Cruise lines have always staffed medical crews who are held to high standards: American College of Emergency Physician guidelines require onboard staff to be on-call 24/7; physicians must have a minimum of three years of post-graduate experience in general and emergency medicine, or be board-certified in emergency, family, or internal medicine; all staff must be certified in advanced life support.

But today, amid the COVID-19 pandemic, the job of being a doctor or nurse at sea calls for more.

“The difference between then and now is not necessarily in the foundational level of medical training, expertise, credentials, or capabilities that our providers have, but rather in an increased focus around recognizing and initiating treatment for potential SARS CoV-2 infections,” says Calvin Johnson, M.D., chief medical officer for Royal Caribbean Group.

A full return to cruising has yet to happen. But there are already big changes in the ways that doctors and nurses on cruise ships do their jobs. There are also big changes in the ways you’ll seek out care if you need it when you're back onboard. Here, a glimpse of what to expect:

Medical staff will be more involved in pre-screening protocols

Pre-COVID, medical teams often collected health information via a verbal or written questionnaire from passengers and crew, mainly in an effort to identify possible sick passengers (those with gastrointestinal complaints or those with chronic illnesses who may need more assistance on-board). Now, that pre-screening process is more rigorous, including temperature checks, assessments about potential COVID-19 symptoms, and a negative test in the days before boarding. “Sometimes, this requires further participation of the physicians in terms of determining whether somebody should enter the vessel fully free to engage in all activities, if they should go into a quarantine period, or if in fact, boarding should be denied,” explains Edward Dees, M.D., fleet doctor for VIKAND. On the medical staff's part, this'll take more effort up front, but it's an important addition to the job. “The more effort we can put forward to be as effective as we can at preventing the virus from ever getting on the ship, the better,” says Dr. Johnson.

Call-aheads, appointments, and in-your-cabin care will replace drop-in visits

If your allergies kicked up or if you felt a bit flu-ish, it used to be that you’d simply drop into a ship’s medical facility. Today? In general, you’d give the medical facility a call first. (Of course, if there’s an emergency or an accident, ships have teams in place to respond ASAP.) For minor issues or standard care, lines like Royal Caribbean are also instituting new formal appointment processes where you can book a time to be seen via phone or app. It’s an effort to mitigate risk, sure, but one that’ll also (hopefully) help people enjoy their vacations more, Dr. Johnson says. (Read: You don't have to take time away from your trip to sit in a waiting room.)

If you ever noticed symptoms that were in-line with COVID-19 on-board? “The recommendation is going to be that people contact us remotely from their cabins,” says Dr. Dees. From there, a physician or nurse can conduct a telemedicine session and—if you needed it—even provide care in your cabin. “We have to think that if somebody has respiratory complaints, then it could be COVID—and there are precautions that have to be taken,” Dees says. 

In short: In a pre-pandemic world, medical professionals tended to focus on you (the one sick person). In the present environment, they'll take into account who you’ve been exposed to—or who you could be exposed to. And that’s a bit more complex.

On-ship medical centers have a new face

One of the biggest changes to the physical space of a ship’s medical facility is that there's no more common waiting room. Instead, you'll likely find two separate spaces: a control care area (for those with potentially infectious diseases) and another area for non-infectious patients. “It's all designed to limit contact between people who may be infectious or non-infectious,” explains Dr. Johnson. Some vessels have redesigned their medical centers to ensure specific isolation rooms, too, he says. Others have turned guest rooms into isolation rooms, stripping out the carpet in lieu of more easily cleanable flooring and negative pressure ventilation (so that air won’t leave the room and potentially spread to other areas).

There’s a potential need for more equipment

A cruise line’s medical department is like a small community hospital emergency department, and ships have always generally had essentials such as heart monitors, defibrillators, ventilators, X-ray machines, lab equipment, and minor surgical and orthopedic supplies. Typically, ships stock what’s known as “par” levels of equipment, Dr. Johnson says. The pandemic has forced medical staff to re-evaluate what equipment there might be an extra need for, such as personal protective equipment (PPE).

There’s likely more medical staff on-board

The size of a ship’s medical staff depends on the size of the ship itself, but it’s standard to have at least one physician and a nurse or two onboard, says Dr. Dees. On larger ships, you might have multiple medical centers on board, both of which are staffed by a doctor and a nurse or nurses. Since the pandemic, Dr. Dees says that extra nurses have been added to staff lists. “A cruise ship is not a hospital ship and we're not trying to turn it into a hospital ship,” says Johnson. “But we certainly are making sure that we have the on-board capabilities to take care of patients.”

The job is harder now

Being an essential worker during the coronavirus pandemic has brought with it all kinds of stressors, not the least of which is this: “The COVID environment heightens the threat to our own personal selves,” says Dr. Dees. It’s an added layer of stress for medical staff that comes with new job requirements such as the ability to manage a potential COVID-19 outbreak, an increased involvement with ship management and personnel, and working in an ever-changing environment. As scientific knowledge grows and experts continue to piece together what works (and what doesn’t) in the fight against COVID-19, ship policies and procedures change rapidly, too. “Sometimes that can bring with it a sense of being overwhelmed, but we're keeping up with it,” Dees says. “I just think, across the industry, working in a post-COVID world is not going to be as leisurely.”