The Culprit Behind the Cruise Ship Outbreaks: Norovirus

Recently, there have been many media reports on infection outbreaks on several cruise ships with tens—even hundreds—of guests having gastrointestinal symptoms and overwhelming onboard medical staff. Although these cases are still being investigated, it is widely believed that these outbreaks were due to norovirus.

Norovirus 101

Norovirus is a zoonotic virus that likely mutated so that it could spread to humans. It is mainly transmitted through food and water but also through close contact with others.

The most common symptoms of norovirus infection include vomiting, diarrhea, and stomach cramping. Symptoms can also include headache, fever, and chills and usually occur after one or two days of exposure. Severe cases can happen but they are very rare and usually only occur in people with high comorbidities.

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Although the symptoms of norovirus might seem severe, they are rarely fatal. (The Epoch Times)

What makes this virus unique is that its genetic information is packaged inside capsids, tough protein shells that have no membrane envelope. This structure prevents common disinfectants such as alcohol from having an effect. Such a shell also allows the virus to survive longer in the environment. This is why norovirus can spread so easily and is also highly contagious.

Norovirus is more common than one might think. It’s closely associated with symptoms of food poisoning and, according to the U.S. Centers for Disease Control and Prevention (CDC), is the leading cause of food-borne illnesses. This is why much of its prevention hinges on rinsing produce, as well as thoroughly cooking shellfish before consumption.

Instead of alcohol, people should use bleach to disinfect hard surfaces after use. Bleach is not the only disinfectant effective against norovirus but will always get the job done.

For people experiencing norovirus symptoms, keep in mind not to come into close contact with or prepare food for others, as the risk of spreading the disease is very high due to the sheer volume of virus (viral load) being replicated inside infected patients. Also, do not forget to wash your hands thoroughly with soap and water at the appropriate times.

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There are several ways to protect yourself against norovirus. (The Epoch Times)

It is important to remember that high viral loads are most commonly observed in stool and vomit, meaning that hand washing and disinfecting should be closely observed. However, there are still some misconceptions about this virus.

It’s Not a Cruise Ship Virus

Back in 2020, the Diamond Princess, a cruise ship with close to 3,000 people aboard, was held at the port in Yokohama and not allowed to dock. Passengers were forced to quarantine on board for at least 14 days, and the cruise ship made many headlines. Of course, that was due to COVID-19, not norovirus.

However, it scarred people with the impression that an outbreak on a cruise ship spells disaster. Cruise ships were implicitly associated with the chance of a disease outbreak after the media reported heavily on this pandemic phenomenon. Stories slowly simmered until recently, when there were outbreaks reported on four cruise ships.

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CDC vessel sanitation reports show that out of the four sanitized cruise ships, the only identified disease agent was norovirus. (The Epoch Times)

These outbreaks are believed to be caused by norovirus, but only the outbreak on the Arcadia cruise ship from P&O Cruises was confirmed to result from the virus spreading via food contamination. In other words, it was most likely food poisoning.

Although people sometimes call norovirus the “cruise ship virus,” the chances of getting norovirus on cruise ships are actually much lower compared to other settings.

For example, it is much more likely to get norovirus in a health care facility or restaurant when compared to a cruise ship. According to, the chance of getting norovirus on land is about one in 15. Meanwhile, the chance of getting norovirus on a cruise ship is about 1 in 5,500.

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The chance of getting norovirus is much lower than expected on a cruise ship compared with other places. (The Epoch Times)

Cases on the Rise

The number of suspected or confirmed norovirus outbreaks in the 2022–23 season so far is rising in the United States and is expected to be higher in the coming spring. There was a huge spike in norovirus outbreaks in the spring season of 2021–22. In the United Kingdom, norovirus cases spiked earlier compared with previous seasons and the numbers are still climbing.

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Norovirus outbreaks in the United States remain modest. (The Epoch Times)

Norovirus can evade our immune system protection through mutations of its capsid protein VP1. This makes it so host antibodies can’t effectively recognize the virus. Alternatively, the virus could have mutations that have altered its docking mechanism via histo-blood group antigens (HBGAs).

Additionally, if two strains of the virus infect a host cell at the same time, there may be a new, recombinant virus that emerges with characteristics from both strains. This makes the virus much less predictable, as it is much more prone to mutations.

There are efforts to develop vaccines against norovirus. However, the commercial drive for vaccine development for norovirus is not strong due to the unpredictability of small cluster outbreaks, not to mention the difficulty in identifying the target demographic.

Besides forcefully pushing for countermeasures, people should also think about what these repeated and unprecedented outbreaks mean for us. We have seen outbreaks of many viruses over the past few years, such as the avian flu, the swine flu, monkeypox, COVID, etc.

Viruses live in a dimension infinitesimally smaller than ours at a scale of nanometers, yet they have their own conditions in which they thrive and flourish. We talk about an ecological balance in nature, and this rule must somehow apply to the dimension of microorganisms such as bacteria and viruses.

A virus that invades others might be considered to be something that disrupts the ecological balance, a rogue organism with the intent to acquire available territory. However, for these organisms to thrive, they need access to an appropriate environment, which in people, translates as those with poor physical or mental health. Buddhism talks about the amount of karma someone has accumulated, which forms a field around a person. An accumulation of bad karma translates into dark energy, sickness, and poor health, which might be what’s taking place in our world right now. Pathogenic invaders are better able to propagate in a world weakened by negativity.

For example, a polluted water source will sicken people who drink from it, while a clean one that has gone through filtering in layers of earth will quench thirst and enliven its surroundings. On a microscopic level, what is allowing these pathogens to thrive? On the human level, it is believed mind and body are connected; surely there is something also beyond the physical world that is enabling these viruses to hit us with wave after wave of outbreaks.

Historically, an epidemic or even a pandemic served as an important sign for people to look inward and check for flaws or mistakes in behavior or thoughts. Yet people today have somehow become inept and indifferent to disease outbreaks, as they are labeled as unavoidable and not influenced by human behavior and thinking. This raises the question: Where is our ethical and spiritual civilization leading us?

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.

Dr. Xiaoxu Sean Lin is an assistant professor in the Biomedical Science Department at Feitian College in Middletown, N.Y. Dr. Lin is also a frequent analyst and commentator for Epoch Media Group, VOA, and RFA. He is a veteran who served as a U.S. Army microbiologist and also a member of Committee on the Present Danger: China.
Jacky Guan is a health writer based in New York.
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