NOROVIRUS PLAGUE SHIP
Written by Rick
(Reprint from the Oslo Cruise, June 2010)
As Marla and I prepared to board the Vision of the Seas, we
were handed an odd piece of paper. It was a health
questionnaire asking us if we were sick. I had never been
asked to sign a document like this on a previous trip, but I
could see they weren't kidding. Without a signature, I would
stay on shore.
Fortunately, I wasn't sick. Neither was Marla. In fact, we
were both feeling pretty good.
Last year's big adventure had been our Barcelona 2009
cruise. Although that trip had been a slam dunk success, the
Continental plane flight over the Atlantic had been
extremely unpleasant. It was a small plane that gave a six
foot man like myself no room to move. My knees felt like
they were in my chest. My shoulders spilled out into the
aisles. All night long, people brushed up against me as they
made their way through the narrow aisles. I got no rest at
all. The ten hour flight left me with more aches and pains
than I have ever experienced before. I was miserable. Nor
was Marla spared. She said she was just as uncomfortable the
whole night long.
Live and learn. So for this 2010 flight, Marla had decided
to give British Airways a first try. Good move. The plane
was much more spacious. Huge difference! I was so
comfortable that I slept for practically the entire flight.
Plus Marla had decided to fly us in a day early to help
overcome jet lag. As a result, we were both feeling pretty
good as we prepared to begin our cruise trip. We weren't
sick so I signed the document without hesitation. However, I
was on guard now. There had to be a reason behind this
Sure enough, I was right. Marla and I had just climbed
aboard a Plague Ship.
It didn't take us long to figure out something was wrong.
The Vision of the Seas was fighting a serious outbreak of
Norovirus. Our first clue was the fact that we were not
allowed to go to our cabin immediately. I had never heard of
this before. I had no idea what the reason was for the
delay. As Marla and I strolled around, we saw Annie Fletcher
and Richard Byrd at a table. We sat down to say hi. That's
when Annie leaned over and whispered that she had heard a
rumor of a Norovirus outbreak. They were still trying to
disinfect the cabins at this very moment.
I frowned. Norovirus is often referred to as "The Cruise
Disease." It is a gastrointestinal illness that usually
lasts for one to two days. Apparently cruise ships are very
vulnerable to outbreaks because everyone is confined to a
limited space, making it easier for the virus to spread.
Other environments that see Norovirus outbreaks include
prisons and hospitals, but for some reason only the cruise
ships get the publicity. If forced to guess, we all have
sympathy for anyone who gets very sick on their vacation, no
matter how brief the illness. Vacations are supposed to be
immune from life's problems; otherwise they aren't a
All the unwelcome publicity aside, Norovirus is hardly
limited to cruise ships. I am certainly no stranger to this
disease. I was sick with the identical problem after eating
tainted Mexican food a couple months back. My painful memory
told me this was one illness I definitely wanted to avoid if
I could. However, putting things into perspective, this was
not bubonic plague, ebola or ecoli we were talking about.
Noro is no picnic, but it isn't fatal and it doesn't last
Once we got in our cabin, we turned on the TV. To the ship's
credit, they came right out and admitted the previous trip
had seen an outbreak of Noro. Using a taped message from the
Captain, he explained the illness.
Symptoms typically begin between 24 and 48 hours after
infection with the virus. Sudden onset of nausea is usually
the first sign of infection. The first stage includes about
six hours of periodic vomiting and diarrhea. Stage Two
usually involves 12 to 18 hours of bed rest. The victims
often experience a mild fever, aching limbs, and headaches.
Symptoms typically disappear after a day or two.
The Captain recommended we wash our hands at every possible
opportunity. He also said to avoid raw, unwashed foods
during a norovirus outbreak which was kind of odd since
someone had just delivered a plate of fruit to our cabin.
How were we supposed to know if it was safe or not? The
Captain concluded his message by assuring us that today's
thorough ship-wide disinfection process should prevent a
similar problem on this trip. I crossed my fingers and hoped
that he was correct.
I had heard that Noro was a problem on some cruise ships,
but I had never been on a ship with this problem before. I
went to the bathroom and washed my hands, then put the
problem out of my mind.
On Day Two, a day at sea, I encountered no problems with
Day Three was our trip to Paris. For some reason, Marla was
mysteriously irritable. She assured me it wasn't anything I
did. She just didn't feel good. We ate lunch at a lovely
outdoor café. I wolfed my delicious sandwich down with a
passion, but Marla said her food tasted terrible. She was so
disgusted with her sandwich that she only ate half of it.
Nor was her complaining limited just to this café. All year
long Marla had talked about French croissants. However, the
croissants she purchased today did nothing for her. In fact,
she said she had no appetite at all.
That night at dinner Marla barely touched her food. Then she
looked at me and said she needed to go back to the cabin. I
nodded and said I would catch up to her in a moment.
Sure enough, as I entered the room, the festivities had just
begun. Marla was very sick; she definitely had Noro. Yuck. I
can't say for sure, but for the rest of the night Marla
seemed to make about one trip to the restroom every hour.
She was in a lot of pain during these episodes, but the pain
would soon subside after the deed was done. Mostly Marla was
exhausted and full of aches.
On Day Four, we were scheduled to go visit Omaha Beach, the
site of the most difficult D-Day Landing. Marla told me she
wanted me to go, but that she preferred to stay in the cabin
and rest. The worst was over. If necessary, she could make
it to the phone. Besides, my trip was only half a day. Marla
figured she could spare me that long.
What do I tell our friends? Marla said for now it would be
easier if I told them she had a headache. That would buy her
some time to see how this illness progressed.
Marla's biggest fear was being quarantined and forced to
stay in the ship's hospital for several days. If she was
going to be sick, she preferred to at least be sick in her
own room. In her experience, it was much easier to get the
needed rest in her quiet cabin than having hospital people
bugging you all day long. I said I completely agreed.
When I returned that afternoon from my trip, Marla was
feeling much better. In fact, she was ready for her first
big meal of the day. Marla wanted a smoothie. I laughed and
immediately went about procuring one for her. Marla
absolutely loved her smoothie. She took little sips all day
long. Marla was so cute about that drink; for the rest of
the trip she complimented me on being kind enough to go get
the smoothie for her the moment she asked. Good grief.
Personally, I felt guilty throughout the previous night
because I didn't know enough about medicine to alleviate her
pain. It is very difficult to see a loved one suffer, even
when you know it isn't that serious.
For the rest of the afternoon, I quietly laid on the cabin
couch reading a book on D-Day while Marla slept. I wondered
how long it would be before it was my turn.
When dinnertime came along, Marla said she was strong enough
to join me, but preferred not to go lest she infect someone
else. Besides, all she really wanted to eat was soup. Room
service could handle that.
What should I tell our friends? Marla smiled. Tell them the
truth. No point in hiding it. I nodded. I agreed with her.
Of course everyone was
worried about Marla. They were all sympathetic. They were
also clearly worried. Marla was the first person from our
group to drop. Would there be more?
Yes, there would be more. By the time the trip ended, Marla
speculated that seven different people out of 36 had fallen
prey to the Norovirus. In addition there were several more
people who had experienced problems, but preferred to blame
their woes on seasickness, not the virus.
As it turned out, the Norovirus was a frequent topic of
conversation for the rest of the trip. Every night as our
group ate dinner, we would compare notes. We would share
what we had learned that day and idly speculate what was
really causing this outbreak. In a way, it was kind of funny
to be talking about such a disgusting topic right in the
middle of dinner. On the other hand, we were all so
comfortable with each other that no one seemed to mind.
We also looked around to see who was
missing. Every empty seat signaled an 'uh oh'.
I have to be honest. As grim as it was to learn that my
friends had gotten sick, I was fascinated by the medical
aspects. It was a huge mystery. We all wanted to be the ones
to discover what was causing so many people to get sick.
This was probably the first time in my life where I could
see why the practice of medicine could be so fascinating...
and frustrating too. This event was occurring right in front
of my eyes. Maybe if I paid close attention, I could figure
In fact, my own wife had gotten it. I had been right at her
side the entire trip before she got sick. Why did she get
it, but not me? Right from the start, Marla had announced
she was determined not to get sick. She washed her hands
constantly. In addition, she refused to use the public
toilets. When she walked the stairs, Marla held her hands in
the air lest she touch something.
As the days passed, I was baffled by the fact that Marla had
gotten it and I hadn't. I wracked my brains to retrace our
steps in Day One and Day Two. What had Marla done that I
hadn't? Had she eaten something different?
Looking for more clues, I started to make friends among the
ship's crew. They were more than willing to discuss the
problem. At every opportunity, I would pump them with
questions about the virus. To my surprise, they said very
few of the crew got sick.
I thought that was an odd thing to say since Jasmina, our
group liaison, had been sick with it on the second day of
our trip. Obviously the ship's staff wasn't invulnerable.
I also learned from my chats that our current trip was the
THIRD TRIP IN A ROW with the problem. I later learned that
this same ship had a huge problem with the norovirus earlier
in the year back when it was stationed in Brazil.
I often wondered if someone among the crew was responsible
for the continued outbreaks. After all, once the passengers
left the ship, they took the virus with them. So what was
getting the NEXT CROP OF PASSENGERS SICK?
Once I discovered that FIVE DIFFERENT VOYAGES on this ship
had experienced Noro, I began to wonder if there was a
Norovirus equivalent of Typhoid Mary on board this ship.
Typhoid Mary was the first person in the United States to be
identified as a 'healthy carrier' of typhoid fever. In 1906,
she played a big part in spreading the disease throughout
Over the course of her career as a cook,
Typhoid Mary was known to have infected 53 people, at
least three of whom died from the disease. Her notoriety is
in part due to her vehement denial of her own role in
spreading the disease, together with her refusal to cease
working as a cook. She was forcibly quarantined twice by
public health authorities and died in quarantine. It is
possible that she was born with the disease, as her mother
had typhoid fever during her pregnancy.
No one on the ship believed my "Noro Mary" theory. The staff
members didn't think they were responsible. The ship's
personnel liked to blame the outbreak on the passengers. One
person lectured us on the poor hygiene of the Scandinavian
people. Yet another person said in the city of Santos,
Brazil, a mediocre water supply was responsible for
spreading the disease throughout the town. People from
Santos then brought the disease on board. This happened back
My favorite waitress was Michelle from Brazil. She said
typically she was as strong as a horse. However one night in
the dining room, a man stumbled trying to sit down. Just as
she reached to steady him, the man coughed directly in her
face. The next day she caught the Norovirus.
Although the research suggests that the virus is not
transmitted by air, it is quite likely that Michelle
received a droplet of infected saliva in the cough spray.
Therefore her story makes complete sense.
One of my favorite people was Erik from San Diego by way of
Las Vegas. Erik, age 26, was the bar manager. He was also
the most informed person I talked to about the problem. Erik
explained he had acquired his vast knowledge in college. He
said his graduation research paper for his hotel management
degree had been specifically on the topic of Norovirus.
Erik told me a bunch of good stories. He said back in the
Eighties, a Norovirus outbreak had occurred among players
and spectators after a football game between the University
of Pennsylvania and Cornell. Researchers eventually
determined everyone got sick from ice that was contaminated
Erik said this ice story showed just tough this virus is. It
is the second most common virus after the cold virus. In
fact, more dangerous viruses like hepatitis C and HIV can't
survive being frozen and will die soon after they're out of
the body. This explains why you are unlikely to catch the
HIV or Hep C from contact with a surface touched by an
Unlike these two more dangerous viruses, the norovirus is so
tough it can linger on surfaces like a hand rail for a long
time waiting for an unsuspecting person to come along and
inadvertently touch it.
So who puts the virus on the hand rail to begin with? Upon
my questioning, Erik took a deep sigh. He didn't really want
to say this out loud, but I told him to go ahead. He said
the virus is contained in both fecal matter and vomit. Erik
said I could only catch it through direct contact. Let's say
an infected person forgets to wash their hands properly
after a bout with diarrhea, then wanders out on the ship.
All it would take would be just a thin film on the finger
that touches a door knob or the handle on a toilet. The next
person who touches that same spot can pick up the virus.
Erik wasn't finished. He said that even if a
person DOES INDEED TOUCH AN INFECTED SPOT, THEY STILL MIGHT
NOT GET SICK. Erik said the person would also have to then
touch their mouth, their nose, or their eyes for the virus
to enter the body. That is
why people should wash their hands constantly. In this way,
their hands would be purified before they accidentally
touched their face.
Before we finished our talk, I asked Erik point-blank if the
disease was airborne. Erik shook his head no. Absolutely
not. It is transmitted strictly by touch. Okay, if you say
so (let me add I later found no professional article that
disagreed with Erik's position).
After my conversation with Erik, I thought about what he
said about not touching the face. I found myself watching
everyone at dinner that night. I was amazed to see EVERYONE
at the table touched their face with their hands at some
point in the meal. They didn't even realize it. One person
rubbed their nose. Another person touched the corner of
their eye. Several people scratched their face. One person
licked some spilled soup off their finger without even
thinking about it.
Later that same night, I went back to the cabin. Having
trouble turning a page in my book, I licked my finger in
order to help turn the stubborn page. I groaned to myself. I
was determined not to get sick and yet I had just violated
Erik's Golden Rule #2: Don't touch your face!
I didn't catch the Norovirus, but it wasn't because I was
tougher or smarter than anyone else. I made the same
mistakes as everyone else. Apparently I was just lucky not
to have touched an infected hot
spot shortly before touching my own face.
There are certain universal precautions that
are even more important when you're aboard a ship. As
important as washing your hands, you have to learn to KEEP
YOUR HANDS AWAY FROM YOUR EYES, NOSE AND MOUTH. This is a
normal human condition to touch your face.
If you sit at a restaurant and watch people eat for five
minutes, you will see what I mean.
Many people think that shaking hands is the problem. Erik
said this is a misconception. Most viruses are not spread by
hand to hand contact alone. They are spread by hand to hand
to mouth (or eyes or nose). If you had the virus ONLY on
your hands, you wouldn't get sick. You still have to touch
your face before you wash your hands to complete the nasty
I might add as I reread my text on this part of the story, I
just caught myself with my fingers touching my mouth. It
seems impossible not to touch our own face. We touch our
faces all the time before we can even think about it! Habits
of a lifetime cannot be changed overnight, which explains
why this nasty little virus keeps finding new hosts.
Speaking of finding new hosts, as the cruise progressed,
people were dropping like flies. One night at dinner we
heard 'Alpha Alpha Alpha west corner of the dining room'.
Someone had a virus-related accident right at the dinner
table somewhere else in the room. Yuck.
On another night, I looked around and wondered where
everyone was. I realized the room was only half-full. Did
this mean what I thought it meant?
Rumors pegged the total number of cases around 300
passengers. Now before you get too alarmed, remember that I
have been on eighteen cruises and this was the FIRST TIME I
have ever encountered Noro. In addition, I have the same
chance of the getting the virus at various Houston
restaurants. As long as we wash our hands before and after
dinner and don't touch our faces between hand washing,
theoretically we are safe.
On the other hand, 300 is an awfully high number. Out of the
total ship population of 2000, I would speculate that
several hundred more people who caught it didn't report it.
I mean, Marla caught it and she is not part of that total
because she didn't report it. A couple other people in our
group didn't report it either. So maybe 500 people caught
Noro ... one in four.
They said it was not spread through the air. Are we to
believe that all 500 people simply failed to wash their
hands? Marla for one washed her hands constantly and she
still got it. That is why I wondered if there was a better
explanation, perhaps something in the food and water.
When I returned home, I reviewed several articles on
I thought this blog was interesting:
"Firstly, I think a cruise ship
is a prime location for any type of contagious illness
to spread - so many people in a confined space!
Air-conditioning has to take its share of the blame -
all that recirculated air, recirculating all the germs
too just in case they passed you by the first time
round. And if it's not the air-conditioning, then it
must be the heat in the general areas. That is bound to
My main suspicions though lie with the passengers (yes,
I do include myself in that category!).
If these ships are scrupulously cleaned and they
certainly appear to be, then somebody must be taking
this bug on board. We are all asked at embarkation
whether we feel/have been unwell etc. Now can you tell
me hand on heart that if you had booked a cruise and
been looking forward to it for six, twelve or eighteen
months, would you honestly answer 'yes' to those
questions and risk being turned away, just because your
tummy felt a bit icky? Maybe therein lies your answer -
human selfishness. But how the cruise lines ever stop
people from lying - well, I can't answer that!"
Then I ran across an Internet
article that stated the Food and Drug Administration points
to contaminated water as one of the most likely causes of
norovirus. I couldn't help but think of Erik's frozen ice
story when I saw this.
The FDA report said that "water is the most common source of
outbreaks and may include water from municipal supplies,
wells, recreational lakes, swimming pools, as well as
contaminated water stored aboard cruise ships".
Well, I drank the ship's water throughout the trip. So did
Marla. She got sick; I didn't. One woman at our table who
purchased bottled water every night got sick. Draw your own
conclusions, but I don't think it was the water… at least
not on this trip.
Another weird feature is that within our group, only two men
got sick while 7 to 10 women got sick. Everyone thought this
was significant, but no one had a theory to explain the
disparity. I didn't dare suggest my secret makeup theory.
Besides the water, I wondered if perhaps the food supplies
might be contaminated. The same FDA report suggested that
"shellfish and salad ingredients are the foods most often
implicated in norovirus outbreaks. Ingestion of raw or
insufficiently steamed clams and oysters poses a high risk
for infection with Norwalk virus. Foods other than shellfish
are contaminated by ill food handlers."
It would be interesting to determine the job positions of
the crew members infected with norovirus. For example, I
read a CDC report that sixty-nine crew members were reported
ill on another recent cruise with a large outbreak. How many
of these crewmembers were cooks, waiters or food handlers?
On the other hand, there are experts who discount the food
and water theory. One article I read said this:
"Health experts confirm that
norovirus on cruise ships is not generally sourced from
food or water, but rather from direct contact with a
person with the "stomach bug." It is also passed along
indirectly on objects or surfaces previously touched by
someone with norovirus, such as handrails or elevator
Personally, I don't agree. Assuming that this virus cannot
be transmitted via the air - the most common method of
spreading disease - then I lean towards the contaminated
water and food theory. I doubt seriously there are enough
contaminated surfaces on that ship to explain the large
number of sick people. You have no idea how hard the ship's
personnel worked throughout this cruise. Every day I saw
dozens and dozens of crew members spraying disinfectant on
every possible public surface in sight.
Those people worked themselves to
the bone trying to rid the ship of this virus. For example,
my Brazilian friend Michelle the waitress and her partner
Caroline both told me they were required to come to their
station an hour earlier than usual every morning to scrub
down their dining room area of responsibility.
The ship was trying as hard as it
could. For example, the day Marla got sick, I asked for a
refund on her trip to Omaha Beach. The ticket clearly said
"No Refund". Nevertheless, when I explained to the man how
sick she was, he gave us a credit with no further questions
asked. I was impressed.
Another woman in our group got sick
about the same time as Marla. However, unlike Marla, she
bravely trudged down to the ship's hospital. They gave her a
free shot and some free medication, sent her back to her
room and told her to rest. The lady reported almost instant
relief from her problems. When Marla and I heard this story,
we both looked at each other. Too bad we were so suspicious.
Marla might have cut her suffering in half.
In my opinion, the ship was bending
over backwards trying to alleviate the suffering.
I realize there is a natural
tendency to blame the ship, but after watching the
superhuman efforts to clean the bathrooms and cabins on this
infected cruise ship, I have to say the ship personnel were
doing everything they had any control over.
Let me add that my Internet
research revealed that norovirus happens to every single
So rather than blame the ship,
Marla and I both adopted the attitude that we were all in
this virus problem together. I talked with every staff
member I met hoping to come up with the key to the puzzle,
but in the end I came up empty. My first case as medical
detective was a failure.
When I got home, my daughter asked
me if my fear of this illness would stop me from taking more
cruises. I told her no.
I said that even though I had my
first cruise experience with the virus, I also know that
very few ships actually have the problem. In my case, only
one trip in 18 has had the problem. Those are pretty good
Besides, every time I go to a
restaurant in my hometown I am taking the same risk. Do
these people practice safe hygiene? Do they wash their food
properly? What about their silverware? How am I supposed to
know the truth about this restaurant until it is too late?
Usually when these problems occur,
our only remedy is to say, "I'm never going back there
again." But in the case of a cruise ship, after watching how
hard they fight the problem, I would give them another
Even if I do run into another
situation like this, I also know that if I am careful, I
have a good chance of not catching it. And if I do catch it,
I am comforted by the fact that Marla survived and was still
able to have a great trip. I would do the same if I am ever
as equally unlucky as my wife.
Besides that, even in the presence
of three straight outbreaks, the ship's crew didn't seem
worried or in any way panicked. That Captain was still
shaking every hand in sight the last time I looked.
So when I compare the slight
chance of catching the illness and weigh this against the
benefits of having a wonderful time and sharing experiences
with family and friends, I have no fear.
If I had one suggestion, I think if
I ran across another Noro problem in the future on a cruise
ship, I would wear gloves.
Although I am sure I would get disapproving looks or at
least teased, this simple precaution might not be such a bad
idea. I would simply explain to people I am wearing the
gloves to remind me not to touch my face. I might add the
gloves would also help prevent touching an infect surface.
Although I am sure the cruise ships
wish to avoid the stigma of posted pictures of travelers
wearing gloves, there might be some interesting benefits.
What if everyone on board wore gloves and people STILL GOT
SICK? Then at least the medical people could discard the
Touch Theory and concentrate their attention elsewhere.
And what if everyone wore gloves
and the problem went away? Once you have three trips in a
row with the same problem, you would think they would
consider a different approach towards solving the problem.
In summary, I realize this has not
been the most pleasant story I have written, but I am sure
you understand the purpose of sharing this story is simple -
forewarned is forearmed.