Royal Caribbean Group has announced new cruise ship health protocols that the company will implement on all cruise ships. Royal Caribbean has submitted their plan to the Centers for Disease Control and Prevention (CDC) for final approval. The company hopes that the new health protocols will allow cruises to start sailing again.
Healthy Sail Panel Outlines Cruise Ship Health Protocols
The Healthy Sail Panel is a group of recognized experts offering advice to the cruise industry. Recently, the group announced that cruising can be safer if cruise lines implement a “robust set of science-backed protocols.”
Using research across various disciplines, the panel has offered a list of more than 70 recommendations across five focus areas. Research and experience used to generate the list included infectious diseases, public health, marine operations and biosecurity.
The following graphic identifies those five focus areas:
Royal Caribbean officials have said that they will use the recommendations to develop,
“new, detailed operating protocols, which will be submitted to the CDC and other authorities around the globe for review and approval.”
Breakdown of Cruise Ship Health Protocols
Some of the protocols may be permanent, while others may change depending on the COVID-19 pandemic and cruise ship operations. Below, we offer an overview of the new cruise ship health protocols.
Cruise Ship Health Protocols: Testing, Screening and Exposure Reduction
All crew members should be tested for COVID-19 between five days and 24 hours before leaving home to join the ship. Crew members must receive a negative result, and must quarantine onboard the ship for seven days before beginning work. Crew members receiving a negative result will begin work.
Cruise ship operators should implement crew surveillance programs. This includes periodically testing crew members for COVID-19. This will provide a reasonable level of confidence among crew members that the virus is not circulating.
Other employees and ancillary staff members should have a daily symptom screening. They will not be required to be tested as regularly as crew members or passengers. Ancillary staff includes transportation providers, luggage porters, etc.
All cruise ship passengers should be tested for COVID-19 between five days and 24 hours before boarding the cruise ship. Passengers should receive a negative result before joining the ship. Cruise operators should be made aware that passengers have documented negative results.
At the time of embarkation, all crew members and guests should have a health screening. The screening should identify any symptoms consistent with COVID-19 or other infectious diseases. The screening should also identify passengers or crew who may have been in contact with someone who has COVID-19.
All individuals boarding the ship should have their temperature taken as part of the boarding process.
Any individual – passenger or crew – who displays symptoms of COVID-19, or who has been in close contact with someone who has COVID-19, who has a fever of 100.4 degrees should have a secondary screening. Medical personnel should determine whether the individual is fit to board the ship.
Denial of Boarding
The cruise operator should not allow individuals to sail if they refuse to affirmatively state their willingness to comply with cruise ship health protocols. Individuals who test positive for COVID-19 or who have been in close contact with someone who is positive should not be allowed to sail.
Guests at an Increased Risk of Illness
Cruise ship operators should use the CDC’s guidelines for determining who may have an increased risk of illness. Individuals who are at a higher risk should discuss their health with a healthcare provider before traveling. The recommendations of a healthcare provider should then be discussed with the cruise operator.
Guest Education and Information
In addition to general education and information about sailing, guests should be provided information about COVID-19. Guests should be encouraged to assess their individual risk. They should be educated on cruise ship health protocols related to COVID-19. All guests should be willing to comply with health and safety protocols.
Onboard Tracking and Monitoring of Symptoms
Cruise ship operators should perform temperatures for all crew members and guests once a day. Routine symptom screening will help identify possible cases of COVID-19.
Cruise ship operators should make certain that education efforts are being utilized to help guests understand how important it is to report symptoms to medical staff. Guests should also be made aware of the possible repercussions of not reporting symptoms.
Personal Protective Equipment (PPE)
Personal protective equipment (PPE) should be available to all crew members and guests. Cruise operators should make sure that crew members and guests understand that they are required to wear a face covering that aligns with the CDC’s recommendations.
Crew members who are in close and regular contact with guests should be required to use complementary PPE. This complementary PPE should be in addition to a face mask or covering.
Cruise operators should consider and adjust crew and guest load factors when returning to sailing. Managing capacity helps maintain appropriate physical and social distancing. Capacity restrictions should be considered based on the size and design of the ship and how many passengers it is equipped for.
Facilities on board, at terminals and at destinations that are designed for cruise operators should be modified to maintain appropriate social and physical distancing per the CDC.
At terminals, signage and floor markers should communicate adequate distancing requirements. Signage and markers should also be used at terminals, on board the ship and at cruise line-owned destinations.
Terminal, Boarding, Debarkation Controls
Cruise operators should use protocols and processes that are touchless, such as during check-in. Processes that speed up the boarding process can also help reduce contact and congestion in terminal areas.
Cruise Ship Health Protocols: Sanitation and Ventilation
Guests should be made aware, in advance, of sanitation protocols used during the pre-board process and at all cruise line-owned destinations. Enhanced sanitation protocols should be implemented on all areas of the ship, terminal and cruise line-owned destinations. Particular attention should be paid to surfaces and high-touch areas.
Cruise operators should make certain that all disinfectants used during sanitation meet the Environmental Protection Agency’s (EPA) List N: Disinfectants for Use Against SARS-CoV-2. For locations outside the United States, cruise staff should use equivalent disinfectants.
Cruise operators should adhere to CDC guidelines when recommending hand washing and hand sanitizer use for guests. Hand sanitizer stations, hand washing stations and hand wipes should be available around the ship for easy access for crew members and guests.
Crew members should receive training on all aspects of infection control. Crew members should give particular attention to hand hygiene. Cruise operators should encourage crew members and guests to utilize hand washing or sanitizing stations before and after participating in group or recreational activities.
Ventilation and filtration controls are important because COVID-19 may be transmitted through the air. Cruise operators should utilize a variety of ventilation and filtration controls to reduce crew and guest exposure to infectious aerosols or droplets.
Cruise operators should upgrade HVAC systems to a filter that minimizes pathogen dispersal. A recommended system is the MERV 13. Operators should optimize indoor air management strategies based on the age of the ship and ventilation constraints.
Cruise operators should focus air management strategies on reducing exposure in areas where crew members and guests are most vulnerable to transmission of airborne droplets.
Cruise Ship Health Protocols: Response, Contingency Planning and Execution
Medical personnel should be augmented to ensure there is enough medical staff onboard to meet the needs of all crew members and guests. This is especially important to ensure preparedness for COVID-19 in the event of an outbreak.
Cruise operators should ensure that there is adequate back-up medical personnel on board. There should be adequate medical leadership onboard each ship to ensure responsibility for infectious disease prevention and response. This leader should oversee execution of health protocols and response in the event of an outbreak. There should also be a doctor onboard the ship who has experience with intensivist training to manage severely ill patients.
Onboard Clinic Design
Onboard clinics should have increased capacity to treat patients who may become critically ill due to COVID-19 or other unrelated illnesses. Cruise operators should ensure there are adequate facilities, that there is a wide variety of medical equipment onboard and that there are adequate tests onboard.
Cruise ship medical facilities should be able to accommodate patients with suspected infectious disease separately from other patients.
When possible, patients who need an appointment with onboard medical staff should have a virtual or remote appointment. Alternatively, medical personnel should attempt to hold appointments in the guests stateroom, rather than in the clinic.
Cruise line medical treatment plans should be responsive and sensitive to the current COVID-19 situation. Medical staff should have a firm understanding of optimal treatment protocols, as well as the needs of each patient. Cruise operators should establish relationships with onshore medical facilities that can offer telemedicine consultations if more serious COVID-19 cases emerge.
Cruise operators should utilize the CDC’s guidelines regarding general exposure. Current guidelines are less than six feet for less than/or equal to 15 minutes. These guidelines are subject to change.
Cruise operators should identify and define low, medium and high risk exposure areas. Contact tracing should be used in order to ensure that all possible COVID-19 infections are identified quickly. Cruise operators should also collect metrics on how effective contact tracing is.
Cruise operators should share information about contact tracing with crew members and guests in a transparent manner.
Isolation or Quarantine
Certain cabins should be designated for isolation or quarantine. Cruise operators should provide guidelines on whether, where and when someone should be isolated or quarantined. These guidelines should be based on exposure risk, symptoms and other relevant factors.
Cruise Ship Health Protocols: Destination and Excursion Planning
There should be a thorough mobilization response plan in place before the ship sets sail. This plan should address various scenarios that may require crew members or guests to debark from the ship. Cruise operators should define the criteria for debarkation scenarios in advance of sailing. There should also be an offsite incident management plan made with medical professionals who are able to rapidly make decisions and respond.
Any debarkation scenario involving individuals who are confirmed to have COVID-19 or are in close contact with someone with COVID-19 should include metrics to keep infected individuals separate from the general population. Cruise operators should have an established communications plan to share information with crew members and guests in a timely manner. Operators should also have a communications system in place to communicate with health authorities in the event of an outbreak.
Destination and Itinerary Planning
In order for ships to sail into a given port, there are two prerequisites that must be satisfied:
- Approval from the local government
- Agreement to allow safe passage to individuals who have COVID-19 and their close contacts. This passage includes debarking and traveling home.
Cruise operators should rely on three key parameters when choosing whether to travel to a given port:
- Current burden of COVID-19 cases (testing rate, positivity rate and number of deaths)
- Local capacity for testing
- Local, regional and national implementation of COVID-19 mitigation protocols
Once cruising restarts, itineraries should be simple. Cruise lines should utilize private cruise line-owned ships and destinations. Destinations and ports should be chosen in areas where there is tight control of the onshore experience. The panel recommends that cruises offer shorter trips in the initial stages of reopening.
During the initial stages of reopening, cruise operators should only allow debarking from ships at destinations that the cruise line owns, operates or sponsors. Limiting guest excursions to verified adventures can limit potential exposure while guests are onshore.
Cruise operators should communicate with onshore vendors to ensure that vendors are following recommendations to reduce COVID-19 transmission. Operators should verify compliance with cruise ship health protocols and should monitor excursion vendors during visits. Guests should be thoroughly informed about possible risks while onshore, and how to minimize the risk of contracting COVID-19 while visiting a destination.
Indoor excursions should only be offered if recommended health and safety measures can be implemented. Such measures include wearing masks, social distancing, etc.
Cruise Ship Health Protocols: Mitigating Risks for Crew Members
Prevention Among Crew
Cruise operators should have measures in place to prevent COVID-19 among crew members. Operators should first manage the population density of crew members in specific areas of the ship. Crew members should reside in single-occupancy cabins in order to minimize close contact with other crew members.
Cruise operators should limit crew members’ close contact with guests whenever possible. When social distancing is not possible, crew members should have access to PPE that is appropriate for their job type.
When debarking from the ship at destinations, crew members should have opportunities to debark, but should limit their movements onshore to minimize the risk of exposure to COVID-19.
Training and Culture
Crew members should receive regular training on cruise ship health protocols. Training should also include how to reduce transmission of COVID-19. Also, operators should empower crew members to help guests and other crew members follow protocols.
Cruise operators should reinforce a ship-wide culture of honesty. Crew members have a collective responsibility to follow protocols and create a safe environment onboard the ship.
Validation and Verification
Cruise operators should have metrics in place to continually self-assess compliance with all cruise ship health protocols. There should also be third-party verification of compliance. Cruise operators should conduct an “after-action review” on ships where there is a COVID-19 infection in order to assess gaps in compliance and make improvements before the ship sails again.
Moving Forward with New Cruise Ship Health Protocols
As cruise lines begin to sail again, cruise operators should adopt a phased approach to sailing. Operators should demonstrate that protocols can be successful before full operations resume.
Cruise operators should also have a formal process for reviewing health and safety experiences onboard ships as they relate to COVID-19. This can help enhance the best practices of cruise operators and crew members.