USA Laws on Quarantine
According to the Center for Disease Control and Prevention (CDC, 2014), the Commerce Clause of the U.S. Constitution section 361 of the Public Health Service Act (42 U.S. Code § 264), empowers the U.S. Secretary of Health and Human Services (HHS) with the authority to prevent the entry and spread of communicable diseases not only from state to state, but also from foreign countries into the United States. The Federal HHS gives power to the CDC (2014) under 42 Code of Federal Regulations parts 70 and 71 “to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases;” this includes cruise ship passengers and crew to find the cause of the illness.
Logistics on a Medical Tourist Cruise Ship?
Quarantine and public health interventions as it relates to cruise ship passengers’ issues may have some effectiveness because there are cabins for the customers. If each person had his or her own cabin when it comes to isolation, the sick could be isolated. If the disease is air-borne, there would need to be proper ventilation in place for the isolated and perhaps the area would need to be sectioned off from the rest of the ship to provide the best ventilation. The CDC (2017) has a Vessel Sanitation Program empowered by the Public Health Service Act (42 U.S.C. Section 264 Quarantine and Inspection Regulations to Control Communicable Diseases) with specific CDC (2010) site to check different cruise lines scores. Breaking a quarantine is a criminal misdemeanor and the laws are enforced by local, state, federal, and tribal authorities according to the CDC (2014). Sometimes, passengers travel for medical tourism. In this situation, the passenger would need to be cleared to travel to the foreign country to receive treatment. If a traveler went to India to receive a cheaper treatment, Petersen & Mohsin (2016) ask should that patient/passenger be screened for multi-resistant strains of bacteria?
International Cruise Ships and Refugees
According to the World Health Organization (WHO, 2017), a 2005 document called the IHR provides the foundation for the legal basis for the health documentation necessary for international travelers and for the safe “transport and sanitary protections for the users of international airports, ports, and ground crossings.” The third edition of the International Health Regulation (IHR, 2005), added on July 11, 2016, includes the World Health Assembly resolution WHA58.3, which is about a “period of protection of vaccination against yellow fever.” If there were travel restrictions and travel bans from areas where disease transmission is high, these would not be boarding a cruise ship, unless a Greek cruise ship were to pick-up Syrian refugees whose boats may have capsized, for example. Those saved may be likely quarantined even if yellow fever is not endemic to Syria due to the size and nature of a cruise ship experience expectations of hygiene, health, and customer service considerations. Regardless, the international and interstate rules on travel restrictions and the Ethics of all Passenger’s Rights to Know would have to be followed.
Safety, Ethics, and Keeping Passengers Informed
On a cruise ship, there is usually one large cafeteria and maybe some smaller bars and snack shops. All the food service would have to be carefully controlled along the quarantine and isolation regulations. Control of communicable disease could be efficient as it would not take very long to de-board all other passengers not under quarantine or isolation. Resources at stops along the cruise could be easily requested besides any in-house medical team that may distribute personal protective equipment as well. Issues some cruise passengers would have if there were a travel restriction would be the discomfort on their vacation at the very least. Customer service would need to be included in the quarantine and isolation requests. Ethically, the whole ship would need to know their risks and the reason for the isolation and quarantine situations. For example, in Turkey, 2016, at a land tourist site there were suicide bombers according to Gonzalez & Lipman (2016). Making sure cruise passengers know their safety is secure is important besides making sure a disease in under control.
Sheila Bitts is a graduate student in Public Health at American Public University System, a poet, novelist, and an APUS 3MT Finalist for 2017.
CDC. (2014, October 8). Quarantine and Isolation. Legal Authorities for Isolation and Quarantine. https://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html
CDC. (2010, January 6). Vessel Sanitation Program (Cruise Line). Advance Cruise Lone Inspection Search. Scores. https://wwwn.cdc.gov/InspectionQueryTool/InspectionSearch.aspx
CDC. (2017, June 28). Vessel Sanitation Program. https://www.cdc.gov/nceh/vsp/default.htm
Gonzalez, V. V., & Lipman, J. K. (2016). Tours of Duty and Tours of Leisure. American Quarterly. 68(3). (pp. 507-521).
Petersen, E., & Mohsin, J. (2016). Should Travelers Be Screened for Multi-Drug Resistant (MDR) Bacteria after Visiting High Risk Areas Such as India? Travel Medicine and Infectious Disease. 14(6). (pp. 591-594).
World Health Organization. (2016). International Health Regulations (2005), 3rd edition. https://edge.apus.edu/access/content/group/1997db15-1275-f9c5-b052-e3f6f6c9ef26/Lessons/Week%205/WHO%20IHR.pdf