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Close call (Covid) on Adventure with happy ending!


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Whew! Good point to not automatically freak out! Just read this in a Facebook group: 

 

Thought of the day, DO NOT PANIC!  We are beginning to wind down our amazing cruise on Adventure of the Seas with Royal Caribbean.  We departed from Nassau Bahamas on Saturday and have enjoyed a very relaxing time.  One requirement of re-entry to the United States is a negative Covid test.  Royal Caribbean International is currently offering this service to all passengers departing from the Bahamas.

We took our tests this morning and went on about our day at sea heading to Freeport as our last port of call.  The testing process was very simple by signing up via an email.  We were in and out in under 8 minutes.  Woohoo. Cocktail time with our favorite bartender in Schooner Lounge with some 90’s Trivia. 

A few minutes into trivia, some ship’s officers showed up and spoke to Tim for a moment and he said he was going to the cabin.  I was a bit puzzled until another officer approached me.  He said Tim’s Covid test was positive and he needed to go back to our quarters.  I was simply blown the $&@) away!  I dashed right up to the cabin.  Tim confirmed what they said and we both were in shock.  Here we are on a full day at sea, hundreds of miles from home, and totally freaking.  15 minutes later a guy from medical shows up to perform a PCR test, the one that takes a sample of your brain according to Tim. 

The phone rang while we were waiting.  I answered and the voice on the other end said he was chief of security.  I put Tim on and he walked him through some things on his phone to set up contract tracing.  I’m still freaking that we are going to be confined to our cabin, or confined to medical.  F$&@!!! OMG we are going to be on the news! 

I finally checked my email and my results were negative.  Woohoo!  I can make a mad dash to the bar for a cocktail before they can catch me.  I wasn’t even told to stay in the room.  I get to the bar and order drinks.  A few minutes later Tim shows up.  Omg, he broke out of jail.  I just knew they would find him and make him walk the plank.  Luckily the results of his PCR test came back NEGATIVE!  What a sigh of relief. 

Moral of the story, stay calm and DO NOT PANIC!  We can’t thank Royal Caribbean International for taking amazing care of us during an extremely emotional time.  Loyal to Royal!

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30 minutes ago, ConstantCruiser said:

Goes to show those quick tests are less reliable.  Crisis averted, protocols worked.  

Good story to see.  

Thanks for posting. 

The protocols didn't work. These *healthy* people very nearly had a vacation ruined. Even if they were PCR positive, so what? 

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2 hours ago, LizzyBee23 said:

The protocols didn't work. These *healthy* people very nearly had a vacation ruined. Even if they were PCR positive, so what? 

Very nearly but didn't - because of the protocols that worked.  The failed quick test was followed up by a more reliable PCR test.  Those are the protocols.  

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I'll be looking out for what happens in October as cold/flu season starts to pick up. It isn't unusual to carry a virus around detectable by PCR that doesn't actually cause you more than a day-long sore throat. Actually, unless you can remember screaming your lungs out, that very same phenomenon is probably what causes most of your very short lived symptoms that don't even rise to the level of being called a cold. I say this because right now when it's 1 or 2 people per cruise, it seems manageable. But what about when it inevitably rises to 15-20 (or more) as the level of virus naturally increases and you're still asking healthy people to not only isolate, but wait for a specialized transport to take them back to the US? How long are those extra costs sustainable?

We need to have our eyes on a near term goal of essentially treating COVID like any other URI: if you are sick, you isolate and the ship provides you medical care or gets you to more sophisticated facilities if needed. All we should be doing is making sure ships actually have the facilities to provide care in the short term (which IMO, was a huge shortcoming pre-pandemic) and do have robust arrangements in place to move seriously ill passengers if needed.

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Sounds like Royal is handling it well all the way around. They didn't immediately cause chaos, and did a second, more thorough test to confirm the results before making rash decisions.

I know it had to have been TERRIFYING but I'm glad you guys made it through and can finish out your cruise with no more drama!

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6 hours ago, LizzyBee23 said:

We need to have our eyes on a near term goal of essentially treating COVID like any other URI:

I agree with the thrust here @LizzyBee23. The current level of hysteria about the variants in the US, especially given the high vax rates among vulnerable populations is unnecessary. In countries with high vax rates, we should be thinking endemic pathogen of interest and managing clusters of it discreetly. I think this is what you mean.

One thing to keep in mind is that while COVID is a URI, the possible outcomes from contracting it, unlike a URI or Flu, are significant across select age and medical status cohorts. You do make the point that each cruise ship has to be equipped to care for COVID cases that go south and to quickly off-load passengers whose clinical status depends on a level of care not available on the ship.

I don't know the details of the capability to do that across the RCL fleet. Can they intubate and ventilate on board? Administer anti-cytotoxic therapies, Administer antibody treatment? These are all life saving early interventions and then the question becomes, as you say, what happens if there are 15-20 cases, 10 of them are over 65 and at risk and 5 of them are already starting to go down hill with low O2 Sat levels. I have a gut feeling the medical staff has the same kinds of protocols for dealing with a very ill COVID case that looks a lot like how they treat an MI or CVA case (Advanced Cardiac Life Support, Stroke Prootcol - both complicated with specific drug and imaging requirements.) 

So, I'm not ready to say, "treat COVID like any other URI. What I am ready to say is that you manage a shipboard COVID positive, unlike a URI, very aggressively with isolation of the positive(s), aggressive contract tracing and quarantine (note isolation and quarantine are different animals) until a diagnosis is confirmed or rejected by a molecular test (PCR and others - and I don't know for sure what RCL is using among molecular tests. It should be RT-PCR as this test is the most reliable diagnostic test but it also requires special and specific handling and processing in a Clinical Laboratory Improvement Amendments (CLIA) certified lab. That's a big deal.

Failing to aggressively manage a shipboard positive case just presents so many possible untoward outcomes that it just isn't worth the risk of less aggressive approaches and I don't think you're suggesting that. A no-kidding outbreak involving an older cohort could quickly overwhelm the ship's medical facility. A death aboard a cruise ship, during transport or immediately after admission to a hospital's COVID wing would quickly end cruising.   

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4 hours ago, Pooch said:

He was potentially positive and you tested negative and your first reaction was to run to the bar before they caught you???

I could see me dashing to the bar ? Gotta get your money’s worth out of that drink package! This wasn’t me BTW. It came from a Royal Facebook group

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21 hours ago, JeffB said:

Failing to aggressively manage a shipboard positive case just presents so many possible untoward outcomes that it just isn't worth the risk of less aggressive approaches and I don't think you're suggesting that. 

I kind of am (though I do agree that the risks of COVID are different from most other URI's for an immunologically naive person). The CDC doesn't recommend that vaccinated passengers who have been exposed to COVID quarantine, and even if you are unvaccinated but positive and asymptomatic the ability for you to infect another person who then succumbs to the disease over the span of the cruise is extraordinarily unlikely. I truly can't see a scenario where the ship's medical facilities would be overrun by people who were healthy when they boarded under typical circumstances. Perhaps special consideration is needed for cruises longer than 7 days, and for passengers above a certain age (vaccinated or not). In my mind, the only chance the cruise ship has to mitigate the negative effects of COVID is at embarkation... Once the ship is underway the focus should be on being able to administer lifesaving care (including the difficult and expensive decision to medevac someone).

I am almost positive the first serious COVID case onboard will be a vaccinated person over 65 who didn't have to be tested to board but was already edging toward showing symptoms. Nothing in the protocol as they are today can capture that, and to me that will present the biggest real risk as flu and cold season pick-up. I think we're letting this theater around catching positive asymptomatic cases distract us from the real bogey sitting just over the horizon. A ship's best chance at being able to deal with that are administering some of the medical interventions you highlighted, and promptly getting that person to shore. 

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Good stuff @LizzyBee23 thanks for posting that.

2 hours ago, LizzyBee23 said:

I think we're letting this theater around catching positive asymptomatic cases distract us from the real bogey sitting just over the horizon

 I'm not an alarmist by any measure but the increased transmissibility of the Deltas is a real factor in prolonging this thing. I see this circumstance as a bogey that is imminent and should be dealt with appropriately.  I still don't think we should or will see major and widespread restrictions to mobility and business activity but there will be inconvenient re-imposition of mitgation measures in places where vax rates are low or risks of transmission high..... indoors in congregate setting. It is not too hard to see the potential for SARS2 obtaining greater capacity to evade our immune systems, vaccines and therapies when it is left to percolate globally. See below:

Delta.thumb.PNG.72545556e2327d530c458d5f93035932.PNG

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So what does this mean vis-a-vis the questions about ship's COVID protocols and how strict or how lenient they should be? Right now, not only in the cruise industry wrt to protocols for handling COVID cases that show up as you described them - the 65yo who has been vaccinated, and who is just emerging as detectably COVID positive, is asymptomatic but is spreading virus particles - but everywhere. We are at a tipping point. The higher the global vax rate, the more quickly this thing ends and the less time SARS2 has an opportunity to mutate, become more transmissible or more lethal. At the level we are discussing this - the risk of COVID becoming wide spread aboard ship - because of the current mutations and the risks attendant to these, I still support a more aggressive COVID protocol  approach ..... for now. 

I have a subscription to the Economist. I just finished reading an incredibly interesting article that detailed exactly how mutations form and why the currently known mutations seem to grow in their capacity to be more transmissible. The article is pay-walled so I'll provide some takeaways:

SARS2 has demonstrated some unique properties in the way viruses mutate. These include multiple substitutions and deletions in a specific protein - the "spike proteins" that bind to ACE2 cells in bats and humans. Bats have many more ACE2 cells and that makes them a perfect reservoir for viral evolution to occur. Humans have relatively less ACE2 cells than bats but humans are still a good reservoir for mutations and that includes asymptomatic people who have been vaxed but get re-infected like the guest you describe. Has that guest been exposed to and been infected by a SARS2 variant that has an R(0) up to 8X more transmissible than the original SARS2? I'd be overly cautious with this guest.  

The good news is that SARS2 may have run out of places on the spike proteins to evolve. The point is made that the behavior of all viruses become limited by this phenomena. While SARS2 has demonstrated its capacity to evolve into more transmissible and potentially more lethal forms, like all viruses, they run out of room to evolve and eventually recede. At some point, this will happen. Right now, as I said, we're at a tipping point. For now, be aggressive.

In humans, the immune system also evolves when it encounters a new threat like SARS2. So, it's a battle that involves SARS2 becoming limited in it's ability to evolve and the human immune system continuing to get better at fighting it and surviving. In the end, humans win. That is a historical perspective that goes way back to when this sort of thing was first recorded and studied, the Bubonic Plague in the mid 1300s. Indeed, it takes a while for this to happen. We aren't there yet. Be aggressive.

 

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  • 2 weeks later...
On 7/2/2021 at 12:19 PM, Pooch said:

He was potentially positive and you tested negative and your first reaction was to run to the bar before they caught you???

Heck, I would need a stiff drink too. ? But it wasn’t Jill, just something she shared. 

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