Cruising During a Pandemic

When the world reopened in the summer of 2021, the prospect of travel danced in my head. I had a lot to celebrate in my personal life, but topping the list was my 10-year wedding anniversary.

"What do you want to do for our anniversary?" I asked my wife.

"I don't know, why don't we just play it by ear?" she responded.

As the heat of the Houston summer gave way to the unpredictable Houston winter (there is no fall in Texas), I began researching potential vacation spots. I looked at resorts in Mexico, the Caribbean, Napa Valley. I watched YouTube videos of different locales, foods, and activities that we could pursue before deciding on a January Caribbean cruise.

The winter inpatient census remained steady owing to the unseasonably high respiratory syncytial virus cases during the spring and summer months. The year was a slog, and psychologically I felt the mental and emotional fatigue of a boxer just waiting for the bell to signal the end of a punishing round. I retreated to my YouTube "vacations." In my phone's cruise app, I counted down the days.

60 days until your vacation, it announced.

60 days between me and a mental recharge. 60 days between me and an escape from reality. 60 days left to hang in there.

Something Wicked This Way Comes

It was after Thanksgiving that we began to hear rumblings of a new variant of COVID. Omicron had already begun to spread in South Africa and the United Kingdom, and the Centers for Disease Control and Prevention was anticipating its arrival in the United States any moment. More infectious than Delta, Omicron was expected to peak in January — just in time to potentially jeopardize our long-planned vacation.

We remained cautiously optimistic. As the cases steadily increased in December, we questioned changing or delaying our travel plans. Mainstream news outlets began reporting on COVID cases on cruise ships. But shortly after New Year's, the CDC warned against cruising, even for vaccinated and boosted passengers. Politicians weighed in, with some calling for a moratorium on these floating "petri dishes of infection." Our vacation, it seemed, was in jeopardy. The cruise line offered opportunities for refunds or rescheduling.

I have been on five previous cruises and have always seen it as a safe and economical way to vacation. Before the pandemic, cruises occasionally made the news when outbreaks of norovirus spread on the ship. The closed environment on the vessel makes infectious spread more likely among people, and I did not doubt the number of Omicron cases that was being reported on board.

We reviewed our cruise's requirements and found that it was a "vaccinated cruise." Passengers 12 years old and up were required to vaccinate and, if eligible, obtain a booster vaccine. All guests were required to take a COVID test no sooner than 48 hours from the date of embarkation. Masks were also strongly recommended while on the ship except while eating or drinking. Passengers who were unvaccinated required a strict vaccine exemption and were eligible only for "bubble" tours at the port of calls. These bubble tours were strictly enforced, and guests were not allowed to wander the ports unaccompanied.

As we carefully weighed our options, we had other factors to consider. Our two oldest children were in elementary school and daycare, and it was not unusual for us to receive updates regarding potential COVID exposures in the classrooms. One potential exposure, or even a COVID-unrelated illness, could throw a wrench in our vacation plans. My parents, who were vaccinated and boosted and who agreed to watch the children for the trip, could also fall ill — leaving us few options for extended childcare. As the countdown to our vacation ticked, we seriously considered postponing our trip.

The last 2 weeks before our trip was a blur. Mentally, I was burned out. As a pediatric hospitalist, it is not unusual for me to work 5- to 7-day stretches, then transition to stretches of evening and overnight shifts during the holiday months of November to January. Usually this schedule did not bother me, but I found my health beginning to suffer as the frequent changes messed with my sleep. Meanwhile, my spouse, ever our family's rock, kept as strong as she could with two school-aged children and an infant at home. She too began feeling touched out. We needed rest and despite all the warnings, we decided to continue with our vacation plans.

Two days before our embarkation date, our trip seemed palpable. Only the remaining rapid COVID tests stood between us and the gangway. When we received our negative results later that day, we felt even more confident.

A Good Decision

The reality of our trip did not set in until we arrived at the cruise terminal. Boarding the massive cruise ship, it was like entering another world. I was pleasantly surprised at how compliant passengers were with the masking guidelines. The cruise line also provided everyone with KN95 masks in their rooms. The spaces were constantly being sanitized and cleaned. We could see how hard both passengers and crew were working to avoid having the voyage ruined by a COVID outbreak. The ship also operated at a little more than 50% capacity, which made our trip significantly less crowded than our previous cruises.

At our sole island port of call, everyone remained masked when we were in groups. The only time the masks came off was when we were eating and distanced from others outdoors. With tourism as the primary income source, the island and port authorities were careful to keep everyone safe and businesses open.

I was glad we made the decision to proceed with our cruise vacation. I know there are others that may judge our decision to go as unwise. However, not to tend to our mental health would be foolish as well. Personal responsibility goes a long way to keeping yourself safe while having fun. We spent time listening to live music while at the bar, masked when not drinking. We walked the open decks, where we could freely unmask away from others. As I sat on the balcony of our ship, the crisp ocean air in my lungs, I thought back on the past 2 years and let all its weight melt away. There will be time for all of that again. But first I had to finish drinking my margarita.

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About Dr. Giancarlo Toledanes

Giancarlo Toledanes, DO, is an assistant professor of pediatrics and a pediatric hospitalist at Texas Children's Hospital and Baylor College of Medicine in Houston. His professional interests include quality improvement, health equity, faculty development, and social psychology. When he is not in the hospital, he is a cook and a handyman to his wife, an amateur LEGO builder to his son, an aspiring unicorn to his daughter, and a walking burp cloth to his baby daughter. Connect with him on Twitter: @ToledanesGian

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