celebrity cruise ship covid outbreak 2022

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‘Not the cruise I signed up for’: 30-fold increase in Covid cases upends industry

The surge has led to passengers stranded on ships, staff shortages and tour cancelations in addition to ports turning ships away

A surge in Covid infections on cruise ships is causing mayhem across the industry, leaving passengers stranded aboard ships, exacerbating staff shortages and prompting the CDC to warn US passengers against all cruise travel.

The CDC director said this week that Covid cases have increased 30-fold in just two weeks. Every one of the nearly 100 cruise ships currently carrying passengers in US waters has reported enough Covid-19 cases to merit investigation by the CDC, according to the agency’s website .

Over the holidays, passengers found themselves floating around on ships that couldn’t dock because foreign ports were turning them away or facing long, onboard quarantines before being allowed to come home, after testing positive for Covid. Dozens of cruises have been cancelled and some ports in the Caribbean and South America are turning ships away from making daily visits.

“It wasn’t the cruise we signed up for,” said Janet Silver Ghent, a Palo Alto retiree and editor who was stuck onboard a South America cruise for eight days, when ports in Chile and Argentina refused to let passengers disembark because of Covid cases.

On December 30, the CDC issued its highest travel warning , advising the public to avoid cruise ship travel even if vaccinated. The agency said, at the time, that the number of infections reported on cruise ships had jumped to 5,013 between 15-29 December – up from only 162 in the first two weeks of December.

CDC director Dr Rochelle Walensky, speaking at a senate health hearing on Tuesday, said that the numbers have continued to skyrocket, though the agency did not respond to requests for updated case counts.

“Just over the last two weeks with Omicron, we’ve seen a 30 fold increase in cases on ships,” Walensky said.

The problems come just six months after the cruise industry’s big comeback, when companies resumed full operations after having voyages shut down for more than a year by the pandemic. Fortunately, unlike the outbreaks that rattled the global cruise industry early in the pandemic, there have been no initial reports of serious illness or death in the latest surge. Most cruise companies are requiring passengers to be fully vaccinated and tested before setting sail, likely helping to limit the severity of outbreaks.

“Our case count has spiked, but the level of severity is significantly milder,” said Royal Caribbean Group’s chief medical officer Dr Calvin Johnson, in a statement last month.

The company reported that, since cruising restarted in the US in June 2021, only 1,745 of its 1.1 million guests have tested positive – a positivity rate of 0.162%. Of those, it said, only 41 people needed hospitalization.

But the case surge is nonetheless causing headaches for cruise operators and passengers. Florida maritime attorney James Walker said that thousands of cruise ship crew members have tested positive and that many are quarantining on a handful of out-of-service ships.

“Given the number of crew members who are ill, there are significant staffing problems,” said Walker, who believes cruise lines should suspend their operations until after the Omicron surge. “For the people who pay to go on a cruise, the service isn’t there.”

‘We were willing to embrace the risks’

By the time the CDC issued its warning against cruise ship travel on 30 December, many holiday passengers were already aboard and seeing their dream cruises disrupted by Omicron. Some have opted to try and make the best of it.

Five days after Utah resident Brett Williams and his wife set sail on what was supposed be an 11-day Caribbean cruise, he said 48 crew members and 51 passengers of the small 342-passenger sailing ship, the MSY Wind Surf, tested positive and had to be taken off the ship for quarantine in Barbados. Within a few days, he and his wife and many other passengers also tested positive and were told they couldn’t fly home until they each received a negative test result.

Despite experiencing no symptoms, Brett Williams’ tests remained stubbornly positive. The psychologist and author made the best of what turned out to be 12 extra days stuck on the ship, eating complimentary deluxe room service meals, taking pictures of beautiful sunsets and working on his new book, a self help guide, ironically titled Unstuck.

At one point, when all the other passengers had been sent home, he and his wife even got to enjoy the ship’s spa pool by themselves, where he joked he wanted to order up “a quarantini”.

“Life has risks,” said Williams, who described the trip as “awesome” despite the disruptions. “We were willing to embrace the risks.”

Ghent and her husband, Allen Podell, also managed to enjoy their South America trip even though their ship, the Viking Jupiter, spent so much time at sea, since they couldn’t dock, that the entertainers aboard used up all their routines in the first few days and had to resort to improvising entirely new material.

Ghent said Viking’s testing routines were extremely strict, requiring all passengers to take a spit PCR test every day. “I spit so much, I never want to spit again,” she said.

Passengers who were deemed to be exposed were taken off the ship for quarantine. These included actor Liev Schreiber, who proceeded to post viral videos from his quarantine hotel in Chile, tapping out beats on a Casio synthesiser and calling himself DJ Covid.

Ghent’s husband, Podell,83, ate voluminous amounts of sushi and spent his time singing along with the guitarist in the Viking ship’s Explorer Lounge. While the boat was never able to dock in its final destination port, Buenos Aires, Argentina, Podell enjoyed belting out renditions of John Denver’s Take Me Home Country Roads and made up his own version of an Evita song: Don’t Make Me Cry, Argentina.

Ghent and Podell eventually got off the ship in Uruguay, where they were supposed to spend one day but ended up spending five. The cruise line chartered a plane to get passengers back to Miami. From there, the couple missed their connecting flight to San Francisco and temporarily lost their baggage, but managed to keep their sense of humor all the same.

“Nobody’s going to feel sorry for us for cruising the Atlantic,” said Podell.

Officials in the cruise industry, which has lost a lot of money since the start of the pandemic, were also trying to take the setbacks in stride. “Omicron is having a big short-term impact on everyone,” said Richard Fain, CEO of Royal Caribbean in a statement, but argued that cruises are one of the safer places for people to vacation because everyone aboard is vaccinated. “Many observers see this as a major step towards Covid-19 becoming endemic rather than an epidemic.”

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Omicron prompts more cruise lines to cancel trips.

In recent weeks, hundreds of passengers have contracted the coronavirus aboard ships.

By Alyssa Lukpat and Ceylan Yeginsu

• Jan. 17, 2022

Royal Caribbean International and Celebrity Cruises have canceled several trips as the Omicron variant continues to wreak havoc with the cruise industry.

In recent weeks, hundreds of passengers have contracted the coronavirus onboard ships, with many falling ill and spending days in quarantine.

On Friday, Royal Caribbean canceled a sailing on the ship Independence of the Seas, in response to “Covid-related circumstances around the world,” the company said on its website.

The company said this month that it had called off planned trips on three ships — Serenade of the Seas, Symphony of the Seas and Jewel of the Seas — and delayed the return to cruising of another, Vision of the Seas, to March.

In a statement on Monday, Celebrity Cruises said it had postponed service on its ship Celebrity Eclipse. The ship was scheduled to make four trips in March and April.

The cruise industry has been battered by the pandemic. It was all but shuttered for nearly 18 months before making a comeback this past summer, but the industry has recently faced mounting criticism about its safety protocols.

Last month, the Centers for Disease Control and Prevention urged travelers to avoid cruises , even after vaccination. The agency raised its Covid-19 warning level for cruise ships to 4, the highest level.

The move came as the number of outbreaks on ships has grown, causing some ports to turn away ships. In December, clusters broke out aboard two Royal Caribbean cruises after they left port in Florida, and more than a dozen people tested positive on a Norwegian Cruise Line vessel after it returned to New Orleans .

Royal Caribbean and Celebrity Cruises require passengers who are eligible for inoculations to receive them. Younger passengers who are not eligible must test negative before sailing.

Alyssa Lukpat is a reporter covering breaking news for the Express desk. She is also a member of the 2021-22 New York Times fellowship class. More about Alyssa Lukpat

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

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

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

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

The number of passengers being quarantined on ships (after testing positive for COVID-19) also is on the rise. And passengers who aren't COVID-19 positive are getting caught up in short-term quarantines for being "close contacts" of shipmates who are.

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

Meanwhile, just getting to ships is becoming increasingly stressful, as getting the pre-cruise COVID-19 test that's often required before cruising is getting more difficult . Plus, a "perfect storm" of soaring COVID-19 cases and rough winter weather has wreaked havoc with airline operations for weeks.

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

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

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

COVID-19 cases on ships are up a lot

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

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

That's a 3,094% increase.

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

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

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

Cruise lines also are testing all crew members regularly.

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

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

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

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

Your itinerary could change

While health authorities no longer are quarantining whole ships when a few passengers or crew test positive for COVID-19, the presence of the illness on board a vessel still could result in notable disruptions to your itinerary.

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

Several ships recently had to skip port calls in Mexico , for instance, after passengers and crew on board the vessels tested positive for COVID-19. The ports have since reopened after Mexico's Health Department overruled the decisions of local port officials.

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

Lines also are dealing with a small but growing number of destinations -- India and Hong Kong, for example -- that are at least temporarily closing to cruising completely, even for ships where no one has tested positive for COVID-19.

Viking on Sunday was forced to announce a major revision of its soon-to-begin, 120-day world cruise after India notified the line it was closing to cruise ships. Viking's 930-passenger Viking Star will begin its world cruise this week by heading south from Los Angeles to Central America and South America instead of sailing westward toward Asia, where it was scheduled to spend a significant amount of time in India.

Your cruise could be canceled on short notice

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

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

Other lines canceling one or more sailings in recent days include Holland America , Silversea , Atlas Ocean Voyages, Regent Seven Seas Cruises, MSC Cruises , Costa Cruises and Oceania Cruises .

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

You probably won't be quarantined, stranded or stuck

As noted above, health authorities no longer are quarantining whole ships when a few -- or even a lot -- of passengers and crew test positive for COVID-19.

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

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

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

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

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

This is one of the biggest risks of taking a cruise right now, and one reason you may consider canceling a sailing scheduled in the short term (see the section on more-flexible cancellation policies below).

Most COVID-19 cases on ships aren't serious

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

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

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

You'll face lots of new health protocols

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

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

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

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

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

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

The CDC says to avoid cruising for now

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

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

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

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

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

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

If you're booked on a cruise in the coming weeks, and you're having second thoughts, there's a good chance you can get out of your trip. Many lines continue to be far more flexible than normal about cancellations.

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

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

That means you could call the line right now to back out of a cruise that is just days away. In normal times, you'd lose all your money if you backed out of a seven-night Norwegian cruise with fewer than 31 days' notice.

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A luxury cruise ship carrying as many as 300 positive Covid cases has docked in Sydney on Friday morning.

The Celebrity Eclipse moored at Circular Quay as the NSW government classified the vessel as a tier 2 Covid risk, signalling there were as many as 99 positive cases per 1000 people on-board.

The cruise ship, which was carrying about 3000 people, had just completed a trip to New Zealand, including stops to Christchurch and Dunedin.

All passengers aged 12 and over had to be fully vaccinated to sail, per the Covid protocols outlined on the Celebrity Cruises website.

Vaccination certificates had to be sighted at the departure point for passengers to be allowed to embark.

It comes a week after the Grand Princess docked in Melbourne, with dozens of Covid-infected passengers allowed to disembark.

A Princess Cruises spokesperson said last week the vessel had been impacted by a spike in cases across Australia.

“Like many other tourism operators, we too have been impacted by the current fourth wave being experienced across Australia,” the spokesperson said.

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

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

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

Please note: This report has been corrected .

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

What is already known about this topic?

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

What is added by this report?

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

What are the implications for public health practice?

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

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

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

Diamond Princess

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

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

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

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

Grand Princess

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

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

Additional Ships

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

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

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

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

Acknowledgments

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

CDC Cruise Ship Response Team

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

California Department of Public Health COVID-19 Team

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

Solano County COVID-19 Team

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

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

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

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

* Not including river cruises.

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

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

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

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

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

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

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

Abbreviation: N/A = not applicable.

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

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

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

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

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

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

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Here's what you can expect if you get COVID-19 on a cruise ship according to a Royal Caribbean passenger who was given the option to quarantine on the ship even after the cruise ended

• Numerous cruise ships have lifted their COVID-19 vaccine and masking requirements.
• If a passenger contracts the virus, cruise ships offer medical treatment and future cruise credits.
• The CDC advises travellers to stay in their cabin and notify the onboard medical team if they get COVID-19.

With travel restrictions easing, cruise ships lifting their COVID-19 vaccine and masking requirements, and some cruise ships that our own Insider reporters found quite crowded , it begs the question: What happens if you contract the virus during your time aboard the ship?

Insider spoke with Matt Hochberg who has been on hundreds of cruises and runs a website called RoyalCaribbeanBlog.com that shares travel tips and advice for those interested in booking a cruise. The website has no affiliation with the cruise line of the same name. 

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.

The US Centers for Disease Control and Prevention advises travelers to stay in their cabin and notify the onboard medical team if symptoms of the virus occur.

Hochberg told Insider that the treatment he received during his time on the ship was fantastic. In less than an hour, a medical team consisting of a doctor and nurse tested him again as well as his family who tested negative. 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. 

Because Hochberg became sick toward the end of his trip, he only had to isolate in his cabin for one day. Guest services provided him with numerous options for his disembarkment plan, including allowing him to stay on board and finish his quarantine until he tested negative. Hochberg decided to disembark where the ship was docked, in Vancouver, Canada, and drive his rental car back to the US.

While contracting COVID can happen anywhere, Hochberg's advice for those boarding a cruise is to be aware of the cruise line's policies and risks. 

Related stories

"It's important to understand what could possibly happen because I think ignorance is not an excuse for anything at this point," he told Insider. 

Medical attention and complimentary amenities on various cruise lines

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.

Royal Caribbean

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.

The company will also offer a pro-rated cruise fare refund if a cruise is cut short for reasons related to COVID-19, for cruises departing on or before September 30, 2022.

On October 21, Princess cruise line updated its COVID policy to welcome all guests, regardless of vaccination status. Anyone presenting symptoms of the virus during their time on board will be tested and reviewed by the company's medical staff.

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. 

Celebrity cruises offer rapid testing and on-site medical teams. 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.

Future cruise credits

Most cruise lines offer future cruise credits if a passenger gets sick with COVID-19, but Hochberg said that process has been challenging. Since his trip in June, he's only partially received his refund. 

Despite getting the virus, he characterized his experience as positive. 

"If you get sick on a cruise, they're going to take care of you. The care that I received was complimentary," he said.

In July, The Centers for Disease Control and Prevention ended its  COVID-19 Program for Cruise Ships , putting the onus on cruise lines to create their own standards.

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 .  

Watch: This is what it takes to be a cruise ship performer

• Main content

More than 175 people fall ill in Celebrity Cruises norovirus outbreak

More than 175 people got sick with norovirus during a recent Celebrity Cruises’ sailing, the Centers for Disease Control and Prevention said.

The agency said 152 of the Celebrity Summit ship’s 2,144 passengers, as well as 25 crew members, reported being ill during its May 15 voyage, according to its website . Their main symptoms were diarrhea, vomiting, abdominal cramps and headache.

"The health and safety of our guests, crew and communities we visit are our top priority," a Celebrity spokesperson said in an emailed statement. "To maintain the highest levels of health onboard our ships, we implement rigorous safety and cleaning procedures, many far exceeding public health guidelines. Combined, these efforts allow us to maintain some of the lowest levels of community spread."

The cruise line and ship’s crew implemented heightened “cleaning and disinfection procedures according to the ship’s outbreak prevention and response plan,” notified guests and encouraged practicing good hand hygiene and reporting illness, according to the agency. They also provided reports of gastrointestinal illness cases to the CDC’s Vessel Sanitation Program twice a day during the outbreak investigation, among other steps.

Cruise ship medical facilities: What happens if you get sick or injured (or bitten by a monkey)

Cruise insurance: Should you buy it through a cruise line? Maybe not, experts say

The incident marks the third norovirus outbreak on Celebrity ships the CDC has posted this year. The line previously saw outbreaks on its Celebrity Equinox and Celebrity Constellation vessels in March. On Celebrity Equinox, 136 passengers and crew reported being ill, while 96 did so on Celebrity Constellation.

Gastrointestinal illness at sea plummeted during the COVID-19 pandemic, but cases have ticked up again as the industry has rebounded.

While norovirus is frequently associated with cruise ships, Ben Lopman, a professor of epidemiology at Emory University’s Rollins School of Public Health, told USA TODAY in February that those represent a "tiny minority of norovirus outbreaks.” The vast majority take place in health care settings like nursing homes, he said.

Nathan Diller is a consumer travel reporter for USA TODAY based in Nashville. You can reach him at [email protected].

clock This article was published more than  1 year ago

One side effect of cruise covid rules: Norovirus has plummeted

Outbreaks of the stomach bug have been far lower than in pre-pandemic years.

One apparent result of the measures cruise lines have taken against covid-19: Outbreaks of gastrointestinal illness have been far lower than in pre-pandemic years.

So far this year, cruise lines have reported two outbreaks of vomiting and diarrhea to the Centers for Disease Control and Prevention that affected 3 percent or more of passengers or crew. That’s part of the outbreak threshold that determines whether the agency discloses episodes to the public. Ships must have a foreign itinerary with U.S. ports and need to be carrying at least 100 people.

The two outbreaks, affecting a total of 113 people, took place on a Carnival Cruise Line ship in late May and a luxury Seabourn voyage from late April through May. Norovirus was the cause of the Carnival illnesses, the CDC said on its site dedicated to updates about gastrointestinal illness on cruise ships; the Seabourn cause was unknown.

Last year, when cruise lines gradually started sailing again after a pause of more than a year, only one outbreak was reported. That one, caused by Vibrio and E. coli bacteria, hit 120 people on a Viking Ocean ship . Operators didn’t report any cases in 2020; the industry voluntary shut down in March of that year.

Three outbreaks in the course of more than a year is much lower than pre-pandemic numbers. In an email, the CDC said the decrease in the number of acute gastroenteritis outbreaks could “most likely be attributed” to the combination of fewer passengers on ships during that time and “nonpharmaceutical interventions used by cruise ships to mitigate COVID-19 transmission, such as increased cleaning and disinfection, increase in the number of hand sanitizer stations, crew served buffets, and physical distancing.”

Norovirus cases on land are also lower than normal. According to the CDC , the number of outbreaks reported by states during the 2021-2022 seasonal year (August to July) is lower than the range reported during the same time over the eight previous years.

The CDC’s Vessel Sanitation Program has worked with the industry to monitor gastrointestinal illness since 1975, after “an excessive number” of outbreaks. Although incidence rates of stomach illness on cruise ships dropped between 2006 and 2019, according to the CDC, pre-pandemic numbers were closer to 10 or 11 outbreaks a year. Between 2017 and 2019, cruise lines reported a total of 32 outbreaks that sickened 3,359 people. Norovirus — which the CDC says “can spread quickly in closed and semi-enclosed environments such as cruise ships” — was found to be a cause in 22 of those episodes.

That’s a small fraction of the number of cruise passengers during those years: More than 13.7 million cruise passengers took cruises from U.S. ports in 2019, according to the Cruise Lines International Association .

Welcome aboard, unvaccinated cruise passengers

William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, said that the reduced number of cruises as the industry restarted and the lower concentration of passengers — at least on many lines — would be likely factors in the lower number of outbreaks. But he said coronavirus precautions are “undoubtedly useful” to combating the spread of norovirus, too.

“The more rigorous we are with all of these hygienic measures, there’s spillover to other infectious agents,” he said.

Norovirus, he said, is “extraordinarily” contagious. Schaffner praised cruise lines for their disinfection practices even before the coronavirus emerged.

“Before that happened, the cruise industry under the guidance of the CDC put into place many infection-control activities that they really implemented rigorously,” he said.

Cruise lines have touted enhanced cleaning and sanitation protocols since the pandemic began. Royal Caribbean International, for example, says on its website that, although hand-sanitizing stations have always been on board, the line has increased the number by 75 percent.

“And we’re placing them anywhere you’re most likely to use them, near elevators and at exits and entrances to all venues, plus anywhere onboard that doesn’t have handwashing stations or restroom sinks in the immediate area,” the site says.

More cruise lines are dropping vaccine requirements

The company said it had enhanced its cleaning protocols, noting that areas that get high traffic, such as elevators, stairways, escalators and promenades, get cleaned every two hours, and gangway rails are cleaned every 20 to 30 minutes when the vicinity is busy.

Norwegian Cruise Line said it had implemented “comprehensive enhanced cleaning and sanitation protocols” and had a dedicated public health officer on all ships to “oversee the day-to-day sanitation and cleanliness of all public areas and accommodations.”

At least temporarily, some cruise lines got rid of self-service buffets in favor of having staff serve passengers at the food stations — though the old style has widely returned, according to the cruise news site Cruise Critic.

The CDC says that norovirus is spread by direct contact or by sharing food or utensils with someone who is infected. Outbreaks can also result from food, water or surfaces that have been contaminated. Common settings include health-care facilities, restaurants, schools or child-care facilities, and cruise ships, the agency says, though it notes that ships account for only 1 percent of all norovirus outbreaks.

The virus can last on surfaces for days or weeks, according to the CDC.

“Norovirus can be especially challenging to control on cruise ships because of the close living quarters, shared dining areas, and rapid turnover of passengers,” the CDC says on its website . “When the ship docks, norovirus can be brought on board in contaminated food or water or by passengers who were infected while ashore.”

More cruise news

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.

Royal Caribbean shares huge onboard health and safety news

W hen you go to a hotel or a theme park and get infected with a virus, you don't know exactly what happened. Maybe you caught the virus at the airport, in a rest stop, on an airplane, or even at your hotel or in a restaurant.

That's generally because by the time you get sick, you're no longer at the place where you got infected. Cruise ships, however, lack the same plausible deniability, and historically viruses spread quickly on ships.

Related: Royal Caribbean bets big on new ships, private destinations

On a seven-day cruise, you might actually have picked up an illness at the supermarket or at work, but when you get sick on the ship, people blame the cruise line. When someone falls ill, cruise lines don't actually care where they got infected. They simply want to slow down the spread of the disease.

That has always been the case, but the Covid pandemic and the Centers for Disease Control (CDC) shutting down the cruise industry from the U.S. for over a year put shipboard illness under a bigger microscope. For months, the federal agency reported on onboard Covid levels and did little to share all of the steps the major cruise lines had taken to mitigate outbreaks.

Now, with Covid becoming less of a concern, Royal Caribbean has shared some big news about its efforts to control another virus, norovirus, which spreads quickly on ships. 

Royal Caribbean has made ships safer

"Norovirus is a very contagious virus that causes vomiting and diarrhea. Anyone can get infected and sick with norovirus. Norovirus is sometimes called the 'stomach flu' or 'stomach bug.' However, norovirus illness is not related to the flu, which is caused by influenza virus," according to the CDC.

The virus can cause problems on cruise ships, but it's actually a pretty rare occurrence.

"Norovirus is the most frequent (over 90%) cause of outbreaks of diarrheal disease on cruise ships and these outbreaks often get media attention, which is why some people call norovirus the 'cruise ship virus.' However, norovirus outbreaks on cruise ships account for only a small percentage (1%) of all reported norovirus outbreaks," the federal agency reported.

You are much more likely to get norovirus in a land-based restaurant or healthcare facility than on a cruise ship, but cruise outbreaks make for good stories and get widespread media attention.

Royal Caribbean began its Norovirus Eradication Campaign in 2023. It's a six-step program that has worked to stop outbreaks on its ships, the Royal Caribbean Blog reported.

Royal Caribbean's plan has worked

Royal Caribbean has enacted a comprehensive plan designed to contain norovirus and prevent its spread.

• Enhanced acute GI training for onboard medical teams and traveling doctors
• Increased doctor oversight of its Outbreak Prevention Plan, which covers requirements like hand washing, buffet oversight, and disinfectant mandates for all public areas aboard its ships.

Switching to PDI SaniCloth Prime hospital-grade disinfectant wipes, wipes certified to kill norovirus by the EPA.

New contactless tap technology, eliminating the need for crew to handle guest cards

Enhanced crew training on what to do when experiencing acute GI symptoms and how to avoid cross-contamination in food and beverage service areas

An update to Royal Caribbean's Safety & Quality Management system to stop self-service in buffets if the onboard norovirus rate exceeds 1.5%

"After the eradication campaign was implemented in June 2023, there was not a single norovirus outbreak onboard any Royal Caribbean International or Celebrity Cruise ship for the remainder of 2023," the report shared.

Celebrity Constellation, however, did have an outbreak in January 2024 that was listed on a CDC website, according to Royal Caribbean Blog.

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There's an Active E. Coli Outbreak Linked to Ground Beef Sold Nationwide—Here's What to Know

Check your refrigerator and freezer ASAP.

Emily Lachtrupp is a registered dietitian experienced in nutritional counseling, recipe analysis and meal plans. She's worked with clients who struggle with diabetes, weight loss, digestive issues and more. In her spare time, you can find her enjoying all that Vermont has to offer with her family and her dog, Winston.

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There’s a public health alert on ground beef products sold nationwide, according to the U.S Department of Agriculture’s Food Safety and Inspection Service (FSIS). This is due to an E. coli O157:H7 outbreak that has potentially contaminated the meat.

The complete list of at-risk products include ground beef patties as well as 5- and 10-pound beef chub (ground beef sold in vacuum-sealed rolls). There is no recall due to the meat being off the market and no longer available to purchase, however the ground beef products have a printed “Use/Freeze By” date of April 22, 2024. This means they can still be in consumer’s refrigerators or freezers, so check yours immediately for these potentially contaminated products.

If you have one of the affected products with the matching date and USDA inspection stamp of EST.960A, dispose of it immediately or return it to its place of purchase. E. coli O157:H7 can cause severe illness resulting in symptoms like diarrhea, abdominal cramping, dehydration and more. It can be deadly for those age 65 or older and for young children, so talk to your healthcare provider as soon as possible if you think you may have been exposed. 

Consumers with questions about the public health alert can contact Gina Adami, Greater Omaha Packing Co., Inc. Representative, at 402-575-4702 or via email at [email protected] .

U.S. Department of Agriculture's Food Safety and Inspection Service. FSIS Issues Public Health Alert for Ground Beef Products Due to Possible E. Coli O157:H7 Contamination

U.S. Department of Agriculture's Food Safety and Inspection Service. List of Products.

Centers for Disease Control and Prevention. E. coli (Escherichia coli) Questions and Answers.

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Christina Applegate Says She Wore Diapers After Contracting Virus from Tainted Salad

"I was so dizzy. I was so sick, I couldn't eat, I couldn't [do] anything," said Applegate about her experience

John Shearer/Getty

Christina Applegate is getting candid about how she ended up needing to wear diapers after contracting a virus from a tainted salad.

Applegate, 52, recalled the health experience in full detail in the latest installment of the MeSsy podcast , which she co-hosts with Jamie-Lynn Sigler .

In the episode "Can I Be Honest?," Applegate explained that her experience began after she contracted COVID-19 from a close friend who "dropped the ball and went to a bowling alley, and came home with the stuff."

The actress, who revealed she was diagnosed with multiple sclerosis (MS) in August 2021, said it turned into long-term COVID, causing her to develop a chest infection where her heart began to do "weird stuff where it speeds up all of a sudden."

Valerie Macon/AFP/Getty

She recalled "pissing out of my a-- for a few days to the point where I was so dizzy. I was so sick, I couldn't eat, I couldn't [do] anything." After doing a stool test, she was diagnosed with sapovirus, which is "responsible for both sporadic cases and occasional outbreaks of acute gastroenteritis," per the National Institutes of Health .

"It is when you ingest the fecal matter of someone else from your food," Applegate explained. "Someone else's poop went into my mouth and I ate it."

Applegate believes she got the virus from a takeout salad at a restaurant she's frequented for 15 years and expressed that she woke up "at three o'clock in the morning in a pool of s---."

"Didn't know it happened, and having MS at three o'clock in the morning and trying to change your sheets, it's not fun. But this brings me to my next point, which we can talk about: I'm wearing diapers," Applegate said.

Gilbert Flores/Variety via Getty

She noted that they are not "pretty" or "accessible," to which Sigler, 42, who revealed her MS diagnosis in January 2016 , agreed.

"So adult diapers are a blush pink usually. And they usually have some sort of bow or floral design along the pelvic area. And to be honest, Christina and I have talked about this, putting on an adult diaper, you're not gonna feel sexy," said Sigler. "You're never gonna slip one on and be like, 'I'm ready for my day.' It's something you gotta wear because your body is malfunctioning."

While Sigler didn't specify when she got the virus, the podcast noted while sharing a clip of the episode on Instagram that "parts of this episode were recorded in 2023."

Back in March, PEOPLE spoke with Applegate and Sigler, who teased the episode while explaining what their podcast is about .

Never miss a story — sign up for  PEOPLE's free daily newsletter  to stay up-to-date on the best of what PEOPLE has to offer, from juicy celebrity news to compelling human interest stories.

"It's not about the specific experience we're having. It's us facing something hard and it's about figuring out how to still push through," said Sigler. "I've never been more ... nervous isn't the word, but like a good anxious about any project I've ever put out more than this, because I care so deeply about it. We are sharing the deepest parts of ourselves."

When PEOPLE asked Applegate and Sigler what were some challenges of living with MS that others may not understand, Applegate replied, "Well, you pee... in your pants. Because you probably can’t get to the bathroom in time. So yeah, diapers."

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New Hampshire’s GOP Is Taking a Stand—Against the Polio Vaccine

The granite state could be the first to ditch polio and measles requirements for child care..

Julia Métraux

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Centers for Disease Control and Prevention

New Hampshire could soon beat Florida—known for its anti-vaccine Surgeon General —when it comes to loosening vaccine requirements. A first-in-the-nation bill that’s already passed New Hampshire’s state House, sponsored only by Republican legislators, would end the requirement for parents enrolling kids in child care to provide documentation of polio and measles vaccination. New Hampshire would be the only state in the US to have such a law, although many states allow religious exemptions to vaccine requirements. 

Currently, Republicans control  New Hampshire’s state House, Senate and governor’s office—but that isn’t a guarantee that the bill will be signed into law, with GOP Gov. Chris Sununu seemingly flip-flopping when it comes to disease control. Sununu did sign a bill in 2021 allowing people to use public places and services even if they did not receive the Covid-19 vaccine. But the next year, the governor vetoed a bill that would bar schools from implementing mask mandates. 

The polio vaccine, first offered in 1955, and the MMR shot, which treats the highly infectious measles, mumps, and rubella viruses, are two very crucial vaccines both in the US and internationally. Since the year 2000 alone, vaccines against measles are estimated to have saved over 55 million lives  around the world. 

The CDC recommends that kids get their first dose of MMR vaccine between 12 and 15 months of age, and a first dose of the polio vaccine at around two months old. All states currently require children to have at least started vaccination against measles and polio in order to enroll in child care, according to the nonprofit Immunize.org. A CDC report found that for the 2021-2022 school year, around 93 percent of children had received the MMR and polio vaccines by the time they entered kindergarten. That figure drops to less than 80 percent for both vaccines—the lowest rate in the country—in Alaska, where a measles outbreak could be devastating. 

Rises in anti-vaccine sentiments have largely been linked to concerns that vaccines cause health issues, like the debunked claim that the MMR vaccine leads to kids being autistic. What parents may want to keep in mind is that polio and measles themselves are disabling conditions: according to the World Health Organization , 1 in 200 polio infections leads to irreversible paralysis. Children who get measles can experience symptoms including swelling of the brain . Death is always a possibility, too. 

“Childhood vaccines have helped protect generations of Americans from potentially devastating vaccine-preventable diseases,” S. Wesley Long, a professor of pathology and genomic medicine at the Houston Methodist medical center, told Mother Jones . “Many of these diseases still exist around the world, and we rely on our collective immunity, often from childhood vaccines, to prevent these diseases from circulating in our population.”

The bill would strike language requiring that immunization records be submitted to child care agencies, but would keep those requirements for students enrolling in kindergarten through 12th grade. As of 2022, according to the nonprofit ChildCare Aware of America , there are some 700 licensed child care centers and homes in New Hampshire (which doesn’t require the Covid-19 vaccine for enrollment in child care, either, despite its efficiency in reducing both death rates and acute symptoms). 

Vaccine hesitancy is rising among parents of young children. A 2023 survey from the Pew Research Center found that around half of parents with kids four or younger thought that not all standard childhood vaccines—a list that also includes hepatitis B, rotavirus, DTaP and chickenpox—may be necessary. Anti-vaccine misinformation plays a role in this phenomenon, which began before the Covid-19 pandemic, but has certainly increased since. In a 2019 UK report , about 50 percent of parents of young kids encountered false information about vaccines on social media. 

While it’s nice when a beloved celebrity makes a comeback, comebacks of the very infectious measles and polio epidemics are less welcome. As New Hampshire’s state epidemiologist, Dr. Benjamin Chan, said during a state Senate hearing on the bill, “as vaccination levels decrease, this is putting our children and our communities and our childcare agencies at risk.”

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Biden administration announces new partnership with 50 countries to stifle future pandemics

President Joe Biden listens as he meets with Iraq’s Prime Minister Shia al-Sudani in the Oval Office of the White House, Monday, April 15, 2024, in Washington. (AP Photo/Alex Brandon)

President Joe Biden speaks as he meets with Iraq’s Prime Minister Shia al-Sudani in the Oval Office of the White House, Monday, April 15, 2024, in Washington. (AP Photo/Alex Brandon)

President Joe Biden speaks during a meeting with Prime Minister Petr Fiala of the Czech Republic in the Oval Office at the White House, Monday, April 15, 2024. (AP Photo/Manuel Balce Ceneta)

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WASHINGTON (AP) — President Joe Biden’s administration will help 50 countries identify and respond to infectious diseases, with the goal of preventing pandemics like the COVID-19 outbreak that suddenly halted normal life around the globe in 2020.

U.S. government officials will offer support in the countries, most of them located in Africa and Asia , to develop better testing, surveillance, communication and preparedness for such outbreaks in those countries.

The strategy will help “prevent, detect and effectively respond to biological threats wherever they emerge,” Biden said in a statement Tuesday.

The Global Health Security Strategy, the president said, aims to protect people worldwide and “will make the United States stronger, safer, and healthier than ever before at this critical moment.”

The announcement about the strategy comes as countries have struggled to meet a worldwide accord on responses to future pandemics. Four years after the coronavirus pandemic, prospects of a pandemic treaty signed by all 194 of the World Health Organization’s members are flailing.

Talks for the treaty are ongoing, with a final text expected to be agreed upon next month in Geneva. It’s meant to be a legally binding treaty that obliges countries to monitor pandemic threats and share scientific findings. But major disputes have emerged over vaccine equity and transferring the technology used to make vaccines.

Even if a deal is hammered out, there would be few consequences for countries that choose not to abide by the treaty.

The U.S. will push on with its global health strategy to prevent future pandemics, regardless of a pandemic treaty or not, a senior administration official told reporters on Monday.

Several U.S. government agencies — including the State Department, the Centers for Disease Control and Prevention, Health and Human Services and the U.S. Agency for International Development, or USAID — will help countries refine their infectious disease response.

Health systems around the globe have been overwhelmed with COVID-19 and other health emergencies such as Ebola, malaria and mpox, the CDC said in a statement. The new strategy will help countries rebuild their agencies, the U.S. agency explained.

“Global health security is national security, and CDC is proud to contribute its expertise, investments and rapid response to protect the health and safety of the American people and the world,” Mandy Cohen, the CDC’s director, said in a statement.

Congo is one country where work has already begun. The U.S. government is helping Congo with its response to an mpox virus outbreak , including with immunizations. Mpox, a virus that’s in the same family as the one that causes smallpox, creates painful skin lesions. The World Health Organization declared mpox a global emergency in 2022, and there have been more than 91,000 cases spanning across 100 countries to date.

The White House on Tuesday released a website with the names of the countries that are participating in the program. Biden officials are seeking to get 100 countries signed onto the program by the end of the year.

The U.S. has devoted billions of dollars, including money raised from private donations, to the effort. Biden, a Democrat, is asking for $1.2 billion for global health safety efforts in his yearly budget proposal to Congress.

Associated Press writer Maria Cheng in London contributed.

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