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Outbreaks of COVID-19 on cruise ships pose a risk for rapid spread of disease beyond the voyage. All persons should defer all cruise travel worldwide during the COVID-19 pandemic. In a report published in late October, before the omicron variant was identified, the CDC noted that cruise lines logged 1,359 Covid-19 confirmed cases between June 26 and October 21 of this year. While most of these cases were asymptomatic or mildly symptomatic, 87 of those who tested positive needed to be hospitalized or medevaced off the ship.
Ships without confirmed cases on board
Commercial maritime travel is characterized by the movement of large numbers of people in enclosed and semi-enclosed settings. Like other close-contact environments, these settings can facilitate the transmission of respiratory viruses from person to person through droplets and small particles or potentially through contact with contaminated surfaces. 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. Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April.
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Princess
Indoor dancing, karaoke and nightclubs are no longer allowed on many ships, including the Majestic Princess, which converted its karaoke area into extra room for spa treatments. On Monday, Australian health authorities confirmed COVID-19 cases on the Coral Princess, one of the first major cruise liners to dock in Western Australia in over two years, according to The Australian Broadcasting Corporation. Most cruise lines offer future cruise credits if a passenger gets sick with COVID-19, but Hochberg said that process has been challenging.
What it means for a ship to be monitored or under 'investigation' by CDC
Eighty-six ships are on yellow status, which signifies that the number of reported Covid-19 cases exceeds .10% — or one-tenth of one percent — of the total number of people onboard the ship. According to the CDC website, 49 of the 86 ships on yellow status have been investigated and remain under observation, while the investigations are still underway for the remaining 37 ships. In some circumstances, additional public health precautions, such as returning to port immediately or delaying the next voyage, may be considered to help ensure the health and safety of onboard travelers or newly arriving travelers.
Shots - Health News
In the event that a guest contracts the virus on their vacation, the company will cover the cost of medical treatment onboard, and the person and their party can stay on the ship for free to complete any required quarantine plans. In June, Hochberg was sailing on a Royal Caribbean ship in Alaska with his family when he began to have a scratchy throat. He brought his own COVID tests — something he advises passengers to do — and tested positive. He informed the cabin crew immediately and was then relegated to his cabin for the remainder of the trip. 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.
Hazard controls
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In addition, masks should also be worn in shared spaces and passengers who are not fully vaccinated against COVID should self-quarantine for five days after travel, in addition to getting tested three to five days after their return, the CDC said. On day two, cases are reported to the CDC, data is pulled from REDCap and the color status is assessed by the agency. On restricted voyages, or cruises carrying paying passengers, just one case among crew merits a yellow status, prompting a CDC investigation. 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.
Recommendations when a voyage’s crew or passenger ARI attack rate reaches 2%‡
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. 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. By the time the Norwegian Breakaway cruise ship docked in New Orleans on Dec. 4, after a weeklong cruise that included stops in Belize, Honduras and Mexico, 17 coronavirus cases had been identified on the ship, including a case of the new Omicron variant. The local and federal health authorities were notified — but not all the disembarking passengers.
You'll face lots of new health protocols
To reduce the likelihood of onboard transmission of SARS-CoV-2, pre-embarkation testing is recommended for all passengers, including those on back-to-back sailings [4]. Completion of testing closer to the time of embarkation (within 1 to 2 days) maximizes the benefit of preventing introduction of infectious persons onboard. The U.S. Centers for Disease Control and Prevention recommends all passengers be fully vaccinated before boarding a cruise ship. The world’s largest cruise companies now require passengers leaving U.S. ports to be fully vaccinated, with limited exceptions. Vaccines are required for passengers on Carnival, Princess, Royal Caribbean and Celebrity cruise lines.
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). ‡ Sources of data should include medical center records and other established surveillance systems for passengers and crew (e.g., employee illness reports). Travelers with ARI who board, as well as those who become sick with ARI onboard, should be identified and tested as soon as possible to minimize transmission of respiratory viruses.
Both the medical team and the guest services team called him regularly to check on him. Doctors provided him with over-the-counter medication and the guest services team helped him plan his disembarkment process. Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.
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. Healthcare providers should understand the advantages and limitations of rapid diagnostic tests, and proper interpretation of negative results of any antigen diagnostic tests. Rapid antigen diagnostic tests have a lower sensitivity compared with RT-PCR, and false negative results can occur frequently. This document provides guidance for cruise ships originating from or stopping in the United States to help prevent, diagnose, and medically manage acute respiratory illness (ARI) caused by SARS-CoV-2 (the virus that causes COVID-19), influenza virus, or RSV.
Anyone presenting symptoms of the virus during their time on board will be tested and reviewed by the company's medical staff. Depending on when you booked your cruise, passengers on Royal Caribbean ships will have access to varying COVID-19 assistance at no extra charge. For guests who made a reservation on or after August 8, 2022, Royal Caribbean will cover the costs of COVID-19-related medical treatments onboard if you test positive. Red status means there is "sustained transmission" of coronavirus or COVID-19-like illnesses on board or there is a potential for cases to "overwhelm" the ship's medical center. Orange status means the ship has reported cases among passengers and is being monitored but levels don't meet the threshold for CDC investigation.
Despite the shutdown, the world’s cruise lines have more than 100 new ships on order to set sail by 2027. The Majestic Princess, a ship designed to serve the Chinese market, made its maiden call from the Port of L.A. Some 200 cruises are scheduled to depart from there in 2022, up from 120 in 2019. According to the company's website, a positive case, that does not require admission to the ship's medical center or medical disembarkation, will be moved to a different cabin during the isolation period. Guests who test positive for COVID-19 on a Carnival cruise will need to isolate until their medical team says it is safe to resume activities, according to the company's website. Carnival offers regular visits from medical staff either in-person or through teleconsultation and guests will have access to complimentary amenities like Wi-Fi and room service.
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). 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. 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. 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. Make an appointment with your healthcare provider or a travel health specialist that takes place at least one month before you leave. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.
Cruise ships are often settings for outbreaks of infectious diseases because of their closed environment, contact between travelers from many countries, and crew transfers between ships. On the Diamond Princess, transmission largely occurred among passengers before quarantine was implemented, whereas crew infections peaked after quarantine (6). On the Grand Princess, crew members were likely infected on voyage A and then transmitted SARS-CoV-2 to passengers on voyage B.
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