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Cruise Ships, Nursing Homes, and Prisons as COVID-19 Epicenters: A “Wicked Problem” With Breakthrough Solutions?

  • Philip D. Sloane
    Correspondence
    Address correspondence to Philip D. Sloane, MD, MPH, Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
    Affiliations
    Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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      I was not surprised that some of the earliest signs of COVID-19 outside of China were outbreaks on cruise ships. Several years ago, during a month on a 500-passenger cruise ship, I learned firsthand how rapidly viral infections can travel through those floating communities. I was the trip physician; the month was December; respiratory virus season had arrived early that year; and we unknowingly welcomed several unwanted guests when our passengers boarded in Nassau. Within 2 weeks, more than half the passengers were actively coughing and the clinic was inundated. On just 1 typical clinic day, I diagnosed 3 cases of Influenza A, 8 patients with viral bronchitis, 1 case of pneumonia, and 3 cases of gastroenteritis. And this was a “small” voyage; more common are passenger lists at least 5 times larger!

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