cruise ship cannot dock due to virus

Cruise ship barred from docking in Mauritius amid outbreak of stomach illness

Officials in the island nation of Mauritius blocked a Norwegian Cruise Line ship from docking there Sunday after more than a dozen passengers were stricken with a stomach illness.

Around 15 passengers aboard the Norwegian Dawn remain in isolation because of an undisclosed "health risk" and are undergoing testing, according to the Mauritius Ports Authority .

"The decision not to allow the cruise ship access to the quay was taken in order to avoid any health risks," the authority said in a statement.

The sick guests “experienced mild symptoms of a stomach-related illness,” Norwegian Cruise Line said in a statement Sunday. The cause of the outbreak has not been released.

“Due to additional testing being required by local authorities before being allowed entry, the government of Mauritius has delayed disembarkation for the current cruise and embarkation for the next cruise by two days,” the Norwegian statement said.

It’s expected that the ship will be allowed to dock Tuesday, the cruise line said, after results of tests conducted Sunday become available.

The Norwegian Dawn has more than 2,100 passengers and 1,000 crew on board. About 2,000 of those travelers were set to complete their journey on Sunday by disembarking in Mauritius, in the Indian Ocean just east of Madagascar, the Ports Authority said. Then more than 2,200 new passengers were scheduled to board.

The authority said that the passengers who were due to start their cruise Sunday would not be able to do so that day and that they would have to be relocated to available hotels.

Norwegian Cruise Line said the ship's "management team met with local authorities to confirm precautions and actions were being taken to ensure the wellbeing of all on board."

Gastrointestinal illnesses are often identified on cruise ships for a few reasons , according to the Centers for Disease Control and Prevention: The ships' close living quarters make it easier for viruses to spread, and the regular addition of new passengers creates opportunities to introduce illness. However, because public health officials track illness cases on cruise ships, such outbreaks may also be reported more often than ones on land.

Last month, an outbreak of norovirus — a common stomach bug that causes vomiting and diarrhea — sickened 92 passengers and eight crew members on a Celebrity Cruises ship.

David K. Li is a senior breaking news reporter for NBC News Digital.

• CruiseMapper
• Ships and Lines

Cruise Ship Norovirus Outbreaks

Here are listed latest cruise ship Norovirus outbreaks on passenger ships, with information what is and how to avoid Norovirus on cruise ships, CDC reports, and news updates.

From the following links, you can skip the intro and jump directly to illness outbreaks in 2024 , 2023 , 2022 , 2020 , 2019 , 2018 , 2017 , 2016 , 2015 , 2014 , 2013 , 2012 , also read about Zika virus , Seasickness , Hospital (shipboard infirmary) and Mercy Ships (hospital ship Africa Mercy) .

Note: The following CruiseMapper link provides information on Coronavirus/COVID outbreaks on cruise ships .

Norovirus outbreaks on cruise ships in 2024

Cruise norovirus outbreaks updates.

Norovirus on ships is spread through contaminated water, foods and surfaces (public restrooms, railings, doorknobs, handles, board games-cards-puzzles-toys, etc). Norovirus withstands chlorine, prolonged exposure outside the body, as well as temperature extremes. Like a virus, Norwalk can't be effectively treated with antibiotics, making it extremely difficult to eliminate in closed environments - like cruise vessels.

Norovirus may incubate up to 48 hours before the symptoms appear. This makes it difficult to restrict an outbreak. Noro symptoms include nausea, vomiting (kids more than adults, abdominal cramps, diarrhea, general weakness, low fever, headache, muscle aches. The illness could last up to 5 days (depending on the person's age, general health, and severity of the exposure to the virus. Recovered patients can still spread the virus for up to 2 weeks.

Quarantining the ill passengers and crew to their cabins is mandatory (at least for 48 hours) to slow the outbreak's spread. Failing to comply with the crew's orders results in fines or even discharge from the ship.

CruiseMapper's Norovirus survey is based on official data from CDC.gov (USA's "Centers for Disease Control and Prevention"). CDC's "Vessel Sanitation Program" assists the cruise tourism industry in preventing and controlling the transmission and spread of gastrointestinal illnesses (Norovirus, ETEC) on passenger ships calling on US seaports.

This program operates under the authority of the Public Health Service Act (fda.gov, "Quarantine and Inspection Regulations to Control Communicable Diseases"). CDC sanitation inspections on passenger ships are conducted twice a year. Scores of 86 are considered passing. Among the issues that CDC health inspectors usually find on board and report are:

• food debris
• dead insects
• insect droppings
• records indicating crewmembers (including cooks and galley staff) working while sick (suffering from gastrointestinal disorders or with acute gastroenteritis/AGE symptoms)
• cracked/corroded equipment
• soiled cutting boards
• food served undercooked
• lack of safety instruction signs.

CDC cruise ship Norovirus reports

Cruise ship outbreaks are reported (posted on the CDC website) when the illness incident meets the following criteria:

• The ship falls within the purview of the Vessel Sanitation Program (VSP). This means if it carries 13+ passengers and has a foreign cruise itinerary with US ports of call in it. Keep in mind, that most departures are from US-based home ports.
• The ship cruise itinerary length is between 3 and 21 days,
• The ship carries 100+ passengers.
• The percentage of infected passengers or crew (cases reported to the ship's med staff) during the cruise is 3% or more. This means small outbreaks on cruise ships will not be reported to the CDC.

CDC cruise ship inspection fees are payable by the shipowner. Fees are based on the vessel's size. VSP doesn't charge fees for consultations related to shipping facilities renovations or new ships. Inspection fees are as follows.

• Small ships (under 3000 GT/gross tons) pay USD 1500 per inspection.
• Small ships (between 3000-15000 GT) pay USD 3000 per inspection.
• Medium ships (between 15000-30000 GT) pay USD 6000 per inspection.
• Large ships (between 30000-60000 GT) pay USD 9000 per inspection.
• Extra-large ships (between 60000-120000 GT) pay USD 12000 per inspection.
• Mega-liners (above 120000 GT) pay USD 18000 per inspection.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness outbreak report would be issued.

CDC ship illness outbreak investigations

VSP (abbrev "Vessel Sanitation Program") monitors CDC's observations on illness patterns for GI (gastrointestinal) outbreaks on passenger shipping vessels ( ferries and cruise ships ).

• VSP conducts outbreak investigations only in cases with 3% or more passengers or crew reported sick with GI symptoms. VSP may also conduct outbreak investigations in cases of unusual GI illness patterns (even if the rate is less than 3%).
• VSP conducts outbreak investigations only on vessels visiting ports in the USA or which are within 15 days of arriving at a US port.
• When an outbreak occurs, VSP asks for ship logs and infirmary records of reported GI cases (symptoms and timing) and illness distribution (among passengers/crew, during each day of the cruise).
• VSP staff usually boards the vessel for epidemiological assessment, interviews, distribution and analysis of illness questionnaires, monitoring cleaning procedures.
• Lab investigations - the onboard med staff often collects stool, vomit, blood specimens, which are then sent to land-based labs to confirm the illness cause.

During the onboard illness outbreak, VSP requires the cruise company to activate the "Outbreak Prevention and Response Plan" (vessel's response to illness cases).

During an outbreak:

• Cleaning and disinfection frequencies are Increased.
• Self-service buffets are stopped.
• All infected (pax/crew) are quarantined to their staterooms/cabins
• Clinical specimens are collected for analysis.
• Daily updates are provided to VSP (cases counts and measures reports)
• All passengers and crew are alerted of the illness.
• Upon boarding on the next scheduled cruise, passengers are notified about the previous voyage's outbreak.
• Occasionally, VSP requires the company to notify port authorities and also to perform cleaning and disinfection in cruise port terminal buildings.

Illness outbreaks on cruise ships (annual statistics)

The following statistics show the number of cruise ship illness outbreaks in recent years. You can compare the number of reports (CDC and news media sources) and the total number of infected (passengers and crew).

In 2014, Time Magazine published the article "The 13 Worst Norovirus Outbreaks on Cruise Ships". In it, the overall winner was Princess Cruises with 5 epidemic illness outbreaks:

• Coral Princess (February 2009, infected 271)
• Crown Princess (January 2010, infected 396)
• Crown Princess (February 2012, infected 363)
• Sun Princess (July 2012, infected 216)
• Ruby Princess (March 2013, infected 276)

Norovirus outbreaks 2023 reports

Norovirus outbreaks 2022 reports, norovirus outbreaks 2020 reports, outbreaks 2019 reports.

In the following table, you can see all 2019-reported Norovirus outbreaks on cruise ships. The listed statistical data is based on CDC or news media reports. It shows the number of sick passengers and crew (with the respective percentage to all), along with the corresponding CDC report pages (if available) as outgoing links.

Note: When the itinerary doesn't include US cruise ports, the ship is not required to report to CDC, thus no official illness report would be issued.

Outbreaks 2018 reports

In 2018, the number of reported illness outbreaks on cruise ships was 15. The total number of infected was 1177 (of those 1099 passengers and 78 crew).

Outbreaks 2017 reports

In 2017, the number of reported illness outbreaks on cruise ships was 21. The total number of infected was 2535 (of those 2450 passengers and 85 crew).

Outbreaks 2016 reports

In 2016, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2504 (of those 2378 passengers and 126 crew).

Outbreaks 2015 reports

In 2015, the number of reported illness outbreaks on cruise ships was 23. The total number of infected was 2570 (of those 2458 passengers and 112 crew).

Outbreaks 2014 reports

In 2014, the number of reported illness outbreaks on cruise ships was 17. The total number of infected was 3559 (of those 3354 passengers and 205 crew).

Outbreaks 2013 reports

In 2013, the number of reported illness outbreaks on cruise ships was 22. The total number of infected was 2385 (of those 2249 passengers and 136 crew).

• According to CDC, in 2013 from Norovirus and similar GI (gastrointestinal) illnesses suffered a total of 1409 passengers (which is 7,5% of all passengers on the inspected cruise vessels) and 96 crew/staff members (which is 1,2% of all). With nearly 12 million cruisers departing from USA and Canada ports in 2013, the Norovirus infection rate is ~0,01% of all passengers.
• It should be noted, that in the past years on many CDC inspections was concluded the Noro virus illness source was off the ship.

Outbreaks 2012 reports

In 2012, the number of reported illness outbreaks on cruise ships was 34. The total number of infected was 5542 (of those 5079 passengers and 463 crew).

Norovirus on cruise ships

All important things you should know about the "cruise virus".

Why do Norovirus incidents happen on cruise ships? There are more than 21 million US cases reported annually, of which 1 mill related to kids. Outbreaks happen mostly during winter months and mainly in more crowded places with close quarters. Among those are schools, hospitals, nursing homes, dormitories, prisons, big resorts, bigger passenger ships (including cruise ferries ). Norovirus is often branded as "cruise ship virus" simply because on ships health officials are required to report every gastrointestinal illness incident. This means Norovirus outbreaks are reported more quickly on ships than on land. Just for comparison, the virus can afflict as many as 3000 people per day in only one big city, which is about the passenger capacity of a typical modern cruiser.

What is Norovirus infection? It's a very common, highly contagious, ruthlessly efficient and uncomfortably bad virus affecting the stomach and large intestines. Often called "stomach flu" (the med term is "Gastroenteritis") the infection results in massive vomiting and diarrhea. Sickness outbreaks are considered as such if the percentage of infected people is over 3%. The virus is not seasonal and usually not serious (in medical terms). It hits 1 in 5 people annually and is the cause of ~50% of all foodborne illness outbreaks in the USA and for ~90% of all non-bacterial gastroenteritis worldwide.

The virus is named after an outbreak in Norwalk (OH, USA). Numerous studies confirm that a quick application of hand sanitizer doesn't kill the Norovirus. It takes about 30 sec of hard rubbing with hot water and soap (including under the nails) to wash it. This virus also mutates (changing its strains). As to its efficiency - a mere 20 particles are enough to get you.

What causes Norovirus on cruise vessels is mainly contaminated food/water. When it comes to ships, it spreads mostly through physical contact with sick people or handling contaminated objects. This includes sharing food/utensils and poor hygiene (not washing hands after bathroom use). The virus also spreads fecally, so you can catch it into the onboard laundry, or while changing diapers, etc. However, many passengers likely can blame a sick crewmember for the virus. According to a survey based on 170 inspection records on ships that docked in Florida ports in 2012, on 59 cruises violations of the required illness reporting laws were reported. A total of 130 crew had gotten sick on those voyages and didn't report their illness in the required time period.

The symptoms are nausea, vomiting, diarrhea, indigestion, abdominal cramps. Also possible are mild fever and headache. It takes 1-2 days for the symptoms to appear. The illness lasts 1 to 4 days, but some people (especially elderly) may be contagious for up to 2 weeks after recovery.

What is the treatment? What to do if you got it? Obviously, the first thing is to go to the ship's infirmary (medical center) and contact the doctor. You should drink plenty of water as dehydration is a side-effect of the illness. There is no real treatment for Norovirus - you just wait it out. A few years ago an experimental Norovirus vaccine (applied as nasal spray) was developed by the "Center for Infectious Diseases and Vaccinology" (Arizona State University). The new vaccine generates a good immune response.

How to avoid Norovirus on cruise ships?

• Wash your hands often (hot water and soap), especially before/after eating and after using the bathroom
• Limit physical contacts as much as possible, pack some extra soap, a personal disinfectant (Lysol, Pepto-Bismol), oral rehydration sachets and treatments for diarrhea
• Avoid eating uncooked food (including salads and sandwiches) and food that cannot be washed (unless it can be peeled or shelled), drink only bottled liquids (preferably without ice), don't share drinks/utensils.
• Drink lots of water.
• Compensation for cruise illness. By contract, cruise lines are not required to compensate passengers who fall ill on cruises. However, they will compensate you if the itinerary was altered/canceled due to an illness outbreak. The deal may include up to 50% refund, up to 50% FCC (future cruise booking discount) or an option to cancel for a full refund plus reimbursement of airline change fees. If you have travel insurance, it covers cancellation due to illness. If you've been infected on the ship, it could also cover medical expenses and to compensate you for all days you're not on the ship before the cruise end.

The following "health advisory" list of recommended actions is often issued during gastrointestinal illness outbreak or on embarkation day (of the next scheduled voyage). It has important suggestions on how to avoid spreading the cruise ship virus infection.

• It is critical that excellent standards of personal hygiene are maintained by all on board, as well as avoiding touching surfaces, such as handrails, door handles, elevator buttons, walls.
• Report any observed evidence of vomiting or diarrhea that you may encounter on the ship.
• Ensure that you minimize direct contact with others during this time, such as handshakes, etc.
• Avoid touching your mouth.
• Wash your hands frequently and thoroughly with soap for at least 20 sec and rinse them well under running water. Ensure that you follow this procedure every time you use the WC, after coughing or sneezing, and before eating, drinking or smoking.
• Attempt to always use your own cabin toilet facilities.
• In addition to hand washing, also use the alcohol hand gels provided where available, and in particular before eating in the self-serve buffet restaurant and outdoor food outlets.
• Should you experience any symptoms of vomiting or diarrhea, return to your cabin and immediately report to the Medical Center or Front Office (Reception, if the infirmary is busy) by dialling 999.

Cruise ship virus procedures

What do they do about it? What actions do lines/operators/CDC actually take in response to a Norovirus cruise outbreak?

An "illness outbreak" is considered when 3% or more of all passengers report symptoms to the ship's med staff. In such cases, the CDC requires cruise lines to file a medical report.

The hotel staff is required to implement special cleaning and disinfection procedures for sanitizing the whole ship. To do that, they use stronger solvents, like Microbac, chlorine bleach, hydrogen peroxide. The Lido Deck's bistro/buffet service switches to manned stations. Often, salt-pepper shakers are taken off the tables. The crew starts offering precautionary tips. Sick passengers and crew are quarantined in their rooms, typically for at least 2 days. When Norovirus outbreaks can't be contained, cruise lines might also pull the ship out of service for a few days for sanitizing.

The CDC's "Vessel Sanitation Program" is for monitoring illness outbreaks on passenger ships carrying 100 or more guests on sailings from 3 to 21 days in length. The ship's medical staff is required by the CDC to maintain illness counts for each itinerary involving a stop at a US cruise port and to give CDC the number of all passengers/crew, plus the number of reported diarrhea cases during that voyage. This is done 24 hrs prior to arrival at any US port of call from a foreign port. And they file such reports even if the "illness number" is zero. This protocol only confirms that the CDC knows everything about it.

Other possible actions and results are red level ("Code Red") cleaning. The boarding/embarkation of new passengers is often delayed to permit more extensive disinfection of public areas and the cabins. Usually, a pre-embarkation health advisory is distributed to all boarding passengers. Additional med staff is sent to the ship in port to assist the disembarkation of infected passengers. Another possibility is the cruise ship to cancel all the itinerary's foreign ports of call and to return to its US home-port before the end of the voyage.

Some cruise lines offer hand-sanitizer dispensers near the ship's restaurants, Lido/pool deck areas and other more crowded public spaces in their effort to keep a lid on sickness outbreaks.

In February 2020, the shipowner cruise company Lindblad Expeditions announced the "Premium Purity" program with a shipwide cleaning system based on ACT CleanCoat technology. The program was rolled out fleetwide after a year trial. The innovative ship cleaning process is based on photocatalytic antibacterial spray that when activated by light kills viruses, bacteria, airborne microbes, mould. The disinfecting product and technology were developed by the Danish company ACT Global AS ( Copenhagen ). The spray is chemical-free, odourless, transparent and can be applied to all surfaces.

Zika virus on cruise ships

Zika virus (aka ZIKV) is a Flavivirus - from the genus of the viruses named West Nile, dengue, tick-borne encephalitis, yellow fever. These plus several other viruses may cause encephalitis (acute brain inflammation). In humans, Zika virus causes the Zika fever which is known to occur only within some equatorial regions. In 2014, Zika spread across the Pacific Ocean to French Polynesia, and soon to Easter Island. In 2015, Zika virus reached Central America, the Caribbean, and South America. In South America were recorded several pandemic outbreaks.

The most severe outbreaks were reported in Brazil, with an alarming surge in newborns with microcephaly. If the mother is infected, the virus may cause microcephaly in newborns. This is a neurodevelopmental disorder - babies are born with an underdeveloped head.

Generally, Zika is a mosquito-borne virus spread by Aedes aegypti (aka "yellow fever mosquito") and Aedes albopictus (aka "Asian tiger mosquito"). However, it became "cruise virus" since the decease can also result from intrauterine (contraceptive device), sexual intercourse, blood transfusion, lab exposure, organ/tissue transplantation, breast milk transmission.

In January 2016, the CDC issued travel guidance on affected countries and suggested using enhanced precautions and even postponing travel. Guidelines (specifically for pregnant women) were issued as well. Similar travel warnings were issued by other health agencies and governments. The CDC list of potentially dangerous for travel countries included (alphabetically) Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Salvador, Samoa, St Maarten, Suriname, Venezuela.

Cruise lines should warn their pregnant passengers of the virus. Cruise ships publish daily health and safety instructions to their passengers on how to avoid mosquito bites. Zika symptoms are fever, skin rash, pain in joints, conjunctivitis (pink eye). It typically lasts from a few days to a week. For now, the illness cannot be prevented by drugs or vaccines.

"Cruise ship virus" politics

Virus outbreaks on cruise ships are actually not that uncommon. Such viral/bacterial outbreak incidents affect the vacation experience of thousands of people, being packed up in a floating resort for many days on end. In confined spaces with frequent passenger turnover (like big capacity cruise ships), it is easy for diseases to spread - whether food- or air-borne, or otherwise. However, there's a tendency to cover up the severity of this issue.

Some of the world's most famous passenger ships are listed in the virus outbreak statistics, yet one hears so little of it in mass media news. And there is no surprise in that since the "cruise illness" news are nothing but bad publicity for the companies - which is bad for a prosperous multi-billion dollar sea travel vacation business. All major cruise line companies will do their best to keep quiet about virus outbreaks on their ships. There are passenger testimonials about quarantined ships and how badly guests have been treated by the line. Virus outbreak news speaks of a lack of proper hygiene control, badly trained staff, bad ship management. The whole responsibility goes to the shipowner (cruise line company) and its management.

Major (in some cases epidemic) illness outbreaks are among the "biggies" that can bring down the brand's reputation on the market. Cruise illness issues often result in lower booking rates and cheaper prices - which is bad for the business.

So it comes as no surprise that when CDC reports an illness outbreak on some vessel, big media sources do not immediately (or ever) respond to the news. You may hear about it on your local radio station, or on your local cable operator, but not necessarily on ABC, CNN, and often not even on Yahoo and MSN news online. It's not about the passengers' health (never been) - it's about the big money that rules our world.

So keep your hands clean, keep your mind clear, always hope for the best. Bad, if meant to happen, will happen anyway, and nothing can change it.

Seasickness on cruise ships

Seasickness is physical disorientation as a result of conflicting signals received by the brain from different body senses. Our inner ear senses the ship's irregular motion, which our eyes can't see because the floor and walls are stable. Depending on individual balance, our ability to adjust to motions varies, so not everyone experiences seasickness.

Seasickness is one of the most common "cruise illnesses". Passengers sensitive to nausea or motion sickness should consult their doctors for medical recommendations prior to departure. Drugs (like Dramamine) are effective against seasickness. At the cruise ship's Infirmary, and also at Reception Desk is provided (free of charge) Meclizine. Know that the bigger the vessel the more stable it is. Also, motion in midship-located areas (including staterooms) is highly reduced in comparison to forward and aft areas.

Seasickness manifests in different ways and is always a result of the body's attempt to correct for the conflicting inputs received from its senses. Common symptoms are cold sweat, dizziness, drowsiness, headache, nausea. When such symptoms are noticed, passengers should take precautions to prevent intensifying the disorientation. The harder the symptoms, the longer the recovery.

If seasickness symptoms are accompanied by diarrhea or fever, passengers should immediately seek medical treatment for Norovirus and avoid spreading the illness to others.

How to prevent seasickness on cruise ships (tips)

Passengers prone to motion sickness are more likely to suffer seasickness. The following prevention tips can minimize discomfort, so before the cruise:

• choose more sheltered routes (clam waters). Open sea and ocean waters are rough and have larger swells, thus river cruises are among your best choices.
• Choose a large liner as larger vessels are more stable and motions are minimized.
• Book centralized/midship stateroom and/or middle deck cabin, where motions are less noticeable.
• Get a good sleep before the voyage - an energetic, well-rested body adjusts easier to new conditions.

During the cruise tips to divert seasickness symptoms include:

• Get involved in onboard activities - this will occupy your mind while the inner ear adjusts to equilibrium changes.
• Avoid napping or lying down - when the body is horizontal, the ship's motion is more pronounced.
• Avoid eating unknown foods - you don't know how your stomach may react to new food/ingredients. Avoid alcohol and acidic-fatty-spicy foods. Stay well-hydrated by drinking plenty of water.
• Walk around to adjust the body's equilibrium to the ship's motion. When on open decks, focus on the horizon to give your eyes and body similar inputs about any tilting or other motion. Depending on the symptoms' severity, it may take several hours.
• Often get fresh air, take deep breaths, keep your lungs clear.
• Some herbal remedies (in tablets or teas) also can ease the symptoms, including ginger and peppermint. Their efficacy varies by person, and are best used together with other prevention methods.

Search for medical assistance - consult the ship's physician if no actions provide relief.

Cruise ship hospital (medical care)

Cruise vessels are not "hospital ships".

Hospital ships are designated as floating medical facilities (hospitals).

Most hospital ships are navy vessels (operated by military forces) which are specifically built for use in war zones.

Attacking a hospital ship is considered a war crime, but enemy forces have the right to board them for inspections.

As of 2018, hospital ships have Brazil (6), China (5), Russia (6), USA (2), Spain (2), and India-Indonesia-Peru-Vietnam (x1).

The navies of USA, UK, Australia, China, France, Italy, Spain, Argentina, and Japan have some classes of military ships fitted with onboard hospitals.

For passengers with health concerns, medical care on cruise ships is a vital part of their travel planning. Most cruise vessels are equipped with either basic infirmary (a small clinic) or larger hospital where sick or injured passengers are treated and cared for by contractor physicians and nurses on 24-hour duty.

Shipboard hospitals as facilities and equipment vary by cruise line and vessel. Clinic's size usually depends on the ship's capacity (passengers plus crew). Generally, bigger and newer ships offer larger and better-equipped medical facilities and are served by bigger infirmary staff.

The ship's medical personnel are independent contractors. This is for limiting the cruise company's liability. There are no internationally specified regulations governing ship infirmaries and medical staffing. Each company has its own standards provided for its passengers' healthcare.

For finding the Infirmary you can use the ship deck plans . On most vessels, the medical facilities are located midship on a lower deck (for easier access and better stability) and usually among other crew facilities. Every passenger stateroom has the Infirmary's number - posted or by the cabin's phone.

Basic medical care on cruise ships

A cruise ship's medical facility can treat only passengers experiencing minor health issues - seasickness, scrapes, sunburns, etc. More severe medical emergencies can't be handled on the ship and usually require medevacs. Coast guard helicopter teams fly to the ship, hoist the passenger (accompanied by a spouse/relative and a crew nurse) and fly them to the nearest land hospital.

Infirmary's equipment and med supplies provide only emergency response and basic treatments in order to stabilize the passenger until transferred ashore.

In cases of severe emergencies, passengers with life-threatening illnesses or injuries are evacuated off the ship - either by boat (if in or near seaport) or by rescue helicopter dispatched from nearest coast guard or other station. In some cases, nearby ships with better medical facilities may assist.

Both emergency and basic care are available on the ship 24 hours a day. All treatments are paid. Outside regular opening hours fees are higher.

Like inland hospitals, medical treatments at sea are pricey. However, unlike on land, most basic travel insurance policies don't cover medical treatments on cruise ships as they are not from the patient's primary caregiver. Purchasing cruise travel insurance with health coverage (medical clauses) is highly recommended.

Shipboard medical service fees vary and are usually set by medical practitioners. General consultations incur costs similar to home visits. Prescription medications or other treatments cost extra. In most cruise ship hospitals, some supplies and medications are provided to passengers and crew for free - like aspirin, seasickness pills, small bandages.

Mercy Ships

"Mercy Ships" is a charity accredited by Better Business Bureau. It operates hospital ships since 1978 and also has currently the world's largest hospital ship (excluding navy vessels) - MV Africa Mercy.

The organization provides free humanitarian aid worldwide, including health care, community development, and health education projects, mental health, agriculture, and water development programs in mainly developing countries in Africa, Caribbean, South America, Oceania.

The organization's headquarters are in Garden Valley (Texas USA), with another 16 offices worldwide - in UK, Spain, Canada, Germany, France, Denmark, Switzerland, Belgium, Holland, Sweden, Norway, South Africa, Australia, New Zealand, South Korea.

Financial support and supplies are mainly through donations from medical companies (medications, supplies, equipment), corporations (fuel, food, building supplies), governments (port fees, drydock costs), general public and also by the crew (all volunteers on a rotational basis). The crew serves with short-term (2 weeks to 2 years) and long-term (min 2 years) contracts. Volunteer crew members occupy both medical (surgeons, dentists, nurses) and general jobs (deckhands, seamen, engineers, machinists, electricians, teachers, cooks, welders, plumbers, agriculturalists.

The crew on Mercy Ships pay all costs associated with their service - fees, travel expenses, passports, insurance, personal expenses.

As 95 of the world's top 100 largest megapolises are port cities, "hospital ships" could provide healthcare very quickly and more efficiently to large numbers of people.

MV Africa Mercy

MV Africa Mercy is a converted former rail ferry (1980-built as "Dronning Ingrid") drydock-refitted in 2007 at Cammell Laird shipyard (Hebburn, England).

The ship project started in March 1999 with the vessel's acquisition through a donation from Balcraig Foundation (UK), which purchased the boat for US$6,5 million.

Ferry's train deck was reconstructed and converted into a hospital. Project's total cost was over USD 62 million.

Vessel details include:

• Volume/GT tonnage 16572 tons
• LOA length 152 m (499 ft )
• Width 23,7 m (78 ft)
• Draft 6 m (20 ft)
• Powerplant 4x BW main engines plus diesel generators
• Propulsion two shafts with controllable pitch propellers
• Speed 19 Kn/35 kph/22 mph
• Passenger capacity 484
• Crew capacity 450
• Fleet of 28 vehicles (used in land-based operations)
• Annual drydock maintenance and refurbishment are done in Durban (South Africa).

As for facilities and amenities, the hospital ship has 5 operating rooms, Intensive Care Unit, an ophthalmic unit, CT scanner, X-Ray, labs, recovery ward (82 beds), a daycare center, a school (for all ages), library, launderette, convenience store, restaurant, gymnasium, shops, Starbucks Cafe (donated), satellite communications.

Africa Mercy has a total of 126 staterooms for the staff/crew. They are located on upper decks and include cabins for families, couples and single cabins.

Land-based operations ("Field Service") include mobile clinics providing screening for potential surgery patients, healthcare, dental care, also mental health programs, infrastructure projects.

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Norovirus outbreaks on cruise ships surge to decade-high levels: How to avoid the stomach bug

In 2023, a decade-high number of cruise ships have reported an unwelcome passenger on board: norovirus.

Outbreaks of the stomach bug have surged on cruise ships this year, reaching the highest levels seen in 10 years. Since January 2023, there have been 13 confirmed norovirus outbreaks on cruise ships under U.S. jurisdiction — that's more outbreaks in six months than there have been during any full year since 2012, according to data from the U.S. Centers for Disease Control and Prevention .

After a lull during the COVID-19 pandemic, cases of the highly contagious virus that causes diarrhea and vomiting, aka stomach flu, spiked this winter and spring on land. As post-pandemic travel surges and millions of Americans return to cruise ships, an increasing number of cruise lines are reporting outbreaks at sea.

Norovirus outbreaks on cruise ships

Most recently, a norovirus outbreak in June on the Viking Neptune sickened 110 passengers (over 13% of the ship's guests) and nine crew members with vomiting, diarrhea and abdominal cramps, according to the CDC . The CDC has tracked outbreaks of gastrointestinal illness on cruise ships through its Vessel Sanitation Program (VSP) since 1994.

Several weeks prior, a Celebrity Summit cruise ship reported an outbreak of norovirus that sickened more than 150 passengers and 25 crew members, per the CDC . It was the third norovirus outbreak on a Celebrity Cruises vessel this year. Another popular cruise line, Royal Caribbean International, has reported four outbreaks since January.

Cruise ships are required to report cases of gastrointestinal illness to the CDC before arriving at any U.S. port, and the CDC will notify the public about outbreaks if they meet certain criteria, including: the ship is carrying 100 or more passengers, the voyage is three to 21 days long, and 3% or more of passengers or crew report symptoms, per the CDC .

The number of outbreaks in the first six months of 2023 is higher than the yearly total during every year since 2012, when there were 16 outbreaks on cruise ships reported to the CDC.

Norovirus can spread year-round, but it tends to have a wintertime seasonality and peak during the colder months. Outbreaks are most common between November and April, TODAY.com previously reported.

"It's a virus we typically see all throughout spring, so it’s not unusual to be see cases in April and May, (and) we are continuing to see many cases now," Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells TODAY.com.

However, as travel surges this summer, travel-related illnesses are expected to surge, as well. “I think our travel frenzy after COVID is partially fueling this continued spread (of norovirus),” says Ostrosky.

What should people know about norovirus and how to avoid getting sick on cruise ships this summer?

Norovirus symptoms and treatment

The most common symptoms of norovirus are vomiting, nausea, diarrhea and abdominal pain, Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology and medicine at Yale School of Public Health, tells TODAY.com.

Less commonly, norovirus may cause a headache, muscle aches, or a low-grade fever — symptoms usually develop within one to two days after exposure to the virus,  per the CDC .

In the vast majority of people, norovirus symptoms will last several days and resolve on their own.

There’s no specific treatment or antiviral for norovirus, according to Ostrosky, but most cases can be managed at home with supportive care like hydration and rest. Sick people should also isolate until their symptoms resolve, the experts emphasize.

Some people are at higher risk of developing severe norovirus symptoms — these include infants, the elderly, and people with compromised immune systems, Ostrosky noted.

How does norovirus spread?

Norovirus is highly contagious and can spread directly through sick people and contaminated surfaces, food, or drinks.

Transmission often occurs when tiny virus particles in feces or vomit from an infected person end up in another person's mouth through direct contact or by touching contaminated surfaces and putting unwashed hands in the mouth or nose, TODAY .com previously reported .

Norovirus can also get into food before, during or after preparation, and it's the top germ causing foodborne illness in the U.S., per the CDC . Virus particles can contaminate drinking water that isn't treated properly or pools when people poop in the water.

It only takes a small number of virus particles for norovirus to spread, which is why norovirus causes so many explosive outbreaks, Ko previously told TODAY.com.

Exposure to less than 100 norovirus particles can make someone sick, and infected people typically shed billions of particles, according to the CDC.

Most people are infectious from symptom onset until about two or three days after recovering, but some people can remain contagious for weeks, Ko notes. People can get infected with norovirus multiple times in their lifetime.

Is norovirus common on cruise ships?

Certain environments are more conducive to the virus spreading. According to the CDC , the most common settings for norovirus outbreaks are health care facilities, restaurants or catered events, schools, day cares and, of course, cruise ships.

Cruise ships are often associated with norovirus because of the enclosed spaces, close living quarters, communal dining and high turnover of passengers, experts note. That said, outbreaks of acute gastrointestinal illnesses are relatively infrequent on cruise ships compared to settings on land, the CDC notes .

How to avoid norovirus on a cruise

Hand hygiene is key to prevent the spread of the highly contagious virus — but the way you clean your hands matters, experts note. It has to be with soap and water, because alcohol-based hand sanitizers are not effective against norovirus.

“Norovirus is one of the few viruses that doesn’t get deactivated by alcohol. You actually need to use soap and water to physically destroy it and remove it from your hands,” Ostrosky previously told TODAY.com.

It's important to wash your hands with soap and clean water frequently, but especially after using the bathroom or changing diapers, before eating and before touching your face.

Surfaces or objects that are contaminated with norovirus can be cleaned with a high-level disinfectant like bleach, per Ostrosky.

On cruise ships, avoid sick people if you can. Passengers who experience norovirus symptoms like vomiting and diarrhea should notify staff and follow recommended precautions, per the CDC .

Caroline Kee is a health reporter at TODAY based in New York City.

CDC: Avoid Cruise Travel, Even If You're Vaccinated, Due to COVID Risk

The agency updated its travel health notice for cruise ships to a level 4, the highest risk level on the cdc's threat scale, by staff • published december 30, 2021 • updated on december 30, 2021 at 2:07 pm.

The U.S. Centers for Disease Control and Prevention is advising people to avoid traveling on cruise ships, regardless of vaccination status, due to the high risk of COVID-19 infection onboard ships.

The agency increased its travel warning for cruise ships from a Level 3 to a Level 4, its highest level. The advisory comes as the number of ships under investigation by the CDC for possible COVID-19 outbreaks continue to rise while new cases of infection in the U.S. soar to their highest level on record, with over 265,000 per day on average.

The CDC cautioned that even fully vaccinated travelers may be at risk for getting and spreading COVID-19, noting that the virus spreads easily between people in close quarters, making the chances of getting infected on board a cruise ship very high, even if you are fully vaccinated and have received a booster.

"It is especially important that travelers who are at an  increased risk of severe illness  from COVID-19 avoid travel on cruise ships, including river cruises, worldwide, regardless of vaccination status," the CDC said.

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Its updated guidance stresses that those who are not fully vaccinated or boosted should not embark on a cruise trip. Unvaccinated passengers or those who have not received the second dose of a two-shot regimen, like those required for the Pfizer and Moderna vaccines, are now also being asked to self-quarantine for a full five days after cruise travel.

The CDC said Wednesday 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say whether it planned to extend the expiration date of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

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Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus’s spread.

The Mexican government  said  Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

This is a breaking news update. Please check back for updates.

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On Cruise Ships, Omicron Puts Safety Protocols to the Test

Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members.

By Ceylan Yeginsu

By the time the Norwegian Breakaway cruise ship docked in New Orleans on Dec. 4, after a weeklong cruise that included stops in Belize, Honduras and Mexico, 17 coronavirus cases had been identified on the ship, including a case of the new Omicron variant. The local and federal health authorities were notified — but not all the disembarking passengers.

“I only found out after I got home and saw it on the news,” said Betsy Rodriguez, a retired veterinarian who took the Caribbean cruise with her daughter. “We felt pretty safe knowing everyone on the ship was vaccinated, but I guess it would have been good to know people tested positive so we could have been more careful.”

Since the cruise industry restarted operations in the United States this June, its efforts to keep the coronavirus at bay — or at least contained, unlike the major outbreaks experienced in 2020 — have been largely successful. Most cruise companies mandate full vaccinations for crew and most passengers, and have implemented strict health and safety protocols to swiftly identify coronavirus cases onboard and reduce their spread.

But in recent months, as new and highly contagious variants have emerged and case numbers steadily increase worldwide, these measures are being put to the test. Many lines are adjusting their masking, testing and vaccine rules, while criticism is mounting about the lack of transparency in reporting positive cases to passengers and crew members during sailings.

A crew member on the Breakaway, who spoke on the condition of anonymity because he was not permitted to speak to the news media, said he first heard about the outbreak from a friend and fellow employee. When he contacted management, they neither shared the number of positive cases nor identified who was infected.

“I would like to know who tested positive because this new variant spreads very quickly and I have a medical condition which means I need to be very careful and protect myself,” he said, voicing concern that if he became sick, he could be sent back to his home country. “I can’t afford that because I need to take care of my family at home.”

Most cruise companies do not publicly announce the number of coronavirus cases identified during sailings, but all cruise ships operating to and from U.S. ports must submit daily numbers to the Centers for Disease Control and Prevention, which uses a color-coded system to inform the public whether the number of cases is above or below the agency’s threshold for an investigation. Sharing this data is one of many requirements in the Framework for Conditional Sailing Order, a series of C.D.C. guidelines that cruise companies must follow to operate in U.S. waters.

The 17 cases on board the Norwegian Breakaway were first publicly reported by the Louisiana State Department of Health on Dec. 4. All passengers and crew members — more than 3,200 people — onboard were fully vaccinated, following the company’s policy.

Norwegian declined to comment on its policies for reporting cases on board its ships or whether any additional Breakaway crew members tested positive after passengers disembarked.

“All the identified cases onboard were asymptomatic,” a company spokesman said in a statement. “We implemented quarantine, isolation and contact tracing procedures for identified cases and tested all individuals on Norwegian Breakaway before disembarkation.” In addition, he said, passengers were given “post-exposure and quarantine public health guidance” as laid out by the C.D.C.

Reporting to the C.D.C.

The coronavirus wreaked havoc on the cruise industry in the early stages of the pandemic , infecting hundreds of cruise passengers and workers, and requiring the sector to shut down for 18 months. To begin sailing, cruise ships had to agree to the C.D.C.’s Conditional Sailing Order, which is valid until Jan. 15.

Among the safety measures the order requires — beyond submitting the daily number of coronavirus cases — is a prevention and control plan for each cruise ship. The plan, said Bari Golin-Blaugrund, a spokeswoman for the Cruise Line International Association trade group, includes “procedures for informing passengers and crew members that a threshold of Covid-19 has been met or exceeded.”

“The reporting requirements and practices of the cruise industry are practically unmatched compared to other sectors in the United States, especially within the travel and tourism sector,” she said.

In a C.D.C. report of coronavirus data published last month, cruise operators had reported 1,359 positive cases between June 26 and Oct. 21. During that time, 49 hospitalizations, 38 medical evacuations and one death occurred because of coronavirus infections detected onboard cruise ships.

The report highlighted several large outbreaks, including one in which a symptomatic passenger who tested positive on a ship in July was linked to 20 additional cases over two sailings. One ship reported 58 positive between July 24 and Aug. 28 and another reported 112 cases over four consecutive voyages, which ended on Sept. 7. Most of the cases were breakthrough infections in fully vaccinated passengers.

While the C.D.C. relies on data reported by the cruise companies, the agency also carries out inspections to make sure that cruise ships are in compliance.

With the rise of Delta and Omicron variants, and as the virus surges across the world, cruise lines have been adjusting their health and safety protocols, reinstating measures like mask mandates and requiring additional testing from passengers. Starting Jan. 13, Disney Cruise Line will require all children over the age of 5 to be fully vaccinated against the coronavirus.

Demand remains high

Despite the new restrictions and risks posed by new variants, demand for future cruises remains high. Carnival, the world’s largest cruise company, reported that its bookings for the second half of 2022 have surpassed bookings for 2019. Royal Caribbean said the Delta variant had hit bookings in 2021 and 2022, but not for 2023.

“I think what people have been saying is, I want to get out there, but I don’t want to do it too soon. I want to make sure that things have stabilized,” Richard D. Fain, chairman and chief executive of Royal Caribbean Cruises, said in the company’s last earnings call in October.

Miranda Gibson, 63, an avid cruiser from Tampa, Fla., took two cruises this summer, but then canceled three cruises she had planned for the rest of the year because of her concerns over the Delta variant.

“The first cruise I took in June in the Caribbean was heaven because everyone was vaccinated, Covid was under control and it was the first time in so long that we could have some carefree fun,” she said.

“Now with the variants everything is prickly again and you can’t really get a true relaxing cruise experience when you are worrying about Covid and masks and rules,” she explained. “I’m booked in June 2022 and I know I’ll be tempted to go before then but I’m going to wait until it’s safer.”

Others believe cruise ships are among the safest vacation environments, because of the vaccine requirements and testing protocols.

“When you’re on a plane, or in a hotel or at a theme park you don’t know who has Covid around you,” said Timothy Ryan, 67, a retired financial trader from Miami who has 16 cruises booked through 2022. “On a cruise, it’s detected right away and the positive cases are isolated, so you can continue your vacation in a Covid-free bubble. I really don’t know a safer way to travel.”

52 Places to Love in 2021

We asked readers to tell us about the spots that have delighted, inspired and comforted them in a dark year. Here, 52 of the more than 2,000 suggestions we received, to remind us that the world still awaits.

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

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

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

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

Please note: This report has been corrected .

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

What is already known about this topic?

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

What is added by this report?

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

What are the implications for public health practice?

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

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

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

Diamond Princess

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

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

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

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

Grand Princess

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

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

Additional Ships

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

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

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

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

Acknowledgments

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

CDC Cruise Ship Response Team

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

California Department of Public Health COVID-19 Team

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

Solano County COVID-19 Team

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

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

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

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

* Not including river cruises.

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

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

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

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

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

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

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

Abbreviation: N/A = not applicable.

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

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

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

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

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

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

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

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Cruise ship carrying 1,500 passengers stuck in Spain port due to Bolivian passengers' visa problems

B ARCELONA, Spain (AP) — A cruise ship reportedly carrying 1,500 passengers was stuck Wednesday in the Spanish northeastern port of Barcelona due to the visa problems of a group of Bolivian passengers who were due to disembark there, officials said.

Authorities say 69 Bolivians were not being allowed to leave the ship because they lacked valid documents to enter the European border-free Schengen area. Solange Duarte, a Bolivian diplomat in Barcelona, told The Associated Press she received reports some of the stranded Bolivians had been duped into obtaining fake visas but had no further information.

“We have asked the families to indicate who has processed this visa and we have not gotten answers,” she said, adding she heard it was possible the Bolivians would be transferred to a different ship.

Spain's national police was looking into the possibility of a fake visa scam, Duarte said.

Spanish state news agency Efe and other media said some 1,500 passengers were on board the MSC Armony hoping to continue the cruise to Croatia.

Bolivia's deputy foreign affairs minister, Fernando Pérez, said the country was waiting "to see what the Spanish authorities decide what to do.”

A statement from the Bolivian Foreign Ministry on Tuesday said the Bolivian Embassy in Spain and the country’s Consulate General in Barcelona “are carrying out the pertinent steps to address this case,” coordinating with Spanish authorities, as well as with the MSC Cruises Company.

MSC Cruises said in a statement the Bolivians included families and children.

It said the “passengers appeared to have proper documentation upon boarding in Brazil. We have been informed by the authorities that the visas are not valid for entry into the Schengen area. As a result, passengers have not been able to disembark in Barcelona, which was their final destination.”

The company said the ship remained in port while it works with authorities to facilitate the process.

The Schengen area is an ID-check-free travel zone comprising 29 European countries, most from the European Union.

This story was corrected to show that the Schengen zone is a European rather than European Union creation and comprises 29 countries.

The Associated Press

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More cruise ships are under CDC investigation following COVID-19 outbreaks on board

The Associated Press

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard. Wilfredo Lee/AP hide caption

Carnival Cruise Line's Carnival Horizon cruise ship is shown docked at PortMiami in April. The Centers for Disease Control and Prevention is investigating more cruise ships due to new COVID-19 cases aboard.

MIAMI — The U.S. Centers for Disease Control and Prevention is investigating more cruise ships due to new cases of COVID-19 as the omicron variant drives extremely high infection levels in the industry hub of Florida.

The CDC said 88 vessels are now either under investigation or observation, but it did not specify how many COVID-19 cases have been reported. Four other vessels are also being monitored by the CDC as well.

Florida hit a new record for daily cases on Tuesday with 46,900 new cases in a day. Since Christmas, the state's 7-day average of daily cases has surpassed previous records set during last summer's surge, rising to 29,400 infections.

Coronavirus hospitalizations in the state have also risen from about 1,200 patients two weeks ago to about 3,400 on Wednesday. But that is still less than one-fifth the number of hospitalizations reported in late August due to the delta wave.

Democratic Sen. Richard Blumenthal is calling for the CDC and cruise lines to again halt cruise travel, six months after the industry mounted its comeback.

"Our warnings have proved sadly prescient and continuously compelling. Time for CDC and cruise lines to protect consumers, again pause — docking their ships," the Connecticut senator posted on Twitter.

Cruise lines have not announced any plans to halt cruising. And the CDC did not say it would adopt any changes, adding it still had plans to allow for the expiration of a set of rules that cruises must follow to sail during the pandemic. The regulation, called a conditional sailing order, is scheduled to expire on Jan. 15 to become a voluntary program.

Coronavirus Updates

Covid-19 outbreaks hit 3 cruise ships as florida breaks record for new cases.

"CDC acknowledges that it is not possible for cruising to be a zero-risk activity," CDC spokesperson Jasmine Reed said in an emailed statement.

Most lines require adult passengers to show proof of vaccination against COVID-19. Cruise ships are allowed to relax measures such as mask use if at least 95% of passengers and 95% of crew are fully vaccinated.

The federal agency recommends that people avoid cruise travel if they are at increased risk of severe illness, regardless of vaccination status.

None of the ships so far appear to have so many cases that they would overwhelm medical resources on board and require a return to port. But some have been denied entry at some foreign ports.

Several Florida-based ships have reported outbreaks. The Carnival Freedom was denied entry to Aruba and Bonaire after an undisclosed number of passengers and crew aboard caught the virus.

Some cruise ships have not been allowed to disembark in Mexican ports due to cases reported, bringing to memory the early days of the pandemic when cruise lines negotiated docking plans as ships were being turned away by officials worried about the virus's spread.

The Mexican government said Tuesday it would allow cruise ships with reported coronavirus cases to dock. The country's Health Department said passengers or crew who show no symptoms will be allowed to come ashore normally, while those with symptoms or a positive virus test will be quarantined or given medical care.

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Woman found dead after ct mobile home fire identified, cruise ship carrying 1,500 passengers stuck in spain port due to bolivian passengers’ visa problems.

A view of the cruise ship MSC Armony moored in the port of Barcelona, Spain, Wednesday, April 3, 2024. Authorities said Wednesday that a group of 69 Bolivians are not being allowed to disembark from a cruise ship in the Spanish northeastern port of Barcelona because they lack valid documents to enter the European Union’s Schengen area. (AP Photo/Emilio Morenatti)

A passenger is photographed on the cruise ship MSC Armony, moored in the port of Barcelona, Spain, Wednesday, April 3, 2024. Authorities said Wednesday that a group of 69 Bolivians are not being allowed to disembark from a cruise ship in the Spanish northeastern port of Barcelona because they lack valid documents to enter the European Union’s Schengen area. (AP Photo/Emilio Morenatti)

Passengers are photographed on the cruise ship MSC Armony, moored in the port of Barcelona, Spain, Wednesday, April 3, 2024. Authorities said Wednesday that a group of 69 Bolivians are not being allowed to disembark from a cruise ship in the Spanish northeastern port of Barcelona because they lack valid documents to enter the European Union’s Schengen area. (AP Photo/Emilio Morenatti)

BARCELONA, Spain (AP) — A cruise ship reportedly carrying 1,500 passengers was stuck Wednesday in the Spanish northeastern port of Barcelona due to the visa problems of a group of Bolivian passengers who were due to disembark there, officials said.

Authorities say 69 Bolivians were not being allowed to leave the ship because they lacked valid documents to enter the European border-free Schengen area. Solange Duarte, a Bolivian diplomat in Barcelona, told The Associated Press she received reports some of the stranded Bolivians had been duped into obtaining fake visas but had no further information.

“We have asked the families to indicate who has processed this visa and we have not gotten answers,” she said, adding she heard it was possible the Bolivians would be transferred to a different ship.

Spain’s national police was looking into the possibility of a fake visa scam, Duarte said.

Spanish state news agency Efe and other media said some 1,500 passengers were on board the MSC Armony hoping to continue the cruise to Croatia.

Bolivia’s deputy foreign affairs minister, Fernando Pérez, said the country was waiting “to see what the Spanish authorities decide what to do.”

A statement from the Bolivian Foreign Ministry on Tuesday said the Bolivian Embassy in Spain and the country’s Consulate General in Barcelona “are carrying out the pertinent steps to address this case,” coordinating with Spanish authorities, as well as with the MSC Cruises Company.

MSC Cruises said in a statement the Bolivians included families and children.

It said the “passengers appeared to have proper documentation upon boarding in Brazil. We have been informed by the authorities that the visas are not valid for entry into the Schengen area. As a result, passengers have not been able to disembark in Barcelona, which was their final destination.”

The company said the ship remained in port while it works with authorities to facilitate the process.

The Schengen area is an ID-check-free travel zone comprising 29 European countries, most from the European Union.

This story was corrected to show that the Schengen zone is a European rather than European Union creation and comprises 29 countries.

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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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Cruise ship stranded in Spanish port resumes sailing after removal of passengers with visa problems

Dozens of bolivian passengers with visa problems were removed from the ship, authorities say.

American woman disappears in Spain after unidentified man spray-painted apartment security cameras

Sanna Rameau, friend of American woman Ana Maria Knezevic, who is missing in Spain, tells 'Fox & Friends First' about the odd nature of her disappearance.

• A cruise ship stuck in Barcelona has resumed its route after Bolivian passengers with visa problems were removed.
• The Spanish government and MSC Cruises reached an agreement to remove 69 Bolivian passengers.
• The Bolivian passengers were taken to a transit zone in the port but were not allowed to enter Spanish territory.

A cruise ship stuck in the northeastern Spanish port of Barcelona will be able to resume its route after a group of Bolivian passengers with visa problems were taken off the vessel on Thursday, authorities said.

The Spanish government said in a statement it had reached an agreement with MSC Cruises Company in which 69 Bolivian passengers were removed from the boat and taken to a transit zone in the port, but were not granted permission to enter Spanish territory.

The ship got stranded in Barcelona this week after the Bolivian passengers were not allowed to disembark because they lacked valid documents to enter the European border-free Schengen area, an ID-check-free travel zone comprising 29 European countries that Spain is part of.

CRUISE SHIP REPORTEDLY STRANDED IN SPANISH PORT DUE TO PASSENGER VISA PROBLEMS

Barcelona was meant to be the final destination for the Bolivian passengers, but the boat was scheduled to travel onward to other countries.

The cruise ship MSC Armony is seen moored on April 3, 2024, in the port of Barcelona, Spain. The ship was able to resume its route after a group of Bolivian passengers with visa problems were taken off the vessel on Thursday. (AP Photo/Emilio Morenatti)

The cruise company agreed to provide another boat from Livorno, Italy, for the Bolivian passengers later Thursday, the government statement said. It was not clear if that boat would remain in Barcelona until the situation is resolved or take the Bolivian passengers elsewhere.

Under the agreement, MSC Cruises will also provide food and health care for the impacted Bolivians and immigration officials will work to resolve the passengers' visa problems as quickly as possible, it added.

The MSC Armonia, with more than 1,000 passengers reportedly on board, plans to sail to Italy on Thursday, the cruise company said.

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Solange Duarte, a Bolivian diplomat in Barcelona, told The Associated Press on Wednesday she had received reports that some of the stranded Bolivians had been duped into obtaining fake visas but had no further information.

"We have asked the families to indicate who has processed this visa and we have not gotten answers," she said.

Spain’s national police were looking into the possibility of a fake visa scam, Duarte said.

MSC Cruises said in a statement Wednesday the Bolivian "passengers appeared to have proper documentation upon boarding in Brazil " but Spanish authorities later said the visas were not valid for entry into the Schengen area.

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Baltimore cruises to reroute after bridge collapse pauses port traffic

Carnival, royal caribbean will move some operations to norfolk while baltimore recovers from key bridge collapse.

Cruise lines are scrambling to make alternative plans and avoid the Port of Baltimore while officials suspend vessel traffic amid cleanup and rescue efforts around the Francis Scott Key Bridge collapse.

Three major cruise lines sail from Baltimore, though no ships were in port Tuesday morning. The next cruise was scheduled to depart Sunday, but its operator confirmed late Tuesday afternoon that the voyage would instead head out from Norfolk.

Amira M. Hairston, a spokeswoman for the Baltimore port, said in an email that the status of the upcoming cruise ship schedule is not yet known.

“At this time we do not know how long vessel traffic will be suspended. As soon as that is determined we will provide an update. Until then please keep those involved in your prayers,” Hairston wrote.

Royal Caribbean International’s Vision of the Seas left Saturday for a 12-night southern Caribbean cruise with plans to return April 4. The cruise line said in a statement Tuesday that it was “closely monitoring the situation, and our port logistics team is currently working on alternatives for Vision of the Seas’ ongoing and upcoming sailings.”

On Thursday, the cruise company said the current sailing would end in Norfolk.

“Our guests on board will be provided compensation and complimentary shuttle transportation as well as Wi-Fi and phone calls to adjust their travel arrangements,” Royal Caribbean said.

Upcoming cruises on April 4 and 12 will sail from Norfolk as well, and passengers will be compensated for the change. The ship was already scheduled for maintenance in the Bahamas after the April 12 cruise.

“We are deeply saddened by the tragedy and collapse of the Francis Scott Key Bridge and extend our heartfelt prayers to all those impacted,” the company said.

Carnival Legend set off Sunday for a seven-day Bahamas cruise; the ship was scheduled to return March 31 and depart for its next sailing the same day. Instead of coming back to Baltimore, Carnival said late Tuesday, it will end its trip in Norfolk, and free buses will bring passengers back to Baltimore.

The ship’s next seven-day cruise will leave Norfolk and return to the port. In a news release , Carnival said it would temporarily move Baltimore operations to Norfolk “while Key Bridge rescue and cleanup efforts continue.”

“Our thoughts remain with the impacted families and first responders in Baltimore,” Christine Duffy, president of Carnival Cruise Line, said in a statement. “We appreciate the pledge made by President Biden today to dedicate all available resources to reopen Baltimore Harbor to marine traffic as soon as possible. As those plans are finalized, we will update our future cruise guests on when we will return home to Baltimore, but in the meantime, we appreciate the quick response and support from officials in Norfolk.”

Carnival Pride is supposed to start sailing from Baltimore next month, mostly to the Bahamas and eastern Caribbean.

Norwegian Cruise Line does not have cruises scheduled out of the port until later this year. American Cruise Lines, a U.S. river cruise operator, has Chesapeake Bay trips on small vessels scheduled from Baltimore starting in May. The cruise line said it will monitor developments “and make adjustments if needed.”

Cruise Lines International Association (CLIA) said it was “deeply saddened” by the bridge collapse and was closely following the situation. “Right now, the most important thing to do is to allow the emergency workers to do their work,” the group wrote in a statement.

This year, 12 ships are scheduled to make a total of 115 calls at the Port of Baltimore, the industry association said. With room for roughly 2,000 or 2,100 passengers at double occupancy, most Baltimore-based ships are much smaller than the record-breaking behemoths that sail from Florida ports.

“Any adjustments to current cruise activity at the port will be announced as soon as available by the individual cruise lines,” CLIA said in its statement.

A news release issued last month by Maryland Gov. Wes Moore’s office said that more than 444,000 individuals cruised out of the Port of Baltimore last year, the most since 2012. The Maryland Port Administration said in a news release last year that the cruise industry generates nearly 400 jobs and $63 million in revenue every year for local businesses.

The port positions itself as a convenient option for cruising year-round, thanks to its location off Interstate 95 and plentiful parking. More than 40 million people live within a six-hour drive of the city, the port administration says.

Baltimore bridge collapse

How it happened: Baltimore’s Francis Scott Key Bridge collapsed after being hit by a cargo ship . The container ship lost power shortly before hitting the bridge, Maryland Gov. Wes Moore (D) said. Video shows the bridge collapse in under 40 seconds.

Victims: Divers have recovered the bodies of two construction workers , officials said. They were fathers, husbands and hard workers . A mayday call from the ship prompted first responders to shut down traffic on the four-lane bridge, saving lives.

Economic impact: The collapse of the bridge severed ocean links to the Port of Baltimore, which provides about 20,000 jobs to the area . See how the collapse will disrupt the supply of cars, coal and other goods .

Rebuilding: The bridge, built in the 1970s , will probably take years and cost hundreds of millions of dollars to rebuild , experts said.

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March 27, 2024 - Baltimore Key Bridge collapse

By Kathleen Magramo , Antoinette Radford, Alisha Ebrahimji , Maureen Chowdhury , Elise Hammond , Tori B. Powell and Aditi Sangal , CNN

Our live coverage of the Baltimore bridge collapse has moved here .

Here's what you should know about the Key Bridge collapse

From CNN staff

Officials recovered the bodies of two construction workers who were on Baltimore's Francis Scott Key Bridge when it collapsed early Tuesday morning after a 984-foot-long cargo ship collided into a pillar.

Maryland Gov. Wes Moore called the collapse Wednesday " a global crisis ."

"The national economy and the world's economy depends on the Port of Baltimore. The port handles more cars and more farm equipment than any other port in the country," Moore said.

Here's what you should know:

• The victims: The six people who are presumed dead were from Mexico Guatemala, El Salvador and Honduras, according to Col. Roland L. Butler Jr, the superintendent of Maryland State Police. Two bodies were recovered and have been identified as Alejandro Hernandez Fuentes from Mexico and Dorlian Ronial Castillo Cabrera from Guatemala. The two workers were filling potholes on the bridge and were later found trapped in a red pickup truck in about 25 feet of water, Butler said. The FBI is handling notifying the victims' families, Butler said.
• Recovery efforts: Authorities are pausing search efforts for the four other workers who are presumed dead, because additional vehicles are encased in concrete and other debris, making it unsafe for divers, Butler said. Once salvage operations clear the debris, divers will search for more remains, he said.
• The investigation: The National Transportation Safety Board is leading the investigation into the fatal incident, according to the agency's chair Jennifer Homendy. During a Wednesday news conference, Homendy said there were 21 crew members and two pilots on board the Dali cargo ship when it crashed into the bridge. She also said a senior NTSB hazmat investigator identified 56 containers of hazardous material, and that some containers are in the water. The agency received six hours of voyage data from the ship and the investigation could take 12 to 24 months to complete, Homendy said. She emphasized that NTSB will not analyze information collected or provide conclusions while on scene of the collapse.
• Looking forward: Department of Transportation Secretary Pete Buttigieg said rebuilding the bridge will not be "quick or easy" but that it will get done. He said there are four main focus points ahead: reopening the port, dealing with supply chain issues until its reopening, rebuilding the bridge and dealing with traffic issues until the bridge is rebuilt. Biden  pledged the full support  of the federal government in the response and recovery efforts. His administration has already conveyed a sense of urgency to open up federal funding to remove debris and ultimately rebuild the bridge. Maryland has submitted a request to the Biden administration for emergency relief funds "to assist in our work going forward," Moore said Wednesday.

It's almost impossible to place people on the bow of ship due to the unstable structure, fire official says

 From CNN's Sarah Engel

Baltimore City Fire Chief James Wallace said Wednesday that the cargo ship's bridge structure and containers at the bow remain unstable.

"It's going to be very difficult, if not impossible, and very dangerous, to place people on the bow of that boat right now," Wallace told CNN's Kaitlan Collins.

"Naturally, we're still very cognizant of the fact that there are hazardous materials on board the vessel itself," Wallace said, alluding to the National Transportation Safety Board saying earlier that 56 containers were carrying hazardous materials.

Wallace said his team is relying heavily on aerial recognizance, including drones. "That's the only way we're able to see in," he said.  

He added that the aerial surveillance has "been able to really assure us right now we have no [chemical] reactions on board." 

"It's just utter devastation," NTSB chief says of the bridge collapse site

From CNN's Aditi Sangal

Jennifer Homendy, chair of the National Transportation Safety Board, called the site of the Key Bridge collapse "devastating."

"It's pretty devastating, certainly, seeing not just what's going on with the cargo containers, but just looking at what was a bridge span — three bridge spans that is pretty much gone. It's just utter devastation," she said at Wednesday evening's news briefing.

She added that she is thinking of families who lost loved ones and those who are waiting to reunite with their lived ones.

NTSB interviewed the Dali's captain and some other crew members today, agency chief says

The National Transportation Safety Board has interviewed the ship's captain, his mate, the chief engineer and one other engineer today, according to Chair Jennifer Homendy.

The two pilots on board the Dali at the time of collision will be interviewed tomorrow, she added.

Cargo ship's voyage data recorder is basic when compared to an airplane's, NTSB chair says

From CNN's Tori B. Powell

The voyage data recorder on the cargo ship Dali was a "newer model" but is considered basic when compared to that on an airplane, according to National Transportation Safety Board Chair Jennifer Homendy.

"But it is very basic compared to say, a flight data recorder, where we would have 1,000 parameters," she said at a news conference on Wednesday.

The NTSB chief investigator Marcel Muise added:

"It's not a ship-wide system recorder, so most of the sensors that are being recorded are from the bridge. So things like GPS, the audio, rudder feedback, rudder commands are recorded on there. But not engineering, the temperature of each cylinder, power distribution sensors."

There were no tug boats with Dali at the time of the collision. That's normal, NTSB chief says

There were no tugs with Dali when the cargo vessel collided with Baltimore's Key Bridge, which is normal protocol, according to National Transportation Safety Board Chair Jennifer Homendy.

Remember: At 01:26:39 on Tuesday, Dali's pilot made a general very high frequency (VHF) radio call for tugs in the vicinity to assist, the NTSB investigator Marcel Muise had said.

"The tugs help the vessel leave the dock, leave the port and get into the main ship channel. And then they leave. Once it's on its way, it's a straight shot through the channel. So there are no tugs with the vessel at the time. So they were calling for tugs," she said.

NTSB chair says she saw some containers that were carrying hazardous materials in the water

National Transportation Safety Board Chair Jennifer Homendy said she did see some of the 56 containers that were carrying hazardous materials in the water.

When asked how many

When asked how many containers of hazardous materials were in the water, Homendy said:

"I did see some containers in the water, and some breached significantly on the vessel itself," she said. "I don't have an exact number, but it's something that we can provide in an update."

Homendy said that a preliminary report should be out in two to four weeks.

This post has been updated with more quotes from Homendy.

Bridge did not have any redundancy, unlike the preferred method for building bridges today, NTSB chair says

Baltimore's Key Bridge did not have any redundancy, which is included in the preferred method of building bridges in the present day, according to National Transportation Safety Board Chair Jennifer Homendy.

"The bridge is a fracture critical," she explained. "What that means is if a member fails that would likely cause a portion of, or the entire bridge, to collapse, there's no redundancy. The preferred method for building bridges today is that there is redundancy built in, whether that's transmitting loads to another member or some sort of structural redundancy. This bridge did not have redundancy," Homendy said.

There are 17,468 fracture critical bridges in the United States out of 615,000 bridges total, she said, citing the Federal Highway Administration.

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Cruise ship stuck in Spain will resume sailing after Bolivian passengers with visa problems removed

Spanish authorities say a cruise ship stuck in the northeastern port of Barcelona will be able to resume its route after a group of Bolivian passengers with visa problems were taken off the vessel

MADRID -- A cruise ship stuck in the northeastern Spanish port of Barcelona will be able to resume its route after a group of Bolivian passengers with visa problems were taken off the vessel on Thursday, authorities said.

The Spanish government said in a statement it had reached an agreement with MSC Cruises Company in which 69 Bolivian passengers were removed from the boat and taken to a transit zone in the port, but were not granted permission to enter Spanish territory.

The ship got stranded in Barcelona this week after the Bolivian passengers were not allowed to disembark because they lacked valid documents to enter the European border-free Schengen area, an ID-check-free travel zone comprising 29 European countries that Spain is part of.

Barcelona was meant to be the final destination for the Bolivian passengers, but the boat was scheduled to travel onward to other countries.

The cruise company agreed to provide another boat from Livorno, Italy , for the Bolivian passengers later Thursday, the government statement said. It was not clear if that boat would remain in Barcelona until the situation is resolved or take the Bolivian passengers elsewhere.

Under the agreement, MSC Cruises will also provide food and health care for the impacted Bolivians and immigration officials will work to resolve the passengers' visa problems as quickly as possible, it added.

The MSC Armonia, with more than 1,000 passengers reportedly on board, plans to sail to Italy on Thursday, the cruise company said.

Solange Duarte, a Bolivian diplomat in Barcelona, told The Associated Press on Wednesday she had received reports that some of the stranded Bolivians had been duped into obtaining fake visas but had no further information.

“We have asked the families to indicate who has processed this visa and we have not gotten answers,” she said.

Spain’s national police were looking into the possibility of a fake visa scam, Duarte said.

MSC Cruises said in a statement Wednesday the Bolivian “passengers appeared to have proper documentation upon boarding in Brazil" but Spanish authorities later said the visas were not valid for entry into the Schengen area.

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