Cruising during the COVID-19 pandemic is off to a rocky start.
Nearly a month after Carnival Corporation began promoting and selling tickets for its first comeback cruises on AIDA brand ships in Germany scheduled to launch this week, the company canceled two cruises because it has not yet received necessary approvals from Italy, the ships' flag state.
"This has typically not been an issue in the past, especially once other necessary regulatory approvals had been secured," said Carnival Corp. spokesperson Roger Frizzell in an email. "But this is a new day that requires even greater scrutiny with our review process tied to our various cruise policies and protocols, especially health _ something that will ultimately benefit our guests, our crew members and our cruise line in the process."
The false start comes after 10 AIDA crew members tested positive for COVID-19 last week after traveling to Germany from the Philippines and Indonesia to begin working.
And they aren't the only cruise companies affected.
Three crew members on two of Carnival Corp.'s Costa Cruises ships off the coast of Italy tested positive over the weekend, and two had to be hospitalized.
TUI Cruises, partially owned by Royal Caribbean Group, canceled its July 31 German-based cruise to nowhere on its Mein Schiff 1 ship when it could not get enough crew to Germany to operate the ship following positive tests of five newly arrived crew members.
A passenger on French cruise company Ponant's Paul Gauguin cruise ship tested positive for the virus Sunday and the ship's passengers and crew are now quarantined on board in Tahiti awaiting test results.
The largest outbreak occurred on a ship owned by Norwegian cruise company Hurtigruten. When it resumed cruising in early July, Hurtigruten was the first company to do so following a four-month pause in cruising worldwide.
Norwegian health authorities notified Hurtigruten on July 29 that one of the 209 passengers aboard its MS Roald Amundsen ship's July 17 cruise had tested positive for COVID-19 after disembarking on July 24, according to Norwegian media.
Two days later, four crew members who had been isolated after showing symptoms tested positive for the virus; previously the company had said their symptoms were not related to COVID-19. That same day, 177 passengers disembarked without knowledge of their possible exposure. Since then, 32 more crew members out of 164 total and three more passengers have tested positive.
Monday, the company canceled future cruises on the ship and two others.
"We have made mistakes," Hurtigruten CEO Daniel Skjeldam said in a statement. "On behalf of all of us in Hurtigruten, I am sorry for what has happened. We take full responsibility." A spokesperson for the company did not respond to requests for comment about the delayed response.
The outbreaks call into question how effectively cruise companies can protect passengers and crew from COVID-19 before a vaccine is available. Seven cruise ships in and around U.S. waters with only crew on board are currently experiencing outbreaks of COVID-19 or COVID-like illness, according to the U.S. Centers for Disease Control and Prevention. Cruises remain banned in the U.S. until at least October 1.
Of the companies that have restarted passenger cruising to date, AIDA Cruises, TUI Cruises and Hurtigruten have not required passenger testing prior to boarding.
MSC Cruises, a Geneva-based company with U.S. headquarters in South Florida, announced Monday that it will test all passengers for COVID-19 using a rapid test before boarding as it prepares to resume cruises in the Mediterranean pending government approvals. MSC passengers who test positive will be tested again using a PCR test and denied boarding if they test positive, the company said in a statement.
The CDC has not yet approved any protocols for U.S.-based ships to restart cruising. AIDA received permission to begin cruises in Germany from port authorities in Rostock and Kiel; the cruises do not make any port stops. Europe does not have an agency regulating cruising's return.
Dr. Michael Callahan, director of the Clinical Translation, Vaccine and Immunotherapy Center at Massachusetts General Hospital, said he is not surprised by the recent outbreaks. As the co-founder of Rescue Medicine, an international disaster medical organization that provides emergency medical help to cruise ships, he was deployed to the Diamond Princess and Grand Princess cruise ship COVID-19 outbreaks earlier this year.
"Once you have it on board, it is a perfect transmission environment," he said. "It's protected from UV. It has air conditions that favor virus survival, and ship designs and activities that favor transmission."
Tight interior hallways where small air droplets can linger and tall staircases where air droplets can fall more than six feet have the potential to infect those who walk through them, Callahan said. He recommends cruise companies divide passenger and crew decks into cohorts that do all activities together, turn the hallways into one-way traffic zones to limit congestion, and designate elevators as either up or down. Masks should be required for all passengers and crew at all times outside cabins and everyone should be thermally scanned several times each day, he said.
Callahan and four other doctors interviewed by the Herald in May about how cruise companies can keep passengers and crew safe if they decide to operate before a vaccine is available said pre-boarding testing will help companies prevent bringing an asymptomatic passenger on board, but even testing has its limits.
"The enormity of probability of delayed presentation will allow people to get on the ship that are positive," he said. "But it is better than not testing."
Crew members coming from areas where the number of cases is rising should not be allowed on the ship until they have tested negative twice within four days in the embarkation country, Callahan said. AIDA Cruises was allowing crew members to board while their tests were still pending, and is now keeping everyone on land until the results come back, Frizzell said.
It is impossible to eliminate the risk of COVID-19 infections at sea completely, Callahan said, but companies can do more than they are doing now to substantially mitigate the risk.
"If they don't get good at this they are going to be crushed," he said. "It's not just Band-Aids and fire extinguishing anymore. This is about continuity of business."
