Dip a COVID-cautious toe in cruise waters

We maintain a COVID-cautious* household as the third pandemic summer waxes. Where one member of our family is at high risk, we all choose to modify our daily behaviors to continue to protect him.

This is a cost of multi-generational living, though I find the personal and familial benefits of sharing our home with an elder abundant and easily justified. Since we can afford all the masks and testing we need, expending this trivial effort is well worth it. That’s the calculus in our home.Disposable surgical mask

Given our status, then, as “more careful than most,” it may surprise some that we plan to embark on a cruise with our teens in a little more than a month. Cruising, after all, gave the world its first widely reported COVID-19 super-spreader event.

Read a CDC research paper on the epidemiology of the Diamond Princess outbreak in February 2020 here.Cruise line booking page headlined 37 days before you leave with photos of Icelandic ports

There’s no doubt that the closed environment of a cruise ship offers a unique opportunity for certain germs to infect a captive audience of susceptible passengers. Many minds will leap immediately to norovirus. In truth, however, norovirus is common everywhere, but an outbreak is much more noticeable when a group of thousands travels en masse for seven or more days and management is required to track cases on board.

Similarly, though COVID-19 is definitively joining current passengers on cruise ships—in spite of requirements for vaccination and pre-embarkation testing—there is little evidence that the virus passes between personal staterooms via HVAC or other means. Actual contact tracing of ship-acquired infections, as on land, suggests spread directly from infected person to uninfected person.2012 Carnival cruise Saint John NB Canada - 3

The greater risk on a cruise comes from queuing to board or partake in activities, eating or drinking in common facilities, or from socializing with other guests. More bodies in close proximity invites more infections. It’s math, not a magical zone of infection brought on by taking a ship out to sea.

Why, then, if we remain vigilant and siloed on land, is my family setting sail?

Like many, the pandemic disrupted our travel plans in 2020. For us, the result was a Future Cruise Credit (a.k.a., an F.C.C.). Cruise Critic defines Future Cruise Credits here.

We could have requested a cash refund when COVID-19 kept us from our 2020 voyage between Copenhagen and Boston. Instead, we opted to gamble on the future solvency of Holland America Line (HAL) and took the F.C.C. instead. Part of my personal rationale was the simple desire to see HAL survive the economic hit of the sudden shutdown.

The major down side to any credit like this is the set of contingencies for spending it. Unless we wanted to argue over the details of the F.C.C. we’d accepted, we had to book a cruise before the end of 2022.Pile of money

Here’s the key to why my family is cruising this summer: we’re not all going. While our 2020 trip would have included a grandparent, our 2022 party consists only of parents and children. All of us are vaccinated, boosted, and at statistically low risk of COVID-19 complications if infected. Our high risk loved ones are not inclined to sail at this time.

For those of us embarking on a pandemic-era Holland America Line cruise, we are opting in based upon a few important understandings:

  • We realize that we will be taking a greater risk of catching COVID-19 than we do at home, but we have decided that this risk is worth the benefit of a relaxing vacation together with the reward of a chance to visit foreign destinations long on our wish list(s).
  • We prefer the risk of being cruise ship passengers over that of unmasked air travel for the summer of 2022, especially given recent frequent flight cancellations and spectacular, hours’ long delays reported at major airports worldwide. We don’t have to fly to get to our embarkation/debarkation port, and we won’t have to leave** our cabin once aboard a ship unless we want to.
  • We booked two staterooms for our party of four, and one of them is a suite° with an extra large balcony. This is more space than we have ever paid for in the past, but we believe we might prefer to remain mostly cloistered while at sea, depending upon COVID case rates when and where we sail. We decided we wouldn’t travel without private access to fresh air, i.e., a balcony.
  • We reserved an additional, extra-fee private outdoor space for this sailing—on HAL’s fleet, these are dubbed Cabanas, placed in a restricted access area called the Retreat, and, again, booking one is a first for us—so we will have a dedicated area beyond our cabins to spend time if case rates exceed our comfort thresholds.
  • We’re prepared to skip going ashore at early stops in easily reached ports close to home in order to increase the odds*** we stay healthy for visits to rare, “bucket list” destinations further afield.
  • We’re each packing extra amusements that will allow any one of us to spend days on end alone in a room, and I’ve beefed up the travel medicine kit.
  • And, perhaps most important of all, we are setting sail having decided in advance that even isolating in our staterooms—aside from accessing our cabana via the stairs, no elevators—would be “enough” vacation to make the entire trip worthwhile. Dining on room service and entertaining ourselves on a balcony at sea will be sufficient, if not ideal. If we also get to enjoy the rest of the ship’s public amenities, all the better.

Until our embarkation, we won’t really know which activities will or won’t meet our risk tolerance and feel worthwhile. This is a higher than usual level of uncertainty for me to embrace. I acknowledge I can be prone to anxiety; I’m better known for demanding control than going with the flow.2012 Carnival cruise Saint John NB Canada - 1

Living through a pandemic serves to remind me, though, that life is short, and opportunities not taken can be lost forever. We have educated ourselves about the current situation with the virus, and we’ve prepared as best we can for such unpleasant scenarios as believing the risk of infection too high to risk socializing aboard ship or catching COVID at sea.

My kids are growing up fast. One will be moving away from home for the first time in just a couple of months. I want to take us all on one more vacation before it becomes necessary to negotiate with yet another adult life and all its mature entanglements to get away together.Woman hugs child

COVID-19 stole from everyone: lives, time, opportunities… I can’t know for certain that our cruise will be smooth sailing, but, if my analysis is correct, it should be worth the risk.

* Since there is no universal definition for “being careful” with regards to COVID, I’ll post mine. Our household choices in June 2022 continue to include:

  • limiting time inside any building beyond our home with the exception of one child who goes to school/camp in person,
  • wearing masks indoors anywhere but at home,
  • requesting that all visitors or tradespeople entering our home wear a mask,
  • wearing masks outdoors where social distancing isn’t possible,
  • antigen testing the kid who attends school/camp every weekend before he spends one unmasked afternoon per week with his grandfather (otherwise, that kid masks around Grandpa),
  • antigen testing our occasional visitors before eating or drinking with them,
  • only eating or drinking with visitors to our home outdoors or at a distance of ~10+ feet indoors.

We use—and offer those entering our home—several styles of N95, KN94, and surgical masks to ensure all this masking is as efficacious as possible. Even within the family, our faces don’t fit the same masks well.

See the CDC epidemiology paper referenced in paragraph three. The following quote comes from the Discussion section of that report, and it matches what I’ve read elsewhere over the past two years following pandemic news coverage:

“Spatial clustering was not identified on a specific deck or zone, and transmission does not seem to have spread to neighboring cabins, implying that droplet or contact transmission to nearby cabins was not the major mode of infection. Risk of infection did increase with cabin occupancy, but a relatively small proportion of cases in the same cabin had >4 days between their onsets, implying a common source of infection. Beyond that, however, the major transmission routes might include a common source outside the cabin and aerosolized fomite or contact transmission across different deck levels.”

I feel it is only fair to disclose that we had only paid a deposit for a fraction of the total cost, not the full fare for our cancelled 2020 vacation. Wagering many thousands of dollars would have felt foolish to me in support of a corporation, but a few hundred was an amount I could afford to lose with equanimity.

In particular, I found the crew aboard my past HAL sailing to be simultaneously professional and amiable. Keeping this subsidiary of Carnival Corporation in the black seemed likely to keep more of these excellent employees on the payroll during a bleak time.

**Apart from the mandatory muster—or lifeboat—drill. Cruise ships rightly enforce the requirement that every person aboard learns what to do in the unlikely event of an emergency at sea. Due to COVID, these are now conducted with less crowding and standing around in large groups than they used to entail.

°This will be our first experience of the Holland America Line suite category NS, or a Neptune Suite. The corner aft NS we chose is known for its exceptionally large balcony that wraps around the side and back of the ship, offering seating with more likelihood of shade-, sun-, or wind- protection than a standard balcony would.

***Testing positive for COVID-19 aboard a ship means a passenger will be quarantined according to that ship’s specific procedures. On HAL, last I heard, quarantined passengers are required to move to a balcony stateroom in a reserved section of rooms set aside and dedicated to housing those with COVID. On other lines, passengers quarantine in the stateroom they originally booked. In most cases reported by Cruise Critic board members, partners are given the option to stay together or lodge apart assuming only one tests positive.

We aren’t sure what will happen if both parents test positive but the young adults don’t, but we’re ready to live with the consequences either way.

These policies could change at any time, however, and I have read anecdotal evidence of ships adjusting rules on the fly by necessity when more passengers require quarantine than there were dedicated cabins for the sick.

Season’s Greetings to all people of goodwill

Season’s Greetings to All!

I’d like to offer a Merry Christmas to everyone celebrating today, but also Warm Winter Wishes to the rest.Mom's idea of a restrained Xmas with dozens of gifts piled high under tall tree

I believe we all win when we give others the benefit of the doubt: if I tell you Happy Holidays instead of Merry Christmas, I don’t intend to denigrate your savior. Instead, I hope you recognize that my own beliefs differ, but you have my respect for your Joyeux Noël.

My favorite Christmas lyric is “peace to men of goodwill!” May this message find every reader safe, secure, feeling cozy and full of joy.

A December 23rd article in the New York Times informed me that for many—especially women, people aged 18-44, and independents or Republican voters with modest incomes—2021 might be the source of even more stress over the holidays than 2020.

So many are exhausted and demoralized.

I immediately sent a text to my sister-in-law upon reading that story. I thanked her for all that she does, especially when I’m on the other side of the country, and told her how grateful I am that she married into our family. What a delight to enjoy—and like!—one’s relatives.

It’s easy to overlook kindness when life feels hectic. Extending a hand to someone else is a surprisingly effective way to find one’s own balance.

Let someone know they are appreciated today, and perhaps you can ease some of that holiday stress afflicting a loved one or yourself. If your home is beautifully decorated or you’re dining in relative splendor, make sure whoever provided such bounty to you knows it matters.

And offer to do the tidying up if someone else arranges most of your holiday cheer! A shout out to my kids who washed all the dishes after our festive dinner last night.

For all that I am firmly aware of the rising caseload of the Omicrom variant, and the lingering specter of inflation punishing our pocketbooks, December of 2021 offers good news that I feel compelled to acknowledge. Let’s look at those sunny spots on the horizon.

Without being totally divorced from reality, it is definitive that we are seeing some of the highest daily COVID-19 case rates of the entire pandemic. I agree that this sucks! Omicrom is a rip-roarin’ beast of infection; it’s many times more infectious than Delta, which superseded those original strains of SARS-CoV-2 from early 2020.

In spite of that ugly, hospital-cramming fact, the amazing step forward of mRNA vaccinations means that the novel coronavirus is now, finally, actually only approaching the flu in terms of order of magnitude of lethality.

According to David Leonhardt’s Dec. 23rd article in the New York Times, here’s some hard data on the current degree of risk from COVID-19:

The risks here for older people are frightening: A rate of 0.45 percent, for instance, translates into roughly a 1 in 220 chance of death for a vaccinated 75-year-old woman who contracts Covid.

You’ll want to view the article to see its excellent graphs to get the fullest picture.
That is frightening, but what about when we consider other common ailments? From the same article:

One reassuring comparison is to a normal seasonal flu. The average death rate among Americans over age 65 who contract the flu has ranged between 1 in 75 and 1 in 160 in recent years, according to the C.D.C.

Until I read this story, I wasn’t aware that COVID-19 has become, for a vaccinated senior citizen, less deadly than an average flu. What a powerfully reassuring data point! I find this a reason for great hope.

bandage on upper arm

Before I go on, allow me to make obvious this other point: the unvaccinated are not nearly so safe. COVID-19 is much deadlier for the unvaccinated than flu is.

The last flu outbreak to kill millions, plural, was the “Asian flu” of the mid-1950’s, with a total death count estimated around 2 million souls worldwide.

An otherwise similar unvaccinated elderly woman is 13 times more likely to die of COVID than the vaccinated hypothetical person above. There remains a much, much higher probability of death for that unvaccinated 75 year old woman than she would face in a typical flu season.

COVID-19 leaped onto the charts as the third leading cause of death for Americans in 2020, and the elderly bear the brunt of this burden. We lost 1.8 years of life expectancy last year; that’s the worst decline in over 70 years, since WWII saw so many killed between 1942-43.

It is wonderful that we’re moving toward taming the novel coronavirus from killer of millions to “only” fatal to hundreds of thousands. While not enough, that is good, and it should be appreciated…when it actually happens.

As of November 22, we’d lost more Americans in 2021 than we did in 2020. No one should ever forget that.

Yet savor the positive news as much as you dwell on the negative and your life will be better. If you are fortunate enough to have been vaccinated, your personal risk now pales compared to those who’ve mostly been tricked out of taking a life-saving inoculation

happy face smile
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In addition to the lifesaving wonder of vaccines that measurably reduce deaths amongst our most vulnerable population, we’ve also seen two new drugs approved as treatment options for COVID-19 in the USA this week. Where the latest variant has rendered ineffective some of our most effective earlier therapies, these new treatments arrive just in time.

They could also save us a lot of money.

To have new treatments people can self-administer at home—thus sparing exhausted, overburdened hospital staff while our total case numbers reach record heights—is another blessing. It’s hard for me to quantify how much I would prefer to pick up a prescription from my local pharmacy for a few days’ worth of pills if I had COVID over making repeated visits to a hospital or clinic.

The antiviral COVID pills from Pfizer and Merck will initially cost the federal government around $700 per dose. This represents an enormous savings spread over millions of doses vs. pricier monoclonal antibody treatments all of which cost $1200 or more at the heavily discounted government bulk purchase rate.Pile of money
Patients will also be spared unpredictable fees for visiting those staffed locations necessary to administer IV therapies. In an era of high inflation—and personally facing a mandatory switch to a new health insurance plan from a different provider starting January 1st—I find this a great relief.

I’ve never had a confusing or even shocking bill after visiting a pharmacy, unlike every time I’ve been a patient at a hospital. Reflecting on the fact that I’m so incredibly privileged that I’ve never had a gap* in my insurance coverage, it seems likely that others fear surprise bills far more than I do.

The pandemic isn’t over. Thoughtful individuals should still be wearing masks and making efforts to improve ventilation while meeting with those outside their households. That said, we understand more than ever about how COVID-19 spreads. Many of us are vaccinated, thus protected against the worst outcomes of the disease. Available treatments have expanded from desperate guesses to multiple effective therapeutics.

This ugly, lonely, uncomfortable period in history will end, though those of us who’ve lived through it may well spend the rest of our lives processing the experience. For example, many of us grew up with grandparents whose behavior was permanently affected by surviving the Great Depression.

Right now, on Christmas Day, 2021, I encourage you to look for the positive anywhere you can. Experiencing terrible events isn’t the only predictor of future suffering; so is how one responds to those challenges, and what one makes with the memories.

Things could be better, but, of course, they could also be worse. Having made it to my father’s house and remained in good health in spite of the journey, I find so much to celebrate this year.

May all these little celebrations be less fraught in 2022.

Wishing every reader good health, good cheer, and a large measure of optimism for the year ahead!

It was a painfully frustrating message replete with disinformation from an old friend the other day that prompted me to research and think about these comparisons. For the vaccinated, COVID may now be similar to a “mere” flu; for the unvaccinated elderly, endemic COVID-19 is still a virulent threat to be taken seriously.

Publicly available data makes all of this very clear. In 2020, 3 million people died from COVID-19. In a usual year, flu kills between 290,000 and 650,000 around the world. No math degree is required to calculate that somewhere in the ballpark of four to 10 times as many deaths occurred in 2020 than we would have expected from “mere” influenza.

The two most commonly prescribed antibody treatments, those made by Eli Lilly and Regeneron, don’t work against the Omicrom variant. Only GlaxoSmithKline’s sotrovimab—the most recently approved monoclonal antibody therapy—offers protection from Omicrom. These therapies cost thousands of dollars per dose (retail of ~$3000-5000 according to this news story, though other sources state that the federal government bought in bulk for $2100 per Regeneron dose and $1250 each for Eli Lily’s) and are administered intravenously, requiring a trained health care professional’s presence for every dose.

*Though the Affordable Care Act has led to a major increase in how many Americans have health insurance at any given time, in 2020, 9.5% had some coverage but also experienced a “gap” in continuous care, whereas another 12.5% remained completely uninsured.