tag:theconversation.com,2011:/us/topics/cruise-liner-31423/articlesCruise liner – The Conversation2022-10-28T01:41:02Ztag:theconversation.com,2011:article/1933842022-10-28T01:41:02Z2022-10-28T01:41:02ZCruise ships are back and carrying COVID. No, it’s not 2020. But here’s what needs to happen next<p>Cruise ships carrying passengers with COVID are back in the news. The Coral Princess, with an unconfirmed number of people testing positive on board, is <a href="https://www.canberratimes.com.au/story/7959796/virus-infected-cruise-ship-to-dock-in-wa/">set to dock</a> at Fremantle, Western Australia. The Quantum of The Seas, with passengers reportedly testing positive, <a href="https://twitter.com/9NewsQueensland/status/1585194230825246721">is heading for</a> Brisbane. There have been similar situations at other ports in <a href="https://www.rnz.co.nz/news/national/477429/cruise-ship-with-covid-19-cases-failed-to-follow-current-isolation-guidelines">New Zealand</a> and <a href="https://www.cruiselawnews.com/2022/10/articles/disease/covid-cruise-ships-return-down-under-with-hundreds-of-infected-guests/">the Pacific</a>.</p>
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<p>But this isn’t 2020. The cruise ship industry and health authorities have learned much from large outbreaks linked to the Ruby Princess and Diamond Princess cruise ships early in the pandemic.</p>
<p>Yet, there’s even more we can do to limit the impact of SARS-CoV-2 (the virus that causes COVID) spreading from cruise ships to communities on land.</p>
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Read more:
<a href="https://theconversation.com/fleas-to-flu-to-coronavirus-how-death-ships-spread-disease-through-the-ages-137061">Fleas to flu to coronavirus: how 'death ships' spread disease through the ages</a>
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<h2>Why are we worried about cruise ships?</h2>
<p>Cruise ships can have epidemics of a variety of infectious diseases, <a href="https://theconversation.com/cruise-ships-can-be-floating-petri-dishes-of-gastro-bugs-6-ways-to-stay-healthy-at-sea-this-summer-126351">not just COVID</a>, facilitated by large numbers of people in close proximity, especially during indoor social activities.</p>
<p>We know SARS-CoV-2 is spread mainly by <a href="https://theconversation.com/the-pressure-is-on-for-australia-to-accept-the-coronavirus-really-can-spread-in-the-air-we-breathe-160641">inhaling contaminated air</a>, so indoor activities may pose a risk if ventilation is poor.</p>
<p>Cruises typically last at least a week, which covers the incubation period for infections such as influenza and COVID. So all it takes is for one infected person to be on the ship to set off an epidemic.</p>
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<p>Staff stay on ships much longer than passengers, and can continue to infect new passengers, perpetuating a cycle of outbreaks. </p>
<p>But <a href="https://www.nature.com/articles/s41591-020-0869-5#Fig1">almost half</a> of infections are transmitted asymptomatically. So, without testing everyone on board (before they board and during outbreaks), infectious people can board a ship without being aware they are infected and cause an epidemic. Infected staff can also infect new passengers, and passengers can infect communities they visit on land.</p>
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Read more:
<a href="https://theconversation.com/cruise-ships-are-coming-back-to-nz-waters-should-we-really-be-welcoming-them-188974">Cruise ships are coming back to NZ waters – should we really be welcoming them?</a>
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<h2>What happened with cruise ships and COVID in 2020?</h2>
<p>Early in the pandemic, large outbreaks on ships, such as the <a href="https://theconversation.com/yes-australians-on-board-the-diamond-princess-need-to-go-into-quarantine-again-its-time-to-reset-the-clock-131906">Diamond Princess</a> made the headlines. Some 634 of 3,711 (17%) people on board <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180">tested positive</a> for COVID. The ship was quarantined for two weeks. </p>
<p>An <a href="https://elifesciences.org/articles/58699?utm_source=content_alert&utm_medium=email&utm_content=fulltext&utm_campaign=26-August-20-elife-alert">estimated 69%</a> of transmissions on board were transmitted asymptomatically.</p>
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Read more:
<a href="https://theconversation.com/yes-australians-on-board-the-diamond-princess-need-to-go-into-quarantine-again-its-time-to-reset-the-clock-131906">Yes, Australians on board the Diamond Princess need to go into quarantine again. It's time to reset the clock</a>
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<p>The Ruby Princess had a COVID outbreak in March 2020 with <a href="https://www.abc.net.au/news/2022-10-12/nsw-ruby-princess-class-action-trial-covid-19-testing-sydney/101527156">around 700 cases</a>. Yet health authorities allowed passengers to disembark in Sydney without testing, who then dispersed around the country at a time we had no vaccines. </p>
<p>Our research <a href="http://www.ijtmgh.com/article_119534_550421b9e1139603f85c3fc9af97d25a.pdf">showed</a> this resulted in growing community clusters for weeks afterwards.</p>
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Read more:
<a href="https://theconversation.com/ruby-princess-inquiry-blames-nsw-health-officials-for-debacle-144512">Ruby Princess inquiry blames NSW health officials for debacle</a>
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<h2>But it’s not 2020</h2>
<p>We now have vaccines. But vaccination rates vary globally (and cruise passengers are often from many countries). Some vaccines are <a href="https://pmj.bmj.com/content/postgradmedj/98/1159/389.full.pdf">less effective than others</a>, not everyone is up-to-date with their <a href="https://theconversation.com/millions-of-australians-still-havent-had-their-covid-boosters-what-message-could-convince-them-now-190482">booster shots</a>, <a href="https://www.bmj.com/content/377/bmj-2022-071113">vaccine immunity wanes</a> (even after having a booster), and current vaccines are generally <a href="https://theconversation.com/whats-the-difference-in-protection-against-omicron-between-2-doses-and-3-doses-of-vaccine-176447">less-effective</a> against currently circulating Omicron subvariants.</p>
<p>This means people can be infected and infectious despite being vaccinated.</p>
<p>Many of us have also had COVID, especially in 2022. But our immunity following infection (whether or not we’re also up to date with our vaccines) wanes too. People who were infected with older variants may also have a <a href="https://www.science.org/doi/10.1126/science.abq1841">dampened immune response to Omicron</a>, which means limited protection.</p>
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<p>Cruise ships and health authorities have also tightened up their COVID protocols. </p>
<p>The New South Wales government, for instance, publishes on its website <a href="https://www.nsw.gov.au/covid-19/travel/cruising-rules">the COVID risk</a> of in-coming vessels. It places ships in one of three categories according to a number of factors, including the number of COVID cases on board.</p>
<p>Cruise ships also have <a href="https://cruisepassenger.com.au/news/coral-princess-covid-outbreak/">strict protocols</a> for controlling and managing outbreaks. This includes masks for close contacts, mandatory isolation for infected passengers for five days, and testing of anyone with symptoms.</p>
<p>The problem is that transmission can continue because of asymptomatic infections. The ship may need medical evacuations or assistance for severely ill people. There is also the problem of infection being transmitted to communities on shore after people without symptoms disembark.</p>
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Read more:
<a href="https://theconversation.com/what-the-let-it-rip-covid-strategy-has-meant-for-indigenous-and-other-immune-compromised-communities-176664">What the 'let it rip' COVID strategy has meant for Indigenous and other immune-compromised communities</a>
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<h2>We can do more</h2>
<p>People disembarking and unknowingly spreading the virus is especially a problem for small towns.</p>
<p>The itinerary of the Coral Princess, which has since been modified, included the Western Australian towns of Broome and Geraldton, both of which have large Aboriginal communities, and other towns, such as Albany and Busselton. </p>
<p>Small towns may not have a hospital, may have limited access to health care, and would not have capacity to deal with many severely ill patients. Capacity for medical evacuations are also limited.</p>
<p>In the map below, we can see how hospitals are distributed in rural areas around Broome. Most hospitals are near Perth and the southwest coast. Broome has one hospital with about 40 beds. Large hospitals in Perth and Darwin are about 2,000 kilometres away, which would be the destinations for medical evacuations of severely ill patients.</p>
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<a href="https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map showing distribution of hospitals in Western Australia" src="https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1067&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1067&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492085/original/file-20221027-36452-5tqk25.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1067&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Most major hospitals are near Perth, which is about 2,000 kilometres from Broome.</span>
<span class="attribution"><span class="source">Samsung Lim, author provided</span></span>
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<p>So it’s important to monitor for outbreaks in Broome after the Coral Princess docked there this week, and ensure availability of testing to enable early intervention (such as antiviral drugs) to control outbreaks.</p>
<p>Cruises with outbreaks on board should ideally <a href="https://ozsage.org/working_group/regional-rural-and-remote/">avoid</a> small towns or remote locations with limited health services or vulnerable populations, as the impacts on these communities may be much greater than in a large city. </p>
<p>Visiting small towns during an on-board epidemic <a href="https://ozsage.org/media_releases/ozsage-position-statement-cruise-ship-epidemic-and-risk-to-small-towns-in-western-australia/">would be safer</a> if everyone who disembarks is tested first, is negative, and wears a mask on shore.</p>
<h2>What else could we do?</h2>
<p>The cruising industry has acknowledged the reality of COVID being a continuing threat. This could be improved by recognising the role of asymptomatic transmission in testing policies.</p>
<p>For instance, all passengers and crew should have a negative rapid antigen test at the start of the cruise, and during an outbreak. All close contacts and all disembarking passengers should be tested for COVID, regardless of symptoms. The cost of testing would be much less than the lost costs of large epidemics.</p>
<p>During a cruise epidemic, companies also need to consider the locations being visited, how much COVID is already present there (some remote towns have very little COVID) and available health-care systems for locals.</p>
<p>Rapid use of antivirals may also help to control epidemics on board as these allow passengers testing positive to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00644-2/fulltext">clear the virus faster</a>.</p>
<p>The aviation industry <a href="https://www.ashrae.org/file%20library/technical%20resources/covid-19/12-19_walkinshaw.pdf">does well</a> in providing safe air in-flight. The cruise industry has also started <a href="https://www.cruisecritic.com.au/articles.cfm?ID=5474">changing ventilation</a> to add fresh air instead of recirculated air indoors.</p>
<p>But there is still some way to go before we can say the threat of COVID is over, on-board or on land.</p><img src="https://counter.theconversation.com/content/193384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre currently receives funding from NHMRC, MRFF and Sanofi for nvestigator driven research.</span></em></p><p class="fine-print"><em><span>Samsung Lim receives funding from Medical Research Future Fund, Department of Health.</span></em></p><p class="fine-print"><em><span>Ashley Quigley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve learned much from large COVID outbreaks linked to the Ruby Princess and Diamond Princess cruise ships early in the pandemic. But there’s still some way to go.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyAshley Quigley, Research Assistant, UNSW SydneySamsung Lim, Associate Professor, Biosecurity Program, The Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1447042020-08-19T11:37:38Z2020-08-19T11:37:38ZCan the cruise industry really recover from coronavirus?<figure><img src="https://images.theconversation.com/files/353609/original/file-20200819-25336-faw6bv.jpg?ixlib=rb-1.1.0&rect=176%2C1193%2C5363%2C2522&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/valletta-malta-7-january-2020-msc-1641835369">Shutterstock/VladislavMavrin</a></span></figcaption></figure><p>On Sunday the first major cruise ship to take to the Mediterranean in almost five months <a href="https://www.bbc.co.uk/news/world-europe-53802045">sailed out</a> of the Italian city of Genoa. Passengers on the MSC Grandiosa were tested for coronavirus before stepping on board. The ship – which has brought in an array of strict measures to limit the spread of the virus – will stop at three Italian ports and the Maltese capital Valletta in a seven-day voyage. But will these measures be enough to help the sector survive the pandemic? A lot is riding on the success of this Italian cruise. </p>
<p>After all, it was hard to imagine a cruise like this happening at all at the height of the pandemic – when ships were referred to as “<a href="https://www.bbc.co.uk/news/world-asia-51470603">floating Petri dishes</a>”. Worldwide media coverage showed ships being turned away from ports and left marooned in the ocean with passengers <a href="https://www.theguardian.com/world/2020/mar/27/stranded-at-sea-cruise-ships-around-the-world-are-adrift-as-ports-turn-them-away">stranded at sea</a>. </p>
<p>It did look bad. Between February and April, more than <a href="https://www.gov.uk/government/news/19000-british-travellers-return-from-cruise-ships-after-major-international-effort">19,000 British travellers</a> from 59 vessels in 20 different countries had to be repatriated by the government. </p>
<p>It wasn’t just bad news for tourists. In April, Andy Harmer, director of Cruise Lines International Association UK and Ireland (CLIA), <a href="https://www.telegraph.co.uk/travel/cruises/articles/industry-warning-cruise-shutdown-job-losses/">said</a> the 90-day cruise suspension would cost the UK economy £888 million, lead to the loss of 5,525 jobs and £287 million in wages. Across the UK, the industry supports 40,517 direct jobs paying £1.35bn in wages. CLIA says the industry generates £10bn annually for the UK economy.</p>
<h2>COVID cruises</h2>
<p>So now the cruise industry is hoping strict new protocols will help it regain consumer confidence. New measures <a href="https://www.breakingtravelnews.com/news/article/msc-grandiosa-departure-sees-cruise-sector-return-in-europe/?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter">include</a>: arriving at cruise terminals at set time slots; screening travellers with temperature checks, medical reviews, health questionnaires and an antigen COVID-19 swab test.</p>
<p>Guests on MSC cruises will receive a wristband, which provides them with contactless options on board. For example, wristbands can be used to open cabin doors without touching handles and for making payments. They will also help to facilitate proximity and contact tracing, if needed. The MSC Grandiosa has also reduced capacity, with about about 2,500 passengers on board its debut cruise – <a href="https://www.ship-technology.com/news/msc-grandiosa-first-cruise-five-month-suspension/#:%7E:text=The%20MSC%20Grandiosa%20will%20operate,the%20country%20from%2015%20August">about 70%</a> of normal, pre-pandemic, passenger numbers. </p>
<p>Other cruise companies are experimenting too. TUI Cruises and Hapag Lloyd recently concluded inaugural “no-call” <a href="https://contentsharing.net/actions/email_web_version.cfm?ep=4R57DX0NHpZHrueRADPOx5N_fcLFFUmnSQLT7sUSj0MqKni5B1hoXCEcQoPzneqPfQ22WkYLq_aFh1LzPRn00H5ZvTE8aVZk6qIs17QQ6CrYc0sodeyhVvEO62OUBs8v">voyages</a> (so no city stop-overs) from Hamburg without incident.</p>
<p>Those two cruise companies have also produced <a href="https://www.hl-cruises.com/travel-safely">ten-point plans</a> to reassure passengers and encourage more people into travelling again. Points include: pre-boarding thermal image screening for travellers; social distancing; 40% less guests; table numbers in the restaurants reduced; fewer participants in sports and entertainment events; ships equipped with a laboratory and expanded medical teams. Crew members will undergo regular COVID tests. </p>
<p>All these measures will be needed to fight the virus and shore up customer confidence, as there has already been a failure. Earlier in August the expedition cruise ship, MS Roald Amundsen, owned by Norwegian firm Hurtigruten, suffered an <a href="https://www.bbc.co.uk/news/world-europe-53636854">outbreak of coronavirus</a> during its week-long voyage to Svalbard in the Arctic.</p>
<h2>Adapt or sink</h2>
<p>It is anticipated that prices will be reduced to entice passengers back on board. There are already deals available to book for next year, including discounts on cabin upgrades and drinks packages. But some firms are going further by considering domestic-only cruises to overcome travel restrictions. For example, cruise company <a href="https://www.telegraph.co.uk/travel/cruises/news/viking-cruise-around-britain-british-islands-summer-2020/">Viking</a> is investigating UK trips for Britons who are missing their cruise holidays. All these adaptions just go to show how innovative the industry is being to help encourage passengers to cruise again. </p>
<p>But will it be enough? To add to the sector’s pain, the Foreign and Commonwealth Office <a href="https://www.gov.uk/government/news/over-70s-and-at-risk-brits-advised-against-travelling-on-cruise-ships#:%7E:text=A%20Foreign%20%26%20Commonwealth%20Office%20spokesperson,those%20with%20high%2Drisk%20conditions.&text=See%20our%20guidance%20on%20cruise%20ship%20travel%20and%20our%20coronavirus%20travel%20advice">advice</a> for the over-70s not to take cruises at all remains in place. Passengers aged 50 and above have represented the <a href="https://reports.mintel.com/display/1018561/">core customer base</a> in recent years. And much of this came from the over-70s. </p>
<p>So it will be interesting to watch who returns first. Industry experts believe it will be passengers who travelled in inter-generational parties and fell in love with the cruise lifestyle who will return first – but with their children rather than their grandparents. They understand how cruise ships operate and are not in the high-risk age group. Research shows that “<a href="https://www.sciencedirect.com/science/article/pii/S0160738315000511?via%3Dihub">crisis-resistant</a>” tourists are also less likely to be put off by the risks. </p>
<p>Although the long-term sustainability of the sector is uncertain, it can take solace in the fact that cruise passengers are notoriously loyal. Tourism studies <a href="https://www.tandfonline.com/doi/full/10.1080/10548408.2016.1167349">have shown</a> that visitors return even after a disaster. And, according to a <a href="https://cruising.org/-/media/research-updates/research/consumer-research/2018-clia-travel-report.pdf">survey</a> conducted by CLIA, nine out of ten passengers said they “probably or definitely will” cruise again. Nevertheless, all eyes are now MSC Grandiosa to see if it can successfully navigate these tricky waters and give this ailing industry some hope.</p><img src="https://counter.theconversation.com/content/144704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A loyal customer base will help the cruise liner industry as it takes its first tentative steps towards recovering from the pandemic.Liz Sharples, Senior Teaching Fellow (Tourism), University of PortsmouthKokho Jason Sit, Senior Lecturer in Marketing, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1319062020-02-20T05:46:45Z2020-02-20T05:46:45ZYes, Australians on board the Diamond Princess need to go into quarantine again. It’s time to reset the clock<p>Today’s evacuation of about 180 passengers from the cruise ship Diamond Princess to serve another period of quarantine back in Australia has raised questions about the best way to control spread of the coronavirus.</p>
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<p>The passengers had already spent 14 days quarantined on board the ship, which had been docked in Japan, and now face another 14 days at the Howard Springs quarantine facility close to Darwin.</p>
<p>Di Stephens, Northern Territory’s acting chief health officer, <a href="https://www.abc.net.au/news/2020-02-20/cruise-ship-australians-arrive-darwin-for-coronavirus-quarantine/11981394">told the ABC</a> today:</p>
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<p>These people need to go into quarantine because we are not entirely convinced that the quarantine procedures on that ship were 100% effective.</p>
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<p>By contrast, Japan’s health ministry is allowing <a href="https://www.nytimes.com/2020/02/19/world/asia/japan-cruise-ship-coronavirus.html">hundreds of people</a> to leave the ship without being subject to further quarantine.</p>
<p>So what’s behind Australia’s announcement to impose a second quarantine period? And what were conditions like on board to prompt this decision?</p>
<h2>What’s quarantine?</h2>
<p>Quarantines have been put in place around the world as part of the global public health response to COVID-19 – the disease caused by a new coronavirus, now named SARS-CoV-2. </p>
<p>The idea is to limit the spread of the virus within and between countries.</p>
<p>Formal measures designed to limit contact between infected (or potentially infected) people are called “social distancing”. And they have been used to control communicable diseases for <a href="https://www.bible.com/bible/116/LEV.13.NLT">at least 2,500 years</a>.</p>
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Read more:
<a href="https://theconversation.com/remote-village-to-metropolis-how-globalisation-spreads-infectious-diseases-92216">Remote village to metropolis: how globalisation spreads infectious diseases</a>
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<p>Today, the term <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5229a2.htm">quarantine refers to</a> the separation or restriction of movement of people who are not ill but are believed to have been exposed to an infectious disease. </p>
<p>This differs to isolation, which is the term used for the separation or restriction of movement of people who are ill, thereby minimising onward transmission.</p>
<h2>How long should quarantine last?</h2>
<p>Quarantine periods are determined by certain characteristics of the infectious agent, most notably the incubation period. This is the period between being exposed to it and symptoms appearing.</p>
<p>For COVID-19, the <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.5.2000062">average incubation period</a> is thought to be around six days, and can range from two to 11 days.</p>
<p>While a <a href="https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1.full.pdf">preliminary report</a> has suggested a longer incubation period of up to 24 days, this is <a href="https://doi.org/10.1002/jmv.25708">considered unlikely</a>.</p>
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Read more:
<a href="https://theconversation.com/how-contagious-is-the-wuhan-coronavirus-and-can-you-spread-it-before-symptoms-start-130686">How contagious is the Wuhan coronavirus and can you spread it before symptoms start?</a>
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<p>People who have been in close contact with someone confirmed to have COVID-19 are considered to have been potentially exposed to the virus. As a precaution, these people are placed in quarantine, essentially to “sit out” their potential incubation period.</p>
<p>The quarantine period of 14 days currently being used in Australia and elsewhere for COVID-19 takes into account the maximum known incubation period for this disease, plus a few extra days as a reasonable precaution.</p>
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<p>In quarantine, people will either develop the disease and have symptoms or they will remain well. In theory, if a person remains well after their period of quarantine, they are deemed uninfected and restrictions are lifted.</p>
<p>Another factor that influences how long someone needs to be quarantined is the infectious period. That’s the period during which the infection can be transmitted from one person to another.</p>
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Read more:
<a href="https://theconversation.com/theres-no-evidence-the-new-coronavirus-spreads-through-the-air-but-its-still-possible-131653">There's no evidence the new coronavirus spreads through the air – but it's still possible</a>
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<p>If the infectious period starts before the symptoms (from asymptomatic or minimally symptomatic individuals), the virus can be transmitted silently. This can substantially complicate disease prevention and control. </p>
<p>When a new virus emerges – as with SARS-CoV-2 – the infectious period is largely unknown. While the proportion of asymptomatic or minimally symptomatic COVID-19 cases is not clear, it is increasingly apparent people can be infected <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2001899?query=RP">without having any symptoms</a>. However, further evidence is needed to see if these people can infect others.</p>
<h2>When is it best to extend the quarantine period?</h2>
<p>Crucial to quarantine is ensuring that best possible infection control practices are put in place to prevent ongoing transmission. </p>
<p>It is also essential to assess real-time data about newly diagnosed cases, which tells us how effective quarantine measures have been.</p>
<p>In some circumstances, it may be necessary to extend a person’s period of quarantine, as in the case of the Australian citizens on board the cruise ship Diamond Princess.</p>
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Read more:
<a href="https://theconversation.com/cruise-ships-can-be-floating-petri-dishes-of-gastro-bugs-6-ways-to-stay-healthy-at-sea-this-summer-126351">Cruise ships can be floating petri dishes of gastro bugs. 6 ways to stay healthy at sea this summer</a>
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<h2>So, what happened on board the Diamond Princess?</h2>
<p><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">Data from the World Health Organisation</a> (WHO) give us clues to what’s behind Australia’s decision to impose a second period of quarantine.</p>
<p>The graph below shows there may have been up to four possible waves of infections on board, including an initial undetected wave before quarantine measures were imposed.</p>
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<img alt="" src="https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=698&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=698&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=698&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=877&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=877&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316386/original/file-20200220-92530-g31xi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=877&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>These data demonstrate ongoing SARS-CoV-2 transmission between people on board during the quarantine period. It also indicates breaches in infection control on board may have contributed to ongoing waves of infections, which an expert highlights in the video below.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/t-J1OSg2hw8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An expert raises concerns about infection control measures on the Diamond Princess cruise ship.</span></figcaption>
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<p>Evidence of ongoing transmission during the quarantine period supports the decision by several countries to evacuate their citizens from the Diamond Princess, including Australia, to “reset the clock” and to impose a further 14-day quarantine period.</p>
<p>This additional measure – while causing considerable and understandable frustration to those affected – is designed to limit transmission of COVID-19 within Australia.</p>
<h2>The rights of individuals versus public good</h2>
<p>Implementing public health measures, such as isolation and quarantine, requires decision-making that <a href="https://www.who.int/healthsystems/topics/health-law/chapter10.pdf">balances the rights</a> of individuals and public good.</p>
<p>When appropriately designed and implemented, quarantine and isolation work. Even when quarantine is not absolutely adhered to, it can still be effective at reducing the likelihood of large-scale outbreaks. </p>
<p>With <a href="https://www.ncbi.nlm.nih.gov/books/NBK92450/">SARS</a> (severe acute respiratory syndrome), these strategies were thought to have been an important part in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1691853/">controlling the epidemic</a>, though they were <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5229a2.htm">resource and labour intensive</a>.</p>
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Read more:
<a href="https://theconversation.com/yes-theres-merit-in-quarantining-people-on-christmas-island-to-prevent-the-spread-of-coronavirus-130879">Yes, there's merit in quarantining people on Christmas Island to prevent the spread of coronavirus</a>
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<img src="https://counter.theconversation.com/content/131906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Quarantine measures on the Diamond Princess cruise ship weren’t effective, suggests new data. So Australian passengers without symptoms are going into quarantine again.Stacey L Rowe, PhD candidate, Monash UniversityBenjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and ImmunityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/657592016-09-23T10:12:41Z2016-09-23T10:12:41ZWhy cruise liners could be a crucial part of the response to national disasters<figure><img src="https://images.theconversation.com/files/138512/original/image-20160920-12448-1blxcwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canapes not required. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-106416110/stock-photo-luxury-cruise-ship-sailing-at-sunset.html?src=pWXOKp5E33RvvZ5f9g2qXQ-2-93">EpicStockMedia</a></span></figcaption></figure><p>In January and February 2014, two major earthquakes <a href="https://www.theguardian.com/world/2014/feb/03/greek-island-kefalonia-earthquake">hit the</a> Greek island of Kefalonia. No one was killed and only one person injured, thanks to strict construction rules in an area of regular seismic activity, yet the earthquakes were a human disaster nonetheless: they damaged the homes of about 5,000 of the 36,000 island inhabitants, leaving them all homeless. </p>
<p>Large scale homelessness and damaged infrastructure are common after earthquakes like these. After this Kefalonian disaster, however, something unique happened: luxury cruise ships provided victims with temporary accommodation and other necessities in the days and weeks that followed. </p>
<p>This has the potential to be tremendously important to how we handle disasters in future. It could provide a blueprint that has major implications both for victims and economic recovery. </p>
<p>To avoid the worst when crises like earthquakes strike, governments and NGOs continuously prepare disaster relief plans. There include three internationally recognised phases. There’s a preparation phase, which is about logistics: sourcing everything from emergency services to food to tents. These resources are then deployed during phase two, immediate response, ahead of a third phase for reconstruction. </p>
<p>In Kefalonia, the island’s authorities did not have the resources to handle these phases in-house. Amid heavy rain and cold weather in the hours after the first earthquake struck, they requested assistance from NGOs like the Red Cross and Lions Clubs and, unusually, the private sector – in this case Greek shipowners. These organisations all began collaborating instantly. </p>
<p>Some victims received standard-issue army tents and camped in a local sports stadium for a night, which is the sort of thing that traditionally happens in these situations. But temperatures were very cold and there was no heating, so they were taken along with everyone else to two cruise ships. These had been provided by the shipowners either free or at minimum cost within 24 hours of the first earthquake. </p>
<h2>Making a difference</h2>
<p>Victims and other local people that participated in <a href="https://pureapps2.hw.ac.uk/portal/en/publications/getting-the-right-thing-done-in-kefallonia--ethics-cruise-industry-and-disaster-management(9b5ec4cb-d07d-4a79-b949-c7ceff26762c)/export.html">our research</a> into how the disaster was handled said that using these vessels brought only positive outcomes. The crew’s training in handling demanding customers during regular cruises was extremely useful, since many victims were severely traumatised. </p>
<p>The ships gave these people high-quality accommodation, catering and sanitary facilities, which enabled them to think about how to restructure their lives in a safe and relaxed environment. Our respondents all agreed it was a much better solution than camping. Many victims remained onboard for two months. </p>
<p>The other benefit of moving the victims offshore was that it cleared the vicinity of the earthquake. This made it easier for the local government to focus on quickly repairing damaged infrastructure such as roads, water supply systems and ports. It enabled it to skip much of the first two phases in dealing with a natural disaster and move straight to reconstruction. </p>
<p>It is worth pointing out that the shipowners did not get involved for any potential future economic benefit. They sought no publicity and were ready to break ongoing contracts if necessary to assist the victims. Like the crew and everyone else involved in the humanitarian response, they were motivated purely out of a sense of doing the right thing. </p>
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<a href="https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/138623/original/image-20160921-21701-11l4rh2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ferries to the rescue.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/a/a7/Superfast.JPG">Wikimedia</a></span>
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<h2>Shipping them in</h2>
<p>According to the <a href="http://www.unep.org/urban_environment/issues/coastal_zones.asp">UN Environment Programme</a>, half of the world’s population lives within 60km of the sea, and three-quarters of all large cities are located on the coast. What happened in Kefalonia should therefore be seen as a template for disaster relief for a large proportion of the world’s population. </p>
<p>Cruise ships can provide an immediate high-quality response that is not affected by weather conditions. While they would have been less helpful after the recent earthquake in <a href="http://www.wtvq.com/2016/08/28/the-latest-italy-lowers-quake-death-toll-back-to-290/">Accumoli</a> in Italy, which was further inland, Kefalonia demonstrates how such ships can free up resources for restoration. </p>
<p>Neither is there any need to ask shipowners for favours in the event of disaster. Country governments in high-risk zones ought to be assessing to what extent their shipping sector might be able to help, and open negotiations in advance. Countries without shipping industries ought to be looking at reaching agreements with shipowners from other countries, while NGOs should consider their potential to help with such arrangements, too. </p>
<p>In Greece two years ago, necessity was the mother of an extremely innovative invention. Not only could it benefit other countries after natural disasters, there is no reason why it couldn’t be used to handle other situations of human distress such as refugee crises as well.</p><img src="https://counter.theconversation.com/content/65759/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stavros Karamperidis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tents and food parcels are one thing, ready-built accommodation is another.Stavros Karamperidis, Assistant Professor in Shipping and International Logistics, Heriot-Watt UniversityLicensed as Creative Commons – attribution, no derivatives.