It’s an issue that’s often overlooked, even though norovirus outbreaks on cruise ships are often national front page news and the federal Centers for Disease Control and Prevention carefully tracks the cruise line industry’s sanitary practices and incidences of acute gastrointestinal illness.
Intestinal illnesses that tend to spread quickly on cruise ships, such as norovirus, may get disproportionate attention for how rare they are. The CDC found fewer than two of every 1,000 cruise ship passengers gets an acute gastrointestinal illness onboard, and only about 1 in 10,000 is affected by an outbreak.
But the CDC does not keep statistics for acute injuries or overall patient visits on the vessels. The American College of Emergency Physicians has guidelines for cruise ship medical facilities and staff, and those have been adopted by the Cruise Lines International Association, or CLIA, as official policy for its members, including Norwegian – but they are just guidelines and not requirements.
Medical staff size has been a problem during some well-publicized norovirus outbreaks, including one on a Royal Caribbean cruise in December when hundreds of passengers fell ill and overwhelmed the ship’s three nurses. Critics questioned if a ship with more than 5,000 passengers should have had a larger medical staff.
“One of the first things that those anticipating going on a cruise should think about is the health care available to them on the ship, and it’s widely variable depending on which cruise ship line they choose,” said Dr. Jay Kaplan, a medical director for LCMC Health and past president of ACEP, the national emergency physicians’ group that sets the cruise ship guidelines.
He said it’s a problem that cruise ships don’t always follow the ACEP recommendations for medical equipment and staff certifications. He said cruise lines whose medical directors are ACEP members have been very responsive, but adds, “I can’t talk about the others.”
The Aymonds’ carrier, Norwegian Cruise Lines, is a member of CLIA and reports to ACEP’s Cruise Ship Section about its expectations for contracted medical staff. Physicians must “hold a medical degree from a recognized college or university and a current valid medical license … and maintain certification in advanced cardiac life support.” It also requires additional certifications for physicians and nurses, three years of post-graduate training for both and expects them to be conversant in English.