Ruby Princess - Special Inquiry - Evidence To Date

[BRANDEE]

4 minutes ago, OzKiwiJJ said:

Usually there are two versions of the flu virus. The first one is designed for younger people with healthy immune systems and comes out late March. The second one is "stronger" and better for Seniors. I contaced my GP when the first one was released this year but was told to wait until the second one came out.

We have the exact same thing, only our time frame is late September/October in northeast USA.  Been getting the "senior strong" the past few years.

[possum52]

10 minutes ago, BrissieB said:

There were also availability issues.  Initially only the over 65's were being administered.  I am eligible for the free flu shot due to other conditions and I was rescheduled 3 times due to availability.  I was unable to get it until late April.  At that point in time my doctor was recommending everyone get the flu shot this year.  The concerns about drain on the hospital system and adding covid cases to the usual flu ones were a big consideration.

 

I had my over 65 flu jab on 6th April but my husband had his at least 2 weeks earlier and was given the last one the medical centre had on hand which is why I had to wait for the next delivery. Regional areas seemed to have had delivery issues - friends had to wait until into May for theirs in South West Gippsland whereas my parents in south west Victoria had theirs just after me.

 

My children and grandchildren had their flu jabs in late April.

 

Leigh

[BrissieB]

24 minutes ago, possum52 said:

Regional areas seemed to have had delivery issues

 

I'm Brisbane and we definitely had shortages so I can only guess what regional was like.  Our wait list was over 10 pages long at the point I was added to it.  I've even had supply issues on other prescription medications.  I don't stockpile now but I will fill my scripts over a week out in case I have to chase around.

[Docker123]

I got the special extra strength one just before Easter. The other had been available through chemists for a few weeks prior.

 

One of the reasons for the big push this year was to try and ensure fewer cases so that there would be less of a demand on hospital beds, respirators etc. required for serious cases. In line with the closing off elective surgeries.

 

Still waiting.

[Cyrix400]

Two interesting points - nicely summarised - from the Opening Statement of the Counsel Assisting the Inquiry made on 5 March, which I just have read.

The first 2 paragraphs  talk about the nature of covid.

The next 2 paragraphs talk about the role of the Inquiry - and attributing the blame is NOT the main one.

 

"Coronaviruses are neither new nor uncommon. They are known to cause respiratory infections. Some infections, like the common cold, cause relatively mild symptoms. Other coronaviruses – such as those that cause SARS (Severe Acute Respiratory Syndrome, a virus genetically similar to the Covid-19 virus) and MERS (Middle East Respiratory Syndrome) – cause severe illness.

It is directly related to an understanding of this Inquiry’s Terms of Reference (TOR) to note that the Covid-19 virus can cause severe illness. Its early symptoms are similar to those associated with the common cold, and influenza – sore throat, a fever, fatigue, a cough, and difficulty breathing. Statistically, it appears that perhaps 80% of people who contract Covid-19 have mild symptoms, before recovery. I say perhaps because our knowledge of this virus, and its long-term effect on humans, is obviously limited. Dwelling again on statistics for a moment, 15 percent of people have severe infections, and five percent require care in a hospital intensive care unit or equivalent. Covid-19, as we tragically know, can also lead to death. In the most severe case, and this is summary and not exclusive of other critical complications, sufficient lung cells are destroyed, prompting a strong immune response. Air sacs in the lungs become inflamed and fill with fluid, and the patient is unable to uptake sufficient oxygen. There are matters related to the age of people who contract the virus, and whether they have underlying health issues of a variety of seriousness, but they don’t need to be explored as the main focus of this Inquiry, or further today"

------------------------------

"The most important aspect of what you do, Commissioner, is unlikely to be attributing blame to any person or any group of people – if there is blame to be attributed – for the decision to allow passengers to disembark from the Ruby Princess on 19 March. It will, first, be more important to determine what the facts are. Who knew what, and when?Who passed on information, and to whom? Who made the crucial decisions, and why?

 

 

 The next most important responsibility given to you is the request for you to make recommendations. Protocols and policies were in place that are relevant to the manner in which this ship was treated. Decision making processes were also involved. Some recorded partly in writing, and partly not. You have been asked to make findings of fact and recommendations about these policies, protocols, and the decision-making process generally".

[Pushka]

3 hours ago, OzKiwiJJ said:

Usually there are two versions of the flu virus. The first one is designed for younger people with healthy immune systems and comes out late March. The second one is "stronger" and better for Seniors. I contaced my GP when the first one was released this year but was told to wait until the second one came out.

Yes that's exactly what I was told. I'm not eligible for the 65+ due to age but as I have Lupus I can get it on medical grounds. We wanted to have a flu shot early as last year hubby caught flu in early April and was very sick as Adelaide had a bad early burst (I note that one of the strains in the quadra is "Adelaide"). Touch wood I've never had the flu but he has had several bouts but I don't catch it from him. 🤷‍♀️Dr also said the shot only lasts for around 4 months and he suggested I have the stronger version later in July when everyone has had their first rounds. 
 

Once a couple of weeks passed there were definitely shortages of both types in central Adelaide from about mid April until end of May. 

Edited June 29, 2020 by Pushka

[Cruisegroover]

There has been a few mentions by passengers they spoke to staff at OPT on 8 March about why the ship was delayed, was the ship good to sail etc. Most passengers said the staff were wearing black and white can't remember seeing a name tag etc and I suppose they presumed they were Princess staff.  Has it been established if these staff were Princess/Carnival employees or employees of the company who provides the shoreside services including check-in and checking passenger documentation prior to entry into the terminal. Just curious about this.

[NSWP]

4 hours ago, OzKiwiJJ said:

Usually there are two versions of the flu virus. The first one is designed for younger people with healthy immune systems and comes out late March. The second one is "stronger" and better for Seniors. I contaced my GP when the first one was released this year but was told to wait until the second one came out.

Correct, I had to wait until the 'senior flu vaccine became available down here, so I got it on 1st of May.

[Aus Traveller]

1 hour ago, Cruisegroover said:

There has been a few mentions by passengers they spoke to staff at OPT on 8 March about why the ship was delayed, was the ship good to sail etc. Most passengers said the staff were wearing black and white can't remember seeing a name tag etc and I suppose they presumed they were Princess staff.  Has it been established if these staff were Princess/Carnival employees or employees of the company who provides the shoreside services including check-in and checking passenger documentation prior to entry into the terminal. Just curious about this.

Staff on shore wearing black and white would probably be locally-based check-in or security staff.

[BRANDEE]

14 hours ago, Cruisegroover said:

There has been a few mentions by passengers they spoke to staff at OPT on 8 March about why the ship was delayed, was the ship good to sail etc. Most passengers said the staff were wearing black and white can't remember seeing a name tag etc and I suppose they presumed they were Princess staff.  Has it been established if these staff were Princess/Carnival employees or employees of the company who provides the shoreside services including check-in and checking passenger documentation prior to entry into the terminal. Just curious about this.

 

There were some crew members walking around talking to the passengers waiting.  We spoke with the CD and also one of the assistant CD's while waiting.  They had name tags that identified themselves.  There were also shore staff, who were directing lines and answering questions and handing out health questionnaires.

[Cyrix400]

Highlights from the evidence of Dr Selvey - Special Inquiry Mon 29 June

 

A a few interesting yet very reluctantly made admissions by Dr Christine Selvey, acting director of communicable diseases with NSW Health.

She was very reluctant to comment on certain aspects, including the" very  poor decisions" made  by her colleagues, but was strongly pressed to answer by the Commissioner who said to her "you don't have intellectual incapacity to comment, I am sure" and that he was interested in the Dr's comments.

 

1.  More covid swabs should have been taken and  the passengers should have stayed on Ruby Princess until the results of the swabs taken became known. - The Dr said that with 'hindsight' it would have been a better decision. The Commissioner noted that you do don't need 'hindsight' that you should not let people scatter before getting test results - and that he was interested in the extend to which the decision, to allow people off the ship before tests results were back, have been a very poor decision the NSW health officials involved.

(The domino efffect, in scattering possibly infected pax across the public transport system, into taxis and planes, where they could potentially spread the virus to other members of the public)

 

2. Dr Selvey asserted that the decision to allow pax to disembark was the proportionate response to the risk which had been increasing " as the epidemic took off in the rest of the world". The Commissioner posited that the increasing risk suggest NSW Health would  "run the gauntlet of passenger disapproval" - and the Dr replied "That's correct".

 

3. Dr agreed that it would have been better for passengers to be told  on arrival on 19 March that the public health order made on 16 March required them to to isolate for 14 days. She conceded that the "outcomes would have been improved' had pax been quarantined on March 19 (in hotels?) but that "at that time it wasn't considered" by Health NSW - it applied only to overseas arrivals. 

 

4. When asked why Dr Sevley seemed 'reluctant' to question 'poor decisions' made by her colleagues at NSW Health, the Dr said that she was not involved in cruise ship assessments and wasn't in a position to make a judgment. The Commissioner  then sternly  remarked: "Yet at the time and still you hold responsibility for forming judgments and acting on judgments about good systems and bad systems and which should be followed. It that right? It is part of your job. You are interested in the systems for public health screening and protection. Is that right?   A - Yes"

 

5. When questioned about discrepancies in information between federal and state correspondence regarding travel after disembarkation from the ship, self isolation timelines and the use of face masks -  the Dr agreed that the messaging "should be consistent"

 

6. NSW Health did not try to contact airlines about Ruby Princess pax travelling onward, as this was handled by federal authorities, rather than on state level - it was not done by the Commonwealth until 22 March, i.e. 2 days after the results were obtained. Dr Selvey admitted that there was "no reason that I'm aware' why NSW Health could not have contacted the airlines.

 

7. Dr Selvey was not aware if NSW Health had taken steps to notify the 98 crew disembarking in Sydney on March 19 about positive Covid results. She recalled that there was a discussion with Carnival Australia reps and it was their preference to keep all their crew (including the crew member who tested positive) on board the ship, and to manage the outbreak according to the US Centre fo Disease Control plan for management of Covid 19 on a cruise ship.

[Aus Traveller]

Cyrix400 - That was an interesting post. One interesting point in the last para - One crew member tested positive, but 645 or so Australian passengers tested positive. We don't know how many international passengers. I wonder where that points to for the source of the infection.

Edited June 29, 2020 by Aus Traveller

[NSWP]

17 hours ago, Cruisegroover said:

There has been a few mentions by passengers they spoke to staff at OPT on 8 March about why the ship was delayed, was the ship good to sail etc. Most passengers said the staff were wearing black and white can't remember seeing a name tag etc and I suppose they presumed they were Princess staff.  Has it been established if these staff were Princess/Carnival employees or employees of the company who provides the shoreside services including check-in and checking passenger documentation prior to entry into the terminal. Just curious about this.

Carnival Brands including Princess use 'Intercruises' as their shore staff, GBenjo's opposition.

[Cyrix400]

12 minutes ago, Aus Traveller said:

Cyrix400 - That was an interesting post. One interesting point in the last para - One crew member tested positive, but 645 or so Australian passengers tested positive. We don't know how many international passengers. I wonder where that points to for the source of the infection.

 

To clarify  - many more crew members got infected afterwards - and some were taken from the ship to Sydney hospitals.  Another example of how  difficult it is to achieve infection control on the ship - even  without pax at that stage - but of course the affected crew might have got infected prior to the ship's arrival in Sydney - without symptoms yet visible at that time.

[Aus Traveller]

3 minutes ago, Cyrix400 said:

 

To clarify  - many more crew members got infected afterwards - and some were taken from the ship to Sydney hospitals.  Another example of how  difficult it is to achieve infection control on the ship - even  without pax at that stage - but of course the affected crew might have got infected prior to the ship's arrival in Sydney - without symptoms yet visible at that time.

Agreed. Many more crew members became infected afterwards, and there could have been some asymptomatic ones when the ship arrived in Sydney. However, the proportion of passengers infected was much, much higher than for the crew who work and spend their off-duty hours in fairly cramped quarters.

[Porky55]

11 minutes ago, Cyrix400 said:

To clarify  - many more crew members got infected afterwards - and some were taken from the ship to Sydney hospitals. 

Just an interesting fact about the crew here, and BRANDEE could confirm if she saw this too - the crew on Ruby Princess seemed to be a somewhat older demographic than we had become used to on cruise ships.
DH commented at dinner on our first night about the much older waiters/assistant waiters - and he doesn’t notice much but the menu and his food normally.
Even our room Steward was older than average .........🤔

Edited June 29, 2020 by Porky55

[OzKiwiJJ]

36 minutes ago, Aus Traveller said:

Cyrix400 - That was an interesting post. One interesting point in the last para - One crew member tested positive, but 645 or so Australian passengers tested positive. We don't know how many international passengers. I wonder where that points to for the source of the infection.

Essentially the spread of the infection in Ruby, in terms of passengers and crew, was very, very close to that of Diamond where they did identify patient zero as a passenger.

[christodan]

51 minutes ago, Cyrix400 said:

Dr Selvey was not aware if NSW Health had taken steps to notify the 98 crew disembarking in Sydney on March 19 about positive Covid results. She recalled that there was a discussion with Carnival Australia reps and it was their preference to keep all their crew (including the crew member who tested positive) on board the ship, and to manage the outbreak according to the US Centre fo Disease Control plan for management of Covid 19 on a cruise ship.

 

Interesting point. Makes Carnival seem far more prudent than NSW Health in handling the virus. 

[GUT2407]

23 hours ago, BrissieB said:

I'm Brisbane and we definitely had shortages so I can only guess what regional was like.  Our wait list was over 10 pages long at the point I was added to it.  I've even had supply issues on other prescription medications.  I don't stockpile now but I will fill my scripts over a week out in case I have to chase around.

Yep, my GP said his allocation Of flu shots was double his normal and he still ran out, people who normally scoffed when he asked about then getting the shot were keen as mustard.

[NSWP]

3 hours ago, Porky55 said:

Just an interesting fact about the crew here, and BRANDEE could confirm if she saw this too - the crew on Ruby Princess seemed to be a somewhat older demographic than we had become used to on cruise ships.
DH commented at dinner on our first night about the much older waiters/assistant waiters - and he doesn’t notice much but the menu and his food normally.
Even our room Steward was older than average .........🤔

They do not put the 'gun service crews' on the Australian based Princess ships,  I have noted that.

[Cyrix400]

6 hours ago, Aus Traveller said:

Agreed. Many more crew members became infected afterwards, and there could have been some asymptomatic ones when the ship arrived in Sydney. However, the proportion of passengers infected was much, much higher than for the crew who work and spend their off-duty hours in fairly cramped quarters.

 

6 hours ago, OzKiwiJJ said:

Essentially the spread of the infection in Ruby, in terms of passengers and crew, was very, very close to that of Diamond where they did identify patient zero as a passenger.

 

Both very interesting points made by the above two members - any theories out there why pax more prone to infection - besides demographic factors on this particular cruise??

[Aus Traveller]

2 minutes ago, Cyrix400 said:

 

 

Both very interesting points made by the above two members - any theories out there why pax more prone to infection - besides demographic factors on this particular cruise??

Do you mean more prone to infection than the crew? Simple. If the infection started with a passenger, it would spread among the passengers who crowd into lifts and sit close together in the theatre. Passengers don't get that close to crew members. Similarly, if the infection started with a crew member, there would be more of them with the virus. They crowd into the crew lifts and they sit close together in their dining room that works with buffet service and crew sitting at small  4 or 6 person tables. They also crowd into the crew bar after they finish work.

[OzKiwiJJ]

15 minutes ago, Cyrix400 said:

 

 

Both very interesting points made by the above two members - any theories out there why pax more prone to infection - besides demographic factors on this particular cruise??

Some passengers would have been coughing while in public spaces, either without covering their mouths or coughing into their hands then touching various surfaces around the ship. That comment is based on observations from a cruise we did last year.

 

Some passengers may not have been as careful about touching their faces while out and about around the ship.

 

Some passengers may not have been as rigorous about washing their hands and/or using sanitizer.

Edited June 30, 2020 by OzKiwiJJ

[Cyrix400]

Inquiry - 4 specific recommendations by the expert panel, likely to be adopted

 

The Commissioner sought the opinion of two medical experts, independent of NSW Health, from the Univ of NSW (Profs Kelleher and Grulich) to review  & comment on a number of technical & medical matters and approaches taken in respect of Ruby Princess.

This included:  the classification of  ship risk (low, medium, high); the distinction between those pax presenting with respiratory disease and those with 'influencza like illness;  the threshold of 1% rate of relevant infection on board; and the experts' views on the explanations provided in the anonymously authored NSW Health Report on the Ruby Princess Cruise 8 to 19 March. No significant shortcoming found by the experts - and their reasoning for it is  in their report - Exhibit 99 on the Inquiry website.

 

What is interesting however are their four specific recommendations what should be done differently, if a similar situation (new outbreak / pandemic? )arise in future with a cruise ship entering NSW Ports.

 

These are:

1. The earlier ban on cruise ships  - if the national ban on cruise ship that commenced on 18 March had started 10 to 14 days earlier, it would have prevented any covid cases being related to Ruby Princess cruise of 8 March 2020. The experts note the well-documented high risk nature of cruise ships with respect to respiratory transmission.

 

2. Change to on board procedure, with more attention paid to passengers with acute respiratory infection and not just influenza like symptoms. This would involve more testing for flu on board and for covid swabbing to be done on land - and in some extreme even whilst the ship is still at sea. ( swabs picked  up by helicopter off Australia coast ??). Also the ships  logs kept  should include everybody's travel history in the last 14 days, not just country of residence, because recent travel is a critic risk factor in early pandemic. 

 

3. There needs to me a more direct and systematic updating of ships doctors and state public health physicians when national case definitions change (as almost daily changes that occurred in the definition of covid). These changes should be actively communicated to these critical components of the response, rather than just published for information.

 

4. Changes in disembarkation  where there is potential spread of respiratory pathogens - this refers to a highly- organised disembarkation procedures that really maintain social distancing and reduced crowding (i.e my take is that this would mean much smaller disembarkation groups, with strict supervision by staff - which would take much longer to get people off)

 

 

[MicCanberra]

All fairly sensible recommendations that can be easily implemented.

I think the first second and last ones are quite obvious, even without hindsight.