The Ruby Princess cruise ship off the coast of Sydney (Image: AAP/Joel Carrett)

The federal government has made a key change to the information it seeks from cruise ships in light of the escalating scandal of the Ruby Princess.

The change is an apparent admission that insufficient detail was given on the health of passengers on board the ship, though who is responsible for the failure — the company or health authorities — remains unclear.

The ship, the single-biggest source of COVID-19 infections in Australia, accounts for more than 500 infections Australia-wide and for five deaths.

A week after the Ruby Princess docked, as confirmed cases of COVID-19 infections were spiralling across Australia, the federal government changed a key question on a standard pre-arrival form which ships’ captains are required to complete.

The information they declare matters because it shapes the assessment which health authorities make.

When the Ruby Princess docked on March 19 — two weeks ago today — the ship was asked to answer “yes” or “no” to the question of whether any passengers or crew had:

  • Persistent coughing and difficulty breathing with no apparent cause and no history or similar symptoms (but not persistent coughing and difficulty breathing caused by asthma, heart disease, obesity, chronic bronchitis or emphysema). 

The question was revised on March 25, a week ago, to ask whether any passengers or crew had:

  • New coughing illness which developed in the past two weeks (but not caused by an existing chronic disease e.g. asthma, heart disease, obesity, chronic bronchitis or emphysema).  Yes or No.

The Federal Department of Health told Inq the question was revised to “align” it with screening processes used for ill travellers on arrival, and to “address feedback from stakeholders” that the question as it was previously worded was not clear regarding reporting of COVID-19 symptoms.

“The decision to change the wording of the question was supported by the chief human biosecurity officers in each state and territory,” a department spokesman said. (The role of chief human biosecurity officer at the federal level is occupied by the chief medical officer Brendan Murphy.)

The change was clearly aimed at flushing out any new coughing illness developed over the past 14 days. 

 But medical practitioners see the change as being too little, too late. 

Dr Chris Moy, president of the Australian Medical Association of South Australia — a state which has been affected by a large number of cruise ship cases from NSW — said the change was “quibbling at the edges”.

“Although there is a clarification on the matter the far bigger issue is using common sense above nitpicking about individual criteria,” he said.

Yet why would a cruise ship docking at an Australian port on March 19 — with the virus pandemic gathering pace around the world — have any doubt at all about the intent of a question about the health of passengers?

The federal government’s change — as unnecessary as it may seem — lays bare the defence being adopted by international cruise lines to account for infected passengers leaving their ships: that the government didn’t ask the right question.

And it underscores the risks inherent in a self-reporting regime under which a cruise company is asked to volunteer information which is potentially damaging to its reputation and to its bottom line. 

Carnival Corporation, which owns the Ruby Princess, has refused to answer Inq’s questions on precisely what information it gave in answer to the health question as it appeared on the Maritime Arrivals Reporting System (MARS).

The system is designed to document biosecurity risks, carried by humans on board a ship or by a ship’s cargo. It is operated by the Federal Department of Agriculture which shares information with state health departments and the Australian Border Force. 

NSW Health has also refused to answer the question of whether or not Carnival provided full and accurate information on the risk on board the Ruby Princess. An elderly woman was removed from the ship shortly after docking at 2.30 on the morning of March 19 and was taken by a waiting ambulance. She died six days later. 

The silence from Carnival and NSW Health points to the breakdown of a system which has become riddled with conflicts of interest and which has seen a blurring of the lines between the regulator and the regulated. 

Medical judgments on board the Ruby Princess — which might or might not be prejudicial to the business — are in the hands of doctors employed by Carnival. Carnival’s chief medical officer, Dr Grant Tarling, is at the same time senior vice president of the multibillion-dollar Carnival Corporation, which is listed on the US and UK stock exchanges.

It is unclear who can compel the production of medical information given the Ruby Princess is registered in Bermuda and subject to the law of Bermuda — a jurisdiction known for the favourable conditions it offers shipping owners. 

To date, Carnival has relied on the defence that it was acting on approvals from NSW Health, but did tell NSW Health that some of its passengers exhibited “flu-like” symptoms.

Yet in the case of the Ruby Princess — a leading “stakeholder”, to use the Federal Health department’s language — it is hard to see how there could be any doubt about the intention of the health question it was asked.  

Even before the Ruby Princess docked in Sydney on March 19, Tarling’s world had exploded with COVID-19 outbreaks on other ships.  

In Japan, the Diamond Princess had been forced to hold 2000 passengers in quarantine off the coast of Japan for more than a fortnight. 

In the US, on March 7, two crew members of Carnival’s Regal Princess had to be tested for COVID-19, leading to a delay in the ship docking.

In the US, on March 8, the Royal Princess was subject to a no-sail order after it was discovered a crew member had been transferred to the ship from the Grand Princess cruise ship.

Off the coast of California, the Grand Princess had been sitting in quarantine after a passenger died due to COVID-19 infection. That drama began on March 4 and continued through to March 16 when all passengers and more than half of the ship’s crew members were taken off the ship.

Perhaps most concerning, on March 17 (in the US), as the Ruby Princess was closing in on Sydney, the US Centre for Disease Control issued a preliminary report which pointed to staff involved in food preparation on board the Diamond Princess as hastening the spread of coronavirus on the ship.

The Ruby Princess entered Sydney Harbour on March 19, Australian time. Three crew have since tested positive to the virus and been brought ashore under police escort for treatment.

The cruise industry, led by Carnival, is a major profit spinner for the Port Authority of NSW, a corporatised government body which reports its financial results to the NSW Treasury. The authority makes no bones about the power of the cruise industry.

“Cruise is the fastest growing tourism sector in Australia. It is also a growing trend for Australians, with 1.35 million people, or 5.8% of the population cruising in 2018,” the Port Authority says, quoting from a report commissioned by the cruise ship lobby group, Cruise Lines International Association.

The Port Authority quotes the lobby group’s 2018 estimate that the cruise industry is worth $4.8 billion nationally, with 58% “attributed” to NSW.

The Port Authority regulates the movement of ships in Sydney Harbour. It is paid fees for providing navigation and pilot services. For passenger ships it is paid a $40-per-head berthing fee, which translates to around $110,000 for the Ruby Princess’ 2750 passengers who disembarked on March 19.

For its part, NSW has been investing in the cruise industry. The government released a Cruise Development Plan in 2018, setting out a long–term strategy to develop the industry in NSW, including a possible new terminal in Sydney, a joint project of the Port Authority of NSW and the NSW Treasury.

Carnival Corporation is the biggest cruise industry player internationally and in Australasia.  

Last year it reported record total revenues of US$20.8 billion — an increase of US$2 billion over the previous year.

The glamorous image of cruising puts a lick of paint over a business model which relies on exploiting the legal and tax loopholes available in flag-of-convenience countries such Panama and Bermuda. The jurisdictions allow cruise companies to employ crew from countries such as the Phillipines while avoiding labour laws of the UK or Australia.

The revelation of the change to the key health question comes as Home Affairs Minister Peter Dutton accuses some cruise ships of lying about the COVID-19 situations on board.

Carnival Corporation’s Australian head office has declined to answer these questions from Inq, provided Wednesday:

  • Ships — including the Ruby Princess — are required to self-report re illness on board. Do you accept that on the face of it this is a conflict of interest, given that ships’ doctors are paid by the company?
  • In the case of Carnival, the chief medical officer, Grant Tarling, is a long-serving and now senior employee of the company.  What assurance does the public have that he is NOT acting in the interests of the company?
  • Can you shed light on who the on-board doctors are?

NSW Health said that cruise ship voyages into Sydney linked to confirmed COVID-19 cases in NSW were:

  • Ovation of the Seas, docked March 18 — 74 cases
  • Voyager of the Seas, docked March 18 — 34 cases plus five crew members
  • Ruby Princess, docked March 19 — 337 cases plus three crew members
  • Celebrity Solstice, docked March 19 — 11 cases

As of this morning the number of confirmed coronavirus cases in Australia was 4976, with NSW accounting for 2298 of those.

NOTE: This article has been updated to correct the name of the Port Authority of NSW.