Cruise Industry: Is the West Africa Ebola outbreak a threat?

First discovered in 1976, Ebola is an extremely dangerous virus that causes a severe hemorrhagic fever in humans and other primates – it is so deadly that the western world has classified it as a possible bioterrorism weapon and it kills more than 60% of those who become infected with it.

At the time of writing in 2014, the virus had killed more than 700 people in West Africa, with a further 1,300 people believed to be infected in what is the largest and most dangerous outbreak of the disease in medical history.

The World Health Organisation (WHO) has warned of catastrophic consequences if the virus isn’t contained, while African nations and the international community have mobilised to send resources to West Africa to try and prevent further spread of the disease. There have been confirmed cases in Liberia, Sierre Leone, Senegal, Nigeria and Guinea where the current outbreak originated in February, and with 14 cruise ships due to visit the West African region on 32 different cruises through the 2014 and 2015 cruise seasons, Cruise Arabia & Africa wondered what impact the current outbreak might have on the cruise industry. Past outbreak have not required any re-routing or cancellations of cruises visiting West Africa, but this is the largest epidemic since the virus was discovered and has put the travel and tourism industry on high alert.

While the Ebola virus does not pose an imminent threat to the west, where advanced medical infrastructure is more than capable of handling a contagious disease of this nature than that of West African nations, it has already had a significant impact on regional and international travel. Asky, a major West African airline had suspended flights to Liberia and Sierra Leone as of August 3rd, 2014, along with Nigeria’s largest airline Arik Air. Emirates Airlines, based in Dubai, is the first major international airline to cancel flights, while other international and regional carriers such as British Airways and South African Airways are continuing flights but have insisted they are monitoring the situation closely.

It is important to note that, according to the US Centres for Disease Control (CDC) the virus is primarily spread through bodily fluids or objects that have become infected with the secretions of an infected person. It is not airborne like the ‘cruise ship bug’ Norovirus and is therefore less contagious. However, there is some research that suggests the virus may be transmitted through close contact with an infected person if they cough on or near someone else – part of what makes Ebola such a concerning contagious disease is that there is still so much the medical community do not know for sure about it.

What is a potential concern for cruise passengers visiting West Africa during the current outbreak is the fact that a cruise ship is, in essense, a close community of several hundred or thousands of people living in close proximity to one another for the duration of the cruise – which typically last several weeks on those cruises that visit West African port of call. The factors that make Norovirus an extreme threat for cruise ships therefore could also make Ebola a significant concern for cruise lines visiting the West Africa region. Like many other contagious viruses, the Ebola pathogen can survive outside its host for significant amounts of time. “It is not known how long the virus can survive on contaminated surfaces and dead bodies, but it is longer than other viruses and has been reported to be at least several weeks,” writes Payal K. Patel M.D., a clinical fellow in infectious diseases in Boston.

According to the CDC, the incubation period for Ebola is 8 to 10 days, after which those suffering from the virus will begin to show symptoms common to a number of other ailments (fever, headache, joint pain, weakness, diarhea, vomitting and stomach pain) – it is therefore difficult for medical staff to known whether the symptoms are indeed those of Ebola without testing for it specifically. During the incubation period carriers of Ebola are not contagious, they become so after symotoms set in. It is unclear whether the 14 cruise ships visiting West Africa through 2014 and 2015 will have the facilities to conduct such tests and if not it may leave them vulnerable to an onboard outbreak.

If an outbreak were to occur onboard, however, modern cruise ships are extremely well equipped to contain it, based on their experience with Norovirus, which far less deadly, but a lot more contagious. All mainstream cruise lines have a set of containment and quarantine procedures for contagious diseases, including the specialised cleaning of areas suspected to have been contaminated, the enforced quarantining of those suspected to be carrying a serious virus and advanced onboard medical facilities to provide care for infected persons. The worry for some cruise industry observers, however, is that because of the high fatality rate of Ebola compared to Norovirus, passengers would have to be quarantined in the onboard medical facility in order for intensive care to be provided by a doctor. When a passenger has a confirmed or suspected case of Norovirus, they’re usually quarantined in their cabins. An outbreak of Ebola aboard a cruise ship could therefore put the vessel’s medical facilities under immense strain before outside help could be provided from land.

We reached out to all ten of the mainstream cruise line’s featuring West African ports on their 2014 and 2015 cruise itineraries to try and get some answers to passengers’ potential questions on how the Ebola outbreak in West Africa might impact the cruise industry. What we heard back is that all cruise lines featuring the West Africa region on their cruise itineraries are monitoring the situation closely. “Fred. Olsen Cruise Lines adheres to all Foreign and Commonwealth Office travel advice and has been monitoring the Ebola Virus outbreak very closely,” the British cruise line told Cruise Arabia & Africa. “Currently travel to the West African ports of Dakar, Senegal and Banjul, The Gambia, which Fred. Olsen Cruise Lines’ Braemar plans to visit in November and December 2014, has not been restricted.” A spokesperson for Saga Cruises also confirmed that no itinerary changes were planned for Saga Pearl’s port calls in the ports of Banjul, The Gambia and Dakar, Senegal in November. The classic cruise ship, marketing exclusively at cruise passengers over the age of 50 years, will sail on a 24-night voyage to the region from Southampton.

Cruise Arabia & Africa reached out to the Cruise Line’s International Association to find out whether they feel that cruise ships’ experience with Norovirus has prepared them for handling a hypothetical Ebola outbreak on-board, but a spokesperson from the organisation refused to entertain the comparison, instead insisting that the risk was too negligible to be of any consequence. “Very few cruise ships ever visit the region where Ebola cases are being reported,” the CLIA told Cruise Arabia & Africa. “However, we are monitoring the situation very closely along with our colleagues in the rest of the travel industry as well as international health organizations.” Not all cruise lines that had planned to visit the region feel as secure about West Africa as a cruise destination, however. At the time of writing, Cruise & Maritime Voyages had just become the first cruise line to cancel all port calls in Africa. The cruise ship Astor was meant to visit Angola, Sao Tome, Benin, Togo, Ghana, Sierra Leone, Gambi and Senegal on her way back to the UK from Australia via South Africa in April, 2015, but those ports have been cancelled and replaced with Cape Verde and St Helena stops instead. “CMV is re-routing due to the recent Ebola outbreak and associated health risks in the West African region,” the cruise line confirmed to Cruise Arabia & Africa.

Luckily for the cruise industry, the Ebola outbreak in West Africa is affecting a part of the world that is not a major cruise destination. In 2003, when the SARS outbreak spread through much of Southeast Asian and eventually went global, killing hundreds of people and infecting thousands, it caused travel chaos, with airlines and cruise lines forced to re-route their planes and vessels and cancel itineraries altogether. That came at a time when the travel industry was still trying to find its feet following the devastating September 11th terror attacks on New York and the subsequent war in Afghanistan. The Ebola outbreak, at the time of writing, was devastating parts of West Africa, particularly Sierre Leone, Ghana and Liberia, but the cruise industry, for now, seems fairly isolated from it, and, because of the way in which Ebola is spread, cruise passengers visiting West Africa are in no danger as the countries of The Gambia and Ghana have no reported infections. Senegal is the main tourist hub of the region, making the one reported case of Ebola in the capital Dakar a “top priority emergency” according to the World Health Organisation, but at the time of writing there were no additional reports of infection.

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