How Will Cruise Ships Handle H1N1?
by Paul Motter, CruiseMates Editor
September 11, 2009

One cruise line, MSC, has an innovative approach to H1N1 screening during the boarding process. And yes, it matters.

Whether they were calling it "Swine Flu," "H1N1" or even "the eminent worldwide pandemic," last spring we were told a grave danger was afloat.

In the end it didn't really matter. As in all cases of wide-spread panic, perception was reality.

Comparisons of H1N1 to the 1918 Spanish Flu were running rampant back then, but an estimated fifty-million people died from that pandemic, and so far in 2009 we have just over 1600 verified deaths from H1N1 worldwide. This includes what was predicted to be a virulent flu season below the equator. Despite the efforts of the best and brightest down under, the onset of winter just couldn't be delayed long any longer.

Now we know that H1N1 flu symptoms look for the most part like any other flu. The virus still responds to anti-virals (like Tamiflu) and the H1N1 vaccine is already being administered on a test-case basis and should be widely available next month.

I would describe what we saw last spring as panic.

Back then H1N1 symptoms were described as; severe or persistent vomiting, pain or pressure in the chest or abdomen and difficult breathing and shortness of breath. Today the CDC describes H1N1 symptoms as: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue - pretty much the same as any other flu.

So, the H1N1 threat was a little over-rated then, but it is still a threat going forward, albeit a different one than many predicted. So, how will the cruise lines respond to H1N1 this year?

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H1N1 and Last Cruise Season

Last April 28 the first "Mexican Flu" outbreaks occurred in regions far from any cruise ports of call, so that morning every cruise line declared it would not change a single itinerary. Then the incessant drumbeat of media hyperbole won the day and by 4:00 PM every cruise line had canceled every single stop in Mexico. Talk about a cruise to nowhere, ships already within sight of Cabo San Lucas didn't stop there - even though the entire Baja was H1N1 free.

During the summer a few cruise ships endured H1N1 fallout, not from real outbreaks onboard, but merely from rumors that they may have had it. Several Caribbean islands refused to let them dock.

One Royal Caribbean ship spent almost a week at sea. In the end the crewmember flu tests came back as Influenza-A, but not H1N1. (H1N1 is a form of Influenza-A, but not all Influenza-A is H1N1). The same events transpired in Europe and Alaska. Any ship even rumored to have H1N1 onboard was effectively barred from landing.

H1N1 and the Coming Cruise Season

While the recent panic has subsided, should H1N1 take hold on a cruise ship it could start all over again. So, what do the cruise lines plan to do now?

One of the most compelling approaches comes from independent European cruise line, MSC Cruises. The 11-ship fleet plans to use thermal scanners at passenger check-in points to pre-screen embarking guests for signs of a fever. The controversial question becomes - what does MSC do if they believe a person may be carrying H1N1?

Having a qualified health official at the pier to determine if people are a true viral danger is the only logical approach to this problem. You not only weed out the carriers trying to hide it, but you can also clear the innocents denied their cruise for having a "flu-ish" appearance.

And this is where the MSC Cruises approach makes the most sense. MSC will have thermal scanners at each check-in to detect people with a fever. If the thermal scanner detects a fever of 100.4 or greater the guest will be checked for additional signs of influenza such as cough, sore throat, runny nose, sneezing, body aches, chills, headaches, diarrhea, fatigue or vomiting. If some or all of those symptoms are verified they will be escorted to the ship's infirmary where an Influenza Rapid Test Kit will be administered. If a virus is present, they will determine its type.

As noted, all H1N1 cases are a form of Influenza-A, but not all Influenza-A is H1N1, so even with the Rapid Test Kit further processing is required. The final determination will be whether or not it appears to be contagious H1N1. That is a tough call presumably based upon their age, specific symptoms and who the person has been in contact with recently. Actual H1N1 verification is a very complicated process. (one of the reasons the number of verified cases is not 50-million)

Unfortunately, the other cruise lines have not yet planned to go this far. Due to Norovirus every cruise line has already been asking every passenger to complete a simple form at check-in with only two questions:

• Have you experienced any flu-like symptoms lately?
• If yes, what are they?

You probably already know that an affirmative answer can lead to denial of access to the ship, so only the unaware or those simply too desperately honest are ever stopped. But since almost everyone already knows this - the forms alone do little if anything to prevent an outbreak of H1N1.

Even worse, those who are denied their cruise because of these forms may not have really been sick, especially with a flu virus. They might have had a bad bowl of chili.

We have received letters from people who were denied boarding a fully paid cruise because of these forms. All I can say is "too bad you weren't on the bus where the cruise line representative told everyone to say no to every question." Nor were they given a second chance to explain their answer and request a more thorough and timely re-check of their health by a qualified professional.

With MSC Cruises the forms are still in place, which may find the small percentage of people carrying a communicable virus without a fever, but the important thing is that the forms will do no harm. Everyone who gets flagged will get a second check in the shipboard infirmary for a further determination.

Cruise Boarding Denied for H1N1

Make no mistake - the indication that any person may have H1N1 is enough for a cruise line to deny boarding even a fully paid passenger. The MSC method may be a bit officious, but it is also far more accurate - and when you are talking about the price of a cruise that is important.

The cruise lines without medical personnel at check-in are far more likely to allow a viral carrier onboard and far more likely to bar people who do not deserve to be barred. It's a pretty big outcome for a simple process. But the number of people all this will affect depends on one thing...

How Bad Will This Flu Season Get?

How bad will the coming H1N1 flu season get? It had been widely speculated that H1N1 could come roaring back with a vengeance this fall in a mutated form immune to vaccines and anti-virals. But so far that hasn't happened. In South America where the flu season is just ending it has not been any worse than in recent years.

The H1N1 vaccine is scheduled to be readily available in the U.S. in four to six weeks. Testing has already begun.

We really don't know how bad it will get, but the safest way to insure your trip is "Cancel for any Reason" insurance. Here is an outline of these Cancel for Any Reason policies.

You should know that most policies specifically state pandemics are NOT covered, and H1N1 has already been declared a pandemic by the WHO. Holland America offers "Cancel for Any Reason" as a part of its cruise line insurance policy. We think this is a very good bet. But you have to cancel before you try to join the ship - if you try to check in and you are denied it is probably too late.

If they choose not to let you onboard you have very little recourse. All we can tell you is this - cruise lines DO want you onboard, they make more money that way. They probably retain a few more customers, as well.

Please stay well this season, and if you have children or grandchildren in school, or if you work in place where you may encounter the H1N1 virus, then consider buying cancel for any reason insurance before your trip. Hopefully the H1N1 scare will just fade into a distant memory, like this... "Hey, remember that world pandemic thing last year? Whatever happened with that?"