & Marty sailing away]

Implemented Noro prevention and while slightly inconvenient at times, it works.

[gooch47]

I've had noro, or what I'm pretty sure was noro a half dozen times. But since we stopped going to the buffet maybe fifteen or twenty cruises ago I have not been sick except for a terrible cold three summers ago on a dreary Baltic cruise.

 

Your mileage may vary.

[Loonbeam]

Actually that's a pretty good point about the vector, especially given people's habits of absentmindedly chewing on them. Think I will carry a small pen with me if they go code red.

 

It's the PENS.

I just got off of the Ruby a half hour ago. We had the Ultimate drink package. We must have signed a hundred chits using staff pens. How many hands are on those pens? All of them.

 

 

Sent from my iPad Mini Retina

[Carolyn R]

When I first started cruising I heard here on Cruise Critic that during a code red for noro the salt shakers are removed from the tables. Ever since then I have brought a tiny salt shaker with me on every cruise. I have never had to use it so I now consider it my good luck charm. I also wash my hands a lot.

[Ethel5]

When I first started cruising I heard here on Cruise Critic that during a code red for noro the salt shakers are removed from the tables. Ever since then I have brought a tiny salt shaker with me on every cruise. I have never had to use it so I now consider it my good luck charm. I also wash my hands a lot.

 

Good job at warding off Noro! Keep up the good work and keep the salt shaker full.:D

[Colo Cruiser]

Good job at warding off Noro! Keep up the good work and keep the salt shaker full.:D

 

 

Like garlic around the neck. :eek:

[Ethel5]

Like garlic around the neck. :eek:

 

Not once have I ever been bitten by a Vampire!!

[Boytjie]

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?

 

On HAL the first 48 hours are under Code Orange: no self-service of food or drink in the buffet and taco bar outside.

[enidcruiser]

All this discussion is about the ship being kept clean and the hand washing to prevent it, but I want to know from anyone who has been infected on the ship, what do they give you from the medical department to take care of it?

Imodium, Cipro (like what you take for "food poisoning"), anything else? Just wondering.

Do they just quarantine you to your cabin and that's it? Surely they give you something.

[Colo Cruiser]

All this discussion is about the ship being kept clean and the hand washing to prevent it, but I want to know from anyone who has been infected on the ship, what do they give you from the medical department to take care of it?

Imodium, Cipro (like what you take for "food poisoning"), anything else? Just wondering.

Do they just quarantine you to your cabin and that's it? Surely they give you something.

 

 

Quarantine, treat symptoms only.