Why is COVID-19 Showing Up on So Many Cruise Ships? TESTING

Based on all of the positive comments from my last two articles, I thought I would get more into the actual subject…and make it personal. (Mom and my kids: Read On!) So here we go!

It seems like COVID-19 is showing up on many of the early startup cruises (SeaDream, Paul Gauguin, Uncruise and Hurtigruten). Other than Hurtigruten, which violated so many laws, protocols, and common decency, it can’t be that cruise ships are somehow attracting COVID-19 infected guests like filings to a magnet. No, it must be something else.

I started my career as a biologist so my thought process has always been: “Give me all the known facts and then ask, ‘What do I observe and then what conclusions are possible?'” I then transitioned into being an environmental and maritime lawyer and the same approach served me well for decades more. So as I read these COVID-19 news stories the same thought process has been running through my head.

I thought I would share “where my head is at” in the hope that it gives you something to think about and, just maybe, if done right a pathway to going on a cruise being one of the safest ways to travel.

First, let me get the illogical “We have more COVID-19 cases because we test more” argument out of the way. That is a great metaphysical argument (not really), but in the real world – and I don’t know why the media just doesn’t say this plainly – the cases exist. Testing is merely a way to find those existing cases. Burying one’s head in the sand (reduce testing) doesn’t make the factually existing cases go away. And saying, “Well I think Johnny is worse than me, so I am actually good.” doesn’t fly either. (Did it with your kids or, heck when you were a kid? Nope. Not a chance.)

Second, let me address the follow-on issue. The measure is not how many cases are found in total. And, to be sure, I am tired of the total number of cases every known being shoved in our faces. The measure is how many people that are CURRENTLY tested are positive for COVID-19 how many are currently hospitalized and how many are currently dying. (Treatments are different now, nursing homes are separated out, etc.)

And what are the demographics…and I mean the real demographics. Let me explain this a bit. I technically am I diabetic (I take one pill a day and have no need to regularly monitor my blood sugar.) I technically am over 60. So I am, based upon the limited demographic information provided, “at-risk”. However, I am physically fit. I’ve hiked over 10 miles in the past two days at elevations ranging from 6,000 to 7,000 feet (so my lung function and capacity is far better than the vast majority of people, no less 60+year-olds). I have a 35-inch waist and have no issues with nerves, eyes, feeling, etc. In fact, even with my follicly-challenged lack of much hair, most people think I am in my early 50s (or, with enough wine, some lie and say late 40s).

Why am I telling you this? Because with my basic demographic information I can get testing for COVID-19 pretty much whenever I want (albeit the wait time for results went from 48 hours to 9 days) and I have been tested three times as a result of living in my, unfortunately, tourist-overrun (normally) slice of heaven here in Lake Tahoe. However, the real demographics show that the issue is not that I am over 60, but that when one is over 60 there tend to be other factors (being overweight, reduced lung capacity, poor circulation, etc.). And while being diabetic may be a legitimate concern on its own, according to the highly regarded medical authority, The Lancet:

The reason for worse prognosis in people with diabetes is likely to be multifactorial, thus reflecting the syndromic nature of diabetes. Age, sex, ethnicity, comorbidities such as hypertension and cardiovascular disease, obesity, and a pro-inflammatory and pro-coagulative state all probably contribute to the risk of worse outcomes. Glucose-lowering agents and anti-viral treatments can modulate the risk…

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30238-2/fulltext

So now, here I sit over 60, but not 65, with diabetes but none of the conditions that are actually of concern for diabetics (other than a slightly elevated glucose level treated with a “glucose-lowering agent”). So with the full demographic information, I am actually looking pretty darn good in this COVID world. If I was an “old” 60+ year-old sitting in a nursing home – where approximately 50% of the COVID-19 deaths have occurred – that might be a whole ‘nuther story.

So where am I going with this? Perspective! And that perspective allows me to go back to that second issue, the follow-on one, which is “What does the testing show?”. The vast majority of people have not been tested, but everyone really should be – with prompt results – so that COVID-19 positive people can be isolated (and treated if necessary) to break the cycle of transmitting the disease to others. If many people are tested and the number of people that are actively infected is high that means that transmission rates are high and, thus so is the spread. By being tested – even if you feel fine and have no symptoms – helps in two ways: It catches asymptomatic cases and it gives a more realistic percentage of positive cases (hopefully lowering the rate, but probably actually at this point increasing it).

And, of course, the argument that only sick people are being tested so of course the positivity rate is high is nonsense. I have been tested three times. My daughter (who lives in the FORMER hotspot of Brooklyn) has been tested twice. All negative results. And, of course, there are many people that fear (and that is the correct term) they might be infected due to a symptom associated with COVID-19 and they also come back negative.

And then things become complicated because there are so many people that contract a COVID-19 infection but are asymptomatic. And the people that are infected but their symptoms have yet to show and, thus, have a five day period when they can unknowingly shed the virus.

So what does this have to do with COVID-19 being discovered on the recent cruises? To me, observing all the facts that I have available to me (noting that frustratingly all of them are not):

1. The most cruise activity has been in Norway and Norway has a ridiculous (and, dare I say, regionally arrogant) waiver from testing and quarantining for anyone from Nordic countries.
2. Two of the COVID-19 infection instances (SeaDream and Hurtigruten) have been identified as individuals from Denmark. No testing!
3. The Hurtigruten fiasco was caused in large by failing to notify the passengers of a prior COVID-19 infection onboard. And, of course, No testing!
4. The Hurtigruten fiasco was caused in large part by failing to test certain Filipino crew and then failing to quarantine them. Again, No testing!
5. The Paul Gauguin infection was discovered three days into a cruise. Discovered by testing!
6. The SeaDream infection was discovered three days after a disembarked passenger was discovered to have COVID-19 by Testing! While this person is likely to have had it on the prior cruise, SeaDream terminated the subsequent cruise and is testing everyone; noting that all of its crew were quarantined for 10 days in hotels and tested before boarding the ship, so the change of it originating from the crew is minimal. Testing and Testing!

What this shows me is that:

• There is no way to make any place where there is any public interaction 100% COVID19 free.
• The focus cannot be to eliminate COVID-19 because, like the common cold, norovirus, the flu, and many other diseases it just isn’t going to happen. We say that things like measles and smallpox are eliminated, but when vaccinations stop the disease reappears. So preventing everything from dining in a restaurant to going on a cruise is not a plan to eliminate COVID-19, but to reduce its spread so life can move forward.
• Testing combined with Contact Tracing is vital. If these two things were not done in the above cases, imagine the potential spread as a result of the unknowingly infected Danish persons or the Hurtigruten crew.
• We have learned that if you do not properly test and do not properly quarantine there are going to be avoidable spread.
• We have learned that there are far more asymptomatic people walking around then we could have imagined and that they are probably the ones that are spreading the disease both most effectively and most widespread. (Denmark, to Norway, to the ship and its crew and passengers, back to Norway and then back to Denmark as one example)
• We have learned that not only effective and timely testing before embarking is critical, but that controls to not only isolate the infected people is essential but to safeguard against them unwittingly infecting others.

And I am, so far, left with this question that is yet unanswered:

How effective are the implemented and proposed testing and onboard protocols at (a) reducing (as elimination is not realistic, as shown above) COVID-19 infected passengers embarking; (b) controlling the spread from anyone infected to the extent that it does not require a lockdown or quarantining of an entire ship or termination of a voyage; and (c) to what extent various governments will embrace passengers arriving if they have been properly screened per (a) and if there is effective control per (b).

Now, back to the initial, “It can’t be like cruises attract COVID-19 infected passengers. It must be something else. What is it?” The answer, hopefully you can see, is simple:

There are heightened levels of scrutiny! Yep, it is that simple. More testing. More contact tracing. And – and I emphasize this – more awareness of where the failure to be vigilant causes significant issues and spread. As my former therapist would say to me during my years of marriage counseling (I tried!), “So how’s that working out for you. Not well? So Stop Doing It!” In short, cutting corners doesn’t work out well.

• COVID-19 doesn’t infect or spread less because of your nationality.
• COVID-19 doesn’t rear its ugly head sooner because you are going on a cruise.
• COVID-19 spends more time hiding and then spreading in asymptomatic people than in people who show symptoms.
• COVID-19 will not allow any cruise line (or any other business) to take shortcuts or think it can’t affect them if they aren’t truly vigilant

Most importantly, we all need to learn to moderate our concerns against reality. And each person has his/her own reality. I am 60+ with diabetes, but because I educated myself on the realities (my reality) I have no hesitation to go on a cruise or dine outside at a properly set up restaurant or talk with someone without a mask if socially spaced. I would not, however, send my 87-year-old mother who has breathing issues on a cruise, but I am thrilled she regularly walks the streets of New York City with a mask and dines outside in a properly set up restaurant, rather than sitting alone in her apartment other than visits from my younger sister (in full COVID-19 battle armor).

The cruise and travel world is not coming to an end. I don’t know what will be the situation in November or December 2020 or January or April 2021. But what I do know is I have learned a lot from the cruise events of this past week and will continue to learn more.

To me, because while the information is still coming in, the recent events do not sound a death knell, as many have said. They have actually given me hope and long term enthusiasm because we have learned a lot and the errors made are so obvious and avoidable that they have shown what not to do and why the developed protocols make sense.

So with antivirals and vaccines being very optimistically promoted (even with my skeptical eye), protocols being developed and refined, the obvious need for testing, testing and testing now beyond any logical question, I am actually comforted.

But as The Honorable James W. Kehoe, who was a United States District Court Judge, lectured to me as a young, enthusiastic and driven lawyer, as he leaned over his bench, and in a Southern drawl, “Son, you’re gunna win this case. Ya’ just ain’t gunna do it today.”

Hang in there. Keep the facts ahead of the emotions. Don’t let the politics (on any side) discount the science. We are going to overcome the effects of COVID-19 and we are going to do it soon. We just ain’t gunna do it today.

Give me a call, drop me an email or send me a Facebook message!

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