cruise ship covid rates

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.

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Cruise Ship COVID Status Tracker (July 16): Daily Update Chart & News

Note: As of July 18, the CDC is no longer operating its voluntary Covid-19 program for cruise ships . This includes no longer updating the daily color status of ships. As such, we are no longer able to update this page.   If you have questions regarding cases on a ship you are sailing, the CDC website says passengers “have the option of contacting their cruise line directly regarding outbreaks occurring on board their ship.”

As cruising returns, it does so under dramatically different protocols than when trips were suspended back in March 2020. These new procedures are all designed to limit the number of cases on ships. 

For cruise passengers, that can create a number of questions. Is it safe to cruise? What are cruise ships doing to keep passengers healthy? Is there a way to track COVID cases on cruise ships?

Currently the Centers for Disease Control offers a voluntary program to follow for ships sailing in the United States (every major cruise ship is opted in). This includes everything from policies for testing crew members, to what to do if there are cases on a ship, to recommendations surrounding masking and distancing.

In addition, the health agency publishes regular updates about the status of cases on cruise ships using a color-coded system. While it doesn’t provide actual case numbers, it does tell the public which ships have possibly had bouts of the virus. This gives insight into what’s happening on all the ships either sailing or planning to sail from the United States.

In This Article...

Current Color Status of Ships

Below is the current status of all ships tracked by the CDC. While the CDC only provides the latest day’s update on its website , we’ve included past days so that you can see how the status of each vessel changes. We continue to update this table regularly to track each ship’s status over time. The CDC releases new data each weekday.

Data from July 15 (posted July 16) shows 95 of 95 ships the CDC tracks have “non-green” status, indicating the possibility of COVID cases during the past seven days. Keep in mind that the status changes from green with as little as one case. 

Note: A status other than green does not definitively mean cases were found on the ship, though it is most likely. “HV” stands for highly vaccinated cruise ship. More discussion of colors and vaccination status is covered in “What the Color-Coded Status Means” below.

(Click to Enlarge)

Recent Updates and Commentary

Today, 95 ships (100% of ships currently tracked) have “non-green” status. This figure has risen steadily in recent months. Currently, cruising is seeing the lowest number of “green” ships since we began tracking — including during the Omicron spike.

Zero ships are green as of the latest update. Zero ships are yellow. Ninety-five have orange status: 

Ships with status changes to or from “green” since last update:

Ships removed from list:

Ships added to list:

– During the course of the CDC’s tracking, the status of ships typically follows cases on land. The number of green ships bottomed and then rebounded sharply following the Omicron wave. However, there has been a downturn in the number of green ships in recent months. From a recent peak of 58 green ships in mid-March, the figure has fallen to zero vessels.

– The current count of zero green ships is lower than the previous low of nine ships during the peak of the Omicron wave . That doesn’t mean there are necessarily more total cases on cruise ships (case counts aren’t released), however, more ships are being impacted. 

Still, at the moment 100% of cruise ships are orange , meaning that all cruise ships tracked have possible Covid cases. We have not seen a green-status ship since late June.

– With the fall in the number of green ships, Cruzely offered some commentary on what passengers should know surrounding cruises and Covid. For example, case numbers could be higher than earlier in the pandemic, however, specific case numbers are not released. Meanwhile, cases do appear relatively mild according to comments from cruise lines and health departments.

– Even with all ships having orange status, we recently explained that protocols in travel — including on cruises — have trended toward being less restrictive. And while there is no definitive sign of it happening soon, we did discuss if a relaxing of the testing requirement to sail might be on the horizon .

What the Color-Coded Status Means

The table above tracks roughly 90 cruise ships across more than a dozen cruise lines. Each day cruise ships can voluntarily submit the “Enhanced Data Collection (EDC) During COVID-19 Pandemic Form” to the CDC. This gives the agency insight into COVID or COVID-like illness on the vessel.

The agency then assigns one of four colors — green, yellow, orange, and red — to each ship, depending on the daily reports. The table is updated several times a week, providing a simple color-coded way to see where there might be issues.

Updates to the Color Status Previously, the CDC’s color status varied from green, to orange, yellow, then red. Starting in mid-February, the new order is green, yellow, orange, then red. The agency said the orange and yellow colors were switched “to go in a more logical color order.”

As well, status now depends on the number of possible cases based on both passengers and crew. Previously, cases among either passengers or crew could lead to a different color status, depending on who was sick.

Now if there are cases but they are under 0.3% of combined passengers and crew on the ship, then yellow status is given. Cases above 0.3% of those onboard (3 cases out of 1,000 people onboard) earns orange status. Red is still available for higher spread.

Colors are assigned based on the number of possible cases and the ship’s current sailing status (sailing with passengers or crew only).

Green: No reports of COVID or COVID-like illness for seven days and on-time daily submission of EDC forms for the past week.

Yellow: COVID of COVID-like illness reported in the last seven days. If sailing with passengers, the level reported is less than 0.3% of passengers and crew. If sailing with crew only, then cases are less than 1% of all crew.

Orange: Cases for more than 0.3% of passengers and crew if sailing with passengers. If sailing crew only, then cases reported in more than 1% of crew. Failing to submit a daily EDC report on-time also gives orange status.

Red: Sustained transmission of illness or the potential for cases to overwhelm medical resources on the ship. Failing to submit a daily EDC report also gives red status.

Gray: Indicates no data for the ship due to it choosing not to comply with the CDC’s voluntary program.

White (N/A): Ships that either have recently left sailing from the U.S. or have just arrived to sail from the U.S. We have marked the days before or after CDC tracking as “N/A” since there is no data. We remove the ship from the table 10 days after it is no longer tracked. This status is not an official color designation by the CDC, but we use it to show which ships have recently arrived or left.

Vaccination Status for Ships In addition to changing the color status, the CDC also introduced different vaccination levels for ships to give the public more insight: 

Not Highly Vaccinated (NHV): These are ships sailing with less than 90% of passengers and 95% of crew fully vaccinated.

Highly Vaccinated (HV): Ships with at least 90% of passengers and 95% of crew fully vaccinated, but less than than those amounts considered “up to date” with their vaccines. “Up to date” means having a booster dose of the vaccine if eligible.

Vaccination Standard of Excellence (VSE): This new category encompasses ships that have at least 90% of passengers and 95% of crew “up to date” with their COVID vaccines, meaning eligible passengers have a booster shot.

What Cruise Ships Are Doing to Keep Passengers & Crew Healthy

While cruise ships are linked to the early days of the pandemic, they have taken extraordinary steps to limit the number of cases on board. In fact, while cases have been reported regularly on ships, the total numbers and spread appear to be small. Omicron did increase cases, however.

To keep passengers healthy, cruise lines are using vaccines and testing as the cornerstones of their plans. Ships sailing require vaccination for nearly all passengers who are eligible.

In addition to vaccines, cruise lines require tests for all passengers before boarding in the United States, even if they have the shot. 

While some lines are allowing a small number of unvaccinated passengers sail, more restrictions are usually placed on these guests. For instance, multiple tests are required before and during sailing. Travel insurance is required in many instances. Some areas of the ship may be off-limits if a passenger doesn’t have the shot.

Already we’ve seen the protocols change to adapt to variants. There will be more changes in store, depending on the direction of virus cases on land.

Is it Safe to Take a Cruise?

There is little doubt that unabated, illness can spread in the close confines of a cruise ship. That said, the measures taken by cruise lines and the CDC have helped to limit cases.

Royal Caribbean Group, for example, said toward the start of 2022 they had seen about 1.3 million passengers sail and reported 2,500 cases among them (crew cases were not disclosed). That comes out to about 0.2%.

Still, during the Omicron spike cases did rise on ships. Between December 15 and December 29, there were more than 5,000 cases on ships tracked by the CDC, according to The Washington Post , citing CDC data. (The CDC typically doesn’t release case numbers.) We’ve also seen the number of ships with possible cases rise since March.

The protocols in place still seem to keep cases lower than what may be seen on land, but all cruise ships right now appear to have cases onboard. Cases do seem to be more mild than with past variants. Still, there has been a rise in the number of orange ships that is worth noting for people who are risk-averse .

There’s little argument that if there are cases on land — of which there are plenty — then there can be cases on ships. The good news is that with the mitigation efforts put in place by cruise lines, these cases are also more likely to be found and contained, especially compared to other places like sports stadiums, airports, or land-based resorts. 

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I was on the NCL Bliss this past week (July 16-23). Were there any reported cases of Covid? I have had two boosters. I have cold symptoms (cough and sore throat)and wondering if I should get tested.

As of July 16, the CDC no longer updates the color status page, so there’s no easy way to know at a glance. You can contact the cruise line directly to ask, however, it’s not clear if they disclose that information.

Any one sailed on Independence of the Seas recently and come back with Covid?

Celebrity Crusie line from Seattle to Alaska July 8 to July 15 2022 with Abraham. wondering if anyone knows the infection rate status? thank you

Remember, with cruising comes travel to the ports. My wife and I traveled from Detroit to Seattle, leaving one very crowded airport and touching down in another very crowded airport for a layover. We also spent several days in Seattle prior to boarding the cruise ship – and did several tours in Seattle and spent the day in a very crowded Pike Street Market. Who is to say when someone is infected????

I felt safer on the Holland America cruise than I did at any of the airports, the hotel, the tours and restaurants between point A and B.

Recently took a Carnival cruise July 11-15 out of Port Canaveral and my son and I both tested positive for COVID-19 the day we returned. Have been sick ever since. We’re both fully vaccinated and I had the booster in December 2021. I definitely recommend getting a booster shot if you’re eligible 2-3 weeks before going on the cruise. I’m eligible for a second booster but didn’t get it. Wish I had.

Got on the Carnival Dream in May 2022.It started out great the first four days, then I started hearing people coughing here and there,then started seeing red bio-hazard bags in hallway.I figured at that moment that Covid was pretty rampant on the ship, but there was never a notification from staff, cruise director or anyone regarding or reiterating what was going on or increasing any safety measures. We tried to stay safe, took distant routes,and took stairs but there was pretty much no way around it with so many on board. After the cruise,we exited the ship.I noticed that on my Facebook group,I stopped seeing beach pictures and started seeing sick notification posts.People were posting that they were not feeling well and tested positive when they got home.It was well over 100 positive from the group that I know, I can only imagine what the total count would be as the ships total count. I was with a family member on this trip,in the same room on our eight day cruise.Afterwards, we drove four hours to get home.She was tired and had chills and a headache on the way home.She tested positive at home.We immediately quarantined at home.I didn’t have symptoms but I was sure I had to have it especially with all the day to day interactions.I have other family members in my home and I did not want to take a chance of spreading it to them. Surprisingly, I did not end up testing positive.All I can think of is that I received the booster fourteen days before boarding and I am sure that is what helped me. I had been debating on getting it, but glad that I did.My family member recovered but was very ill for a few days and still has a lingering light cough. In my opinion,the cruise lines should also have people boarding show that they have had a CURRENT booster at least 14-20 days before the cruise instead of just needing to show a negative test at boarding and proof of PAST vaccinations. I also found out that the cruise that went before us on The Carnival Dream as well as Carnival Vista had many cases as well and they continue to have many cases today. All I can say is , I Wish I knew then what I know now.Oh well.

My wife and I got Covid during our Alaska cruise on the Crown Princess last week, June 4-11. We all had the boosters and took every precaution. Didn’t matter. For several days we had 12 foot seas and 50 knot winds. They auto locked the balcony doors at that point and we were unable to get any outside fresh air. Air system the culprit?

We got off the NCL Sky on June 3 while in Covid quarantine. The whole thing was handled horribly by NCL. We left with at minimum a dozen other people in our quarantine group from our part of the hall. On the Facebook group for our roll call dozens are now positive since Friday. We were tricked into signing paperwork that they filled in meds after signing and prices. We froze our card on board after receiving $800 charges each for Paxlovid. We would have never signed for that. We actually signed that paper before even leaving our room to head to quarantine or receiving any Paxlovid. In fact we signed a paper saying everything medical on board was complimentary. They tried to not let us leave. Then they dropped us at a hotel they said they had an agreement with. They said they knew we were coming with Covid and had a room ready. We verified this with NCL before agreeing to be dropped there. None of it was true. Hotel had no idea and told us they continue to drop people there having told them this. We were dropped in a lobby full of unsuspecting guests with no place to be quarantined to keep them protected. The whole thing was horrible.

My boyfriend and I just debarked Carnival Horizon yesterday. We both started having mild symptoms Saturday and today we both test positive for covid. I’m vaccinated and boosted, he’s vaccinated. Our cruise director came down with covid two days into the cruise. This is our first time ever having covid. We both have been so careful and we let our guard down, and now are paying the price. I wish I didn’t go on the ship!

Hope you get to feeling better. No fun.

Carnival is scheduling more four and five day cruises because Omicron COVID symptoms take longer than four days to develop. I just came back from a four day cruise on the Carnival Miracle. After two days at home from the cruise the COVID hit me like a truck. Carnival does not report COVID rates from four day cruises and should be more honest about infection rates on ships. The Miracle was built in 2003 and I suspect many of the cabins share the same HVAC system thus spreading the virus from one cabin to several others. Carnival is operating under a ” don’t look up” attitude and on the basis that the Omicron variant is not that serious. A lot of jobs and profits are at stake , but that is no excuse to willfully spread a virus and not trying to pinpoint sources/data of the spread on ships such as which cabins are more dangerous. I would suspect inside cabins. Good news is that my doctor says I should be over the virus in 4-5 miserable days.

I don’t know if that’s the case. Right now the vast majority of ships — no matter what sort of cruises they sail — are orange. As well, even with shorter cruises the crew is still on the ship for longer times and crew case counts also impact the standing of ships.

It seems the U.S. is in another wave. Cruise passengers should know that there is a risk of Covid. The number of ‘green’ ships has fallen sharply since March.

Hope you get to feeling better soon!

Why is the Wonder of the Seas not listed? We were on the trans-Atlantic voyage beginning Apr20 from FLL and there were at least 30 cases of covid – I was one of them.

Since Wonder of the Seas left the U.S., it is no longer tracked by the CDC. When it returns later this year, it should be on the list.

It appears that the Koningsdam has Yellow for the last 2 weeks of November. We are debating whether to take our cruise of December 12th or postpone … Any thoughts appreciated

James, it’s impossible to say. It really depends on your personal situation and risk tolerance. I will say that yellow could mean as little as one case on the ship, if it’s with a member of the crew. Unfortunately, specific numbers aren’t shared, so we just don’t know.

The nice thing about cruises is that you do know everyone is vaccinated and tested before getting on the ship. Bottom line: cases no doubt can be found on ships, but there are also more rigorous protocols than just about anywhere else. It depends on if you’re comfortable or not with the situation.

Considering a cruise on a ship recently coded as yellow (Koningsdam). That could mean they haven’t submitted their daily report, or have a certain number of crew, or percentage of passengers sick. That could mean only one crew or two passengers or many more. How can I get a report of the exact number of suspected infections?

So that ship has now been turned back green — indicating no possible cases in the past seven days. Unfortunately, specific numbers of cases are not released to the public.

This color coding is so confusing. Orange is a blend of yellow and red. You’d think it meant something worse than yellow.

Why is the Sky Princess ship not listed? We’re interested in knowing the colors of that particular ship. Can you please assist us in getting this information? Thank you!

Looks like she doesn’t sail from the U.S. until November, so the ship isn’t under the CDC’s orders. Expect more insight in a few weeks.

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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.

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Royal Caribbean reports dozens of cases on a cruise that left Florida on Saturday.

The ship, the Odyssey of the Seas, represents the cruise line’s second mass infection this month.

By Johnny Diaz

• Dec. 23, 2021

Dozens of people aboard a Royal Caribbean International cruise ship tested positive for the coronavirus after it set sail from Fort Lauderdale, Fla., on Saturday, according to the cruise line.

Fifty-five fully vaccinated passengers and crew members on the ship, the Odyssey of the Seas, tested positive, the cruise line said in a statement on Thursday, noting that the number represented 1.1 percent of those on board.

The ship, which was on an eight-night cruise, will not sail to Curaçao and Aruba as planned and will remain at sea until it returns to Fort Lauderdale on Sunday, Royal Caribbean said.

“The decision was made together with the islands out of an abundance of caution due to the current trend of Covid-19 cases in the destinations’ communities as well as crew and guests testing positive on board,” the company said. All of the people on the ship who tested positive “are fully vaccinated and mildly symptomatic or asymptomatic,” the cruise line added.

The Odyssey of the Seas , one of Royal Caribbean’s newest ships, made its maiden voyage in July. It can carry more than 5,500 guests and more than 1,600 crew members.

The health episode was reported shortly after a similar one on another Royal Caribbean ship, the Symphony of the Seas. The cruise line said this week that 48 people on that ship tested positive for Covid-19 after it set sail from Miami on Dec. 11. The ship returned to port in Miami on Dec. 18 after a seven-night Caribbean cruise.

Those cases were identified because of contact tracing after a guest tested positive, the cruise line said, adding that 95 percent of the passengers aboard the Symphony of the Seas were fully vaccinated against Covid-19 and 98 percent of the people who tested positive were fully vaccinated.

Royal Caribbean requires travelers 12 and older to be fully vaccinated against Covid-19 and to test negative before boarding. Younger children who are not vaccinated must provide a negative P.C.R. test result before sailing and test negative at the terminal before boarding.

The company said that all of its crew members were fully vaccinated against Covid-19 and were tested weekly.

At the beginning of the pandemic in 2020, outbreaks on cruise ships sickened people and upended the tourism industry.

Since the cruise industry restarted operations in the United States this June, efforts to keep the coronavirus at bay have been largely successful. Most companies require full vaccination for crew members and most passengers, and they put strict health and safety protocols in place.

But as the highly contagious Omicron variant drives up coronavirus cases in much of the United States and Europe , and criticism of cruise lines has mounted over a lack of transparency in reporting positive cases to passengers and crew members, many lines have adjusted their rules for masking, testing and vaccines.

Johnny Diaz is a general assignment reporter covering breaking news. He previously worked for the South Florida Sun Sentinel and The Boston Globe. More about Johnny Diaz

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Every U.S. cruise with passengers has coronavirus cases on board

The cdc has opened investigations into 92 ships.

Coronavirus cases have been reported on every cruise ship sailing with passengers in U.S. waters.

According to the Centers for Disease Control and Prevention, all 92 ships with passengers have met the threshold for investigation by the public health agency. In every case, the CDC has either started an investigation or has investigated and continues to observe the ship.

The number of ships under investigation had grown sharply in recent days, but it wasn’t until Tuesday’s update, using data submitted by cruise lines Monday, that every ship reached that level.

Last week, the CDC warned all travelers, including those who are vaccinated, to avoid cruise ships. The advice came after the agency said the number of cases skyrocketed from 162 in the first two weeks of December to 5,013 between Dec. 15 and 29.

CDC warns against cruise travel after 5,000 new cases in 2 weeks

“The virus that causes COVID-19 spreads easily between people in close quarters on board ships, and the chance of getting COVID-19 on cruise ships is very high, even if you are fully vaccinated and have received a COVID-19 vaccine booster dose,” the agency cautioned .

Cruise lines are requiring all crew and most, if not all, passengers to be fully vaccinated to sail. Passengers also need proof of a recent negative test before boarding.

In addition to the 92 ships with passengers on board, 18 vessels are in U.S. waters with crew only, according to the CDC. Of those, two have met the threshold for investigation, and three have reported cases but not enough to warrant an investigation. Thirteen crew-only ships have reported no cases, according to the data.

“As part of investigating cruise ships that meet the investigation threshold, CDC will obtain additional information from the cruise ship, such as case exposure histories, details about close contacts, traveler vaccination rates, and medical capacities,” CDC spokeswoman Caitlin Shockey said in an email.

She said the agency would work closely with cruise lines and “consider multiple factors” before moving ships from their current status — yellow — to the more serious red status, in which a ship would return to port right away or delay a sailing. To reach that mark, a ship must have sustained transmission of covid-19 or covid-like illness and the potential for “cases to overwhelm on board medical center resources,” the CDC says .

Cruise passengers on holiday trips deal with outbreaks: ‘We’re sailing on a petri dish’

Since late December, several cruises have been turned away from ports because of passengers or crew on board testing positive. Most have continued on their journeys, even when they were forced to skip the stops they had planned.

On Wednesday, however, Norwegian Cruise Line confirmed it was canceling a nine-day Caribbean voyage on Norwegian Getaway that was scheduled to leave Miami that day. The reason, according to the cruise line: “COVID related circumstances.”

The operator gave the same reason on Tuesday for bringing a ship, Norwegian Pearl, back to Miami after it left for an 11-night Panama Canal trip Monday. According to the Miami Herald , passengers were informed that the trip was ending after an unspecified number of crew tested positive; the company would not provide that number to The Washington Post. The vessel is scheduled to return to Miami on Thursday.

“We will never compromise on health and safety and we will of course, continue to take all appropriate action to ensure everyone’s well-being and to protect public health,” the company said in a statement .

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Living at sea: Travelers on a 9-month world cruise are going viral on social media. For some travelers, not even nine months was enough time on a ship; they sold cars, moved out of their homes and prepared to set sail for three years . That plan fell apart, but a 3.5-year version is waiting in the wings.

Passengers beware: It’s not all buffets and dance contests. Crime data reported by cruise lines show that the number of sex crimes has increased compared to previous years. And though man-overboard cases are rare, they are usually deadly .

The more you know: If you’re cruise-curious, here are six tips from a newcomer. Remember that in most cases, extra fees and add-ons will increase the seemingly cheap price of a sailing. And if you happen to get sick , know what to expect on board.

Cruise lines dropped COVID-19 rules. How did that affect cases? We got numbers from the CDC.

• Many cruise lines dropped COVID-19 vaccine requirements and further eased testing rules in early September.
• CDC data show the number of new positive cases following the rule changes.
• The numbers did not show a consistent pattern among major lines.

David Hancock spent his September vacation doing things he'd never done. He went on a cruise for the first time, hugged a sloth at an animal park in Honduras, and at some point during the trip, likely contracted COVID-19.

The 36-year-old firefighter had avoided infection for two years, but tested positive the morning after he and his wife, Melissa, who had been celebrating their 15th wedding anniversary, returned home to Savannah, Tennessee.

But not even COVID-19 could put a damper on their Royal Caribbean International sailing. "I went all that time since COVID began without getting it ... so I went and got it on a cruise ship," he told USA TODAY.

"But because I was vaccinated and boosted, my symptoms were mild," he said, adding that he would definitely go on a cruise again.

Cruise lines change COVID-19 rules: Royal Caribbean, Disney Cruise Line further lift requirements

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'Was it worth the risk? I don't think so': What it's like to cruise with fewer COVID rules

Many recent cruise line policy changes reflect a shifting approach to the pandemic. Major cruise lines, including Royal Caribbean, Carnival Cruise Line, and Norwegian Cruise Line International dropped their vaccine requirements for many sailing in early September and eased testing rules, about two weeks before Hancock left for his seven-night voyage.

However, after the Centers for Disease Control and Prevention ended its COVID-19 Program for Cruise Ships in July and stopped updating its related webpage , COVID-19 spread amid the more relaxed approaches has been a relative mystery.

But data from the CDC obtained by USA TODAY through a Freedom of Information Act request shed some light on the numbers cruise lines reported to the agency after the rules were changed.

What COVID-19 case numbers did cruise lines report to the CDC?

The numbers also only represent new COVID-19 cases identified by positive viral tests on cruise ships entering or leaving from the U.S. The data does not show the test positivity rate or the number of passengers on the sailings.

►Norwegian began welcoming all passengers regardless of vaccination status on Sept. 3 and dropped all pre-cruise testing requirements for vaccinated passengers 12 and older. In the weeks that followed, the cruise line reported similar numbers to the weeks leading up to the rule change. The week beginning Sept. 4, the cruise line reported 138 new cases, and reported another 161 the following week. For the week of Sept. 18, two weeks after dropping requirements , Norwegian reported 204 new cases, and just 25 the following week.

The cruise line had previously reported 234, 164 and 184 cases in the three weeks leading up to the change, respectively.

►Carnival made similar changes on Sept. 6, scrapping its requirement for unvaccinated passengers to apply for a vaccine exemption  and further easing its pre-cruise testing rule for vaccinated passengers on many sailings.

The cruise line reported 193 new cases for both the weeks of Sept. 11 and the following week and another 144 during the week beginning Sept. 25.

Carnival had previously reported 214, 265, and another 214 new cases in the three weeks leading up to the change, respectively, including the week of Sept. 4.

►Royal Caribbean also began welcoming all travelers regardless of vaccination status and further eased pre-cruise testing for vaccinated passengers for many sailings on Sept. 5.

The line reported 341 new cases the week of Sept. 11, and 306 the week after. The line then reported another 237 new cases for the week of Sept. 25. In the weeks preceding the change, Royal Caribbean had reported 448, 311, and 348 new cases, respectively, including the week of Sept. 4.

Dr. Peter F. Rebeiro, an assistant professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center, said,   generally speaking, if unvaccinated passengers who test negative – as they were required to at the time – are mixed in with a mostly-vaccinated group, the "overall risk is not going to spike a huge amount,"   he said. However, he noted that vaccinated passengers can still spread the virus. 

Rebeiro also noted that if transmission among the general population is lower at the time a passenger boards a cruise, the likelihood they will spread the virus is lower.

Anne Madison, a spokesperson for the Cruise Lines International Association, the industry's leading trade group, emphasized the safety of cruise travel.

"CLIA-member cruise lines have a strong track record for effectively managing COVID-19 by making science-driven and medically informed decisions – and continue to have health protocols in place that exceed those of nearly any other venue or travel sector outside of healthcare settings," she said in an emailed statement.

Madison added that as a condition of their membership, cruise lines must keep up certain protocols, including "maintaining elevated public health measures to mitigate the introduction or spread of COVID-19 on board ships" and sailing with high vaccination levels among passengers and crew members, among others.

Story continues below.

What does that mean for passengers?

The data did not show a consistent pattern in new cases for other major cruise lines, including Celebrity Cruises, Princess Cruises, or Holland America Line, either. Celebrity made similar changes on Sept. 5, while Princess and Holland America did so on Sept. 6.

During roughly the same period, the weekly COVID-19 case rate per 100,000 people steadily declined in the U.S., from 209 the week of Aug. 17 to 96.5 the week of Oct. 5, according to CDC data .

The "CDC has determined that the cruise industry has access to the necessary tools to prevent and mitigate COVID-19 on board," CDC spokesperson Tom Skinner said in an emailed statement. "While CDC provides guidance for cruise ships operating in U.S. waters under CDC’s jurisdiction, individual cruise lines will determine their own specific COVID-19-related requirements for cruise travel. Any decrease in the volume or frequency of routine screening testing of crew by cruise lines may result in lower counts of asymptomatic cases."

Victoria Alvarez knew Carnival had eased its protocols by the time she got on her Caribbean cruise in late September. Living in Florida, she said, she was used to more relaxed rules .

But the risk of getting COVID-19 did cross her mind during the trip. The 27-year-old business administration manager said the ship was crowded, particularly in the dining and entertainment venues.

Alvarez, who is vaccinated and boosted, said she and her friends took some extra precautions of their own, such as eating outside when they could and avoiding the pools, which were packed. "We just saved our swimming for the islands," she said.

"I don't know if I just haven't been in crowds like that in a while, but it was just, like, it's a lot," she added of the experience.

What precautions can people take?

Anna Bershteyn, an assistant professor in the Department of Population Health at New York University Grossman School of Medicine, said that there may be other factors the data does not reflect, "but it doesn't seem that this policy (change) had any consistent effect across cruise lines."

While there are still many COVID-19-related deaths across the country each day, she said, many people have been assessing their own risk tolerance. "It comes to this decision, what are the precautions that people should take versus going back and living life?" Bershteyn said.

Cruises will return to Japan: Country reopens to international cruise ships for first time since the pandemic

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While not all passengers have felt completely safe on cruises since many lines relaxed their rules, Hancock said he and his wife are planning on taking another cruise with Royal Caribbean, even as it has further rolled back requirements .

"I feel as though COVID's not going to be going anywhere," Hancock said "It's kind of with us for the long haul. It's just a matter of preparations people take and what risks they're willing to take."

Bershteyn recommended travelers take steps to protect themselves, first by staying up to date on all the vaccine doses they are eligible for. She also recommended they make a plan with their doctor in case they do get sick, and contact the cruise line to see what options they would have.

If travelers have taken those steps, she said, she would advise travelers who want to take a cruise to go ahead. "We can't put our life on hold indefinitely, but we do want those safety nets in place in case something happens," she said.

Bershteyn also recommended travelers look for opportunities to take extra precautions when doing so "is not going to take away" from the experience, which she noted may be different for each traveler. In her case, she wears a face mask when she is in crowded places such as airports, while others may opt to eat outdoors when possible.

Have you gone on a cruise recently? What was your experience like?

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Are Cruise Ships Safe Again?

Vivek Prakash / Getty Images

Key Takeaways

• The risk of a COVID-19 outbreak is higher when a lot of people share a common space, like a cruise ship.
• Most cruise lines have dropped vaccination and testing requirements.
• Consider your risk level based on your health status before booking a cruise, and take precautions while on board to avoid getting sick.

A cruise ship carrying 800 Covid-positive passengers recently docked in Sydney after being hit with a major COVID-19 outbreak—a scenario eerily reminiscent of the early pandemic days. It was a stark reminder that the pandemic is not over, and that cruising still presents a certain level of COVID-19 risk.

So is it safe to go on a cruise now? What are some things you can consider before deciding whether to board one this holiday season?

According to Brian Labus, PhD, MPH , an assistant professor in epidemiology at the University of Nevada, Las Vegas, said it’s important to consider whether you feel comfortable with the risks associated with cruising based on your health status.

“When a lot of people share any common space, like a cruise ship, the risk of an outbreak goes up,” Labus told Verywell. “When an outbreak does occur on a cruise ship, the high-density environment means a lot of people can get sick in a very short period of time.”

For example, Labus said, you may not want to go on a cruise that will place you in the middle of the ocean and away from any hospital for several days if you’re at high risk of severe illness.

However, we may have a skewed perception of the actual risk of cruise ship outbreaks. Thousands of cruises travel and disembark each week without incident, but we don’t hear about them, Labus said. We only hear about the occasional outbreaks on the news, so we might think they happen all the time.

How to Avoid Getting Sick on Cruise Ships

Like other businesses, cruise lines have mostly dropped their vaccination and/or testing requirements. But cruise lines still have safety protocols in place to prevent and control COVID-19 outbreaks on board, Labus said.

Since the specifics can vary depending on the cruise, you can look up a cruise line’s COVID-19 protocols on its website. Carnival Cruise Line, for example, may require guests who test positive for COVID-19 and their close contacts to quarantine in their rooms until a medical team determines it’s safe to resume their activities.

Leading up to your cruise vacation, it’s a good idea to limit your exposure to people outside of your household, wear a mask in crowded settings, practice good hand hygiene, and take a rapid test before you go. Making sure to get an updated COVID-19 booster and a flu shot at least two weeks before your trip is also extremely important, Labus said.

Though you might not be able to socially distance as much as you’d like while on a cruise, Labus said you can still practice the same COVID-19 precautions on board.

“Protecting yourself from disease on a cruise is no different than protecting yourself anywhere else,” he said.

If you get word of an outbreak on board, don’t panic, Labus said. Listen closely to the crew’s instructions, as every ship and every situation is different. Trust that the ship has protocols that are developed by medical professionals, he added, and these measures will allow them to respond appropriately and provide the best protection to everyone on board.

“If you do get sick, make sure to report your illness to the crew,” Labus said. “Trying to hide your illness just puts everyone around you at risk.”

What This Means For You

If you’re considering booking a cruise this holiday season, assess your risk level based on your health status. If you do decide to set sail on a ship, take precautions before and during your trip to avoid getting sick. In the occasion of an outbreak on board, listen closely to instructions. If you feel sick, be sure to report your illness to the crew.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our  coronavirus news page .

By Mira Miller Miller is a journalist specializing in mental health, women's health, and culture. Her work is published in outlets ranging from Vice to Healthnews.

This Cruise Ship Has the Highest COVID-19 Infection Rate in the World

T he number of patients infected with the COVID-19 coronavirus aboard a quarantined cruise ship docked in Yokohama, Japan has continued to rise—making the ship the largest cluster of the deadly virus outside China.

An additional 44 cases of the illness were identified on the Diamond Princess on Thursday, bringing the total number of infections to 218. That accounts for more than one third of all cases detected outside mainland China.

Japanese health officials will allow elderly passengers to leave the cruise ship and complete their quarantines at a shoreside facility if they test negative for COVID-19, the country’s health ministry said Thursday.

With nearly 6% of the 3,711 passengers and crew members now infected, the 952-foot cruise ship also has the highest infection rate of the coronavirus anywhere in the world. Wuhan, China, the city where the disease is believed to have originated has nearly 33,000 official cases—but spread across a population of more than 11 million, that’s an infection rate of less than 0.3%.

Sign up for our daily coronavirus newsletter by clicking on this link , and please send any tips, leads, and stories to [email protected] .

Health experts say the Diamond Princess highlights the high risk that an infection will spread in confined spaces. According to the U.S. Centers for Disease Control and Preventions, close-contact environments such as cruises can facilitate the transmission of viruses through droplets or contaminated surfaces.

And due to the long duration that passengers are on their vessel, traveling on a cruise ship could present higher infection risks than other forms of transportation, like planes and trains, according to Hui-ling Yen, an expert on influenza transmission at the University of Hong Kong.

“On an airplane, if there were exposure to the virus, you probably only have one generation of transmission because of the duration of the flight. On a cruise, the transmission could be sequential. One person may infect another, who may infect another,” she says. “You could have an ongoing transmission trend.”

The past few days have seen an exponential increase, but the worst could be over, Yen says.

“This few days should have been the peak. Most of the literature about the virus ​reported that the mean incubation period is around 5 days. So if the quarantine works, we should start to see a decline soon,” Yen adds.

According to Japan Times , 29 of the latest batch of 44 people infected with the coronavirus are Japanese, with the remaining 15 from other countries. One case is a crew member. A large majority of the newly confirmed patients are elderly.

The passengers and crew on the Diamond Princess are halfway through a 14-day quarantine on the virus-stricken cruise ship. The quarantine began Feb. 5 after the company learned that a passenger from Hong Kong who had previously been onboard had tested positive for coronavirus. The quarantine has been set to end Feb. 19.

Japan’s health minister Katsunobu Kato said Thursday that passengers age 80 or older will be permitted to disembark the cruise ship if they test negative for the virus and complete their quarantine at a temporary facility.

“On the cruise ship, there are elderly with pre-existing conditions and those who are staying inside rooms without windows having to take part in the quarantine period,” Kato said, according to Japan Times . “In those situations, as they have no choice but to stay for a long time period, there are individuals whose chronic illnesses get worse and compromise their health.”

Individuals who test negative and want to leave the ship can begin disembarking as early as Friday, Kato said.

Princess Cruises confirmed the Japanese government’s decision in a statement.

“From the information available it is our understanding that this will be a phased approach, with the most medically vulnerable guests in the first phase, including older adults with pre-existing health conditions,” the company said.

Those who test positive for the virus will be taken to a local hospital for further examination and isolation, according to the cruise line.

Until they are evacuated or the quarantine period ends, passengers have been largely confined to their rooms; their chief interactions are with crew members who deliver food three times a day, a number of passengers on the cruise told TIME. Since the weekend, they have been allowed out on the open decks in shifts for about an hour at a time, provided they wear face masks and stand no closer than 2 meters (6.5 feet) to each other.

Kent Frasure, a 42-year-old passenger from Portland, Oregon, is alone in his cabin after his wife tested positive for the virus and was brought to a hospital.

“[She has] no symptoms and is not receiving any treatment or medication,” he says. “They are checking her temperature and vitals every day.”

Read more: ‘Like I’m in a Bad Movie.’ Concerns Mount on Quarantined Ship as More Passengers Test Positive for Coronavirus

As the number of cases on the cruise continues to rise sharply, passengers said they want everyone on board to be tested. Up till now, only those who have reported symptoms and who live in the same cabins as passengers who have been diagnosed with the virus have been tested. (It is unclear how many passengers have taken tests, though the Japanese health ministry said Wednesday that 492 samples—includes specimens collected from the same people multiple times—have been collected.)

But a shortage in COVID-19 test kits has prevented health authorities from widespread testing, with authorities acknowledging a “limited capacity to process virus test samples.”

Given the lack of testing kits, officials say they are prioritizing elderly passengers and those living in windowless rooms. They will be tested first and allowed to disembark if they are found to be negative. The Japanese health authorities will house them at designated lodgings when they are on land.

Globally, more than 60,000 people have been infected with the virus, and more than 1,300 have died as a result. The vast majority of cases are in mainland China .

The Diamond Princess is among the cruise ships that have been caught in the middle of the coronavirus outbreak. The Westerdam , which was denied entry to five ports including in Thailand, Taiwan and the U.S. territory of Guam, finally docked in Cambodia Thursday morning.

Last week, passengers on the World Dream cruise ship in Hong Kong were held for four days after the company learned that three passengers who had sailed on the vessel earlier were confirmed to have the virus. Passengers were finally allowed to disembark on Monday after all crew tested negative for the virus.

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CDC Stops Reporting COVID-19 Cases on Cruise Ships—Here's How You Can Still Stay Safe

As BA.5 cases continue to rise, cruises pose a significant risk of infection.

• The Centers for Disease Control and Prevention (CDC) has ended its program to report COVID-19 cases on cruise ships.
• Experts say this may make cruises less safe for people who want to avoid high levels of COVID-19 transmission
• Travelers are encouraged to check in with their preferred cruise line about COVID-19 infections and safety precautions.

The Centers for Disease Control and Prevention (CDC) will no longer report coronavirus cases for U.S. cruise ships, ending a program put in place during the pandemic to help the public monitor the spread of the virus.

The initiative, called the COVID-19 Program for Cruise Ships, ended on July 18, according to a notice from the CDC. Cruise lines will have to continue reporting case counts to the agency; however, the CDC will no longer share each ship's COVID status or a color-coded chart detailing the level of spread on their webpage.

"Cruise ships have access to guidance and tools to manage their own COVID-19 mitigation programs," the CDC said on its website . "While cruising poses some risk of COVID-19 transmission, CDC will continue to publish guidance to help cruise ships continue to provide a safer and healthier environment for crew, passengers, and communities going forward."

The agency also stated they ended the program because it depended upon each cruise line to have the same COVID-19 screening testing standards, which may now vary among cruise lines.

How Will This Affect COVID-19 Safety on Cruise Ships?

The CDC's decision to end the COVID-19 program will allow cruise lines to set their own COVID-19 policies, Sherrill Brown, MD , medical director of infection prevention at AltaMed Health Services, told Health .

Dr. Brown said depending on the cruise line, COVID safety precautions could be more or less strict, which could result in some cruise lines being safer to travel on compared to others.

For people looking to book a cruise, they won't have access to publicly available coronavirus data for cruise travel and "will no longer be able to tell if one cruise line or another has a better track record of reducing COVID cases on board," Dr. Brown added.

Terez Malka, MD , emergency medicine physician and pediatrician at K Health , told Health this change could also make it easier for people to go on a cruise because some companies will drop requirements like testing before embarking and while on board.

In addition, she said customers may not end up needing to quarantine while on a cruise in the event of testing positive, though some cruise lines may require quarantine if you are having symptoms and test positive.

"However, this also means that cruise travel will be less safe for those that are trying to avoid areas with high volumes of COVID infections, and means that travelers and staff will not know the COVID rates on board," Dr. Malka said.

Nevertheless, the CDC said customers will have the option "to contact their cruise line directly" to get information about outbreaks and other COVID-19 protocols on board their trip.

"Travelers will have to do their homework and trust that the cruise line they choose to travel with is following the recommended precautions and being honest regarding any outbreaks on board," Dr. Brown said.

What Are Cruise Lines Doing in Light of the CDC's Decision?

In a statement to Health , Carnival Cruise Line said it will work closely with public health officials to operate with a set of robust protocols to maintain public health and public confidence. Carnival said it welcomes the CDC's decision to end its current program, and it will "review the newest guidelines when they are posted in the coming days."

For now, Carnival Cruise said there are no immediate changes to the current COVID-19 protocols they have in place and guests should continue to use its " Have Fun. Be Safe " website when planning their upcoming trip.

Meanwhile, the Cruise Lines International Association (CLIA), will also continue to have health and safety protocols and policies in place, and will continue to prioritize the health and safety of passengers, crew, and communities, Anne Madison, a spokesperson for CLIA, told Health .

Is It Safe to Take a Cruise During The BA.5 Wave?

According to the CDC, as of July 16, the BA.5 Omicron subvariant makes up nearly 79% of all COVID-19 cases in the U.S.

Dr. Brown said because BA.5 is much more contagious than previous variants, a crowded cruise environment where individuals are not wearing masks will increase the chance of COVID-19 spreading both indoors and outdoors, especially on a crowded deck or pool.

She added while there have been fewer reported COVID-19 outbreaks on cruise lines in the news, outbreaks are still happening . Since cruise ships travel from one port to another with large volumes of people, getting on a cruise fosters an environment where "it would be very easy for outbreaks to occur."

Dr. Malka echoed this message and said since COVID cases and severity have risen significantly with the BA.5 wave, "there would be a significant risk of COVID infection when embarking on a cruise (or any vacation that involves crowds, is not requiring masks and distancing, and is not tracking cases)."

Travelers intending to go on cruises need to consider the safety of traveling in a closed environment where testing is not occurring and others could be spreading the virus unknowingly, Dr. Malka said. In addition, individuals that are at high risk of severe COVID complications or hoping to avoid COVID infection should opt not to embark on cruises that do not have COVID safety protocols and testing in place.

"The fact that there is less oversight could lead to a situation where cruise travel may be more risky if the cruise lines are not following very strict standards for COVID-19 safety," Dr. Brown said. "One must weigh the risks of travel and potentially being exposed and infected with the benefit of visiting beautiful places and experiencing cruise life."

How to Stay Safe on a Cruise

People who plan to go on a cruise should take safety precautions to keep themselves and others around them safe. One thing to do before going on a cruise is to research COVID-19 and other safety precautions being taken onboard by a specific cruise line.

For example, Dr. Malka said even though the CDC is no longer requiring COVID-19 testing, some cruise lines may still require a test prior to travel and while on board.

If you are unable to find a cruise line that is enforcing COVID precautions—or if you just want to be as COVID-safe as possible while on a cruise—Dr. Malka and Dr. Brown said there are other measures people can take to stay safe. Those include:

• Wearing masks indoors and outdoors in all public places or crowded environments.
• Engaging in activities that take place outdoors, have limited crowds, or are socially distanced.
• Drinking and dining outdoors when possible.
• Choosing to get vaccinated for COVID-19 and staying up to date with boosters at least two weeks in advance of the cruise.
• Washing your hands frequently with soap and water or using hand sanitizer regularly.

Dr. Malka added travelers can also avoid excessive alcohol, eat healthily and get proper sleep to help support their immune system which can decrease their risk of getting sick.

"I would also recommend that cruise travelers follow these same precautions when stopping at different ports throughout the cruise," Dr. Brown said.

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• v.27(1); 2022 Jan 6

A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020

Kathryn s willebrand.

1 Yale Institute of Global Health, New Haven, Connecticut, United States

2 Yale School of Public Health, New Haven, Connecticut, United States

Lauren Pischel

3 Yale School of Medicine, Section of Infectious Diseases, New Haven, Connecticut, United States

Amyn A Malik

Samuel m jenness.

4 Emory University Rollins School of Public Health, Atlanta, Georgia, United States

Saad B Omer

5 Yale School of Nursing, Orange, Connecticut, United States

Associated Data

Cruise ships provide an ideal setting for transmission of SARS-CoV-2, given the socially dense exposure environment.

To provide a comprehensive review of COVID-19 outbreaks on cruise ships.

PubMed was searched for COVID-19 cases associated with cruise ships between January and October 2020. A list of cruise ships with COVID-19 was cross-referenced with the United States Centers for Disease Control and Prevention’s list of cruise ships associated with a COVID-19 case within 14 days of disembarkation. News articles were also searched for epidemiological information. Narratives of COVID-19 outbreaks on ships with over 100 cases are presented.

Seventy-nine ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (interquartile range (IQR): 1–17.8), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median attack rate for COVID-19 was 0.2% (IQR: 0.03–1.5), although this distribution was right-skewed with a mean attack rate of 3.7%; 25.9% (27/104) of voyages had at least one COVID-19-associated death. Outbreaks involving only crew occurred later than outbreaks involving guests and crew.

Conclusions

In the absence of mitigation measures, COVID-19 can spread easily on cruise ships in a susceptible population because of the confined space and high-density contact networks. This environment can create superspreader events and facilitate international spread.

Introduction

Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is facilitated by prolonged contact and close proximity to an infectious individual in poorly ventilated settings [ 1 ]. Leisure ocean cruises provide an ideal setting for efficient transmission of SARS-CoV-2, given the socially dense exposure environment. While outbreaks have also occurred on military and other vessels [ 2 ], leisure cruise ships have been the most conducive for outbreaks of a variety of infectious respiratory and diarrheal diseases such as influenza and norovirus [ 3 - 5 ]. Because they represent a EUR 125 billion industry and provide many jobs globally [ 6 ], cruise ships are clearly vulnerable to pandemics.

The most publicised outbreak of coronavirus disease (COVID-19) on a cruise ship as at the time of writing (May 2021) was the Diamond Princess outbreak in Yokohama, Japan in early February 2020. This case garnered great attention early on in the pandemic. Of the 3,711 passengers on board, 712 tested positive for SARS-CoV-2; 311 of those who tested positive were asymptomatic for COVID-19 at the time of testing and nine died [ 7 ]. After multiple outbreaks were identified on other cruise ships, a No Sail Order was implemented by the United States (US) Centers for Disease Control and Prevention (CDC) on 14 March 2020 [ 8 ]. Even after the No Sail Order took effect, intermittent cases were reported among crew who remained on the ships. Cruises restarted in force over the summer of 2021 with different infection prevention strategies, frequent testing strategies and vaccination requirements [ 9 , 10 ].

Previous systematic reviews of the transmission of SARS-CoV-2 and response to COVID-19 outbreaks on cruise ships have been limited to searches of the scholarly literature and, therefore, reported only on a limited number of outbreaks covered in the scientific literature [ 11 ]. Understanding the dynamics of outbreaks on cruise ships and evaluating the non-pharmaceutical interventions that have been successfully or unsuccessfully employed on these ships can inform future prevention research and policies, as well as benefit planning for future outbreaks with similar transmission patterns.

In this review, we evaluated PubMed and news sources to collate information on COVID-19 outbreaks on cruise ships before 1 October 2020, along with measures taken and clinical outcomes. The objectives of the study were to (i) determine the number of commercial ocean line cruise ships associated with COVID-19 cases before 1 October 2020 and (ii) characterise these outbreaks based on number of cases, number of passengers (both crew members and guests), number of people at risk, timing of the outbreak, number of COVID-19 diagnostic tests performed and clinical outcomes.

Information sources

We searched for data on COVID-19 outbreaks associated with ocean cruise ships via PubMed for case reports, brief reports and reviews [ 12 ]. To include cruise ship outbreaks not described in the biomedical literature, news sources were searched as well. The database compiled by the Miami Herald [ 13 ] of news reports and the list of cruise ships reporting COVID-19 outbreaks provided by the US CDC [ 14 ] were used as foundational material. All sources were checked and expanded upon via Google News searches of the cruise ship name and keywords (see below). The articles were then read and assessed for information about number of cases, outcomes of cases, number of crew members and guests at risk, as well as location of the outbreak, and these data were stored in an Excel spreadsheet. A review of articles retrieved from PubMed and newspaper articles was performed by two authors (KW and LP). We contacted the articles’ authors and the cruise lines for clarification, as needed [ 15 ].

Search strategy

Search terms PubMed were (‘COVID’ OR ‘COVID-19’ OR ‘coronavirus’ OR ‘SARS-CoV-2’ OR ‘SARS’) AND (‘ship’ OR ‘ships’ OR ‘cruise’ OR ‘cruises’ OR ‘liner’) from 1 November 2019 to 1 October 2020. The Miami Herald database [ 13 ] of news reports and the US CDC list of cruise ships reporting COVID-19 outbreaks were searched, and checked against Google News searches of the cruise ship name and keywords. The search was completed on 5 October 2020. Irrelevant articles that did not address cruise ships and COVID-19 were excluded by title and abstract review. Articles were included if they were published between 1 November 2019 and 1 October 2020 and described cases or clusters of COVID-19 on ocean line cruise ships among either guests or crew, or COVID-19 cases that were subsequently linked to these ships. The status of cases – both those who met the clinical criteria for COVID-19 but did not receive a test and those who had a positive SARS-CoV-2 test (test type was not often specified) were recorded as probable or confirmed COVID-19 cases as stated by authors of each respective article. Articles were excluded if they did not provide any specific information on the timing of the outbreak, number of passengers on board, number of cases or number of tests. River cruises, cargo ships and freight ships were excluded. Articles were excluded if they were commentaries without primary data. If non-English sources were referenced in other included sources, these were translated and included in the review, though non-English literature was not specifically searched.

Definitions

A ‘cruise ship’ was defined as a given vessel or boat, while a ‘voyage’ was defined as a trip that the ship could take i.e. one ship could have multiple voyages. ‘Passenger’ was used to refer to both guests and crew members; when source information was not clear, individuals were counted as passengers. A COVID-19 outbreak was defined as at least one case of COVID-19 associated with a cruise ship voyage within 14 days of case disembarkment or at least one case of COVID-19 associated with guests or crew still on board, according to the definition of the US CDC at the start of the pandemic [ 16 ]. The resulting list of cruise ships was cross-referenced with the US CDC’s list of international cruise ships with COVID-19 outbreaks [ 14 ] and cases were verified through CruiseMapper, ( https://www.cruisemapper.com/accidents ) and WikiWand ( https://www.wikiwand.com/en/COVID-19_pandemic_on_cruise_ships ) . Itineraries and locations were verified on several common, publicly available cruise websites, including CruiseMapper ( https://www.cruisemapper.com ), Crew Center ( https://crew-center.com ) and Iglu Cruise ( https://www.iglucruise.com ) . The number of guests and crew members were also verified on Crew Center or alternative sources if the cruise was not on this website. Location of the outbreak – when unclear – was noted as the next port of call. Because international ships report their occupancy to the US Securities and Exchange Commission (SEC; https://www.sec.gov ), this information was used to estimate the number of passengers for the first two quarters of 2020. If 2020 reports were not available, the 2019 reports were used.

A descriptive analysis was performed characterising the COVID-19 cases. Cruise ships were stratified into cruise voyages with less than 20 cases, 20 to 100 cases and greater than 100 cases. A sensitivity analysis was performed including voyages with two or more cases identified. A narrative review was also performed for the cruise ships with more than 100 cases. Data analysis was done in RStudio (version 1.3.1056; R version 4.0.2, Vienna, Austria). When the number of guests or crew on board was not explicitly stated, the number of passengers was estimated from SEC reports.

Literature review

A total of 79 ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. These ships were cross-referenced against the US CDC’s list of international cruise ships associated with COVID-19 outbreaks; no additional ships were found. From the PubMed search, 568 papers were identified. After removal of duplicates, as some papers had different identification numbers on preprint servers and journal websites, 296 papers were identified; however, only 43 were directly related to cruise ships based on their titles and abstracts, and were included for further analysis ( Figure 1 ). After a review of each full paper from PubMed, 39 papers were included. Of those, 30 papers involved the Diamond Princess and six papers addressed cruise ships docked in Australian waters (though the number, names and voyages were not provided in the reports). One article about the public health response to the Diamond Princess also reported on the Grand Princess. The Ruby Princess, the Greg Mortimer and the Costa Atlantica each had one article. For the remainder of the 74 ships, all information came from a total of 177 news articles). The occupancy data from the SEC can be found in the supplement ( Table S1 ).

PRISMA flowchart for search strategy and literature review of COVID-19 cases on cruise ships worldwide, November 2019–October 2020

COVID-19: coronavirus disease; US CDC: United States Centers for Disease Control and Prevention.

Records of biomedical literature, including case reports, brief reports and reviews, were identified through database searches in PubMed. Additional sources used included the database compiled by the Miami Herald [ 13 ] of news reports and the list of cruise ships reporting COVID-19 outbreaks provided by the US CDC were used as foundational material. All sources were checked and expanded upon via Google News searches of the cruise ship name and keywords.

Descriptive analysis of cruise ships

The number of ships associated with COVID-19 cases was distributed across a variety of cruise lines. Twenty-four of 51 different cruise line companies had at least one case of COVID-19. Overall, 22.3% (79/354) of ocean line cruise ships had at least one case of COVID-19 from January to October 2020 [ 14 ].

Nineteen ships had more than one voyage with a case of COVID-19. Of these, 14 had an increase in the number of cases in later voyages. Four of the 19 cruise ships had one case reported for each voyage. One ship of the 19 had a decrease in COVID-19 cases over time (the Costa Favolosa had a decrease in cases from 58 of 4,789 passengers to 2 of 1,009, the later outbreak was when only crew was on board and with one fifth the number of passengers; Supplementary Table S2 ).

There was sparsity of data for many of the 104 voyages; 21 voyages only reported one case and no associated date, of these, 11 voyages from 10 ships only reported one case and no other information was available about these cruise ships, such as if guests or crew were infected. These voyages were on the list of cruise ships from the US CDC.

Only 18 of the 104 voyages provided information about the number of COVID-19 tests that were performed and 10 of these voyages had only crew on board. These voyages that provided SARS-CoV-2 PCR testing were later in the year than those that did not provide testing, with a mean date of outbreak identification on 2 April 2020 (standard deviation (SD): 27.8 days) compared with 9 April March 2020 (SD: 42.9 days) for those that did not provide testing. Of these 18 voyages, a median of 234 tests were performed (IQR: 30–939), which covered 45.5% of all cruise ship passengers (11,141/24,492). For six cruise voyages, 100% of the passengers were tested, with a median number of 127 COVID-19 cases (IQR: 67–144) identified and a median attack rate of 37.0% (IQR: 21.1–56.8).

The median total number of passengers at the time of outbreak was 2,040 passengers (IQR: 969–4,269). However, this is a rough estimate, as a confirmed value was only available for 44 of the 104 voyages and the remainder were estimated based on cruise ship capacity. The median number of days from when passengers disembarked to identification of the outbreak was 7 days (IQR: 2–12). However, there was a large proportion of missing data for this calculation, with only 56 of 104 voyages included.

Examining all voyages, the number of cases and deaths were low. The median number of cases per ship was three (IQR: 1–18), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median overall attack rate was 0.2% (IQR: 0.0–1.5), though this distribution was skewed to the right with a mean attack rate of 3.8%; 25.9% of voyages had at least one COVID-19-associated death. The median number of COVID-19-associated deaths across those ships with cases was zero (IQR: 0–1), though again there was a right-skew of the data. Three voyages had a 100% CFR; however, each of these voyages only reported one case ( Supplementary Table S3 ).

The sensitivity analysis showed 65 voyages were associated with two or more COVID-19 cases; of these, the median number of cases per ship was higher compared with all voyages (n = 12; IQR: 4–48), with a median attack rate of 0.9% (IQR: 0.39–3.5). The median number of deaths in this sensitivity analysis was still zero (IQR: 0–1).

Analysis by outbreak size

To gain a greater understanding of outbreak characteristics based on outbreak size, the cruise ship voyages were divided into three groups based on number of COVID-19 cases: less than 20 cases (n = 78), 20 to 100 cases (n = 17) and greater than 100 cases (n = 9). All voyages associated with a particular ship are presented ( Table 1 and Supplementary Table S2 and S3 ); each voyage was analysed with its respective number of cases, e.g. Voyage A of Ship X, with 120 cases, is included as ‘greater than 100 cases’ and Voyage B of Ship X, with 50 cases, is included as ‘20 to 100 cases’. Nine voyages had greater than 100 cases; these outbreaks occurred earlier in the pandemic, with the median outbreak identified on 24 March 2020 (SD: 27.7 days) ( Table 1 ). Five of these large outbreaks happened with passengers on board, i.e. Ruby Princess, Diamond Princess, Ovation of the Seas, Grand Princess, Greg Mortimer. The remaining four had only crew on board, i.e. Disney Wonder, Costa Atlantica, Celebrity Apex, Horizon, and occurred several weeks later (median date: 7 April 2020; IQR: 23 March–26 April 2020). The median attack rate for these voyages was 21% (IQR: 19.2 –23.9) and CFR was 0.8% (IQR: 0–2.0). Two ships had an attack rate of over 50%: the Greg Mortimer, which had an attack rate of 59% with both guests and crew on board, and the Horizon, with an attack rate of 50% and only crew on board. The Grand Princess had the highest CFR of 4.1% while the Ruby Princess had the highest absolute number of deaths of passengers (n = 29), of which 21 were guests. Even in these outbreaks with a higher number of COVID-19 cases, there was often still uncertainty about data quality and completeness; for example, the Disney Wonder reported ca 200 crew cases, though no further specific details about this outbreak could be obtained.

CA: California; COVID-19: coronavirus disease; NA: not available; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SEC: Securities and Exchange Commission; UAE: United Arab Emirates; US: United States.

a Total COVID-19 cases may not equal the sum of crew and guest cases because some reports did not identify cases as crew members or guests.

b  Numbers are approximate; when number of guests was not known, the maximum occupancy of guests was used.

c Numbers were taken from SEC reports.

Of the 17 ships that had one voyage with 20 to 99 cases of COVID-19 ( Supplementary Table S2 ), six only had crew on board and the median number of cases was 44 (IQR: 27–58), the median attack rate was 2.9 (IQR: 1.2–6.4) and the CFR was 2.6% (IQR: 0–5.0). Mean date outbreak identified 13 March 2020 (SD: 35.8).

The remaining 61 ships and 78 voyages had less than 20 cases ( Supplementary Table S3 ). The mean date of outbreak identification was 2 March 2020 (SD: 32.9 days). Twenty-seven of the 78 voyages had only crew on board. These 61 ships had a median of two COVID-19 cases (IQR: 1–4). The median attack rate was the lowest of the three groups at 0.1 (IQR: 0.0–0.3). However, for three ships that had only crew on board, the only case reported was a fatality.

Thirty-seven of the 104 total voyages had only crew on board during the COVID-19 outbreak, with a median of seven cases (IQR: 2–27). These voyages occurred later than those with guests and crew on board ( Figure 2 ). Of these voyages, eight (21.6%) reported deaths. The resulting median attack rate was 0.5 (IQR: 0.2–5.6) although, as mentioned previously, for three ships the only case reported was a fatality. The Celebrity Flora had the highest attack rate of any of the ships, at 69.6%. All 69 crew members were tested for SARS-CoV-2 and 48 tested positive, although no fatalities were reported. Similarly, on the Horizon, all 250 crew members were tested with a resulting attack rate of 50%. The Celebrity Apex, which was in France preparing for its maiden voyage and only had crew on board, had an attack rate of 19.7% and 100% of the crew members tested; no deaths were reported [ 17 ].

Number of COVID-19 cases in guests (n = 1,658) and crew members (n  = 1,792) on cruise ships over time, worldwide, 1 February–1 August 2020

COVID-19: coronavirus disease.

Narrative review

To offer a clearer picture of different cruise ship scenarios, we have produced a chronological, narrative review of cruise ship voyages with over 100 COVID-19 cases. The first four voyages are described in the main text, and descriptions about the other ships (n = 6 of 9 voyages) can be found in the Supplement.

Diamond Princess – departed from Yokohama Port, Japan, 20 January 2020

The Diamond Princess cruise ship has 1,337 passenger cabins and can hold a maximum of 2,670 guests and 1,100 crew members [ 7 , 18 - 20 ]. The outbreak on the Diamond Princess was the first COVID-19 outbreak identified on a cruise ship. At the time of the outbreak, there were 2,666 guests and 1,045 crew members on board [ 7 , 18 - 20 ]. On 25 January 2020, 5 days after the ship’s departure from Yokohama Port, Japan, a guest with upper respiratory symptoms disembarked in Hong Kong. On 1 February, the guest tested positive for SARS-CoV-2. Ten additional cases were identified on 4 February after the Japanese Ministry of Health conducted initial screening tests to identify further cases on the ship. All guests on board were placed into quarantine on the ship in Yokohama Port for 14 days. Guests at highest risk for severe disease were tested and repatriated before the end of the 14-day quarantine. Guests and crew who tested positive were removed from the ship and taken to a hospital on land [ 7 , 18 - 20 ]. Guests who remained on board were required to isolate in their rooms, but were allowed into common areas during specified time windows if they wore masks and gloves. Crew members continued to live in their quarters, ate in common areas and were required to wear personal protective equipment (PPE), i.e. face masks [ 21 ] and gloves [ 22 ], outside of their cabins [ 7 , 23 - 25 ]. Crew members also delivered food to guests in pairs of two, wearing full PPE. Following the repatriation of all guests, the crew completed an additional 14-day quarantine in the guest cabins. In total, there were 712 cases, 554 among the guests and 152 among the crew [ 7 , 18 - 20 ].

As this outbreak occurred early on in the COVID-19 pandemic, studies on the Diamond Princess outbreak provided foundational knowledge about the clinical course, testing characteristics, epidemiology and utility of infection control practices when there was little other biomedical literature available.

Grand Princess - Voyage A departed from San Francisco, CA, 11 February 2020; Voyage B departed from San Francisco, 21 February 2020

The Grand Princess cruise ship can hold around 3,100 guests and 1,100 crew members. COVID-19 cases were identified on two Grand Princess voyages, which have been widely referred to as ‘Voyage A’ and ‘Voyage B’. Voyage A departed San Francisco, California (CA), US on 11 February 2020, sailed to Mexico and then returned to San Francisco on 21 February [ 7 , 26 ]. Some guests and crew members remained on the ship for Voyage B, which left San Francisco for Hawaii on 21 February, carrying 2,422 guests and 1,111 crew members. On 4 March 2020, COVID-19 cases were identified in guests and crew from Voyage A, prompting testing on Voyage B [ 7 ]. The ship was quarantined in Oakland, CA. However, during the quarantine, only 1,103 tests were performed (type of test not specified), because of concern among the guests that testing positive would require them to quarantine for longer on land [ 27 , 28 ]. Ultimately, 123 cases were identified and five people died – four guests and 1 crew member [ 7 ]. Because only around 30% of guests and crew were tested, the true number of cases may have been higher than reported.

Ruby Princess – departed from Sydney, Australia, 8 March 2020

The Ruby Princess cruise ship departed Sydney, Australia on 8 March 2020, with ca 2,647 guests and 1,151 crew members. Throughout the course of the 11-day voyage, over 100 guests presented to the ship’s medical centre for upper respiratory symptoms; 36 guests presented to the medical centre with influenza-like symptoms, accounting for 0.94% of the ship’s total passengers. As the prevalence of influenza-like-illness did not reach the 1% threshold for an outbreak set by the New South Wales Ministry of Health, the ship was classified as ‘low-risk’ as opposed to ‘high-risk’ [ 29 ]. The situation was further complicated, as some rapid influenza tests run aboard the Ruby Princess came back positive for influenza A. However, many patients presenting with influenza-like symptoms tested negative. Upper respiratory samples were sent to a testing facility in Sydney, as the ship did not have the capacity to test for SARS-CoV-2 (test type unclear). Later reporting revealed that 120 people on board the Ruby Princess met the case definition for COVID-19 at the time of disembarkment [ 30 ]. Passengers were allowed to disembark in Sydney on 19 March. On the same day, the first passenger cases were identified [ 29 ]. In total, 907 primary cases were identified (605 guests and 202 crew members) and 29 people died. In late April, the Ruby Princess outbreak was linked to 13% of all COVID-19 cases in Australia [ 31 ].

SARS-CoV-2 falls into a class of pathogens that spreads readily on cruise ships, such as influenza and norovirus [ 32 , 33 ]. These pathogens can spread quickly when many people are in close proximity for prolonged periods of time, and rapid action is required to prevent larger outbreaks. As opposed to the spread of COVID-19 in indoor settings, where cluster size is usually around five people per household [ 34 , 35 ], cruise ship environments have the potential for case numbers to rise to several hundreds. A review of multiple superspreading events of COVID-19 indicates that 40% of published COVID-19 superspreading events are associated with travel [ 36 ]. Closed environments are associated with 18.7 times greater odds of transmitting SARS-CoV-2 from a primary to a secondary case compared with open-air environments [ 37 ] and cruise ships – by design – have extensive, heavily trafficked, closed environments.

COVID-19 outbreaks on cruise ships have the potential to accelerate international spread of the disease. Several of the larger outbreaks (greater than 100 cases per voyage) were associated with subsequent superspreader events once passengers returned to their countries of origin, which was particularly notable early in the COVID-19 pandemic. For example, over 10% of COVID-19 cases in Australia were linked to the Ruby Princess and two of its passengers were the likely source of a major outbreak in Tasmania [ 38 ], while 16% of the COVID-19 cases in the state of Iowa, US were linked back to the MS Asara (a river cruise) in Egypt [ 39 ]; 17% of all US cases early in the pandemic were linked to cruise ships [ 7 ]. Cruise ships also brought the first cases of COVID-19 to islands such as St. Lucia, Cuba, the Cayman Islands and Puerto Rico [ 17 ]. Of the 79 cruise ships and 104 voyages identified in this study, the median attack rate for COVID-19 was 0.2% (IQR: 0.03–1.5), but there was significant heterogeneity in the attack rate, which ranged from 0.1% to 69.6%. This estimation is limited by the large amount of missing and estimated data throughout the dataset. However, understanding how COVID-19 can potentially spread on cruise ships will be important to prevent future outbreaks.

The number of COVID-19 cases associated with cruise ship voyages during the early COVID-19 pandemic spanned a large range, from one to 907 cases. Cruise ship-associated outbreaks could largely be divided into four notable groups: (i) large outbreaks (greater than 100 cases) that were heavily reported in news media and for which more complete though not authoritative information was available ( Table 1 ); (ii) outbreaks with less than 100 cases; (iii) outbreaks for which there was limited information other than that a case was associated with a cruise ship voyage within 14 days of disembarkation; and (iv) outbreaks among crew members after guests disembarked.

It was often not known how many COVID-19 tests were obtained on board the cruise ships; only 19 of the 79 ships reported this number. SARS-CoV-2 PCR testing capacity was limited early on in the pandemic, which could account for the low testing rates and the low reporting of test numbers at that time. Of the 19 ships that reported the number of tests performed, six (five of which had only crew on board) tested 100% of people on board; as these ships had a high median attack rate of 40%, this suggests that if further testing had been performed on other voyages, more cases may have been found.

Another important theme that emerged in this review was the vulnerability of the crew. After guests disembarked following the US CDC’s No Sail Order passed on 14 March 2020, a considerable number of crew members remained on board the cruise ships for prolonged and undetermined amounts of time and under difficult conditions [ 40 , 41 ]. Three ships with only crew on board each reported one case of COVID-19 that was a death. As the CFR is estimated to be between 1.2 and 4.7% in the general population [ 42 ], these ships with only one fatal case suggest under-reporting of the total number of cases. Finally, COVID-19 was not the only illness that had a profound impact on the health of the crew, as the psychological toll of the pandemic and working conditions during this period should not be underestimated.

Europeans are the second largest group of cruise ship passengers globally: in 2019, over 7.7 million Europeans travelled on cruises and 7.6 passengers embarked from European ports [ 43 ]. In addition, Europe is the second most common region of cruise ship deployment after the Caribbean, with 28% of the global industry deployed from Europe, 17% of which is based in the Mediterranean. Several cruise companies are based in Europe, including MSC Cruises, which carried 2.7 million passengers in 2019, and TUI Cruises, which carried 1 million passengers in 2018–19. Carnival Cruises, which has the capacity to carry 3.2 million passengers from the European market, is British- and American-owned. The number of passengers on cruise ships has begun to increase again in 2021, after a nadir in 2020 [ 14 ]. Over the summer of 2021, cruises have restarted in Europe with strict non-pharmaceutical measures including distancing and testing, as well as vaccination requirements in place.

Limitations

The search for epidemiological information on SARS-CoV-2 infections was limited by several factors. For 67 of the ships included in this study, all the epidemiological information came from news reports rather than the scientific literature. News and media sources are infrequently the primary source for scientific publications, and not all cases of COVID-19 on cruise ships might have generated news articles. For example, earlier in the pandemic, cases remotely associated with a cruise ship might have been reported, but later in the pandemic—as the virus was more widespread throughout multiple communities—such pieces might not have been reported. Crew members or guests with easier to access to reporters, or cruise ships closer to large cities might be more likely to be featured in a news report. It would be beyond our ability to fully classify this publication bias. Furthermore, news articles often do not completely report all the epidemiological information typical for a scientific publication of an outbreak. News sources might have been published in the middle of an outbreak, as opposed to at the end of an outbreak, so final numbers may not be accurate. As data were scarce, any epidemiological information contained in the articles was included, which may contribute to some lower quality of evidence in the source material. Considering all data obtained in this study, limitations also include a large amount of missing data on multiple variables. For example, only 19 voyages reported on the number of SARS-CoV-2 tests performed on board. Eleven cruise ships were only identified via the US CDC list of cruise ships, but no further information was found, resulting in substantial epidemiological gaps. These voyages were counted as having only one case. When not explicitly reported, the number of guests was estimated using the maximum number of guests, which may also have underestimated them attack rate. At times, we identified conflicting reports, such as a crew member reporting that tens to hundreds of crew members had viral upper respiratory tract infections, but no cases were confirmed by the cruise line [ 25 , 44 ]. On the Norwegian Gem, three deaths were reported, including the cruise doctor; however, no COVID-19 cases were reported, although tests were available [ 45 ].

Very few ships, primarily those with over 100 cases, had extensive epidemiological characterisation of their outbreaks. In ships with lower case numbers, vital epidemiological information was often difficult to determine, such as when the outbreak was identified, how many people were at risk and how many tests were performed. Only the Diamond Princess, the Grand Princess and the Greg Mortimer had thorough epidemiological descriptions published in the scholarly literature. The remainder of the outbreaks were defined primarily on information from news sources. We performed a parallel search for ‘COVID-19’ or ‘SARS-CoV-2’ and ‘cruise’ or ‘cruise ship’ using Nexis Uni ( https://www.lexisnexis.com/en-us/professional/academic/nexis-uni.page ) yielded over 10,000 results. This was beyond our capacity to review in full, but a randomly selected subset of results did not suggest any relevant information. Therefore, this database was not included in this study as a source of information. However, the news citations included in our search were the top results from the Google News search engine, and therefore some cases or reports could have been missed. Reassuringly, a meta-analysis of the scholarly literature by Kordsmeyer et al., which examined four databases over a shorter duration (January–July 2020) was roughly in line with the observations of our search [ 11 ]. In this study, a total of 37 studies were included, of which 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 of these studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises (which was excluded from our analysis) and one study about the MS Westerdam (which may have had multiple outbreaks).

With the re-launching of cruises in 2021, the European Centre for Disease Prevention and Control and the US CDC proposed updated guidance for risk mitigation [ 8 , 46 ]. Strategies to mitigate risk at the individual level may include mandatory COVID-19 testing before embarkation, temperature checks and health questionnaires before disembarkation and intermittently throughout the cruise, as well as recommendation/verification of vaccination of guests and crew, a pre-travel negative test, or proof of recovery from COVID-19 before travel, although protocols may vary by cruise company and port of departure [ 47 - 49 ]. Other proposed control measures include managing the number and flow of passengers to allow for physical distancing, mandatory mask wearing while on board and contact tracing for positive cases. Environmental upgrades include updating heating, ventilation and air conditioning (HVAC) systems to include high efficiency particulate air (HEPA) filters in high-risk locations; increased frequency of environmental cleaning; and greater access to hand sanitizer to decrease potential transmission [ 50 , 51 ]. A registry of guests and crew with comorbidities and medications could also be helpful for triage and resource allocation if passengers were required to stay on board during an outbreak. Modelling of passenger movement could also be used to help model maximum occupancy, as has been done in other settings [ 52 , 53 ]. Each cruise ship should have proposed policies or plans in place for assessing the COVID-19 epidemiology of destinations, plans for medical evacuation and repatriation of guests and outbreak contingency plans [ 46 ]. With the rise of the omicron variant, as of December 30, 2021 the US CDC considers cruise ship travel Level 4 risk and recommends avoidance of all cruise ship travel regardless of a person’s vaccination status [ 54 ].

Because of the limitations of the data presented, a centralised global registry similar to the US CDC norovirus registry would be useful [ 55 ]. Several countries, such as Jamaica [ 56 ], New Zealand [ 57 ] and Australia, have produced some reports for cruise ships in their waters, but there is no international registry of cruises. A consolidated registry would allow for all information to be present in a single location with minimum quality and standard data that would allow for future meaningful epidemiological studies of COVID-19 on cruise ships and a greater understanding of the disease overall [ 55 ]. In the interim, we have collated the available data so that they can be used for analysis and to improve understandings of COVID-19 outbreaks on ships.

COVID-19 can spread easily on cruise ships because of the confined space and high density contact networks, which can create superspreader events. As has been shown by previous analysis, considerable measures need to be taken when cases are identified on a cruise ship, such as immediate isolation of cases upon diagnosis, restriction of guests to cabins, limiting guest and crew contacts and performing early mass screening with a high sensitivity rapid tests. It is important to have accurate record keeping of the number of cases and the interventions implemented so that it is possible to properly track the situations that are most prone to COVID-19 outbreaks and to understand which interventions provide successful mitigation. As cruise ships continue to resume their operations, these steps remain important to prevent outbreaks.

Acknowledgements

We would like to thank the Miami Herald. Without their reporting and recording of data, this publication would not have been possible. We would also like to thank Sarah Blaskey and Taylor Dolven from the Miami Herald and the New South Wales Ministry of Health for responding to our requests for information.

Miami Herald tip line: https://www.miamiherald.com/news/submit-news

Supplementary Data

Ethical statement: Institutional Review Board approval was not sought as all data were gleaned from public sources such as scientific or news articles.

Funding statement: This study was supported with funding from the Yale Institutes for Global Health. This work was funded in part by National Institutes of Health Grant 5T32AI007517–20 (to L.P.)

Conflict of interest: None declared.

Authors’ contributions: KW and LP share first authorship. KW conceived the presented idea. KW and LP performed the systematic review and literature searches. LP performed descriptive analysis. KW wrote the narrative review. KW, LP, AAM wrote the manuscript. SBO and SJ supervised the project. All authors provided critical feedback and helped shape the research, analysis and manuscript.

Outbreak Updates for International Cruise Ships

The Vessel Sanitation Program (VSP) requires cruise ships to log and report the number of passengers and crew who say they have symptoms of gastrointestinal illness. Learn more about illnesses and outbreaks reported to VSP and find information about outbreaks of gastrointestinal illness on cruise ships.

Medical staff on cruise ships under U.S. jurisdiction must send gastrointestinal illness case reports to VSP at specific times:

• Before arriving to a U.S. port from a foreign port. This report is required even when there are no cases of gastrointestinal illness. Cruise ship staff send this report between 24 and 36 hours before the ship arrives at a U.S. port.
• When 2% or more of the passengers or crew have gastrointestinal illness. Cruise ship staff send this report any time the ship is in the United States or within 15 days of arriving at a U.S. port.
• If 3% or more of the passengers or crew have gastrointestinal illness.

VSP posts cruise ship outbreaks when they meet all of the following criteria:

• Are on ships under VSP jurisdiction (see about VSP ).
• Are on ships carrying 100 or more passengers.
• Are on voyages from 3-21 days long.
• Are on voyages where 3% or more of passengers or crew report symptoms of gastrointestinal illness to the ship’s medical staff.

VSP may also post information on gastrointestinal illness outbreaks of public health significance that do not necessarily meet the above criteria.

Important Notes

Data on this page are from ship surveillance reports and from CDC-led investigations.

• The gastrointestinal illness cases reported are totals for the entire voyage.
• These cases do not represent the number of active (symptomatic) cases of gastrointestinal illness at any given port of call or at disembarkation.
• CDC has not verified all the case numbers represented in the following updates.

Learn how passengers can protect themselves with these  tips for healthy cruising .

Find  more information  about gastrointestinal illness outbreaks on land and at sea.

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*There were an unknown but significant number of passenger cases who reported their illness by phone to the medical facility onboard but were not seen in a timely manner and disembarked the ship

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Cruise demand leaves pandemic in rearview with record passengers, more construction on tap

M IAMI BEACH — The COVID pandemic drove the cruise industry to a standstill, but numbers released Tuesday signal the years of comeback are officially over with more expansion on tap.

More than 31.7 million passengers took cruises worldwide in 2023, said Kelly Craighead, Cruise Line International Association president and CEO, speaking at the annual Seatrade Cruise Global conference at Miami Beach Convention Center.

CLIA is the lobbying group for member cruise lines, including Royal Caribbean, Disney Cruise Line, Carnival, Norwegian, MSC and most other major brands.

The pandemic shut down sailing from March 2020 with only a small number of ships coming back online 18 months later in summer 2021. Cruise lines didn’t return to full strength until partially through 2022, so it wasn’t until a full year of sailing in 2023 that the industry could get a real handle on just what the demand had grown to as people returned to vacation travel.

“We are an industry that’s resilient and thriving all around the world, breaking records in ways we might never have imagined,” she said.

The 2023 total is 2 million more than the industry had in 2019. CLIA projects 34.1 million in 2024 growing to 34.6 million in 2025. It’s still a miniscule chunk of the overall travel pie of more than 1.3 billion, but cruise’s share is growing.

She noted that surveys of travelers who would consider a cruise for a vacation are at an all-time high, noting that 82% who had previously cruised said they would cruise again, but more importantly, among those who had never sailed, 71% would consider it.

The youngest generations — Gen X, Millennials and Gen Z — are the biggest drivers.

The fleet for the growing demand continues as well, including the introduction this year of the world’s largest cruise ship, Royal Caribbean’s Icon of the Seas.

She said CLIA member lines had more than 300 ships sailing globally for the first time in 2023, with 14 new ships that began sailing in 2023 and another eight expected before the end of the year. They have 88 new ships on order through 2028.

Already this year, both Royal Caribbean Group and Carnival Corp. announced major new ship construction deals, and Norwegian Cruise Line Holdings added to that this week with its order of eight more vessels across its three brands.

The heads of those groups were on stage to discuss where the industry is headed and enjoy their recent success.

Carnival Corp.’s president and CEO Josh Weinstein put it in a way that gained plaudits from fellow panelists and others at the conference.

“The concept of pent-up demand for cruising is gone,” he said. “We have been cruising for three years, right? It’s over. This is natural demand because we all provide amazing experiences. We delivered happiness to literally 31 million guests last year. And people see it, they feel it.”

A big part of what cruising missed during the pandemic he said was that word-of-mouth promotion that is needed to convince people to try their product.

“We now have 31 million people getting off our ships and going home and telling their friends and family who have never cruised before, ‘You don’t know what you’re missing.’ ‘This is amazing.’”

All of the leaders echoed the industry line that they offer a much better value than land-based vacations, but that the experience gap between the two has now shifted in their favor coming out of the pandemic.

“The appreciation for building memories with your friends and family coming out of COVID is at extraordinarily high levels,” said Jason Liberty, president & CEO at Royal Caribbean Group. “Also wealth transfer, right? Grandparents wanting to see that wealth transfer live, watching their kids and their grandkids experience that is also at an all-time high. … We have the secular trends of people buying less stuff, they want experiences. We’re in the experience business.”

Another bright aspect to the industry has been the spillover effect of all of the new ships since the pandemic, said Harry Sommer, president & CEO at Norwegian Cruise Line Holdings Ltd.

“Their new products are so extraordinary, and so much better than what was delivered back in ’15, ’16 and ’17, that it’s driving additional excitement for the entire industry,” Somer said. “When any new ship is delivered, no matter whether it’s part of our portfolio or the other portfolios, demand improves for all of us because it adds excitement to the industry.”

©2024 Orlando Sentinel. Visit orlandosentinel.com. Distributed by Tribune Content Agency, LLC.

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Nearly 30 Silversea Cruise passengers sickened by outbreak on board

Passengers expecting outstanding cuisine aboard a luxury Silversea cruise liner spent much of their vacation in the ship's bathrooms with a gastrointestinal virus, the Centers for Disease Control and Prevention (CDC) said Monday.

At least 28 passengers and one crew member among the Silver Nova's 633 passengers fell ill during their 16-day Easter-themed cruise that set sail in Callao, Peru, the agency said.

They all reported the same primary symptom: diarrhea.

DISNEY CRUISE LINE PASSENGER RESCUED BY US COAST GUARD AFTER EMERGENCY OFF PUERTO RICO

The cause of the outbreak is still unknown, but the agency noted that noroviruses are typically caused by eating contaminated food or drinking contaminated water.

The Silver Nova, the cruise company's newest liner introduced in 2023, boasts butler service for each suite and a ratio of one crew member for every 1.3 guests.

READ ON THE FOX NEWS APP

Workers aboard the ship aim to show guests "outstanding gastronomy," according to the Silversea website. At the end of last year, "Top Chef's" Nina Compton joined its staff, and offered personal cooking lessons to passengers.

Sick passengers were quarantined in their rooms, the CDC said. Other passengers were notified, and crew members "increased cleaning and disinfection procedures."  

FLORIDA MAN BELIEVES SON IS ALIVE AFTER JUMPING OFF CRUISE SHIP: REPORT

"The health and safety of our guests, crew and communities we visit are our top priority," a spokesperson for Silversea Cruises told Fox News Digital. "To maintain an environment that supports the highest levels of health and safety onboard our ships, we implement rigorous cleaning procedures, many of which far exceed public health guidelines."

Prices for the voyage, which began on March 31 and ended on April 16, started at $11,700 for a double-occupancy room, according to CruiseMapper.

SEARCH FOR MISSING SOUTH CAROLINA CRUISE PASSENGER COMPLICATED BY JUNGLE TERRAIN AS FAMILY DEMANDS US HELP

The New York Post reported that the Silversea outbreak was the fourth this year, including one that saw 130 people struck with diarrhea and vomiting and another that saw 104 passengers fall ill on a Holland America liner.

The CDC reported 14 cruise ship outbreaks in 2023.

Original article source: Nearly 30 Silversea Cruise passengers sickened by outbreak on board

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These are the cruise ships with the best — and worst — sanitation scores so far this year

• The CDC randomly inspects cruise ships to help prevent the spread of stomach viruses. 
• The agency has reported 13 norovirus outbreaks on cruise ships this year.
• These are the cruise ships with the best and worst sanitation report cards in 2023 so far.

There's nothing like a stomach virus to ruin your vacation, as hundreds of cruise ship passengers have unfortunately learned this year.

The Centers for Disease Control and Prevention has reported 13 norovirus outbreaks on cruise ships so far in 2023. The last time the industry's yearly gastrointestinal illness outbreak total was that high was back in 2016 — and it's only July.

For the agency to report a cruise-ship outbreak, 3% or more of passengers or crew members must report symptoms of gastrointestinal illness, such as vomiting and diarrhea, to the ship's medical staff. During the most recent outbreak, a 14-day cruise aboard the Viking Neptune in June, slightly over 13% of passengers (110 of 838) reported being ill with predominant symptoms of abdominal cramps, vomiting, and diarrhea, according to the CDC.

The nasty stomach bug isn't just a cruise-ship problem, though. Norovirus cases have spiked across the United States this year, which some experts say is the result of ending COVID-19 restrictions .

"People often associate cruise ships with acute gastrointestinal illnesses such as norovirus, but acute gastrointestinal illness is relatively infrequent on cruise ships," the CDC says on its website. "Health officials track illness on cruise ships. So outbreaks are found and reported more quickly on a cruise ship than on land."

To try to help prevent the spread of stomach viruses at sea, the CDC randomly inspects cruise ships and scores them on a scale of 0 to 100 through the Vessel Sanitation Program . Inspection scores of 85 and lower are considered "not satisfactory" by the agency.

Related stories

Most vessels have received scores in the high 90s — only one cruise ship, the MSC Seaside, has failed the CDC's sanitation inspection so far this year. The vessel received an unusually low score of 67 , nearly 20 points below the agency's passing grade.

An MSC Cruises representative told Insider at the time that the cruise line had launched an internal investigation based on the inspector's concerns and taken immediate corrective actions.

"MSC Cruises rigorously adheres to health protocols, and the results of this inspection do not reflect the brand's high standards," the person added.

In the past 10 years, only three other cruise ships have received sanitation scores below 70, CDC records show. Violations can include something as small as not posting a raw-eggs advisory on the omelet station or a single fly hovering in a food area. But before going on your next cruise adventure, it doesn't hurt to check out the ship's most recent sanitation rating.

These are the cruise ships with the highest and lowest sanitation scores so far this year:

The 15 cruise ships with perfect scores of 100

The 15 cruise ships with scores below a 95.

Correction: July 17, 2023 — An earlier version of this story included a photo caption that misstated how many passengers and crew members aboard the Nieuw Amsterdam reported being ill during a May voyage. It was 284 people, not 539.

• Main content

Fincantieri: ‘Covering All Brands’ with Eye on Future Fuels

• April 18, 2024

Coming off a big newbuild order from Norwegian Cruise Line Holdings, Daniele Fanara, director newbuilding and after-sales at Fincantieri, is positive on the future.

“We are serving all segments of the market, from small luxury vessels to mega-size vessels to upper premium,” said Fanara, speaking to Cruise Industry News. “This covers all the brands in the cruise industry.”

Fanara said Fincantieri was very proud to be working with a variety of operators and being able to serve each of them in a tailored, customized way.

“We have cross fertilization with our technology, including the capacity to design the vessel,” he added.

The new Norwegian Cruise Line Holdings order for eight ships includes orders for all three company brands, with new classes of ships for each of them. Norwegian, Oceania and Regent will all get new bigger ships, with orders for the Norwegian brand stretching to 2036.

“We are proud the trust that Norwegian gave us to develop such an important program,” said Fanara.

Looking at future technologies, Fanara said the ships were being developed.

“Our attention is focused on three main fuels,” he said. “One is LNG, one is methanol, and one is hydrogen. Hydrogen is the most innovative one. We are developing new ideas on how and when we can implement hydrogen onboard the vessels.”

New ships for Oceania and Regent are being developed to be methanol ready.

“Today there is no real answer on the fuel of the future,” Fanara continued. “It’s a matter of availability. What’s important from our side is that we are always studying the latest technology available. We are also exploring CO2 capture technology.”

Fanara said among the alternative fuels, LNG was notable in the fact it was being used today.

“There are ships sailing on LNG. The other technology is in a different phase of development. We need to monitor them so we are ready to implement them if necessary,” he explained.

Questions are coming in from cruise lines on alternative fuel practicalities, Fanara said, but with the most questions on hydrogen.

“It is the most innovative, it is the most unknown.”

Fanara called the cruise industry resilient.

“Soon after Covid, the speed at which the industry recovered and came back to strong booking and revenue levels is incredible,” he said.

Fanara expects other orders to follow, citing market demand and the value gap between cruise- and land-based vacations.

Shipbuilding Costs

Costs are up to build ships.

“A greener vessel is for sure more expensive to build,” Fanara noted. “But is the value of this additional cost worth it for the industry?

“The owners can say the ships are more expensive. We had Covid, we had wars and the result of this has been inflation. If you mix inflation and the technology transition, the result is not less expensive ships.”

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