The Post-Coronavirus Cruise? Not Ready to Sail

Data shows that there were far more cases of Covid-19 on cruise ships than have been reported, but the companies and the C.D.C. have yet to establish how the boats can come back.

A no sail order from the C.D.C. has kept Pier 90, part of the Manhattan Cruise Terminal, empty for months.
A no sail order from the C.D.C. has kept Pier 90, part of the Manhattan Cruise Terminal, empty for months.Credit...Chang W. Lee/The New York Times

W. Bradford Gary spent 10 days trapped inside a cruise ship cabin off the coast of Brazil in March while health authorities in several countries scrambled to figure out what to do with a vessel full of older people who had potentially been exposed to the coronavirus.

But when faced with the question of whether he’d ever cruise again, he doesn’t hesitate.

“We are very anxious to get back on board,” he said, and he believes he’s not alone: “There are people like us who want to do this.”

Mr. Gary, 70, a retired corporate executive who lives in Palm Beach, Fla., imagines the cruise ship of the near future equipped with special disinfecting ultraviolet lights and air flow contraptions commonly used in sterile laboratories. He envisions larger cabins, fewer passengers and a lot more outdoor spaces. “We want to know everything is safe,” he said.

That is a big order.

With more than 20 million passengers a year, the $45 billion global cruise industry has a particularly vexing challenge: Its most loyal customers, older people, also happen to be the key demographic at risk for the new illness that has swept the planet, killing more than 450,000 people. Cruises also have the very things that help the coronavirus spread: large gatherings, confined spaces and workers who live in tight shared quarters.

More than three months after the Centers for Disease Control and Prevention issued a no sail order for all United States cruises, interviews with health officials, loyal passengers, industry experts, cruise executives and maritime lawyers made clear that restarting operations would require rethinking cruising itself — from the number of passengers onboard to how they are fed, housed and entertained — and that the government and the cruise lines are not close to figuring it out.

Last week, the Cruise Lines International Association (CLIA), the cruise industry’s trade group, said that it was voluntarily extending the no sail period from U.S. ports until Sept. 15. Earlier, Carnival Corporation, the world’s biggest cruise company, had suggested that it could start sailings by Aug. 1.

According to Martin Cetron, the C.D.C.’s director for the Division of Global Migration and Quarantine, cruise ships offer fertile ground for the “seeding, amplification, and dissemination” of Covid-19, worsened by the fact that crew members often transfer from one ship to another, taking diseases with them.

Breaking that chain of infection is key.

But as restaurants, casinos, movie theaters and theme parks are poised to reopen, with plans in place to prevent the spread of the highly infectious disease, the cruise industry has not publicly laid out its strategy.

Bari Golin-Blaugrund, a spokeswoman for CLIA, said, “The cruise industry is taking a holistic approach to planning for Covid-19 safety, when sailing is allowed, that would ideally entail a door-to-door strategy beginning at the time of booking through the passengers’ return home.”

She said cruise ships are already cleaned several times a day, but the industry is using the time off to rethink everything from offshore excursions to enhanced medical capabilities onboard and evacuations.

As to setting out highly detailed plans for what a post-pandemic cruise might look like, “We’re not there yet,” she said.

ImagePier 92, center, is part of the Manhattan Cruise Terminal, from which ocean-going ships depart. It is now closed while the no sail order is in place. 
Pier 92, center, is part of the Manhattan Cruise Terminal, from which ocean-going ships depart. It is now closed while the no sail order is in place. Credit...Chang W. Lee/The New York Times

The coronavirus hit the cruise industry hard. Passengers were stranded for weeks while people on board got sick and were quarantined in their staterooms. A Miami Herald analysis showed at least 80 people died worldwide.

New data from the C.D.C., released in response to a Freedom of Information Act request by The Times shows that more than 100 ships in the U.S. jurisdiction alone had outbreaks on board, sickening nearly 3,000 people, including more than 850 passengers. The C.D.C.’s figures count cases that were “clinically compatible” with Covid-19, but not confirmed in a lab, and a handful that occurred among crew after passengers disembarked.

The C.D.C. records show Carnival, which had 47 ships on which people fell ill across its nine brands, was most affected. Through a spokesman, Carnival disputed the figures, saying the C.D.C.’s methodology resulted in overcounting. If only cases with a lab confirmation were included, the number of Carnival ships affected would be 15.

Royal Caribbean had 28 ships with coronavirus cases — almost half its fleet.

Only 15 of the 121 cruise ships that entered U.S. waters after March 1 did not have the disease on board, the records show.

Cruise companies and public health officials are still evacuating and repatriating tens of thousands of crew members who have remained at sea as the pandemic raged, the C.D.C. said.

As of Sunday, there were still 68 ships at sea with 21,506 crew members on board in the U.S. jurisdiction alone.

The coronavirus marked the first time the agency issued a travel advisory against a particular mode of travel, as opposed to a geographic area, Martin Cetron, the C.D.C.’s director for the Division of Global Migration and Quarantine, said. The C.D.C.’s initial advisory, which recommended against cruise travel but did not ban it, was issued March 8, after more than 700 people got sick aboard the Diamond Princess ship in Japan.

The advisory turned into a no sail order after it became clear that companies were continuing to embark on voyages and passengers were not canceling in large numbers, Dr. Cetron said. “This situation wasn’t responding to self-regulation.”

When cruises resume, some changes are likely inevitable, such as thermal scanners at terminals to check for elevated temperatures, disinfection foggers to clean boats between cruises and upgraded ventilation systems. Self-serve buffets may be a thing of the past.

The Times asked 10 of the biggest cruise lines to outline their preparations for resuming sailings. Only one, Genting Cruise Lines, a Hong Kong-based company that mostly operates in Asia, agreed to talk about its plans in detail.

While Princess Cruises, part of Carnival Corporation, did not respond directly, it posted a seven-page health advisory outlining some of the steps it plans to take, including increasing the temperature of washers and dryers for better disinfection of bedding and towels. Stateroom surfaces will be cleaned twice a day.

Carnival said it was still too soon to offer any details. In a conference call with journalists in April, Carnival’s chief executive, Arnold W. Donald, said he would let medical experts decide whether to require medical clearances for older passengers.

Royal Caribbean’s chief executive, Richard Fain, said in a May earnings call that he planned to unveil a “healthy return to service program” that would focus on upgraded health screenings for passengers before boarding, as well as new procedures for dealing with infections on board. But that plan has not yet been released.

Arthur L. Diskin, who was a Carnival cruise ship doctor for 18 years, said the adjustments will likely be tailored to each company’s market. Longer cruises, for example, tend to have passengers who are much older, so changes should account for that.

“Maybe they don’t have a disco,” he said. “Maybe they adapt to have more outdoor dining venues so people can be adequately spaced.”

But none of those changes address the biggest questions of how to prevent a disease that has generally been checked by isolation and social distancing on cruise ships carrying thousands of passengers expecting to party and enjoy themselves. Will they keep people six feet apart? Will they make them wear masks?

The first step, said Mattia Jorgensen, a naval architect and marine engineer with the Finnish company Foreship, which specializes in ship design and engineering, is a thorough analysis of how the virus gets on board ships and spreads.

“We need to really look at how we don’t get it on board, and in the event it gets on board, how do we contain it,” he said.

Mr. Jorgensen said several large cruise ship companies hired his firm to help design solutions, but the process cannot be completed until the C.D.C. shares its own guidance.

One of the biggest problems cruise companies are expected to tackle is how to manage their staff. Crew often transfer from one ship to another and take illnesses with them. Companies are expected to make changes that will limit crew movement between ships.

James Walker, a lawyer in Miami whose practice is focused on suing cruise companies, said ships are going to have to seriously examine how much time they spend cleaning ships between voyages. Cruise companies do not make money while in port, and are always anxious to head off to another voyage, he said.

A review of the C.D.C.’s preliminary list of affected ships that came to U.S. ports show they sometimes ended one cruise and began another on the same day. One ship, the Carnival Valor, had three back-to-back cruises on which passengers contractedCovid-19. The ship is designed to carry almost 3,000 passengers in 1,487 staterooms. On quick turnarounds, ships come in to port at 7 a.m. and head out with new passengers at 4 p.m.

“There’s never enough time to clean,” Mr. Walker said. “And cruise lines all know. It’s not like they bring in professional cleaning crews that do exhaustive work. They use the same cabin attendants who have to be there to greet the guests when they show up.”

Ms. Golin-Blaugrund, the CLIA spokeswoman, said that “Cruise ships are cleaned and sanitized, under normal circumstances, with a frequency that is nearly unparalleled in other settings. Multiple times daily, crews clean and sanitize surfaces known for transmitting germs, such as handrails, door handles and faucets. At the end of a voyage and before a new one begins, ships are cleaned completely from top to bottom.”

As part of the industry’s Vessel Sanitation Program, she said, “Cruise ship crews are trained in sanitation and public health practices and ships undergo unannounced inspections twice a year.”

Sheri Griffiths, a video blogger who runs CruiseTipsTV, a YouTube channel, with her husband, said the industry also needs to rethink its cancellation policies. In the past, those who canceled had to forfeit their payments — often thousands of dollars — which could lead people to travel even if they are feeling unwell.

  • Updated June 24, 2020

    • A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

“That’s a huge and significant change to the future of cruising, and it’s critical they do that

For people to feel safe, they need to feel that the passengers around them won’t be boarding the ship sick, and they need to know the crew will be held to a high standard of wellness,” Ms. Griffiths said.

Princess Cruises’ advisory said that it would issue full refunds or credits to passengers who had to cancel because they were not well or had been exposed to the virus.

As for Ms. Griffiths: “I will get on a cruise when the C.D.C. says that I don’t have to self-quarantine when I get off a ship,” she said.

Those looking for a blueprint as to how the cruise companies might respond could look to Genting Cruise Lines’s plan.

In April, Genting worked with local port officials and industry trade groups to come up with an eight-part safety guide outlining disinfection procedures and rules for social distancing.

In an interview, Kent Zhu, the company’s president, said the guidelines were designed to market the company’s cruises to wary passengers and provide a template for other companies. “The passengers needed to know what actually a cruise line would be able to do to make sure they feel comfortable,” he said. “They want to be reassured that it’s safe.”

Mr. Zhu said the company is aiming to begin cruising by the middle of the summer with limited itineraries to countries that have the virus under control.

Under the new guidelines, the company will use infrared temperature screenings on the gangway to weed out sick travelers and require passengers 70 and older to provide a “doctor’s certificate of fitness for travel.” The plan allows guests to cancel up to 48 hours before a sailing without financial penalty; in an interview, Mr. Zhu said Genting would offer refunds to those who failed health screenings.

The guide also outlines stringent sanitation protocols, including a twice-daily wipe down of passenger cabins and hallways. Elevators will be disinfected every two hours. And in the ship’s theater, crew members will clean each pair of 3-D glasses before and after passengers use them to watch movies.

Crew members will wear face masks, undergo temperature checks twice a day and will no longer transfer to different ships.

Epidemiologists say the most important change the cruise lines could make is more difficult: reducing the number of passengers on each cruise.

“Of course, that has all kinds of implications for the industry financially and otherwise,” said William Schaffner, an infectious disease expert at Vanderbilt University. “But the notion of spacing people apart starts with having fewer people on board.”

Genting is taking that step: Its boats will sail with up to 40 percent fewer passengers.

“We will not be able to make the same money anymore,” Mr. Zhu said. “As long as we can keep our operations going when we resume — enough to keep the company going — we will be happy enough for a few months.”

Dr. Schaffner called the Genting guidelines “pretty comprehensive,” though he said that masks might need to be part of the equation. (Genting’s plan does not require passengers to wear masks or stay any distance apart from each other onboard.) “They have decided, and if we were running the cruise industry, we might come to the same decision: If we require passengers to wear masks, that’s not the cruise experience, that goes a step too far,” he said.

But at the very least, he said, companies should offer to provide passengers with masks when they get off the ship for day trips and mingle with people on shore.

“That’s a time period people should be very much encouraged” to wear masks, he said.

Fred Kantrow and his wife were among the passengers who fell ill with coronavirus after sailing aboard the Celebrity Eclipse, a cruise ship owned by Royal Caribbean. Their daughter, who picked them up from the airport on their return home, got sick too.

Mr. Kantrow, 59, a lawyer from Smithtown, N.Y., sued Celebrity after the experience, saying they had not done enough to prevent the onboard outbreak of the disease. The Eclipse was forced to sail for two extra weeks when Chile refused to let passengers disembark; during that time the ship continued to host crowded parties, photographs included in Mr. Kantrow’s lawsuit show.

The C.D.C. records show 92 people from that ship tested positive for Covid-19, and Mr. Kantrow’s suit claims two died.

“I don’t know that they are going to be able to do anything to get me back,” he said. “It’s really hard to trust them. In two or three years will my position change? Maybe. But when we got off ship, my wife said, ‘Yeah, I’m not doing that again.’”

Mr. Kantrow’s lawyer, Michael Winkleman, who has filed seven Covid-related lawsuits against cruise companies, said Congress should use the pandemic to better regulate the cruise industry, which does not have to abide by U.S. labor laws or pay full corporate taxes, because almost all of the companies are foreign corporations. The Death on the High Seas Act, for example, limits how much families can claim when someone dies on a cruise.

The industry’s track record, he said, shows they will not make proactively make changes that will hurt their bottom line. (CLIA’s spokeswoman, Ms. Golin-Blaugrund, disputed that idea saying that the cruise lines “have repeatedly demonstrated their willingness to invest in public health and safety onboard and that the industry “voluntarily suspended operations globally.”)

“I think there are two forces stronger than the virus,” Mr. Winkelman said, “the love that people have for cruises because it’s such a unique product, and the fact that the companies have so few hurdles and roadblocks in front of them.”

David Yaffe-Bellany contributed reporting.

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