Outbreaks of infectious diseases can happen on cruise ships because people spend time close together and with travelers from many countries. The current scientific evidence suggests that cruise ships pose a greater risk of COVID-19 transmission than other settings because of the high population density onboard ships, which are typically more densely populated than cities or most other living situations. While this is one contributing factor, CDC’s surveillance data show that drastically decreasing population onboard without additional mitigation measures does not end transmission.
Other factors likely contributing to onboard transmission are crew living and working in close quarters in a partially enclosed environment where social distancing may prove challenging, even with a limited number of people. Additionally, mild illnesses and asymptomatic infections make case detection and isolation and quarantine practices based on clinical presentation alone challenging. Thus, unrecognized spread of infection among crew may keep the virus circulating from one voyage to the next.
Disease can spread between ships when crew members from a ship with an outbreak transfer to other ships. Infected people may also travel on cruise ships between countries.
CDC had a No Sail Order in place from March 14 to October 29, 2020 that suspended cruise ship passenger operations in the United States.
From July 20 through September 21, 2020, CDC invited public commentsexternal icon on specific questions regarding interventions, methods, protocols, and procedures for protecting the public’s health as well as the health of prospective passengers, crew members, and industry-related service providers. The majority of respondents (approximately 75%) expressed support for resuming passenger operations in a way that mitigates the risk of spreading COVID-19. Most respondents also expressed the need for increased public health measures and accommodations for travelers, including health screening, testing, mask use, social distancing, travel insurance, and refunds.
As of October 30, 2020, CDC will take a phased approach to resuming passenger operations. The initial phases will consist of testing and additional safeguards for crew members. CDC will ensure cruise ship operators have adequate health and safety protections for crew members while they build the onboard laboratory capacity needed to test crew and future passengers.
Subsequent phases include simulated (mock) voyages with volunteers playing the role of passengers to test cruise ship operators’ ability to mitigate COVID-19 risk, certification for ships that meet specific requirements, and return to passenger voyages in a manner that mitigates COVID-19 risk among passengers, crew members, and communities. The phases are subject to change based on public health considerations and cruise ship operators’ ability to mitigate COVID-19 risk.
CDC’s Framework for Conditional Sailing Order replaces CDC’s No Sail Order. This Order introduces a phased approach for the resumption of passenger cruises. It also provides a basis for the issuance of additional technical instructions and orders. This Order describes requirements for testing crew and developing onboard testing capacity. Future orders will address additional activities to help cruise lines prepare for and return to passenger operations in a way that mitigates the risk of spreading COVID-19.