The Ship and the Microbe: Why Cruise Ships Keep Making People Sick

But I'll be honest, I never thought of a buffet line in the Bahamas as the same kind of sovereignty puzzle.

Pues lo es.

It is exactly that.

Las llamadas banderas de conveniencia, que es cuando un barco se registra en un país con regulaciones laxas y bajos impuestos, como Panamá, Bahamas o las Islas Marshall, crean un vacío legal deliberado.

What are called flags of convenience, where a ship registers in a country with lax regulations and low taxes, like Panama, the Bahamas, or the Marshall Islands, creates a deliberate legal vacuum.

Las navieras lo saben perfectamente y lo explotan desde hace décadas.

Shipping companies know this perfectly well and have been exploiting it for decades.

So who actually has teeth here?

Who can walk onto a cruise ship and say, this isn't good enough?

En la práctica, cuando se trata de barcos que tocan puertos estadounidenses, el CDC tiene un programa llamado Vessel Sanitation Program, que existe desde los años setenta precisamente porque hubo una serie de brotes gravísimos en esa época.

In practice, for ships that call at U.S.

Realizan inspecciones sin previo aviso, puntúan los barcos de cero a cien, y publican los resultados.

ports, the CDC runs a program called the Vessel Sanitation Program, which has existed since the seventies precisely because there were a series of very serious outbreaks back then.

Es uno de los pocos mecanismos de rendición de cuentas que realmente funciona.

They conduct unannounced inspections, score ships from zero to one hundred, and publish the results.

Right, and that program has a history that's worth pausing on.

Because the reason it exists tracks back to a specific moment.

In the early seventies, there were multiple outbreaks on cruise ships, and public health officials realized they had essentially zero authority to do anything about it.

Y hay algo fascinante sobre la historia del propio norovirus: durante décadas se lo llamó simplemente "el virus de Norwalk", por una ciudad de Ohio donde hubo un brote escolar en 1968 que los investigadores estudiaron con especial detalle.

And there's something fascinating about the history of norovirus itself: for decades it was simply called the Norwalk virus, named after a city in Ohio where there was a school outbreak in 1968 that researchers studied in particular detail.

La historia de cómo nombramos las enfermedades dice mucho sobre cómo las percibimos.

The history of how we name diseases tells us a lot about how we perceive them.

The naming of diseases is its own whole rabbit hole.

We went through it with COVID, with Ebola, with the Spanish flu which wasn't Spanish.

There's a geopolitics of nomenclature that the WHO has been trying to navigate for years.

Exactamente.

Exactly.

Desde 2015 la OMS intenta evitar nombrar enfermedades con lugares geográficos, grupos de personas o animales específicos, porque genera estigma y consecuencias económicas reales para esas comunidades.

Since 2015 the WHO has been trying to avoid naming diseases after geographic places, specific groups of people, or animals, because it generates stigma and real economic consequences for those communities.

Pero el daño a veces ya está hecho: el virus de Norwalk, la gripe española, el síndrome respiratorio de Oriente Medio.

But the damage is sometimes already done: the Norwalk virus, the Spanish flu, Middle East Respiratory Syndrome.

And cruise ships have their own stigma problem, don't they.

Every time there's an outbreak, the industry absorbs a hit.

But the industry is also enormous.

Princess Cruises alone, which operates the Caribbean Princess, is a multi-billion dollar company.

So how much does one outbreak actually cost them?

Menos de lo que debería, francamente.

Less than it should, frankly.

La industria del crucero es una de las más hábiles del mundo en gestionar la percepción.

The cruise industry is one of the most skilled in the world at managing perception.

Tienen departamentos de relaciones públicas enormes, contratos de reserva que protegen a la naviera más que al pasajero, y una capacidad impresionante para que un brote desaparezca de los titulares en cuarenta y ocho horas.

They have enormous public relations departments, booking contracts that protect the shipping company more than the passenger, and an impressive ability to make an outbreak disappear from the headlines within forty-eight hours.

I've seen that playbook in other industries.

The speed at which something becomes yesterday's news is itself a form of power.

Y mientras tanto, la industria del crucero sigue creciendo a un ritmo espectacular.

And in the meantime, the cruise industry keeps growing at a spectacular rate.

En 2023, más de treinta y cinco millones de personas hicieron un crucero en todo el mundo.

In 2023, more than thirty-five million people took a cruise worldwide.

Se espera que en 2030 esa cifra supere los cincuenta millones.

By 2030 that figure is expected to exceed fifty million.

Estamos hablando de ciudades flotantes que cada año son más grandes y más densas.

We're talking about floating cities that get bigger and denser every year.

Which raises a question I don't think I've heard asked seriously enough: at what point does the sheer scale of this industry become a public health issue that goes beyond individual outbreaks?

We're not just talking about a bad week on the Caribbean Princess.

We're talking about a permanent infrastructure of disease transmission.

Es una pregunta legítima, aunque hay que tener cuidado de no exagerar.

It's a legitimate question, though we should be careful not to exaggerate.

Los estudios epidemiológicos muestran que la tasa de infección en cruceros no es necesariamente más alta que en entornos terrestres equivalentes: hoteles de gran tamaño, campamentos de verano, residencias universitarias.

Epidemiological studies show that infection rates on cruise ships aren't necessarily higher than in equivalent land-based environments: large hotels, summer camps, university residences.

Lo que distingue al crucero es la imposibilidad de escapar y la velocidad de contagio en el primer día o dos.

What distinguishes the cruise ship is the impossibility of leaving and the speed of transmission in the first day or two.

That's actually a useful corrective.

I tend to reach for the dramatic framing, and you're right that the comparison matters.

Though I'd push back a little: can you check out of a university residence if there's a norovirus going around?

Yes, you can.

You cannot sail yourself to shore.

Cierto.

True.

Y ahí está la clave ética de todo esto.

And that's the ethical core of all this.

El contrato implícito entre la naviera y el pasajero es profundamente asimétrico: tú asumes el riesgo de estar en un entorno cerrado del que no puedes salir, y a cambio recibes unas vacaciones.

The implicit contract between the shipping company and the passenger is deeply asymmetric: you assume the risk of being in a closed environment you cannot leave, and in exchange you get a vacation.

Si algo va mal, las opciones son muy limitadas.

If something goes wrong, your options are very limited.

Spain has a complicated relationship with cruise tourism, right?

Barcelona, the Canary Islands.

There's been real tension there between the economic value and the cost to residents.

Totalmente.

Completely.

Barcelona lleva años debatiendo si los cruceros aportan más de lo que destruyen.

Barcelona has been debating for years whether cruises contribute more than they destroy.

El problema clásico es que los cruceros dejan poco dinero en tierra: los pasajeros comen en el barco, duermen en el barco, compran en el barco.

The classic problem is that cruises leave very little money on land: passengers eat on the ship, sleep on the ship, buy on the ship.

Lo que dejan en la ciudad es contaminación del aire, saturación de los barrios históricos y agua contaminada en el puerto.

What they leave in the city is air pollution, overcrowding in historic neighborhoods, and polluted water in the port.

I reported from Barcelona during the peak of the anti-tourism protests around 2017.

People were putting signs in their windows.

The anger was real.

And I remember thinking at the time that cruise passengers were particularly resented because they were the most visible and the least integrated.

Y desde el punto de vista de la salud pública, hay otro ángulo que casi nunca se menciona: los trabajadores.

And from a public health perspective, there's another angle almost never mentioned: the workers.

Los barcos tienen entre mil y dos mil empleados viviendo en condiciones de espacio muy limitado, muchas veces en camarotes sin ventanas en las cubiertas inferiores.

Ships have between a thousand and two thousand employees living in very limited space, often in windowless cabins on the lower decks.

Cuando hay un brote de norovirus, son ellos quienes están más expuestos y quienes tienen menos posibilidad de protegerse.

When there's a norovirus outbreak, they are the most exposed and the least able to protect themselves.

The worker angle is always the one that gets lost.

Every time there's an outbreak story, the coverage is about the passengers.

The workers are invisible.

Y provienen mayoritariamente de países en desarrollo, con contratos que los atan al barco durante meses sin posibilidad real de abandonar el trabajo.

And they come mostly from developing countries, with contracts that tie them to the ship for months with no real possibility of leaving the job.

Si se ponen enfermos, pierden ingresos.

If they get sick, they lose income.

Si hay un brote, siguen sirviendo el bufé porque no hay quien los sustituya.

If there's an outbreak, they keep serving the buffet because there's no one to replace them.

Es una vulnerabilidad estructural que la industria ha preferido no examinar demasiado de cerca.

It's a structural vulnerability the industry has preferred not to examine too closely.

Which brings me back to the CDC report.

A hundred and fifteen passengers.

What we don't know from that number is how many crew members were also affected, and whether that data is even collected and reported in the same way.

El Vessel Sanitation Program del CDC sí recoge datos de tripulación, pero la transparencia en ese aspecto es mucho menor.

The CDC's Vessel Sanitation Program does collect crew data, but transparency on that front is much lower.

Las navieras tienen incentivos para minimizar las cifras entre el personal porque implica reconocer que el barco operó con personal infectado, lo que abre responsabilidades legales serias.

Shipping companies have incentives to minimize staff numbers because it means admitting the ship operated with infected personnel, which opens up serious legal liability.

So where does this leave us?

The industry keeps growing, the outbreaks keep happening, the regulatory tools exist but have real limits, and the conversation tends to disappear after forty-eight hours.

Is there any version of this where something actually changes?

Yo creo que el cambio vendría de dos sitios posibles.

I think change would come from two possible places.

Primero, un brote lo suficientemente grave como para que la cobertura mediática no pueda ser contenida: algo del tamaño y la visibilidad de lo que ocurrió con el Diamond Princess durante el COVID.

First, an outbreak serious enough that media coverage can't be contained: something on the scale and visibility of what happened with the Diamond Princess during COVID.

Segundo, una acción legal colectiva de pasajeros o tripulantes que logre establecer precedente.

Second, a class action lawsuit from passengers or crew that manages to set a precedent.

Sin alguno de esos dos catalizadores, el statu quo es demasiado rentable para la industria.

Without one of those two catalysts, the status quo is too profitable for the industry.

The Diamond Princess.

Twenty-seven hundred passengers quarantined off Yokohama in February 2020.

I remember that coverage.

It was the first time many people in the West understood viscerally what containment actually looks like when it fails.

Y a pesar de eso, la industria de los cruceros se recuperó más rápido de lo que nadie esperaba.

And despite that, the cruise industry recovered faster than anyone expected.

En 2023 ya superaba los niveles de pasajeros de antes de la pandemia.

By 2023 it was already exceeding pre-pandemic passenger levels.

La gente tiene una memoria muy corta cuando se trata de cosas que disfruta.

People have very short memories when it comes to things they enjoy.

Los cruceros son baratos, son cómodos, y prometen el mundo en una sola reserva.

Cruises are cheap, they're comfortable, and they promise the world in a single booking.

Eso es muy difícil de combatir con datos epidemiológicos.

That's very hard to fight with epidemiological data.

That tension between what we know and what we choose sits at the center of a lot of public health debates.

We knew what cigarettes did for decades before the numbers moved.

Maybe the question isn't when the industry changes.

Maybe it's when passengers do.

Dicho esto, tampoco quiero dejar la impresión de que los cruceros son una trampa mortal.

That said, I don't want to leave the impression that cruises are a death trap.

La inmensa mayoría de los viajes terminan sin ningún brote.

The vast majority of voyages end without any outbreak.

El norovirus es desagradable pero raramente fatal en personas sanas.

Norovirus is unpleasant but rarely fatal in healthy people.

El problema real es sistémico y tiene que ver con quién asume el riesgo, quién tiene el poder, y quién paga las consecuencias.

The real problem is systemic and has to do with who assumes the risk, who holds the power, and who pays the consequences.

Como casi siempre.

As almost always.

One thing I kept noticing as you talked, and I want to circle back to it before we wrap up: you used a word a few times that I think is worth unpacking.

You said "brote" for outbreak.

Which I know as a word from botany, from plants.

How does it end up meaning disease outbreak in Spanish?

Es una metáfora preciosa, en realidad.

It's a beautiful metaphor, actually.

"Brote" viene del verbo "brotar", que significa germinar, surgir de repente desde abajo.

Brote comes from the verb brotar, which means to sprout, to surge suddenly from below.

Una planta brota.

A plant sprouts.

Un volcán brota.

A volcano erupts.

Y una enfermedad también "brota": aparece de golpe en un lugar, se extiende, y luego puede remitir.

And a disease also brotas: it appears suddenly in a place, spreads, and then may recede.

La imagen es casi perfecta para describir la epidemiología.

The image is almost perfect for describing epidemiology.

In English we say outbreak, which is also a botanical metaphor if you think about it.

Something breaking out from containment.

But brote has a more organic quality to it.

A sprout is alive.

It grows.

That's almost more unsettling than "outbreak."

Y como curiosidad: en contextos médicos también usamos "epidemia" para algo más extendido, "endemia" para algo que persiste en una zona geográfica de forma habitual, y "pandemia" cuando cruza fronteras a escala global.

And as a side note: in medical contexts we also use epidemia for something more widespread, endemia for something that persists habitually in a geographic area, and pandemia when it crosses borders on a global scale.

Pero "brote" es el término más preciso para un evento localizado y repentino, exactamente lo que pasó en el Caribbean Princess.

But brote is the most precise term for a localized and sudden event, exactly what happened on the Caribbean Princess.

So next time I read a headline about a hundred and fifteen sick passengers, I'll picture a seedling pushing through the soil of a buffet table.

That's going to stay with me, Octavio.

Maybe more than I wanted it to.

De nada.

You're welcome.

Y la próxima vez que pidas hielo en un crucero, recuerda esta conversación.

And the next time you ask for ice on a cruise ship, remember this conversation.