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Majestic Princess: cruise ship passengers disembark in Sydney after mass Covid outbreak

Covid-positive passengers told to stay away from public transport after biggest single outbreak since Ruby Princess

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The Majestic Princess cruise ship – carrying about 800 Covid-19 positive passengers – has docked in Sydney and passengers have disembarked in the city.

The ship docked at Circular Quay early Saturday morning, having sailed from New Zealand. It will depart Sydney for Melbourne on Saturday afternoon.

The docking of the ship has raised the spectre of the arrival in Sydney of the Ruby Princess in March 2020 – early in Australia’s pandemic – which was ultimately linked to 28 deaths and more than 600 infections, sparking a NSW government special commission of inquiry and a class action case against the operator .

About 4,600 passengers and crew were aboard the Majestic Princess when it docked in Sydney early on Saturday.

Operator Princess Cruises said virus patients had been isolating and every passenger had been given a rapid antigen test in the 24 hours before arrival.

Guests who tested positive and chose to stay on the ship were required to isolate for at least five days.

While people with Covid are currently not required to isolate in Australian jurisdictions, it is recommended they stay home while unwell.

Marguerite Fitzgerald, who is president of the Majestic Princess’s parent company, Carnival Australia, said all cases were asymptomatic or mildly symptomatic and they had been warned to stay away from public transport.

“Much of this has been in planning for months,” she said. “We always knew that there was a risk that at some point we were going to see a surge in community transmission and that we would then see that on ship.”

Fitzgerald rejected comparisons between the current circumstances and the arrival of the Ruby Princess.

“That is nearly three years ago and, since then, we as a community have learned a lot, a lot more about Covid,” she said.

“We’ve learned what works to help mitigate transmission, we’ve learnt how to keep our vulnerable people safe and it is no different in the cruise industry.”

One passenger disembarking told the ABC the ship’s crew had handled the outbreak onboard carefully.

“It was scary because we heard about it, but of course we tested negative, and the Majestic Princess were really good with the protocols. [We] wore masks for these last seven days and we were very careful when we went ashore.”

The home affairs minister, Clare O’Neil, said NSW Health was the “lead agency for managing how they are going to assist the passengers and deal with disembarkation on a case-by-case basis”.

“I would say that there regular protocols and plays that have arisen out of the Ruby Princess,” O’Neil said.

NSW Health assessed the Covid risk level for the Majestic Princess as “Tier 3” which indicated a high level of transmission. Such “high impact” vessels have “a lot of cases on board (100 or more positive cases per 1,000 people) and/or the vessel is unable to maintain critical services due to staffing or resource shortages”.

The outbreak comes after a surge in case numbers across Australia over the past week – an anticipated “fourth wave” – prompting Queensland to ask residents to mask up in health facilities, indoors and on public transport.

• Australia news
• Coronavirus
• New South Wales

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clock This article was published more than  1 year ago

A cruise ship with 800 covid cases docks in Sydney

An earlier version of this story said the Ruby Princess cruise ship is owned by Carnival Cruise Line. The ship is owned by the Carnival Corporation. The story has been corrected.

A cruise ship carrying some 800 people who have tested positive for the coronavirus docked in downtown Sydney on Saturday, triggering memories of a deadly ship-related outbreak in Australia’s largest city in the early, pre-vaccine days of the pandemic.

The Majestic Princess, which returned from New Zealand, is carrying more than 4,000 people, according to the Australian Broadcasting Corp (ABC). Princess Cruises, the cruise line, said in a statement that all guests onboard took a rapid antigen test within 24 hours of disembarking and that passengers who had tested positive would exit separately and not take public transport. Australia no longer requires people who have tested positive for the virus to isolate, though local authorities have issued guidance that covid patients onboard ships should isolate for five days after testing positive.

“Our onboard medical team will continue to support guests until they disembark,” Princess Cruises said in a statement. It did not respond to a question about whether customers who had tested positive could isolate onboard until they recovered, though the company said it would help guests access accommodation for isolation. The Majestic Princess was scheduled to soon sail to Melbourne, Australia’s second-largest city.

The health department of New South Wales, the state in which Sydney is located, said in a separate statement that patients had been isolating onboard. State authorities said that there was a “Tier 3” covid risk level aboard the Majestic Princess, indicating a “high level of transmission.”

Cruise ships have been a potent incubator for the coronavirus. In the United States, the Centers for Disease Control and Prevention monitored such ships for transmission at sea for about two years ; it also warned against cruise travel amid the omicron spike during last year’s holiday season. The CDC still recommends getting vaccinated and taking a coronavirus test before boarding a cruise ship.

In early 2020, Carnival Corporation’s Ruby Princess allowed thousands of passengers to disembark in Sydney, placing the cruise ship at the center of one of Australia’s largest covid outbreaks. At least 28 people died and 700 cases were linked to the ship, according to the ABC . Another Carnival ship, the Diamond Princess , also logged 12 Covid-related fatalities earlier that year, including the first Australian national to die of the virus.

But the country has since lifted coronavirus restrictions on international travel: Proof of vaccination or a negative coronavirus test are no longer required for entry, and mask-wearing on international flights is encouraged but not mandatory, according to Australia’s Department of Health and Aged Care.

The absence of restrictions is a far cry from how Australia first handled the pandemic. Sydney, the commercial capital, enacted a 106-day lockdown in 2021, while Melbourne endured the world’s longest stay-at-home lockdown. Australia also closed its borders to nearly all international travelers for nearly two years , reopening in February. It deported tennis ace Novak Djokovic for being unvaccinated, preventing him from competing in this year’s Australian Open. The country has one of the lowest covid death rates in the Western world.

One side effect of cruise covid rules: Norovirus has plummeted

Australia’s reopening came after it achieved one of the world’s highest immunization rates. As of Nov. 9, nearly 96 percent of residents older than 16 have received two doses of a coronavirus vaccine . The country of 25.7 million people reported a seven-day rolling average of 12 deaths on Friday, or about half that of a month ago.

But New South Wales authorities said this week that the state had entered a new wave of the pandemic, and some medical experts fear that the upcoming holiday season will trigger a spike in infections that could challenge the hospital system in a country that has removed virtually all curbs on the virus.

“If the major public hospitals on the east coast aren’t overwhelmed with patients and facing staff shortages over the holiday break - I’ll donate $1000 to charity,” tweeted physician Steve Robson, president of the Australian Medical Association, in response to news of infections on board the Majestic Princess. (Most of Australia’s population lives on its east coast.)

Katerina Ang contributed to this report.

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Cruise Ship With 800 Covid-Positive Passengers And Crew Docked In Sydney

After cases soared, a cruise ship with 800 Covid-positive passengers docked in Sydney , Australia.The wave of infections spread around both passengers and crew members on a cruise ship sailing from New Zealand.

The Majestic Princess cruise ship was halfway through a 12- day voyage when the outbreak happened. Cases increasingly spread which led to mass Covid-19 testing for 3,300 passengers on board. Of these passengers, 800 tested positive alongside a few crew members.

According to CNN, the ship had 4,600 passengers and crew on board in total.

Related: Disney Cruise Line Presents Marvel Day At Sea

Cruise ship with 800 Covid-positive passengers docked in Sydney:

The uptick in cases has been linked to the rise of infections in Australia.

In a media briefing, Carnival Australia president Marguerite Fitzgerald told reporters that a large number of the cases were detected at least halfway into the voyage, adding that all cases were either asymptomatic or mildly symptomatic.

She also highlighted that all guests who tested positive will have help “with accessing private transport and accommodation to complete their isolation period”. Fitzgerald added that Carnival Australia maintains the most stringent of measures to keep all safe onboard, including requiring 95% of guests over the age of 12 to be vaccinated and testing staff and passengers for Covid before they board.

The incident is reminiscent of the outbreak on the ship Ruby Princess, which belongs to the same operator, earlier in the pandemic. When asked about the comparison, the BBC shares that Fitzgerald responded: “Since then, we as a community have learnt a lot, a lot more about Covid.”

According to reports, the Majestic Princess will soon depart for Melbourne.

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Cruise ship with 800 Covid cases docks in Sydney

• Published 12 November 2022
• Coronavirus

A holiday cruise ship carrying about 800 passengers with Covid-19 has docked in Sydney, Australia.

The Majestic Princess cruise ship arrived at Circular Quay, having sailed from New Zealand.

About 4,600 passengers and crew were aboard the ship when it docked - meaning around one in five had Covid.

The outbreak is reminiscent of the Ruby Princess cruise ship Covid outbreak of early 2020, where at least 900 people tested positive and 28 died.

Marguerite Fitzgerald, the president of cruise operator Carnival Australia, said a large number of cases started to be detected about halfway through the 12-day voyage.

All cases were either asymptomatic or mildly symptomatic, she said.

Staff would be assisting all guests who have tested positive "with accessing private transport and accommodation to complete their isolation period", she said. The ship will soon depart for Melbourne.

Asked about comparisons between the Majestic Princess and the Ruby Princess - which also belongs to the same operator - Ms Fitzgerald said: "Since then, we as a community have learnt a lot, a lot more about Covid."

The outbreak comes as Covid cases rise across Australia.

In New South Wales, 19,800 new cases were detected in the seven days to Friday.

Related Topics

• Cruise ships

More on this story

'Serious mistakes' made over cruise ship outbreak

• Published 17 August 2020

Cruise ship docks in Sydney after 800 people on board infected by COVID outbreak

• A cruise ship where 800 people on board have tested positive for COVID has docked in Sydney.
• The president of the cruise operator said cases began to rise halfway through the voyage. 
•  54,661 cases of COVID were reported across Australia in the last week. 

A cruise ship suffering a major COVID outbreak has docked in Sydney, Australia.

The BBC reports that approximately 4,600 passengers and crew were aboard the luxury Majestic Princess, and 800 people were affected by the outbreak of the viral bug. 

President of the cruise operator Carnival Australia Marguerite Fitzgerald told ABC Australia that they began seeing many cases halfway through the 12-day cruise around New Zealand, with all cases either asymptomatic or mildly symptomatic. 

Related stories

She told the news outlet, "Reflective of the increase in community transmissions, we too have seen more guests test positive for COVID-19 on the current voyage of Majestic Princess. This is a result of mass testing of our 3,300 guests."

She added that staff would be assisting all COVID-positive guests "with accessing private transport and accommodation to complete their isolation period," according to ABC. 

One passenger told ABC, per The Guardian: "It was scary because we heard about it, but of course, we tested negative, and the Majestic Princess were really good with the protocols. [We] wore masks for these last seven days, and we were very careful when we went ashore."

Carnival Australia did not immediately respond to Insider's request for comment. 

COVID cases are spiking across Australia, with 54,661 cases reported across the country in the last week, said The Guardian.

According to Reuters , Australian authorities have been working to assure the public that this ship outbreak is under control. Home Affairs Minister Clare O'Neil said that authorities had created "regular protocols" since the March-April 2020 Ruby Princess outbreak when hundreds caught COVID-19-linked an Australian cruise around the coast of New Zealand, and 28 people died.

O'Neil told Reuters that the authorities are determining how to get passengers off the Majestic Princess "on a case-by-case basis."

The ship will soon depart for Melbourne, Australia.

Watch: The rise and fall of the cruise industry

• Main content

Hundreds of COVID-positive passengers disembarked cruise ship in Sydney

Around 800 people were infected on board the majestic princess..

The Majestic Princess cruise ship docked in Sydney with about 800 COVID-19 positive people aboard before heading to Melbourne and then Tasmania. Source: AAP / DEAN LEWINS/AAPIMAGE

• About 800 passengers were infected with COVID-19 on board the Majestic Princess.
• NSW Health says the COVID risk level for the ship is Tier 3, indicating a high level of transmission.
• At least 580 positive cases disembarked from the ship in Sydney.

Queensland is re-introducing COVID-19 rules amid a surge in cases. Will other states follow?

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'poor communication upset us', covid-positive passengers told to isolate, nsw health says covid risk level is high.

Ruby Princess inquiry slams 'inexplicable' and 'unjustifiable' decisions by NSW Health

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More Than 800 Passengers Got COVID On A Cruise Ship, Which Then Let People Off In Australia

The cases are all mild or asymptomatic.

BuzzFeed News Reporter

The Majestic Princess cruise ship docked at the International Terminal at Circular Quay in Sydney on Nov. 12, 2022.

Passengers on a cruise ship where more than 800 people tested positive for COVID-19 disembarked on Saturday in Sydney.

The Majestic Princess returned from a 12-day voyage to New Zealand carrying more than 4,000 people, according to the Australian Broadcasting Corp . That means 20% of the people on board got COVID.

Marguerite Fitzgerald, the president of the ship’s cruise operator Carnival Australia, said at a Saturday press conference that cases started to rise about halfway through the trip. She also said that all cases were mild or asymptomatic.

A spokesperson for the ship’s cruise line, Princess Cruises, said in a statement that all guests on board took rapid antigen tests within 24 hours of disembarking. Those who tested positive were told to exit separately from others and to avoid public transportation. Cruise line staff were also helping people who were positive find accommodations to continue isolating, Princess Cruises Senior Vice President Stuart Allison said in a statement to Australian outlet 9 News .

The Majestic Princess prepares to depart from Sydney in November 2022.

In an additional statement to CNN , Fitzgerald said the cruise operator has been implementing “the most rigorous and strict measures which go well above current guidelines,” including testing staff and passengers for COVID before they board and requiring 95% of guests over the age of 12 to be vaccinated. She said that Carnival Australia ships have made more than 50 voyages, “with a vast majority of more than 100,000 guests unimpacted by COVID.”

“However, the emergence of COVID in the community has meant we have seen a rise in positive cases on the last three voyages,” she added.

The Majestic Princess has since continued on to Melbourne, carrying 220 people from the original New Zealand cruise, SBS News reported . That means at least 580 people who got COVID on the ship disembarked in Sydney.

The Majestic Princess docked in Sydney

After Australia closed its borders for two years, tourism is back in the country, and neither proof of vaccination nor a negative COVID test is required to enter. The country also no longer requires people with positive COVID tests to isolate, but local authorities in New South Wales advised individuals who test positive to isolate for five days after. These relaxed guidelines serve as a sharp contrast with Australia's once-intense COVID regulations .

Carnival cruise ships have been incubators for COVID in the past. In March 2020, the Ruby Princess allowed thousands of passengers to disembark in Sydney. At least 700 cases were linked to the ship, and at least 28 people died, according to the ABC . There were 12 COVID-related fatalities later that year linked to the Diamond Princess .

“Didn’t… didn’t we already do this?” one Twitter user wrote in response to the news about the 800 COVID cases on the Majestic Princess .

Other users are raising questions about how safe it is to cruise while the pandemic is ongoing, even if vaccines provide protection against severe illness.

The Twindenberg @jonkudelka I didn’t understand why anyone would pay to go on a cruise ship before covid but seriously how much would you have to hate yourself to do it now? 12:33 AM - 12 Nov 2022 Reply Retweet Favorite

The Cockatoo @DarcyAmaroo Back to square one. That’s how it started. A cruise ship docking with hundreds of cases of Covid on board. Why would you go on a crowded cruise ship with Covid still spreading through the population? 08:32 PM - 11 Nov 2022 Reply Retweet Favorite

covid is not over @twee_i_a I get it, I really do. The need 2 get back to a "normal life" is absolutely critical for all of us. But we are going to have to realize that for ALL of us to have any hope of doing that, many of us are going to have to change the way we go about things. Cruises are not necessary. 07:26 PM - 11 Nov 2022 Reply Retweet Favorite

MelissaD 🔥💧🐨🌱💓🌍 😷 @D_Melissa2 If cruise ships are going to have 800+ Covid-19 🦠 + cases of people disembarking from them we really need to talk about responsibilities to the community. 11:12 PM - 11 Nov 2022 Reply Retweet Favorite

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A cruise ship with around 800 cases of Covid-19 on board has docked in Sydney on Saturday morning just as the state declares a fourth wave of the virus.

The Majestic Princess pulled into Sydney’s international cruise ship passenger terminal at Circular Quay at around 6am on Saturday.

Video posted to social media captured the moment it pulled into the harbour with passengers clinging to their balcony.

Almost one in four guests on board have now been diagnosed with Covid-19 after a 12-day trip around New Zealand.

Passengers Stephen and Sharon Leslie said while they felt safe onboard the cruise, they were disappointed another outbreak had occurred.

“It’s just disappointing for the cruise industry … and towards the end it did spoil things a bit,” Mrs Leslie told the Daily Telegraph.

Danielle Whitney-Smart was forced to spend the last few days of her first-cruise experience stuck in her cabin.

“It was great but definitely strange by the end,” Ms Smart told the Daily Telegraph.

She said she “couldn’t fault” the cruise company who ramped up cleaning protocols to manage the spread of rising cases.

Ambulance crews were standing by at the overseas passenger terminal as people prepared to disembark the ship.

A Princess Cruises spokesperson confirmed the outbreak and said positive cases were isolating in their rooms this morning.

“These guests are mildly symptomatic or asymptomatic and are isolating in their staterooms. All unimpacted guests are wearing masks and this will continue when they disembark in Sydney on 12 November,” the spokesperson said in a statement.

“Reflective of the increase in community transmission, we too have seen more guests test positive for Covid-19 on the current voyage of Majestic Princess.”

The #MajesticPrincess is pulling into Sydney Harbour right now. May it not be a giant superspreader in this stunning city. pic.twitter.com/LWXIv0JvyJ — David Wild (@Wildaboutmusic) November 11, 2022

The outbreak is the single biggest case of cruise ship infections in Australia since the Ruby Princess docked in 2020.

There were 900 covid cases on board that ship and 28 people died during the subsequent outbreak.

NSW Health is liaising with the cruise operator in the wake of the outbreak to “monitor the health of its passengers and crew members”.

“NSW Health’s assessment is that the Covid-19 risk level for the Majestic Princess is now Tier 3, which indicates a high level of transmission,” a spokesman said in a statement.

Private transport has been arranged for guests who have tested positive to travel to isolation.

“Carnival has advised NSW Health that passengers disembarking from the ship have undertaken a rapid antigen test in the 24 hours leading up to disembarkation,” a NSW Health spokesman said.

“Carnival has advised NSW Health that they are assisting passengers with Covid-19 to make safe onward travel arrangements.”

There are currently 4600 people on-board the Majestic Princess – 3300 guests and 1300 crew.

The outbreak comes as its announced that NSW has entered a fourth wave of Covid-19, with chief health officer Dr Kerry Chant saying that current omicron variants circulating in the community are able to escape immunity.

“The wave is taking off with some trajectory, it will be quite a steep wave and hopefully the decline will be equally as steep,” she told ABC.

“That’s why it’s important the community takes these protective measures now and I can’t stress the urgency — if you’re going to get vaccinated do it immediately.”

NSW Health has issued a measles alert for people in specific Western Sydney locations.

McDonald’s stores across Sri Lanka shut on Sunday after the fast-food giant launched a legal battle with its local franchise holder over allegations of poor hygiene.

Travellers have been warned to protect themselves from a potentially fatal disease in a tourist hotspot.

• Australia News

Hundreds of COVID-19 positive passengers disembark Majestic Princess after cruise ship docks in Sydney

Carnival Australia president Marguerite Fitzgerald confirmed 800 COVID cases had been recorded onboard the Majestic Princess, and the majority of infections were among passengers. 

Hundreds of COVID-19 positive travellers are disembarking a cruise ship docked in Sydney this morning, with passengers advised not to catch public transport home. 

The Majestic Princess carried 3,300 guests and 1,300 crew on a 12-day cruise to New Zealand, with at least 20 per cent of passengers contracting COVID-19.

Speaking in Circular Quay where the vessel docked on Saturday morning, Carnival Australia president Marguerite Fitzgerald confirmed 800 COVID cases had been recorded, and the majority of infections were among passengers. 

“We have been proactively preparing for and managing incidences of COVID-19 and working with NSW Health,” she told reporters.

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“We started to see elevated cases about half way through this voyage.”

Ms Fitzgerald said most infected guests had mild symptoms or were asymptomatic and had been isolating in their cabins. 

Passengers who tested negative for the virus were allowed to disembark the cruise ship first, those who tested positive exited on a deck-by-deck basis through a separate door. 

Ms Fitzgerald said COVID positive passengers were advised not to use public transport when they disembark. 

“To help all our guests return home, we are working with all guests who have tested positive for COVID-19 to assist them with accessing private transport and accommodation to complete their isolation period,” she said.

“As they are getting off, they have advised how they will be returning home.”

NSW Health on Friday night ranked the Majestic Princess as a tier three COVID risk level, which indicates a high level of transmission.

All guests onboard were advised to wear masks and were required to take a rapid antigen test in the last 24 hours to determine how they would disembark.

Uninfected guests disembarking the Majestic Princess on Saturday morning told the Daily Telegraph they were satisfied with the precautions taken by the cruise line. 

“We felt safe most of the time … they were cleaning the whole time,” passenger Sharon Leslie told the publication.

Sharon Kluger said the cruise line kept passengers informed as the outbreak worsened. 

“We weren’t worried about COVID, we were just doing our own thing and wearing our masks,” she said.

It comes as Chief Health Officer Kerry Chant warned New South Wales had entered its fourth COVID-19 wave. 

There are currently 974 COVID-19 patients in NSW hospitals including 32 in ICU, while this week cases jumped from 12,450 to 19,800.

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Cruise ship Majestic Princess with hundreds of COVID-infected passengers docks in Sydney

Health authorities are working with the operators of the Majestic Princess cruise ship that has docked in Sydney Harbour with hundreds of people infected with COVID on board. 

Key points:

• NSW Health says the cruise ship is at a Tier 3 warning, the highest possible COVID alert
• Cruise operator Carnival says about 800 people are infected with the virus
• All passengers will do a rapid antigen test before disembarking

New South Wales Health has confirmed the cruise ship is at the highest COVID alert possible for those on board with a Tier Three warning.

That means at least 20 per cent of people who were on board for the cruise have COVID.

The ship has more than 3,000 passengers and 1,000 crew, with several hundred believed to be infected.

Many passengers disembarked from the ship on Saturday after testing negative to the virus.

The president of cruise operator Carnival Australia, Marguerite Fitzgerald, said there were about 800 people infected, who were mostly passengers.

"This is a 12-day voyage and we started to see elevated cases about halfway through," she said.

Ms Fitzgerald said the infected guests are mild or asymptomatic, and have been isolating in their rooms.

"Reflective of the increase in community transmissions, we too have seen more guests test positive for COVID-19 on the current voyage of Majestic Princess. This is a result of mass testing of our 3,300 guests," she said. 

The company said it had been proactively preparing for COVID-19 incidents and was working closely with NSW Health. 

It comes as the state sees a sharp spike in the number of COVID cases.

Chief Health Officer Kerry Chant on Friday warned NSW had entered its fourth COVID-19 wave , with 19,800 cases detected in the seven days to 4pm on Thursday.

It was a jump of 7,350 cases on the week before, when 12,450 cases were detected in NSW.

NSW Health said in a statement that all COVID-positive people onboard were isolating and being cared for by the staff medical team.

"NSW Health's assessment is that the COVID-19 risk level for the Majestic Princess is now Tier 3, which indicates a high level of transmission," it said in the statement.

"Carnival has advised NSW Health that they are assisting passengers with COVID-19 to make safe onward travel arrangements."

One man leaving the ship said he thought the cruise operator had done a good job with protocols, but passengers were not listening to instructions.

"It was scary because we heard about it [the infections] but we tested negative, and the Princess Majestic were really good with the protocols," he said.

"We wore masks for the last seven days and we were very careful when we went ashore, so some people don't just listen. Obviously they didn't [follow the rules] and that was the problem, people just don't take COVID seriously."

Another passenger praised the crew and said the cruise was enjoyable.

"Fantastic, no problems. The crew were terrific, and we've had a great time," he said.

"You've got to accept that this is how it's going to be, and no we thoroughly enjoyed it."

Carnival said all positive cases would be separated from other guests when they disembark the ship.

"We understand this current wave of COVID-19 is concerning to many in the community and we take our responsibility in keeping everyone safe very seriously," it said in a statement.

"All guests disembarking have undertaken a rapid antigen test in the past 24 hours, which will determine how they will disembark the ship.

"All guests will be masked, regardless of COVID status."

The Opposition said while the situation was delicate it would not be calling for restrictions.

"No, I'm not calling for that [restrictions], I think that the advice from Kerry Chant [NSW Health Chief Officer] this morning was wise," leader Chris Minns said.

"Let's manage this situation using the expert advice and expertise of our chief health officer ... I've got confidence in them to navigate through a tricky situation." 

• X (formerly Twitter)

Related Stories

Nsw enters 'fourth wave' of covid-19 pandemic with sharp rise in new cases.

The latest COVID case numbers may not be completely reliable – but they do give us an important insight

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.

Planning a cruise? Start with these stories:

• A beginners guide to picking a cruise line
• The 5 most desirable cabin locations on any cruise ship
• The 8 worst cabin locations on any cruise ship
• A quick guide to the most popular cruise lines
• 21 tips and tricks that will make your cruise go smoothly
• 15 ways cruisers waste money
• What to pack for your first cruise

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• v.69(12); 2020 Mar 27

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

Leah f. moriarty, mateusz m. plucinski, barbara j. marston, ekaterina v. kurbatova, barbara knust, erin l. murray, nicki pesik, david fitter, miwako kobayashi, mitsuru toda, paul t. canty, tara scheuer, eric s. halsey, nicole j. cohen, lauren stockman, debra a. wadford, alexandra m. medley, joanna j. regan, kara tardivel, stefanie white, clive brown, christina morales, cynthia yen, beth wittry, amy freeland, sara naramore, ryan t. novak, david daigle, michelle weinberg, anna acosta, carolyn herzig, bryan k kapella, kathleen r. jacobson, katherine lamba, atsuyoshi ishizumi, john sarisky, erik svendsen, tricia blocher, christine wu, julia charles, riley wagner, andrea stewart, paul s. mead, elizabeth kurylo, stefanie campbell, rachel murray, paul weidle, martin cetron, cindy r. friedman, casey barton behravesh, william bower, catherine bozio, zachary braden, mary catherine bertulfo, kevin chatham-stephens, victoria chu, barbara cooper, kathleen dooling, christine dubray, emily curren, margaret a. honein, kathryn ivey, jefferson jones, melissa kadzik, nancy knight, mariel marlow, audrey mccolloch, robert mcdonald, andrew klevos, sarah poser, robin a. rinker, troy ritter, luis rodriguez, matthew ryan, zachary schneider, caitlin shockey, jill shugart, margaret silver, paul w. smith, farrell tobolowsky, aimee treffiletti, megan wallace, jonathan yoder, pennan barry.

California Department of Public Health

Ricardo Berumen, III

Brooke bregman, kevin campos, rosie glenn-finer, hugo guevara, jill hacker, kristina hsieh, mary kate morris, ryan murphy, jennifer f. myers, tasha padilla, chao-yang pan, adam readhead, estela saguar, maria salas, robert e. snyder.

California Department of Public Health.

Meileen Acosta

Solano County Department of Public Health

Beatrix Kapuszinsky

Bela matyas, glen miller, asundep ntui, jayleen richards.

Solano County Department of Public Health.

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. § , ¶

Abbreviation: N/A = not applicable.

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).

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/ .

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

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).

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

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.

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; field teams at repatriation sites; National Institute of Infectious Diseases, Japan.

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 .

§§ 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.

Contributor Information

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.

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.

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.

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

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

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

Please note: This report has been corrected .

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

What is already known about this topic?

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

What is added by this report?

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

What are the implications for public health practice?

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

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

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

Diamond Princess

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

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

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

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

Grand Princess

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

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

Additional Ships

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

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

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

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

Acknowledgments

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

CDC Cruise Ship Response Team

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

California Department of Public Health COVID-19 Team

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

Solano County COVID-19 Team

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

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

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

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

* Not including river cruises.

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

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

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

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

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

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

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

Abbreviation: N/A = not applicable.

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

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

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

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

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

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James D. Morgan/Getty

A cruise ship carrying nearly 5,000 passengers was forced to dock in Sydney on Friday after about 800 people tested positive for COVID-19, according to the BBC. The Majestic Princess left New Zealand when, halfway through its 12-day voyage, guests began to fall ill. The cases are mainly asymptomatic or mildly symptomatic, according to the BBC. The ship’s operator, Carnival Australia, would work with its guests to find them private lodging to complete their isolation periods, a spokesperson said. Carnival Australia oversaw the COVID disaster that was the Ruby Princess, which saw hundreds fall ill in 2020 with COVID and led to 28 deaths. Asked about the two incidents, the spokesperson said: “Since then, we as a community have learnt a lot, a lot more about COVID.”

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Cruise Ship, Floating Symbol of America’s Fear of Coronavirus, Docks in Oakland

After days awaiting clearance to come ashore, the Grand Princess arrived in the San Francisco Bay with 21 confirmed coronavirus cases on board, and possibly more.

Cruise Ship With Infected Passengers Docks in Oakland

The grand princess, carrying at least 21 passengers with the coronavirus, passed through the golden gate bridge and docked at the port of oakland on monday..

Passengers: “Whoooo!” “We’re home!” “So the people that already tested positive will go ashore first, as well as people that are showing symptoms. Then the Californians, which is our group. ... We’re not going to be released. We’re going to be released to the state and federal health departments where we’re transported to an air force base and then we begin our 14-day quarantine.” “Thank you!” “Oakland rocks!” [ship’s horn blowing] “Oakland rocks!”

By Thomas Fuller ,  John Eligon and Jenny Gross

OAKLAND, Calif. — The Grand Princess, the cruise ship stranded for days on the high seas off California, sailed into the Port of Oakland on Monday, met by workers in protective gear who marshaled a large-scale quarantine operation for 21 people on board infected with the coronavirus , along with the thousands of other passengers and crew members.

For a harbor with a storied history of shipbuilding during the Second World War, this was a moment of humility in the San Francisco Bay. The ship came over the past week to symbolize both the nation’s fear of the disease and the conflicting political signals that have governed the response.

“We are so relieved,” said Cookie Clark, a retired realtor whose vacation to Hawaii ended on live television as the cruise ship steaming under the Golden Gate Bridge was broadcast around the world. “Floating around was so stressful.”

On a sun-soaked morning, Ms. Clark and her husband joined other passengers on their balconies, waving toward shore as two large tugboats helped guide the vessel through the narrow shipping lane that runs past Alcatraz Island and the skyscrapers of downtown San Francisco. A harbor pilot who had boarded the vessel wearing biologic protective gear navigated the boat at high tide through the bay.

In recent days, as the cruise ship turned in circles 10 miles off the coast of San Francisco, its more than 2,400 passengers have followed the tension and public squabbling over their fate.

President Trump said last week that he would prefer the ship dock elsewhere because it would otherwise increase the number of coronavirus cases in the United States. And on Friday, before anyone on the ship was notified, passengers learned from watching Vice President Mike Pence on live television that people on board had tested positive for the virus.

At a news conference at the White House on Monday, Mr. Trump and Mr. Pence sought to reassure the country. “We are going to handle it and we have been handling it very well,” Mr. Trump said.

“It’s not our country’s fault,” the president added. “This was something we were thrown into.”

Of the cruise ship, Mr. Pence said the 21 people confirmed with the virus had been taken from the ship and put in “proper isolation.”

The transfer of passengers was to continue through Monday and Tuesday and would be done in “very, very carefully controlled environments,” he said.

With only 45 people on board tested so far, the number of infections seemed very likely to rise.

Some residents of Oakland have expressed resentment that their city had been chosen for the ship to dock. The Grand Princess was originally scheduled to arrive at the cruise ship terminal in wealthier San Francisco across the Bay.

“I think it’s a total disgrace to my family, to all the taxpayers, to the rest of the people who don’t have a voice,” said Michael Green, 38, riding a bicycle through his West Oakland community.

Mr. Green said he was not sold on the authorities’ assurances that they were whisking passengers from the cruise ship away to quarantine on military bases.

“All it takes is one to escape,” he said.

Yet even as the authorities promised ample precautions for the new arrivals, the virus was already well established in the San Francisco Bay Area, a hot spot in the United States.

Health officials in Santa Clara County, in the heart of Silicon Valley, reported the county’s first death from the virus on Monday. San Francisco reported five new cases, bringing the total in the city to 13. And in Southern California, the number of confirmed infections increased to 16, with two new cases announced.

Gov. Gavin Newsom said on Sunday that he expected the number of reported cases to rise as testing became widely available.

He said Oakland had been chosen for the cruise ship’s disembarkation because it was logistically convenient, near the Oakland airport, where foreign passengers will depart on charter flights home. It is also about one hour away from Travis Air Force Base, where many of the passengers were scheduled to be taken on Monday for a 14-day quarantine.

Most of the California residents on the ship, who make up about 40 percent of the passengers, will be sent to Travis, where evacuees from Wuhan, China, the origin of the outbreak, were quarantined last month . Other Californians will be sent to a base outside San Diego.

Residents of other states would most likely complete their mandatory quarantine at Joint Base San Antonio-Lackland in Texas or Dobbins Air Reserve Base in Georgia, the Defense Department said.

The authorities said it could take two to three days to offload all the passengers from the ship.

Passengers began disembarking into an 11-acre containment area on Monday, where they were being triaged. Those showing signs of acute illness were to be brought to medical facilities.

The spread of the virus aboard the ship is another blow for the cruise industry after last month’s debacle of the Diamond Princess in Japan. The cruise liner quarantined in the port of Yokohama became a case study in how quickly coronavirus can spread aboard a ship and the difficulties of conducting an onboard quarantine. More than 700 people who were on the ship became infected, and eight people died.

The spread of infection on both ships also raises questions about the health and safety of crew members, many of whom hail from poorer countries. While all passengers on the Grand Princess will disembark, most of the crew members will remain on the ship, which will leave the San Francisco Bay within around three days, Mr. Pence said on Monday.

“The remaining people on the ship — the crew itself — will push off from the dock and they will be quarantined and observed and treated shipboard,” Mr. Pence said.

Grant Tarling, the chief medical officer of the company, said over the weekend that the company believed that the virus was brought aboard the Grand Princess by a passenger on a previous cruise . Dr. Tarling said he believed that the passenger infected crew members, spreading coronavirus more widely in the ship.

“We believe his illness was community acquired in California before he joined the ship,” Dr. Tarling said of the passenger, who had boarded his cruise on Feb. 11 and disembarked Feb. 21. He was from Placer County in California.

The company made the assessment judging by the date that the patient had fallen ill, around two or three days after boarding the ship, Dr. Tarling said.

One of the crew members who tested positive for the virus on Friday was the waiter who had served the ill passenger for the entire cruise. Two of the passenger’s travel companions also tested positive.

Denise Stoneham, a passenger on the Grand Princess, was relieved when she heard the ship would be docking at the Port of Oakland on Monday. But, as she scrolled through social media, Mrs. Stoneham, a code enforcement officer from Novato, Calif., became more distressed. People in Oakland were posting that they did not want the ship to dock there.

“It just makes me angry that people are putting a label on us,” said Mrs. Stoneham, 52. “We’re human beings, we want to come home. We’re not an infestation that’s coming to their city.”

As passengers passed their final hours on board before the planned start of disembarkation, some replayed in their minds the interactions they had with crew members who may have been infected by the coronavirus.

On Michele Smith’s first night on the cruise, on Feb. 21, an old friend, one of the Grand Princess crew members, came up her to her and her husband and gave them a big hug and kiss and shook their hands.

They snapped a photo with the crew member, named Amado, and every night over the next week, would give him a hug and a kiss.

“They probably don’t get many hugs on the cruise, and people need love,” Mrs. Smith said. “I just wanted to let him know we cared about him.”

A week later, on Tuesday, Amado was not in the dining hall. When Mr. and Mrs. Smith asked other servers what had happened to him, one looked hesitant and then said he thought it was Amado’s night off. Another said Amado had come down with allergies.

“That was my first ‘uh-oh,’” Mrs. Smith, 57, said. “How do you get allergies in the middle of the ocean?” That was the last time they saw Amado.

On Friday night, Mr. and Mrs. Smith, sitting on the bed in their room, learned from television news that 19 of the 21 people who had tested positive for coronavirus were crew members. Mrs. Smith said she felt sick with worry — her stomach hurt, her chest hurt.

“Now it gets crazy. Now it gets real,” Mr. Smith said.

“Up until now, it didn’t feel real,” his wife added. “You just think, no, it can’t be us.”

Thomas Fuller and John Eligon reported from Oakland, and Jenny Gross from New York. Sonner Kehrt contributed reporting from Berkeley, Calif.

Thomas Fuller is the San Francisco bureau chief. He has spent the past two decades in postings abroad for The Times and the International Herald Tribune in Europe and, most recently, in Southeast Asia. More about Thomas Fuller

John Eligon is a Kansas City-based national correspondent covering race. He previously worked as a reporter in Sports and Metro, and his work has taken him to Nelson Mandela's funeral in South Africa and the Winter Olympics in Turin. More about John Eligon

Jenny Gross is a reporter in London. Before joining The Times, she covered British politics for the The Wall Street Journal.  More about Jenny Gross

Come Sail Away

Love them or hate them, cruises can provide a unique perspective on travel..

 Cruise Ship Surprises: Here are five unexpected features on ships , some of which you hopefully won’t discover on your own.

 Icon of the Seas: Our reporter joined thousands of passengers on the inaugural sailing of Royal Caribbean’s Icon of the Seas . The most surprising thing she found? Some actual peace and quiet .

Th ree-Year Cruise, Unraveled:  The Life at Sea cruise was supposed to be the ultimate bucket-list experience : 382 port calls over 1,095 days. Here’s why  those who signed up are seeking fraud charges  instead.

TikTok’s Favorite New ‘Reality Show’:  People on social media have turned the unwitting passengers of a nine-month world cruise  into  “cast members”  overnight.

Dipping Their Toes: Younger generations of travelers are venturing onto ships for the first time . Many are saving money.

Cult Cruisers: These devoted cruise fanatics, most of them retirees, have one main goal: to almost never touch dry land .

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Thousands on virus-hit cruise ship await disembarkation in California

• By Associated Press
• March 8, 2020

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Video by Washington Post

The Grand Princess is expected to arrive at the Port of Oakland after days of uncertainty, the ship's captain reminded passengers that the wait would continue for many on board. There are more than 3,500 passengers and crew aboard the ship, which has been lingering off the California coast since late last week.

ASSOCIATED PRESS

Passenger aboard the Grand Princess celebrate as they arrive in Oakland, Calif., today. The cruise ship, which had maintained a holding pattern off the coast for days, is carrying multiple people who tested positive for COVID-19, a disease caused by the new coronavirus.

The Grand Princess cruise ship passed beneath the Golden Gate Bridge in this view from Sausalito, Calif., today. The cruise ship carrying over a dozen people infected with the coronavirus passed under the bridge as federal and state officials in California prepared to receive thousands of people on the ship that has been idling off the coast of San Francisco.

Carrying multiple people who have tested positive for COVID-19, the Grand Princess maintained a holding pattern about 30 miles off the coast of San Francisco, Sunday. Federal and state officials in California prepared to receive thousands of people today from a cruise ship that has been idling off the coast of San Francisco with at least 21 people aboard infected with the coronavirus.

Carrying multiple people who have tested positive for COVID-19, the Grand Princess maintains a holding pattern about 30 miles off the coast of San Francisco today.

OAKLAND, Calif. >> Thousands of passengers aboard a cruise ship struck by the novel coronavirus waited anxiously Tuesday for their chance to leave the vessel, even if meant being shipped to military bases for weeks of quarantine.

After days of being forced to idle off the Northern California coast, the Grand Princess docked Monday at the Port of Oakland with some 3,500 passengers and crew on board.

“Everyone was hollering and clapping” as the giant vessel sailed under the Golden Gate Bridge and entered the harbor, passenger Karen Schwartz Dever said.

About two dozen people who need acute medical care were taken off the ship, although it wasn’t clear how many had tested positive for the new virus, COVID-19, said Brian Ferguson, a spokesman for the California Office of Emergency Services.

Many of the nearly 240 Canadians on board left the ship after the critically ill and stood outside two tents displaying Canadian flags. Canada and the UK were among the countries sending chartered flights to retrieve their citizens.

But some 2,000 passengers, including hundreds of Californians, were still aboard by the time disembarkation ended Monday night. It was to resume Tuesday morning, the captain told passengers.

Carolyn Wright, 63, of Santa Fe, New Mexico, could look out of her cabin window as passengers lined up. Around them, she noted, were people in yellow protective clothing, gloves and even a few hazardous materials suits.

For days, passengers aboard the ship had been isolated in their cabins. When they were finally allowed a few minutes on deck, she said, they were warned to wear masks and try to stay 6 feet away from each other.

But after docking, video showed long lines forming for the processing tents. Ambulances were on hand to take some passengers away.

“They were cueing up the passengers like cattle,” Wright said. “Everybody was bunched up. They were physically touching each other and they were backed up along the gangplank.” Then, she said, they were taken away in chartered buses.

“I’m just totally freaked out by that,” said Wright. “It’s outrageous. If that’s safe, then why were we stuck in our rooms? It’s been stressed for the past five days that we’re not to have any contact with any other passengers?”

“We’re trying to stay calm and were trying to stay positive but it’s getting harder and harder. They can’t make up their minds how to keep us safe,” said Wright’s cabin mate, Beryl Ward, 77, of Santa Fe.

“The president didn’t even want us to get off the ship. So that didn’t make me happy,” she added. “Wish you were here, Mr. Trump!”

On Sunday, before the ship docked, Dr. John Redd of the U.S. Department of Health and Human Services had urged passengers to remain in their rooms and said: “We’re making every effort to get them off the ship as safely and quickly as possible.”

He called the elaborate but quickly planned disembarkation process a “really unprecedented and difficult operation.”

The Grand Princess had been held off the coast since Wednesday because of evidence that it was the breeding ground for more than 20 infections tied to a previous voyage.

U.S. passengers will be flown or bused from the port — chosen for its proximity to an airport and a military base — to bases in California, Texas and Georgia for testing and a 14-day quarantine. Some arrived Monday night at Travis Air Force Base in Northern California. The ship carried people from 54 countries, and foreigners were to be whisked home.

But Wright and others said nobody had been told the details. Only about 50 people had been tested for the virus.

“I’m willing to be quarantined,” Wright said. “‘But I want to know if I’m positive or not. We don’t even know if we’re going to get tested. It’s all rumor and speculation.”

“I’m bored and frustrated,” she added. “All of a sudden a two-week vacation has turned into a five-week vacation.” Passengers need to worry about who is looking after their children or pets, not to mention preparing their taxes before the deadline and earning a living. A professional photographer, she was looking at five weeks without earning a salary.

About 1,100 crew members, 19 of whom have tested positive for COVID-19, will be quarantined and treated aboard the ship, which will dock elsewhere after passengers are unloaded, California Gov. Gavin Newsom has said.

The California governor and Oakland mayor sought to reassure people that none of the cruise ship passengers would be exposed to the public before completing the quarantine. Officials were trying to decide where the ship and its crew would go next.

Cruise ships have come under scrutiny by those who view them as potential germ factories because they pack thousands of people in close quarters.

Another Princess ship, the Diamond Princess, was quarantined for two weeks in Yokohama, Japan, last month because of the virus. Ultimately, about 700 of the 3,700 people aboard became infected in what experts pronounced a public health failure.

A third vessel, the Caribbean Princess, was supposed to dock in Grand Cayman on Monday but the cruise line said it will keep its thousands of passengers and crews from disembarking until crew members are tested for COVID-19.

Around the world, nations have limited the movements of millions of people in an effort to stop the spread of COVID-19. Italy was to impose travel restrictions and other strict public health measures nationwide starting Tuesday.

In Northern California, Santa Clara County announced a ban of all large gatherings of at least 1,000 people for the rest of the month in response to the coronavirus outbreak. The announcement Monday came hours after the public health department announced the county’s first coronavirus death, a woman in her 60s.

The virus has shaken global markets, with stocks taking their worst one-day beating on Wall Street since 2008 and oil prices suffering their most brutal losses since the start of the 1991 Gulf War. Even with Asian markets posting modest gains Tuesday, fear was rampant that economies stood at the brink of recession.

For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

According to the World Health Organization, people with mild illness recover in about two weeks, while those with more severe illness may take three to six weeks to recover. In mainland China, where the virus first exploded, more than 80,000 people have been diagnosed and more than 58,000 have so far recovered.

The virus has infected 600 people in the United States, and at least 26 have died, most in Washington state. Surgeon General Jerome Adams said communities will need to start thinking about canceling large gatherings, closing schools and letting more employees work from home, as many companies have done after an outbreak in the Seattle area.

Pearl Jam on Monday announced it was postponing 17 North American shows on its upcoming tour over coronavirus concerns.

In Silicon Valley, NASA’s Ames Research Center is essentially closed with restricted access because an employee tested positive Sunday for the coronavirus. Workers will be on “mandatory telework status” and three earth science airplane missions are being delayed to later this year, the county said.

Several universities have begun online-only courses, including the University of Washington, Stanford University and Columbia University.

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Elderly man who recently traveled to Washington state becomes Hawaii’s second coronavirus case

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Are cruises safe? Here’s what you need to know about cruise ship security and safety

I f you've watched the news at any point over the past several years, it's likely you've seen disturbing stories about cruise ship norovirus or COVID-19 outbreaks and passengers "falling" overboard. Combine that with reports of sexual assault and fistfights, and it's no surprise you might be wondering whether cruise ships are safe.

Here, I'll address some prospective passengers' biggest concerns and offer tips and advice on cruise ship safety so you can maintain peace of mind on your voyage.

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

Are cruise ships safe?

Let's cut right to the chase: Yes, cruise ships are generally safe as long as you use common sense and remember that vessels are not impervious to accidents, illness or people who just don't know how to behave. As with any place you might live or visit ashore, there are risks, but those risks can be mitigated if you keep a few simple tenets top of mind.

The key thing to recognize is that you should maintain the same level of awareness, self-control and vigilance as you would anywhere else. When you're in your hometown, would you invite a complete stranger into your bedroom, leave your wallet unattended in plain sight or allow your very young child to run around unsupervised? If the answer is no, you shouldn't be doing those things on a cruise ship, either. (And if the answer is yes, I have questions.)

Although you have power over the above, sometimes circumstances are beyond your control. Perhaps the weather is bad, or something mechanical goes wrong with the vessel. Cruise ships are equipped with advanced navigational equipment to avoid storms, and engine room contingencies allow onboard operations to continue, even if the ship's speed or propulsion is affected.

Ships also employ entire onboard teams of engineers and mechanics who are able to fix problems on the spot, as well as crew members trained to fight fires. The bridge — the ship's main control center — is constantly in touch with shoreside teams who provide additional assistance.

With that, here's a bit more advice on how to make your sailing safer, followed by answers to some of your most burning safety-related queries.

Cruise safety tips

Cruise ship safety measures are in place on every vessel in every major cruise line's fleet. However, there are some extra tips you can follow to stay safe on a cruise.

• Pay attention during the muster drill. Muster drills are a pain, and nobody likes them. However, they tell you what to do in case of an emergency, so it behooves you to pay attention. The information offered during them — including where your muster station is and how to properly don a life jacket — could end up saving your life.
• Keep a close eye on your keycard. Treat it the same as you'd treat a credit card or your keys. It grants access to your cabin and also serves as your onboard charge card for purchases. If you lose it, report it to guest services immediately so they can deactivate the old one and issue you a replacement.
• Lock up your valuables. Keep your jewelry, passports, wallets, electronics and other important items locked in your cabin safe when you aren't using them, and don't leave them lying unattended in public areas.
• Don't invite strangers to your cabin. Don't tell them your cabin number or otherwise divulge sensitive personal information. If you're cruising by yourself, also use caution when telling people you're alone.
• Supervise your children. Allowing young children to roam the ship alone without an adult or member of the youth club staff is not only potentially unsafe but also can be an annoyance to other passengers.
• Avoid drinking so much alcohol that you lose your wits. It could lead to slipping and falling or cause you to engage in unsafe behaviors, such as entering crew areas or climbing on railings. It also could make you more susceptible to theft or assault. Plus, hangovers can really put a damper on the next day's fun.
• Steer clear of crew-only areas, and never stand on furniture or climb anywhere you aren't supposed to be. Restricted areas are restricted for a reason, and entering them can result in injury or death.
• Don't assume everyone on your sailing is trustworthy. Simply being on the same ship doesn't mean your fellow passengers are on the up and up. Most are, but some might not be. Treat strangers with the same level of scrutiny as you would in any other environment.

Are there police on cruise ships?

Do cruise ships have police? Is there security on cruise ships? Again, the answer is yes. Cruise ship police officers are more like security guards, many of whom serve as law enforcement officers or members of the military in their countries of residence when they aren't working on board.

Cruise security guards have the authority to break up fights and mitigate passenger hostility, drunkenness and other inappropriate behavior. They also have the authority to place rowdy, violent or otherwise dangerous passengers in the ship's jail, known as a brig .

Serious rule violations could warrant cruisers' removal from the ship at the next port of call and notification of authorities. However, maritime law is dicey and often unclear when it comes to which country has jurisdiction over crimes that happen in international waters.

Will I get sick on a cruise?

Getting sick on a cruise is a possibility, as it is anywhere you go. However, ships are held to high cleanliness standards that are dictated and monitored by the U.S. Centers for Disease Control and Prevention via the Vessel Sanitation Program, which was implemented in the 1970s.

The VSP requires all passenger ships that carry more than 13 people to submit to random, unannounced inspections if they wish to visit ports in the U.S. The requirements are rigorous, and any score lower than 86 out of 100 is considered failing. (Scores and lists of infractions for all ships can be found on the VSP website .)

Prior to the COVID-19 pandemic, the biggest health threat on ships was norovirus , which manifests as a highly contagious gastrointestinal illness that's easily spread through food contamination and surface contact in close quarters.

After the coronavirus shut down the industry, cruise lines further strengthened their protocols to include safeguards against airborne pathogens. They included social distancing and mask-wearing requirements , as well as the enhancement of air filtration systems. Other measures included contact tracing protocols, mandatory vaccination requirements and the expansion of onboard medical facilities and staff.

Many of the COVID-19-related policies — including requirements for mask-wearing and mandatory vaccination — have been relaxed, but the lines are able to reinstate them quickly if needed.

In addition to following cruise ship wellness policies, there are other ways you can minimize your chances of becoming ill when you sail. The best way to avoid both catching and transmitting germs is to wash your hands, particularly before eating and after using the restroom or coming in contact with high-touch surfaces like handrails and elevator buttons.

Hand sanitizer is plentiful on ships, too; while it's great for use between trips to the sink, it shouldn't be a substitute for thorough and frequent hand-washing. Additionally, when you cough or sneeze, do so into your upper arm or the crook of your elbow.

With regard to seasickness , toss a couple of remedies into your bag when you're packing. Tried-and-true options include Dramamine or Bonine pills, acupressure bands, ginger candies and behind-the-ear patches. In a pinch, seek out a green apple or ginger ale from the buffet or room service.

Also make sure you're getting plenty of rest, staying hydrated, wearing sunscreen with an appropriate SPF and knowing your limits when it comes to alcohol.

Above all, if you're feeling ill before embarkation, don't cruise. Take advantage of your travel insurance 's cancel for any reason coverage (if that's included in your particular policy) to get your money back and avoid spreading sickness to others.

Can you fall off a cruise ship?

Yes, it's possible to fall off a cruise ship , but it doesn't happen without effort. To help ensure passenger safety, cruise vessels' cabin balconies and outdoor decks have railings that are roughly chest height on an average-size person. Thick metal or Plexiglas panels or metal bars are positioned under the railings to prevent people from slipping through. Even so, it's important to keep a close watch on young children at all times.

Most people who go overboard fall because they were inebriated, entered a restricted area or engaged in behavior they shouldn't have — such as standing on railings or furniture or climbing between balconies — or a combination thereof.

It's not possible for someone to slip on a wet deck or trip over a door frame and simply fall off a cruise ship.

Do cruise ships have enough lifeboats?

Yes, they do. Following the sinking of the Titanic, which didn't have enough lifeboats for everyone, the international maritime community developed Safety of Life at Sea standards. Under SOLAS, passenger ships are now required to carry enough lifeboats for all passengers. They are outfitted with navigation and communications equipment and basic necessities required for survival until help arrives.

Additionally, ships are required to hold muster drills for all cruisers prior to the start of each voyage, even for passengers who have cruised before. During the drills, guests learn what to do and where to report in the event of an emergency. They also learn what the emergency signal sounds like and how to put on a life jacket. (Ships must also carry enough life jackets for everyone, including specially designed ones for children and pets.)

Do cruise ships have doctors?

Yes, all big mainstream oceangoing cruise ships have trained medical staff on board, usually a combination of doctors and nurses. Many cruise lines increased the number of medical professionals on their ships following the onset of COVID-19.

Cruise ship medical centers are equipped to perform basic stabilization in the event of accidents, illness and other emergencies. They are not full hospitals, though, which means beds are limited, and they lack more complex treatment capabilities. They are designed to keep passengers stabilized and comfortable until they can be sent to a nearby land-based hospital.

They can, however, treat things like seasickness, cuts and bruises and other minor ailments without the need to offload passengers. They are also now equipped to conduct COVID-19 testing and isolation, and ventilators are on hand in the event that any serious cases arise.

Note that because they are never far from land-based medical care, most river cruise vessels do not have onboard medical staff. Additionally, medical care can be expensive on cruise ships that do offer it. It's generally not covered by regular health insurance, so always purchase a travel insurance policy.

Bottom line

So, are cruises dangerous? The answer is, generally, no. They're safe if you follow the same common-sense practices you'd use anywhere else. It's easy to let your guard down when you're having a great time on vacation, but remember: Cruise ships are like floating cities, which means they aren't immune to potential dangers.

Cruise ship safety is the responsibility of both the cruise line and individual passengers. Make sure to exercise an appropriate level of vigilance by protecting your valuables, refraining from inviting strangers to your cabin or giving out too much personal information, paying attention to muster drills, frequently washing your hands, keeping an eye on your children, staying out of restricted areas and knowing your limits when it comes to alcohol consumption.

Have more cruise questions? TPG has answers:

• Packing for a cruise? These items aren't allowed on board
• Man overboard: Cruise ship overboards and how they happen
• What is baked Alaska, and why is it paraded around cruise ships?
• What are the largest cruise ships in the world?
• Gentlemen hosts: These men cruise to make sure single ladies have a great time
• What is the Jones Act and how does it impact cruise ships?
• What is a lido deck on a cruise ship?
• What's a cruise cabin guarantee and will it save you money?
• What's the difference between a cruise ship concierge and a butler?

Editorial disclaimer: Opinions expressed here are the author’s alone, not those of any bank, credit card issuer, airline or hotel chain, and have not been reviewed, approved or otherwise endorsed by any of these entities.

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Coronavirus

Covid-19 live updates: santa clara co. reports 1st omicron case.

SAN FRANCISCO (KGO) -- A surge in coronavirus cases has been reported in the Bay Area and across California as well as the country due in part to the emergence of the highly-contagious delta variant .

The latest number of confirmed cases in the U.S. can be found at the CDC's 2019 Novel Coronavirus in the U.S. page. (The CDC updates the webpage on Monday, Wednesday and Friday.)

Join anchor Kristen Sze for ABC7's daily, interactive newscast about the coronavirus outbreak in the Bay Area and around the world. You can check here to stream the show Monday-Friday at 3 p.m.

• MAPS: Check out the latest maps of COVID-19 cases, deaths in the US, world
• CORONAVIRUS IN CA: Get resources and information about COVID-19
• LATEST LOCAL CASES: Updated number of COVID-19 cases, deaths in San Francisco Bay Area
• CORONAVIRUS TIMELINE: Tracking major moments of COVID-19 pandemic in San Francisco Bay Area

Here are the latest developments on the respiratory illness in the Bay Area:

Dec. 10, 2021

11 a.m. Health officials give update on 1st omicron case in Santa Clara Co.

Santa Clara County health officials say the person who contracted the omicron variant was exposed in Florida. The person noticed symptoms on Nov. 30 and was tested on Dec. 1. The person was vaccinated but not boosted and had "very mild" illness, according to Santa Clara Co. Health Director Dr. Sara Cody.

Health officials say they are doing waste water surveillance where they found the omicron variant in a sewer shed that serves 200,0000 people in the north part of the county.

8:40 a.m. Santa Clara Co. reports 1st omicron case

Santa Clara County is reporting its first case of omicron. The person is in isolation and was fully vaccinated but had not received a booster; they had recently returned from domestic travel out of state.

Dec. 8, 2021

Free COVID-19 testing, vaccination clinic in Oakland closes due to staffing, vaccine shortages

A free COVID-19 testing and vaccination clinic in downtown Oakland has abruptly closed its doors, city officials announced Wednesday. The clinic at 250 Frank Ogawa Plaza, near City Hall, was scheduled to stay open until at least the end of December. But a shortage of vaccine and of staff forced it to close, according to city officials. City officials said a clinic in the Fruitvale area is open and supplying boosters, vaccinations, and testing for free. The clinic is located at 3411 E. 12th St., Suite 130. It is open from 9 a.m. to 5 p.m. seven days a week.

Fauci: Omicron 'almost certainly' not more severe than delta

Dr. Anthony Fauci said that the omicron variant is "almost certainly" not more severe than delta. He stressed, however, that it is important to not overinterpret early data, as the patients being followed skew younger and are less likely to become hospitalized. Severe illness can take weeks to develop.

Dec. 7, 2021

12 pm. Chase Center updates COVID policy for kids

Children ages 5 to 11 now have to provide proof of vaccination or a negative COVID test prior to entry at the Chase Center in San Francisco. The test must be taken no more than 72 hours before the start of the event.

Dec. 6, 2021

12 pm. SAP Center updates COVID policy

The SAP Center in San Jose will now require proof of vaccination or a negative COVID test (within 72 hours of the event) for any guests ages 3-11 starting Thur. Dec. 9.

6:15 a.m. NYC mandating vaccines for all private sector employees

Mayor Bill de Blasio announced a COVID vaccine mandate for all private-sector employers in New York City. The mandate is set to begin on December 27. The mayor called it a proactive, "First in the nation measure." In addition, de Blasio said there will also be required vaccine proof for indoor dining, fitness, and entertainment for children 5 to 11.

5 a.m. 17 people test positive for COVID-19 on cruise ship in New Orleans

At least 17 people aboard a Norwegian Cruise Lines ship docked in New Orleans have tested positive for COVID-19, officials said. The cases were found among both passengers and crew members on the Norwegian Breakaway cruise ship. A probable case of the omicron variant was also identified among a member of the crew, who is not a Louisiana resident and did not leave the ship, according to the Louisiana Department of Health.

Dec. 3, 2021

6:00 p.m. 5 cases of omicron variant identified in Alameda Co.

Alameda County health officials announced Friday evening that they have identified five cases of the omicron variant, all individuals are vaccinated, and most had received boosters. Officials say the cases are linked to a Nov. 27 wedding in Wisconsin which one of these individuals attended upon return from international travel.

5:20 a.m. Hawaii latest state to confirm omicron case

Hawaii became the fifth state to detect the omicron variant, after confirming a case through expedited genomic sequencing, health officials said. The individual is an unvaccinated resident of Oahu who had a previous COVID-19 infection, the state health department said. The person is experiencing "moderate symptoms," the department said. The resident has no recent travel history, indicating that this is a case of community transmission, health officials said.

Dec. 2, 2021

Mask mandate on public transportation extended through March 18

Required masks on public transportation, including airplanes, rails and buses, will be extended through March 18, according to a new plan from the Biden administration.

Dec. 1, 2021

1st US case of Omicron variant reported in San Francisco

The first case of the Omicron variant in the United States is reported in San Francisco, city health officials said on Wednesday.

The city's health department confirmed that the infected person returned from South Africa on November 22, and is a San Francisco resident.

The patient had mild symptoms.

This is the first known case detected nationwide.

Omicron has been named a "variant of concern" and the CDC has been monitoring for it since before Thanksgiving.

Pfizer requests FDA authorization to expand booster eligibility

Pfizer has officially requested Food and Drug Administration authorization of its COVID-19 booster for 16- and 17-year-olds, the company's CEO said.

Nov. 30, 2021

Global case count of omicron variant tops 200

More than 200 confirmed cases of the omicron variant, first identified in Southern Africa, have been reported in over a dozen countries around the world, according to an open-source tracker run by Newsnodes and BNO News.

Nov. 29, 2021

US imposes travel ban from South Africa, 7 other countries

Starting today, the U.S. will impose a new travel ban from South Africa and seven other countries. Israel has also banned foreign travelers from entering the country for two weeks. But the International Air Transport Association has warned against travel bans. It says these restrictions are "not a long-term solution" when it comes to managing variants. Health officials say anyone who has traveled through southern Africa in the last 14 days should get a COVID test and quarantine until they get a negative test result.

Nov. 26, 2021

11 a.m. US to restrict travel from South Africa, 7 other countries Monday

The Biden administration announced the U.S. will be restricting travel from South Africa and seven other countries starting Monday in response to the new Omicron variant. These other countries include Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique, and Malawi.

WHO names new variant 'omicron,' classifies it as highly transmissible virus of concern

A World Health Organization panel named the variant "omicron" and classified it as a highly transmissible virus of concern, the same category that includes the delta variant, the world's most prevalent. The panel said early evidence suggests an increased risk of reinfection. Get more details here .

7:15 a.m. 1st European case of new variant from South Africa confirmed

Belgium's health department has confirmed its first case of the new B.1.1.529 variant. The patient, a woman, had traveled to Belgium from Egypt via Istanbul. She developed symptoms 11 days after her return and was not vaccinated. Her family members have tested negative for COVID and the woman is not in a life-threatening condition, officials said.

Nov. 25, 2021

8 a.m. Bay Area testing sites see increase ahead of Thanksgiving

COVID testing sites around the Bay Area have been pretty busy leading up to Thanksgiving. Test site organizers at the Santa Clara County fairgrounds say the line has picked up after a plateau in recent weeks. Everyone ABC7 News spoke with, including a number of college students, say they just want to do the right thing before seeing family.

6 a.m. Judge orders vaccine mandate for CA prison employees

A federal judge has ordered California prison employees to be fully vaccinated against the coronavirus by Jan. 12, potentially reducing the number of COVID-19 cases among young and adult inmates. Inside the state's four youth correctional institutions, a total of 255 youth and 278 staff members have contracted the virus since the onset of the pandemic, even as the number of incarcerated youth dwindles at the state level.

Plus, a federal report found that half of the outbreaks in California's state prisons between May and July were traced back to employees. The order comes after months of uncertainty as the California Correctional Peace Officers Association and Gov. Gavin Newsom requested a postponement of a vaccination mandate for prison staff.

Nov. 23, 2021

Pediatric COVID cases rise for 3rd week

The U.S. has reported an increase in pediatric COVID-19 cases for the third week in a row. Nearly 142,000 children tested positive in the last week, which is a 16% increase from the week prior and a 41% jump over the last three weeks, according to a new report from the American Academy of Pediatrics and the Children's Hospital Association. Nearly 6.8 million children have tested positive for COVID-19 since the pandemic began.

Nov. 22, 2021

Newsom gives update on boosters while visiting Bay Area vaccine clinic

Gov. Gavin Newsom is in the Bay Area on Monday, where he discussed the importance of boosters during an event held at a vaccine clinic.

Indoor mask mandate in effect in Santa Cruz Co.

An indoor mask mandate is now in effect in Santa Cruz County and it covers private settings like a home. If you are getting together with others who don't live in the same household the county says you should mask up regardless of vaccination status. Businesses are also required to follow the guidelines. You can take off your mask when eating or drinking.

Nov. 19, 2021

Apple sets Feb. 1 deadline for employees to return to office

Apple has a new deadline of February 1 for employees to return to the office. Many will have to come in at least three days a week, but some workers will have to be in the office four to five days a week. The company will offer some teams up to four weeks of remote work each year. Vaccinations aren't mandatory, but unvaccinated workers will have to test every day.

Nov. 18, 2021

Oakland Unified hosting a vaccine clinic today

The Oakland Unified School District is hosting a vaccine clinic today. It will include a visit by the State Epidemiologist. The clinic runs from noon to 6 p.m. at Markham Elementary School. If you can't make it to that one -- you have options. The district says it's planning 21 vaccination pop-ups this week at elementary schools. It's also offering COVID testing and take-home tests during the week-long break.

Nov. 17, 2021

Alameda Co. releases vaccination data

Alameda County says it's continuing to ensure vaccinations are accessible to all. It announced that 81% of Latino residents and 74% of Black residents 12 years and older have received at least one dose of the COVID-19 vaccine. Latino and Black residents have lower vaccination rates than other races and ethnicities in the county, and are among the most disproportionately impacted.

Nov. 16, 2021

Pfizer agrees to let other companies make its COVID-19 pill

Pfizer has signed a deal with a U.N.-backed group to allow other manufacturers to make its experimental COVID-19 pill. The deal will provide equitable access to more than half the world's population living in 95 countries. The oral treatment is shown to reduce the risk of COVID-related hospitalizations and death by 89%. This agreement is similar to an agreement made by Merck last month.

Nov. 15, 2021

Dozens of inmates under quarantine after outbreak at Santa Cruz County Jail

A dozen inmates at the Santa Cruz County Main Jail tested positive for COVID-19 last week in what authorities say is the most significant outbreak at the lockup since the start of the pandemic. The cases came to light on Nov. 12 during routine testing using rapid tests, according to a release on Monday from Sheriff Jim Hart. The prisoners who tested positive are either asymptomatic or have mild symptoms, and have been quarantined. Another 35-40 inmates who were exposed have been quarantined as well, the sheriff said.

Israel to begin vaccinating younger children

Israel's Ministry of Health announced that children ages 5 to 11 would be eligible for vaccination against COVID-19. The decision follows an advisory panel's approval last week of the low-dose Pfizer-BioNTech vaccine for 5- to 11-year-olds.

Nov. 12, 2021

Sonoma Co. to hold vaccine clinics for kids

The Department of Health Services will host three COVID-19 vaccination clinics for children this afternoon in Sonoma County. A clinic at Healdsburg Fitch Mountain Elementary School starts at 3. Roseland Elementary in Santa Rosa will hold its clinic at 3:30. And Dunbar Elementary in Glen Ellen will open its doors starting at 4.

Nov. 11, 2021

Somoma Co. expands health order to include flu vaccinations

Sonoma County is expanding its county health order to include flu vaccinations. Workers at certain health care and congregate facilities will need to get their COVID and flu shots. County officials say flu shots are especially important this year to prevent hospitals from being overrun by both influenza and COVID-19 patients -- or the so-called "twindemic."

Nov. 10, 2021

Cases, hospitalizations climbing in Calif.

California is reversing course in the battle against COVID-19 with cases climbing once again. The state is up to 6,000 new cases per day and hospitalizations have jumped 4% in just two weeks. That's put the state back in the red category for high transmission. And experts say the next few months are critical because of the holidays for whether we'll see another winter surge.

Nov. 9, 2021

Grand Princess cruise ship returns to SF

The cruise ship that captured international attention during the earliest days of the pandemic returned to San Francisco. The Grand Princess was back in the city yesterday, for the first time since the cruise industry restarted sailings. One of the earliest major COVID outbreaks happened aboard this ship in March 2020. The ship was held off our coast for days as authorities scrambled to come up with a quarantine plan for the thousands of passengers on board.

Nov. 8, 2021

Viva Calle returns to San Jose

Viva Calle has returned to San Jose as part of a citywide program to get people outside to enjoy parks and outdoor spaces following COVID-19 closures. Several miles of San Jose streets were closed to cars yesterday.

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Cruises see a fair amount of overboard incidents: Are ships equipped?

Mental health crises can happen anywhere. But what happens if you're stuck in the middle of the ocean?

Between 2009 and 2019, there were 212 overboard incidents – when a guest or crew member goes over the edge of a ship – according to  statistics compiled for Cruise Lines International Association  by consulting firm G.P. Wild (International) Limited. "In discussions with cruise line representatives, they indicated that in every case where the cause of the (overboard) was established following a careful investigation it was found to be the result of an intentional or reckless act," the report said, noting that motives could not be determined in some cases.

There were also numerous reports of suspected suicides among crew trapped at sea during the COVID-19 pandemic. And while cruise lines have protocols and services in place to support to guests and crew members, some experts say they are lacking.

Cruise ships feature a range of amenities, from roller coasters and go-kart tracks to spas and dining, but passengers may not always know where to find mental health resources on board.

‘It’s really, really, really needed’

Cruise ships may be designed to prioritize fun and relaxation, but not everyone responds the same to that approach.

For some passengers, being around family members or away from their day-to-day routine can be stressful, said Dr. Tia Dole, Chief 988 Suicide & Crisis Lifeline Officer at Vibrant Emotional Health. “But for other people who might have been struggling with their mental health … going on a vacation actually takes you out of your environment, it makes you feel better,” she said.

The widespread presence of alcohol and gambling in onboard casinos may also prove challenging for some travelers, said Dr. Michelle Riba, a clinical professor at the University of Michigan Medical School's Department of Psychiatry and former president of the American Psychiatric Association.

"People have to be self-reflective and talk to their loved ones about how problematic it might be to be on a ship where there's easy access to that," she said.

And when it comes to the kinds of overboard incidents that appear in news reports with some frequency, she said jumping into the water has perhaps been featured prominently in films and TV shows, and cruises may provide another "access point" to impulsive suicides.

Travis Heggie, a professor at Bowling Green State University who studies tourist health and safety issues, said it's difficult to draw concrete comparisons, however, between rates at sea and on land due to a lack of comprehensive statistics. Riba added that it would be hard to compare the two, given varying demographics and other factors.

Still, suicide on cruise ships is a “growing concern” for Heggie, among both guests and crew. He has recommended adding mental health care to cruise ship infirmaries in his research .

“It’s really, really, really needed,” he said.

Dole also emphasized that “the reasons why people die by suicide are as unique as a fingerprint” and said it’s important not to generalize.

"The circumstances that lead up to completed suicide, and the things that sort of push people over the edge are incredibly unique," she said.

Do cruise ships have mental health resources?

If passengers find themselves in need of mental health support during a cruise, some lines do have resources available.

Passengers sailing with Carnival Corp., the parent company of brands including Carnival Cruise Line, Princess Cruises and Holland America Line, can contact onboard medical staff “who are available 24/7 for mental health support and other medical needs,” a spokesperson for the company said in an email.

“With a referral from the shipboard medical team, guests may also access tele-psychiatrist services for face-to-face consultations with these licensed specialists within 24 hours if needed,” the spokesperson added. The consultations are offered through a third-party company that connects passengers with U.S.-based psychiatrists (the company did not respond to USA TODAY’s request for comment).

While training in mental health care varies among onboard medical staff, they can “fulfill recommendations made by the psychiatrists.” There is a pharmacy on board with many medications used to treat mental health problems, and those not carried on the vessel can be ordered in a port.

Like other medical care, passengers have to pay for any costs associated with mental health services. “Travel insurance coverage varies by provider and typically covers acute-need services but usually includes limitations for pre-existing illnesses,” the spokesperson said. “We urge travelers to contact travel insurance providers directly for specific terms and conditions.”

Crew members can also see psychiatrists via telehealth with a referral from the onboard medical team. The company also has an employee assistance program that allows them to access free mental health services.

Royal Caribbean Group, another major cruise line operator, and Cruise Lines International Association, the industry’s leading trade group, did not answer questions regarding onboard mental health resources before publishing. Norwegian Cruise Line Holdings Ltd. did not respond to a request for comment.

Cruise ships may also quarantine passengers deemed to be a threat to themselves or others, according to Michael Winkleman, a maritime attorney with Lipcon, Margulies & Winkleman, P.A.

“Our team of onboard medical professionals safeguards the health and well-being of our guests and crew (including mental health), which may include placing a patient under secure watch in the medical center or in a cabin depending on the risk,” the Carnival Corp. spokesperson said.

While there are major differences – namely, being in the middle of the ocean – Winkleman said there are some commonalities between cruise lines’ approach and that of hotels or resorts, which often do not have on-site mental health providers. “They are just expecting to provide a fun, safe vacation for their guests,” he said.

Crises on cruises, like an overboard incident, for example, may also get outsized attention given their setting, Heggie added. "People are expecting to go and have a good time and have the vacation or holiday mindset, and, 'Oh, something bad happened.' "

However, Winkleman said he thinks cruise lines “could do a lot more” to provide mental health support to crew, many of whom work rigorous schedules on months-long contracts.

How passengers can care for their mental health

Travelers can take proactive steps to care for their mental health before a trip if need be. If passengers have a mental health provider, Dole recommends speaking with them beforehand and making sure they have any medication they might need.

Passengers can also reach out to their therapists mid-cruise to schedule a session as needed – though state laws regarding telehealth vary and could prevent them from accessing care. “But generally speaking, it's really about where the person resides,” Dole said. “So (if) you're on a work trip, and you're like, ‘I need to see my therapist,’ they'll see you.”

Riba noted that it may be more difficult to coordinate than at home with spotty cell service and possible time differences.

The 9-8-8 Suicide & Crisis Lifeline also works in U.S. states as well as territories like Puerto Rico and the U.S. Virgin Islands.

How safe are cruise stops?: Travel advisories are only one marker for destinations

Checking in with your fellow travelers can also be helpful. Dole said, “One of the biggest clues someone is struggling” is a change in behavior. Typically, that takes the form of withdrawal, but it could also manifest in people engaging in risky or dangerous behaviors.

“‘I noticed something is different,’” she suggested saying. “‘Is there something happening that you feel comfortable talking to me about?’ And that that's not going to make people be defensive as much as, ‘What's wrong? Are you okay? What's happening?’”

Dole recommended framing the question in a way that avoids sounding judgmental or accusatory. “But actually asking the question, especially for young people, can save someone's life,” she said.

If you or someone you know may be struggling with suicidal thoughts, you can call  988  any time day or night, or chat online.   Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.

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

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Here's what to know about dengue, as Puerto Rico declares a public health emergency

Joe Hernandez

Victoria Micieli, director and scientist at the Center for Parasitological and Vector Studies of the national scientific research institute CONICET, classifies different species of mosquitoes at a laboratory in La Plata, in Argentina's Buenos Aires Province, on Tuesday. Luis Robayo/AFP via Getty Images hide caption

Victoria Micieli, director and scientist at the Center for Parasitological and Vector Studies of the national scientific research institute CONICET, classifies different species of mosquitoes at a laboratory in La Plata, in Argentina's Buenos Aires Province, on Tuesday.

Puerto Rico has issued a public health emergency after recording an unusually rapid rise in dengue cases over the first few months of this year.

It's the latest area to grapple with a surge of infections of the mosquito-borne disease, which sickens an estimated 100–400 million people globally each year.

According to Puerto Rico's health department, the territory has recorded 549 cases since the start of the year, nearly half of which have occurred in the San Juan region. Puerto Rico saw a total of 1,293 cases throughout all of last year, the Associated Press reported .

Goats and Soda

With a million cases of dengue so far this year, brazil is in a state of emergency.

"This year, dengue cases have exceeded historical figures," Puerto Rico's health secretary Carlos Mellado López said in a statement.

Dengue has been surging elsewhere, too. Brazil has seen a dramatic uptick in dengue this year, with more than one million cases, while Peru experienced a record number of infections last summer. Argentina is also on the cusp of a record-breaking dengue outbreak .

According to the World Health Organization, about half of the world's population is now at risk for the disease.

What is dengue?

People typically contract dengue through the bite of an Aedes mosquito infected with one of the four types of the dengue virus.

Most people with dengue will show no signs of infection or experience only mild symptoms , such as fever, muscle and joint pain and nausea. They typically recover in one or two weeks.

According to the Centers for Disease Control and Prevention, only a quarter of people infected with dengue get sick.

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The u.s. is unprepared for the growing threat of mosquito- and tick-borne viruses.

In rare cases, dengue can require hospitalization and be potentially fatal. More severe symptoms include bleeding gums and nose, abdominal pain and persistent vomiting.

Those who've gotten dengue previously are more likely to become seriously ill with a subsequent infection.

Though there is no specific medicine to treat dengue, sufferers can take acetaminophen to control their fever and reduce pain.

How to keep yourself safe

Roughly half of the Earth's population could catch dengue where they live. Found most commonly in tropical and subtropical climates, dengue is endemic to more than 100 countries in Asia, Africa, the Americas and elsewhere, according to the WHO, and has been spreading to parts of Europe. Last year Florida and Texas reported dengue cases.

There is a vaccine for dengue called Dengvaxia. In the U.S., it is approved for use in children between ages 9–16 who have previously been infected with the disease, and in other parts of the world it is available to adults up to age 45.

Experts say the best way to avoid contracting dengue is to prevent mosquito bites .

There's A Promising New Vaccine For One Of The World's Top Health Threats

Insect repellents such as DEET, Picaridin and IR3535 can help keep mosquitoes at bay. People can also wear loose-fitting clothing that covers their arms and legs and use mosquito nets.

At home, people should have screens in windows and doors and regularly dump standing water from items like flower pots to prevent mosquitoes from laying eggs.

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