cruise ship lockdown

There's COVID-19 on nearly every cruise ship right now: Here's what cruisers need to know

Things are getting iffy again for cruisers -- at least for those with near-term bookings.

The ongoing surge in COVID-19 cases around the world is causing a growing number of disruptions to itineraries and even some last-minute cancellations of entire voyages.

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.

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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.

Still, the situation isn't anywhere near as dramatic or disruptive as what we saw at the start of the COVID-19 pandemic two years ago, when whole ships were being quarantined due to outbreaks of the illness and, eventually, the entire industry shut down.

As I saw myself during a cruise to Antarctica in recent weeks, many sailings are operating relatively normally, even when there are COVID-19 cases on board.

Here's a look at everything you need to know if you've got a cruise booked in the coming weeks -- or further out.

COVID-19 cases on ships are up a lot

While cruise ships have recorded relatively few cases of COVID-19 over the past year, in part due to unusually strict health protocols , the number of passengers and crew testing positive on ships has been rising sharply in recent weeks along with the greater surge on land.

At the end of December, the U.S. Centers for Disease Control and Prevention reported that 5,013 COVID-19 cases had been reported on cruise vessels operating in U.S. waters during the last two weeks of the month, up from just 162 cases during the first two weeks of the month.

That's a 3,094% increase.

Anecdotal reports are that the number of cases on ships is up even more in the first 10 days of the new year.

Notably, all 92 cruise vessels currently operating in U.S. waters have recorded at least a handful of COVID-19 cases in recent weeks, according to CDC data.

Still, it's important to note that most of these "cases" of COVID-19 are asymptomatic or mild, only discovered during routine testing. While some ships only are testing passengers who report feeling ill for COVID-19 (and close contacts of those who subsequently test positive), other ships are testing every single passenger at least once per voyage, sometimes more. One line, Viking , is testing every single passenger for COVID-19 every day.

Cruise lines also are testing all crew members regularly.

The result is the detection of many asymptomatic cases that otherwise would have gone undetected. This is a level of surveillance that is much greater than what is the norm for other travel venues such as land-based resorts or theme parks, and it can give the false impression that the positivity rate for COVID-19 on ships is unusually high as compared to other places.

If anything, the positivity rate is far lower on ships than on land, thanks to much stricter health protocols (more on that in a moment).

It's also important to note that the detection of COVID-19-positive passengers or crew on board your ship won't necessarily impact your sailing (unless you are among those testing positive).

Health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19. The current protocol on most ships is to isolate COVID-19-positive passengers and crew but otherwise continue on with voyages as planned.

Your itinerary could change

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.

Cruise lines in recent weeks have faced a growing number of ports that are balking at allowing ships with COVID-19-positive passengers or crew to dock.

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.

Cruise ships also have had to cancel stops recently at the islands of Aruba, Bonaire and Curaçao, and at San Juan, Puerto Rico, due to local worries about COVID-19-positive passengers and crew on board and/or tighter COVID-19-related entry requirements.

Lines also are dealing with a small but growing number of destinations -- India and Hong Kong, for example -- that are at least temporarily closing to cruising completely, even for ships where no one has tested 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.

Your cruise could be canceled on short notice

A growing number of cruise lines are canceling sailings on short notice, citing the disruptions caused by COVID-19. The world's largest cruise operator Royal Caribbean on Friday canceled soon-to-depart sailings on four of its 25 ships, including the next three departures of the world's largest ship, Symphony of the Seas .

Norwegian Cruise Line on Wednesday canceled soon-to-depart voyages on eight of its 17 ships.

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 .

The cancellations come as lines struggle to maintain adequate staffing levels on some ships due to crew members testing positive. When crew test positive, they and their close contacts must stop working and isolate, even if asymptomatic, leaving shipboard venues short-staffed.

You probably won't be quarantined, stranded or stuck

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.

The current protocol on most ships is to quickly isolate COVID-19-positive passengers and their close contacts. But only the COVID-19-positive passengers are being isolated long term.

As my colleague Ashley Kosciolek experienced first-hand on a cruise in 2021, close contacts only are being isolated for a short period while they are tested for COVID-19. If they test negative, they typically are allowed out of their rooms to rejoin the rest of their fellow cruisers on board.

This means that many sailings are going ahead as planned, with little disruption, even when some passengers and crew on the trips test positive for COVID-19. I experienced this myself in late December when on a Silversea vessel where four passengers tested positive for COVID-19. Some passengers who were deemed close contacts of the passengers who tested positive were isolated for a short period while being tested for COVID-19. But the positive cases had little impact on most of the passengers on board the vessel, and the voyage went ahead as planned.

Such a protocol comes at the recommendation of the CDC, which has set guidelines for how cruise lines should respond to COVID-19-positive cases on board ships, and it has worked well for the past year .

Of course, if you do test positive for COVID-19 on a ship, you will, unfortunately, face what could be several days of isolation in a cabin on a ship or on land. If you are an American cruising overseas, you also won't be able to return to the U.S. until you have tested negative for COVID-19 (or until you recover from the illness and are cleared in writing to travel by a licensed healthcare provider or a public health official).

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).

Most COVID-19 cases on ships aren't serious

Cruise lines are reporting that the vast majority of passengers testing positive for COVID-19 in recent weeks are asymptomatic or have mild symptoms.

All major cruise lines currently are requiring all or nearly all passengers to be fully vaccinated for COVID-19, with some also starting to require booster shots , to boot. This creates an onboard population that is far less likely to experience serious symptoms of COVID-19 than a cross-section of people on land, according to CDC data.

For all adults ages 18 years and older, the cumulative COVID-19-associated hospitalization rate is about eight times higher in unvaccinated persons than in vaccinated persons, according to the latest CDC data.

You'll face lots of new health protocols

If you haven't cruised since before the pandemic, you might be surprised by how many new health- and safety-related policies cruise lines have implemented to keep COVID-19 off ships.

For starters, there are the vaccine mandates noted above. No other segment of the travel industry has been as uniform in requiring almost every customer to be fully vaccinated against COVID-19.

Related: Will I need a COVID-19 vaccine to cruise? A line-by-line guide

As noted above, cruise lines also are requiring passengers to undergo COVID-19 tests before boarding ships -- a screening process that is keeping many COVID-19 positive people from ever stepping on board a vessel.

When COVID-19 is detected on a ship, cruise lines sometimes then test passengers multiple times to ensure it isn't spreading. On my recent trip to Antarctica, I underwent six COVID-19 tests in just eight days -- three in advance of stepping on board the vessel (including a PCR test required by Chile, where my trip began) and three while on board.

In addition, most cruise lines now are requiring passengers to wear masks at all times while in interior spaces of vessels, and they have stepped up cleaning regimens, improved air filtration systems on ships and made other onboard changes.

The CDC says to avoid cruising for now

On Dec. 30, the CDC added cruise ships to its list of "Level 4" destinations you should avoid visiting for now due to high levels of COVID-19.

For what it's worth, more than 80 countries around the world -- including a good chunk of all the places you might want to travel -- are on this list. So, the CDC is basically telling you that now isn't a good time to travel. Fair enough. But the warning shouldn't be seen as a call-out on any elevated risk to cruising as opposed to visiting other places, per se.

Places on the Level 4 list currently include Canada, much of Europe and nearly every country in the Caribbean.

The cruise industry has been highly critical of the designation, arguing that cruise ships are far safer places to be right now than almost anywhere else, given their strict health protocols.

"The decision by the CDC to raise the travel level for cruise is particularly perplexing considering that cases identified on cruise ships consistently make up a very slim minority of the total population onboard — far fewer than on land — and the majority of those cases are asymptomatic or mild in nature, posing little to no burden on medical resources onboard or onshore," the main trade group for the industry, the Cruise Lines International Association, said in a statement to TPG.

You can cancel if you're worried (in many cases)

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. Many lines continue to be far more flexible than normal about cancellations.

Take cruise giant Carnival Cruise Line . Its current flexible cancellation policy allows passengers to cancel as long as a public health emergency remains in effect and receive 100% of the cruise fare paid in the form of a future cruise credit. Passengers are also able to cancel if they test positive for COVID-19. (Proof of a positive test result is required.)

Another large line, Norwegian, just last week extended its pandemic-era Peace of Mind policy to allow passengers to cancel any sailing taking place between now and May 31. For now, the cancellation needs to be done by Jan. 31, and the refund would come in the form of a future cruise credit to be used on any sailing that embarks through Dec. 31.

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.

Planning a cruise? Start with these stories:

• A beginners guide to picking a cruise line
• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
• What to pack for your first cruise

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An unofficial disney cruise line news, information, weather, and photo blog..

CDC Reveals New COVID-19 Program for Cruise Ships

On Wednesday, the Centers for Disease Control and Prevention finally revealed details on the new COVID-19 Program for Cruise Ships. This information comes nearly a month after the Conditional Sailing Order (CSO) expired on January 15, 2022. Moving forward, the CDC recommends that cruise ships operating in U.S. waters choose to participate in CDC’s COVID-19 Program for Cruise Ships.

Before we get into the details, please keep the following in mind – the rule of the land for your next Disney Cruise will be what is defined in the information provided directly by Disney Cruise Line for your specific sailing, and shared on Disney Cruise Line’s Know Before You Go pages for US sailings .

According to the CDC, cruise lines have until February 18, 2022, to inform CDC if they are participating in CDC’s COVID-19 Program for Cruise Ships. Until then, CDC encourages cruise lines to continue to follow all CDC public health measures for cruise ships, including reporting, testing, and infection prevention and control.

Between now and February 18, all cruise ships in U.S. waters will continue to be assigned a Red, Orange, Yellow, or Green color status unless they inform CDC they are choosing not to participate in CDC’s COVID-19 Program for Cruise Ships.

Additionally, cruise ships’ vaccination status classification will reflect their vaccination status classification in effect prior to January 15, 2022, unless they inform CDC of a different status.

On February 22, 2022, if cruise lines have not informed CDC of their decision to participate in the program, their ships will automatically be designated as “Gray” indicating they are not participating in CDC’s COVID-19 Program for Cruise.

Cruise lines choosing to opt into the program will be required to follow all recommendations and guidance as a condition of their participation in the program. Those opting in will continue to receive a color status for cruise ships operating in U.S. waters on CDC’s  Cruise Ship Color Status  webpage.

Cruise ships opting into CDC’s COVID-19 Program for Cruise Ships must have a COVID-19 response plan detailing protocols and procedures, provide daily surveillance data to the CDC, and have port agreements in place with U.S. port and local health authorities where the ship intends to dock or port.

Cruise Ship Vaccination Status Classifications

As part of CDC’s COVID-19 Program for Cruise Ships, cruise ship vaccination status classifications are defined as:

• Not Highly Vaccinated : ships with less than 95% passengers and 95% crew who are fully vaccinated.
• Highly Vaccinated : ships with at least 95% passengers and 95% crew who are fully vaccinated, but with less than 95% of passengers and 95% of crew who are up to date with their COVID-19 vaccines.
• Vaccination Standard of Excellence : ships with at least 95% passengers and 95% crew who are  up to date with their COVID-19 vaccines .

As of January 16, 2022, the CDC defines “up to date” as “a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.”

Cruise Ship Passenger Impacts

Below is just a brief overview of the hot topic issues such as embarkation screening, mask requirements, and shore excursions. The complete summary of the new program can be reviewed here ( archived pdf ).

Onboard COVID-19 Testing for Symptomatic Travelers (Crew and Passengers) and Close Contacts

All travelers onboard the cruise ship with signs and symptoms of COVID-19, regardless of vaccination status, must be isolated and tested immediately upon notifying medical staff of symptom onset. Results must be reported to CDC in aggregate through the EDC form.

Close contacts must quarantine for at least 5 full days on ships that have a Vaccination Standard of Excellence, otherwise at least 10 days after their last exposure.

Screening of Embarking Passengers

Cruise ship operators choosing to opt into CDC’s COVID-19 Program for Cruise Ships Operating in U.S. Waters must screen passengers for signs or symptoms of COVID-19 and screen for a known close contact exposure to a person with COVID-19 within the past 10 days.

Passengers with signs or symptoms of COVID-19

• Deny boarding if not fully vaccinated and without documentation of recovery.
• May board at operator’s discretion if fully vaccinated, up to date with their COVID-19 vaccines, or with documentation of recovery and embarkation day test is negative by viral test (antigen-negative must be confirmed with NAAT). If an alternate infectious etiology (e.g., influenza, respiratory syncytial virus (RSV), Legionella, Streptococcal pharyngitis) is identified through laboratory testing, routine infection control precautions recommended for the diagnosis should be followed.

Passengers who have a known close contact exposure in the past 10 days

• Deny boarding unless fully vaccinated, up to date with their COVID-19 vaccines, or has documentation of recovery
• fully vaccinated or up to date with their COVID-19 vaccines, and asymptomatic
• with documentation of recovery from COVID-19 and asymptomatic

Testing of Embarking and Disembarking Passengers for Cruise Ship Operators Choosing to Opt into CDC’s COVID-19 Program for Cruise Ships

At this time, all persons, including port personnel, crew, and passengers are advised that CDC’s Mask Order  remains in effect and requires the wearing of well-fitting masks on conveyances entering, traveling within, or leaving the United States, and in U.S. transportation hubs.

• While the Order permits temporarily removing a mask for brief periods of time while eating or drinking, removal of the mask for extended meal service or beverage consumption would constitute a violation of this Order.
• Cruise ship operators, at their discretion, may advise all passengers and crew that they do not have to wear a well-fitting mask if outdoors. CDC still recommends that people wear a mask if they are not up to date with their COVID-19 vaccines and in crowded outdoor areas.
• Masks do not have to be worn while inside one’s own cabin.
• Travelers should not wear a mask when doing activities that may get the mask wet, like swimming at the beach or in recreational water facilities. A wet mask can make it difficult to breathe and may not work as well when wet. This means it is particularly important for bathers who are not fully vaccinated to maintain physical distancing of at least 6 feet (2 meters) when in the water with others who are not traveling companions or part of the same family.

For ships with at least 95% of crew and 95% of passengers up to date with their COVID-19 vaccines, cruise ship operators choosing to opt into CDC’s COVID-19 Program for Cruise Ships, at their discretion, may advise passengers and crew that they do not have to wear a mask in any areas. Confirmation that 95% of crew and 95% of passengers are up to date with their COVID-19 vaccines must be made available to CDC upon request.

Shore Excursions & Transportation Services

Cruise ship operators, at their discretion, may advise passengers and crew that – if they are fully vaccinated or up to date with their COVID-19 vaccines – they may engage in self-guided or independent exploration during port stops or shore leave. The cruise ship operator is additionally advised that foreign or local jurisdictions may have their own requirements.

Cruise Ship Color Status

Color status for cruise ships participating in the program is based on data reported by cruise ships and relevant public health authorities.

The CDC says the color-coding system gives travelers information they can use to make informed decisions before choosing to travel. Color status designations indicate the number of COVID-19 cases reported for each ship in the program, whether an investigation is needed, additional public health measures a ship is taking, and whether a ship has opted out of the program.

“Gray” designated cruise ships are foreign-flagged cruise ships operating in U.S. waters that have chosen not to participate in CDC’s COVID-19 Program for Cruise Ships. These ships may have their own COVID-19 health and safety protocols, which  CDC has not reviewed or confirmed.  CDC cannot confirm the COVID-19 public health measures implemented on “Gray” designated ships. Therefore, CDC does not have information about precautions and interventions, such as mask use, crew testing, or vaccination status of travelers for these ships.

The process for CDC to determine a ship’s color status is based on the following steps:

• COVID-19 program participation Applicable ship types choose whether to participate in CDC’s COVID-19 Program for Cruise Ships. Cruise ships opting into the program on a voluntary basis agree to follow all recommendations and guidance issued by CDC. Foreign-flagged cruise ships operating in U.S. waters will have a “Gray” color status if they choose not to participate in the program. U.S.-flagged cruise ships that choose not to participate in the program will not be listed.
• Surveillance data collectionCruise ships submit surveillance data on a daily basis when they participate in the program. CDC monitors data collected and determines each ship’s color status using surveillance data from the previous 7 days—regardless of voyage dates— and CDC’s investigation findings, as applicable.
• COVID-19 investigationCDC established an investigation threshold based on suspected or confirmed cases of COVID-19 on board cruise ships operating under the program. CDC uses the investigation threshold to determine when an investigation of a ship is needed and determine the appropriate color status of a ship. As part of the investigation, CDC will obtain additional information from the cruise ship, such as case exposure histories, details about close contacts, proportion of travelers on board who are vaccinated for COVID-19, and the ship’s medical capacities. Any ship that meets CDC’s investigation threshold will be designated “Orange”. CDC will work closely with the cruise line and state and local health departments to consider multiple factors before assigning a “Red” status to the ship.   

Color Status Definitions

CDC amended its color-coding system for CDC’s COVID-19 Program for Cruise Ships to align with its revised investigation threshold. The “Orange” and “Yellow” ship colors were reversed for the COVID-19 Program for Cruise Ships to go in a more logical color order.

Color Status Thresholds

When a cruise ship notifies CDC of suspected or confirmed cases of COVID-19 on board, CDC determines whether an investigation is needed based on a predetermined investigation threshold outlined below. CDC will continue to monitor the pandemic, work closely with cruise lines and state, territorial, and local health partners, and consider multiple factors to determine if and when threshold criteria should be revised.

Cruise Ship Status Dashboard

A revised cruise ship color status dashboard has been created to look up the status of cruise ships. It is not easy to read embedded, but it can be opened in a separate browser window. The dashboard can be filled to just show one cruise line.

The window to view the line item ship data limited as it does not adjust to your computer screen. However, you can right click on the table area and choose view as table to see the encapsulated data set. As of now, the data is locked in, and not easily exportable.

According to the data published by the DCD on February 10th, the Disney Cruise Line ships have not informed CDC of their decision to participate in the COVID-19 Program for Cruise Ships. Remember, the cruise lines have until February 18th to notify the CDC of their decision to participate in the program.

Only time will tell how this will or will not impact the experience of your next cruise. Each cruise line will inevitably have their own set of protocols and procedures in place. Therefore, as I mentioned at the start, the rule of the land for your next Disney Cruise will be what is defined in the information provided directly by Disney Cruise Line for your specific sailing, and shared on Disney Cruise Line’s Know Before You Go pages for US sailings .

Cruise Lines International Association (CLIA) Statement

Cruise Lines International Association (CLIA) issued the following statement regarding guidelines and travel health notice updates from the Centers for Disease Control and Prevention (CDC):

The protocols adopted by every CLIA cruise-line member remain unequaled by other industries. Cruise lines are a model for adopting and employing highly effective, layered mitigation measures and have proven their effectiveness in a way that is unmatched by virtually any other commercial setting. Unlike any other travel, tourism, hospitality, or entertainment sector, cruise ships test all persons boarding, have medical, isolation and quarantine facilities on site, implement extensive response plans using only private shoreside resources, and have created an environment where almost every single person is fully vaccinated. The result has been a dramatic drop in the number of COVID-positive cases, with hospitalizations being extraordinarily rare – in fact 80 times lower than on land in the U.S. As compared to all the other sectors which, ironically, are much larger, cater to magnitudes more patrons, and operate many more conveyances and facilities without testing and at only a fraction of the cruise industry’s vaccination rates, cruising has emerged as the safest venue for mitigating COVID-19.  It is through this lens that we are reviewing the details of the guidelines released by the CDC on Feb. 9. Regrettably, upon initial review, the latest CDC guidance appears out of step with the actual public health conditions on cruise ships and unnecessary in light of societal trends away from more restrictive measures. We are confounded by the CDC’s imposition of even more complex and unwarranted measures which ignore empirical evidence that the industry’s protocols have provided a greater level of COVID mitigation than most any other setting. The CDC’s guidance for multitiered cruises is counterproductive to consumers, creating market confusion between the various tiers, and potentially unworkable in practice. CLIA and its members are fervently devoted to preventing the spread of COVID-19 and protecting passengers, crew, and the public against any adverse health consequences. The record of this unwavering commitment is extensive and irrefutable.  Against this backdrop, we continue to be dismayed by the CDC’s decision to maintain any Travel Health Notice for cruise. CDC has long recognized the paramount importance of vaccination in protecting against COVID-19 and the vaccination rate on cruise ships is close to 100%, whereas on land it is only about 63%. It seems unnecessarily discriminatory against cruise to maintain that the chances of getting COVID-19 on a cruise “is very high” even if you are up to date with your COVID-19 vaccines. This discounts the importance of what the CDC has otherwise promoted as the single most important touchstone for public health and safety. The cruise industry remains one of the most highly regulated sectors even after the expiration of the Conditional Sailing Order. CLIA cruise line members will continue to comply with all applicable regulations. CLIA and its members are committed to continue working with the CDC in mutual, cooperative partnership as part of our shared commitment to putting health and safety first. Part and parcel of that goal is seeing signals from CDC that it recognizes the lengths the entire cruise industry has gone to and the success it has achieved in guarding against COVID-19. 

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5 Replies to “CDC Reveals New COVID-19 Program for Cruise Ships”

At little confused by a portion of this. Why would non vaccinated travellers have MORE leeway on their pre-testing than vaccinated travellers? According to this non-vaccinated travellers can get tested 3 days out but vaccinated travellers must wait until 2 data out. Feel backwards to me.

It seems non-vaccinated individuals must be tested twice – no more than 3 days before embarkation AND at embarkation whereas for vaccinated people, the embarkation testing is an OR (i.e. cruiselines can accept the 2-days-prior testing to meet both pre embarkation and embarkation requirements, so it can be just one test for 2 purposes).

Thanks for sharing. This is a lot of information. It looks like the only thing that is different than what Disney is currently doing is allowing “removal of the mask for extended meal service or beverage consumption”. Does this mean they are in violation now or that they would be in violation if they opted to participate? But then it also says the ship can allow passengers to not wear masks at all if 95% or more are vaccinated. I am very curious as to how only 1 out of 4 ships is considered highly vaccinated given the current requirements.

I think the highly vaccinated status depends on the number of children under 5 (those who cannot be vaccinated at this time) are on the ship. The more under age 5 then the percentage of vaccinated passengers drops.

I read this three times, it reads so confusing to me. While this may make sense to DCL and other Lines. For the layman it is a congested assembly of data that does not read cohesively. The most confusing is “removal of the mask for extended meal service or beverage consumption would constitute a violation of this Order.” So what are we supposed to do when dining in Remy or Palo?

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The C.D.C. tells travelers to avoid cruises, regardless of vaccination.

The move came as the number of outbreaks on ships has grown in recent weeks.

By Todd Gregory ,  Ceylan Yeginsu and Oscar Lopez

• Dec. 30, 2021

The Centers for Disease Control and Prevention on Thursday raised its Covid-19 warning level for cruise ships to 4, the highest, and issued a blunt warning: “Avoid cruise travel regardless of vaccination status.”

The move came as the number of outbreaks on ships has grown in recent weeks, causing some ports to turn away ships. Last week, dozens of people on a Royal Caribbean International ship tested positive after it set sail from Fort Lauderdale, Fla., and a Carnival Cruise Line ship returned to Miami on Sunday after positive tests among “a small number on board.”

Calling the C.D.C.’s decision “perplexing,” the cruise industry’s trade group, Cruise Lines International Association, said in a statement that the number of cases onboard made up a very slim minority of the total population and that “the majority of cases were asymptomatic or mild in nature, posing little to no burden on medical resources onboard or onshore.”

Before the C.D.C.’s warning on Thursday, Royal Caribbean Group, one of the biggest cruise companies, said its ships had carried 1.1 million guests since it had restarted U.S. operations in June, with 1,745 people testing positive. While the majority of passengers had mild or no symptoms, 41 people were hospitalized.

“Omicron is having a big short-term impact on everyone, but many observers see this as a major step towards Covid-19 becoming endemic rather than epidemic,” said Richard D. Fain, chairman and chief executive of Royal Caribbean Cruises.

Despite the increase in cruise ship cases, Mexico’s government announced this week that it would let cruise ships dock at its ports even if passengers have tested positive for the coronavirus, and also allow asymptomatic travelers to disembark on its shores.

The announcement came after two cruise ships with Covid outbreaks were refused permission by the authorities in Jalisco State in the last week to let passengers or crew disembark at Puerto Vallarta, a popular tourist destination on Mexico’s Pacific coast.

“Our country maintains its policy of solidarity and fraternity, as well as the principle of non-discrimination towards all people,” the government said in a statement . “The health and tourism authorities remain attentive to provide the necessary medical assistance to those who visit us.”

The coronavirus wreaked havoc on the cruise industry in the early stages of the pandemic , infecting hundreds of cruise passengers and workers and requiring the sector to shut down for 18 months. To begin sailing, cruise ships had to agree to the C.D.C.’s Conditional Sailing Order, which is valid until Jan. 15.

On most cruises out of U.S. ports, almost all crew members and adult passengers are vaccinated and masks are required indoors except for when passengers are eating or drinking.

Among the safety measures the order requires — beyond submitting the daily number of coronavirus cases — is a prevention and control plan for each cruise ship.

Most cruise companies do not publicly announce the number of coronavirus cases identified during sailings, but all cruise ships operating to and from U.S. ports must submit daily numbers to the C.D.C., which uses a color-coded system to inform the public whether the number of cases is above or below the agency’s threshold for an investigation.

Currently 88 cruise ships are being monitored by the C.D.C. because of reported coronavirus cases onboard. The agency does not publicly specify the number of cases on each ship.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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• CORONAVIRUS COVERAGE

How cruise lines are adapting to COVID-19 in the age of Omicron

The pandemic keeps disrupting the cruise industry. Here’s how to navigate if you plan to set sail.

The pandemic is upending the cruise industry once again.

In late December, just six months after cruise ships resumed sailing from United States ports, onboard cases of COVID-19 began to skyrocket—rising from 162 in the first two weeks of the month to 5,000 in the latter half of the month. As U.S. Centers for Disease Control and Prevention director Rochelle Walensky recently told lawmakers , it was about a 30-fold increase.

In the weeks that followed, the CDC warned travelers to avoid cruises even if they’re fully vaccinated . There has been a flurry of cancellations, including several Royal Caribbean and Norwegian Cruise Line sailings , because of crew members calling in sick and destinations closing their ports to cruises. The ships that do set sail have had to tighten their COVID-19 protocols—which include vaccine mandates, testing, and masking—and make last-minute itinerary changes.

Further complicating matters, the CDC’s Conditional Sailing Order—a framework of mandatory safety procedures for foreign-flagged ships in U.S. waters—expired on January 15. Following that guidance will now be optional for cruise ships, meaning they will be able to chart their own safety course.

For people who planned their trips months or even years before Omicron’s arrival, these rapidly changing circumstances have proven almost impossible to navigate around.

“People traveling at all right now have to be very flexible,” says Chris Gray Faust, managing editor of online industry publication Cruise Critic . “Dig into what your cruise line is requiring. What was the policy a month ago may not be the policy today.”

So how can travelers make sense of it all? Here’s what experts say.

How are COVID-19 protocols changing?

Eager to shed their early pandemic reputation as floating disease carriers, cruise lines worked with the CDC to institute fairly rigorous onboard COVID-19 protocols—the agency’s condition for allowing ships to sail from U.S. ports again. The CDC laid out guidance for testing crew and passengers and how to deal with outbreaks. Most cruise lines also instituted vaccine mandates.

( These photos show the surreal world of cruising during the pandemic’s height .)

Not much will change for the ships that participate in the CDC’s new voluntary program. They will still report COVID-19 data to the agency daily and follow specific testing regimes for passengers and crew. Cruise lines won’t get to choose which protocols to follow either, says Captain Aimee Treffiletti, head of the CDC’s maritime unit. If they choose to participate, they must agree to everything.

Norwegian Cruise Line has already indicated that it will join the CDC program. Brian Salerno, senior vice president of global maritime policy for the Cruise Lines International Association , expects many cruise lines will ultimately take part. He argues that cruise lines have often gone beyond CDC requirements—installing air purification technology or even onboard PCR testing laboratories —and aren’t likely to start slacking now.

“It’s a business imperative to do this right,” Salerno says. “Nobody’s going to relax during Omicron.”

It’s also a matter of public image. The CDC plans to continue issuing each ship a color-coded status that anyone can access to check transmission at any given time. Ships that are shaded green have no reported cases of COVID-19, while those that are shaded red are under CDC investigation. Cruise lines that aren’t part of the voluntary program will be shaded gray. Those ships may have their own health and safety protocols, but they haven’t been reviewed by the CDC.

“Nobody wants to be gray,” Salerno says. “Obviously everybody wants to be green.”

But with Omicron cases soaring, why is the CDC loosening its grip on the cruise industry? Treffiletti says the agency is confident that it has identified the best practices for mitigating transmission aboard a cruise ship—which she emphasizes was done in partnership with cruise lines. Now, she says, the CDC has decided to flex its regulatory authority “on a case-by-case basis rather than shutting down all the cruise ships at once.”

The CDC will still be able to board any ship in U.S. waters and conduct inspections, she points out. Ships that aren’t participating in the voluntary program will also have to report every case of COVID-19—just not every day—and will still be subject to the agency’s order requiring masks on public transportation .

How do the vaccine mandates work?

Most cruise lines currently require all passengers, including eligible children, to be fully vaccinated (meaning two doses of Pfizer or Moderna, one dose of Johnson & Johnson, or a WHO-approved equivalent). Salerno says the vaccination rates aboard cruise ships right now are close to 95 percent for passengers and crew members.

Some companies do accommodate children who haven’t gotten a jab: Royal Caribbean and Carnival, for example, require all guests older than 12 to be vaccinated , while younger passengers can board with a negative test. Disney Cruise Lines requires everyone over the age of five to be vaccinated. (The Walt Disney Company is the majority owner of National Geographic Partners.)

Cruise lines also align their vaccination policies with those of their destinations. So even though the United Kingdom considers children fully vaccinated after just one dose of an mRNA vaccine, a ship that sets sail to the Caribbean may only allow children who have had two doses.

Meanwhile, as Omicron spreads, some cruise lines have begun to require booster shots. Beginning February 1, Viking will require anyone who is eligible for a booster dose to get it at least 14 days before setting sail from the U.S. In addition, the CDC recently emphasized that being “up to date” on vaccines includes a booster dose.

Omicron is even more transmissible than the Delta variant—and better at evading vaccine immunity. But while the vaccines are no longer as effective at preventing you from getting infected, they are still the best protection, says Kathryn Willebrand, an epidemiologist who recently co-authored a study of COVID-19 transmission aboard cruise ships with infectious disease physician Lauren Pischel.

Willebrand points out that vaccines are still effective at preventing severe illness—which is especially important when you’re in the middle of the ocean on a boat whose medical staff might be overwhelmed or sick themselves. “You don’t want to need medical care when you’re far from home,” she says.

( Can booster shots protect you from Omicron? )

How often will you be tested?

Cruise lines have been requiring passengers and crew to test before boarding a ship, although specific requirements differ. Some only accept PCR tests, while others will accept the results of a rapid antigen test—in some cases only if the test is overseen by a health professional . And while some companies require you to get tested before you leave home, others administer tests at the terminal prior to boarding .

Crew members are generally subjected to routine testing throughout the voyage because they’re particularly vulnerable to infection. They spend more time on the ship, in closer quarters, and tend to have more interaction with others. But passengers might be required to test before any shore excursion if the port of call requires it, or if they develop symptoms during the trip.

If you don’t have any symptoms, you generally don’t have to be tested before disembarking the ship. Instead, Treffiletti and the CDC recommend getting tested five days after your trip. However, Gray Faust cautions that if you’re flying internationally, your final destination may require a negative test—or the cruise line may administer tests to everyone if there’s a particularly bad COVID-19 outbreak on board.

( 5 things to know about COVID-19 tests in the age of Omicron .)

What happens if there’s an outbreak?

Still, COVID-19 has proven adept at slipping past these protocols, particularly in the time of Omicron. Since COVID-19 is airborne and cruise ships are enclosed environments, the boats are higher risk environments for transmission, says Willebrand. Thousands of people pass through dining rooms, casinos, and other areas where virus particles may be hanging in the air.

Under the CDC guidance , cruise lines are supposed to educate both crew and passengers to identify and report COVID-19 symptoms. If someone onboard develops symptoms, they are tested and isolated until the results come back or until they’re no longer infectious. Those who are still infectious at the end of a journey are typically required to quarantine on shore—and Treffiletti says the CDC can work with cruise lines to facilitate that.

Since passengers are vaccinated, however, close contacts don’t necessarily have to quarantine unless they begin to develop symptoms. Gray Faust says cruise lines have been successful at contact tracing to notify those close contacts for the same reason that cruise ships are so vulnerable to transmission—they are closed communities.

“If you go to a restaurant and the person next to you is sick, you won’t know that,” Gray Faust says. “But on a ship, they do go back and find people. That is something that the cruise ships have developed that really is beyond what other types of travel have done.”

All of this relies on the honor system. Much as we’ve seen on land, there’s always the risk that your fellow seafarers may refuse to comply with mask mandates or hide their symptoms from crew to avoid quarantine. Cruise lines have the power to ask those passengers to disembark and travel home at their own expense.

Still, those rules aren’t always enforced—which is why experts say that the decision to set sail ultimately comes down to your own risk tolerance.

( Here’s what you need to know about traveling during Omicron . )

What can you do to ensure a smoother trip?

Although the CDC recommends that people avoid cruises, Treffiletti says that there are some things you can do to help mitigate your risk if you do decide to travel.

For one, before setting sail, check the color-coded chart on the CDC website to see if your ship is participating in the agency’s voluntary COVID-19 program. If so, you’ll be able to see whether there are any outbreaks on board. If things look grim, most cruise lines have implemented fairly flexible rebooking and cancellation policies.

If you’re just booking now, research the protocols of each cruise line to see if they align with your own comfort level. Gray Faust recommends purchasing trip delay and COVID-19 insurance—an extra cost that will be worth it if you get infected and can’t board your ship.

Gray Faust says your packing list should also account for uncertainties. She recommends packing extra clothing and medication in case you are quarantined at any point. If you can snag them, toss in some extra KN95 masks and rapid antigen tests, too.

But most of all, Gray Faust says cruisers need to go into a trip accepting that there will be health protocols in place—which might change as conditions worsen or improve—and that they’re there to keep you safe.

“You need to be OK with that,” she says. “You can still have a great trip. But you’re protecting yourself and other people by wearing masks and by getting your vaccines.”

National Geographic Expeditions and Adventures by Disney offer cruise departures to many destinations around the world. The Walt Disney Company is the majority owner of National Geographic Partners.

Amy McKeever is a senior writer and editor at National Geographic. You can find her on Twitter .

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Covid-hit Coral Princess cruise ship docks in Sydney

Passengers must record a rapid antigen test before disembarking but crew remain onboard

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A cruise ship with more than 100 Covid-19 positive people onboard has docked in Sydney .

After departing Eden on the New South Wales south coast with more than 2,300 people onboard, the Coral Princess berthed at Circular Quay just before dawn on Wednesday, where it will remain for a day before returning to its home port of Brisbane.

Passengers will have to record a negative result on a rapid antigen test before disembarking but the crew will have to remain.

The outbreak mostly involves infected crew members, with 114 in isolation on Tuesday.

Four passengers were also isolating after positive results, and 24 earlier disembarked in Brisbane , according to Queensland’s chief health officer, John Gerrard.

NSW Health said passengers who tested positive had probably taken the virus onboard with them rather than becoming infected at sea.

The ship docked in Eden on Tuesday, where about 800 passengers disembarked after returning negative tests.

The Eden-Monaro MP and NSW regional development minister, Kristy McBain, said locals had been happy to see the ship dock after bushfires and the pandemic impacted the region.

“When you’ve got towns that rely on tourism it’s been an incredibly difficult couple of years,” McBain told Sydney radio 2GB on Tuesday. “Hopefully this will be the first of many cruise ships to dock this season ... There’s been significant investment into the Port of Eden so that cruise ships could dock in town.”

A Princess Cruises spokesperson said the crew who had tested positive were asymptomatic or had mild symptoms.

At the beginning of the pandemic in March 2020, another Princess cruise liner – the Ruby Princess – was briefly linked to one in eight NSW coronavirus cases.

The latest cruise ship outbreak comes as concern grows about the growing spread of the B.4 and B.5 Omicron subvariants that could reinfect people who have already had the virus.

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The Australian Health Protection Principal Committee has advised shortening the period people are considered immune to the virus to four weeks, requiring people experiencing symptoms more than 28 days after they left isolation to get tested again.

The Pharmaceutical Society of Australia has criticised the end of free rapid antigen tests for concession card holders and called for the government to extend it beyond July.

“Case numbers and hospitalisations are still rising every single day,” said the society’s president, Fei Sim. “Governments should be encouraging more testing, not less.”

Australia recorded 41,336 new coronavirus cases and 58 related deaths on Tuesday.

• Coronavirus
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clock This article was published more than  1 year ago

A cruise ship with 800 covid cases docks in Sydney

An earlier version of this story said the Ruby Princess cruise ship is owned by Carnival Cruise Line. The ship is owned by the Carnival Corporation. The story has been corrected.

A cruise ship carrying some 800 people who have tested positive for the coronavirus docked in downtown Sydney on Saturday, triggering memories of a deadly ship-related outbreak in Australia’s largest city in the early, pre-vaccine days of the pandemic.

The Majestic Princess, which returned from New Zealand, is carrying more than 4,000 people, according to the Australian Broadcasting Corp (ABC). Princess Cruises, the cruise line, said in a statement that all guests onboard took a rapid antigen test within 24 hours of disembarking and that passengers who had tested positive would exit separately and not take public transport. Australia no longer requires people who have tested positive for the virus to isolate, though local authorities have issued guidance that covid patients onboard ships should isolate for five days after testing positive.

“Our onboard medical team will continue to support guests until they disembark,” Princess Cruises said in a statement. It did not respond to a question about whether customers who had tested positive could isolate onboard until they recovered, though the company said it would help guests access accommodation for isolation. The Majestic Princess was scheduled to soon sail to Melbourne, Australia’s second-largest city.

The health department of New South Wales, the state in which Sydney is located, said in a separate statement that patients had been isolating onboard. State authorities said that there was a “Tier 3” covid risk level aboard the Majestic Princess, indicating a “high level of transmission.”

Cruise ships have been a potent incubator for the coronavirus. In the United States, the Centers for Disease Control and Prevention monitored such ships for transmission at sea for about two years ; it also warned against cruise travel amid the omicron spike during last year’s holiday season. The CDC still recommends getting vaccinated and taking a coronavirus test before boarding a cruise ship.

In early 2020, Carnival Corporation’s Ruby Princess allowed thousands of passengers to disembark in Sydney, placing the cruise ship at the center of one of Australia’s largest covid outbreaks. At least 28 people died and 700 cases were linked to the ship, according to the ABC . Another Carnival ship, the Diamond Princess , also logged 12 Covid-related fatalities earlier that year, including the first Australian national to die of the virus.

But the country has since lifted coronavirus restrictions on international travel: Proof of vaccination or a negative coronavirus test are no longer required for entry, and mask-wearing on international flights is encouraged but not mandatory, according to Australia’s Department of Health and Aged Care.

The absence of restrictions is a far cry from how Australia first handled the pandemic. Sydney, the commercial capital, enacted a 106-day lockdown in 2021, while Melbourne endured the world’s longest stay-at-home lockdown. Australia also closed its borders to nearly all international travelers for nearly two years , reopening in February. It deported tennis ace Novak Djokovic for being unvaccinated, preventing him from competing in this year’s Australian Open. The country has one of the lowest covid death rates in the Western world.

One side effect of cruise covid rules: Norovirus has plummeted

Australia’s reopening came after it achieved one of the world’s highest immunization rates. As of Nov. 9, nearly 96 percent of residents older than 16 have received two doses of a coronavirus vaccine . The country of 25.7 million people reported a seven-day rolling average of 12 deaths on Friday, or about half that of a month ago.

But New South Wales authorities said this week that the state had entered a new wave of the pandemic, and some medical experts fear that the upcoming holiday season will trigger a spike in infections that could challenge the hospital system in a country that has removed virtually all curbs on the virus.

“If the major public hospitals on the east coast aren’t overwhelmed with patients and facing staff shortages over the holiday break - I’ll donate $1000 to charity,” tweeted physician Steve Robson, president of the Australian Medical Association, in response to news of infections on board the Majestic Princess. (Most of Australia’s population lives on its east coast.)

Katerina Ang contributed to this report.

Guidance for Cruise Ships on Management of Acute Respiratory Illness (ARI) due to Viral Infection

CDC Respiratory Virus Guidance has been updated. The content of this page will be updated soon.

Describing and Defining Passengers and Crew with Acute Viral Respiratory Illness (ARI)

Reducing the spread of viral respiratory infections, vaccination of crew and passengers, managing passengers or crew with ari upon disembarkation, medical evaluation and management, diagnostic tests for acute viral respiratory illness (ari), respiratory and hand hygiene, outbreak control, infection prevention and control.

• Additional Resources

Attribution Statement

Outbreaks of influenza, COVID-19, r espiratory syncytial virus (RSV) , and other viral respiratory infections can occur at any time of the year among cruise ship passengers and crew members. Many cruise ship travelers are older adults or have underlying medical conditions that put them at increased risk of complications from these respiratory virus infections. Early detection, prevention, and control of such acute viral respiratory infections are important, not only to protect the health of passengers and crew members on cruise ships, but also to avoid spread of these viruses into communities.

This document provides guidance for cruise ships originating from or stopping in the United States to help prevent, diagnose, and medically manage acute respiratory illness (ARI) caused by SARS-CoV-2 (the virus that causes COVID-19), influenza virus, or RSV. This guidance to cruise ship clinics will be updated as needed. CDC recognizes that cruise ships travel worldwide, necessitating awareness of, and responsiveness to, local jurisdictional requirements. Cruise ship management and medical staff need to be flexible in identifying and caring for people with ARI. The healthcare provider’s assessment of a patient’s clinical presentation and underlying risk factors is always an essential part of decisions about the need for further medical evaluation, testing, and treatment.

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.

Signs and symptoms of ARIs can include acute onset of some or all of the following:

• fever or feeling feverish
• nasal congestion
• sore throat
• shortness of breath
• difficulty breathing
• muscle or body aches
• fatigue (tiredness)
• loss of taste or smell

For cruise ship surveillance purposes, CDC defines ARI as an illness of presumed viral etiology with at least two of the following symptoms : fever/feverishness, cough, runny nose, nasal congestion, or sore throat and excluding:

• Confirmed acute respiratory infection diagnoses other than COVID-19 [1] , influenza [2] , or RSV [3] (e.g., Streptococcal pharyngitis, Epstein-Barr virus infection), *
• Diagnoses of bacterial pneumonia: either clinical or test-positive (e.g., by urine Legionella antigen, urine Streptococcus pneumoniae antigen), and
• Non-infectious conditions as determined by the ship’s physician (e.g., allergies)

Fever (a temperature of 100°F [37.8°C] or higher) will not always be present in people with influenza, COVID-19, or RSV. Cruise ship medical personnel should consider someone as having a fever if the sick person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100°F (37.8°C) or higher.

*Other respiratory viruses—for which point-of-care diagnostic tests are not available—may also cause ARI (e.g., rhinovirus, adenovirus, enterovirus, human parainfluenza viruses, human metapneumoviruses).

[1] Confirmed COVID-19 means laboratory confirmation for SARS-CoV-2, the virus that causes COVID-19, by viral test.

[2] Confirmed influenza means laboratory confirmation for influenza A or B by viral test.

[3] Confirmed RSV means laboratory confirmation for RSV by viral test.

Commercial maritime travel is characterized by the movement of large numbers of people in enclosed and semi-enclosed settings. Like other close-contact environments, these settings can facilitate the transmission of respiratory viruses from person to person through droplets and small particles or potentially through contact with contaminated surfaces.

CDC recommends that efforts to reduce the spread of respiratory viruses on cruise ships focus on encouraging crew members and passengers:

• 6 months and older to get vaccinated annually for influenza
• 6 months and older to stay up to date with their COVID-19 vaccines
• who are 60 years and above  to discuss and consider RSV vaccination  with their healthcare provider
• To follow recommendations for babies and young children  and if applicable, to receive monoclonal antibody products to prevent severe RSV
• To avoid contact with ill people prior to scheduled cruising
• To postpone travel if sick with an acute respiratory illness (passengers)
• To take steps to protect themselves and others while traveling
• To consider wearing a mask  in crowded or poorly ventilated indoor areas.

Cruise ship management should include:

• Encouraging good respiratory hygiene and cough etiquette
• Early identification and isolation of crew members and passengers with ARI
• Use of antiviral medications for treatment of people with suspected or confirmed influenza or COVID-19 with severe or complicated illness, or at increased risk of severe illness or complications
• Use of antiviral chemoprophylaxis for post-exposure prophylaxis (PEP) or during influenza outbreaks, if indicated, for people at increased risk of complications

All passengers and crew are also recommended to be up to date with all routine vaccines .

Influenza : CDC recommends that all people 6 months of age and older be vaccinated each year with the influenza vaccine. Crew members should be vaccinated yearly. Vaccination of passengers, especially those at high risk for influenza complications, is recommended at least 2 weeks before cruise ship travel, if influenza vaccine is available and the person has not already been vaccinated with the current year’s vaccine. For more information on influenza vaccine recommendations, see Seasonal Influenza Vaccination Resources for Health Professionals .

COVID-19: CDC recommends that all people 6 months of age and older be up to date with their COVID-19 vaccines. In addition to the protection COVID-19 vaccines provide to individual travelers in preventing severe illness or death from COVID-19, having a high proportion of travelers on board who are up to date with COVID-19 vaccines reduces the likelihood that cruise ships’ medical centers will be overwhelmed by cases of COVID-19. For more information on COVID-19 vaccine recommendations, see COVID-19 Vaccination Clinical and Professional Resources .

RSV : CDC recommends adult travelers ages 60 years and older discuss RSV vaccination with their healthcare provider prior to cruise travel. These new vaccines—which are the first ones licensed in the U.S. to protect against RSV—have been available since the fall of 2023. Babies and young children should follow recommendations and if applicable, receive monoclonal antibody products to prevent severe RSV. For more information, see For Healthcare Professionals: RSV (Respiratory Syncytial Virus) .

Pre-embarkation COVID-19 Testing

To reduce the likelihood of onboard transmission of SARS-CoV-2, pre-embarkation testing is recommended for all passengers, including those on back-to-back sailings [4] . Completion of testing closer to the time of embarkation (within 1 to 2 days) maximizes the benefit of preventing introduction of infectious persons onboard. Ships that choose to use COVID-19 antigen tests should follow FDA guidance .

[4] Back-to-back sailing refers to passengers who stay on board for two or more voyages.

Viral ARI Screening Procedures for Embarking Passengers

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.

Cruise ship operators should consider performing viral testing (e.g., COVID-19, influenza, RSV) for passengers with ARI before they embark. Ships that choose to use COVID-19 antigen tests should follow FDA guidance .

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 .

If the cruise ship operator chooses to test for other infectious etiologies and testing identifies an alternate etiology (e.g., Legionella , Epstein-Barr virus, Streptococcal pharyngitis) through laboratory testing, routine infection control precautions specific to the diagnosis should be followed.

For asymptomatic passengers who have a known COVID-19 close-contact exposure within the 10 days before embarkation, considerations for allowing boarding can include:

• being up to date with COVID-19 vaccines,
• having a negative result on a COVID-19 viral test conducted on the day of boarding, or
• having documentation of recent recovery [5]  from COVID-19

People who are up to date with COVID-19 vaccines are less likely to have severe outcomes if they develop COVID-19 after boarding. 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 .

[5] Documentation of recent recovery from COVID-19 can include the following:

• Paper or electronic copies (including documentation of at-home antigen results) of their previous positive viral test result dated no less than 10 days and no more than 30 days before date of embarkation
• A positive test result dated less than 10 days before embarkation accompanied by a signed letter from a licensed healthcare provider indicating symptom onset more than 10 days before the voyage

Managing Cruise Travelers with ARI and Contacts while on Board

Travelers with ARI who board, as well as those who become sick with ARI onboard, should be identified and tested as soon as possible to minimize transmission of respiratory viruses. The table below provides disease-specific recommendations for persons on board with COVID-19, influenza, or RSV and those exposed (i.e., contacts).

§ The day of last exposure to a case is counted as day 0. Additional testing prior to day 6 can identify new cases earlier. Cruise ship operators may consider this strategy in situations where exposures may have occurred in crowded settings, if unsure of the date of exposure, or if there is difficulty identifying index cases, as often occurs in the cruise ship environment.

^ Individual should properly wear a respirator or well-fitting mask  at all times when outside of cabin indoors until 10 days after the last close contact with someone with COVID-19 (the date of last exposure to a case is considered day 0). During this time, these individuals should have in-cabin dining (with food trays placed and collected outside of cabins) and also wear a respirator or well-fitting mask inside their cabin if any other person (such as a crew cleaning staff) enters the cabin.

† Contacts with high risk of influenza complications should be identified in order to offer post-exposure prophylaxis (PEP)

Crew members with ARI, even if mild, should take the following additional steps—regardless of their COVID-19, influenza, or RSV vaccination status:

• Notify their supervisors.
• Report to the medical center for evaluation and testing, if indicated, according to shipboard protocols.
• Continue to practice respiratory hygiene, cough etiquette, and hand hygiene after returning to work, because respiratory viruses may be shed after the isolation period ends.

Disembarking cruise ship passengers or crew members who have ARI should continue to take recommended precautions after disembarkation. If a passenger or crew member with viral ARI is taken to a healthcare facility off the ship, the facility should be informed before arrival. Medical transport providers should also be notified in advance.

Medical centers on cruise ships can vary widely depending on ship size, itinerary, length of cruise, and passenger demographics.

• Cruise ship medical centers are recommended to follow the operational guidelines  published by the American College of Emergency Physicians (ACEP) as well as disease-specific clinical guidelines (see links provided at the bottom of this section).
• PPE should include surgical masks and NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns.
• Antiviral agents and other therapeutics for COVID-19 , influenza , and RSV (if commercially available), and other antimicrobial medications
• Antipyretics (e.g., acetaminophen and ibuprofen), oral and intravenous steroids, supplemental oxygen
• Onboard capacity to conduct viral tests for SARS-CoV-2 and influenza, and RSV, as well as other infections that may be in the differential diagnosis (e.g., group A Streptococcus , Streptococcus pneumoniae, Legionella )
• Medical center staff should adhere to standard and transmission-based precautions when healthcare personnel are caring for patients with suspected or confirmed COVID-19, influenza, RSV, or other communicable diseases.

For more information, read updated resources for clinicians and guidance on the medical evaluation and management of people with COVID-19 , influenza , or RSV  are available on CDC’s websites.

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.

Healthcare providers should understand the advantages and limitations of rapid diagnostic tests, and proper interpretation of negative results of any antigen diagnostic tests. Rapid antigen diagnostic tests have a lower sensitivity compared with RT-PCR, and false negative results can occur frequently. In symptomatic persons, negative rapid antigen diagnostic test results do not exclude a diagnosis of COVID-19, influenza, or RSV; clinical diagnosis of these illnesses should be considered; however, positive test results are useful to establish a viral etiology and to provide evidence of infection in passengers and crew members aboard ships.

People with ARI should be advised of the importance of covering coughs and sneezes and keeping hands clean because respiratory viruses may be shed after the isolation period ends.

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.

Respirators or well-fitting masks should be readily available and symptomatic passengers and crew should be encouraged to use them if they have to be outside their cabins.

Passengers and crew members should be reminded to wash their hands often with soap and water, especially after coughing or sneezing. If soap and water are not available, they can use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Used tissues should be disposed of immediately in a disposable container (e.g., plastic bag) or a washable trash can.

For more information on respiratory hygiene, see Coughing and Sneezing .

A combination of measures can be implemented to control ARI outbreaks, including isolation of infected people, increased infection prevention and control efforts, antiviral chemoprophylaxis of influenza-exposed people, crew member and passenger notifications, and active surveillance for new cases.

Recommendations when a voyage’s crew or passenger ARI attack rate reaches 2% ‡

• Provide all crew members with respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Minimize the number of crew members sharing a cabin or bathroom to the extent possible.
• Instruct crew members to remain in cabins as much as possible during non-working hours.
• Cancel nonessential face-to-face employee meetings as well as group events (such as employee trainings) and social gatherings.
• Close all crew bars, gyms, and other group settings.
• Close indoor crew smoking areas.
• Maximize the introduction of outdoor air and adjust HVAC systems to increase total airflow to occupied spaces. For additional information on ventilation, see Ventilation in Buildings
• Maximize air circulation in crew outdoor smoking areas.
• Expedite contact tracing (including the use of wearable technology, recall surveys, and the onboarding of additional public health staff).
• Consider serial viral (antigen or NAAT) screening testing of crew every 3–5 days. The onboarding of additional laboratorians may be needed to facilitate the testing process.
• If an influenza outbreak, antiviral chemoprophylaxis  can be considered for prevention of influenza in exposed people depending on their risk for complications, or could be given to all contacts on a cruise ship when the threshold is met or exceeded.

Recommendations when a voyage’s crew or passenger ARI attack rate reaches 3% ‡

• Provide all passengers with respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Position posters educating passengers on how to properly wear respirators or well-fitting masks  in high traffic areas throughout the ship.
• Eliminate self-serve dining options at all crew and officer messes.
• Reduce the dining cohort size for crew, and shorten dining times to avoid crowding.
• Send written notification to passengers on the current, previous, and subsequent voyages informing them of the ARI conditions and measures being taken to reduce transmission on board.
• Cancel crew shore leave.
• Implement a “working quarantine” policy for all crew (i.e., crew perform job duties then return to cabin).
• Require use of respirators or well-fitting masks and provide crew with information on how to properly wear, take off , and clean (if reusable)
• Test all passengers for COVID-19 prior to the end of the voyage, regardless of their vaccination status. Advise those who test positive or have known exposure to follow guidance following disembarkation .

‡ Sources of data should include medical center records and other established surveillance systems for passengers and crew (e.g., employee illness reports).

Considerations for Suspending Passenger Operations

In some circumstances, additional public health precautions, such as returning to port immediately or delaying the next voyage, may be considered to help ensure the health and safety of onboard travelers or newly arriving travelers.

A ship should consider suspending operations based on the following factors:

• 15% or more of the passengers have met ARI criteria; or
• 15% or more of the crew have met ARI criteria; or
• 15% or more of total travelers have met ARI criteria. [6]
• Shortages of supplemental oxygen or other medical supplies related to management of patients with ARI, or
• 3 or more deaths due to ARI in passengers and/or crew during a voyage.
• Evaluate symptomatic travelers and their close contacts,
• Conduct diagnostic and screening testing of travelers,
• Conduct routine medical checks of travelers in isolation, or
• Conduct contact tracing of close contacts, if applicable
• Testing equipment,
• Antipyretics (fever-reducing medications such as acetaminophen and ibuprofen),
• Antivirals and other therapeutics for COVID-19, influenza, and RSV (if commercially available),
• Oral and intravenous steroids, or
• Supplemental oxygen
• Inadequate onboard capacity to fulfill minimum safe manning or minimal operational services, including but not limited to housekeeping and food and beverage services
• A novel respiratory virus or SARS-CoV-2 variant of concern or a new or emerging SARS-CoV-2 variant with potential for increased severity or transmissibility identified among cases on board

[6] These thresholds are subject to change based on the characteristics of the dominant COVID-19 variant or a novel respiratory virus in the United States or elsewhere.

CDC requests that cruise ships submit a cumulative ARI report (even if no ARI cases have occurred) preferably within 24 hours before arrival in the U.S. [7] , and sooner if a voyage’s crew or passenger ARI attack rate reaches 3% [8] . These reports are requested by completing the Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form. Access to the online reporting form has been provided to cruise lines by CDC. Cruise lines that do not have access may contact CDC (email [email protected] ).

In addition, CDC emphasizes that any deaths—including those caused by or suspected to be associated with influenza, COVID-19, RSV, or ARI—that occur aboard a cruise ship destined for a US port must be reported to CDC immediately. Report ARI deaths by submitting an individual  Maritime Conveyance Illness or Death Investigation Form [PDF – 4 pages] for each death.

Vessel captains may request assistance from CDC to evaluate or control ARI outbreaks as needed. If the ship will not be arriving imminently at a U.S. seaport, CDC maritime staff will provide guidance to cruise ship officials regarding management and isolation of infected people and recommendations for other passengers and crew members. CDC staff may also help with disease control and containment measures, passenger and crew notification, surveillance activities, communicating with local public health authorities, obtaining and testing laboratory specimens, and provide additional guidance as needed.

[7] For international voyages with >1 U.S. port (e.g., Canada to multiple Alaskan ports), please submit report to CDC within 24 hours before arrival in the final U.S. port.

[8] For international voyages with >15 days prior to arrival in the U.S., the time period for calculating this attack rate begins at day 15 prior to arrival at a U.S. port.

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.

To reduce the spread of ARI, cruise ship operators should include the following as part of a written IPCP:

• Duties and responsibilities of each department and their staff for all passenger and crew public areas
• A graduated approach for escalating infection prevention and control measures in response to ARI cluster or outbreaks during a voyage with action steps and criteria for implementation
• Procedures for informing passengers and crew members that a threshold of ARI has been met or exceeded, and of any recommended or required measures to prevent spread of infection
• Crew members entering cabins or other areas where people with confirmed or suspected COVID-19 are should be limited, and crew should wear an NIOSH Approved® N95® filtering facepiece respirator or higher in accordance with the Occupational Safety and Health Administration’s (OSHA) Respiratory Protection standard   (29 CFR 1910.134 )
• Disinfectant products or systems used, including the surfaces or items the disinfectants will be applied to, concentrations, and required contact times
• Safety data sheets (SDSs)
• PPE recommendations for crew, which may include surgical masks or NIOSH Approved® N95® filtering facepiece respirators or higher, eye protection such as goggles or disposable face shields that cover the front and sides of the face, and disposable medical gloves and gowns in addition to those recommended by the disinfectant manufacturer in the SDS; for information on health hazards related to disinfectants used against viruses, see Hazard Communication for Disinfectants Used Against Viruses .
• Health and safety procedures to minimize respiratory and dermal exposures to both passengers and crew, when recommended
• Graduated procedures for returning the vessel to normal operating conditions after a threshold of ARI has been met, including de-escalation of cleaning and disinfection protocols

Frequent, routine cleaning and disinfection of commonly touched surfaces with an Environmental Protection Agency (EPA)-registered disinfectant is recommended. For COVID-19, EPA-registered disinfectant  effective against coronaviruses is strongly recommended.

• Isolation and Precautions for People with COVID-19
• COVID-19 Treatments and Medications
• Seasonal Influenza Prevention
• Seasonal Influenza Treatment: What You Need to Know
• Infectious Diseases Society of America guidelines for controlling institutional influenza outbreaks
• Symptoms and Care of RSV (Respiratory Syncytial Virus)
• RSV transmission
• Preventing RSV (Respiratory Syncytial Virus)

N95 and NIOSH Approved are certification marks of the U.S. Department of Health and Human Services (HHS) registered in the United States and several international jurisdictions.

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Cruise ship barred from docking in Mauritius amid outbreak of stomach illness

Officials in the island nation of Mauritius blocked a Norwegian Cruise Line ship from docking there Sunday after more than a dozen passengers were stricken with a stomach illness.

Around 15 passengers aboard the Norwegian Dawn remain in isolation because of an undisclosed "health risk" and are undergoing testing, according to the Mauritius Ports Authority .

"The decision not to allow the cruise ship access to the quay was taken in order to avoid any health risks," the authority said in a statement.

The sick guests “experienced mild symptoms of a stomach-related illness,” Norwegian Cruise Line said in a statement Sunday. The cause of the outbreak has not been released.

“Due to additional testing being required by local authorities before being allowed entry, the government of Mauritius has delayed disembarkation for the current cruise and embarkation for the next cruise by two days,” the Norwegian statement said.

It’s expected that the ship will be allowed to dock Tuesday, the cruise line said, after results of tests conducted Sunday become available.

The Norwegian Dawn has more than 2,100 passengers and 1,000 crew on board. About 2,000 of those travelers were set to complete their journey on Sunday by disembarking in Mauritius, in the Indian Ocean just east of Madagascar, the Ports Authority said. Then more than 2,200 new passengers were scheduled to board.

The authority said that the passengers who were due to start their cruise Sunday would not be able to do so that day and that they would have to be relocated to available hotels.

Norwegian Cruise Line said the ship's "management team met with local authorities to confirm precautions and actions were being taken to ensure the wellbeing of all on board."

Gastrointestinal illnesses are often identified on cruise ships for a few reasons , according to the Centers for Disease Control and Prevention: The ships' close living quarters make it easier for viruses to spread, and the regular addition of new passengers creates opportunities to introduce illness. However, because public health officials track illness cases on cruise ships, such outbreaks may also be reported more often than ones on land.

Last month, an outbreak of norovirus — a common stomach bug that causes vomiting and diarrhea — sickened 92 passengers and eight crew members on a Celebrity Cruises ship.

David K. Li is a senior breaking news reporter for NBC News Digital.

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Cruise Ship Coronavirus/COVID Outbreaks

Coronavirus (COVID-19) is an ongoing pandemic disease that started with the outbreak in Wuhan China in December 2019. WHO (World Health Organization) officially classified the outbreak as a "worldwide pandemic" on March 11, 2020.

NOTE : If you want to skip the following statistical information (including financial), this link jumps down directly to CruiseMapper's table with Coronavirus-impacted passenger ships (2022-2021). Follow this CruiseMapper link for Norovirus outbreaks on passenger ships .

For 1 year (March 15/2020-2021), on cruise ships, Coronavirus affected 3519 people (passengers plus crew, only officially confirmed cases) of whom 73 passengers died . The first epidemic outbreak occurred on Diamond Princess (February/ 712 infected, including 14 deaths). The second outbreak was on Grand Princess (February-March/ infected 132 with 7 deaths). The third/largest outbreak was on Ruby Princess (March/ 852 infected with 22 deaths). Followed a long month of altered or canceled cruises, ship quarantines/in-port lockdowns, port closures (bans on incoming vessels) - mainly in Southeast Asia, Europe, the Caribbean.

The next table shows statistics on the top-pandemic countries (confirmed cases/registered patients and deaths per million) caused by COVID-19 / SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). FOR 1 YEAR ( March 8/2020-2021 ) were reported TOTAL DEATHS 2,6M, TOTAL INFECTED 117,148M, TOTAL RECOVERED 66,38M. In brackets ( per million ) is the number of Coronavirus-related DEATHS PER MILLION (country inhabitants).

Annually, common flu infects ~11% of Earth's total population (~800 million), with influenza deaths varying between 0,5 million and 1,2 million (each year). The main issue with COVID-19 is its much longer incubation period (time between the infection and developing the symptoms) which is 7-14-days (compared to influenza's 1-2-days). Statistically, most Coronavirus patients (~98%) develop the symptoms within 12 days after the infection.

Coronavirus deaths vary greatly by region/country, with the mortality rates being influenced by the volume of testing and population characteristics (average age, overall health, quality of the country's healthcare system). Many countries (including Italy, Spain, Holland, Belgium, Sweden, UK, USA, Canada) report statistical data that includes deaths from suspected COVID-19 cases (including of non-tested people) which results in higher deaths in comparison to countries (like China, Russia, Germany, Japan, Ireland) that report deaths of only confirmed COVID-19 cases.

In early-May 2020, according to Johns Hopkins University (private research facility in Baltimore MD), the global average death-to-Coronavirus ratio was 7,1% (7 deaths on 100 cases treated). Nearly all Coronavirus deaths were elderly people aged 70+ (Italy's average age is 79,5) and the majority had previous health conditions. On June 5, AstraZeneca (British-Swedish biopharmaceutical, 1999-founded) announced that it started manufacturing a potential COVID vaccine. The production (~2 billion doses) was ahead of the human trial results.

• Coronavirus spreads similarly to common influenza (via droplets from coughing/sneezing), with exposure-symptom onset time 2-14 days. Predominant symptoms include fever, dry cough, fatigue, sputum production (saliva+mucus), anosmia (smell blindness), breathing problems (shortness of breath), muscle/joint pains, sore throat, headache. Illness complications include pneumonia (lungs inflammation) and ARDS (acute respiratory distress syndrome).
• Russia successfully treats patients with blood plasma taken from Coronavirus survivors. On April 1, 2021, Russia's Health Ministry registered "COVID Globulin" - the world's first immunoglobulin against the virus. The medicine was developed by Nacimbio (National Immunobiological Company, part of the state-owned Rostec Corporation) and based on blood plasma donated by recovered patients in Moscow. For the production was used 2,5 tonnes of biomaterial. The drug was intended for treating medium (Stage 2) and strong (Stage 3) cases.
• In December 2020, following controlled clinical trials at 3x Hubei hospitals (Zhongnan, Leishenshan, Taihe), China confirmed that ICU patients started to recover after receiving HDIVC (high-dose intravenous Vitamin C). For 7 days, the critically ill COVID patients received 12 g (50 ml, at a rate of 12 ml/hour) HDIVC every 12 hours. The results were improved oxygenation. This study was not evaluated by the USA.

What was the financial impact on the ship cruising industry in 2020-2021?

According to UNWTO (UN's World Tourism Organization), the cruise industry's recovery could be expected by 2020-Q4 (mainly in the USA-Caribbean), but mostly in 2021-Q2. UNWTO expected in 2020 the industry's levels to drop by 70-80% (over 2019), depending on the duration of intercountry travel restrictions and border closures (especially within Europe). According to UNWTO, the financial impact on the industry (projected loss) was between USD 0,85-1,1 billion. The global tourism industry was expected to lose export revenues between USD 0,91-1,2 trillion, affecting 100-120 million jobs/employees. The industry employs ~200,000 shipboard personnel (service staff and maintenance crew).

Note: According to statistical data published in 2022, in 2020-2021, cruise shipping companies lost a collective USD 63 billion.

Between March 12-15, all major cruise shipping companies (ocean and river) suspended operations fleetwide (all vessels in the fleet remained docked/anchored and fully crewed) for periods ranging from 30 up to 60 days. All canceled voyages were fully refunded in FCC (future cruise credit).

Between March 16-30, Fincantieri ( world's largest cruise shipbuilding company ) suspended all activities at its shipyards and offices in Italy. For 2020-H1 (first-half), Fincantieri reported EUR 137 million (~$161M) net loss on EUR 2,4 billion (~$2,827B) revenues - compared to 2019-H1's net income EUR 47M on EUR 2,8B revenues. The suspension resulted in EUR 790M (~$931M) loss on revenues, or 17,5% decrease - including 13,5% from cruise shipbuilding which represented 57% of Fincantieri's revenue in 2020.

On March 16, 2020, Carnival Corporation ( world's largest cruise shipowner ) loaned $3 billion (~EUR 2,77B) with maturity in September 2020. On March 31, Carnival Corp announced plans to issue $6B (~EUR 5,49B) in stock and debt $1,25B (in CCL shares), $3B (in secured notes due 2023, assets-backed loan) and $1,75B (in convertible notes due 2023/debt that converts into equity).

• As of 2020, Carnival's employees in the USA were ~0,5 million.
• On April 2, were issued CCL common stocks for $0,5 billion (reduced from the announced $1,25B) or a total of 62,5 million ordinary shares at $8 per share.
• In mid-May, to further strengthen its liquidity, Carnival Corporation announced a combination of (company-wide / including senior management) furloughs, layoffs, reduced workweeks, salary reductions. The moves resulted in hundreds of millions in cash conservation.
• On June 30, Carnival UK laid off 1/3 of its shore-based staff.
• For 2020-H1, Carnival reported revenues ($5,5B, with losses $5,2 billion ), cash ($6,9B - compared to 2019-H1's $518M), total assets ($49,8B), current liabilities/short-term financial obligations ($11,9B), long-term debt ($4,9B).
• In mid-August, Carnival Corporation reported in a regulatory filing that as of July 31 it had $7,9B (~EUR 6,671B) in cash and cash equivalents, with average monthly cash burn rate (2020-H2) ~$650M (~EUR 550M). This allows ~12 months of cash (with no-sailing ships) to be spent on vessel operations, administrative expenses, capital expenditures/export credit facilities, loans' interests.
• For 2020-Q3 (ending Aug 31) Carnival reported GAAP net loss $2,9B (including $900M non-cash charges), adjusted net loss $1,7B, $8,2B cash and cash equivalents, average monthly cash burn rate $770M (~$17K per minute). A total of 19 older vessels left the 9-brand fleet (~13% of Carnival's total passenger capacity).
• For 2020-Q4 Carnival reported GAAP net loss $2,2B, adjusted net loss $1,9B, cash and cash equivalents $9,5B, monthly cash burn rate ~$500M (~16 months of cash), customer deposits balance $2,2B (mainly FCCs).
• On Feb 10-16, 2021, Carnival priced private offerings in Senior Unsecured Notes for $3,5B (annual interest 5,75%) beginning September 1, 2021, and maturing March 1, 2027.
• For 2021-Q1, Carnival reported GAAP net loss $2B, cash and short-term investments $11,5B, 90% higher booking volumes (over 2020-Q1).
• For 2021-Q4, Carnival reported GAAP net loss $2,6B, Adjusted net loss $2B, liquidity $9,4B, annual interest expenses ~$400M, cruise deposits $360M, ship occupancy 58%, monthly cash burn $510M.
• In 2020-22, Carnival PLC incurred US$36B+ in debt. 2022-Q3 report listed GAAP Loss $770M, Adjusted Net Loss $688M, Adjusted EBITDA ~$300M, revenue increase ~80% (over 2022-Q2), occupancy increase 15%, liquidity $7,4B (including cash and borrowings), ALBD/available lower berth days 21M (92% of fleet's capacity).
• On Dec 21, 2022, Carnival reported a total debt US$34,55B, up from ~US$12B in Dec 2019.

On March 23, 2020, RCG-Royal Caribbean Group ( world's 2nd-largest cruise shipowner ) loaned $2,2 billion (~EUR 2,03B) with maturity in March 2021 and an optional extension for 364 more days (till March 2022). With the new financing, RCG had $3,6+ billion of liquidity (cash deposits plus undrawn credit facilities). The money was secured term-loaned from 3 US banks (JPMorgan Chase, Bank of America Corporation, Goldman Sachs Group) plus the French banking group BNP Paribas.

• In mid-April, RCG announced that ~26% of its USA-based employees (~1300 Americans, out of 5000+) will be permanently laid off or 90-day furloughed (with paid benefits). In early-June, RCG issued Senior Notes (due 2023, fully unconditionally guaranteed) to aggregate up to $1B.
• In early-August, RCG amended a $1,55B unsecured revolving loan (due 2022) with Nordea Bank Abp, $1,925B unsecured revolving loan (due 2024) with Scotiabank, and $1B unsecured loan (3-year) with Bank of America Corporation.
• As of June 30, RCG had liquidity ~$4,1B (cash and cash equivalents) considered enough to survive until the end of 2021 without any income. On August 12, RCG secured a $700M term loan from Morgan Stanley (investment bank) at 3,75% interest and maturing on Aug 12, 2021. The loan was guaranteed by RCI Holdings LLC (RCG's subsidiary that owns all vessels).
• For 2020-Q3, RCG reported Adjusted Net Loss $1,2B, Adjusted Net Income $896,8M, ship expenses $308,6M (down from $680,4M for 2020-Q2), average monthly cash burn ~$270M (~EUR 230M - loan interests, ships-administrative expenses, hedging costs, capital expenditures, but excluding cash refunds of cruise deposits, cash inflows from bookings, agent commissions, debt obligations). As of September 30, 2020, RCG had liquid assets ~$3,7B ($3B in cash and cash equivalents).
• In late-August 2020, Awilhelmsen AS (Norwegian investment company) sold 2 million RCL shares (~$126,91M). Awilhelmsen still owns ~18 million RCL shares.
• Between December 3-31, 2020, RCG exhausted its entire $1 billion ATM (at-the-market) offering (~13M RCL stocks/average sale price $76,65 per share) diluting the company by ~5,8%. ATM is when a company raises money through gradual stock exchange sales instead of selling at once large blocks of stock to big investors (usually at a discount).
• In mid-January 2021, RCG sold the Azamara brand to Sycamore Partners (US private equity firm) for $201M (~EUR 166M / ~GBP 148M).
• After selling 8 ships - 3x Pullmantur (Horizon, Monarch, Sovereign), 3x Azamara (Quest, Journey, Pursuit), 2x RCI (Empress, Monarch), RCG's global fleet capacity decreased by 12316 berths (5984+2138+4194).
• RCG's 2020-Q4 financial report revealed US GAAP Net Loss $5,8B / EUR 4,774B (or $27,05 per share), Adjusted Net Loss $3,9B / EUR 3,21B (or $18,31 per share), $400M in cruise deposits. In 2020, RCG raised ~US$9,3B (~EUR 7,655B) through bond issuances, loans, public common stocks) and as of Dec 31 had liquidity ~$4,4B (EUR 3,62B, including $3,7B in cash-cash equivalents plus $0,7B from a year loan).
• For 2021-Q1 RCG reported Adjusted Net Loss $1,1B (EUR 907M), monthly cash burn ~$330M.
• For 2021-Q2 RCG reported Adjusted Net Loss $1,3B (EUR 1,1B), liquidity ~$5B.
• For 2021-Q3 RCG reported Adjusted Net Loss $1,2B ($4,91 per share), liquidity ~$4,1B ($3,3B cash), 40 ships in operation (~65% fleet capacity), ~$2,8B in cruise deposits (~1/3rd in FCCs).
• For 2021-Q4 RCG reported US GAAP Net Loss $1,4B ($5,33 per share), Adjusted Net Loss $1,2B ($4,78 per share), ~$3,2B in cruise deposits.

On March 12, 2020, NCLH ( world's 4th-largest cruise shipowner ) borrowed $1,55 billion (~EUR 1,43B) via two loans - $675M (final payment Mar 2021) and $875M (maturity in Jan 2024). On May 6, NCLH successfully secured $2,225B of additional liquidity. The capital transactions (by Goldman Sachs) consisted of $400M (public offering of common equity/shareholders at 5,375%), $750M (exchangeable senior notes/bonds), $675M (senior secured notes/debt at 10.25%) and $400M (private investment from L Catterton/USA-based equity capital investment company).

• For 2020-Q3, NCLH reported $1,5B gross proceeds ($288M public offering of common equity, $450M exchangeable senior notes, $750M senior secured notes), GAAP net loss $677,4M, Adjusted Net Loss $638,7M, Revenue $6,5M ($1,9B in 2019), Interest expenses $139,7M ($60,2M in 2019)
• NCLH's average monthly cash burn rate was lowered to ~$190M/~EUR 150M (2020-Q4) and ~$160M (2020-H2) - excluding debts.
• In mid-November 2020, NCLH issued 40 million common stocks ($20,80 per share) to raise $800M (5-month no-sail operations capital).
• In December 2020, NCLH offered senior notes (5,875%, due 2026) for $850M, to be used for general corporate purposes.
• For FY2020, NCLH reported total debt $11,8B (EUR 9,66B), liquidity ~$3,3B (EUR 2,7B/cash and cash equivalents), GAAP Net Loss $4B (EUR 3,275B), Adjusted Net Loss $2,2B (EUR 1,8B), Revenue $1,3B (80,2% decrease over 2019's $6,5B), 53,8% decrease in operating expenses (over FY2019), fuel expenses $264,7M, interest expenses $482,3M.
• For 2021-Q1 NCLH reported total debt $12,2B, cash and cash equivalents $3,5 billion, average monthly cash burn ~$190M, GAAP net loss $1,4B (EPS/Earnings Per Share $4,16), Adjusted Net Loss $668,6M, 79,8% decrease in operating expenses (over 2020-Q1), interest expense $824,4M ($68,9M in 2020).
• For FY2021 NCLH reported GAAP Net Loss $4,5B ($12,33 EPS), Adjusted Net Loss $2,9B ($8,07 EPS), Revenue $600M, Interest Expense $2,1B, operating expenses 246,7%, Capacity Days 18,1%.

On March 27, 2020, TUI AG (owner of 3 cruise companies - TUI, Marella UK, Hapag-Lloyd) loaned from KfW Bank (state-owned, Germany's 3rd-largest) EUR 1,8B (~$2,01B) to its existing credit - to total EUR 3,1B (cash and Revolving Credit Facility). Besides its cruise shipping services, TUI AG also temporarily suspended its flight-hotel- tour divisions' operations.

On April 9, 2020, CDC announced that 20 cruise liners currently docked/anchored in the USA have confirmed or suspected COVID crew cases. In the same statement, CDC extended its " No Sail Order " (officially CSO-"Conditional Sailing Order" regarding departures from the USA) through July 24 (including). Eventually, CSO was extended through August 2021, affecting the Alaskan season. CDC requires COVID vaccination for all passengers and crew but wearing masks is optional.

• Carnival Corporation spent/burned monthly on no-sail operations ~$650 million. Carnival's global fleet includes the brands/subsidiaries AIDA, CCL-Carnival, Costa, Cunard, HAL-Holland America, P&O UK, P&O Australia, Princess, Seabourn.
• RCG-Royal Caribbean spent/burned ~$250-290 million monthly on fleetwide no-sail operations. These expenses (operating plus administrative) were reduced from ~$400M after employment reduction (shipboard and ashore). RCG's global fleet includes the brands/subsidiaries RCI, Celebrity, Marella, Pullmantur, Silversea, TUI.
• NCLH-Norwegian spent/burned ~$160 million monthly on fleetwide no-sail operations. NCLH's global fleet includes the brands/subsidiaries NCL-Norwegian, NCL America, Oceania, RSSC-Regent Seven Seas.
• An MSC 's no-sail month costs were ~$180 million.

During the lay-up period, on the passenger-free liners, the crew was allowed to use all public areas (including bars and restaurants) and also provided with free and unlimited Internet (available 24 hours).

• "Cold lay-up" is shutting down the ship's onboard operations in order to cut costs. The non-employed vessel (out of service) is moored/anchored at a safe place (sheltered from bad weather) and awaiting new employment or charter.
• "Worm/Hot lay-up" is when the out-of-service vessel can restart operations/reenter service at a short notice.

In 2020 (February 9 through December) to The Philippines were repatriated (via charter flights and marine vessels) a total of 95974 Filipino crew (29,3% of all the 327511 overseas working Filipinos).

For the period March 13, 2020, through February 28, 2022 (2 years!), Canada banned from its seaports all foreign-flagged ships with passenger+crew capacity 100+. The ban affected both New England USA-Canada and Alaskan seasons as all non-USA- flagged ships are required (by USA's cabotage laws) to visit a foreign port along the itinerary. Eventually, the ban was extended only through November 1, 2021.

• In April 2021, Alaska State filed a lawsuit against CDC's CSO (no-sail order). In May, the lawsuit was joined by Florida and Texas. The lawsuit's purpose was for CSO to be dropped immediately, allowing companies to restart in the USA. On June 18, Judge Steven Merryday ruled in favor of Florida State in the lawsuit against CDC's CSO. On July 23, following Florida's application to the US Supreme Court (July 18), the 11th Circuit Court of Appeals reversed CDC's CSO (no longer enforceable in Florida). However, CSO remained in effect for all other US states (including the "cruise homeporting" Texas, California, Washington, New York).
• CDC also required all outside USA-homeported ships (serving travelers in foreign countries) to quarantine for 14 days prior to entering US waters. The rule affected many repositioning voyages.
• On May 13, 2021, the US Senate unanimously passed the bill HR1318 (Alaska Tourism Recovery Act) that allows foreign-flagged (large) ships to cruise out of Washington and stop at Alaskan ports bypassing the Canadian ports. The Bill was introduced on February 24 (by the Alaskan Congressman Don Young), unanimously passed by the US House of Representatives (Congress' lower house) on May 19, and signed into law by President Biden on May 24.
• Since February 2021, Canada requires foreigners to self-quarantine for up to 3 days (at their own expense in Gov-designated hotels) while waiting for their COVID test results. The cost (~CAD 2000 pp) includes the hotel, meals, PCR test, security, hotel's cost to keep its staff safe.
• Australia required foreigners to self-quarantine at Gov-approved hotels for 14 days (AUD 2800 pp/AUD 4620 per 4-person family). Reportedly, due to the industry's shutdown, in 2020-21 Australia lost ~AUD 8 billion ($6B / EUR 5B).
• CLIA stats for 2019 (over 2016) showed the industry generated $4,25 billion (~CAD 5,405B) in economic activity in Canada (33% increase), supported ~29,000 Canadian jobs (26% increase) and paid $1,43B (~CAD 1,82B) in wages (43% increase).
• The UK lifted all COVID-induced travel restrictions on March 18, 2022. Data showed that 86% of the population had 2nd vaccination, and 67% had booster/3rd dose.
• On July 18, 2022, CDC officially ended its COVID Program for reporting Coronavirus outbreaks on cruise vessels.

Norway banned Norwegian coastal and Svalbard cruises through May 1, 2021. New Zealand's ban was through May 29, 2021, Australia's - thru April 17, 2022 (after being extended several times).

CLIA member companies (all major cruise brands) suspended departures from US ports initially through Sept 15, then through October 31, November 20, and eventually through December 31. According to CLIA stats, in 2018 the industry generated ~$53+ billion (economic activities), supported 421,000+ jobs in the USA, with every 30th cruiser (from US ports) supporting 1 American job. CLIA's stats for 2019 show that the industry sustained ~1,166 million jobs equaling $50,53 billion (wages and salaries) and $154,5 billion total output worldwide. According to CLIA, one day of cruise suspension in the USA results in a loss of ~$110 million (in economic activities) and ~1000 American jobs. The March-November cruise pause resulted in $25+ billion loss (economic activities) and 164,000+ lost American jobs.

Due to canceled homeporting between March-September 2020, Florida reportedly lost ~$3,2 billion (~EUR 2,73B) in economic activities, ~49500 jobs, ~$2,3 billion (EUR 1,96B) in wages. Florida has some of the world's largest cruise ports (Miami, Port Everglades, Port Canaveral, Tampa). On July 1, 2021, takes effect Florida's "Senate Bill 2006", which also prohibits state-based businesses, schools and Gov agencies to require COVID vaccine passports from customers/employees.

In June 2020, Pullmantur Cruceros (joint-venture of "Cruises Investment Holding" + "RCG-Royal Caribbean") filed for a supervised reorganization/bankruptcy under Spain's insolvency laws. According to unofficial information, Pullmantur's 3 liners will be dismantled at Aliaga Ship Breaking Yard (Turkey).

In May 2020, Carnival Corporation announced plans to sell (including for scrapping ) 6 "less efficient ships" in 2020. In July, the number grew to 13 (~9% reduction in fleet's passenger capacity), in September - to 18 (12% fleet reduction). Between 2006-2018, Carnival sold/exited 28 liners. Carnival expected only 5 of all 9 newbuilds (2020-2021) to be delivered as planned, and also delayed deliveries of all scheduled for 2022-2023 newbuilds.

In July 2020, Carnival Corporation reported operating costs reduction by $7+ billion, capital expenditures reduction by $5+ billion (2020-Q2 through FY2021), additional liquidity $10+ billion, $1,3B savings for FY2020 (from reduced administrative expenses and non-newbuild expenditures) and newbuild capital expenditures (FY2020) reduction by $600+ million. Officially, Carnival reported an average monthly cash burn (for 2020-H2) of ~$650 million. In June 2020, ~60% of the global fleet's 2021 bookings were new, with the remaining ~40% being rebooking with FCCs (credits from canceled voyages).

In late-July 2020, FT Group (German travel company) announced shutting down its branch "FTI Cruises" ( MS Berlin ship ) effective November 1st.

On July 3, 2020, Kleven Verft AS (shipbuilding yard in Ulsteinvik Norway ) filed for bankruptcy protection. Due to financial difficulties, in 2017 the shipyard was sold to Hurtigruten (Norway) , then in January 2020 to DIV Group (Croatia).

On July 6, 2020, the Eckero Line (Finland)-owned subsidiary "Birka Cruises" was shut down. The brand's only cruise ship Birka Stockholm (2004-built) operated the Sweden-Finland route Stockholm - Mariehamn Aland . ~500 employees (mainly crew) lost their jobs. Birka Stockholm is planned for drydock conversion.

On July 20, 2020, CMV's parent company SQTL (South Quay Travel & Leisure Ltd) filed for bankruptcy. The UK-based, SQTL-traded as " Cruise & Maritime Voyages/CMV " (trademarked brand). In June, SQTL-CMV entered into emergency talks with potential investors and lenders but failed to secure funding. In October, all the 5x CMV ships (SQTL-owned) were sold at an auction in London.

As of July 31, 2020, GHK-Genting Hong Kong Ltd reported $3,4 billion in cash and cash equivalents. As of April 3rd, the Malaysian-Chinese billionaire Tan Sri Lim Kok Thay owned 69% of GHK.

• GHK (1965-founded/2022-defunkt) was a Hong Kong China -based holding company operating cruise shipping, shipbuilding and resort businesses. GHK owned Dream Cruises , Star Cruises , Crystal Cruises , MV Werften's shipyards in Germany (Papenburg, Rostock) and Finland's Meyer Turku.
• On August 20, 2020, GHK suspended all payments to creditors, triggering a 58% drop in its shares. For 2020-H1, GHK reported net loss $687,1 million ($55,2M for 2019-H1) after suspending cruise shipping (March-December) and shipbuilding (March-October) operations due to the COVID crisis. GHK applied for long-term funding from Germany's Federal Government (Economic Stabilization Fund) and started seeking an equity partner (private equity firm/investment management company) or debt funding (by private investors) for a stake in Crystal Cruises (ultra-luxury brand). In early-October was announced that GHK will receive EUR 193M (~$227M) from the German Government as a bailout for the MV Werften shipyards.
• On January 10, 2022, the GHK-owned subsidiaries MV Werften and Lloyd Werft filed for insolvency. On January 19, GHK filed for bankruptcy.

In mid-October 2020, Jalesh Cruises India (2019-founded with one-ship/ MS Karnika ) went bankrupt.

In early-November 2020, AIDA applied for a EUR 400 million loan from WSF/Wirtschaftsstablisierungsfonds (German Government's Economic Stabilisation Fund).

In Europe, several intercountry ferry routes were suspended and major seaports closed through July. Large ferry companies announced job redundancies (shipboard and offshore job furloughs) due to drop in Baltic Sea's passenger shipping traffic.

Eventually, all cruise shipping companies canceled their remaining 2020 schedules. New ships under construction (planned for deliveries in 2020-2021) were delayed due to shipyard closures and reduced staff. Those included Odyssey OTS, Wonder OTS, P&O Iona, Carnival Mardi Gras, Enchanted Princess, Celebrity Apex, Costa Firenze, Crystal Endeavor. Shipbuilding orders were postponed or canceled. Older (30+ years of age) vessels were retired from the fleets - most were sold to smaller and new companies, many were scrapped . Companies' shore-based staff was largely reduced (RIF/laid-off), the majority of ship crew contracts were terminated and the crew repatriated.

On May 19, 2021, the European Union reopened its borders to vaccinated non-EU tourists.

In 2022, world's 3 biggest cruise companies had a combined debt of US$74+ billion (Carnival/$36,4B, RCG-Royal Caribbean/$23,8B, NCLH-Norwegian/$14B).

New shipboard safety rules

On July 2, 2020, was released the European Union's 49-page document "Interim Guidance for Restarting Cruise Operations". It recommends new safety protocols (approved by CLIA) including:

• EU Monitoring (worldwide epidemiological situation, rules, travel restrictions)
• approved contingency (COVID-19 outbreak management) plan, adequate onboard testing capacity and crew training
• arrangements for onboard medical treatments and ashore ambulance services
• arrangements (repatriation, onboard quarantine of close contacts, onboard isolation of asymptomatic passengers)
• reporting to the next scheduled cruise port of any possible cases
• reduced ship capacity (passengers and crew), no indoor swimming pools, no self-service buffet dining
• onboard physician (resident doctor and nurse on the ship)

Using face masks is required (by both pax and crew) on buses, during boarding, in the ship's Casino, Infirmary, elevators, hallways/corridors.

Forced social/physical distancing (at least 5 ft / 1,5 m from each other) to be maintained during boarding, at waiting areas and transport stations. Enhanced shipboard hygiene measures include handwashing with soap or alcohol-based liquids (containing min 60% ethanol or 70% Isopropyl alcohol/isopropanol).

In early-August 2020, MSC released a video about its new health and safety protocols.

In late-January 2021, Saga UK became the world's first passenger shipping company to require COVID vaccination (done at least 14 days prior departure) for all customers.

Following the restarts in operations, virtually all cruise companies faced staff shortages and supply chain problems, as well as travel related issues like visa delays, different quarantine rules and vaccine requirements (by country), etc.zzz

Cruise ship COVID outbreaks 2022

Almost all of the onboard outbreaks are related to the Coronavirus Delta variant (SARS-CoV-2 Delta) which was first detected in India (December 2020) and officially named (by WHO) on May 31, 2021.

• COVID-Delta has gene mutations that affected COVID's transmissibility (40-60% more transmissible than COVID-Alpha) as well as the efficiency of the already available vaccines. While the vaccines remained effective to prevent death/hospitalization, some of the vaccinated could still develop symptoms after being infected with the Delta variant, the most common being breathlessness, headache, sore throat, fever, rhinorrhea (runny nose).
• By late-July 2021, COVID-Delta spread to 124 countries and became the dominant strain.
• According to WHO, ~1/3rd of the patients were aged under 30, with a hospitalization rate ~25% and CFR (case fatality rate) 0,2% (compared to Alfa variant's 1,9%).

Since the restart of operations in 2021, all crew and passengers (12 yo and older) were fully vaccinated. Children (under 12) were required prior to boarding to provide negative PCR tests. Almost all of the infected are either asymptomatic or experience only mild symptoms.

Coronavirus outbreaks on ships in 2021

Note: If even one crew is tested COVID-positive, on the vessel are immediately implemented the following emergency safety rules .

• All staff-crew are transferred from their cabins (usually with double-quad occupancy) to passenger staterooms (cabins located on decks above the crew deck) and accommodated one person per room.
• Only on-duty crew are allowed to leave their cabins - the rest must remain isolated.
• Smoking anywhere onboard is forbidden.
• Food, bottled water, linens and toilet paper are delivered to the staterooms upon request. Food-beverage items are ordered from a menu via cabin TV's infotainment system.
• The Infirmary (served by a nurse on 24-hour duty) must be called immediately after experiencing flu-like symptoms (dry coughing, high fever, breathing difficulties).
• Temperature screenings are conducted twice daily (in the staterooms).

Coronavirus outbreaks on ships in 2020

According to a USCG/Coast Guard report issued on April 4th, in or near the USA's territorial waters were a total of 114 cruise ships carrying mainly crew (~93,000). Another 41 liners (with ~41000 crew) were en-route and close to the USA. On April 6, 2021, CDC updated its regulations for disembarked cruise passenger transportation - those without (or experience only mild) symptoms should be disembarked in the USA as quickly as possible and immediately repatriated (via chartered flights) or bussed back home (via private transportation). Using commercial flights and public transportation is not allowed anymore.

According to CDC's July-issued "No-Sail Order" (20-page document), between March 1 and July 10, 80% of the cruise ships in the CDC jurisdiction were affected by COVID-19, with ~3000 cases (suspected and confirmed) and 34 deaths on cruise vessels in the USA's territorial waters.

On March 19, Carnival Corporation, in a press release, offered its permanently docked at ports cruise liners (during the lockdown period) to be used as hospitals for treating non-Coronavirus patients (not as quarantine facilities). These large liners have a minimum cabin capacity of 1000 (per vessel). Each stateroom has an en-suite bathroom (shower-washbasin-toilet) and can be quickly fitted with various medical and remote monitoring equipment (cardiac, respiratory, oxygen saturation, CCTV). All onboard operations (machinery maintenance, food and beverages, cleaning services) are provided by the staff and crew already on the vessel. Carnival stated that the monthly cost per vessel is ~USD 1 million (prolonged ship layup) and ~USD 2-3 million (warm ship layup). "Prolonged layup" means the vessel is manned by a reduced crew, which lowers operational costs but adds time (1-2 weeks at least) to restart service. "Warm layup" means the vessel remains fully crewed and operational.

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What Is the Future of the Cruise Industry After COVID-19?

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According to industry trade organization Cruise Lines International Association, over 30 million people took cruises last year. It’s safe to say that number will be lower in 2020.

During a highly contagious outbreak, a vacation in which thousands of people are traveling together on a ship is seen as potentially life-threatening. And even during the travel industry’s recovery period, airlines and hotels will have to be operating before cruise lines do. Passengers need a way to get to the ship and a place to stay the night before their departure.

I’ve followed cruise line stocks for financial services firms for 17 years and taken over 30 cruises personally, giving me a good perspective on what we might expect to see as both a financial analyst and passenger. While I think the industry will recover, it may not be until 2021 or later — and even then, ships likely won’t sail full at first. And while some changes will be temporary, there are others that could change cruising permanently. Here are a few.

Health checks are in

Cruise lines became much more stringent about health requirements after articles about norovirus threatened to scare off passengers. Signs about washing hands appeared everywhere, bottles of hand sanitizer showed up at restaurants, and passengers were asked to fill out a short health questionnaire before boarding.

Those precautions are likely to seem quaint after COVID-19. I’m not saying you’ll be required to present a doctor’s note of immunity to board a ship, but you’ll get more than a few questions about your health and may be subject to a temperature check or similar screening. The muster drill, which is the first-day assembly to discuss safety, may be as much about health risks as it is about emergency evacuation.

Here’s the part that could hurt the most: Until there is a vaccine for the novel coronavirus, a ship will likely go into lockdown as soon as anyone onboard shows symptoms of the disease, particularly given passenger demographics.

A few years ago, a Carnival Cruise Line executive told me that the average age of passengers was about 50, meaning that a good number of cruisers fall into an age group that seems more susceptible to complications from COVID-19. That’s what’s most likely to impede the recovery of the industry. It’s going to be hard to get customers to pay for a vacation that might result in their being locked in a cabin for a week or longer.

Self-serve buffets are out

The one image everyone seems to have about cruises is the midnight buffet, with passengers picking at pastries as the stars shine overhead. And while that particular event is no longer necessary (mostly because many cruise lines have become 24-hour feasts), the buffet still plays a large role in the cruise experience.

I think it’s safe to say the buffets will stay. Passengers like them too much and food costs are low. But their nature may change. Instead of serving yourself, it’s likely that all food will be served to you by a crew member from behind a sneeze guard. It doesn’t matter how much hand sanitizer you use before you enter a buffet, the cruise line isn’t going to take a chance with people rifling through pieces of fruit, cookies or any of the other food to which passengers help themselves.

Cruise lines hate to do anything that increases their costs, and full-serve buffets could certainly do so. But labor costs are low (since cruise lines are generally not subject to U.S. labor laws), and I suspect that passengers will take less food when someone serves it to them.

» Learn more: How a new cruise ship is built

Taxes are in (maybe)

While most cruise lines operate out of Florida, their incorporation status is more controversial. Carnival Corp., for example, is incorporated in Panama. This status offers them some benefits, and two of the most important are being shielded from U.S. labor laws and U.S. taxes. In 2019, Carnival paid a tax rate of just over 2%, similar to its publicly traded peers. In normal economic times, nobody makes an issue of it.

But these aren’t normal economic times. The cruise lines have already gone to Wall Street to borrow money or sell stock to finance themselves during COVID-19. If they run out of money again, they may need to approach the government for aid.

That’s where things get interesting — technically, the cruise lines are not U.S. companies. But I think it’s highly unlikely that the federal government will allow them to go under, particularly in an election year, given the number of people they employ in Florida.

And it will be equally unlikely that they will be forced to incorporate in the United States. That ship has sailed, so to speak. But if the companies are forced to approach the U.S. government for a loan, Washington will be in a strong position to get some long-term concessions. The cruise lines won’t be forced to pay the full corporate taxes that other industries pay, but I would not be surprised to see financial implications that would affect them long after whatever loans they receive are paid back.

Is that good? If you’re a U.S. citizen, absolutely. More money in the coffers is always a good thing. But somebody has to pay those added costs, and they will likely be passed along to customers, at least in part.

The bottom line

COVID-19 is going to force cruise lines to change the way they operate. You will see some of the impact onboard, while much of it will be behind the scenes. But I’d bring a thermometer along, just in case.

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Norwegian cruise quarantined due to stomach illness cases on board

PORT LOUIS, Mauritius ― Norwegian Cruise Line's Norwegian Dawn arrived in Port Louis Monday after being quarantined off the coast of Mauritius with a reported stomach illness onboard. The ship was originally scheduled to arrive Sunday.

In a statement, Norwegian said "a small number of guests" were experiencing "mild symptoms of a stomach-related illness." The cruise from Mauritius to Cape Town that was originally scheduled to depart on Sunday will now embark passengers in Port Louis on Tuesday, though travelers have not yet received a finalized itinerary.

Norwegian Dawn was on a 12-day itinerary from Cape Town to Port Louis that started on Feb. 13 when the health issues were first reported.

"We have elevated our sanitation procedures aboard the ship as part of our routine measures to ensure a safe environment for all on board and will continue to take any necessary measures to protect our guests, crew and destinations we visit,” a Norwegian spokesperson said in an earlier statement.

Norwegian is providing complimentary hotel accommodations for guests until they are able to board, and assisting current guests on the ship with travel arrangements.

Zach Wichter is a travel reporter for USA TODAY based in New York. You can reach him at [email protected]

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Italy may be in Easter lockdown, but the party’s on at sea

Passengers enjoy the sun by a swimming pool on board the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers take selfies on a deck of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passenger Loredana Battistoni, right, waits to receive a Covid-19 test prior to boarding the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers walk the terminal prior to boarding the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers, from right, Stefania Battistoni, her sons Dasteen and Samuel Pacifici and her mother Loredana Merlo have their hand luggage sanitized prior to boarding the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers, from left, Dasteen and Samuel Pacifici, and Stefania Battistoni and Loredana Merlo enter their cabin after boarding the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers have their body temperature measured as they enter a restaurant of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A passenger wears a face mask in a restaurant of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A man exercises in a gym on the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers pose for a group photo as they board the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Dancers and actors practice in the theater of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers in bath robes enter a lift on the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Passengers, Ilaria Gelli, 48, left, Federico Marzocchi, 45, right, and and their son Matteo Marzocchi, 10, walk on board the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A waiter, wearing Covid-19 protection devices holds a tray of drinks on the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A view of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A view of the MSC Grandiosa cruise ship, center, in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

A passenger stand on the terrace of a cabin of the MSC Grandiosa cruise ship in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

Raffaele Piontecorvo, captain of the MSC Grandiosa cruise ship talks during an interview with the Associated Press, on board the vessel in Civitavecchia, near Rome, Wednesday, March 31, 2021. MSC Grandiosa, the world’s only cruise ship to be operating at the moment, left from Genoa on March 30 and stopped in Civitavecchia near Rome to pick up more passengers and then sail toward Naples, Cagliari, and Malta to be back in Genoa on April 6. For most of the winter, the MSC Grandiosa has been a lonely flag-bearer of the global cruise industry stalled by the pandemic, plying the Mediterranean Sea with seven-night cruises along Italy’s western coast, its major islands and a stop in Malta. (AP Photo/Andrew Medichini)

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ABOARD THE MSC GRANDIOSA (AP) — Italy may be in a strict coronavirus lockdown this Easter with travel restricted between regions and new quarantines imposed. But a few miles offshore, guests aboard the MSC Grandiosa cruise ship are shimmying to Latin music on deck and sipping cocktails by the pool.

In one of the anomalies of lockdowns that have shuttered hotels and resorts around the world, the Grandiosa has been plying the Mediterranean Sea this winter with seven-night cruises, a lonely flag-bearer of the global cruise industry.

After cruise ships were early sources of highly publicized coronavirus outbreaks, the Grandiosa has tried to chart a course through the pandemic with strict anti-virus protocols approved by Italian authorities that seek to create a “health bubble” on board.

Passengers and crew are tested before and during cruises. Mask mandates, temperature checks, contact-tracing wristbands and frequent cleaning of the ship are all designed to prevent outbreaks. Passengers from outside Italy must arrive with negative COVID-19 tests taken within 48 hours of their departures and only residents of Europe’s Schengen countries plus Romania, Croatia and Bulgaria are permitted to book under COVID-19 insurance policies.

On Wednesday, the Grandiosa left the Italian port of Civitavecchia for its weeklong Easter cruise, with 2,000 of its 6,000-passenger capacity and stops planned in Naples and Valletta, Malta, before returning to its home port in Genoa.

Passengers welcomed the semblance of normalcy brought on by the freedom to eat in a restaurant or sit poolside without a mask, even if the virus is still a present concern.

“After a year of restrictive measures, we thought we could take a break for a week and relax,” said Stefania Battistoni, a 39-year-old teacher and single mother who overnight from Bolzano, in northern Italy, with her two sons and mother to board the cruise.

The pandemic has plunged global cruise ship passenger numbers from a record 30 million in 2019 to more than 350,000 since July 2020, according to Cruise Lines International, the world’s largest cruise industry association representing 95% of ocean-going cruise capacity. Currently, fewer than 20 ships are operating globally, a small fraction of CLIA’s members’ fleets of 270 ships.

The United States could be among the last cruise ship markets to reopen, possibly not until fall, and not until 2022 in Alaska. Two Royal Caribbean cruise lines that normally sail out of Miami opted instead to launch sailings in June from the Caribbean, where governments are eager to revive their tourism-based economies despite activist concerns about the health and environmental impact.

On the MSC ship, extra cabins are set aside to isolate suspected virus cases. Because of the contact tracing wristbands, if a passenger tests positive, medical personnel can identify anyone with whom they were in contact. Once the situation is clear, anyone who is positive is transferred to the shore.

According to an independent consulting firm, Bermello Ajamii & Partners, just 23 COVID-19 cases have been confirmed on ships since the industry began its tentative relaunch last summer, for a passenger infection rate of 0.006%.

But cruise industry critics say the risk isn’t worth it and add that cruise companies should have taken the pandemic timeout to address the industry’s long-standing environmental and labor problems.

“All large cruise ships burn huge volumes of the dirtiest, cheapest fuel available,” said Jim Ace of environmental group Stand Earth. “Cruise ship companies could have used the COVID shutdown to address their impacts on public health and the environment. Instead, they scrapped a few of their oldest ships and raised cash to stay alive.”

On board, though, passengers are relishing the chance to enjoy activities that have been mostly closed in Italy and much of Europe for a year: a theater, restaurant dining, duty-free shopping and live music in bars.

The rest of Italy is heading back into full lockdown over the Easter weekend, with shops closed and restaurants and bars open for takeout only to try to minimize holiday outbreaks. In addition, Italy’s government imposed a five-day quarantine on people entering from other EU countries in a bid to deter Easter getaways.

“Let’s say that after such a long time of restrictions and closures, this was a choice done for our mental health,” said Federico Marzocchi, who joined the cruise with his wife and 10-year-old son Matteo.

The European cruise industry is looking to expand the reopening this spring.

Cruises are circulating on Spain’s Canary islands in the Atlantic Ocean off the coast of Africa, including the company AIDA catering to German tourists. Costa Cruises, which with MSC is one of Europe’s largest cruise companies, will resume cruises on May 1, with seven-night Italy-only cruises. Costa plans to begin sailing in the western Mediterranean from mid-June.

Britain is opening to cruise ships in May, with MSC and Viking launching cruises of the British Isles, among several companies offering at-sea “staycation” cruises aimed at capturing one of the most important cruise markets. The cruise industry is hoping Greece will open in mid-May, but the country hasn’t yet announced when it will reopen tourism.

The U.S. Centers for Disease Control and Prevention issued a “framework” for resuming cruises in the U.S., but the industry says the health agency hasn’t spelled out the details that companies need to operate their ships. Once the CDC provides technical requirements, industry officials say it takes about 90 days to prepare a ship for sailing.

The cruise companies complain that last fall’s CDC framework is outdated and should be scrapped. They say it was issued before vaccines were available and before the restart of cruises in Europe, which they say have safely carried thousands of passengers under new COVID-19 protocols. And they complain that cruising is the only part of the U.S. economy that remains shuttered by the pandemic.

The Cruise Lines International Association trade group is lobbying for an early July start to U.S. cruising, noting that loyal cruise customers will just go to elsewhere.

“Cruisers love to cruise, and they will go where the ships are sailing,” said Laziza Lambert, a spokeswoman for the trade group.

Still, environmentalists pushing back against an earlier restart say the timeout imposed by the pandemic provides a window to address the industry’s issues.

“Large cruise ships pollute our air, our water and contribute to climate change. They are toxic to port communities. And they spread COVID. They exploit workers and put passengers at risk,’' Ace said. ”Why should large cruise ships be allowed to return before they have addressed these concerns?”

AP reporters Colleen Barry in Soave, Italy, Nicole Winfield in Rome, and David Koenig in Dallas, contributed to this report.

Follow AP’s pandemic coverage at:

https://apnews.com/hub/coronavirus-pandemic

https://apnews.com/hub/coronavirus-vaccine

https://apnews.com/UnderstandingtheOutbreak

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• PMC7480061.1 ; 2020 Sep 1
• ➤ PMC7480061.2; 2020 Oct 6

This is a preprint.

Dynamic network strategies for sars-cov-2 control on a cruise ship, samuel m. jenness.

1 Emory University Rollins School of Public Health, Atlanta, GA 30322, USA

Kathryn S. Willebrand

2 Yale Institute of Global Health, New Haven, CT 06510, USA

3 Yale School of Public Health, New Haven, CT 06510, USA

Amyn A. Malik

4 Yale School of Medicine, New Haven, CT 06510, USA

Benjamin A. Lopman

Saad b. omer.

5 Yale School of Nursing, Orange, CT 06477, USA

Associated Data

SARS-CoV-2 outbreaks have occurred on several nautical vessels, driven by the high-density contact networks on these ships. Optimal strategies for prevention and control that account for realistic contact networks are needed. We developed a network-based transmission model for SARS-CoV-2 on the Diamond Princess outbreak to characterize transmission dynamics and to estimate the epidemiological impact of outbreak control and prevention measures. This model represented the dynamic multi-layer network structure of passenger-passenger, passenger-crew, and crew-crew contacts, both before and after the large-scale network lockdown imposed on the ship in response to the disease outbreak. Model scenarios evaluated variations in the timing of the network lockdown, reduction in contact intensity within the sub-networks, and diagnosis-based case isolation on outbreak prevention. We found that only extreme restrictions in contact patterns during network lockdown and idealistic clinical response scenarios could avert a major COVID-19 outbreak. Contact network changes associated with adequate outbreak prevention were the restriction of passengers to their cabins, with limited passenger-crew contacts. Clinical response strategies required for outbreak prevention included early mass screening with an ideal PCR test (100% sensitivity) and immediate case isolation upon diagnosis. Public health restrictions on optional leisure activities like these should be considered until longer-term effective solutions such as a COVID-19 vaccine become widely available.

INTRODUCTION

COVID-19, caused by SARS-CoV-2, is responsible for large-scale morbidity and mortality across the world. In addition to virus spread from symptomatic individuals, asymptomatic and pre-symptomatic transmission has also been documented ( 1 ). At an individual level, living in close proximity to someone with COVID-19 increases risk of contracting the disease ( 2 ). At the population level, density of contacts is correlated with COVID transmission potential ( 3 ). Congregate housing environments and related settings with dense human social interactions present ongoing mechanisms for transmission of SARS-CoV-2.

Cruise ship environments are one high-density setting in which COVID transmission dynamics and control measures require further study. Approximately, 29 million people took ocean cruises in 2018; prior to the emergence of COVID-19, 32 million people worldwide were projected to take an ocean cruise in 2020 ( 4 ). There have been many outbreaks of infectious diseases on cruise ships in the past — notably respiratory illness outbreaks and norovirus gastroenteritis ( 5 – 7 ). With the emergence of COVID-19, ship outbreaks have become a significant concern. There have already been several COVID-19 outbreaks on cruise ships, aircraft carriers, and cargo ships ( 8 – 12 ).

The outbreak on Diamond Princess cruise ship has been described in substantial detail ( 12 – 15 ). Since it started prior to imposition of widespread social distancing in most locations, the outbreak has been valuable in characterizing SARS-CoV-2 epidemiology ( 14 ). On January 20th, 2020 the Diamond Princess departed for a 14-day cruise from Yokohama, Japan ( 12 ). On January 25th, a passenger disembarked in Hong Kong and tested positive for COVID 6 days later ( 16 ). The Diamond Princess was then quarantined in Yokohama starting on February 5th. Guests and crew were regularly tested and those who tested positive were removed from the ship ( 12 ). Starting February 16th, with priority given to people at higher risk for COVID complications, guests who tested negative were allowed to voluntarily disembark and carry out the remainder of their quarantine at a non-medical facility on land ( 16 ). On February 23rd, remaining guests were released from the ship in phases to be repatriated, where they were asked to carry out an additional 14-day quarantine ( 12 , 16 ). Crew served an additional 14-day quarantine after the departure of passengers ( 12 , 16 ). As of March 27th, 712 of the 3,711 passengers had tested positive for COVID-19, including 311 of whom were asymptomatic at the time of testing and 9 who died ( 12 ). This outbreak was key in the early estimate of the fraction of COVID cases who remained asymptomatic, at approximately 18% overall.

Mathematical models have greatly contributed to our understanding of COVID-19 transmission dynamics and optimal strategies for disease control. Many modeling studies have been completed, with most using a traditional ordinary differential equation (compartmental) mathematical framework ( 17 ). Because of its assumptions about a large, homogenous, well-mixed population, this framework is limited in representing smaller, dense social settings where the underlying contact networks are highly structured. Rocklöv et. al., for example, was a compartmental model of a simplified stratified ship population (distinguishing ship crew from guests) that estimated empirical transmission parameters on the Diamond Princess ( 13 ). However, this model did not represent the full heterogeneity of contact patterns on the ship and did not consider any counterfactual intervention scenarios.

In this study, we developed a dynamic network-based transmission model for COVID-19 on the Diamond Princess. Our two aims were to: 1) characterize the scope and directionality of SARS-CoV-2 transmission aboard the ship given the control events that occurred; and 2) to estimate the epidemiological impact of counterfactual COVID control and prevention strategies. These findings may inform interventions for COVID-19 on future ship sailings, as well as outbreak control in environments with similar high-density contact patterns.

We used a network-based model of infectious disease dynamics to represent the transmission and natural history of SARS-CoV-2 infection across the Diamond Princess cruise ship. This model was built and simulated with the EpiModel software platform ( 18 ). This uses the statistical framework temporal exponential random graph models (TERGMs) to estimate and simulate dynamic contact networks based on generative models for network data ( 19 ). Our model simulated the individual passengers and crew on the Diamond Princess before and after the major control efforts were implemented to contain the infection spread (Day 15 of the outbreak). The model scenarios were simulated for a period of one month in daily time steps.

Network Structure.

Our model uniquely represented the individuals on the Diamond Princess ship, classified by passenger and crew status (see Figure 1 ). Following documented records, there were 2666 passengers and 1045 crew, with type represented as a categorical nodal attribute ( 13 , 16 ). Age was represented as a continuous attribute, with initial distributions drawn from empirical distributions: passengers averaged 69 years old (interquartile range: 62–73) and crew averaged 36 years old (interquartile range: 29–43) ( 14 ).

This model schematic represents the structural features of the dynamic contact networks within the ship after the lockdown event was imposed. The larger ship is divided into decks, and on each deck, there are multiple sectors, and within sectors passenger cabins and crew quarters. Networks are comprised of passenger-passenger, passenger-crew, and crew-crew contacts. After lockdown, all passenger-passenger contacts are limited to cabinmates, and crew contacts are substantially reduced to mostly within sector contacts.

Passengers were assigned to one of 1337 cabins on the ship, resulting in an average cabin occupancy of 1.99 passengers. Cabins were then grouped with 10 sectors, which were mostly (but not entirely) self-contained units within the ship that consisted of passenger cabins and assigned crew members. Before control measures were implemented (Day 15 of outbreak), passengers were able to make continued and repeated contacts with their own cabin mates, as well as ongoing contact with random other passengers and crew members both within and outside their cabin sector. The average daily passenger-passenger degree was 5 and passenger-crew degree was 8, based on other models and reports of contact levels and mixing across the ship in a non-outbreak setting ( 13 , 20 ). Crew members also concentrated the majority of their contacts in their sector prior to network isolation, but also traveled (and thus made contacts) freely across the ship. The average daily crew-crew member degree was 10.

After network lockdown on Day 15, severe restrictions to network degree and cross-sector mixing were simulated, following the empirical characterization of contact isolation ( 16 ). This included individuals being confined within their passenger cabins (therefore, making other passenger contacts only with their cabinmates), and crew with limited passenger contact for daily meal and cabin cleaning services. Crew were also constrained to making nearly all their contacts (98%) within their own ship sector to reflect the mobility restrictions imposed upon network lockdown. We assumed within lockdown that the within-dyad contact intensity was 5-fold higher for passenger-passenger contacts compared to passenger-crew and crew-crew contacts to account for the higher frequency of exposure within cabins for passenger-passenger contacts.

We represented these evolving networks using a multi-layer dynamic network approach with TERGMs to simulate the complex interactions that varied by person type and time. A total of 6 TERGMs were fit to the network degree distribution statistics above: one for each contact type interaction (passenger-passenger, passenger-crew, and crew-crew), doubled for before and after the network lockdown on Day 15 that fundamentally altered the network structure. The TERGMs were estimated and simulated using standard MCMC-based fitting procedures ( 19 , 21 ), and then diagnosed by comparing the simulated network data against the input data points.

COVID Transmission and Progression.

Our model represented pathogen transmission and disease progression following common COVID-19 modeling approaches ( 17 ). This SEIR framework allowed for infected persons to stochastically transition from susceptible to exposed (latent) stages upon infection ( Supplemental Figure 1 ). Persons then transitioned to either a symptomatic or asymptomatic pathway for the infectious period before recovering. Following estimates from the Diamond Princess, 25–76% of persons entered into the symptomatic infectious pathway, with the probability of symptoms positively correlated with age ( 17 ). Asymptomatic infected persons had 50% the transmission potential compared to those with symptomatic infection ( 22 ).

For persons in the symptomatic pathway, states were divided into a pre-clinical infectious followed by a clinical infectious stage. In the base model, all persons in the clinical infectious stage reduced their contact intensity by 90% after the outbreak was recognized (Day 15). We implemented a mortality process, with general age-specific mortality rates following standardized age-specific mortality data ( 23 ), with a multiplier for excess COVID-related mortality within the clinical infectious state (representing the most severe disease) only. This multiplier was calibrated to reproduce the number of COVID-19 deaths at one month.

Widespread screening was imposed, with screening rates stratified by symptomatic status, following empirical diagnostic patterns on the Diamond Princess ( 16 ). In the base scenario, widespread screening was initiated on Day 15, with higher screening rates for symptomatic cases. We calibrated the stratified daily rates to reproduce the daily case count on the ship. The calibrated screening rates resulted in approximately 3,100 cases screened over the month, with 634 positive cases at one month (see Figure 2 ). We used a PCR sensitivity of 80% ( 24 ), and assumed that diagnosed persons reduced their contact intensity by 90% (similar to the reduction for symptomatic cases).

Panel A (left) shows the results of the primary model calibration, which was to the cumulative diagnoses of COVID-19 that occurred through month 1 on the ship. The primary diagnosis efforts were initiated on Day 15. Model calibration parameters included the symptomatic and asymptomatic diagnosis rates per day and the transmission probability per exposure. The total incidence of disease consistent with this calibration is shown in blue. Panel B (right) shows the daily incidence of all (diagnosed and undiagnosed) new COVID-19 cases in the calibrated model, and then in a model scenario in which there was no network lockdown intervention. The network lockdown date on Day 15 is shown in a vertical line. Both panels display the median (dark line) and interquartile range (light bands) from 1000 simulations of the calibrated model.

Intervention Scenarios.

We modeled three categories of prevention and control interventions: behavioral, clinical, and biological. Control interventions were those imposed in response to the outbreak on the ship (i.e., on or after Day 15) whereas prevention interventions were counterfactual scenarios that could reduce SARS-CoV-2 transmission before an outbreak (i.e., what might be useful for future cruises).

For behavioral interventions, we investigated the impact of the timing of the network lockdown and the intensity of the contact reduction of each of the sub-networks (passenger-passenger, passenger-crew, and crew-crew). Outcomes were the cumulative incidence and mortality at one month. The network lockdown time was varied by implementing the restricted network at counterfactual days across the month, relative to the Day 15 base scenario. Our question was whether imposing the lockdown at an earlier day could have prevented a major outbreak on the ship. We also investigated whether reducing the intensity of contact (conditional on a network dyad existing) could lower overall cumulative incidence, or incidence of cases with a particular contact directionality. This contact intensity reduction was implemented by reducing the per-dyad daily contact rate by a relative amount, where the calibrated base scenario was 100%. This contact intensity reduction was implemented in either in tandem with the Day 15 network lockdown or on Day 1 in the absence of a lockdown.

Clinical interventions consisted of varying the timing of mass screening on the ship, and the intensity of case isolation after a positive diagnosis. We first evaluated, from a control perspective, how varying the intensity of case isolation would reduce the cumulative incidence (the base scenario assumed a 90% reduction). This was evaluated at Day 15, with and without network lockdown, with the contact intensity reduced starting on Day 15. We next estimated, from a prevention perspective, how varying the timing of mass screening from Day 1 to never, would impact the cumulative incidence at one month. Bivariate sensitivity analyses further explored the relationship between screening start date, diagnosis-based contact intensity reduction, and PCR test sensitivity on cumulative incidence.

Biological interventions were simulated by varying the intensity of personal protective equipment (PPE; e.g., face masks) use across the behavioral and clinical interventions. This was implemented in different counterfactual scenarios in which PPE was uniformly used or not used by everyone on the ship in order to understand the total causal effect of PPE use as a ship-wide intervention. We assumed that PPE was used for passenger-crew and crew-crew contact types, but not passenger-passenger contacts after lockdown (because of the difficulty in maintaining these interventions within passenger cabins). This involved modifying the force of infection per contact by a reduction of 40% in the PPE scenarios ( 25 ).

Calibration, Simulation, and Analysis.

Our model was calibrated to the cumulative diagnosis curve through 1 month as observed and reported on the Diamond Princess ( 16 ). Free parameters for model calibration were: the daily screening rate (stratified by symptomatic status), which was allowed to vary in 5-day blocks to avoid overfitting; the intensity for passenger-passenger contacts per day; and the probability of infection per contact. The base calibrated model scenario implemented network lockdown, clinical interventions, and PPE use starting on Day 15. We fit the model to cumulative diagnoses per day, the total number of screening tests at one month, and the total number of deaths at one month. Figure 2 shows the results of this calibration relative to data.

For each reference and counterfactual scenario, we simulated the model 1000 times and summarized the results with medians and 95% simulation intervals. Outcome measures were the cumulative incidence of COVID-19 and the mortality at 1 month. We also quantified the directionality of transmissions by tracking who infected whom by person type (passenger versus crew) on the ship. Outcomes of the number and percent of infections (or deaths) averted were used to compare the cumulative incidence (or mortality) in an experimental scenario relative to the base scenario.

Figure 2 shows the results of the model calibration and timing of the network-related control measures on the Diamond Princess ship. Day 1 represents January 20, and Day 15 represents March 4. The empirical number of positive diagnosed cases at one month was 634, compared to the fitted model of 647 (interquartile range [IQR]: 504, 785). The total incidence consistent with this calibration, which includes undiagnosed cases and false-negative cases (due to imperfect PCR sensitivity), was 948 (IQR: 739, 1146). Panel B shows that the daily total incidence in the calibrated model that includes empirical network lockdown, compared to a model in which no network intervention occurred. In the calibrated model, peak incidence occurred on Day 14, with 165 cases (IQR: 126, 201). In the no-intervention model, peak incidence occurred on Day 20, with daily 298 cases (IQR: 282, 317). In the calibrated model, 66.1% of total cumulative cases had occurred by Day 15 whereas in the no-intervention model, only 21.7% had occurred by Day 15.

Figure 3 shows the results of the primary network intervention, stratified by PPE use starting at the network lockdown. Corresponding numerical results are provided in Supplemental Table 1 . The density of cumulative incidence across the simulations in each scenario is visualized given the model stochasticity. The variability of outcomes within scenario is partially driven by the random seeding of infection and the case clustering within passenger cabins.

This figure shows the distribution of cumulative incidence in the model scenarios that vary the network lockdown time, with and without personal protective equipment (PPE). The base (calibrated) model corresponds to Day 15, when the actual control efforts were implemented. If the network lockdown had never been implemented, over 3500 cases would have been projected. If the lockdown had occurred one Day 1, fewer than 20 cases would be projected. This figure shows the empirical distribution of cumulative incidence across 1000 simulations of each scenario.

In the base scenario, there were an estimated 948 infections and 10 COVID-related deaths. Implementing the network lockdown with PPE 10 days earlier (Day 5) would result in 909 fewer infections and no COVID-19 deaths. Implementing the network lockdown 10 days later (Day 25) was projected to result in 2224 more cases and 20 more COVID deaths. The overall impact of PPE was minimal in these scenarios, conditional on the network lockdown time. The cumulative incidence if the network lockdown had occurred on the same day as the base model (Day 15) but no PPE were ever used would be 1113 cases (152 more than the base scenario with PPE) and 11 deaths (1 more than the base scenario). The impact of PPE was minimal here because of the high network degree and contact intensity within each network link, overwhelming the per-contact reduction in the force of infection from PPE, and the directionality of transmission.

Supplemental Table 2 shows the directionality of transmission events in the base calibrated model with network lockdown and PPE at Day 15, and also in a counterfactual scenario in which there was no network lockdown but PPE use was initiated on Day 1. In the base model, 59% of cumulative cases (551 out of 934) were passenger to passenger transmissions, compared to 17% that were passenger to crew, 13% that were crew to passenger, and 10% that were crew to crew. Control-based interventions aimed at further reducing the contact intensity within each contact type are shown as counterfactuals. If implemented after network lockdown, contact intensity reductions could avert up to an additional 190 cases (in the scenario in which passenger-crew contact intensity were reduced by 100%). This directional contact intensity reduction prevents cases directly (from passengers to crew and crew to passengers) but also indirectly in the other two sub-networks (passenger to passenger and crew to crew). With contact intensity reductions implemented at Day 1 (as a prevention intervention in the absence of network lockdown), even extreme levels of passenger-passenger contact intensity reduction (which would not be realistic on a ship) failed to avert the same number of cases as the network lockdown scenario implemented on Day 1. These scenarios highlight that passenger-passenger contact continues to be the dominant mode of transmission.

Supplemental Table 3 shows the results of the intervention of using diagnoses that prompt case isolation, using the control-based perspective in which the interventions were implemented on Day 15 after screening ramped up. Base models assumed that diagnosis resulted in a 90% reduction in contact intensity across all three contact networks. Even if case isolation were completely relaxed, with no case isolation starting with any diagnoses on Day 15, there would be a minimal impact on cumulative incidence and mortality. The same effects are observed in the set of scenarios in which no network lockdown occurred, but in which case isolation still beginning on Day 15.

Mechanistic reasons for the minimal impact of case isolation are explored in the next scenario set ( Figure 4 and Supplemental Table 4 ) that implemented case isolation from a prevention perspective. These scenarios varied the timing of mass screening of all persons. The Day 1 timing scenario is consistent with pre-screening of all passengers and crew on the ship, as we (optimistically) assumed that results delivery and case isolation occurred on the same day. These scenarios further assumed that no network lockdown or other general contact restriction occurred, in order to represent a natural ship environment without contact restrictions. These scenarios also assumed that diagnosis-based and symptoms-based case isolation was complete (100% of cases diagnosed or with COVID symptoms are isolated immediately).

This figure shows the projected total cumulative incidence at 1 month across scenarios for COVID-19 control based on case isolation after PCR diagnosis. Panel A (left) shows the impact on cumulative incidence based on timing of mass (asymptomatic) screening against intensity of isolation of diagnosed cases (where 0 = full isolation and 1 = no isolation); this highlights that incidence is minimized by screening begins immediately and is associated with complete case isolation (mean incidence in bottom left = 2244). Panel B (middle) shows the impact on cumulative incidence based on timing of mass screening against PCR sensitivity, where the base sensitivity is 80% and the diagnosed isolation intensity is 0; this highlights that incidence is minimized when screening begins immediately and PCR sensitivity is perfect (mean incidence in top left = 0). Panel C (right) shows the impact on cumulative incidence based on diagnosed isolation intensity and PCR sensitivity, with mass screening starting at Day 1; this highlights that incidence is minimized when isolation intensity is highest and PCR sensitivity is perfect (mean incidence in top left = 0).

If mass screening and case isolation were to occur on Day 1, the projected incidence would be 2286 cases, which was 1404 fewer than the scenario in which this prevention strategy were never implemented. Projected cumulative mortality in this scenario was 7 cases (95% SI: 0, 24). PPE use contributed more significantly to prevention in these scenarios than in the network lockdown scenarios in Figure 1 because it would be used for the entire month and a larger fraction of contacts were outside the passenger cabins (PPE use was not represented within cabins). However, even with complete PPE use and immediate diagnosis-based case isolation, the cumulative incidence was 1630 cases and 5 deaths.

Figure 4 highlights the relationships between the prevention mechanisms for this diagnosis-based case isolation. Panels A (left) and B (middle) demonstrate that the optimal timing of mass screening was as soon as possible. Cumulative incidence was further minimized when relative contact intensity after diagnosis trended towards zero (complete isolation). However, in this case the minimal cumulative incidence (in the bottom left scenario) was still 2244. Panel B shows that cumulative incidence was further minimized in an early mass screening scenario with increased PCR sensitivity. In comparison with a base model PCR sensitivity of 80% (resulting in 20% of true-positive cases remaining undiagnosed), a test sensitivity approaching 100% would minimize incidence, assuming complete contact isolation after diagnosis. Panel 3 shows that both case isolation must be complete (relative contact intensity = 0) and PCR sensitivity must be 100% to achieve complete outbreak prevention (in absence of a network lockdown). The expected cumulative incidence in these ideal scenarios was zero.

In our model of SARS-CoV-2 on a cruise ship, we found that only extreme restrictions in social contact or idealistic clinical response strategies could fully avert a major COVID outbreak. Contact network changes associated with adequate outbreak prevention were the restriction of passengers to their cabins, with limited passenger-crew contacts. Clinical response strategies required for outbreak prevention included early mass screening with an ideal PCR test (100% sensitivity) and immediate case isolation upon diagnosis. Without these behavioral and clinical interventions, it was projected that hundreds of COVID-19 cases (with tens of associated deaths) would occur on a ship the size of the Diamond Princess. Ultimately, the public health costs of COVID-19 on a cruise ship environment are likely greater than the leisure benefits. Public health restrictions on activities like these should be considered until longer-term effective solutions such as a SARS-CoV-2 vaccine become widely available.

The driving reason for the extreme interventions necessary for outbreak prevention is the overwhelming force of infection on a high-density setting like a cruise ship. Outbreaks in congregate living and other high-density contact environments have been observed, including in prisons, nursing homes, and university dormitories ( 26 , 27 ). Outbreak control has been challenging in these settings because of the need to maintain ongoing social distancing in environments where that is often infeasible. Mathematical models have also identified the substantial clinical resources needed for further disease control there ( 28 ). The primary effective response in these settings therefore is to implement something like our network lockdown scenario, by restricting contacts to the minimum, and reducing the overall intensity of contacts within these settings (e.g., releasing prisoners or reducing campus population density). Outbreaks on cruise ships will likely continue without substantial contact restriction that may be at odds with the intended purposes of these vessels.

A methodological strength of our model is its dynamic network framework. This allowed for microsimulation of persons over time as their contact networks and disease dynamics co-evolve. This framework avoids the mass action assumptions of ordinary differential equation models violated by these small-scale but high-density ship environments ( 29 ). The stochastic nature of network models also allowed for projection of the range of outcomes within scenarios, especially useful for estimating the probability of outbreaks. Several network-based models for COVID-19 have been developed ( 7 , 20 , 30 , 31 ), including models for social contact restriction in community-based settings and ship environments. One strength of our specific network modeling approach with TERGMs is the representation of dynamic networks in which both the node set and edge set are responsive to epidemic dynamics in statistically principled ways ( 32 ). These network models are also parametrized with representations of contact patterns on the ship rather than idealized (e.g., small-world) networks.

Limitations.

The primary limitation of our study was the assumption about network contact patterns on the ship prior to the network lockdown. While the contact patterns on the Diamond Princess were reasonably well-characterized after the contact restrictions, behavior on the ship prior to that point was been less estimated. Additionally, what is considered an effective contact for respiratory diseases requires behavioral and biological assumptions to decompose the elements of R 0 . While our models require more assumptions than differential equation models, our model outputs were also consistent with the broad population outcomes from those models. For example, we were able to represent the underlying transmission potential projections of the earlier Diamond Princess models and analyses ( 13 , 14 ). Further network data on the unique contact patterns within high-density settings like ships would be greatly informative to future network modeling research.

Conclusions.

Resuming cruise ship activities before a long-term COVID prevention solution becomes available may be inadvisable without fundamentally changing the nature of activities on these vessels. Our findings have implications for other high-density social contact settings in which the multi-layer network contact patterns may drive the high force of infection at multiple hierarchies of contact. In settings where severe contact restriction (e.g., network lockdown) is infeasible, substantial clinical resources (mass screening with rapid but high-sensitivity diagnostic results delivery and case isolation) would be needed for complete outbreak prevention.

Supplementary Material

Supplement 1, supplement 2020.

This work was supported by National Institutes of Health grants R01 AI138783, R01 GM12428003S1, and R01 HD097175.

This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.