Last month, a 77-year-old woman made a fatal decision: She boarded a Carnival cruise in Galveston, Texas, in sunny Belize.
The cruise required a vaccination, and around 96% of all 4,336 passengers and crew were reportedly vaccinated, but no one was required to present a negative Covid test before boarding. After four days on the water, the ship reported a 27-person Covid outbreak that included both passengers and crew. One of the passengers, the 77-year-old, died 10 days later – the first reported fatality since US cruises resumed in June.
The tragic incident begs the question: is it safe to travel on a cruise now?
How predictably, Carnival says yes. In the past few weeks, the company has ordered negative Covid tests for all passengers before boarding and issued a statement to the Washington Post stating that the deceased woman “almost certainly did not develop COVID on our ship”. When she boarded the ship on July 31, there were no testing procedures in place.
Doctors are not convinced. Travel of all kinds is a very high-risk activity right now, explains Dr. Luis Ostrosky, director of infectious diseases at UT Health, part of the University of Texas, Houston. The cases are “completely out of control,” he says. “And we don’t have the vaccine protection we need to make sure people survive if they happen to get one [Covid]. “
And even with safety precautions, cruises harbor residual risks that cannot be neglected, such as unavoidable tightness and potential breakthrough infections.
This is why these risks are particularly dangerous compared to other forms of travel – and what can be done to make cruises safer:
Cruises are “a recipe for transfer”
Even on a good day outside of the pandemic, cruises are challenging from an infection control perspective, Ostrosky says.
On a cruise, you often spend time in common areas. They eat and drink indoors in buffet restaurants with large communal tables, attend shows in theaters, and touch all kinds of surfaces from railings to casino games. If an outbreak occurs at sea, you are confined to the boat, which can make it difficult to contain and manage the outbreak.
“It’s just a prescription for transfer,” says Ostrosky. For this reason, outbreaks of other contagious respiratory or gastrointestinal viruses such as norovirus are common aboard cruises.
In fact, cruises are particularly risky compared to other types of travel, such as driving a car or flying, as they offer more opportunities for longer exposure. “To be honest, the risk is on a two hour flight with everyone masked and airflow good [lower] than being on a cruise ship for five days straight, “says Dr. Preeti Malani, chief health officer at the University of Michigan.
Vaccination regulations help, but aren’t foolproof
Several cruise companies, including Disney Cruise Line and Norwegian Cruise Line, are cracking down on vaccination regulations. A good start, say experts – but not enough.
A full vaccination significantly reduces the risk of hospitalization or death from Covid, Ostrosky notes, but the increased transferability of the Delta variant means vaccination “no longer guarantees that you will not acquire or transmit the infection”. This means that all vaccination regulations must be paired with other safety measures, such as wearing masks and maintaining social distance.
“We can try to make cruises as safe as possible, but we will have breakthrough cases,” says Ostrosky.
Another factor to keep in mind: the community penetration where you live – or, in this case, where a cruise departs – affects your level of risk significantly. “When the community’s penetration is high, as is the case in Florida right now, everything becomes risky,” says Malani. “The idea of going on a cruise is a lot riskier.”
Some of the cruise lines are also waging a different battle – against the state governments that have passed laws or regulations aimed at stopping vaccine mandates. On Wednesday, Texas Governor Greg Abbott passed an executive order banning all state or local mandates that require a Covid vaccination. In Florida, where several popular cruise ports are located, Governor Ron DeSantis signed an executive order in May banning nationwide vaccination records.
Norwegian Cruise Line sued Florida’s top health officials in July, requesting an injunction to enable the company to enforce its vaccination mandate for all passengers and crew. The company won the case earlier this month when US District Judge Kathleen Williams wrote that Norwegian “has proven that public health is endangered by suspending vaccination”.
Relying on a negative Covid test is also a flawed strategy
If you don’t quarantine yourself for two weeks before boarding your Covid test, the test is “fundamentally irrelevant,” says Ostrosky.
To make cruises truly safe, companies would have to require mandatory two-week quarantines, negative Covid tests 24 to 48 hours before boarding, and another negative Covid test immediately after boarding for every passenger and crew member. This is a tedious process and difficult to organize and perform, especially in the middle of a passenger’s vacation.
If you need to take a cruise, do the following:
It can take a while before it is truly safe to board a cruise. Dr. Anthony Fauci, the country’s foremost infectious disease expert, recently said that he believes the country will be in control of Covid and regain a sense of normalcy by spring 2022. But even then, travel and cruising are likely to be high risk.
“We look forward to a future in which more people will be vaccinated and the numbers will be lower, maybe we will be over the delta variant,” says Ostrosky. “This will be a much safer time to travel.”
If your heart is racing to take a cruise by then, get vaccinated if you’re eligible, Malani says. Then look for cruises that require proof of vaccination and only allow reduced capacity – the lower the better. While cruising, choose activities and excursions with less risk, as they always dine al fresco. And of course you step aboard the ship with the understanding that no matter what, you are taking a risk.
The Centers for Disease Control and Prevention (CDC) give cruise lines a color-coded safety status – green, yellow, orange, and red – based on reports of cases of Covid or Covid-like illness. The agency also points out when there are investigations into outbreaks on ships. You can check the CDC’s website for a ship’s Covid status before planning a cruise or getting on board.
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