Air On Board Cruise Ships 'Is Twice As Bad As At Piccadilly Circus'

Breath of fresh air? Passengers on the sundeck of P&O’s Oceana. Photograph: Greg Balfour Evans/Alamy

A C4 Dispatches investigation reveals how ultra-fine particles emitted by cruise liners’ engines are worrying both medical scientists and environmentalists

Passengers on cruise ships could be exposing themselves to dangerous levels of pollution, according to an investigation by Channel 4’s Dispatches team that found some public areas on the ships’ decks were more polluted than the world’s worst-affected cities.

The undercover investigation, which will be broadcast tonight at 8pm, focused on the levels of “ultra-fine particles” found in the air on and around cruise ships, from the fuel the ships’ engines burn. These particles are so small – around a thousandth of the width of a human hair – that they can enter the bloodstream via the lungs.

More than 1.9 million people from the UK travel on a cruise each year and there is growing concern among the scientific community about the health risks.

Dispatches used a P-Trak ultrafine particle counter to measure the ultra-fine particulates suspended in the air on board P&O Cruises’ ship Oceana. The Oceana is more than 250 metres long, 15 storeys high and can carry more than 2,000 passengers.

The device found 84,000 ultra-fine particulates per cubic centimetre on the deck downwind of, and directly next to, the Oceana’s funnels. That’s more than double the amount found at London’s Piccadilly Circus, where the number of ultra-fine particulates per cubic centimetre was 38,400.

Speaking to the Guardian, Dr Matthew Loxham, a specialist in air pollution at the University of Southampton, said these were the levels of pollution you would expect to find in cities such as Delhi or Shanghai. As for the health risks, there is, he says, cause for concern.

'One cruise ships emits as much particulates as a million cars, so 30 ships pollute as much as all the cars in the UK'

Daniel Rieger, environmentalist

“From a scientific point of view, we know that pollution causes adverse health effects even in the short term,” he said. “On a ship deck, you’re exposed to higher levels of pollution so you may get symptoms such as runny nose, cough, dry eyes or a higher risk of asthma attacks. For those that are predisposed, there may be a higher risk of stroke or heart attack.”

However he added that it is difficult to quantify the increase in risk for individual passengers.

“If you had a large enough number of people, you would be likely to see a quantifiable increase,” he said. “But it’s difficult to say with individuals. Asthmatics, particularly, might find it harder to breath, need their medication more, or find the air triggers an asthma attack.”

Large ships run on heavy fuel oil, which is legally permitted to contain 3.5% sulphur – that’s 3,500 times what is permitted in road fuel. In EU ports and waters, ships are legally required to switch to a cleaner diesel, but even this, capped at 0.1% sulphur, is allowed to contain up to 100 times more sulphur than road fuel.

Loxham said: “If the cruise ships are complying with the law and there is still this level of pollutants, the question really is: are these laws fit for purpose?”

As well as impacting on the health of passengers, crew and those who live beside docks, cruise ships are also having an impact on the global environment.

John Maggs, president of the Clean Shipping Coalition, told Dispatches: “Most large ships burn heavy fuel oil. It’s a residual product from the refining industry, so after the refiners have produced the petrol and diesel we put in our cars, they’re left with what is essentially a waste product. It’s called residual fuel, or heavy fuel oil.”

From an environmental point of view, it’s bad because of the air pollution caused by the very high sulphur content. The shipping industry, however, has traditionally liked it because it’s much cheaper than other fuels.”

Also speaking to the Dispatch team, Daniel Rieger of the German environment association NABU (Nature And Biodiversity Conservation Union) said: “Ships cause not only greenhouse gas emissions, but also sulphur oxides, nitrogen oxides and particulate matter. Per day one cruise ship emits as much particulate matter as a million cars. So 30 cruise ships pollute as much as all the cars in the United Kingdom.”

Responding to the Dispatches team, P&O Cruises said: “Since 2005 we have reduced our fuel consumption by … 28%, with the accompanying reduction in air emissions.”

It added that the Oceana is to be fitted with exhaust gas cleaning systems, which are already “installed on 60 ships across its brands… This action significantly improves the quality of air emissions… Soot and particulate matter reductions in excess of 80% have been achieved.”

P&O also said that in 2014 it had reduced CO2 emissions by 20% and “has renewed its goal to continue reducing the rate”.

It said: “The health, safety and welfare of guests and crew across all our ships is our absolute highest priority… We recognise that there is a public interest… related to particulate matter and related health issues”.

By Will Coldwell

Alarming Data On Health Care Abroad For American Travelers, What You Need To Know.

A surprising number of Americans are unclear about the cost of medical care when traveling. A 2017 survey from InsureMyTrip, the authority on travel insurance, found  that many travelers are unclear whether their domestic health insurance works  outside the US.  Thirty-five percent polled were not sure whether their domestic health  insurance plan would cover any doctor or hospital visits while traveling  out of the country. Thirty-five percent said it would provide coverage, while thirty percent  believed their domestic health insurance plan would offer no coverage.  So, what's the right answer? It's complicated. Big insurance providers like Blue Cross and Blue Shield,  Cigna, Aetna may provide emergency and urgent care coverage abroad. However, the definition of emergency varies. Medicare will rarely pay for inpatient hospital, doctor, or ambulance services  you get in a foreign country. Travelers can request clarification of coverage prior to departure. Here’s how: Call your medical insurance provider Ask to review your certificate of coverage for explanation of benefits Ask for hospitals and doctors in area of travel (see a full list of detailed questions) What about emergency medical evacuations? According to the US State Department, very few health insurance companies will  pay for a medical evacuation back to the United States, which can easily cost  up to $100,000, or even more, depending on your condition and location. Travel smart In addition to seeking proper medical protection, travelers can also reduce health risks by learning about destination-specific medical concerns, including required vaccinations.  The US State Department is a helpful resource. The US Federal Consumer Action Handbook also provides travel insurance recommendations for travelers (Source: USAGov in Technology Transformation Service, General Services Administration).

Flu Season: Surprising Do’s And Don’ts For Travelers

Compared to recent years, the 2016-2017 flu season, now at its peak, is shaping up to be relatively severe. In the US, the flu hospitalization rate was 29.4 per 100,000 people the week of Feb. 10, compared to a rate of 5.1 per 100,000 people during a comparable week in 2016, and pneumonia and mortality rates have now passed epidemic thresholds. For those taking advantage of off-season deals and Spring Break vacations to travel in March, this trend may be especially alarming – after all, experts say crowded spaces, new germs, recirculated air, and jet lag can make travelers more vulnerable to the flu.

While travelers may choose to recommit to timeless prevention techniques, like getting plenty of rest and drinking lots of fluids, this flu season, they may also want to brush up on less intuitive factors that may affect their ability to stay well on the road. With this in mind, AIG Travel Global Medical Director Dr. William Spangler has provided a list of lesser-known flu season “do’s” and “don’ts” to clarify common misconceptions about this serious illness, and give travelers the best chance of enjoying their trips in good health.

This flu season, AIG Travel and Dr. Spangler recommend the following to travelers:

• DO get a flu vaccine, but: According to the Centers for Disease Control, getting a seasonal flu vaccine is the single best thing you can do to prevent yourself and others (many of whom, such as children under six months, may not be able to get the vaccine themselves) from getting sick. If you’re among the 60 percent of Americans who haven’t gotten their flu shot this season, talk to your doctor about one today.

• DON’T stop there: Each flu vaccine protects against only those viruses that experts believe will be most common in a given season. The vaccine does not protect travelers from less prevalent strains of the virus (which international travelers may be particularly likely to encounter), nor is it 100 percent effective at preventing the strains it does target. Vaccinated travelers should still take preventive measures, such as regular hand washing, to keep from getting sick.

• DO be extra vigilant, but: Many behaviors that protect people from catching the flu may seem extreme to others or even to travelers themselves. That said, consider the harm in looking a little silly compared to that of contracting a disease that could potentially ruin your trip. Be “that” person, and: wipe down tray tables and arm rests with disinfecting wipes, don’t shake the hands of those with visible symptoms, such as cough and runny nose, and avoid large crowds in areas with known outbreaks.

• DON’T let your guard down post-flu season: While in the northern hemisphere, flu activity drops off significantly after May as the summer approaches, this is also the same time popular destinations in the southern hemisphere (e.g., Australia, Brazil, South Africa) are headed into winter. Flu season at these destinations may be just beginning, and look very different than in the U.S. Travelers are advised to practice healthy behaviors year-round to minimize their risk.

• DO what works for you, but: While some behaviors, such as frequent hand washing, eating healthy foods, and avoiding face touching, are tried and true flu deterrents, there are others – like taking Vitamin D supplements – that medical professionals aren’t so sure about. While these fixes shouldn’t be relied upon exclusively, travelers may (with the blessing of their doctor) try whatever they’d like to fight the flu. Sometimes, feeling healthy is half the battle!

• DON’T fly if you’re sick: That said, it’s critical travelers remain courteous to others, and know when to call it quits. Sick travelers, and especially those with a fever, should postpone or cancel their trips – not only to focus on their own health, but also to protect others from catching their illness. Some larger airlines may even assign staff members to keep any eye out for sick travelers, and prevent them from boarding the flight where they may infect healthy passengers.

This flu season, travelers may also consider purchasing travel insurance as a way to protect their purchase if they or a family member falls ill before a trip, and to help ensure they have the resources and support they need in the event this happens during a trip. Many insurers offer 24/7 assistance services which can connect travelers to medical experts who can assess their case, as well as evacuation coverage to transport travelers home or to a hospital of their choice in the event of an emergency.

Travelore Service Review: DoctorOnDemand.Com Brings Board Certified Doctors To Your Computer, Smartphone, Or Tablet For Just $49.

If your primary doctor's office is closed or you are traveling in the United States you now have access to board certified physicians on your computer, smartphone and tablet for just $49 or covered by your insurance. I tried this service over a weekend when my primary care doctor was not available and was very pleased with how comprehensive my diagnosis was and my prescription was immediately sent to my local pharmacy. For more details please go to www.doctorondemand.com .
Use the discount code Allen60 for $10 off your first visit.

You Know You Should Use Sunscreen. But Are You Using It Right?

Applying sunscreen at Siesta Public Beach in Sarasota, Fla. CreditChip Litherland for The New York Times

Look, we’re not here to nag. We all know we’re supposed to use sunscreen more reliably than we probably do.

Instead of hounding you again, we asked experts for tips on skin cancerprevention and using sunscreen that you’re less likely to have heard: the counterintuitive, the new or the little-known.

Here’s what they told us. (We know this is a little “Eat your vegetables” of us, so we’ll give you a reward if you make it to the end.)

The Basics

Hopefully, you’ve heard these before, but let’s reapply.

Depending on your body size, experts recommend using enough lotion to fill a shot glass, or an ounce, when you’re at the beach. Even if people are smart enough to apply sunscreen, they may not use enough, said Dr. Jerry Brewer, a dermatologic surgeon at the Mayo Clinic in Minnesota.

Even if the bottle says the lotion is waterproof, beachgoers should reapply after swimming.

If you’re not swimming, you should reapply every two hours, regardless of the SPF count.

You should put sunscreen on 15 minutes before exposure.

Look for products that are labeled “broad spectrum protection” with anSPF of 15 to 50.

Spots You’re Likely to Forget

Dr. Elizabeth Hale, a senior vice president for the Skin Cancer Foundation and a dermatologist in New York City, said that both men and women are likely to miss the tops of their ears and the tops of the feet. (Full disclosure: The nonprofit Skin Cancer Foundation receives some funding from sunscreen manufacturers.)

Men are particularly likely to miss their scalps and the backs of their necks, while women are more likely to miss their chest and neck areas, she said.

Dr. Brewer said beachgoers often miss the bottoms of their feet, which can be exposed if they’re lying on their stomachs reading or napping.

Are Spray-On Sunscreens Safe?

This is a tricky one. Not even the Food and Drug Administration is sure, and we still don’t know how effective they are or whether inhaling them can be dangerous.

While some medical professionals suggest you should not use them, “I tend to think it’s better than nothing,” Dr. Brewer said. He recommendedusing the creams and lotions when possible, but said the sprays can be useful if you’re on the go and won’t make time for a full reapplication.

Dr. Hale said spray-on sunscreen should be applied indoors in a well-ventilated area, and never sprayed directly on the face. Trying to apply it on the beach could lead to much of it flying away in the wind, leaving you with inadequate protection.

Though there’s no quantifiable standard like the shot glass of lotion, Dr. Hale suggested spray users create “an even sheen on the skin.”

Help From Technology

Because you’re probably taking your phone to the beach, you could rely on it, instead of your faulty memory, to remind you that it’s time to reapply. Android and iOS are rife with free and inexpensive apps that could alert you when you need it.

You could also seek help from wearables. A jewel-like device called JUNE, which can be worn as a bracelet or a brooch, monitors sun exposure and syncs with an iOS app that can tell you how quickly you’re using up your recommended sun allowance for the day. Or you could try a low-tech wristband, like UVSunSense, that changes colors to signal you should reapply sunscreen or head indoors.

Improving Your Looks, Too

Dr. Hale said that when she tries to persuade patients to take sunscreen more seriously, she sometimes targets their vanity more than their health. She tells them that using sunscreen every day — not just when they’re at the beach or the park — can help prevent the brown spots and wrinklesthat often lead people to seek out dermatologists, and that sun exposure is a primary driver of the skin’s aging process.

“I truly believe sunscreen is the No. 1 anti-aging ingredient,” she said.

Research in 2013 revealed that people who used sunscreen every day had markedly smoother and more resilient skin. The study was funded by the National Health and Medical Research Council of Australia, and no sunscreen makers contributed.

Your Reward

Congratulations for making it all the way through an article about sunscreen. As your reward, we present you this adorable photo gallery of parents applying lotion to visibly annoyed children. You earned it.

By DANIEL VICTOR, www.nytimes.com

An Informed Traveler Is A Safer Traveler

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GRAPHIC

Air Travel Between U.S. and Zika-Affected Areas

Air travel has been a factor in the spread of Zika virus, but some countries are better at detecting and preventing the spread of diseases.

Which sounds like the most dangerous way to spend your next vacation?

1. Going to Brazil, epicenter of the Zika virus, for the Olympics.

2. Visiting Istanbul, where eight German tourists died in a terrorist attack last month.

3. Taking a road trip through Thailand.

4. Staying home to work on a long-put-off home improvement project.

It’s tricky, but it’s not a trick question: There is no wrong answer. The way that you measure risk is based on complex factors, including personal ones. Mosquitoes may love you, terrorism may have touched you directly, your husband may be a terrible driver, and that project may include asbestos removal.

The number of Americans making such calculations is growing: We’re traveling abroad more often and to more places, perhaps because our globalized world — Starbucks in 65 countries! — seems smaller and safer. Until it isn’t. The Zika virus is spreading through the Americas not long after chikungunya infected thousands of American travelers there and Ebola ravaged West Africa. It’s not just disease: Recent terrorist attacks targeting tourists (Tunisia, Egypt, Istanbul) and tourist areas (Paris) have also made such decisions more wrenching.

“There’s a lot going on in the world,” said Daniel Durazo, director of communications at Allianz Global Assistance USA, which sells travel insurance. “There’s a lot of noise out there about the dangers of traveling.”

Yet we’re generally terrible at adjusting the volume.

“How scared or not you are is an emotion, not a statistic,” said David Ropeik, a risk consultant and the author of “How Risky Is It, Really?” As fans of haunted houses will attest, risk and being scared are two different things. But Mr. Ropeik’s point is that in the battle between your gut and your brain, your gut will win. One way to make sensible choices as a traveler is to nudge your gut toward rationality by feeding it accurate information, which is easier said than done.

Zika and terrorism are the latest high-decibel threats. But there are also some deafening silences. For example, you hear very little about the leading cause of nonnatural deaths among Americans abroad: motor vehicle accidents.

According to the latest figures available from the State Department, 223 Americans died abroad in car, bus or motorcycle accidents between July 2014 and June 2015. Other causes of death (homicide, suicide and drowning) also far outweigh terrorism. Sixteen Americans died of “terrorist action” in that period, all but four in places you already know not to go: Syria, Libya, Afghanistan and Somalia.

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So before you even think about terrorism, you may want to check road safety in countries you hope to visit. A ranking of countries by car crash deaths per capita, based on a 2014 report by the respected University of Michigan Transportation Research Institute, shows that among the 10 most dangerous are two beloved destinations: Thailand and the Dominican Republic.

This is not to suggest that you should rush out and cancel your trip to Punta Cana. There, as in many places in the Dominican Republic, travelers tend to stay in resorts, and it is extraordinarily rare to die in a car accident while lying on the beach. As for Thailand, maybe you’d consider a less ambitious road trip, or domestic flights, though I’m not convinced that driving there is much more dangerous than renting a car in any country where you drive on the “wrong” side of the street. (A New Zealand police officer I met in a rural inn told me one of his main duties was to rush to crashes caused by Americans driving on the right.)

Even staying in the United States doesn’t always protect you. Repeated studies showed that after the Sept. 11 attacks, many Americans opted out of flying and drove instead, resulting in at least hundreds of additional road deaths. In hindsight, it would have been better to fly. But at that time, no one could say for sure if more airplanes would be hijacked, and fear was running high. “Not knowing is vulnerability and powerlessness and that raises precaution instinctively,” Mr. Ropeik said.

A similar sort of uncertainty is playing out now with the Zika virus, helped out by dramatic reports. Some people I know have even conflated the virus’s potential danger to pregnant women — it is suspected of causing a birth defect called microcephaly — with the relatively mild illness it causes in the overwhelming majority of those who suffer symptoms at all.

The antidote is good information. Travelers should seek out information specifically for them like the website of the federal Centers for Disease Control and Prevention, which cautions pregnant women against travelingbut restricts its warnings to most others to preventing mosquito bites, rather than changing travel plans. The State Department has yet to issue any travel warnings about Zika (nor does it have any current terrorism-related warnings in Europe, though it mentions Istanbul in its Turkey warning, principally dealing with the southeast part of the country).

Dr. Martin Cetron, director of the Division of Global Migration and Quarantine at the C.D.C., told me that even the warning for pregnant women is based on suspected rather than proven links. “In an era of uncertainty,” he said, “it’s reasonable to take a cautious approach and step back, rather than take a cavalier approach that the consequences won’t happen, and miss an opportunity to protect individuals.” But “you don’t want to swing so far the other way and say from now on no one should go to these places,” he said.

CreditDavid Plunkert

Numbers are often misreported, which can undermine popular understanding of risk. Over 5,000 cases of microcephaly had been reported in Brazil since January 2015. That sounds scary. But a deeper look tells a more complex story. The government investigated 1,345 of those cases, and found 837 were misdiagnoses. That means incidences of microcephaly are maybe a third of what is largely being reported, and it is unknown how many would have occurred without Zika. And Zika cases as a whole have been mostly concentrated in a few states of northeast Brazil, far from Rio de Janeiro’s Olympic venues, and anecdotally at least, mostly in poor neighborhoods where the Aedes aegypti mosquito thrives and repellent use is less common. That is a public health crisis and perhaps a social justice issue, but a far lesser risk to most travelers, especially nonpregnant ones.

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Here we also have a deafening silence. Unmentioned in much of the coverage of Zika is that last year, 1.5 million Brazilians caught dengue fever, which is transmitted by the same mosquito but causes far more serious symptoms: over 800 died. This year has seen new outbreaks. So if you’re a man or nonpregnant woman more scared of Zika than dengue, it’s too late: You’ve already been infected by the news media.

If that is the case and you decide to stay home, keep in mind that carries its own risks. “We are more scared of the unfamiliar than the familiar,” Mr. Ropeik said. Yet we run long- and short-term risks every day: eating fast food, walking under a crane and crossing busy streets, not to mention drinking water tainted with lead.

Arthur Frommer, the octogenarian guidebook guru, has another to add: “I have recently been struck by the fact that you encounter greater danger in the U.S. from gun violence than the popular destinations to which people travel.” He noted that Tim Fischer, a former deputy prime minister of Australia, recently suggested that his country issue a travel warning about the widespread prevalence of guns in the United States; the government did not, but does tell Australians on its Smartraveller site: “You should be vigilant to the possibility of gun crime in all parts of the U.S.”

Some Americans would argue that the United States is in fact safer because of the wide presence of guns; they might logically choose to defer travel to Australia.

Instead of holding off on a trip — or becoming a hermit — the best way to stay safe is to reduce risk on the road. That may be by using mosquito repellent religiously at the Olympics, taking public transport in New Zealand, and spending less time in big European cities and more in small towns. Another way to knock risk down a notch is to mitigate the impact of potential crises by, say, buying medical evacuation insurance. Keeping a list of top hospitals and emergency numbers at the ready helps as well. Allianz’s free TravelSmart app puts that information in your phone, though in developing countries I would check JustLanded.com for the number of a private ambulance service as well.

Once you have assessed potential travel risks, you should compare them with potential travel rewards. That can vary greatly among individuals. Exhibit A: “Travel to me is too vital, too important a part of civilized life that I feel we would give up too much by not traveling for fear of terrorism to France, Belgium and other destinations,” Mr. Frommer said. But for less gung-ho travelers, any added risk could tip the scales and land them at the municipal pool or on the local golf course.

The final thing you have to fear is fear itself. If after careful deliberation you’ve decided that the risks are slim, but you’re still terrified, then consider staying put. Not because of the risk to your health, but the certainty that you’ll be too nervous to appreciate your travels.

Correction: March 6, 2016 

An article last Sunday about minimizing risk while traveling misstated the name of an app from the insurance company Allianz. It is TravelSmart, not Smart Traveler.

By SETH KUGEL, www.nytimes.com

A version of this article appears in print on February 28, 2016, on page TR1 of the New York edition with the headline: The Antidote to Travel Anxiety: Information. Order Reprints