Image: Emerald Princess waits
Reuters file
In early July, the Bermudan cruise ship Emerald Princess was anchored in Helsingborg Harbor in southern Sweden. A total of 13 crew members and one passenger were diagnosed with the H1N1 flu virus and quarantined on board when the ship visited Helsinki on June 28.
By Travel writer
msnbc.com contributor
updated 9/1/2009 9:46:50 AM ET 2009-09-01T13:46:50

Swine flu — it’s nothing to sneeze at. Clinically known as H1N1, the virus is poised to make a major appearance in the coming months, but is already creating its share of concern, confusion and contradictory headlines.

Last week, a White House advisory panel issued a report saying that 60-120 million Americans could become infected this fall and winter and as many as 90,000 could die. A day later, the Centers of Disease Control and Prevention (CDC), the agency tasked with protecting public health, said that was highly unlikely.

What’s a traveler to do? Based on the flu-induced hullabaloo of last spring, the best advice at this point is to take appropriate precautions, be prepared for sudden changes in flight schedules and cruise itineraries and enjoy your trip.

The lull after the storm
“There’s good news and bad news with H1N1,” says Dr. Mark Gendreau, senior staff physician at the Lahey Clinic in Burlington, Mass., and assistant professor of emergency medicine at the Tufts University School of Medicine. “The bad news is that there’s the potential that 30-50 percent of the U.S. population could develop flu-like symptoms. The good news is that from a pandemic-preparedness standpoint, the government has really gotten its act together.”

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Meanwhile, the World Health Organization (WHO) recently reported that rates of H1N1 infection are currently declining in North America, Europe and much of the southern hemisphere (although rising in tropical Asia). The decline in South America, in particular, is considered an indicator of the virus’ potential impact in the U.S. this fall.

Given the above, CDC considers 90,000 fatalities a worst-case scenario. (By comparison, seasonal flu kills about 35,000 Americans each year.) The agency has highlighted increased risks for select populations — children, young adults and pregnant women, among them — but at this point, no one is recommending that anyone in good health cancel their travel plans.

That, of course, is a far cry from last April, when the initial outbreak triggered a CDC advisory recommending that people avoid all non-essential travel to Mexico. The advisory was lifted three weeks later, but the effects wreaked havoc on travelers’ plans and took a heavy toll on an industry already reeling from the recession and concurrent cutbacks in business and leisure travel.

Swine flu

The cruise industry, for example, swerved en masse, forgoing Mexican ports for other Caribbean islands, extra days at sea and, in the most extreme cases, turning scheduled Mexican Riviera itineraries into trips to San Francisco, Seattle and British Columbia. Some passengers were offered onboard credits and the chance to rebook, but neither option did much for cruisers’ moods or the companies’ bottom lines.

Meanwhile, hotels across Mexico sat empty — in May, occupancy rates at Marriott properties in the country were as low as the mid-teens — as did airports from Cancun to Cabo San Lucas. In the second quarter, Continental Airlines and Delta Airlines reported flu-related losses of $50 million and $125 to $150 million, respectively, with the latter reporting that the toll for the year could hit $250 million before the fall flu season had even begun.

Avoid surprises and spreading germs
So, does past history provide any indication of future performance? In terms of H1N1’s prevalence or severity, probably not. In terms of the travel industry’s response and the subsequent impact on travelers, it very well may. Preparedness, not panic, is the order of the day, and that’s as true for travel plans as it is for personal hygiene. Until CDC or WHO issues an alert or other advisory, here are some points to keep in mind:

Cruising: Cruise lines have long required embarking passengers to fill out pre-boarding health questionnaires. This summer, though, the U.S. industry rolled out enhanced protocols, under which passengers who report flu-like symptoms (fever, runny nose, etc.) or previous contact with a confirmed case of H1N1 will be subject to secondary screening by medical personnel.

Some cruise lines are going even further. Last week, Italy’s MSC Cruises announced that it would use thermal imaging cameras to check embarking passengers for elevated body temperatures that may be a sign of infection. (There was no indication how the company planned to differentiate between the feverish and the merely flushed.)

Remember, too, that cruise lines have always reserved the right to change itineraries, substituting ports of call and/or spending additional days at sea, with reimbursement, if any, determined on a case-by-case basis. If this spring was any indication, only those passengers booked on the most drastically altered itineraries are likely to be eligible for rebooking, onboard credit or other compensation.

Air travel: As with the cruise lines, most airlines won’t formalize rebooking/cancellation policies until the government issues an advisory against traveling. “We have regular, ongoing discussions with CDC and WHO,” says Continental spokesperson Julie King, “and we regularly pass information on to our offices around the world.” Several airlines are in the process of developing contingency plans to handle any flu-related disruptions this fall.

In the meantime, be aware that the State Department has issued an alert that travelers heading to China from the U.S. or Mexico may face quarantine if they or other passengers exhibit fever or flu-like symptoms. As of late August, approximately 2,000 travelers have reportedly been held in isolation, some for as long as seven days.

As for flying in general, fliers can breathe a little easier knowing that H1N1 is not an airborne virus, but rather, transmitted via droplets. And since aircraft ventilation systems work in a side-to-side, circular manner (as opposed to front-to-back), the risk of exposure rapidly decreases with distance. “When people say that if you’re sitting in row five, you’re susceptible to the germs in row nine, that’s not the case,” says David Castelveter, spokesman for the Air Transport Association.

Flu activity around the country

Insurance: Generally speaking, travel insurance will cover H1N1 infection — with one major caveat. Some policies include a pandemic clause, which nullifies all coverage once a pandemic is declared. That’s currently the case since WHO declared a Phase 6 pandemic in June. (Said designation, by the way, refers only to the virus’ ability to spread, not its severity.)

As a result, says Chris Harvey, CEO of Squaremouth.com, an online insurance-comparison site, travelers considering insurance should pursue a policy without a pandemic clause. (Some will cover quarantine; others won’t.) He also recommends steering clear of “cancel for any reason” policies due to their high cost and fine-print limitations.

Most important, perhaps, remember that no policy will provide coverage for fear of getting sick. “It’s like saying, ‘I think a hurricane is going to hit where I’m going,’” says Harvey. “Getting swine flu is covered; the fear of it isn’t.”

Prevention: CDC has approved two prescription drugs, oseltamivir (brand name Tamiflu) and zanamivir (brand name Relenza), for both the prevention and treatment of H1N1. They expect to have approximately 45 million doses available by mid-October, with up to 160 million by the end of the year.

As for vaccinations, priority will be given to those in high-risk groups (e.g., children, young adults, pregnant women and those with underlying health conditions), followed by the general population as conditions and availability warrant. Those who usually get the seasonal flu vaccine should continue to do so as the two vaccines are not cross-effective.

In the meantime, says Dr. Phyllis Kozarsky, a CDC travel health consultant, sick people should stay home and healthy people, including travelers, should redouble their efforts to practice the age-old tenets of good personal hygiene. That means washing your hands regularly, using hand sanitizers (at least 60-percent alcohol) and covering your mouth when sneezing or coughing. For more information on H1N1 and travel, visit the CDC Web site.

“It’s the same old story,” says Kozarsky, “but it’s the same old story with an exclamation mark.”

Rob Lovitt is a frequent contributor to msnbc.com. If you'd like to respond to one of his columns or suggest a story idea, drop him an e-mail.

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