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When the new coronavirus began to spread in Canada in early March, the Public Health Agency of Canada recommended against “all cruise ship travel” due to the risk of contracting COVID-19.

“The virus can spread quickly on cruise ships due to the close contact between passengers,” said chief public health officer Dr. Theresa Tam in a presser.

There have since been multiple outbreaks of COVID-19 on cruise ships around the world — and yet, despite all of this, cruise bookings for 2021 appear to be on the rise.

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The cruise booking site cruisecompete.com had a 40 per cent increase in bookings for 2021 compared to 2019, the company told the Los Angeles Times, and a recent poll conducted by cruisecritic.com found that 75 per cent of people plan to book cruises at the same rate as before once the coronavirus outbreak is over.

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But after facilitating the rapid spread of the new coronavirus, can cruise ships still be considered safe?

“The short story here is that any place where you crowd lots of people together [is] prone to infectious diseases,” said Dr. Michael Libman , tropical disease expert and professor of medicine at McGill University.

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“The fact is that cruise ships are a little bit unique because you crowd a lot of people together in a fairly enclosed space, and it’s not just for … a few hours, it’s for days.”

Cruise ships have a long history of infectious disease outbreaks.

In 2019, a cruise ship was quarantined in St. Lucia due to a confirmed case of measles. There have also been issues with respiratory infections like influenza and chickenpox as well as norovirus and E. coli.

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According to the U.S. Centre for Disease Control and Prevention (CDC), in 2019 alone there were eight confirmed outbreaks of norovirus on seven different cruise ships.

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Dr. Rachael Lee, infectious disease physician and hospital epidemiologist at the University of Alabama, Birmingham Hospital, agrees with Libman.

“Viral infections can spread whenever large numbers of people are in close proximity for an extended time, especially in a closed environment,” she said.

“We’ve seen viral outbreaks on cruise ships before for that reason.”

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However, Libman says these problems have been addressed by most large cruise lines.

“I think the industry learned from it and put into place extra sanitary, hygienic measures to try and stop that kind of thing,” he said. “You certainly don’t hear about it as much anymore.”

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Another factor that could play a part is the sheer amount of travel that happens during any one cruise.

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“People get off the boat, they mix with people in one place, then they get back on the boat and go mix with people in another place,” Libman said. Tweet This

“That’s how things move. There’s no doubt about that.”

Libman, who is also the co-principal investigator of GeoSentinel, a global network for the surveillance of travel-related morbidity, believes something unique occurred when the new coronavirus landed on cruise ships.

In his work, he attempts to track infectious diseases as they spread — something that has been relatively difficult with COVID-19.

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“The fact is that something happened on board several cruise ships,” Libman said. “The Diamond Princess [ship] saw some 700 people get infected, despite the boat being docked and some kind of quarantine measures going on.

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“We don’t completely understand what went on. I think time will tell.” Tweet This

Social factors

Cruise lines suffer from a “systemic issue” of inequality, according to Mathieu Poirier, a social epidemiologist and professor at York University.

“I think a lot of people overlook that [cruise ships] essentially employ people at a very low cost,” Poirier said.

“These cleaners [and food preparers] are often making well under $5 an hour, and these are the people we are relying on to clean surfaces, prepare food safely, report these diseases once they happen and deal with them.”

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In Poirier’s view, until cruise employees are paid more, hygiene will continue to be a concern.

“The people that we’re relying on to make these cruises safe … aren’t getting paid enough to do the work that needs to be done in a meaningful way,” he said.

“Until that gets taken care of, I think we’re going to see a continuation of what we’ve seen in the last few decades: a lot of these infectious diseases spreading and them not being controlled quickly or effective enough,” Poirier said.

Responsible travel

Given the concerns about the spread of infectious diseases on cruise ships, some experts worry travellers will be too eager to go aboard once the immediate threat of COVID-19 has passed.

“I don’t criticize the people who have rebooked … but I would worry about [the safety of] cruises in the next 18 months or so,” said Kerry Bowman , bioethicist and professor in the faculty of medicine at the University of Toronto.

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“The problem would be you could be creating risk not just for yourself but other people.”

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Bowman recognizes that cruises are a relatively accessible way to see the world, especially for older people, but he anticipates that they will carry a lot of risk in a post-pandemic world.

“It’s a similar issue to that of long-term care,” he said. “There are big similarities between the two — communal dining, enclosed spaces.”

The fate of cruises

When public health officials first issued warnings about avoiding cruise ship travel in early March, the Cruise Lines International Association (CLIA) said the measures were “unwarranted.”

In a statement on March 7, the CLIA said it has already taken proactive measures to protect against the spread of the new coronavirus, including stringent pre-boarding screening procedures.

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“With the proactive measures put in place by the cruise industry based on prevailing guidance from global health authorities, arbitrary restrictions are unwarranted and could have long-term detrimental effects on the Canadian people and economy,” the statement read.

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However, despite changing protocol on cruise ships, experts aren’t convinced the industry will bounce back right away.

Libman hopes that once a COVID-19 vaccine is created, the new coronavirus will just become like another influenza — but until that happens, “it’s easily imaginable that people are going to be terrified of any kind of crowd.”

Bowman agrees: “How comfortable are you going to be on a plane with 300 people for nine hours?” he said. “I think the whole travel front is going to be reconfigured.”

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For now, Libman says more research is needed before cruises can be considered completely safe again.

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“The transmission dynamics [of COVID-19 on cruise ships] aren’t completely understood at the moment,” Libman said.

“I imagine as we learn more about it, we’ll be able to put in measures to try and prevent this kind of thing in the future because clearly, coronavirus is not going away anytime soon.”

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

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To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

Meghan.Collie@globalnews.ca