Extending Cruise Ban, C.D.C. Says Ships Helped Spread Coronavirus

By Frances Robles

In a scathing order extending the current “no sail” order on U.S. cruise lines, the agency said it spent 38,000 hours managing the outbreaks on ships.

The Disney Wonder docked in San Diego in March. An outbreak on the ship lasted for weeks. 
The Disney Wonder docked in San Diego in March. An outbreak on the ship lasted for weeks. Credit...Sean M. Haffey/Getty Images

As the coronavirus pandemic raged around the world, cruise ship companies continued to allow their crews to attend social gatherings, work out at gyms and share buffet-style meals, violating basic protocols designed to stop the spread of the highly transmissible virus, the Centers for Disease Control and Prevention said in a scathing 20-page order, released Thursday, that extended the suspension of cruise operations until Sept. 30.

In a rebuke of the cruise ship companies, Robert R. Redfield, the director of the C.D.C., blamed them for widespread transmission of the virus. The C.D.C. said there were 99 outbreaks aboard 123 cruise ships in United States waters alone, the agency said in the statement. From March 1 until July 10, 80 percent of the ships in the C.D.C.’s jurisdiction were affected by the coronavirus. The agency said there had been nearly 3,000 suspected and confirmed cases and 34 deaths on ships in U.S. waters.

As of July 3, nine ships still had ongoing or resolving outbreaks.

The C.D.C. spent at least 38,000 hours managing the crisis, the order said. Public health authorities had to do contact tracing for some 11,000 passengers, more than the number of contacts identified from airplane flights since the beginning of pandemic, the C.D.C. said.

The cruise industry has struggled to manage the coronavirus pandemic since the start, when the Diamond Princess, part of the cruise giant Carnival Corporation, moored in the Japanese harbor of Yokohama, Japan, amid an outbreak that eventually infected 712 people and killed nine of them. Even as warnings were issued about the dangers of cruise-ship travel, passengers kept boarding and ships kept sailing.

Though more and more cruise passengers fell ill, companies continued their voyages, offering entertainment that included live music and pool parties. The industry ultimately suspended operations in mid-March, but as ships made their way to port, many passengers and crew were stranded around the world, as countries refused the ships entry.

One ship arrived in Fort Lauderdale with four dead passengers on board.

Many of those passengers who were allowed to disembark from contaminated ships “traversed international airports, boarded planes and returned to their homes,” the C.D.C. said, potentially spreading the virus further.

The cruise industry had already voluntarily suspended operations until Sept. 15, and many companies withdrew their ships from United States waters, removing them from the C.D.C.’s jurisdiction. But the order from Dr. Redfield underscores the gap between the industry and the public health agency. The companies cannot begin to sail again until they come up with cohesive plans for prevention and mitigation of the illness.

Cruise ship companies submitted plans on how to safely evacuate crews, but nearly all the companies failed to meet the basic requirements necessary to stop the spread of the coronavirus, the C.D.C. said. Crew members still bunked together and shared bathrooms. Even ships that seemed to have gone a month without any coronavirus cases had crew members who tested positive upon reaching shore, Dr. Redfield said.

One company, Norwegian Cruise Lines, said it felt it had exceeded recommended C.D.C. guidance, because crew members were not just asked but “encouraged” to wear face coverings, the order said. Disney acknowledged that some of its asymptomatic-infected crew members had not quarantined until after the results of shipwide testing came in.

The companies created a task force to come up with recommendations on how to safely sail, but according to the C.D.C., the group will not produce its findings for several months.

If unrestricted cruise-ship passenger operations were permitted to resume, it would put “substantial unnecessary risk” on communities, health care workers, port personnel and federal employees, the order said, as well as placing passengers and crew members at increased risk.

The agency’s previous no-sail order was set to expire July 24.

Disney said only one of its four ships, the Disney Wonder, had an outbreak on board —but only after passengers had disembarked. The company tested every crew member on board and isolated non-essential crew to their cabins for three weeks in April. Half the 174 crew who tested positive had no symptoms, the company said.

Updated July 16, 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 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.

The ship has not had a positive case since May 8, Disney said.

Royal Caribbean and Norwegian Cruise Line, whose failures were specifically cited in the C.D.C. document, released statements in response to the order that did not specifically address the allegations.

Norwegian said it canceled trips through September, as well as cruises embarking from or calling on ports in Canada in October. “We continue to partner with the C.D.C. and other authorities to mitigate the impact of COVID-19 by prioritizing the health and safety of our passengers and crew,” the company said.

Royal Caribbean said it would suspend operations through September to comply with the order. “The health and safety of our guests, crew and the communities we visit is our top priority,” the company said.

Carnival Cruises said that it had already extended its suspension through September. But the company plans three voyages in Germany next month through a European line, and Italy trips are also expected soon, a spokesman said.

Bari Golin-Blaugrund, a spokeswoman for the Cruise Line Industry Association, a trade organization that represents most of the major cruise companies, released a statement that did not address the C.D.C. criticisms.

“As we continue to work towards the development of enhanced protocols to support the safe resumption of cruise operations around the world, we look forward to timely and productive dialogue with the C.D.C. to determine measures that will be appropriate for ocean-going cruise operations to resume in the United States when the time is right,” she said.

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Page 2

Even as Covid-19 sickened passengers, the Costa Luminosa was slow to act to prevent infections, despite two previous serious outbreaks on its parent company’s ships.

The Costa Luminosa arriving in Marseille, France, on Thursday. It was denied docking in other ports because of coronavirus cases onboard.
The Costa Luminosa arriving in Marseille, France, on Thursday. It was denied docking in other ports because of coronavirus cases onboard.Credit...Daniel Cole/Associated Press

Travel and travel planning are being disrupted by the worldwide spread of the coronavirus. For the latest updates, read The New York Times’s Covid-19 coverage here.

A waiter in the crowded cruise ship passageway approached the isolated passenger with a tray of food, two glasses of juice, plastic gloves on his hands — and a white table napkin across his face.

The napkin, tied over his mouth like a bandanna on a bank robber in an old western, was presumably supposed to protect the crew member aboard the Costa Luminosa from the spread of the coronavirus, which had already sickened three passengers. This was on Sunday, March 15, the first day that the crew began wearing gloves and shields over their mouths.

ImageA waiter aboard the ship wore a napkin as a makeshift mask.
A waiter aboard the ship wore a napkin as a makeshift mask.Credit...Chris S/Chris S, via Reuters

A picture snapped by a passenger and circulating on social media encapsulated the missteps by a cruise company that seemed to be improvising its coronavirus response, even after the high-profile disasters that left hundreds sickened on two other ships, the Diamond Princess and the Grand Princess, owned by its corporate parent, Carnival Cruises.

“We kept saying, ‘They’ll do better. They’ll see what happened on the Diamond and the Grand, and they’ll do better for us.’ But what they did was way worse — and they lied as well,” said Kelea M. Edgar Nevis, 57, of Arizona, who was on the ship with her 80-year-old husband. “It was ridiculous.”

Jim and Kelea Nevis took the cruise as a “bucket-list trip,” she said. Credit...Courtesy Kelea Nevis

A week passed between the time the first passenger in whom coronavirus was suspected, an Italian woman, took ill and the moment that Costa Cruises instituted sanitary protocols, which included isolating everyone in their cabins, taking their temperatures daily and making employees wear protective gear. Another passenger who later tested positive for the coronavirus had been taken off the ship a week before her for other health reasons.

As the Costa Luminosa was heading across the Atlantic with more people getting sick, another Carnival ship, the Grand Princess, finally docked in Oakland, Calif., with 21 infected passengers on board after being stranded for days.

Citing ship logs, the Miami Herald reported on Wednesday that at least 24 crew members and 50 passengers on the Costa Luminosa were classified as sick. On Thursday, Carnival said that only seven people, including two crew members, were showing symptoms, and that the logs included people who were close contacts of the sick.

Meals left outside passengers’ doors after the ship began instituting coronavirus protocols. Credit...Chris S/Chris S Via Reuters

The ship is now docked in Marseille, France, and French health authorities have boarded to conduct health checks. Americans on board have been told that a chartered plane will take them to Atlanta. Various government agencies are involved in figuring out what to do with them next, and some U.S. states may allow them to isolate at home, as some people who sailed on the Grand Princess did, the Centers for Disease Control and Prevention said.

When cruise lines decided to suspend U.S. sailings last week 40 ships carrying tens of thousands of passengers were in the middle of their voyages. On at least three of them, passengers got Covid-19 while cruise ship companies, port officials, governments and international health organizations scrambled to determine whose rules applied. Thousands of people were at sea, sometimes confined to tiny cabins, but also enjoying the bar, serving themselves from the buffet and enjoying festivities while more people contracted the disease and the ship captains tried to figure out what to do.

The Braemar, a ship operated by Fred. Olsen Cruise Lines, was denied entry by four countries when a guest, four crew members and two passengers who had been on the ship tested positive. Cuba opened its port to them, and about 700 mostly British passengers took chartered flights home to England on Wednesday. Also Wednesday, nearly 100 passengers who had been in quarantine — with six infected passengers aboard the Silver Explorer cruise off the coast of Chile — were flown out of that country on charter flights, according to Chilean officials.

Meanwhile, passengers aboard the Silver Shadow were close to completing a week in quarantine in the port of Recife in northern Brazil over coronavirus fears that are so far unfounded. Both the Silver Explorer and Silver Shadow are operated by Silversea Cruises, which is owned by Royal Caribbean.

The Costa Luminosa, a 965-foot-long ship built in 2009, is owned by the Crociere Group, Italy’s biggest tour operator. Headquartered in Genoa, the company has 27 ships in service that offer trips from the Mediterranean to South America.

The company, which is part of the Carnival Corp., came under fire in 2012, when its Costa Concordia ran aground off Tuscany, killing 32 people. The captain was sentenced to 15 years for manslaughter.

The Costa Luminosa first left Fort Lauderdale, Fla., for a cruise around the Caribbean on Feb. 24. But the coronavirus was raging in Italy, and Jamaica did not let the Italians disembark as scheduled on Feb. 28. The next day, one of the ship’s passengers, a 68-year-old Italian man, was evacuated on Grand Cayman Island after having two heart attacks.

The ship returned to Fort Lauderdale to drop some passengers off and pick more up. Destination: Venice. It was to be a grand affair with stops in Antigua, Puerto Rico, Málaga, Spain, the Canary Islands and Marseille.

“We had planned a bucket list trip — 30-night cruise and 30 around Europe, as my husband had spent 40 nights in the hospital back in October and November,” Mrs. Nevis, who was on the ship with her 80-year-old husband, said in an email.

Kelly D. Edge, 60, a former HGTV decorator who lives in Miami, booked the cruise at the last minute with her husband, Woody Edge, 65. Rates on the Costa Cruises itinerary were already so appealing — starting at $350 a person for a windowless cabin — that the couple booked a suite for $1,250 a person. After the epidemic, Ms. Edge wanted her money back, but the company wasn’t giving refunds. She packed a roll of paper towels and disinfectant wipes.

When they arrived for their sailing on March 5, Costa sent them an email saying that the United States wouldn’t let the ship go to Italy, so their final destination would be Marseille, instead. They got a $500 shipboard credit.

“So we committed and went on,” Ms. Edge said. “So we felt manipulated from the beginning.”

The ship was only half full.

By March 7, two days after the ship left Fort Lauderdale, a 68-year-old Italian woman who had already gone to the ship’s doctor for a headache returned to the doctor with “worsening respiratory conditions,” a Costa spokeswoman, Rossella Carrara, said. (An earlier communiqué from the company said she had cold symptoms.)

She was evacuated in Puerto Rico on March 8, while the more than 1,400 passengers, including 168 Italians and 233 Americans, spilled out to the streets of Old San Juan to enjoy a day of leisure.

Her close contacts were isolated, Ms. Carrara, a company vice president and spokeswoman, stressed.

The protocol was strict and the reaction swift, Costa Cruises said. “We underline that the patient had already been placed in isolation on board,” the company said in a statement.

The next day, Antigua refused the ship entry, and the man who had the heart attacks in the Cayman Islands and had stayed behind in the hospital there started to develop a dry cough, so the doctors there tested him for the coronavirus.

By then, the Costa Luminosa’s sailing had turned into a trans-Atlantic cruise to nowhere, with Antigua and Spain turning the vessel away, while the employees in charge minimized the situation on board and gave passengers misleading information. The gym stayed open and the Ping-Pong contests continued.

On March 11, the cruise stopped group activities like lounge and pool parties.

Ms. Edge, who had taken advantage of the cheap cruise, was feeling worried. “If we make it the next 6 days to Tenerife with no illness, my attitude will most likely change,” she wrote in an email. “But now it feels scary. Real or imagined.”

On March 12, three days after the Cayman Islands patient’s coronavirus test was taken, it came back positive for Covid-19.

It is unclear if the cruise line was ever notified, The casino, piano bar, pool, karaoke and gym stayed open, passengers said. The bands kept playing.

“The bar stools were cheek to cheek,” Mrs. Nevis said.

A day later, at about 9 p.m. on Friday, March 13 — five days after the sick woman was evacuated during the ship’s Puerto Rico stop — the governor of Puerto Rico gave a news conference announcing that the woman had tested positive. So had her husband. The news swept through the ship as passengers read about it on social media and news reports. But Costa Cruises took no further significant action, though serving utensils were taken away from the buffet, passengers said.

At 2:15 p.m. the following afternoon, the cruise company told The New York Times that it still had not received official word from local health authorities. “However, we are aware that unofficial information is circulating on the alleged positivity of the 68 years old lady of Italian nationality who has been hospitalized in Puerto Rico on March 8,” the company said in an email.

Updated July 16, 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 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.

“I did show our waiter in the restaurant the tweet about the positive test, and it was definitely the first he’d heard about the results, so the crew is also kept in the dark as far as I can tell,” said Morgan Battisti, a 51-year-old retiree from Oregon who was on board.

Asked about the Costa Luminosa on Saturday, Carnival’s chief medical officer, Grant Tarling, said: “What ship?”

The Costa Luminosa was being handled in Europe, he said.

Passengers were not allowed to disembark in the Canary Islands that day. However, three sick passengers, two with respiratory problems and one with a fever, were evacuated. The remaining passengers took photos of the ambulances and the men in hazardous materials suits outside.

Hours later that same night, even worse news came. The man who had the heart attacks in the Cayman Islands had died of the coronavirus.

Late on March 15, the company instituted the established protocol for an outbreak on board.

People were to have their temperatures taken every day, and all 1,421 passengers were isolated to their rooms. Food was delivered to the cabins. The crew started wearing masks and gloves, and eventually even gowns over their clothes.

People with inside rooms were moved to cabins with balconies.

“The organization of all of this, of course, required some time, as you can imagine,” Ms. Carrara, the company spokeswoman, said.

She stressed that the company had introduced “rigid preboarding screening,” which included temperature checks for everyone and restrictions for people coming from hard-hit areas.

She did not answer questions about whether the ship had been notified about the Cayman Islands man’s illness, or why the cruise line waited for official notification from health authorities before instituting stricter health protocols.

“Every situation is unique, as you know, but there continues to be broad coordination, guidance and learning provided from medical and maritime at our sister brands and the corporation,” she said.

The ship’s interior after news of the coronavirus outbreak was shared with passengers and protocols were put in place.Credit...Chris S/Chris S Via Reuters

One of the notable issues that the ship faced was the lack of clarity about who was in charge of the official notifications that would trigger ship protocols. World Health Organization protocols, for example, call for passengers who test positive and their close contacts to disembark and not be allowed to travel internationally. Social distancing is encouraged, such as eliminating the buffet. But what happens when the test results take days?

“One of the questions I heard was ‘Who has authority over us?’ It’s a good question,” Ms. Battista said. “Costa? Italy? The U.S., or your home country? When you’re out in international waters rather than on home soil, the answers get murky.”

Roger Frizzell, a senior vice president at Carnival, noted that 10 other ships across the company were “disrupted for testing and all ten were negative.”

“Princess is documenting the entire account in both cases and will be sharing learnings with our other brands, the industry and others to help everyone better prepare and better combat the virus,” he wrote in an email.

In Tenerife, the Canary Islands, the ship was met by workers in hazmat suits and three sick passengers were taken off the ship. Credit...Courtesy Kelly Edge

Many passengers disembarked in Marseille on Thursday and were put on buses, with little information about how they were getting home. It is unclear whether they will be required to quarantine, and where. In exchange for the interruptions on the cruise, they were offered a $50 credit to spend on board for every port they were turned away from, and a refund credit to use for another voyage within the year.

At a news conference on Thursday, President Trump suggested that Carnival cruise ships might be put into service as hospitals.

Reporting was contributed by Aurelien Breeden in Paris; Ernesto Londoño in Rio de Janeiro; and Elaine Glusac in Chicago.

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