Publisher Health

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

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

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

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

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

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

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

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

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

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

Reporting to the C.D.C.

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

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

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

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

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

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

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

Demand remains high

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

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

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

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

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

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

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

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