amadeus river cruises covid 19

Do You Need to Be Vaccinated to Cruise? It Depends on the Ship and Destination

While most cruise lines have scrapped covid vaccine and testing requirements, some companies and international cruise ports still have vaccination and testing rules in place..

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If you’re planning on sailing with Viking anytime soon, you’d better track down that COVID-19 vaccine certificate.

Courtesy of Viking

When cruising restarted in spring 2021, after a nearly 15-month pandemic-spurred shutdown imposed by the U.S. Centers for Disease Control and Prevention (CDC), cruisers faced a barrage of rules, including strict requirements for COVID-19 vaccinations and precruise COVID-19 testing. Later, the rules started to go by the wayside, and it was hard to keep track of who was requiring what. Not anymore.

Most cruise lines have now dropped or are soon dropping rules for both vaccinations and precruise testing, with at least one notable exception. Viking —on its river, ocean, and expedition ships—still requires everyone on board be fully vaccinated .

Another line that was still requiring COVID vaccinations, small-ship line Windstar Cruises, will be scrapping its vaccine mandate as of June 1, 2023. “We’ve invested in and improved our health and safety processes, including upgrading the HVAC systems on all of our ships, which has led to a cleaner and safer environment on board,” says Windstar president Christopher Prelog. “When combined with the widespread availability of vaccines and medical treatments, the risk factors are considerably lower now, giving us the confidence to lift the requirement.”

Are COVID vaccinations and testing still required for cruises?

Most cruise lines have dropped both their vaccine and testing requirements. Those that have lingered into 2023—mostly lines operating smaller ships—have been quietly scaling back their requirements.

The result: While there was a time after cruising restarted that you could be assured that your fellow passengers, at least those age 12 and up, were both fully vaccinated and tested for COVID-19 before getting on the ship, that is not the case anymore.

That said, specific countries have their own requirements, and several countries still require that cruise ship passengers are vaccinated and/or tested before arrival. If you are doing an itinerary outside of the Caribbean or Europe (where most vaccine and testing requirements have been dropped)—including to select countries in Central and South America or to Australia—you still have to read your cruise line’s precruise health and safety information carefully to make sure you comply with the latest requirements.

Contact your cruise line or check the U.S. State Department’s travel advisories for the latest.

What to know before you cruise

Vaccine and pretrip testing requirements can be confusing, especially if you are cruising internationally. Cruise lines have their own rules; countries have their own rules.

Before your trip, you will need to review your cruise line’s health and safety protocols. If a precruise test is required by a certain country, you will find that noted. In this case, you may be required to arrive at your ship with a negative COVID-19 test result in hand or not. (If testing is required, it can typically be either a PCR test or tele-health-monitored antigen test , paid for by the passenger. The cruise line may also require a test at the pier, paid for by the cruise line.)

If being fully vaccinated is required, that means having received the original series of vaccines at least 14 days prior to your cruise, or the original series plus a booster shot or shots.

As was the case even before the pandemic, you will be asked at embarkation to fill out a questionnaire inquiring about your current health status and whether you currently have any symptoms of illness.

You are free to pack and wear masks on your cruise. Most cruise lines suggest you do wear masks in crowded indoor situations—but it’s not enforced.

A quick cruise line guide to COVID requirements

Here’s a rundown of the basic rules for some leading cruise lines. Note: There may be additional requirements if you are traveling internationally. Be sure to review the latest requirements prior to boarding.

American Queen Voyages

On American Queen Voyages’ river, ocean, Great Lakes, and expedition ships, there are no longer any precruise testing or vaccinations required. Face coverings are optional, though masks may be required of any passengers showing symptoms.

Precruise testing is no longer required for vaccinated guests sailing with Azamara , except in ports where testing is required. No vaccination is necessary for cruises departing from or returning to the United States or Europe. In Australia, all guests 12 years and older must be fully vaccinated at least 14 days before sailing with all required COVID-19 vaccine doses (including a booster shot). Children under 12 years old are not required to be vaccinated.

Celebrity Cruises

No vaccination or testing is required on the majority of Celebrity Cruises sailings. Destinations with stricter requirements include: the Galápagos, Australia and New Zealand, transatlantic crossings, and select Central and South America itineraries. Unvaccinated guests need to be tested in Brazil, Chile, and Colombia.

As of April 23, 2023, on the Queen Mary 2 and Queen Victoria , and as of June 8, 2023, on the Queen Elizabeth , vaccinations and testing will no longer be required by Cunard (until then, testing and vaccination requirements apply).

Disney Cruise Line

For sailings embarking from the United States, which are the bulk of Disney Cruise Line’s sailings, no vaccination or testing is required. Disney recommends all guests be vaccinated before sailing and take a test for COVID-19 two days prior to their cruise. There are additional requirements on repositioning cruises and in Australia, so it is important to check the line’s website before your cruise.

Holland America Line

There are no precruise testing or vaccination requirements on most Holland America Line itineraries. There are requirements on select voyages (you can look up a specific voyage’s requirements on the line’s website).

Lindblad Expeditions

For voyages embarking on or after May 11, 2023, Lindblad Expeditions will no longer require guests to be fully vaccinated, although the line recommends guests be fully vaccinated (for cruises prior to that time, all passengers age five and up must be vaccinated). Lindblad recommends, but does not require, passengers take a predeparture COVID-19 test within five days of the start of their expedition.

Oceania Cruises

Vaccine requirements are purely dependent on the destinations being visited on each Oceania cruise. Passengers are advised to be up to date on the latest regulations for all destinations on their cruise itinerary.

Paul Gauguin Cruises

Effective April 2023, Paul Gauguin Cruises no longer requires that passengers are vaccinated or tested for COVID prior to embarkation, but it continues to encourage vaccination. “Paul Gauguin Cruises’ officers, staff and crew will remain fully vaccinated,” the line states. Travelers will need to present a health declaration form at embarkation.

Regent Seven Seas Cruises

Vaccines and precruise testing are generally not required to sail with Regent Seven Seas Cruises . There are some requirements in place based on local health regulations in a specific country a ship is visiting. Regent notifies guests approximately 30 days prior to sailing of any country-specific protocols.

Royal Caribbean

No vaccine or precruise testing is required on the majority of Royal Caribbean itineraries, with a few exceptions: Cruises from Australia, transpacific and transatlantic sailings, and cruises from Hawai‘i to Vancouver.

No vaccine or testing required except on certain Seabourn itineraries where a country may have specific requirements.

No vaccination is required for Silversea passengers except as designated by the destination. Precruise testing is not required except when specified by a destination.

Viking Cruises

All passengers and crew are required to be vaccinated on Viking’s river, ocean, and expedition ships—without exception. Viking strongly recommends passengers receive a booster dose before departing. Viking recommends but does not require a predeparture COVID-19 test (except if required by a destination).

Virgin Voyages

Virgin Voyages has no precruise testing or vaccination requirements. Masks may be required at select times.

Windstar Cruises

Beginning June 1, 2023, Windstar will no longer require guests to be vaccinated. Crew will continue to be vaccinated. Masks are optional, with the line highly recommending guests wear masks in indoor public spaces. All guests fill out a health questionnaire on embarkation. A precruise COVID-19 test is not required unless you show symptoms.

This article was originally published in May 2022; it was most recently updated on April 19, 2023, with current information.

CDC warns older adults, travelers in COVID high-risk groups not to take cruises, even if they're vaccinated

The Centers for Disease Control and Prevention has updated its guidance for travelers who are at increased risk for severe illness from COVID-19 to recommend they avoid cruise ships, regardless of vaccination status.  

The new  guidance applies to  older adults, people with certain medical conditions and pregnant and recently pregnant people. Prior to Friday’s announcement, the agency recommended that only people who were not fully vaccinated against COVID-19 avoid cruise ships.  

The change comes as the U.S. faces its fourth wave of COVID-19, driven by the delta variant. As of Friday, the country has reported 987,417 new cases and 6,037 virus-related deaths in the past week, according to data from Johns Hopkins University .  

The CDC's website says the virus that causes COVID-19 can spread easily between people in close quarters on ships, and the chance of getting COVID-19 on cruise ships is “high.” 

COVID-19 outbreaks have been reported on cruise ships in recent months, despite various  testing and vaccination requirements among cruise lines. 

Learn more: Best travel insurance

In July, four vaccinated adults and two unvaccinated children tested positive for COVID-19 on a Royal Caribbean ship that had required passengers 16 and older to be fully vaccinated against COVID-19 and all passengers to receive a negative test before boarding. Last week, 27 people – 26 of whom were crew members –  tested positive for COVID-19 on Carnival Cruise Line's Carnival Vista ship. More than 99% of crew members were vaccinated on the ship and 96.5% of passengers were vaccinated, according to the Belize Tourism Board. 

CDC protocol says at least 95% of passengers and crew must show proof of vaccination to board a cruise ship. 

A number of cruise lines have  strengthened COVID-19 regulations on U.S. sailings as the delta variant continues to spread. Princess Cruises, Holland America Line and Carnival Cruise Line added mask requirements in select spaces and testing requirements for all passengers, regardless of vaccination status, earlier this month. 

The CDC recommends people who go on cruises wear a mask in shared spaces and get tested one to three days before their trip and three to five days after, regardless of vaccination status. Passengers who are not fully vaccinated should also self-quarantine for at least seven days after their cruise ends, according to the CDC's website.

► COVID-19 on cruise: 27 people on board Carnival Cruise Line ship test positive for COVID-19

► Positive tests on cruise: Four vaccinated adults, two unvaccinated children test positive for COVID on Royal Caribbean ship

Contributing: Morgan Hines, USA TODAY. Follow USA TODAY reporter Bailey Schulz on Twitter: @bailey_schulz . 

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.

For more cruise guides, tips and news, sign up for TPG's cruise newsletter .

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.

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More cruise ships are under CDC investigation following COVID-19 outbreaks on board

The Associated Press

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard. Wilfredo Lee/AP hide caption

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard.

MIAMI — The U.S. Centers for Disease Control and Prevention is investigating more cruise ships due to new cases of COVID-19 as the omicron variant drives extremely high infection levels in the industry hub of Florida.

The CDC said 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Florida hit a new record for daily cases on Tuesday with 46,900 new cases in a day. Since Christmas, the state's 7-day average of daily cases has surpassed previous records set during last summer's surge, rising to 29,400 infections.

Coronavirus hospitalizations in the state have also risen from about 1,200 patients two weeks ago to about 3,400 on Wednesday. But that is still less than one-fifth the number of hospitalizations reported in late August due to the delta wave.

Democratic Sen. Richard Blumenthal is calling for the CDC and cruise lines to again halt cruise travel, six months after the industry mounted its comeback.

"Our warnings have proved sadly prescient and continuously compelling. Time for CDC and cruise lines to protect consumers, again pause — docking their ships," the Connecticut senator posted on Twitter.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say it would adopt any changes, adding it still had plans to allow for the expiration of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

Coronavirus Updates

Covid-19 outbreaks hit 3 cruise ships as florida breaks record for new cases.

"CDC acknowledges that it is not possible for cruising to be a zero-risk activity," CDC spokesperson Jasmine Reed said in an emailed statement.

Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

The federal agency recommends that people avoid cruise travel if they are at increased risk of severe illness, regardless of vaccination status.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus's spread.

The Mexican government said Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

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

Weekly / March 27, 2020 / 69(12);347-352

On March 23, 2020, this report was posted online as an MMWR Early Release.

Please note: This report has been corrected .

Leah F. Moriarty, MPH 1 ; Mateusz M. Plucinski, PhD 1 ; Barbara J. Marston, MD 1 ; Ekaterina V. Kurbatova, MD, PhD 1 ; Barbara Knust, DVM 1 ; Erin L. Murray, PhD 2 ; Nicki Pesik, MD 1 ; Dale Rose, PhD 1 ; David Fitter, MD 1 ; Miwako Kobayashi, MD, PhD 1 ; Mitsuru Toda, PhD 1 ; start highlight Paul T. Cantey, MD 1 ; end highlight Tara Scheuer, MPH 3 ; Eric S. Halsey, MD 1 ; Nicole J. Cohen, MD 1 ; Lauren Stockman, MPH 2 ; Debra A. Wadford, PhD 2 ; Alexandra M. Medley, DVM 1 ,4 ; Gary Green, MD 5 ; Joanna J. Regan, MD 1 ; Kara Tardivel, MD 1 ; Stefanie White, MPH 1 ; start highlight Clive Brown, MD 1 ; end highlight Christina Morales, PhD 2 ; Cynthia Yen, MPH 2 ; Beth Wittry, MPH 1 ; Amy Freeland, PhD 1 ; Sara Naramore, MPH 3 ; Ryan T. Novak, PhD 1 ; David Daigle, MPH 1 ; Michelle Weinberg, MD 1 ; Anna Acosta, MD 1 ; Carolyn Herzig, PhD 1 ; Bryan K Kapella, MD 1 ; Kathleen R. Jacobson, MD 2 ; Katherine Lamba, MPH 2 ; Atsuyoshi Ishizumi, MPH, MSc 1 ; John Sarisky, MPH 1 ; Erik Svendsen, PhD 1 ; Tricia Blocher, MS 2 ; Christine Wu, MD 3 ; Julia Charles, JD 1 ; Riley Wagner, MPH 1 ; Andrea Stewart, PhD 1 ; Paul S. Mead, MD 1 ; Elizabeth Kurylo, MCM 1 ; Stefanie Campbell, DVM 1 ; Rachel Murray, MPH 1 ; Paul Weidle, PharmD 1 ; Martin Cetron, MD 1 ; Cindy R. Friedman, MD 1 ; CDC Cruise Ship Response Team; California Department of Public Health COVID-19 Team; Solano County COVID-19 Team ( View author affiliations )

What is already known about this topic?

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.

What is added by this report?

More than 800 cases of laboratory-confirmed COVID-19 cases occurred during outbreaks on three cruise ship voyages, and cases linked to several additional cruises have been reported across the United States. Transmission occurred across multiple voyages from ship to ship by crew members; both crew members and passengers were affected; 10 deaths associated with cruise ships have been reported to date.

What are the implications for public health practice?

Outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond the voyage. Aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

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An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* ( 1 ). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness ( 2 ). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well ( 3 ). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection ( 4 ). During February–March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

During February 7–23, 2020, the largest cluster of COVID-19 cases outside mainland China occurred on the Diamond Princess cruise ship, which was quarantined in the port of Yokohama, Japan, on February 3 ( 3 ). On March 6, cases of COVID-19 were identified in persons on the Grand Princess cruise ship off the coast of California; that ship was subsequently quarantined. By March 17, confirmed cases of COVID-19 had been associated with at least 25 additional cruise ship voyages. On February 21, CDC recommended avoiding travel on cruise ships in Southeast Asia; on March 8, this recommendation was broadened to include deferring all cruise ship travel worldwide for those with underlying health conditions and for persons aged ≥65 years. On March 13, the Cruise Lines International Association announced a 30-day voluntary suspension of cruise operations in the United States ( 5 ). CDC issued a level 3 travel warning on March 17, recommending that all cruise travel be deferred worldwide. †

Diamond Princess

On January 20, 2020, the Diamond Princess cruise ship departed Yokohama, Japan, carrying approximately 3,700 passengers and crew ( Table ). On January 25, a symptomatic passenger departed the ship in Hong Kong, where he was evaluated; testing confirmed SARS-CoV-2 infection. On February 3, the ship returned to Japan, after making six stops in three countries. Japanese authorities were notified of the COVID-19 diagnosis in the passenger who disembarked in Hong Kong, and the ship was quarantined. Information about social distancing and monitoring of symptoms was communicated to passengers. On February 5, passengers were quarantined in their cabins; crew continued to work and, therefore, could not be isolated in their cabins ( 6 ). Initially, travelers with fever or respiratory symptoms and their close contacts were tested for SARS-CoV-2 by reverse transcription–polymerase chain reaction (RT-PCR). All those with positive test results were disembarked and hospitalized. Testing was later expanded to support a phased disembarkation of passengers, prioritizing testing of older persons, those with underlying medical conditions, and those in internal cabins with no access to the outdoors. During February 16–23, nearly 1,000 persons were repatriated by air to their home countries, including 329 persons who returned to the United States and entered quarantine or isolation. § , ¶

The remaining passengers who had negative SARS-CoV-2 RT-PCR test results,** no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarkation. Those passengers who had close contact with a person with a confirmed case completed land-based quarantine, with duration determined by date of last contact. After disembarkation of all passengers, crew members either completed a 14-day ship-based quarantine, were repatriated to and managed in their home country, or completed a 14-day land-based quarantine in Japan.

Overall, 111 (25.9%) of 428 U.S. citizens and legal residents did not join repatriation flights either because they had been hospitalized in Japan or for other reasons. To mitigate SARS-CoV-2 importation into the United States, CDC used temporary “Do Not Board” restrictions ( 7 ) to prevent commercial airline travel to the United States, †† and the U.S. Departments of State and Homeland Security restricted travel to the United States for non-U.S. travelers.

Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 ( Figure 1 ). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died ( 8 ). Infections also occurred among three Japanese responders, including one nurse, one quarantine officer, and one administrative officer ( 9 ). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).

Grand Princess

During February 11–21, 2020, the Grand Princess cruise ship sailed roundtrip from San Francisco, California, making four stops in Mexico (voyage A). Most of the 1,111 crew and 68 passengers from voyage A remained on board for a second voyage that departed San Francisco on February 21 (voyage B), with a planned return on March 7 (Table). On March 4, a clinician in California reported two patients with COVID-19 symptoms who had traveled on voyage A, one of whom had positive test results for SARS-CoV-2. CDC notified the cruise line, which began cancelling group activities on voyage B. More than 20 additional cases of COVID-19 among persons who did not travel on voyage B have been identified from Grand Princess voyage A, the majority in California. One death has been reported. On March 5, a response team was transported by helicopter to the ship to collect specimens from 45 passengers and crew with respiratory symptoms for SARS-CoV-2 testing; 21 (46.7%), including two passengers and 19 crew, had positive test results. Passengers and symptomatic crew members were asked to self-quarantine in their cabins, and room service replaced public dining until disembarkation. Following docking in Oakland, California, on March 8, passengers and crew were transferred to land-based sites for a 14-day quarantine period or isolation. Persons requiring medical attention for other conditions or for symptoms consistent with COVID-19 were evaluated, tested for SARS-CoV-2 infection, and hospitalized if indicated. During land-based quarantine in the United States, all persons were offered SARS-CoV-2 testing. As of March 21, of 469 persons with available test results, 78 (16.6%) had positive test results for SARS-CoV-2. Repatriation flights for foreign nationals were organized by several governments in coordination with U.S. federal and California state government agencies. Following disinfection of the vessel according to guidance from CDC’s Vessel Sanitation Program, remaining foreign nationals will complete quarantine on board. The quarantine will be managed by the cruise company, with technical assistance provided by public health experts.

On February 21, five crew members from voyage A transferred to three other ships with a combined 13,317 passengers on board. No-sail orders §§ were issued by CDC for these ships until medical logs were reviewed and the crew members tested negative for SARS-CoV-2.

Additional Ships

The Diamond Princess and Grand Princess had more than 800 total COVID-19 cases, including 10 deaths. During February 3–March 13, in the United States, approximately 200 cases of COVID-19 were confirmed among returned cruise travelers from multiple ship voyages, including the Diamond Princess and Grand Princess, accounting for approximately 17% of total reported U.S. cases at the time ( 10 ). Cases linked with cruise travel have been reported to CDC in at least 15 states. Since February, multiple international cruises have been implicated in reports of COVID-19 cases, including at least 60 cases in the United States from Nile River cruises in Egypt ( Figure 2 ). Secondary community-acquired cases linked to returned passengers on cruises have also been reported (CDC, unpublished data, 2020).

Public health responses to COVID-19 outbreaks on cruise ships were aimed at limiting transmission among passengers and crew, preventing exportation of COVID-19 to other communities, and assuring the safety of travelers and responders. These responses required the coordination of stakeholders across multiple sectors, including U.S. Government departments and agencies, foreign ministries of health, foreign embassies, state and local public health departments, hospitals, laboratories, and cruise ship companies. At the time of the Diamond Princess outbreak, it became apparent that passengers disembarking from cruise ships could be a source of community transmission. Therefore, aggressive efforts to contain transmission on board and prevent further transmission upon disembarkation and repatriation were instituted. These efforts included travel restrictions applied to persons, movement restrictions applied to ships, infection prevention and control measures, (e.g., use of personal protective equipment for medical and cleaning staff), disinfection of the cabins of persons with suspected COVID-19, provision of communication materials, notification of state health departments, and investigation of contacts of cases identified among U.S. returned travelers.

Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment, contact between travelers from many countries, and crew transfers between ships. On the Diamond Princess, transmission largely occurred among passengers before quarantine was implemented, whereas crew infections peaked after quarantine ( 6 ). On the Grand Princess, crew members were likely infected on voyage A and then transmitted SARS-CoV-2 to passengers on voyage B. The results of testing of passengers and crew on board the Diamond Princess demonstrated a high proportion (46.5%) of asymptomatic infections at the time of testing. Available statistical models of the Diamond Princess outbreak suggest that 17.9% of infected persons never developed symptoms ( 9 ). A high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew. SARS-CoV-2 RNA was identified on a variety of surfaces in cabins of both symptomatic and asymptomatic infected passengers up to 17 days after cabins were vacated on the Diamond Princess but before disinfection procedures had been conducted (Takuya Yamagishi, National Institute of Infectious Diseases, personal communication, 2020). Although these data cannot be used to determine whether transmission occurred from contaminated surfaces, further study of fomite transmission of SARS-CoV-2 aboard cruise ships is warranted.

During the initial stages of the COVID-19 pandemic, the Diamond Princess was the setting of the largest outbreak outside mainland China. Many other cruise ships have since been implicated in SARS-CoV-2 transmission. Factors that facilitate spread on cruise ships might include mingling of travelers from multiple geographic regions and the closed nature of a cruise ship environment. This is particularly concerning for older passengers, who are at increased risk for serious complications of COVID-19 ( 4 ). The Grand Princess was an example of perpetuation of transmission from crew members across multiple consecutive voyages and the potential introduction of the virus to passengers and crew on other ships. Public health responses to cruise ship outbreaks require extensive resources. Temporary suspension of cruise ship travel during the current phase of the COVID-19 pandemic has been partially implemented by cruise lines through voluntary suspensions of operations, and by CDC through its unprecedented use of travel notices and warnings for conveyances to limit disease transmission ( 5 ).

Acknowledgments

Staff members responding to COVID-19 outbreaks on cruise ships; Japan’s Ministry of Health, Labour and Welfare; California Department of Public Health; cruise ship passengers; Princess Cruises; Christina Armantas, Matthew Bacinskas, Cynthia Bernas, Brandon Brown, Teal Bullick, Lyndsey Chaille, Martin Cilnis, Gail Cooksey, Ydelita Gonzales, Christopher Kilonzo, Chun Kim, Ruth Lopez, Dominick Morales, Chris Preas, Kyle Rizzo, Hilary Rosen, Sarah Rutschmann, Maria Vu, California Department of Public Health, Richmond and Sacramento; Ben Gammon, Ted Selby, Solano County Public Health; Medic Ambulance Service; NorthBay HealthCare; Sutter Solano Medical Center; Kaiser Permanente Vallejo Medical Center; Kaiser Permanente Vacaville Medical Center start highlight ; field teams at repatriation sites; National Institute of Infectious Diseases, Japan end highlight .

CDC Cruise Ship Response Team

Casey Barton Behravesh, CDC; Adam Bjork, CDC; William Bower, CDC; Catherine Bozio, CDC; Zachary Braden, CDC; Mary Catherine Bertulfo, CDC; Kevin Chatham-Stephens, CDC; Victoria Chu, CDC; Barbara Cooper, CDC; Kathleen Dooling, CDC; Christine Dubray, CDC; Emily Curren, CDC; Margaret A. Honein, CDC; Kathryn Ivey, CDC; Jefferson Jones, CDC; Melissa Kadzik, CDC; Nancy Knight, CDC; Mariel Marlow, CDC; Audrey McColloch, CDC; Robert McDonald, CDC; Andrew Klevos, CDC; Sarah Poser, CDC; Robin A. Rinker, CDC; Troy Ritter, CDC; Luis Rodriguez, CDC; Matthew Ryan, CDC; Zachary Schneider, CDC; Caitlin Shockey, CDC; Jill Shugart, CDC; Margaret Silver, CDC; Paul W. Smith, CDC; Farrell Tobolowsky, CDC; Aimee Treffiletti, CDC; Megan Wallace, CDC; Jonathan Yoder, CDC.

California Department of Public Health COVID-19 Team

Pennan Barry, California Department of Public Health; Ricardo Berumen, III, California Department of Public Health; Brooke Bregman, California Department of Public Health; Kevin Campos, California Department of Public Health; Shua Chai, California Department of Public Health; Rosie Glenn-Finer, California Department of Public Health; Hugo Guevara, California Department of Public Health; Jill Hacker, California Department of Public Health; Kristina Hsieh, California Department of Public Health; Mary Kate Morris, California Department of Public Health; Ryan Murphy, California Department of Public Health; Jennifer F. Myers, California Department of Public Health; Tasha Padilla, California Department of Public Health; Chao-Yang Pan, California Department of Public Health; Adam Readhead, California Department of Public Health; Estela Saguar, California Department of Public Health; Maria Salas, California Department of Public Health; Robert E. Snyder, California Department of Public Health; Duc Vugia, California Department of Public Health; James Watt, California Department of Public Health; Cindy Wong, California Department of Public Health.

Solano County COVID-19 Team

Meileen Acosta, Solano County Department of Public Health; Shai Davis, Solano County Department of Public Health; Beatrix Kapuszinsky, Solano County Department of Public Health; Bela Matyas, Solano County Department of Public Health; Glen Miller, Solano County Department of Public Health; Asundep Ntui, Solano County Department of Public Health; Jayleen Richards, Solano County Department of Public Health.

Corresponding author: Leah F. Moriarty, [email protected] , 770-488-7100.

1 CDC COVID-19 Response Team; 2 California Department of Public Health; 3 Solano Public Health, Fairfield, California; 4 Epidemic Intelligence Service, CDC; 5 Sutter Medical Group of the Redwoods, Santa Rosa, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* Not including river cruises.

† Warning level 3: avoid non-essential travel due to widespread ongoing transmission: https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china .

§ Quarantine was used for persons who were exposed; isolation was used for persons who had positive test results for SARS-CoV-2.

¶ Movement for one person with resolved COVID-19 was not restricted.

** Based on Japanese testing procedures, which at the time included taking one oropharyngeal swab.

†† Travel restrictions were lifted when persons had either completed a 14-day monitoring period without symptoms or had met clinical criteria for release from isolation. https://japan2.usembassy.gov/pdfs/alert-20200227-diamond-princess.pdf pdf icon external icon .

§§ CDC has the authority to institute a no-sail order to prevent ships from sailing when it is reasonably believed that continuing normal operations might subject newly arriving passengers to disease.

• Cruise Lines International Association. 2019 cruise trends & industry outlook. Washington, DC: Cruise Line International Association; 2019. https://cruising.org/news-and-research/-/media/CLIA/Research/CLIA-2019-State-of-the-Industry.pdf pdf icon external icon
• Millman AJ, Kornylo Duong K, Lafond K, Green NM, Lippold SA, Jhung MA. Influenza outbreaks among passengers and crew on two cruise ships: a recent account of preparedness and response to an ever-present challenge. J Travel Med 2015;22:306–11. CrossRef external icon PubMed external icon
• World Health Organization. Coronavirus disease (COVID-2019) situation reports. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ external icon
• CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020. Epub March 18, 2020. CrossRef external icon
• Cruise Lines International Association. CLIA announces voluntary suspension in U.S. cruise operations. Washington, DC: Cruise Line International Association; 2020. https://cruising.org:443/news-and-research/press-room/2020/march/clia-covid-19-toolkit external icon
• Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial investigation of transmission of COVID-19 among crew members during quarantine of a cruise ship—Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:312–3. CrossRef external icon PubMed external icon
• Vonnahme LA, Jungerman MR, Gulati RK, Illig P, Alvarado-Ramy F. Federal travel restrictions for persons with higher-risk exposures to communicable diseases of public health concern. Emerg Infect Dis 2017;23:S108–13. CrossRef external icon PubMed external icon
• Ministry of Health, Labour and Welfare. About new coronavirus infections [Japanese]. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2020. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000164708_00001.html external icon
• Mizumoto, K., Kagaya, K., Zarebski, A. and Chowell, G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Eurosurveillance 2020;25. CrossRef external icon
• CDC. Coronavirus disease 2019 (COVID-19): cases in U.S. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Abbreviation: N/A = not applicable.

FIGURE 1 . Cumulative number of confirmed coronavirus disease 2019 (COVID-19) cases* by date of detection — Diamond Princess cruise ship, Yokohama, Japan, February 3–March 16, 2020

Source: World Health Organization (WHO) coronavirus disease (COVID-2019) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/ external icon .

* Decline in cumulative number of cases on February 13 and February 25 due to correction by WHO for cases that had been counted twice.

FIGURE 2 . Cruise ships with coronavirus disease 2019 (COVID-19) cases requiring public health responses — worldwide, January–March 2020

Suggested citation for this article: Moriarty LF, Plucinski MM, Marston BJ, et al. Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3 external icon .

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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 .

Related Topics

• CORONAVIRUS
• PUBLIC HEALTH
• CRUISE SHIPS

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