When you go to a hotel or a theme park and get infected with a virus, you don't know exactly what happened. Maybe you caught the virus at the airport, in a rest stop, on an airplane, or even at your hotel or in a restaurant.

That's generally because by the time you get sick, you're no longer at the place where you got infected. Cruise ships, however, lack the same plausible deniability, and historically viruses spread quickly on ships.

Related: Royal Caribbean bets big on new ships, private destinations

On a seven-day cruise, you might actually have picked up an illness at the supermarket or at work, but when you get sick on the ship, people blame the cruise line. When someone falls ill, cruise lines don't actually care where they got infected. They simply want to slow down the spread of the disease.

That has always been the case, but the Covid pandemic and the Centers for Disease Control (CDC) shutting down the cruise industry from the U.S. for over a year put shipboard illness under a bigger microscope. For months, the federal agency reported on onboard Covid levels and did little to share all of the steps the major cruise lines had taken to mitigate outbreaks.

Now, with Covid becoming less of a concern, Royal Caribbean has shared some big news about its efforts to control another virus, norovirus, which spreads quickly on ships. 

Royal Caribbean has made ships safer

"Norovirus is a very contagious virus that causes vomiting and diarrhea. Anyone can get infected and sick with norovirus. Norovirus is sometimes called the 'stomach flu' or 'stomach bug.' However, norovirus illness is not related to the flu, which is caused by influenza virus," according to the CDC.

The virus can cause problems on cruise ships, but it's actually a pretty rare occurrence.

"Norovirus is the most frequent (over 90%) cause of outbreaks of diarrheal disease on cruise ships and these outbreaks often get media attention, which is why some people call norovirus the 'cruise ship virus.' However, norovirus outbreaks on cruise ships account for only a small percentage (1%) of all reported norovirus outbreaks," the federal agency reported.

You are much more likely to get norovirus in a land-based restaurant or healthcare facility than on a cruise ship, but cruise outbreaks make for good stories and get widespread media attention.

Royal Caribbean began its Norovirus Eradication Campaign in 2023. It's a six-step program that has worked to stop outbreaks on its ships, the Royal Caribbean Blog reported.

Royal Caribbean's plan has worked

Royal Caribbean has enacted a comprehensive plan designed to contain norovirus and prevent its spread.

1. Enhanced acute GI training for onboard medical teams and traveling doctors
2. Increased doctor oversight of its Outbreak Prevention Plan, which covers requirements like hand washing, buffet oversight, and disinfectant mandates for all public areas aboard its ships.

3. Switching to PDI SaniCloth Prime hospital-grade disinfectant wipes, wipes certified to kill norovirus by the EPA.

4. New contactless tap technology, eliminating the need for crew to handle guest cards

5. Enhanced crew training on what to do when experiencing acute GI symptoms and how to avoid cross-contamination in food and beverage service areas

6. An update to Royal Caribbean's Safety & Quality Management system to stop self-service in buffets if the onboard norovirus rate exceeds 1.5%

"After the eradication campaign was implemented in June 2023, there was not a single norovirus outbreak onboard any Royal Caribbean International or Celebrity Cruise ship for the remainder of 2023," the report shared.

Celebrity Constellation, however, did have an outbreak in January 2024 that was listed on a CDC website, according to Royal Caribbean Blog.

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 - by New Deal democrat

Real median household income is one of the best measures of average Americans’ well-being, but the official measure is only reported once a year, in September of the following year.

So right now the most recent official measure is for calendar year 2022 (when you might remember gas prices surged to $5/gallon). In other words, it’s hopelessly out of date.

There are several ways of approximating real median household income on a more timely basis available in the public data. 

For this purpose, wages are a very imperfect proxy, because income includes things like stimulus payments or debt relief during the pandemic, and also because - especially during the pandemic - layoffs were concentrated among low wage workers, thus distorting the averages higher.

The best proxies make use of personal income. We can also get information from total payrolls. The below graph shows both real personal income (blue) and real aggregate payrolls (red), both divided by population. Here’s the data starting before the pandemic:

And here is the close-up after the end of pandemic related stimulus payments:

The big difference between the two is that real payrolls only include wages and salaries, while real incomes includes all sources of income, including stimulus payments and things like social security. Thus real per capita payrolls declined sharply during the fist months of the pandemic, and did not recover until late 2022, while incomes soared due to the pandemic related programs. Further, real payrolls stalled during 2022, while real incomes per capita actually declined.

Since late 2022, both measures have consistently increased. 

Additionally, a few private services have been able to use monthly data from the survey that gives rise to the jobs report to create a far more timely and illuminating monthly update. The best of these that I know of is Motio Research.

Here’s their most recent update, through March:

 

Like personal income, household income really spiked with the pandemic relief programs in 2020. It then went nowhere for almost three years, stuck at the same level it had been in 2019. Again, like personal income, that’s because of the spike in inflation, and the fact that jobs and real payrolls didn’t return to their pre-pandemic levels until 2022 and 2023 respectively.

The one remaining puzzle is why real *median* household income declined again into mid-2023, vs. *average* personal income, which increased.  One explanation might be the expiration of pandemic stimulus and relief programs, although I would expect that to show up in the broader income measure.

Some light can be shed by looking at *median* wage growth, as documented by the Fed:

Note that, compared with inflation, median (rather than average) wages continued to decline until early 2023. 

Another important explanation is likely that income growth has been concentrated among the the lowest quintile of households. In connection with the latest annual update, US News and World Report wrote:

 

While overall household wealth in America fell from the end of 2021 through the first three quarters of 2022, the bottom 20% of households by income saw their wealth grow.

“In total, household wealth for the lowest-income quintile rose by nearly 10% while wealth in all other income quintiles fell, according to figures from the Federal Reserve and nonpartisan data center USAFacts.

Here is the accompanying graph:

This very much helps explain why Biden’s approval ratings have been so poor throughout 2022 and 2023.

But, to return to the Motio Research graph, note that since last June, the trend has been rising again, and in March real median household income reached its highest level ever except for the 2020 stimulus months. What this means is that, if real household income growth had been concentrated among the lowest quintile through 2022, by mid-2023 it had spread upward to include the median group as well, and with some fits and starts this growth has continued.

Which is good news for the average American household.

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The term “mysterious pneumonia” has become particularly triggering since early 2020. This is how the yet-to-be-named disease COVID-19 was first described when a cluster of cases was identified in Wuhan, China.

This term is being used again to describe a cluster of “atypical” pneumonia cases in Buenos Aires, Argentina. Some cases of psittacosis, also known as “parrot fever”, have been confirmed within this cluster. Before you start stocking up on toilet paper and masks or taking your parrot back to the pet shop, let me explain what we do and don’t know about this new outbreak. It might save you some money.

Psittacosis, or parrot fever, is caused by bacteria called Chlamydia psittaci, and is a common infection in birds. It is usually transmitted from animal to human via close contact with birds, including parrots and cockatiels, and also poultry such as ducks and turkeys.

The bacteria can be found in faeces and other excretions*excreta?*. So people at higher risk include vets, pet shop workers or those who own birds.

Psittacosis is usually mild but can be a severe infection, especially in vulnerable people such as the elderly or those with weak immune systems.

The Argentina outbreak was first reported on April 17 2024 in ProMED, a widely used site for reporting infectious disease outbreaks around the world. The short post there highlighted there being around 60 cases of “atypical” pneumonia in the previous 30 days, many of them in younger people and several requiring hospitalisation and critical care.

The report to ProMED suggests 20 cases showed evidence of psittacosis, with ten of them confirmed positive by laboratory testing. Many of these cases are reported to have had no obvious contact with birds. The source of the content is also unknown – described merely as “an individual known to ProMED”.

Psittacosis is uncommon, but not unknown. The UK government indicates there are around 25 to 50 cases reported in England and Wales each year.

A 2017 systematic review concluded that around 1% of pneumonia cases not acquired in a hospital may be the result of psittacosis. A World Health Organization situation report dated March 5 2024 describes dozens of human cases across several European countries with five deaths.

WHO advice includes quarantining, frequent handwashing, encouraging people with pet birds to keep cages clean, positioning of cages such that faeces cannot spread between them, and to avoid overcrowding.

One Australian study associated a higher risk of psittacosis with mowing the lawn without using a grass catcher. It is possible that the lawnmower would have run over and “aerosolised” some infected faeces that were subsequently inhaled.

So, how serious is this Argentina outbreak and how concerned should the wider world be? There are often local respiratory infectious disease outbreaks, potentially causing severe pneumonia, and these do not spread more widely or internationally. COVID was very much the exception, rather than the rule.

At the time of writing this article, there is very little information available about the Argentina outbreak. There has been no statement from the public health authorities in Argentina, nor the WHO Pan America Health Organisation.

Among the key pieces of information we really would need to know is the likelihood of human-to-human transmission. For example, if an investigation concludes that all cases were at the same workplace, where potentially they may have been exposed to infected bird faeces, then there most probably has been one source of infection. This makes the public health response more straightforward, with fewer implications for the wider population.

If (hypothetically) the epidemiology tells us that a probable scenario would be multiple cases of human-to-human transmission of psittacosis, this would be much more concerning.

A paper investigating a 2020 outbreak in China concluded that the study data might “represent the first documented report of human-to-human transmission of C. psittaci in China”. But this is rare – and there is currently no clear evidence of this in Argentina.

In its conclusion to the situation report about the 2024 European psittacosis outbreak, the WHO concluded that there is “no indication of this disease being spread by humans nationally or internationally”, and that based on the available information, the risks “posed by this event are low”.

It would be reasonable to apply similar thinking to the Argentina outbreak. But more information is needed to provide proper conclusions.

Psittacosis is one of many infections that can pose a risk to human health in specific circumstances. But there is no indication that “parrot fever” will be the Next Big Thing. This shows the importance of outbreak surveillance and reporting across all parts of the world, with real-time epidemiology and laboratory data being made available to provide up-to-date public information.

Michael Head has previously received funding from the Bill & Melinda Gates Foundation and the UK Department for International Development, and currently receives funding from the UK Medical Research Foundation.

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