By David Best, Director of Public Health

Introduction

The COVID-19 pandemic has been the largest crisis faced by the cruise industry to date, both in size and in consequences. Eighteen months into the pandemic, and with requirements for resuming business stricter than in other transportation sectors, the gradual resumption of operations is finally underway in most regions. The cruise industry’s return to service though hasn’t been entirely smooth with many ships reporting ongoing COVID-19 cases onboard.

In this article, we look at some of the key recommendations for vessel operators to consider, as a result of recent scientific studies regarding the SARS-CoV-2 virus and its emerging variants, with a focus on COVID-19 mitigation strategies.

1. COVID-19 Vaccinations

Vaccines are a game changer. Although, recent studies by the Centers for Disease Control and Prevention (CDC) and Oxford University seem to indicate a moderate reduction in effectiveness of COVID-19 vaccines in the face of the Delta variant, vaccine efficacy against hospitalization (>80%) is still preserved in those individuals fully vaccinated. Vaccines, such as Pfizer BioNtech, AstraZeneca, and Moderna, all reduce the risk of death by more than 85%, regardless of the variant. Combined with the fact that those vaccinated are less likely to become infected in the first place, supports having a full vaccination policy requirement for passengers and crew as a primary strategy for any cruise line resuming operations.

When considering what type of vaccination to provide your crew, present-day evidence suggests that mRNA vaccines, such as Pfizer-BioNTech or Moderna, are more effective in all areas than the viral vector types like the J&J/ Janssen COVID-19 vaccine.

2. Health Screening & Testing

While vaccines reduce the health complications associated with COVID-19, they don’t offer full immunity to the disease. Breakthrough cases—when a person who has been fully vaccinated becomes infected—are being reported with recent CDC evidence suggesting that the Delta variant is thought to be up to 60% more transmissible than the original version of the virus. Pre-embarkation health screening and testing should still be a key component in COVID-19 mitigation plans, regardless of an individual’s vaccination or recovery status.

Crew members should be routinely tested for SARS-CoV-2 – at least every 14 days if fully vaccinated – with increased frequency for those whose exposure risks are known to be higher, such as restaurant staff and housekeeping personnel.

3. Face Mask Policies

The picture emerging suggests that vaccinated people are more likely to experience symptoms after catching the Delta variant in comparison to earlier forms of the virus, with similar viral loads being noted in both groups. Consequently, maintaining face mask requirements for all indoor public areas onboard is still considered a prudent strategy, and a recommended part of a vessel operators comprehensive, multi-layered approach to reduce the associated risks of COVID-19 transmission, especially with the prevalence of new, more aggressive variants.

Changes to standard operating procedures can help to minimize exposure risks. For example, not permitting smoking and drinking in casino areas will better protect crew members working in these locations. In the restaurants and bars onboard where removing face coverings is unavoidable, cruise lines should evaluate upgrading standard medical masks for their crew to N95/FFP2 masks (or higher) during service hours.

4. Case Detection and Management

When possible or confirmed cases of COVID-19 are discovered onboard, immediate isolation in pre-designated cabins, as well as protocols to rapidly identify and quarantine close contacts, is paramount in preventing further spread of the virus. Most of the current regulatory guidance was written with the Alpha variant in mind and so with the emergence of more transmissible variants, cruise lines should regularly reassess their protocols and definitions regarding close contacts.

Streamlining the contact tracing process can be achieved by evaluating the use of technologies, such as wearable bands, and other initiatives, such as pre-assigned seating in restaurants. Implementing strategies in passenger and crew populations can further mitigate transmission and exposure risks and potentially reduce the number of individuals needing to quarantine following a COVID-19 case.

5. Crew Training

As part of returning to service, cruise lines have had to prepare comprehensive COVID-19 contingency plans to meet competent health authorities’ requirements. To translate policies from paper to onboard operations, procedures should be clear and concise, so crew members know what to do, and when to do it.

The importance of crew training in the application of your company’s COVID-19 control and response measures should not be understated. Even the best written policies will struggle to be effective if the crew are not properly trained, which includes explaining the “why” behind the policy prerequisites.

Conclusion

The cruise industry has the right to resume its operations, but it must do so with collective responsibility, coordinated plans, comprehensive health protocols, and transparency. There isn’t one solution to mitigate the risks of COVID-19 transmission onboard. Cruise lines need to implement a multi-layered approach to meet the challenges of the current crisis, providing a healthier and safer environment for their guests, crew, and the communities they visit.

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