Sick Bay 

What's the Straight Dope on norovirus?

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Just read of yet another cruise liner affected by norovirus. I served in the U.S. Navy for four years, crammed cheek to jowl with 3,000 other sailors, and we never once had any such problems. I never heard of any other naval vessels so afflicted either. What’s the straight dope, Cecil? Does the Navy add some secret antiviral element to their coffee, or are those seagoing civilians just a bunch of pantywaists? Is there any record of any naval vessel being afflicted by norovirus?A Cheshire County Shellback

Any naval vessel? That gives us a lot of leeway, Shelly. Assuming you’ll also permit a little latitude in terms of gastrointestinal diagnosis, I give you the troop transport Argentina, which sailed from New York to Glasgow in the summer of 1943. Doctors never determined exactly what got into the men who embarked on that unfortunate voyage, but whatever it was, it lost no time getting out. Of more than 6,100 sailors and soldiers aboard, 3,000 reported sick with the trots (i.e., dysentery), and one died.

Despite the lack of a definite ID, the conditions that enabled the bug to flourish were obvious. The ship was severely overcrowded and lacked adequate toilets, showers and bunk space—the men had to sleep in shifts. The galleys and mess areas were in constant use and didn’t have adequate equipment for washing and sterilizing dishes.

Four days out, a dysentery epidemic began, and the Argentina descended into chaos. The port physician who inspected the vessel on its arrival in Glasgow described a hellish scene. Stoves, tables and nominally clean utensils were covered with rotting crud. Garbage was strewn everywhere and piled two or three inches deep around the filthy, overflowing trash cans. Troop quarters stank of vomit and diarrhea. “The latrines themselves were beyond description,” the doctor wrote. “I can truly say I have never seen a United States transport in such deplorable sanitary condition.”

OK, exceptional case, thank God. Only a handful of other major dysentery outbreaks aboard U.S. naval vessels were reported during World War II. In fact, despite the scale and duration of the conflict, the overall incidence of disease in the U.S. military during the war was remarkably low.

Low compared to what? Why, all previous U.S. wars. World War II was the first armed conflict in U.S. history where deaths of military personnel in combat exceeded deaths due to disease. I make a point of this, Shelly, because you seem to think the Navy kept you and your fellow sailors out of sick bay with pixie dust. Not so—or, anyway, not entirely. Sure, antibiotics and vaccination helped enormously. But an equally important factor was the brass finally getting it through their heads to embrace basic principles of public health: Avoid contaminated food. Dispose of garbage. Keep the toilets clean.

Some statistics, drawn from Two Faces of Death: Fatalities from Disease and Combat in America’s Principal Wars, 1775 to Present, a 2008 paper by Vincent Cirillo:

Revolutionary War. Disease deaths: 18,500. Combat deaths: 7,200. Ratio of disease to combat deaths: 2.6:1. Germs arguably were a factor in changing the course of U.S. history—the American invasion of Canada in 1775 was foiled by a smallpox outbreak.

War of 1812. Disease deaths: 17,000. Combat deaths: 2,300. Ratio: 7.5:1, the worst ever for the U.S.

Civil War. Disease deaths: 225,000. Combat deaths: 110,000. Ratio: 2:1. The ratio was low for the era—not because sanitation measures were particularly good but because battlefield slaughter was particularly bad.

World War I. Disease deaths: 57,000. Combat deaths: 50,000. Ratio: 1.1:1.

World War II. Disease deaths: 15,000. Combat deaths: 230,000. Ratio: 0.06:1. The tide turns.

Indeed, since then, U.S. military disease deaths in wartime have been minimal. That’s not to say there’s been no disease. Malaria was a major problem in Vietnam that was brought under control only after rigorous efforts to protect the troops from mosquitoes.

Which brings us back to the present, the U.S. Navy, and norovirus. Possibly up to this point you’ve been thinking: never mind the ancient history—today the Navy is the picture of healthy living. I call your attention to a medical journal article entitled “Epidemic Infectious Gastrointestinal Illness Aboard U.S. Navy Ships Deployed to the Middle East During Peacetime Operations—2000-2001.” From this we learn as follows:

• During the two-year survey period, researchers identified 11 outbreaks of infectious gastrointestinal disease (IGI) on ten U.S. Navy vessels. “Our analyses indicate that IGI outbreaks are common occurrences aboard U.S. Navy ships in [the Persian Gulf],” they write. The most frequently encountered IGI: norovirus.

• The overall incidence of IGI on the naval vessels studied was 33 outbreaks per 1,000 ship-weeks.

• During roughly the same era, IGI incidence on the cruise ships you speak of so disparagingly was about four outbreaks per 1,000 ship-weeks. In other words, Mr. Not-No-Norovirus-in-My-Navy, outbreaks of this icky condition on U.S. naval vessels (and having suffered through a bout of norovirus myself, I can testify that IGIs don’t get much ickier) were about seven times worse.

Send questions to Cecil via straightdope.com or write him c/o Chicago Reader, 350 N. Orleans, Chicago 60654.

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