What's worse than being stricken with a stomach bug on vacation? Maybe it's being quarantined on a cruise ship with hundreds of other passengers suffering from the same illness.
That's what happened to Randy Fulp when he sailed to Mexico with a group of friends on the Caribbean Princess in January. An appraiser from Sacramento, Calif., Fulp is a seasoned cruiser and knows the risk of getting sick, particularly in winter. Cruise ships are on high alert for sightings of the Norwalk virus, also known as norovirus or stomach flu, a highly contagious gastrointestinal illness.
Still, on the third day of their vacation, Fulp's wife, Peggy, became violently ill. "She started vomiting and having diarrhea," he says. "It was uncontrollable."
His cousin's wife was even unluckier. Overcome with the same sickness while on a shore excursion, she sprinted back to the ship. "She didn't make it to her cabin before she vomited," Fulp recalls. "Two crew members yelled at her to get to her cabin, which she was trying to do as fast as possible."
Although shipwide outbreaks are relatively common in the cruise industry, 2014 is off to an unusually queasy start. There have been three high-profile incidents, according to the Centers for Disease Control and Prevention (CDC): Fulp's Caribbean Princess episode, a relatively minor outbreak that affected 181 of 3,102 passengers; an outbreak on Norwegian Cruise Lines' Star, which affected 130 of 2,318 passengers, roughly the same percentage as on the Caribbean Princess; and one on Royal Caribbean's Explorer of the Seas, which infected 634 of 3,071 passengers and was so severe that it earned the ship the nickname "Exploder of the Seas."
In a further twist, the CDC also reported that the gastrointestinal virus on the Explorer of the Seas, which it identified as the GII.4 Sydney strain, was relatively new.
Amid these outbreaks, which often happen in the glare of the media spotlight, several questions have emerged about such diseased cruises. Who's to blame for them? What are passengers owed when half a ship is quarantined? And can an infection be prevented?
It seems that the only absolutely certain way to stay uninfected is to stay home. There's no vaccine to protect you from norovirus, and simply applying a dab of antibacterial gel before eating at the buffet won't cut it, say experts. Washing your hands frequently with soap and warm water and minding what you touch can help prevent an infection, but it's no guarantee.
"It goes back to the adage our parents and teachers drummed into us," says Susan Rehm, vice chairman of the Cleveland Clinic's Department of Infectious Disease. "Wash your hands and keep them away from your face."
Cruise insiders insist that the odds of getting sick are negligible. "Infection rates are very low when compared to rates on land," says Mike McGarry, a spokesman for the Cruise Lines International Association (CLIA), a trade association for the cruise industry.
Last year, the CDC reported only seven confirmed shipboard norovirus outbreaks, with 1,238 afflicted passengers worldwide, or 0.0059 percent of 21 million cruise passengers. In 2012, the agency reported 16 norovirus outbreaks on ships.
"No industry nor facility is as tightly regulated as the cruise industry," says Stewart Chiron, who writes a blog called "The Cruise Guy." He says that the media fixation on cruise ship outbreaks distorts the truth, which is that just a fraction of passengers is infected by a gastrointestinal virus. "Media like the cruise industry because it's very visual and attracts viewers, listeners and readers," he notes.
Critics take a different view. They claim that the risk of an infection is real and that cruise lines too often play it down. Kendall Carver, chairman of the International Cruise Victims Association, says that despite industry promises that it's able to screen passengers for gastrointestinal illnesses and promises to sanitize ships after each outbreak, it can't seem to control the contagion. "As the ships get bigger and bigger, the chance of an outbreak happening multiplies tremendously," adds Carver. "It's only going to get worse."
The cruise industry, led by CLIA, last year adopted a voluntary 10-point passenger "bill of rights," which spelled out travelers' right to compensation under certain circumstances, such as a mechanical failure. But it doesn't specifically address a norovirus outbreak, leaving it up to a cruise line to determine how to address the inevitable complaints that arise from passengers who are infected on their vacation.
The bigger the outbreak, the better your chances of securing a more generous compensation package. For example, Royal Caribbean offered passengers on the Explorer of the Seas a 50 percent refund and a 50 percent future cruise certificate in the amount of the cruise fare paid for the sailing, according to cruise line spokeswoman Cynthia Martinez.
Fulp says that Princess issued him a credit for his port fees in Belize, which came to about $100 per person, and a 20 percent future cruise credit.
Jim Walker, a maritime attorney based in Miami, says that there's a reason cruise lines pay up only when news helicopters are circling their ships as they pull into port. They constantly suggest that their passengers are to blame for the outbreaks. A review of the recent CDC reports shows that the CDC never conclusively determines how and where the virus comes onto the ship, which cruise lines interpret as an exoneration of their sanitary practices, he says.
"The ship has enhanced cleaning for a few hours and then sets sail again," Walker says. "The cruise line accuses the passengers of bringing the virus aboard. Repeat cycle."
You don't have to get sick to see things his way. Stephen O'Brien, a bus supervisor from Dublin, was a passenger on the Explorer of the Seas, and although he didn't become ill, he watched as the GII.4 Sydney strain turned the vessel into a "ghost ship." On his level, one of every six staterooms had a yellow quarantine sticker, indicating an infection. He has no evidence for it, but he thinks that the cruise line didn't sanitize the vessel thoroughly enough before the start of the cruise, and he holds Royal Caribbean responsible for the ensuing outbreak.
"Could things have been handled better?" he asks. "Maybe."
The argument about who's responsible for norovirus or how much compensation passengers deserve may never be settled. But here's one thing everyone can agree on: Spending most of your cruise doubled over in pain is no way to vacation.