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All Hands Off Deck! A Hands-On Guide to Fighting a Shipboard Norovirus

On board viruses start like this: One infected passenger comes aboard, leaves his germs on a handrail and all of a sudden everyone's sick -- just like kindergarten. Though major outbreaks are rare, cruise lines have stepped up their sanitation routines to reduce the chance of transmission.

We've all seen the news reports or read about the occasional outbreak of the Norovirus stomach bug on cruise ships. Cases of the flu-like gastrointestinal bug turn up on ships every so often, and the media has done its part to sensationalize it over the years, including coverage of the outbreaks on Freedom of the Seas just last week. Truth is, as icky as it seems, the Norovirus bug is more common than the common cold. The virus causes vomiting, stomach cramps, diarrhea and general nausea that typically runs its course over a couple of days, and is brought on by simple contagion: One infected passenger comes aboard, leaves his germs on a handrail, and all of a sudden everyone's sick -- just like kindergarten. Though major outbreaks are rare, to avoid them (and the dramatic headlines) as much as possible, cruise lines have stepped up their already vigilant sanitation routines to further reduce the chance of transmission.

I recently experienced the preparedness firsthand aboard Holland America's Statendam.

When we got to the cruise terminal in Auckland on November 24 for a two-week cruise around New Zealand and Australia, we found that the boarding of the ship was delayed a few hours. I soon learned from Statendam Hotel Manager Stan Kuppens why: The ship was being thoroughly cleaned because of a handful of Norovirus cases during the cruise that had ended that day. Reacting to prevent a more widespread outbreak, the ship went into what Holland America (HAL) calls "code red."

Under normal circumstances, an HAL ship operates in code green, which entails daily cleaning of the ship with a regular detergent. Kuppens told me when two to three cases of the gastrointestinal (or GI) bug are reported within one day, then the ship moves up to a code yellow status. First, at the time a GI case is reported, the guest is quarantined in his or her cabin for 24 hours and the cabin is also vigorously cleaned as soon as possible. At the yellow level, passengers will not likely notice what is going on behind the scenes, but the ship will be undergoing a daily cleaning regimen with a special hydrogen peroxide-based product called Virox 5, that kills germs (the "5" indicating the number of minutes the solution takes to work). It can be used in the form of a wipe or sprayed from a spray bottle. On the day our cruise started, Kuppens told me the ship had gone into "code red," the highest of the three levels, which is typically implemented when there are five or more cases of GI illness per day over successive days. Kuppens points out that HAL's threshold for moving into either yellow or red code is stricter than what the U.S. Centers for Disease Control (CDC) advises.

Under the directive of HAL's headquarters in Seattle, different protocols are initiated for different scenarios. In this recent situation, Kuppens ordered a special cleaning group known as the "hit team" to implement a three-part "super sanitization" routine starting the night before my cruise began. The team not only wipes the ship stem to stern with Virox 5, but also sprays the ship's cabins and public areas with the cleaning agent from a hose attached to a backpack and also via fogging machines set up around the vessel. The terminal in Auckland, and the buses that would be taking passengers to and from the airport, were also cleaned top to bottom with Virox. Kuppens said sometimes an outside cleaning team is brought aboard in port to assist, but in this case, crew members handled it themselves.

Asked if there were any side-effects to the use of Virox 5, the hotel manager said there were none to speak of with the exception of the solution leaving streaks on the ship's brass railings and other surfaces. The surfaces could be spiffed up again, he said, with some vigorous polishing.

"We do it in three steps to make sure we cover it all," says Kuppens, who helped to create the "super sanitization" process in 2003 when he and a "hit team" traveled from ship to ship to thoroughly clean each one.

Code red includes not only super-duper cleaning, but prevention as well. For the six days the Statendam remained in code red, a moratorium was put on the self-service operation of the lido buffet. As guests slid their trays down the buffet line, restaurant staff served all the food, not allowing guests to handle breads, fruit, communal serving spoons or anything else until it was placed on their tray. A crew member was also positioned at the drinks station, handing out glasses of water, iced tea and coffee so passengers were not touching the dispensers. More Purell hand sanitizing stations than I'd ever seen were placed at the entrances to restaurants, elevators and other places, and crew was vigilant about reminding passengers to take a squirt of the stuff to clean their hands. After a day or two of this, even my four-year-old boys were rubbing the gel on their hands as if by second nature. Other code red guidelines included closing the hot tubs and ceasing the distribution of fresh fruit baskets to the cabins. Though at first it all seemed a bit tedious, most passengers adapted easily and went about having fun.

I can certainly say first hand how relieved we all were that a potentially unpleasant situation was prevented, and with barely a blip on anyone's holiday radar. My young sons and I, as well as the other 1,200 or so passengers, remained happy and healthy throughout the entire voyage, enjoying the gorgeous scenery of New Zealand and Australia.

Hats off to the hit team!

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