What Happens If Someone Gets COVID on Your Cruise?

Note: Since first writing this article, the Centers for Disease Control has come out with new guidelines for cruises to return to sailing. According to their framework, cruises with “a threshold of COVID-19 being detected” are to immediately end and return to port while passengers are isolated and quarantined. We’ve updated the article below based on the latest from the CDC.

When it comes to the return of cruises there are an enormous amount of questions. When will ships return? What will the experience be like? Will I have to wear a mask?

Cruzely has covered these questions in-depth. But there is one unique question that many passengers have, and it could have a major impact on their cruise: What happens if a passenger on a cruise ship gets COVID?

In fact, in a recent survey, we asked passengers about their biggest questions for when cruises return. Among the most common wasn’t if cruising was safe or when trips will return. It was what happens if someone gets sick on the ship?

Will everyone have to quarantine if one passenger gets sick? Will cruise passengers be stranded on the ship? Will the cruise be cancelled? 

People seem more concerned not about getting sick on their cruise… but what happens if someone else gets sick. And for good reason.

We all saw ships at the start of the pandemic held in quarantine. Passengers who weren’t ill were held on ships for days or weeks, with many eventually becoming sick. No one wants to take part in that experience.

So now that cruises are returning in some spots, what will happen to both healthy and sick passengers if someone gets COVID on a cruise ship?

Plans Put in Place to Prevent and Detect COVID

The world saw the terrible headlines when virus cases were linked to cruise ships at the start of the pandemic. The rise in cases led to the eventual suspension of cruises.

As we saw, however, those cases tied to cruising were actually relatively small (around 3,000-4,000 cases) given the tens of millions of cases of COVID now seen around the world. Even so, there’s little argument that a place like a cruise ship — with thousands of passengers in a relatively small area — can mean the spread of an illness.

In response, cruise lines have gone to work on creating policies and protocols to allow them to return sailing safely while reducing the risk of transmission on the ship. Those plans are extensive.

For an example, Royal Caribbean and Norwegian Cruise Lines actually joined together to create the “Healthy Sail Panel” — a team of medical experts tasked with coming up with plans on how to sail again while protecting passengers.

That panel released a list of 74 recommendations that it is offering to the entire cruise industry, covering everything from how to keep passengers from getting sick to what to do if someone does come down with the virus. 

Passengers in Port of Miami

Among the policies recommended by the panel or already announced by the cruise industry:

100% testing of passengers and crew before boarding
Everyone boarding the ship has to be tested prior to sailing. Perhaps the biggest move made by the industry, universal testing will help to limit the potential of a person boarding with COVID and possibly spreading it around the ship.

Limited capacity & social distancing
Cruises are starting back less than full capacity to allow more space for each passenger. As well, just like on land there are social distancing rules enforced around the ship in popular areas like casinos, pools, and theaters.

Facemasks
Perhaps the most controversial step is passengers on ships are being asked to mask up when distancing isn’t feasible. That doesn’t mean you have to wear a mask by the pool, but in interior areas of the ship, masks are recommended.

Advanced filtration
There’s concern that the virus can be spread through air conditioning systems. Because of that, many ships are being retrofitted with advanced filters capable of taking out smaller particles and also taking in fresh air instead of re-circulating indoor air.

Upgraded medical facilities
Among the recommendations set to be put in place are upgrades to ship medical centers to better handle potential virus outbreaks. Of course, that also includes tests available on ships should they be needed.

Contingency plans for cases on the ship (isolation, contact tracing, debarkation)
Cruise lines are also putting in new procedures for what happens if there is a case (or cases) on the ship. This includes cabins set aside for quarantines, contact tracing procedures, and plans for how to debark sick (and healthy) passengers.

But in addition to what cruise lines have announced, the CDC created a “Framework for Conditional Sailing.” Not only does this 40-page document outline how cruise lines can return, but it also spells out the rules they must follow to do so.

Among those rules laid out are those concerning what cruise lines must do if there is a case of COVID on the ship during a sailing.

What Happens to Passengers With COVID on a Cruise?

No matter how stringent the regulations, with the number of cases around the world, it seems inevitable that a case will eventually find its way onto the ship. Even cruise line executives acknowledge this.

“With all the protocols we have, there’s still likely, eventually at some point, to be a case on board,” said Carnival Corporation CEO Arnold Donald. “If it’s in the community overall, there’s no perfect system to prevent it.”

So what happens if someone is confirmed or suspected of having COVID on a cruise? First, passengers boarding are required to test negative for the virus before they board. If a passenger doesn’t test negative, then they won’t be allowed on the ship.

Even so, the virus can incubate and turn into a positive case after boarding. In that case, the CDC has laid out their rules:

Minimum Standards for Management of Passengers and Crew from COVID-19-affected Cruise Ships for Restricted Passenger Voyages

 

(a) Based on a threshold of COVID-19 being detected in passengers or crew, as determined through CDC technical instructions or orders, a cruise ship operator must immediately take the following actions:

 

(1) Conduct such notification of passengers, crew members and other government entities as CDC may require.

 

(2) Immediately end the restricted passenger voyage, cancel future restricted passenger voyages until directed by the CDC that such voyages may resume, and return the ship to the U.S. port of embarkation.

 

(3) Immediately isolate any sick or infected passengers and crew in single occupancy cabins with private bathrooms and quarantine all remaining passengers and non-essential crew.

  • CDC Framework for Conditional Sailing

First, according to these rules, if there is a “threshold of COVID-19” detected on the ship, then the cruise will end and immediately return to the departure port. Future trips will also be canceled until allowed by the agency.

(What’s not clear is the threshold of cases. We have reached out to the CDC for more details.)

Anyone testing positive is set to be isolated on the cruise ship in a single-occupancy cabin. The Healthy Sail Panel recommends that cruise lines are to set aside cabins specifically prepared for isolation. Passengers that are isolated with cases will have their food brought to them and have medical consults from the ship’s doctor.

From there, the Healthy Sail Panel also recommends contact tracing to determine if other passengers have been in close contact. This is generally considered to be within six feet of a positive person for at least 15 minutes.

The CDC framework requires that cruise lines also have agreements in place with ports and health authorities. These agreements should outline disembarking sick passengers, including having transportation arranged to get them home or to medical care using noncommercial transportation. 

In other words, that could mean specially chartered flights or car transport instead of letting ill passengers fly through an airport. The goal is to get people to medical help or back home while coming in contact with as few other people as possible. 

What Happens to Healthy Passengers If There Are Cases on Board?

Debarking the cruise ship with packed bags

Even in the worst outbreaks tied to cruise ships, many more people did not get the virus than did have the illness. In other words, if there are cases on a cruise, it’s most likely the largest percentage of people will be healthy.

So what happens to those healthy passengers if they happen to be on a ship where COVID cases are found? 

The big fear of many is that they will be stuck on the ship in port, confined to their rooms for an undetermined amount of time. At this point, that doesn’t seem likely in our opinion.

The CDC’s framework makes clear that if a “threshold” of cases is found, cruise lines are to end the cruise, isolate sick passengers and quarantine everyone else:

(3) Immediately isolate any sick or infected passengers and crew in single occupancy cabins with private bathrooms and quarantine all remaining passengers and non-essential crew.

 

(4) Disembark and evacuate passengers and crew only in such a manner as prescribed in the cruise ship operator’s preexisting port and local health authority agreements.

 

(5) Arrange to disembark and transport passengers and crew using noncommercial transportation or other transportation in accordance with CDC’s technical instructions and orders.

 

(6) Instruct disembarking passengers and crew to stay home and continue to practice social distancing after reaching their final destination as per CDC technical instructions or orders.

  • CDC Framework for Conditional Sailing

In the Healthy Sail Panel’s recommendations, they cite the need for defining “criteria for small-, moderate-, and large-scale debarkation scenarios in advance of cruising.”

For example, with a small and contained number of cases, it’s suggested that sick guests could be isolated and taken off the ship while the cruise continues, according to the recommendations. Larger outbreaks could lead to the cancellation of the cruise and have the ship immediately head back to home. 

The CDC requires any cruise — if it meets the threshold of cases on board — to be ended immediately. Once the cases are found, passengers are to be quarantined. 

Passengers are also set to be tested before disembarking the ship as the CDC calls for this on any cruise that’s taken, whether there are positive cases or not. 

Interestingly, there is no distinction made in the CDC’s framework regarding the transportation of sick or healthy passengers. It simply says that passengers and crew must use “noncommercial transportation or other transportation in accordance with CDC’s technical instructions and orders.”

In other words, things like commercial flights or taxis to get home seem out of the question, even if a person tests negative. (Further clarification could come later.)

In fact, the agency is requiring cruise lines to post a travel advisory on marketing materials, which advises passengers that “if a threshold of COVID-19 is detected… their subsequent travel, including their return home, may be restricted or delayed.”

Given that we’ve seen the risk of more spread by keeping passengers on a cruise ship during an outbreak, however, it seems unlikely that an entire ship will be quarantined at the dock or offshore without allowing healthy passengers to leave.

A Real-World Example of Cases on a Returning Cruise

Costa Diadema

While the CDC rules spell out what should happen if a U.S.-based cruise ship has cases found, in Europe, we’ve already seen a real-world example. There, Costa Diameda had a situation where cases were discovered on the ship.

According to reports, seven passengers tested positive during the cruise. These passengers debarked while the cruise continued. Later, another passenger was identified through contact tracing and tested positive.

At that point, the cruise, which consisted of French passengers, was cancelled. France had recently declared a state of emergency in response to a sharp rise in cases in the country. With that in mind, while the number of passengers who tested positive was relatively small, the cruise line decided to cancel the two-week sailing ten days early. Passengers were all tested before disembarking.

So in this case, we saw a small number positive cases that allowed the cruise to continue. Eventually, however, the decision was made to cancel a cruise completely in response. Passengers were tested before leaving and allowed to return home.

Bottom Line: As cruises return to the United States, there’s still plenty that’s yet to be seen. However, given the plans laid out by the CDC and what we’ve seen in Europe, there is a good idea of what will happen.

In Europe, small outbreaks seem like they will be handled onboard with isolation of selected passengers. Larger outbreaks could mean the end of the cruise and a large-scale debarkation of passengers.

In the United States, the CDC has taken a stance that a “threshold” of cases found on a ship mean the end of the cruise and passengers will need to quarantine until the ship returns home. They will then be given alternative transportation home.

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