This is a sick way to spend your vacation

eAlisa /
eAlisa /

What’s worse than being stricken with stomach flu on vacation? Maybe it’s being quarantined on a cruise ship with hundreds of other passengers suffering from the same illness.

That’s what happened to Randy Fulp when he sailed to Mexico with a group of friends on the Caribbean Princess in January. An appraiser from Sacramento, Fulp is a seasoned cruiser and knows the risk of getting sick, particularly at this time of year. Cruise ships are on high alert for sightings of the Norwalk virus, also known as the norovirus or stomach flu, a highly contagious gastrointestinal illness.

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Still, on the third day of their vacation, Fulp’s wife, Peggy, became violently ill. “She started vomiting and having diarrhea,” he says. “It was uncontrollable.”

His cousin’s wife was even unluckier. Overcome with the same sickness while on a shore excursion, she sprinted back to the ship. “She didn’t make it to her cabin before she vomited,” Fulp recalls. “Two crew members yelled at her to get to her cabin, which she was trying to do as fast as possible.”

Although shipwide outbreaks are relatively common in the cruise industry, this year is off to an unusually aggressive start. There have been three high-profile incidents, according to the Centers for Disease Control and Prevention: Fulp’s Caribbean Princess episode, a relatively minor outbreak that affected 181 of 3,102 passengers; an outbreak on Norwegian Cruise Lines’ Star, which affected 130 of 2,318 passengers, roughly the same percentage as on the Caribbean Princess; and one on Royal Caribbean’s Explorer of the Seas, which infected 634 of 3,071 passengers and was so severe that it earned the ship the nickname “Exploder of the Seas.”

In a further twist, the CDC also reported that the gastrointestinal virus on the Explorer of the Seas, which it identified as the GII.4 Sydney strain, was relatively new.

Amid these outbreaks, which often happen in the glare of the media spotlight, several questions have emerged about such diseased cruises. Who’s to blame for them? What are passengers owed when half a ship is quarantined? And can an infection be prevented?

It seems that the only absolutely certain way to stay uninfected is to stay home. There’s no vaccine to protect you from norovirus, and simply applying a dab of antibacterial gel before eating at the buffet won’t cut it, say experts. Washing your hands frequently with soap and warm water and minding what you touch can help prevent an infection, but it’s no guarantee.

“It goes back to the adage our parents and teachers drummed into us,” says Susan Rehm, vice chairman of the Cleveland Clinic’s Department of Infectious Disease. “Wash your hands and keep them away from your face.”

Cruise insiders insist that the odds of getting sick are negligible. “Infection rates are very low when compared to rates on land,” says Mike McGarry, a spokesman for the Cruise Lines International Association (CLIA), a trade association for the cruise industry.

Last year, the CDC reported only seven confirmed norovirus outbreaks, which came to just 1,238 total afflicted passengers worldwide, or 0.0059 percent of 21 million cruise passengers. In 2012, the agency reported 16 norovirus outbreaks on ships.

“No industry nor facility is as tightly regulated as the cruise industry,” says Stewart Chiron, who writes a blog called The Cruise Guy. He says that the media fixation on cruise ship outbreaks distorts the truth, which is that just a fraction of passengers is infected by a gastrointestinal virus. “Media like the cruise industry because it’s very visual and attracts viewers, listeners and readers,” he notes.

Critics take a different view. They claim that the risk of an infection is real and that cruise lines too often play it down. Kendall Carver, chairman of the International Cruise Victims Association, says that despite industry promises that it’s able to screen passengers for gastrointestinal illnesses and promises to sanitize ships after each outbreak, it can’t seem to control the contagion. “As the ships get bigger and bigger, the chance of an outbreak happening multiplies tremendously,” adds Carver. “It’s only going to get worse.”

The cruise industry, led by CLIA, last year adopted a voluntary 10-point passenger “bill of rights,” which spelled out travelers’ right to compensation under certain circumstances, such as a mechanical failure. But the bill doesn’t specifically address a norovirus outbreak, leaving it up to a cruise line to determine how to address the inevitable complaints that arise from passengers who are infected on their vacation.

The bigger the outbreak, the better your chances of securing a more generous compensation package. For example, Royal Caribbean offered passengers on the Explorer of the Seas a 50 percent refund and a 50 percent future cruise certificate in the amount of the cruise fare paid for the sailing, according to cruise line spokeswoman Cynthia Martinez.

Fulp says that Princess issued him a credit for his port fees in Belize, which came to about $100 per person, and a 20 percent future cruise credit.

Jim Walker, a maritime attorney based in Miami, says that there’s a reason cruise lines pay up only when news helicopters are circling their ships as they pull into port. They constantly suggest that their passengers are to blame for the outbreaks. A review of the recent CDC reports shows that the CDC never conclusively determines how and where the virus comes onto the ship, which cruise lines interpret as an exoneration of their sanitary practices, he says.

“The ship has enhanced cleaning for a few hours and then sets sail again,” Walker says. “The cruise line accuses the passengers of bringing the virus aboard. Repeat cycle.”

You don’t have to get sick to see things his way. Stephen O’Brien, a bus supervisor from Dublin, was a passenger on the Explorer of the Seas, and although he didn’t become ill, he watched as the GII.4 Sydney strain turned the vessel into a “ghost ship.” On his level, one of every six staterooms had a yellow quarantine sticker, indicating an infection. He has no evidence for it, but he thinks that the cruise line didn’t sanitize the vessel thoroughly enough before the start of the cruise, and he holds Royal Caribbean responsible for the ensuing outbreak.

“Could things have been handled better?” he asks. “Maybe.”

That appears to be the consensus among passengers who have sailed on an infected cruise: Whatever a cruise line may have done to help passengers felled by stomach flu, they expected more. Fulp, for his part, has a long list of disappointments, from missed shore excursions to the $115 the ship charged for an “in cabin” visit by a doctor. His cousin rejected any compensation and will never set foot on another cruise.

Fulp is having second thoughts about taking another cruise, too. He and his wife are trying to get a refund for another sailing scheduled for later this year.

The argument about who’s responsible for norovirus or how much compensation passengers deserve may never be settled. But here’s one thing everyone can agree on: Spending most of your cruise doubled over in pain is no way to vacation.

Who's ultimately responsible for the norovirus outbreaks?

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51 thoughts on “This is a sick way to spend your vacation

  1. sorry but in terms of “the company gives you a product and you use it” – rule I have ti side with the OP.

    usually (such as if this was about an airline) i would say “well they got to their destination, right?”

    but when you take a cruise you pay for the positive experience of taking a cruise.

    1. I agree – by plane, the goal is to reach a destination, the trip is a way to accomplish it. In a ship, the goal is to enjoy the trip, the destination doesn’t matter, even because you usually return to the departing point 😉

  2. IMHO, the poll is like asking which came first, the chicken or the egg. On my last cruise, I found the crew constantly cleaning. I also found passengers, using sanitizer that was found throughout the ship. BUT, I still saw people not covering their mouths when they coughed, not washing their hands before leaving the restroom, snorting into their hands after swimming when still in the pool. You can clean all you want, but if people don’t take measures to be as clean as possible, we can’t be surprised that in close quarters illnesses show up. My grandparents generation grew up with children dying of childhood diseases and medicines that didn’t exist as they do today. They took more precautions with their health than I see people doing today.

    1. That’s a bit generous. People before penicillin typically died. You didn’t have “weaker” people surviving past their ailments. Look at the flu epidemic. Therefore, hardier people lived longer and those with more compromised immune systems died.

      You know the single largest killer in WWI and before? Spread of Disease.

  3. There are a few scientific ways to determine whether a passenger brought the virus onboard, or whether the virus was there all along.

    1. Does the genetic code of the virus differ from one cruise to the next? If so, then a passenger probably brought it onboard. If not, that virus was almost certainly already on the ship.

    2. Does the crew get sick from it at generally the same infection rate as the passengers? If so, a passenger probably brought it onboard. If not, it’s likely that many of the crew are already immune to that particular virus meaning it’s been onboard for a while.

    1. My understanding from an inside at RCCL is that they were able to determine which person had brought the infection onboard because it was such an unusual strain. How they did it, I don’t know.

    2. I’m not sure the cruise industry WANTS to know. The way it is now, they can set the level of compensation to their liking. If it turns out THEY are to blame, they’re going to have to give cash refunds to everybody affected.

      If I were the cruise industry, I’d rather not know. That way I can have plausible deniability and keep control of the compensation issue.

      1. The CDC has to clear each ship before it sails again – and in either case, they are not legally bound to refund you because you got ill – just like a hotel, resort, airline, etc doesn’t

  4. The answer to the survey is “neither”. It’s a virus. If you read up about norovirus in particular (especially this latest strain), it’s a nasty one. Unlike most viruses, is especially hardy in open-air, sometimes persisting on surfaces for days. The only sure way to kill it is vigorous scrubbing with bleach. The idea that after each and every single cruise each and every single surface in the entire ship that a passenger might touch can be cleaned is unreasonable. We would never require that a hotel or nursing home scrub every single surface from top to bottom once a week, and hotels, schools, and nursing homes are responsible for more noro cases annually than cruise ships; you just don’t hear about them because the total size of the outbreak is smaller. (If you ever hear of a “stomach bug” going around over the course of a week or two, it’s probably noro.)

    And yes, it’s more likely to be passengers bringing it on-board. The crew simply has very little opportunity to leave the ship; they get, at best, a few hours in port once a week. It’s a lot more likely that a passenger will come on-board shedding the virus (it continues to shed after symptoms cease) or they’ll pick it up during their journey to the ship. That doesn’t mean the passengers are evil, gross, people, it’s just a difficult virus to avoid getting and avoid spreading once you have it, no matter how much you wash. (As in, you use an airport restroom after an infected traveler did and pick up the virus from the lever on the paper towel dispenser, sink knob, or maybe the change you got back at the airport food court or the back of the chair you pulled out to sit down.)

  5. Close Quarters: Close Quarters: Close Quarters.

    A single infected person can turn a simple illness into an epidemic. Look at the Flu. Every year, the CDC publishes a map of the Flu Outbreak. In no time, the virus has crisscrossed the United States, infections millions.

    Moral of the story: Even the best sanitation process can’t negate personal responsibility.

    Cruise lines and passengers both share a responsibility. Passengers appearing sick need be denied boarding. Cruise lines need to make sure efforts to decontaminate a ship are done sufficiently.

    1. It would help a lot if pax who are too sick to fly and to cruise are not forced to board anyway or lose the cost of their entire trip. If you just had noro, you remain infectious for several days.

      1. Agreed. If a passenger has a doctor’s note substantiating their contagious, a full refund or unrestrictive for a future trip of equal value is in short order.

        Sick passengers end up costing more in the long run.

        1. Doctor’s notes weren’t always truthful so the carriers adjusted their policies. So we have lying past passenger to thank for the restrictive rules.

          1. No system is 100 percent. However, better to be a bit overly generous than to board contagious passengers.
            Law of numbers seems to say that allowing a few slip through the cracks is cheaper than the consequences. Consider 600 out of 3000 people sick.

            50% refunds + 50% voucher to 3000. We’re talking millions lost. Losing a few thousand is quite a bit cheaper than allow epidemics. Not going to prevent all spread but will aid in the process.

          2. I am not defending, I am saying that vendors use to be more lenient but thanks to lying passengers and their false doctors notes, vendors had to tighten things up.

  6. Have to disagree with @sirwired, but it’s “both”.

    Cruise lines need to shut down long enough between cruises to properly disinfect their ships. Passengers need to stay home if they are sick or in their cabins if they become sick. Alcohol-based disinfectants aren’t sufficient, as some merely move the virus around; good hand-washing helps a great deal, but also isn’t a perfect cure-all.

    I used to be the camp director for a scout camp where we had 250+ people in and out of the buildings, and especially the pool, every single week. You simply would not believe the number of parents who sent their child to camp sick because “this is the only week they can go” and “they need to earn *this* badge on *this* timetable”. Funny, though – a child can’t earn any badge related to swimming after he pollutes it (to put it mildly) and the pool needs to be drained and refilled.

    1. Again, requiring a top-to-bottom disinfection between every single cruise is unreasonable. A complete disinfection takes about two DAYS, and is well in excess of any required measures on land at facilities susceptible to noro. The cost of such a requirement would be well in excess of the benefit; noro, for all the misery it causes, is not particularly dangerous.

      If a scout came down with noro at your camp, did you keep the staff away from their day off to swap each and every mattress with bleach, disinfect every seat in the dining hall, etc.?

      (And did you really drain the pool every time some kid lost it? I thought the standard for pools was to shut it down long enough to “shock” it… doesn’t a drain and refill of a standard-size lap pool take days?)

      1. Wasn’t ignoring you – just too busy with non-Elliott stuff. 🙂

        No mattresses at camp – it was all tent camping. Scouts wiped their own tables and chairs and then staff went through with the sanitizing solution after every meal. We also hosed down the changing areas and bathrooms daily with a sanitizing solution.

        We had an incredibly antique pool, so sometimes shocking the pool was problematic. If the pollutant was fecal or vomit, we skimmed it as best as we could, flushed the filters, drained the pool down a couple of feet, flushed the filters some more, shocked it, tested it, added more water, tested it etc. That took a full day. Word traveled very quickly in camp whenever “something” was in the pool, so we had to be very publicly active with cleaning out the pool.

        We also sent the sick scout home. Parents were very unhappy when I did that. I once had a parent become so angry with me for having to come pick up his son that I had to call the local sheriff. The man took out his anger by slicing his son’s tent to pieces.

  7. I wonder why you do not hear of this virus on LAND — just on ships. Does anyone know? I see people all the time (I work in theater) who do not wash their hands — I tell them about it before they leave the rest room. My policy is to TOUCH nothing where a public toilet is located. Open the door to the room with paper towel (carry in pocket) touch nothing while in there unless you have your hands covered — same with the sink, etc. I know people laugh at me for my “germophobia” but
    I have not had even a COLD in 30 years.

    1. It’s on land. My mother’s senior care facility has a lot of it going around right now. It also appears periodically in the schools, especially in the winter, and school is closed for a couple of days while everything gets bleached and disinfected. The latter makes the news. The former is “just how it is”.

    2. I got it either at the airport (where i worked a full shift) or on a plane on Christmas Day. Within 24 hours I was sicker than I’ve been in years, possibly a decade. Based on all the news reports and symptoms, this is what I had.
      I’m going on a cruise in less than 2 weeks, and I’m very nervous (was on another cruise years ago with a friend who contracted Noro…wasn’t pretty) but I’ll take as many precautions as I can, knowing that I’m exposed plenty before I ever get on the ship.

    3. You do, but most complain of a stomach virus going around. Since ships, by law, have to have their actual numbers in place, the media jumps on every case. Couple years back, DisneyWorld even closed down a day due to this – no big stink made about that. And remember, these same folks are onboard for several days, plenty of time to spread that infection around to others.

  8. Two thousand plus passengers plus a thousand or so crew members in a closed system for a long enough time for multiple sequential disease transmissions means one case will amplify into an “outbreak” really easily. The fault is having cruise ships in the first place.

    1. And planes – hotels – museums – theme parks – senior facilities – schools. Ridiculous argument there. This breaks out everywhere, NOT just on ships.

  9. Funny how an aircraft carrier can be out to sea for 8 months with about 6,000 people onboard crammed into tight berthing (sleeping) spaces…and yet, this kind of outbreak doesn’t happen.

    1. That’s a terrific point. I served in the Navy from ’69 to”77… on the Coral Sea, CVA-43 and Gridley, DLG-21, and never saw this kind of sickness. Maybe we sailors were just more hygienic than your average cruise ship passenger. (snerk, choke…) 🙂

    2. Noro doesn’t spontaneously generate. Cruise ships have a complete rotation of thousands of passengers every week, and it gets on-board when one of those passengers comes on infected. As long as none of the 8k sailors on a carrier bring such an illness on-board when they leave port, the ship will stay healthy.

  10. I agree with Bodega, passengers and cruiselines share responsibility equally. Ships are not particularly clean and some cruisers are slobs. One way to combat the problem is to require a full 24 hours between disembarkation and the new passengers for a complete cleaning of everything on the ship. This will not happen until we all stop cruising. With the sicknesses, the ships adrift for days with mechanical (read poor maintenance) issues, among other problems, it will be a long time before I even think about a cruise.

  11. I haven’t yet been on a cruise where I do not see people using the bathroom and not washing their hands. I notice this wherever I am using a public rest room. I commend NCL because their staff actually chases people down going into the buffet with hand sanitizer and I see how many people don’t use that too.

    I believe the cruise lines could lessen the spread of this if they did not allow passengers to handle the serving pieces at the buffet. High end cruise lines have staff that are behind the buffet with gloves on that distribute food. As long as you allow passengers to handle serving tools and touching things with their bare hands, such as bread, you will see this happen on occasion. I blame the passengers AND the cruise lines.

    1. That is your choice. Please don’t make your decisions on some Chicken Little story. There are scores of cruises each week throughout the world that are just fine.

      1. Thank you for your response. I also have noted that the cruise lines aren’t very good at controlling smoking in non smoking areas and doing incredibly preposterous things like allowing smoking on balconies. Why on earth would someone pay extra to have a balcony where they can enjoy the open sea air and instead get inundated with smoke? Taking that and the food issues into account, it really doesn’t seem that health is something they are concerned about. When a hotel does stupid things like that, you can move. Not so with a cruise ship.

        1. Agreed on the rules but you know them before you book. So you not going on one makes sense. I’ve taken my chances and other than one time, had nobody smoking on their balcony. But when it happened, I knew it was a possibility and just dealt with it. I did want to buy him a more quality cigar though, lol.

          1. I don’t like to go “looking for trouble”. If I know that an industry or company doesn’t do something well, I stay away from them. I use companies that do a good job – and generally they do.

          2. Well, I am not going to “stay home”, but I most certainly wont’ be going on a cruise in the foreseeable future.

        2. For someone who hasn’t cruised you seem to have it all wrapped up on how things go. If you don’t wish to cruise, that is fine, but don’t make statements on things you don’t know about or experienced. Many cruise lines do not allow smoking on balconies. I have watched ships being cleaned while on board as a passenger and while doing site inspections. They take all this very seriously.

          1. But I do know people who have cruised and I know them very well. Most cruise lines are quite adept at sucking extra money from people at every turn. Certainly the food issue and cleanliness issue is not rare. I understand they don’t pay their employees very well. The sources I know haven’t cruised on every ship out there but certainly on the ships they’ve been on, smoking has been an issue quite frequently. I have good sources and I believe them. Besides which, from what I have seen, most people in the hospitality industry seem more willing to cut off their right arm than approach a smoker who is puffing where they should not. As far as I am concerned, there is not much good to say about this industry. Cruising the open seas on a ship should be a pleasant experience.

          2. You are right, a cruise should be a pleasant experience and you are also right that you shouldn’t ever try one. Listen to the negatives by your friends, keep that 1/2 empty glass in front of you and stay away from cruising. It isn’t for you.

          3. My glass is pretty much full, and I have, for the most part, wonderful and stress free experiences since I don’t deal with cruise lines nor (for the most part) travel agents. Although I did just book a conference, and unfortunately, the conference travel agent has to book the rooms. Hope they don’t screw it up as badly as last time it was done. (and seriously, they did screw it up).

  12. The Puuuuuke Boat.
    Soon you’ll having a case of runs.
    The Puke Boat.
    There’s a disease for most everyone.
    We’ll set a course for the bathroom,
    Our butt’s on the porcelain queen.

  13. Whoever brings the virus on board was exposed to it 48-72 hours before they have symptoms and become ill. That could be passengers or crew who were exposed. Since the illness takes a bit of time to develop it is hard to say where it came from. The big issue is the next cruise and that is a test of how well the ship is cleaned—including crew quarters. And sanitizing must take place on a daily basis in any place people congregate—–be it a cruise ship, a university dorm or a hospital. (My niece’s dorm was quarantined for it last year and a UK Hospital was closed to all but essential people when the virus spread through it in January.)
    It is hard to answer the poll question today—unless we know exactly who brought the virus on board with them.

  14. It is an easy answer. Since the cruise ships can’t biologically control it, the passengers wan’t cancel and lose their money, the crew can’t miss their work, then JUST DON”T CRUISE! The bigger they are, the more you will get sick.

  15. I went back and looked at what I think is Chris’s original source (same one used by Ned Levi on Consumer Traveler one of Chris’s sister sites).

    Here’s the facts … Most outbreaks were confined to the passenger population and the number of crew members infected were orders of magnitude lower than the passengers. Given the cramped crew conditions you would assume the opposite. The key difference is that the crew is instructed to go to medical at the first signs of infection and they are segregated (quarantined) to make sure that they don’t spread the infection to others (something that passengers don’t do). From what friends have told me, the Navy does the same thing and they have the advantage of staying at sea with the same group for extended periods of time.

    I also noticed that you don’t see serial infections. They tend to be limited to one cruise. That points to passengers bringing the illness on board with them. The illness leaves when they do. The cruise line’s cleaning program gets it under control between boardings.

    For those that think these infections don’t happen on land, guess again. My wife is a teacher, I’ve lost count of the number of times “the stomach flu” has gone through her building. The good news is these tend to be self-limiting because people stay home and, in effect, quarantine themselves.

    So, its passengers that bring it on board. Cruise lines really can’t stop passengers from lying on their health screening questionnaires. Oh course, why would a passenger acknowledge not feeling well and risk being denied boarding at the same time. Ultimately, all of these boil down to someone boarding with the “stomach flu” and spreading it around. That one passenger is to blame.

    I think the ultimate answer if the cruise line’s want to stop it is either, 100% screening prior to the cruise (unlikely) or opting to refund passengers denied boarding by the cruise doctors. Sorry, as Greg House used to say, “Everybody lies” and notes from your personal doctor can be used for your insurance policy (same reason why airlines stopped taking them).

  16. There is no way the ship crew can sanitize all surfaces often enough. Don’t like it? Don’t cruise. Consider your own resistance. I think who gets sick depends more upon individual resistance than on exposure. I would like to know how many cruise ship norovirus victims are elderly or have other health issues.
    For decades, I worked in a large Social Security office that was downtown in a major northeastern city (meaning that the city had severe winters). Because of the SSI program, we mostly interviewed the wretched of the earth: the homeless, prisoners getting out of jail, inmates getting out of mental hospitals, etc. I was not good at washing my hands after shaking hands or after they borrowed my pen (except when they had active TB!). Then I took the subway home, hanging on to a pole. I did get colds and sore throats a lot, but I never had a stomach problem.
    If you cruise, don’t touch ANYTHING. Tip: to avoid having to touch stair rails, use the elevators. Then press the button with your knuckle, not your fingertip. Get your exercise some other way. You must use the elevators, because if you use the stairs, you MUST use the handrail. This is a ship! A face plant down the stairs can ruin your trip faster than norovirus.
    In any sea state but a flat calm, the occasional larger wave can move the ship just enough to pitch you down the stairs. Even in a flat calm sea, the possibility of ship maneuvers requires “one hand for the ship, one hand for yourself.” I was on a ship in a calm sea that had to make an emergency turn to avoid a hazard to navigation. A large channel buoy had broken its mooring and could have punched a hole in our hull. These buoys weigh tons. Because of the sudden turn, the ship heeled enough to send dinner plates onto the deck.

    1. I never take elevators on a ship and I never touch ship rails with my bare hands. I never touch rails on escalators, either. I keep clean tissue in my pocket and will use that if I have to touch and I keep santi-wipes with me at all times. I use gloves when I ride a bus in the city, but I try to walk when possible. On our most recent cruise, I found the crew constantly wiping down railings, elevator buttons, door knobs….just like we do at home. Keep your hands and fingers away from your eyes and nose, always! Wash your hands frequently. On a cruise, we each take our own hand towel and don’t use the others. We get them replaced twice a day when our rooms get refreshed. Lots of people had colds on our last cruise, but we managed to keep healthy.

      1. To bodega3: Good for you! Don’t forget to wipe the keys of the keyboard in the ship’s computer center.
        I still think that at least older passengers should not use the stairs on ships. On our last ship, the Oceania Marina, the main stairs had such thick and soft carpeting and such narrow stair treads (because of the thick carpeting) that they would have caused an unstable stair descent in a building on land.
        For many, stairs are no longer option at all (your turn and mine will come). I hope they and all others who use the elevators will heed my advice about using the knuckle to push the button. I first saw that being done by a doctor or other health professional in a large clinic in my area. I thought, “If that’s good enough for him, it’s good enough for me.” You do have to practice at home, at work or in stores. You can’t just start doing it at sea, or you will forget.

        1. Yes, this all has to be a part of your regular routine when out and about. Use your side to push open doors or your feet to click the handicap button to get a door open (at my doctor’s medical facility, they have one that is at foot level…excellent!). I use my own pen when asked to sign something and I cringe when I have to use a touch screen. The Today Show did a segment on all this and touch screens at stores and banks were worst than bathroom toilets for germs.

  17. In the airline industry the debate of issuing a refund for no-shows with a doctor’s excuse never got resolved. I wonder if the cruise lines ought to consider it. If your ill the day of departure, stay home for a full refund for you and your partner.

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