Public Health Responses to COVID-19 Outbreaks on Cruise Ships Worldwide, February March 2020 MMWR

Table Of Content

• CDC monitoring 94 cruise ships for COVID. Here's how to check whether your ship is on the list.
• Guests and crew members test positive for COVID-19 aboard Princess Cruise ship
• California returns to job growth in March, but unemployment rate remains highest in nation
• The House votes for possible TikTok ban in the U.S., but don’t expect the app to go away any time soon
• Coral Princess
• Viral ARI Screening Procedures for Embarking Passengers

The company will also offer a pro-rated cruise fare refund if a cruise is cut short for reasons related to COVID-19, for cruises departing on or before September 30, 2022. The CDC advised that those who choose to travel on a cruise should get vaccinated against COVID-19 before their trip and, if eligible, receive a booster dose. This is one of the biggest risks of taking a cruise right now, and one reason you may consider canceling a sailing scheduled in the short term (see the section on more-flexible cancellation policies below). Other lines canceling one or more sailings in recent days include Holland America, Silversea, Atlas Ocean Voyages, Regent Seven Seas Cruises, MSC Cruises, Costa Cruises and Oceania Cruises.

CDC monitoring 94 cruise ships for COVID. Here's how to check whether your ship is on the list.

The current protocol on most ships is to isolate COVID-19-positive passengers and crew but otherwise continue on with voyages as planned. The number of passengers being quarantined on ships (after testing positive for COVID-19) also is on the rise. And passengers who aren't COVID-19 positive are getting caught up in short-term quarantines for being "close contacts" of shipmates who are. Despite tight industrywide protocols — including pre-departure Covid testing as well as vaccine mandates — it is not uncommon for ship passengers or crew to test positive for the illness.

Guests and crew members test positive for COVID-19 aboard Princess Cruise ship

As noted above, health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19. Viking on Sunday was forced to announce a major revision of its soon-to-begin, 120-day world cruise after India notified the line it was closing to cruise ships. Viking's 930-passenger Viking Star will begin its world cruise this week by heading south from Los Angeles to Central America and South America instead of sailing westward toward Asia, where it was scheduled to spend a significant amount of time in India. Health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19.

California returns to job growth in March, but unemployment rate remains highest in nation

Factors that facilitate spread on cruise ships might include mingling of travelers from multiple geographic regions and the closed nature of a cruise ship environment. This is particularly concerning for older passengers, who are at increased risk for serious complications of COVID-19 (4). The Grand Princess was an example of perpetuation of transmission from crew members across multiple consecutive voyages and the potential introduction of the virus to passengers and crew on other ships. Vessel captains may request assistance from CDC to evaluate or control ARI outbreaks as needed.

Green status means there have been no reported cases of coronavirus or COVID-19-like illnesses on board. As of Monday morning, there were 16 ships with green status, and some of those ships are on crew-only voyages. While health authorities no longer are quarantining whole ships when a few passengers or crew test positive for COVID-19, the presence of the illness on board a vessel still could result in notable disruptions to your itinerary.

The Carnival Cruise Line's Carnival Sunrise ship is seen in the port of Miami on Dec. 23, 2020, amid the coronavirus pandemic. "It is important to know that there is at least a two-day lag in the posting of an updated color status," the CDC's Daigle told USA TODAY. That means you could call the line right now to back out of a cruise that is just days away. In normal times, you'd lose all your money if you backed out of a seven-night Norwegian cruise with fewer than 31 days' notice. The first known person in California to die of the virus at the time,[205] as well as the first cases in Alberta,[222] Hawaii,[223] and Utah,[224] were all former passengers of Grand Princess.

Testing is generally not recommended for asymptomatic people who recovered from COVID-19 in the past 30 days. If exposed passengers are allowed to board, see information below regarding recommendations for management onboard. Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

"If you get sick on a cruise, they're going to take care of you. The care that I received was complimentary," he said. While contracting COVID can happen anywhere, Hochberg's advice for those boarding a cruise is to be aware of the cruise line's policies and risks. If you're booked on a cruise in the coming weeks, and you're having second thoughts, there's a good chance you can get out of your trip. No other segment of the travel industry has been as uniform in requiring almost every customer to be fully vaccinated against COVID-19. Here's a look at everything you need to know if you've got a cruise booked in the coming weeks -- or further out.

The results of testing of passengers and crew on board the Diamond Princess demonstrated a high proportion (46.5%) of asymptomatic infections at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected persons never developed symptoms (9). A high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew. Although these data cannot be used to determine whether transmission occurred from contaminated surfaces, further study of fomite transmission of SARS-CoV-2 aboard cruise ships is warranted. During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table).

Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members during sailings. You will usually be required to show proof of vaccination at the terminal before boarding. Some cruise lines will also require passengers — whether vaccinated or not — to show proof of a COVID-19 test taken within two days of boarding a vessel.

On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California.

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The table below provides disease-specific recommendations for persons on board with COVID-19, influenza, or RSV and those exposed (i.e., contacts). Cruise ship operators should consider denying boarding for passengers who test positive for infectious viral etiologies during pre-embarkation screening, as well as those who tested positive for COVID-19 within 10 days before embarkation. If boarding is permitted, see guidance for isolation and other measures provided below. This document also provides guidance for preventing spread of ARI during and after a voyage, including personal protective measures for passengers and crew members and control of outbreaks. The federal agency recommends that people avoid cruise travel if they are at increased risk of severe illness, regardless of vaccination status. But in recent months, as new and highly contagious variants have emerged and case numbers steadily increase worldwide, these measures are being put to the test.

Several ships recently had to skip port calls in Mexico, for instance, after passengers and crew on board the vessels tested positive for COVID-19. The ports have since reopened after Mexico's Health Department overruled the decisions of local port officials. Governments and ports responded by preventing many cruise ships from docking and advising people to avoid travelling on cruise ships. Many cruise lines suspended their operations to mitigate the spread of the pandemic.

Infection prevention and control (IPC) are critical to reducing the spread of ARI. Each cruise ship should maintain a written Infection Prevention and Control Plan (IPCP) that details standard procedures and policies to specifically address infection control and cleaning/disinfection procedures to reduce the spread of ARI. Cruise ship operators should consider screening embarking passengers for viral ARI symptoms, a history of a positive COVID-19 viral test within the 10 days before embarkation, and a history of exposure to a person with COVID-19 within the 10 days before embarkation. Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members. One day after the C.D.C. announcement, as dozens of crew members and other passengers were confined to small cabins, infected and quarantined, thousands of revelers packed into ship bars, casinos and deck venues, partying like it was 2019. Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries.

Meanwhile, just getting to ships is becoming increasingly stressful, as getting the pre-cruise COVID-19 test that's often required before cruising is getting more difficult. Plus, a "perfect storm" of soaring COVID-19 cases and rough winter weather has wreaked havoc with airline operations for weeks. Cruise operators should ensure passengers and crew have access to well-stocked hygiene stations with soap and water and/or hand sanitizer, tissues, paper towels, and trash receptacles. Respiratory specimens for ARI testing should be collected immediately upon illness onset, with the understanding that repeat testing may be indicated based on the viral etiology or state of the COVID-19 pandemic. In general, molecular tests are recommended over antigen tests because of their greater sensitivity; multiplex assays are available that can detect SARS-CoV-2, influenza A and B, and RSV.