Cruise ship medicine: COVID edition
The Cruising Industry
COVID-19 has decimated businesses and entire economies on a global scale. Some enterprises are affected significantly more than others. Hairdressers, movie cinemas, and restaurants, to name a few of the hardest hit. One industry stands alone in its scale of destruction.
In 2019 30 million people worldwide embarked on a cruise. These numbers represented a growth of 11 percent from 2017, and an almost doubling of numbers from 2009. Estimates say that in 2019 the industry served a whopping 134 billion USD in total economic output and was employing 1.1 million people globally. (According to CLIA-Cruise Lines International Association). Today all but a small handful of ships are operating commercially. Most are anchored at sea wholly empty and devoid of life but for a skeleton crew. Floating vessels can be spotted from all major port cities around the world, and are a stark reminder of the current global situation.
A billion dollar floating home
A handful of human beings call these floating giants “home.” Many people remain stranded on these ships for upwards of 12 months due to international travel and CDC restrictions. Most ship operators have dropped their crew count to cut costs. This state of affairs is called “essential manning.” Essential manning means, for example, that an 1100 crew member vessel, now has about 200 people. A full or near full medical team is included in the essential manning crew count and in most cases consists of at least two doctors and two nurses. The critical crew members take care of the ship’s basic operational needs so that active duty can resume within a short time frame(guest operations). Life for these people is peculiar to say the least. Currently, no crew member can leave the confines of the ship. A face mask is worn at all times and in every situation. Strict social distancing measures are in place.These measures are so stringent that married couples who work on the ship are not allowed to share or enter each other’s cabins. Breaking these rules is punishable by disciplinary action including immediate termination. Strictly scheduled mealtimes remind one of a military operation, and self-serving meals are prohibited. Social distancing is ever-present and enforced. Downtime includes going to the gym (makeshift outdoor gym with social distancing measures and not more than four people allowed at a time), walking in the open deck, swimming in the ship’s pool, and tanning. Despite these restrictions, there is surprisingly tremendous morale among most crew members and strengthening of comradeship. Most would rather be here, working, and earning a salary as extreme global lockdowns have left many people jobless.
A makeshift outdoor gym.
A ship docked in U.S. waters holds operators in compliance with stringent and generally inhumane CDC regulations. For example, a straightforward tonsillitis case can change the ship’s status, from green, to yellow or red. (Green=COVID free; Yellow= Pending results; Red=active/suspected COVID) Once a ship is deemed red or yellow by the CDC, the tiny human pleasures that can take a crew member’s mind to a better place cease to exist. No gym, no pool, no bar, no socializing, and strict curfews are commonplace. Onboard medical personnel faces massive burdens, as the need to diagnose and report these minor illnesses could affect the mental health of hundreds of people who are already under immense psychological strain. Some crew have not seen their loved ones for over a year, and have not set foot on land since March. Furthermore, if your CDC status is changed from green to yellow/red, crew members scheduled to fly home are restricted from boarding commercial flights, irrespective of personal COVID PCR results. Delays in the repatriation of crew for weeks or sometimes months have become the “new normal”. Charter flights are costly not easily arranged when things go wrong. Regulations aside, life as a medical team member is generally less strenuous when compared to normal operations. Having achieved a “green” status and with only 200 lives onboard, there is much time in the day to indulge in personal interests and activities. Major emergencies are currently rare, and with stringent public health protocols in place, communicable diseases are, for the most part, non-existent. A full medical team ensures minimal hours spent on call and even less in the clinic(however an ever looming outbreak could spell utter disaster). Irrespective of increased personal time, we all still dream of a day when we can visit new cities, meet new and exciting people, and carry out life-saving evacuations and procedures. That is what we signed up for, and it is what we love to do. When will this return to normality happen? Unfortunately, this remains to be the domain of speculators and clairvoyants. Until such time we can only remain hopeful.