Seems every few weeks there’s another cruise ship in to be deep-cleaned and fumigated – another hospital ward closed and out of action.
This time it’s Fred Olsen’s flagshipBalmoral again, back less than a month after the last norovirus hit. A setback this fine Norwegian cruise line does not deserve – especially when it looks like a passenger brought it on board with them.
No cure, no warning
But that’s the thing with norovirus – the complete lack of warning. Today you’re right as rain, 48 hours later you’re as sick as a dog.
That poor passenger walked up the gangplank, all fine and dandy – to be struck down with cramps and endless hours on the hopper. And endless more, driving the bus.
Er, almost. At least it’s not the cruise line’s fault.
But that’s the other thing about norovirus. Most of the time we bring it on ourselves.
Oh yes, we do.
Because without a doubt, the biggest cause of norovirus is not washing our hands – which almost all of us forget to do when we’re having fun. Or avoid.
Not a wise mistake to make. Norovirus is easily spread and highly contagious. The Don’t-Wash-Hands Disease.
All those things you touch
You pick it up slamming a taxi door – next moment you’re wolfing a chicken and bacon baguette between meetings and – boom! You didn’t wash your hands, did you? You swallowed the germs. Two days time and you’re hurling your guts out.
Maybe not even a taxi. Between us we have scary bad habits.
Unless you wash your hands – get rid of the germs that surround you every day whenever you can. Otherwise, you get on a cruise ship and it goes round like wildfire.
Well of course it does – there’s thousands of you all living close next-door to each other, sharing the same bathrooms, eating in the same space. It’s a wonder they ever stop it at all.
Unlucky for some
And just occasionally they don’t – like on this latest cruise with the Balmoral.
They could have been unlucky though, as happened to Holland America Line’s Amsterdam, back in 2002. The stuff lingers, you see – can survive on all kinds of surfaces for weeks. And cruise ships are usually turned round in just days – they can’t afford myths.
Four times, one after the other, Amsterdam set out on a new cruise – and four times, one after the other, norovirus made her turn back, hardly into the voyage. There are so many nooks and crevices on a cruise liner, even deep cleaning may not get all of the bug out – they even had to scrub individual poker chips in the casino!
A more effective way
Easier to use Hypersterilisers – a whole batch of them ganged together can do the ship overnight.
They work on ionised hydrogen peroxide, see. Negatively-charged microscopic molecules all repelling each other, forcing themselves into the tightest, smallest, most out-of-the-way places, trying to escape each other.
Riding up into the air too – and hard up against every surface. Underneath and behind too. Actively dispersing like no ordinary disinfectant spray ever can – a supercharged gas plasma grabbing at positively charged viruses and bacteria it meets on the way and oxidising them to destruction.
All viruses, all bacteria – norovirus too. And Ebola, if you’re cruising West Africa.
And safe too – reverting back to just oxygen and water when it’s done. No need for masks like they had to wear on Balmoral – though it can catch your throat when it’s working, so best to stay away for the odd hour.
No smell either – no chemical after-pong or nothing.
A good thing too. Smell is a good give-away that germs are still working – the easy way to tell that food is off. It’s why the loo pongs too – if it’s not clean.
Hypersteriliser units are supplied to businesses and institutions across the UK, notably the haematology and other critical units at Salford Royal Hospital, Greater Manchester; Doncaster & Bassetlaw Hospital; South Warwickshire Hospital; Coventry & Warwickshire Hospital; and Queen Victoria Hospital, East Grinstead.
The Halo Hypersteriliser system achieves 6-log Sterility Assurance Level – 99.9999% of germs destroyed.It is the only EPA-registered dry mist fogging system – EPA No 84526-6. It is also EU Biocide Article 95 Compliant.
Not nice, norovirus. It stops you doing nice things too.
Holidays, celebrations, momentous occasions – the ultimate party pooper.
So here’s a guide to help you avoid it. To side-step catching it in the first place, and protect yourself when other people around you come down with it.
You can be unlucky, of course. But nine times out of ten, these simple tips should help you stay out of trouble.
First off, know that norovirus is very, very virulent – an unpleasant illness on a hair trigger that is easily touched off. Other viruses and most bacteria need at least 20 or 30 cells to attack you with if they’re going to infect you.
Norovirus only needs half that, which makes it twice as dodgy. A nasty, horrible illness that’s super-contagious – spread mostly by touch, but also in the air. Get it on your fingers, your clothing or your skin and you have to be really careful.
It’s also pernicious, at home anywhere and able to survive on most surfaces for over a month. And since it spreads so easily, anything touched by other people is a possible contact point – especially high-touch objects like door handles, grab rails, light switches, phones, keypads and cutlery you eat with.
How does it get into your body?
Usually through your mouth. You can breathe it in or swallow it, either on contaminated food or anything eaten with your fingers.
Which means everybody’s favourite fast foods – hot dogs, pizzas, burgers, sandwiches, fish and chips, chicken drumsticks, wraps, crisps, biscuits, cake – all the easy fast foods.
Or if you’re on holiday – olives, pitta, humous, shawarmas, kebabs, falafel, Tex-Mex favourites like tacos, fajitas, tamales, burritos and tortillas – not to mention churros, pancakes, baklava or a good dripping cone of ice cream.
Yup, all the nice stuff when you’re having a nice time. Indulgent, spur-of-the-moment, soul-boosting street-food. Tasty, tactile, goodness oozing from your fingers – you know the score.
But note the common denominator – all finger food. Stuff you can scoff with your hands, right in the middle of doing something else. Or anything with a lot of handling by others around you – tear-and-share, buffets, smorgasbords, group curries.
All easily contaminated by just one person’s unclean fingers –including yours.
Finger-lickin’ good, maybe – fingers pointing at trouble more like.
Big tummy trouble.
And that’s the bummer.
Because most of the time we eat without thinking because our hands LOOK clean. Yet realistically our fingers could be loaded with all kinds of yuk too small to see – a single norovirus cell is just 2 microns across, about a 10,000th the width of a human hair.
It floats around easily in the air, lighter than cigarette smoke. And settles invisibly on your skin, scraping together easily with its brothers and sisters as you wipe your hand across – groups of 20, 500, 1,000 cells, all ready to go.
Which brings us to Reality Check One – most norovirus attacks are self-inflicted. The stuff is already on our skin and we don’t even know it. We let our hygiene lapse at the wrong moment – and four hours later it’s cramps, vomiting and diarrhoea like we don’t ever want to believe.
Like the nagging granny in our heads keeps reminding us – WASH YOUR HANDS, WASH YOUR HANDS, WASH YOUR HANDS.
If only it was that easy.
Because when does anyone get the chance, on the go most of the time – especially on holiday?
But unfortunately, that’s not good enough if you want to skip the spoil-sport tummy-torture. All it needs is ONE slip up, one forgetful moment with unwashed paws, and you’ll be chundering through the next few days.
One in the eye
Uh huh. So here’s a memory jogger.
You’re on the beach, yeah? Slapping on the suntan lotion. You wipe your hands down, but somehow, you touch your face – and the stuff gets in your eye.
Yeow, itch, instant anguish. Your whole day scuppered till you get back to the hotel, rinse your eye out and sit there with a damp cloth to your face for an hour. But let that tell you something.
That’s how norovirus works.
It’s a fact of life that we touch our faces all the time – 2,000-3,000 times a day for some of us. And that’s norovirus’s easiest way into our bodies – through the soft tissue of our eyes and mouth.
Suntan lotion on your fingers just loses you a day. Norovirus on your fingers can screw your whole holiday – or your wedding, or your graduation, or anything else it’s the pits to lose out on.
Yeah, so you know the drill.
WASH YOUR HANDS, WASH YOUR HANDS, WASH YOUR HANDS. Particularly after going to the loo – and always before food.
From lo-giene to hygiene
Shocking revelation isn’t it, to sit down to this slap-up dinner after a wonderful day – and suddenly realise that with all the places you’ve been and things you’ve done, you haven’t washed your hands since breakfast?
So Reality Check Two – handling norovirus means hiking our personal hygiene to a whole different level. Day-to-day, what we’re living with most of the time is “low-giene”.
Yeah, yeah, dirty hands. But you see these reports all the time, lots of people all getting sick at the same – what about food poisoning? Don’t vendors and restaurants serve food that’s contaminated?
For sure. And we all know the cause. Either the food itself is off, or is touched in preparation by someone with dirty hands.
Not as common as you might think, because anywhere that sells food wants to be in business today AND tomorrow. They also have laws to follow, standards to observe, codes of practice. So most of the time, they DO take care. A law suit could cost big money – and easily be the end of them.
So how can you tell if it’s self-inflicted or food poisoning?
Your fault or theirs?
Reality Check Three – the vomiting, the diarrhoea, they’re earth-shatteringly violent because that’s how norovirus spreads itself – as far and wide as possible, very quickly.
Even so, it takes time to assert itself – and from that, you can often tell how it started.
If an outbreak happens in ones and twos, it’s probably triggered by an individual – either from unwashed hands or by suspect food from an external source – something eaten before they arrived where you are. Unwashed hands most likely – suspect self-inflicted
If a whole crowd of people comes down together, that suggests they were exposed simultaneously – some kind of shared experience. That could be either from something they’ve eaten – they were all served the same dish at the same time. Unwashed hands most likely again – though this time in preparing a popular food dish – suspect staff hygiene lapse, or dodgy food source.
Norovirus also triggers by mishap, as happened in a Swiss hotel – bad luck for everyone in the place, who all came down with it at once. Flash flooding from a cloudburst overwhelmed the drains, forcing guests and staff to wade through water backed up from the toilets.
An outbreak was inevitable, however much everyone washed themselves and their clothes – furniture, fittings and all facilities were all heavily contaminated – instant infection until they were destroyed and the whole building sanitised.
Bad, bad boomerang
Which leads to Realty Check Four – the norovirus boomerang effect. The virus returns very easily to cause repeat outbreaks if it is not completely and utterly removed after the hit in the first place.
Cruise liners are really prone to this for two reasons. Lots of people close together in shared eating and living space, handling the same objects. Plus millions of nooks and crannies where the virus can hide during even the most rigorous scrub-downs.
The handling thing is a nightmare, as there are endless things that everybody touches that can pass on by contact. Called fomites, these germ-transfer items include glasses, knives and forks, deck chairs, gym equipment, poker chips, playing cards, courtesy bibles, whatever – all of which have to be individually sanitised to avoid repeats.
Repeat outbreaks happened recently with Fred Olsen Line’s Balmoral – struck down 6 times since 2009 – and a latest misfortune just last month that ruined an Old England to New England cruise for hundreds of passengers.
Holland America Line’s Caribbean cruise liner Amsterdam was also unlucky – having to cancel four trips in succession because of repeat outbreaks in 1982. It got so bad, the ship had to be taken out of service to ensure thorough decontamination – and new passengers were even warned before embarking that the ship had previously had problems it couldn’t get rid of.
Get out of jail, free
Doom and gloom? Avoid holidays like the plague?
You can just as easily catch norovirus at home, just by forgetting to wash your hands.
And that’s the key to a perfect holiday, even the stay-at-home kind. Always wash your hands before putting anything in your mouth. And keep your hands clean too. Your fingers might be safe, but the things you touch with them are almost certainly not – indoors or outdoors, germs are a reality we have to live with.
Recognising that, plan for when you can’t wash your hands too.
Always carry hand-wipes, even if they’re not antibacterial. Easy enough to use, right at the dinner table – and doing it properly will get rid norovirus and 99.9% of all other germs.
Handbag size antibacterial gel is good too – the alcohol base kills germs, though is not as effective as physically wiping them away.
Beyond that, be careful.
If somebody close to you comes down with norovirus, you don’t need to get it too. Obviously avoid accident areas of vomit or diarrhoea. Keep well clear, the yuk can spread several feet in all directions.
If you’re involved in a clean-up, wear gloves, cover your nose and mouth too. Wash all over thoroughly afterwards and discard your clothes for thorough washing too.
Clean beyond normal
Be aware though that normal disinfecting is unlikely to go far enough. The whole place needs a good going-over, especially every last nook and cranny if the virus is not to come back again.
Almost impossible with scrubbing and bleach, the easy way is with ionised hydrogen peroxide – misted up into the air by a Hypersteriliser and electrostatically charged so it disperses actively in all directions, killing airborne and surface germs deep into every crack and crevice.
All viruses and bacteria dead, no boomerang, no nothing.
We mean seriously deadly, like cancer, typhoid, or the Black Death.
Would we see still loads of cruise ship passengers repeatedly coming down with norovirus?
Again & again, norovirus 2.0
Because it’s happened again – and keeps on happening. The latest “Old England to New England” voyage of a lifetime by Fred Olsen Line’s cruise ship Balmoral has just docked Stateside with a report of hundreds down with this pernicious vomiting bug.
Predictably because it’s the most likely cause, the cruise line reckon the virus was probably brought on board by a passenger. In the close quarters of a cruise ship, any outbreak is difficult to contain, with the result that 252 victims have been reported – slightly more than the 7 claimed by the cruise line.
We say predictable because norovirus is highly contagious and spreads most easily by direct contact. It only requires 10 norovirus cells to infect someone – so anyone coming aboard a ship after a long day’s sight-seeing, touching all kinds of things with little or no opportunity to wash hands, could be Patient Zero.
Yes, norovirus could quite easily have been brought on board by any passenger over the years – anybody eating a sandwich ashore with unwashed hands could have been the carrier – but repeated outbreaks every year begin to look like the ship itself could be cause, despite intensive “barrier cleaning” between voyages.
Check out any ship at the dock and maintaining hygiene is an immediate and obvious problem. On every mooring rope are cone-shaped metal plates – rat guards to prevent disease-carrying rodents stowing away.
Sure those sweeping angular lines are impressive, but inside the hull they mean all kinds of tight, irregularly shaped spaces that are difficult to access and even more difficult to keep clean. Of necessity, some spaces are not accessible at all – like deep down under the deck plates, where oil-laden water sloshes round the bilges.
The ultimate survivor
No good against an adversary like norovirus – able to survive for days and even months on hard surfaces. Or even years in still water – perhaps not the bilges, but how about the drinking water tanks?
And just how thorough are those between voyage “barrier cleans” anyway? A cruise ship costs around £1.5 million per day just to keep afloat, so how much time can its owners afford to have it docked for cleaning?
Bear in mind that turnaround time between cruises can be as short as eight hours – in which the ship has to be cleaned out, re-victualled, refuelled, new linen loaded and made up, the works.
Come on gang! The meter’s running, let’s get this sucker back to sea ASAP.
Hmm, makes you wonder what “barrier cleaning” is, hey?
How clean is “clean” in 8 hours?
There is also “terminal cleaning” which looks the better option – variously defined as removing all detachable objects, cleaning lighting and air duct surfaces in the ceiling, then cleaning everything downward to the floor.
Items removed – fomites such as furniture, carpets, drapes, table cloths, cutlery, taps, basins, playing cards, poker chips, books, bottles, glasses, coasters and all bar hardware – are thoroughly sanitised before being returned.
Uh huh, not exactly easy in eight hours.
Then there is the issue of HOW the ship is cleaned – how long exposure time the disinfecting agents have to be sure of killing the norovirus. From studies by the CDC, not everything works – not bleach, not glutaraldehyde , not ethanol, not quats, not steam.
Nor do all techniques – not applied everywhere, not enough contact time, not effective at killing the microorganisms involved.
You missed a bit
Take just one instance.
Passengers spend a lot of time clutching the ship’s rail, excited about arrivals, excited about departures – or simply hanging on to look cool, sipping their piña coladas in the sunset. Does someone really go round and wipe down all the ship’s rails – and all the deck chairs come to that – or do they get forgotten, being outside on the deck?
Why does no-one seem to be taking this seriously? Norovirus is ALREADY a killer that takes down 200,000 people every year – usually through dehydration or electrolyte imbalance. Imagine it up there with cancer, typhoid and Black Death.
How would it be if we saw some heavyweight death numbers – mostly from people not washing their hands – and the rest from things not being cleaned thoroughly enough?
Because norovirus is not going to go away. It’s going to continue to mutate and proliferate – until in nuisance value alone it does the numbers, clobbering productivity and generally making life unliveable.
Sorted, sort of
OK, so the ship sort of gets cleaned and goes back into service – and another outbreak happens ten months from now – dirty hands coming aboard, or spreading out from the unprocessed air gap under the linen storage on “D” deck?
So they scrap the ship and build a new one, the problem isn’t going to go away.
Not unless we learn to wash our hands before they ever go anywhere near our mouths. And we start using properly effective measures to eliminate all germs from enclosed spaces – including under linen storage and in bilge openings.
All it takes is to mist up the air space with ionised hydrogen peroxide penetrating everywhere – and germs are electrostatically attracted like iron filings to a magnet, oxidised to nothing in seconds flat.
Maybe they’ll even get sensible and build a spray system in – exactly like the sprinkler system already used for fires. Imagine that, a self-sterilising cruise ship – able to decontaminate itself completely in just hours while in port for turnaround – or disinfect selected areas completely at will, while still out on voyage.
And if we still haven’t learned to wash our hands?
Feed everybody Cornish pasties. That thick crust round the edge was invented specially for tin miners to grab hold and eat safe – even though their hands were coated in deadly arsenic from the tin ore.
Not so deadly any more after hydrogen peroxide, no norovirus either.
Though pasties might get monotonous on a seven-day cruise.