Trauma and Distress on a Cruise during the COVID-19 Pandemic: A Qualitative Study with Italian and French Tourists

The COVID-19 pandemic has drastically changed our daily lives. One of the sectors most affected was tourism and travel – and, more specifically, cruises, given the prolonged time passengers spend with others within the small spaces of the cruise ship. While finding well-organised entertainment opportunities on cruises is possible, emergency conditions may cause panic. On such occasions, reactions can be highly stressful or even traumatic. This research explores the events and emotions experienced by passengers during a cruise ship quarantined for COVID-19. The empirical materials consist of interviews with 15 passengers. The analyses show four thematic areas: fear of contagion, feelings of discrimination, cooperation between passengers and relationship with the crew. The problems during a cruise ship quarantine presented by the passengers in this study reveal the need for psychological preparation for the crew and security personnel. Finally, we suggest that telemedicine and telepsychology are key elements to improve the efficiency of behavioral control on cruise ships and to mitigate the COVID-19 effects on tourists' well-being during a quarantine. © 2023 by the author.

Can ship travel contain COVID-19 outbreak after re-opening: a Bayesian meta-analysis.

Large gatherings of people on cruise ships and warships are often at high risk of COVID-19 infections. To assess the transmissibility of SARS-CoV-2 on warships and cruise ships and to quantify the effectiveness of the containment measures, the transmission coefficient (ß), basic reproductive number (R0), and time to deploy containment measures were estimated by the Bayesian Susceptible-Exposed-Infected-Recovered model. A meta-analysis was conducted to predict vaccine protection with or without non-pharmaceutical interventions (NPIs). The analysis showed that implementing NPIs during voyages could reduce the transmission coefficients of SARS-CoV-2 by 50%. Two weeks into the voyage of a cruise that begins with 1 infected passenger out of a total of 3,711 passengers, we estimate there would be 45 (95% CI:25-71), 33 (95% CI:20-52), 18 (95% CI:11-26), 9 (95% CI:6-12), 4 (95% CI:3-5), and 2 (95% CI:2-2) final cases under 0%, 10%, 30%, 50%, 70%, and 90% vaccine protection, respectively, without NPIs. The timeliness of strict NPIs along with implementing strict quarantine and isolation measures is imperative to contain COVID-19 cases in cruise ships. The spread of COVID-19 on ships was predicted to be limited in scenarios corresponding to at least 70% protection from prior vaccination, across all passengers and crew.

187 - Cruise Ship Infectious Disease Outbreak

This chapter examines infectious disease outbreak on a cruise ship, including the outbreaks and handling of 2020 Sars-CoV-2 on cruise ships early in the COVID-19 pandemic.

An empirical and modelling approach to the evaluation of cruise ships' influence on air quality: The case of La Paz, Mexico.

Maritime activity has diverse environmental consequences impacts in port areas, especially for air quality, and the post-COVID-19 cruise tourism market's potential to recover and grow is causing new environmental concerns in expanding port cities. This research proposes an empirical and modelling approach for the evaluation of cruise ships' influence on air quality concerning NO2 and SO2 in the city of La Paz (Mexico) using indirect measurements. EPA emission factors and the AERMOD modelling system coupled to WRF were used to model dispersions, while street-level mobile monitoring data of air quality from two days of 2018 were used and processed using a radial base function interpolator. The local differential Moran's Index was estimated at the intersection level using both datasets and a co-location clustering analysis was performed to address spatial constancy and to identify the pollution levels. The modelled results showed that cruise ships' impact on air quality had maximum values of 13.66 µg/m3 for NO2 and 15.71 µg/m3 for SO2, while background concentrations of 8.80 for NOx and 0.05 for SOx (µg/m3) were found by analysing the LISA index values for intersections not influenced by port pollution. This paper brings insights to the use of hybrid methodologies as an approach to studying the influence of multiple-source pollutants on air quality in contexts totally devoid of environmental data.

International cruise research advances and hotspots: Based on literature big data

This paper makes a systematic visual analysis of cruise research literature collected in science network database from 1996 to 2019. The results show that: the overall number of published literature on cruise research is growing;North American states, Europe, and Asia are the main regions of cruise research. The evolutionary of theme development of cruise research has three stages, and the current hot topics of cruise research can be summarized as cruise tourism, luxury cruises, cruise passengers, destination ports, environmental and biological conservation, and cruise diseases. Future research in the cruise field are in the areas of cruise supply chain, technology in cruise, children's cruise experience, itinerary design, planning and optimization, brand reputation and luxury cruises, public transportation in destinations, environmental responsibility of passengers and corporate social responsibility, optimization of energy systems, climate change in relation to the cruise industry, the Chinese cruise market and risk management of cruise diseases.

Environmental Compliance and Practices Of Cruise Ships in ísafjörður, Iceland

The drastic growth of cruise tourism in the world, while potentially beneficial for economic growth in local communities, also brings concerns regarding environmental impacts. This research used the port of Ísafjörður, Iceland, a growing hotspot destination for cruise ships, as a case study to aid in understanding the potential environmental impacts from cruise ships. The study's aims were: 1) to determine the quantity and type of waste discharged to the shore facilities by cruise ships in Ísafjörður in 2019, and 2) to explore the compliance behavior of the ships in adhering to Icelandic and international environmental regulations. To do this, quantitative and qualitative questions were presented in a survey to officers from 40 cruise ships, accounting for 87% of the total 46 different ships that docked in Ísafjörður in the 2019 cruise ship season. The survey questions were designed based on the MARPOL Convention and the law of Iceland, and these questions were compared with the ship's statutory record or ship's certificates to strengthen the reliability of the data. The questions covered five categories: emissions, waste oil, wastewater, garbage and food waste, and ballast water. Results showed that very little garbage and food waste had been discharged to shore facilities, and this was likely because Ísafjörður is one of several stops for many cruise ships in Iceland and the waste had simply been discharged elsewhere. In assessing the other four categories, 8 out of the 40 cruise ships carried out illegal activities, including 12 specific violation cases. This article discusses three primary reasons for those violations: accessibility, inconsistency, and monitoring. This research was conducted pre-COVID-19;however, by 2022 cruise ship calls in Ísafjörður approached preCOVID-19 numbers. Interested parties such as local communities, national decision makers, tourism boards, municipal planners, and environmental agencies must use the best available knowledge, such as this study, to manage the positive and negative aspects of the growth of cruise ship tourism, and perhaps even more so in a post-COVID-19 phase.

Coordinated location-allocation of cruise ship emergency supplies under public health emergencies

For the rapid development of the cruise industry, the cruise disaster relief supply chain has attracted extensive attention, especially because COVID-19 cases on international cruise ships occurred. In this paper, we propose an idea of coordination layout for cruise ship emergency supplies, the problem optimized two objective functions of maximizing coverage satisfaction and minimizing the total cost, addressing the low efficiency of resource utilization at the same. By applying to cruise ship emergency supplies layout of Northeast Asia cruise port group system, using expert scoring method and AHP to evaluate cruise port security vulnerability. The NSGA-II algorithm is used to solve the multi-objective programming model. A numerical example shows that the optimization design model and method are valid and feasible, and the algorithm is efficient for solving the above collaborative location and allocation problem of sectional reserves, which can also offer a variety of decision-making options. © 2023 the Author(s), licensee AIMS Press

Geographic Factors for Managing Cruise Ship Destination Port to Attraction Passenger Transfer in the Caribbean Region

The Cruise Line industry (CLI) is working on plans to recover from the economic impacts of COVID-19. Along with the expected benefits of a post COVID19 surge in cruise tourism, destination ports have an opportunity to mitigate potential impacts that come with the tourist economy. In this study, we expand on our previous work on four CLI destination sites (two in the Caribbean and two meso-American) to a larger regional study area in the Caribbean Sea and investigate the sustainability of destination marine infrastructure and near port transportation resilience. Twenty-Eight destinations were analyzed in the study. All the CLI destinations ports in the study are considered mature for cruise tourism and have tourist attractions of interest (including historic, natural, shopping, and other areas with sociocultural authenticity), which can be reached during a one day ship visit. An analysis of the marine traffic and geographic settings provides a more complete picture on key parameters that can potentially impact the commerce and livelihoods of local communities near destination ports. The results of the study also provide potential solutions for mitigating these impacts. As a baseline for fully operational cruise industry in the Caribbean Sea, the 2019 cruise year was analyzed since it was the last full year without impact from COVID-19. This paper offers a wider empirical view of CLI impacts on the Caribbean region once the industry resumes to full capacity following the COVID-19 pandemic, and it presents results and recommendations to build a framework for continued study of CLI sustainability.

Transmission of SARS-CoV-2 Associated with Cruise Ship Travel: A Systematic Review.

BACKGROUND: Maritime and river travel may be associated with respiratory viral spread via infected passengers and/or crew and potentially through other transmission routes. The transmission models of SARS-CoV-2 associated with cruise ship travel are based on transmission dynamics of other respiratory viruses. We aimed to provide a summary and evaluation of relevant data on SARS-CoV-2 transmission aboard cruise ships, report policy implications, and highlight research gaps. METHODS: We searched four electronic databases (up to 26 May 2022) and included studies on SARS-CoV-2 transmission aboard cruise ships. The quality of the studies was assessed based on five criteria, and relevant findings were reported. RESULTS: We included 23 papers on onboard SARS-CoV-2 transmission (with 15 reports on different aspects of the outbreak on Diamond Princess and nine reports on other international cruises), 2 environmental studies, and 1 systematic review. Three articles presented data on both international cruises and the Diamond Princess. The quality of evidence from most studies was low to very low. Index case definitions were heterogeneous. The proportion of traced contacts ranged from 0.19 to 100%. Studies that followed up >80% of passengers and crew reported attack rates (AR) up to 59%. The presence of a distinct dose-response relationship was demonstrated by findings of increased ARs in multi-person cabins. Two studies performed viral cultures with eight positive results. Genomic sequencing and phylogenetic analyses were performed in individuals from three cruises. Two environmental studies reported PCR-positive samples (cycle threshold range 26.21-39.00). In one study, no infectious virus was isolated from any of the 76 environmental samples. CONCLUSION: Our review suggests that crowding and multiple persons per cabin were associated with an increased risk of transmission on cruise ships. Variations in design, methodology, and case ascertainment limit comparisons across studies and quantification of transmission risk. Standardized guidelines for conducting and reporting studies on cruise ships of acute respiratory infection transmission should be developed.

How COVID-19 Has Been Affecting the Overall Cruise Ship Design Paradigm

The actual, global pandemic situation has dramatically involved every aspect of our lives. This also greatly affected the cruise ship industry. At first, cruise companies tried to face the problem by adapting existing ships at the situation, with no time to rethink completely their project. The opinion of scientists, architects and field experts highlighted the need to devise a new way to design cruise ships, considering passenger management, marketing and medical aspects. Particular attention must be paid to public areas, where individuals would be most vulnerable to airborne transmission. The sanitizing operations have now to follow even stricter operational protocols than in the past. A constant update monitoring of the passenger flows through the so-called smart technologies would allow, when dealing with a suspected case, to trace a timeline of its activities on board and, therefore, to avoid the rise of an outbreak. An implementation of the overall efficiency of vertical connections (which helps the management of potentially contaminated waste) and on-board medical spaces such as the hospital and the pharmacy shall be advised. From an anthropological point of view, it is essential to consider in more depth issues such as social distancing and the possibility of permanently decreasing the number of passengers, in favour of safety and on-board liveability. In the post COVID-19 era, the cruise ship can become a 'health bubble', a microcosm where people can enjoy an even more rewarding and safe experience. © 2022 The authors and IOS Press. All rights reserved.

The Inside Story of COVID-19 Pandemic on the Diamond Princess as the prime mover of Present and Future Ship Design

But this coronavirus has forced us into a new framework, within which we move without any ease: everything has new ways, everything appears as never seen, it's like finding yourself in an uncharted territory.. ' (G. Arma, 2020) With these words Gennaro Arma, Captain of the Diamond Princess cruise ship, describes the very first moments following the detection of what would become the first recorded outbreak of Covid-19 outside of China. It occurred during a roundtrip cruise which departed from Yokohama port, in Japan, on 20 January 2020. Among the 3,700 people on board, more than 700 tested positive for the virus, 14 of whom died during hospitalization. A situation which was faced without the support of emergency protocols that contemplated a modus operandi to follow. The ship constituted a confined control volume which allowed to analyze the main routes of virus propagation that mainly occur through direct contact between individuals, indirect one via contaminated objects and surfaces (also referred to as fomites) and airborne transmission. This has greatly affected the overall design paradigm, especially concerning the safety levels to be assured on board. The paper is going to analyze these focal points, starting from a possible implementation of HVAC system. It comes after an extensive study of the air flow circulation, as well as the application of filtering and purifications solutions, considering ship age and ventilation type, assessing the possibility of isolating those sectors of the plant acting on some areas dedicated to the management of emergency situations. Synoptically, there will be an extensive analysis related to the different surface types present on board and possible design interventions (i.e. smart materials). The Diamond Princess experience represents the prime mover aimed at the world of scientific research at the formulation of design guidelines applicable to the world of cruise ships and, consequently, in the civil architecture field. The outcome results have helped to build a transversal, holistic know-how, thanks to which it will be possible to control the occurrence of future pandemic episodes. © 2022 The authors and IOS Press. All rights reserved.

Fear and poor mental health among workers during the global cruise tourism crisis: Impact of low employability and family support

This research examines how fear of the crisis affects the mental health of hospitality workers in the cruise industry by performing a cross-sectional survey and using partial least squares model. Results confirm that fear of pandemic-induced shutdown negatively affects the mental health of cruise ship employees. The moderating effect of perceived employability outside the cruise ship industry and family emotional support are also uncovered. This study successfully consolidates the literature on job demand, job resources, work engagement, and well-being to determine the complex essence of cruise ship employees’ work engagement and well-being. Theoretically, this study expands the scarce literature that links the fear of the crisis with employees’ poor mental health. Some previous studies have examined this relationship in other contexts of economic crisis throughout history, but, for obvious reasons, none of these studies have had the opportunity to investigate a global economic crisis associated with a health crisis.

COVID-19 Anchor for Cruise Tourism. An analysis of Gdańsk’s and Gdynia's Cruise Tourism in the 2017-2020 Period

In many Member States, European regions and cities, tourism is a key factor in the economic and social structure. The COVID-19 pandemic that broke out in 2020 caused significant losses in the tourism sector area in all European Union (EU) countries. This applies in particular to one of the elements of the tourism sector of any economy with access to the sea-the possibility of accepting cruise ships. This cruise tourism sector has also been hit hard by the COVID-19 pandemic. The aim of this paper is to estimate the number of selected expenditures of passengers and cruise ship crews entering the ports of Gdańsk and Gdynia, which are a source of revenue for the region, as well as the impact of the COVID-19 pandemic on limiting the growth of this tourism segment. Our study takes a holistic approach by estimating the amount of revenue generated by tourists arriving in the two ports in the Gulf of Gdańsk capable of handling large cruise ships. Based on the number of arriving tourists in 2017-2020, the study estimates the income of tourism enterprises that receive a direct cash inflow from offering services to arriving tourists. The tourism sector that was particularly affected by the pandemic was cruise tourism. In 2020, this sector recorded an over 5-fold decrease in the number of cruise ship passengers. The conclusions of the study show that the number of cruise ships arriving in the analysed ports in 2020 decreased significantly compared to the previous year, similarly to other ports in the region. At the same time, the number of passengers visiting the analysed ports decreased substantially. Nevertheless, the dynamic growth of cruise tourism in the Baltic Sea basin, which began before the COVID-19 pandemic, allows for conclusions about further development of this tourism segment and its potential impact on the region’s economy after the crisis which occurred in 2020. © 2022 by ASERS® Publishing. All rights reserved.

Surmounting challenges and breaking barriers: will the cruise liners open up new frontiers in the new global village?

Purpose There are numerous pressures on the cruise tourism industry as in the recent past, many well-established cruise tourism locations have been turning tourists and ships away due to overtourism. It is argued here that now is the time to consider the introduction of new destinations. Design/methodology/approach The article is based on a literature review and discussions with experienced practitioners. Findings The cruise industry has continued to evolve and the numbers of people engaging in cruise tourism had been on the increase globally until the Covid-19 pandemic. Medium-sized and mega ships with state-of-the-art facilities were in regular use. Despite the fact that there was a boom, the need for an extension of cruise lines destinations has arisen as there are numerous nations with exciting locations waiting to be discovered. Some of the limitations of such destinations include difficulty of access for large mega ships and infrastructure. A way forward can be found though by engaging local smaller boats/ships to transfer tourists to local destinations. Research limitations/implications More work is needed to clarify issues such as (1) the readiness of proposed host communities to receive tourists;(2) terms and conditions of engagement of local boat companies;(3) cruising infrastructure development and (4) facilities upgrading that is compatible with international cruising standards. Originality/value This paper highlights some of the issues being faced by cruise companies in well-established tourism destinations. It also emphasizes the need for new, hitherto undiscovered locations to accommodate a likely expansion in demand in the post-Covid-19 era.

A Study of the Transmission Dynamics of COVID-19 on the Diamond Princess Cruise Ship

The transmission of COVID-19 in relatively closed places such as ships, prisons, hospitals, is still a public concern. We take the transmission situation on the Diamond Princess Cruise ship as an example to study the transmission dynamics of COVID-19 in a relatively closed place. The Agent-Based Modeling (ABM) method is applied to simulate the transmission dynamics of COVID-19. The Latin Hypercube sampling is proposed for parameter estimation in ABM. The simulation results show that most of the infected cases on the Diamond Princess Cruise ship were transmitted between passengers. However, at the beginning of the quarantine, the number of passengers infected by crew was much more than the number of passengers infected by other passengers. Based on this results, several control measures are designed. If at the beginning of the quarantine, the lab testing was strengthened for crew members, and the infected crew were disembarked in time, the final number of infected would be greatly reduced. Furthermore, if this measure was supplemented with the conventional control measures, the final number of infected would be further reduced. © 2022, The Editorial Department of Complex Systems and Complexity Science. All right reserved.

Risk factors, immune response and whole-genome sequencing of SARS-CoV-2 in a cruise ship outbreak in Norway.

OBJECTIVE: To improve understanding of SARS-CoV-2-transmission and prevention measures on cruise ships, we investigated a Norwegian cruise ship outbreak from July to August 2020 using a multidisciplinary approach after a rapid outbreak response launched by local and national health authorities. METHODS: We conducted a cross-sectional study among crew members using epidemiologic data and results from SARS-CoV-2 polymerase chain reaction (PCR) of nasopharynx-oropharynx samples, antibody analyses of blood samples, and whole-genome sequencing. RESULTS: We included 114 multinational crew members (71% participation), median age 36 years, and 69% male. The attack rate was 33%; 32 of 37 outbreak cases were seropositive 5-10 days after PCR. One PCR-negative participant was seropositive, suggesting a previous infection. Network-analysis showed clusters based on common exposures, including embarkation date, nationality, sharing a cabin with an infected cabin-mate (adjusted odds ratio [AOR] 3.27; 95% confidence interval [CI] 0.97-11.07, p = 0.057), and specific workplaces (mechanical operations: 9.17 [1.82-45.78], catering: 6.11 [1.83-20.38]). Breaches in testing, quarantine, and isolation practices before/during expeditions were reported. Whole-genome sequencing revealed lineage B.1.36, previously identified in Asia. Despite extensive sequencing, the continued transmission of B.1.36 in Norway was not detected. CONCLUSIONS: Our findings confirm the high risk of SARS-CoV-2-transmission on cruise ships related to workplace and cabin type and show that continued community transmission after the outbreak could be stopped by implementing immediate infection control measures at the final destination.

Cruise Ship Travel in the Era of Coronavirus Disease 2019 (COVID-19): A Summary of Outbreaks and a Model of Public Health Interventions.

BACKGROUND: Cruise travel contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission when there were relatively few cases in the United States. By 14 March 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending US cruise operations; the last US passenger ship docked on 16 April. METHODS: We analyzed SARS-CoV-2 outbreaks on cruises in US waters or carrying US citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of 4 interventions (screening for coronavirus disease 2019 (COVID-19) symptoms; viral testing on 2 days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and reducing port visits to 1) for 7-day and 14-day voyages. RESULTS: During 19 January to 16 April 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1669 reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections and 29 confirmed deaths. Longer voyages were associated with more cases (adjusted incidence rate ratio, 1.10, 95% confidence interval [CI]: 1.03-1.17, P < .003). Mathematical models showed that 7-day voyages had about 70% fewer cases than 14-day voyages. On 7-day voyages, the most effective interventions were reducing the number of individuals onboard (43.3% reduction in total infections) and testing passengers and crew (42% reduction in total infections). All four interventions reduced transmission by 80.1%, but no single intervention or combination eliminated transmission. Results were similar for 14-day voyages. CONCLUSIONS: SARS-CoV-2 outbreaks on cruises were common during January-April 2020. Despite all interventions modeled, cruise travel still poses a significant SARS-CoV-2 transmission risk.

Unique Evolution of SARS-CoV-2 in the Second Large Cruise Ship Cluster in Japan.

In the initial phase of the novel coronavirus disease (COVID-19) pandemic, a large-scale cluster on the cruise ship Diamond Princess (DP) emerged in Japan. Genetic analysis of the DP strains has provided important information for elucidating the possible transmission process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a cruise ship. However, genome-based analyses of SARS-CoV-2 detected in large-scale cruise ship clusters other than the DP cluster have rarely been reported. In the present study, whole-genome sequences of 94 SARS-CoV-2 strains detected in the second large cruise ship cluster, which emerged on the Costa Atlantica (CA) in Japan, were characterized to understand the evolution of the virus in a crowded and confined place. Phylogenetic and haplotype network analysis indicated that the CA strains were derived from a common ancestral strain introduced on the CA cruise ship and spread in a superspreading event-like manner, resulting in several mutations that might have affected viral characteristics, including the P681H substitution in the spike protein. Moreover, there were significant genetic distances between CA strains and other strains isolated in different environments, such as cities under lockdown. These results provide new insights into the unique evolution patterns of SARS-CoV-2 in the CA cruise ship cluster.

A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020.

BackgroundCruise ships provide an ideal setting for transmission of SARS-CoV-2, given the socially dense exposure environment.AimTo provide a comprehensive review of COVID-19 outbreaks on cruise ships.MethodsPubMed was searched for COVID-19 cases associated with cruise ships between January and October 2020. A list of cruise ships with COVID-19 was cross-referenced with the United States Centers for Disease Control and Prevention's list of cruise ships associated with a COVID-19 case within 14 days of disembarkation. News articles were also searched for epidemiological information. Narratives of COVID-19 outbreaks on ships with over 100 cases are presented.ResultsSeventy-nine ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (interquartile range (IQR): 1-17.8), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median attack rate for COVID-19 was 0.2% (IQR: 0.03-1.5), although this distribution was right-skewed with a mean attack rate of 3.7%; 25.9% (27/104) of voyages had at least one COVID-19-associated death. Outbreaks involving only crew occurred later than outbreaks involving guests and crew.ConclusionsIn the absence of mitigation measures, COVID-19 can spread easily on cruise ships in a susceptible population because of the confined space and high-density contact networks. This environment can create superspreader events and facilitate international spread.