cruise ship covid outbreak 2022

All of the 91 US cruises currently at sea have confirmed or suspected COVID-19 on board, the CDC says

• All 91 US cruises currently at sea have at least one COVID-19 case on board, according to the CDC.
• They're all being either investigated or observed by the CDC.
• Cruise lines are canceling voyages amid rising coronavirus cases among passengers and crew.

All 91 US cruises currently at sea have confirmed or suspected COVID-19 cases on board, according to the Centers for Disease Control and Prevention (CDC).

The figure comprises cruise ships carrying passengers that are currently in US waters or set to enter them, and includes vessels operated by Carnival, Princess, Disney, Royal Caribbean, and Norwegian.

The CDC said it had investigated all 91 ships and is keeping them under observation, save for two where the agency's probes were at an earlier stage.

Cruise ships have been a hotbed for outbreaks of COVID-19 since the start of the pandemic and the CDC recommends that all travelers avoid cruises regardless of vaccination status. The probability of getting COVID-19 on a cruise ship is "very high," even for passengers with booster shots, the CDC said.

Meanwhile, cruise lines are canceling voyages amid rising coronavirus cases among passengers and crew .

Norwegian said Tuesday that it was cutting short a voyage that departed from Miami on Monday "due to Covid-related circumstances." CBS Miami reported there was a COVID-19 outbreak among the crew of the ship, which was destined for an 11-day round-trip via the Panama Canal.

On Wednesday, Norwegian canceled a nine-day Caribbean cruise scheduled to set sail later that day, again citing factors related to the coronavirus.

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It's also canceled some other upcoming cruises, including some as far ahead as April, "due to ongoing travel restrictions."

Norwegian says that all crew and passengers have to be vaccinated against COVID-19. Guests also are tested before boarding the ship and have to wear masks on board.

All 91 US cruises are "yellow" status

All 91 ships the CDC has under observation or is investigating have been assigned "yellow" status by the agency, per data collected Wednesday and published Thursday. This means that at least 0.1% of passengers are believed to be infected – including cases reported in passengers within five days of leaving the ship – or that at least one crew member is infected.

The CDC defines a "COVID-19 case" as a person with a positive COVID-19 test. The definition also includes people with COVID-19-like illnesses who refuse to get tested, test negative for COVID-19 but weren't confirmed to have any other respiratory illnesses, had inconclusive test results, or weren't able to get tested due to a lack of resources on board.

Yellow status means a ship has met the threshold for a CDC investigation. Ships can also be assigned yellow status if they fail to submit certain data on time.

The Washington Post reported that the CDC's Tuesday update marked the first time all US cruises with passengers had been assigned at least yellow status.

A Carnival spokesperson previously told Insider that the CDC had been "fully informed and supportive of its protocols and operational plans."

Of the 19 US cruises at sea with just crewmembers on board, three had yellow status, meaning the CDC was investigating. Ten had green status, meaning the ship had no reported cases of COVID-19. Six had orange status, meaning fewer than 1% of staff had COVID-19 and the CDC wasn't investigating.

The CDC's cruise database only includes foreign-flagged cruise ships operating or planning to operate in US waters, and US-flagged cruise ships that choose to participate voluntarily.

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Omicron prompts more cruise lines to cancel trips.

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

By Alyssa Lukpat and Ceylan Yeginsu

• Jan. 17, 2022

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

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

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

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

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

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

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

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

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

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

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

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All 92 U.S. cruises with passengers have reported COVID cases

All cruise ships carrying passengers in U.S. waters have recorded outbreaks of COVID-19 onboard, according to data from the Centers for Disease Control and Prevention. 

All of the 92 cruise ships have reported enough cases to warrant an investigation. For cruise ships with passengers, this means 0.10% or more of passengers and one or more crew members have caught the virus or that the ship over a period of seven days did not report lab results to the CDC for a day or more.

The agency now advises even fully-vaccinated people to avoid cruises. Last week, it updated its travel health notice for cruise ships to level 4, the highest level. It had previously cautioned against cruise travel for the immunocompromised and those who had not been fully vaccinated.

“The virus that causes COVID-19 spreads easily between people in close quarters on board ships, and the chance of getting COVID-19 on cruise ships is very high, even if you are fully vaccinated and have received a COVID-19 vaccine booster dose,” the agency said on its website . 

Cases on cruise ships have been steadily increasing . In a statement from late December, the CDC reported tha t 5,013 COVID cases had been reported on cruise ships operating in U.S. waters between Dec. 15 and 29, up from just 162 cases during the first two weeks of December.

Norwegian Cruise Line, one of the largest players in the industry, on Wednesday canceled a nine-day cruise to the Caribbean hours before the ship was set to leave because of “COVID related circumstances.” The company also recalled the Norwegian Pearl to port on Wednesday after one day of what was supposed to be a nine-day journey. 

As of Wednesday the company has canceled voyages on eight ships, because of “ongoing travel restrictions.” Another large cruise company, Royal Caribbean, announced Friday it was also canceling some sailings and pushing back one ship’s return to sea.

Some Caribbean countries are tightening their rules for arriving cruise passengers based on the increased COVID cases. Passengers arriving in Barbados, for example, must be fully vaccinated against COVID and have tested negative three days before entering the country to be able to freely visit. Those who are vaccinated but don’t have the test can only visit as part of limited “bubble tours” either operated by the cruise line or third-party operators in the country.

Three of the largest companies in the cruise ship industry, Norwegian, Royal Caribbean, and Carnival, all lost money in 2021 and are expected to suffer losses again this year. All the companies’ stock prices dropped last week after the CDC changed its guidance, although they have slightly recovered this week.

Cases of the Omicron variant have exploded in the U.S. The country was reporting a daily average of 600,000 cases daily as of Friday, according to the New York Times .

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

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

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

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

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

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

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

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

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

COVID-19 cases on ships are up a lot

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

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

That's a 3,094% increase.

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

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

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

Cruise lines also are testing all crew members regularly.

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

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

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

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

Your itinerary could change

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

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

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

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

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

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

Your cruise could be canceled on short notice

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

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

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

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

You probably won't be quarantined, stranded or stuck

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

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

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

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

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

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

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

Most COVID-19 cases on ships aren't serious

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

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

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

You'll face lots of new health protocols

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

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

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

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

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

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

The CDC says to avoid cruising for now

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

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

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

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

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

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

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

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

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

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

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Coronavirus Updates

People should avoid cruise travel regardless of their vaccination status, the cdc says.

Jonathan Franklin

The Carnival Cruise Line's Carnival Sunrise ship is seen in the port of Miami on Dec. 23, 2020, amid the coronavirus pandemic. Daniel Slim/AFP via Getty Images hide caption

The Carnival Cruise Line's Carnival Sunrise ship is seen in the port of Miami on Dec. 23, 2020, amid the coronavirus pandemic.

The Centers for Disease Control and Prevention issued a new advisory Thursday that travelers should avoid traveling by cruise ship, regardless of vaccination status, after a recent surge in positive COVID-19 cases onboard ships.

The agency increased its travel warning for cruises to Level 4 — the highest level — following investigations of dozens of ships that have had outbreaks of the virus.

"Even fully vaccinated travelers may be at risk for getting and spreading COVID-19 variants," the CDC said on its website .

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Following the identification of the omicron variant, there has been an increase in the number of COVID-19 cases among cruise passengers and crew reported to the agency, the CDC said.

More cruise ships have reached "level yellow" — the level where the CDC investigates a ship's COVID outbreak.

"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 agency added.

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

There are 91 cruise ships currently under investigation or observation, according to the CDC website. However, the agency has not specified how many COVID-19 cases have been reported, according to The Associated Press .

An additional three ships are being monitored.

The CDC advised that those who choose to travel on a cruise should get vaccinated against COVID-19 before their trip and, if eligible, receive a booster dose.

In addition, masks should also be worn in shared spaces and passengers who are not fully vaccinated against COVID should self-quarantine for five days after travel, in addition to getting tested three to five days after their return, the CDC said.

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In an email to NPR, a spokesperson for the Cruise Lines International Association said the trade group was "disappointed" by the CDC's latest advisory against cruise ship travel.

"While we are disappointed and disagree with the decision to single out the cruise industry—an industry that continues to go above and beyond compared to other sectors—CLIA and our ocean-going cruise line members remain committed to working collaboratively with the CDC in the interest of public health and safety," the trade group said .

Most cruise lines require adult passengers to show proof of vaccination against COVID-19, according to AP.

For now, CDC guidanc e allows cruise ships to relax measures — such as mask usage — if at least 95% of passengers and 95% of the cruise ship crew are fully vaccinated against the coronavirus.

• cruise ship
• CDC COVID-19 guidance

Cruise lines dropped COVID-19 rules. How did that affect cases? We got numbers from the CDC.

• Many cruise lines dropped COVID-19 vaccine requirements and further eased testing rules in early September.
• CDC data show the number of new positive cases following the rule changes.
• The numbers did not show a consistent pattern among major lines.

David Hancock spent his September vacation doing things he'd never done. He went on a cruise for the first time, hugged a sloth at an animal park in Honduras, and at some point during the trip, likely contracted COVID-19.

The 36-year-old firefighter had avoided infection for two years, but tested positive the morning after he and his wife, Melissa, who had been celebrating their 15th wedding anniversary, returned home to Savannah, Tennessee.

But not even COVID-19 could put a damper on their Royal Caribbean International sailing. "I went all that time since COVID began without getting it ... so I went and got it on a cruise ship," he told USA TODAY.

"But because I was vaccinated and boosted, my symptoms were mild," he said, adding that he would definitely go on a cruise again.

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'Was it worth the risk? I don't think so': What it's like to cruise with fewer COVID rules

Many recent cruise line policy changes reflect a shifting approach to the pandemic. Major cruise lines, including Royal Caribbean, Carnival Cruise Line, and Norwegian Cruise Line International dropped their vaccine requirements for many sailing in early September and eased testing rules, about two weeks before Hancock left for his seven-night voyage.

However, after the Centers for Disease Control and Prevention ended its COVID-19 Program for Cruise Ships in July and stopped updating its related webpage , COVID-19 spread amid the more relaxed approaches has been a relative mystery.

But data from the CDC obtained by USA TODAY through a Freedom of Information Act request shed some light on the numbers cruise lines reported to the agency after the rules were changed.

What COVID-19 case numbers did cruise lines report to the CDC?

The numbers also only represent new COVID-19 cases identified by positive viral tests on cruise ships entering or leaving from the U.S. The data does not show the test positivity rate or the number of passengers on the sailings.

►Norwegian began welcoming all passengers regardless of vaccination status on Sept. 3 and dropped all pre-cruise testing requirements for vaccinated passengers 12 and older. In the weeks that followed, the cruise line reported similar numbers to the weeks leading up to the rule change. The week beginning Sept. 4, the cruise line reported 138 new cases, and reported another 161 the following week. For the week of Sept. 18, two weeks after dropping requirements , Norwegian reported 204 new cases, and just 25 the following week.

The cruise line had previously reported 234, 164 and 184 cases in the three weeks leading up to the change, respectively.

►Carnival made similar changes on Sept. 6, scrapping its requirement for unvaccinated passengers to apply for a vaccine exemption  and further easing its pre-cruise testing rule for vaccinated passengers on many sailings.

The cruise line reported 193 new cases for both the weeks of Sept. 11 and the following week and another 144 during the week beginning Sept. 25.

Carnival had previously reported 214, 265, and another 214 new cases in the three weeks leading up to the change, respectively, including the week of Sept. 4.

►Royal Caribbean also began welcoming all travelers regardless of vaccination status and further eased pre-cruise testing for vaccinated passengers for many sailings on Sept. 5.

The line reported 341 new cases the week of Sept. 11, and 306 the week after. The line then reported another 237 new cases for the week of Sept. 25. In the weeks preceding the change, Royal Caribbean had reported 448, 311, and 348 new cases, respectively, including the week of Sept. 4.

Dr. Peter F. Rebeiro, an assistant professor of medicine in the Division of Infectious Diseases at Vanderbilt University Medical Center, said,   generally speaking, if unvaccinated passengers who test negative – as they were required to at the time – are mixed in with a mostly-vaccinated group, the "overall risk is not going to spike a huge amount,"   he said. However, he noted that vaccinated passengers can still spread the virus. 

Rebeiro also noted that if transmission among the general population is lower at the time a passenger boards a cruise, the likelihood they will spread the virus is lower.

Anne Madison, a spokesperson for the Cruise Lines International Association, the industry's leading trade group, emphasized the safety of cruise travel.

"CLIA-member cruise lines have a strong track record for effectively managing COVID-19 by making science-driven and medically informed decisions – and continue to have health protocols in place that exceed those of nearly any other venue or travel sector outside of healthcare settings," she said in an emailed statement.

Madison added that as a condition of their membership, cruise lines must keep up certain protocols, including "maintaining elevated public health measures to mitigate the introduction or spread of COVID-19 on board ships" and sailing with high vaccination levels among passengers and crew members, among others.

Story continues below.

What does that mean for passengers?

The data did not show a consistent pattern in new cases for other major cruise lines, including Celebrity Cruises, Princess Cruises, or Holland America Line, either. Celebrity made similar changes on Sept. 5, while Princess and Holland America did so on Sept. 6.

During roughly the same period, the weekly COVID-19 case rate per 100,000 people steadily declined in the U.S., from 209 the week of Aug. 17 to 96.5 the week of Oct. 5, according to CDC data .

The "CDC has determined that the cruise industry has access to the necessary tools to prevent and mitigate COVID-19 on board," CDC spokesperson Tom Skinner said in an emailed statement. "While CDC provides guidance for cruise ships operating in U.S. waters under CDC’s jurisdiction, individual cruise lines will determine their own specific COVID-19-related requirements for cruise travel. Any decrease in the volume or frequency of routine screening testing of crew by cruise lines may result in lower counts of asymptomatic cases."

Victoria Alvarez knew Carnival had eased its protocols by the time she got on her Caribbean cruise in late September. Living in Florida, she said, she was used to more relaxed rules .

But the risk of getting COVID-19 did cross her mind during the trip. The 27-year-old business administration manager said the ship was crowded, particularly in the dining and entertainment venues.

Alvarez, who is vaccinated and boosted, said she and her friends took some extra precautions of their own, such as eating outside when they could and avoiding the pools, which were packed. "We just saved our swimming for the islands," she said.

"I don't know if I just haven't been in crowds like that in a while, but it was just, like, it's a lot," she added of the experience.

What precautions can people take?

Anna Bershteyn, an assistant professor in the Department of Population Health at New York University Grossman School of Medicine, said that there may be other factors the data does not reflect, "but it doesn't seem that this policy (change) had any consistent effect across cruise lines."

While there are still many COVID-19-related deaths across the country each day, she said, many people have been assessing their own risk tolerance. "It comes to this decision, what are the precautions that people should take versus going back and living life?" Bershteyn said.

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While not all passengers have felt completely safe on cruises since many lines relaxed their rules, Hancock said he and his wife are planning on taking another cruise with Royal Caribbean, even as it has further rolled back requirements .

"I feel as though COVID's not going to be going anywhere," Hancock said "It's kind of with us for the long haul. It's just a matter of preparations people take and what risks they're willing to take."

Bershteyn recommended travelers take steps to protect themselves, first by staying up to date on all the vaccine doses they are eligible for. She also recommended they make a plan with their doctor in case they do get sick, and contact the cruise line to see what options they would have.

If travelers have taken those steps, she said, she would advise travelers who want to take a cruise to go ahead. "We can't put our life on hold indefinitely, but we do want those safety nets in place in case something happens," she said.

Bershteyn also recommended travelers look for opportunities to take extra precautions when doing so "is not going to take away" from the experience, which she noted may be different for each traveler. In her case, she wears a face mask when she is in crowded places such as airports, while others may opt to eat outdoors when possible.

Have you gone on a cruise recently? What was your experience like?

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• CORONAVIRUS COVERAGE

How cruise lines are adapting to COVID-19 in the age of Omicron

The pandemic keeps disrupting the cruise industry. Here’s how to navigate if you plan to set sail.

The pandemic is upending the cruise industry once again.

In late December, just six months after cruise ships resumed sailing from United States ports, onboard cases of COVID-19 began to skyrocket—rising from 162 in the first two weeks of the month to 5,000 in the latter half of the month. As U.S. Centers for Disease Control and Prevention director Rochelle Walensky recently told lawmakers , it was about a 30-fold increase.

In the weeks that followed, the CDC warned travelers to avoid cruises even if they’re fully vaccinated . There has been a flurry of cancellations, including several Royal Caribbean and Norwegian Cruise Line sailings , because of crew members calling in sick and destinations closing their ports to cruises. The ships that do set sail have had to tighten their COVID-19 protocols—which include vaccine mandates, testing, and masking—and make last-minute itinerary changes.

Further complicating matters, the CDC’s Conditional Sailing Order—a framework of mandatory safety procedures for foreign-flagged ships in U.S. waters—expired on January 15. Following that guidance will now be optional for cruise ships, meaning they will be able to chart their own safety course.

For people who planned their trips months or even years before Omicron’s arrival, these rapidly changing circumstances have proven almost impossible to navigate around.

“People traveling at all right now have to be very flexible,” says Chris Gray Faust, managing editor of online industry publication Cruise Critic . “Dig into what your cruise line is requiring. What was the policy a month ago may not be the policy today.”

So how can travelers make sense of it all? Here’s what experts say.

How are COVID-19 protocols changing?

Eager to shed their early pandemic reputation as floating disease carriers, cruise lines worked with the CDC to institute fairly rigorous onboard COVID-19 protocols—the agency’s condition for allowing ships to sail from U.S. ports again. The CDC laid out guidance for testing crew and passengers and how to deal with outbreaks. Most cruise lines also instituted vaccine mandates.

( These photos show the surreal world of cruising during the pandemic’s height .)

Not much will change for the ships that participate in the CDC’s new voluntary program. They will still report COVID-19 data to the agency daily and follow specific testing regimes for passengers and crew. Cruise lines won’t get to choose which protocols to follow either, says Captain Aimee Treffiletti, head of the CDC’s maritime unit. If they choose to participate, they must agree to everything.

Norwegian Cruise Line has already indicated that it will join the CDC program. Brian Salerno, senior vice president of global maritime policy for the Cruise Lines International Association , expects many cruise lines will ultimately take part. He argues that cruise lines have often gone beyond CDC requirements—installing air purification technology or even onboard PCR testing laboratories —and aren’t likely to start slacking now.

“It’s a business imperative to do this right,” Salerno says. “Nobody’s going to relax during Omicron.”

It’s also a matter of public image. The CDC plans to continue issuing each ship a color-coded status that anyone can access to check transmission at any given time. Ships that are shaded green have no reported cases of COVID-19, while those that are shaded red are under CDC investigation. Cruise lines that aren’t part of the voluntary program will be shaded gray. Those ships may have their own health and safety protocols, but they haven’t been reviewed by the CDC.

“Nobody wants to be gray,” Salerno says. “Obviously everybody wants to be green.”

But with Omicron cases soaring, why is the CDC loosening its grip on the cruise industry? Treffiletti says the agency is confident that it has identified the best practices for mitigating transmission aboard a cruise ship—which she emphasizes was done in partnership with cruise lines. Now, she says, the CDC has decided to flex its regulatory authority “on a case-by-case basis rather than shutting down all the cruise ships at once.”

The CDC will still be able to board any ship in U.S. waters and conduct inspections, she points out. Ships that aren’t participating in the voluntary program will also have to report every case of COVID-19—just not every day—and will still be subject to the agency’s order requiring masks on public transportation .

How do the vaccine mandates work?

Most cruise lines currently require all passengers, including eligible children, to be fully vaccinated (meaning two doses of Pfizer or Moderna, one dose of Johnson & Johnson, or a WHO-approved equivalent). Salerno says the vaccination rates aboard cruise ships right now are close to 95 percent for passengers and crew members.

Some companies do accommodate children who haven’t gotten a jab: Royal Caribbean and Carnival, for example, require all guests older than 12 to be vaccinated , while younger passengers can board with a negative test. Disney Cruise Lines requires everyone over the age of five to be vaccinated. (The Walt Disney Company is the majority owner of National Geographic Partners.)

Cruise lines also align their vaccination policies with those of their destinations. So even though the United Kingdom considers children fully vaccinated after just one dose of an mRNA vaccine, a ship that sets sail to the Caribbean may only allow children who have had two doses.

Meanwhile, as Omicron spreads, some cruise lines have begun to require booster shots. Beginning February 1, Viking will require anyone who is eligible for a booster dose to get it at least 14 days before setting sail from the U.S. In addition, the CDC recently emphasized that being “up to date” on vaccines includes a booster dose.

Omicron is even more transmissible than the Delta variant—and better at evading vaccine immunity. But while the vaccines are no longer as effective at preventing you from getting infected, they are still the best protection, says Kathryn Willebrand, an epidemiologist who recently co-authored a study of COVID-19 transmission aboard cruise ships with infectious disease physician Lauren Pischel.

Willebrand points out that vaccines are still effective at preventing severe illness—which is especially important when you’re in the middle of the ocean on a boat whose medical staff might be overwhelmed or sick themselves. “You don’t want to need medical care when you’re far from home,” she says.

( Can booster shots protect you from Omicron? )

How often will you be tested?

Cruise lines have been requiring passengers and crew to test before boarding a ship, although specific requirements differ. Some only accept PCR tests, while others will accept the results of a rapid antigen test—in some cases only if the test is overseen by a health professional . And while some companies require you to get tested before you leave home, others administer tests at the terminal prior to boarding .

Crew members are generally subjected to routine testing throughout the voyage because they’re particularly vulnerable to infection. They spend more time on the ship, in closer quarters, and tend to have more interaction with others. But passengers might be required to test before any shore excursion if the port of call requires it, or if they develop symptoms during the trip.

If you don’t have any symptoms, you generally don’t have to be tested before disembarking the ship. Instead, Treffiletti and the CDC recommend getting tested five days after your trip. However, Gray Faust cautions that if you’re flying internationally, your final destination may require a negative test—or the cruise line may administer tests to everyone if there’s a particularly bad COVID-19 outbreak on board.

( 5 things to know about COVID-19 tests in the age of Omicron .)

What happens if there’s an outbreak?

Still, COVID-19 has proven adept at slipping past these protocols, particularly in the time of Omicron. Since COVID-19 is airborne and cruise ships are enclosed environments, the boats are higher risk environments for transmission, says Willebrand. Thousands of people pass through dining rooms, casinos, and other areas where virus particles may be hanging in the air.

Under the CDC guidance , cruise lines are supposed to educate both crew and passengers to identify and report COVID-19 symptoms. If someone onboard develops symptoms, they are tested and isolated until the results come back or until they’re no longer infectious. Those who are still infectious at the end of a journey are typically required to quarantine on shore—and Treffiletti says the CDC can work with cruise lines to facilitate that.

Since passengers are vaccinated, however, close contacts don’t necessarily have to quarantine unless they begin to develop symptoms. Gray Faust says cruise lines have been successful at contact tracing to notify those close contacts for the same reason that cruise ships are so vulnerable to transmission—they are closed communities.

“If you go to a restaurant and the person next to you is sick, you won’t know that,” Gray Faust says. “But on a ship, they do go back and find people. That is something that the cruise ships have developed that really is beyond what other types of travel have done.”

All of this relies on the honor system. Much as we’ve seen on land, there’s always the risk that your fellow seafarers may refuse to comply with mask mandates or hide their symptoms from crew to avoid quarantine. Cruise lines have the power to ask those passengers to disembark and travel home at their own expense.

Still, those rules aren’t always enforced—which is why experts say that the decision to set sail ultimately comes down to your own risk tolerance.

( Here’s what you need to know about traveling during Omicron . )

What can you do to ensure a smoother trip?

Although the CDC recommends that people avoid cruises, Treffiletti says that there are some things you can do to help mitigate your risk if you do decide to travel.

For one, before setting sail, check the color-coded chart on the CDC website to see if your ship is participating in the agency’s voluntary COVID-19 program. If so, you’ll be able to see whether there are any outbreaks on board. If things look grim, most cruise lines have implemented fairly flexible rebooking and cancellation policies.

If you’re just booking now, research the protocols of each cruise line to see if they align with your own comfort level. Gray Faust recommends purchasing trip delay and COVID-19 insurance—an extra cost that will be worth it if you get infected and can’t board your ship.

Gray Faust says your packing list should also account for uncertainties. She recommends packing extra clothing and medication in case you are quarantined at any point. If you can snag them, toss in some extra KN95 masks and rapid antigen tests, too.

But most of all, Gray Faust says cruisers need to go into a trip accepting that there will be health protocols in place—which might change as conditions worsen or improve—and that they’re there to keep you safe.

“You need to be OK with that,” she says. “You can still have a great trip. But you’re protecting yourself and other people by wearing masks and by getting your vaccines.”

National Geographic Expeditions and Adventures by Disney offer cruise departures to many destinations around the world. The Walt Disney Company is the majority owner of National Geographic Partners.

Amy McKeever is a senior writer and editor at National Geographic. You can find her on Twitter .

Related Topics

• CORONAVIRUS
• PUBLIC HEALTH
• CRUISE SHIPS

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They were on a luxury cruise, then the coughing began – the ship that became a global Covid pariah

When passengers boarded the MS Zaandam in March 2020, they were preparing for the holiday of a lifetime. Within days they would be confined to their rooms on a liner that no country would let dock. How long would their ordeal last?

O n the five-hour drive to the docks of Buenos Aires, Claudia Osiani thought hard: do I board the cruise ship or cancel my birthday voyage? With her husband, Juan, she discussed the recent spate of deadly virus outbreaks on cruise ships in Japan and California. “This cruise is different; it will be packed with locals,” Juan reassured her, and it made them feel safer. He had sacrificed so much to provide Claudia with this fantasy of a 14-day voyage through the wilds of South America, and she loved him too much to let on that she was petrified at the thought of embarking.

It was early March 2020, and the first wave of the Covid-19 virus was spreading not only in Wuhan, China, but Italy and Spain. In the UK, cases totalled 273; in Argentina there were fewer than a dozen and it felt like a northern hemisphere issue. “We’re going so far south,” Claudia told Juan in the car. “It’s going to be a bunch of Argentinians on that ship, maybe some Chileans.”

At the docks they spotted their ship, the MS Zaandam. Christened in May 2000, the Dutch-flagged vessel had the feel of an ocean liner of a bygone age. She was steeped in the nearly 150-year history of the Holland America Line, for decades the industry leader in service and style, and known in its marketing materials as “the Spotless Fleet”.

Claudia and Juan had been together for 42 years. Claudia was a stickler for detail and liked to swim and cycle. She was an experienced psychologist, and gregarious, open to speaking her mind, making grand gestures. Juan, a soft-spoken accountant, was in many ways her opposite. His mother was an immigrant from Bath, England; his father was from the Netherlands. But they’d made it work, raising three children who’d given them nine grandchildren.

As the couple boarded, they found that almost none of the passengers came from Argentina or South America. Their hopes of cruising with people from countries spared by this new deadly virus vanished. Aboard the Zaandam were 305 Americans, 295 Canadians, 105 French, 131 Australians and 229 UK citizens.

As more than 1,200 guests and almost 600 crew settled in, the Zaandam became a buzzing community that included 10 decks, eight bars, two pools, a casino, a mini tennis court, an art gallery, a library and a performance hall with a capacity for 500. As last-minute preparations to leave were made, dancers limbered up, magicians rehearsed, members of an a cappella choir belted out tunes and a team of massage therapists were busy kneading away knots from the stress of life onshore. Few passengers were monitoring the news channels that would have alerted them that on 8 March 2020, just 48 minutes before the Zaandam’s departure, the US state department posted a warning that was as unambiguous as it was unprecedented: “American citizens, especially with underlying conditions, should not travel by cruise ship.”

Aboard the Zaandam, the musicians tuned their instruments.

T he cruise was a once-in-a-lifetime chance to visit the strait of Magellan, navigate the Beagle Channel, follow Darwin’s route, and then cruise up the west coast of South America for an excursion to relive the excitement of Hiram Bingham’s 1911 “ discovery ” of Machu Picchu, high in the Peruvian Andes. They would end with a passage through the Panama Canal, island hop in the Caribbean and then disembark at Fort Lauderdale.

Down in the holds , the quartermasters went over the stores for the long trip. To feed all passengers and crew on a ship like the Zaandam for a long cruise typically required 60,000 kilos of vegetables, 40,000 eggs, 20,000 steaks, 16,000 cans of beer and soda, and hundreds of cases of wine. In addition to these carefully itemised supplies, another traveller was aboard the ship – a deadly stowaway probably hiding in the lungs of a passenger or a crew member.

In the run-up to the Zaandam’s departure from Buenos Aires, Holland America medical experts had dispatched advice on how to protect against coronavirus. Dr Grant Tarling delivered updates in cheery three- to five-minute videos posted on corporate websites. “Given recent events and general inquiries we have received about travellers’ health,” said Tarling, looking into the camera in one video released in late February, a map of the world behind him, “you may want to bring your own thermometer.” Tarling, the company’s lead medic, also demonstrated the correct position to sneeze, bringing his bent arm close to his nose. “If you cough or sneeze, do it into a tissue or your bent elbow.” His third piece of advice was: “Buy travel insurance.” The doctor suggested passengers read the insurance coverage closely to “make sure it is the kind ‘cancel for any reason’ and covers many unexpected travel situations, such as medical care and evacuation”.

Back at corporate headquarters, Holland America and its owner, Carnival Corporation – the world’s largest travel and leisure conglomerate with more than 100,000 employees and a stock valuation in the billions – had already dealt with the virus on several other ships. Two Carnival ships – the Grand Princess and the Ruby Princess – were suffering severe Covid outbreaks off the Pacific coasts of the US and Australia, respectively. The Diamond Princess had been hit hard in Japan a few weeks earlier, when hundreds were infected and at least nine people died.

Soon after boarding, Claudia noticed the first coughs. Once she tuned into the sound, it seemed to be everywhere. I can see these people are sick – anybody can, she thought.

Nine days into the cruise, as the world was locking down, Claudia marched down to the front desk, by the huge pipe organ. “How can the captain allow this? Allow people to gather in groups, so close to each other, if there is a pandemic all around?” she asked. Claudia urged the staff to take precautions, to protect the ship from Covid. She walked the ship, unnerved by all the older Europeans, Americans and Canadians gathering, seemingly oblivious to the threat. The gym, spa and hair salon were open, packed with people. This makes no sense, Claudia thought. Everywhere she glanced, she saw evidence of Carnival Corporation’s efforts to fulfil its brand slogan, Choose Fun.

In the tight crew quarters far closer to the waterline, workers began to succumb. Some told their supervisors; others soldiered on. Wiwit Widarto, the boat’s laundry supervisor, felt tired, his muscles aching. He assumed it must be his workload, or maybe a common cold. He and the rest of his crew were working nonstop, 10-12 hours a day, in the sweltering confines of the ship’s cramped laundry rooms, trying to keep up. More passengers and crew were spending more and more time in their cabins, which translated into piles of soiled sheets, towels and napkins.

Crew members made valiant attempts to limit the outbreak. They seemed to be everywhere, politely suggesting that passengers wash their hands or make use of the hand sanitiser stations. The self-serve buffets were shielded by Plexiglas, and servers were posted every few feet to ladle out the portions and minimise passengers’ contact with food. Even the US Centers for Disease Control and Prevention ( CDC ) and the World Health Organization were confused – was the virus able to live on surfaces? How long did it survive?

As the cruise entered the second week, fear was ruining the voyage for Claudia and Juan. Near the strait of Magellan, nervous locals had protested over the ship’s arrival, worried they might bring the virus to the remote Chilean city of Punta Arenas. Along with friends from Argentina, they drank tea in the dining room and avoided crowds. They were sitting near the sweeping main staircase – the one that always reminded Claudia of the one aboard the Titanic – when an announcement startled them.

“Good afternoon. This is your captain speaking from the bridge with an important announcement,” Captain Ane Smit began, addressing the entire ship. “I ask that everyone please listen closely.” The news was grim. An influenza-like respiratory virus had sickened many passengers. “Out of an abundance of caution, we must ask that you return to your staterooms as soon as you are done with lunch,” the captain continued, “where, regrettably, we are going to have to ask you to remain.”

Many cabins had less space than a one-car garage. Dozens of rooms were windowless. Claudia sat in the cabin with Juan, nervously staring out of a salt-streaked porthole, or watching television. Relying on her experience as a psychologist, she knew that anxiety, fear and depression were all rising. The uncertainty ate away at her.

Instead of a comfortable crash pad for naps between happy hours and city tours, the cabin now felt like a cell for two. Meals, once a highlight, were now cloaked in anxiety. Lunch arrived via a disturbing, invisible operation. Claudia heard the sudden cry “Foooooooooood!”, then the clanking of a delivery cart as it was wheeled down the hall. Then at the next cabin, the cry “Foooooooood!”, and the next.

Opening the door, she found a tray on the floor. With bath soap, she washed every fork, knife and plate. When the soap ran out, she switched to shower gel for the glasses and edges of the tray, which she gingerly brought to the side of the bed. Claudia and Juan eyed the food with suspicion. They chewed cautiously, enjoying not a bite, nor a sip of the complimentary red wine. Juan and Claudia were supposed to be disembarking in three days – their original itinerary was nearly over – but now all schedules had been shredded.

Panicked by the outbreak, passengers rang and insisted on special services; Widarto made a point of going to their cabins to personally change their sheets or exchange towels. Some guests were clearly sick, but he helped them as best he could. Adding to the workload, one after another of Widarto’s staff members fell ill. He ordered them to bed, which meant he and the remaining members of staff had to work even harder. After three decades on cruise ships, Widarto was a perfectionist, and that drove him to work harder at times like these. When he called his wife, Anny, back in Indonesia, she noticed his voice was different. “You have to go to medical, to the pharmacy,” Anny said, growing more concerned. “You have to get some help.”

Widarto explained that he’d gone to the medical centre, but all they had to offer him was paracetamol. Anny was shocked. “You need to stay strong, focus on yourself, get better,” she said, attempting to raise his spirits. Widarto told her he’d do his best, but just before hanging up, he shocked his wife.

“Anny,” he said, “please pray for me.”

Widarto wore a mask and gloves when he could, but was that enough to protect against any virus left on sheets and pillowcases? Rumours flew about that Widarto had removed sheets from the bed of a guest so sickened that he was unable to walk and was transported to the medical centre in a wheelchair. Word was that the passenger had died, but no one could be sure.

Widarto faced more immediate challenges. He was losing staff at an alarming rate. Over the previous three days, they had kept getting sicker. Their cramped, sweltering workspace seemed to amplify the coughs. The two doctors aboard weren’t much help. A couple of housekeeping staff had reported to the sick bay, and returned with no more than a paracetamol and a bottle of cough syrup. Widarto was subdued as he confessed to a friend: “I can’t taste anything.”

A s the Zaandam steamed north up the west coast of South America, country after country announced ever more strict precautions to protect their populations. None would take the chance of letting a cruise ship dock, despite intense efforts by the cruise line and diplomats to gain safe harbour. The crisis was growing by the day; an international pandemic – the first in a century – was declared, and airline travel was shutting down. Instead of their fantasy escape, the crew and passengers aboard the Zaandam were shunned. No one knew much about the new Covid virus, but cruise ships were assumed to be giant incubators.

Warren Hall, a South African gynaecologist who was the chief medic on the Zaandam, oversaw a sparse medical staff in the bow end of one of the lower decks. At the entrance, there was a reception and two examination rooms. The medical centre had surgical tools and medicine at the ready for emergency procedures. Down a hallway, there were four inpatient rooms, outfitted like those in a hospital.

Medical staff were experienced in treating life-threatening illnesses far from land: fatal heart attacks and falls were common among the older passengers. But when patients were in a grave condition, the ship would typically rush to port and unload the stricken individual. Now, the infirmary was awash with coughing passengers and ill crew members who lined up in the corridor, waiting their turn. Some looked as if they might topple over at any moment. Passengers and crew also crowded inside the tiny reception area. And in each of the examination rooms, a patient lay supine. The coughing was incessant. The two doctors and four nurses worked valiantly but were overwhelmed.

As the outbreak spread through the locked-down ship, family members of those trapped aboard launched social media campaigns to rescue their loved ones. They created a Facebook page and hundreds joined to share what they knew. Reporters began to interview passengers, and timelines were flooded with pleas for help. A newlywed Mexican couple on their honeymoon created a WhatsApp group. They named it Zaandam Prisoners.

With no chance to escape, Claudia returned to a familiar role: caretaking. She rang her friends on board and cheerfully chatted about the sun, the sea and the wind. Her top priority was an elderly couple who were relying on sleeping pills to cope with the stress of lockdown. She knew that in situations of extreme, prolonged stress or trauma, people tended to self-medicate with whatever was at hand: booze or, in this case, sedatives. Claudia was able to help put their minds at ease by calling over the ship’s phone with soothing, detailed descriptions of scenes outside the cabin window in what she dubbed “weather therapy”.

A TV channel featured a live camera shot from the bow of the Zaandam , displaying the open ocean in a wide-angle panorama. Rather than bringing calm and tranquillity, the live feed further emphasised to Claudia that they were ploughing the seas, destination unknown. She felt as if she were incarcerated in some kind of surreal, vaguely luxurious floating prison.

In the medical centre, the patients got sicker and sicker. John Carter, a 75-year-old from north Devon, was among the most gravely ill. For hours, he was in a critical condition. Dr Hall diagnosed bacterial pneumonia brought on by an unknown viral infection. As Carter’s breathing worsened, Hall threaded a tube into his lungs and connected him to a ventilator.

Hall had just 11 tanks of oxygen on board, and the ventilator was going through the supply rapidly. Hall knew that a flood of elderly patients with respiratory issues would necessitate far more oxygen. Without it, they might die. There was no doubt that Carter had to have it. But it wasn’t enough, and Carter died. His grieving widow was then left alone, only able to speak by phone with family. They issued a plea on her behalf: “She is obviously distressed and extremely frightened … she is struggling … and feeling unwell.”

Below decks, Widarto was trying to find the strength to call Anny at their home in Batam, Indonesia. He now felt too sick to work in the stifling heat. But, as always, guests called and called, requesting fresh sheets, or just needing to talk. Widarto felt obliged to go to their aid. He put on the best face he could for Anny as he called via WhatsApp. They exchanged hellos, and Widarto tried to calm Anny down, set her mind at ease. “Please don’t be sad,” he said. “You need to be a strong mom. For the kids.”

Anny pressed him, trying to find out what was wrong. Finally, Widarto confessed that his fever was rising, and the coughing was worse than ever. He thought the limited stocks of medicine were reserved for the ill passengers and was relying on home remedies, like hot tea with lemon. Then he interrupted the conversation: he had to go. A passenger had called, requesting a fresh blanket.

Anny was shocked. Why was Widarto insisting on working? He seemed distant, taking his time before answering.

“Please, please rest,” Anny pleaded. “Please. Don’t work while you’re feeling unwell.”

“I can’t. I can’t afford to do that,” Widarto finally responded. His voice trailed off. “Lots of my staff are falling ill. Someone’s got to work.”

“Please, stay strong,” Anny said; she was crying.

E ntering the third week of its odyssey, the Zaandam sailed further north up the coast of South America; a flurry of diplomatic notes whizzed back and forth as US, Canadian, French and British diplomats pressed the government of Ecuador to let the passengers get off. Thanks to a policy of hiring former navy admirals and coastguard commanders, the Holland America leadership worked smoothly with the diplomats – on many issues they spoke the same language, fought for the same goals.

But even if the Zaandam obtained clearance to let passengers disembark, there was no assurance that Holland America could win permission to fly them home. “I’ll ask our team in Quito, but early signals are bad, as gov’t has shut down movement and borders,” wrote a US diplomat in an email. “The governor of Guayaquil has been very active in denying entry.”

Few options remained. Emergency medical flights were in short supply everywhere. Wealthy individuals around the world with the means to pay $25,000 or $200,000 for a private escape had booked jets, helicopters and yachts for a swift retreat from the virus. Holland America had the cash to secure these flights, but what would be the use if the plane couldn’t land?

Navigators aboard the Zaandam, helped by Holland America executives onshore, began charting multiple options – would they be allowed through the Panama Canal? Should they head to a US port in San Diego? But the reality was clear: they were on a voyage to nowhere. Passengers largely obeyed the lockdown orders. At times, small groups would be ushered out for 15 minutes of fresh air, but seeing crew members in masks just added to the sense of danger. No one knew how many were infected, but the number of little red stickers placed on the doors of those thought to have Covid marked the spread.

As the ship anchored off the coast of Panama, reinforcements finally arrived. Carnival Corporation had ordered the Zaandam’s sister ship the Rotterdam to rush down from Mexico. It carried essential crew and was empty of passengers. The plan was to dilute the problem by moving healthy passengers off the Zaandam and on to the Rotterdam. Additional medical supplies and personnel and support crew could also be brought aboard what was now dubbed by the media “The Pariah Ship”.

Claudia was praying that she and Juan would be allowed to transfer when she heard a knock. She opened the door and a crew member wearing a gown, gloves and a face mask delivered the good news: they were among the roughly 800 passengers cleared to leave. They gathered their suitcases and sat down in a small transfer boat known as a tender. Claudia was elated to be leaving; she knew she was lucky. Their early precautions had worked, as neither she nor Juan were infected. Now they were on a circuitous but hopeful path back to their home in Argentina.

Back on the Zaandam, however, the raging outbreak had struck down scores of crew and passengers. Then on 27 March, Captain Smit took to the airwaves again – this time with the grim news that four passengers had died. One was John Carter. Another man had collapsed on his way to the bathroom and died on the floor. Another had suffocated, unable to breathe as his lungs were destroyed by Covid. Medical personnel were swamped by calls and overworked, forced to run from one cabin to another, yet still the patients waited hours, sometimes more, to be seen by a doctor.

As the Zaandam headed for Florida , mixed signals from the Trump administration stymied attempts by Holland America to find a way to get several dozen people in desperate need of medical care off the ships. It took endless rounds of negotiations between the cruise line, CDC officials, Florida state health authorities, the White House and diplomats from a dozen countries to finally develop an evacuation protocol that was acceptable to all.

On 2 April 2020, nearly a month after leaving Buenos Aires, a fleet of buses lined up on the docks of Port Everglades in Florida, and most passengers from both the Zaandam and Rotterdam were allowed to disembark. A row of ambulances were ready as well. One of the first people evacuated from the Zaandam was Widarto, who was now fighting for his life. Hall had done what he could, but Widarto’s condition had deteriorated, the virus destroying his lungs; he badly needed ICU care.

Within minutes, they moved Widarto down the gangway and into an ambulance. The ambulance sped off. A medical team at Broward Health Medical Center in Fort Lauderdale was waiting for him. But doctors were not optimistic: in a video call, they told Anny that her husband was losing the battle, that his lungs were filling with fluid, and that nothing they had done was stopping that deadly process. When that time came, the doctors could only revive him with the defibrillator, gambling that they could shock life back into his body. But that procedure could have devastating consequences, the doctor warned; he could end up paralysed. Anny had to make a choice: did she want him resuscitated? Or would it be kinder to let him die? She talked it over with her family and they agreed. “If he flatlines, let him die in peace,” she said. “That’s what God would want to happen. If God wanted him alive, he would be alive.” Anny was only able to see him on a video call before he died.

Two dozen passengers were medically evacuated, but hundreds more were deemed fit for travel. Bundled on to buses and dumped at airport terminals, they then crisscrossed the country and the world, and some carried the virus.

Although hundreds of passengers had walked off both the Zaandam and the Rotterdam, Claudia and Juan were told they could not disembark. Claudia waited for a few hours and then called reception. It took a moment to unravel what was happening. “Oh – we’re so, so sorry, but you will not be disembarking,” the receptionist announced cheerfully.

“What do you mean?” Claudia asked.

“There was a problem with your flight to Argentina. We need you to stay on the ship a little while longer, while we work out a solution.”

The Argentinians were stuck in bureaucratic gridlock. So, too, were the hundreds of crew, as the CDC had decided it was too dangerous to let potentially infected crew members into society. The Rotterdam and the Zaandam left Florida and abandoned US territorial waters, docking instead near the Bahamas.

Day after day, the two ships sailed in what pilots call “doughnut patterns” as crew and approximately nine passengers remained locked down. With the help of the cruise line, Claudia was untangling the logistics of organising a flight back to Argentina when the captain’s voice sounded loudly over the ship’s public intercom. He appeared to be giving orders exclusively to the crew. To Claudia, it felt as if they didn’t exist; that they were ghosts on a ghost ship.

“Personnel will now move to deck two,” the captain declared. Or that’s what Claudia thought he had said. “Deck two, Juan? That’s us, right?”

Soon, a powerful chemical smell wafted into their cabin. A pungent disinfectant stench burned the back of her throat, making her wince. Claudia grabbed a face mask and burst out of the cabin, desperate to breathe fresh air. With Juan, she ran to an exit. Outside, the sun blinded them momentarily. Claudia fell to the deck, gasping for air.

Claudia spotted a surveillance camera and ran toward the tiny lens, screaming in Spanish for help. Soon, one of the ship’s officers arrived. Claudia scolded him for accidentally trying to poison them as they disinfected the ship. At first the officer didn’t understand her machine-gun Spanish, but eventually they were transferred to a new room with a private balcony. Despite the upgrade, they felt like orphans, forgotten on an empty cruise ship, with no sign of liberation.

As she entered her second month at sea, Claudia was still in lockdown, and as furious as ever. For another three weeks, they circled the Caribbean waiting for the plane to fly them home. Claudia knew that her years as a psychologist provided exactly the emotional toolkit she would need to endure this confinement. I can’t cry and throw a tantrum like a child, she thought. What surprised her, however, was how hard it was to apply her skills to a new patient: herself.

Help came in the form of her 80-year-old neighbour, a man named Tito from Uruguay, who, like clockwork every morning, strode out to his balcony, adjacent to Claudia and Juan’s room, and bellowed to the ocean: “Toooooooday ... can be a goooooooood daaaaaaay! Let’s nail it!” Sometimes Claudia joined in the screaming.

Finally, the Argentinian government resolved the logistics, and arranged for charters and sanitation “bubbles” that could safely bring Claudia and Juan, and the other citizens, back to Uruguay and Argentina. It was now late April 2020, seven weeks after Claudia and Juan boarded what was supposed to be a two-week celebratory cruise.

In a statement, a representative of Holland America Line said: “As the world’s knowledge of Covid-19 evolved over time, Holland America Line aligned with guidelines from the CDC, the World Health Organization and other local health authorities.” They said of the stories in this article: “While some claims do not match the recollection of our team members who were there, that should not diminish the importance of the story of Zaandam, its guests and crew, and people in all walks of life who dealt with the devastating first weeks of a mysterious virus. We mourn all who were lost to Covid-19, and we are thankful for those who helped bring our full fleet back to sailing today with a continued strong commitment to health and safety.”

When Claudia arrived at the door to her seaside apartment in Mar del Plata, Argentina, the country was enduring the full brunt of the viral onslaught. Thousands were sick, a rigid lockdown in place. The official death toll stood at roughly 200.

Inside her home, instead of relief, Claudia felt vulnerable. Nothing was normal. Her favourite routines were prohibited under lockdown. No more swimming with her girlfriends. No more rehearsals with the theatre group. Even the smell of her house had changed. Or had she?

Before the Zaandam odyssey, before Covid, Claudia and Juan had carefully selected an apartment with an ocean view. Their living-room windows framed a wide slice of the Atlantic. Her panorama now felt like a mocking reminder, as if she was still trapped at sea. When Claudia looked out her window, she couldn’t escape the sensation that she was on the balcony of a cruise ship. After one brief glance into the expanse of the waves, Claudia drew the curtain and told herself: “That’s enough ocean view for the moment.”

• Coronavirus
• Infectious diseases

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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 .

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Bare rooms, rotten fruit and boredom: Quarantine life on infected cruises

Welcome to cruises’ omicron surge, where isolation comes with windowless rooms and bare-bones meals

Frank Rebelo lined up the upgrades well before he boarded his Caribbean cruise: the dining package that would let him eat at high-end restaurants, the beverage package that would keep the drinks flowing. But after contracting covid-19 and isolating in a designated cabin, he had to order off the room service menu: turkey sandwich, pizza, burgers and three choices for dessert.

“They were like, ‘We’re going to give you the minimum you need to survive,’ " said Rebelo, 54, who owns a small trucking company and works as a DJ while splitting his time between Tijuana and Las Vegas.

His nine-night voyage on the Norwegian Getaway late last month went awry after a coronavirus surge sent cases soaring to record heights on land and at sea. According to the Centers for Disease Control and Prevention, cruise lines sailing in U.S. waters reported 5,013 coronavirus cases between Dec. 15 and Dec. 29, about 30 times more than the total from the previous two weeks.

On Dec. 31, the CDC escalated its travel warning for cruises to Level 4, advising against cruise travel even for the vaccinated. By that time, it was too late for Rebelo and thousands of others to heed the message.

Every U.S. cruise with passengers has coronavirus cases on board

Although passengers must follow strict rules to cruise — with the vast majority of people onboard vaccinated and everyone required to test negative — infections have slipped through. As positive cases mount, passengers and crew have coped with less-than-ideal accommodations. Many interviewed by The Washington Post reported long waits for service, hours without water, bare-bones food and confusion over when and who to test — even as most ships maintain their course.

A box of rice for dinner

For customers such as Rebelo, waiting on room service when they paid for premium options can feel like an indignity. For crew, quarantine can be even more difficult — even without getting sick.

One crew member on Royal Caribbean’s Odyssey of the Seas, who did not want her name published because she is still employed by the company, said she was sent to “soft quarantine” after having contact with someone who tested positive. That means she was allowed to work but required to spend the rest of her time in her room.

She said one day she found her lunch outside her door as workers were fogging the hallway with cleaning chemicals. She decided not to eat the food.

“One night my dinner was like just a box of rice. Nothing else. Not even a roll or a vegetable,” she said. “Just rice. I was like, cool, glad I have a box of Pop Tarts in my room.”

A former member of the cruise director staff on Oasis, Ovation and Harmony of the Seas said he tested positive for coronavirus recently and was served food in quarantine that seemed inedible to him. He declined to have his name used because of concerns about endangering future job prospects.

He provided pictures that showed a rotting orange; a small seafood salad in a box with a slice of watermelon; and a box with a scoop of white rice, a hard-boiled egg and a paltry pile of corned beef hash.

“It would be different if I worked for, like, a construction company that doesn’t know anything about how to prepare food,” he said. Royal Caribbean did not address questions about meals it provides to quarantining crew members.

Aboard the Norwegian Encore, however, passenger Kelly Araujo said she and her mother took solace in room service deliveries. The 18-year-old student at Duke University said she could order anything available from the dining rooms to her quarantine room. She ate lava cake with a molten chocolate center every night.

Araujo and her mother spent four days in a windowless room without seeing sunlight. They would nap, watch TV or scroll online, losing track of the hours.

“It just felt like one really, really, really long day,” Araujo said. “Even when we’d wake up, we would do the same thing the next day.”

During part of a three-week sailing on the Seabourn Ovation, Barry Kluger was exiled to the quarantine floor. The 68-year-old retired public relations executive missed his wife, he said, getting to see her only when she would visit a balcony near his and talk to him through an opening in a wall. Kluger, who was vaccinated, boosted and previously infected, had an asymptomatic case. He spent most of his lonely days online, posting updates about his quarantine on social media. On New Year’s Eve, he wore a tux, ordered champagne and rang in 2022 with his wife over Zoom.

Kluger said the crew, to their credit, did their best to entertain him. The cruise director brought him trivia and board games. His meals, although served on disposable plates, looked elaborate: Two ginormous shrimp on a bed of greens and dollops of sauces, grilled prawns with roasted autumnal vegetables, an assortment of mussels and octopus over yellow rice.

“Cruise lines didn’t create covid,” he said. “Everyone’s trying to feel their way through it.”

‘They did not want to know’

Araujo, the college student who enjoyed nightly lava cake, said within three days of her family’s Norwegian sailing, her mother started feeling nauseated. The family thought it was motion sickness at first.

“When we tested positive, it was like they didn’t know what to do,” she said of the company. “It was like they had not thought that anyone was going to test positive.”

Araujo, whose father tested negative, said staff told her she and her mother were the only people to test positive, but she wondered how many other guests carried the virus without getting a test. Initially, her family was told they would disembark together on the U.S. Virgin Islands. Instead, they stayed on and split up so she and her mother could quarantine.

On the Norwegian Getaway, Rebelo said he had to argue to receive a test after he developed a cough and chills.

“They grilled me,” Rebelo said. “They did not want to know. If you were firm with them, and I was, they came up and tested.”

He said he and other infected passengers on the Dec. 27 cruise tried to provide information about their close contacts on the ship, but “they would not take it down.” The ship’s next sailing was canceled.

In response to questions about his claims, Norwegian sent a link to its protocols, which say the company has “various contact tracing methodologies to identify and notify those who may have been exposed.”

Rebelo said the cruise companies are promoting their safety precautions before people board but should be doing more before they return to land. The CDC doesn’t require disembarkation testing for fully vaccinated passengers.

“You’ve been cruising around in this petri dish for 10 days,” he said. “Shouldn’t you have to test before you can go back on land?”

‘This is absolutely awful’

Graphic designer Mike Ratliff, 33, found out his 4-year-old daughter had contracted covid because she had to get tested before the end of the cruise on the Harmony of the Seas, as Royal Caribbean requires for unvaccinated kids on trips that are five nights or longer.

His daughter had been feeling a little tired and had a cough, but he said those symptoms didn’t seem out of the ordinary, especially several days into a busy cruise.

Then Ratliff found out she was positive. He thought the rest of his group — three older kids, his wife and parents, all vaccinated — would have to isolate because everyone had been exposed.

But Ratliff said only he had to isolate because he took his daughter to get tested; his wife had to persuade staff to let her join with their 6-year-old son because she did not want to be separated from her ill, youngest child. No one else in the group was tested on the ship.

He said his father even followed up with officials on board to make sure they didn’t need to quarantine or get tested. According to Royal Caribbean International spokeswoman Lyan Sierra-Caro, passengers identified as a close contact less than 24 hours before to the end of the cruise are supposed to quarantine but are not tested on board.

During the day and a half left of the Western Caribbean sailing, Ratliff started documenting his experience with videos on TikTok, calling the account “Cruising With Covid.”

“5-Star Service” he wrote on one video where he got what sounded like a busy signal as he tried to reach room service for food and water.

“This is absolutely awful,” he says.

@cruisingwithcovid 5-Star Service. #perfectday #harmonyoftheseas #royalcaribbean #theroyalcomeback #cruise #theRoyalSETBACK #covid #quarantine #deck9 #deck6 @royalcaribbean @cruiseindustrycritic @cdc.official @jimwalker ♬ original sound - CWC

Sierra-Caro said passengers are provided with free bottled water and room service.

Ratliff said it took at least an hour to reach room service, and then another hour to get food delivered. After the first meal, he said, he made the mistake of throwing out empty water bottles, realizing too late that there was no way to collect water from the sink to drink. His efforts to get more water sent to the room were fruitless before dinner, which he said arrived nearly three hours after they ordered it and was “super cold.”

After Ratliff and his wife drove their four kids home from Central Florida’s Port Canaveral, everyone in the family got sick. His parents tested positive, but his immediate family didn’t even bother getting tested.

While Ratliff said his family knew cruising came with risk of covid, he was disappointed with the way they were treated after his daughter tested positive.

“It was just frustrating that they weren’t able to meet basic needs,” he said. “We’re still a guest on the ship that we paid money to be on.”

Even though some shows and events got canceled because of staffing issues, Ratliff said it was a good cruise early on, with stops in Cozumel, Costa Maya and Roatan.

“We had a good time up until we didn’t,” he said.

Cruise passengers on holiday trips deal with outbreaks: ‘We’re sailing on a petri dish’ Listen to article 7 min

‘They were just overwhelmed’

David Beyer, a 68-year-old travel adviser from Colorado, tested positive Dec. 30, eight days after boarding the Celebrity Equinox for the “ultimate Southern Caribbean cruise.”

Beyer developed a slight cough before he woke up “not feeling good at all.” After waiting hours for a test and results, he relocated from his cabin to an isolation room a couple of floors down.

The new room was a “stripped-down” version of the original, Beyer said, with just a bar of soap in the shower, no tissues and no bath mat.

“If I’d had hair I needed to shampoo, I would’ve been [out of luck]” he said. “Thank goodness I’m bald.”

His husband, Don McCleary, kept their original room because he had tested negative; McCleary said he planned to get tested again this week because he had covid symptoms.

Until the ship returned to Fort Lauderdale, Fla., on Jan. 3, Beyer passed the time talking on the phone, playing games on his cellphone, watching TV and gazing at the sea from the balcony. He was able to order from the dining room menu, though the process to obtain the lukewarm food that arrived in paper boxes left a lot to be desired.

“Sometimes I was dialing upward of nine to 10 times to get through,” he said. “I think it was just so many people they were just overwhelmed, and it took a long time.”

CDC warns against cruise travel after 5,000 new coronavirus cases in 2 weeks

After a Caribbean cruise on the Celebrity Reflection, Elizabeth Seguin is stuck in quarantine in Miami for two weeks before she can make it home to Quebec. The 23-year-old disembarked on Jan. 2 for a trip that was supposed to be a respite from lockdown in the cold Canadian province.

Within her group of three families, eight people tested positive on the ship, Seguin said. She wishes she knew how many passengers in total were infected.

“We would hear the announcement every morning, like, 'It’s New Year’s Eve. I hope you have a good new year,’ ” she said, "and that kind of sucked, because we were stuck and couldn’t participate in all of that.”

Still, Seguin said she thought it was just as safe on a cruise as it would be in plenty of environments on land.

“When you go to a hotel, they don’t ask for your vaccination, they don’t ask for negative tests,” she said. “If you go to a concert, or you go to a festival, you can still get covid.”

Coronavirus: What you need to know

Covid isolation guidelines: Americans who test positive for the coronavirus no longer need to routinely stay home from work and school for five days under new guidance planned by the Centers for Disease Control and Prevention. The change has raised concerns among medically vulnerable people .

New coronavirus variant: The United States is in the throes of another covid-19 uptick and coronavirus samples detected in wastewater suggests infections could be as rampant as they were last winter. JN.1, the new dominant variant , appears to be especially adept at infecting those who have been vaccinated or previously infected. Here’s how this covid surge compares with earlier spikes .

Latest coronavirus booster: The CDC recommends that anyone 6 months or older gets an updated coronavirus shot , but the vaccine rollout has seen some hiccups , especially for children . Here’s what you need to know about the latest coronavirus vaccines , including when you should get it.

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Norovirus outbreaks linked to 2 cruise ships with over 150 infected

A total of 161 passengers have reported falling ill during voyages on princess cruises' sapphire princess and royal caribbean international's radiance of the seas.

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The Centers for Disease Control and Prevention are investigating two seemingly separate outbreaks of Norovirus linked to U.S. cruise ships.

Cases have been linked to Princess Cruises' Sapphire Princess and Royal Caribbean International's Radiance of the Seas.

The CDC's Vessel Sanitation Program (VSP) is tracking the "very contagious" outbreaks following reports of passengers in distress .

CARNIVAL FREEDOM PASSENGER ONBOARD DURING FIRE RECOUNTS 'DANGEROUS, TERRIFYING' EXPERIENCE

The Radiance of the Seas, a Royal Caribbean cruise ship, is pictured docked at a port in Seward, Alaska. (iStock)

Approximately 67 out of 1,993 passengers on the Radiance of the Seas reported falling ill during its voyage from Tampa to Los Angeles between Apr. 8 and 22. An additional two crew members also reported illness . 

The predominant symptoms reported from those affected by the Norovirus were diarrhea and vomiting.

WORRIED THE CRUISE SHIP WILL LEAVE WITHOUT YOU? KEEP THESE THINGS IN MIND

A view of the sign at the Center for Disease Control headquarters is seen in Atlanta, Georgia. (Nathan Posner/Anadolu Agency via Getty Images / Getty Images)

Approximately 94 of 2,532 passengers on the Sapphire Princess reported similar symptoms during its voyage from Los Angeles into the South Pacific that began Apr. 5 and is scheduled to conclude on May 7.

An additional 20 members of the 1,066 crew reported symptoms as well.

Fox Business reached out to both Princess Cruises and Royal Caribbean International for comment on the situation but did not receive a response.

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This photo shows the Sapphire Princess cruise ship, operated by Princess Cruises, docked at the Marina Cruise center in Singapore. (ROSLAN RAHMAN/AFP via Getty Images / Getty Images)

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

One of the biggest health risks posed by Norovirus infection is dehydration — the CDC recommends those infected drink plenty of liquids to aid recovering.

The CDC's Vessel Sanitation Program requires cruise lines to report and document cases of illness on their ships in order to facilitate coordinated responses in case of emergency.

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The CDC ends COVID reporting on cruise ships. Is this good for public health?

Plus, the who warns of rising covid hospitalizations, ba.2.75 is on the way, monkeypox may be declared a ‘global health emergency,’ and more..

Cruise ship companies are thrilled that the Centers for Disease Control and Prevention ended its COVID-19 monitoring program that tracked how many COVID-19 cases were reported ship-by-ship. On Monday, the constantly updated spreadsheet was gone without a trace, replaced with this notice:

It is hard to make sense of why the CDC would pull back from a detailed monitoring program just as COVID-19 cases are again rising worldwide . (The World Health Organization says cases in Europe have tripled in the last six weeks, and hospitalizations have doubled.)

When the site took down the monitoring page, 93 of the 95 ships reporting to the CDC system had enough COVID-19 cases among passengers and crew to be “under observation” by the CDC. You can see a cached version of the CDC cruise ship monitoring page from July 18 here . Here is a screenshot of that cached dashboard, which shows almost all of the ships reporting COVID-19 data were under observation:

The CDC’s cruise ship status dashboard on July 18, 2022. (CDC)

This is what those colors used to mean:

Cruise lines will report COVID-19 data to the CDC, but the CDC won’t pass that information along to you. Instead, the CDC says, passengers “have the option of contacting their cruise line directly regarding outbreaks occurring on board their ship.” In other words, the CDC will still have the data that could allow the public to see the COVID-19 levels on each ship, but it is up to you now to call the cruise line and ask for it.

The CDC website says the now-closed system “depended upon each cruise line having the same COVID-19 screening testing standards, which may now vary among cruise lines.”

CDC spokesperson Kristen Nordlund emailed an explanation to The Washington Post :

CDC has determined that the cruise industry has access to the necessary tools (e.g., cruise-specific recommendations and guidance, vaccinations, testing instruments, treatment modalities, and non-pharmaceutical interventions) to prevent and mitigate COVID-19 on board.

Cruise lines generally require adult passengers to be vaccinated and provide a recent negative COVID-19 test before boarding. Cruise lines have varied requirements for children.

Andy Bloch, who is a master at turning data into charts, posted this . I link to his Twitter post and his exhaustive charts with one caveat: Even the highest COVID-19 numbers on the ships are still not as high as you will find in some counties and countries.

Yesterday, the CDC ended its opt-in “COVID-19 Program for Cruise Ships” that tracked COVID-19 tests and cases. https://t.co/6Zmvug9xdr They updated the data one last time last night. I’ve been extracting the data and decided to publish it here: https://t.co/hWkL5EXOKy pic.twitter.com/SNDYX4v87G — Andy Bloch (@Andy_Bloch) July 19, 2022

With no pesky COVID-19 data to plant doubts in people’s minds, cruise ship stocks rose fast on Tuesday.

The cruise industry argued that the CDC kept ships under scrutiny that far exceeded any monitoring for concert halls, hotels or convention centers. Earlier this year, the CDC made the reporting program voluntary. But, of course, a key difference is that people don’t live in concert halls for days and go home if they notice sick or reckless people around them.

The CDC’s decision to take down the cruise ship monitoring page also comes just as a new book called “Cabin Fever” by Michael Smith and Jonathan Franklin goes public . It tells the nightmare story of 1,200 passengers and 600 crew stuck on the MS Zaandam when COVID-19 spread through the ship like wildfire during the first weeks of the pandemic’s rage.

WHO warns of COVID hospitalizations rising now, worse to come in a few months

The World Health Organization is warning that the newest variants of omicron are “super infectious” and that COVID-19 hospitalizations, which have doubled across Europe in the last few weeks, will grow worse soon.

Look at these increases from the WHO’s COVID-19 dashboard:

The Associated Press reports :

WHO’s Europe director, Dr. Hans Kluge, described COVID-19 as “a nasty and potentially deadly illness” that people should not underestimate. He said super-infectious relatives of the omicron variant were driving new waves of disease across the continent and that repeat infections could potentially lead to long COVID. “With rising cases, we’re also seeing a rise in hospitalizations, which are only set to increase further in the autumn and winter months,” Kluge said. “This forecast presents a huge challenge to the health workforce in country after country, already under enormous pressure dealing with unrelenting crises since 2020.” Earlier this week, editors of two British medical journals said the country’s National Health Service has never before had so many parts of the system so close to collapsing. Kamran Abbasi, of the BMJ and Alastair McLellan of the Health Service Journal wrote in a joint editorial that the U.K. government was failing to address persistent problems worsened by COVID, including ambulances lining up outside hospitals too overloaded to accept new patients.

We barely understand BA.5 and now BA.2.75 is on the way

A coronavirus variant called BA.5 is now the dominant vaccine-escaping COVID-19 variant to infect people in America. But already, the WHO is tracking what could be the next problem: BA.2.75.

The variant has shown up in 15 countries and is on the move . It has been detected in seven U.S. states, including Washington, California, Illinois, New York, North Carolina, Texas and Wisconsin.

The newest variant has gained the unofficial name “Centaurus,” after a Twitter user got the notion that the endless string variants that contain numbers and not a name are not being taken seriously enough.

Keep in mind that every person who gets infected with COVID-19 becomes a host, a potential incubator for the virus to morph again. So, the danger is not just that COVID-19 will make a person sick or cause long-COVID, but that every new case is a potential birthplace for a new threat.

WHO decides tomorrow if monkeypox is a ‘global health emergency’

At last count, 63 countries had reported 9,200 cases of monkeypox , and the number is growing fast. Now the WHO will hear the latest data and decide whether to declare the outbreak a “global health emergency.” That is the highest alarm that the WHO can sound about a health crisis.

The WHO says most infections have been reported in men of young age who have sex with men. Most of the cases are in or near big cities.

France24 reports :

The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash. But the report said that in this outbreak, many cases were not presenting with the classically-described clinical picture. Among the cases who reported at least one symptom, 81 percent presented with a widespread rash on the body, 50 percent presented with fever and 41 percent presented with genital rash.

The WHO says :

Monkeypox is usually considered mild and most people recover within a few weeks without treatment. However, the disease is frequently uncomfortable or painful, and can sometimes lead to complications that require close medical follow-up.

The CDC’s latest state-by-state monkeypox case count shows 1,814 cases , which means cases are increasing by a few hundred daily.

The science behind ice cream headaches

Children sitting in a car in Prayagraj, in the northern Indian state of Uttar Pradesh, eat ice cream on Wednesday, April 13, 2022. (AP Photo/Rajesh Kumar Singh)

Ice cream and popsicles definitely are part of the treatment plan to cure summertime overheating. But when it is as hot as it is now, some of us ravage through our frozen treats to keep them from melting … and then the ice cream headache sets in.

There is a quick cure. But first you have to know what causes ice cream headaches.

Ice cream headaches have a couple of fancier names: cold-stimulus headaches or trigeminal headaches. They are “thought to be caused” by the cold treat touching the roof of your mouth and constricting the blood vessels in the palate. I say “thought to be caused” because there is still a bit of mystery behind them.

Here is the clinical explanation of how brain freezes happen from the University of Melbourne :

When a part of the body gets really cold, the blood vessels in that area will tend to constrict. This is called vasoconstriction , and it minimizes the amount of blood that can flow through that area and be cooled down. You might notice your fingers or toes going pale when you’re out in the cold, and this is exactly why! On the other hand, when your body gets too warm, blood vessels expand to allow more blood to pass through. When the blood vessels near the skin expand, this allows heat to be released and the body to cool down. This is why people can get flushed or red-faced after being in a warm room or exercising . So, when a really cold substance hits the roof of your mouth or the back of your throat, it causes a rapid change of temperature there. And it just so happens that at this location we find the juncture of two very important blood vessels: the internal carotid artery (which is responsible for supplying blood to the inside of the brain), and the anterior cerebral artery (which travels along the front of your brain and sits right on top of the brain tissue) When these arteries are hit with the sudden chill of your rapidly consumed ice cream, they constrict very quickly. The body then compensates for this rapid constriction by sending a bunch of blood there to try warm them back up. This causes them to widen. Scientists think it is this contracting and expanding that triggers pain sensors and creates the sensation of pain.

The Cleveland Clinic advises you to bring the temperature in your mouth back to normal to relieve a brain freeze. But a room temperature drink works best; not something too hot or cold that will just cause more blood vessel reaction. The other treatment, Cleveland Clinic says, is to “try pressing your thumb or tongue against the roof of your mouth.”

By the way, people who suffer migraines may be more likely to have ice cream headaches. There is also some evidence that cold stimulus headaches can touch off a migraine.

Johns Hopkins researchers say one of the unknowns about ice cream headaches is why the pain is not felt in the mouth so much as other parts of the head and face:

The pain, through a quirk of our anatomy, is not felt so much in the mouth as it is “referred” to other areas of the face — behind the eyes and nose, in the forehead or elsewhere.

So, you learned another phrase today, “referred pain.”

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here  to get it delivered right to your inbox.

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Cruises Still Sailing Despite COVID Outbreaks

While the Omicron variant spreads, COVID-19 is not sparing cruise ships. 

The CDC lists nearly 90 ships that are under observation or investigation, including major cruise lines. 

But on a sunny Wednesday afternoon, passengers set for sail on a Royal Caribbean cruise out of Tampa. 

"When I’m seeing the number of people that kind of got on the ship I'm nervous but they said that everybody has to be double vaccinated and the boosters so we were comfortable about that," said Maissa King before boarding. 

"You gotta enjoy life, you can't hide away in a house all the time, you have to at least try," John Lunshof said. 

The CDC is also monitoring four other ships. The threshold for an investigation includes cases in at least 0.10% of passengers or in at least one crew member. 

Britany and Raymond Kelly said they looked forward to a vacation over Christmas with their daughter on a Royal Caribbean cruise out of Miami. 

"Kind of like a mixture between a comedy movie and a horror movie," Raymond Kelly said of their experience.

The Kelly’s said Britany first tested positive while on board the cruise. While Raymond and their daughter tested negative initially, they said the next day Raymond also tested positive. 

"It seemed like they didn't want to test me or my daughter again because they didn’t want another positive case on board," he said. 

They describe confusion with what tests to take before boarding, and later, frustration with the service and care they received after they said they tested positive on the ship and isolated in a hotel. 

"I'm just disappointed they were not prepared for the what if. I was honestly impressed with them like cleaning the boat and stuff but they didn't think it all the way through," said Britany Kelly. 

Royal Caribbean had not yet responded to Newsy's request for comment at the time of publication, but tells customers on its web site. "An inherent risk of exposure to COVID-19 exists in any public place where people gather." 

The cases come as the Omicron variant spreads. Some public health officials say some data shows it appears the variant may be less severe. 

But when it comes to next steps, Senator Richard Blumenthal called for a pause. He tweeted in part, "Cruises are repeating recent history as Petri dishes of COVID infection." 

"The numbers are a much higher average today than they were even a month ago," said James Walker.

Walker is an attorney who represents passengers and crew members against cruise lines and runs the blog Cruise Law News. 

"If you're gonna go on a cruise prepare for there to be a disruption. Prepare yourself for the possibility the port communities won’t let whatever cruise ship you're on stop in your jurisdiction," said Walker.

This week the Mexican government announced it would allow ships with cases to dock. 

Cruise lines have pointed to the protocols they've implemented to mitigate the spread of the virus.

"We are working closely with the CDC and local health authorities in all ports and destinations that we visit. The rapid spread of the Omicron Variant may shape how some destination authorities view even a small number of cases, even when they are being managed with our vigorous protocols. Some destinations have limited medical resources and are focused on managing their own local response to the variant. Should it be necessary to cancel a port, we will do our best to find an alternative destination," said AnneMarie Mathews, the senior director for communications for Carnival Cruise line, in part in a statement. 

"Whenever we experience a positive case on board, we immediately enact a series of proven protocols, including quarantine, contact tracing and PCR testing to identify, isolate and mitigate any further transmission. That said, largely in part to our vaccination policy and thorough embarkation procedures, we've been able to detect any possible positive cases prior to boarding and ensure those folks are well taken care of. As we continue to navigate the challenges we’re collectively facing in the fight against COVID-19, we are confident in our health and safety measures and will continue them moving forward," a Virgin Voyages spokesperson stated. 

The Cruise Lines International Association said cases in recent weeks make up a slim percentage of total population on board. 

"No setting is immune from the impacts of COVID-19. The difference with cruise ships is that our members have measures in place that were designed specifically for moments like this, and those measures continue to prove effective to mitigate COVID-19 amongst cruise passengers, crewmembers, and communities," said Bari Golin-Blaugrund, Vice President of Strategic Communications and Public Affairs.

When it comes to future cruises, people are still booking. 

"We're seeing the demand especially. It was very strong until beginning of December, then when Omicron came out things slowed down. But we are seeing after February, we're still seeing strong traction on bookings," said Bob Cook, the director of sales with Go Travel.

The CDC notes "cruising will always pose some risk of COVID-19 transmission."

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