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The Diamond Princess cruise ship (shown docked in Yokohama, Japan, on February 10) was quarantined in the city after passengers tested positive for coronavirus.

When passengers booked their vacations on the ill-fated Diamond Princess, they were likely looking forward to hanging out in a hot tub, not a hot zone. Now most of them are quarantined off the coast of Japan, hoping to avoid testing positive for the 2019 novel coronavirus, which has already infected more than 200 people on the cruise ship.

Health officials in protective gear removed suitcases from the Diamond Princess cruise ship in Yokohama, Japan. Its believed they belonged to passengers evacuated and taken to hospitals after testing positive for coronavirus.

The fact that the largest outbreak of COVID-19 outside of mainland China is happening on a cruise cant be reassuring to travelers who are already skittish about health issues on boat-based trips, which are well known incubators of gastrointestinal illnesses. The Center for Disease Control and Prevention (CDC) offers a helpful database of cases, broken down by year.

The vast majority of cruises dont experience any problems. But confined spaces mean that even one sick person can create a serious situation, explains Tullia Marcolongo, executive director of the nonprofit International Association for Medical Assistance to Travelers. Its the domino effect, and you have nowhere to go, she says.

Cruise companies work to minimize the risk of illness by maintaining cleanliness and monitoring health on board their ships. In response to the coronavirus outbreak, Carnivalthe parent company of Princess Cruiseshas introduced expanded protocols, including enhanced onboard sanitation measures with non-toxic materials and pre-boarding medical evaluations, as needed. On its website, Royal Caribbean Cruises touts its health and safety program, such as internal and external inspections, frequent water systems testing, and strict food handling rules.

Passengers can do their part, too. The first thing I would say is that the power is in your hands, Marcolongo says. She means that literally. Frequent hand washing can be a critical preventative measure for norovirus, colds, and other yucky things circulating on a ship. To make sure you scrub long enough, sing Happy Birthday twice, she suggests, and dont miss the spots between your fingers. If theres no soap and water nearby, use an alcohol-based hand sanitizer. Many ships make sanitizer stands readily available to passengers, Marcolongo adds.

David Parenti, director of the George Washington University Travelers Clinic and professor of medicine at the George Washington University School of Medicine and Health Sciences, advises being aware of when youve held handrails and touched other surfaces. Until you can wash your hands, dont stick them in your eyes or mouth.

Unfortunately, Parenti says, there are lots of other ways to get sick, both on ship and on land. It all has to do with luck. If youre on a ship with norovirus, thats bad luck. If you are on a cruise ship, you will need to eat. Those risks are something you dont have a lot of control over, he says.

This is where you should sit on the plane to avoid getting sick.

To be proactive, travelers can set up a pre-vacation doctors appointment to make sure their immunizations are up to date. Depending on your destination, that flu shot might be important even if youre taking off in the middle of the summer. Keep in mind that the U.S. influenza season is the opposite of the Southern Hemisphere, Parenti notes. He recommends getting the vaccine for Hepatitis A and checking on your immunity to measles; you could possibly use another shot. (A measles case was responsible for a different cruise quarantine in May 2019.)

Because of the limited number of medications on board, its smart to pack whatever you think you might need, Marcolongo adds. That includes first-aid basics as well as some standard over-the-counter supplies, which for gastrointestinal issues include Loperamide (Immodium) and oral rehydration salts.

Miami-based attorney Jack Hickey once represented cruise companiesand now sues them over personal injury claims. His advice? What I tell people is get trip insurance and make sure it covers an air ambulance. Travelers who experience emergencies and need to pay for transportation will be in for some serious sticker shock otherwise.

Be realistic about what kind of care you can actually expect on board a ship. If you get sick or injured, get back to the U.S. as quickly as possible, Hickey advises. Although cruises undoubtably excel at hospitality, he says, they tend to be lacking when it comes to medical care. Its not a hospital, but a ship carrying 3,000 to 6,000 people and going to isolated areas of the world, says Hickey, who thinks there typically arent enough doctors and staff to handle a heavy workload, and that the facilities arent adequately equipped. Almost uniformly, they have X-ray machines. But [ships] do not have good machines or people who know how to read films well, he says.

The coronavirus quarantinewhich is keeping people cooped up in tight cabins for weeksis a reminder that mental health problems could also arise, especially for anyone with issues around anxiety or claustrophobia. Travel insurance doesnt necessarily cover that, Marcolongo notes.

Learn how the coronavirus compares to Ebola, flu, and other outbreaks.

As scientists learn more about the virus and how its transmitted, there may be more scrutiny of ventilation systems on cruise ships, Parenti adds. In a hospital, its possible to put a patient in a respiratory isolation room with frequent air exchanges.

Thats not an option for most cruise accommodations. The next best choice, according to Parenti? I would take a window, personally. At least you could open it and get a breeze that way.

Vicky Hallett is a Florence, Italy-based health and travel writer. Follow her on Instagram.

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Here's how to avoid getting sick on a cruise Viruses and bacteria spread quickly on ships - msnNOW

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