I was most fortunate to have the opportunity to join several friends on a vacation at the end of January.  The thought of several days in the sun and warmth far far away from the cold and blustery Michigan weather was something I had been looking forward to for several months—the promise of great food, entertainment, and plenty of on- and off-ship activities.

It’s important to understand that as a swine vet, it’s quite possible that I may notice some things that others may not. The first thing I became aware of immediately upon boarding the ship was that probably more than half of the 4,000 individuals on board could be classified as geriatric. The second thing I learned was that essentially, once the gang ramp is lifted, with the exception of the entertainers, we were all trapped… there were no new entrants, and nobody was leaving the ship. After hearing a few coughs and sniffles indicating the potential for influenza or other respiratory virus on board, and knowing that norovirus, a nasty gastrointestinal (GI) bug, can spread quickly on cruise ships, and having a sense that a large percentage of my co-inhabitants were likely susceptible to contracting any type of virus simply due to their age, I was interested to know whether the cruise ship had established practices that aimed to minimize spread from person to person. Do you see how my mind works?  To me, this scenario isn’t much different than trying to prevent the transfer (biocontainment) of a respiratory or GI virus in swine facilities. 

A few years ago, when porcine epidemic diarrhea virus (PEDv) first impacted our industry, I began working with Melissa Millerick-May, an industrial hygienist/exposure scientist who’s research is focused on minimizing human and animal exposures to environmental contaminants including viruses and bacteria with an aim to prevent the development of disease. In speaking with her, she often talks about how small changes in behavior (think management routines), often at little-to-no cost, can make a huge impact in terms of preventing illness, which often results in significant cost savings.  She describes the most difficult task is to convince or ‘train’ a person to change a particular practice or way of working in a way that stops the ‘spread’ of contaminant, but she notes that once the change is made, the individual finds it to have been relatively easy. 

In the 1960’s, Dr. Maxwell Maltz reported that it only takes 21 days of changing a behavior to form a new ‘habit’. The actual ‘number of days’ has been debated throughout the years, but I can tell you from my experience on the cruise that when it comes to preventing the spread of pathogen amongst passengers, the staff whipped-us into ship-shape within a very short time period. How did they do this?

Eliminating spread via control of food consumption For the most part, what and where we ate was a tightly controlled operation. Food consumption was primarily contained within designated dining areas. Except for paper cups, there were no take-away containers, only real plates and cutlery, and the presentation of food was beautiful, such that guests felt it was a ‘privilege’ to be afforded such a nice dining experience.

Minimization of pathogen spread Bacteria and viruses are often transferred from person to person or person to ‘item’ by contamination of the hands. Considering this, there was essentially an ‘enforced’ disinfection protocol on-board the ship. Prior to entering the dining rooms, salons, fitness room, and even the elevators, there were hand disinfectant (Purell) stations that dispense copious amounts of antiseptic onto each guest’s hands. Very quickly, we became aware that if we wanted to eat, we had to disinfect our hands first. There were two lines formed for entry into the dining hall with a Purell station located at the head of each line. If you did not use the Purell, there was a person who ran over to you and squirted some in your hand. To avoid the insult of being chased down by a Purell Enforcer, people adopted the Pavlovian ‘habit’ of using the dispensers each and every time they came into view of a Purell station.

Perhaps due to these behavior changes, the inhabitants remained healthy. I did not hear coughing, sneezing, or reports of nausea—other than some upright and jerky movements in the disco.

The rest of the United States was not so fortunate. The 2017–2018 season has seen the highest levels of influenza-like illness (ILI) cases since 2009. In the same week that we were enjoying balmy breezes and drinking lemon drops (yummy), the ILI activity for most of the states was ranked high. 

The point behind this story: I have converted to the Millerick-May choir, that controlling pathogens should be “at the source.” With Melissa’s knowledge, adoption of training, and just a few changes in human behavior, we can bio-contain virus and bacteria before they spread. 

 Let’s get on the love boat of reducing pathogens.