Real-Time, Systematic Disease Detection on Cruise Ships: Feasibility Assessment for Outbreak Prevention

The heavy toll of COVID-19 on the cruise industry has highlighted the long-standing issue of disease and epidemic management on ships. Optimal prevention of outbreaks on cruise ships would be achieved if each individual on board could be accurately diagnosed at the onset of symptoms, with or without a visit to the ship’s health center. This chapter discusses whether the current state of the art in point-of-care diagnostics, biosensors, and wearable devices can meet this challenge. Prevention of outbreaks on cruise ships begins in the ship’s health center with accurate diagnosis of sick individuals. Diagnostic capabilities there should be expanded to include a broad range of commercially available point-of-care tests, in order to cover all common infectious diseases. This should be complemented by real-time, accurate, individualized disease detection throughout the ship. The most mature option for respiratory disease recognition is undoubtedly the monitoring of respiratory sounds in the cabin or via wearable devices. Correlating symptoms and vital signs correlation measured with specific models of smart wearable devices is feasible, but is not fully generalized and validated. More selective solutions based on biomarkers or direct pathogen detection would be particularly appropriate but are still at the research stage. Until disease tracking becomes fully available, it is proposed to perform real-time, continuous symptom tracking. This can be achieved with current commercial technologies, either with smart wearable devices, with fixed cabin sensors and/or with sensors deployed throughout the ship. A positively screened individual would be offered an immediate visit to the health center. There, a point-of-care diagnosis would be performed immediately to assess the risk that the symptoms are caused by an infectious disease.