Swine Flu - Cruise to Nowhere

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http://scienceblogs.com/effectmeasure/2009/05/swine_flu_cruise_to_nowhere.php

Consider the Carnival Cruise Line ship, Pacific Dawn. It docked three days ago in Sydney onroute to the Great Barrier Reef to take on new passengers and let off others. But then, according to news reports (but see this version from the ship's onboard blog; h/t crof), 2 children came down with swine flu, followed shortly thereafter by additional passengers:

Carnival Corp.'s luxury cruise ship Pacific Dawn was asked not to stop at ports in north Queensland after 38 people caught swine flu while on a South Pacific voyage, Australian health officials said.

Passengers and crew tested positive for the H1N1 virus after nine days at sea on the 11-deck vessel. Most patients had a "mild illness" and were diagnosed after the ship docked in Sydney on May 25. Pacific Dawn will now reach Brisbane, Quensland's capital, tomorrow after three new cases were reported, the state's health department said yesterday.

"All passengers will be screened before disembarking and any passengers with symptoms will be swabbed and provided with masks and a course of Tamiflu," Jeanette Young, Queensland's chief health officer, said in a statement, referring to Roche Holding AG's anti-flu medicine.

Australia's health ministry said cases among people on board the ship have been found in Adelaide, Brisbane, Canberra, the Gold Coast, Melbourne and Sydney, contributing to a more than twofold increase in the nation's swine flu case tally to 147 in 12 hours. Southeastern Victoria state said 43 additional cases were confirmed late yesterday, bringing its total to 96. (Jason Gale, Bloomberg)

OK, fine. Doesn't sound too unreasonable, although the cat's out of the bag for sure. But the rhetoric and actions around a futile government attempt to contain the virus are not so fine and they led to predictable results:

Swine flu victims are being kicked out of their Sydney hotels by nervous proprietors who fear bad publicity might drive other customers away.

Ouch. If you make flu cases sound like lepers they'll be treated like lepers. And the result will be further spread of the disease rather than containment.

The doubling of swine flu cases in 12 hours makes it obvious that the virus is starting to circulate in the community. There is no hope of bottling this up any more (if there ever was). Australia should be bending all its efforts (and its public education) to managing the consequences of a new flu virus. This means being straightforward with the public about three things. The first is that so far the virus is clinically like seasonal flu. It is reasonable to tell people this, not to allay fear but because it is true. It may change, but that's what we see at the moment. But the second thing to be straightforward about is that seasonal flu is something to respect. It's a "seasonal flu" teachable moment. Flu of any kind can make you very sick and even kill you. The third thing is that even though the impact on the individual is not so very different than the flu people are used to, the effect on the community could be very different because of the potential speed of spread and the age groups and number of those affected. So people need to get ready for that.

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

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The comments section at Effect Measure's post of the day is always a good read, though sometimes what is said there could be a violation of TOS here. There is frequently lively and informed discussion from some very knowledgeable people. Of note, Jody Lanard, a very well known risk communicator comments on the recent events in Australia.

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_cruise_to_nowhere.php

Australia's robust focus on containment leads to an obvious dilemma: Fear of the disease can increase stigma, which can increase efforts to hide disease, which can lead to increased spread of the disease. (This is old news of course.)

Another problem is focusing on one strategy, while not simultaneously warning people -- dramatically -- that it is likely to fail.

Australia's "containment" effort has been Quixotically admirable, and may well have slowed the rate of spread -- a benefit in a country which can make its own vaccine, and a benefit in all countries in reducing peak impact on health care facilities.

But a major message is missing in most countries which are emphasizing containment: Preparing the public for the failure of containment, and helping them visualize a widepread epidemic.

...it does help the population brace itself, and feel less shocked and blindsided.

I am currently working in one of many countries that are trying to imagine informing the public, in the future, when the country has its first H1N1 death. These countries know it will not help to just say, "But of course lots of people die of flu every year..." They know people are justifiably more upset about a death from a new flu virus that is even more unpredictable than the "usual" flu.

"Telling people what to expect" is a way of drawing on their resilience, and showing you trust that they can handle bad news -- treating them like adults.

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Even though Swine Flu is for the most part mild right now, perhaps public health authorities in tourist destinations need to be thinking of how we can provide for the care of sick visitors in the event that there are large numbers of people becoming ill in our upcoming flu season.

Where will we house ill visitors if they are not sick enough to be in the hospital? Some of them may not be able to pay for an extra week confined to their beds in some hotel. Realistically this could occur in places that draw large numbers of international tourists like Florida does. We should be learning from the Australian experience before it repeats itself in the not too distant future.

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the media here are certainly keeping the public aware that a major outbreak is likely despite quarantine precautions - predictions of up to 20% of the population being affected have been made by ministers and public health officials, how have also mentioned the possibility of deaths from H1N1.

I agree that there's a huge potential for general influenza education going begging.

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Even though Swine Flu is for the most part mild right now, perhaps public health authorities in tourist destinations need to be thinking of how we can provide for the care of sick visitors in the event that there are large numbers of people becoming ill in our upcoming flu season.

Where will we house ill visitors if they are not sick enough to be in the hospital? Some of them may not be able to pay for an extra week confined to their beds in some hotel. Realistically this could occur in places that draw large numbers of international tourists like Florida does. We should be learning from the Australian experience before it repeats itself in the not too distant future.

Never thought of this, it is good point.

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'Swine flu' cruise ship blocked from Caribbean ports

http://www.dailymail.co.uk/travel/article-1192309/Swine-flu-fears-raised-Royal-Caribbean-cruise-ship.html

Thinking of taking a cruise? Got a prior existing condition? Maybe you should get the pneumoccal vaccine before you go.

Just a thought...

I am reading more and more about cruise ships and swine flu. Perhaps there are discounts for taking a cruise now because of all of the bad publicity.

Fears that another cruise ship has been struck by swine flu are mounting after it was blocked from entering two ports this week.

Royal Caribbean's Adventure of the Seas is making a seven-night tour of the Southern Caribbean and was this week denied entry at St Lucia and Antigua.

Two members of the crew and one passenger have reportedly displayed flu-like symptoms.

Chief executive officer for the Antigua and Barbuda Tourism Authority Colin James told cruise website CruiseCritic.co.uk that despite three people being isolated and treated in Barbados, the ship was stopped from visiting St Lucia.

The website reported: 'Permission to dock in Antigua was also denied, based on advice from Antigua's chief medical officer and minister of health.'

Mr James added that the cases were confirmed as the H1N1 virus but a Royal Caribbean spokeswoman said earlier this week that full lab results were not yet available.

This is not the first time Royal Caribbean has been affected by swine flu - crew members were struck down with the virus on Serenade of the Seas in May.

And the news comes after the cruise operator said that the recent swine flu outbreak had hit its earnings.

Alaska says 5 swine flu cases on cruise liner

http://www.reuters.com/article/domesticNews/idUSTRE5575RG20090608

Five crew members on a Holland America cruise ship have been diagnosed with the H1N1 swine flu virus after tests in the Alaskan port of Ketchikan last week, according to the Alaska Division of Public Health.

The incident on the Carnival Corp-owned cruise liner follows a month after rival Royal Caribbean reported two probable swine flu cases among crew on one of its ships.

The crew members on Holland America's Zaandam were tested last Wednesday, and results of tests conducted by Alaska's virology laboratory turned out positive, said Dr. Beth Funk, an epidemiologist with the division.

"We were asked to do the testing on some of the ill crew members when the ship was in Ketchikan last week," Funk said. Five specimens were taken, and "all five were positive for the novel H1N1 strain of influenza," she said.

Funk said she did not know what the crew members did after the tests results came back Thursday or where the ship was as of Monday, although it was believed to be heading into Canadian waters.

Alaska officials have notified their Canadian counterparts of the test results, Funk said.

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http://finance.yahoo.com/news/Swine-flu-sends-cruise-ship-apf-3138846644.html?x=0&.v=1

Aruban health authorities checked passengers and crew from the cruise ship Ocean Dream on Friday for signs of the swine flu that cut short their Caribbean trip, and some could find themselves spending still more time on board.

The Health Ministry on the Dutch territory said the tests were a precaution to prevent the spread of the virus after three crew members tested positive for the H1N1 influenza and 11 others showed symptoms.

Helicopters buzzed overhead and Coast Guard boats flanked the cruise ship as passengers disembarked into the cruise terminal. Nearly a dozen health officials shrouded in white clothes and wearing masks tended to them as they checked for symptoms.

Swabs will be taken for further analysis from anyone who shows symptoms. If a preliminary test comes back positive, they will be kept under surveillance on the ship along with cases of people with confirmed cases.

Those judged healthy will be driven to the airport in order of their flight departures, said Edison Briesen, transport and tourism minister.

Reports of the illnesses on the Ocean Dream led port authorities in Grenada and Barbados to block the ship's scheduled stops Wednesday and prompted Pullmantur to cut short a nine-day cruise that was supposed to end this weekend.

One Venezuelan and one Argentine among those disembarking showed possible swine flu symptoms and were separated from the others, Deputy Health Minister Nancy Perez told government television.

The company said passengers would receive a partial refund. Venezuela's state news agency, Agencia Bolivariana de Noticias, said the passengers were from Spain, Colombia, United States, Argentina, Peru, Netherlands, Brazil, Chile, Panama, Uruguay, Russia, Romania, France, Belgium, Ireland and Italy.

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Swine Flu Aboard Helsinki Cruise Liner

http://yle.fi/uutiset/news/2009/06/swine_flu_aboard_helsinki_cruise_liner_835370.html?origin=rss

Fourteen cases of the H1N1 virus have been confirmed onboard a cruise liner that docked in Helsinki on Sunday. The Emerald Princess cruise liner docked in the capital for eight hours en route to St. Petersburg.

According to the Russian Ria Novosti news agency, swine flu has been confirmed among 13 crew members and one passenger. They have been quarantined on the vessel.

All other passengers have undergone health checks and have left the ship in St. Petersburg. Most of the over 4,400 people on the ship, flying under the Bermudan flag, were Americans.

Passengers were taken on board the ship on June, 25. Laboratory samples were taken during a stopover in Oslo. The ship docked at the Hernesaari Harbour and due to return next Wednesday.

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Even though Swine Flu is for the most part mild right now, perhaps public health authorities in tourist destinations need to be thinking of how we can provide for the care of sick visitors in the event that there are large numbers of people becoming ill in our upcoming flu season.

Where will we house ill visitors if they are not sick enough to be in the hospital? Some of them may not be able to pay for an extra week confined to their beds in some hotel. Realistically this could occur in places that draw large numbers of international tourists like Florida does. We should be learning from the Australian experience before it repeats itself in the not too distant future.

People should have travel health insurance. That usually covers government imposed quarantine. Someone will take the money if hotels are evicting people simply because they have the H1N1.

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People should have travel health insurance. That usually covers government imposed quarantine. Someone will take the money if hotels are evicting people simply because they have the H1N1.

DolceVita (I love your name!!), it's a very good idea!

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