THE CRUISE industry is considering a U.S. Public Health Service suggestion that all ship owners hire on-board "sanitation consultants."
Despite good winter sales figures, the industry is revealing its concern in the wake of publicity about sporadic illnesses aboard cruise ships and a high rate of failure to pass government sanitation inspections of vessels touching U.S. ports. Some cruise lines already use private consultants.
The latest reported outbreak of gastrointestinal illness aboard a cruise ship occurred last week in the Caribbean, when the Statendam radioed to PHS officials that it had 42 cases of diarrhea aboard. The ship was enroute to St. Thomas with about 800 passengers. At St. Thomas, PHS inspectors boarded to conduct an investigation as the vessel headed for Miami. By the time it docked Friday, about 250 passengers had contracted what the PHS termed "a mild" illness that was "probably viral."
Dr. William A. Terranova, a PHS medical epidemiologist in Atlanta, said preliminary results of tests to be made from specimens taken from stricken passengers will not be available until next week. The cause of infection may not be identified immediately, he said, and sometimes the source can never be pinpointed. Statendam of Holland-America Cruises had a smaller outbreak last December.
Last month the Costa Line's Angelina reported 267 passengers - 43 percent - suffered from a gastrointestinal illness during a Caribbean cruise, according to Terranova. Shigellosis was the causative organism, Terranova said, and it apparently was in the food and not the water. But it has not been determined if the bacterium was present in the food when brought aboard the ship, or if was transmitted later by a food handler, he said.
More than 70 passenger ships from various countries were given hundreds of unannounced inspections last year by employes of the PHS' Quarantine Division of the Bureau of Epidemiology, the Center for Disease Control (CDC). In about 70 percent of the cases, vessel sanitation inspection reports showed failing scores.
Ship operators were consulted by CDC during formulation of the inspection procedures, and, when questioned, cruise line representatives repeatedly expressed the need for outside inspection and their dedication to the safety and health of their passengers.
But industry spokesman also have criticized the inspection grading system as being unfair, stating they fear that the public will miisinterpret the results. And while they agree that there is a high rate of deficiencies, they emphasize that there is no high rate of disease aboard passenger ships.
Cruises represent "about a $1 1/2-billion industry," according to a Cruise Lines International Association spokesman, and there is "no indication passengers are staying away from ships" because of the publicity.
The Atlanta-based CDC took the first steps toward a voluntary sanitation inspection program more than five years ago in an effort to reduce or eliminate shipboard outbreaks of gastrointestinal illnesses. Major outbreak have occurred in the past. The program was beefed up in 1975. It has few teeth, inone sense, but there are indications that the cruise lines are very wary of antagonizing the Public Health Service.
CDC officials believe the program reduces potential health hazards aboard cruise ships, and they confirm cruise line operators' statements that passengers today are less likely to suffer a shipboard illness. 'Reportable Signs'
Vessels (and aircraft) arriving at U.S. ports, according to regulations, are required to report ahead by radio "only (1) when certain signs and symptoms of quarantinable or other communicable diseases are observed on board, (2) when there has been a death on board or (3) when the ship is arriving from smallpox or plague-infected countries."
One of the "reportable signs and symptoms" is any diarrhea "severe enough to interfere with work or normal activity." All gastrointestinal ailments among passengers and crews must be reported, the CDC said.
The Public Health Service has no authority to force cruise lines to comply with her recommendations on vessel sanitation, or to assess penalties for ships failing surprise inspections in port, and the vessels are permitted to continue to sail regardless of how low they may score.
Yet CDC does have some clout. If deficiencies were judged immediately critical (such as, an outbreak of disease whose cause is unknown, or a serious problem with a vessel's portable water system that cannot be immediately remedied), the captain would be asked not to sail until the conditions were corrected, according to the CDC. If the vessel sailed before corrections were made, the CDC could inform foreign ports and the vessel could be refused docking privileges.
There have been only two instances since the sanitation inspection program went into effect, the CDC said, when vessels were requested not to embark. In both cases the operators complied promptly.
When an outbreak of illness occurs, explained Joseph Giordano, director of the Quarantine Division, in a telephone interview, "the problem is in food handling and preparation." Water is not the culprit "in the vast majority of cases," he added. The CDC "recently recommended to the New York Committee, International Committee of Passenger Lines, that members consider employing on-board sanitation consultants who essentially would do the same job we're doing."
John C. Yashuk, chief of the Quarantine Division's control unit in Miami, one of a number of ports where ships undergo examination, said the most common areas in which vessels are marked defective are "refrigerator temperatures, improper storage of raw and cooked meats within the refrigerator, improper thawing of frozen meat and poultry products, and not properly sanitizing food equipment or food services."
Giordano said the consultant "would be able to monitor" practices aboard the vessel and "hopefully they would pass inspections." The suggestion "was quite favorably received," Giordano said, and the cost would be "really quite minimal." Two Cardinal Rules
John Reurs, chairman of the New York Committee and spokesman for 15 member companies with about 50 cruise liners of foreign registry, said: "The operation of passenger cruise vessels is subject to two cardinal rules - safety of life at sea and environmental safety to insure the health of passengers and crew. Without those two elements we wouldn't be in business."
Reurs said that "approximately 1,000 people reported some form of gastrointestinal problem out of more than 1 million passengers who sailed last year from U.S. ports. Not all of the illnesses can be traced to shipboard cruises . . . in relation to that kind of problem elsewhere, including within the United States, that's very, very low." CDC officials could not immediately confirm Reurs' figure on illnesses. Some passengers may become ill after eating ashore, and others may have been exposed to disease before boarding, but the CDC said that some outbreaks have occured before a vessel reached its first port.
"We welcome outside inspection." Reurs said, confirming that lines "are considering the possibility" of hiring on-board experts who would often sail on the cruises. "Many lines already seek advice from sanitation consultants and the internal expertise available to these lines is considerable. Some lines have spent hundreds of thousands of dollars to rebuild kitchens," he said.
"There is no question about the high incidence of reports of deficiencies but there is no high incidence of disease," Reurs said. He added that officials are "puzzled by the inability of some ships to perform consistently despite obvious efforts to meet requirements."
Reurs singled out the grading system that has raised the ire of many cruise line officials. "Standards that are condensed into this ship inspection sheet mean that if any one of the first 32 items are found deficient, the ship is given a 20-point demerit, which therefore means the ship does not meet Public Health Service standards." A grade of 84 or higher is considered as "meeting standard."
"Each of the 32 can represent hundreds of inspected items," Reurs said. "For example, refrigeration (item 14, see copy of form on this page) could represent 150 or more refrigerators. If any one is found malfunctioning, or the thermometer is defective, then you lose 20 points." (No more than 20 points may be deducted in any one section.) "Worked Long and Hard"
Giordano said the CDC "worked long and hard (on the form), invited all the industry, reviewed it with them, almost put on a course that explained how bacteria multiplied and a variety of other information. We developed those criteria, presented them to the lines and requested comment.
"Our position is that a deficiency on any one of those items is potentially capable of causing illness among the passangers," Giordano explained. "If they will shut down that one refrigerator, we will not fail the vessel. If they replace that one thermometer, we will not fail the vessel. Any item that can be corrected while the inspector is on board will not result in a deduction.
"Allegations have been made about a question of different interpretations by inspectors," Giordano said. "Our inspections are open. I have said to industry management, if you have that problem we'll board the vessel together. We're not puzzled (by inconsistencies in ship performances); we're of the opinion that the job can be done."
Yashuk said "the inspectors who go aboard the vessels conduct uniform inspections. They're objective, not subjective. Inspectors are bound to follow certain administrative procedures, which tell them the method of filling out forms, how to conduct spot checks, and how to follow up." Some vessels consistently pass, some fail just as consistently, and others fluctuate.
"The ships that pass most of the time have top management that takes a serious interest in the sanitation program," Yashuk added. He feels that much progress has been made by the cruise industry in meeting government standards. But inspection reports show that vessels are still being marked down regularly for deficiencies, such as:
"The refrigerated bulk milk dispenser had a temperature of 66 degrees F., the machine was unplugged and contain a carton of milk. Three of the ships personnel were informed, but no attempt was made to correct this deficiency."
"Utensils in the ... pantry were not clean. Cutlery stored in the bakery shop was greasy. Utensils should be washed and sanitized before storing. The glass washing machine in the ... lounge is supplied with cold water ... The interior of the main galley steam table needs cleaning." "Peeling Paint"
"Paint is peeling from the range hood over the ... cooking range. Condensation drippage exists over the steam kettles ... and on the food preparation counter in the crew galley. Overhead peeling paint and condenstion drippage are sources of potential contamination of food and equipment."
"Roaches were observed in the main galley, crew galley and bakery."
"A waiter was observed placing ice in glasses with his fingers. The ice storage bins of ice machines Nos. 2 and 6 are rusted.
"No chlorine residual was detected in swimming pool water. Also, pool water was very murky. After check of pool chlorinator, which was operating correctly, the ship's engineers determined that a pool recirculating filter was clogged."
"Meat slicing machines in crew and main galley were improperly cleaned ... much grease and food remnants on surfaces. Corrected while on board."
"Pastry shop: Flour in pull-out bins under marble table top was obviously contaminated from liquid and other foreign matter falling from working surfaces above."
Yashuk will send a copy of the latest inspection report on a specific cruise vessel to anyone writing to request it from his office: Sanitation Vector Control Activity, Quarantine Division, 1015 N. America Way, Room 107, Miami, Fla. 33132. Such reports tell only how the vessel fared during its last inspection, and thus may not give a complete picture. Not all vessels are inspected every month; some may not dock regularly in this country.
In addition, Reurs believes "there is a danger of misinterpreting the report sheet. It's fine for a public health inspector or skilled technician," he said, "but other people would have great difficulty gauging the relative merits and hazards as reported.
What should a prospective cruise passenger deduce from a report?
An examination of monthly summaries of inspections for 12 months last year shows, for example, that the Boheme, a ship of West German registry operated by the Commodore Cruise Line out of Miami, was rated "meets standard" in February, April, May, June and again in December, but failed to meet standards on five other monthly inspections. In January, the Boheme was not checked; last month the vessel failed to pass in San Juan. The Boheme's record is better than many.
"If I were the average passenger," said Dean Hofmeister, chief executive officer of Commodore, "and I had to read a report on a ship - the entire report that details the reasons - I would certainly try to deduce whether they were items of a technical nature as against reasons that might indicate the overall unsanitary condition aboard a ship."
The February report on the Boheme, in the explainatory. "Results and Recommendations" portion accompanying the monthly inspection checklist, showed that the vessel failed for two main reasons: the temperature of a refrigerator in the crew's quarters was too high (52 degrees instead of 40), and a recorder that analyzes chlorine residuals in the potable water supply was not calibrated accurately - it was reading a lower amount than was in the water. (There was actually too much chlorine and it affected the taste of the water, according to Hofmeister.)
"We all want this inspection," said Hofmeister. "I want the Public Health Service aboard these ships. They help me in creating the emphasis for our personnel to work hard enough to meet standards." But he added: "No matter how hard we work, there are going to be times when one or the other of our vessels will fall an inspection."
Holland-America Cruises and the Cunard Line offer two recent case histories.
Last year the Statendam of Holland-America passed three out of seven monthly inspections. The ship failed the January and February inspections this year.
The Statendam had failed the November 1977, inspection and then passed on Dec. 19. But earlier in December, inspectors went aboard in St. Thomas and found 29 cases of unreported diarrhea in the medical log. Later, it was learned that additional passengers and some crewmen had also suffered from gastrointestinal illnesses on the same Carribbean cruise. The ship carried 695 passengers and 415 crew (passenger capacity is about 800), hence the outbreak was a small percentage of those aboard.
A fine of up $5,000 can be imposed by the Public Health Service for violation of reporting procedures (all cases of illness must be reported). The CDC asked the line if there were extenuating circumstances.
Oscar Kolb, a spokesman for the line, said during a telephone interview that the failure to report was a case of "human error," and that was also the reason Holland-America cited in its reply to the CDC, Giordano said last weel that CDC had written to the line that the government had decided to close the matter "without fine or further action."
But in the letter to Holland-America, Giordano said, "we reminded them that we need their full cooperation ... and, if there are further violations, that it would be necessary for us to consider appropriate action under the law." (The Statendam promptly reported its latest outbreak to the CDC)
Discussing the case, Kolb made the following statement: "Unquestionably it is Holland-America's policy to maintain the highest possible safety and health standards, and in this connection Holland-America retains the services of the National Sanitation Inspection Service, a full-time sanitation consultant firm based in Miami, whose personnel visit each of our ships on a regular basis. On occasion they sail on cruises. "Immediate Action"
"At the present time we are in the process of enlarging the hotel staff on each ship to include a full-time sanitation officer, who will be fully guided by all standards of the Public Health Service. Whenever Public Health advises of any situation that falls short of their high-standards, Holland-America takes immediate action to correct any situation."
Cunard Line's Queen Elizabeth II, the last major liner in regular scheduled transatlantic service, passed two out of seven monthly inspections last year. The line recently canceled $35,000 in advertising in the Sunday Times of London after that paper ran stories reporting that U.S. inspectors had found unsatisfactory conditions in the galleys of QE2 and other Cunard ships.
The QE2 also piles the cruise lanes of the Carribbean, as does Cunard's newest and much smaller vessel, the Princess, which failed eight out of nine monthly inspections last year. The Princess passed in January.
William C. North, vice president for public relations at Cunard's New York office, said the publicity is "costing us millions of dollars" and that Cunard vessels had been unfairly singled out.
The cancellation of newpaper advertising "is an English matter," North said. "In our country there is a complete separation between Cunard's advertising and public relations. Both department heads have the same rank - vice president. The British paper, when they wrote the original story, devoted the story principally to the Cunard ships because they are British vessels.
"The other 50 or 60 vessels of foreign registry were naturally of not as much interest to a British audience ... there were many ships that did not have as good a record as Cunard," North said. "Then, beginning six weeks later and thereafter, the same English-oriented story appeared in American publications ... and gave an entirely different impression to the American reader.
"Consequently," the Cunard spokesman added, "we have been the principal line affected by the publicity, which is really about our industry. We don't necessarily accept that everything in the story is true anyway.
While the cruise lines are reticent to criticize the Public Health Service, Eugene Solomon, president of National Sanitation Inspection Service of Miami, speaks bluntly: "In my judgement, the inspection form is designed to fail a ship. The thing that we have realized is that there is no consistency in the PHS forms. They have their guidelines, but there is a discrepancy in interpretation. They go overboard." "There's No Appeal"
Solomon said that "all of our people who do inspection work for us aboard vessels are former Public Health Service employes," with the exception of himself. He said his company does sanitation inspection work for Norwegian American Line. Norwegian Caribbean Line, the Eastern Steamship Co. and Holland-America Cruises, among others.
"You have $100-million companies ship inspections, it becomes a matter of public record, and there's no appeal" from the CDC grades, Solomon said. He added, "I have the highest respect for the integrity of the inspectors, who are trying to do their best job they can under the circumstances."
R.J. Kwortnik, executive director of Cruise Lines International, which is a sales promotional association of 24 companies with approximately 80 cruise ships, said that "undoubtedly the subject of inspections will be a matter of discussion" when executives hold their quarterly meeting tomorrow.