For centuries, disease has been as unavoidable to seaborne life as the waves and the wind and the surf. After all, the ancient Egyptians and Greeks wrote despairingly about scurvy – a particularly nasty marine illness that, by the Age of Discovery, was killing thousands of sailors every year. Other ailments, for their part, spread quickly in the cramped cabins and fetid latrines of oceangoing vessels. Even in the 19th century, measles, scarlet fever, smallpox and typhoid were all common at sea. On some convict vessels, the rotting hulks carrying British criminals to Australia, the death rate was one in three.

Happily, conditions at sea are far more salubrious nowadays. Yet as recent experiences show, diseases can still spread rapidly – even with all the ranks of modern medical science arrayed against them.

Over just a few weeks in February 2020, for instance, nearly 20% of the crew and passengers of the Diamond Princess, a Carnival ship, were infected with coronavirus. Around the same time, the Ruby Princess (another Carnival ship) saw 900 people infected with the disease off the coast of Australia, with 28 deaths ultimately linked to the outbreak. Obviously, all this is unsustainable, especially when cruise operators finally begin welcoming passengers back once more. Yet with thousands of people eating, drinking and socialising together in spaces barely the length of a few football pitches, figuring out a solution is far from easy. It’s therefore unsurprising that companies are working hard to get procedures in place early. By working with scientists and doctors, they hope to avoid repeating the mistakes of 2020 – with lessons for cruise ships long after we are all vaccinated.

“Public health education – in the communities we touch, but also for the guests and crew that come aboard – continues to play a vital role.” 

Dennis Peyton, Vikand


Number of cruise ships that use Vikand's medical services 


New expertise on board

Though the spread of coronavirus on cruise ships like the Diamond Princess got the attention of pundits struggling to understand a new and worrying disease, it was far from a singular case. Cruise operators have been long used to dealing with medical emergencies aboard. From oxygen tanks to defibrillators and stretchers, indeed, American College of Emergency Physicians standards have dictated the sophistication of cruise ship infirmaries for years. “I really would have to acknowledge the work of not only the cruise lines, but also their partnerships collectively – with academia and with local, national and international health authorities – to develop policies both before and during the pandemic,” says Dennis Peyton, director of the public health practice at Vikand, a company that provides medical services to over 170 cruise vessels.

That being said, the speed at which Covid-19 can spread and its capacity to leave large numbers of passengers at risk has spurred the industry into action. If nothing else, that can be seen in the frantic moves some operators have made to bring experienced medical professionals aboard. At Viking, for example, Vice Admiral Raquel Bono was recently appointed the operator’s chief health officer. She once served as director of the US Defense Health Agency. Dr Calvin Johnson is another grand arrival. Earning his stripes as medical director for New York City’s Department of Health, and as secretary of health for the Commonwealth of Pennsylvania, he’s now the chief medical officer at Royal Caribbean.

These appointments make sense both from a healthcare perspective and a PR one. As both Peyton and Johnson explain, after all, there are plenty of parallels in fighting diseases on land and sea. “In many ways, it’s very similar,” says Johnson, adding that, just like cruise ships, even isolated clinics and hospitals can quickly become swamped by a new disease. No wonder, then, that operators are using many antiviral tactics now familiar on land. At Norwegian, for example, passenger capacity will be reduced to help with social distancing. Princess Cruises, meanwhile, is mandating the use of face masks in public spaces. Royal Caribbean is even considering trademarking its own brand of face covering.

Still, it’d be wrong to suggest that public health at sea is totally analogous with gatherings on dry land. As Johnson notes, the transmissibility of coronavirus can cause serious problems when hundreds or thousands of people are trapped together in a floating hotel with nowhere else to go. While people typically infect around two of their fellows with coronavirus, that number can rise to seven on cruise ships. Perhaps for this reason, Peyton puts a premium on educating customers about best practices. “Public health education – in those communities we’ll touch, but also for the guests and crew that come aboard – will continue to play a vital role.”

Cruises in the age of coronavirus

So, beyond the basics – masks and lines of scotch tape 6ft apart – what might the future of cruise travel actually look like? To answer that question, operators have done more than simply recruiting new medical officers. Rather, they’ve swept up experts from the best hospitals and universities on earth, gathering them into a kind of clinical Navy Seals outfit. A typical example comes from MSC, which boasts a “blue-ribbon” team of specialists to develop new health and safety protocols. Carnival has gone down a similar path, as has Cunard. But probably the most impressive of these groups is Royal Caribbean’s Healthy Sail Panel. Including around a dozen experts, spanning epidemiology, virology, public health and more, it promises to “strengthen our current procedures and create new ones across the entire cruise experience”.

Given Peyton’s comments focus on education, it’s perhaps unsurprising that the Healthy Sail Panel’s new procedures begin with instructing guests. Before embarking, you’ll now have to watch detailed videos about coronavirus, as well as secure negative tests. From there, you’ll be escorted to your ventilated staterooms (possibly upgraded with the latest HVAC equipment) and encouraged to socialise out on deck. When you reach your next port of call, disembarkation will be staggered, and the gangways and corridors will be festooned with signs about the dangers of infection. And when you’re out exploring the sights in Panama or Tahiti, Royal Caribbean cleaning staff will be busy, dousing your cabin in medical-grade disinfectant. All told, says Johnson, the point is to move towards a “more preventative, proactive environment.”

Fair enough. But even the best cleaning regime on earth can’t totally prevent the possibility of coronavirus slipping in and wreaking havoc. Here operators seem to have learnt the lessons of last year, where they were slow to quarantine passengers until it was too late (one epidemiologist described conditions on the ill-fated Diamond Princess as “chaotic,” even as infections spiralled and the Japanese government sat by helpless).

At Royal Caribbean, explains Johnson, each positive test kickstarts a “series of processes and protocols” which first involve isolating a patient in a room with negative pressure, to stop anyone nearby from catching the bug. Next, says Johnson, comes contact tracing. “That means identifying those people patients may have been in contact with – and potentially could have passed the infection on to – and putting them into a quarantine environment.”

Another challenge, of course, is the risk of patients catching the illness onshore. That’s especially true in those nations that are slower to vaccinate their populations – hardly impossible given many cruises stop in developing countries.

“That means identifying those people patients may have been in contact with and putting them into a quarantine environment.” 

Dr Calvin Johnson, Royal Caribbean

The way forward, suggests Johnson, is to work closely with local governments, scouting out clinics and hospitals, and preparing the ground if a traveller falls sick thousands of miles from home. “It’s about thinking ahead, planning ahead,” he explains. “It’s about ensuring that you can draw upon those healthcare resources and those relationships wherever they may be needed to protect passengers.” Peyton agrees, emphasising how crucial “itinerary planning” is to keeping shoreside excursions secure.

Health precautions are here to stay

With vaccination continuing apace across much of the Western world, the coronavirus emergency may soon slide into memory. Even so, don’t expect the systems dreamt up by the Healthy Sail Panel to disappear anytime soon. As Johnson puts it: “This won’t be the last infectious disease that we see that can have an impact on all aspects of society, and that includes the cruise industry.” Peyton makes a similar point, noting that influenza and measles – or even illnesses that are yet to emerge – will keep operators on their toes. In other words, though passengers two or three years from now may not have to wear masks between sips of mojito, they will probably have to fill out forms about health conditions before they’re allowed past the gangplank.

This is likely to be shadowed by a broader revamp of on-board health provisions. Already, Norwegian has promised to equip every one of its 17 ships with a dedicated health officer. And with operators from Princess to Costa committed to improving seaborne medical facilities in the face of the pandemic (Vikand, for its part, helped develop a new breathalyser test for coronavirus), there’s every reason to hope that the industry will be able to cope with the next emergency far better than it did during the tumultuous period of 2020 – in whatever form it takes.