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Posted on March 12, 2020 at 2:19 AM

by Charlene Sathi, HBSc, MS and Lydia Dugdale, MD, MAR

When sailors used to become sick at sea, their mates had to decide whether to throw them overboard or isolate them below deck until they could find help in harbor towns.

The crew of the Grand Princess cruise ship, recently stranded with COVID-19 off California’s coast, didn’t face decisions this stark. But the ship certainly met with resistance in port and the governmental response further muddied the waters, leaving thousands of individuals anxiously floating miles from American soil, without answers. If the Grand Princess fiasco teaches us anything, it’s that we need ethical guidance for the care of quarantined individuals on cruise ships.

That guidance should come from the top, but it hasn’t. President Trump insisted that all 3500 passengers and crew members—many of whom were American citizens—remain on the ship for the sole purpose of keeping coronavirus numbers down. The Centers for Disease Control & Prevention (CDC) preferred that the boat’s occupants disembark. But the President disagreed, stating, “I’d rather have the people stay. … I would rather – because I like the numbers being where they are. I don’t need to have the numbers double because of one ship that wasn’t our fault.” We must never jeopardize the well-being of others in order to manipulate statistics.

Isolation rhetoric leads to further stigmatization. Public attitudes toward those on board were hostile. People in Oakland did not want the cruise ship docking on their soil. Reflecting on the social media animosity, one passenger on the Grand Princess said, “It just makes me angry that people are putting a label on us, we’re human beings, we want to come home. We’re not an infestation that’s coming to their city.” Sound ethical policy regarding cruise ship quarantines will help mitigate such othering.

Even if leadership fails us, society is duty-bound to care for the sick. And a cruise liner is by no means the ideal location for recovery from coronavirus. Resources onboard are limited, and passengers fear running out of prescription medications. It is impracticable to fly medical supplies to a ship when resource-rich hospitals are available. The ethical move is to transport sick passengers to the care they require.

What’s more, it is morally reprehensible to detain healthy, uninfected individuals on a ship in close proximity to those with coronavirus—risk of infection goes up. The CDC acknowledges this chance, noting, “COVID-19 appears to spread more easily between people in close quarters aboard ships.” If we are serious about thwarting virus spread, the priority must be to protect uninfected individuals from exposure while providing the sick with necessary medical care.

A call for policies on the ethical treatment of quarantined cruise ship passengers might be denounced as redundant. Although the World Health Organization has long cautioned about disease outbreaks on cruise ships, it offers no concrete recommendations. The United Nations’ International Labour Organization (ILO) convention for the health of seafarers requires unspecified medical supplies and the presence of a doctor if 100 or more people sail for more than three days. It calls for international cooperation among UN member states in the event of serious illness at sea, but it too is scant on particulars. Despite the fact that the convention is legally binding, adherence is variable. Closer to home, the CDC has recommended postponing all non-essential sea travel during the coronavirus pandemic. But cruise lines have amped up their screening procedures. And since many are continuing to sail, the problem likely won’t go away.

Although the COVID-19 pandemic is global, quarantine efforts are local. And with the current administration’s emphasis on nationalism, it makes sense for the United States to decide how it wants to treat passengers on American cruise ships as well as passengers on non-American cruise ships docked in the United States. The CDC, together with the executive and legislative branches of government, need to adopt policies for the ethical treatment of cruise ship passengers and crew that prioritize care of the critically-ill, regardless of nationality and ability to pay. Policies must seek to prevent the spread of disease by safeguarding the health of the uninfected. Most importantly, they must refuse the leveraging of human life for political ends.

We have thankfully moved past an era when it was permissible to cast the sick overboard in order to save the rest. Let’s ensure through the crafting of sound policy that we treat our fellow sojourners not as means to an end but as ends unto themselves.

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